搜索结果：Journal of eating disorders

Rural adolescents face disproportionately higher rates of disordered eating, though it is unknown what about living in a rural community impacts disordered eating risk. The objective of the present study was to understand how rural adolescents describe their rural culture as impacting eating disorder risk using a qualitative study design. Semi-structured interviews using the American Psychiatric Association Cultural Formulation Interview were conducted among individuals (Mage = 20.0, Range 16-25) who developed disordered eating as an adolescent (10-19 years of age) while living in a rural community. Interviews were recorded and transcribed verbatim, and transcripts were analyzed using inductive thematic analysis. Four themes were identified: "Everyone knows everyone," Diet Culture & Weight Stigma, Body Ideals, and Initiating Events. Participants reported that everyone in their community knew everyone else and about their lives. Participants described this innate sense of community as being helpful at times, and harmful at other times. The sense of community was seen as a strength when participants felt they could get support from their community members. But felt that the close sense of community was harmful as there was a very narrow definition of acceptable social standards and a strong pressure to meet those expectations. Participants reported a strong cultural overvaluation of thinness, including the normalization of dieting and disordered eating, as well as frequent experiences of implicit and explicit weight stigma. Relatedly, body ideals differed by gender, but thinness was valued by girls and younger adults and muscularity by boys. Participants described many situations they believed contributed to their disordered eating, including chronic stressors like food insecurity, traumatic events like deaths, and a fear of rejection for not fitting social expectations in their rural communities. Findings suggest that specific aspects of living in rural communities may uniquely increase eating disorder risk, particularly the pressure to fit the narrowly defined social expectations in rural communities. However, the study also identified aspects of living in rural communities that participants viewed as protective and potentially useful in future preventative efforts, such as having a strong sense of community and support from that community. Rural communities face higher rates of disordered eating, but it is unknown what impacts disordered eating risk in rural communities. The current study interviewed ten people who developed disordered eating in adolescence when living in a rural community. The goal of the interviews was to understand what about living in a rural community impacted their eating disorder risk, both good and bad. From these interviews, we learned that participants thought there were things about living in a rural community that were both protective and harmful for their disordered eating, and sometimes both. They thought that the strong sense of community put pressure on them to fit a certain mold, but also that sense of community could be used as a strength to help people get treatment. They also felt that in their community there was an emphasis on being thin that was harmful. Overall, findings suggest that there are things about living in a rural community that impact eating disorder risk, some of which are similar to other populations and some may be unique, and more work is needed in rural populations.

Vitamin D deficiency and depressive disorders are both common in patients with eating disorders (EDs). However, the association between vitamin D status and current depressive disorder (CDD) in EDs populations remains insufficiently explored. We conducted a cross-sectional study including 481 outpatients with EDs assessed at a specialized eating-disorders unit in Montpellier, France. Psychiatric diagnoses were established using the Mini-International Neuropsychiatric Interview (M.I.N.I.). Eating-disorder severity was assessed with the Eating Disorder Examination Questionnaire (EDE-Q). Serum 25-hydroxyvitamin D levels were measured as part of routine clinical assessment, and vitamin D deficiency was defined as <&#x2009;20 ng/mL. Odds ratios (ORs) were estimated using logistic regression. Vitamin D deficiency was significantly associated with higher odds of CDD (OR 1.98, 95% CI 1.20-3.28; p&#x2009;=&#x2009;0.008). This association persisted after adjustment for EDs severity, psychiatric comorbidities, and season of assessment. No significant interactions were found between vitamin D deficiency and eating-disorder subtype, EDE-Q score, or season. Vitamin D deficiency was associated with the presence of a current depressive disorder in patients with eating disorders, independently of EDs subtype, severity, and seasonality. These findings support the clinical relevance of assessing vitamin D status in patients with EDs presenting with depressive symptoms. Longitudinal studies are needed to clarify the direction and clinical implications of this association. People with eating disorders often have low vitamin D levels, and depression is also common in this group. We studied 481 outpatients seen in a specialist eating disorder service in Montpellier, France, to find out whether vitamin D deficiency was more frequent in those who also had a current depressive disorder. Vitamin D deficiency was defined as a blood level below 20 ng/mL. We found that patients with vitamin D deficiency were almost twice as likely to have a current depressive disorder as those without deficiency. This relationship remained after taking into account eating disorder severity, other psychiatric conditions, and the season of assessment. It was also similar across different eating disorder subtypes. Because this was a cross-sectional study, we cannot determine whether low vitamin D contributes to depression, whether depression contributes to low vitamin D, or whether other factors influence both. Still, our findings support checking vitamin D status in patients with eating disorders who present with depressive symptoms.

There is an unmet need for evidence-based and accessible interventions designed to treat eating disorders in sexual minoritized men, given their heightened vulnerability to developing disordered eating. Digital interventions are a promising avenue for eating disorder treatment because of their accessibility and flexibility in delivery. Here, we present a randomised controlled trial of Seed, a 10-week treatment-focussed digital intervention for eating disorders, among sexual minoritized men. Participants (N&#x2009;=&#x2009;126 sexual minoritized men) with a binge-spectrum eating disorder diagnosis (e.g., bulimia nervosa, binge-eating disorder) were randomly allocated to one of three conditions: (1) a waitlist control (2) a personalised intervention, where participants received personalised content recommendations based on their individual symptom profile, or (3) a default intervention, in which participants received no personalised recommendations. Changes from baseline in eating disorder symptoms were evaluated via clinical interview and self-report at 10 week and 6 month follow up. Relative to the waitlist control and default conditions, participants in the personalised intervention condition reported significantly greater decreases in their global Eating Disorder Examination interview scores at post-intervention/10-week follow up. We did not observe any significant changes in self-reported eating disorder symptoms. Our results are tentative as we were underpowered to detect small-to-medium treatment effects. Our study provides preliminary evidence for the efficacy of Seed for treating eating disorders in sexual minoritized men, particularly when personalised content recommendations are provided. However, future research must provide greater quality evidence through well-powered, more rigorous clinical trials. This trial was retrospectively registered on 04/03/2026 (Trial ID ACTRN12626000271303). Sexual minoritized (e.g., gay, bisexual) men are more likely to have an eating disorder than heterosexual men. Despite this, no eating disorder treatments have been evaluated specifically among sexual minoritized men. In this study, 126 sexual minoritized men with eating disorders trialled a 10-week eating disorder treatment delivered on a smartphone app called Seed. Participants&#x2019; eating disorder symptoms were measured before and after completing the 10-week treatment both through an interview with a psychologist who recorded their symptoms, and through a questionnaire that participants completed by themselves online. Men who trialled the app reported fewer eating disorder symptoms when their symptoms were assessed through an interview, but not when measured through the questionnaire. Importantly, this study needed a larger number of participants to accurately examine how well the app worked, and whether any improvements in eating disorder symptoms were maintained long term (e.g., 6 and 12 months after finishing the treatment). More research is needed to determine whether the Seed app is helpful for treating eating disorders in sexual minoritized men.

Recovery in eating disorders (EDs) is often defined in terms of symptom remission, potentially overlooking the broader meanings individuals attribute to illness and recovery. Qualitative research has highlighted the multidimensional nature of recovery, yet less is known about how therapeutic contexts may shape how individuals make sense of illness, change, and recovery. This study aimed to explore how individuals with EDs conceptualize illness and recovery, and how these meanings may be shaped through participation in group psychotherapy. A qualitative study was conducted within an interpretivist framework using reflexive thematic analysis. Ten adult outpatients with EDs participated in semi-structured interviews at the end of a group psychotherapy program integrated within a multidisciplinary treatment setting. Participants described a shift from understanding the ED mainly through food, weight, body image, and symptom control toward a more emotionally and relationally informed understanding of distress. Recovery was increasingly constructed as a multidimensional and non-linear process involving emotional awareness, self-acceptance, agency, identity renegotiation, and connection with others. The group was experienced as a space that fostered recognition, belonging, and reflection, while also exposing participants to shame, fear of judgment, and emotional vulnerability. Findings suggest that group psychotherapy may support a reconfiguration of how individuals with EDs understand illness and recovery, moving from a primarily symptom-centred perspective toward a more holistic, relational, and personally meaningful framework. Rather than operating mainly through direct behavioural change, the group appeared to function as a space for meaning-making, emotional reflection, and relational experimentation. This study highlights emotional awareness, identity renegotiation, self-acceptance, and interpersonal connection as potential targets for fostering recovery in EDs. Trial registration The study protocol (n. 0034565/i) was approved by the local Institutional Review Board. Eating disorders are often understood mainly in terms of eating behaviours, weight, and body image. However, people with eating disorders may experience illness and recovery in broader and more personal ways, involving emotions, relationships, identity, shame, and self-acceptance. This study explored how adults with eating disorders understood their illness and recovery after taking part in group therapy within a multidisciplinary treatment setting. Ten adults were interviewed after completing a group therapy program. Before the group experience, participants often described their eating disorder mainly through symptoms such as food restriction, bingeing, purging, body dissatisfaction, and weight control. After the group, many described their difficulties in a broader way, linking the eating disorder to emotions, relationships, and personal experiences. Recovery was seen not only as reducing symptoms, but also as becoming more aware of emotions, accepting oneself, developing personal agency, and connecting with others. The group helped some participants feel understood and less alone, but it could also involve shame, fear of judgment, and emotional vulnerability. Overall, group therapy appeared to support broader and more personally meaningful understandings of recovery.

To assess the effects of waiting time for outpatient psychotherapeutic interventions on patient-reported outcomes in adolescents and adults with eating disorders. MEDLINE, Embase, APA PsycInfo, CENTRAL and BASE were searched on 12 August 2025. Quantitative studies of adolescents (&#x2265;&#x2009;10 years) and adults with eating disorders that examined waitlist conditions prior to outpatient psychotherapeutic interventions and measured eating disorder pathology with the Children's Eating Attitudes Test (chEAT) or Eating Disorder Examination-Questionnaire (EDE-Q) were eligible. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A within-group random-effects meta-analysis was performed assessing pre-post change scores of the EDE-Q Global Score (primary analysis) and EDE-Q subscales (secondary analyses). A full protocol has been pre-registered on PROSPERO (registration number: CRD420251090691). Nine waitlist-controlled studies (total n&#x2009;=&#x2009;647, waitlisted n&#x2009;=&#x2009;283) including adult participants with bulimia nervosa, binge-eating disorder and 'eating disorder not otherwise specified' met our eligibility criteria. Eight studies (waitlisted n&#x2009;=&#x2009;273) were included in the meta-analysis. Participants entered the waiting period with high EDE-Q Global Scores, ranging from 3.08 to 4.65 across studies. The pooled pre-post effect estimate was Hedges' g&#x2009;=&#x2009;-&#x2009;0.17 (95% CI -&#x2009;0.30 to -&#x2009;0.05), indicating a negligible reduction in eating disorder pathology. Certainty of evidence was rated as moderate, given the high risk of bias across studies. Based on our results, waiting in waitlist control groups represents a period during which substantial eating disorder pathology and associated distress persist without therapeutic intervention. Further research is needed to better understand the effects of waiting time for regular eating disorder treatment outside a study setting. Study participants on a waitlist to be treated for bulimia nervosa, binge-eating disorder, and &#x2018;eating disorder not otherwise specified&#x2019; continued to report high levels of eating disorder symptoms while waiting about 10 weeks for psychotherapy. This means that individuals may experience considerable distress during a delay in starting treatment. However, being on a study waitlist is not the same as waiting for treatment in everyday healthcare. In a study, participants know when and what kind of treatment they will get, which might already help reduce symptoms before treatment even starts. We could not find studies that assessed the effects of waiting time in everyday healthcare.

The mental well-being benefits and challenges of pet ownership have been explored in many populations, including clinical populations such as individuals with depression, anxiety, and posttraumatic stress disorder. Critically, there are currently no published studies focusing specifically on pet ownership for individuals with eating disorders. The present work aimed to explore pet ownership experiences of adults experiencing eating disorders. Semi-structured interviews were conducted with 17 cat- and dog-owning British adults (eight cat owners, six dog owners, three participants with both cats and dogs) with diagnosed or suspected eating disorders. Reflexive thematic analysis was utilized to identify two overarching themes and seven subthemes relating to the role of the human-pet bond in eating disorder symptoms and treatment. Data-driven themes include personal recovery experiences, the dual role of pets in eating behaviors, exercise experiences, pets' influence on cognitions, body image perceptions, and self-identity, as well as pets' roles in personal recovery motivations. Furthermore, pets were found to impact treatment experiences, represented by themes that discuss pets as catalysts for change and partners during treatment, while also creating challenges around separation during treatment. The present study found that pets can be largely beneficial for individuals with eating disorders, especially for those in later stages of personal recovery; however, pets can also create challenges, especially for individuals in earlier stages of personal recovery. The present work also provides a foundation for future work related to pet ownership for individuals with eating disorders, such as further exploration on incorporating pets into eating disorder treatment, how to utilize the human-pet relationship to support symptom reduction, and how to mitigate challenges posed by pets related to treatment, with the results having key relevance for the development of clinical interventions for this population. The study examined the relationships that people with eating disorders have with their pets. Semi-structured interviews were conducted with 17 participants who owned cats or dogs. Two overarching themes and seven subthemes were identified. These themes included the role pets play in personal recovery experiences and personal recovery motivation, the dual function of pets in eating behaviors and exercise experiences, how pets influence thought patterns, perceptions of body image, and self-identity, and how pets provide motivation and support, but also challenges related to treatment. The findings of this study provide a better understanding of the support, but also challenges, related to pet ownership for people with eating disorders, and provide a foundation for future research in this area. Future work building on the present study may focus on incorporating pets into eating disorder treatment, how to utilize pets to support symptom reduction, and how to mitigate challenges posed by pets related to treatment.

This study aimed to examine the psychometric properties of the Turkish version of the Night Eating Questionnaire (NEQ) in an adolescent clinical sample. The sample consisted of 267 adolescents aged 13-17 years (64.8% girls; mean age&#x2009;=&#x2009;15.23&#x2009;&#xb1;&#x2009;1.29 years) recruited from child and adolescent psychiatry outpatient clinics of two university hospitals in T&#xfc;rkiye. The NEQ, Eating Attitudes Test-26 (EAT-26), Revised Child Anxiety and Depression Scale - Child Version (RCADS-CV), and Sleep Quality Scale and Sleep Variables Questionnaire (SQS-SVQ) were administered. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency, and convergent validity were examined. EFA identified a four-factor structure accounting for 62.39% of the total variance, consistent with the original factor solution. CFA supported the four-factor structure of the NEQ (CMIN/df&#x2009;=&#x2009;1.606, RMSEA = 0.048, CFI = 0.964, TLI = 0.951), consisting of nocturnal ingestions, evening hyperphagia, morning anorexia, and mood/sleep disturbances. Internal consistency was acceptable for the total scale (Cronbach's &#x3b1;&#x2009;=&#x2009;0.73). The NEQ demonstrated meaningful convergent validity through significant positive correlations with sleep quality, anxiety, depression, and disordered eating attitudes. Adolescents in the overweight group reported significantly higher NEQ total scores, particularly on the evening hyperphagia and mood/sleep disturbances subscales. Girls showed higher scores on morning anorexia and mood/sleep disturbances compared with boys. The Turkish NEQ demonstrated satisfactory psychometric properties in an adolescent clinical sample and appears to be a valid and reliable instrument for assessing night eating symptoms in Turkish adolescent clinical populations. Night Eating Syndrome (NES) is a condition in which people eat a large portion of their daily food late in the evening or during the night. To better understand and identify these behaviors, researchers often use questionnaires that measure the severity of night eating symptoms. In this study, we examined whether the Turkish version of the Night Eating Questionnaire (NEQ) is a reliable and useful tool for assessing night eating behaviors in adolescents. A total of 267 adolescents aged 13&#x2013;17 years who were receiving care at child and adolescent psychiatry clinics participated in the study. They completed the NEQ along with several questionnaires about eating habits, sleep quality, and emotional well-being. Our findings showed that the Turkish NEQ works well in adolescents and can reliably measure different aspects of night eating, such as eating during the night, eating large amounts in the evening, loss of appetite in the morning, and sleep or mood-related difficulties. We also found that adolescents with higher body weight tended to report more severe night eating symptoms, and girls reported more sleep- and mood-related symptoms than boys. These results suggest that the NEQ can help clinicians identify night eating symptoms in adolescents and may support earlier recognition of eating-related problems in young people.

Peer support (PS) is increasingly incorporated into eating disorder services as an adjunct to clinical treatment, yet qualitative evidence exploring how it is experienced by service users remains limited. Since 2023, the Eating Disorders Unit at South London and Maudsley (SLaM) NHS Foundation Trust has piloted a 1-1 PS pathway alongside routine care. Semi-structured qualitative interviews were conducted with twelve adults diagnosed with an eating disorder who had received 1-1 PS within outpatient or day care services. Interviews explored participants' subjective experiences and the perceived meaning of PS within their wider recovery journeys. Data was analysed using reflexive thematic analysis within a constructivist-interpretivist framework. Seven interrelated themes captured how participants experienced PS: relational understanding and normalisation; informality and shared power; re-positioning the eating disorder within a wider life; safety and non-judgement; imagining recovery through lived example; practical knowledge as relationally embedded; and multi-layered relatability. Participants described PS as distinct from formal treatment, valuing its relational qualities and lived-experience grounding. A commonly reported limitation concerned the time-limited nature of PS, with many participants expressing a desire for additional sessions. This qualitative evaluation provides insight into how 1-1 PS is experienced within a specialist eating disorder service. Rather than evidencing effectiveness, the findings illuminate relational and meaning-making processes through which PS was perceived as helpful. These insights informed the development of an eating disorder-specific PS feedback tool and have implications for service development and future research. Eating disorders are serious mental health difficulties that can affect both physical health and everyday life. Although psychological treatments can be helpful, many people find recovery difficult and services are often under pressure. Peer support involves receiving support from someone who has their own lived experience of an eating disorder and recovery.Since 2023, the Eating Disorders Unit at South London and Maudsley NHS Foundation Trust has offered 1&#x2013;1 peer support alongside usual eating disorder treatments. This study explored how people experienced this support. Twelve adults who had received peer support were interviewed.Participants described feeling understood, less judged, and more able to open up. Seeing a peer support worker who had experienced recovery helped participants feel hopeful and imagine a future beyond their eating disorder. Peer support also helped some people reconnect with valued parts of life, such as hobbies, relationships, and goals.Some participants described an initial apprehension around potentially triggering aspects of the PS roles, prior to starting the sessions.A common challenge was that peer support was time-limited, and many participants wanted additional PS sessions.These findings informed the development of a new feedback questionnaire which aims to capture what service users find most meaningful about peer support.

Binge Eating Disorder (BED) is an eating disorder characterized by recurrent episodes of binge eating accompanied by a sense of loss of control. This study aimed to examine the reliability, validity, and classification accuracy of a new instrument, the Binge Eating Disorder Questionnaire (BED-Q), in a sample of 364 individuals diagnosed with Type 2 diabetes (T2D). A total of 364 participants were included from a Danish cohort of 2,465 individuals with T2D. BED diagnosis was established using the Structured Clinical Interview for the DSM (SCID) based on the DSM-5 criteria, which served as the reference standard. The BED-Q was evaluated for internal consistency and unidimensionality using Cronbach's alpha and confirmatory factor analysis (RMSEA, CFI, TLI, SRMR). Receiver Operating Characteristic (ROC) analyses assessed diagnostic performance, and optimal cut-off values were determined using the area under the curve (AUC), sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value, and Youden's index. The BED-Q showed excellent internal consistency (Cronbach's &#x3b1;&#x2009;=&#x2009;0.94; average inter-item correlation&#x2009;=&#x2009;0.68), and confirmatory factor analysis supported a one-factor model with good final model fit (&#x3c7;&#xb2; (11)&#x2009;=&#x2009;8.239, p&#x2009;=&#x2009;0.692, CFI&#x2009;=&#x2009;1.000, TLI&#x2009;=&#x2009;1.006, RMSEA&#x2009;=&#x2009;0.000, SRMR&#x2009;=&#x2009;0.014). ROC analyses indicated good diagnostic accuracy (AUC&#x2009;=&#x2009;0.86). A cut-off score of 12 provided optimal discrimination between BED and non-BED cases (Youden's index&#x2009;=&#x2009;0.71, sensitivity&#x2009;=&#x2009;0.91, specificity&#x2009;=&#x2009;0.81, PPV&#x2009;=&#x2009;0.77, NPV&#x2009;=&#x2009;0.92). The BED-Q demonstrated excellent reliability, unidimensionality, and diagnostic accuracy relative to a gold standard structured clinical interview. These findings support the use of the BED-Q as a valid screening instrument for BED. A cut-off score of 12 provided optimal sensitivity and specificity, consistent with DSM-5 and ICD-11 criteria. Further validation in diverse populations is recommended. Binge Eating Disorder (BED) is an eating disorder characterized by eating large amounts of food while feeling a loss of control over one&#x2019;s eating. This study examined whether a new questionnaire, the Binge Eating Disorder Questionnaire (BED-Q), can reliably identify people who may have BED. We tested the BED-Q in 364 adults with Type 2 diabetes from a large Danish health study. We looked at whether the questions measured the same underlying problem (binge eating), whether the scale was consistent, and how accurately it could distinguish between people with and without BED. The BED-Q performed very well on all tests, showing that it measures binge eating symptoms in a clear and reliable way. We also identified a total score of 12 or higher as the best cut-off point for indicating possible BED. At this level, the questionnaire correctly identified most people with BED and correctly excluded most people without the disorder. These results suggest that the BED-Q is a useful and accurate tool for screening BED. Further research should examine how well it works in the general population and other patient groups.

In this study, latent profile analysis (LPA) was used to identify naturally occurring patterns or profiles of maladaptive and adaptive perfectionism, impulsivity, and disordered eating (DE) in early adolescence (111 boys, 138 girls; M age&#x2009;=&#x2009;13.6 years). Profile membership at age 13 was used to examine disordered eating patterns assessed at ages 11 and 12, providing insights into how symptoms had developed prior to profile formation. Using LPA, we identified five profiles: (1) high functioning (2), maladaptively impulsive (3), anxious-avoidant (4), maladaptively perfectionistic, and (5) maladaptively impulsive-perfectionistic. The maladaptively perfectionistic profile showed the highest levels of dieting, preoccupation with food, and body concerns as well as perceived sociocultural pressure to be thin, followed by the maladaptively impulsive-perfectionistic profile. Analyses of earlier DE patterns indicated that the anxious-avoidant profile consistently showed the lowest BMI and highest perceived pressure to eat, both at age 13 and at earlier assessment points, suggesting possible feeding-related difficulties. The findings confirm that maladaptive and adaptive perfectionism, impulsivity, and BMI are jointly associated with the development of DE in early adolescence, demonstrating that considering these traits together yields greater explanatory value than focusing on any single factor alone. While identifying general risk factors is essential, differentiating personality-based profiles of vulnerable adolescents may be particularly valuable for targeted early prevention. This study examined how perfectionism and impulsivity are linked to disordered eating in early adolescence. We studied 249 boys and girls aged 13 to 14 and also looked at their eating patterns from ages 11 to 12. We identified naturally occurring groups of adolescents based on their levels of perfectionism, impulsivity, and disordered eating, and found five distinct profiles that differed in their eating-related attitudes and behaviors. Among the profiles found, adolescents with high perfectionism showed the strongest signs of restrictive eating, preoccupation with food, and concerns about their body. Another group had low body weight and reported feeling pressure from others to eat, suggesting feeding-related challenges. Some of these differences were already evident at ages 11&#x2013;12, suggesting that these patterns were present across early adolescence. These findings highlight that young people can experience disordered eating in different ways. Recognising such patterns may help identify those at greater risk and improve early prevention and support.

In eating disorders, service models provide a structure for the delivery of assessment and treatment to people across a range of settings. High-quality service models can improve a person's satisfaction with the care provided, sustain them in treatment and promote better outcomes. To capture and explore the perspectives of former service users, carers and eating disorder clinicians on their experiences of eating disorder service models. This phenomenological study used semi-structured interviews to explore perspectives of former Australian service users (n&#x2009;=&#x2009;5), carers (n&#x2009;=&#x2009;15) and eating disorder clinicians (n&#x2009;=&#x2009;29) on eating disorder service models. Thematic analysis identified four themes: (1) Navigating the service system, (2) Weight as a measure of progress, (3) Competent clinicians: a needle in a haystack and (4) Who is steering the ship? The first three themes were shared across all participant groups, while the fourth was specific to clinicians. Service models were described by participants as overstretched, contributing to shorter treatment duration, with skilled clinician shortages further constraining care. Participants reported over-reliance on weight to determine service model access (and thus, access to treatment) and as a trigger for discharge, despite consensus that recovery cannot be measured by weight alone. To enhance eating disorder service models, participants proposed strengthening the workforce, facilitating timely access, using more holistic outcome measures, and tailoring care to individual needs within coordinated, stepped service pathways. These findings highlight opportunities for system-level reform and the need for clearer leadership to guide consistent standards and accountability. When people seek help for an eating disorder, typically their care is provided through a service model. Eating disorder service models can be located in a hospital, or the community, and provide a structure for how assessment and treatment is delivered to help a person recover.Service models for eating disorders can be very different. This means that people who access service models have varied experiences. In this study, clinicians who work in Australian eating disorder service models, people who have received assessment and/or treatment for an eating disorder in Australia and carers of people who have an eating disorder were all interviewed. There were some common themes identified from the information provided in the interviews. Many people reported that they found locating and accessing eating disorder service models complicated. In addition, there were not enough clinicians who understand eating disorders to provide adequate support. Lastly, eating disorders needed clear leadership, so eating disorder service models can improve how they provide care and be more consistent in how they support people.

Alkaline urine pH has previously been reported in patients with restrictive eating disorders (EDs) over 30 years ago, however its prevalence is not routinely reported. This study carries out a preliminary investigation of the change in urine pH in malnourished adolescent and young adult patients hospitalised with restrictive EDs during an initial two weeks of higher energy nutritional rehabilitation. A retrospective review was carried out of the medical charts of malnourished adolescent and young adult patients (aged 14-21) hospitalised with restrictive EDs for &#x2265;&#x2009;14 days during a 2-year period (January 2018-December 2019) and provided with assertive nutritional rehabilitation. Linear mixed effects models were used to estimate weekly within patient change in urine pH and identify possible associations with degree of malnutrition, medical instability, and purging status. Seventy-nine patients (75 female, 4 male) with mean age 17.3&#x2009;&#xb1;&#x2009;1.4 years were included. On admission, patients were commenced on mean 2179&#x2009;&#xb1;&#x2009;476&#xa0;kcal/day. No incidence was recorded of clinical refeeding syndrome during nutritional rehabilitation. The average decrease in urine pH&#x2009;&#x2265;&#x2009;7 from baseline to 1 week of medical refeeding was statistically significant (56.6% vs. 29.9%, p&#x2009;=&#x2009;0.001). Urine pH decreased from a mean of 7.0&#x2009;&#xb1;&#x2009;0.9 at baseline to a mean of 6.6&#x2009;&#xb1;&#x2009;0.7 after one week of refeeding, and further decreased to a mean of 6.5&#x2009;&#xb1;&#x2009;0.7 by the end of two weeks. Compared with purging patients, for non-purging patients there was a stronger association between medical instability at admission, low percentage median body mass index, and urine pH&#x2009;&#x2265;&#x2009;7. The findings of this study suggest a change in urine pH from &#x2265;&#x2009;7 to <&#x2009;7 can be observed after one week of assertive nutritional rehabilitation in adolescent and young adults hospitalised with restrictive EDs. Further research is required to investigate potential mechanisms underlying elevated urine pH observed in patients with restrictive EDs, and the change that is observed during nutritional rehabilitation. A small number of studies have reported that urine pH is elevated (pH&#x2009;&#x2265;&#x2009;7) in patients with restrictive eating disorders (EDs), such as anorexia nervosa. This study retrospectively reviewed the medical charts of 79 consecutive adolescent and young adult patients, hospitalised with a restrictive ED. When comparing urine pH from admission to after one week of medical refeeding, the number of patients with urine pH&#x2009;&#x2265;&#x2009;7 decreased significantly (56.6% vs. 29.9%, p&#x2009;=&#x2009;0.001). The strongest association with having pH&#x2009;&#x2265;&#x2009;7 was medical instability on admission, lower percentage median body mass index, and no history of purging behaviours.The findings of this study suggest a change in urine pH from &#x2265;&#x2009;7 to <&#x2009;7 can be observed after one week of higher energy medical refeeding in a subgroup of adolescent and young adults hospitalised with restrictive EDs. Further research is needed to examine the underlying mechanisms that cause the elevation of urine pH observed in patients with restrictive EDs, and the change that is observed during medical refeeding.

Twitter's "EDTWT" community constitutes a prominent online space for eating disorder (ED) discourse, yet large-scale computational characterization remains limited. To characterize EDTWT behavioral patterns, emotional dynamics, thematic structure, and develop automated content classification methods through computational analysis of a three-year dataset. We analyzed 48,341 tweets from 18,587 users (January 2022-February 2025). Analyses included engagement patterns, temporal dynamics, clinical keyword prevalence, multi-method sentiment analysis (TextBlob, VADER, clinical affect lexicons), topic modeling (LDA, NMF), and ensemble-based multi-label classification. User engagement followed a highly skewed distribution in which a small number of highly active users generated the majority of content (62.1% of users posted only once, while the top 10% produced 48.9% of all content), suggesting that a concentrated subset of users may warrant particular clinical attention. Temporal patterns showed a 7.5-fold difference in posting volume between Friday night peaks and Tuesday morning troughs, with consistent nocturnal peaks between 21:00 and 23:00. Clinical keywords appeared in 26.6% of tweets (body image 14.4%, restrictive eating 6.7%, recovery 4.3%). Sentiment was slightly positive (M=0.060, SD=0.282) with moderate subjectivity (M=0.298). Topic modeling revealed ten themes including calorie tracking (13.2%), Spanish (9.7%) and Polish (8.2%) subcommunities, and recovery discourse (9.4%). An ensemble of automated classifiers trained to categorize eating disorder content achieved strong performance (macro F1=0.753, &#x3ba;=0.703, where higher values indicate better classification accuracy), outperforming a biomedical-domain language model by 21.4% on the least frequently occurring content categories. EDTWT exhibits complex heterogeneity with coexisting pro-ED content, recovery discourse, and culturally-specific subcommunities. The concentration of activity among a small number of highly active users enables efficient identification of individuals who may be at elevated risk and in need of targeted support. Automated classification enables scalable content monitoring for digital mental health surveillance and evidence-based platform moderation. This study examined three years of Twitter posts from the eating disorder community known as EDTWT. We analyzed nearly 50,000 tweets from over 18,000 users to understand how people use this online space. We found that a small group of very active users creates most of the content, while many people only post once. Posting activity peaks on Friday nights and late evenings, times when people may feel particularly vulnerable. About one-quarter of tweets mentioned eating disorder symptoms like body image concerns or restrictive eating, though recovery-related content was also present. The community includes people from different countries, with notable Spanish and Polish-speaking groups. Surprisingly, many posts expressed positive emotions, often related to achieving weight loss goals rather than overall wellbeing. We developed computer tools that can automatically identify different types of eating disorder content, which could help social media platforms and mental health professionals monitor these communities more effectively. Our findings suggest that online eating disorder communities are complex spaces where harmful content exists alongside recovery support, requiring thoughtful approaches to both protect vulnerable individuals and preserve helpful peer connections.

Large earthquakes may be associated with traumatic stress and eating-related outcomes, but evidence from Turkey remains limited. This study examined the associations between direct earthquake exposure, post-earthquake traumatic stress, and eating-related outcomes approximately two years after the 6 February 2023 Kahramanmara&#x15f;-centred earthquakes. This cross-sectional comparative online survey was conducted in Turkey between March and June 2025. Adults were classified as directly exposed (n&#x2009;=&#x2009;602) or comparison (n&#x2009;=&#x2009;615) based on residence in the 11 affected provinces and self-reported earthquake experience. Participants completed the Post-Earthquake Trauma Level Determination Scale (PETLDS), Salzburg Emotional Eating Scale (SEES), Mindful Eating Questionnaire (MEQ), and SCOFF eating disorder screening tool, together with sociodemographic and self-reported anthropometric measures. Adjusted group differences were estimated using multivariable regression models controlling for age, BMI, gender, marital status, education, employment, income status, and earthquake-related loss. Additional adjusted models examined whether PETLDS total score was independently associated with eating-related outcomes. Direct exposure was strongly associated with higher traumatic stress (PETLDS total: B&#x2009;=&#x2009;12.30, 95%CI 10.66 to 13.94; p&#x2009;<&#x2009;0.001) and with higher scores on most PETLDS subscales, whereas the PETLDS emotional subscale was higher in the comparison group (B=-1.09, 95%CI -1.37 to -0.81; p&#x2009;<&#x2009;0.001). Direct exposure was not independently associated with SEES total score (p&#x2009;=&#x2009;0.153), MEQ total score (p&#x2009;=&#x2009;0.584), or a positive SCOFF screen (OR&#x2009;=&#x2009;1.286, 95%CI 0.969 to 1.706; p&#x2009;=&#x2009;0.081), although small exploratory subscale differences were observed. In additional adjusted models, higher PETLDS total score was associated with lower MEQ total score and greater odds of a positive SCOFF screen (both p&#x2009;<&#x2009;0.001), but not with SEES total score. Direct exposure was strongly associated with traumatic stress, whereas eating-related associations were limited. Traumatic stress severity was more clearly associated with lower mindful eating and higher eating disorder risk screening positivity, supporting trauma-informed post-disaster care and nutritional screening in highly stressed individuals. The 6 February 2023 Kahramanmara&#x15f; earthquakes affected many people in Turkey and may have had long-term effects on their mental health and eating behaviours. In this study, we compared adults who experienced the earthquakes directly with those who were not directly exposed to them. Over 1,200 people completed an online survey regarding traumatic stress, emotional eating, mindful eating and the potential risk of eating disorders. Those who directly experienced the earthquakes reported higher levels of traumatic stress. However, when other factors were taken into account, direct exposure to the earthquakes alone was not found to have a clear association with general emotional eating, mindful eating, or the risk of eating disorders. Instead, individuals with higher levels of traumatic stress were more likely to report lower levels of mindful eating and a higher risk of eating disorders. These findings suggest that post-disaster support should include mental health assessments, and that screening for eating-related issues could be particularly beneficial for those experiencing high levels of traumatic stress.

Eating disorders are often perceived to mainly affect young women, however previous research shows that they can both appear and persist in older populations. Research on eating disorders in older people is scarce, and there are no treatment guidelines or specialized diagnostic criteria, meaning that disordered eating in older adults is often misattributed to dementia, somatic illness, or the ageing process itself. This increases the risk of incorrect diagnosis and treatment, and hinders person-centred care. In order to start bridging this knowledge gap, the present study aimed to describe nursing home staff's experiences and reflections on disordered eating among the residents. The study adopted a qualitative approach and a descriptive design. A total of 26 participants (registered nurses, licensed practical nurses and care assistants) were recruited from three nursing homes in mid-Sweden. Four focus group interviews were conducted, using a fictional patient case - a vignette - to help discussion. The interviews were audio recorded, transcribed, and analysed using qualitative content analysis inspired by Graneheim and Lundman. Three themes were identified during the analysis. The theme It's not disordered eating behavior, it's dementia or ageing - or is it? referred to staff's initial attribution of all problematic eating behaviors to dementia or other age-related illnesses. The theme Lack of knowledge, lack of time, lack of resources - We don't know, and no one else does, either contained reflections on the lack of education and resources that was experienced in all professions. The theme Navigating conflicts of interest related to problematic eating behaviors - a rocky path included perceptions of conflicts and ethical dilemmas related to food and eating. Staff in nursing homes do not have sufficient training and resources to identify and diagnose residents with disordered eating behaviors, which is a barrier to safe and person-centred care. Not much is known about eating disorders (EDs) in older people, even though EDs affect all age groups. In this study, we carried out four focus group interviews with staff at three nursing homes in Sweden, and asked them to discuss and reflect on their experiences of disordered eating behaviors among the older people they work with. In the results, we found that the staff described disordered eating among the older people, but they often did not realize that the behaviors may be because of an ED. Instead, the staff thought that they might be caused by dementia, or by other illnesses related to the ageing process. The results also showed that nursing home staff lacked education and resources to deal with EDs among the residents, and that they didn&#x2019;t know where to turn for help. They also described conflicts and ethical dilemmas around food and eating. It is important to improve nursing staff&#x2019;s knowledge about EDs in older people, and to make sure there is access to suitable resources and specialized care.

Eating disorders (EDs) are serious illnesses which profoundly impact individuals and the people close to them. Despite robust evidence that early intervention improves clinical outcomes, help-seeking by individuals with EDs is low and long periods of untreated illness are common. Social support networks can facilitate help-seeking, although most research has focused on the experiences of parents supporting adolescents with anorexia nervosa (AN) to seek help and engage in treatment. The present study sought to explore the perspectives of a broadly defined group of 'close others' on help-seeking for all EDs. Twelve qualitative interviews were conducted with 'close others' - partners, siblings, extended family members and parents - who had experience of individuals with a broad range of EDs including AN, bulimia nervosa (BN), avoidant/restrictive food intake disorder (ARFID), and other specified feeding or eating disorder (OSFED). Data were analysed using reflexive thematic analysis. Themes were categorised into barriers and facilitators of help-seeking, alongside the impact on close others. Barriers identified by close others could be categorised into three main groups: close other factors (e.g., limited knowledge/ confidence in identifying the problem), patient factors (e.g., ambivalence), and systemic factors (e.g., restrictive service criteria and long wait times). Close others facilitated help-seeking by educating themselves about EDs, learning to navigate healthcare systems and actively working to reduce their loved one's ambivalence about help-seeking. Close others reported several negative impacts on their well-being, including guilt, stress and frustration, social isolation and challenges juggling competing responsibilities. The findings of this study demonstrate that broadly defined social networks can play an active role in supporting individuals to seek help for EDs. These findings should be interpreted with caution given that the sample was predominantly White and largely comprised individuals with experience of AN. Interventions aimed at improving help-seeking for ED should draw on social support networks as one way of improving access to treatment. Inclusive service models, which involve close others in care, should offer both psychological and practical support to help reduce carer burden and distress. Eating disorders (EDs) are serious mental illnesses that affect both the people who have them and the people close to them. Getting help early can make recovery more likely, but many people with EDs find it hard to ask for help. We interviewed partners, siblings, parents and other family members of people with different EDs. We asked them about their experience supporting their loved one to get help. From these interviews, we found several challenges and supports for getting help. Challenges included not understanding the problem, not knowing where to get help, and the person with the ED being unsure about wanting help. Close others played an active role in helping their loved one to seek help by learning more about EDs, finding out about available services, and helping with practical tasks like booking appointments. Close others described feeling stressed, frustrated and guilty. Strategies to help people get support for EDs should recognise the important role of their social networks. Education about EDs should be aimed at the general public so more people understand the problem and how to help.

Persistent dietary restriction can result in people with eating disorders becoming so severely physically and mentally compromised that they are considered a risk to their own life. In these circumstances, individuals may be subjected to involuntary treatments, including nasogastric tube (NGT) feeding under restraint. This systematic scoping review identifies and assesses the evidence available to healthcare professionals to inform clinical practice decisions related to NGT feeding under restraint in eating disorder care, and highlights gaps in knowledge to be addressed in future research. Six electronic databases, six grey literature sites, 12 professional bodies, and four eating disorder conference websites were searched in May 2025. 36 sources met inclusion criteria, including: peer reviewed papers and practice guidelines. Peer-reviewed literature (22) included quantitative, qualitative, and mixed methods research studies, and systematic reviews. Grey literature (14) included practice guidance in the form of expert opinion, expert consensus, and practice standards. A narrative review was structured using deductive analysis focused on the following research questions in relation to eating disorders care: (1) where and how is NGT feeding under restraint happening? (2) how are healthcare professionals making decisions about when and how to use NGT feeding under restraint? (3) what are patients, parents/carers, and healthcare professionals' experiences of NGT feeding under restraint? And (4) what are the patient outcomes of NGT feeding under restraint? There is clear guidance that NGT feeding under restraint should be delivered minimally, as a lifesaving intervention in line with the legal principle of 'least restrictive practice'. No comprehensive, multi-disciplinary guidelines or frameworks were identified to support achieving this in practice. Further research is required to improve understanding of who is at risk of receiving NGT feeding under restraint, the long- and short-term risks associated with its use, and what care processes can improve patient outcomes. Future research should support development of multi-disciplinary guidance to improve clinical decision-making and patient outcomes.

The Australia & New Zealand Academy for Eating Disorders (ANZAED) established a credentialing system for general practitioners (GPs) in 2024. The ANZAED Eating Disorder Credential formally recognises GPs who have the necessary knowledge and training to provide safe and effective care to patients with eating disorders (EDs). The aim of this study was to learn about the experiences of both credentialed and non-credentialed GPs, with a particular focus on their reasons for becoming credentialed, barriers to becoming credentialed, and how the Credential has impacted their clinical practice. Thirty-eight GPs (37 female, 21 credentialed, 17 non-credentialed) completed an online mixed-methods survey, with both open-ended questions and multiple-choice questions. The survey asked about their perceptions of the Credential and their experiences with the credentialing system. The main motivations to become credentialed were to receive recognition for their training (n&#x2009;=&#x2009;15, 71.4%) and improve their knowledge about EDs (n&#x2009;=&#x2009;9, 42.9%). The main reasons to not become credentialed were not wanting to increase their ED caseload (n&#x2009;=&#x2009;11, 64.7%) or be identified as an ED specific GP (n&#x2009;=&#x2009;10, 58.8%). Three quarters (n&#x2009;=&#x2009;16, 76.2%) of credentialed GPs did not perceive their ED patient caseload changing after becoming credentialed. Content analysis of open-ended questions yielded two themes: (1) The value of the Credential; and (2) Need for increased clarity about the Credential. Theme 1 highlighted the financial and workload barriers to becoming credentialed, whilst also indicating that GPs perceived that the Credential would improve their care of EDs. Theme 2 identified some areas where there was a need for increased understanding of the Credential's requirements for GPs and its potential impact on people living with EDs. GPs are motivated to become credentialed to gain recognition for their ED knowledge and training. However, improvements in the credentialing system may encourage its uptake. These may include increasing the Credential's visibility and recognition, addressing perceptions of the financial impact, improving clarity about the Credential's overall aims and providing additional support to GPs in their learning. The ANZAED Eating Disorder Credential for general practitioners (GPs) was introduced to recognise GPs with additional training and knowledge to care for people with eating disorders. GPs who became credentialed mainly did so to gain formal recognition for their eating disorder training and to improve their knowledge, while those who did not become credentialed often worried about increased workload or being identified as an eating disorder specialist GP. Most GPs who were credentialed did not report seeing more eating disorder patients after receiving the Credential, suggesting concerns about increased caseload may not be realised in practice. GPs generally saw value in the Credential but identified a need for clearer information about its purpose, requirements, and impact, as well as concerns about cost and workload.

School-based health centers (SBHCs) play a key role in connecting youth to health services, including primary care. Despite some literature exploring their mental health services, little is known about the role SBHCs play in screening for and treating eating disorders. In this study, we surveyed 56 SBHC providers, assessing their familiarity with providing care and screening for mental health concerns, including eating disorders. We also qualitatively explored areas to improve efforts around mental health care and screening. Results suggest that while the majority of participants indicated that they were familiar with mental health disorders, they were less familiar with eating disorders. Furthermore, despite rating screenings for eating disorders of great importance, the frequency of such screenings was comparably lower. Qualitative findings highlight two emerging themes focused on addressing gaps in mental health care: (a) training, continuing education, and addressing misconceptions around eating disorders; and (b) SBHC staffing and resource constraints.