Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa

SEED-AN and a non-specialised, severe mental illness (SMI) community treatment model: perspectives of professionals and patients of a QoL-focussed treatment

BACKGROUND

Improving care for SEED-AN patients is urgently needed. Current specialist eating disorder (SEDU) programs have minimal impact, resulting in poor quality of life. Flexible assertive community treatment (FACT) focuses on improving the quality of life of people with severe mental illness.

AIM

This study systematically examined professionals' and patients' experiences with existing care for SEED AN in two settings in two health districts in the Netherlands. Specifically, the specialised Eating Disorder Unit and FACT.

METHODS

A qualitative approach was used: Twelve professionals participated in focus groups, and four professionals and six patients were interviewed individually. Reflective thematic analysis was used to analyse the data.

RESULTS

Four themes were constructed: "We feel ignorant in the treatment of SEED-AN patients"; "There is a disability to act"; "We are more than executive practitioners alone"; and "The professionals at FACT have given me back my confidence in treatment". The findings reflect how support for SEED-AN patients is provided by both FACT and SEDU professionals and how SEED-AN patients experience the FACT approach.

DISCUSSION

A resource group model promotes collaboration among professionals, patients and the patient's support system. The model is expected to increase knowledge about SEED-AN among stakeholders who support the quality of life of SEED-AN patients.

Understanding Family Experiences: A Study on Mental Health Literacy in Adolescent Eating Disorder Diagnoses

BACKGROUND

Adolescent eating disorders pose a significant public health challenge and strongly affect both physical and emotional well-being. Early diagnosis is important for improving treatment outcomes, though it remains complex due to multiple influencing factors. The family perspective is essential in this process, as it provides valuable insights into changes in adolescents' habits and emotional health.

METHODS

A descriptive qualitative study was conducted between January and February 2023. Interviews were conducted with 12 participants using a phenomenological approach to explore the experiences and perspectives of family members of adolescents with eating disorders.

RESULTS

Four thematic blocks comprising several categories were identified: (T1) diagnosis, (T2) family, (T3) resources, and (T4) treatment. The participants emphasized the need for early intervention and a multidisciplinary approach to the treatment of eating disorders. Family therapy was recognized as vital to treatment, and common dissatisfaction with the public health structure underscores the need for greater investment in research and access to specialists. Mental health nurse practitioners play an important role in providing comprehensive care and support, as well as mental health literacy.

CONCLUSIONS

A holistic, patient-centered approach, including family involvement and appropriate support systems, is key to improving the outcomes and quality of life of adolescents undergoing treatment for eating disorders. Improving healthcare resources and addressing the challenges faced by families is essential. In addition, mental health literacy is critical, as it enables families to understand the disease better, make informed decisions, and actively participate in the recovery process, thus contributing to improved therapeutic outcomes and quality of life for patients.

The association between weight-adjusted-waist index and psoriasis: A cross-sectional study based on NHANES 2009 to 2014

Weight-adjusted-waist index (WWI) is an anthropometric indicator of central obesity, which is calculated by dividing the waist circumference (WC) by the squared weight. The purpose of this study was to investigate the association between WWI and psoriasis in adults. Multivariate logistic regression and smoothing curve fitting were used to investigate the relationship between WWI and psoriasis based on data from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. Subgroup analysis and interaction tests were employed to examine the population-level stability of this connection. There was a positive association between WWI and psoriasis in 15,932 participants > 20 years of age. In the fully adjusted model, each 1-unit increase in WWI was associated with a 14% increase in the risk of developing psoriasis [1.14 (1.01, 1.32)]. Participants in the highest quartile of WWI had a 38% higher risk of developing psoriasis than those in the lowest quartile [1.38 (1.01, 1.94)]. This positive association was more pronounced in males. WWI is positively associated with psoriasis in US adults. Our findings imply that WWI has the potential to improve psoriasis prevention in the general population.

Disruption of network hierarchy pattern in bulimia nervosa reveals brain information integration disorder

The human brain works as a hierarchical organization that is a continuous axis spanning sensorimotor cortex to transmodal cortex (referring to cortex that integrates multimodal sensory information and participates in complex cognitive functions). Previous studies have demonstrated abnormalities in several specific networks that may account for their multiple behavioral deficits in patients with bulimia nervosa (BN), but whether and how the network hierarchical organization changes in BN remain unknown. This study aimed to investigate alterations of the hierarchy organization in BN network and their clinical relevance. Connectome gradient analyses were applied to depict the network hierarchy patterns of fifty-nine patients with BN and thirty-nine healthy controls (HCs). Then, we evaluated the network- and voxel-level gradient alterations of BN by comparing gradient values in each network and each voxel between patients with BN and HCs. Finally, the association between altered gradient values and clinical variables was explored. In the principal gradient, patients with BN exhibited reduced gradient values in dorsal attention network and increased gradient values in subcortical regions compared to HCs. In the secondary gradient, patients with BN showed decreased gradient values in ventral attention network and increased gradient values in limbic network. Regionally, the areas with altered principal or secondary gradient values in BN group were mainly located in transmodal networks, i.e., the default-mode and frontoparietal network. In BN group, the principal gradient values of right inferior frontal gyrus were negatively associated with external eating behavior. This study revealed the disordered network hierarchy patterns in patients with BN, which suggested a disturbance of brain information integration from attention network and subcortical regions to transmodal networks in these patients. These findings may provide insight into the neurobiological underpinnings of BN.

Evaluation of Mean Plasma Glucose Levels Using HbA1C in Patients With Severe Eating Disorders

OBJECTIVE

Hypoglycemia causes significant morbidity and mortality in patients with severe eating disorders. We measured average glycemic levels using hemoglobin A1C (HbA1C) in patients hospitalized for extreme anorexia nervosa (AN) and avoidant restrictive food intake disorder (ARFID).

METHODS

This was a prospective, single-center cohort study conducted in an inpatient medical stabilization unit. Clinical outcomes were compared using paired t-tests. Additional analysis comparing clinical variables between undetectable and detectable HbA1c used two-sample t-tests.

RESULTS

The study cohort consisted of 148 individuals, 90% female, average age of 31 years, average admit body mass index of 12.5 kg/m2, and mean percentage ideal body weight of 60.1%. Diagnoses included AN-restricting (54%), AN-binge purge (39%), and ARFID (7%). HbA1C and fructosamine levels decreased from admission to discharge. Serum glucose levels increased significantly from admission to discharge. Mean HbA1C was 4.7% on admission and 4.3% on discharge.

DISCUSSION

This study evaluated mean blood glucose levels using HbA1C in patients with extreme forms of AN and ARFID. Given the concern for morbidity and mortality from hypoglycemia in this population, which can be overlooked on a single point-of-care glucose measurement, HbA1C is a valuable laboratory measure of glycemic status in patients with extreme forms of eating disorders.

Neuropsychiatric considerations in treating anorexia nervosa patients with osteopathic manipulative medicine: a narrative review

Osteopathic manipulative medicine (OMM) has a growing recognition in serving as an effective treatment to promote adaptation and homeostasis of the body by addressing musculoskeletal, neural, vascular, and lymphatic structures to promote self-healing and regulation. OMM can treat the musculoskeletal tension and sympathetic hyperactivity resulting from the increased cortisol response and hypersensitivity found in varying psychiatric illnesses, including anorexia nervosa (AN). This paper addresses the considerations necessary for treating AN patients with OMM, emphasizing the need to evaluate their abnormal high-level neuronal processing of sensory information, including differences in touch perception compared to the general population. Current literature was gathered utilizing a combination of the following keywords: anorexia nervosa, perception of touch, and osteopathic manipulative medicine/treatment. No literature was found addressing the effects of OMM on treating AN patients. Eight studies addressed the change in perception of touch found in AN patients. Results of the literature review reveal that the perceptions of touch in AN patients are distorted and can lead to reduced perceived pleasantness encountered in social interactions and touch. Specific changes have been found in C-tactile (CT) afferents responsible for the positive effects of touch, thus influencing emotional regulation. The significance of addressing this topic is to provide insight into the pathophysiological processes of AN and to inform physicians of unconventional stimuli that may exacerbate AN symptoms and behaviors. Further study is required to elucidate the role and mechanism of OMM in patients with AN and whether manual therapy could worsen pathological behavior and thinking patterns seen in AN patients. Such studies could include, but are not limited to, examining biological factors such as cortisol levels in AN patients receiving OMM and collecting data about AN patients' thinking patterns and behavior during OMM treatment.

Do premorbid weight parameters predict BMI 30 years after adolescent-onset anorexia nervosa?

PURPOSE

To examine anthropometric predictors of BMI 30 years after the onset of adolescent AN.

METHODS

A group of 51 individuals with adolescent-onset AN were identified in Sweden in 1985. Anthropometric data have been collected from birth records and school nurse charts. A group matched for gender, school and age constituted a healthy control group. Possible predictors of BMI 30 years after AN onset including ponderal index (a variable that estimates body proportionality and composition during the infancy period) and highest BMI Z score (highest BMI in childhood, adjusted for age and sex) were analyzed with linear regression and multivariate analysis.

RESULTS

None of the five possible predictors were significantly correlated to BMI outcome 30 years after AN onset. In the control group, BMI at the 18- and 30-year follow-ups were statistically significantly predicted by ponderal index at birth (18-year follow-up: r = 0.36, p = .015; 30-year follow-up: r = 0.32, p = .034).

CONCLUSIONS

We found no statistically significant premorbid anthropometric predictors of BMI 30 years after the onset of AN. Ponderal index at birth appears to normally predict BMI outcomes in the general adult population. Having had AN during adolescence may have caused a disruption of the expected long-term BMI trajectory, resulting in a lower weight status than expected. These findings may be implemented in clinical practice to address patients' fear of exponential weight gain after recovery.

Disgust drivers do not impact on the altered body in action representation in anorexia nervosa

Disgust is a powerful emotion that evolved to protect us from contamination and diseases; it also cores to very human feelings, such as shame. In anorexia nervosa, most of the knowledge on disgust regards food. However, disgust can be elicited by varied drivers, including body-related self-disgust, which may be more central to this condition. Here, we investigate in depth how disgust triggers related to the body influence altered representations in anorexia nervosa. Women with anorexia nervosa and healthy women performed the Hand Laterality Task, in which they were asked to judge the laterality of hands without and with a disgust charging feature (i.e., with a body product or with a body violation). We computed accuracy and reaction time for the effect of biomechanical constraints, an index of motor imagery. We also measured the general disgust sensitivity through a self-report questionnaire. Participants with anorexia nervosa were overall less accurate and slower compared with controls, suggesting a non-canonical (i.e., not based on motor imagery) approach to solving the task. However, they showed the same pattern of responses as controls for disgust-charged stimuli, despite reporting higher levels of disgust sensitivity. Our results suggested the absence of specific effects of disgust drivers on the (altered) body in action representation in anorexia nervosa. We discuss this evidence focusing on the role of the psychopathological symptoms characterising anorexia nervosa. We also reflect on the efficacy of experimental methodologies used to detect alterations in body representation in this clinical condition.

The effect of Acceptance and Commitment Therapy on perceived stress, rumination, and distress tolerance in women with Bulimia Nervosa

This study aimed to evaluate the efficacy of Acceptance and Commitment Therapy (ACT) in mitigating perceived stress, rumination, and distress tolerance among women diagnosed with Bulimia Nervosa (BN) in Ahvaz, Iran. A quasi-experimental pre-test-post-test design with a control group was employed. The target population consisted of all female BN patients referred to the Ahvaz Binge Eaters Association between February and May 2022. Patients were definitively diagnosed with BN by a clinical specialist using a structured clinical interview adhering to DSM-5 criteria. From an initial pool of 91 patients, 50 were randomly selected for participation and subsequently assigned to either the experimental or control group, with each group comprising 25 individuals. Pre-test analysis revealed no significant group differences in perceived stress, rumination, or distress tolerance among women with BN. However, post-test scores indicated a significant decrease in both perceived stress and rumination within the experimental group compared to the control group (p < .01). Furthermore, the post-test analysis demonstrated that ACT intervention significantly improved distress tolerance in women with BN (p < .01). These findings suggest that ACT may be a promising therapeutic approach for alleviating psychological distress and enhancing emotional regulation in individuals grappling with BN.

Multivariate patterns linking brain microstructure to temperament and behavior in adolescent eating disorders

Eating disorders (EDs) are multifaceted psychiatric disorders characterized by varying behaviors, traits, and cognitive profiles thought to drive symptom heterogeneity and severity. Non-invasive neuroimaging methods have been critical to elucidate the neurobiological circuitry involved in ED-related behaviors, but often focused on a limited set of regions of interest and/or symptoms. The current study harnesses multivariate methods to map microstructural and morphometric patterns across the entire brain to multiple domains of behavior and symptomatology in patients. Diffusion-weighted images, modeled with restriction spectrum imaging, were analyzed for 91 adolescent patients with an ED and 48 healthy controls. Partial least squares analysis was applied to map 38 behavioral measures (encompassing cognition, temperament, and ED symptoms) to restricted diffusion in white matter tracts and subcortical structures across 65 regions of interest. The first significant latent variable explained 46.9% of the covariance between microstructure and behavior. This latent variable retained a significant brain-behavior correlation in held-out data, where an 'undercontrolled' behavioral profile (e.g., higher emotional dysregulation, novelty seeking; lower effortful control and interoceptive awareness) was linked to increased restricted diffusion across white matter tracts, particularly those joining frontal, limbic, and thalamic regions. Individually-derived brain and behavior scores for this latent variable were higher in patients with binge-purge symptoms, compared to those with only restrictive eating symptoms. Findings demonstrate the value of applying multivariate modeling to the array of brain-behavior relationships inherent to the clinical presentation of EDs, and their relevance for providing a neurobiologically-informed model for future clinical subtyping and prediction efforts.

Exploring validated strategies for screening for eating disorders in adolescents and adults in primary health care: a scoping review protocol

BACKGROUND

This study will be the first scoping review dedicated to investigating screening strategies for eating disorders specifically performed in the primary health care setting, as no comprehensive examination has been performed to date. Our primary aim is to explore the available literature and assess and identify validated screening strategies for eating disorders in adolescents and adults within the primary care context.

METHODS

The study protocol was developed following the guidance outlined by the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols and the Joanna Briggs Institute methodology for scoping reviews. This study will adhere to the PRISMA extension for scoping reviews to report review data. The protocol was registered on the Open Science Framework. The review will include studies that involve validated screening strategies for eating disorders in adolescents and adults utilising primary health care services. Experimental, quasiexperimental, observational, qualitative, and mixed-methods study designs and reviews will be eligible without language or publication year restrictions. Six databases (MEDLINE-PubMed, Embase, LILACS, CINAHL, Web of Science, PsycINFO) and grey literature will be searched. Studies will be selected and extracted by two independent reviewers via online Covidence. The results will be presented in narrative form and through tables and graphs. When possible, descriptive qualitative content analysis will be conducted.

DISCUSSION

The expected results of this scoping review will shed light on validated strategies for screening for eating disorders in primary health care. This will equip health care professionals with well-substantiated empirical evidence. Moreover, it is anticipated to uncover research gaps, nurturing the ongoing development and refinement of screening strategies for eating disorders in primary health care. The results will be widely disseminated to the scientific community, policy-makers, service providers, and the general public.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered on the Open Science Framework ( https://osf.io/pybvf ).

Analysis of Suicidal Behavior in Adult Inpatients with Anorexia Nervosa: Prevalence of Suicide Attempts and Non-Suicidal Self-Injury and Associated Factors-Data Before and After the COVID-19 Pandemic

Background/Objectives: Anorexia nervosa (AN) has a high mortality rate frequently related to suicidality; however, there are few studies on suicide attempts (SAs) and non-suicidal self-injuries (NSSIs) in adult inpatients with AN. This study aims to describe SA and NSSI prevalence and related clinical and sociodemographic factors in adult inpatients with AN. Methods: We retrospectively analyzed data on 298 inpatients hospitalized between 2014 and 2023. Suicidality and clinical and sociodemographic data were collected by experienced psychiatrists; then, the patients completed a battery of self-report questionnaires investigating eating-related and general psychopathology. Results: A total of 9.7% of the inpatients reported an SA in their lifetime, and 13.4% reported NSSI. The percentages were lower among patients with restricter-type AN (5.6% SA and 6.6% NSSI) and higher among patients with binge-purging AN (18% SA and 27% NSSI). SAs were associated with unemployment, binge-purging AN, personality disorders, and lifetime sexual abuse; NSSIs were correlated with family psychiatric disorders, binge-purging AN, personality disorders, body dissatisfaction, restriction, and eating-related concerns. No differences emerged in the frequency of reported suicidality between patients tested before and after the COVID-19 pandemic. Conclusions: Suicidality is a relevant issue in AN. Many factors in the history of the patients and their eating-related pathologies should be considered as potentially associated with SA and NSSI and carefully assessed.

Increased Prevalence of Binge Eating Disorder and Bulimia Nervosa in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

CONTEXT

Polycystic ovary syndrome (PCOS) is associated with disordered eating/eating disorders, but prior meta-analyses are limited by small numbers.

OBJECTIVE

To inform the 2023 International PCOS Guideline, we performed a systematic review and meta-analysis evaluating the prevalence of disordered eating/eating disorders among women with and without PCOS.

METHODS

Ovid MEDLINE, EMBASE, PsycInfo, and All EMB were searched from inception through February 1, 2024, for studies that compared prevalences of eating disordered/disordered eating in adolescent or adult women. Random effects meta-analyses were used to estimate the pooled odds ratios (OR) or standardized mean differences (SMD) of outcomes in women with PCOS compared to controls. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias.

RESULTS

Of 1352 articles identified, 20 were included, with a total of 28 922 women with PCOS and 258 619 controls. Individuals with PCOS had higher odds of any eating disorder (OR: 1.53 [1.29, 1.82], 8 studies), which persisted in studies where PCOS was diagnosed by Rotterdam criteria (OR: 2.88 [1.55, 5.34], 4 studies). Odds of bulimia nervosa, binge eating disorder, and disordered eating, but not anorexia nervosa, were increased in PCOS. Mean disordered eating scores were higher in PCOS (SMD: 0.52 [0.28, 0.77], 13 studies), including when stratified by normal and higher weight body mass index. Most included studies were of moderate quality, with no evidence of publication bias.

CONCLUSION

Our study informs the 2023 PCOS Guideline recommendations for consideration of the risk of disordered eating/ eating disorders in care of women with PCOS, regardless of weight, especially during providing lifestyle counseling.

Early-onset anorexia nervosa: a scoping review and management guidelines

BACKGROUND

Anorexia nervosa (AN) is a serious multifactorial eating disorder characterized by insufficient nutritional intake to maintain a minimum normal weight for one's age and height, a fear of gaining weight and a distorted body image. It affects mainly adolescents, but a decreased age at diagnosis has been reported, leading to the definition of a rare form of AN called early-onset or prepubertal anorexia nervosa (EOAN; ORPHA 525738), with reported epidemiological and clinical specificity. Current knowledge and specific treatments for this particular condition remain scarce. We aim to summarize the literature review and synthesize actual knowledge on EOAN for preliminary guidelines to harmonize the diagnosis, treatment and follow-up.

METHODS

A scoping literature review was performed from 2010-2021 using PubMed, Web of Science, PsycInfo and Cochrane via the following search terms: (anorexia nervosa) AND (early-onset OR premenarchal OR prepubertal OR childhood). International guidelines were screened for additional hits. Data extraction was limited to findings relevant to the key topic questions: epidemiology and clinical specificities section, diagnosis and initial evaluation section, treatment section, and follow-up and prognosis section.

RESULTS

A total of 1257 titles were retrieved via the initial search strategy. Finally, 42 records were included in the present article (30 articles and 11 international guidelines and 1 literature review). We identified 15 articles relevant for the epidemiology and clinical specificities section, 11 for the diagnosis and initial evaluation section, 3 for the treatment section, and 1 for the follow-up and prognosis section. Despite the growing literature on the epidemiological and clinical features of EOAN, knowledge of specific treatments and prognoses remains scarce in the absence of extensive standardized data collection and few age-specific clinical research protocols. Current international guidelines generally extrapolate strategies proposed for adolescents and young adults to children with a low level of evidence.

CONCLUSIONS

Continuing research efforts in this specific younger population is needed to validate child-specific care strategies, enabling the establishment of age-appropriate recommendations with a higher level of evidence targeting specific determinants and clinical specificities of EOAN.

A never-ending story: The COVID-19 pandemic and the increase of hospital admissions for typical and atypical anorexia nervosa in children, adolescents and young adults in the post-pandemic era in Germany

BACKGROUND

A large increase in the rate of hospitalizations for adolescents and children with anorexia nervosa (AN) was observed during the coronavirus disease (COVID-19) pandemic. It is still not clear whether this was a temporary effect or whether the increased admission rates persist.

METHODS

Data were retrieved from the largest health insurance in Germany comprising 2.5 million children between 9 and 19 y. All patients of this age group with a discharge diagnosis of typical (AN) and atypical AN (AAN) according to the International Classification of Diseases, Tenth Revision (ICD-10), were included. Admission rates per 10,000 person-years were computed separately by sex, age and type of AN for entire years from 2019 to 2022 and the first half of 2023 in relation to the entire number of insured persons of the same sex and age per year.

RESULTS

Two years after the final lockdown admission rates were still significantly higher in adolescent and childhood AN than in the pre-COVID-19 time. While admission rates declined for adolescents in 2023, those for children remained high, with an increase for girls of more than 40% compared with the rate before the pandemic (1.42 (CI 1.26, 1.60); p < 0.0001). The highest admission risk for AAN relative to the pre-COVID-19 period was observed in adolescents in the first half of 2023 (1.6; CI 1.34; 1.90; p < 0.0001).

CONCLUSIONS

Children appear to be especially vulnerable to the pandemic-associated disruptions. Clinicians should try to determine the ongoing effects of the pandemic and support early detection and treatment of AN to prevent its often lifelong consequences.

Why them? A systematic review on common factors among youth who receive compulsory treatment for anorexia nervosa

Background: Compulsory interventions, including compulsory nasogastric tube feeding, are sometimes necessary for youth with life-threatening anorexia nervosa. However, these interventions are also potentially traumatic for patients and clinicians alike.Objective: To improve early recognition and prevention of compulsory interventions, we evaluated common factors among youth with anorexia nervosa who receive compulsory treatment.Method: We conducted a systematic literature search of peer-reviewed studies in PubMed, Embase, Medline, PsycINFO, and WOS core collection. Two authors independently screened 7 447 articles and conducted a quality appraisal of the included studies. We thematically synthesised patient, contextual, and treatment factors of youth (≤ 24 years) who received compulsory treatment for anorexia nervosa.Results: We included 16 studies and five themes, with ten subthemes, emerged from the data, most with a medium strength of evidence. Patients exhibited common character traits, various comorbidities, and lives marked by instability or adversity. Furthermore, patients experienced complicated contextual factors, including family dysfunction and social isolation.Discussion: Prolonged and inconsistent treatment histories may increase social isolation and anorexia identification, which in turn may lead to increased treatment resistance and a higher likelihood of compulsory interventions.Conclusion: The diversity of presented factors in this systematic review emphasises the importance of personalised care. Early acknowledgement of factors associated with the illness is crucial for working towards recovery and preventing further deterioration. Furthermore, even when anorexia nervosa diverts all attention to dangerous levels of weight loss, attention to quality of life may help a patient find treatment motivation.

Activity-based anorexia (ABA) model: Effects on brain neuroinflammation, redox balance and neuroplasticity during the acute phase

Several evidences suggest that immuno-inflammatory responses are involved in the pathogenesis of anorexia nervosa (AN). Herein we investigate the possible alteration of key mediators of inflammation, redox balance, and neuroplasticity in the brain of rats showing an anorexic-like phenotype. We modeled AN in adolescent female rats using the activity-based anorexia (ABA) paradigm and measured gene expression levels of targets of interest in the prefrontal cortex (PFC) and dorsal hippocampus (DH). We observed reduced mRNA levels of pro-inflammatory cytokines IL-1β and TNF-α, the inflammasome NLRP3, and the microglial marker CD11b in both PFC and DH of ABA animals. Conversely, the mRNA of IL-6, which acts as both a pro-inflammatory and anti-inflammatory cytokine, was increased. Moreover, we observed an overall upregulation of different antioxidant enzymes in PFC, while their profile was not affected or opposite in the DH, with the exception of MT1α. Interestingly, ABA animals showed elevated levels of the neuroplasticity marker BDNF in both PFC and DH. Our data indicate that ABA induction is associated with anatomical-specific cerebral alteration of mediators of neuroinflammation, oxidative balance and neuroplasticity. Although more research should be conducted, these results add important information about the role of these systems in the complex AN etiopathogenesis.

Systematic review of the epidemiology of eating disorders in the Arab world

PURPOSE OF REVIEW

The Arab world is dealing with modernization and sociocultural changes both associated with eating disorders. The present review provides an update of 'Eating disorders in the Arab world: a literature review', which was published in 2020.

RECENT FINDINGS

There are 22 recent epidemiological studies on eating disorders in five different countries in the Arab world. A large-scale national mental health survey reported a 12-month eating disorder prevalence of 3.2% and an eating disorder lifetime prevalence of 6.1%. Binge-eating disorder was the most common eating disorder (12-month prevalence = 2.1%, lifetime prevalence = 2.6%), 1.6% was at high risk for binge-eating disorder. Overall, between 23.8 and 34.8% was at high risk for any eating disorder. Body-shape dissatisfaction, a high BMI and separated/widowed/single marital status were associated with eating disorder pathology.

SUMMARY

Although there is still a lack of studies compared to the western world, the number of epidemiological studies on eating disorders in the Arab world is growing and there is an increase in studies using appropriate assessment-tools and norms. It is recommended to offer specialized treatment and to implement preventive programs.

[Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different?]

Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different? Abstract: Objective: Primary adrenal insufficiency (Addison's disease) is a rare differential diagnosis of anorexia nervosa. This case report presents important differential diagnostic aspects. Methods: We prepared a case report of a 14-year-old female patient according to the CARE guidelines, taking the patient's and the child's parents' view into consideration. Results: The diagnosis of primary adrenocortical insufficiency was reached using specific laboratory diagnostics approximately 9 months after the onset of symptoms, including sudden body weight loss. Significant differential diagnostic aspects were the absence of a body schema disorder and skin hyperpigmentation prominent in the physical examination. The patient experienced a high psychosocial burden because of the unclear diagnosis over 9 months. The diagnosis and substitution therapy with hydrocortisone led to a rapid improvement of the physical and psychological symptoms. Conclusions: This case report emphasizes the importance of a thorough somatic differential diagnosis in the context of a suspected anorexia nervosa.

Emotion Regulation, Eating Psychopathology, and Putative Transdiagnostic Psychological Processes: Findings from an Exploratory Network Analysis in a College Sample

OBJECTIVE

Considering the prevalence of ED-related prodromal symptoms among higher education students (making them a population at risk for developing EDs), the main goals of this study were to conduct a network analysis in a college sample and to explore multivariate dependencies between a selection of empirically informed variables of interest to eating psychopathology, namely difficulties in emotion regulation and psychological processes (e.g., interoceptive awareness, self-compassion, self-criticism, mindfulness, and experiential avoidance).

METHODS

The sample included 294 college students (Mage = 21.4, SD = 5.0; MBMI = 22.4, SD = 3.7). A Gaussian graphical network model was estimated to visualize interactions among the studied variables and to assess their centrality in terms of betweenness, closeness, strength, and expected influence.

RESULTS

A network system with 21 nodes was estimated (sparsity = 0.52). Nodes assessing disordered eating symptoms displayed the strongest correlation coefficients with nodes assessing dimensions of interoceptive awareness: eating concerns and not-distracting (r = -0.11), shape concerns and trusting (r = -0.16), and weight concerns and trusting (r = -0.10). Self-compassion was the node with the highest betweenness (SELFCS = 2.27) and closeness centrality (SELFCS = 1.70). The nodes with the highest strength centrality were strategies (DERS = 1.91) and shape concerns (EDE-Q = 1.51).

DISCUSSION

In this network model conducted in a college sample, eating-related symptoms were mainly associated with dimensions of interoceptive awareness. Also, the lack of effective strategies to regulate emotions, shape concerns, and self-compassion stood out as central nodes in the network model. The results suggest that addressing these variables may be promising in disrupting network systems marked by the presence of prodromal eating psychopathology symptoms in at-risk populations (e.g., college students).

Associations between parental rearing style and amygdala and hippocampal subfield abnormalities in drug-naive females with anorexia nervosa

BACKGROUND

Altered volumes in the hippocampus and amygdala have been linked to anorexia nervosa (AN). This study aimed to investigate amygdala and hippocampal subfields volume abnormalities in AN patients, and their associations with parental rearing practices and clinical psychological characteristics.

METHODS

This study included twenty-nine drug-naive females with AN from West China Hospital of Sichuan University, China, and fifty-nine age- and gender-matched healthy controls (HCs) recruited through advertisement. All participants underwent T1-weighted imaging. Amygdala and hippocampal subfields volume was calculated using FreeSurfer 7.0. The Core Self-Evaluation Scale (CSES) and Rosenberg Self-Esteem Scale (RSES) were used to assess the psychological characteristics of AN patients. The Egna Minnen av Barndoms Uppfostran (EMBU) was employed to evaluate parental rearing practices. Group differences in brain volumes were analyzed with covariates like age and total intracranial volume (TIV). Partial correlation analysis explored the correlations between brain region volumes and clinical psychological characteristics.

RESULTS

AN patients exhibited lower RSES and CSES scores, and more adverse parental rearing style than healthy norms. After adjusting for covariates, AN patients showed decreased gray matter volume (GMV) in the left medial (Me) and cortical (Co) nucleus, as well as in the right hippocampal-amygdala transition area (HATA). GMV in the left Me was correlated with years of education among HCs but not among AN patients. GMV in the right HATA was positively correlated with paternal penalty and severity, as well as maternal overinterference.

CONCLUSION

This study supports structure abnormalities in amygdala and hippocampus in AN patients and suggests that parental rearing practices may be associated with hippocampal abnormalities, potentially contributing to the pathophysiology of AN. Addressing appropriate parental rearing styles may offer a positive impact on AN.

Mental and physical health in children of women with a history of anorexia nervosa

Few studies have investigated the offspring of women with anorexia nervosa (AN). The aim of this study was to examine perinatal status, mental and physical health in the offspring of mothers with a history of AN. Fifty-one individuals with adolescent-onset AN and 51 matched controls (COMP) have been followed prospectively. Presently, 30 years after AN onset, at a mean age of 44 years, female participants who had given birth (nAN = 40, nCOMP = 40) were interviewed regarding psychiatric health in their offspring using the Developmental and Well-Being Assessment and the MINI International Neuropsychiatric Interview. In addition, information on the offspring's perinatal status, psychiatric- and physical health was obtained from the Swedish Medical Birth Register and The Swedish National Patient Register. Data regarding mental and physical health were available for 83 and 86 offspring in the AN and COMP groups, respectively. At birth, all of weight, length, head circumference and ponderal index were significantly reduced in the offspring of mothers with a history of AN. In adolescence, parental interviews indicated an overrepresentation of current psychiatric diagnoses in the offspring of mothers with AN. Compared with the offspring in the COMP group, endocrinological, immune and metabolic disorders were much more common in the offspring of the AN group. In conclusion, a history of AN increases the risk of worse perinatal outcome of the offspring. Later on, in childhood and adolescence, psychiatric and physical morbidity may be overrepresented in the offspring of women with AN.

Dynamic functional connectivity in anorexia nervosa: alterations in states of low connectivity and state transitions

BACKGROUND

The onset of anorexia nervosa (AN) frequently occurs during adolescence and is associated with preoccupation with body weight and shape and extreme underweight. Altered resting state functional connectivity in the brain has been described in individuals with AN, but only from a static perspective. The current study investigated the temporal dynamics of functional connectivity in adolescents with AN and how it relates to clinical features.

METHOD

99 female patients acutely ill with AN and 99 pairwise age-matched female healthy control (HC) participants were included in the study. Using resting-state functional MRI data and an established sliding-window analytic approach, we identified dynamic resting-state functional connectivity states and extracted dynamic indices such as dwell time (the duration spent in a state), fraction time (the proportion of the total time occupied by a state), and number of transitions (number of switches) from one state to another, to test for group differences.

RESULTS

Individuals with AN had relatively reduced fraction time in a mildly connected state with pronounced connectivity within the default mode network (DMN) and an overall reduced number of transitions between states.

CONCLUSIONS

These findings revealed by a dynamic, but not static analytic approach might hint towards a more "rigid" connectivity, a phenomenon commonly observed in internalizing mental disorders, and in AN possibly related to a reduction in energetic costs as a result of nutritional deprivation.

Psilocybin restrains activity-based anorexia in female rats by enhancing cognitive flexibility: contributions from 5-HT1A and 5-HT2A receptor mechanisms

Psilocybin has shown promise for alleviating symptoms of depression and is currently in clinical trials for the treatment of anorexia nervosa (AN), a condition that is characterised by persistent cognitive inflexibility. Considering that enhanced cognitive flexibility after psilocybin treatment is reported to occur in individuals with depression, it is plausible that psilocybin could improve symptoms of AN by breaking down cognitive inflexibility. A mechanistic understanding of the actions of psilocybin is required to tailor the clinical application of psilocybin to individuals most likely to respond with positive outcomes. This can only be achieved using incisive neurobiological approaches in animal models. Here, we use the activity-based anorexia (ABA) rat model and comprehensively assess aspects of reinforcement learning to show that psilocybin (post-acutely) improves body weight maintenance in female rats and facilitates cognitive flexibility, specifically via improved adaptation to the initial reversal of reward contingencies. Further, we reveal the involvement of signalling through the serotonin (5-HT) 1 A and 5-HT2A receptor subtypes in specific aspects of learning, demonstrating that 5-HT1A antagonism negates the cognitive enhancing effects of psilocybin. Moreover, we show that psilocybin elicits a transient increase and decrease in cortical transcription of these receptors (Htr2a and Htr1a, respectively), and a further reduction in the abundance of Htr2a transcripts in rats exposed to the ABA model. Together, these findings support the hypothesis that psilocybin could ameliorate cognitive inflexibility in the context of AN and highlight a need to better understand the therapeutic mechanisms independent of 5-HT2A receptor binding.

Ethical concerns in caring for persons with anorexia nervosa: content analysis of a series of documentations from ethics consultations

BACKGROUND

Caring for patients with anorexia nervosa (AN) is associated with high levels of moral distress among healthcare professionals. The main moral conflict has been posited to be between applying coercion to prevent serious complications such as premature death and accepting treatment refusals. However, empirical evidence on this topic is scarce.

METHODS

We identified all 19 documentations of ethics consultations (ECs) in the context of AN from one clinical ethics support service in Switzerland. These documentations were coded with a sequential deductive-inductive approach and the code system was interpreted in a case-based manner. Here, we present findings on patient characteristics and ethical concerns.

FINDINGS

The ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case.

CONCLUSIONS

Ethical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. However, currently, uncertainty around general justifiability, eligibility criteria, and concrete protocols hinders their adoption.

Influence of Nutrition, Lifestyle Habits, and Socio-Demographic Determinants on Eating Disorder Symptoms in the Spanish Young Adult Population: A Cross-Sectional Nationwide Survey

Eating disorders represent a complex and multifaceted public health challenge, highly prevalent among young people. Background and Objectives: To examine the prevalence of eating disorders in the Spanish young adult population aged 18-30 years, and their correlation with various eating habits and lifestyle factors. Materials and Methods: A descriptive, cross-sectional survey was carried out using a non-probabilistic snowball sample. The valid and reliable NutSo-HH Scale was employed to collect data on nutrition, lifestyle, and health habits. Results: Data were collected from 9692 Spanish young adults, of which 101 (1.04%) were diagnosed with anorexia nervosa and 71 (0.73%) with bulimia nervosa. The prevalence of anorexia and bulimia was significantly higher (p < 0.001) in women than in men, regardless of socio-demographic variables such as educational level, income, region, and size of city of residence. A considerable percentage of participants showed possible symptoms of eating disorders. Nutritionally, individuals with eating disorders consumed less fast food and fried or ultra-processed food but tended to consume coffee and energy drinks more frequently. Additionally, sleep quality and duration were more adversely affected in individuals with eating disorders compared to the general population. Sedentary lifestyles did not significantly differ between those with eating disorders and healthy individuals, though physical activity increased in people with bulimia. Conclusions: The interplay between young adults' dietary habits, lifestyle factors, and mental health underscores the urgent need for targeted interventions to effectively address these complex public health challenges.

Adaptations to family-based treatment for Medicaid-insured adolescents with anorexia nervosa

Background

Family-based treatment (FBT) is the leading intervention for adolescents with anorexia nervosa (AN); however, it is under researched in socioeconomically disadvantaged and racially diverse youth.

Methods

Semi-structured interviews were completed with ten FBT clinicians who practice in publicly-funded settings. Interview questions were focused on implementation challenges, overall acceptability and appropriateness of FBT, and naturally-occurring treatment adaptations.

Results

Content analysis revealed common themes relating to the implementation of FBT in publicly-funded, community-based settings: acceptability and appropriateness, complexity and learnability, perceived core components of FBT, cultural adaptations, socioeconomic factors, logistical considerations, organizational and systemic barriers, training acceptability, participant's self-efficacy, and telehealth accommodations.

Conclusion

The discussed themes offer insights into the implementation of FBT for settings with limited resources, aligning with prior research on clinical adaptations for multicultural patients. Recognizing these themes can guide clinical adjustments and refine the adapted treatment model in real-world settings for patients facing systemic barriers.

Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa

BACKGROUND

Anxiety is a core characteristic of anorexia nervosa and a potential target of exposure therapy, which requires a profound understanding of the patients' fears in order to be successful. The knowledge about fears in anorexia nervosa that should be targeted during exposure therapy can be enriched by laboratory research to the precise emotional and behavioral responses of anorexia nervosa patients when they are exposed to disorder relevant fear stimuli.

METHODS

In the laboratory, patients with anorexia nervosa (n = 15) and healthy controls (n = 51) were exposed to 1. their own body weight and a 10% higher body weight on the scale, 2. a standardized lab breakfast, and 3. five virtual bodies with different BMIs ranging from extreme underweight to lower healthy weight. The participants emotional (anxiety, disgust, satisfaction, acceptance) and behavioral responses (calorie consumption) were assessed. Patients with anorexia nervosa but not the healthy controls then received an intensive exposure treatment (~ 30 individual exposure sessions) targeting their individual fears, next to standard care. After the exposure treatment, it was investigated whether the patients' responses to the laboratory tasks changed.

RESULTS

Across all tasks, the patients reported more anxiety than healthy controls. The patients also consumed less calories during the breakfast and accepted the different body weights on the scale less than healthy controls. During the virtual body exposure, the patients' emotional responses did not differ per avatar but they reacted more negatively towards avatars with healthier weights than did healthy controls. After the exposure treatment, the patients reported less fears and they consumed more calories while their BMIs had increased. They were also more accepting of healthier weights.

CONCLUSIONS

Exposure to food-, body- and weight-related stimuli in the laboratory induces emotional reactions in patients with anorexia nervosa that are informative for the identification of exposure therapy treatment targets. In addition, exposure therapy targeting individual fears in patients with anorexia nervosa led to symptom reduction and is a promising intervention for the treatment of anorectic fears, though more research is needed to optimize its efficacy.

Experts' views on the implementation of digital interventions for eating disorders: a Delphi study

BACKGROUND

Eating disorders (EDs) constitute a considerable burden for individuals and society, but adequate and timely professional treatment is rare. Evidence-based Digital Mental Health Interventions (DMHIs) have the potential both to reduce this treatment gap and to increase treatment effectiveness. However, their integration into routine care is lacking. Understanding practitioners' attitudes towards DMHIs for EDs is crucial for their effective use.

AIMS

To investigate the consensus among German ED treatment experts on the relevance of different influencing factors for DMHI use in EDs.

METHODS

This Delphi study consisted of two rounds and was conducted online with an initial sample of N = 24 ED experts (Mage=41.96, SDage=9.92, n = 22 female). Prior to the Delphi rounds, semi-structured qualitative telephone interviews were performed to explore participants' attitudes, experiences, and expectations towards DMHIs. In order to construct the Delphi survey, content analysis was applied to a subset of ten interviews. A total of 63 influencing factors were identified and grouped into three main categories: contextual conditions, design, and content of DMHIs. In both Delphi rounds, the interview participants were subsequently invited to rate each of the factors with regard to their importance on 10-point scales. Group percentages and individual ratings of the first round (n = 23) were presented in the second round (n = 21). Consensus was calculated for each item (defined as IQR ≤ 2).

RESULTS

Importance ratings were high across items (M = 7.88, SD = 2.07, Mdn = 8). In the first round, 48% of the items reached consensus, with its most important (Mdn = 10) factors referring to data security, evidence base, technical requirements, usability, and specific DMHI content (psychoeducation, crisis intervention). In the second Delphi round, a consensus was reached on 73% of the items. No consensus was reached on 17 items.

CONCLUSIONS

The findings on practitioners' attitudes and priorities have relevant implications for subsequent DMHI development, dissemination, and implementation strategies, indicating that the highest-rated factors should be highlighted in the process.

Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Bulimia Nervosa (BN): A Review and Insight into Potential Mechanisms of Action

INTRODUCTION

Bulimia nervosa (BN) is a disorder primarily affecting adolescent females, characterized by episodes of binge eating followed by inappropriate compensatory behaviors aimed at preventing weight gain, including self-induced vomiting and the misuse of diuretics, laxatives, and insulin. The precise etiology of BN remains unknown, with factors such as genetics, biological influences, emotional disturbances, societal pressures, and other challenges contributing to its prevalence. First-line treatment typically includes pharmacotherapy, which has shown moderate effectiveness. Neuroimaging evidence suggests that altered brain activity may contribute to the development of BN, making interventions that directly target the brain extremely valuable. One such intervention is repetitive transcranial magnetic stimulation (rTMS), a non-invasive stimulation technique that has been garnering interest in the medical community for many years.

METHODS

This review explores the use of rTMS in the treatment of BN. Searches were conducted in the PubMed/Medline, ResearchGate, and Cochrane databases.

RESULTS

Twelve relevant studies were identified. Analysis of the results from these studies reveals promising findings, particularly regarding key parameters in the pathophysiology of BN. Several studies assessed the impact of rTMS on binge episodes. While some studies did not find significant reductions, most reported decreases in binge eating and purging behaviors, with some cases showing complete remission. Reductions in symptoms of depression and food cravings were also demonstrated. However, results regarding cognitive improvement were mixed. The discussion focused heavily on potential mechanisms of action, including neuromodulation of brain networks, induction of neuroplasticity, impact on serotonergic dysfunction, anti-inflammatory action, and HPA axis modulation. rTMS was found to be a safe intervention with no serious side effects.

CONCLUSIONS

rTMS in the treatment of BN appears to be a promising intervention that alleviates some symptoms characteristic of the pathophysiology of this disorder. An additional effect is a significant reduction in depressive symptoms. However, despite these findings, further research is required to confirm its effectiveness and elucidate the mechanisms of action. It is also recommended to further investigate the potential mechanisms of action described in this review.

Fecal microbiota transplantation of patients with anorexia nervosa did not alter flexible behavior in rats

OBJECTIVE

Patients with anorexia nervosa (AN) are often anxious, display inflexible behavior and disrupted reward processing. Emerging evidence suggests that gut dysbiosis in patients contributes to the disease phenotype and progression.

METHODS

In a preclinical study, we explored whether AN-derived microbiota impacts cognitive flexibility, anxiety, and dopamine signaling using fecal microbiota transplantation (FMT) in tyrosine hydroxylase-cre rats. We performed probabilistic reversal learning task (PRLT) at the baseline, after antibiotic treatment, and following FMT from patients with AN and controls. We assessed flexible behavior, task engagement, and ventral tegmental area (VTA) dopamine signaling during and in the absence of reward. Furthermore, anxiety-like behavior was evaluated with open field (OF) and elevated plus maze (EPM) tests.

RESULTS

Neither antibiotic-induced dysbiosis nor AN FMT led to significant alterations in the number of reversals or lever press strategies after reinforced or nonreinforced lever presses (win and lose-stay) in the PRLT. However, the number of initiated trials decreased after antibiotic treatment while remaining unchanged after FMT. No significant differences were observed in VTA dopamine activity, anxiety measures in the OF and EPM tests. Microbiome analysis revealed limited overlap between the microbiota of the donors and recipients.

DISCUSSION

No evidence was found that the microbiota of patients compared to controls, nor a depleted microbiome impacts cognitive flexibility. Nonetheless, antibiotic-induced dysbiosis resulted in reduced task engagement during the PRLT. The relatively low efficiency of the FMT is a limitation of our study and highlights the need for improved protocols to draw robust conclusions in future studies.

PUBLIC SIGNIFICANCE

While our study did not reveal direct impacts of AN-associated gut microbiota on cognitive flexibility or anxiety behaviors in our preclinical model, we observed a decrease in task engagement after antibiotic-induced dysbiosis, underscoring that the presence of a gut microbiome matters. Our findings underscore the need for further refinement in FMT protocols to better elucidate the complex interplay between gut microbiota and behaviors characteristic of anorexia nervosa.

New perspectives on the role of biological factors in anorexia nervosa: Brain volume reduction or oxidative stress, which came first?

Anorexia nervosa (AN) is an eating disorder (ED) that has seen an increase in its incidence in the last thirty years. Compared to other psychosomatic disorders, ED can be responsible for many major medical complications, moreover, in addition to the various systemic impairments, patients with AN undergo morphological and physiological changes affecting the cerebral cortex. Through immunohistochemical studies on portions of postmortem human brain of people affected by AN and healthy individuals, and western blot studies on leucocytes of young patients and healthy controls, this study investigated the role in the afore-mentioned processes of altered redox state. The results showed that the brain volume reduction in AN could be due to an increase in the rate of cell death, mainly by apoptosis, in which mitochondria, main cellular organelles affected by a decreased dietary intake, and a highly compromised intracellular redox balance, may play a pivotal role.

Exploring the moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating in Chinese adolescents

OBJECTIVES

Previous research suggests potential moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating. However, relevant research is mainly conducted on adult women from Western countries, and limited evidence exists for adolescent samples, especially from non-Western contexts (e.g., China). Thus, this study aimed to examine the moderating roles of dispositional mindfulness and body image flexibility in the relationship between body dissatisfaction and disordered eating in Chinese adolescents.

METHOD

We recruited 545 Chinese adolescents (53.9% boys, aged 12-16 years) who completed measures of body dissatisfaction, dispositional mindfulness, body image flexibility, and disordered eating. Moderation analyses were examined with PROCESS macro on SPSS.

RESULTS

In separate models, both higher dispositional mindfulness and body image flexibility weakened relationships between body dissatisfaction and disordered eating. However, when both dispositional mindfulness and body image flexibility were entered into the same moderation model, only body image flexibility showed a significant moderating effect.

DISCUSSION

Both dispositional mindfulness and body image flexibility may weaken the association between body dissatisfaction and disordered eating in adolescents. However, body image flexibility might have a stronger effect than dispositional mindfulness. These findings suggest that interventions aimed at reducing body dissatisfaction to prevent disordered eating in adolescents may pay more attention to adolescents' body image flexibility.

Effectiveness of Yoga as a Complementary Therapy for Anorexia Nervosa: A Systematic Review

Anorexia nervosa (AN) is a severe psychiatric condition associated with high disability and mortality. The purpose of the present manuscript is to critically summarize evidence about the effectiveness of yoga for this condition. A bibliographic search was conducted in the main database sources (PubMed, Embase, and Scopus). Articles in English about the effectiveness of yoga in AN were included. Two hundred thirty-three articles were initially identified and 5 articles were included in the present review. With the exception of one study, all had several methodological limitations such as the presence of confounding factors (e.g., psychiatric comorbidity) or a too limited sample of patients. However, globally yoga seems to ameliorate AN symptoms, especially those regarding emotional dysregulation. Yoga is a candidate complementary treatment for the management of AN, but more randomized controlled studies with larger samples and limited bias are necessary to draw robust conclusions. It would be also interesting to verify in comparative trials the effectiveness of yoga with respect to other treatments such as psychotherapy or the administration of pharmacological compounds. Finally, the practice should be modified adapting to the specific needs of this type of patient.

Eating disorders among international migrants: a systematic review and meta-analysis

PURPOSE

Migrants may have elevated exposure to stressors, which can affect their physical and mental well-being. However, migrants often experience a healthy immigrant effect, the applicability of this phenomena to eating disorders is unknown. We aimed to synthesize the available literature and estimate a summary measure of prevalence odds ratio for eating disorders in migrant populations compared to local populations.

METHODS

A literature search was conducted using MEDLINE, Embase, PsycINFO, and Web of Science with keywords on migration and eating disorders. Inclusion criteria involved using a validated eating disorder scale and having a comparator group. Two independent reviewers performed study screening and data extraction. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. Random-effects models of meta-analysis were applied to compare eating disorder prevalence between migrants and local populations.

RESULTS

There were 10 studies included in our review (meta-analysis = 6, narrative synthesis = 4). Studies provided prevalence estimates for: any eating disorder, binge eating disorder, anorexia nervosa, and bulimia nervosa. Among studies with a diagnostic instrument, the pooled prevalence odds ratio (POR) between migrants and local populations for any eating disorder was 0.45 (95%CI: 0.35-0.59). However, a subgroup analysis of eating disorder instruments among studies using risk assessment tools demonstrated inconsistent findings, with both increases and decreases in prevalence.

CONCLUSION

Migrants were found to have a lower prevalence of eating disorders compared to local populations, supporting the healthy immigrant hypothesis. However, this effect differs between diagnostic and risk assessment tools.

Overall and cause-specific mortality in anorexia nervosa; impact of psychiatric comorbidity and sex in a 40-year follow-up study

OBJECTIVE

This study investigates the overall and cause-specific mortality in males and females with anorexia nervosa (AN) from 1977 to 2018, focusing on the impact of psychiatric comorbidity on mortality risk, a less explored aspect despite a high prevalence in patients with AN.

METHOD

We conducted a nationwide population-based cohort study in Denmark including all patients with AN (n = 14,774) with a median follow-up time of 9.1 years and a 1:10 age- and sex-matched general population comparison cohort. Using Cox proportional hazard model, we calculated adjusted hazard ratios (aHR) for death stratified by psychiatric comorbidity, sex, and age at AN onset and evaluated the causes of death using Fine and Gray sub-distribution hazard ratios (SHR).

RESULTS

In patients with AN, the weighted average aHR for all-cause mortality was 4.5 [95% CI 4.1-4.9] with up to 40 years follow-up. Psychiatric comorbidity was present in 47% of patients with AN at index date, which was associated with a 1.9-fold increase in 10-year mortality compared with patients without comorbidity and a notably four-fold increase, when diagnosed at age 6-25 years. The mortality risk was similar according to sex. 13.9% of all deaths in patients with AN were due to suicide (SHR 10.7 [8.1-14.2]). The risk of dying of natural causes was increased with a SHR of 3.8 [95% CI 3.4-4.2].

DISCUSSION

The increased mortality risk in both males and females with AN and psychiatric comorbidity, particularly when diagnosed at young age, underscores the need for comprehensive treatment addressing both AN and coexisting psychiatric conditions.

PUBLIC SIGNIFICANCE

The mortality in patients with anorexia nervosa (AN) is high and we show in our study that the mortality is doubled in the presence of psychiatric comorbidity particularly the first 10 years after diagnosis seen in both sexes and with suicide as a major cause of death. These findings stress the importance of detection and treatment of psychiatric comorbidities alongside the eating disorder to prevent fatal outcome.

Developmental activity-based anorexia alters hippocampal non-genomic stress response and induces structural instability and spatial memory impairment in female rats

OBJECTIVE

Anorexia nervosa (AN) is characterized by hyperactivation of the hypothalamic-pituitary-adrenal axis and cognitive deficits. However, little is known about the rapid non-genomic stress response involvement. This study investigates the molecular, structural and behavioral signatures of the anorexic phenotype induction in female rats on stress-related mechanisms in the hippocampus.

METHOD

Female adolescent rats, exposed to the combination of food restriction and wheel access, i.e., the activity-based anorexia (ABA) protocol, were sacrificed in the acute phase of the pathology (postnatal day [P]42) or following a 7-day recovery period (P49).

RESULTS

ABA rats, in addition to body weight loss and increased wheel activity, alter their pattern of activity over days, showing increased food anticipatory activity, a readout of their motivation to engage in intense physical activity. Corticosterone plasma levels were enhanced at P42 while reduced at P49 in ABA rats. In the membrane fraction of the hippocampus, we found reduced glucocorticoid receptor levels together with reduced expression of caldesmon, n-cadherin and neuroligin-1, molecular markers of cytoskeletal stability and glutamatergic homeostasis. Accordingly, structural analyses revealed reduced dendritic spine density, a reduced number of mushroom-shaped spines, together with an increased number of thin-shaped spines. These events are paralleled by impairment in spatial memory measured in the spatial order object recognition test. These effects persisted even when body weight of ABA rats was restored.

DISCUSSION

Our findings indicate that ABA induction orchestrates hippocampal maladaptive structural and functional plasticity, contributing to cognitive deficits, providing a putative mechanism that could be targeted in AN patients.

Bulimia nervosa and treatment-related disparities: a review

Introduction

Bulimia nervosa (BN) is a type of eating disorder disease usually manifesting between adolescence and early adulthood with 12 as median age of onset. BN is characterized by individuals' episodes of excessive eating of food followed by engaging in unusual compensatory behaviors to control weight gain in BN. Approximately 94% of those with BN never seek or delay treatment. While there are available treatments, some populations do not have access. Left untreated, BN can become severe and lead to other serious comorbidities. This study is a review of randomized controlled trials to explore available treatments and related treatment disparities. The objective of this review was to identify differences among treatment modalities of BN and aide in the further treatment and research of bulimia nervosa.

Methods

This study followed narrative overview guidelines to review BN treatment studies published between 2010 and 2021. The authors used PubMed and PsychInfo databases to search for articles meeting the inclusion criteria. Search terms included phrases such as, BN treatment, BN and clinical trials, and BN and randomized clinical trials.

Results

Most of the reviewed studies had their sample sizes between 80 and 100% female with age range between 18 and 60 years old. Sample sizes were mostly between 80 and 100% white. Treatment practices included both pharmacological and psychosocial interventions, such as cognitive behavioral therapy (CBT) and limited motivational interviewing (MI). Most studies were in outpatient settings.

Conclusion

Reviewed research shows that certain populations face disparities in BN treatment. Generally, individuals older than 60, males and racial minorities are excluded from research. Researchers and practitioners need to include these vulnerable groups to improve BN treatment-related disparities.

Severe and enduring anorexia nervosa and the proposed "Terminal anorexia" category: an expanded meta synthesis

This updated meta-synthesis explores further dimensions of the lived experience of severe and enduring anorexia nervosa (SE-AN) since recent contention regarding proposed "terminal anorexia nervosa (T-AN)". The paper aims to update the original synthesis and to situate participant responses to the category of "T-AN". Thus, extending the proposed conceptualization of the SE-AN experience. A systematic search identified published scholarship (between August 2022 and July 2023), derived from five bibliographic databases. A comprehensive methodology combining Interpretative Phenomenological Analysis and a meta-ethnographic framework enabled the synthesis of meta-themes across 9 new studies. These meta-themes were mapped onto the primary synthesis to further develop upon the earlier LE conceptualization of SE-AN. Nine extracted papers expanded the voices to 447 people within 45 studies. All papers affirmed and enriched the previous themes, and a novel theme was generated from the recent papers. The new theme, "walking on a knife's edge, caught between worlds", informed an expanded conceptualization of SE-AN, termed the Web of Hope. Thus, demonstrating how participants held onto hope in the face of the SE-AN experience. Death, dying and "terminality", were notably absent in the 36 papers in the previous meta-synthesis. Since the proposal of the category of "terminal anorexia" in 2022, studies on the lived experience of SE-AN increasingly focused on how people hold onto hope alongside SE-AN. The findings further drive the field to reflect on therapeutic interventions, labelling and diagnosis, in the face of unknowns, on the premise of "first, do no harm".

Disordered Eating/Eating Disorders in Adolescents

The coronavirus disease 2019 pandemic was as tressful time for adolescents, with increased isolation, loss of routines, and changes in access to medical care. In this setting, the medical system saw a significant rise in the number of adolescents seeking care for eating disorders, as well as increased severity of patient presentation. Telehealth treatment for eating disorders was a unique shift during the pandemic, with some benefits but not universally positive experiences among patients, families and providers.

Nasogastric tube feeding under physical restraint of children and young people with mental disorders: a comprehensive audit and case series across paediatric wards in England

OBJECTIVE

To estimate the number of patients on paediatric wards in England who received nasogastric tube (NGT) feeding under physical restraint from April 2022 to March 2023, identify the demographics and clinical characteristics of these patients, and which personnel facilitated the restraint.

DESIGN

Audit and anonymous case series SETTING: Paediatric wards in England.

PATIENTS

Children and young people receiving this intervention in a 1-year period.

OUTCOME MEASURES

An online survey was sent to all paediatric wards in England, with the option of submitting anonymous case studies.

RESULTS

136/143 (95.1%) acute paediatric units responded. 144 young people received this intervention across 55 (38.5%) paediatric units. The predominant diagnosis was anorexia nervosa (64.5%), age range 9-18 years (M=14.2, SD=2.1). The duration of NGT feeding under restraint ranged from 1 to 425 days, (M=60.2, SD=80.4). Numerous personnel facilitated the restraints, including mental health nurses, paediatric nurses, security staff, healthcare assistants and parents/carers.

CONCLUSION

NGT feeding under restraint is a relatively common intervention in acute paediatric units in England. Understanding the demographics of those receiving this intervention may highlight where additional support is needed. Further research is needed to understand when this intervention transitions from a lifesaving intervention to ongoing management.

A peer mentoring program for eating disorders: improved symptomatology and reduced hospital admissions, three years and a pandemic on

BACKGROUND

Peer support involves people (mentors) using their own experiences to assist others (mentees). The impetus to include peer support in eating disorder recovery is high, however research on implementation of peer roles in eating disorder management is limited. A previous pilot study found positive but preliminary results for a Peer Mentor Program (PMP) for eating disorders. The PMP has since developed over time, including broadening its eligibility criteria and shifting to predominantly online delivery during COVID-19. This study aimed to evaluate the updated version of the PMP, on a larger and more diverse group of mentees.

METHODS

Previously collected PMP service data from July 2020 to April 2022 (during COVID-19 lockdowns) was evaluated for fifty-one mentees using mixed methods. Data from program start (baseline), mid-point (3-months) and end (6-months) for measures of eating disorder symptoms as measured by the Eating Disorder Examination Questionnaire (EDE-Q) and psychological wellbeing as measured by the Depression, Anxiety and Stress Scale (DASS) was evaluated. Frequency of eating disorder-related hospital admissions during PMP participation versus the 6 months prior, direct program costs and qualitative mentee feedback were also analysed. One way ANOVA's with post hoc tests were used to evaluate symptom change and thematic analysis was conducted on qualitative data.

RESULTS

Program attendance averaged 12.12 (SD ± 1.57) of a possible 13 sessions. Statistically significant and clinically meaningful improvements were demonstrated across all subscales of the eating disorder and psychological wellbeing symptom measures. EDE-Q Global score and DASS scores decreased significantly by program end. Fewer eating disorder-related hospital admissions were reported during PMP than the 6-months prior. Qualitative findings were positive and themed around the unique benefits of lived experience connection, a new kind of space for recovery, hope and motivation for change. Challenges with the time limited nature of the mentee-mentor relationship were expressed.

CONCLUSIONS

The important benefits of a PMP for individuals with eating disorders are further supported. There is a pressing need for high quality, co-produced research, utilising a mixture of designs and fidelity to core peer work principles, to inform further implementation of peer work into eating disorder policy and practice.

The Association of Social Media Use and Eating Behaviour of Belgian Adolescent Girls Diagnosed with Anorexia Nervosa-A Qualitative Approach

BACKGROUND

Social media have become integral in adolescents' lives, presenting both opportunities and risks, especially concerning psychiatric issues like eating disorders, prevalent in this vulnerable age group.

METHODS

This qualitative study employed semi-structured interviews with seven adolescent girls (aged 15-17) diagnosed with eating disorders. Interviews covered seven predefined topics, recorded and transcribed for thematic analysis.

RESULTS

Participants identified four key themes: exposure to selective content, biased interpretation, behavioural adaptation, and evolving perspectives during recovery. They highlighted social media's role in exacerbating body dissatisfaction and altering behaviours related to eating disorders.

CONCLUSIONS

This research underscores the critical need for awareness and guidance in adolescents' social media use to mitigate negative impacts, emphasizing the potential link between exposure to specific content and cognitive-behavioural changes in those with eating disorders. Further investigation is warranted to deepen our comprehension of these dynamics.

The Microbiome in Child and Adolescent Psychiatry

Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.

Treatment of Eating Disorders: Current Status, Challenges, and Future Directions

Specific psychological treatments have demonstrated efficacy and represent the first-line approaches recommended for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Unfortunately, many patients, particularly those with anorexia nervosa, do not derive sufficient benefit from existing treatments, and better or alternative treatments for eating disorders are needed. Less progress has been made in developing pharmacologic options for eating disorders. No medications approved for anorexia nervosa exist, and only one each exists for bulimia nervosa and for binge-eating disorder; available data indicate that most patients fail to benefit from available medications. Longer and combined treatments have generally not enhanced outcomes. This review presents emerging findings from more complex and clinically relevant adaptive treatment designs, as they offer some clinical guidance and may serve as models for future enhanced treatment research.

Diagnosed eating disorders in Danish registers - incidence, prevalence, mortality, and polygenic risk

Eating disorders are a group of severe and potentially enduring psychiatric disorders associated with increased mortality. Compared to other severe mental illnesses, they have received relatively limited research attention. Epidemiological studies often only report relative measures despite these being difficult to interpret having limited practical use. The aims of this study were to evaluate the incidence and prevalence of diagnosed anorexia nervosa (AN), bulimia nervosa, and eating disorder not otherwise specified recorded in Danish hospital registers and estimate both relative and absolute measures of subsequent mortality - both all-cause and cause-specific in a general nationwide population of 1,667,374 individuals. In a smaller, genetically informed case-cohort sample, the prediction of polygenic scores for AN, body fat percentage, and body mass index on AN prevalence and severity was estimated. Despite males being less likely to be diagnosed with an eating disorder, those that do have significantly increased rates of mortality. AN prevalence was highest for individuals with high AN and low body fat percentage/body mass index polygenic scores.

Building Confidence in Discussing Genetics With Patients With Eating Disorders and Their Families

Many individuals with eating disorders and their family members are well-informed about advances in science that could affect the treatment and outcome of these illnesses. They appropriately apply this knowledge to evaluate available treatments and advocate for the best possible evidence-based care. They ask hard questions that many clinicians are often ill-prepared to answer. Genetics has advanced our understanding of eating disorders and provides a novel lens through which to understand these pernicious illnesses. Clinicians can now update their understanding of the etiology of eating disorders and abandon outdated etiological theories, some of which have done harm to patients and their families. Without becoming expert in psychiatric genetics, psychiatrists and other mental health care professionals can develop a general overview of the science, understand what it can and cannot offer, incorporate genetic factors into their case conceptualizations, and boost their confidence in discussing these topics with patients and families.

Patient and clinician perspectives on supported mealtimes as part of anorexia nervosa treatment: A systematic review and qualitative synthesis

OBJECTIVE

To systematically review the literature on clinicians' and patients' experiences of supported mealtimes in the treatment of anorexia nervosa.

METHOD

This systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD42022372565). PsycINFO, MEDLINE and Embase were searched up to the 20th of November 2023 for qualitative articles investigating the perspectives of healthcare professionals and patients on clinician-supported meals across all clinical settings. Data were analysed using thematic synthesis. The Critical Appraisal Skills Programme was used to evaluate the quality of selected studies.

RESULTS

This review comprised of 26 studies; eight concerned with the perspectives of clinicians only, 16 addressing patients' views, and two studies exploring the views of both groups. Experiences of both groups were generally negative, and three overlapping themes were identified: lack of consistency in care provided, high levels of negative emotions and an uncomfortable power dynamic.

CONCLUSIONS

This review suggests that supported mealtimes are experienced more positively by patients when rules are clear and consistently enforced, and when clinicians make informal conversation and supportive comments. Our findings highlight the need for best practice guidelines and clinician training to improve the delivery of supported mealtimes. Such guidelines and training should be coproduced in collaboration with patients and carers.