Speaking of That: Terms to Avoid or Reconsider in the Eating Disorders Field

The Conclusive and Continuous Tool to Assess Severity and Improvement of Eating Disorders (CONTASI-ED): Development and Psychometric Properties

Background: Accurately assessing eating disorder (ED) severity and treatment progress is essential for effective intervention. The Comprehensive and Continuous Tool to Assess Severity and Improvement of Eating Disorders (CONTASI-ED) was developed to address limitations in existing assessments by incorporating behavioral, cognitive, and physiological markers. Objectives: This study aimed to examine the psychometric properties and sensitivity to symptom changes of the CONTASI-ED in a community-based clinical sample of women with ED. Methods: Participants were 58 females diagnosed with EDs and 10 healthy controls. The CONTASI-ED assessments were conducted over multiple time points in outpatient and intensive treatment settings. We examined reliability, validity, and sensitivity to treatment-related change. The CONTASI-ED scores were compared with EAT-26, and multivariable analyses explored the effects of body mass index (BMI), age, and post-traumatic stress disorder (PTSD) on symptom trajectories. Results: The CONTASI-ED demonstrated strong reliability, with test-retest correlations between 0.72 and 0.90 and inter-rater reliability of 0.68-0.95. The tool effectively distinguished ED patients from healthy controls (p < 0.001) and correlated strongly with EAT-26. Significant reductions in the CONTASI-ED scores over time (p < 0.001) reflected treatment-related improvements-although temporary score increases highlighted greater self-awareness and symptom disclosure. BMI, age, and PTSD significantly influenced symptom severity and treatment response. Conclusions: The CONTASI-ED demonstrated strong reliability and validity in distinguishing clinical and non-clinical cases and in tracking treatment-related changes. However, the findings are based on a relatively small, all-female sample, underscoring the need for further validation in more diverse populations.

Conducting ethical, co-produced research with autistic individuals with an eating disorder: best practice guidelines

There is a notable overlap between autism and eating disorders (EDs), and autistic individuals may experience poorer ED treatment outcomes than non-autistic peers. To make meaningful change in this field, it is imperative that we actively engage in co-production of research, however there are currently no guidelines to support co-production with autistic people with eating disorders. This paper reports on best practice guidelines that were co-produced across a series of workshops bringing together autistic people with EDs, researchers, clinicians, third-sector organisations, and parents/carers. The guidelines are intended to be used as a foundation for future co-produced autism and ED research. By creating a trusted, ethical co-production relationship, we hope to generate more clinically meaningful and translatable research.

Ngā Māuiui Kai: creating Indigenous Māori terms for eating disorders in Aotearoa New Zealand

BACKGROUND

Māori (the Indigenous people of Aotearoa New Zealand) report higher rates of eating disorders than non-Māori, but access treatment at lower rates. Diagnostic terms lacking in cultural relevance likely contribute to Māori exclusion in eating disorder spaces. Developing terms in te reo Māori (the Māori language) presents an opportunity to challenge eating disorder stereotypes and increase cultural safety in the eating disorder workforce.

METHODOLOGY

Guided by a Māori worldview and the practice of wānanga (to meet, discuss, and think deeply about a topic), we present a Māori language glossary for eating disorders. The glossary is informed by expertise in te reo Māori, mātauranga Māori (the body of Māori knowledge), and eating disorders, and combines terms already in use with newly developed terms.

RESULTS

We propose an umbrella term for eating disorders (ngā māuiui kai), as well as terms for anorexia nervosa (māuiui whakatiki), bulimia nervosa (pukuruaki), binge eating disorder (māuiui kaihoro), and avoidant restrictive food intake disorder (karo kai, with three subtypes of low interest [arokore kai], sensory-based avoidance [āmaimai rongo kai], and concern about the consequences of eating [wehi-ā-kai]). We also propose terms for related concepts of body image difficulties (māuiui whakawā ata), perfectionism (māuiui kōtihitihi) and emotion dysregulation (kare-a-roto kōtitititi).

CONCLUSION

This glossary is available for use by anyone looking for terms that come from a mana-enhancing (empowering, respectful, and strengths-based) Māori worldview. The kupu (words, terms) in this glossary are offered as possibilities for use, rather than as definitive or correct, in the hopes they will promote discussion about stigma, indigeneity, and language in the eating disorders field.

Barriers and facilitators to ethical co-production with Autistic people with an eating disorder

BACKGROUND

Co-production is the collaboration between researchers and the lived experience community in designing, conducting and sharing research. The importance of co-production is increasingly advocated in both the autism and eating disorder fields. Despite this, there remains a lack of clarity at how to define, apply and conduct ethical co-production. Understanding common challenges and what we can do to overcome these challenges are integral to ensuring ethical and meaningful research with Autistic people with an eating disorder. The current study therefore explored: What are the barriers and facilitators to ethical co-production with Autistic people with an ED?

METHODS

Five workshops were conducted with 30 collaborators exploring barriers and facilitators to ethical co-production. Synchronous (online workshops) and asynchronous (offline discussion forum) data was analysed using thematic analysis. Themes were co-produced by a neurotypical and Autistic researcher with lived/living experience of an eating disorder.

RESULTS

Four themes were identified that explored barriers to ethical co-production: unequal partnerships, the inaccessibility of research, excluded by diagnoses and communication differences. Three themes were identified with regards to facilitators of ethical co-production: shared power (with sub-themes relationships, not roles and creative compensation), clarity and transparency and autism-affirming approaches.

DISCUSSION

Conducting ethical co-production with Autistic people with eating disorders has the potential to generate meaningful research that can be translated into improving the lives of the Autistic and eating disorder community. To achieve this, co-production teams should strive towards shared power and long-term relationships, adapting for communication differences and preferences and operating firmly within an autism-affirming framework. It is hoped that study findings will inspire collaboration, discussion and novel, translatable research.

"It is more isolating to patients if you aren't familiar with the resources": a pilot test of a clinician sensitivity training on eating disorders in pregnancy

It is more isolating to patients if you aren't familiar with the resources: A pilot test of a clinician sensitivity training on eating disorders in pregnancy.(IRB Number: 1909705198).Background Pregnant women with a history of eating disorders (EDs) or active EDs have greater maternal and child health complications. They are also unlikely to disclose their history with an ED to their clinician, few of which are confident in their knowledge to provide appropriate care for patients who present with EDs. This study's goal was to evaluate changes to knowledge, behavior, and attitudes for health professionals who were part of a sensitivity training (to provide information of and awareness, address potential clinician biases, and offer strategies for more patient-centered care with de-stigmatizing language) about eating disorders and pregnancy compared with those who received a reference document.Methods Our pilot study compared responses of health professionals before and after this sensitivity training (N = 54) with a group who were provided a clinician reference document about the same topic (N = 61).Results Mann-Whitney Wilcoxon tests showed significant differences between the sensitivity training and reference document groups, with the sensitivity training resulting in increases to participants' perception of ED's relevance to overall treatment (p = 0.018), comfort in providing resources (p < 0.0001), frequency of ability to introduce strategies (p = 0.001), and interest in additional strategies/recommendations in treating patients with eating disorders (p = 0.009). Thematic analysis of the open-ended responses indicated four major themes: Resources and support, Treatment, Additional training, and Clinician Strategies. Discussion Results indicated that the sensitivity training improved training outcomes compared to the reference document group. Qualitative responses from both groups indicated four themes that can help inform ED-centered care. This study provides context for future directions for continuing education courses as well as clinical training recommendations for treating pregnant patients with EDs.

40 years of research on eating disorders in domain-specific journals: Bibliometrics, network analysis, and topic modeling

Previous studies have used a query-based approach to search and gather scientific literature. Instead, the current study focused on domain-specific journals in the field of eating disorders. A total of 8651 documents (since 1981 to 2020), from which 7899 had an abstract, were retrieved from: International Journal of Eating Disorders (n = 4185, 48.38%), Eating and Weight Disorders (n = 1540, 17.80%), European Eating Disorders Review (n = 1461, 16.88%), Eating Disorders (n = 1072, 12.39%), and Journal of Eating Disorders (n = 393, 4.54%). To analyze these data, diverse methodologies were employed: bibliometrics (to identify top cited documents), network analysis (to identify the most representative scholars and collaboration networks), and topic modeling (to retrieve major topics using text mining, natural language processing, and machine learning algorithms). The results showed that the most cited documents were related to instruments used for the screening and evaluation of eating disorders, followed by review articles related to the epidemiology, course and outcome of eating disorders. Network analysis identified well-known scholars in the field, as well as their collaboration networks. Finally, topic modeling identified 10 major topics whereas a time series analysis of these topics identified relevant historical shifts. This study discusses the results in terms of future opportunities in the field of eating disorders.

Development and validation across trimester of the Prenatal Eating Behaviors Screening tool

Rapid screening tools are useful for identifying at-risk patients and referring them for further assessment and treatment, but none exist that consider the unique medical needs of pregnant women with eating disorders (EDs). There is a need for a rapid, sensitive, and specific screening tool that can be used to identify a potential ED in pregnancy. We started with a set of 25 questions, developed from our qualitative work along with other ED screening tools, and tested on a development (n = 190) and validation sample (n = 167). Statistical analysis included factor analysis and logistic regressions with ROC curves. Development and validation samples were combined for trimester analysis (n = 357). Refining the tool to 12 items demonstrated strong internal reliability (development alpha = 0.95, validation alpha = 0.91). With correlated errors, questions demonstrated acceptable CFA fit (development: GFI: 0.91, RMSEA: 0.10, NNFI: 0.95; validation: GFI: 0.85, RMSEA: 0.14, NNFI: 0.86). Similar fits were seen by trimester: first trimester n = 127, GFI: 0.89, RMSEA: 0.12, NNFI: 0.94; second trimester n = 150, GFI: 0.83, RMSEA: 0.14, NNFI: 0.88; third trimester n = 80, GFI: 0.99, NNFI: 0.99. Validation against current ED diagnosis demonstrated acceptable sensitivity and specificity using a cutoff of 39 (development sensitivity = 80.7%, specificity = 79.7%, OR = 16.42, 95% CI: 7.51, 35.88; validation sensitivity = 69.2%, specificity = 86.5%, OR: 17.43, 95% CI: 6.46, 47.01). Findings suggest the PEBS tool can reliably and sensitively detect EDs across pregnancy trimesters with 12 questions. A further implication of this work is to reduce health and mental health treatment disparities through this standard and rapid screening measure to ensure early identification and treatment.

Can a Short Screening Tool Discriminate Between Overeating and Binge Eating in Treatment-Seeking Individuals with Obesity?

OBJECTIVE

Existing screening tools are inadequate in differentiating binge eating from normative overeating in treatment-seeking individuals with overweight or obesity, as these individuals tend to overendorse loss-of-control (LOC; the hallmark characteristic of binge eating) on self-report measures. In order for treatment centers to efficiently and accurately identify individuals who would benefit from specialized treatment, it is critical to develop effective brief screening tools. This study examined the sensitivity and specificity of a self-report screener designed to be used by an outpatient treatment center on a large scale.

METHODS

Participants were treatment-seeking individuals (N = 364) with overweight or obesity who were administered the screener and who completed a subsequent interview assessing for LOC and binge eating.

RESULTS

Discriminant analyses revealed that the screener achieved 77.6% sensitivity and 77.0% specificity in predicting clinician-assessed LOC and 75.2% sensitivity and 74.1% specificity in predicting "full-threshold" binge eating (i.e., ≥12 objectively large binge-eating episodes within the past 3 months). Post hoc analyses indicated that male participants were more likely to be misclassified with the screener.

CONCLUSIONS

The self-report screener demonstrated satisfactory predictive ability, which is notable given the challenges of discriminating between LOC and normative overeating. However, room for improvement remains. In particular, the inclusion of additional screener items that more fully capture the binge-eating experience in males is warranted.

René Girard and the Mimetic Nature of Eating Disorders

French historian and literary critic René Girard (1923-2015), most widely known for the concepts of mimetic desire and scapegoating, also engaged in the discussion of the surge of eating disorders in his 1996 essay Eating Disorders and Mimetic Desire. This article explores Girard's ideas on the mimetic nature and origin of eating disorders from a clinical psychiatric perspective and contextualizes them within the field of eating disorders research as well as in relation to broader psychological, sociological and anthropological models of social comparison and non-consumption. Three main themes in Girard's thinking on the topic of eating disorders are identified and explored: the 'end of prohibitions' as a driving force in the emergence of eating disorders, eating disorders as a phenomenon specific to modernity, and the significance of 'conspicuous non-consumption' in the emergence of eating disorders.

Commit* to change? A call to end the publication of the phrase 'commit* suicide'

Background. Countering stigma is a fundamental facet of suicide prevention efforts.  Integral to this is the promotion of accurate and sensitive language.  The phrase ‘commit* suicide’ has prompted marked opposition primarily due to the connotations of immorality and illegality.  Methods. The study investigated the frequency of the use of the wordstem ‘commit’, in relation to self-harm and suicidal behaviours, in the three leading suicide-specific academic journals between 2000 and 2015.  Results. One third (34%) of articles published since the year 2000 used the word ‘commit*’ when describing an act of self-harm or suicide. Over half of these articles (57%) used the phrase on more than one occasion, with 6% using it more than 10 times in the same manuscript. The percentage of papers utilising the word ‘commit*’ has fluctuated over time, but there is a promising downward trend in the use of this phrase from 33% in 2000 to 13% in 2015 ( p < 0.001).  Discussion. We advocate for the implementation of publication requirements regarding the language used when discussing suicide. Whilst we call for collective responsibility amongst academics and clinicians, editors hold a unique position in ensuring that outdated, inaccurate and stigma-laden terms are expunged from the scientific literature.

Prevention of eating disorders: A systematic review of randomized, controlled trials

OBJECTIVE

This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention.

METHOD

A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted.

RESULTS

Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up.

DISCUSSION

The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required. © 2016 Wiley Periodicals, Inc.