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Avila-Parcet A, Martín-Blanco A, Gawron L, Cano M, Peña-Arteaga VDL, Carceller-Sindreu M, Soler J, Portella MJ, Faustino G, Cardoner N, Carmona I Farrés C. Evaluating the efficacy of radically open dialectical behavior therapy (RO-DBT) in patients with anorexia nervosa: study protocol for a randomized controlled clinical trial. BMC Psychiatry 2025; 25:403. [PMID: 40251556 PMCID: PMC12008890 DOI: 10.1186/s12888-025-06854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 04/14/2025] [Indexed: 04/20/2025] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe and disabling disorder, with relapse rates as high as 50% after the first episode, posing a significant challenge for clinicians. Most therapies excessively focus on nourishment, resulting in temporary weight restoration but with no improvements in general well-being and quality of life. Radically Open Dialectical Behavior Therapy (RO-DBT) is a transdiagnostic treatment designed to address overcontrol, a key aspect in the functioning of patients with AN. To date, no clinical trial (CT) has shown its efficacy in these patients or evaluated its neurobiological mechanism of action. METHODS A randomized CT in weight restored adult AN patients will be conducted, with one group receiving treatment as usual (TAU) and the other TAU plus RO-DBT, with the main outcome being quality of life. Secondary variables will include eating disorders (EDs) symptoms, overcontrol characteristics, autistic traits, and neuroimaging changes. DISCUSSION The results will address a gap in knowledge regarding AN treatment, with the expectation that patients receiving TAU with RO-DBT will exhibit improved quality of life and experience fewer relapses at the one-year follow-up. This is the first study examining neuroimaging changes in RO-DBT to better understand its underlying mechanisms. TRIAL REGISTRATION The study has been registered in ClinicalTrials.gov in September 22, 2023. It can be found in https://classic. CLINICALTRIALS gov/ct2/show/NCT06050421 . TRIAL REGISTRATION NUMBER NCT06050421.
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Affiliation(s)
- Aina Avila-Parcet
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
| | - Ana Martín-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Leonor Gawron
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
| | - Marta Cano
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain.
- CIBERSAM, ISCIII, Madrid, Spain.
| | - Víctor De la Peña-Arteaga
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
| | - Mar Carceller-Sindreu
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria J Portella
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gloria Faustino
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
| | - Narcís Cardoner
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Cristina Carmona I Farrés
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), 167 Sant Antoni Maria Claret St., Pavilion 18, Barcelona, 08025, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Bryant E, Marks P, Griffiths K, Boulet S, Pehlivan M, Barakat S, Touyz S, Maguire S. Treating the individual: moving towards personalised eating disorder care. J Eat Disord 2025; 13:63. [PMID: 40205596 PMCID: PMC11983806 DOI: 10.1186/s40337-025-01246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 03/24/2025] [Indexed: 04/11/2025] Open
Abstract
Eating disorders (EDs) are complex and heterogeneous conditions, which are often not resolved with conventional, manualised treatments. Arguments for the development of holistic, person-centred treatments accounting for individual variability have been mounting amongst researchers, clinicians and people with lived experience alike. This review explores the transformative potential of personalised medicine in ED care, emphasising the integration of precision diagnostics and tailored interventions based on individual genetic, biological, psychological and environmental profiles. Building on advancements in genomics, neurobiology, and computational technologies, it advocates for a shift from categorical diagnostic frameworks to symptom-based and dimensional approaches. The paper summarises emerging evidence supporting precision psychiatry, including the development of biomarkers, patient-reported outcomes, predictive modelling, and staging models, and discusses their application in ED research and clinical care. It highlights the utility of machine learning and idiographic statistical methods in optimising therapeutic outcomes and identifies key challenges, such as ethical considerations, scalability and implementation.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Kristi Griffiths
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Stephanie Boulet
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Melissa Pehlivan
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Barakat
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
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Wilksch SM, O'Shea A, Crosby R, Lawson R, Wade TD. Pragmatic Indicated Prevention and Early Intervention for Disordered Eating: A Randomized Controlled Trial of Media Smart Targeted Internet Program in Youth. J Am Acad Child Adolesc Psychiatry 2025:S0890-8567(25)00168-6. [PMID: 40158725 DOI: 10.1016/j.jaac.2025.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/03/2025] [Accepted: 03/21/2025] [Indexed: 04/02/2025]
Abstract
OBJECTIVE We evaluated 3 new features of Media Smart Targeted (MST), an 8-module Internet, self-guided, indicated prevention and early intervention for disordered eating (DE): a broader audience, optimal rate of program delivery, and impact on social media (SM) behaviors. METHOD Participants (N = 555, aged 13-25 years, of any gender, from Australia and New Zealand) were randomized to: MST-Flexible (MST-F: user accesses modules at own rate, n = 184); MST-Standard (MST-S: weekly module release, n = 187); and control (body image tips, n = 184). Primary (Eating Disorder Examination-Questionnaire [EDE-Q] Global and DE diagnostic status), secondary (DE risk factors) and tertiary (SM) outcome measures were completed at baseline and at post-program, 6-month, and 12-month follow-up. RESULTS A total of 52.2% of participants randomized to MST-F or MST-S accessed their intervention. Modified intent-to-treat analyses (n = 378) included these participants (MST-F = 109; MST-S = 84) and all controls (n = 184) showed MST-F participants were more likely to complete each module and full program than MST-S participants. More favorable outcomes for EDE-Q Global were reported in the MST-F condition than control. MST-F and MST-S participants with baseline DE were 94% and 92% respectively less likely than controls to meet DE criteria at any point from post program onward (n = 36). Compared to controls, participants in the MST-F condition experienced significant improvements regarding regular eating, clinical impairment, internalization, and SM behaviors, including reduced appearance comparisons, following of appearance-based influencers, use of TikTok, and fewer SM accounts. CONCLUSION Although self-guided Internet interventions have lower completion rates and more modest effects than face-to-face indicated prevention programs, MST-F can be delivered at scale, with low cost and greater flexibility in target audience, to achieve meaningful reductions in DE risk, symptoms, and SM behaviors. CLINICAL TRIAL REGISTRATION INFORMATION A randomised controlled trial of an efficacious school-based eating disorder risk reduction program: A comparison of 2, 4 and 8 lessons; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377675 DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
- Simon M Wilksch
- Flinders University Institute for Mental Health and Wellbeing, South Australia, Australia; Advanced Psychology Services, Adelaide, South Australia, Australia.
| | - Anne O'Shea
- Flinders University Institute for Mental Health and Wellbeing, South Australia, Australia
| | - Ross Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Rachel Lawson
- South Island Eating Disorders Service, Te Whata Ora- Health New Zealand, Christchurch, New Zealand
| | - Tracey D Wade
- Flinders University Institute for Mental Health and Wellbeing, South Australia, Australia
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Zickgraf HF, Schwartz RA. Broadening the conceptualization of panic disorder to include the fear presentation of avoidant/restrictive food intake disorder: The legacy of panic control therapy. Behav Res Ther 2025; 185:104677. [PMID: 39729646 DOI: 10.1016/j.brat.2024.104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 12/06/2024] [Accepted: 12/20/2024] [Indexed: 12/29/2024]
Abstract
The presentation of avoidant/restrictive food intake disorder (ARFID) characterized by fear of aversive consequences of eating (fear-ARFID) has both phenomenological and mechanistic similarities to panic disorder. In this narrative review, we propose a shared model of the pathogenesis of the two disorders, centered on interoceptive sensitivity as the key maintenance mechanism. We review the evidence that fear-ARFID, which involves restrictive eating motivated by a desire to avoid aversive events (e.g., choking, vomiting, abdominal pain) related to the gastrointestinal tract, onsets with an unexpected event and develops through catastrophic misinterpretation of the probability or significance of the event reoccurring, heightened awareness of minor interoceptive sensations associated with the feared event (i.e., interoceptive sensitivity), escalating anxiety and increasingly frequent experience of minor interoceptive sensations, and increasingly extensive avoidant behavior. Given the support for shared maintenance mechanisms with panic disorder, we suggest a program of clinical research evaluating the adaptation of elements of Panic Control Therapy (PCT), a well-established empirically supported treatment for panic disorder, to treat fear-ARFID. Developing and testing new intervention strategies based on PCT could expand ARFID patients' access to appropriate care by enabling anxiety-experienced clinicians to use their existing competencies to treat fear-ARFID using a disorder-specific evidence-based treatment.
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Affiliation(s)
- Hana F Zickgraf
- Rogers Behavioral Health, Research Center, Oconomowoc WI & Philadelphia PA, 34700 Valley Rd, Oconomowoc, WI, 53066, USA.
| | - Rachel A Schwartz
- Rogers Behavioral Health, Research Center, Oconomowoc WI & Philadelphia PA, 34700 Valley Rd, Oconomowoc, WI, 53066, USA.
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Weissman RS, Martin-Wagar CA, Attaway S, Penwell T, Hogan A, Pruscino I. Taking Steps Toward a Consensus on Night Eating Syndrome Diagnostic Criteria. Int J Eat Disord 2024; 57:2341-2358. [PMID: 39431409 DOI: 10.1002/eat.24309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 09/05/2024] [Accepted: 10/02/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Night eating syndrome (NES) is included in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, as an example of "Other Specified Feeding or Eating Disorders" with minimal guidance about how to define and operationalize NES. The literature suggests that research practices vary widely, making it difficult to draw conclusions about the public health burden of, effective interventions for, or policy implications relevant to NES. This Forum article seeks to illustrate the lack of definitional agreement to underscore the need for a consensus about NES diagnostic criteria, and to propose steps toward closing knowledge gaps and achieving consensus. METHOD We searched PubMed and PsycINFO titles and abstracts, using "NES" as the search term, for research articles published in English between January 1, 2013 to August 12, 2024 with sample sizes of NES > 10 and ages 18 or older. Eligible articles were coded for NES definitions and assessment method used to diagnose participants with NES and for information about comorbidity of NES and any other eating disorder (ED). RESULTS Seventy-three articles met inclusion criteria. Most commonly, NES was diagnosed using a diagnostic criteria set (35/73) or a symptom score threshold (34/73); among the former, only eight studies employed DSM-5 NES criteria. Thirteen studies, varying widely in methodology, examined comorbidity with other EDs, most commonly binge-eating disorder where comorbidity was high. CONCLUSION Heterogeneity of definitions and assessment impede progress in the study of NES. We propose strategies for developing a consensus definition and addressing research gaps.
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Affiliation(s)
| | | | - Sarah Attaway
- Department of Psychology, University of Montana, Missoula, Montana, USA
| | - Taylor Penwell
- Department of Psychology, University of Montana, Missoula, Montana, USA
| | - Ava Hogan
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Isabella Pruscino
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
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Monteleone AM, Abbate-Daga G. Effectiveness and predictors of psychotherapy in eating disorders: state-of-the-art and future directions. Curr Opin Psychiatry 2024; 37:417-423. [PMID: 39146554 DOI: 10.1097/yco.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers. RECENT FINDINGS Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes. SUMMARY Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.
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Affiliation(s)
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Kaşak M, Öğütlü H, Doğan U, Zickgraf HF, Türkçapar MH. Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish adolescents. J Eat Disord 2024; 12:105. [PMID: 39060938 PMCID: PMC11282626 DOI: 10.1186/s40337-024-01066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study evaluates the psychometric properties of the Turkish version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a population of Turkish adolescents. METHOD The NIAS, designed to screen for ARFID symptoms, including picky eating, fear-related eating behaviors, and low appetite, was administered to secondary school students between 13 and 18 ages in Muğla, Turkiye. RESULTS Based on a sample of 268 adolescents, the NIAS's reliability and validity in this demographic are supported. The research utilized confirmatory factor analysis to verify its three-factor structure and various reliability tests, including Cronbach's alpha and test-retest reliability, confirming the scale's internal consistency and temporal stability. The descriptive analysis highlighted significant differences in NIAS scores across BMI categories, with underweight adolescents scoring higher, suggesting a potential link between ARFID symptoms and lower body weight. Criterion validity was supported by significant correlations between NIAS subscales and measures of anxiety, depression, and eating behaviors, indicating the scale's effectiveness in reflecting relevant psychopathological features. CONCLUSION Overall, the study establishes the Turkish NIAS as a useful tool for identifying ARFID in Turkish adolescents, aiding early detection and intervention in this at-risk age group. Further research is recommended to explore the scale's utility across different clinical settings and refine its diagnostic accuracy, enhancing our understanding of ARFID's impact on youth mental health and nutritional status.
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Affiliation(s)
- Meryem Kaşak
- Department of Child and Adolescent Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
| | - Hakan Öğütlü
- Department of Child and Adolescent Psychiatry, Cognitive Behavioral Psychotherapies Association, Karum Is Merkezi Iran Caddesi No: 21 06680 Gaziosmanpasa Mah., Ankara, Turkey.
| | - Uğur Doğan
- Departmant of Guidance and Counseling, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Hana F Zickgraf
- Department of Psychology, University of South Alabama, Mobile, AL, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
- Rogers Behavioral Health, Oconomowoc, WI, USA
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Downs J, Baker S, Carnegie A. Eating disorders: meeting the need for a data driven and coproduced response to pandemic disruption. BMJ 2024; 385:q1403. [PMID: 38918013 DOI: 10.1136/bmj.q1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Affiliation(s)
- James Downs
- Eating Disorders Clinical Research Network, King's College London, UK
| | - Suzanne Baker
- Eating Disorders Clinical Research Network, King's College London, UK
| | - Anna Carnegie
- Eating Disorders Clinical Research Network, King's College London, UK
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Elwyn R, Adams M, Sharpe SL, Silverstein S, LaMarre A, Downs J, Burnette CB. Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality. J Eat Disord 2024; 12:70. [PMID: 38831456 PMCID: PMC11145809 DOI: 10.1186/s40337-024-01016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and psychiatry, Thompson Institute, Birtinya, QLD, Australia
- University of the Sunshine Coast, Birtinya, QLD, Australia
| | | | - Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP, Collective), West Palm Beach, FL, USA
| | | | | | | | - C Blair Burnette
- Department of Psychology, Michigan State University, Lansing, MI, USA.
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Ryan EG, Gao CX, Grantham KL, Thao LTP, Charles-Nelson A, Bowden R, Herschtal A, Lee KJ, Forbes AB, Heritier S, Phillipou A, Wolfe R. Advancing randomized controlled trial methodologies: The place of innovative trial design in eating disorders research. Int J Eat Disord 2024; 57:1337-1349. [PMID: 38469971 DOI: 10.1002/eat.24187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
Randomized controlled trials can be used to generate evidence on the efficacy and safety of new treatments in eating disorders research. Many of the trials previously conducted in this area have been deemed to be of low quality, in part due to a number of practical constraints. This article provides an overview of established and more innovative clinical trial designs, accompanied by pertinent examples, to highlight how design choices can enhance flexibility and improve efficiency of both resource allocation and participant involvement. Trial designs include individually randomized, cluster randomized, and designs with randomizations at multiple time points and/or addressing several research questions (master protocol studies). Design features include the use of adaptations and considerations for pragmatic or registry-based trials. The appropriate choice of trial design, together with rigorous trial conduct, reporting and analysis, can establish high-quality evidence to advance knowledge in the field. It is anticipated that this article will provide a broad and contemporary introduction to trial designs and will help researchers make informed trial design choices for improved testing of new interventions in eating disorders. PUBLIC SIGNIFICANCE: There is a paucity of high quality randomized controlled trials that have been conducted in eating disorders, highlighting the need to identify where efficiency gains in trial design may be possible to advance the eating disorder research field. We provide an overview of some key trial designs and features which may offer solutions to practical constraints and increase trial efficiency.
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Affiliation(s)
- Elizabeth G Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Orygen, Melbourne, Victoria, Australia
| | - Kelsey L Grantham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Le Thi Phuong Thao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anaïs Charles-Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rhys Bowden
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alan Herschtal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Orygen, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Mental Health, Austin Health, Melbourne, Victoria, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ayton A. Physical health metrics are essential for establishing the effectiveness of eating disorder treatment. Lancet Psychiatry 2024; 11:95-96. [PMID: 38104585 DOI: 10.1016/s2215-0366(23)00400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Agnes Ayton
- Oxford Health NHS Foundation Trust, Cotswold House, Warneford Hospital, Oxford OX3 7JX, UK; Faculty of Eating Disorders, Royal College of Psychiatrists, London, UK.
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Kiely L, Conti J, Hay P. Anorexia nervosa through the lens of a severe and enduring experience: 'lost in a big world'. J Eat Disord 2024; 12:12. [PMID: 38254163 PMCID: PMC10804804 DOI: 10.1186/s40337-023-00953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. METHOD A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. FINDINGS The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. CONCLUSIONS The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, 2560, Australia
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