Screening, assessment and diagnosis in the eating disorders: findings from a rapid review

Relationship between parental perfectionism and child's disordered eating: mediating role of parental distress and validation of the arabic version of the eating disorders examination questionnaire-short-parent version (EDE-QS-P)

BACKGROUND

Eating disorders are an emerging global health crisis, with significant implications for both physical and psychological well-being. Disordered eating behaviors in childhood can serve as precursors to more severe eating disorders if left untreated. Previous literature evidences a strong association between perfectionism, as well as parental control and eating disorders, highlighting perfectionism as a significant factor in the development and maintenance of ED symptoms. Early intervention during this critical developmental period is essential to address these risks, prevent the progression to clinical eating disorders, and support healthier long-term outcomes for children. This study aimed to assess the mediating role of parental psychological distress in the association between perfectionism in parents and disordered eating in children. As a secondary objective, the study intended to validate the Arabic version of the Eating Disorders Examination Questionnaire-Short Parent Version (EDE-QS-P).

METHODS

A diverse sample of Lebanese parents of children aged 6-11 years (N = 502; mean age of 36.24 ± 8.29 years, 74.5% of mothers) were recruited from schools, community centers, and healthcare facilities into this cross-sectional study. One parent per child completed all the questionnaires, which assessed disordered eating in children, parental perfectionism, and psychological distress. The instruments used included the Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P) for disordered eating, the Big Three Perfectionism Scale - Short Form (BTPS-SF) for parental perfectionism, and the Depression, Anxiety, and Stress Scale-8 Items (DASS-8) for parental psychological distress. The SPSS software v.25 was used for statistical analysis. To examine the factor structure of the EDE-QS-P, we conducted a Confirmatory Factor Analysis (CFA) using SPSS AMOS v.28 software. The mediation analysis was conducted using PROCESS MACRO v.3.4 model 4.

RESULTS

The Arabic EDE-QS-P showed a unidimensional factor structure, strong internal consistency reliability and high convergent validity. Higher child's disordered eating scores were reported by fathers compared to mothers (8.32 ± 9.12 vs. 5.62 ± 7.69, t (500) = 3.01, p = 0.003). Parental distress mediated the association between parental perfectionism and child's disordered eating (indirect effect: Beta = 0.14; Boot SE = 0.02; Boot CI 0.11; 0.18). More parental perfectionism was significantly associated with more parental distress, and higher parental distress was significantly associated with more child's disordered eating. Higher parental perfectionism was significantly and directly associated with more child's disordered eating.

CONCLUSION

This study successfully validated the Arabic version of the EDE-QS-P in Lebanon, confirming its validity and reliability for assessing parental-reported disordered eating in children in Arab contexts. Elevated parental perfectionism correlates with increased child disordered eating, mediated by parental distress. This suggests that healthcare providers should be alert to signs of perfectionism and psychological distress in parents and provide appropriate interventions, such as cognitive-behavioral therapy or stress management techniques, to alleviate these issues and lower the risk of eating disorders in children.

Intersectionality in help-seeking for eating disorders: a systematic scoping review

BACKGROUND

Individuals with marginalised social characteristics (e.g. by race/ethnicity, gender, body weight) report experiencing eating disorder (ED) symptoms but do not proportionally access treatment. There may be unique factors experienced by individuals with multiple marginalised social characteristics which are not included in our current understanding of help-seeking for EDs. The present review sought to examine the extent of evidence exploring help-seeking and service utilisation for (EDs) by people with more than one marginalised social characteristic or identity. MAIN: A systematic scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Four databases (PsycINFO, PubMED, Embase, Medline) were searched for papers explicitly examining help-seeking or service utilisation for people with more than one marginalised social characteristic or identity (e.g. race/ethnicity, sexual orientation, weight status). Included studies underwent qualitative synthesis employing an existing model of help-seeking adapted for this review. The most common ED investigated was binge eating disorder (BED) and the most frequently reported marginalised characteristics were overweight/obesity and race/ethnicity. Other intersectional characteristics identified included socioeconomic status (SES), gender, and sexual orientation. People with marginalised social identities such as race/ethnicity or gender were more likely to seek help for BED when they also experienced a higher BMI. There was consensus across studies included in this review that help-seeking rates are low for people with an ED.

CONCLUSION

Mental health literacy and cultural beliefs about help-seeking are important factors affecting the experiences of people with intersectional identities and this may impact their likelihood to seek help. Results suggest that future studies should consider the interaction between social characteristics and identities in their analyses of outcomes in EDs as this is an emerging area of research, extension of our findings is also needed. The protocol for this review is registered via PROSPERO number CRD42024525849.

The impact of incorporating an eating disorder screening tool and an eating disorder diagnostic workshop in outpatient general psychiatry settings in publicly insured populations: a case series

With an elevated prevalence of disordered eating in low-income settings, efforts to optimize the detection of eating disorders (EDs) in such settings are necessary. A significant barrier relates to the scarcity of training for clinicians not working in specialized ED settings. This manuscript assessed the impact of an ED screening tool and an ED assessment workshop upon the detection of EDs in publicly insured psychiatry settings. Leveraging a case series design to assess 165 consecutive adult patients in outpatient psychiatry settings, we indexed the prevalence of ED diagnoses rendered by psychiatrists when assessing patients (i) without prior knowledge of ED symptoms, (ii) after being made aware of patient scores from an ED screening measure, and (iii) after undergoing an ED assessment workshop, and being made aware of patient screening scores. While 27% of the sample reported clinically significant ED symptoms on the screening measure, ED diagnoses were only rendered in 2% of the sample when psychiatrists were not made aware of ED symptoms prior to assessment. In contrast, incorporating a screening tool altered the rates of ED diagnoses, with 18% of the sample receiving an ED diagnosis. Moreover, the combinatorial introduction of both the ED screening measure and an ED assessment workshop further altered diagnostic practice-with this resulting in ED diagnoses in 27% of the sample. The findings suggest that ED screening and training workshops can have significant impacts on diagnostic accuracy and, with little cost, can provide patients with diagnoses that would otherwise go undetected.

Shortening duration of untreated illness in young people with first episode eating disorders: protocol of a randomised controlled feasibility trial of a smartphone friendly multi-modal decision-making tool (FREED-M) to improve help-seeking

BACKGROUND

Early intervention gives young people the best chance to recover from eating disorders (EDs). An important focus of early intervention is shortening the time between a person first developing symptoms and starting treatment (duration of untreated eating disorder; DUED). Patient-related factors (e.g. poor mental health literacy and help-seeking difficulties) are strongly associated with DUED. The aims of our study are to co-design and test the feasibility of FREED-Mobile (FREED-M), an online intervention tool for young people with early-stage EDs. This tool aims to improve knowledge about EDs, increase motivation to seek treatment and teach early steps towards change or recovery, thus reducing DUED.

METHODS

We will carry out a randomised controlled feasibility trial comparing the FREED-M tool with a control intervention where individuals are sign-posted to an ED charity website. The objectives of the proposed trial are to establish/estimate: (a) attrition rates at follow-up (primary feasibility outcome); (b) participant recruitment; (c) intervention uptake, completion rates and acceptability; (d) intervention effect sizes and standard deviations for outcomes to inform the sample size calculation for a large-scale randomised controlled trial (RCT); (e) stakeholder views on the intervention. We aim to recruit 116 participants (young people, aged 16-25, with first episode ED) from primary care, schools and universities, ED services and social media. Online assessments will be carried out at baseline, end of intervention and follow-up (weeks 0, 4 and 12 post-randomisation, respectively). Outcomes will include motivation and readiness to change, attitudes and intentions towards help-seeking, ED symptoms, mood and social functioning, and health-related quality of life. Additionally, we will carry out a qualitative evaluation of participants' views of the intervention and study design.

DISCUSSION

The results of this feasibility trial will inform adaptations to the intervention as needed, as well as the study design (e.g. sample size, primary outcomes) of a future large-scale RCT to assess the effectiveness of the FREED-M intervention. If effective, this novel, online intervention has the potential for wide dissemination and for substantially reducing DUED to improve long-term patient outcomes.

TRIAL REGISTRATION

ISRCTN, ISRCTN15662055. Registered 27 July 2022, https://www.isrctn.com/ISRCTN15662055 .

'Captivating voices': evaluation of a patient-centred animated video on excessive physical exercise and eating disorders

This project aimed to evaluate the acceptance of a short, animated video addressing excessive exercise within the context of eating disorder (ED) behaviours among diverse target groups, assess its impact and explore potential associations with disordered eating risk. An online survey was conducted, recruiting 170 participants who were shown a 3-minute and 11-second long animated video portraying narratives of individuals with lived experiences related to excessive exercise and ED. Participants provided demographic information, engaged in the video evaluation answering a 9-item questionnaire and completed a subsequent ED screening and a drive for muscularity questionnaire. In an optional open-ended comment section, participants provided suggestions, feelings, ideas and criticism. Individuals identified as at risk for disordered eating reported a significantly higher personal impact of the video, including the motivation to self-reflect on their personal exercise habits. Qualitative analyses revealed themes related to suggestions for the video's use, general reflections on sports behaviours and ED, and reactions to the video's artistic design. This interdisciplinary project underscores the potential of artistic animated short videos co-designed with individuals with lived experience in conveying narratives and fostering introspection among individuals at risk for ED and excessive exercise behaviours. Further exploration and refinement of interdisciplinary artistic approaches are recommended to enhance effectiveness and inclusivity in addressing ED and associated behaviours.

Translation and Adaptation of the SCOFF Questionnaire to the Greek Language (G-SCOFF) Using a Tertiary-Setting Adolescent Sample

BACKGROUND/OBJECTIVES

Feeding and eating disorders (FEDs) constitute an important mental health problem today, especially among youngsters. The Sick, Control, One, Fat, Food (SCOFF) questionnaire was developed 25 years ago and remains the most frequently applied screening tool for FEDs among adults and youngsters. The aim of the present study was to translate and adapt the SCOFF questionnaire to the Greek language, using a tertiary-setting adolescent sample.

METHODS

A total of 167 adolescents (86 boys, 81 girls) admitted to the pediatric outpatient clinics of the Georgios Gennimatas and Hippokration General hospitals completed the SCOFF questionnaire. Anthropometric indices were measured and dietary intake was recorded.

RESULTS

A total of 74 adolescents (44.3% of the sample) were classified as engaging in disordered eating behaviors and as possible patients with FEDs based on the SCOFF questionnaire. No differences were noted in the dietary intake between adolescents who screened positive and those who screened negative for FEDs. The body mass index z-score and obesity status were greater among children screening positive for FEDs compared to those screening negative (p < 0.01). One patient who was later diagnosed with anorexia nervosa was detected as a possible FED case by the questionnaire.

CONCLUSIONS

The present study revealed that more than two out of five adolescents attending a pediatric clinic exhibited disordered eating behavior. The use of the G-SCOFF questionnaire is feasible and effective for FED triage in the Greek tertiary pediatric setting.

Can we effectively manage binge eating disorder with pharmacotherapy?

INTRODUCTION

Pharmacological and other treatments for binge eating disorder (BED) predate its inclusion as the third main eating disorder in the 2013 DSM-5. Currently, second in line to psychological therapy are psychotropics such as antidepressants, anticonvulsants and stimulants.

AREAS COVERED

This review summarizes the evidence and emerging evidence on the pharmacotherapies for BED and their potential for wider use.

EXPERT OPINION

Pharmacotherapy has utility as an alternative or adjunctive treatment for those exhibiting insufficient response to, or not preferencing, psychological interventions. Medications may also benefit individuals with BED and other co-occurring mental health conditions, such as depression and attention deficit hyperactivity disorder. In addition, there are several agents (e.g. glucagon like peptide-1 receptor agonists and the combination of naltrexone-bupropion) displaying promise for weight and binge eating reduction in people with BED and high BMI. Future research should extend the understanding of the role of medication in BED, focusing on their sustained effects over time, when and if they may be ceased, their effectiveness in people with adequate weight, and the risks associated with weight loss in those with BED and high weight.

The Essentials: Upskilling a National Health Workforce in the Identification and Treatment of Eating Disorders

OBJECTIVE

Health practitioners report limited skills and lack of confidence in managing and treating people with eating disorders. The purpose of this study was to evaluate the national rollout of comprehensive basic training in identification, assessment, treatment, and management of people with eating disorders to clinicians.

METHODS

The Essentials: Training Clinicians in Eating Disorders is a core competency eLearning program. As part of a nation-wide multidisciplinary workforce training strategy, 7500 course places were provided free of charge to public and private health care professionals across all jurisdictions of Australia between January 2020 and March 2022.

RESULTS

A total of 7370 health professionals enrolled during the study period. All learning outcomes showed improvement with large effect (Cohen's d = 1.2-2), with the largest improvements for self-reported knowledge of requirements for working with children and adolescents. Effects did not depend on years of working with eating disorders suggesting that the training was beneficial across levels of experience. Those who started with very low knowledge of eating disorders or higher willingness to treat eating disorders were most likely to complete the course. Most participants reported that the course was relevant to their clinical practice, that they expected their clinical practices to change, and that they would recommend the course to other health professionals.

DISCUSSION

The strategy to provide government-funded core competency training in eating disorder care to healthcare professionals met key objectives by reaching health professionals eligible to provide government-rebated services in public and private settings across all jurisdictions including regional and remote areas.

The future of the eating disorder field: Inclusive, aware of systems, and personalized

Eating disorders are serious psychiatric illnesses associated with large amounts of suffering, high morbidity, and high mortality rates, signifying a clear need for rapid advancements in the underlying science. Relative to other fields of clinical psychological science, the eating disorder field is new. However, despite the fields' late beginnings, there is growing science in several important areas. The current paper discusses the current literature in three primary areas of importance: (a) diversity and inclusion, (b) systemic and social factors, and (c) treatment personalization. We discuss how these areas have huge potential to push both eating disorder and clinical psychological science in general forward, to improve our underlying understanding of psychological illness, and to enhance treatment access and effectiveness. We call for more research in these areas and end with our vision for the field for the next decade, including areas in need of significant future research.

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 ).

The need for more inclusive measurement to advance equity in eating disorders prevention

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

Associations Between Weight Discrimination, Eating-Disorder-Related Psychiatric Impairment, and Eating-Disorder Treatment Interest Across the Weight Spectrum

OBJECTIVE

Only approximately 20% of college students with an eating disorder (ED) seek treatment. One barrier to seeking treatment is weight discrimination. Past research demonstrates that experiencing weight discrimination is associated with increased ED risk and decreased in-person treatment engagement. Weight discrimination may be a particularly relevant treatment barrier for students who have a higher body weight given their higher likelihood of experiencing weight discrimination.

METHODS

College students with a probable ED diagnosis (N = 372; Mage = 23.94; 73.12% women, 18.55% men, 6.18% another gender; 11.29% Asian, 4.57% Black, 12.63% Hispanic, 83.60% White, 4.84% Native American, and 0.54% another race) completed an online self-report survey that included the Clinical Impairment Assessment (CIA), Experience of Weight Discrimination (EWD) Scale, and a 0-100 scale to indicate interest in participating in virtual guided self-help ED treatment.

RESULTS

Linear regression showed significant positive relationships between weight discrimination and ED-related psychiatric impairment and treatment interest.

DISCUSSION

Elevations in CIA scores corroborate past literature that suggested that weight discrimination was positively related to ED psychopathology. Contrary to past research, college students who experienced weight discrimination had greater treatment interest. Students who experience weight discrimination may view virtual self-guided treatment as less weight-stigmatizing due to the "do-it-yourself" approach and no in-person interactions. Findings highlight the potential impacts of weight discrimination on acceptability of ED-related care. Future research is needed to identify ways to reduce weight discrimination and promote weight-inclusive practices in the medical system.

Loss of Bone Density in Patients with Anorexia Nervosa Food That Alone Will Not Cure

BACKGROUND

Anorexia Nervosa is a highly lethal illness that is also associated with many medical complications. Food restriction and weight loss define this illness. Most of its physical complications are reversible with weight restoration, with the notable exception of the loss of bone density, which is commonly present in anorexia nervosa.

METHODS

A comprehensive scientific literature review was performed in order to explore bone disease in anorexia nervosa.

RESULTS

The pathophysiology of the loss of bone mineral density in anorexia nervosa was elucidated, along with the diagnosis and treatment of osteoporosis in patients with anorexia nervosa, including the nutritional approach to weight restoration.

CONCLUSIONS

Loss of bone mineral density in anorexia nervosa is very aggressive. Nutritional rehabilitation is a cornerstone to treating this, along with medicinal considerations.

Actions speak louder than coaches: Eating disorder behaviour among student-athletes

The objective of the current study was to examine the prevalence of eating disorder behaviours among student-athletes at a small, non-NCAA (Canadian) university, while evaluating the influence of gender, type of sport, and perceived social support. Two hundred participants (130 female, 70 male) completed an online survey that assessed participants eating disorder behaviours (EAT-26), behaviours consistent with the Adonis Complex (ACQ) and perceived social support (modified MPSS). The results revealed significant differences in eating disorder behaviour between female and male athletes, with females scoring significantly higher; yet no differences were found between how female and male athletes scored on the Adonis Complex Questionnaire. Significant differences were found between lean-sport and non-lean sport athletes, with lean sport athletes exhibiting more eating disorder behaviours. Furthermore, non-lean sport male athletes were found to score significantly higher than lean-sport male athletes for the Adonis Complex. Perceived social support was found to be negatively correlated to eating disorder behaviours and when considering gender and type of sport, accounted for unique variance in eating disorder behaviour. These results suggest that student-athletes are susceptible to negative mental health outcomes, even within the context of a smaller (and non-NCAA) university context, and eating behaviours vary among athlete and sport type. The results highlight the importance of continued research in this area and of having support systems in place for student-athletes and increasing awareness of athletic staff and coaches as to the seriousness and prevalence of eating disorder behaviours.

Maladaptive exercise in eating disorders: lifetime and current impact on mental health and treatment seeking

BACKGROUND

Many patients with eating disorders report exercise as a central symptom of their illness-as a way to compensate for food intake, prevent weight-gain, and/or reduce negative affect. Previous findings show associations between maladaptive exercise and more severe eating disorder pathology, higher risk for relapse, other co-morbid symptoms, and worse treatment outcome.

METHODS

In this study, we included 8252 participants with eating disorders and investigated associations between maladaptive exercise (both lifetime and current) and ED pathology, illness duration, depression, anxiety, self-harm and suicidal ideation, and treatment seeking patterns in individuals with lifetime maladaptive exercise. Participants were included via the Swedish site of the large global study The Eating Disorders Genetics Initiative (EDGI) and completed measures of both lifetime and current symptomatology.

RESULTS

Results indicate that lifetime maladaptive exercise is associated with higher prevalence of lifetime depression and anxiety and with patients more often receiving treatment, although these results need to be investigated in future studies. Current maladaptive exercise was associated with more severe ED symptoms, and higher levels of depression, anxiety, obsessive-compulsive traits, and suicidal ideation.

CONCLUSIONS

Our findings point to the complexities of exercise as an eating disorder symptom and the need for clearly assessing and acknowledging this, as well as tailoring interventions to treat this symptom to achieve sustainable recovery.

Undetected eating disorders among adolescent psychiatric inpatients

AIM

The aim of this study was to identify the prevalence of undetected eating disorders (EDs) among adolescent psychiatric inpatients and to investigate the association between clinical, psychiatric, and sociocultural factors and EDs.

METHODS

Between January and December 2018, patients aged 12-18 years, hospitalized for inpatient-level treatment were given the self-assessment questionnaires of the Eating Attitudes Test-26 (EAT-26), the Contour Drawing Figure Rating Scale (CDFRS), the Child Behaviour Check List, and Sociocultural Attitudes Toward Appearance Questionnaire-4 after their routine unstructured clinical diagnostic assessment on admission by a psychiatrist. Patients were reassessed after reviewing the psychometric assessment results.

RESULTS

The prevalence of EDs among 117 psychiatric inpatients was 9.4%, all were female and all diagnosed with unspecified feeding and eating disorder. We showed that 63.6% of patients with EDs was diagnosed after the screening and not with the routine clinical interview. EAT-26 scores were weakly correlated with affective (r = 0.314, p = .001), anxious (r = 0.231, p = .012), somatic (r = 0.258, p = .005), and impulsive maladaptive behaviours (r = 0.272, p = .003). A formal ED diagnosis was positively associated with media pressure, (OR:1.660, 95% CI: 1.105-2.495) and oppositional defiance (OR: 1.391, 95% CI: 1.005-1.926), and negatively with conduct problems (OR: 0.695, 95% CI: 0.500-0.964). The CDFRS results were not different between the ED and non-ED groups.

CONCLUSIONS

Our study suggests EDs remain a prevalent yet often overlooked diagnosis in adolescent psychiatric inpatients. Health care providers should screen for EDs in inpatient psychiatric settings as a part of routine assessment to improve the identification of disordered eating behaviours that often begin during adolescence.

A Narrative Review of Early Intervention for Eating Disorders: Barriers and Facilitators

Eating disorders (EDs) are serious psychiatric illnesses that typically develop during adolescence and emerging adulthood. Early intervention is important for improved outcomes for young people with EDs, yet help-seeking is low and individuals often have a significantly protracted start to treatment, suggesting that early intervention is not well established in the ED field. Previous reviews on facilitators and barriers to early intervention for EDs largely cover perceived barriers related to patient variables and perspectives, whereas clinician-, service-, and healthcare system-related facilitators and barriers are less frequently reviewed. The aim of this review is to synthesize the literature on barriers to and facilitators of early intervention for EDs, regarding patient-, clinician-, service-, and healthcare system-related factors. A narrative review was conducted by searching for relevant peer-reviewed, English-language articles published up until July 2023 on PubMed and PsychINFO. The search was conducted in two steps. First, key search terms were used to identify existing reviews and meta-analyses on facilitators and barriers to early intervention for EDs. Then, additional search terms were added to search for primary and secondary research on patient/family, clinician, service, and healthcare system-related barriers and facilitators. The identified literature shows that, after overcoming intrinsic, motivational barriers (such as self-stigma, denial, and ambivalence), help-seeking individuals may be met with long service waiting lists and limited treatment options. Despite these barriers, there is ongoing research into early intervention in practice, which aims to reach underserved populations and facilitate early intervention despite high service demands and shortages of trained healthcare professionals. Funding for ED research and services has historically been low, and there is also a research-practice gap. This highlights the need for increased consideration of, and funding for early intervention for EDs, to remove barriers as well as facilitate discussions around how to make early intervention programs scalable and sustainable.

Current approaches in the recognition and management of eating disorders

Eating disorders are now well acknowledged mental health problems that are common and present in people from diverse sociodemographic backgrounds. The past decade has seen a rapid expansion in research into eating disorder interventions. In response to the increasing burden of eating disorders, the Australian Government Department of Health and Aged Care has implemented significant policy changes to improve patient access to Medicare and inpatient treatment facilities. There are several international clinical practice guidelines and a robust evidence base particularly for first line care with specific psychological therapies, including guidelines for the management of eating disorders in individuals with a high weight. Medications play an important adjunct role in care, and novel neuromodulating treatments, such as psychostimulants, are under study. There is emerging evidence for increased person-centred care, with more choice in the form of alternatives to hospital inpatient programs and more respectful consideration of care for all who experience an eating disorder, including people with high weight.

Risk factors of disordered eating in adolescent girls from a community sample: a multidimensional approach

BACKGROUND

Eating disorders (ED) are severe, chronic, and complex in nature mental illnesses that are difficult to treat. One of the ways to stave off EDs is by screening among adolescents to preempt the development of clinical forms of ED in risk groups.

AIM

1) to investigate the prevalence of ED risk among adolescent girls and compare subgroups at high and low risk of ED; 2) to investigate using a multidimensional approach those variables that can interact with temperament and character traits to predict ED symptomatology.

METHODS

The cross-sectional observational self-report study of a community sample of adolescent girls 1217 years old (n=298; M=14.771.13) was carried out in the city of Ryazan, Russia. The Russian versions of Eating Attitudes Test and Cloningers Temperament and Character Inventory-Revised were used. In addition, an original questionnaire (Risk Factors of Eating Disorders) was developed. Regression models (to test for significant moderation) and path analysis (to test for significant mediations) were used.

RESULTS

Girls at risk of developing EDs are characterized by a heightened level of concern about weight and dissatisfaction with their body, tend to suffer from low self-directedness, higher novelty seeking and tendency to higher harm avoidance, display high alexithymia, experience self-distrust, negative emotionality and are dissatisfied with family relationships. They also suffer from low self-esteem and tend to be perfectionism and engage in risk behavior. Significant moderating effects were uncovered between the following ED risk factors: (1) self-distrust/risk behavior and BMI; (2) alexithymia/negative emotionality/self-esteem and cooperativeness; and (3) negative emotionality/risk behavior and self-transcendence. Family relationship dissatisfaction mediates the association between self-directedness/cooperativeness/self-transcendence and disordered eating.

CONCLUSION

There are various mutual influences between the numerous ED risk and prevention factors, which all together determine the paths between the predictors and final outcome.

Current Discoveries and Future Implications of Eating Disorders

Eating disorders (EDs) are characterized by severe disturbances in eating behaviors and can sometimes be fatal. Eating disorders are also associated with distressing thoughts and emotions. They can be severe conditions affecting physical, psychological, and social functions. Preoccupation with food, body weight, and shape may also play an important role in the regulation of eating disorders. Common eating disorders have three major types: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). In some cases, EDs can have serious consequences for an individual's physical and mental health. These disorders often develop during adolescence or early adulthood and affect both males and females, although they are more commonly diagnosed in young adult females. Treatment for EDs typically involves a combination of therapy, nutrition counseling, and medical care. In this narrative review, the authors summarized what is known of EDs and discussed the future directions that may be worth exploring in this emerging area.

Gastric Myoelectric Activity and Body Composition in Women with Binge Eating Disorder and Bulimia Nervosa: A Preliminary Trial Study

Women with eating disorders (EDs) often complain of abnormal gastric responses, which may impact their eating patterns and, consequently, their body composition. Binge eating disorder (BED) and bulimia nervosa (BN) have been shown to affect gastric myoelectric activity (GMA), which may provide a basis for the gastric response in this disease population. This study aimed to examine GMA and body composition in patients with an ED compared to age-body mass index (BMI) matched controls. This case-control study included 18 adults diagnosed with BED or BN compared to 19 age-gender-BMI-matched controls. The electrogastrography with water load test was used to measure GMA during fasting and after water loading to satiety. Body composition was measured using a bioelectric impedance analyzer. The results showed that the ED group had a significantly higher water load than the control group and increased percentages of tachygastria times. Comparing the BED and BN subgroups showed differences in body composition status between the subgroups in the form of less fat mass, muscle mass, and total body water in the BN subgroup. In the BN subgroup, fat mass was associated with the average dominant frequency in the EGG. Thus, measuring GMA may be a promising approach to understanding gastric abnormalities in patients with EDs. Therapies targeting improving body composition in women with BED and BN are recommended in future ED management strategies.

Public perceptions of people with eating disorders: Commentary on results from the 2022 Australian national survey of mental health-related stigma and discrimination

Mental illness is highly prevalent in the community. As such, significant attention has been paid in recent years to raising awareness of the mental health disorders (including eating disorders). This includes efforts to normalise help-seeking, campaigns to reduce stigma and discrimination, targeted research funding and advocacy for improved and accessible mental health service provision. But have these initiatives changed public attitude? The 2022 National Survey of Mental Health-Related Stigma and Discrimination is the first of four national surveys canvassing the general public's perceptions of people with mental health disorders (including stigmatising and discriminatory beliefs) conducted since 1995 to include eating disorders. It finds significant prejudice against those with mental health disorders still exists within the community, particularly among younger Australians. For eating disorders, this is primarily related to attributions of blame and personal weakness. Findings from the survey are discussed in this commentary.

Toward a more comprehensive understanding and support of parents with a child experiencing an eating disorder

OBJECTIVE

The majority of eating disorder (ED) carer research has been conducted with parents of adult patients, using qualitative methodologies, focusing on carer burden and distress during treatment. This article aimed to use results from a large, national, quantitative survey of parents of child or adolescent patients as a springboard for encouraging a more comprehensive investigation of parent experiences.

METHODS

The online survey assessed treatment experiences and parent distress (DASS-21) but also less commonly investigated topics including symptom detection, experiences with primary care providers, and impacts on parent physical and psychological health, romantic relationship, finances, and employment.

RESULTS

Key findings included parents (N = 439; 91.6% female): were the first person to notice the ED symptoms in 81.8% of cases; had only a 14.7% chance of a helpful experience with both the first general practitioner and first therapist they saw; needed to see M = 3.55 therapists before finding one that could help; reported worse than normal psychological health (96.0%), physical health (70.5%), and romantic relationship (92.7%); required M = 70.06 days leave from work to care for their child (per household); and 91.8% accessed treatment in the private sector with median out-of-pocket expenses of AUD 10,0001-AUD 20,000.

DISCUSSION

Recommendations to address research and practice gaps include: increased focus on supporting initial symptom detection; improving primary care and treatment experiences; and, increasing the number of ED treatment providers. Urgently needed are solutions to the overwhelming demand for services and clearly, more support for parents. Such strategies are vital for reducing the overall burden of EDs.

PUBLIC SIGNIFICANCE

Most eating disorder (ED) caregiver research has focused on experiences of supporting adult patients during treatment. This article used a large national survey to explore parent experiences of their child or adolescent's ED in less commonly investigated areas, such as detection, primary care, impact on parent physical and psychological health, romantic relationship, employment and finances. Findings suggested mixed experiences with health care providers and a very significant toll of the illness on the domains measured. Recommendations were provided for how these important areas can be addressed.

Prevention and early intervention in eating disorders: findings from a rapid review

BACKGROUND

Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs.

METHODS

This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review.

RESULTS

In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist.

CONCLUSIONS

Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.

Prevention of eating disorders: 2022 in review

This review of 17 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion ➔ types of prevention ➔ case identification/referral ➔ treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews ➔ clarifying risk and protective factors ➔ program innovation and feasibility studies ➔ efficacy and effectiveness research ➔ program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Five articles fell into the category of prevention rationale, theory, and critical analyses, while seven articles addressed risk factors (RFs) for various aspects of DE. Eating Disorders also published two pilot studies, two prevention efficacy trials, and one effectiveness study in 2022. One implication of the 17 articles reviewed is that RF research toward construction of selective and indicated prevention programs for diverse at-risk groups should address a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses, protective factor research, and case studies of multi-step activism at the local, state (province, region), and national levels.

Risk factors for eating disorders: findings from a rapid review

BACKGROUND

Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders.

METHODS

The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper.

RESULTS

A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms.

CONCLUSION

Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.