Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

Re-imagining connection: the role of late autism diagnosis in eating disorder recovery and social support

This paper explores the complex relationship between autism, social connection, and eating disorder recovery, drawing on the lived experiences of two late-diagnosed autistic adults with histories of longstanding and severe eating disorders. Using narrative and autoethnographic methods, we examine how delayed autism diagnosis intersects with the social dimensions of illness, and the process of treatment and recovery. We identify unique barriers autistic individuals with eating disorders face in building meaningful social connections, navigating support systems, and accessing appropriate care. By integrating personal insights with existing research, we advocate for earlier autism screening and neurodiversity-affirming treatment approaches that embrace and value autistic differences, including the strengths inherent in neurodivergence. This requires a shift in how social support is conceptualised within eating disorder care, prioritising the creation of meaningful connections that address the unique social and emotional needs of autistic individuals. We argue for clinical practices that not only recognise the challenges faced by neurodivergent individuals but also embrace the strengths they bring, fostering environments where autistic individuals can engage authentically in their recovery process. This approach ultimately benefits patients and treatment providers alike, promoting more inclusive, empathetic, and effective care for all.

Examining the biological causes of eating disorders to inform treatment strategies

Despite their prevalence, eating disorders (EDs) are under-researched and often misunderstood. A recent focus of research on the biological underpinnings of EDs has helped to reframe our understanding of their origins, but there remain a lack of effective treatment options, high rates of relapse and, unfortunately, high mortality and morbidity. In this Review, we highlight the many facets of normal and pathological feeding behaviour and body weight regulation and suggest that these provide a framework with which to develop integrative methods to study, and ultimately treat, EDs. We propose that a better understanding of the biological causes of ED, and their crucial interactions with psychological and environmental factors, is necessary to progress the field. This can be achieved through a combination of preclinical and clinical investigations, which provide complementary information on these highly complex disorders. In the era of individualized medicine and with the advent of artificial intelligence tools that allow the amalgamation of multimodal data, we hope that a better understanding of the biology of EDs may hold the answer to effectively overcoming the debilitating effects of these conditions.

Predictors of Anorexia Nervosa and Obsessive-Compulsive Disorder Comorbidity and Order of Diagnosis in a Danish National Cohort

OBJECTIVE

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are highly comorbid; however, limited research has examined etiological pathways specific to individuals with AN developing OCD or individuals with OCD developing AN. This exploratory study aimed to identify factors influencing AN-OCD comorbidity with a focus on the order of diagnosis.

METHOD

Using Danish national registers, 6449 individuals with AN and 9352 individuals with OCD were examined to assess the risk of subsequent OCD and AN. Explored predictors included parental characteristics, birth characteristics, childhood adversity, autoimmune and autoinflammatory diseases, psychiatric disorders, and prescriptions. Hazard ratios (HR) were calculated using Cox regression. Parallel analyses were conducted for the risk of subsequent anxiety disorder to determine predictors unique to AN-OCD comorbidity.

RESULTS

Among individuals with AN, high birth weight (HR = 3.06) was uniquely associated with increased risk of subsequent OCD. For individuals with OCD, a history of other eating disorders (HR = 7.47) was associated with elevated risk of developing AN, whereas anxiety disorders in first-degree (HR = 0.32) and female first-degree relatives (HR = 0.22) were uniquely protective against AN.

DISCUSSION

These exploratory findings suggest that distinct pathways may be involved in the order of onset for AN-OCD comorbidity. Specifically, for individuals with AN who subsequently developed OCD, high birth weight appeared to increase risk, whereas for individuals with OCD who later developed AN, familial anxiety disorders seemed to play a protective role. Findings could inform early screening and prevention efforts for individuals with AN at high risk for OCD, and vice versa.

Machine learning models for diagnosis and risk prediction in eating disorders, depression, and alcohol use disorder

BACKGROUND

Early diagnosis and treatment of mental illnesses is hampered by the lack of reliable markers. This study used machine learning models to uncover diagnostic and risk prediction markers for eating disorders (EDs), major depressive disorder (MDD), and alcohol use disorder (AUD).

METHODS

Case-control samples (aged 18-25 years), including participants with Anorexia Nervosa (AN), Bulimia Nervosa (BN), MDD, AUD, and matched controls, were used for diagnostic classification. For risk prediction, we used a longitudinal population-based sample (IMAGEN study), assessing adolescents at ages 14, 16 and 19. Regularized logistic regression models incorporated broad data domains spanning psychopathology, personality, cognition, substance use, and environment.

RESULTS

The classification of EDs was highly accurate, even when excluding body mass index from the analysis. The area under the receiver operating characteristic curves (AUC-ROC [95 % CI]) reached 0.92 [0.86-0.97] for AN and 0.91 [0.85-0.96] for BN. The classification accuracies for MDD (0.91 [0.88-0.94]) and AUD (0.80 [0.74-0.85]) were also high. The models demonstrated high transdiagnostic potential, as those trained for EDs were also accurate in classifying AUD and MDD from healthy controls, and vice versa (AUC-ROCs, 0.75-0.93). Shared predictors, such as neuroticism, hopelessness, and symptoms of attention-deficit/hyperactivity disorder, were identified as reliable classifiers. In the longitudinal population sample, the models exhibited moderate performance in predicting the development of future ED symptoms (0.71 [0.67-0.75]), depressive symptoms (0.64 [0.60-0.68]), and harmful drinking (0.67 [0.64-0.70]).

CONCLUSIONS

Our findings demonstrate the potential of combining multi-domain data for precise diagnostic and risk prediction applications in psychiatry.

Mechanism-based subtyping in binge eating: understanding neurobehavioral heterogeneity across negative emotionality, approach behavior, and executive function

Binge eating (BE), a transdiagnostic feature that occurs across eating disorders and in the general population, carries significant health risks even in the absence of a full-syndrome diagnosis. The limited efficacy of current treatments for binge-type eating disorders highlights the need to better understand the mechanistic heterogeneity underlying BE to optimize treatment allocation, advance personalized medicine, and ultimately improve outcomes. We hypothesized considerable heterogeneity within three neurofunctional domains prevalent across compulsive behaviors and implicated in BE: approach-related behavior, executive function, and negative emotionality. We analyzed data from 612 participants (ages 18-59, 66% female) from the enhanced Nathan Kline Institute-Rockland Sample, including 461 controls and 151 individuals with BE behaviors. Using data-driven statistical modeling of comprehensive, multimodal measures across the three hypothesized domains, we identified subtypes of BE. Subtypes were validated using assessments of eating pathology, substance use, clinical diagnostics, and resting-state functional magnetic resonance imaging. Three distinct and stable subtypes emerged: a 'Negative Emotionality' subtype characterized by greater negative affect, emotion dysregulation and psychiatric comorbidity, an 'Approach' subtype with higher approach-related and impulsive behaviors, and a 'Restrained' subtype that was overcontrolled and harm avoidant. The Approach and Restrained subtypes further demonstrated unique neurobiological profiles, as determined by graph theory analysis of resting-state functional connectivity. All subtypes showed similar proportions of BE episodes meeting clinical-level threshold (≥4 objective binge episodes/month), and no differences in BMI, indicating functionally distinct expressions of BE, beyond clinical severity and diagnostic classification. This study is the first to explore the mechanistic heterogeneity of BE through a comprehensive multi-modal assessment across three neurofunctional domains in a single sample. Findings highlight the need for updated models of BE etiology that integrate approach/reward-related behaviors, impulsivity and overcontrolled behaviors, and negative emotionality, and suggest the potential of these functionally-derived subtypes to inform the development of personalized, targeted interventions.

The Double-Edged Sword of Translational Research: Stakeholder Perspectives of the Enablers and Challenges Implementing Anorexia Nervosa Treatment in Rural Health Settings

OBJECTIVE

To explore the translational research processes that emerged at the early phase of the implementation of telehealth-delivered family-based therapy (FBT) for young people with anorexia nervosa (AN) attending Australian rural health services.

SETTING

Commencing mid-2019, five rural health districts across New South Wales (NSW) participated in the study.

PARTICIPANTS

Nine stakeholders, including study coordinators, clinicians and eating disorder coordinators, participated in a semi-structured interview during the early implementation of telehealth-delivered FBT.

DESIGN

Inductive thematic analysis methodology was used to identify key research factors that enabled and challenged the implementation.

RESULTS

The translational research improved patient access to evidence-based care, afforded health services access to clinical expertise, workforce training and supervision and assisted with meeting government directives of improving care pathways. However, the study and intervention implementation were challenged by research-related factors, including ethical and clinical dilemmas, the burden of stakeholders holding multiple roles and general challenges associated with integrating research into non-academic health services.

CONCLUSION

To optimise implementation and to bridge the access gaps particularly felt by rural families and health settings, translational studies ought to consider the enablers and challenges identified by the stakeholders.

TRIAL REGISTRATION

ACTRN12620001107910.

Anorexia nervosa-an update

Anorexia nervosa (AN) is a severe psychiatric disorder with the highest mortality rate among eating disorders. It predominantly affects adolescents and young adults, with a significant increase in prevalence among adolescents observed since the coronavirus disease 2019 (COVID-19) pandemic. It is frequently associated with other psychiatric disorders, such as depression, anxiety and obsessive-compulsive disorders as well as numerous physical complications. An early diagnosis and treatment are associated with better outcomes. The treatment of choice for AN includes cognitive behavioral therapy and family-based therapy for children and adolescents. Innovative treatment approaches, such as home treatment and technology-based interventions, have shown promising preliminary results. With the exception of moderate evidence supporting the use of olanzapine regarding weight gain, there is currently no evidence for the efficacy of psychopharmacotherapy in AN. Future research should focus on prevention, early detection and intervention, relapse prevention, personalized treatment approaches, management of comorbid disorders, long-term studies and the influence of psychosocial factors.

Advancements in the Diagnosis and Treatment of Eating Disorders in Children and Adolescents: Challenges, Progress, and Future Directions

Eating disorders (EDs) in children and adolescents pose significant diagnostic and therapeutic challenges due to their early onset, developmental complexity, and frequent psychiatric comorbidities. This narrative review identifies key clinical and systemic challenges, including difficulties in early detection, overlapping symptomatology, limited pharmacological options, and unequal access to specialized care. Recent progress includes revisions in diagnostic criteria (e.g., DSM-5 and ICD-11), advancements in psychometric assessment tools tailored for pediatric populations, and increasing evidence supporting psychotherapeutic interventions such as cognitive behavioral therapy, family-based therapy, and digital health approaches. Future directions involve long-term outcome studies on treatment efficacy, developing culturally sensitive and personalized care models, and implementing integrated multidisciplinary treatment frameworks. By synthesizing empirical literature from 2018 to 2024, this review underscores the urgent need for developmentally informed, evidence-based strategies to enhance the early detection, treatment, and recovery outcomes for young individuals affected by EDs.

Psychopathological Comorbidities in Children and Adolescents with Feeding and Eating Disorders: An Italian Clinical Study

OBJECTIVES

Feeding and eating disorders (FED) represent a major public health issue and are the second leading cause of death among psychiatric conditions in children and adolescents. Psychopathological comorbidities play a significant role in the onset and persistence of FED, yet research on their underlying structure remains limited. This study explores the psychiatric comorbidities associated with FED, focusing on common etiopathogenetic factors and their clinical implications.

METHODS

Data were retrospectively collected from the Italian Regional Center for FED in the Emilia-Romagna Region between June 2023 and April 2024. Diagnoses were assigned following DSM-5 criteria using the Italian version of the semi-structured K-SADS-PL diagnostic interview. Principal component analysis (PCA) was performed to identify latent psychological dimensions underlying FED psychopathology, retaining five components based on the scree plot. Additionally, an analysis of covariance (ANCOVA) was conducted to examine differences in factor scores across FED subtypes, while adjusting for potential confounders.

RESULTS

Seventy-two participants were included (mean age: 14.6 years; mean BMI: 18.3 kg/m2; male-to-female ratio: 1:8). Diagnoses were distributed as follows: 63.9% anorexia nervosa (AN), 13.9% other specified feeding and eating disorder (OSFED), 6.9% avoidant restrictive food intake disorder (ARFID), 4.2% binge eating disorder (BED), 4.2% unspecified feeding and eating disorder (UFED), and 2.7% bulimia nervosa (BN). All participants met the criteria for at least one psychiatric comorbidity. Identified psychopathological clusters include the following: (1) mood disorders (66.5%); (2) anxiety disorders (87.5%); (3) obsessive-compulsive and related disorders (47.2%); (4) neurodevelopmental disorders, i.e., attention-deficit/hyperactivity disorder (ADHD) (30.5%); (5) disruptive and impulse-control disorders (13.9%); and (6) psychotic symptoms (40.3%). No instances of tic or elimination disorders were detected. Conduct disorder was more prevalent among UFED, BED, and BN patients compared to other FED (p = 0.005), and moderate/severe ADHD was associated with higher body mass index (BMI) (p = 0.035). PCA revealed distinct psychological dimensions underlying FED, while ANCOVA indicated significant differences in factor scores across FED subtypes, supporting the presence of shared transdiagnostic mechanisms.

CONCLUSIONS

This study highlights the complex interplay between FED and psychiatric comorbidities, emphasizing the need for early intervention and personalized treatment approaches. The dimensional structure identified through PCA suggests that common psychopathological factors may drive FED development, and ANCOVA findings support their differential expression across FED types. Future research should further investigate these transdiagnostic mechanisms to optimize clinical care.

Service models in eating disorders: a scoping review

BACKGROUND

The complexity of eating disorders can be reflected in the different diagnoses, varied clinical presentations and diverse personal circumstances of people living with an eating disorder. Given this complexity, adaptable and flexible service models are essential for effective care. Service models outline a structure for health care delivery that targets the health-related needs of people. The characteristics of existing service models providing assessment and treatment for eating disorders are not well described or understood.

OBJECTIVE

The purpose of this scoping review was to map and describe the different types of service models for eating disorders and their characteristics.

METHOD

The JBI methodology for scoping reviews was used. A search of four databases (MEDLINE Complete, EMBASE, PsychINFO, and CINAHL) and grey literature was conducted. Sources describing service models supporting individuals with eating disorders were included.

RESULTS

After duplicates were removed, the remaining sources were screened and read in full, and 30 sources were included in the review. Most service models were eating disorder specialist, located in metropolitan areas and based in community settings. Key characteristics of eating disorder service models included person-centred care, involvement of family and carers, co-design and lived experience contribution, multidisciplinary team, accessibility, identification and management of co-occurring conditions and integration with broader service systems.

CONCLUSION

Findings indicate vast differences between service models for eating disorders. However, there are examples of innovative and effective service models that show promise. The characteristics of service models for eating disorders identified in this review provided insight into what constitutes an effective and high-quality service model in the sector.

The effect of eHealth-based guided self help interventions for binge eating disorder : a meta-analysis of randomized controlled trials

With rapid technological advancements, eHealth-based guided self-help interventions have become accessible, flexible, cost-effective, and stigma-reducing treatment options for binge eating disorder (BED). This meta-analysis evaluated the effectiveness of these interventions in individuals diagnosed with BED or showing BED symptoms, based on eight randomized controlled trials with 1,575 participants. Intervention length varied between a single session to four months. Six studies focused solely on web-based guided self-help interventions, one study implemented a hybrid approach combining face-to-face and online components, and another study employed two distinct online guided self-help methods. The interventions included psychoeducational modules, therapist feedback, online behavior monitoring, and self-assessments. eHealth-based guided self-help significantly reduced binge eating psychopathology (SMD: 0.53; 95% CI: 0.20-0.86) and objective binge eating (OBE) days (SMD: 0.49; 95% CI: 0.12-0.85) compared to controls. These interventions offer effective solutions for individuals facing barriers to traditional treatment access.

[Anorexia nervosa-An update. German version]

Anorexia nervosa (AN) is a severe psychiatric disorder with the highest mortality rate among eating disorders. It predominantly affects adolescents and young adults, with a significant increase in prevalence among adolescents observed since the coronavirus disease 2019 (COVID-19) pandemic. It is frequently associated with other psychiatric disorders, such as depression, anxiety and obsessive-compulsive disorders as well as numerous physical complications. An early diagnosis and treatment are associated with better outcomes. The treatment of choice for AN includes cognitive behavioral therapy and family-based therapy for children and adolescents. Innovative treatment approaches, such as home treatment and technology-based interventions, have shown promising preliminary results. With the exception of moderate evidence supporting the use of olanzapine regarding weight gain, there is currently no evidence for the efficacy of psychopharmacotherapy in AN. Future research should focus on prevention, early detection and intervention, relapse prevention, personalized treatment approaches, management of comorbid disorders, long-term studies and the influence of psychosocial factors.

The role of co-occurring conditions and genetics in the associations of eating disorders with attention-deficit/hyperactivity disorder and autism spectrum disorder

Eating disorders (EDs) commonly co-occur with other psychiatric and neurodevelopmental disorders including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); however, the pattern of family history and genetic overlap among them requires clarification. This study investigated the diagnostic, familial, and genetic associations of EDs with ADHD and ASD. The nationwide population-based cohort study included all individuals born in Denmark, 1981-2008, linked to their siblings and cousins. Cox regression was used to estimate associations between EDs and ADHD or ASD, and mediation analysis was used to assess the effects of intermediate mood or anxiety disorders. Polygenic scores (PGSs) were used to investigate the genetic association between anorexia nervosa (AN) and ADHD or ASD. Significantly increased risk for any ED was observed following an ADHD or ASD diagnosis. Mediation analysis suggested that intermediate mood or anxiety disorders could account for 44%-100% of the association between ADHD or ASD and ED. Individuals with a full sibling or maternal half sibling with ASD had increased risk of AN compared to those with siblings without ASD. A positive association was found between ASD-PGS and AN risk whereas a negative association was found between AN-PGS and ADHD. In this study, positive phenotypic associations between EDs and ADHD or ASD, mediation by mood or anxiety disorder, and genetic associations between ASD-PGS and AN and between AN-PGS and ADHD were observed. These findings could guide future research in the development of new treatments that can mitigate the development of EDs among individuals with ADHD or ASD.

Mental Health Impacts of Self-Help Interventions for the Treatment and Prevention of Eating Disorders. A Meta-Analysis

OBJECTIVE

Self-help programs are recommended as a first step in the management of eating disorders. Yet, whether self-help interventions have broader mental health benefits beyond symptom and risk reduction remains unclear. As randomized controlled trials (RCTs) also assess general mental health secondary to eating disorder symptoms, we conducted a meta-analysis to investigate whether and to what extent pure self-help interventions for eating disorders produce improvements in these secondary outcomes.

METHOD

Twenty-seven RCTs of pure self-help interventions for the prevention or treatment of eating disorders were included. Mean age ranged from 16 to 46 years. Most self-help interventions were based on cognitive-behavioral therapy. Most interventions were delivered via digital means (Internet, apps, etc.). Random effects meta-analyses were conducted on six outcomes: depression, anxiety, general distress, quality of life, self-esteem, and psychosocial impairment. Analyses were stratified based on pre-selected (at risk/symptomatic) and clinical samples.

RESULTS

For pre-selected samples (k = 18), significant pooled effects favoring self-help over controls were observed for depression (g = 0.24), anxiety (g = 0.23), distress (g = 0.23) and self-esteem (g = 0.18). Effects remained robust when adjusting for risk of bias. Non-significant effects were observed for quality of life and impairment. Crucially, > 80% of trials on pre-selected samples delivered a waitlist control. For clinical samples (k = 9), significant pooled effects favoring self-help were found for distress (g = 0.39), impairment (g = 0.39), and quality of life (g = 0.29), although these results should be interpreted with caution as the number of studies was low.

CONCLUSION

Self-help interventions produce small improvements in those mental health symptoms that are typically comorbid with eating disorders.

Glucagon-like Peptide-1 Receptor Agonists in the Context of Eating Disorders: A Promising Therapeutic Option or a Double-Edged Sword?

Glucagon-like peptide-1 Receptor Agonists (GLP-1 RAs) have been one of the most discussed issues in medicine for the past few years. Initially dedicated to patients with type 2 diabetes mellitus (T2DM), the medicine turned out to be an effective weight-loss treatment for people beyond this population. Whereas their beneficial somatic and metabolic effect are beyond doubt, their possible psychiatric adverse reactions have raised concerns. Eating disorders (EDs) are among the mental illnesses whose number is increasing worldwide. Thus, this review aims to summarize the status of knowledge on the correlation between the popularity of GLP-1 RAs and EDs. The conclusions are not unequivocal, pointing out that GLP-1 ARs have the potential to be an effective therapeutic option in some cases of Eds, but if used inappropriately, may increase morbidity of eating disorders.

Using CBT-E in the Treatment of Anorexia Nervosa With Comorbid Obsessive-Compulsive Personality Disorder and Clinical Perfectionism

OBJECTIVE

Several studies and clinical vignettes emphasize the association between eating disorders and maladaptive personality traits that should be targeted in treatment to strengthen the therapeutic prognosis and outcome. The aim of this paper is to present a single case study with a patient showing comorbid Anorexia Nervosa (AN) and Obsessive-Compulsive Personality Disorder (OCPD) with perfectionistic traits, using Cognitive Behavioral Therapy for Eating disorders (CBT-E) and Perfectionism (CBT-P).

METHODS

The patient, a young girl aged 17 years, was underweight when entering therapy and received an enhanced version of CBT-E with 40 sessions as recommended in the manual. The treatment was adjusted for adolescents with a heightened focus on motivation, therapeutic alliance, and parental involvement. The clinical interventions were structured in accordance with CBT-E for adolescents with six added sessions targeting clinical perfectionism based on CBT-P focusing on over-evaluation of achievements in addition to weight and shape.

RESULTS

The patient showed a gradual decrease in eating disorder symptoms and perfectionism through the 1-year treatment. She was normal weight by the end of therapy, enjoyed varied food, was more socially engaged and balanced clinical perfectionism with more healthy strivings and standards. She was also able to express her need for boundaries and rest to family, friends and her sports team. At the final assessment, she did not fulfill diagnostic criteria for AN or OCPD with perfectionistic traits, but she showed some symptoms in achievement situations that was targeted by information and preventive interventions.

CONCLUSION

In accordance with the manual for CBT-E, perfectionism should be targeted as part of the treatment for eating disorders when in the clinical range. This was done in the present case with AN and perfectionistic traits within a comorbid OCPD, using elements of CBT-P that showed positive results and meaningful changes for the patient.

[Therapeutic residential facilities for individuals with eating disorders: A survey on care concepts, clientele and outcomes]

Specialized therapeutic residential communities for individuals with eating disorders have become increasingly common in Germany. These facilities provide intensive care for clients whose disorder is too severe to be managed with outpatient psychotherapy alone. The study explores which residents are treated in these settings, which measures are carried out there and how the result is to be assessed from the perspective of the professionals.All residential communities affiliated with the German Federal Association for Eating Disorders (Bundesfachverband Essstörungen e.V. BFE) were invited to participate in the study. Seventeen residential community providers contributed data, which consisted of questionnaires completed by health professionals to collect key information about clients discharged over a one-year period.Data from 101 clients was analyzed. The majority of clients had been diagnosed with anorexia nervosa (78%), followed by bulimia nervosa (18%). Many clients had been hospitalized multiple times in the past. The mean age was 21 years (SD: 3.7), with 16 residents being minors at admission. The average length of stay was 17 months. Among clients with anorexia nervosa, the mean Body Mass Index (BMI) increased from 17.5 kg/m² at admission to 19.4 kg/m² at discharge. According to the evaluations by the staff, 73% of the clients with bulimia nervosa no longer had any binge eating episodes at the time they were discharged. Other disorder-specific symptoms also notably improved in both groups. Facilities commonly provided psychotherapeutic and socio-pedagogical interventions in individual and group formats, along with family therapy and crisis management as needed. Professionals rated the services as generally helpful for most residents.Specialized residential communities for individuals with eating disorders play a critical role in supporting recovery, particularly during the transition between inpatient and outpatient care.

"When Standard Treatments Are Not Enough" - Showcasing Schema Therapy for the Treatment of Anorexia Nervosa and Borderline Personality Disorder

Whilst standard cognitive and behavioural treatments lead to clinical improvement for approximately half of the people with eating disorders, preliminary evidence indicates that complex comorbidity, including personality difficulties, insecure attachment patterns and Posttraumatic stress disorder, may hinder treatment engagement and outcomes. Such comorbidities tend to be associated with increased emotional dysregulation, rigidity of beliefs, and dissociation. Schema Therapy is a transdiagnostic approach that interweaves the treatment of current eating disorder symptomatology and comorbid presentations through addressing early maladaptive schemas linked to unmet attachment needs and traumas. The goals are to promote integration, coherence, and resilience of self, whilst reducing reliance on the eating disorder as a means of self-regulation and substitute identity. In this case example, we follow a 27-year-old woman with an eating disorder (Anorexia Nervosa) and comorbid personality disorder (Borderline Personality Disorder), illustrating how Schema Therapy can effectively treat both conditions by healing the underlying schemas. This case study highlights the ways in which the therapeutic 'limited reparenting' approach is used to interweave cognitive, experiential, and behavioural techniques that address clients' chronically unmet emotional needs, and the importance of enhancing the individual's Healthy Adult mode to facilitate self-regulation and the client's capacity to effectively manage their own psychological needs in the future.

The Association Between Disordered Eating and Musculoskeletal Injury Among Marine Officers Upon Entry to the Basic School

INTRODUCTION

Active duty service members (ADSMs) may be at heightened risk for eating disorders (EDs) and sub-clinical disordered eating (DE). ADSMs are also at a high risk for musculoskeletal injury (MSK-I). Given the risk for EDs/DE among ADSMs as well as robust physical requirements of military training, additional research is needed to elucidate links between DE and risk for MSK-I among ADSMs. The aim of the present study was to assess the prevalence of DE and associations with MSK-I among Marine Corps officers entering a 6 month leadership course.

MATERIALS AND METHODS

The current cross-sectional study is part of a large, prospective study, the Initiation of Marine Physiological Assessment of Combat Training (IMPACT) study. Participants completed the Eating Disorder Examination-Questionnaire Short (EDE-QS) and self-reported the presence of a recent (≤6 months) MSK-I upon entry to an officer training course. A logistic regression was used to assess the association between elevated DE (EDE-QS ≥15) and recent MSK-I, adjusting for age, race, sex, and commissioning source.

RESULTS

N = 1,382 officers (11.6% female, MAge: 24.8 ± 2.9 years, 26.6% racial/ethnic minority) completed the questionnaires. Seven percent had elevated DE (EDE-QS score ≥15) (female: 10.6%, male: 6.9%, P = .10); 18.3% self-reported recent MSK-I (female: 26.3%, male: 17.3%; P = .009). Females had 17% greater odds of MSK-I compared to males (aOR: 1.17, 95% CI: 1.03-1.33, P = .02). Moreover, females with elevated DE had greater odds of MSK-I than males with elevated DE (aOR= 1.38); among females, odds of MSK-I were greatest among those with elevated DE (aOR= 1.35).

CONCLUSIONS

In this sample of Marine officers, DE was associated with greater odds of a recent MSK-I among women only. Results align with previously reported relationships between DE and skeletal health in female athletes. Prospective research is needed to elucidate the temporal nature of these relationships.

Treating Patients With Comorbid Eating Disorders and Personality Disorders: A Rationale

Eating disorders (ED) have heightened risk for both psychiatric and medical complications, and they require more effective psychological interventions, in light of evidence saying that treatment response is often incomplete, and attrition is significant. One possible avenue to improve treatment effectiveness is address the frequent co-occurrence with personality disorders (PD). When persons suffer from both ED and PD they would present with complex manifestations and serious interpersonal problems. In parallel, their capacity to form a solid working alliance can be limited. They are likely to have difficulty trusting clinicians and engaging in the necessary work needed to counteract their maladaptive ideas about food, weight and body image, and to change their problematic eating habits. This introduction of the issue of the Journal of Clinical Psychology: In Session devoted to treating patients with comorbid ED and PD describe the rationale for why it is necessary to assess and treat PD symptoms integrated with appropriate ED focused treatment.

Family-based treatment at home in adolescents with eating disorders and co-occurring mental health conditions: rationale and study design of a mixed methods trial

BACKGROUND

The significant impact of eating disorders on adolescents necessitates the evaluation of current treatments. Family-based Treatment (FBT) is the standard treatment but has modest remission rates, highlighting the need for improvements. Assessing its effectiveness in adolescents with co-occurring mental health conditions is also crucial. In the Netherlands, there is a growing focus on home-based treatment. This study aims to enhance remission rates in FBT by adapting it for use in a home setting (FBT-H).

OBJECTIVE

This mixed-method study combines single case studies with qualitative research. The primary objective is to assess the effects and experiences of FBT-H in adolescents with eating disorders and co-occurring mental health conditions across variables such as weight, eating disorder symptoms, anxiety, mood, well-being, quality of life, and family dynamics. Additionally, it explores the experiences of adolescents, parents, and practitioners with FBT-H.

METHODS

Adolescents (12-18 years old) with anorexia nervosa (AN) or other specified feeding or eating disorders (OSFED), alongside co-occurring mental health conditions, will participate in FBT-H, attending about two home sessions per week for 6-12 months. Ten patients will be monitored with intensive measurements over one year. Baseline assessments include somatic screening, clinical interviews, and evaluations of mood, anxiety, and family dynamics. The primary outcome is weight change from baseline to one year post treatment, and secondary outcomes (e.g., eating disorder symptoms, quality of life, parent-child relationships, and caregiving burden) are assessed at baseline and then every three months. General well-being and therapeutic relationships are tracked weekly. One-year post treatment, somatic health, and mood/anxiety symptoms will be reassessed alongside qualitative interviews with adolescents, parents, and practitioners.

DISCUSSION

The FBT-H study has the potential to yield significant findings for providing effective treatments for adolescents with eating disorders and co-occurring mental health conditions. By examining a range of variables beyond weight and eating disorder symptoms, this study aims to provide comprehensive insights into the potential benefits and limitations of this home treatment.

REGISTRATION

The study was approved by the Dutch Medical Ethics Committee 'METC Oost Nederland' (Dossier Number: 2023-16217).

CLINICAL TRIAL REGISTRATION

NCT06792227, ClinicalTrials.gov, registered on 25 January 2025.

TRIAL REGISTRATION

Clinical Trial Number: NCT06792227.

Emergency medical reviews and medical admission transfers during psychiatric inpatient eating disorders unit treatment

OBJECTIVE

There is limited information regarding emergency medical reviews (EMRs) and medical admission transfers for psychiatric eating disorders inpatients. We aimed to describe (i) EMRs during psychiatric inpatient eating disorders treatment at the Eating Disorders Unit (EDU), Austin Hospital in Melbourne, Victoria, and (ii) medical admission transfers during EDU admissions.

METHODS

Retrospective review of patient files was undertaken for inpatients aged 18-65 years with an eating disorder who resided within the Body Image & Eating Disorders Treatment & Recovery Service (BETRS) catchment area and were admitted to EDU between 01/01/21 to 30/10/23.

RESULTS

Among 177 EDU admissions there were 33 EMRs and 17 medical transfers. On average, inpatients with EMRs or medical transfers were older with greater medical multimorbidity or polypharmacy, and a higher proportion of atypical anorexia nervosa and anorexia nervosa - binge/purge subtype. EMR indications included postural tachycardia, hypotension, sinus tachycardia, hypokalaemia, hypoglycaemia, altered conscious state, and chest pain. Medical admission indications included refeeding in the setting of vital sign derangement, intravenous potassium, vital sign derangement or falls attributed to antipsychotic use, infection, abdominal pain, and self-harm.

CONCLUSION

Early medical assessment and intensive monitoring are recommended for older patients with greater medical multimorbidity/polypharmacy, orthostasis, or higher risk of electrolyte instability. Caution should be undertaken regarding antipsychotic use in this vulnerable population.

Mental and Somatic Conditions in Children With the Broad Avoidant Restrictive Food Intake Disorder Phenotype

Importance

Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with diverse psychiatric and somatic symptoms and therefore consult various pediatric subspecialties. Large-scale studies mapping coexisting conditions are, however, lacking.

Objective

To characterize the health care needs of youth with ARFID.

Design, Setting, and Participants

This cohort study used the Child and Adolescent Twin Study in Sweden (CATSS), in combination with inpatient and specialized outpatient clinical diagnoses from the Swedish National Patient Register. Data were collected from July 2004 to April 2020, and data were analyzed from September 2022 to February 2024.

Exposure

Using a composite measure derived from parent or guardian reports and register data, children with the broad ARFID phenotype occurring between the ages of 6 to 12 years were identified, as well as children without ARFID.

Main Outcomes and Measures

From more than 1000 diagnostic International Classification of Diseases (ICD) codes, mental and somatic conditions within or across ICD chapters, the number of distinct per-person diagnoses, and inpatient treatment days between participants' birth and 18th birthdays were specified (90 outcomes). Hazard ratios (HRs) and incidence rate ratios (IRRs) were calculated.

Results

Of 30 795 CATSS participants, a total of 616 children (2.0%) with the broad ARFID phenotype occurring between the ages of 6 to 12 years were identified, and 30 179 children without ARFID were identified. Of 616 children with ARFID, 241 children were female (39.1%). Relative risks of neurodevelopmental, gastrointestinal, endocrine or metabolic, respiratory, neurological, and allergic disorders were substantially increased in children with ARFID (eg, autism: HR, 9.7; 95% CI, 7.5-12.5; intellectual disability: HR, 10.3; 95% CI, 7.6-13.9; gastroesophageal reflux disease: HR, 6.7; 95% CI, 4.6-9.9; pituitary conditions: HR, 5.6; 95% CI, 2.7-11.3; chronic lower respiratory diseases: HR, 4.9; 95% CI, 2.4-10.1; and epilepsy: HR, 5.8; 95% CI, 4.1-8.2). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had significantly more distinct mental diagnoses (IRR, 4.7; 95% CI, 4.0-5.4) and longer hospital stays (IRR, 5.5; 95% CI, 1.7-17.6) compared with children without ARFID. Children with ARFID were diagnosed with a mental condition earlier than children without ARFID. No sex-specific differences emerged.

Conclusions and Relevance

This cohort study yields the broadest and most detailed evidence of coexisting mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties.

Cardiac interoceptive processing and emotional experience in binge eating behavior: Neural evidence of disengagement from bodily sensations

OBJECTIVE

This study provides a comprehensive assessment of cardiac interoception in individuals with binge eating (BE) behavior and compares their emotional experience and affective state related to heartbeat perception with those of healthy controls (HCs).

METHOD

After a 5-min resting phase, participants (n = 28 BE group, n = 28 HC group) completed the heartbeat counting task, with concurrent EEG and ECG recording. Indices for interoceptive accuracy (IAcc), interoceptive beliefs (IBe), and interoceptive insight (IIn) were computed. Heart rate (HR) and heart rate variability (HRV) served as indicators of bodily signal strength. Heartbeat-evoked potentials (HEPs) were derived to assess the neural representation of cardio-afferent signals at the cortical level during rest or task performance. Emotional experiences and changes in affective state from pre-to post-task were assessed using self-reports.

RESULTS

The BE group exhibited lower mean HR and higher HRV compared to HCs. No group differences were found in IAcc, IBe, or IIn. HCs showed increased HEP amplitudes during the task compared to rest, whereas no such effect was observed in the BE group. Both groups reported an increase in negative affect from pre-to post-task, with the BE group experiencing significantly higher negative affect post-task.

DISCUSSION

The altered neural representation observed in the BE group may reflect disengagement from bodily sensations, which may impair emotion processing and regulation, potentially contributing to BE behavior. Further research is warranted to determine whether this pattern is specific BE-related eating disorders (EDs) or relevant to EDs in general.

Eating disorders among an online sample of Canadian and American boys and men

There is a continued need to identify the prevalence and sociodemographic correlates of eating disorders, particularly among the under-researched group of boys and men, to inform prevention and intervention efforts. Data from The Study of Boys and Men, a sample of 1553 boys and men aged between 15 and 35 years in Canada and the United States, were analyzed in 2024. Probable eating disorder diagnoses were identified using a previously established algorithm based on current diagnostic criteria. A multivariable logistic regression analysis was used to determine the sociodemographic correlates of meeting the criteria for any probable eating disorder diagnosis. The prevalence of meeting the criteria for any probable eating disorder diagnosis was 21.3 % (95 % confidence interval [CI] 18.7-24.1), while meeting criteria for a probable bulimia nervosa diagnosis had the highest prevalence (5.8 %, 95 % CI 4.6-7.1) and anorexia nervosa had the lowest prevalence (0.34 %, 95 % CI 0.1-0.8). Boys and men who identified as gay (adjusted odds ratio [AOR] 2.28, 95 % CI 1.35-3.85) or bisexual (AOR 2.22, 95 % CI 1.23-3.99) had higher odds of meeting criteria for any probable eating disorder diagnosis, compared to those who did not. Finally, boys and men who had a higher body mass index (BMI) (AOR 1.18, 95 % CI 1.14-1.23) had greater odds of meeting criteria for any probable eating disorder diagnosis. Findings add to the growing understanding of eating disorders among boys and men. Targeted and tailored prevention and intervention programming is needed for sexual minority boys and men, and those with higher BMIs.

Effects of Covid-19-related anxiety on overeating and weight gain in a diverse college sample

The outbreak of the Covid-19 pandemic has been linked with caloric overeating and weight gain. We employed a mediation analysis to determine whether pandemic-associated overeating was a direct effect of Covid-19-related anxiety (affect regulation theory) or mediated by a coping mechanism of escape eating (escape theory). A diverse pool of college students participated in a repeated cross-sectional study during three separate waves: May 2021 (wave 1, n = 349), December 2021 (wave 2, n = 253), and March 2022 (wave 3, n = 132). The results revealed a significant indirect effect of Covid-19-related anxiety on high-caloric overeating mediated by escape eating, but no direct path between Covid-19-related anxiety and caloric overeating. Analysis of racial/ethnic status uncovered significantly greater Covid-weight gain in Hispanic participants compared with White, Black, and Asian participants. Our results suggest that Covid-19 weight gain is a byproduct of a mediated escape mechanism differentially affecting racial/ethnic groups.

A meta-analysis of mortality rates in eating disorders: An update of the literature from 2010 to 2024

Elevated mortality rates have been reported in individuals with eating disorders (EDs). However, no meta-analysis in the past decade has provided an updated, comprehensive synthesis of mortality across all ED diagnoses while exploring potential moderating factors. We conducted a systematic search in four databases (PsycINFO, MEDLINE, Embase and Web of Science) from 2010 to 29 Oct 2024. Studies that reported standardized mortality ratios (SMRs) in individuals with a diagnosed ED (including formal diagnoses and self-reports) were included. Random-effects meta-analyses were conducted to pool estimates across studies. Meta-regression was conducted to examine predictors of heterogeneity. Meta-analysis of SMRs of effect sizes revealed elevated mortality risk for individuals with an ED (regardless of ED subtype); weighted SMR = 3.39 (95 % CIs: 2.90, 3.95), p < .001, I2 = 95.1 %, Q(df=73) = 1492.39, p < .001. SMRs were highest for individuals with anorexia nervosa (5.21; k = 30), followed by eating disorder not otherwise specified (2.51; k = 8); bulimia nervisa (2.20; k = 18) and binge eating disorder (1.46; k = 3). Individuals with EDs demonstrate markedly heightened mortality rates, especially among those with anorexia nervosa. Our findings are crucial for identifying key factors influencing mortality in EDs, guiding targeted interventions to reduce preventable deaths.

Examining transdiagnostic factors among religious and spiritual individuals with comorbid eating disorders and post-traumatic stress disorders

Eating disorders (EDs) have a harmful impact on the lives of millions of individuals in the United States. Research indicates that comorbid trauma could negatively impact treatment outcomes, reinforcing ED symptomology. Transdiagnostic approaches underscore experiential avoidance as a maintaining factor for EDs and other comorbid concerns, while mindfulness and adaptive coping help disrupt avoidance of emotional experiences. In addition to treatment approaches, clinicians must consider cultural identity factors, such as religion and spirituality (R/S), to engage in culturally responsive treatment. In the present study, we examined transdiagnostic factors in a clinical sample of 1153 individuals with comorbid EDs and post-traumatic stress disorder (99.6% of the sample), specifically considering differences between those who identified as religious, spiritual, or neither. Using a one-way analysis of variance, we found statistically significant differences in ED symptomology and adaptive coping scores across groups. Conversely, we found no statistically significant differences in mindfulness and experiential avoidance scores across groups. Despite the small effect sizes, these preliminary findings add to the existing body of research on R/S using a transdiagnostic framework, supporting the integration of spirituality into ED treatment to promote adaptive coping. Future research is needed to address the study's limitations, such as exploring adaptive coping styles that may further explain these relationships.

Family therapy and cognitive behavior therapy for eating disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis

Family therapy for eating disorders (ED) is well-established and represents the treatment choice for ED in children and adolescents according to guidelines, with cognitive behavior therapy (CBT) as a second line treatment. There is limited knowledge about how these treatments work in routine clinical care. The goal of the present meta-analysis is to investigate the effectiveness of family therapy and CBT for various EDs in children and adolescents when carried out in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until December 2023. The outcome of family therapy and CBT, methodological quality, risk of bias, and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with ED efficacy studies. Forty-four effectiveness studies comprising 3251 family therapy or CBT patients were included. Large to very large within-group effect sizes (ES) were found for ED-psychopathology (0.80) and weight measures for AN (1.64) at post treatment. The attrition rate was 15%. Risk of bias was considerable. Moderate to large ES were found for family therapy and CBT, respectively. The benchmarking analysis showed that effectiveness studies had comparable ESs to efficacy studies (0.80 and 0.84 for the ED-psychopathology at post treatment). The findings support family therapy and CBT for ED in children and adolescents as effective treatments when delivered in routine clinical care, with effects comparable with those found in efficacy studies. The evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.PROSPERO [CRD42023441794].

Genomic links between symptoms of eating disorders and suicidal ideation

Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, are psychiatric conditions associated with high mortality rates, particularly due to suicide. Although eating disorders are strongly associated with suicidal ideation, attempts, and fatalities, the precise relationship between these conditions remains poorly understood. While substantial genetic influences have been identified for both eating disorders and suicidality, the shared genetics contributing to their co-occurrence remain unclear. In this study, we utilized a multivariate approach to examine the shared genetic architecture of eating disorder symptoms, suicidal thoughts and behaviors in ~20,000 participants from the COVID-19 Psychiatry and Neurological Genetics (COPING) study. We applied individual-level structural equation modeling to explore the factor structure underlying eating disorder symptoms and suicidal ideation, followed by genetic correlation analyses. We modeled the general factor of susceptibility to eating disorders and suicidal ideation that was as strongly genetically influenced as both conditions, with mean SNP heritability of 9%. Importantly, despite the frequent co-occurrence of eating disorders with other psychiatric conditions, our findings highlight the specificity of the relationship between eating disorders and suicidality, independent of other co-occurring psychopathology, such as depression and anxiety. This specificity highlights the need for targeted approaches in understanding the shared susceptibility factors.

Look at My Body: It Tells of Suffering-Understanding Psychiatric Pathology in Patients Who Suffer from Headaches, Restrictive Eating Disorders, or Non-Suicidal Self-Injuries (NSSIs)

Background/Objectives: Adolescence is a developmental stage characterized by profound physical and psychological transformations, often leading to vulnerabilities such as body dissatisfaction, identity challenges, and the use of maladaptive coping strategies. This often leads to body-related psychopathologies, including headaches, restrictive eating disorders, and non-suicidal self-injury (NSSI). The present study aimed to describe the typical functioning and features of these conditions and the differences between the three groups, and to identify the most effective assessment for predicting these conditions. Methods: Sixty adolescent patients (51 female; mean age = 15.34 ± 1.80) were divided into three groups: headaches, restrictive eating disorders, and NSSI, and assessed for differences in symptoms, cognitive performance, personality, functioning, and illness severity using semi-structured interviews, clinician-based scales, and performance-based tests like the Rorschach inkblot test, according to the Rorschach Performance Assessment System (R-PAS). Results: Individuals with headaches experienced more internalizing symptoms, had an average IQ, maintained some functioning areas, and had distorted patterns of self-other relationships with the tendency to project malevolent aspects onto others. Patients with restrictive eating disorders had high levels of depressive symptoms, above-average IQ scores, negative symptoms, moderate presence of obsessive-compulsive personality traits, disorganized thinking, and a tendency to interpret situations subjectively. Patients with NSSI showed the highest level of depressive symptoms and social anxiety symptoms, and a considerable presence of psychotic symptoms and perceptual distortions. Negative symptoms, borderline personality traits, and psychosis symptoms had the strongest predictivity. Conclusions: The study provides clinicians with relevant insights into the features of these conditions and highlights assessment strategies, tailored interventions, and enhanced outcomes for these vulnerable populations.

Exploring Multidisciplinary Approaches to Comorbid Psychiatric and Medical Disorders: A Scoping Review

Psychiatric disorders often coexist with internal medical conditions, posing significant challenges to diagnosis, treatment, and overall patient outcomes. This study examines the bidirectional relationship between these conditions, emphasizing their impact on morbidity, treatment adherence, and quality of life. Through a comprehensive review of the peer-reviewed literature, we explore the physiological, neuroinflammatory, and psychosocial mechanisms that underpin these interactions. Key psychiatric disorders, including depression, anxiety, cognitive impairments, and psychosis, are identified as critical contributors to diagnostic complexity and therapeutic hurdles. Our findings underscore the importance of integrated, multidisciplinary care models, advocating for early detection, routine mental health screening, and personalized treatment strategies. Challenges such as overlapping symptoms, diagnostic ambiguities, and potential drug interactions are critically analyzed, with practical, evidence-based recommendations proposed for clinical practice. Despite advancements, significant research gaps persist, particularly the lack of longitudinal studies and the limited application of precision medicine tailored to this population. Future directions focus on enhancing diagnostic tools, developing innovative therapeutic approaches, and integrating mental health services into routine care. This study highlights the critical need for holistic, patient-centered approaches to manage comorbid psychiatric and internal medical conditions, offering actionable insights to improve outcomes and bridge existing gaps in research and practice.

'It takes a village': patient lived experiences of residential treatment for an eating disorder

BACKGROUND

Residential treatment facilities for eating disorders are becoming increasingly common and purport to provide recovery-orientated care in a less restrictive environment than traditional hospital settings. However, minimal attention has focused on individuals' lived experiences of these residential services.

AIMS

This study explores participants' lived experiences of care at Australia's first residential facility for the treatment of eating disorders.

METHOD

Qualitative data were collected as part of a clinical evaluation (June 2021 to August 2023). Fifteen women participated in semi-structured interviews about their experience of treatment following discharge. Data were analysed with inductive reflexive thematic analysis.

RESULTS

Three main themes were generated from the data that included participants' journeys to treatment, experiences of treatment and the transitions associated with and following discharge. Cutting across these main themes were participants' encounters of barriers, setbacks and hope. Participant experiences of residential treatment were complex and multifaceted, marked by inherent ideological dilemmas that arose in balancing standardised treatment protocols with person-centred and recovery-oriented care. Participants also spoke of reclaiming a sense of self and identity beyond their eating disorder, emphasising the importance of relationships and consistent and collaborative care.

CONCLUSIONS

Participant accounts of residential treatment emphasised the importance of holistic, person-centred and recovery-oriented care. Despite the complexities of treatment experiences, participant narratives underscored how recovery may be more about the reclamation of a sense of identity outside of the eating disorder than merely symptom improvement. As such, adopting person-centred and recovery-oriented treatment approaches within residential treatment settings may maximise individual autonomy and promote holistic recovery pathways.

Attentional Processing Biases in Young People With Binging and Purging Behavior

OBJECTIVE

Binging and purging are transdiagnostic features of eating disorders (EDs). Attentional biases (ABs) toward food and body shape cues and negative affect (NA) are associated with ED psychopathology. These ABs might also be present in people with subthreshold ED not meeting full diagnostic criteria. We investigated ABs to food and body shape cues and the interaction between ABs and NA in young people with binge/purge behavior (B/P group) and healthy controls (HC group). Our B/P sample consisted of individuals with threshold and subthreshold ED, including participants with BN, AN-R, and AN-B/P.

METHOD

We conducted two studies. Study 1 recruited n = 54 HC and n = 53 B/P participants aged 16-25, and Study 2 recruited n = 73 HC and n = 72 B/P participants. In Study 1, ABs toward food and body shape cues were compared between B/P versus HC participants using a pictorial dot-probe task. In Study 2, ABs were compared between B/P versus HC participants after NA induction using the Cyberball social exclusion task. Indexes of attentional engagement and disengagement were computed.

RESULTS

There was a main effect of cue type on attentional engagement at 0.2 s (p = 0.006,η p 2 $\eta _p^2$  = 0.075) and 2 s (p = 0.040,η p 2 $\eta _p^2$  = 0.043), and attentional disengagement at 2 s (p = 0.006,η p 2 $\eta _p^2$  = 0.077) in Study 1. Findings were not replicated following NA induction in Study 2. No main effect of group or group × cue type interaction was found.

DISCUSSION

Our results disagree with previous research supporting the importance of ABs toward food and body shape cues in young people with threshold and subthreshold EDs and suggest these might not constitute a relevant target in the treatment of ED behavior. However, due to a heterogeneous approach to measuring ABs and multiple types of AB being described in EDs, further research is needed to clarify whether ABs map onto transdiagnostic models of behavioral dysregulation.

Exploration of cognitive flexibility and emotion recognition in adolescents with eating disorders

OBJECTIVES

This study compared cognitive flexibility (CF) and emotion recognition (ER) in adolescents with eating disorders (ED) to a healthy group.

METHODS

Forty healthy individuals aged 12-18 years with no psychiatric diagnosis and 46 patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) according to DSM-5 criteria participated. CF was assessed using the Cognitive Flexibility Scale (CFS), Stroop Test, and Berg Card Sorting Test (BCST), while ER was evaluated using the test of perception of affect via nonverbal cues.

RESULTS

CFS scores were lower in the ED group compared to the control group. Neuropsychological test results indicated similar BCST perseverative error percentages among ED patients and controls. However, while the BED group demonstrated greater difficulties with inhibitory control, as shown in the Stroop Test, the BN and AN groups performed similarly to the control group. ER performance was similar across groups, although the AN subgroup exhibited heightened recognition of negative emotions, particularly disgust and fear.

CONCLUSIONS

This study highlights unique and shared neurocognitive patterns related to CF and ER profiles of ED patients. Despite self-reports of greater cognitive rigidity among ED patients, objective tests did not consistently confirm it. Notably, BED patients exhibited inhibitory control challenges, aligning with impulsive tendencies. ER abilities were similar to controls; however, the AN subgroup showed heightened sensitivity to certain negative emotions, such as disgust. These findings underscore the need for further research with larger, more balanced samples to explore how CF and ER vary across developmental stages and subtypes.

Eating disorders in minority ethnic populations in Australia, Canada, Aotearoa New Zealand and the UK: a scoping review

BACKGROUND

Historically, eating disorder (ED) research has largely focused on White girls and women, with minority ethnic populations underrepresented. Most research exploring EDs in minority ethnic populations has been conducted in the United States (US). The aim of this scoping review, the first of its kind, was to systematically examine research on disordered eating and EDs among minority ethnic populations in Australia, Canada, Aotearoa New Zealand and the United Kingdom (UK), four countries with shared sociocultural and healthcare characteristics. An inequity lens was applied to highlight gaps in research, access, and treatment experiences.

METHOD

Five databases (Medline, Embase, PsycINFO, CINHAL and Web of Science) were searched up to March 7, 2024. Two independent reviewers screened titles and abstracts and full texts against eligibility criteria resulting in the inclusion of 87 records (76 peer-reviewed articles and 11 theses). Included studies were charted according to their focus, study design, sample characteristics and findings, with a particular focus placed on prevalence, access to treatment and treatment experience.

RESULTS

The majority of identified studies were conducted in the UK (61%, 53 studies). There was a notable lack of studies investigating assessment, diagnosis and intervention. Methodologies varied, though most studies utilised cross-sectional survey designs. Most samples were non-clinical, exclusively or predominantly girls and women, and focused on adolescents and young adults. Asian populations were the most frequently studied minority ethnic group. Understanding of prevalence and treatment experience amongst minority ethnic groups was limited.

CONCLUSION

There is a need for further research addressing inequities in ED prevalence, service access, and treatment experiences among minority ethnic and Indigenous groups, especially in Australia, Canada and Aotearoa New Zealand. Improved ethnicity data collection and culturally sensitive approaches to assessment, diagnosis and treatment are essential. Recommendations for future research and clinical practice are provided.

Efficacy of the ECHOMANTRA online intervention to support recovery from anorexia nervosa in adult patients: study protocol of a randomized controlled multi-center trial

BACKGROUND

Poor quality of life in adults with anorexia nervosa (AN) and persistent high rates of readmission highlight the necessity of developing interventions to optimize treatment outcomes. ECHOMANTRA is a novel online intervention based on interventions for carers (Experienced Carers Helping Others, ECHO) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) with anorexia nervosa. The objective of this paper is to describe the study protocol of a randomized control trial (RCT) aimed at evaluating the efficacy of an adaptation of the ECHOMANTRA for adults AN inpatients and outpatients, and their carers, to be implemented as an add-on to treatment-as-usual (TAU).

METHODS

In a multi - center pilot randomized controlled trial (RCT), 148 adult AN patients, and their carers, will be randomized to receive treatment as usual (TAU) or TAU plus ECHOMANTRA. Assessments will take place at baseline (T0), post-intervention (2-month) (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Primary outcomes will be eating disorder psychopathology and psychological well-being. For carers, outcome variables will include psychological well-being, accommodation and enabling behaviors, expressed emotion, illness burden, quality of life and care skills.

DISCUSSION

This study will provide evidence of the efficacy of this novel, online and protocolized intervention in facilitating the recovery of these patients.

TRIAL REGISTRATION

ISRCTN registry (Identifier: 80253157 https://doi.org/10.1186/ISRCTN80253157 ).

Disabilities and eating disorders: A theoretical model and call for research

OBJECTIVE

There is an urgent need for research on eating disorders among individuals with disabilities. This paper highlights the lack of research on the relationships between disabilities and EDs, despite their common convergence.

METHOD

In this paper, we aim to 1) highlight the need for further research investigating the relationships between disability status and EDs, 2) describe existing frameworks for conceptualizing disability, 3) utilize such frameworks to propose a novel theoretical model of ED/disability relationships and related sociocultural factors and 4) identify future directions for research in this area.

RESULTS

We propose a multidimensional theoretical model of the relationships between EDs and disabilities. Further, we describe how these relationships are likely influenced by a system of individual factors (e.g., disability (in)visibility, food access, and self-identification) and sociocultural factors (e.g., ableism/discrimination and weight stigma).

DISCUSSION

Scholars are encouraged to test our proposed model and further investigate experiences of disability and ED co-occurrence with participatory research and mixed-methods designs. ED prevention and screening programs, as well as treatment access and efficacy, need to be evaluated for disabled populations. Disability should also be routinely collected as a demographic across studies, and ED measures should be validated and/or developed for individuals with disabilities.

Anxiety and body-focused repetitive behaviors: A systematic review and meta-analysis of comorbidity rates and symptom associations

Body-focused repetitive behavior (BFRB) disorders, including hair pulling disorder (trichotillomania [TTM]) and skin picking disorder (SPD), frequently co-occur with anxiety disorders, but reported comorbidity rates vary widely. Additionally, research on the relationship between anxiety and BFRB symptoms has yielded inconsistent findings. This meta-analysis and systematic review examined (1) the prevalence of comorbid anxiety disorders in individuals with BFRB disorders and (2) correlations between anxiety and BFRB symptom measures. The study protocol was pre-registered on PROSPERO. A systematic search of PsycInfo, PubMed, and Web of Science identified 119 studies (N=15,902) reporting anxiety prevalence rates in BFRB disorders and/or correlations between anxiety and BFRBs. Random-effects meta-analyses were conducted, including subgroup analyses for TTM and SPD, and meta-regression to examine potential moderators. Results indicated that comorbid anxiety disorders, including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), social anxiety, panic disorder, and specific phobia, were relatively common in BFRBs. Current prevalence rates were 19.2% for GAD, 12.8% for OCD, 10.6% for social anxiety, and 27.5% for 'any anxiety disorder.' Lifetime prevalence rates were 22.4% for GAD, 13.8% for OCD, 11.0% for social anxiety, and 35.9% for 'any anxiety disorder.' Pooled correlations between anxiety and BFRB severity were low to moderate (all BFRBs r=.29; TTM r=.27; SPD r=.34). Anxiety symptoms showed stronger correlations with focused BFRB measures (r=.42) than automatic (r=.15). These findings highlight a nuanced relationship between anxiety and BFRBs. While comorbid anxiety disorders are frequently observed in BFRB populations, anxiety severity is only modestly associated with BFRB severity. Implications for future research and clinical practice are discussed.

Navigating the Complexities of Managing Severe Anorexia Nervosa in a Medical Ward: A Case Report

Anorexia nervosa (AN) is a severe, life-threatening psychiatric disorder often accompanied by significant physical health complications, requiring specialized treatment that is challenging to provide in a general medical setting. This case report presents the complex challenges encountered in managing a 49-year-old woman with severe AN of the purging subtype in a general medical ward setting. Admitted with a life-threatening low body mass index (BMI) of 7.9 and critical physical health issues, her case underscores the intricate relationship between the psychiatric and physical health aspects of AN, especially in an environment with limited specialized resources. The report details her care course, which included medical stabilization, management under the Mental Health Act (MHA), and challenges such as observation, nutritional support, and the ethical complexities surrounding patient autonomy and consent. Additionally, the case highlights systemic limitations, including the lack of specialized training for medical and nursing staff in treating severe AN, as well as the need for multidisciplinary collaboration to navigate risks associated with nasogastric (NG) feeding, refeeding syndrome, and co-occurring psychiatric issues. This report emphasizes the necessity for improved training, specialized resources, and coordinated care in treating complex cases of AN in non-specialized settings to enhance patient outcomes.

[Personality traits of patients with eating disorders]

OBJECTIVE

To study the personality traits of patients with anorexia nervosa (AN) and bulimia nervosa (BN) based on the human-structural personality model by Günter Ammon. The focus is on the impact of these traits on the development and persistence of eating disorders (ED).

MATERIAL AND METHODS

A cross-sectional observational study was conducted on 131 patients diagnosed with AN (n=72) and BN (n=59). The study used clinical, psychopathological, psychometric, and statistical methods. The I-structural test of Ammon was used to assess personality structure. Sixty-four patients were retested 18 months after treatment.

RESULTS

The baseline data showed reduced structural ego functions in all patients. Significant differences (p<0.05) were found in the narcissism scale: in patients with AN - 36.32±1.82, in patients with BN - 18.97±1.82 (p<0.001). Patients with AN had more pronounced destructive and deficient traits related to fear and inner limits. In contrast, patients with BN had more pronounced destructive and deficient traits related to external limits and impulsivity. After 18 months, there was an improvement in measures of constructive anxiety, narcissism, and sexuality.

CONCLUSION

All patients had difficulties with identity formation, emotion regulation, and frustration tolerance. Patients with AN showed rigid internal limits and emotional suppression, and patients with BN showed weak limits and a tendency to impulsive actions. Improvement during treatment confirms the need for an individual approach based on the patient's traits in the therapeutic process. It may contribute to reducing the risk of recurrence and achieving a long-term remission of the ED.

Application of implementation science frameworks to inform the adaptation process of an evidence-based eating disorder prevention program for high-risk perinatal individuals

Background

The perinatal period is a high-risk time for body dissatisfaction and disordered eating. Evidence-based interventions for disordered eating have not been adapted to address the needs of this population. We describe the process of adapting the Body Project, an evidence-based eating disorder (ED) prevention program, for pregnant individuals with histories of disordered eating behaviors.

Method

Our approach is informed by ADAPT, a framework offering guidance for adapting interventions to new contexts, to modify the Body Project for pregnant individuals. Following initial adaptations informed by a needs assessment and stakeholder input, we conducted a pilot trial with individuals who have lived experience relative to our target population (i.e., previously pregnant individuals with ED history, n = 10). Participants provided feedback on the intervention through surveys and a focus group assessing perceptions of the intervention and barriers and facilitators to its implementation as guided by the Consolidated Framework for Implementation Research (CFIR).

Results

Eighty percent of enrolled participants attended five or more sessions (out of six). Across sessions, average satisfaction ratings were 9.28 (1 = poor to 10 = excellent). Most participants (89%) reported improvements in body satisfaction. Approximately 33% reported reductions in disordered eating with the remainder reporting no change due to healthy eating behaviors at baseline. Themes from the focus group are reported aligning with CFIR domains and all final modifications are summarized and reported aligning with the Framework for Reporting Adaptation and Modifications-Enhanced.

Conclusions

Applying implementation science frameworks to structure our process for making and summarizing planned adaptations, we adapted an empirically supported ED prevention program for pregnant individuals with histories of an ED. We made adaptation decisions based on participant feedback while weighing intervention fidelity and scalability. We will formally test the adapted intervention in a subsequent pilot randomized controlled trial versus a time- and dose-matched educational control.

The impact of gender-affirming interventions on eating disorder diagnosis risk among transgender and gender-diverse individuals

BACKGROUND

The objective of this study is to evaluate the risk of being diagnosed with an eating disorder among transgender and gender-diverse (TGD) individuals, specifically examining how this risk differs following gender-affirming medical therapy (GAMT).

METHODS

The study utilizes electronic medical record (EMR) data from the TriNetX database. A total of 90,955 TGD individuals were identified in the TriNetX database. TGD individuals were divided into cohorts according to gender-affirming interventions they received. To assess the risk of eating disorder diagnoses across groups, we applied a Cox proportional hazards model with gender-affirming care as a time-varying covariate.

RESULTS

Here we show that transfeminine individuals receiving hormone therapy (HT) have a significantly higher likelihood of being diagnosed with an eating disorder compared to those without intervention (HR:1.67, 95% CI:1.41, 1.98). Conversely, transmasculine individuals on HT exhibit a reduced risk of being diagnosed with an eating disorder relative to those without intervention (HR: 0.83, 95% CI: 0.76, 0.90).

CONCLUSIONS

After undergoing gender-affirming medical therapy, the risk of eating disorder diagnosis increases for transfeminine individuals and decreases for transmasculine individuals. The observed differences in risk between transfeminine and transmasculine individuals on GAMT may be attributed to factors such as gendered societal norms, variations in screening practices, and the physiological effects of hormone therapy on eating disorder symptomatology. Further research is needed to clarify these influences and support tailored interventions.

Clinical and genetic associations for night eating syndrome in a patient biobank

OBJECTIVE

Night eating syndrome (NES) is an eating disorder characterized by evening hyperphagia. Despite having a prevalence comparable to some other eating disorders, NES remains sparsely investigated and poorly characterized. The present study examined the phenotypic and genetic associations for NES in the clinical Mass General Brigham Biobank.

METHOD

Cases of NES were identified through relevant billing codes for eating disorders (F50.89/F50.9) and subsequent chart review; patients likely without NES were set as controls. Other diagnoses were determined from billing codes and collapsed into one of 1,857 distinct phenotypes based on clinical similarity. NES associations with diagnoses were systematically conducted in phenome-wide association scans using logistic regression models with adjustments for age, sex, race, and ethnicity. Polygenic scores for six related traits, namely for anorexia nervosa, depression, insomnia, sleep apnea, obesity, and type 2 diabetes were tested for associations with NES among participants of European ancestry using adjusted logistic regression models.

RESULTS

Phenome-wide scans comparing patients with NES against controls (cases n = 88; controls n = 64,539) identified associations with 159 clinical diagnoses spanning 13 broad disease groups including endocrine/metabolic and digestive diseases. Notable associations were evident for bariatric surgery, vitamin D deficiency, sleep disorders (sleep apnea, insomnia, and restless legs syndrome), and attention deficit hyperactivity disorder. The polygenic scores for insomnia and obesity were associated with higher odds of NES (insomnia: odds ratio [OR], 1.24; 95% CI, 1.07, 1.43; obesity: 1.98; 95% CI, 1.71, 2.28).

DISCUSSION

Complementary phenome-wide and genetic exploratory analyses provided information on unique and shared features of NES, offering insights that may facilitate its precise definition, diagnosis, and the development of targeted therapeutic interventions.

Clinical heterogeneity of feeding and eating disorders: using personality psychopathology to differentiate "simplex" and "complex" phenotypes

BACKGROUND

To investigate Feeding and Eating Disorders (FED) heterogeneity based on the co-occurrence of FED symptoms and personality psychopathology, on the hypothesis that empirical profiles would not confirm current FED categories but identify unique phenotypes carrying different levels of clinical complexity.

METHODS

Latent Profile Analysis profiled FED patients based on the assessment of both FED symptoms, through the Eating Disorders Inventory, third version (EDI-3), and personality characteristics, through the Minnesota Multiphasic Personality Inventory-2. Then, profiles were compared across socio-demographic and clinical characteristics.

RESULTS

Among 109 eligible patients, three FED profiles were identified: (i) FED simplex (low eating symptoms, absence of dysfunctional personality); (ii) FED simplex-severe (high eating symptoms only); and (iii) FED complex-severe (high eating symptoms and dysfunctional personality). Despite an uneven distribution (χ2(6) = 15.20, adjusted-p = 0.029), FED profiles did not unequivocally confirm clinical diagnoses (e.g., Anorexia Nervosa). A difference in Body Mass Index (BMI) was observed (K(2) = 15.06, adjusted-p = 0.001), but lower BMI did not identify the most severe group. Profiles differed in EDI-3 overall scores (e.g., Eating Disorder Risk Composite: K(2) = 43.08, adjusted-p < 0.001), Body Uneasiness Test Global Severity Index (GSI: K(2) = 29.33, adjusted-p < 0.001), Binge Eating Scale severity (K(2) = 25.49, adjusted-p < 0.001), number of psychiatric (K(2) = 8.79, adjusted-p = 0.021) and personality diagnoses (K(2) = 11.86, adjusted-p = 0.005), and Symptom Checklist-90-Revised GSI (F(2,103) = 37.68, adjusted-p < 0.001), with FED complex-severe patients being generally the most severely impaired in terms of FED symptoms, body concerns, depersonalization, and psychiatric comorbidities.

CONCLUSIONS

Findings support the hypothesis of distinguishing FED simplex and complex phenotypes, based on the co-occurrence of dysfunctional personality, with implications for FED severity and clinical practice.

Association of psychosocial risk factors and liver transplant evaluation outcomes in metabolic dysfunction-associated steatotic liver disease

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a standardized psychosocial assessment tool used in liver transplantation (LT) evaluation and has been primarily studied in patients with alcohol-associated liver disease. We aimed to evaluate the relationship between SIPAT score and metabolic syndrome severity and LT waitlist outcomes in a large cohort of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We performed a single-center retrospective cohort study of patients with MASLD evaluated for LT from 2014 to 2021. The utility of the previously defined total SIPAT cutoff (<21 [excellent/good candidates] vs. ≥21 [minimally acceptable/high-risk candidates]) was studied. Multivariable logistic regression analyses examined associations between continuous SIPAT scores and LT waitlisting outcomes. The Youden J statistic was used to identify the optimal SIPAT cutoff for patients with MASLD. A total of 480 patients evaluated for transplant with MASLD were included. Only 9.4% of patients had a SIPAT score ≥21. Patients with SIPAT score ≥21 had higher hemoglobin A1c compared to patients with lower psychosocial risk (median [IQR]: 7.8 [6.0-9.7] vs. 6.6 [5.8-7.9]; p = 0.04). There were no other differences in metabolic comorbidities between SIPAT groups. Increasing SIPAT score was associated with decreased odds of listing (OR: 0.82 per 5-point increase; p = 0.003) in multivariable models. A SIPAT of ≥12 was identified as the optimal cutoff in this population, resulting in an adjusted OR for a listing of 0.53 versus SIPAT <12 ( p = 0.001). In this large cohort of patients with MASLD evaluated for LT, few patients met the previously defined high SIPAT cutoff for transplant suitability. Nevertheless, increasing the SIPAT score was associated with waitlist outcomes. Our suggested SIPAT cutoff of ≥12 for patients with MASLD warrants further external validation using data from other centers.

Evaluating the role of binge planning and binge inevitability within affect regulation models of binge eating

Affect regulation models posit that aversive affective states drive binge-eating behavior, which then regulates negative emotions. However, recent findings among individuals with binge-eating disorder (BED) suggest that food-related anticipatory processes may precede and potentially explain the negative affect thought to drive binge eating. Specifically, studies using ecological momentary assessment (EMA) demonstrate that the negative affective state of "Guilt" (from the Positive and Negative Affect Schedule) most strongly predicts later binge eating in the natural environment, and it has been hypothesized that planning a binge or feeling that a binge-eating episode is inventible may account for the increases in Guilt observed prior to binge episodes. In the present study, we tested the hypothesis that binge planning or inevitability may contribute to feelings of shame (a key facet of the broader Guilt construct), which then predict binge-eating episodes, using EMA in 43 individuals with BED. Consistent with hypotheses, feelings of binge inevitability and planning prospectively predicted binge-eating episodes. Further, binge planning predicted subsequent increases in shame. However, shame did not predict subsequent increases in binge planning. Finally, a mediation model revealed that binge planning (Time 1) predicted future binge eating (Time 3) directly and indirectly through increases in shame (Time 2). The results provide novel evidence that individuals with BED anticipate and actively plan for binge-eating episodes, and that binge planning may explain the increased shame/guilt typically observed before binge eating. Overall, accruing evidence suggests that negative affect, although predictive of binge eating, may be better conceptualized as a consequence of the anticipatory processes that lead to binge eating, rather than the starting point, at least among some individuals with BED. Future experimental research is needed to more conclusively test this hypothesis.

Oral health status of individuals with eating disorders: Systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis evaluates the oral health status of individuals diagnosed with eating disorders (EDs) compared to healthy controls.

DATA & SOURCES

Electronic database search was conducted in five databases. Two independent reviewers carried out screening, data extraction, risk of bias assessment, sensitivity analysis, subgroup analysis (by type of eating disorder), and certainty of evidence grading with Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Assessed oral health outcomes included dental caries, erosion, oral hygiene, periodontal status, salivary flow, pH and composition, myofascial pain, bruxism, malocclusion, oral lesions, dentine hypersensitivity, and oral health-related quality of life (OHRQoL).

STUDY SELECTION

The literature search yielded 2,322 articles. Thirty-three articles were included in the present review.

CONCLUSION

Individuals with EDs had poorer oral health outcomes compared to healthy controls, although the effect estimates are uncertain due to very low certainty of evidence. Dental caries and gingival inflammation severity, and prevalence of dental erosion, myofascial pain, malocclusion, oral lesions, and dentine sensitivity were higher amongst individuals with EDs compared to healthy controls. They also had lower salivary flow and pH, which are risk factors for oral diseases. No significant difference in bruxism was noted and inconclusive results were obtained for oral hygiene and periodontal status. Dental professionals may identify signs of EDs during routine appointments and may play an important role in the early referral and prompt management of patients with EDs. Clinical Significance With growing awareness of the interconnectedness between oral and psychological health, this article reviews various oral health outcomes in individuals with eating disorders compared to controls. The findings highlight the importance of interdisciplinary collaboration as dentists may be among the first to detect these issues during routine appointments.

A cross-sectional evaluation of binge-eating behavior and its correlation with anxiety disorders among adolescents in Northern Saudi Arabia: implications for future generations

Background and aim

Binge-eating behavior and anxiety disorders pose a significant public health issue worldwide, as it has severe implications for both the physical and mental health of the adolescent population. The present study evaluated the prevalence of binge-eating behavior, anxiety disorders, and associated factors among the northern Saudi adolescent population. Furthermore, we assessed the correlation between binge eating and anxiety.

Methods

The present population-based cross-sectional study was carried out among adolescents in the Aljouf region of Saudi Arabia from June 2023 to December 2023. A total of 384 eligible participants were selected using the convenience sampling method. The present study used a pretested Arabic version of the binge eating scale (BES) and Hamilton Anxiety Scale (HAM-A) to assess the binge-eating behavior and anxiety disorders among the target population. The Spearman correlation test determined the strength and direction of the correlation between BES and HAM-A scores. Furthermore, logistic regression analysis was applied to find the associated factors for binge-eating behavior among the study participants.

Results

Of the 384 participants, moderate and severe binge-eating behaviors were found among 11.2% and 8.3% of the respondents, respectively. Regarding the severity of anxiety as assessed by the HAM-A scale, mild, moderate, and severe anxiety were shown among 12.8%, 9.6%, and 7.5% of the participants, respectively. Also, the study found a positive correlation between binge eating and anxiety scores, with a correlation coefficient of 0.26 and a p-value of 0.001. Furthermore, being female (p = 0.001), moderate (p = 0.004), and severe anxiety (P = 0.001) were significantly associated with binge-eating behavior.

Conclusion

The present research findings advocate for the implementation of targeted interventions and support services aimed at decreasing binge-eating behavior and anxiety, thereby promoting the overall well-being of adolescents and building stronger future generations. Moreover, it is recommended that optional courses about binge eating be incorporated into the curricula of schools and universities.