Eating disorders in children and adolescents: epidemiology, diagnosis and treatment

A review on exploration-exploitation trade-off in psychiatric disorders

Balancing exploration and exploitation is a crucial aspect of adaptive decision-making, but psychiatric disorders can disrupt this balance in various ways, shedding light on their neurocognitive roots and guiding targeted interventions. In this systematic review, we aimed to delineate potential exploration-exploitation impairments across psychiatric disorders. Through a thorough search on PubMed, we identified forty-six relevant studies employing tasks probing exploration-exploitation balances, which we synthesized to reveal distinct patterns. These disorders are clustered into three categories: addictive patterns, emotional/cognitive disturbances, and neurological (neurodevelopmental and neurodegenerative) disorders. Our findings show that anxiety and mood disorders often enhance exploratory behaviors, while depression impact decision stability and reward sensitivity. In contrast, schizophrenia, OCD (Obsessive-Compulsive Disorder), and ADHD (Attention-Deficit/Hyperactivity Disorder) are characterized by excessive switching and difficulties in balancing exploration and exploitation, leading to impaired learning and adaptability. Additionally, disorders with addictive-like features disrupt optimal decision-making strategies by either heightening exploration or causing maladaptive persistence, thus skewing the balance away from effective decision-making. Individuals exhibiting addiction-like or compulsive behaviors often demonstrate imbalances in the explore-exploit trade-off, resulting in suboptimal decision-making characterized by reduced exploration, flawed foraging strategies, and impulsive or perseverative choices despite adverse outcomes. This suggests that such disorders may originate from dysfunctional foraging processes applied to decision-making. In sum, different patterns of exploration-exploitation balance in different disorders are crucial in understanding the difficulties in learning and decision making of neuropsychiatric disorders. This suggests that such disorders may stem from dysregulated decision-making processes, where uncertainty plays a central role. Dysfunctions in dopaminergic and noradrenergic pathways appear to disrupt the brain's representation of uncertainty, thereby altering exploratory behavior. In sum, the varying patterns of exploration-exploitation balance across different disorders are critical for understanding the challenges in learning and decision-making associated with neuropsychiatric conditions.

Management of transitions to adult services for young people with eating disorders: survey of current practice in England

AIMS AND METHOD

The Royal College of Psychiatrists has published recommendations for managing transitions between child and adolescent mental health services (CAMHS) and adult services for eating disorders. A self-report questionnaire was designed to establish how many CAMHS teams meet these recommendations and was distributed to 70 teams providing eating disorders treatment in England.

RESULTS

Of the 38 services that participated, 31 (81.6%) reported a flexible upper age limit for treatment. Only 6 services (15.8%) always transferred young people to a specialist adult eating disorders service and the majority transferred patients to either a specialist service or a community mental health team. Most services complied with recommended provision such as a written transition protocol (52.6%), individualised transition plans (78.9%), joint care with adult services (89.5%) and transition support for the family (73.7%).

CLINICAL IMPLICATIONS

Services are largely compliant with the recommendations. It is a concern that only a small proportion of services are always able to refer to a specialist adult service and this is likely to be due to a relative lack of investment in adult services.

Physical Activity and Physical Fitness among University Students-A Systematic Review

The aim of this systematic review was to examine the scientific evidence regarding physical activity and physical fitness among university students. The search and analysis of the studies were done in accordance with the PRISMA guidelines. An electronic databases search (Google Scholar, PubMed, Science Direct, and Scopus) yielded 11,839 studies. Subsequently, the identified studies had to be published in English between 2011 and 2021, the experimental study had to have included males and females attending a faculty, and the participants had to have been evaluated for physical activity and fitness. A total of 21 studies were included in the quantitative synthesis, with a total of 7306 participants, both male and female. After analyzing the obtained results, it could be concluded that university students show a satisfactory level of physical activity and physical fitness. However, the results vary due to different factors involved, mostly related to the cultural differences and educational systems in different countries. As this study observes mediocre results of physical activity and physical fitness among university students, it is crucial to get their attention and awareness, to at least maintain a satisfactory level of physical activity and physical fitness.

Occurrence, sociodemographic, and clinical correlates of eating disorders among a sample of secondary school students in Egypt

Background

Eating disorders are common in adolescents. Data on occurrence rates, sociodemographic correlates, and risk factors in Egyptian population are needed along with better screening tools to inform future research and service development. We aimed to estimate the occurrence of eating disorders in a representative sample of Egyptian adolescent students and to examine the sociodemographic and clinical risk factors associated with eating disorders. So, a multistage random selection of 407 adolescent students from public and private secondary schools in Eastern Tanta, Egypt, was carried out. All participants were subjected to screening using the Eating Attitude Test (EAT) and the eating disorders section of the clinician version of the Structured Clinical Interview for DSM-IV axis-I disorders

Results

Occurrence estimates of anorexia nervosa and bulimia nervosa were 6.1% and 3.2%, respectively. Being female, overweight (BMI = 25–29.9 kg/m2), low self-esteem, and high body shape preoccupation were significantly associated with eating disorders risk among adolescents.

Conclusions

Eating disorders are prevalent in the general adolescent population. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.

Identification des pratiques prometteuses dans le traitement de l’anorexie mentale

L’anorexie mentale inquiète, d’une part, car elle est associée à de nombreuses complications médicales et, d’autre part, car elle est liée à un mauvais pronostic. Face à ces constats, il est impératif que les traitements les plus efficaces soient offerts aux personnes présentant une anorexie mentale. Cet article vise à présenter une revue systématique de la littérature portant sur les modalités thérapeutiques prometteuses dans le domaine de l’anorexie mentale. Parmi celles-ci, notons le traitement ambulatoire, l’importance d’une équipe multidisciplinaire ainsi que différentes approches psychothérapeutiques, dont l’approche familiale.

The Relationship between Conservatism and Psychological Well-Being in Adolescents

This study investigated the extent to which adolescents' levels of conservatism, their gender and home language can predict their psychological well-being. Conservatism is described as a social attitude, characterised by an intemalisation of the dominant values of the social environment within which the individual functions. Psychological well-being is described as a state that is characterised by aspects such as a sense of coherence, satisfaction with life, fortitude, coping, hardiness, self-actualisation, potency and psychological resilience. The sample consisted of 1 238 adolescents in the Eastern Cape and Gauteng provinces. Six attitude groupings of conservatism were identified, namely religious fundamentalism, anti-hedonism, conforming attitude towards authority, teenage behaviour, ethnocentrism and insistence on strict rules or punishment. The results of this study indicate that adolescents with high levels of conservatism in terms of religious fundamentalism, anti-hedonism, conforming attitude towards authority and teenage behaviour may also experience high levels of psychological well-being.

Differential motivational profiles following adolescent sucrose access in male and female rats

Adolescents are the highest consumers of sugar sweetened drinks. Excessive consumption of such drinks is a likely contributor to the development of obesity and may be associated with enduring changes in the systems involved in reward and motivation. We examined the impact of daily sucrose consumption in young male and female rats (N=12 per group) across the adolescent period on the motivation to perform instrumental responses to gain food rewards as adults. Rats were or were not exposed to a sucrose solution for 2 h each day for 28 days across adolescence [postnatal days (P) 28-56]. They were then trained as adults (P70 onward) to lever press for a palatable 15% cherry flavored sucrose reward and tested on a progressive ratio (PR) schedule to assess motivation to respond for reinforcement. Female rats exposed to sucrose had higher breakpoints on the PR schedule than controls, whereas male rats exposed to sucrose had lower breakpoints than controls. These results show that consumption of sucrose during adolescence produced sex-specific behavioral changes in responding for sucrose as adults.

[Catecholamine excretion in patients with eating disorders]

OBJECTIVE

To compare clinical features of eating disorders and parameters of monoamine metabolism.

MATERIAL AND METHODS

Authors examined 21 patients with eating disorders during 2008-2011 using clinical/psychopathological method. To evaluate the status of monoamine neuromediator system, urine levels of dopamine, noradrenalin and adrenaline excretion were measured using high-yield liquid chromatography with electrochemical detection. The reference group included 26 sex- and age-matched volunteers.

RESULTS AND CONCLUSION

The common patterns of the pathogenesis of compulsive urges of different origin were identified. The results indicate not only nonspecific changes in catecholamine systems of patients with eating disorders associated with different stress disorders but also demonstrate the pathogenetic correlations between dopaminergic activity and clinical symptoms of addiction.

Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment

Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960-2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30-40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70-100 kcal/kg/day can achieve a weight gain of 1-1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.

Self-reported sleep duration and weight-control strategies among U.S. high school students

STUDY OBJECTIVE

To determine if self-reported sleep duration was associated with weight-control behaviors among US high school students.

DESIGN

National Youth Risk Behavior Survey.

SETTING

United States, 2007.

PARTICIPANTS

US high school students (N = 12,087).

MEASUREMENTS

Students were asked if they had engaged in several weight-control behaviors during the 30 days before the survey to lose or maintain weight. Self-reported sleep duration categories included very short (≤ 5 h), short (6 or 7 h), referent moderate (8 or 9 h), and long (≥ 10 h). Sex-specific logistic regression analyses with race/ethnicity, grade, and body mass index category as covariates were conducted using SUDAAN to account for complex study design.

RESULTS

Approximately half the students reported short sleep duration (51.8% of males and 54.3% of females), whereas very short sleep durations were reported by another 14.8% of males and 16.9% of females. Among males, very short sleepers were significantly (P < 0.05) more likely than moderate sleepers to report dieting (36.3% versus 26.1%), fasting (14.2% versus 4.3%), and purging (4.3% versus 1.1%) to lose or maintain weight during the 30 days before the survey. Among females, the respective very short, short, and moderate sleepers varied (P < 0.05) in dieting (59.9%, 55.0%, and 47.5% respectively), fasting (28.3%, 15.2%, and 10.3%, respectively), and taking diet pills (13.3%, 6.8%, and 4.3%, respectively). Prevalence of purging was significantly higher only for very short sleepers (12.3%, 6.0%, and 3.9%, respectively).

CONCLUSION

Self-reported short sleep duration was associated with dieting and three unhealthy weight-control behaviors in this population. If our findings are confirmed, intervention studies should be conducted to examine the effect of educational interventions.

The clinical biochemistry of anorexia nervosa

In anorexia nervosa, under-nutrition and weight regulatory behaviours such as vomiting and laxative abuse can lead to a range of biochemical problems. Hypokalaemia is the most common electrolyte abnormality. Metabolic alkalosis occurs in patients who vomit or abuse diuretics and acidosis in those misusing laxatives. Hyponatraemia is often due to excessive water ingestion, but may also occur in chronic energy deprivation or diuretic misuse. Urea and creatinine are generally low and normal concentrations may mask dehydration or renal dysfunction. Abnormalities of liver enzymes are predominantly characterized by elevation of aminotransferases, which may occur before or during refeeding. The serum albumin is usually normal, even in severely malnourished patients. Amenorrhoea is due to hypogonadotrophic hypogonadism. Reduced concentrations of free T4 and free T3 are frequently reported and T4 is preferentially converted to reverse T3. Cortisol is elevated but the response to adrenocorticotrophic hormone is normal. Hypoglycaemia is common. Hypercholesterolaemia is a common finding but its significance for cardiovascular risk is uncertain. A number of micronutrient deficiencies can occur. Other abnormalities include hyperamylasaemia, hypercarotenaemia and elevated creatine kinase. There is an increased prevalence of eating disorders in type 1 diabetes and the intentional omission of insulin is associated with impaired metabolic control. Refeeding may produce electrolyte abnormalities, hyper- and hypoglycaemia, acute thiamin depletion and fluid balance disturbance; careful biochemical monitoring and thiamin replacement are therefore essential during refeeding. Future research should address the management of electrolyte problems, the role of leptin and micronutrients, and the possible use of biochemical markers in risk stratification.

Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: results of a case-control systemic research

This article presents the results of a broader clinical research into the effectiveness of integrated treatments in teenage eating disorders, carried out at the Complex Operative Unit of Psychotherapy (Unità Operativa Complessa or U.O.C.) of the Department of Psychiatric Sciences and Psychological Medicine in collaboration with the Department of Neuropsychiatric Science for Child Development (Dipartimento di Scienze Neuropsichiatriche dell'Età Evolutiva), both at the "La Sapienza" University of Rome. The hypothesis of this research project is that in diagnosticable situations such as anorexia or bulimia, an integrated and multidisciplinary treatment, which combines medical-nutritional interventions and family psychotherapy, allows better results than a single kind of treatment, which is the usual medical- nutritional intervention supported by psychiatric counselling. Twenty-eight cases (16 of bulimia and 12 of anorexia) were selected and then subdivided, with a randomized distribution, into two (experimental and control) homogeneous groups of 14 patients. The grouping variables were the diagnosis, the disorder's seriousness and duration, BMI, gender, age, family composition and social status. The variables which have been examined in this article are the clinical parameters, which were valuated in accordance with the DSM IV-TR criteria, and relational parameters which were explored through the use of the W.F.T. Test (Wiltwyck Family Tasks). These parameters were tested at beginning as well as at the end of the therapies, in both the experimental group and the control group. Statistical analysis has shown that the experimental group, which was followed with the integrated treatment, experienced a significant improvement of the parameters as related to dysfunctional family interaction modalities, and that this improvement was correlated to the positive evolution of the clinical parameters. This improvement was not present or not of the same degree in the control group. The results, moreover, demonstrate the effectiveness of an integrated systemic treatment based on a complex approach compared to a reductionist approach.

An examination of medical and psychological morbidity in adolescent males with eating disorders

The objective of this study was to examine the clinical profile of adolescent male patients presenting for eating disorder (ED) assessment over a 17-year period. A retrospective cohort study was completed. A total of 52 patients (8% of the total sample) were included in the study. The average age of patients was 14.7 years and the most common diagnosis observed was Eating Disorder Not Otherwise Specified (EDNOS). Rates of concurrent depression and anxiety were very high, as were rates of medical co-morbidity, including osteoporosis. Our study supports findings documented in previously published reports of males with eating disorders and adds to the limited knowledge base which targets adolescents specifically. Multi-center controlled trials are required to further investigate male-specific ED symptomatology, treatment courses, and outcomes.

The same but different? Treatment of anorexia nervosa in adolescents and adults

A significant number of patients with anorexia nervosa have to be transferred from child and adolescent mental health services (CAMHS) to adult services. CAMHS and adult services differ in terms of therapeutic approach and the availability of specialist treatment. CAMHS treatment is often based around family interventions, which aim to help parents take control of their child's eating, and patients are often encouraged to 'externalise' the illness. Adult treatment tends to be based around individual therapy, and the patient is encouraged to take personal responsibility for change. The place of inpatient treatment is generally accepted for adults but there is uncertainty about its effectiveness for adolescents. Young people may find it difficult to negotiate the transition between services, and CAMHS and adult services need to work more closely together. Transitions should be carefully planned, with thorough preparation of both patients and their families.

Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia?

PURPOSE

Concerns about refeeding syndrome have led to relatively conservative nutritional rehabilitation in malnourished inpatients with anorexia nervosa (AN), which delays weight gain. Compared to other programs, we aggressively refed hospitalized adolescents. We sought to determine the incidence of hypophosphatemia (HP) in 12-18-year-old inpatients in order to inform nutritional guidelines in this group.

METHODS

A 1-year retrospective chart review was undertaken of 46 admissions (29 adolescents) with AN admitted to the adolescent ward of a tertiary children's hospital. Data collected over the initial 2 weeks included number of past admissions, nutritional intake, weight, height, body mass index, and weight change at 2 weeks. Serum phosphorus levels and oral phosphate supplementation was recorded.

RESULTS

The mean (SD) age was 15.7 years (1.4). The mean (SD) ideal body weight was 72.9% (9.1). Sixty-one percent of admissions were commenced on 1,900 kcal (8,000 kJ), and 28% on 2,200 kcal (9,300 kJ). Four patients were deemed at high risk of refeeding syndrome; of these patients, three were commenced on rehydration therapy and one on 1,400 kcal (6,000 kJ). All patients were graded up to 2,700 kcal (11,400 kJ) with further increments of 300 kcal (1,260 kJ) as required. Thirty-seven percent developed mild HP; no patient developed moderate or severe HP. Percent ideal body weight at admission was significantly associated with the subsequent development of HP (p = .007).

CONCLUSIONS

These data support more aggressive approaches to nutritional rehabilitation for hospitalized adolescents with AN compared to current recommendations and practice.

Interaction between disinhibition and restraint: Implications for body weight and eating disturbance

An increase in obesity is usually accompanied by an increase in eating disturbances. Susceptibility to these states may arise from different combinations of underlying traits: Three Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition. Two studies were conducted to examine the interaction between these traits; one on-line study (n=351) and one laboratory-based study (n=120). Participants completed a battery of questionnaires and provided self-report measures of body weight and physical activity. A combination of high Disinhibition and high Restraint was associated with a problematic eating behaviour profile (EAT-26), and a higher rate of smoking and alcohol consumption. A combination of high Disinhibition and low Restraint was associated with a higher susceptibility to weight gain and a higher sedentary behaviour. These data show that different combinations of Disinhibition and Restraint are associated with distinct weight and behaviour outcomes.

Eating disorders in the obstetric and gynecologic patient population

The eating disorders anorexia nervosa and bulimia nervosa and eating disorders not otherwise specified disproportionately affect women, have profound effects on the overall well-being of women and their children, and can have mortality rates as high as those found with major depression. These disorders may present to obstetrician-gynecologists (ob-gyns) clinically as menstrual dysfunction, low bone density, sexual dysfunction, miscarriage, preterm delivery, or low birth weight in offspring. Ninety percent of eating disorders develop before the age of 25 in otherwise healthy young women, a group that characteristically seeks the majority of their health care from ob-gyns. For all of these reasons, ob-gyns must have a greater awareness of these disorders and a lower index of suspicion for screening their patients than they currently do. Otherwise, they may miss life-threatening illness, treat characteristic amenorrhea inappropriately, or inadvertently intervene to help these women conceive, contributing to maternal and fetal risks. As providers of both primary and specialty care for women, ob-gyns have the opportunity to play a vital role in prevention and diagnosis of eating disorders and in the multidisciplinary management required to effectively manage these disorders.

Comparison of eating attitudes between adolescent girls with and without Asperger syndrome: daughters' and mothers' reports

Despite the evidence that individuals with Asperger syndrome (AS) have a propensity for being underweight or having comorbid eating disorders, no previous research has compared the eating attitudes of adolescent girls with AS to typically developing peers. This study compared reports of eating problems provided by the adolescent girls themselves (56 with and 56 without AS) and their mothers on the EAT-26. Results indicated that adolescent girls with AS are at a higher risk for eating problems than their typically developing peers according to their reports and the reports of their mothers. Moreover, it was found that although the agreement between mothers' and daughter's reports is very satisfactory, mothers of girls with AS report statistically less eating-disordered behaviors than their daughters.

Low socioeconomic status predicts abnormal eating attitudes in Latin American female adolescents

The objective of this study was to study the proportion of Ecuadorian students fulfilling criteria on the Eating Attitudes Test (EAT) in relation to socioeconomic status. Seven hundred and twenty three female adolescent participants recruited from Quito, Ecuador were administered a brief questionnaire consisting of the EAT-40 as well as lifestyle questions. Mean EAT-40 score was 17.12, with 14% fulfilling criteria. Lower socioeconomic status and watching more television predicted higher scores; however BMI, age, and positive smoking status failed to correlate. The presently unvalidated Spanish version of the EAT-26 highly correlated with the validated EAT-40 (R=0.94). A higher than expected proportion of Ecuadorians are at risk for eating disorders, especially among lower socioeconomic groups. The EAT-26 should be considered for validation as a primary screening tool in Latin America.

Increasing rate of weight loss among schoolchildren, especially girls, in Sweden

PURPOSE

This study compared the rates of relative weight loss (body mass index, BMI) among boys and girls, from age 7 to 18 years, in two birth cohorts to determine changing patterns over time.

METHODS

Samples from two Swedish national birth cohorts, 1973 and 1981 (all children born on the 15th day of every month), with few missing cases (4.5% and 1.6%, respectively), were studied. Data (height and weight) were collected from school health records and analyzed longitudinally. Episodes of more than 5% reduction in BMI for 3530 boys and girls born in 1973 and 3041 boys and girls born in 1981 were analyzed and compared.

RESULTS

An increased rate in 1981 compared with 1973 of relative weight reduction episodes was found for both boys and girls. The increase for girls was most pronounced, started from a higher rate, and was seen in nearly all body weight categories and in all ages. For boys, the reductions increased for all body weight categories in the age interval 7-9 years; otherwise, the pattern was much more heterogeneous. Body weight and reduction of BMI were highly correlated in both cohorts, as more of the overweight than the thinner children reduced their BMI. For girls, the increase in rate reduction between 1981 and 1973 was highest among the thinnest individuals.

CONCLUSIONS

Both boys and, especially, girls had an increased rate of weight loss in two longitudinal cohorts. Whether healthy or unhealthy behavior is causing the increase needs to be investigated further.

Repetitive transcranial magnetic stimulation: A possible novel therapeutic approach to eating disorders

The two most common eating disorders, anorexia nervosa and bulimia nervosa, are characterized by aberrant eating patterns and disturbances in body image. Treatment involves combining individual, behavioural, group, and family therapies, possibly with medications. Studies have found that medication, chiefly antidepressants, could be of help in bulimia nervosa but the evidence is weaker for use in anorexia nervosa. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that briefly stimulates or depresses cortical areas within the brain. It has been used in the treatment of various psychiatric disorders, especially major depression, which is a condition that patients with eating disorders often experience as a significant comorbidity. Given that both disorders may share a common pathogenesis, this report proposes that rTMS may represent an alternative strategy for the treatment of eating disorders. Other evidence that supports this notion comes from animal studies that show that rTMS can change feeding behaviours and central neurotransmitters related to the regulation of eating behaviours. Further investigation into the dose, duration and type of rTMS stimulus is needed to verify the efficacy of this intervention in eating disorders.

Outcome predictors in the short-term treatment of anorexia nervosa: an integrated medical-psychiatric approach

OBJECTIVES

Factors predicting clinical outcome in the short-term treatment of anorexia nervosa.

DESIGN

Longitudinal follow-up study.

SETTING

Department of Clinical and Experimental Medicine, "Federico II" University of Naples.

PARTICIPANTS

Fifty-eight young anorectic women consecutively attending the outpatient Unit between January 1997 and December 2000.

MAIN OUTCOME MEASURES

Body weight changes over six months' follow-up.

RESULTS

Body weight changes in the short term was exclusively predicted by the prevalent underlying psychiatric disorder, being increased in the patients with prevalently depressive traits, decreased in those with psychotic features and unchanged in those with a prevalently narcissistic personality.

CONCLUSIONS

The prevalent psychiatric disorder seems to predict clinical outcome in the short term. Body weight gain per se cannot always be the main target of medical intervention, at least in the early phase of the treatment of malnutrition secondary to major eating disorders.

Social anxiety as a barrier to treatment for eating disorders

BACKGROUND

The goal of this pilot investigation is to determine the relationship between social anxiety and treatment-seeking behavior for eating disorders in an outpatient psychiatric clinic.

METHOD

Twenty-eight patients seeking treatment for anorexia or bulimia at an outpatient eating disorders clinic completed a battery of self-report measures on eating pathology, attachment style and functioning, and social anxiety at initial intake appointment. Levels of eating pathology and social anxiety at consult were compared with service utilization records on entry into treatment.

RESULTS

Individuals who did not engage in treatment had significantly higher levels of social anxiety (F = 8.29, df = 1, p < .05) compared with those who did engage in treatment. There were no differences in demographic characteristics, diagnoses, or level of eating pathology at intake.

CONCLUSIONS

Social anxiety may act as a barrier to effective help-seeking and utilization of mental health treatment among individuals with eating disorders. Replication of these findings in a larger sample and more in-depth study of the mechanism of the observed association between use of services and social anxiety may be useful in planning more effective outreach in the community to underserved populations in need of treatment for eating disorders.