Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study

BACKGROUND

Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study aimed to identify potential differences in the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, in order to contribute to a better understanding of their diverse needs and experiences.

METHODS

The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 years) with bulimia nervosa or binge-eating disorder (BN/BED) enrolled in the Binge Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and their current mental health and gastrointestinal symptoms. Untreated participants (n = 291, 38%) were compared with treated participants (n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives.

RESULTS

Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent eating disorder symptoms over their lifetime, and greater body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. A history of anorexia nervosa was positively associated with treatment engagement. Individuals self-reporting a history of inpatient or residential treatment exhibited the most severe illness history, those with outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history.

CONCLUSIONS

Historically overlooked and marginalized populations self-reported lower treatment access rates, while those who accessed treatment reported more severe eating disorder and comorbid mental health symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not represent individuals with milder symptoms or racial and ethnic diversity, and males. Community-based recruitment is crucial for improving the ability to apply research findings to broader populations and reducing disparities in medical research. Trial Registration ClinicalTrials.gov NCT04162574 ( https://clinicaltrials.gov/ct2/show/NCT04162574 ).

Binge-eating disorder with and without lifetime anorexia nervosa: A comparison of sociodemographic and clinical features

OBJECTIVE

To compare individuals who have experienced binge-eating disorder (BED) and anorexia nervosa (AN) (BED AN+) to those who have experienced BED and not AN (BED AN-).

METHOD

Participants (N = 898) met criteria for lifetime BED and reported current binge eating. Approximately 14% had a lifetime diagnosis of AN. Analyses compared BED AN+ and BED AN- on sociodemographic variables and clinical history.

RESULTS

The presence of lifetime AN was associated with more severe eating disorder symptoms, including earlier onset, more frequent, more chronic, and more types of eating disorder behaviors over the lifetime, as well as a higher lifetime prevalence of bulimia nervosa (BN). Participants with lifetime AN reported being more likely to have received treatments for BED or BN, had significantly lower minimum, current, and maximum BMIs, had more severe general anxiety, and were significantly more likely to be younger and female. In the full sample, the lifetime prevalence of unhealthy weight control behaviors was high and treatment utilization was low, despite an average 15-year history since symptom onset. Gastrointestinal disorders and comorbid anxiety, depression, and attention-deficit/hyperactivity disorder symptoms were prevalent.

DISCUSSION

Individuals fared poorly on a wide array of domains, yet those with lifetime AN fared considerably more poorly. All patients with BED should be screened for mental health and gastrointestinal comorbidities and offered referral and treatment options.

PUBLIC SIGNIFICANCE

Individuals experiencing binge-eating disorder have severe symptomology, but those who have experienced binge-eating disorder and anorexia nervosa fare even more poorly. Our study emphasizes that patients with binge-eating disorder would benefit from being screened for mental health and gastrointestinal comorbidities, and clinicians should consider history of unhealthy weight control behaviors to inform treatment and relapse prevention.

Recommendations to encourage participation of individuals from diverse backgrounds in psychiatric genetic studies

We present innovative research practices in psychiatric genetic studies to ensure representation of individuals from diverse ancestry, sex assigned at birth, gender identity, age, body shape and size, and socioeconomic backgrounds. Due to histories of inappropriate and harmful practices against marginalized groups in both psychiatry and genetics, people of certain identities may be hesitant to participate in research studies. Yet their participation is essential to ensure diverse representation, as it is incorrect to assume that the same genetic and environmental factors influence the risk for various psychiatric disorders across all demographic groups. We present approaches developed as part of the Eating Disorders Genetics Initiative (EDGI), a study that required tailored approaches to recruit diverse populations across many countries. Considerations include research priorities and design, recruitment and study branding, transparency, and community investment and ownership. Ensuring representation in participants is costly and funders need to provide adequate support to achieve diversity in recruitment in prime awards, not just as supplemental afterthoughts. The need for diverse samples in genetic studies is critical to minimize the risk of perpetuating health disparities in psychiatry and other health research. Although the EDGI strategies were designed specifically to attract and enroll individuals with eating disorders, our approach is broadly applicable across psychiatry and other fields.

For better or worse: Associations among psychopathology symptoms, interpersonal emotion dynamics, and gender in couples

Communication has long been associated with the well-being of a couple's relationship, and it is also important to explore associations with individual well-being. This study examined the associations between emotions communicated within couple interactions and each partner's psychopathology symptoms concurrently and up to 3 years later. Vocally-encoded emotional arousal (f₀) was measured during couples' (N = 56) conversations. Analyses examined each partner's trajectories of f₀ and how each partner influenced the other's f₀ across the conversation. The findings indicated that women experienced higher symptoms if they (a) decreased more steeply in f₀ overall and (b) returned to their baseline in f₀ more quickly. Moreover, women had higher symptoms if they had a steeper return to baseline because of men's elevated f₀. In contrast, men experienced higher symptoms when men (a) more slowly returned to baseline and (b) changed their f₀ trajectory because of women's elevated f₀. That is, women who expressed less emotional arousal, independently and as a result of the influence of their male partner, experienced more symptoms. In contrast, men's symptoms were differentially associated with their own independent experience of emotional arousal (in which he experienced fewer symptoms when changing arousal more quickly) from how they responded to women's arousal. Given how differently men's and women's psychopathology were associated with emotional expression, these findings raise questions about how partners can communicate to protect their own and their partner's mental health in the short- and long-term. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive-behavioral couple therapy for same-sex female couples: A pilot study

Despite comparable levels of relationship satisfaction and intimacy, same-sex couples break up faster and more often than different-sex couples, highlighting a need for quality couple therapy. Research suggests that culturally tailored services are desired by same-sex couples and may be more effective and better received. Although efficacious couple therapies exist to treat relationship distress, they have been overwhelmingly studied with different-sex couples. Sexual minority (SM) affirming couple therapies have not been systematically developed or evaluated. The current study involved developing and pilot testing a couple therapy tailored for distressed same-sex female couples. This treatment integrates the SM stress model with the empirically supported cognitive-behavioral couple therapy framework and is the first culturally tailored couple therapy for same-sex couples to be empirically evaluated. Therapists delivered the treatment in an open-trial format to a pilot sample of 11 same-sex female couples experiencing relationship distress and SM stress. Treatment was delivered with high adherence to the treatment manual. Participants reported high treatment satisfaction. As hypothesized, participants experienced significant decreases in relationship distress and improvements in couple coping with SM stress from pre- to post-therapy. Limitations precluded clear conclusions regarding anticipated improvements in individual mental health. Participants experienced comparable or stronger improvements in relationship functioning compared to couples in a similar benchmark study. Given this is a small pilot study, results are interpreted with caution. Implications for culturally tailoring evidence-based couple therapy for marginalized groups are discussed.

Love in the time of COVID-19: A brief report on relationship and individual functioning among committed couples in the United States while under shelter-in-place orders

The COVID-19 pandemic in the United States has changed many aspects of people's daily life, including increased time at home in response to shelter-in-place orders, heightened stress about health effects of COVID-19, and shifts in other domains of life (e.g., employment). These lifestyle changes are likely to impact the well-being of individuals and their romantic relationships. This investigation examined how COVID-19 influenced couple and individual well-being in real-time during the early phase of the pandemic. Data were collected in early May 2020 during shelter-in-place orders in the United States. Participants in committed relationships (n = 332) completed an online survey assessing their experiences currently and before the pandemic. Results suggested that while couple functioning overall maintained or even improved, individual well-being was more negatively impacted by the pandemic. Moreover, some groups who are at higher risk of a poor health outcome from COVID-19 or experience unique challenges as a result of COVID-19 reported worse outcomes (e.g., those whose employment changed) while others did not decline in their psychological and couple functioning (e.g., Black individuals and older individuals). These findings suggest that the pandemic has had varied impacts on couples and individuals, as well as across different virus-related risk factors. Further research is needed to understand the nuanced effects of this pandemic on couples and individuals across time.

A South African Couple-Based HIV Prevention Program: Preliminary Evidence of the Long-Term Effects

The goal of our study was to provide qualitative data on the long-term effects of a couple-based HIV prevention program, the Couples Health Co-Op (CHC), in South Africa. Qualitative focus group discussions were conducted with nonrandomly selected Black South African men (n = 27) and women (n = 23) who had participated in the Couples Health Co-Op 4 to 6 years prior to our study. The study evaluated: (a) salient content and skills learned, (b) long-term changes and challenges, and (c) recommendations for intervention improvement. Findings revealed (a) communication/problem-solving, safe sexual behaviors, and negative effects of alcohol were most salient; (b) long-term changes occurred in communication and healthier sexual behavior; alcohol use remained challenging; and (c) participants recommended continuing the couple format and suggested targeting teenage couples. We offer preliminary evidence of the strengths and weaknesses of the Couples Health Co-Op and provide a basis for future studies to build on these results.