Testing associations between assessments of cognitive flexibility and eating disorder symptoms in adolescent bulimia nervosa.

OBJECTIVE: Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision-making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents. METHODS: Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self-induced vomiting episodes (SVEs) at baseline and end-of-treatment (EOT). RESULTS: Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (𝛽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11-0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (𝛽 = 0.05, p = 0.005, 95% CI = [0.01-0.08]) positively associated with SVE frequency at EOT. DISCUSSION: The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes. PUBLIC SIGNIFICANCE: Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom-level outcomes. However, less flexible thinking at the start of treatment predicted self-induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN.

Perceptual Dysfunction in Eating Disorders.

Eating disorders (EDs) are characterized by abnormal responses to food and weight-related stimuli and are associated with significant distress, impairment, and poor outcomes. Because many of the cardinal symptoms of EDs involve disturbances in perception of one's body or abnormal affective or cognitive reactions to food intake and how that affects one's size, there has been longstanding interest in characterizing alterations in sensory perception among differing ED diagnostic groups. Within the current review, we aimed to critically assess the existing research on exteroceptive and interoceptive perception and how sensory perception may influence ED behavior. Overall, existing research is most consistent regarding alterations in taste, visual, tactile, and gastric-specific interoceptive processing in EDs, with emerging work indicating elevated respiratory and cardiovascular sensitivity. However, this work is far from conclusive, with most studies unable to speak to the precise etiology of observed perceptual differences in these domains and disentangle these effects from affective and cognitive processes observed within EDs. Further, existing knowledge regarding perceptual disturbances in EDs is limited by heterogeneity in methodology, lack of multimodal assessment protocols, and inconsistent attention to different ED diagnoses. We propose several new avenues for improving neurobiology-informed research on sensory processing to generate actionable knowledge that can inform the development of innovative interventions for these serious disorders.

Testing the role of associative learning in evidence-based treatments for anorexia nervosa.

Treatments for anorexia nervosa (AN) remain ineffective for many patients. Processes that can account for differential treatment outcomes remain mostly unknown. We propose that the field test the role of associative learning in current psychological treatments. We hold that this line of research could yield actionable information for understanding non-response and improving long-term outcomes. To make this argument, we define associative learning and outline its proposed role in understanding psychiatric disorders and their treatment. We then briefly review data exploring associative learning in AN. We argue that associative learning processes are implicitly implicated in existing treatments; by this rationale, baseline differences in learning may interfere with treatment response. Finally, we outline future research to test our hypotheses. Altogether, future research aimed at better understanding how associative learning may contribute to AN symptom persistence has the potential to inform novel directions in intervention research. PUBLIC SIGNIFICANCE: There is a pressing need to improve outcomes in treatments for anorexia nervosa (AN). We propose that individual differences in associative learning-the ability to form and update associations between cues, contexts, behaviors, and outcomes-may account for differential response to existing treatments. Undertaking this research could provide an understanding of how current treatments work and inform new approaches for those who may be at risk of poor outcomes.

Characterising use of recovery record among a large, transdiagnostic sample of adults with eating disorders across higher levels of care.

OBJECTIVE: Smartphone applications (i.e., apps) designed to target mental health symptoms have received increasing public and empirical attention, including in eating disorder|eating disorders (EDs) treatment. While some data have begun to characterise app users in non-controlled settings, there is limited information on use of apps in higher levels of care (e.g., partial hospitalisation or residential treatment programs) for EDs. METHOD: This study aimed to explore metrics of use while in treatment for a commonly used ED-focused mobile app (Recovery Record) among individuals enroled in intensive outpatient, partial hospitalisation, residential, or inpatient treatments (N = 2042). RESULTS: Results indicated that older individuals and participants with binge eating disorder demonstrated more frequent app engagement compared to younger participants and other ED diagnoses, respectively. Individuals entering at intensive outpatient and partial hospitalisation levels of care, as well as those with routine discharges engaged more frequently with RR compared to individuals entering in inpatient or residential treatment, and those with non-routine discharges. CONCLUSIONS: Our data provide initial descriptions of how RR may be used within higher levels of care for adults with EDs. Further work is needed to establish the benefit of these apps in clinical settings for EDs over and above standard treatment, better characterise for whom these apps provide benefit, and identify how best to tailor the experience to promote engagement across the full spectrum of ED patients.

Effects of borderline personality disorder symptoms on dialectical behavior therapy outcomes for eating disorders.

Existing literature on the effects of borderline personality disorder (BPD) and eating disorder (ED) comorbidity in terms of clinical presentation and treatment outcome has been limited and inconclusive. The present study examined whether clients with EDs and varying levels of BPD symptoms presented with more severe ED symptoms at admission, and whether they responded to dialectical behavior therapy (DBT)-based treatment. Participants (N = 176) were adults in a DBT-based partial hospitalization program for EDs at an academic medical center. Participants completed self-report measures at admission, 1-month postadmission, discharge, and 6-month follow-up. Results suggested that patients with elevated BPD symptoms at admission had greater ED symptoms during treatment, evidenced by small to moderate effect sizes. However, patients with high BPD symptoms demonstrated steeper declines in binge eating, fasting, and parasuicidal behavior early during treatment compared to patients with low BPD symptoms. Individuals with high BPD symptoms at admission (i.e., probable BPD diagnosis) were as likely to meet remission criteria and relapse as individuals with low BPD symptoms, though this null finding may be influenced by small cell sizes. Our findings also suggest that DBT skills use does not predict changes in symptoms. In sum, our findings suggest that while clients with higher BPD symptoms may improve during DBT-based partial hospitalization, their ED symptoms may remain more severe. Future studies are needed to determine whether adjunctive treatments improve outcomes for clients with EDs and comorbid BPD symptoms in DBT programs and whether skills use quality is a better predictor of ED symptom changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Modification of an inpatient medical management protocol for pediatric Avoidant/Restrictive Food Intake Disorder: improving the standard of care.

BACKGROUND: No guidelines currently exist that represent a standardization of care for Avoidant/Restrictive Food Intake Disorder (ARFID) on an inpatient service. Unique features of this diagnosis (e.g., sensory sensitivity contributing to involuntary emesis) suggest that established protocols that were developed for anorexia nervosa might be less effective for adolescents with ARFID. To inform improved inpatient medical stabilization and care for these patients, we first provide an overview of clinical characteristics for patients with ARFID who presented to a pediatric hospital for inpatient eating disorder care. We use these descriptives to outline the rationale for, and executions of, modifications to an inpatient protocol designed to flexibly meet the needs of this clinical population. METHODS: Chart review with descriptive statistics were conducted for patients who had received an ARFID diagnosis from March 2019 to March 2023 (N = 32, aged 9-23). We then present a case series (n = 3) of adolescents who either transitioned to a novel adjusted protocol from an original standard of care on the inpatient service, or who received only the standard protocol. RESULTS: The sample was aged M(SD) = 15.6 (3.3) years, 53% male, and a majority (69%) presented with the ARFID presentation specific to fear of negative consequences. On average, patients had deviated from their growth curve for just over two years and presented with mean 76% of their estimated body weight. Of those requiring nasogastric tube insertion during admission (n = 8, 25%), average duration of tube placement was 15 days. From within this sample, case series data suggest that the adjusted protocol will continue to have a positive impact on care trajectory among adolescents admitted for ARFID including improved weight gain, reduction of emesis, and improved food intake. CONCLUSIONS: Findings demonstrate the likely need to tailor established medical inpatient protocols for those with ARFID given different symptom presentation and maintenance factors compared to patients with anorexia nervosa. Further research is warranted to explore the longer-term impact of protocol changes and to inform standardization of care for this high priority clinical population across care sites.

No current standard of care exists for pediatric patients with Avoidant/Restrictive Food Intake Disorder (ARFID) who are hospitalized for medical stabilization related to complications secondary to malnutrition. Clinical features of this diagnosis (e.g., sensory sensitivity) suggest that existing treatment protocols developed for patients with other restrictive eating disorders, like anorexia nervosa, may be less effective for patients with ARFID. This study first describes a pediatric sample of patients with ARFID upon admission to an inpatient service. Then, a case series is used to illustrate the potential benefits of using an adjusted protocol that was modified to better suit the needs of children and adolescents with ARFID. Findings support future study of the proposed adjusted protocol and may inform future standardization of improved care for this high priority clinical population.

An exploration of the association between premorbid weight status on patient and caregiver factors at pre and post-treatment among youth with anorexia nervosa/atypical anorexia nervosa.

Patients with atypical anorexia nervosa (AAN) or anorexia nervosa (AN) with premorbid history of higher weight (PHW; median BMI ≥ 85th %ile) may report greater eating disorder (ED) pathology, anxiety, and depression, than patients with premorbid history of lower weight (PLW; mBMI <85th %ile). Less is known about caregiver attitudes or treatment outcome related to premorbid weight history. The current study examined associations between premorbid weight history and patient/caregiver factors at presentation, during treatment, and end of treatment among adolescents (N = 138) diagnosed with AN/AAN and their caregivers who received interdisciplinary ED treatment. The sample comprised adolescents with PHW (n = 58, 40.6 %) or PLW (n = 82, 59.4 %). Adolescents with PHW did not differ with regard to patient- or caregiver-reported ED symptoms, comorbid psychopathology, rates of treatment completion, and attainment of estimated body weight compared to PLW (ps > .05). Adolescents with PHW (vs. PLW) were more likely to be diagnosed with AAN (67.9 %, p < .001), identify as cisgender male (p < .001) and to have lost more weight prior to presentation (p < .001). Perceived caregiver burden was lower among adolescents with PHW vs. PLW (p < .001). Further research should expand on this preliminary study exploring associations between premorbid weight history on patient and caregiver factors at treatment presentation and conclusion to enhance the efficacy of evidence-based treatment across the weight-spectrum.

Back to the future: Progressing memory research in eating disorders.

OBJECTIVE: Human behaviors, thoughts, and emotions are guided by memories of the past. Thus, there can be little doubt that memory plays a fundamental role in the behaviors (e.g., binging), thoughts (e.g., body-image concerns), and emotions (e.g., guilt) that characterize eating disorders (EDs). Although a growing body of research has begun to investigate the role of memory in EDs, this literature is limited in numerous ways and has yet to be integrated into an overarching framework. METHODS: In the present article, we provide an operational framework for characterizing different domains of memory, briefly review existing ED memory research within this framework, and highlight crucial gaps in the literature. RESULTS: We distinguish between three domains of memory-episodic, procedural, and working-which differ based on functional attributes and underlying neural systems. Most recent ED memory research has focused on procedural memory broadly defined (e.g., reinforcement learning), and findings within all three memory domains are highly mixed. Further, few studies have attempted to assess these different domains simultaneously, though most behavior is achieved through coordination and competition between memory systems. We, therefore, offer recommendations for how to move ED research forward within each domain of memory and how to study the interactions between memory systems, using illustrative examples from other areas of basic and clinical research. DISCUSSION: A stronger and more integrated understanding of the mechanisms that connect memory of past experiences to present ED behavior may yield more comprehensive theoretical models of EDs that guide novel treatment approaches. PUBLIC SIGNIFICANCE: Memories of previous eating-related experiences may contribute to the onset and maintenance of eating disorders (EDs). However, research on the role of memory in EDs is limited, and distinct domains of ED memory research are rarely connected. We, therefore, offer a framework for organizing, progressing, and integrating ED memory research, to provide a better foundation for improving ED treatment and intervention going forward.

The impact of social media use on body image and disordered eating behaviors: Content matters more than duration of exposure.

Social media use is rapidly expanding in terms of frequency, duration, and the diversity of platforms available. Given evidence for associations between social media use, body image disturbances, and disordered eating it is important to identify potentially harmful aspects of social media use that could serve as intervention targets. This study surveyed two demographically diverse undergraduate student cohorts in 2015 and 2022 to compare patterns in social media use, body image, and disordered eating behaviors between samples, including as a function of the COVID-19 pandemic, and to test the hypothesized moderating role of specific content consumed in the association between social media use and maladaptive outcomes. Participants in 2022 reported greater body image disturbances, more frequent vomiting and laxative use, and more time spent on a greater number of social media accounts, with significantly greater use of image-based platforms such as Snapchat, TikTok, and YouTube. Moderated regression analyses suggest that type of content consumed, but not the amount of time spent on social media or diversity of platforms utilized, is associated with body image disturbances and disordered eating behaviors after controlling for gender and body mass index. Specifically, exposure to weight loss content was associated with lower body appreciation, greater fears of negative appearance evaluation, and more frequent binge eating. Contrary to initial hypotheses, exposure to body positivity/neutrality content did not have protective effects. Findings suggest that interventions targeting negative consequences of social media use should focus on addressing content consumed, rather than time spent on social media platforms.

Predictors of Treatment Outcome in Eating Disorders: A Roadmap to Inform Future Research Efforts.

PURPOSE OF REVIEW: With the current review, we provide a brief summary of recent literature that tests clinically observable characteristics at baseline that may impact treatment response, across eating disorder diagnoses. We then provide a critical discussion regarding how researchers may shift their approach to this research to improve treatment implications and generalizability of these findings. RECENT FINDINGS: Recent work has broadly replicated prior findings suggesting a negative impact of lower weight status, poor emotion regulation, and early-life trauma on eating disorder treatment outcomes. Findings are more mixed for the relative contributions of illness duration, psychiatric comorbidity, and baseline symptom severity. Recent studies have begun to explore more specific domains of previously tested predictors (e.g., specific comorbidities) as well as previously neglected identity-related and systemic factors. However, recent research continues to use similar sampling techniques and approaches to analysis used in prior work. We propose that resolving remaining questions and illuminating predictors of treatment outcome in eating disorders requires a new approach to research sampling and study design. Suggested changes that can be applied within a traditional clinical trial framework may yield new insights with relevance across transdiagnostic eating disorder presentations.

Open Science in eating disorders: Using current evidence to inspire a plan for increasing the transparency of our research.

OBJECTIVE: There is increasing consensus that open science practices improve the transparency and quality of clinical science. However, several barriers impede the implementation of these practices at the individual, institutional, and field levels; understanding and addressing these barriers is critical to promoting targeted efforts in increasing effective uptake of open science. METHODS: Within this research forum, we drew from publicly available online information sources to identify initial characterizations of researchers engaged in several types of open science practices in the field of eating disorders. We use these observations to discuss potential barriers and recommendations for next steps in the promotion of these practices. RESULTS: Data from online open science repositories suggest that individuals using these publishing approaches with pre-prints and articles with eating-disorder-relevant content are predominantly non-male gender identifying, early to mid-career stage, and are more likely to be European-, United States-, or Canada-based. DISCUSSION: We outline recommendations for tangible ways that the eating disorder field can support broad, increased uptake of open science practices, including supporting initiatives to increase knowledge and correct misconceptions; and prioritizing the development and accessibility of open science resources. PUBLIC SIGNIFICANCE STATEMENT: The use of open science practices has the potential to increase the transparency and quality of clinical science. This Forum uses publicly sourced online data to characterize researchers engaged in open science practices in the field of eating disorders. These observations provide an important framework from which to discuss potential barriers to open science and recommendations for next steps in the promotion of these practices.

Examination of bidirectional relationships between fear of negative evaluation and weight/shape concerns over 3 years: A longitudinal cohort study of Australian adolescents.

OBJECTIVE: Adolescents commonly experience both fear of negative evaluation and weight/shape concerns. However, evidence concerning the prospective associations between these constructs during adolescence is limited. The current study examined the bidirectional relationships between fear of negative evaluation and weight/shape concerns over a 3-year period in adolescents. METHOD: Australian high school students (n = 2073; 55% girls) completed self-report measures at three timepoints, each 1 year apart. RESULTS: Findings showed a bidirectional relationship, whereby increases in fear of negative evaluation predicted exacerbated weight/shape concerns, and vice versa. Results point towards a vicious maintenance cycle between fear of negative evaluation and weight/shape concerns. DISCUSSION: Findings from the current study highlight the importance of considering both fear of negative evaluation and weight/shape concerns in the development of health promotion and prevention programs designed to reduce the occurrence and adverse effects of body dissatisfaction or improve general mental health. PUBLIC SIGNIFICANCE: Many adolescents experience some level of fear of negative evaluation (i.e., worry about being judged by others) and worry about their weight and/or shape. This study examined the prospective relationship between both constructs. Findings showed a bidirectional relationship, whereby higher fear of negative evaluation predicted increased weight/shape concerns, and vice versa. Programs designed to reduce body dissatisfaction might be improved by targeting both fear of negative evaluation and weight/shape concerns.

Integrating evidence-based PTSD treatment into intensive eating disorders treatment: a preliminary investigation.

PURPOSE: Given data suggesting common co-occurrence and worse outcomes for individuals with eating disorders (EDs) and post-traumatic stress disorder (PTSD), it is critical to identify integrated treatment approaches for this group of patients. Past work has explored the feasibility and initial efficacy of intervention approaches that draw on evidence-based treatments for both EDs and PTSD; however, this work remains limited in scope. In the current study, we explored the feasibility and naturalistic outcomes of PTSD treatment delivered within the context of intensive ED treatment. METHOD: Participants were 57 adult men and women with DSM-5 EDs and comorbid PTSD who completed a course of either Prolonged Exposure (PE; n = 22) or Cognitive Processing Therapy (CPT; n = 35) (Msessions = 10.40; SD = 5.13) and weekly validated measurements of clinical symptoms while enrolled in ED programming. RESULTS: Multi-level models for PTSD symptoms indicated a significant linear effect of time, such that participants demonstrated significant decreases over time in PTSD symptoms, regardless of treatment modality. CONCLUSION: Our preliminary investigation provides support for the feasibility and efficacy of an integrated approach to treating EDs and PTSD. It is critical for future work to undertake randomized tests of this integrated approach using large, heterogeneous samples. LEVEL OF EVIDENCE: Level IV, multiple time series with intervention.

Anticipatory and consummatory pleasure in eating disorders.

BACKGROUND: Recent research suggests that anhedonia, or the inability to experience pleasure, is elevated in individuals with eating disorders (EDs). However, past literature has only studied anhedonia in EDs as a unidimensional construct rather than separately examining anticipatory (i.e., prediction of pleasure for a future event) and consummatory (i.e., enjoyment of a present event) pleasure. Given that these subcomponents of pleasure have distinct neurobiological correlates, studying pleasure as a multifaceted construct may yield important insights into the underlying mechanisms of binge eating or food restriction. METHODS: A sample of 124 women with anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorder and 84 control women (CW) completed self-report measures of anticipatory pleasure, consummatory pleasure, ED symptoms, depression, harm avoidance, and anxiety. RESULTS: Individuals with EDs endorsed significantly lower anticipatory pleasure than CW, but there were no significant group differences in consummatory pleasure. Further, there were no significant differences in self-reported pleasure among ED diagnostic groups. Within the ED sample, anticipatory pleasure but not consummatory pleasure was positively related to binge eating frequency and significantly negatively correlated with cognitive ED symptoms, state and trait anxiety, and harm avoidance. Both anticipatory and consummatory pleasure was negatively associated with depression. CONCLUSION: The results of the current study suggest that lower pleasure across the ED spectrum may be due to deficits in anticipatory, but not consummatory, pleasure. Future research should continue to explore the behavioral, affective, and neural correlates of anticipatory pleasure in EDs to characterize better how it relates to the onset and maintenance of binge eating and other eating disorder pathology.

Anhedonia, or the inability to experience pleasure, has been observed in individuals with eating disorders. Neuroscience research suggests that pleasure may be separated into two distinct components: anticipatory pleasure (how much someone predicts they will enjoy a future experience) and consummatory pleasure (how much someone enjoys a present experience). In the current study, individuals with eating disorders and healthy controls completed questionnaires assessing anticipatory and consummatory pleasure, binge eating, other eating disorder behaviors, depression, anxiety, and constructs associated with reward and punishment sensitivity. The sample with eating disorders reported significantly lower anticipatory but not consummatory pleasure than the control sample. Within the eating disorder sample, greater anticipatory pleasure was also related to higher binge eating frequency but lower depression, anxiety, and weight and shape concerns. These results suggest that anticipatory pleasure may be particularly important in future research on the etiology and treatment of eating disorders.

Exploring the contributions of affective constructs and interoceptive awareness to feeling fat.

PURPOSE: Feeling fat, a subjective feeling of being overweight that does not always correspond to actual body weight, is commonly reported in patients with an eating disorder. Research suggests that feeling fat relates to deficits in interoceptive awareness, the perception and integration of signals related to body states. Relatedly, recent work has linked feeling fat to affective constructs, such as depressive symptoms and guilt. The current study explores the unique relationships between feeling fat, self-reported, and objective IA, guilt, alexithymia, and depressive symptoms. METHOD: Female undergraduates (N = 128) completed the 11th item of the Eating Disorder Examination Questionnaire, the Toronto Alexithymia Scale, the Guilt subscale of the Positive and Negative Affect Schedule, and the Beck Depression Inventory-II. Participants also completed two IA measures: a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness. RESULTS: All collected measures explained 56% of the variability in feeling fat. Depressive symptoms, self-reported IA, and BMI accounted for significant variability in feeling fat. Relative weights analyses revealed that depressive symptoms accounted for the most variability in feeling fat (19%). This finding remained significant after controlling for BMI, which also accounted for significant variability in feeling fat (25%). CONCLUSIONS: Our results replicate previous findings that depressive symptoms relate significantly to feeling fat and extend this work by incorporating the role of interoceptive awareness, guilt, and alexithymia. Endorsement of feeling fat during an intake assessment may alert clinicians to assess for depressive symptoms, and focusing on depressive symptoms in treatment may improve feeling fat. LEVEL OF EVIDENCE: Level I Evidence obtained from an experimental study.

Associations of suicide risk with emotional reactivity, dysregulation, and eating disorder treatment outcomes.

INTRODUCTION: Emotional processes play a role in both suicide risk and eating disorders (EDs), which are often comorbid. However, limited research has explored how emotional processes relate to suicide risk in EDs and the prognostic value of suicide risk for ED treatment. Thus, the current study examined associations between emotion dysregulation and reactivity with suicide risk in patients with EDs, and determined if suicide risk predicts ED treatment outcomes. METHODS: Participants (n = 201) were adults in an ED partial hospitalization program who completed measures at admission, 1-month post-admission, and discharge. RESULTS: When controlling for depressive symptoms, limited access to adaptive emotion regulation strategies, difficulties engaging in goal-oriented behaviors, and engaging in impulsive behavior when experiencing negative emotions (i.e., emotion dysregulation) were associated with suicide attempt frequency. Depressive symptoms were associated with suicide risk severity, while emotion dysregulation and reactivity were not. Importantly, patients with elevated suicide risk at admission improved comparably to other risk categories across treatment, despite presenting with greater ED symptoms at admission. CONCLUSION: Emotion dysregulation and depression are salient factors when examining suicide risk in patients with EDs. Suicide risk and attempt history may not negatively impact ED treatment outcomes when using emotion-focused treatment.

Characterizing changes in obsessive-compulsive symptoms over the course of treatment for adolescent bulimia nervosa.

OBJECTIVE: Data suggest that obsessive-compulsive (OC) symptoms are commonly observed in adolescents with eating disorders and predict poorer treatment response. Further, emerging data among adults suggest that changes in OC symptoms relate to changes in eating disorder symptoms across treatment. Given evidence that early invention decreases risk for protracted illness, evaluating processes that may relate to treatment response will be useful in increasing the effectiveness of existing interventions. Therefore, the current investigation explored changes in general and eating disorder-specific OC symptoms throughout family-based treatment (FBT) and cognitive behavioral therapy (CBT) for bulimia nervosa (BN), as well as associations among these changes and eating disorder outcomes at follow-up. METHOD: Participants (N = 110) received 18 sessions of FBT or CBT and completed measurements of general and eating disorder-specific OC symptoms at baseline, end-of-treatment, and 6- and 12-month follow-up. RESULTS: Multilevel models indicated that across both treatments, there was no change in general OC symptoms, whereas all eating disorder-related OC symptoms decreased over treatment and follow-up. Exploratory analyses indicated that lower severity in discharge eating-disorder-specific OC symptoms contributed to lower eating pathology at follow-up. DISCUSSION: Together, findings support the efficacy of both FBT and CBT in helping to reduce eating disorder-specific OC symptoms and suggest that adjunctive intervention may be required for ameliorating general OC symptoms in this population. PUBLIC SIGNIFICANCE: BN is associated with significant increases in mortality and societal cost, and there is a pressing need for innovations within available treatments for young people with this disorder. In the current study, we explore the extent to which existing evidence-based treatments for adolescent BN are effective in targeting obsessive-compulsive symptoms, a known predictor of treatment response and common co-morbidity in this population.

Use of Telehealth in the Management of Adolescent Eating Disorders: Patient Perspectives and Future Directions Suggested from the COVID-19 Pandemic.

Efforts to increase accessibility of eating disorder (ED) treatment via telemedicine have been ongoing for the past decades. However, there has been a recent surge in research focused on remote delivery of interventions since the onset of the novel coronavirus pandemic (COVID-19) in 2020, the related lockdowns, and an exponential increase in ED symptoms in youth secondary to the pandemic worldwide. In the current review, we provide a focused summary of existing literature regarding telehealth for the treatment of EDs in adolescents using a frame of past, present, and future work. Specifically, we begin with a brief overview of research in remote delivery for EDs in youth prior to 2020. Then, we detail more recent studies in this domain, with a focus on research conducted during the COVID-19 pandemic. We close by outlining limitations of the existing data and future steps necessary to expand the rigor and impact of this work. Overall, there are considerable limitations associated with research conducted during the pandemic, but an increase in the acceptability of remote delivery methods and interest in hybrid care appears to be feasible, and likely to be lasting. Future work must replicate more recent research in non-pandemic contexts and prioritize evaluation of factors that will aid in matching patients to the most efficient and effective modalities of care moving forward.

Exploring the role of disgust sensitivity and propensity in selective eating.

While disgust is a clinically and theoretically relevant construct for selective eating, limited research has examined how different aspects of disgust relate to selective eating severity in adults. Thus, the present study sought to 1) compare disgust propensity (how easily people are disgusted) and disgust sensitivity (how unpleasant disgust is) across a spectrum of selective eaters, 2) explore the specificity of the associations between disgust sensitivity/propensity and selective eating across selective eating and related phenotypes, and 3) explore whether the relationship between selective eating and disgust is food-specific. Participants were 554 adults recruited on Amazon's Mechanical Turk who completed cross-sectional surveys on study constructs. The sample was recruited to over-represent individuals with high levels of selective eating. Results support that disgust propensity, but not sensitivity, was elevated in the impaired selective eating group compared to non-impaired selective eaters and non-selective eaters. Only the selective eating phenotype was independently associated with both disgust sensitivity and propensity. Correlation results supported that the associations between selective eating and disgust were specific to the disgust elicited by food (i.e., animal protein, fruits, vegetables). Overall, results support that disgust propensity and disgust sensitivity play a role in selective eating. Results imply that disgust sensitivity associated with selective eating appears limited to the food domain and may be more specific to disgust eliciting food itself, rather than signs of food contamination or spoilage.

Evaluating the use of lamotrigine to reduce mood lability and impulsive behaviors in adults with chronic and severe eating disorders.

BACKGROUND: Gold-standard psychological and pharmacological treatments for bulimic-spectrum eating disorders only result in remission for around 50% of patients; patients with affective lability and impulsivity represent a subgroup with particularly poor outcomes. Both dialectical behavior therapy (DBT), a treatment for emotion dysregulation, and lamotrigine, a mood stabilizer, have demonstrated promise for targeting affective lability and impulsivity; however, data exploring the combination of these interventions remain limited. OBJECTIVE: We followed a group of women with recurrent dysregulated eating behaviors (N = 62) throughout intensive DBT treatment and compared the symptom trajectory of those prescribed lamotrigine (n = 28) and those who were not (n = 34). METHOD: Participants completed surveys every 2 weeks throughout treatment. RESULTS: Group analyses suggested that all participants self-reported decreases in emotional reactivity, negative urgency, and symptoms of borderline personality disorder (BPD). The lamotrigine group reported greater elevations in BPD symptoms at baseline, but demonstrated steeper decreases in emotion and behavioral dysregulation than the non-matched comparison group. Within-subject analyses suggested that within the lamotrigine group, subjects reported greater decreases in symptoms following prescription of lamotrigine. CONCLUSIONS: Findings provide initial data suggesting that lamotrigine could be useful as an adjunctive treatment for patients with affective lability and impulsivity. LEVEL OF EVIDENCE: IV, time series without randomization.