Taking a Global View of the OSFED Category From Inside and Outside the DSM-5: Comment on Dang et al. 2024.

This Commentary discusses the findings of Dang et al.'s systematic review and metanalysis on the "Other Specified Feeding or Eating Disorder" (OSFED) category in the context of current conceptualizations and main international diagnostic schemes of classification, the DSM-5 and the ICD-11. The aim to reduce less specified eating disorder categories in these classifications has not been completely achieved and OSFED cases remain prevalent. Different definitions of OSFED contribute to difficulties in study selection and limitation of data aggregation in metanalysis, highlighting the need for improving methodologies for studying OSFED subtypes. Although use of either the DSM-5 or ICD-11 scheme concurs with Dang et al.'s main finding that OSFED comprises categories of similar clinical significance to the recognized eating disorders, the ICD-11 includes more people with anorexia nervosa, bulimia nervosa, or binge-eating disorder who would receive a DSM-5 OSFED diagnosis. This may have impacts for epidemiological studies of distribution as well as for identification and treatment of the individual. We support that before creating new eating disorder categories, consideration be given to also broadening current DSM-5 criteria. This approach may result in fewer OSFED subtypes needing elevation to distinct categories, potentially limiting these to just purging disorder and night eating syndrome.

Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories.

OBJECTIVE: This review investigated the extant literature regarding the relationship between eating disorder diagnoses and sensory processing as measured by validated and reliable self-report inventories. Increasing evidence highlights the role of sensory processing in cognitive functions. Sensory processing is implicated in mental-ill health, including eating disorders (ED) and body image disturbances. However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored. METHOD: We included studies involving participants aged 15 years or older with an eating disorder diagnosis confirmed by semi-structured or structured interviews. We further limited inclusion to articles using validated and reliable self-report instruments to measure sensory processing. Our meta-analysis focused on studies using the interoceptive awareness subscale from the second version of the Eating Disorder Inventory. We used the Critical Appraisal checklist for quasi-experimental studies to assess the quality of included articles. RESULTS: There were 19 studies that met our inclusion criteria. Most studies showed moderate-to-high quality. Anorexia nervosa (AN) and bulimia nervosa (BN) were associated with heightened exteroception. Moreover, people with AN reported a heightened sense of taste compared to those with BN. Our meta-analysis comprising 10 studies, 19 samples, and 6382 participants revealed that AN (binge-purge subtype) and BN were associated with increased interoceptive difficulties compared to AN (restrictive subtype) or binge-eating disorder. DISCUSSION: Overall, this review emphasizes the need for a deeper investigation into sensory processing, spanning both exteroception and interoception, in relation to ED. This may prove important for individualizing person-centered care. PUBLIC SIGNIFICANCE: How people process internal, for example, hunger, and external, for example, taste and sensations is known to influence cognition and mental-ill health, including ED and body image disturbances. However, the ways in which sensory processing may contribute to ED are incompletely understood. We found that individuals with AN or BN experienced heightened exteroception, while people with an eating disorder characterized by purging reported increased interoceptive difficulties. These patterns could inform the development of more personalized treatments.

OBJETIVO: Esta revisión investigó la literatura existente sobre la relación entre los diagnósticos de trastornos de conducta alimentaria y el procesamiento sensorial, medido mediante inventarios de autoreporte validados y fiables. Cada vez hay más evidencia que destaca el papel del procesamiento sensorial en las funciones cognitivas. El procesamiento sensorial está implicado en la salud mental, incluidos los trastornos de conducta alimentaria y las alteraciones de la imagen corporal. Sin embargo, los fundamentos fisiopatológicos del procesamiento sensorial, que abarcan la exterocepción y la interocepción, en relación con los trastornos alimentarios permanecen poco explorados. MÉTODO: Incluimos estudios con participantes de 15 años o más con un diagnóstico de trastorno de conducta alimentaria confirmado por entrevistas semiestructuradas o estructuradas. Además, limitamos la inclusión a artículos que utilizaran instrumentos de autoreporte validados y fiables para medir el procesamiento sensorial. Nuestro metaanálisis se centró en estudios que utilizaron la subescala de conciencia interoceptiva de la segunda versión del Inventario de Trastornos de Conducta Alimentaria. Utilizamos la lista de verificación de Evaluación Crítica para estudios cuasiexperimentales para evaluar la calidad de los artículos incluidos. RESULTADOS: Hubo 19 estudios que cumplieron con nuestros criterios de inclusión. La mayoría de los estudios mostraron una calidad moderada a alta. La anorexia nerviosa y la bulimia nerviosa se asociaron con una exterocepción elevada. Además, las personas que padecían anorexia nerviosa reportaron de un sentido del gusto más agudizado en comparación con aquellas que padecían bulimia nerviosa. Nuestro metaanálisis, que comprendió 10 estudios, 19 muestras y 6382 participantes, reveló que la anorexia nerviosa (subtipo atracones­purga) y la bulimia nerviosa se asociaron con dificultades interoceptivas aumentadas en comparación con la anorexia nerviosa (subtipo restrictivo) o el trastorno por atracón. DISCUSIÓN: En general, esta revisión enfatiza la necesidad de una investigación más profunda sobre el procesamiento sensorial, abarcando tanto la exterocepción como la interocepción, en relación con los trastornos de conducta alimentaria. Esto puede ser importante para personalizar la atención centrada en la persona.

A systematic review and meta-synthesis of qualitative research investigating disordered eating and help-seeking in elite athletes.

OBJECTIVE: Elite athletes are at elevated risk for disordered eating and eating disorders; however, little is known about risk and maintaining factors, or barriers and facilitators of help-seeking in this cohort. This systematic review synthesized qualitative findings regarding possible risk and maintaining factors for disordered eating, as well as barriers to and facilitators of help-seeking in elite athletes. METHOD: We conducted a search for qualitative studies that included experiences with body image concerns or disordered eating in elite athletes. A systematic search of CINAHL, PsychINFO, MEDLINE, and Scopus databases identified 828 articles, with 87 retained after title and abstract screening, and 38 included in the review. Quality appraisal was conducted using the checklist for appraising qualitative research (CASP). Data were extracted from each article, including demographic information (e.g., biological sex, age, sport type, level of competition, current, or former athlete) and the text under the "results" or "findings" section. Meta-themes were identified using inductive thematic meta-synthesis. RESULTS: The extracted data indicated that most studies sampled female athletes from the United States and UK. Eight meta-themes were identified: (1) the power imbalance; (2) hyperfocus on body, food, and exercise; (3) rigidity; (4) the athlete's balance; (5) the athlete identity; (6) overvaluation and oversimplification; (7) shame, fear, and stigma; and (8) knowledge, education, and self-identification. DISCUSSION: These findings highlighted gaps in the demographic representation of specific groups in this research (e.g., males, para-athletes, and ethnic diversity) and propose hypotheses of how sport pressure might contribute to athletes' experiences with disordered eating. PUBLIC SIGNIFICANCE: Disordered eating and body image concerns are prevalent and can have debilitating impacts for elite athletes; however, help-seeking is rare for this population. It remains unclear what factors contribute to disordered eating and/or inhibit help-seeking among elite athletes versus the general population. Understanding athletes' perspectives will inform the modification of prevention and treatment strategies to address athlete-specific factors.

OBJETIVO: Los atletas de élite tienen un riesgo elevado de presentar patrones alimentarios disfuncionales y trastornos de la conducta alimentaria; sin embargo, se sabe poco sobre los factores de riesgo y mantenimiento, así como las barreras y facilitadores para buscar ayuda en esta cohorte. Esta revisión sistemática sintetizó hallazgos cualitativos sobre posibles factores de riesgo y mantenimiento para conductas alimentarias disfuncionales, así como barreras y facilitadores para búsqueda de ayuda en atletas de élite. MÉTODO: Realizamos una búsqueda de estudios cualitativos que incluyeran experiencias con preocupaciones sobre la imagen corporal o conductas alimentarias disfuncionales en atletas de élite. Una búsqueda sistemática en las bases de datos CINAHL, PsychINFO, MEDLINE y Scopus identificó 828 artículos, quedándonos con 87 después de la revisión de títulos y resúmenes, y 38 quedaron incluidos en la revisión. Se realizó una evaluación de calidad utilizando la lista de verificación para evaluar la investigación cualitativa (CASP). Se extrajeron datos de cada artículo, incluyendo información demográfica (por ejemplo, sexo biológico, edad, tipo de deporte, nivel de competencia, atleta actual o retirado) y el texto bajo la sección de "resultados" o "hallazgos". Se identificaron meta­temas utilizando la meta­síntesis temática inductiva. RESULTADOS: Los datos extraídos indicaron que la mayoría de los estudios incluyeron atletas femeninas de EE. UU. y Reino Unido. Se identificaron ocho meta­temas: (1) el desequilibrio de poder; (2) hiperenfoque en el cuerpo, la comida y el ejercicio; (3) rigidez; (4) el equilibrio del atleta; (5) la identidad del atleta; (6) sobrevaloración y simplificación excesiva; (7) vergüenza, miedo y estigma; y (8) conocimiento, educación y auto­identificación. DISCUSIÓN: Estos hallazgos destacaron brechas en la representación demográfica de grupos específicos en esta investigación (por ejemplo, hombres, para­atletas, diversidad étnica) y proponen hipótesis sobre cómo la presión deportiva podría contribuir a las experiencias de los atletas con conductas alimentarias disfuncionales.

The Modeled Cost-Effectiveness of a Prevention Program Targeting Both Eating Disorders and High BMI.

OBJECTIVE: Prevention programs for eating disorders (EDs) and high body index mass (BMI) have the potential to reduce the onset of these interconnected public health concerns. However, it remains unclear whether routine implementation of such programs would be cost-effective. This study aims to determine the cost-effectiveness of an intervention that aims to prevent both ED and high BMI. METHOD: A Markov model was developed to evaluate the incremental cost-effectiveness of a targeted school-based program, Healthy Weight, that aims to prevent both EDs and high BMI among Australian adolescents with body image concerns (aged 15-18 years), versus a "no intervention" comparator. A cost-utility analysis was conducted from a "healthcare and education" sector perspective with costs (measured in 2019 Australian dollars) and health impacts modeled over the lifetime of the target population. An incremental cost-effectiveness ratio (ICER), expressed as cost per health-adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions. RESULTS: The mean intervention cost and HALYs gained were AUD$2.13 million (95% CI, AUD$1.83-2.43 million) and 146 (95% CI, 90-209), respectively. With healthcare cost-savings (AUD$3.97 million) included, the intervention was predicted to be cost-saving (AUD$1.83 million; 95% CI, AUD$0.51-3.21 million). Primary findings were robust to extensive sensitivity analyses. DISCUSSION: The Healthy Weight intervention is likely to represent good value-for-money. To ensure the successful implementation of this program at the population level, further research on its feasibility and acceptability among schools and the wider community is required.

Cost-utility and cost consequence of a telehealth intervention targeting improvement in addictive eating for Australian adults (the TRACE program).

BACKGROUND: The TRACE (Targeted Research for Addictive and Compulsive Eating) intervention was evaluated in a 3-month randomized controlled trial which demonstrated significant improvement in Yale Food Addiction Scale scores favoring dietitian-led telehealth (active intervention) compared with passive and control groups. This study aimed to determine intervention costs and cost-utility. METHODS: Costs of each intervention (2021$AUD) and incremental net monetary benefit (iNMB; incremental benefit, defined as Quality-Adjusted Life Years (QALY) gained, multiplied by willingness to pay threshold minus incremental cost) were calculated to estimate differences between groups. RESULTS: The active intervention (n = 38) cost $294 (95% UI: $266, $316) per person compared to $47 (95% UI: $40, $54) in the passive intervention (n = 24), and $26 in the control group (n = 37). At a cost-effectiveness threshold of $50 000 per QALY score gained, the active intervention iNMB was -$186 (95% UI: -$1137, $834) and the passive group $127 (95% UI: -$1137, $834). Compared to the control group, estimates indicate a 30% chance of the active intervention, and a 60% chance of the passive intervention being cost effective. CONCLUSION: Although the overall cost of the active intervention was low, this was not considered cost-effective in comparison to the passive intervention, given small QALY score gains. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ACTRN12621001079831.

Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity.

Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced ICD-11 criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using ICD-11 criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (N = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder- and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable ICD-11 diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, rs = .285-.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.

A qualitative exploration of food choice motives of urban indigenous food gatekeepers in Fiji: Implications for the use of the food choice questionnaire.

Pacific Island Countries (PICs) have exceptionally high rates of obesity and non-communicable diseases. The causes are complex but one prominent factor is the notable shift from traditional plant and seafood diets to diets high in unhealthy processed foods. Literature is sparse on the motives behind food choice decisions of Pacific Islanders. The widely used Food Choice Questionnaire (FCQ) (Steptoe et al., 1995) is a multi-dimensional tool capturing nine potential food choice motives. This study used a hybrid thematic analysis. Fourteen in-depth semi-structured interviews with urban indigenous Fijian mothers were conducted to (1) explore how the nine FCQ motives impact food choice (2) to examine conceptual equivalence of the nine FCQ motives and (3) to identify additional food choice motives, not captured in the FCQ. Mothers identified seven of the nine FCQ motives (i.e., health, mood, convenience, sensory appeal, weight control and familiarity) and three new food choice motives (i.e., food that is filling, religious dietary restrictions and food quality) as important determinants of food choice. Moreover, while choosing foods that promote health and well-being was identified as an important food choice motive, mothers also identified four other motives, that they considered important, which lead to over-eating and unhealthy eating. Food choice is a complex, layered decision, driven by multiple considerations, some more important than others. These findings can inform diet-related interventions and policy within this community. Adapting the FCQ for broader PIC use through further qualitative exploration in PICs, and validating the adapted FCQ with larger samples will enhance its utility in measuring food choice motives in PICs.

A three-arm randomised controlled trial of a telehealth intervention targeting improvement in addictive eating for Australian adults (the TRACE program).

There is a substantial research base for addictive eating with development of interventions. The current 3-arm RCT aimed to investigate the efficacy of the TRACE (Targeted Research for Addictive and Compulsive Eating) program to decrease addictive eating symptoms and improve mental health. Participants (18-85 yrs) endorsing ≥3 addictive eating symptoms were randomly allocated to 1) active intervention, 2) passive intervention, or 3) control group. Primary outcome was change in addictive eating symptoms 3-months post-baseline measured by the Yale Food Addiction Scale. Depression, anxiety and stress were also assessed. A total of 175 individuals were randomised. Using Linear Mixed Models, from baseline to 3-months, there was significant improvement in symptom scores in all groups with mean decrease of 4.7 (95% CI: -5.8, -3.6; p < 0.001), 3.8 (95% CI: -5.2, -2.4; p < 0.001) and 1.5 (95% CI: -2.6, -0.4; p = 0.01) respectively. Compared with the control group, participants in the active intervention were five times more likely to achieve a clinically significant change in symptom scores. There was a significant reduction in depression scores in the active and passive intervention groups, but not control group [-2.9 (95% CI: -4.5, -1.3); -2.3 (95% CI: -4.3, -0.3); 0.5 (95% CI: -1.1, 2.1), respectively]; a significant reduction in stress scores within the active group, but not passive intervention or control groups [-1.3 (95% CI: -2.2, -0.5); -1.0 (95% CI: -2.1, 0.1); 0.4 (95% CI: -0.5, 1.2), respectively]; and the reduction in anxiety scores over time was similar for all groups. A dietitian-led telehealth intervention for addictive eating in adults was more effective than a passive or control condition in reducing addictive eating scores from baseline to 6 months. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12621001079831.

The effectiveness of the TRACE online nutrition intervention in improving dietary intake, sleep quality and physical activity levels for Australian adults with food addiction: a randomised controlled trial.

BACKGROUND: Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three-arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian-led telehealth intervention at 3 months. METHODS: Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m2 were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non-core foods were reported. RESULTS: The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) -0.0 to 12.9], p = 0.049), non-core foods (-6.4%/day [95% CI -12.9 to 0.0], p = 0.049), sweetened drinks (-1.7%/day [95% CI -2.9 to -0.4], p = 0.013), takeaway foods (-2.3%/day [95% CI -4.5 to -0.1], p = 0.045) and sodium (-478 mg/day [95% CI -765 to -191 mg], p = 0.001). CONCLUSIONS: A dietitian-led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change.

Comparative utility of the DSM-5 and ICD-11 diagnostic classifications of eating disorders of recurrent binge eating in an Australian community-based sample.

OBJECTIVE: The present study aimed to compare the estimated prevalence, sociodemographic features and impacts of Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Other Specified Feeding or Eating Disorder (OSFED; BN or BED of low frequency and/or limited duration) when comparing the DSM-5 with the broader ICD-11 diagnostic criteria for size and specifiers of binge-eating episodes in a general population epidemiological sample. METHODS: 2977 individuals (1524 women and 1453 men) aged ≥15 years from randomly selected households in South Australia were interviewed in person. Participants were asked questions relating to sociodemographic features, symptoms of eating disorder pathology, physical and mental health-related quality of life (HRQoL; SF-12) and role impairment. RESULTS: The estimated prevalence of only one diagnosis, namely BED, was lower when applying DSM-5 criteria than when applying ICD-11 criteria, largely due to the Criterion B binge-eating specifiers of the DSM-5. There were no significant differences in participants' demographic features, HRQoL, or role impairment between the comparable diagnosis of either scheme. CONCLUSIONS: There were few differences in distribution and similar levels of health impacts when applying either diagnostic scheme in this epidemiological study. However, cases of BED may be missed when using the stricter criteria of DSM-5 in epidemiological surveys. Further studies are needed to assess the clinical utility of the DSM-5 and ICD-11 diagnostic specifiers of binge-eating.

Severe and enduring anorexia nervosa and the proposed "Terminal anorexia" category: an expanded meta synthesis.

This updated meta-synthesis explores further dimensions of the lived experience of severe and enduring anorexia nervosa (SE-AN) since recent contention regarding proposed "terminal anorexia nervosa (T-AN)". The paper aims to update the original synthesis and to situate participant responses to the category of "T-AN". Thus, extending the proposed conceptualization of the SE-AN experience. A systematic search identified published scholarship (between August 2022 and July 2023), derived from five bibliographic databases. A comprehensive methodology combining Interpretative Phenomenological Analysis and a meta-ethnographic framework enabled the synthesis of meta-themes across 9 new studies. These meta-themes were mapped onto the primary synthesis to further develop upon the earlier LE conceptualization of SE-AN. Nine extracted papers expanded the voices to 447 people within 45 studies. All papers affirmed and enriched the previous themes, and a novel theme was generated from the recent papers. The new theme, "walking on a knife's edge, caught between worlds", informed an expanded conceptualization of SE-AN, termed the Web of Hope. Thus, demonstrating how participants held onto hope in the face of the SE-AN experience. Death, dying and "terminality", were notably absent in the 36 papers in the previous meta-synthesis. Since the proposal of the category of "terminal anorexia" in 2022, studies on the lived experience of SE-AN increasingly focused on how people hold onto hope alongside SE-AN. The findings further drive the field to reflect on therapeutic interventions, labelling and diagnosis, in the face of unknowns, on the premise of "first, do no harm".

Outcomes and associated clinical features of people with eating disorders participating in residential treatment facilities: a scoping review.

Residential treatment programs for eating disorders (EDs) have gained popularity in recent years, expanding beyond the United States to countries such as Canada, Italy, and the United Kingdom. These programs offer a "home-like" environment where individuals reside for several weeks or months, emphasising both physical restoration and psychological recovery. This scoping review aimed to provide an update since the most recent reviews on the literature regarding outcomes of residential treatment programs for EDs and to explore clinical features that were associated with these outcomes. Methods used followed the Joanna Briggs Institute guidelines for scoping reviews. A systematic search of electronic databases was conducted, and 12 studies met the inclusion criteria. All studies reported improvements in various outcomes from admission to discharge, including changes in eating psychopathology, weight restoration, depression, anxiety, and quality of life. Additionally, three studies reported positive outcomes at intervals after discharge and three predictive factors (self-compassion, personality organisation, and resistance to emotional vulnerability) were reported in a small number of studies. While residential treatment facilities consistently showed positive outcomes, the review highlights the need for randomised controlled studies to establish the efficacy of these programs for EDs. Future research should include controlled studies comparing residential facilities to other treatment settings and incorporate long-term follow-up outcomes and further studies of emergent predictive factors identified in this review.

Embracing a different outlook: Strengths and goals of individuals currently in treatment for anorexia nervosa.

PURPOSE: Developing personal goals beyond weight and shape, and promoting the agency to pursue those goals, could aid in treatment and recovery from anorexia nervosa (AN). This research explores the strengths, interests and goals of individuals currently receiving treatment for AN and evaluates how treatment services are supporting them to work towards personal goals across all areas of everyday life. METHOD: A total of 58 community-dwelling adults currently receiving treatment for anorexia nervosa at any stage of recovery completed the Client Assessment of Strengths, Interests and Goals Self-Report (CASIG-SR). Participants reported their goals for accommodation, work and study, interpersonal relationships, recreational activities, spirituality, religion or life purpose, physical health and mental health, and the personal strengths and supports needed to achieve those goals. Concordance scores were calculated between importance of personal goals and level of support from current services regarding these goals. RESULTS: Themes identified across goals, strengths and supports were Connection, Independence & Confidence, Meaning & Self: The Real Me, and Stability & Balance. Work and study goals and strengths were identified strongly. The key support needed was stability from the current treatment team to provide a stable base for change. Concordance scores indicate support provided for personal goals was less than the importance of the goal to the individual. CONCLUSION: Results suggest goals for everyday living are critical to recovery in anorexia nervosa. Specific clinical considerations to increase motivation and hope are increased access to peer support, a focus on increasing positive affect, supporting safe exercise and promoting outdoor experiences and connection with nature. LEVEL III: Evidence obtained from well-designed cohort or case-control analytic studies.

A systematic review with meta-analyses of the relationship between recurrent binge eating and sleep parameters.

BACKGROUND: Sleep problems are known to compound the negative effects of other health issues, such as eating disorders and the associated behavior of binge eating. Previous studies suggested associations between binge eating and sleep problems, but the strength of the relationship is unknown. METHODS: We conducted a systematic review with meta-analyses examining the relationship between binge eating and sleep parameters. We searched for studies in Scopus, PubMed, and PsycInfo. The quality of evidence, including risk of bias, was assessed with adaptations of the Newcastle-Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies, depending on study design. Data was synthesized as the difference in sleep between people who did or did not have binge eating. RESULTS: Thirty-one reports of studies met our eligibility criteria. Results are presented in 12 meta-analyses. In the 7 reports of studies (with 4448 participants) that assessed poor overall sleep quality, we found poorer overall sleep quality in people with binge eating compared to people without binge eating, with a standardized mean difference of 0.77 (95% confidence interval [CI] 0.61-0.92; P < 0.001), which is a large effect size. In addition, we found evidence that people with binge eating had significantly greater hypersomnia/daytime sleepiness (7 reports of studies with 4370 participants), insomnia (5 reports of studies with 12,733 participants), and difficulty falling asleep (3 reports of studies with 4089 participants) compared to people without binge eating, with moderate effect sizes (standardized mean differences of 0.57-0.66). CONCLUSIONS: People with binge eating exhibit poorer overall sleep quality compared to people without binge eating, and may also exhibit greater hypersomnia/daytime sleepiness, insomnia, and difficulty falling asleep. It is recommended that healthcare professionals routinely screen for poor overall sleep quality when treating people with binge eating-and address sleep difficulties when present.

Twenty-year associations between disordered eating behaviors and sociodemographic features in a multiple cross-sectional sample.

BACKGROUND: Disordered eating behaviors (DEB) impact on health and wellbeing worldwide. This study aimed to examine sociodemographic trends in the prevalence of DEB over 20 years in the Australian general population. METHODS: Data were derived from five sequential cross-sectional surveys (1998, 2008, 2009, 2016 and 2017) with population-representative samples of adults and adolescents residing in South Australia (N = 15 075). DEBs investigated were objective binge eating (OBE), strict dieting/fasting, and purging. Sociodemographic data included gender, age, educational level, work and marital status, and residence. RESULTS: OBE prevalence increased significantly. Strict dieting/fasting also increased from 1998 to 2008/9 but remained stable between 2008/9 and 2016/7. Purging prevalence did not change significantly over time. All survey years were associated with a significantly higher odds of OBE, and strict diet/fasting compared to 1998. Lower age, a higher Accessibility Remoteness Index of Australia (ARIA) score, higher body mass index (BMI), higher educational attainment, and not being in a married or de facto relationship were independently associated with greater adjusted odds for endorsing OBE. Younger age, female gender, and higher BMI were also independently associated with greater adjusted odds for endorsing strict dieting/fasting. CONCLUSIONS: The increased prevalence of DEBs in various strata of Australian society has both public health and clinical implications. The results refute the stereotype that eating disorders (EDs) predominantly affect young women. They build impetus for future research on EDs among men and older individuals, with a view to developing tailored public health and clinical interventions for these populations.

Current approaches in the recognition and management of eating disorders.

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

Disentangling eating disorder diagnostic schemes. Commentary on Walsh et al., "A systematic review comparing atypical anorexia nervosa and anorexia nervosa".

This commentary discusses the systematic review by Walsh et al. that has found that people with atypical anorexia nervosa have similar symptoms and severity as have people with anorexia nervosa. In this paper, the discussion is broadened to other eating disorders diagnoses and the problem of overlap and crossover between syndromes that impacts adversely on the need for diagnoses to be distinct both at assessment but also over time. It is argued that the derivation of eating disorder diagnostic criteria has also been vulnerable to erroneous assumptions and biased observations. Whether atypical anorexia nervosa becomes a standalone diagnosis or is joined with an expanded anorexia nervosa, future delineations should be based on empirical research including neuroscience.

Associations among relationship status, gender, and sexual attraction in Australian adolescents' eating pathology.

OBJECTIVE: Engaging in romantic relationships in adolescence may inadvertently increase participation in appearance culture and the risk for eating pathology. Little research has considered this effect, particularly as it relates to adolescents' gender identity and sexual attraction. Therefore, this study examined the associations among relationship status, gender, and sexual attraction in adolescents' eating pathology. METHODS: Data from the first wave of the EveryBODY study, a large sample of Australian adolescents aged 11-19 years (n = 3262, Mage  = 15.00, 53.80% girls), were used. Participants reported their relationship status and eating pathology (fasting, purging, binge eating, driven exercise, steroid use, and shape/weight concerns) using an online survey. RESULTS: Logistic regressions adjusting for age and BMI percentile revealed that romantic relationships were associated with higher adjusted odds (AORs) for reporting clinical frequency/severity threshold of fasting, purging, steroid use, and shape and weight concerns (AORs: 1.34-3.68). Relative to boys, girls had higher adjusted odds of reporting clinical frequency/severity threshold of all eating disorder features (AORs: 1.47-7.40), except for steroid use for muscle gain. Adolescents who reported same-sex attraction, were unsure of their sexual attraction, or did not endorse any sexual attraction had greater adjusted odds of reporting clinical frequency/severity threshold of fasting, purging, and shape and weight concerns (AORs: 1.35-1.83) than those with only other-sex sexual attraction. Interactions among relationship status, gender, and sexual attraction were nonsignificant. CONCLUSIONS: Romantic experience emerged as a novel correlate for adolescents' eating pathology. Future research should uncover the contextual factors within relationships that may contribute to this association. PUBLIC SIGNIFICANCE: The initiation of romantic relationships is normative during adolescence. However, adolescents' romantic desirability is often determined by their physical appearance, increasing the risk for eating pathology. Among a large sample of Australian adolescents, romantic involvement was associated with greater likelihood of clinical threshold eating pathology for adolescent boys and girls, regardless of sexual attraction. It is urgent to identify the factors within romantic relationships that are associated with eating pathology.

Development of transdiagnostic clinical risk prediction models for 12-month onset and course of eating disorders among adolescents in the community.

OBJECTIVE: To develop and internally validate risk prediction models for adolescent onset and persistence of eating disorders. METHODS: N = 963 Australian adolescents (11-19 years) in the EveryBODY Study cohort completed online surveys in 2018 and 2019. Models were built to predict 12-month risk of (1) onset, and (2) persistence of a DSM-5 eating disorder. RESULTS: Onset Model. Of the n = 687 adolescents without an eating disorder at baseline, 16.9% were identified with an eating disorder after 12 months. The prediction model was based on evidence-based risk factors for eating disorder onset available within the dataset (sex, body mass index percentile, strict weight loss dieting, history of bullying, psychological distress, weight/shape concerns). This model showed fair discriminative performance (mean AUC = .75). The most important factors were psychological distress, weight and shape concerns, and female sex. Diagnostic Persistence Model. Of the n = 276 adolescents with an eating disorder at baseline, 74.6% were identified as continuing to meet criteria for an eating disorder after 12 months. The prediction model for diagnostic persistence was based on available evidence-based risk factors for eating disorder persistence (purging, distress, social impairment). This model showed poor discriminative performance (mean AUC = .65). The most important factors were psychological distress and self-induced vomiting for weight control. DISCUSSION: We found preliminary evidence for the utility of a parsimonious model for 12-month onset of an eating disorder among adolescents in the community. Future research should include additional evidence-based risk factors and validate models beyond the original sample. PUBLIC SIGNIFICANCE: This study demonstrated the feasibility of developing parsimonious and accurate models for the prediction of future onset of an eating disorder among adolescents. The most important predictors in this model included psychological distress and weight and shape concerns. This study has laid the ground work for future research to build and test more accurate prediction models in diverse samples, prior to translation into a clinical tool for use in real world settings to aid decisions about referral to early intervention.

Conceptualisation of severe and enduring anorexia nervosa: a qualitative meta-synthesis.

BACKGROUND: Severe and enduring anorexia nervosa (SE-AN) is amongst the most impairing of all mental illnesses. Collective uncertainties about SE-AN nosology impacts treatment refinement. Qualitative research, particularly lived experience literature, can contribute to a process of revision and enrichment of understanding the SE-AN experience and further develop treatment interventions. Poor outcomes to date, as evidenced in clinical trials and mortality for people with SE-AN (1 in 20) demonstrate the need for research that informs conceptualisations and novel treatment directions. This interpretative, meta-ethnographic meta-synthesis aimed to bridge this gap. METHODS: A systematic search for qualitative studies that explored the AN experiences of people with a duration of greater than 3 years was undertaken. These studies included those that encompassed phenomenology, treatment experiences and recovery. RESULTS: 36 papers, comprising 382 voices of SE-AN experiences informed the meta-ethnographic findings. Four higher order constructs were generated through a synthesis of themes and participant extracts cited in the extracted papers: (1) Vulnerable sense of self (2) Intra-psychic processes (3) Global impoverishment (4) Inter-psychic temporal processes. Running across these meta-themes were three cross cutting themes (i) Treatment: help versus harm, (ii) Shifts in control (iii) Hope versus hopelessness. These meta-themes were integrated into conceptualisations of SE-AN that was experienced as a recursive process of existential self-in-relation to other and the anorexia nervosa trap. CONCLUSIONS: The alternative conceptualisation of SE-AN proposed in this paper poses a challenge to current conceptualisations of AN and calls for treatments to engage with the complex intra and inter-psychic processes of the SE-AN, more fully. In doing so, clinicians and researchers are asked to continue to be bold in testing novel ideas that may challenge our own rigidity and attachment to dominant paradigms to best serve the individual person with SE-AN. The 'global impoverishment of self', found in this synthesis of AN experiences, should inform proposed diagnostic criteria for SE-AN.