Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base.

OBJECTIVE: To map and examine the systematic review evidence base regarding the effects of cognitive-behavioral therapy (CBT) for eating disorders (EDs), especially against active interventions. METHOD: This systematic review is an extension of an overview of CBT for all health conditions (CBT-O). We identified ED-related systematic reviews from the CBT-O database and performed updated searches of EMBASE, MEDLINE, and PsychInfo in April 2021 and September 2022. RESULTS: The 44 systematic reviews included (21 meta-analyses) were of varying quality. They focused on "high intensity" CBT, delivered face-to-face by qualified clinicians, in BN, BED and mixed, not specifically low-weight samples. ED-specific outcomes were studied most, with little consensus on their operationalization. The, often insufficient, reporting of sample characteristics did not allow assessment of the generalizability of findings. The meta-analytic syntheses show that high intensity one-to-one CBT produces better short-term effects than a mix of active controls especially on ED-specific measures for BED, BN, and transdiagnostic samples. There is little evidence favoring group CBT or low intensity CBT against other active interventions. DISCUSSION: While this study found evidence consistent with current ED treatment recommendations, it highlighted notable gaps that need to be addressed. There were insufficient data to allow generalizations regarding sex and gender, age, culture and comorbidity and to support CBT in AN samples. The evidence for group CBT and low intensity CBT against active controls is limited, as it is for the longer-term effects of CBT. Our findings identify areas for future innovation and research within CBT. PUBLIC SIGNIFICANCE: This study provides a comprehensive mapping and quality assessment of the current large systematic review research base regarding the effects of cognitive behavioral therapy (CBT) for eating disorders (EDs), with a focus on comparisons to other active interventions. By transcending the more limited scope of individual systematic reviews, this overview highlights the gaps in the current evidence base, and thus provides guidance for future research and clinical innovation.

OBJETIVO: Mapear y examinar la base de evidencia de la revisión sistemática con respecto a los efectos de la terapia cognitivo-conductual (TCC) para los trastornos de la conducta alimentaria (TCA), especialmente contra las intervenciones activas. MÉTODO: Esta revisión sistemática es una extensión de una visión general de la TCC para todas las afecciones de salud (TCC-O, Fordham et al., 2021a). Se identificaron revisiones sistemáticas relacionadas con los TCA a partir de la base de datos TCC-O y se realizaron búsquedas actualizadas en EMBASE, MEDLINE y PsychInfo en abril de 2021 y septiembre de 2022. RESULTADOS: Las 44 revisiones sistemáticas incluidas (21 metanálisis) fueron de calidad variable. Se centraron en la TCC de "alta intensidad", administrada cara a cara por clínicos calificados, en BN, TpA y muestras mixtas, no específicamente de bajo peso. Los resultados específicos de los TCA fueron los más estudiados, con poco consenso sobre su operacionalización. El informe, a menudo insuficiente, de las características de la muestra no permitió evaluar la generalización de los hallazgos. Las síntesis metaanalíticas muestran que la TCC uno a uno de alta intensidad produce mejores efectos a corto plazo que una combinación de controles activos, especialmente en medidas específicas de TCA para TpA, BN y muestras transdiagnósticas. Hay poca evidencia a favor de la TCC grupal o la TCC de baja intensidad frente a otras intervenciones activas. DISCUSIÓN: Si bien este estudio encontró evidencia consistente con las recomendaciones actuales de tratamiento de los TCA, también destacó las brechas notables que deben abordarse. No hubo datos suficientes para permitir generalizaciones con respecto al sexo y el género, la edad, la cultura y la comorbilidad y para apoyar la TCC en las muestras de AN. La evidencia para la TCC grupal y la TCC de baja intensidad contra los controles activos es limitada, al igual que para los efectos a más largo plazo de la TCC. Nuestros hallazgos identifican áreas para la innovación y la investigación futuras dentro de la TCC.

Excess mortality associated with eating disorders: population-based cohort study.

BACKGROUND: Individuals with eating disorders have a high mortality risk. Few population-based studies have estimated this risk in eating disorders other than anorexia nervosa. AIMS: To investigate all-cause mortality in a population-based cohort of individuals who received hospital-based care for an eating disorder (anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified) in Ontario, Canada. METHOD: We conducted a retrospective cohort study of 19 041 individuals with an eating disorder from 1 January 1990 to 31 December 2013 using administrative healthcare data. The outcome of interest was death. Excess mortality was assessed using standardised mortality ratios (SMRs) and potential years of life lost (PYLL). Cox proportional hazards regression models were used to examine sociodemographic and medical comorbidities associated with greater mortality risk. RESULTS: The cohort had 17 108 females (89.9%) and 1933 males (10.1%). The all-cause mortality for the entire cohort was five times higher than expected compared with the Ontario population (SMR = 5.06; 95% CI 4.82-5.30). SMRs were higher for males (SMR = 7.24; 95% CI 6.58-7.96) relative to females (SMR = 4.59; 95% CI 4.34-4.85) overall, and in all age groups in the cohort. For both genders, the cohort PYLL was more than six times higher than the expected PYLL in the Ontario population. CONCLUSIONS: Patients with eating disorders diagnosed in hospital settings experience five to seven times higher mortality rates compared with the overall population. There is an urgent need to understand the mortality risk factors to improve health outcomes among individuals with eating disorders.

Worse Metabolic Control and Dynamics of Weight Status in Adolescent Girls Point to Eating Disorders in the First Years after Manifestation of Type 1 Diabetes Mellitus: Findings from the Diabetes Patienten Verlaufsdokumentation Registry.

OBJECTIVE: To assess indications of eating disorders in girls with type 1 diabetes mellitus (T1DM). STUDY DESIGN: In total 31 556 girls aged >6 months and <23 years of age with T1DM from the Diabetes Patienten Verlaufsdokumentation (DPV) cohort were analyzed including 155 (0.49%) girls with anorexia nervosa, 85 (0.27%) girls with bulimia nervosa, 45 (0.14%) girls with binge eating disorder, and 229 (0.73%) girls with eating disorders not otherwise specified. Patient characteristics, weight changes, numbers of patients with severe hypoglycemia and diabetic ketoacidosis (DKA), changes of glycosylated hemoglobin A1c (HbA1c) levels, use of pumps, and prevalence of celiac disease and autoimmune thyroiditis were compared between girls with and without eating disorders. Multiple logistic regression analyses were performed. RESULTS: Eating disorders were significantly associated with late pubertal age, nonusage of pumps, no migration background, increased HbA1c levels, increased frequencies of DKA and severe hypoglycemia, and celiac disease were not related to eating disorders. Significant differences in HbA1c levels, prevalence of DKA and severe hypoglycemia between girls with and without eating disorders were already detectable in the first years after onset of T1DM. A decrease of body mass index (BMI)-SDS increased the risk for comorbid anorexia nervosa (7.1-fold [95% CI 3.6-14.3] compared with stable BMI-SDS, 6.9-fold [95%CI 3.4-14.1] compared with increase of BMI-SDS). CONCLUSIONS: Poor metabolic control and increased rates of DKA and severe hypoglycemia in the first years after manifestation of T1DM can be hints for eating disorders in girls with T1DM, and weight loss is specific for anorexia nervosa. These clinical features should lead to screening for eating disorders especially at a late pubertal age.

Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters.

OBJECTIVE: This study seeks to examine the long-term reproductive consequences of eating disorders (ED), to assess variation in reproductive outcomes by ED type, and to examine reproductive differences between women with previous ED diagnosis and their discordant sisters. METHOD: Using a sample of women with previous ED diagnosis generated by the Utah Population Database, this study compares the fecundity (parity) and age at first birth of women by ED subtype (bulimia nervosa [BN], anorexia nervosa [AN], and ED not otherwise specified [EDNOS]) (n = 1,579). We also employed general population match case-control, and discordant sibling pair analyses, to estimate the magnitude of association between EDs and reproductive outcomes. RESULTS: Women previously diagnosed with AN or EDNOS experienced delayed first birth (HRR = 0.33, HRR = 0.34, respectively) and lower parity (IRR = 0.19, IRR = 0.22, respectively) relative to BN (p < .05), the general population (p < .05), and closest-aged sisters (p < .05). Women previously diagnosed with BN experienced more moderate reductions and delays to their reproduction, and had similar reproductive outcomes as their discordant sisters. DISCUSSION: Clinicians should consider ED type and family fertility histories when addressing the long-term reproductive health needs of women with prior AN, BN, or EDNOS diagnosis. Women previously diagnosed with AN or EDNOS likely experience the greatest reductions and delays in reproduction across their lifespan. Reproductive health screenings may be especially critical for the wellbeing of women with a history of AN or EDNOS.

Prevalence of chew and spit and its relation to other features of disordered eating in a community sample.

BACKGROUND: Until recently, research into Chew and Spit (CHSP) behavior has predominantly focused on clinical samples, and little is known of its prevalence in the community. The current study aimed to bridge this gap by exploring CHSP features in a representative sample of the general population. We hypothesized that the point-prevalence of CHSP would be less than 1%; concurrent with other eating disorder symptomology, and associated with poorer health related quality of life (HRQoL). METHODOLOGY: Using the 2016, respondent-based, South Australian Health Omnibus Survey (HOS), data were collected on 3047 participants aged ≥15 years old. HRQoL was assessed with the Short-Form health-questionnaire-v1 (SF-12). RESULTS: CHSP point prevalence was 0.4% (95% CI .23 to .69%; n = 13), and was more prevalent in people with compensatory disordered eating behaviors. The median age of those with CHSP was 39, and both mental and physical HRQoL were reduced compared with the general population (Mdn: MHQoL = 49; HRQoL = 50), with MHQoL being significantly lower in those with symptoms of a clinically diagnosable ED and concurrently engaged in CHSP (z = -2.33, p = .020). CONCLUSIONS: Due to the low prevalence of CHSP, the reliability of inferential statistics may increase the chance of Type II errors, therefore, future studies should use larger samples. Although CHSP is not "common" in a wider community sample, its prevalence appears to be similar to other ED associated symptoms.

Food addiction, orthorexia, and food-related stress among dietetics students.

PURPOSE: Health sciences, and in particular Nutrition and Dietetics students, have been shown to exhibit an increased prevalence of disordered eating. The aim of the present cross-sectional study was to evaluate other specified feeding and eating disorders (OSFEDs), including stress-related eating, food addiction, and orthorexia, in relation to the dietary intake, among nutrition/dietetics students. METHODS: A total of 176 undergraduate students from a Department of Nutrition and Dietetics, in Greece, participated in the study. Dietary intake was recorded, and the prevalence of Eating and Appraisal Due to Emotion and Stress (EADES), food addiction (with the modified Yale Food Addition scale mYFAS), and orthorexia were assessed. Chi-square and t tests were performed between sexes, orthorexic and non-orthorexic students, as well as between food-addicted and non-addicted participants. Multiple linear regression analysis assessed relationships between energy intake, BMI or waist circumference, and the food-related psychometric scales. RESULTS: Among participating students, 4.5% had food addiction and 68.2% demonstrated orthorexia. No differences were observed between men and women, concerning the prevalence of food addiction and orthorexia, the sum of mYFAS symptoms, or individual EADES factors. Orthorexic students exhibited increased BMI, reduced energy, and saturated fat intake. In addition, orthorexic men consumed more vegetables. Multiple linear regression analysis revealed that orthorexic behavior was associated with increased BMI, waist circumference and energy intake. Lower BMI was associated with increasing ability to cope with emotion-and-stress-related eating and increasing appraisal of ability and resources to cope with emotions and stress. Emotion-and-stress-related eating was negatively associated with BMI. Appraisal of ability and resources to cope with emotions and stress was associated with the energy intake. Finally, age was positively correlated with the appraisal of outside stressors/influences, indicating increased ability to cope with outside stressors among older students. CONCLUSIONS: The study shows that despite the suggested interventions, the problem of OSFEDs among nutrition and dietetics students is still valid. Regular screening, counseling, and education is needed to reduce its prevalence. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Prevalence and severity of eating disorders: A comparison of DSM-IV and DSM-5 among German adolescents.

OBJECTIVE: Changes in the DSM-5 eating disorders criteria sought to increase the clarity of the diagnostic categories and to decrease the preponderance of nonspecified eating disorders. The first objective of this study was to analyze how these revisions affect threshold and EDNOS/OSFED eating disorder diagnoses in terms of prevalence, sex ratios, and diagnostic distribution in a student sample. Second, we aimed to compare the impairment levels of participants with a threshold, an EDNOS/OSFED and no diagnosis using both DSM-IV and DSM-5. METHOD: A sample of 1654 7th and 8th grade students completed self-report questionnaires to determine diagnoses and impairment levels in the context of an eating disorder prevention program in nine German secondary schools. Height and weight were measured. RESULTS: The prevalence of threshold disorders increased from .48% (DSM-IV) to 1.15% (DSM-5). EDNOS disorders increased from 2.90 to 6.23% when using OSFED-categories. A higher proportion of girls was found throughout all the diagnostic categories, and the sex ratios remained stable. The effect sizes of DSM-5 group differences regarding impairment levels were equal to or larger than those of the DSM-IV comparisons, ranging from small to medium. DISCUSSION: We provide an in-depth overview of changes resulting from the revisions of DSM eating disorder criteria in a German adolescent sample. Despite the overall increase in prevalence estimates, the results suggest that the DSM-5 criteria differentiate participants with threshold disorders and OSFED from those no diagnosis as well as or even more distinctly than the DSM-IV criteria.

Mortality in eating disorders - results of a large prospective clinical longitudinal study.

OBJECTIVE: To report on long-term mortality in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (ED-NOS), causes of death, and predictors of early death. METHOD: A large sample of consecutively admitted inpatients (N = 5,839) was followed-up on vital status through the German civil registry office. Of these patients 1,639 were treated for AN, 1,930 for BN, 363 for BED, and 1,907 for ED-NOS. Data from the main inpatient hospital treatment were applied to bivariate and multivariate Cox regression analyses on survival time from onset of eating disorder to death or end of observation. Standardized mortality ratios (SMR) were computed matched for age, gender, and person-years. RESULTS: SMR were 5.35 for AN, 1.49 for BN, 1.50 for BED, 2.39 for narrowly defined ED-NOS, and 1.70 for widely defined ED-NOS. Patients with AN died earlier than patients with BN, BED, or ED-NOS who did not differ. A diagnosis of AN, chronicity, later age of onset, not living in a relationship, and an irregular type of discharge from index inpatient treatment were major predictors of a shorter time to death. Suicidality was a univariate predictor of a shorter time to death in BN only. AN patients mostly died from natural causes related to their eating disorder. DISCUSSION: Mortality in AN is excessive and considerably higher than in BN, BED, and ED-NOS.

Other specified and unspecified feeding or eating disorders among women in the community.

OBJECTIVE: To examine the occurrence, course, and clinical picture of the DSM-5 residual categories 'Other Specified Feeding or Eating Disorder' (OSFED) and 'Unspecified Feeding or Eating Disorder' (UFED), to describe potential subtypes, and to evaluate whether the subdivision of the residual category appears meaningful. METHOD: We screened women from the 1975-79 birth cohorts of Finnish twins (N = 2825) for lifetime eating disorders using questionnaires and the SCID interview. This analysis characterizes women who reported clinically significant eating disorder symptoms but did not fulfill diagnostic criteria for DSM-5 anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). RESULTS: Thirty-eight women (21% of those with an eating disorder) fell in the residual OSFED/UFED category. A third of them (N = 14) fulfilled OSFED criteria, whereas two thirds (N = 24) fell in the UFED category. The lifetime prevalence of OSFED/UFED was 1.5% (95% CI 1.1-2.0%), less than half of the prevalence of DSM-IV eating disorder not otherwise specified (EDNOS). The mean age of onset of OSFED/UFED was 18 years, median duration of symptoms was two years, and the 5-year probability of recovery was 60%. Over a third of women with OSFED/UFED suffered from comorbid psychiatric disorders. Both residual categories were clinically heterogeneous and included atypical forms of AN, BN, and BED. CONCLUSIONS: Applying the DSM-5 criteria in a community sample of young women more than halved the occurrence of residual eating disorder diagnoses, but resulted in two instead of one clinically heterogeneous residual categories. Nevertheless, residual eating disorders were associated with considerable clinical severity. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1010-1017).

Health services utilization in patients with eating disorders: evidence from a cohort study in Emilia-Romagna.

PURPOSE: To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas. METHODS: The study cohort consists of patients aged 12-64 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1 year from the first contact. Data were extracted from regional administrative databases. RESULTS: The study cohort included 1550 cases, 36.8 % with anorexia nervosa, 21.9 % with bulimia nervosa and 41.3 % with ED not otherwise specified. Adolescents (12-17 years) were 18.6 %, young adults (18-30) 32.7 % and older adults (31-64) 48.7 %. The annual treated prevalence rate was 5.2/10,000 (13.3 for adolescents, 9.3 for young adults and 3.4 for older adults) and was highest among adolescent (24.6/10,000) and young adult females (17.1/10,000). Cases without a record for ED in the previous year were 46.8 %. Older adults displayed higher comorbidity and used more services including hospital-based care. Outpatient care greatly exceeded inpatient care across age groups. Variations in care patterns across regional areas were found. CONCLUSIONS: Our results indicate that the care pathway for ED varies among age groups and geographical areas, but is consistent with the regional care model that favors the use of outpatient services. Future perspectives include evaluating the integration among mental health services, specialty outpatient units and primary care.

The prevalence and adverse associations of stigmatization in people with eating disorders.

OBJECTIVE: To date, studies of stigma relating to eating disorders have been largely confined to surveys of the public. We sought to examine the prevalence and correlates of stigma as reported by individuals with eating disorders. METHOD: An online survey designed to assess frequency of exposure to potentially stigmatizing attitudes and beliefs as well as the perceived impact of this on health and well-being was completed by a cross-national sample of 317 individuals with anorexia nervosa (n = 165), bulimia nervosa (n = 66), or Eating Disorder Not Otherwise Specified (EDNOS; n = 86). RESULTS: Participants rated two beliefs as both particularly common and particularly damaging, namely "I should be able to just pull myself together" and "I am personally responsible for my condition". Participants with bulimia nervosa more commonly experienced the belief that they had "no self-control" and male participants more commonly experienced the belief that they were "less of a man". More frequent stigmatization was associated with higher levels of eating disorder psychopathology, a longer duration of disorder, lower self-esteem, and more self-stigma of seeking psychological help. DISCUSSION: Stigma towards individuals with eating disorders, as experienced by sufferers, is common and associated with numerous adverse outcomes. The perceptions that eating disorders are trivial and self-inflicted should be a focus of destigmatization interventions. Efforts to reduce stigma towards individuals with bulimia nervosa may need to focus on perceptions of self-control, whereas efforts to reduce stigma towards males with eating disorders may need to focus on perceptions of masculinity/manhood.

Parental mental illness and eating disorders in offspring.

OBJECTIVE: To investigate which parental mental illnesses are associated with eating disorders in their offspring. METHOD: We used data from a record-linkage cohort study of 158,679 children aged 12-24 years at the end of follow-up, resident in Stockholm County from 2001 to 2007, to investigate whether different parental mental illnesses are risk factors for eating disorders in their offspring. The outcome measure was diagnosis of any eating disorder, either from an ICD or DSM-IV code, or inferred from an appointment at a specialist eating disorder clinic. RESULTS: Mental illness in parents is a risk factor for eating disorders in female offspring (Adjusted Hazard Ratio (AHR) 1.57 (95% CI 1.42, 1.92), p < 0.0001). Risk of eating disorders is increased if there is a parental diagnosis of bipolar affective disorder (AHR 2.28 (95% CI 1.39, 3.72), p = 0.004), personality disorder (AHR 1.57 (95% CI 1.01, 2.44), p = 0.043) or anxiety/depression (AHR 1.57 (95% CI 1.32, 1.86), p < 0.0001). There is a lack of statistical evidence for an association with parental schizophrenia (AHR 1.41 (95% CI 0.96, 2.07), p = 0.08), and somatoform disorder (AHR 1.25 (95% CI 0.74, 2.13), p = 0.40). There is no support for a relationship between parental substance misuse and eating disorders in children (AHR 1.08 (95% CI 0.82, 1.43), p = 0.57). DISCUSSION: Parental mental illness, specifically parental anxiety, depression, bipolar affective disorder, and personality disorders, are risk factors for eating disorders in their offspring.

A new social-family model for eating disorders: A European multicentre project using a case-control design.

OBJECTIVE: To examine a new socio-family risk model of Eating Disorders (EDs) using path-analyses. METHOD: The sample comprised 1264 (ED patients = 653; Healthy Controls = 611) participants, recruited into a multicentre European project. Socio-family factors assessed included: perceived maternal and parental parenting styles, family, peer and media influences, and body dissatisfaction. Two types of path-analyses were run to assess the socio-family model: 1.) a multinomial logistic path-model including ED sub-types [Anorexia Nervosa-Restrictive (AN-R), AN-Binge-Purging (AN-BP), Bulimia Nervosa (BN) and EDNOS)] as the key polychotomous categorical outcome and 2.) a path-model assessing whether the socio-family model differed across ED sub-types and healthy controls using body dissatisfaction as the outcome variable. RESULTS: The first path-analyses suggested that family and media (but not peers) were directly and indirectly associated (through body dissatisfaction) with all ED sub-types. There was a weak effect of perceived parenting directly on ED sub-types and indirectly through family influences and body dissatisfaction. For the second path-analyses, the socio-family model varied substantially across ED sub-types. Family and media influences were related to body dissatisfaction in the EDNOS and control sample, whereas perceived abusive parenting was related to AN-BP and BN. DISCUSSION: This is the first study providing support for this new socio-family model, which differed across ED sub-types. This suggests that prevention and early intervention might need to be tailored to diagnosis-specific ED profiles.

Cognitive Behaviour Therapy for Bulimia Nervosa and Eating Disorders Not Otherwise Specified: Translation from Randomized Controlled Trial to a Clinical Setting.

BACKGROUND: Enhanced Cognitive Behaviour Therapy (CBT-E) (Fairburn, Cooper and Shafran, 2003) was developed as a treatment approach for eating disorders focusing on both core psychopathology and additional maintenance mechanisms. AIMS: To evaluate treatment outcomes associated with CBT-E in a NHS Eating Disorders Service for adults with bulimia and atypical eating disorders and to make comparisons with a previously published randomized controlled trial (Fairburn et al., 2009) and "real world" evaluation (Byrne, Fursland, Allen and Watson, 2011). METHOD: Participants were referred to the eating disorder service between 2002 and 2011. They were aged between 18-65 years, registered with a General Practitioner within the catchment area, and had experienced symptoms fulfilling criteria for BN or EDNOS for a minimum of 6 months. RESULTS: CBT-E was commenced by 272 patients, with 135 completing treatment. Overall, treatment was associated with significant improvements in eating disorder and associated psychopathology, for both treatment completers and the intention to treat sample. CONCLUSIONS: Findings support dissemination of CBT-E in this context, with significant improvements in eating disorder psychopathology. Improvements to global EDE-Q scores were higher for treatment completers and lower for the intention to treat sample, compared to previous studies (Fairburn et al., 2009; Byrne et al., 2011). Level of attrition was found at 40.8% and non-completion of treatment was associated with higher levels of anxiety. Potential explanations for these findings are discussed.

Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents.

OBJECTIVE: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a considerably revised eating disorder section. The aim of this study was to establish the prevalence and severity of eating disorders based on the new DSM-5 criteria in a community cohort of adolescents. METHOD: This study is part of TRAILS (TRacking Adolescents' Individual Lives Survey), a Dutch cohort study on mental health and social development from preadolescence into young adulthood. At baseline, the participants (n = 2,230) were about 11 years old. Body mass index was measured at all four assessment waves. At age 19, the Composite International Diagnostic Interview was administered to 1,584 of the participants. A two-stage screening approach was used to estimate the prevalence of DSM-5 eating disorders. Adolescents at high risk for eating disorders (n = 312) were selected for an additional interview administered by eating disorder experts. RESULTS: Of the high-risk group n = 296 (95%) could be interviewed. Among the women, the lifetime prevalence of DSM-5 anorexia nervosa was 1.7%, of bulimia nervosa 0.8% and of binge eating disorder 2.3%. Eating disorders were relatively rare among the men. The severity of most cases was mild to moderate and detection and treatment rates depended on the level of severity. DISCUSSION: The most common DSM-5 eating disorder diagnoses in adolescents in the community are anorexia nervosa and binge eating disorder. Severity ratings for eating disorders seem valid in terms of both the distribution in the community and the correlation with detection and treatment by health care services.

Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis.

Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta-analysis were conducted. Thirty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered.

Late onset eating disorders in Spain: clinical characteristics and therapeutic implications.

OBJECTIVE: The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). METHOD: All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO. ASSESSMENT: Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices. RESULTS: LAO individuals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. CONCLUSION: LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.

An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders.

OBJECTIVE: This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. METHOD: Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). RESULTS: There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). CONCLUSION: This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. KEY PRACTITIONER MESSAGE: CFT offers new ways to conceptualize and formulate some of the self-critical and shame-based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging.

Oro-dental manifestations of eating disorders: a systematic review.

BACKGROUND: Eating disorders (EDs) pose a significant risk to health, especially when not diagnosed early. For several years EDs and oral health has been extensively studied, and now it is quite clear the existence of a correlation between specific oral manifestations and these disorders. While these oral signs could potentially aid early diagnosis of EDs, their identification and the eventual establishment of a correlation is currently heavily limited to the clinician's experience. The present systematic review critically examines existing literature, offering an updated overview of oro-dental manifestations associated with EDs. METHOD: MEDLINE (via PubMed), Web of Science, Scopus, and grey literature were searched, and relevant epidemiological comparative studies were screened using the Rayyan software. No limitations have been imposed on the research regarding oro-dental outcomes, encompassing all medically diagnosed EDs. The quality of the studies was valuated using AXIS appraisal tool for cross-sectional studies. RESULT: Out of 3990 studies, 32 fulfilled the eligibility criteria and were included in the synthesis. The identified eating disorders include Anorexia Nervosa, Bulimia Nervosa and/or Eating Disorders Not Otherwise Specified, predominantly among female subjects, primarily originating from Europe. The evaluated oro-dental outcomes include dental erosion, caries, saliva assessment, hygiene-periodontal parameters, and mucosal tissue appearance. The association with erosion is confirmed while gingival recession, dentinal hypersensitivity, salivary flow thresholds and aspects relating to oral pathology are receiving increasing support from emerging evidence. DISCUSSION: This trend emphasizes the critical role of the complete intraoral examination to detect significant oro-dental signs that may indicate the onset of an ED.

The article is a review of existing studies that explores the link between eating disorders and oral health issues. It found that people with eating disorders, including anorexia nervosa and bulimia nervosa, may experience dental problems such as tooth erosion, cavities, and altered saliva production. The review findings emphasize the importance of dental care providers recognizing these signs early and suggests better training for dental professionals. By doing so, they can help diagnose eating disorders sooner and recommend appropriate treatment. This approach aims to improve patients' overall wellbeing by addressing both the oral health issues and the underlying eating disorders, making it essential for patients and medical teams to be aware of the interconnectedness between oral health and eating disorders.

Diagnosed eating disorders in Danish registers - incidence, prevalence, mortality, and polygenic risk.

Eating disorders are a group of severe and potentially enduring psychiatric disorders associated with increased mortality. Compared to other severe mental illnesses, they have received relatively limited research attention. Epidemiological studies often only report relative measures despite these being difficult to interpret having limited practical use. The aims of this study were to evaluate the incidence and prevalence of diagnosed anorexia nervosa (AN), bulimia nervosa, and eating disorder not otherwise specified recorded in Danish hospital registers and estimate both relative and absolute measures of subsequent mortality - both all-cause and cause-specific in a general nationwide population of 1,667,374 individuals. In a smaller, genetically informed case-cohort sample, the prediction of polygenic scores for AN, body fat percentage, and body mass index on AN prevalence and severity was estimated. Despite males being less likely to be diagnosed with an eating disorder, those that do have significantly increased rates of mortality. AN prevalence was highest for individuals with high AN and low body fat percentage/body mass index polygenic scores.