Lifetime and current mental health based on avoidant/restrictive food intake disorder history versus other eating disorder history in the Healthy Minds Study.

OBJECTIVE: Research on psychiatric comorbidities associated with avoidant/restrictive food intake disorder (ARFID) primarily compares ARFID versus anorexia nervosa (AN). Little is known about comorbidities associated with mixed ARFID/other eating disorder (ED) history or ARFID comorbidities relative to EDs beyond AN. This study assessed lifetime and current psychiatric factors in a large college sample with varying ED histories. METHOD: Participants were United States students from the 2021/2022 Healthy Minds Study who endorsed lifetime professionally diagnosed EDs (N = 4657). Chi-square tests compared lifetime ED groups (ARFID, ARFID + Non-ARFID ED, Non-ARFID ED) on lifetime neurodevelopmental, anxiety, obsessive-compulsive, trauma/stressor-related, and depressive disorder prevalence, and suicidality and counseling/therapy receipt. Multivariate analysis of variance evaluated current depressive, anxiety, and ED symptom differences. RESULTS: Lifetime neurodevelopmental and anxiety disorders were less prevalent in "Lifetime Non-ARFID ED" than ARFID groups. Lifetime depressive, trauma/stressor-related, and obsessive-compulsive disorders were relatively more prevalent in "Lifetime ARFID + Non-ARFID ED." This group demonstrated relatively greater current depressive symptoms and past-year suicide attempts. Lifetime ARFID groups demonstrated relatively greater current anxiety. All groups differed on current ED symptoms. Effects were small. DISCUSSION: Historical ARFID is associated with neurodevelopmental disorders and historical/current anxiety. Mixed ARFID/non-ARFID ED history may indicate increased propensity toward varied psychopathology. PUBLIC SIGNIFICANCE STATEMENT: This study replicated findings that ARFID is associated with neurodevelopmental and anxiety disorders in the lifespan through young adulthood. Extending prior work, results suggest a history of ARFID is associated with increased anxiety in young adulthood. Finally, a history of both ARFID and other eating pathology is associated with increased risk for a wide range of psychiatric difficulties (e.g., obsessive-compulsive symptoms, suicide attempts) in the lifespan through young adulthood.

Examining measurement invariance of appetitive trait and ARFID symptom measures by food security status.

OBJECTIVE: Measures assessing appetitive traits (i.e., individual differences in the desire to consume food) and disordered eating have generally been developed in predominantly food-secure populations. The current study aims to test measurement invariance (MI) for a measure of appetitive traits and a measure of Avoidant Restrictive Food Intake Disorder (ARFID) symptomology across food security status. METHOD: Data from a sample of mothers (n = 634) and two undergraduate samples (n = 945 and n = 442) were used to assess MI for the Adult Eating Behavior Questionnaire (AEBQ), which measures appetitive traits, and the Nine Item ARFID Screen (NIAS), which measures ARFID symptomology. Current food security was assessed using the 18-item USDA Household Food Security Survey Module, which was dichotomized into two groups: 1) the 'food insecure' group included marginal, low, and very low food security and 2) the 'food secure' group included high food security. Overall and multi-group confirmatory factor analyses were conducted separately for each measure in each sample. RESULTS: Results demonstrated scalar (i.e., strong) MI for both measures across samples, indicating that these measures performed equivalently across food-secure and food-insecure individuals. CONCLUSION: Findings suggest that differences in appetitive traits by food security status observed in prior research are not artifacts of measurement differences, but instead reflect true differences. Additionally, past mixed results regarding the relationship between food insecurity (FI) and ARFID symptomology are not likely driven by measurement error when using the NIAS.

Cross-sectional and longitudinal associations between higher weight and eating disorder risk among collegiate athletes.

OBJECTIVES: To examine whether higher weight status is associated with increased eating disorder risk in athletes. DESIGN: Study 1 used cross-sectional (N = 942) and longitudinal (N = 483) data collected over a five-year period from Division I athletes at a Midwestern university. Study 2 used cross-sectional data from athletes competing at various levels at universities across the United States (N = 825). METHODS: Weight and height were measured in Study 1 and self-reported in Study 2; higher weight was defined as body mass index ≥ 25 kg/m2. Eating disorder risk was assessed with preliminary (Study 1) and final (Study 2) versions of the Eating Disorders Screen for Athletes. Study 1 examined weight status in relation to both concurrent and one-year changes in Eating Disorder Screen for Athletes score. Study 2 examined weight status in relation to both the Eating Disorders Screen for Athletes score and elevated eating disorder risk using the established Eating Disorders Screen for Athletes cut-off. All models adjusted for gender and sport type; Study 2 additionally adjusted for race/ethnicity, age, and competition level. RESULTS: Across studies, higher weight status was significantly associated with increased eating disorder risk among athletes. This association was observed both cross-sectionally and longitudinally, and the prevelence of elevated eating disorder risk was 43 % greater among athletes with higher weight status than among those without higher weight status. CONCLUSIONS: Despite existing stereotypes that eating disorders tend to occur with low weight status, findings highlight the importance of screening all athletes for eating disorders, regardless of their weight status.

Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish children.

BACKGROUND: The nine item avoidant/restrictive food intake disorder screen (NIAS) is a short and practical assessment tool specific to ARFID with three ARFID phenotypes such as "Picky eating," "Fear," and "Appetite". This study aimed to evaluate the psychometric properties of the Turkish translation of the NIAS parent form and to investigate the relationship between ARFID symptoms and anxiety, depression symptoms, and eating behaviors in a sample of Turkish children. METHOD: Parents were asked to provide their children's sociodemographic data and to complete the NIAS, Eating Disorder Examination Questionnaire-Short (EDE-QS), Children's Eating Behavior Questionnaire (CEBQ), and Revised Child Anxiety and Depression Scale (RCADS) scales. RESULTS: The sample included 440 participants between 6 and 12 ages. Turkish NIAS demonstrated good internal consistency. The three-factor model of the Turkish NIAS was in an acceptable structure. The Turkish NIAS scale was shown to be valid and reliable. NIAS scores were shown to be higher in underweight participants. The NIAS-parent version subscales showed expected convergent and divergent validity with the CEBQ, EDEQ-S, and RCADS scales in children, except CEBQ emotional overeating and desire to drink subscales were correlated with NIAS. CONCLUSION: The Turkish version of the NIAS is valid and reliable in evaluating ARFID symptoms in children.

Assessment tools for avoidant/restrictive food intake disorder (ARFID), which is quite common in children, are quite limited. NIAS-parent version is a practical and valuable scale that can be used in the clinic. This study found that the Turkish version of the NIAS is valid and reliable in evaluating ARFID symptoms in children. In the psychometric properties of the Turkish NIAS, ARFID symptoms were associated with anxiety and depression symptoms and food-avoidant eating behavior. It was also found that ARFID was not associated with eating disorder symptoms. In addition, the paper shows initial data concerning the psychometric properties related to the Turkish NIAS-parent version. It is the first study to evaluate the relationship of ARFID subtypes with anxiety, depression symptoms, appetite characteristics, and BMI percentages in children.

Systematic review of pharmacological treatments that reduce conditioned taste aversions in rodents: A potential animal model of pediatric feeding disorder and avoidant/restrictive food intake disorder (ARFID).

Avoidant/restrictive food intake disorder (ARFID) is diagnosed when food avoidance leads to clinically significant nutritional, weight/growth, or psychosocial impairment. As many as 81.5% of children and adolescents diagnosed with ARFID have a history of a medical condition associated with pain, fatigue, or malaise. ARFID is diagnosed and treatment begins after the medical condition is resolved but food avoidance remains. Effective treatment involves repeated exposure to eating food and related stimuli aimed at creating inhibitory learning to counteract learned fears and aversions. Treatment usually involves positive reinforcement of food approach behavior and escape extinction/response prevention to eliminate food avoidant behavior. To shed light on the neural mechanisms that may maintain ARFID and to identify candidate pharmacological treatments for adjuncts to behavioral interventions, this paper systematically reviews research on drug treatments that successfully reduce conditioned taste aversions (CTA) in animal models by disrupting reconsolidation or promoting extinction. The mechanism of action of these treatments, brain areas involved, and whether these CTA findings have been used to understand human eating behavior are assessed. Collectively, the results provide insight into possible neural mechanisms associated with resuming oral intake following CTA akin to the therapeutic goals of ARFID treatment and suggest that CTA animal models hold promise to facilitate the development of interventions to prevent feeding problems. The findings also reveal the need to investigate CTA reduction in juvenile and female animals and show that CTA is rarely studied to understand disordered human feeding even though CTA has been observed in humans and parallels many of the characteristics of rodent CTA.

Validation of the youth-nine item avoidant/restrictive food intake disorder screen.

OBJECTIVE: This study assessed the factorial, divergent, and criterion-related validity of the Youth-Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (Y-NIAS) in a paediatric clinical sample at initial evaluation for an eating disorder (ED). METHOD: Participants included 310 patients (82.9% female, 77.4% White, Age M = 14.65) from a tertiary ED clinic. Confirmatory factor analysis (CFA) evaluated the three-factor of the Y-NIAS. One-way analysis of variance compared Y-NIAS scores across diagnoses. A receiver operating curve analysis assessed the ability of each subscale to identify ARFID presentations from the full sample. Two logistic regressions assessed the criterion-related validity of the obtained Y-NIAS cut-scores. RESULTS: CFA supported the original three-factor structure of the Y-NIAS. Clinically-elevated scores were observed in all diagnostic groups except for binge-eating disorder. Subscales were unable to discriminate ARFID cases from other ED diagnoses. Cut scores were identified for picky eating subscale (10) and Fear subscale (9), but not for Appetite subscale. In combination with the ED Examination Questionnaire (EDE-Q), classification accuracy was moderate for ARFID (62.7%) and other EDs (89.4%). DISCUSSION: The Y-NIAS demonstrated excellent factorial validity and internal consistency. Findings were mixed regarding the utility of the Y-NIAS for identifying clinically-significant ARFID presentations from other ED diagnoses.

Preliminary Validation of The Eating Disorders Examination Questionnaire-Short Parent Version (EDE-QS-P).

OBJECTIVE: There is a lack of reliable and valid parent-report measures assessing eating disorder (ED) pathology in children and adolescents. This study aimed to develop and provide preliminary validation of a new parent-report measure, the 12-item Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P). METHOD: The EDE-QS-P was completed by 296 parents seeking treatment for their child at an ED clinic. Children (ages 6-18, N = 296) completed the Eating Disorder Examination-Questionnaire (EDE-Q), the seven-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9). RESULTS: After removing item 10, the 11-item version of the EDE-QS-P showed borderline adequate fit to the one factor solution and strong internal consistency (α = 0.91). This measure also demonstrated strong convergent validity with child scores on the EDE-Q (r = .69), and moderate convergent validity with child scores on the GAD-7 (r = .37) and PHQ-9 (r = .46). The EDE-QS-P was able to differentiate children with EDs characterized by body image disturbances (e.g. anorexia nervosa) from those with avoidant/restrictive food intake disorder, who do not experience shape or weight concerns. DISCUSSION: The 11-item EDE-QS-P may be a promising parent-report measure of ED pathology in children and adolescents.

Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults.

Purpose: The purpose of the study was to provide initial evidence for the internal consistency and convergent validity of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in a sample of transgender and nonbinary (TGNB) youth and young adults. Methods: Returning patients at a Midwestern gender clinic (n=164) ages 12-23 completed the NIAS, sick, control, one stone, fat, food (SCOFF), patient health questionnaire 9 (PHQ-9), and generalized anxiety disorder 7 (GAD-7) during their clinic visit. Age, sex assigned at birth, gender identity, weight, and height were also collected. Confirmatory factor analysis was used to establish the hypothesized three-factor structure of the NIAS in this sample. Relationships between the NIAS subscales and anthropometric data, SCOFF, PHQ-9, GAD-7, and sex assigned at birth were explored for convergent and divergent validity, and proposed screening cutoff scores were used to identify the prevalence of likely avoidant/restrictive food intake disorder (ARFID) in this population. Results: The three-factor structure of the NIAS was an excellent fit to the current data. Approximately one in five (22%) of the participants screened positive for ARFID. Approximately one in four participants scored above the picky eating (27.4%) or appetite (23.9%) cutoffs. Assigned female at birth participants scored significantly higher on the NIAS-Total, Appetite, and Fear subscales than those assigned male at birth. NIAS-Total was significantly related to all convergent validity variables other than age, with a moderate-strong correlation with other symptom screeners (SCOFF, PHQ-9, GAD-7), and a small negative correlation with body mass index percentile. Conclusions: Evidence supports the NIAS as a valid measure to screen for ARFID among TGNB youth and young adults.

Exploring differences in disordered eating and related appetitive traits among women based on childhood and current food security status.

Despite emerging evidence that food insecurity (FI) is associated with elevated rates of eating pathology, little is known about the lasting impact of FI on eating behaviors. Studies that have explored the association between FI during childhood and eating behavior in adulthood have not accounted for current FI. The present study explored differences in disordered eating (DE) and related appetitive traits among four groups of cisgender female mothers: individuals who (1) endorsed childhood FI only (n = 96), (2) endorsed current FI only (n = 134), (3) endorsed both childhood and current FI (n = 257), and (4) denied both childhood and current FI (n = 146). Participants responded to online questionnaires including items from the USDA Household Food Security Survey Module, the 7-item Eating Disorder Examination-Questionnaire, the Eating Disorder Diagnostic Scale, and the Adult Eating Behavior Questionnaire. Adjusting for age and race/ethnicity, ANCOVAs explored mean differences between groups in DE and appetitive traits, and a modified Poisson regression model examined differences in binge-eating prevalence across the four FI groups. The "current FI only" group consistently endorsed the highest levels of DE and related appetitive traits followed by the "current and childhood FI" group, suggesting newly food-insecure women may be at highest risk for DE. Interestingly, across almost all constructs, the "childhood FI only" group did not differ significantly from the "no FI" group. These findings suggest that improved access to food may help offset risk for adult DE related to experiences of FI in childhood.

Negative emotional eating patterns among American university students: A replication study.

Emotional eating (EE) has been consistently associated with obesity, weight gain, and certain eating disorders (EDs). Given the cultural influence on food consumption and eating styles, comparison of EE patterns of individuals in culturally distinct nations (e.g., USA and China) could yield interesting differences in findings. However, given the increasing convergence in eating practices between the above-mentioned nations (e.g., higher reliance on outdoor eating at restaurants among Chinese adolescents), EE patterns might share significant similarities. The present study examined EE patterns of American college students and is a replication of the study done by He, Chen, Wu, Niu, and Fan (2020) on Chinese college students. Responses of 533 participants (60.4% women, 70.1% White, aged 18-52 (mean age = 18.75, SD = 1.35), mean self-reported body mass index = 24.22 kg/m2 and SD = 4.77) on the Adult Eating Behavior Questionnaire (Emotional overeating and emotional undereating subscales) were examined using Latent Class Analysis to identify specific patterns of EE. Participants also completed questionnaire measures of disordered eating and associated psychosocial impairment, depression, stress, and anxiety symptoms, and a measure of psychological flexibility. A solution with four classes emerged, i.e., emotional over- and undereating (18.3%), emotional overeating (18.2%), emotional undereating (27.8%), and non-emotional eating (35.7%). Current findings replicated and extended findings from He, Chen, et al. (2020) in that the emotional over- and undereating class exhibited the highest risks for depression, anxiety, stress, and psychosocial impairment due to disordered eating symptoms as well as lower psychological flexibility. Individuals who have difficulty with awareness and acceptance of their emotions appear to engage in the most problematic form of EE and could benefit from Dialectical behavior therapy and Acceptance and commitment therapy skills training.

The impact of between-session habituation, within-session habituation, and weight gain on response to food exposure for adolescents with eating disorders.

OBJECTIVE: Exposure therapy is a promising treatment for eating disorders (EDs). However, questions remain about the effectiveness of exposure to feared foods during the weight restoration phase of treatment, and the importance of between-session and within-session habituation. METHOD: We recruited 54 adolescents from a partial hospitalization program (PHP) for EDs which included daily food exposure. Throughout treatment, participants provided subjective units of distress (SUDS) ratings before and after eating a feared food, and completed measures of ED symptomatology. RESULTS: Multilevel models found that pre-exposure SUDS decreased over time, providing some evidence that between-session habituation occurred. In contrast, the difference between pre-exposure and post-exposure SUDS did not decrease over time, indicating that within-session habituation did not occur. Weight gain predicted greater between-session habituation to feared foods, but did not predict within-session habituation. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes, including weight gain and improvements on the Children's Eating Attitudes Test and Fear of Food Measure. DISCUSSION: Partial hospitalization programs that include daily exposure to feared foods may be effective at decreasing anxiety about foods for adolescents with EDs who are experiencing weight restoration. Further research is warranted to replicate our findings challenging the importance of within-session habituation, and to better understand between-session habituation and inhibitory learning as mechanisms of change when conducting food exposure for EDs. PUBLIC SIGNIFICANCE: This study provides some evidence that PHPs that include food exposure may be useful for adolescents with EDs who are experiencing weight restoration. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes. Further research is needed to determine whether clinicians can disregard within-session habituation when conducting food exposure for EDs, and understand the importance of between-session habituation as a potential mechanism of food exposure.

Cross-cultural adaptation and validation of the Nine Item ARFID Screen (NIAS) in Mexican youths.

Avoidant/Restrictive Food Intake Disorder (ARFID) is defined by limited volume or variety of food intake motivated by the sensory properties of food, fear of aversive consequences, or lack of interest in food or eating associated with medical, nutritional, and psychosocial impairment. Currently, two of the most widely validated measures are The Eating Disturbances in Youth-Questionnaire (EDY-Q) and the Nine Item ARFID Screen (NIAS). The latter has proven valid and reliable for assessing this disorder. OBJECTIVE: To validate a culturally sensitive adaptation of the NIAS instrument and evaluate its psychometric properties in Mexican youths. METHOD: The sample consisted of 800 participants aged 12-30 (M = 18.56, SD = 3.52) from Mexico City and Hidalgo public educational institutions. RESULTS: The S-NIAS obtained a Cronbach's alpha of 0.84, adequate construct validity adjustment rates: CMIN = 1.88; GFI = 0.97; AGFI = 0.94; CFI = 0.98; RMR = 0.050; and RMSEA = 0.047. Measurement invariance by gender, age, and survey administration which show that construct is understood in the same way across both groups and despite the change from paper-and-pencil to online survey administration. CONCLUSION: The psychometric properties of the Spanish Nine Item ARFID Screen (S-NIAS) indicate that it is a valid and reliable instrument for evaluating symptoms associated with ARFID in this sample of youths. PUBLIC SIGNIFICANCE: Although there are advances in studying ARFID, their epidemiological data comes mainly from a few countries. Furthermore, these data are scarcer due to the lack of validated screening and assessment instruments available in a variety of world languages; having instruments for the evaluation of ARFID symptoms is essential because it could function as an auxiliary means for the detection and prevention of people at risk.

A consensus document on definition and diagnostic criteria for orthorexia nervosa.

PURPOSE: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE: Level V: opinions of expert committees.

Use of a brief, retrospective Comprehensive Feeding Practices Questionnaire in a bariatric-surgery seeking adult population.

Parental feeding practices in childhood have been shown to contribute to childhood eating habits, behaviors, and weight status. Less understood is the longitudinal impact of parental feeding practices on these variables in adulthood. Therefore, the aim of the present work was to validate a modified, brief, Comprehensive Feeding Practices Questionnaire (CFPQ) reformatted to account for retrospective recollections of parental feeding practices experienced in childhood among a sample of adults with obesity. Adults (n = 719, mean age = 44.3 years, mean BMI = 47.1 kg/m2) completed a modified, brief, retrospective CFPQ containing seven pre-defined subscales of the original CFPQ. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) procedures were used to evaluate survey factor structure and associations with gender, BMI, and self-reported race. An EFA derived six-factor model demonstrated better model fit and reliability than the originally proposed seven-factor model. Gender and self-reported race were not correlated with subscales of the brief, retrospective, CFPQ, while BMI was positively correlated with the Food as Reward subscale. This six-factor, brief, retrospective, CFPQ can be used to provide insight into the potential origins of individual eating behaviors, and warrants use in future work attempting to clarify the relationships between parental feeding practices and eating behaviors in adulthood.

The Polish Version of the Avoidant/Restrictive Food Intake Disorder Questionnaire-Parents Report (ARFID-Q-PR) and the Nine Items Avoidant/Restrictive Food Intake Disorder Screen-Parents Report (NIAS-PR): Maternal Perspective.

The aim of the present study was to develop and validate the Avoidant/Restrictive Food Intake Disorder Questionnaire-Parents Report (ARFID-Q-PR), a new tool to diagnose ARFID, based on a report submitted by Polish mothers of children aged 2 to 10 years. In total, 167 mothers of boys and girls aged 2 to 10 participated in the study. We used the ARFID-Q-PR and the Nine Items Avoidant/Restrictive Food Intake Disorder Screen-Parents Report (NIAS-PR). In addition, all mothers were asked to provide information on age, sex, height and weight, chronic somatic diseases, neurodevelopmental and mental disorders as well as intellectual disability of their children. Results of the reliability analysis demonstrated that the ARFID-Q-PR had adequate internal consistency (Cronbach's alpha of 0.84). The stability of the ARFID-Q-PR factorial structure was confirmed. It is composed of three subscales: (1) attitudes to food; (2) justification for restrictions; (3) somatic symptoms. Our findings demonstrated that the ARFID-Q-PR total score was positively associated with the NIAS-PR total score. In addition, children with developmental and mental disorders substantially demonstrated more ARFID symptoms than did the children in the general population. The Polish version ARFID-Q-PR can be used to recognize the ARFID symptoms in young children by the main feeder in the family-mother or father.

Orthorexia nervosa and eating disorder behaviors: A systematic review of the literature.

BACKGROUND: Orthorexia nervosa (ON) involves obsessive thoughts about healthy eating and distress related to this obsession. There is still dispute over whether ON should be considered on the obsessive-compulsive spectrum, the eating disorder (ED) spectrum, or as its own disorder. Based on current research, orthorexic behaviors seem to be closely related to eating disorder behaviors. However, given the range of instruments used to measure ED and ON, and the lack of consistency in the specific ED domains explored, a review of the current literature is warranted. OBJECTIVE: The objective of this study was to review the literature relating ON and ED symptoms in an effort to understand the nature of their relationship, and to identify ED symptom domains most closely related to ON. METHODS: A search was conducted on PubMed, Science Direct, and Web of Science using the term "orthorexia" and at least one of the following: "anorexia nervosa," "bulimia nervosa," "eating disorder," "arfid," "restrictive," "body image," "weight concern," "shape concern." After exclusion criteria were applied, 42 articles were included in the review. RESULTS: The results indicated that ON is consistently related to both trait and disordered restrictive eating symptoms of anorexia nervosa, and weight control motivations for food choice. However, ON was less consistently related to binge-spectrum eating disorder symptoms, emotional eating, uncontrolled eating, or body dissatisfaction/shape and weight concerns. CONCLUSION: The finding that ON symptoms are related to restraint and weight loss efforts, but not to body dissatisfaction or dysregulated eating suggests that ON may represent a distinct ED.

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.

Food insecurity is associated with eating disorders independent of depression and anxiety: Findings from the 2020-2021 Healthy Minds Study.

OBJECTIVE: To examine the association between food insecurity and eating disorder (ED) risk independent of co-occurring anxiety/depression. METHOD: Data were provided by 121,627 undergraduate/graduate students who participated in the 2020-2021 Healthy Minds Study (HMS). Participants responded to questionnaire measures of food insecurity and risk for EDs, depression, and anxiety. Established cut-offs were used to identify students with food insecurity and probable psychopathology. Separate modified Poisson regressions adjusted for age, gender, race/ethnicity, and socioeconomic background examined the association between food insecurity and each form of psychopathology. The association between food insecurity and probable ED was then examined in a regression further adjusted for probable depression and anxiety. RESULTS: Food insecurity was significantly associated with all three forms of psychopathology when examined separately (prevalence ratios ranged from 1.41 to 1.54, all p's < .001). When accounting for probable depression/anxiety, food insecurity was significantly associated with 1.19 times greater prevalence of a probable ED (p < .001). DISCUSSION: The association between food insecurity and EDs was replicated in a large, national sample of university students. To our knowledge, this is the first study to examine the independence of this relationship after adjusting for depression/anxiety. This finding supports the hypothesis that specific mechanisms, rather than general psychological distress, likely underlie the food insecurity-ED relationship.

The landscape of eating disorders research: A 40-year bibliometric analysis.

OBJECTIVE: Employing bibliometric methods, the present study aimed to map out the general landscape of existing research on eating disorders (EDs) over the past decades. METHOD: Using the Web of Science database, we retrieved 41,917 research articles related to EDs published from 1981 to 2020. After removing those without an abstract, a total of 37,446 articles were retained. The study outlined the distribution of scholarship by time, languages, regions, and countries, and identified major research lines by applying latent topic modelling. RESULTS: Results revealed a general increasing trend in the number of publications on EDs research, and researchers from Western countries dominated the production of related scholarship. The distribution of published scholarship varied significantly by languages, regions, and countries. Seven main research topics emerged from past research (i.e., animal studies of food intake, risk factors and at-risk groups for eating disorders, body image in eating disorders, studies of cognition and brain in eating disorders, symptomatology and comorbidity of eating disorders, body weight and nutrition status in eating disorders, and treatment of eating disorders), with different topics showing unique research trends across the years. CONCLUSIONS: This bibliometric analysis presents the most complete up-to-date overview on published research on EDs. While there is an increasing trend for EDs research, the available research evidence is generally from Western countries; thus, it is suggested that cooperation on EDs research should be strengthened between Western countries and other countries in the future.