Examining changes in binge-eating disorder network centrality and structure in patients treated with cognitive-behavioral therapy versus interpersonal psychotherapy.

OBJECTIVE: A sizeable minority of patients with binge-eating disorder (BED) do not fully respond to evidence-based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for identification of the most strongly connected symptoms, which could inform intervention targets. This study estimated networks of BED features at pretreatment and posttreatment to assess whether cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) differentially impacted the interrelationships of BED symptoms/features. METHODS: Participants were 392 adults (83% women, 88% white) with BED who received CBT (n = 236) or IPT (n = 156) and assessed at pretreatment and posttreatment. Networks were estimated across timepoints and treatments. Expected influence (EI) was calculated; symptoms with the highest EI have the most strong and frequent associations with other symptoms. We also assessed whether the symptoms with the highest and lowest EI predicted posttreatment remission indicators. RESULTS: In the CBT and IPT networks, shape concern, weight concern, and eating concern had the highest EI at pretreatment and posttreatment. EI significantly increased from pretreatment to posttreatment for some symptoms in CBT but did not change for any symptoms in IPT. Shape concern significantly and positively predicted BED remission indicators in CBT and IPT. CONCLUSIONS: CBT and IPT similarly impacted interrelations among BED features. Pretreatment EI predicted posttreatment remission indicators, indicating that pretreatment centrality could signal meaningful intervention targets. Clinical implications and avenues for future research are discussed including how personalized network analysis may advance the understanding of the clinical utility of centrality. PUBLIC SIGNIFICANCE: Cognitive behavioral therapy and interpersonal therapy for binge-eating disorder, which are two leading evidence-based treatments for binge-eating disorder that are quite different in their models and approaches, similarly impacted interrelations among binge-eating disorder symptoms. In addition, the most strongly interconnected symptom predicted indicators of remission. Studying the interrelations among symptoms may provide new insight on how treatments impact symptom relationships and inform intervention targets.

The relationship between individual symptom connectivity and global eating disorder symptom severity.

BACKGROUND: The network approach has emerged as a useful framework for conceptualizing and investigating psychopathology, including eating disorders. Network connectivity, that is, the density of the connections among network nodes, has been somewhat neglected despite its theoretical relevance. As predicted by network theory, symptom connectivity would be distinct but related to symptom severity and may be a useful clinical indicator of psychopathology as stronger and/or more diffuse connections among symptoms offer more avenues for symptom activation. This study aimed to investigate the relationship between moment-by-moment individual-level symptom connectivity and global levels of symptom severity in the context of eating disorder symptoms and experiences. METHODS: A sample of 58 female undergraduate college students, mean (SD) age = 20.5 (3.1) provided data on eating disorder symptoms eight times a day over the course of 10 days. Network analyses were used to calculate the eating disorder symptoms network connectivity for each participant. In addition, participants completed survey of self-report measures of eating disorder symptom severity and trait mindfulness and body image flexibility. RESULTS: Analyses revealed a moderate, positive relationship between individual network connectivity and eating disorder symptom severity. In addition, symptom connectivity predicted unique variance of symptom severity even after controlling for other clinically-relevant variables. CONCLUSIONS: Individual-level network connectivity may be an important dimension of psychopathology and further work exploring the role of network connectivity is warranted. PUBLIC SIGNIFICANCE: These findings suggest that symptom severity and the extent to which different eating disorder symptoms are connected are related but different dimensions. Investigating how these different dimensions play a role in eating disorder pathology could help to better understand and treat these disorders.

Anhedonia in eating disorders: A meta-analysis and systematic review.

OBJECTIVE: Anhedonia, or loss of pleasure, is related to deficits in reward processing across a variety of psychiatric disorders. In light of research suggesting abnormal reward processing in eating disorders (EDs), the study of anhedonia in EDs may yield important insights into the role of reward in eating pathology. This meta-analysis and review aimed to provide both a quantitative and qualitative synthesis of the existing literature on this topic. METHOD: We conducted this research (or these meta-analyses) according to PRISMA guidelines. We searched four databases for both peer-reviewed and unpublished literature, and included studies only if a self-report or clinical interview measure of anhedonia was administered to a sample with an ED diagnosis. RESULTS: We included 21 studies in the systematic review, and 10 studies in two meta-analyses that compared anhedonia between ED and control samples (n = 9 studies) and within different ED diagnoses (n = 5 studies). Meta-analyses revealed that anhedonia was significantly higher in ED groups compared to healthy controls, but there was no significant difference in anhedonia between ED diagnostic groups. A qualitative review of the literature also suggested that anhedonia may be correlated with increased ED symptom severity. DISCUSSION: Findings indicated that anhedonia is elevated in EDs and may be a relevant treatment target. Future research should examine how self-reported anhedonia may correlate with components of reward processing in EDs in order to improve theoretical models as well as targeted interventions.

OBJETIVO: La anhedonia, o pérdida de placer, está relacionada con déficits en el procesamiento de recompensas en una variedad de trastornos psiquiátricos. A la luz de la investigación que sugiere una anormalidad en el proceso de la recompensa en los trastornos de la conducta alimentaria (TCA), el estudio de la anhedonia en los TCA puede producir información importante sobre el papel de la recompensa en la patología alimentaria. Este metanálisis y revisión tuvo como objetivo proporcionar una síntesis cuantitativa y cualitativa de la literatura existente sobre este tema. MÉTODO: Se realizó esta investigación (o estos metanálisis) de acuerdo con las guías PRISMA. Se realizaron búsquedas en cuatro bases de datos de literatura revisada por pares y no publicada, y se incluyeron estudios solo si se administró una medida de anhedonia en el autoreporte o en una entrevista clínica a una muestra con un diagnóstico de TCA. RESULTADOS: Se incluyeron 21 estudios en la revisión sistemática y 10 estudios en dos metanálisis que compararon la anhedonia entre TCA y las muestras de control (n = 9 estudios) y dentro de diferentes diagnósticos de TCA (n = 5 estudios). Los metanálisis revelaron que la anhedonia fue significativamente mayor en los grupos de TCA en comparación con los controles sanos, pero no hubo diferencias significativas en la anhedonia entre los grupos de diagnóstico de TCA. Una revisión cualitativa de la literatura también sugirió que la anhedonia puede estar correlacionada con una mayor gravedad de los síntomas de TCA. DISCUSIÓN: Los hallazgos indicaron que la anhedonia está elevada en los TCA y puede ser un objetivo de tratamiento relevante. La investigación futura debe examinar cómo la anhedonia autoreportada puede correlacionarse con los componentes del procesamiento de recompensas en los TCA para mejorar los modelos teóricos, así como las intervenciones dirigidas.

Accountability in promoting representation of historically marginalized racial and ethnic populations in the eating disorders field: A call to action.

Promoting representation of historically marginalized racial and ethnic populations in the eating disorders (EDs) field among professionals and the populations studied and served has long been discussed, with limited progress. This may be due to a reinforcing feedback loop in which individuals from dominant cultures conduct research and deliver treatment, participate in research, and receive diagnoses and treatment. This insularity maintains underrepresentation: EDs in historically marginalized populations are understudied, undetected, and undertreated. An Early Career Investigators Workshop generated recommendations for change that were not inherently novel but made apparent that accountability is missing. This paper serves as a call to action to spearhead a paradigm shift from equality to equity in the ED field. We provide a theoretical framework, suggest ways to disrupt the feedback loop, and summarize actionable steps to increase accountability in ED leadership and research toward enhancing racial/ethnic justice, equity, diversity, and inclusion (JEDI). These actionable steps are outlined in the service of challenging our field to reflect the diversity of our global community. We must develop and implement measurable metrics to assess our progress toward increasing diversity of underrepresented racial/ethnic groups and to address JEDI issues in our providers, patients, and research participants.

Eighteen-month Course and Outcome of Adolescent Restrictive Eating Disorders: Persistence, Crossover, and Recovery.

OBJECTIVE: In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake disorder (ARFID). To inform nosology of low-weight restrictive eating disorders in adolescents, we examined outcomes including persistence, crossover, and recovery in an 18-month observational study. METHOD: We assessed 82 women (ages 10-23 years) with low-weight eating disorders including AN (n = 40; 29 restricting, 11 binge-eating/purging), atyp-AN (n = 26; 19 restricting, seven binge-eating/purging), and ARFID (n = 16) at baseline, nine months (9 M; 75% retention), and 18 months (18 M; 73% retention) via semi-structured interviews. First-order Markov modeling was used to determine diagnostic persistence, crossover, and recovery occurring at 9 M or 18 M. RESULTS: Among all diagnoses, the likelihood of remaining stable within a given diagnosis was greater than that of transitioning, with the greatest probability among ARFID (0.84) and AN-R (0.62). Persistence of BP and atypical presentations at follow-up periods was less stable (AN-BP probability 0.40; atyp-AN-R probability 0.48; atyp-AN-BP probability, 0.50). Crossover from binge-eating/purging to restricting occurred 72% of the time; crossover from restricting to binge-eating/purging occurred 23% of the time. The likelihood of stable recovery (e.g., recovery at both 9 M and 18 M) was between 0.00 and 0.36. CONCLUSION: Across groups, intake diagnosis persisted in about two-thirds, and recovery was infrequent, underscoring the urgent need for innovative treatment approaches to these illnesses. Frequent crossover between AN and atyp-AN supports continuity between typical and atypical presentations, whereas no crossover to ARFID supports its distinction.

The longitudinal relationship between family and peer teasing in young adulthood and later unhealthy weight control behaviors: The mediating role of body image.

OBJECTIVE: Sociocultural theories hold that family and peer weight-related teasing increases the risk for unhealthy weight control behaviors (UWCBs) by negatively impacting body image. Although much cross-sectional support exists for these pathways, longitudinal data are lacking. This study tested the longitudinal relationships among peer and family teasing (occurrence and perceived impact) in early adolescence, body satisfaction in late adolescence, and UWCBs in young adulthood among a racially/ethnically and socioeconomically diverse population. METHOD: Data were drawn from three waves of Project EAT over a 15-year period (Eating and Activity in Teens and Young Adults), and included responses from 1,902 young adults (57% female). RESULTS: Among female participants, a mediated indirect pathway emerged with family weight-related teasing predicting increased engagement in UWCBs in early adulthood via poorer body image in late adolescence. In contrast, peer teasing did not predict body image or UWCBs. Among boys, the mediated indirect pathways were not significant. However, poor body image in late adolescent males predicted higher likelihood of engaging in UCWBs in early adulthood. DISCUSSION: These findings support the long-term impact of family weight-related teasing on greater risk for UWCBs among girls and young women, and poor body image as a mechanism accounting for this relationship. Moreover, the results highlight the poor body image among adolescent boys as a factor for increased risk of engaging in UWCBs in early adulthood. Pending replication in current cohorts, health promotion and prevention involving family members of early adolescents that address family weight teasing and body image are needed.

Clinical moderators and predictors of cognitive-behavioral therapy by guided-self-help versus therapist-led for binge-eating disorder: Analysis of aggregated clinical trials.

OBJECTIVE: Cognitive-behavioral therapy (CBT)-therapist-led (CBTth) and guided-self-help (CBTgsh)-has efficacy for binge-eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. METHOD: Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge-eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). RESULTS: Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0) and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT-type and treatment length (OR = 2.66). For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission. DISCUSSION: Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect-sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes.

"Waste not and stay at home" evidence of decreased food waste during the COVID-19 pandemic from the U.S. and Italy.

The COVID-19 pandemic has profoundly disrupted household food purchasing and preparation, including elements identified as important drivers of household food waste. The two main aims of this study were (1) to examine changes in food waste behaviors since the start of the COVID-19 pandemic in the U.S. and Italy; and (2) to investigate potential predictors of food waste behavior, including avoidance of supermarkets, increased home cooking, and increased role of health concerns in food choices. A sample of n = 478 (79% female) individuals from the U.S., mean (SD) age = 30.51 (10.85), and n = 476 individuals from Italy, (78% female), mean (SD) age = 33.84 (12.86), completed an online survey between April 8th and April 28th 2020. Just under half of respondents (49%) reported decreased food waste since the start of the pandemic. Rates were significantly higher among the U.S. sample (61.5%, n = 294) compared to the Italian sample (38%, n = 180). Controlling for the time since restrictions were introduced, age, gender, and perceived financial security, logistic regression revealed greater reduction in food waste since the beginning of the pandemic for U.S. individuals relative to participants from Italy (OR = 0.47, p < .001). In addition, increased importance of health concerns when making food choices (OR = 1.34, p < .005) as well as more frequent cooking (OR = 1.35, p < .001), and greater avoidance of supermarkets (OR = 1.15, p = .049) were associated with greater probability of less food waste. Scarcity and greater reliance on cooking may encourage individuals to reflect on food waste practices. Further research should explore how these factors may be targeted to reduce food waste beyond the pandemic.

Muscle dysmorphia: A systematic and meta-analytic review of the literature to assess diagnostic validity.

OBJECTIVE: Although muscle dysmorphia (MD) is a new addition to DSM-5 as a specifier of body dysmorphic disorder (BDD), previous studies have treated MD as a stand-alone diagnosis. We aimed to assess the validity of MD as a stand-alone diagnosis via systematic and meta-analytic review of MD literature using both Robins and Guze criteria and additional criteria from Kendler. METHOD: We performed a systematic search of ProQuest, PsycInfo, and PubMed databases for the period of January 1993 to October 2019 resulting in 40 papers to examine Robins and Guze's criteria (clinical picture) as well as those added by Kendler (antecedent validators; concurrent validators; predictive validators). RESULTS: We identified two distinct symptomatic presentations of MD using cluster analysis, a behavioral type and cognitive/behavioral type. For examining the concurrent validators, quantitative meta-analyses differentiated MD populations from controls; however, results were inconclusive in delineating MD from existing disorders. For assessing antecedent and predictive validators, the symptomatic profiles, treatment response, and familial links for MD were similar to those for BDD and for eating disorders. DISCUSSION: We found preliminary support for MD as a clinically valid presentation, but insufficient evidence to determine whether it is best categorized as a specifier of BDD or unique psychiatric condition.

OBJECTIVO: Aunque la dismorfia muscular (MD, por sus siglas en inglés) es una nueva adición al DSM-5 como un especificador del trastorno dismórfico corporal (BDD, por sus siglas en inglés), los estudios previos han tratado la MD como un diagnóstico independiente. El objetivo fue evaluar la validez de la MD como un diagnóstico independiente a través de revisiones sistemáticas y metaanalíticas de la literatura de MD utilizando los criterios de Robin y Guze (1970) y los criterios adicionales de Kendler (1980). MÉTODO: Realizamos una búsqueda sistemática de las bases de datos ProQuest, PsycInfo y PubMed para el período de enero de 1993 a octubre de 2019, lo que resultó en 40 documentos para examinar los criterios de Robins y Guze (cuadro clínico), así como los agregados por Kendler (validadores antecedentes; validadores concurrentes; validadores predictivos). RESULTADOS: identificamos dos presentaciones sintomáticas distintas de MD mediante análisis de conglomerados, una de tipo conductual y una de tipo cognitivo / conductual. Para examinar los validadores concurrentes, los metaanálisis cuantitativos diferenciaron las poblaciones de MD de los controles; sin embargo, los resultados no fueron concluyentes para delinear la MD de los trastornos existentes. Para evaluar los validadores antecedente y predictivo, los perfiles sintomáticos, la respuesta al tratamiento y los vínculos familiares para la MD fueron similares a los de la BDD y los trastornos de la conducta alimentaria. DISCUSIÓN: Encontramos apoyo preliminar para la MD como una presentación clínicamente válida, pero evidencia insuficiente para determinar si se clasifica mejor como un especificador de BDD o una condición psiquiátrica única.

The impact of the COVID-19 pandemic on eating disorder risk and symptoms.

The current COVID-19 pandemic has created a global context likely to increase eating disorder (ED) risk and symptoms, decrease factors that protect against EDs, and exacerbate barriers to care. Three pathways exist by which this pandemic may exacerbate ED risk. One, the disruptions to daily routines and constraints to outdoor activities may increase weight and shape concerns, and negatively impact eating, exercise, and sleeping patterns, which may in turn increase ED risk and symptoms. Relatedly, the pandemic and accompanying social restrictions may deprive individuals of social support and adaptive coping strategies, thereby potentially elevating ED risk and symptoms by removing protective factors. Two, increased exposure to ED-specific or anxiety-provoking media, as well as increased reliance on video conferencing, may increase ED risk and symptoms. Three, fears of contagion may increase ED symptoms specifically related to health concerns, or by the pursuit of restrictive diets focused on increasing immunity. In addition, elevated rates of stress and negative affect due to the pandemic and social isolation may also contribute to increasing risk. Evaluating and assessing these factors are key to better understanding the impact of the pandemic on ED risk and recovery and to inform resource dissemination and targets.

Behavioral symptoms of eating disorders among adopted adolescents and young adults in the United States: Findings from the Add Health survey.

OBJECTIVE: More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating-disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals. METHOD: We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self-induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis. RESULTS: Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (ps < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (ps < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms. DISCUSSION: This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.

Identifying duration criteria for eating-disorder remission and recovery through intensive modeling of longitudinal data.

OBJECTIVE: Outcome states, such as remission and recovery, include specific duration criteria for which individuals must be asymptomatic. Ideally, duration criteria provide predictive validity to outcome states by reducing symptom-return risk. However, available research is insufficient for deriving specific recommendations for remission or recovery duration criteria for eating disorders. METHOD: We intensively modeled the relation between duration criteria length and rates of remission, recovery, and subsequent symptom return in longitudinal data from a treatment-seeking sample of women with anorexia nervosa (AN) and bulimia nervosa (BN). We hypothesized that the length of the duration criterion would be inversely associated with both rates of remission and recovery and with subsequent rates of symptom return. RESULTS: Generalized estimating equations supported our hypotheses for all investigated eating-disorder features except for symptom return when using the Psychiatric Status Rating for AN. DISCUSSION: We recommend that 6 months be used for remission definitions applied to binge eating, purging, and BN symptom composite measures, whereas no duration criteria be used for low weight and AN symptom composites. We further recommend that 6 months be used for recovery definitions applied to BN symptom composites and AN symptom composites, whereas 18 months be used for individual symptoms of binge eating, purging, and low weight. The adoption of these duration criteria into comprehensive definitions of remission and recovery will increase their predictive validity, which in turn, maximizes their utility.

Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder.

OBJECTIVE: We aimed to characterize the current and lifetime prevalence of comorbid psychiatric diagnoses and suicidality in treatment- and nontreatment-seeking individuals with full and subthreshold avoidant/restrictive food intake disorder (ARFID). We also sought to examine unique associations between the three DSM-5 ARFID profiles (i.e., sensory sensitivity, fear of aversive consequences, and lack of interest in food or eating) and specific categories of psychiatric diagnoses and suicidality. METHOD: We conducted structured clinical interviews with 74 children and adolescents with full or sub threshold ARFID to assess the presence of comorbid psychiatric diagnoses, suicidality, and the severity of each of the three ARFID profiles. RESULTS: Nearly half of the sample (45%) met criteria for a current comorbid psychiatric diagnosis, and over half (53%) met criteria for a lifetime comorbid diagnosis. A total of 8% endorsed current suicidality and 14% endorsed lifetime suicidality. Severity in the sensory sensitivity profile was uniquely associated with greater odds of comorbid disorders in the neurodevelopmental, disruptive, and conduct disorders category; the anxiety, obsessive-compulsive, and trauma-related disorders category; and the depressive and bipolar-related disorders category. Severity in the fear of aversive consequences profile was associated with greater odds of disorders in the anxiety, obsessive-compulsive, and trauma-related disorders category. DISCUSSION: Our findings underscore the severity of psychopathology among individuals with ARFID and related presentations, and also highlight the potential that shared psychopathology between specific ARFID profiles and other psychiatric disorders represent transdiagnostic constructs (e.g., avoidant behavior) that may be relevant treatment targets.

Restrictive eating, but not binge eating or purging, predicts suicidal ideation in adolescents and young adults with low-weight eating disorders.

OBJECTIVE: This study examined the relationship between eating-disorder behaviors-including restrictive eating, binge eating, and purging-and suicidal ideation. We hypothesized that restrictive eating would significantly predict suicidal ideation, beyond the effects of binge eating/purging. METHODS: Participants were 82 adolescents and young adults with low-weight eating disorders. We conducted a hierarchical logistic regression, with binge eating and purging in Step 1 and restrictive eating in Step 2, to predict suicidal ideation. RESULTS: Step 1 was significant (p = .01) and explained 20% variance in suicidal ideation; neither binge eating nor purging significantly predicted suicidal ideation. Adding restrictive eating in Step 2 significantly improved the model (ΔR2 = .07, p = .009). This final model explained 27% of the variance, and restrictive eating (but not binge eating/purging) significantly predicted suicidal ideation (p = .02). DISCUSSION: Restrictive eating is associated with suicidal ideation in youth with low-weight eating disorders, beyond the effects of other eating-disorder behaviors. Although healthcare providers may be more likely to screen for suicidality in patients with binge eating and purging, our findings indicate clinicians should regularly assess suicide and self-injury in patients with restrictive eating. Future research examining how individuals progress from suicidal ideation to suicidal attempts can further enhance our understanding of suicide in eating disorders.

Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa.

OBJECTIVE: Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are restrictive eating disorders. There is a proposal before the American Psychiatric Association to broaden the current DSM-5 criteria for ARFID, which currently require dietary intake that is inadequate to support energy or nutritional needs. We compared the clinical presentations of ARFID and AN in an outpatient sample to determine how a more inclusive definition of ARFID, heterogeneous for age and weight status, is distinct from AN. METHODS: As part of standard care, 138 individuals with AN or ARFID completed an online assessment battery and agreed to include their responses in research. RESULTS: Individuals with ARFID were younger, reported earlier age of onset, and had higher percent median BMI (%mBMI) than those with AN (all ps < .001). Individuals with ARFID scored lower on measures of eating pathology, depression, anxiety, and clinical impairment (all ps < .05), but did not differ from those with AN on restrictive eating (p = .52), and scored higher on food neophobia (p < .001). DISCUSSION: Allowing psychosocial impairment to be sufficient for an ARFID diagnosis resulted in a clinical picture of ARFID such that %mBMI was higher (and in the normal range) compared with AN. Differences in gender distribution, age, and age of onset remained consistent with previous research. Both groups reported similar levels of dietary restriction, although ARFID can be distinguished by relatively higher levels of food neophobia. Currently available measures of eating pathology may capture certain ARFID symptoms, but highlight the need for measures of impairment relative to ARFID.

Negative psychological correlates of the pursuit of muscularity among women.

OBJECTIVE: There is increasing public and scientific focus on women's pursuit of a muscular and toned appearance. However, the psychological correlates of women's drive for muscularity are currently unclear. Therefore, we examined the associations of drive for muscularity with four important negative psychological indices among women: eating disorder (ED) symptoms, and symptoms of depression, anxiety, and stress. METHOD: A sample of 221 university women completed an online survey that included measures assessing the aforementioned constructs. RESULTS: Drive for muscularity evidenced positive associations with all negative psychological indices, except for anxiety. Muscularity-oriented attitudes, as opposed to behaviors, demonstrated the strongest associations with ED and depression symptoms. DISCUSSION: Our findings make a novel contribution to the scant literature by demonstrating that women who endorse attitudes and/or behaviors geared toward attaining the female muscular ideal may be susceptible to experiencing ED symptoms and negative emotional states. This study provides preliminary evidence that muscularity-oriented attitudes, in particular, may be a promising target for the treatment of EDs and negative emotional states in women with a preoccupation toward muscularity.

Eating disorder recovery is associated with absence of major depressive disorder and substance use disorders at 22-year longitudinal follow-up.

BACKGROUND: Psychiatric comorbidity is common in eating disorders (EDs) and associated with poor outcomes, including increased risk for relapse and premature death. Yet little is known about comorbidity following ED recovery. METHODS: We examined two common comorbidities, major depressive disorder (MDD) and substance use disorder (SUD), in adult women with intake diagnoses of anorexia nervosa and bulimia nervosa who participated in a 22-year longitudinal study. One hundred and seventy-six of 228 surviving participants (77.2%) were interviewed 22 years after study entry using the Eating Disorders Longitudinal Interval Follow-up Evaluation to assess ED recovery status. Sixty-four percent (n = 113) were recovered from their ED. The Structured Clinical Interview for DSM-IV was used to assess MDD and SUD at 22 years. RESULTS: At 22-year follow-up, 28% (n = 49) met criteria for MDD, and 6% (n = 11) met criteria for SUD. Those who recovered from their ED were 2.17 times more likely not to have MDD at 22-year follow-up (95% CI [1.10, 4.26], p = .023) and 5.33 times more likely not to have a SUD at 22-year follow-up than those who had not recovered from their ED (95% CI [1.36, 20.90], p = .008). CONCLUSION: Compared to those who had not fully recovered from their ED, those who had recovered were twice as likely not to be diagnosed with MDD in the past year and five times as likely not to be diagnosed with SUDs in the past year. These findings provide evidence that long-term recovery from EDs is associated with recovery from or absence of these common major comorbidities. Because comorbidity in EDs can predict poor outcomes, including greater risk for relapse and premature death, our findings of reduced risk for psychiatric comorbidity following recovery at long-term follow-up is cause for optimism.

Ethnic and racial diversity in eating disorder prevention trials.

Recruiting diverse samples for prevention trials is challenging, but essential. This paper provides baseline data for four racial/ethnic groups from a randomized controlled trial of a mobile-based prevention intervention and systematically reviews recruitment trends in diversity across technology-based prevention studies. Female emerging adults completed measures of appearance esteem, body image flexibility, appearance comparison, and self-compassion. White participants reported lower body esteem and body image flexibility, and higher appearance comparison compared to Black and Asian participants. Latina participants evidenced higher appearance comparison compared to Black participants. The literature review revealed that while rates of diversity in previous trials vary, the majority of the participants were White. Efforts are needed to increase diversity in prevention trials.

Eating Disorders in Ethnic Minorities: an Update.

PURPOSE OF REVIEW: Eating disorders are recognized to occur across ethnic and racial groups. The aim of the present review was to examine recent advances in the understanding of the development, presentation, and intervention approaches specific to eating disorders among ethnic and racial minority groups. RECENT FINDINGS: An increasing number of measures have been found to be useful tools for assessing eating disorder risk and symptoms among ethnic and racial minority populations. In addition, further evidence has emerged supporting the relationship between higher levels of eating disorder symptoms and acculturation stress, as well as investment in appearance ideals. In contrast, the relationship between ethnic identity and eating disorder symptoms is less consistent, although several studies suggest that positive ethnic identity may be protective. Finally, increasing efforts have been made to develop and implement culturally sensitive interventions by tailoring evidence-supported treatments. Our understanding of and capacity to treat eating disorders among ethnic and racial minority groups continues to improve. However, further research is needed, particularly among neglected groups, such a smaller ethnic and racial groups, males, and intersecting minority statuses.

Risk factors for disordered weight control behaviors among Korean adolescents: Multilevel analysis of the Korea Youth Risk Behavior Survey.

OBJECTIVE: To investigate the prevalence and risk factors for disordered weight control behaviors (DWCB) in South Korean adolescents at multiple levels, including individual, family, school, and geographic area. METHOD: We drew participants from the 11th Korea Youth Risk Behavior Web-based Survey, conducted in 2015, with 65,529 adolescents (31,687 girls, 33,842 boys) aged 12-18 years. DWCB was defined as engaging in any of the following behaviors for weight control over the past month: fasting, one-food diet (eating only one food over an extended period of time for weight control), vomiting, and taking laxatives/diuretics/unprescribed diet pills. Sex-stratified four-level multilevel logistic models examined potential predictors of DWCB, including age, body-mass index, puberty, perceived household economic status, parental education, living structure, school type and sex-composition, percentage of students participating in school nutrition programs, and urbanicity. RESULTS: Overall, 6.2% of Korean adolescents (8.9% of girls, 3.7% of boys) exhibited any DWCB. We found significant between-school variation among girls and boys and between-classroom variation among girls. Older age, overweight/obesity, pubertal maturity, high household economic status (vs. mid-range economic status), and vocational schooling (vs. general) were positively associated with DWCB among girls and boys. Low household economic status (vs. mid-range economic status), higher parental education, and coeducational schooling (vs. single-sex) were positively associated with DWCB among girls only. DISCUSSION: The findings suggest that DWCB are prevalent among Korean adolescents across age, sex, and socioeconomic status. Social contextual factors including school and familial environmental factors, as well as individual characteristics, should be considered when developing effective prevention strategies.