Eating disorders among queer and trans individuals: Implications for conceptualization, assessment, and treatment.

Eating disorders (EDs) have been traditionally viewed as a disorder affecting cisgender, heterosexual women. Yet, the prevalence of EDs among queer and trans (QnT) individuals, coupled with the lack of interventions that attend to contextual factors related to sexual orientation and gender identity, underscore a critical health disparity issue requiring urgent attention. Here, we first review factors pertaining to QnT individuals' minoritized sexual and gender identities that are important to consider in ED conceptualization for this population (e.g., minority stressors, identity-based body image standards). Next, we describe problematic assumptions present in existing ED assessment and propose more inclusive approaches. Lastly, we provide suggestions for practices that providers can implement within their treatment of EDs among QnT individuals.

A Pilot, Time-Series Investigation of Depression, Anxiety, and Eating Disorder Symptoms in Adults Experiencing Major Depressive Symptoms: The Need for Eating Disorder Assessment and Research in Depression.

Major Depressive Disorder (MDD) is a prevalent psychiatric disorder impacting 10-16% of Americans in their lifetime. Approximately 60% of individuals with MDD have comorbid anxiety disorders. Additionally, although scarce research has examined eating disorders (EDs) in depression, a bidirectional association exists between ED and MDD symptoms. The current pilot study (N = 31 individuals with moderate to severe depression) modeled networks of depressive, anxiety, and ED symptoms using intensive time-series data. This study also tested if temporal central symptoms predicted six-month clinical outcomes. The most central symptoms were guilt, self-dislike, lack of energy, and difficulty concentrating. Several anxiety and ED symptoms were also central, including physical anxiety, social anxiety, body dissatisfaction, and desire for thinness. The central symptom crying predicted six-month depression with a medium effect size. These findings suggest anxiety and ED symptoms may influence the day-to-day course of depression in some individuals with comorbid diagnoses, but predictors of symptoms across hours may differ from predictors across longer time scales (i.e., months). Time scale should be considered when conducting and interpreting research on MDD. Research, assessment, and treatment for MDD should continue to explore transdiagnostic approaches including anxiety and ED symptoms to optimize care for individuals with complex presentations.

Eating Disorder Screening and Treatment in a Medically Underserved Southern State: Data Collected by a Legislative Eating Disorder Council and Implications for Statewide Assessment.

Healthcare providers play a key role in early identification of eating disorders (EDs), especially in underserved states where ED treatment resources are lacking. Currently, there is little known about ED screening and treatment practices in underserved states. The current study assessed current ED screening and treatment practices among healthcare providers in an underserved state using data collected by a government-formed state ED council. Healthcare providers (N = 242; n = 209 behavioral health providers; n = 33 medical providers) practicing in Kentucky completed a brief, anonymous survey on ED screening and treatment practices, comfort with screening for EDs, and interest in continued education. Over half of healthcare providers indicated screening for EDs, with the majority using a clinical interview. After identification of ED symptoms, providers reported a combination of treating in-house, referring out, or seeking consultation. In bivariate analyses, medical providers were significantly more likely than behavioral health providers to use a screening tool specifically designed for EDs. The majority of medical providers indicated that they received education about EDs and feel knowledgeable about ED screening tools, though most reported infrequent use of these screening tools in their practice. Nearly all behavioral health and medical providers expressed interest in continuing education on ED screening and treatment. These findings indicate a need for, and interest in, education on evidence-based ED screening and treatment resources in underserved states and demonstrate the utility of a state ED council to collect these data to inform future education and treatment strategies.

Integrating clinician and patient case conceptualization with momentary assessment data to construct idiographic networks: Moving toward personalized treatment for eating disorders.

Eating disorders are serious psychiatric illnesses with treatments ineffective for about 50% of individuals due to high heterogeneity of symptom presentation even within the same diagnoses, a lack of personalized treatments to address this heterogeneity, and the fact that clinicians are left to rely upon their own judgment to decide how to personalize treatment. Idiographic (personalized) networks can be estimated from ecological momentary assessment data, and have been used to investigate central symptoms, which are theorized to be fruitful treatment targets. However, both efficacy of treatment target selection and implementation with 'real world' clinicians could be maximized if clinician input is integrated into such networks. An emerging line of research is therefore proposing to integrate case conceptualizations and statistical routines, tying together the benefits from clinical expertise as well as patient experience and idiographic networks. The current pilot compares personalized treatment implications from different approaches to constructing idiographic networks. For two patients with a diagnosis of anorexia nervosa, we compared idiographic networks 1) based on the case conceptualization from clinician and patient, 2) estimated from patient EMA data (the current default in the literature), and 3) based on a combination of case conceptualization and patient EMA data networks, drawing on informative priors in Bayesian inference. Centrality-based treatment recommendations differed to varying extent between these approaches for patients. We discuss implications from these findings, as well as how these models may inform clinical practice by pairing evidence-based treatments with identified treatment targets.

Sensor technology implementation for research, treatment, and assessment of eating disorders.

Sensor technology has made huge technological advances in the past decade. Many sensor technologies (e.g., wearable wristbands) have been integrated into health research with the ability to substantially improve health outcomes and reduce health care costs. Despite the rapid technological developments in sensor technology, little research has examined sensor technology in eating disorders (EDs). The overarching aim of the current article is to briefly review the literature on sensor technology and health outcomes, including EDs, and discuss several potential ideas for the application of sensor technology in the treatment, assessment, and diagnosis of EDs. We will also present data from a feasibility case study with an ED participant and healthy control providing a brief example of how wearable sensor technology might be implemented in ED research. Overall, we will discuss how sensor technology could be used to improve treatment and assessment of EDs and represents an idea in need of more research in the ED field.

Repetitive negative thinking predicts eating disorder behaviors: A pilot ecological momentary assessment study in a treatment seeking eating disorder sample.

BACKGROUND: Repetitive negative thinking is a transdiagnostic process that occurs across several psychological disorders, including eating disorders. Individuals with eating disorders have higher levels of repetitive negative thinking than controls, and repetitive negative thinking is associated with eating disorder behaviors. However, no study has measured how momentary repetitive negative thinking may subsequently impact daily eating disorder behaviors and vice-versa. METHOD: In the current study (N = 66, recently treated individuals recruited from an eating disorder treatment center), we examined the relationship between repetitive negative thinking and subsequent eating disorder behaviors and vice-versa using ecological momentary assessment. RESULTS: We found that higher momentary repetitive negative thinking predicted higher subsequent weighing and body checking. We also found that higher momentary meal-specific repetitive negative thinking predicted higher subsequent weighing and lower subsequent compensatory behavior. We also found that higher repetitive negative thinking predicted higher eating disorder symptoms at one-month follow-up. CONCLUSION: There are short-term and long-term negative effects of repetitive negative thinking in the eating disorders. Targeting repetitive negative thinking may be important for decreasing eating disorder behaviors.

Meal and snack-time eating disorder cognitions predict eating disorder behaviors and vice versa in a treatment seeking sample: A mobile technology based ecological momentary assessment study.

Individuals with eating disorders experience high anxiety when eating, which may contribute to the high relapse rates seen in the eating disorders. However, it is unknown if specific cognitions associated with such anxiety (e.g., fears of gaining weight) may lead to engagement in eating disorder behaviors (e.g., weighing oneself). Participants (N = 66) recently treated at a residential eating disorder facility and diagnosed with an eating disorder (primarily anorexia nervosa; n = 40; 60.6%) utilized a mobile application to answer questions about mealtime cognitions, anxiety, and eating disorder behaviors four times a day for one week. Hierarchical linear models using cross-lag analyses identified that there were quasi-causal (and sometimes reciprocal) within-person relationships between specific eating disorder cognitions and subsequent eating disorder behaviors. These cognitions predicted higher anxiety during the next meal and eating disorder pathology at one-month follow-up. Interventions personalized to target these specific cognitions in real time might reduce eating disorder relapse.

Stress is associated with exercise differently among individuals with higher and lower eating disorder symptoms: An ecological momentary assessment study.

OBJECTIVE: Stress is associated with the maintenance of eating disorders and exercise behaviors. However, it is unclear how stress is associated with exercise and vice-versa among individuals with higher levels of eating disorder symptoms in daily life. The current study tested the moderating effect of eating disorder symptoms on the relationships between (1) daily stress and later exercise behavior and (2) daily exercise behavior and later stress. METHOD: Female college students [N = 129, mean age = 19.19 (SD = 1.40)] completed the Eating Disorder Inventory-2. Participants then completed measures of stress and exercise four times daily across seven days using an automated telephone ecological momentary assessment system. Data were analyzed using multilevel models. RESULTS: Drive for thinness, bulimic symptoms, and body dissatisfaction significantly moderated the relationship between daily stress and later exercise (ps = .01-.05), such that higher daily stress predicted higher later exercise only in individuals who were low (but not average or high) in drive for thinness, bulimic symptoms, and body dissatisfaction symptoms. DISCUSSION: Stress is associated with exercise differentially depending on individuals' eating disorder symptoms. Our findings suggest that only individuals with lower levels of eating disorder symptoms exercise when stressed.

Interpersonal constraint conferred by generalized social anxiety disorder is evident on a behavioral economics task.

Although social anxiety disorder appears to confer impairment in friendships, evidence beyond self-report is minimal. We used the flexible iterated prisoner's dilemma as a simulated interaction with a friend with 27 individuals with the generalized type of social anxiety disorder and 23 demographically equivalent individuals without the disorder. Participants with generalized social anxiety disorder were less giving on the task. Lower giving was also moderately associated with interpersonal variables (e.g., coldness). A trend was also found for participants with generalized social anxiety disorder to show lower assertiveness on the task. The connection between generalized social anxiety disorder and friendship impairment appears likely to be partially explained by interpersonal constraint that is perceived by others as coldness and manifests in a behavioral economics task.