Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study.

BACKGROUND: Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study aimed to identify potential differences in the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, in order to contribute to a better understanding of their diverse needs and experiences. METHODS: The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 years) with bulimia nervosa or binge-eating disorder (BN/BED) enrolled in the Binge Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and their current mental health and gastrointestinal symptoms. Untreated participants (n = 291, 38%) were compared with treated participants (n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. RESULTS: Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent eating disorder symptoms over their lifetime, and greater body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. A history of anorexia nervosa was positively associated with treatment engagement. Individuals self-reporting a history of inpatient or residential treatment exhibited the most severe illness history, those with outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. CONCLUSIONS: Historically overlooked and marginalized populations self-reported lower treatment access rates, while those who accessed treatment reported more severe eating disorder and comorbid mental health symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not represent individuals with milder symptoms or racial and ethnic diversity, and males. Community-based recruitment is crucial for improving the ability to apply research findings to broader populations and reducing disparities in medical research. Trial Registration ClinicalTrials.gov NCT04162574 ( https://clinicaltrials.gov/ct2/show/NCT04162574 ).

The majority of individuals with eating disorders never enter treatment. However, most clinical research on eating disorders recruits participants from clinics and treatment centers. Therefore, most of our knowledge about eating disorders may not represent the majority of people with eating disorders, particularly those who do not enter treatment. We studied 762 people with bulimia nervosa or binge-eating disorder recruited from the community to a large research study. We compared participants who reported never accessing treatment (38%) to participants who reported having accessed treatment at some point in their lives (62%). Untreated participants were much more likely to identify as male and as a racial or ethnic minority compared with participants who had accessed treatment (who identified mostly as female and White). Participants who had accessed treatment had a more severe illness history and higher levels of body dissatisfaction and mental health symptoms at the time of the study. The present study highlights the importance of recruiting research participants from the community to clinical studies as a way to address medical inequity in marginalized and underrepresented groups. Additionally, caution is advised when generalizing research findings from research samples who have sought treatment to all people with eating disorders.

Binge-eating disorder with and without lifetime anorexia nervosa: A comparison of sociodemographic and clinical features.

OBJECTIVE: To compare individuals who have experienced binge-eating disorder (BED) and anorexia nervosa (AN) (BED AN+) to those who have experienced BED and not AN (BED AN-). METHOD: Participants (N = 898) met criteria for lifetime BED and reported current binge eating. Approximately 14% had a lifetime diagnosis of AN. Analyses compared BED AN+ and BED AN- on sociodemographic variables and clinical history. RESULTS: The presence of lifetime AN was associated with more severe eating disorder symptoms, including earlier onset, more frequent, more chronic, and more types of eating disorder behaviors over the lifetime, as well as a higher lifetime prevalence of bulimia nervosa (BN). Participants with lifetime AN reported being more likely to have received treatments for BED or BN, had significantly lower minimum, current, and maximum BMIs, had more severe general anxiety, and were significantly more likely to be younger and female. In the full sample, the lifetime prevalence of unhealthy weight control behaviors was high and treatment utilization was low, despite an average 15-year history since symptom onset. Gastrointestinal disorders and comorbid anxiety, depression, and attention-deficit/hyperactivity disorder symptoms were prevalent. DISCUSSION: Individuals fared poorly on a wide array of domains, yet those with lifetime AN fared considerably more poorly. All patients with BED should be screened for mental health and gastrointestinal comorbidities and offered referral and treatment options. PUBLIC SIGNIFICANCE: Individuals experiencing binge-eating disorder have severe symptomology, but those who have experienced binge-eating disorder and anorexia nervosa fare even more poorly. Our study emphasizes that patients with binge-eating disorder would benefit from being screened for mental health and gastrointestinal comorbidities, and clinicians should consider history of unhealthy weight control behaviors to inform treatment and relapse prevention.

Recommendations to encourage participation of individuals from diverse backgrounds in psychiatric genetic studies.

We present innovative research practices in psychiatric genetic studies to ensure representation of individuals from diverse ancestry, sex assigned at birth, gender identity, age, body shape and size, and socioeconomic backgrounds. Due to histories of inappropriate and harmful practices against marginalized groups in both psychiatry and genetics, people of certain identities may be hesitant to participate in research studies. Yet their participation is essential to ensure diverse representation, as it is incorrect to assume that the same genetic and environmental factors influence the risk for various psychiatric disorders across all demographic groups. We present approaches developed as part of the Eating Disorders Genetics Initiative (EDGI), a study that required tailored approaches to recruit diverse populations across many countries. Considerations include research priorities and design, recruitment and study branding, transparency, and community investment and ownership. Ensuring representation in participants is costly and funders need to provide adequate support to achieve diversity in recruitment in prime awards, not just as supplemental afterthoughts. The need for diverse samples in genetic studies is critical to minimize the risk of perpetuating health disparities in psychiatry and other health research. Although the EDGI strategies were designed specifically to attract and enroll individuals with eating disorders, our approach is broadly applicable across psychiatry and other fields.

For better or worse: Associations among psychopathology symptoms, interpersonal emotion dynamics, and gender in couples.

Communication has long been associated with the well-being of a couple's relationship, and it is also important to explore associations with individual well-being. This study examined the associations between emotions communicated within couple interactions and each partner's psychopathology symptoms concurrently and up to 3 years later. Vocally-encoded emotional arousal (f0) was measured during couples' (N = 56) conversations. Analyses examined each partner's trajectories of f0 and how each partner influenced the other's f0 across the conversation. The findings indicated that women experienced higher symptoms if they (a) decreased more steeply in f0 overall and (b) returned to their baseline in f0 more quickly. Moreover, women had higher symptoms if they had a steeper return to baseline because of men's elevated f0. In contrast, men experienced higher symptoms when men (a) more slowly returned to baseline and (b) changed their f0 trajectory because of women's elevated f0. That is, women who expressed less emotional arousal, independently and as a result of the influence of their male partner, experienced more symptoms. In contrast, men's symptoms were differentially associated with their own independent experience of emotional arousal (in which he experienced fewer symptoms when changing arousal more quickly) from how they responded to women's arousal. Given how differently men's and women's psychopathology were associated with emotional expression, these findings raise questions about how partners can communicate to protect their own and their partner's mental health in the short- and long-term. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Love in the time of COVID-19: A brief report on relationship and individual functioning among committed couples in the United States while under shelter-in-place orders.

The COVID-19 pandemic in the United States has changed many aspects of people's daily life, including increased time at home in response to shelter-in-place orders, heightened stress about health effects of COVID-19, and shifts in other domains of life (e.g., employment). These lifestyle changes are likely to impact the well-being of individuals and their romantic relationships. This investigation examined how COVID-19 influenced couple and individual well-being in real-time during the early phase of the pandemic. Data were collected in early May 2020 during shelter-in-place orders in the United States. Participants in committed relationships (n = 332) completed an online survey assessing their experiences currently and before the pandemic. Results suggested that while couple functioning overall maintained or even improved, individual well-being was more negatively impacted by the pandemic. Moreover, some groups who are at higher risk of a poor health outcome from COVID-19 or experience unique challenges as a result of COVID-19 reported worse outcomes (e.g., those whose employment changed) while others did not decline in their psychological and couple functioning (e.g., Black individuals and older individuals). These findings suggest that the pandemic has had varied impacts on couples and individuals, as well as across different virus-related risk factors. Further research is needed to understand the nuanced effects of this pandemic on couples and individuals across time.

La pandemia de la COVID-19 en los Estados Unidos ha cambiado muchos aspectos de la vida diaria de las personas, por ejemplo, el aumento del tiempo que pasan en sus hogares en respuesta a órdenes de confinamiento, un estrés más elevado por los efectos de la COVID-19 en la salud, y cambios en otros aspectos de la vida (p. ej.: en el empleo). Estos cambios en el estilo de vida probablemente repercutan en el bienestar de las personas y en sus relaciones amorosas. En esta investigación se analizó cómo la COVID-19 influyó en el bienestar de las parejas y de los individuos en tiempo real durante la primera fase de la pandemia. A principios de mayo de 2020 se recopilaron datos durante las órdenes de confinamiento en los Estados Unidos. Los participantes que estaban en relaciones de pareja estables (n=332) contestaron una encuesta en línea donde se evaluaron sus experiencias de ese momento y las anteriores a la pandemia. Los resultados indicaron que, si bien el funcionamiento de la pareja en general se mantuvo o incluso mejoró, la pandemia afectó más negativamente el bienestar individual. Además, algunos grupos que tienen mayor riesgo de resultados desfavorables en la salud como consecuencia de la COVID-19 o enfrentan dificultades singulares como resultado de la COVID-19 informaron peores resultados (p. ej.: aquellos cuyos empleos cambiaron), mientras que otros no tuvieron un empeoramiento de su funcionamiento psicológico y de pareja (p. ej.: las personas de color y las personas mayores). Estos resultados sugieren que la pandemia ha tenido efectos variados en las parejas y en los individuos, así como entre los diferentes factores de riesgo relacionados con el virus. Se necesitan más investigaciones para comprender los efectos sutiles de esta pandemia en las parejas y en los individuos con el transcurso del tiempo.

Cognitive-behavioral couple therapy for same-sex female couples: A pilot study.

Despite comparable levels of relationship satisfaction and intimacy, same-sex couples break up faster and more often than different-sex couples, highlighting a need for quality couple therapy. Research suggests that culturally tailored services are desired by same-sex couples and may be more effective and better received. Although efficacious couple therapies exist to treat relationship distress, they have been overwhelmingly studied with different-sex couples. Sexual minority (SM) affirming couple therapies have not been systematically developed or evaluated. The current study involved developing and pilot testing a couple therapy tailored for distressed same-sex female couples. This treatment integrates the SM stress model with the empirically supported cognitive-behavioral couple therapy framework and is the first culturally tailored couple therapy for same-sex couples to be empirically evaluated. Therapists delivered the treatment in an open-trial format to a pilot sample of 11 same-sex female couples experiencing relationship distress and SM stress. Treatment was delivered with high adherence to the treatment manual. Participants reported high treatment satisfaction. As hypothesized, participants experienced significant decreases in relationship distress and improvements in couple coping with SM stress from pre- to post-therapy. Limitations precluded clear conclusions regarding anticipated improvements in individual mental health. Participants experienced comparable or stronger improvements in relationship functioning compared to couples in a similar benchmark study. Given this is a small pilot study, results are interpreted with caution. Implications for culturally tailoring evidence-based couple therapy for marginalized groups are discussed.

A pesar de los niveles comparables de satisfacción con la relación y de intimidad, las parejas del mismo sexo se separan más rápidamente y con más frecuencia que las parejas de distinto sexo, lo cual destaca la necesidad de una terapia de pareja de calidad. Las investigaciones indican que las parejas del mismo sexo desean recibir servicios adaptados a las culturas, los cuales pueden ser más eficaces y mejor recibidos. Aunque existen terapias de pareja eficaces para tratar el distrés en las relaciones, estas se han estudiado en su mayoría con parejas de distinto sexo. Las terapias de pareja dedicadas a las minorías sexuales no se han desarrollado ni evaluado sistemáticamente. El presente estudio implicó el desarrollo y la prueba piloto de una terapia de pareja adaptada para parejas femeninas del mismo sexo con distrés. Este tratamiento integra el modelo de estrés de las minorías sexuales con el marco de la terapia de pareja cognitivo-conductual respaldado empíricamente, y es la primera terapia de pareja adaptada culturalmente para parejas del mismo sexo que se evalúa empíricamente. Los terapeutas administraron el tratamiento en un formato de estudio abierto a una muestra piloto de 11 parejas femeninas del mismo sexo que sufrían distrés relacional y estrés por minoría sexual. El tratamiento se aplicó con una alta adhesión al manual de tratamiento. Las participantes informaron una alta satisfacción con el tratamiento. Como se planteó en la hipótesis, las participantes disminuyeron considerablemente el distrés relacional y mejoraron en el afrontamiento del estrés por minoría sexual de la pareja después de la terapia respecto de antes de la terapia. Las limitaciones impidieron sacar conclusiones claras con respecto a la previsión de mejorías en la salud mental individual. Las participantes tuvieron mejorías comparables o más marcadas en el funcionamiento de la relación respecto de las parejas de un estudio comparativo similar. Teniendo en cuenta que este es un estudio piloto pequeño, los resultados se interpretan con cautela. Se comentan las implicancias para adaptar culturalmente la terapia de pareja factual para grupos marginados.

A South African Couple-Based HIV Prevention Program: Preliminary Evidence of the Long-Term Effects.

The goal of our study was to provide qualitative data on the long-term effects of a couple-based HIV prevention program, the Couples Health Co-Op (CHC), in South Africa. Qualitative focus group discussions were conducted with nonrandomly selected Black South African men (n = 27) and women (n = 23) who had participated in the Couples Health Co-Op 4 to 6 years prior to our study. The study evaluated: (a) salient content and skills learned, (b) long-term changes and challenges, and (c) recommendations for intervention improvement. Findings revealed (a) communication/problem-solving, safe sexual behaviors, and negative effects of alcohol were most salient; (b) long-term changes occurred in communication and healthier sexual behavior; alcohol use remained challenging; and (c) participants recommended continuing the couple format and suggested targeting teenage couples. We offer preliminary evidence of the strengths and weaknesses of the Couples Health Co-Op and provide a basis for future studies to build on these results.