Assessing motivation for treatment in eating disorders: psychometric validation of the Italian version of the Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ-ITA).

PURPOSE: Treatment resistance is a significant challenge in addressing eating disorders (EDs). The Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ) has been previously validated in ED populations to assess patients' motivation for treatment. This study aimed to validate the ACMTQ in the Italian language (ACMTQ-ITA) and evaluate its psychometric properties. METHODS: We recruited a clinical sample of adults aged 18 or older, diagnosed with EDs, proficient in the Italian language, and providing written informed consent. Participants with psychiatric comorbidities such as schizophrenia, bipolar disorder, and substance use disorder were excluded from the study. Validity of the ACMTQ-ITA was assessed using reliability analysis with Cronbach's α and McDonald's ω estimates, and Confirmatory Factor Analysis (CFA). RESULTS: Results from the reliability analysis confirmed the internal consistency of the Autonomous Motivation (AM) factor (α = 0.82, ω = 0.82), the Controlled Motivation (CM) factor (α = 0.76, ω = 0.77), and the ACMTQ-ITA overall score (α = 0.79). The CFA confirmed the two-factor solution (i.e., AM and CM) identified in the original validation of the ACMTQ (Comparative Fit Index = 0.92, Akaike Information Criterion = 3427.26, Bayesian Information Criterion = 3486.82; Root Mean Square Error of Approximation = 0.08, Standardized Root Mean Square Residual = 0.09). CONCLUSION: The ACMTQ-ITA emerged as a valid and reliable tool for measuring motivation for treatment in individuals with EDs. Its implementation may facilitate the comprehension of treatment motivation, offering valuable clinical insights and implications for health management practices. LEVEL OF EVIDENCE: Level V, descriptive studies.

Guided self-help treatment for children and young people with threshold and subthreshold eating disorders: A pilot study protocol.

BACKGROUND: Prompt access to evidence-based treatment for children and young people with eating disorders is important for outcomes, yet the gap in service provision remains pervasive. Record levels of young people are waiting for eating disorder treatment and access to care is limited. Guided self-help interventions that are brief and require minimal clinician support have the potential to meet the unprecedented demand for treatment quickly and effectively. OBJECTIVE: To examine the feasibility, acceptability and proof of concept of a novel, CBT guided self-help intervention for children and young people with threshold and subthreshold eating disorders. METHODS: A single-arm, proof-of-concept pilot study of the CBT guided self-help intervention will be conducted. Children and young people (aged 11-19) with threshold and subthreshold eating disorders will receive a self-help intervention covering the core components of CBT, supported by 8 weekly guidance sessions delivered remotely. Clinical outcomes (eating-related psychopathology and associated impairment, changes in weight, depression, anxiety, and behavioural difficulties) will be assessed at baseline and post-intervention (12 weeks). Feasibility and acceptability of the intervention will be measured using various outcomes, including adherence to, and engagement with the intervention, rates of recruitment and retention, measure completion and treatment satisfaction. Qualitative data will also be collected for future intervention refinement. DISCUSSION: If the intervention is shown to produce clinical benefits in this pilot study, a fully powered randomised pilot study will be warranted with the ultimate goal of increasing access to psychological treatment for children and young people threshold and subthreshold eating disorders. ADMINISTRATIVE INFORMATION: This study protocol (S1 File) adheres to the guidelines outlined in the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist for trial protocols [1, 2] which can be found in S1 Checklist. The numbers in parentheses in this protocol correspond to the item numbers in the SPIRIT checklist. The order of items has been modified to group similar items.

Pediatric Feeding Disorder and the School-Based Speech-Language Pathologist: An Evidence-Based Update for Clinical Practice.

PURPOSE: This prologue introduces the forum "Pediatric Feeding Disorder and the School-Based SLP: An Evidence-Based Update for Clinical Practice" and informs the reader of the scope of articles presented. METHOD: The guest prologue author provides a brief history of pediatric feeding and swallowing services in the public-school setting, including previous forums on swallowing and feeding services in the schools (Logemann & O'Toole, 2000; McNeilly & Sheppard, 2008). The concepts that have been learned since the 2008 forum are shared. The contributing authors in the forum are introduced, and a summary is provided for each of the articles. CONCLUSIONS: The articles provide evidence-based information on topics that are uniquely of interest to school-based speech-language pathologists managing pediatric feeding and swallowing in their districts. The topics shared in this forum range from relevant information on anatomy, physiology, developmental milestones, and differential diagnosis to therapeutic practice when identifying and treating pediatric feeding and swallowing in the school setting. The forum also includes focused articles on the necessity of collaboration with families during the treatment process, current information on legal parameters dealing with school-based pediatric feeding disorder services, and a framework for assessment and treating pediatric feeding disorder in the school setting.

Eating disorders: is there a correlation between severity of physical compromise and admission outcomes?

BACKGROUND: The Medical Emergencies in Eating Disorders (MEED) report was first released by the Royal College of Psychiatrists in 2022 (updated 2023) to aid clinicians in recognising medical compromise due to an eating disorder and to provide guidance for management. AIMS: This study looked at admissions over 5 years to explore whether there is a correlation between MEED medical compromise parameters and three outcomes: length of stay, detainment under the Mental Health Act 1983, and discharge destination. METHODS: A retrospective study of 26 patients admitted to a large teaching hospital for an eating disorder between 2018 and 2023. The risk assessment from the MEED report was used to create a score for physical compromise and analysed to determine whether there was a correlation between the score and discharge destination, detainment under the Mental Health Act and length of stay. FINDINGS: Demographic data were comparable with larger studies, with increasing numbers and 19.2% having autism spectrum disorder. There was no correlation between the scoring tool and detainment under the Act, discharge destination or length of stay. CONCLUSION: Increasing numbers of patients are presenting with eating disorders. Physical compromise was not a predictor for admission outcomes, but this could be further explored in larger studies.

Clinical effectiveness, cost-effectiveness and process evaluation of group schema therapy for eating disorders: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Eating disorders (EDs), such as (atypical) Anorexia (AN) and Bulimia Nervosa (BN), are difficult to treat, causing socioeconomic impediments. Although enhanced cognitive behavioral therapy (CBT-E) is widely considered clinically effective, it may not be the most beneficial treatment for (atypical) AN and BN patients who do not show a rapid response after the first 4 weeks (8 sessions) of a CBT-E treatment. Alternatively, group schema therapy (GST) may be a valuable treatment for this ED population. Even though GST for EDs has yielded promising preliminary findings, the current body of evidence requires expansion. On top of that, data on cost-effectiveness is lacking. In light of these gaps, we aim to describe a protocol to examine whether GST is more (1) clinically effective and (2) cost-effective than CBT-E for (atypical) AN and BN patients, who do not show a rapid response after the first 4 weeks of treatment. Additionally, we will conduct (3) process evaluations for both treatments. METHODS: Using a multicenter RCT design, 232 Dutch (atypical) AN and BN patients with a CBT-E referral will be recruited from five treatment centers. Clinical effectiveness and cost-effectiveness will be measured before treatment, directly after treatment, at 6 and at 12 months follow-up. In order to rate process evaluation, patient experiences and the degree to which treatments are implemented according to protocol will be measured. In order to assess the quality of life and the achievement of personalized goals, interviews will be conducted at the end of treatment. Data will be analyzed, using a regression-based approach to mixed modelling, multivariate sensitivity analyses and coding trees for qualitative data. We hypothesize GST to be superior to CBT-E in terms of clinical effectiveness and cost-effectiveness for patients who do not show a rapid response to the first 4 weeks of a CBT-E treatment. DISCUSSION: To our knowledge, this is the first study protocol describing a multicenter RCT to explore the three aforementioned objectives. Related risks in performing the study protocol have been outlined. The expected findings may serve as a guide for healthcare stakeholders to optimize ED care trajectories. TRIAL REGISTRATION: clinicaltrials.gov (NCT05812950).

Understanding Eating Disorders and the Nurse's Role in Diagnosis, Treatment, and Support.

ABSTRACT: Eating disorders (EDs) are a severe type of mental illness that nurses in many settings may encounter. The three primary eating disorders-anorexia nervosa, bulimia nervosa, and binge eating disorder-are described here. Signs, symptoms, and treatment of eating disorders are outlined, along with the importance of nurses in early identification of EDs and developing therapeutic relationships with patients. A case study and elements of spiritual care are presented.

Readiness and Personality Disorders: Considering Patients' Readiness for Change and Our System's Readiness for Patients.

ABSTRACT: The culture around personality disorder treatment has changed drastically in the past generation. While once perceived as effectively untreatable, there are now numerous evidence-based treatment approaches for personality disorders (especially borderline personality disorder). The questions, however, of who should be matched to which treatment approach, and when, remain largely unanswered. In other areas of psychiatry, particularly substance use disorders and eating disorders, assessing patient treatment readiness is viewed as indispensable for treatment planning. Despite this, relatively little research has been done with respect to readiness and personality disorder treatment. In this article, we propose multiple explanations for why this may be the case, relating to both the unique features of personality disorders and the current cultural landscape around their treatment. While patients with personality disorders often face cruel stigmatization, and much more work needs to be done to expand access to care (i.e., our system's readiness for patients), even gold-standard treatment options are unlikely to work if a patient is not ready for treatment. Further study of readiness in the context of personality disorders could help more effectively match patients to the right treatment, at the right time. Such research could also aid development of strategies to enhance patient readiness.

Eating disorders and obesity: bridging clinical, neurobiological, and therapeutic perspectives.

Eating disorders (EDs) and obesity are complex health conditions sharing various risk and maintenance factors, intensified in cases of comorbidity. This review explores the similarities and connections between these conditions, examining different facets from a multidisciplinary perspective, among them comorbidities, metabolic and psychological factors, neurobiological aspects, and management and therapy implications. We aim to investigate the common characteristics and complexities of weight and EDs and explore their interrelationships in individuals who experience both. The rising prevalence of EDs in people with obesity necessitates integrated approaches to study this comorbidity and to identify and analyze both common and distinct features of these conditions. This review may offer new opportunities for simultaneous prevention and management approaches, as well as future lines of research.

Established and emerging treatments for eating disorders.

Eating disorders (EDs) are common mental health conditions that carry exceedingly high morbidity and mortality rates. Evidence-based treatment options include a range of psychotherapies and some, mainly adjunctive, pharmacological interventions. However, around 20-30% of people fail to respond to the best available treatments and develop a persistent treatment-refractory illness. Novel treatments for these disorders are emerging, but their efficacy and clinical relevance need further investigation. In this review article, we first outline the evidence-base for the established treatments of the three 'classical' EDs [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)]. We then review research on some of the most promising emerging treatment modalities, discussing the questions and challenges that remain.

Staging models in eating disorders: A systematic scoping review of the literature.

Eating Disorders (ED) are characterized by low remission rates, treatment drop-out, and residual symptoms. To improve assessment and treatment of ED, the staging approach has been proposed. This systematic scoping review is aimed at mapping the existing staging models that explicitly propose stages of the progression of ED. A systematic search of PubMed, PsycINFO, Scopus was conducted with the terms staging, anorexia nervosa, bulimia nervosa, binge-eating disorders, eating disorders. Eleven studies met inclusion criteria presenting nine ED staging models, mostly for anorexia nervosa. Three were empirically tested, one of which was through an objective measure specifically developed to differentiate between stages. Most staging models featured early stages in which the exacerbation of EDs unfolds and acute phases are followed by chronic stages. Intermediate stages were not limited to acute stages, but also residual phases, remission, relapse, and recovery. The criteria for stage differentiation encompassed behavioral, psychological, cognitive, and physical features including body mass index and illness duration. One study recommended stage-oriented interventions. The current review underscores the need to empirically test the available staging models and to develop and test new proposals of staging models for other ED populations. The inclusion of criteria based on medical features and biomarkers is recommended. Staging models can potentially guide assessment and interventions in daily clinical settings.

Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting.

OBJECTIVE: Treatments for eating disorders are moderately effective, with cognitive behavior therapy (CBT) providing the strongest evidence. However, it remains important to investigate other interventions, particularly for eating disorders with greater complexity (e.g., substantial comorbidity; trauma history) or for patients who have not responded adequately to previous treatments. METHOD: This randomized controlled trial compared CBT against compassion-focused therapy for eating disorders (CFT-E), where half of the sample had a childhood trauma history. The study was pre-registered and adequately powered. A total of 130 patients were randomly assigned to CBT or CFT-E and were assessed at pre-treatment, post-treatment and one-year follow-up. The primary outcome measure was the total score on the Eating Disorder Examination-Interview (EDE), and secondary outcome measures were the Symptom Checklist-90, Inventory of Interpersonal Problems-64 and Post-Traumatic Symptom Scale. Attrition during treatment was low (13%), suggesting good acceptability. RESULTS: Eating pathology (EDE scores) reduced substantially overall, with large effect sizes, and there were no differences between therapies. However, at follow-up, for patients with a childhood trauma history, CFT-E maintained benefits better than CBT. CONCLUSION: While both CBT and CFT-E resulted in significant reductions in eating pathology, CFT-E showed superior maintenance of benefits for patients with a history of childhood trauma at one-year follow-up, underlining the necessity of tailored interventions for specific patient subgroups.

A meta-analysis of disordered eating and its association with self-criticism and self-compassion.

OBJECTIVE: Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE. METHOD: Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted. RESULTS: Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88). DISCUSSION: Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE. PUBLIC SIGNIFICANCE STATEMENT: Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments.

OBJETIVO: Los futuros tratamientos para los trastornos de la conducta alimentaria (TCA) deben ser mejorados mediante la focalización en los mecanismos de mantenimiento. La literatura sugiere que la autocrítica y el perfeccionismo autocrítico actúan como mecanismos clave que exacerban los TCA, y que la autocompasión protege contra la autocrítica. Este meta-análisis examina las asociaciones entre la autocrítica y el perfeccionismo autocrítico en la alimentación disfuncional (AD), y revisa cómo la autocompasión y la autocrítica se relacionan entre sí con respecto a la AD. MÉTODO: Las búsquedas en tres bases de datos arrojaron 135 estudios con 42,952 participantes. Se analizaron la heterogeneidad, el sesgo de publicación y las evaluaciones de calidad. También se llevaron a cabo análisis de moderación entre las medidas de autocrítica, las medidas de autocompasión, entre muestras clínicas y no clínicas, y entre estudios transversales y experimentales. RESULTADOS: Los modelos de efectos aleatorios mostraron una asociación positiva media entre la autocrítica y la AD (r = .37), y 10 subgrupos relacionados con diversas medidas de autocrítica utilizadas en la literatura mostraron asociaciones positivas pequeñas a grandes con la AD (r = .20-.52). Además, evidencia preliminar sugiere relaciones negativas entre la autocompasión y la AD (r = −0.40-−0.43) y relaciones negativas entre la autocompasión y la autocrítica (r = −.04-−.88). DISCUSIÓN: Los niveles mayores de autocrítica están relacionados con mayores niveles de AD y niveles reducidos de autocompasión, lo que sugiere la necesidad de abordar la autocrítica y fomentar la autocompasión en los tratamientos estándar para los TCA. Comprender mejor estas interacciones en conjunto con estudios de intervención puede ayudar a desarrollar intervenciones más efectivas y eficientes dirigidas a la autocrítica y la autocompasión para personas con AD.

A randomised controlled evaluation of an online perfectionism intervention for people with disordered eating - how perfect does it need to be?

Less help-seeking for an eating disorder is predicted by higher levels of denial of, and failure to perceive, illness severity. This research evaluates a "backdoor" approach to early intervention by investigating whether internet cognitive behaviour therapy for perfectionism can significantly improve disordered eating. Additionally, we investigated whether a more interactive intervention impacted outcomes. Participants were recruited worldwide online; 368 were screened, 172 (46.7%) met inclusion criteria (endorsed high shape, weight, or eating concerns) and randomised to an interactive (Focused Minds Program; FMP) or static PDF intervention (Centre for Clinical Intervention; CCI-P) or waitlisted (control condition). Participants completed assessments on disordered eating, perfectionism, and a range of secondary variables at the end of treatment, and 1- and 3-month follow-up. Intent-to-treat analyses indicated that, compared to control, FMP resulted in significantly lower levels of disordered eating at each assessment and CCI-P at the 1- and 3-month follow-up (respective 3-month follow-up between group effect sizes of 0.78 and 0.54). There were no significant differences between the two active interventions on any measure except depression and hated self. Results suggest an alternative approach to directly tackling disordered eating that is low-cost is effective, with a more interactive intervention producing a more rapid effect.Trials Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621001448831.

Valuing patient perspectives in the context of eating disorders.

PURPOSE: This paper advocates for the inclusion of patient perspectives in the diagnosis and treatment of eating disorders (EDs) for ethical, epistemological, and pragmatic reasons. We build upon the ideas of a recent editorial published in this journal. Using EDs as their example, the authors argue against dominant DSM-oriented approaches in favor of an increased focus on understanding patients' subjective experiences. We argue that their analysis stops too soon for the development of practical-and actionable-insights into how to effect the integration of first-person and third-person accounts of EDs. METHODS: Contextual analysis was used to make the case for patient perspectives. RESULTS: We use anorexia nervosa (AN) as an example to demonstrate how the integration of patient manifestations and voices offers a promising methodology to improve patient diagnosis and treatment. We suggest that Acceptance and Commitment Therapy (ACT) can support patients with AN by reconciling their values with the values that arise from a clinician's duty of care. CONCLUSIONS: We conclude that there are no good scientific reasons to exclude first-person perspectives of EDs in psychiatry. LEVEL OF EVIDENCE: Level V: Opinions based on clinical experience.

Understanding and treating body image disturbances in eating disorders through body illusion interventions: a scoping review protocol.

BACKGROUND: We plan a scoping review aimed to synthesize what is known about the use of sensory-driven body illusion (BI) interventions for understanding and treating body image disturbance (BID) in people diagnosed with clinical eating disorders (EDs) and people with subclinical ED symptomatology. Our study will provide an outline of the current literature, identify gaps within the literature, and suggest novel directions for future research. METHODS/DESIGN: The scoping review process will be guided by the methodological framework of Arksey and O'Malley, subsequent recommendations by Levac et al., and the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews guidelines. The following electronic databases will be systematically searched: MEDLINE (via PubMed), Web of Science, PsycINFO, and Scopus. Furthermore, to identify additional studies, we will use a search engine such as Google Scholar, and for grey literature, we will include Proquest for Dissertations and Theses. A search strategy has been identified and agreed upon by the research team in conjunction with a research librarian. Two researchers will screen the titles and abstracts independently and then assess the full text of the selected citations for the inclusion criteria. A third reviewer will be involved in cases of disagreement. Data will be extracted, collated, and charted to summarize all the relevant methods, outcomes, and key findings in the articles. DISCUSSION: A better understanding of this topic will aid in the development and refinement of current treatments aimed at treating BID in people with EDs. Implications and recommendations for research, policy, and practice in the context of the ED community will be discussed. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/3bcm6/?view_only=83b2e8a2445d4266909992e3dfb51929.

A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in adult men with Type 1 diabetes mellitus.

AIMS: This qualitative study aimed to develop the first cognitive behavioural (CBT) model outlining the development and maintenance of disordered eating in adult men living with Type 1 diabetes to improve on previous theoretical models of Type 1 diabetes and disordered eating and to draw comparisons to women with Type 1 diabetes and disordered eating. METHODS: Twenty-seven men (n = 16 with Type 1 diabetes and disordered eating, n = 11 with Type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using thematic analysis and individual CBT formulations were developed for each participant to inform the model. RESULTS: Men with Type 1 diabetes and disordered eating experience negative thoughts about food, insulin, weight/shape and diabetes itself, which cause negative emotions such as fear and vulnerability and difficulties with diabetes self care such as problems with hyper and hypoglycaemia and problems accessing structured education and technology result in men feeling more dissatisfied about their body weight/shape. CONCLUSIONS: This CBT model of disordered eating in men with Type 1 diabetes can guide new interventions.

Nurturing innovation, catalyzing change: Honoring the legacy of Dr. C. Barr Taylor in the eating disorders field.

This Virtual Issue of the International Journal of Eating Disorders honors the legacy of the late Dr. C. Barr Taylor in the eating disorders (EDs) field. For decades, Dr. Taylor led the way in not only conducting the research needed to achieve the ultimate goal of making affordable, accessible, and evidence-based care for EDs available to all, but also nurturing the next generation of scientific leaders and innovators. Articles included in this Virtual Issue are a selection of Dr. Taylor's published works in the Journal in the past decade, spanning original research, ideas worth researching, commentaries, and a systematic review. We hope this Virtual Issue will inspire the next generation of research in EDs, and equally, if not more importantly, the next generation of young investigators in the field. We urge the field to continue and build upon Dr. Taylor's vision-to increase access to targeted prevention and intervention for EDs in innovative and forward-thinking ways-while embracing his unique and powerful mentorship style to lift up early career investigators and create a community of leaders to address and solve our field's biggest challenges.

Facing Eating Disorder Fears: An Open Trial Adapting Prolonged Exposure to the Treatment of Eating Disorders.

Eating disorders (EDs) are maintained by core fears, which lead to avoidance behaviors, such as food avoidance or compensatory behaviors. Previously tested exposure-based treatments for EDs have generally focused on proximal outcomes (e.g., food), rather than addressing core fears (e.g., fear of weight gain and its consequences). The current study tested the feasibility and initial clinical efficacy of 10 sessions of imaginal and in vivo exposure for core ED fears (termed "Facing Eating Disorder Fears"), mainly fear of weight gain and its associated consequences. Participants were 36 adults with anorexia nervosa (AN), bulimia nervosa, or other specified feeding and eating disorders determined by semistructured diagnostic interviews. ED symptoms, fears, and body mass index (BMI) were assessed at pretreatment, posttreatment, and 1-month follow-up. Treatment involved 10 sessions of imaginal and in vivo exposure to ED fears in combination with in vivo exposures to feared and avoided situations as homework. ED symptoms and fears decreased from pre- to posttreatment and at 1-month follow-up. BMI increased significantly from pre- to posttreatment, particularly for those with AN. Effect sizes ranged from small to very large. ED symptoms and fears decreased and BMI increased following exposure. Increases in BMI occurred without any direct intervention on eating, suggesting that weight gain can be achieved without a specific focus on food during ED treatment. Facing Eating Disorder Fears may be a feasible stand-alone intervention for EDs. Future research must test comparative efficacy through randomized controlled trials.