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Objective: This research forum describes the use of the intervention mapping for adaptation (IMA) framework to develop and evaluate a novel intervention for athletes with mild eating disorder (ED) symptoms. Methods: The six IMA steps were followed. In step 1 (needs assessment), we conducted a systematic review of athlete ED interventions and held interviews/focus groups with athletes and sports professionals to inform intervention format and delivery. In step 2 (intervention search), needs assessment information guided the search for an evidence‐based intervention suitable for adaptation to athletes. In steps 3 and 4 (intervention development), the identified intervention was adapted and feedback sought from athletes and sport professionals. In steps 5 and 6 (implementation and evaluation), a feasibility study was conducted with athletes (n = 35; females: n = 27; Mage = 27.1). Results: The review highlighted poor evidence for the acceptability and relative efficacy of existing interventions, which were all delivered face‐to‐face in groups. Interview/focus group data suggested a need for more accessible intervention formats (e.g., self‐help). One non‐athlete self‐help intervention was determined suitable for adaptation to athletes, and adaptations were made. Initial feedback suggested the adapted intervention was relevant within sport settings. The feasibility study revealed that the intervention (MOPED‐A: Motivational and Psycho‐Educational Self‐Help Programme for Athletes with Mild Eating Disorder Symptoms) can be feasibly implemented, is acceptable to athletes and shows potential for reducing ED symptoms. Discussion: IMA is a useful framework for developing participant‐centered and evidence‐based interventions. The findings and approach taken provide a framework for other researchers and clinicians in developing similar interventions in the ED domain. Public Significance: The novel self‐help intervention described in this article was developed using intervention mapping and provides promise as a tool for reducing eating disorder symptoms in athletes. We describe how adopting and systematically following a health intervention development approach, such as intervention mapping, can ensure that eating disorder interventions are participant‐centered, contextually relevant, and evidence‐based, which in turn could help to maximize their reach and effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: Identities that lie outside of exclusively male and female, such as non-binary and genderqueer, have become increasingly more prevalent and visible within recent years. However, to date, the role of terminology in the development of such gender identities has been under-researched. This study aims to: (1) Examine what role terminology plays in coming to identify as non-binary. (2) Explore the continuing importance of terminology once a non-binary identity is established. Methods: This study uses thematic analysis on data produced from interviews with 16 participants who self-selected for the study and were recruited from several transgender and LGBTQ+ organisations on the basis that they identified outside the gender binary of male and female. Results: The analysis uncovered several key themes and sub-themes relating to terminology choice, encountering new terms and the process of identifying with new terminology, as well as becoming visible and understood by others. Conclusions: This study found that terminology is not only central in coming to identify as something other than exclusively male and female, it also remains an important factor when it comes to making a non-binary identity visible to others. [ABSTRACT FROM AUTHOR]

Objective: The primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho‐Educational Self‐Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED‐A). A mixed‐methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED‐A in reducing athletes' eating disorder symptoms. Method: Thirty‐five athletes were recruited. Participation involved completing MOPED‐A over a 6‐week period and completing self‐report measures at baseline (T1), post‐intervention (T2) and 4‐week follow‐up (T3). A subsample (n = 15) completed an interview at T2. Results: Retention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED‐A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3. Conclusions: The MOPED‐A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted. Highlights: Participant recruitment to the study was feasible, and an acceptable proportion of participants were retained throughout the study.This is the first study to show that the format and delivery of a self‐help intervention is acceptable to athletes with mild eating disorder symptoms, and that athletes valued the intervention being tailored to them which facilitated participation and completion.The intervention demonstrates potential for reducing athletes' eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Background: Globally, there is a lack of a standardized assessment process prior to the initiation of gender affirming medical interventions and consequently there is a discrepancy in this process among different transgender health services. Aim: The main objective of this study is to investigate the outcome of the initial assessment process at a national transgender health service. Method: The outcome of people over the age of 17 years, assessed at a large national transgender health service in the United Kingdom during a 2-year period was categorized into: (1) recommendation for cross-sex hormone treatment, or (2) no recommendation for cross-sex hormone treatment. In addition, 200 case notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process. Results: During the study period, a total number of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for cross-sex hormone treatment, leaving 237 (38.4%) patients who required a longer assessment period or were discharged. The factors associated with being recommended for cross-sex hormone treatment were having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88% (n= 176) of the cases. Discussion: Although the results of the study may not be generalizable to other international centers, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the routine inclusion of two assessors needs to be reviewed. [ABSTRACT FROM PUBLISHER]

Background: Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation. Objective: To the authors' knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature. Method: Eight research articles and 31 sport policies were reviewed. Results: In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport's policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based. Conclusion: Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised. [ABSTRACT FROM AUTHOR]

This study examined the associations between conscientious perfectionism (high standards), self-evaluative perfectionism (self-criticism) and eating psychopathology among dancers. A sample of 244 female dancers, with a mean age of 20.11 years (standard deviation = 1.97) completed the Perfectionism Inventory and Eating Disorder Examination Questionnaire. Self-evaluative perfectionism predicted eating psychopathology (eating restraint, eating concern, weight concern and shape concern). This relationship was not moderated by conscientious perfectionism. The mediation analyses showed that although conscientious perfectionism predicted eating psychopathology, this relationship was fully mediated by self-evaluative perfectionism. These findings demonstrate the greater influence of self-evaluative perfectionism, rather than conscientious perfectionism, on eating psychopathology in dancers. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Normative data for measures of eating disorder (ED) psychopathology provide a fundamental description of a presentation and a means to establish clinically significant change following an intervention. Clinical norms for the ED population are lacking and out of date following the publication of Diagnostic and Statistical Manual of Mental Health Disorders (DSM) 5. This study aimed to show that scores from the Eating Disorder Examination Questionnaire (EDE-q) and the Eating Disorder Inventory (EDI) differ across ED diagnosis groups and provide norm data for DSM-5 ED diagnoses. Patients ( n = 932) presenting to an out-patient service over 5 years were retrospectively re-diagnosed based on DSM-5 criteria. Statistical analysis showed a significant difference on most subscale scores of the EDE-q and the EDI across diagnosis. Means, standard deviations and percentile ranks are presented by diagnosis. The norms detailed contribute to improving the accuracy with which scores are interpreted when using DSM-5 and aid with the assessment of clinically significant change following treatment. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This study assessed the 5-factor structure of the Compulsive Exercise Test (CET) and explored the relationship between compulsive exercise and eating psychopathology in athletes. Confirmatory and exploratory factor analyses of the CET were conducted with 689 competitive athletes (18–35 years of age). Convergent validity with the Eating Disorders Examination Questionnaire (EDE-Q) was explored. The 5-factor structure showed a poor fit; an alternative 3-factor structure is proposed. Exercising for weight control and exercising to avoid a negative mood were strongly associated with eating psychopathology. Implications for using the CET with athletes are discussed. [ABSTRACT FROM AUTHOR]

Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta-analysis were conducted. Thirty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

In this qualitative study, we aimed to investigate work demands experienced by health-care workers in an adult eating disorder inpatient service. We also aimed to investigate the use of social support and job satisfaction in this setting. Twelve health-care workers from an eating disorder inpatient ward, including nurses, health-care support workers, and occupational therapists, participated in semistructured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. A number of work demands were discussed relating to therapeutic care, physical care, and organizational demands. Most participants discussed social support at work as being highly valuable, formally and informally, whereas external support was viewed as less important. Despite the challenges of caring for patients with eating disorders, the majority of participants reported good patient-related job satisfaction, but poor job satisfaction in relation to organizational factors. Eating disorder inpatient care is complex and demanding, necessitating effective teamwork, communication, and support systems among health-care workers. Interventions should be developed to target barriers to care, including time constraints, administrative workload, and insufficient allocation of staff. [ABSTRACT FROM AUTHOR]

Previous research has suggested that invalidating childhood environments are positively related to the symptoms of eating disorders. However, it is unclear how childhood environments might impact upon the development of eating disorder symptoms. This study examined the relationship between parental invalidation and eating disorder-related attitudes in a nonclinical sample and tested the mediating effect of attitudes towards emotional expression. Two hundred women, with a mean age of 21 years, completed measures of invalidating childhood environments, attitudes towards emotional expression, and eating pathology. Eating concerns were positively associated with recollections of an invalidating parental environment. The belief that the expression of emotions is a sign of weakness fully mediated the relationship between childhood maternal invalidation and adult eating concern. Following replication and extension to a clinical sample, these results suggest that targeting the individual's attitude towards emotional expression might reduce eating attitudes among women who have experienced an invalidating childhood environment. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to pilot a brief form of interpersonal psychotherapy (IPT) for the treatment of patients with bulimic disorders. Method Ten patients with bulimic disorder treated with a new brief version of IPT (IPT-BN10) completed measurements of eating disorders psychopathology (Eating Disorders Examination Questionnaire, Bulimic Investigatory Test Edinburgh) and depression (Beck Depression Inventory). The results were matched with a group of patients treated with conventional IPT and with waiting list control. Results Statistical differences were found between starting and ending of therapy for those patients treated with IPT-BN10. Statistical difference was also found when comparing with waiting list control. Discussion The pilot study suggests that IPT-BN10 may be an effective treatment for patients having bulimic disorders; however, this hypothesis needs to be tested in an experimental way. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: This research had two aims. First, to assess the current mealtime practices within UK eating disorders units. Second, to investigate staff perspectives of these mealtimes, including their involvement and understanding of patients' experience. Method: Study 1 involved a survey to assess mealtime protocols across 22 eating disorders units. In Study 2, sixteen semistructured interviews were conducted with staff at three eating disorders units. Results: Between and within-unit variation exist regarding the implementation of mealtimes. Thematic analysis revealed that staff perceived their provision of mealtimes to be influenced by their own interpersonal difficulties created by the meals. Additionally, they perceived that these issues could be aided by forward planning, successful teamwork, and focused staff training. Discussion: There is a need for specialized mealtime implementation training. Furthermore, research is required to evaluate current mealtime practices from patient perspectives and to determine the impact of modified mealtime approaches on treatment outcome. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Objective To retrospectively explore the first disclosure of eating problems and the impact of disclosure factors on subsequent help-seeking amongst women with eating disorders. Method Seventy-one eating disorder service users were interviewed using the newly developed Eating Disorder Disclosure Interview and the Eating Disorder Examination Questionnaire. Results Faster access to specialist services was associated with being older at first disclosure and with disclosures that involved either a general practitioner, an individual's partner or mother. Patients' appraisals of 'other-initiated' and 'volunteered' disclosures did not differ, although 'other-initiated' disclosures were younger and accessed help more quickly than those who 'volunteered'. The more positively 'other-initiated' disclosures were appraised, the quicker the subsequent help-seeking. Conclusion The findings indicate that initiating a disclosure might lead to earlier access to treatment for individuals with eating disorders. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective This study aimed to identify the strategies employed by coaches when identifying disordered eating (DE) among track and field athletes. Design This was a qualitative study and an inductive thematic analysis was conducted. Method Semi structured interviews were conducted with eleven track and field coaches, with experience of coaching at national and international level. The interviews were recorded, transcribed verbatim and analysis was conducted. Results Track and field coaches reported using physical, social and performance indicators to identify disordered eating in their athletes. Coaches also monitored their athletes' eating attitudes and behaviors. Weight loss (both observed and objectively monitored) was considered to be a key indicator of disordered eating. Coaches placed a high level of importance on weight for performance, and an “ideal” female athlete body. Previous experiences of detecting disordered eating and a close relationship with the athlete facilitated the identification of disordered eating. Athlete secrecy and masking behaviors, difficulties in communication and coaches' stereotypical beliefs were found to complicate the identification process. Conclusions This study highlights the need for additional information, advice and guidance for track and field coaches to improve their knowledge and confidence in identifying disordered eating among their athletes. [ABSTRACT FROM AUTHOR]