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Background: Individuals with overweight or obesity are at a high risk for so-called 'atypical' or immunometabolic depression, with associated neurovegetative symptoms including overeating, fatigue, weight gain, and a poor metabolic profile evidenced e.g. by dyslipidemia or hyperglycemia. Research has generated preliminary evidence for a low-calorie diet (LCD) in reducing depressive symptoms. The aim of the current systematic review and meta-analysis is to examine this evidence to determine whether a LCD reduces depressive symptoms in people with overweight or obesity. Methods: Eligible studies were identified through PubMed, ISI Web of Science, and PsycINFO until August 2023. Standardized mean differences (SMDs) were derived using random-effects meta-analyses for (1) pre-post LCD comparisons of depression outcomes, and (2) LCD v. no-diet-control group comparisons of depression outcomes. Results: A total of 25 studies were included in the pre-post meta-analysis, finding that depression scores were significantly lower following a LCD (SMD = −0.47), which was not significantly moderated by the addition of exercise or behavioral therapy as a non-diet adjunct. Meta-regressions indicated that a higher baseline BMI and greater weight reduction were associated with a greater reduction in depression scores. The intervention-control meta-analysis (n = 4) found that overweight or obese participants adhering to a LCD showed a nominally lower depression score compared with those given no intervention (SMD = −0.29). Conclusions: There is evidence that LCDs may reduce depressive symptoms in people with overweight or obesity in the short term. Future well-controlled intervention studies, including a non-active control group, and longer-term follow-ups, are warranted in order to make more definitive conclusions. [ABSTRACT FROM AUTHOR]

Objective: Fraudulent participation is an escalating concern for online clinical trials and research studies and can have a significant negative impact on findings. We aim to shed light on the risk and to provide practical recommendations for detecting and managing such instances. Methods: The FREED‐Mobile (FREED‐M) study is an online, randomized controlled feasibility trial to assess a digital early intervention for young people (aged 16–25) in England or Wales with eating problems. The trial involved baseline (week 0), post‐intervention (week 4), and follow‐up (week 12) surveys, alongside weekly modules provided over 4 weeks on the study website. Study completers were compensated with £20 shopping vouchers. Despite the complexity of the trial design, two instances of fraudulent sign‐ups occurred in January and March 2023. To counter this, we developed a "fraudulent participants protocol" following internal investigations and discussions with collaborators. Results: The implementation of prevention measures such as reCAPTCHA updates, IP address review, and changes in reimbursement effectively halted further fraudulent sign‐ups. Our protocol facilitated the systematic identification and withdrawal of suspected or clear fraudsters and was demonstrably robust at distinguishing between fraudsters and genuine responders. Discussion: All remote, online trials or studies are at risk of fraudulent participation. Drawing from our experience and existing literature, we offer practical recommendations for researchers considering online recruitment and data collection. Vigilance and the integration of deterrents, and data quality checks into the study design from the outset are advised to safeguard research integrity. Public Significance: Fraudulent participation in digital research can have asignificant impact on research findings, potentially leading to biased resultsand misinformed decisions. We developed an effective protocol for theprevention, identification, and management of fraudulent participants. Bysharing our insights and recommendations, we hope to raise awareness of thisissue and provide other researchers with the knowledge and strategies necessaryto safeguard research integrity moving forward. [ABSTRACT FROM AUTHOR]

Background: A significant number of people with bulimia nervosa (BN) or binge‐eating disorder (BED) do not seek professional help. Important reasons include limited knowledge of eating disorders (EDs), feelings of shame, treatment costs, and restricted access to specialized healthcare. In this study, we explored if a novel therapy delivered in a primary care setting could overcome these barriers. We investigated factors such as motivation and expectations and included the patients' and newly trained therapists' perspectives. Method: We interviewed 10 women with BN (n = 2) or BED (n = 8), enrolled in the Physical Exercise and Dietary therapy (PED‐t) program, in a Healthy Life Center (HLC) located in a primary healthcare facility. Interview topics discussed were motivations for and expectations of therapy, and the treatment location. In addition, 10 therapists from HLC's were interviewed on their experiences with the PED‐t training program and expectations of running PED‐t within their service. The semi‐structured interviews were analyzed using reflexive thematic analysis. Results: Most patients had limited knowledge about EDs and first realized the need for professional help after learning about PED‐t. Patients exhibited strong motivations for treatment and a positive perception of both the PED‐t, the new treatment setting, and the therapists' competencies. The therapists, following a brief training program, felt confident in their abilities to treat EDs and provide PED‐t. With minor operational adjustments, PED‐t can seamlessly be integrated into national HLC service locations. Conclusion: PED‐t is an accessible therapeutic service that can be delivered in a primary care environment in a stepped‐care therapy model. Public Significance: This study investigates the views and experiences of patients and newly trained therapists of PED‐t (Physical Exercise and Dietary therapy), a new program‐led primary care therapy for binge‐eating spectrum eating disorders. The treatment and the locations for the intervention, that is, local health care centers, were found to be highly acceptable to both patients and therapists, thus PED‐t could easily be integrated as a first step into a step‐care delivery model. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Multi‐family therapy (MFT‐AN) is a promising group‐based treatment for adolescent anorexia nervosa. This study aimed to explore how young people and parents perceived change to occur during MFT treatment. Methods: Young people (10–18 years) diagnosed with anorexia nervosa or atypical anorexia nervosa and their parents who completed MFT‐AN alongside family therapy for anorexia nervosa within the preceding 2 years were eligible for this study. Semi‐structured qualitative interviews were conducted. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. Results: Twenty‐three participants (8 young people, 10 mothers and 5 fathers) completed interviews. Five main themes were identified; (1) Powerful connection, (2) Intensity, (3) New learning and perspective shifts, (4) Comparisons, and (5) Discharge is not recovery. There was a strong sense that being with others in a similar position in an intense environment were key factors in promoting change. Comparisons were inevitable and could promote insight and foster motivation, but could also be unhelpful at times. Participants spoke about how recovery continues beyond service use and requires ongoing attention and support. Conclusions: Through the mechanisms of connection, intensity, new learning and comparisons change is perceived to occur in MFT‐AN. Some of these are considered unique to this treatment format. Key points: Multi‐family therapy is perceived as a unique, challenging and helpful treatment for young people with anorexia nervosa.The combination of connecting with others in a similar position, the treatment intensity, new knowledge obtained in the group and the impact of comparisons between group members was described as leading to hope, increased mentalisation and change.Participants described how recovery continues beyond service use and that the end of treatment is not the same thing as recovery from anorexia nervosa. [ABSTRACT FROM AUTHOR]

Objective: The high burden of eating disorders (EDs) and limited availability of treatment speaks of a need to explore new avenues for treatment delivery. To understand if new treatment avenues are helpful and acceptable to patients, we investigated the effectiveness of Physical Exercise and Dietary Therapy (PED‐t) in participants with bulimia nervosa or binge‐eating disorder, and acceptability when the PED‐t was implemented in a Healthy Life Center in a municipal primary healthcare service. Method: Exercise physiologists and one dietitian were trained in ED literacy and to run PED‐t, before screening women for eligibility. Effectiveness (n = 16) of PED‐t and participants' experiences (n = 8) were evaluated by a mixed methods study design. Results were analyzed by relevant statistics and reflexive thematic analysis. Results: Of 19 eligible participants, 16 completed treatment. At post‐treatment, the Eating Disorder Examination Questionnaire global score, binge‐eating frequency, and symptoms of depression were lower, and nine (56% of completers) were in remission. Participants' treatment experiences were classified into two overarching themes: "competence" and "emotional support." Participants reported high acceptance for PED‐t, the local venue and group format, and felt that PED‐t provided them with coping tools and increased mental strength. However, many also spoke of an unmet need to address emotional eating. Discussion: Findings point to a potential for making an effective ED therapy more accessible, and that participants find the local low‐threshold delivery within a group‐format helpful. With small adjustments, the PED‐t could emerge as a promising first‐line treatment for bulimic EDs. Public Significance Statement: Limited access to treatment for EDs, patients' high barriers to help‐seeking, and the high rates of limited efficacy from psychotherapy speak of a need to explore new therapies and avenues for delivery. In this study, we build on findings from a controlled ED treatment trial and replicate the beneficial effects and find a high patient acceptance of "physical exercise and diet therapy" implemented in a real, non‐clinical setting. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the effect of maternal eating disorders (ED) on mother‐infant quality of interaction at 8 weeks and bonding and child temperament at 1 and 2 years postnatally. We also aimed to explore the relationship between maternal ED psychopathology, comorbid psychiatric difficulties, and both mother‐infant quality of interaction and bonding in women with ED. Women were recruited to a prospective longitudinal study. By the time of giving birth, the sample consisted of 101 women of the initial 137 (73.7%). Overall, 62 women (ED = 36; HC = 26) participated in the 8‐week assessment, 42 (ED = 20; HC = 22) at 1 year, and 78 (ED = 34; HC = 44) at 2 years. Mann‐Whitney U Test was used to explore association between maternal ED and mother‐infant quality of interaction and between maternal ED and bonding. Spearman correlations were used to explore associations between maternal ED psychopathology, comorbid psychiatric difficulties, and both mother‐infant quality of interaction and bonding. Results: We found no differences between early mother‐infant interaction and bonding in mothers with ED in comparison to HC. High levels of maternal ED psychopathology were correlated with high anxiety levels, higher negative affectivity, and lower extraversion in children of ED mothers both at 1 and 2 years. Furthermore, high levels of ED psychopathology were also associated with lower effortful control at 1 year. Conclusions: Findings imply that maternal ED have an impact on child temperament. Future research should focus on resilience and on which protective factors might lead to positive outcomes. These factors can be then used as therapeutic and preventative targets. Key points: Our study did not find significant differences in each domain of mother‐infant quality of interaction and bonding between cases and controls.Positive correlations were found between high levels of maternal ED psychopathology, anxiety, and high levels of negative affectivity, and lower extraversion in children at both 1 and 2 years, and ED psychopathology and lower effortful control at 1 year.Children's temperament is compromised in the presence of a maternal eating disorder. Detection and early intervention are recommended to facilitate mother‐child interactions and to prevent any later adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: Psychotherapy is the treatment of choice for anorexia nervosa (AN) but mechanisms of action are still largely unknown. Growing research suggests that synchrony between patient and therapist contributes to treatment success. Adding to this literature, this study examined the association between language style matching (LSM) among patient and therapist as an indicator of interpersonal (verbal) synchrony and treatment outcome in AN. Method: Audio recordings of mid‐treatment therapy sessions (n = 25) in a multi‐centre randomized controlled trial on the Maudsley Model of Anorexia Nervosa Treatment for Adults were transcribed and used to calculate LSM for each patient‐therapist dyad. These scores were used to predict treatment outcome at 12‐month follow‐up. Results: LSM did not predict body mass index (primary outcome) at follow‐up. However, higher LSM (M = 0.87, SD = 0.04) was associated with lower eating disorder psychopathology (accounting for 11% of the variance) and higher recovery rates (accounting for 28% of variance) at follow‐up. Conclusions: These preliminary findings suggest that verbal synchrony between patients with AN and their therapists contributes to favourable treatment outcomes. High levels of LSM may reflect therapeutic empathy, cooperation, or mutual positive perception. Further research should explore the mechanisms of linguistic synchrony with larger samples to allow for stronger conclusions. Highlights: Verbal synchrony among patients with anorexia nervosa (AN) and their therapists in mid‐treatment sessions did not predict body mass index but eating disorder symptoms and recovery 12 months after randomisation.These findings advance the idea that verbal synchrony between patients with AN and their therapists contributes to favourable treatment outcomes, possibly through empathy, cooperation, or mutual positive perception.If the findings can be replicated in larger and more heterogeneous samples, these may inform the development of automated clinical support tools for therapists. [ABSTRACT FROM AUTHOR]

Objective: This paper used network analysis to test the associations between eating disorder‐related psychopathology and carers' responses to anorexia nervosa symptoms in adolescents. Additionally, the prognostic value of central and bridge network nodes was explored. Method: This is a secondary analysis of a three‐armed randomised‐controlled‐trial of adolescents with anorexia nervosa (n = 149) and their primary carer (n = 149) who were allocated to either treatment as usual (TAU), or one of two versions of a carer skills intervention (ECHO) added to TAU. A network analysis was run in the full sample. The prognostic role of central and bridge nodes was tested through multiple regression analyses. Results: Carers' depression and emotional over‐involvement, as well as patients' depression showed the highest strength centrality. Patients' depression and carers' accommodation exhibited the highest bridge expected influence. Across the full sample, and in the ECHO group, carers' accommodation predicted patients' higher body mass index (BMI), while patients' depression predicted worse psychosocial functioning at 1‐year follow‐up. In the ECHO group, higher carers' depression also predicted lower BMI. Conclusions: Carers' accommodation and depression in both carers and patients were involved in the maintenance of psychopathology in adolescents with anorexia nervosa. Depression in both patients and carers is a potential treatment target for family interventions. Key points: Accommodation is the carers' variable most connected with adolescents' symptoms and is positively associated with adolescents' BMI at 1 year follow‐up.Depression is the adolescents' symptom most connected with carers' functioning and predicts impaired psychosocial functioning at 1 year follow‐up.carers' depression contributes to the maintenance of anorexia nervosa psychopathology and is negatively associated with adolescents' BMI at 1 year in ECHO treatment group. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the psychosocial burden in parents of children with spinal muscular atrophy (SMA), detected by newborn screening (NBS), for which first pilot projects started in January 2018 in Germany. The survey, performed 1–2 years after children's diagnosis of SMA via NBS, included 3 parent-related questionnaires to evaluate the psychosocial burden, quality of life (QoL)/satisfaction and work productivity and activity impairment in the families. 42/44 families, detected between January 2018 and February 2020, could be investigated. Interestingly, statistical analysis revealed a significant difference between families with children that received SMN-targeted therapy vs. children with a wait-and-see strategy as to social burden (p = 0.016) and personal strain/worries about the future (p = 0.02). However, the evaluation of QoL showed no significant differences between treated vs. untreated children. Fathers of treated children felt more negative impact regarding their productivities at work (p = 0.005) and more negative effects on daily activities (p = 0.022) than fathers of untreated children. Thus, NBS in SMA has a psychosocial impact on families, not only in terms of diagnosis but especially in terms of treatment, and triggers concerns about the future, emphasizing the need for comprehensive multidisciplinary care. Understanding the parents' perspective allows genetic counselors and NBS programs to proactively develop a care plan for parents during the challenging time of uncertainty, anxiety, frustration, and fear of the unknown. [ABSTRACT FROM AUTHOR]

Depression, anxiety and eating disorders ("social-emotional disorders") are common during adolescence/emerging adulthood, periods of intense identity development. Despite this, there are few reviews of existing research on the relationship between symptoms of these disorders and ongoing identity development. This study systematically reviewed, narratively synthesized and meta-analyzed longitudinal investigations of the relationship between identity synthesis/confusion and depression, anxiety and eating disorders symptoms during adolescence/emerging adulthood. Three databases (PsycInfo, Medline, Embase) were searched. Study quality was systematically appraised, findings were qualitatively synthesized and (where possible) meta-analyzed. 20 studies (55% "fair" quality, 45% "poor" quality) were identified, including 13,787 participants (54.2% female, mean age = 14.48 years, range 10–29 years). The narrative synthesis found evidence of bidirectional relationships between identity synthesis/confusion and depression, anxiety and eating disorder symptoms. Meta-analyses and meta-regressions of a sub-sample of studies (N = 9) indicated no significant associations between identity synthesis or confusion and anxiety or depression symptoms. More high-quality research is needed before firm conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study explored participants' experience of approach bias modification training (ABM) with transcranial Direct Current Stimulation (tDCS) for binge eating disorder (BED) within a randomised controlled trial (RCT). A subset of participants who completed the RCT were interviewed to attain feedback on treatment experience and outcomes. Method: 15 participants with BED who completed the RCT were recruited, using purposive sampling. Participants received six sessions of concurrent ABM training with either real or sham tDCS. Semi‐structured interviews relating to study experience and treatment outcomes were conducted and data were analysed thematically. Results: The combined ABM and tDCS intervention was deemed acceptable and worthwhile by participants interviewed across both intervention groups. Negative preconceptions of tDCS were an initial deterrent to study participation for some, yet the brain stimulation experience was found to be tolerable. Minor and transient sensations and side effects attributed to tDCS were reported by most participants during and after stimulation, in addition to less pleasant aspects of ABM training, with no significant adverse effects reported by interviewees. Positive outcomes were described by participants across both intervention groups, relating to changes in BED symptoms and to broader beneficial effects on associated cognitive and emotional factors. Two participants experienced a shift in autonomy, attributed to tDCS and the combined intervention respectively. Conclusions: Adults with symptoms of BED found concurrent ABM and tDCS sessions to be acceptable, despite initial apprehension about the safety of tDCS. Findings are relevant to the neuroethics literature and may inform science communication strategies on neuromodulation treatments. Key points: Novel, brain‐targeted treatment adjuncts are needed to improve clinical outcomes for patients with binge eating disorder (BED). This study is the first to explore participants' experience of multi‐session concurrent approach bias modification training (ABM) and transcranial Direct Current Stimulation (tDCS) for BED within a randomised control trial (ICARUS RCT: ISRCTN35717198)All interviewees would recommend study participation to others, which may indicate high rates of acceptability of the combined intervention. Facilitators and potential barriers to study enrolment and engagement were outlined. The perceived impact of tDCS on participants' autonomy and identity was discussed by a minority of participants interviewed. Participants reported an apprehension of, and misconceptions around, tDCS as a safe treatment modality prior to participation in the RCTFindings from this study will complement quantitative findings from the RCT in informing the development and evaluation of future studies. Additionally, participants' feedback is relevant to the discussion of the potential impact of neuromodulation on autonomy and identity, and may inform science communication strategies disseminating information about non‐invasive brain stimulation technologies to the public [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effectiveness of evidenced‐based psychological treatments (specifically, Cognitive‐Behaviour Therapy for Eating Disorders [CBT‐ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology. Method: Three hundred and seventy‐nine participants meeting criteria for DSM‐5 anorexia nervosa, bulimia nervosa, binge‐eating disorder or other specified feeding or eating disorder completed pre‐ and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging. Results: Ninety seven percent of participants received treatment in line with evidence‐based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m2 over treatment, with similar outcomes for MANTRA and CBT‐ED. Discussion These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence‐based psychotherapies to real‐world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders. [ABSTRACT FROM AUTHOR]

Background: Duration of untreated eating disorder (DUED), that is, the time between illness onset and start of first evidence‐based treatment, is a key outcome for early intervention. Internationally, reported DUED ranges from 2.5 to 6 years for different eating disorders (EDs). To shorten DUED, we developed FREED (First Episode Rapid Early Intervention for EDs), a service model and care pathway for emerging adults with EDs. Here, we assess the impact of FREED on DUED in a multi‐centre study using a quasi‐experimental design. Methods: Two hundred and seventy‐eight patients aged 16–25, with first episode illness of less than 3 years duration, were recruited from specialist ED services and offered treatment via FREED. These were compared to 224 patients, of similar age and illness duration, seen previously in participating services (treatment as usual [TAU]) on DUED, waiting times and treatment uptake. Results: FREED patients had significantly shorter DUED and waiting times than TAU patients. On average, DUED was reduced by ∼4 months when systemic delays were minimal. Furthermore, 97.8% of FREED patients took up treatment, versus 75.4% of TAU. Discussion: Findings indicate that FREED significantly improves access to treatment for emerging adults with first episode ED. FREED may reduce distress, prevent deterioration and facilitate recovery. Highlights: This study is a large‐scale replication of an earlier single‐centre pilot study of First Episode Rapid Early Intervention for Eating Disorders (FREED). Findings indicate that, as in the pilot study, FREED significantly reduces duration of untreated eating disorder and is associated with significantly shorter wait times for both assessment and treatment when implemented at scaleDifferences between groups were more pronounced when systemic delays were minimalThe proportion of FREED patients taking up treatment was significantly higher than in treatment as usual, suggesting that a shorter interval between help‐seeking from primary care and an offer of specialist assessment/treatment has clear down‐stream benefits [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to identify latent classes of trajectory of change in body mass index (BMI) between the initial and thirteenth session of outpatient treatment for adult anorexia nervosa and identify the association with outcome. Method: Participants (n = 120) were randomised to one of three outpatient therapies. Results: Four latent classes were identified; two classes (higher, rapid and higher, moderate) had BMI > 17 kg/m2 at initial assessment, and both gained significantly more weight over the 13 sessions compared to the other two classes. The third and fourth classes (middle, stable and low, stable) had an initial BMI of 16.44 and 15.31, respectively, and neither gained weight over the first 13 sessions. Compared to the other three classes, the higher, rapid class (N = 19, 16%) showed a significantly greater BMI increase over the first 13 sessions of therapy and a significantly higher rate of remission at end of treatment and 12‐month follow‐up (18–22 months post‐randomisation). Conclusions: The group with the greatest early weight gain had significantly higher levels of remission. Higher BMI at baseline without substantial early weight gain was insufficient to produce higher levels of remission than those with lower weight at baseline. [ABSTRACT FROM AUTHOR]

Background: Outpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa. Methods: Participants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months. Results: Adherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks. Conclusions: Augmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance. [ABSTRACT FROM AUTHOR]

Objective: This study assessed longer‐term outcomes from a randomised controlled feasibility trial of 20 sessions of real versus sham high‐frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex in adults with severe, enduring anorexia nervosa (SE‐AN). Methods: Thirty participants who completed the original study protocol were invited to take part in an open follow‐up (18‐months post‐randomisation), assessing body mass index (BMI), eating disorder (ED) symptoms and other psychopathology. Results: Twenty‐four participants (12 each originally allocated to real/sham) completed the 18‐month follow‐up. Ten of 12 participants who originally received sham treatment had real rTMS at some stage during the follow‐up. A medium between‐group effect size was seen for BMI change from baseline to 18‐months, favouring those originally allocated to real rTMS. In this group at 18‐months, five participants were weight recovered (BMI ≥18.5 kg/m2), compared with one participant in the original sham group. Both groups showed further improvement in ED symptoms during the follow‐up. Effects on mood were largely maintained at follow‐up, with catch‐up effects in the original sham group. Conclusions: Findings suggest that rTMS treatment effects on mood are durable and that BMI and ED symptom improvements need time to emerge. Large‐scale trials are needed. [ABSTRACT FROM AUTHOR]

Objective: Individuals with anorexia nervosa (AN) pursue low‐fat, low‐calorie diets even when in a state of emaciation. These maladaptive food choices may involve fronto‐limbic circuitry associated with cognitive control, habit, and reward. We assessed whether high‐frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) influenced food‐related choice behavior in patients with severe, enduring (SE)‐AN. Method: Thirty‐four females with SE‐AN completed a Food Choice Task before and after 20 sessions of real or sham rTMS treatment and at a 4‐month follow‐up. During the task, participants rated high‐ and low‐fat food items for healthiness and tastiness and then made a series of choices between a neutral‐rated food and high‐ and low‐fat foods. Outcomes included the proportion of high‐fat and self‐controlled choices made. A comparison group of 30 healthy women completed the task at baseline only. Results: Baseline data were consistent with previous findings: relative to healthy controls, SE‐AN participants showed a preference for low‐fat foods and exercised self‐control on a greater proportion of trials. There was no significant effect of rTMS treatment nor time on food choices related to fat content. However, among SE‐AN participants who received real rTMS, there was a decrease in self‐controlled food choices at post‐treatment, relative to baseline. Specifically, there was an increase in the selection of tasty‐unhealthy foods. Discussion: In SE‐AN, rTMS may promote more flexibility in relation to food choice. This may result from neuroplastic changes in the DLPFC and/or in associated brain areas. [ABSTRACT FROM AUTHOR]

Background: We explored the utility of "staging" anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12‐month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment. Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: "early stage" (illness duration <3 years; n = 60) and "severe and enduring" stage (SE‐AN; n = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS ≥60) and illness duration (≥7 years). Results: At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE‐AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work/social adjustment at baseline, and lower rates of improvement in work/social adjustment at 12 months compared to "early stage" respondents. Discussion: Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision‐making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To compare the clinical outcomes of adolescents and young adults with anorexia nervosa (AN) comorbid with broad autism spectrum disorder (ASD) or ASD traits. Method: The developmental and well‐being assessment and social aptitude scale were used to categorize adolescents and young adults with AN (N = 149) into those with ASD traits (N = 23), and those who also fulfilled diagnostic criteria for a possible/probable ASD (N = 6). We compared both eating disorders specific measures and broader outcome measures at intake and 12 months follow‐up. Results: Those with ASD traits had significantly more inpatient/day‐patient service use (p = .015), as well as medication use (p < .001) at baseline. Both groups had high social difficulties and poorer global functioning (strengths and difficulties questionnaire) at baseline, which improved over time but remained higher at 12 months in the ASD traits group (p = .002). However, the improvement in eating disorder symptoms at 12 months was similar between groups with or without ASD traits. Treatment completion rates between AN only and ASD traits were similar (80.1 vs. 86.5%). Discussion: Adolescents with AN and ASD traits show similar reductions in their eating disorder symptoms. Nevertheless, their social difficulties remain high suggesting that these are life‐long difficulties rather than starvation effects. [ABSTRACT FROM AUTHOR]

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer ( n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers' distress change was not a significant predictor of patients' body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother-offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Case formulation is a core component of many psychotherapies and formulation letters may provide an opportunity to enhance the therapeutic alliance and improve treatment outcomes. This study aimed to determine if formulation letters predict treatment satisfaction, session attendance, and symptom reductions in anorexia nervosa (AN). It was hypothesized that higher quality formulation letters would predict greater treatment satisfaction, a greater number of attended sessions, and greater improvement in eating disorder symptoms. Method Patients were adult outpatients with AN ( n = 46) who received Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) in the context of a clinical trial. A Case Formulation Rating Scheme was used to rate letters for adherence to the MANTRA model and use of a collaborative, reflective, affirming stance. Analyses included linear regression and mixed models. Results Formulation letters that paid attention to the development of the AN predicted greater treatment acceptability ratings ( p = 0.002). More reflective and respectful letters predicted greater reductions in Eating Disorder Examination scores ( p = 0.003). Discussion Results highlight the potential significance of a particular style of written formulation as part of treatment for AN. Future research should examine applicability to other psychiatric disorders. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:874-882) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study reports follow-up data from a multicenter randomized controlled trial ( n = 142) comparing the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with broadly defined anorexia nervosa (AN). At 12 months postrandomization, all patients had statistically significant improvements in body mass index (BMI), eating disorder (ED) symptomatology and other outcomes with no differences between groups. MANTRA was more acceptable to patients. The present study assessed whether gains were maintained at 24 months postrandomization. Methods Follow-up data at 24 months were obtained from 73.2% of participants. Outcome measures included BMI, ED symptomatology, distress, impairment, and additional service utilization during the study period. Outcomes were analyzed using linear mixed models. Results There were few differences between groups. In both treatment groups, improvements in BMI, ED symptomatology, distress levels, and clinical impairment were maintained or increased further. Estimated mean BMI change from baseline to 24 months was 2.16 kg/m2 for SSCM and 2.25 kg/m2 for MANTRA (effect sizes of 1.75 and 1.83, respectively). Most participants (83%) did not require any additional intensive treatments (e.g., hospitalization). Two SSCM patients became overweight through binge-eating. Discussion Both treatments have value as outpatient interventions for patients with AN. © 2016 Crown copyright. International Journal of Eating Disorders. (Int J Eat Disord 2016; 49:793-800) [ABSTRACT FROM AUTHOR]

Objective The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa. Method A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents ( n = 196) of adolescents ( n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report. Results Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour was significantly lower in fathers than in mothers. Accommodating behaviours mediated the relationship between objective burden and subjective burden in mothers, whereas EE and carers' skills did not mediate this relationship for either parent. Discussion The objective burden for most mothers is high. In order to reduce subjective burden, it may be helpful to target accommodating behaviours. Trial Registration ISRCTN83003225 - Expert Carers Helping Others (ECHO). Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association [ABSTRACT FROM AUTHOR]

Objective: To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). Method: The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWANPRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. Results: The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. Discussion: The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM. VC 2015 The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

In order to investigate the degree to which symptom reduction in the treatment of adults with anorexia nervosa (AN) impacted on their carers' psychological distress, we examined 12 participants in an outpatient treatment trial and their nominated 'significant other'. Measures of eating psychopathology in the person being treated for AN were collected on six occasions: baseline, session 4, session 10, session 25 (end of treatment), and at three-month and 12-month follow-up. At these same time points, measures of psychological distress were collected from carers. Early significant reductions in eating psychopathology were found in the AN group at session 4, whereas significant reductions in carers' distress were found at three-month follow-up and maintained at 12-month follow-up. These reductions were moderated by baseline body mass index of the person with AN. Carers whose significant other had a lower BMI at baseline received most benefit in terms of symptom reduction at 12-month follow-up. Clinical implications include the need to provide more direct support to carers in order to achieve more clinically significant reductions in distress, and the need to discuss a carer's expectations of the recovery process. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message: Only 61% of adults being treated for anorexia nervosa (AN) were willing to allow their carer to be contacted by researchers in order to ask them to complete questionnaires over the duration of treatment and follow-up., Significant reductions in eating psychopathology from those being treated for AN was followed by significant reductions in their carers' distress some 12 months later., Reductions of carers' distress was associated with only a small effect size and may indicate that more clinically significant reductions requires individualised support for the carers., Carers whose significant other had a lower body mass index at baseline received most benefit in terms of symptom reduction at 12-month follow-up, which may indicate a need to clarify a carer's expectations of the recovery process. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The aim of this study was to develop and validate a new questionnaire designed to measure caregiver skills that, in line with the interpersonal component of the cognitive interpersonal maintenance model (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006), may be helpful in the support of people with anorexia nervosa (AN). A further aim is to assess whether this scale is sensitive to change following skills-based caregiver interventions. Method The Caregiver Skills (CASK) scale was developed by a group of clinicians and caregivers. Preliminary versions of the scale devised for both caregivers and parents were given at baseline and at follow-up after two studies of caregiver interventions (a clinical trial of the effectiveness of guided self-help and training workshops). Exploratory and confirmatory factor analyses (CFA) were used to test the factorial structure of the CASK scale. Cronbach's alpha was used to measure internal consistency of the CASK scales. Results Exploratory Factor Analysis suggested a six component solution ( Bigger Picture, Self-Care, Biting-Your-Tongue, Insight and Acceptance, Emotional Intelligence and Frustration Tolerance) and this model was confirmed with CFA. Significant clinically relevant correlations were found between the CASK scales and other standardised measures of caregivers' attitudes and behaviours. Furthermore, greater improvements on abilities measured by the CASK scale were found in caregivers who received skills-training than caregivers assigned to a 'treatment as usual' condition. Discussion The CASK scale is a measure of the fidelity of interventions based on the cognitive interpersonal maintenance model and is sensitive to the intensity of the intervention provided. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:290-297) [ABSTRACT FROM AUTHOR]

This study aims to investigate longitudinal patterns of psychopathology during the antenatal and postnatal periods among women with current (C-ED) and past (P-ED) eating disorders. Women were recruited to a prospective longitudinal study: C-ED ( n = 31), P-ED ( n = 29) and healthy control (HC; n = 57). Anxiety, depression and ED symptoms were measured at four time points: first/second trimester, third trimester, 8 weeks and 6 months postpartum. Linear mixed effects models were used to test for group differences. Women with C-ED and P-ED, in all diagnostic categories, had significantly higher levels of psychopathology at all time points. ED symptoms decreased in the C-ED group, compared with an overall increase in the other two groups but subsequently increased after pregnancy. Overall, depression and state and trait anxiety scores decreased in the C-ED group compared with the HC group throughout the antenatal and postnatal periods. High levels of psychopathology are common throughout the antenatal and postnatal periods among women with current and past ED, and despite some overall reductions, symptoms remain clinically significant. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study aimed to explore the neuro- and social-cognitive profile of a consecutive series of adult outpatients with anorexia nervosa (AN) when compared with widely available age and gender matched historical control data. The relationship between performance profiles, clinical characteristics, service utilization, and treatment adherence was also investigated. Method Consecutively recruited outpatients with a broad diagnosis of AN (restricting subtype AN-R: n = 44, binge-purge subtype AN-BP: n = 33 or Eating Disorder Not Otherwise Specified-AN subtype EDNOS-AN: n = 23) completed a comprehensive set of neurocognitive (set-shifting, central coherence) and social-cognitive measures (Emotional Theory of Mind). Data were subjected to hierarchical cluster analysis and a discriminant function analysis. Results Three separate, meaningful clusters emerged. Cluster 1 ( n = 45) showed overall average to high average neuro- and social- cognitive performance, Cluster 2 ( n = 38) showed mixed performance characterized by distinct strengths and weaknesses, and Cluster 3 ( n = 17) showed poor overall performance (Autism Spectrum disorder (ASD) like cluster). The three clusters did not differ in terms of eating disorder symptoms, comorbid features or service utilization and treatment adherence. A discriminant function analysis confirmed that the clusters were best characterized by performance in perseveration and set-shifting measures. Discussion The findings suggest that considerable neuro- and social-cognitive heterogeneity exists in patients with AN, with a subset showing ASD-like features. The value of this method of profiling in predicting longer term patient outcomes and in guiding development of etiologically targeted treatments remains to be seen. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:26-34) [ABSTRACT FROM AUTHOR]

Background Families express a need for guidance in helping their loved ones with anorexia nervosa (AN). Guided self-help interventions can offer support to caregivers. Methods One hundred seventy-eight adult AN patients and their caregivers were recruited from 15 UK treatment centres. Families were randomized to carers' assessment, skills and information sharing (C) intervention + treatment as usual (TAU) or TAU alone. Feedback forms were sent at 6 months post-discharge and, if not returned, at 12 months. One hundred two (57%) patient forms ( n = 50TAU; n = 52C) and 115 (65%) caregiver forms ( n = 60TAU; n = 55C) were returned. Two researchers coded data blind, using thematic analysis. Results (i) Caregivers and patients express a need for post-discharge support. (ii) Patients identify helpful and unhelpful support strategies, useful for developing future interventions. (iii) Patients could identify positive caregiver behaviour changes targeted in intervention. (iv) Guided self-help may benefit caregiver and sufferer, post-discharge. Conclusion Caregiver interventions can be a useful tool that will improve the cost effectiveness of inpatient treatment by enhancing the well-being of caregivers and patients. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To (1) determine whether childhood risk factors for early onset binge eating and purging eating disorders also predict risk for later-onset binge eating and purging disorders, and (2) compare the utility of childhood and early adolescent variables in predicting later-onset disorders. Method Participants ( N = 1,383) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed when participants were aged 14, 17, and 20. Risk factors for early onset eating disorders have been reported previously (Allen et al., J Am Acad Child Psychiat, 48, 800-809, 2009). This study used logistic regression to determine whether childhood risk factors for early onset disorders, as previously identified, would also predict risk for later-onset disorders ( n = 145). Early adolescent predictors of later-onset disorders were also examined. Results Consistent with early onset cases, female sex and parent-perceived child overweight at age 10 were significant multivariate predictors of binge eating and purging disorders with onset in later adolescence. Eating, weight, and shape concerns at age 14 were also significant in predicting later-onset disorders. In the final stepwise multivariate model, female sex and eating, weight, and shape concerns at age 14 were significant in predicting later-onset eating disorders, while parent-perceived child overweight at age 10 was not. Discussion There is overlap between risk factors for binge eating and purging disorders with early and later onset. However, childhood exposures may be more important for early than later onset cases. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:802-812) [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore whether a six session cognitive behavioural group intervention targeting perfectionism is efficacious in reducing perfectionism in adults with anorexia nervosa in an inpatient setting. Method Adults with anorexia nervosa received a group perfectionism intervention in an inpatient setting. Self-report and patient satisfaction questionnaires were completed at the beginning of the first session and end of the last session. Results Significant changes of moderate effect size were observed for overall perfectionism, concern over mistakes and personal standards dimensions of perfectionism following participation in the group. These changes were found to be independent of change in body mass index. Conclusions A group cognitive behavioural approach appears to be efficacious in reducing perfectionism in adults with anorexia nervosa. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background Eating disorders ( ED) have a peak rate of onset in school-aged children. Little is known about teachers' experiences of ED. Method A total of 826 school staff completed an online questionnaire exploring their Eating Disorder experiences. Responses were analysed using content analysis principles. Results 74 per cent of respondents' schools had received no training on ED, 40% did not know how to follow up pupils' Eating Disorder concerns and 89% of respondents felt uncomfortable teaching pupils about ED. Conclusions School staff feel ill-equipped to support ED. Training in the recognition, support and teaching of ED would be welcomed and could improve outcomes for young people. [ABSTRACT FROM AUTHOR]

Background Advances in the treatment of anorexia nervosa (AN) are most likely to arise from targeted, brain-directed treatments, such as repetitive transcranial magnetic stimulation (rTMS). We describe findings from two individuals with treatment-resistant AN who received 19-20 sessions of neuronavigated, high frequency rTMS, applied to the left dorsolateral prefrontal cortex. Method Within-session measures assessed changes pre-rTMS, post-rTMS in subjective eating disorder (ED) experiences. Weight, ED symptoms and mood were assessed pre-treatment, post-treatment and at 1 month follow-up. Results In both cases, there was improvement in ED symptomatology and mood after 19-20 sessions of neuronavigated rTMS, and these changes persisted or continued to improve at follow-up. Within sessions, Patient A demonstrated a consistent reduction in subjective ED experiences, and Patient B a reduction in some ED related experiences. Conclusions These findings suggest that rTMS has potential as an adjunct to the treatment of AN and deserves further study. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The accurate reporting of the trial methodology and results is essential for accurate judgement on the quality of the research. This review aims to assess the impact of the adequacy of allocation concealment on treatment effect estimates. Methods A search was performed in MEDLINE (via the Ovid platform) to identify all randomized controlled trials ( RCTs) indexed in January 2011 within its set of 'core clinical journals'. Meta-regression was undertaken on a subset of two arm trials to quantify the association between adequacy of allocation concealment and effect size. Results Adequate allocation concealment methods were used in 27% ( n = 23) of included trials. There was insufficient information given in 68% ( n = 58) of trials to make a judgement on allocation concealment. Meta-regression showed that there was a trend, not statistically significant, towards a smaller effect size between adequacy of allocation concealment and effect sizes. Conclusion This review highlighted that research needs to be reported to a higher standard and there are many trials reporting poor methods of allocation concealment within the small sample of trials included in this review. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to investigate eating disorder diagnostic status and related symptoms in early pregnancy. Methods Pregnant women (n=739), attending their first routine antenatal scan, were assessed using an adapted version of the Eating Disorder Diagnostic Scale (EDDS). Prevalence estimates and eating disorder symptoms were assessed during the first 3 months of pregnancy and, retrospectively, in the 6 to 12 months prior to pregnancy. Results During pregnancy 7.5% of women met diagnostic criteria for an eating disorder, compared to prepregnancy prevalence of 9.2%. Approximately one quarter (23.4%) of women reported high weight and shape concern during pregnancy; binge eating was endorsed by 8.8%, and 2.3% of women engaged in regular compensatory behaviours. Conclusions Eating disorders are more common than previously thought in pregnancy. There is a clinical need for increased understanding of eating disorder symptomatology during pregnancy and for appropriate screening tools to be incorporated into antenatal care. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: Several studies have used the Forms of Self-Criticism/Reassurance Scale (FSCRS; Gilbert, Clarke, Hempel, Miles, & Irons, 2004) when exploring the role of emotion regulation in psychopathology. However, psychometric evaluation of the FSCRS is limited. The present study sought to confirm the factor structure of the FSCRS based on theoretical and empirical grounds in a large sample of the general population. Method: The FSCRS was completed by a large sample of men and women ( N= 1,570) as part of an online survey. The data were randomly split in order to perform both independent exploratory (EFA) and confirmatory factor analyses (CFA). One-, two- and three-factor solutions were examined. Results: A three-factor model of reassured-self (RS) and the two types of self-criticism, inadequate-self (IS), and hated-self (HS), proved to be the best-fitting measurement model in this sample (χ2= 800.3, df= 148, p < .001; CFI [comparative fit index]= .966, TLI [Tucker Lewis index]= .961, RMSEA [root mean square error of the approximation]= .074). Although very similar to the original questionnaire, there were some differences in terms of the items that were retained. Validity was confirmed with the shortened FSCRS showing the same associations with mood and sex as the original version of the FSCRS. Conclusion: A three-factor model (RS, IS and HS) provided the best-fitting structure and confirmed the separation of different types of self-criticism. Future research should explore the degree to which these separable aspects of self-criticism are theoretically and clinically meaningful and to identify the role of self-reassurance in ameliorating their effects. Practitioner Points Positive clinical implications The current paper has established that the FSCRS consists of self-reassurance and two separable factors of self-criticism (inadequate-self and hated-self)., The current paper refined a measure to test the role of different kinds of self-criticism in the aetiology of psychopathology as well as evaluate outcomes following intervention., Cautions and limitations The current study did not recruit a clinical sample and responses from a clinical group may have revealed a different factor solution., A high percentage of the sample was classed as 'white' and female so the results of this study may not be representative of the general population. [ABSTRACT FROM AUTHOR]

Objective: To explore the role of specialist outpatient eating disorders services and investigate how direct access to these affects rates of referral, admissions for inpatient treatment, and continuity of care. Method: Services beyond primary care in Greater London retrospectively identified adolescents who presented with an eating disorder over a 2-year period. Data concerning service use were collected from clinical casenotes. Results: In areas where specialist outpatient services were available, 2-3 times more cases were identified than in areas without such services. Where initial outpatient treatment was in specialist rather than nonspecialist services, there was a significantly lower rate of admission for inpatient treatment and considerably higher consistency of care. Discussion: Developing specialist outpatient services with direct access from primary care is likely to lead to improvements in treatment and reduce overall costs. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Objective Evidence suggests that poor emotional processing perpetuates anorexia nervosa (AN); however, emotional processing following recovery and interactions between aspects of processing remain unknown. This study examined beliefs about emotions, emotional tolerance and avoidance and emotion suppression to preserve relationships in recovered AN patients. It also explored whether beliefs about emotion are related to emotional avoidance. Design A cross-sectional between-groups design was employed. Method Currently ill ( n = 40), recovered AN patients ( n = 24) and a sample of healthy controls ( n = 48) completed measures of clinical and demographic background in addition to the Beliefs About Emotions, Distress Tolerance and Silencing the Self emotional processing questionnaires. Results Recovered and healthy control groups were comparable (except for higher externalised self-perception in recovered participants) and both had better emotional processing than current AN patients. Beliefs about emotions correlated with level of emotional avoidance. Conclusions This study demonstrates functional levels of emotional processing following recovery from AN. It substantiates models proposing that maladaptive beliefs about emotions link to emotional avoidance and supports inclusion of these factors as treatment foci. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective This study aims to use an experimental design to investigate verbal expression of emotion in anorexia nervosa (AN) and bulimia nervosa (BN). Method Forty-two patients with AN, 26 patients with BN and 34 healthy controls (HCs) were videoed talking about discrete emotional experiences. Talks were analysed using the Linguistic Inquiry and Word Count. Participants also completed the Emotion Regulation Questionnaire (ERQ). Results People with AN used fewer words when describing their emotional experiences and fewer positive affect words than HCs. People with BN were indistinguishable from HCs. Both ED groups had higher scores on the suppression subscale of the ERQ compared with HCs. Suppression was negatively correlated with negative verbal expression. Discussion This study highlights differences between AN and BN in emotion expression. It supports a model of AN, which highlights emotion inhibition as a maintaining factor of the illness. Methods of emotion regulation in EDs may contribute to increased negative mood and poorer social functioning. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate a novel and brief skills-based therapy for in-patients with anorexia nervosa, which addressed 'cold' and 'hot' cognition. Method Eighty one adults with anorexia nervosa were recruited from two eating disorder in-patient units. In one unit, patients received 10 sessions of cognitive remediation and emotion skills training (CREST) plus treatment as usual. In the other, patients received treatment as usual only. Primary outcomes were body mass index and neuropsychological performance scores. Results Both groups improved significantly in body mass index and cognitive flexibility. The CREST group also improved on central coherence. Neither group improved significantly on emotion-processing tasks, although the CREST group did show a larger magnitude of change. Conclusion Improvement in 'cold' cognition was achieved in a short period, whereas emotion-processing difficulties might take longer and more therapeutic work to change. Given that effect sizes in the CREST group were larger for the emotion-processing tasks, improved power may benefit future studies. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This systematic review summarises and critically appraises the literature on structural magnetic resonance imaging in people with a current or past eating disorder. Studies using voxel-based morphometry image analysis were included. Ten studies reported on a total of 236 people with a current or past eating disorder and 257 healthy controls. Sample heterogeneity prohibited a meta-analytic approach. The findings do not unequivocally indicate grey or white matter volume abnormalities in people with an eating disorder. Nevertheless, these preliminary data suggest that, compared with healthy controls, people with anorexia nervosa have decreased grey matter in a range of brain regions and that those with bulimia nervosa have increased grey matter volumes in frontal and ventral striatal areas. Research in the recovery phase and longitudinal studies suggest that potential brain tissue abnormalities may recover with clinical improvement. Overall, as the available data are inconclusive, further efforts in this field are warranted. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Decision making is impaired in female patients with anorexia nervosa (AN), but it is unclear if the same impairment is present in male patients with AN. Method Decision making was assessed in 48 AN individuals (19 male and 29 female patients) and 61 healthy controls (20 male and 41 female patients) using the Iowa Gambling Task (IGT). Results Both male and female patients with AN performed significantly worse than healthy controls on the IGT. No gender differences in IGT performance were found across groups. Male patients had higher impulsivity scores, but impulsivity had not predicted poor decision-making performance. Discussion Impaired decision making is present in male and female patients with AN. These data suggest that male patients with AN are very similar to female patients in decision making, and as a result, treatment approaches that seek to improve this ability should be similar in both genders. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]