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Objective: Anorexia nervosa (AN) is a serious eating disorder treated using psychological interventions, yet outcomes remain limited. Emotional difficulties are recognised as a treatment target. This research programme developed and evaluated feasibility of an emotion‐focused therapy for adults with AN. Methods: Phase One intervention development utilised 'intervention mapping'. Qualitative research drew on lived experience highlighting objectives for change. Empirical evidence was synthesised into hypotheses of core emotional difficulties and an associated model of change. Relevant psychotherapeutic theory‐based change methods were integrated to form the Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS) intervention, guidebook and clinician training package. Phase Two tested SPEAKS in a single‐arm, multisite feasibility trial across two specialist services, utilising prespecified progression criteria, and embedded process evaluation. Results: SPEAKS was 9–12 months (40 sessions) of weekly individual psychotherapy, drawing on a range of psychotherapeutic modalities, predominantly Emotion Focused Therapy and Schema Therapy. Forty‐six participants consented to feasibility trial participation; 42 entered the trial and 34 completed. Thirteen of 16 feasibility criteria were met at green level and three at amber, highlighting areas for improving model adherence. Conclusions: A randomised controlled trial is indicated. Therapist training and guidebook adjustments to improve model adherence are suggested. Highlights: Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex is an emotion‐focused intervention for adults with Anorexia nervosa following a proposed causal model of emotion change. Theory, tasks and techniques integrate Emotion Focused Therapy and Schema Therapy, alongside other modalities, to facilitate the proposed change processes.SPEAKS was developed using a clear 'intervention mapping' process, utilising mixed methods and seeking to engage and learn from those with lived experience.This feasibility trial suggests SPEAKS is an acceptable, engaging and clinically feasible intervention and progression to a larger randomised controlled trial is indicated. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self‐harm (SH). This is the first national study in England to quantify this association in a hospital population. Method: A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999–2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio‐demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis. Results: We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self‐harm after admission with AN was 4.9 (95%CI 4.7–5.1) in females and 4.8 (95%CI 3.9–5.8) in males. For BN it was 9.0 (95%CI 8.4–9.6) in females and 9.8 (95%CI 7.7–12.2) in males. There were strong associations between AN and BN and other SH. Discussion: Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10‐fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required. Public significance: This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self‐harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self‐harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self‐harm. [ABSTRACT FROM AUTHOR]

With ageing there is frequently a loss of appetite, termed anorexia of ageing, which can result in under-nutrition. We do not know how appetite control alters with ageing. The objective of this study was to investigate whether differences in the release of, and response to, gastrointestinal appetite hormones is altered in young compared to old healthy volunteers. We hypothesised that an increase in PYY and GLP-1 or a decrease ghrelin may result in a decreased appetite. A comparative experimental design, using a cross-sectional sample of ages from a healthy population, matched for sex and BMI was used. The study compared total ghrelin, acyl-ghrelin, PYY, GLP-1 and subjective appetite responses to ingestion of a standardised 2781kj (660 kcal) test meal. 31 female volunteers aged between 21 and 92yrs took part. Multiple linear regression showed that both age and sex had an independent effect on energy intake. Subjective appetite scores showed that hunger, pleasantness to eat, and prospective food intake were significantly lower in the older age groups. PYY incremental area under the curve (IAUC) was greater in the oldest old compared to younger ages f(3,27) = 2.9, p = 0.05. No differences in GLP-1, ghrelin or acyl-ghrelin were observed in the older compared to younger age groups. Our data suggest that there may be increases in postprandial PYY(3-36) levels in female octogenarians, potentially resulting in reduced appetite. There does not appear to be any change in ghrelin or acyl-ghrelin concentrations with ageing. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Recent research indicates that eating disorders (ED) are associated with type 1 diabetes and Crohn's disease. The aim of this study was to determine whether, in a hospitalized population, a range of autoimmune diseases (AIDs) occurred more often than expected in people with anorexia nervosa (AN) or bulimia nervosa (BN), and whether AIDs elevated the risk of ED. Method Retrospective, record-linkage cohort study using national administrative statistical data on hospital care and mortality in England, 1999-2011. In people admitted when aged 10-44, cohorts of 8,700 females and 651 males with AN, and 4,783 females and 330 males with BN were constructed, along with a control cohort with the same age range. Results were expressed as risk ratios comparing each ED cohort with the control cohort. Results The overall rate ratio for an AID after admission for AN was 2.04 (95% confidence interval 1.81-2.28) in females, and 1.14 (0.37-2.67) in males; and, for BN, 1.83 (1.56-2.14) in females, and 4.41 (2.11-8.10) in males. Rate ratios for AN after admission for an AID were 3.34 (2.94-3.79) in females, 3.76 (2.06-6.53) in males; and those for BN were 2.57 (2.22-2.97) in females, and 3.10 (1.50-5.90) in males. There were significant associations between ED and several specific individual AIDs. Discussion Strong associations between ED and specific AIDs exist, although it is not possible from this study to determine if these are causal. Clinicians should be aware of the co-occurrence of these conditions. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:663-672) [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]

The present study uses personal construct theory and the repertory grid technique to examine staff views of individual clients with a diagnosis of anorexia nervosa, in particular those clients who purge and restrict. Fourteen members of nursing staff, both qualified and non-qualified, participated in the research. The results suggest that the 14 members of staff interviewed did construe clients who purge and clients who restrict in markedly different ways. The theoretical implications of this finding are discussed. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Clients with anorexia who purge and those who restrict may present with different needs. • The care package may therefore need to be altered. • The study supports a differentiation between Anorexia Nervosa subtypes. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the experience of care giving for people with anorexia nervosa and to compare it with the experiences of those people who care for a person with a psychotic illness., Method: Carers (parents, siblings and husbands) of people with eating disorders who had experienced an episode of inpatient care for anorexia nervosa (n=71) were given the General Health Questionnaire and the Experience of Caregiving Inventory. A sample of carers (N=68) of people with a psychotic illness from the community were used as a comparison group. A subgroup of the carers (n=20) of people with anorexia nervosa were asked to write about their experiences., Results: The clinical samples had a similar duration of illness, but the patients with anorexia nervosa were significantly younger and a larger proportion were living at home. The general health scores were significantly higher in the carers of anorexia nervosa and they experienced higher levels of difficulties in most areas of caregiving. A variety of variables from the Caregiving Inventory contributed to the level of psychological distress, accounting for 36% of the variance. The themes of guilt and shame were additional dimensions that were addressed in the letters., Conclusions: Carers of people with anorexia nervosa are challenged by the difficulties their role produces.