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ABSTRACT Objective Method Results Discussion Trial Registration Adults with binge‐eating disorder (BED), compared with those without BED, demonstrate higher blood‐oxygen–level‐dependent (BOLD) response to food cues in reward‐related regions of the brain. It is not known whether cognitive behavioral therapy (CBT) can reverse this reward system hyperactivation. This randomized controlled trial (RCT) assessed changes in BOLD response to binge‐eating cues following CBT versus wait‐list control (WLC).Females with BED (N = 40) were randomized to CBT or WLC. Participants completed assessments at baseline and 16 weeks including measures of eating and appetite and functional magnetic resonance imaging (fMRI) to measure BOLD response while listening to personalized scripts of binge‐eating and neutral‐relaxing cues. Data were analyzed using general linear models with mixed effects.Overall retention rate was 87.5%. CBT achieved significantly greater reductions in binge‐eating episodes than WLC (mean ± standard error decline of 14.6 ± 2.7 vs. 5.7 ± 2.8 episodes in the past 28 days, respectively; p = 0.03). CBT and WLC did not differ significantly in changes in neural responses to binge‐eating stimuli during the fMRI sessions. Compared with WLC, CBT had significantly greater improvements in reward‐based eating drive, disinhibition, and hunger as assessed by questionnaires (ps < 0.05).CBT was effective in reducing binge eating, but, contrary to our hypothesis, CBT did not improve BOLD response to auditory binge‐eating stimuli in reward regions of the brain. Further studies are needed to assess mechanisms underlying improvements with CBT for BED.ClinicalTrials.gov identifier: NCT03604172 [ABSTRACT FROM AUTHOR]

Objective: This study aimed to understand COVID-19 pandemic impacts on anxiety, depression, and addictive/excessive behaviors, with exploration of intolerance of uncertainty (IU) and social connectedness as potential moderators. Participants: Adult college students participated. Method: Our online survey assessed symptoms and behaviors prior to COVID-19, during the initial outbreak (Wave 1), and during early 2021 (Wave 2). Results: Significant increases were found in anxiety, depression, binge eating, sexual behaviors, video game playing, internet/social media usage, and compulsive exercise in both waves. IU moderated the relationship between both depression/anxiety and certain excessive behaviors; social connectedness moderated the relationship between anxiety and smoking. Conclusions: This study replicated prior work and highlights new impacts on addictive/excessive behaviors, as well as moderating effects from social connectedness and IU. Future research is warranted to evaluate the efficacy of treatments targeting IU and social connectedness as the pandemic continues to unfold. [ABSTRACT FROM AUTHOR]

• We had collected data from 462 adolescent girls followed over an 8-year period. • Different risk factors univariately and multivariately predicted eating disorders. • Similar risk factors predicted future onset of BN, BED, and PD. • Risk factors for AN are qualitatively distinct and should be investigated further. Because very few prospective studies have identified risk factors that predicted future onset of threshold/subthreshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD), we analyzed prospective data collected from a large cohort of adolescent girls followed over an 8-year period to advance knowledge about risk factor specificity. Adolescent girls recruited from middle schools in Texas (N = 492; M age = 13.02 [ SD = 0.73], age range = 11–15) completed questionnaires assessing risk factors at baseline and diagnostic interviews assessing eating disorders annually over 8 years. Only low BMI predicted future AN onset. Pressure to be thin, thin-ideal internalization, body dissatisfaction, negative emotionality, low parent support, and modeling of eating pathology predicted future BN onset. Pressure to be thin, thin-ideal internalization, negative emotionality, low parent support, and modeling of eating pathology predicted future BED onset. Pressure to be thin, body dissatisfaction, dietary restraint, low parent support, modeling of eating pathology, and high BMI predicted future PD onset. Predictive effects were medium-to-large. Results support etiological theories of eating disorders that postulate the pursuit of the thin ideal, body dissatisfaction, negative affect, dietary restraint, and interpersonal issues increase risk for most eating disorders. The evidence that girls with low body weight are at risk for AN, whereas girls with high body weight are at risk for PD are novel. Although several risk factors predicted future onset of BN, BED, and PD, results suggest that risk factors for AN are qualitatively distinct and should be investigated further. [ABSTRACT FROM AUTHOR]

Binge eating disorder (BED) is the most prevalent eating disorder. Treatment options include pharmacotherapy as well as psychotherapy, with the latter recommended as a first-line option. However, the use of psychotherapeutic interventions poses several challenges. Antidepressants are easily accessible, but they lack robust evidence-base. This systematic review aims to comprehensively examine the efficacy and safety of antidepressants for the treatment of BED. Five databases were searched for randomized controlled trials (RCTs) comparing antidepressants vs. placebo in BED until 23/11/2023. Pairwise meta-analytic evaluations were performed. The primary outcomes were remission and binge eating frequency. Secondary outcomes were response to treatment, eating psychopathology, depression, anxiety, body weight, Body Mass Index (BMI), all-cause discontinuation, discontinuation due to adverse effects and total adverse events. Sixteen RCTs with a total of 984 participants were meta-analysed. Antidepressants were more effective than placebo in achieving remission (RR: 1.39, 95 % CI: 1.04 to 1.86) and in reducing binge eating episodes (SMD: -0.29, 95 % CI: -0.51 to -0.06). Similarly, in the secondary outcomes of response and depression, antidepressants demonstrated superiority over placebo. Antidepressants appear to be effective in reducing symptoms of BED. Small samples and effect sizes hinder the generalizability and clinical utility of these results. There is a lack of follow-up findings regarding the maintenance of effects. There is a pressing need for more RCTs examining antidepressants and other types of pharmacotherapy. Future research should include larger number of participants and increase the duration of follow-up. [ABSTRACT FROM AUTHOR]

Using data from 165 adult participants who enrolled in four studies of cognitive-behavioral therapy (CBT) for binge-spectrum eating disorders (EDs), this secondary analysis examined 1) whether pretreatment hopelessness predicted posttreatment eating pathology, loss-of-control (LOC) eating frequency, and purging frequency; 2) whether treatment had an indirect effect on those outcomes through change in hopelessness; and 3) whether treatment had an indirect effect on hopelessness through those ED measures. The Eating Disorder Examination was used to assess overall eating pathology, LOC frequency, and purging frequency. Hopelessness was measured with one item from the Beck Depression Inventory-II. Regression models showed that pretreatment hopelessness predicted posttreatment LOC eating frequency but not overall eating pathology or purging frequency. Single-group tests of indirect effects showed no effect of reduction in hopelessness on reduction in ED symptoms, but there was an effect of reduction in ED symptoms on reduction in hopelessness. [ABSTRACT FROM AUTHOR]

Objective: Going extended periods of time without eating increases risk for binge eating and is a primary target of leading interventions for binge‐spectrum eating disorders (B‐EDs). However, existing treatments for B‐EDs yield insufficient improvements in regular eating and subsequently, binge eating. These unsatisfactory clinical outcomes may result from limitations in assessment and promotion of regular eating in therapy. Detecting the absence of eating using passive sensing may improve clinical outcomes by facilitating more accurate monitoring of eating behaviours and powering just‐in‐time adaptive interventions. We developed an algorithm for detecting meal consumption (and extended periods without eating) using continuous glucose monitor (CGM) data and machine learning. Method: Adults with B‐EDs (N = 22) wore CGMs and reported eating episodes on self‐monitoring surveys for 2 weeks. Random forest models were run on CGM data to distinguish between eating and non‐eating episodes. Results: The optimal model distinguished eating and non‐eating episodes with high accuracy (0.82), sensitivity (0.71), and specificity (0.94). Conclusions: These findings suggest that meal consumption and extended periods without eating can be detected from CGM data with high accuracy among individuals with B‐EDs, which may improve clinical efforts to target dietary restriction and improve the field's understanding of its antecedents and consequences. Highlights: Regular eating is an important treatment target for binge‐spectrum eating disorders (B‐EDs).The present study developed an algorithm for detecting extended periods of time without eating using blood glucose data.The developed algorithm may be used to improve interventions for B‐EDs. [ABSTRACT FROM AUTHOR]

Eating disorders (ED) are serious psychiatric illnesses, with no everyday support to intervene on the high rates of relapse. Understanding physiological indices that can be measured by wearable sensor technologies may provide new momentary interventions for individuals with ED. This systematic review, searching large databases, synthesises studies investigating peripheral physiological (PP) indices commonly included in wearable wristbands (heart rate [HR], heart rate variability [HRV], electrodermal activity [EDA], peripheral skin temperature [PST], and acceleration) in ED. Inclusion criteria included: (a) full peer‐reviewed empirical articles in English; (b) human participants with active ED; and (c) containing one of five wearable physiological measures. Kmet risk of bias was assessed. Ninety‐four studies were included (Anorexia nervosa [AN; N = 4418], bulimia nervosa [BN; N = 916], binge eating disorder [BED; N = 1604], other specified feeding and eating disorders [OSFED; N = 424], and transdiagnostic [N = 47]). Participants with AN displayed lower HR and EDA and higher HRV compared to healthy individuals. Those with BN showed higher HRV, and lower EDA and PST compared to healthy individuals. Other ED and Transdiagnostic samples showed mixed results. PP differences are indicated through various assessments in ED, which may suggest diagnostic associations, although more studies are needed to validate observed patterns. Results suggest important therapeutic potential for PP in ED, and larger studies including diverse participants and diagnostic groups are needed to fully uncover their role in ED. Key points: Different independent ED groups display distinct physiological patternsAN groups generally show lower physiological activity compared to healthy controlsAspects of physiology may indicate severity of illness in people with EDs [ABSTRACT FROM AUTHOR]

Objectives: Negative urgency is associated with short‐term maintenance of binge eating and purging in unselected samples. The current study used an eating disorder sample to test the hypothesis that negative urgency maintains bulimia nervosa (BN) and purging disorder (PD) at long‐term follow‐up. It was also hypothesized that baseline differences in negative urgency between BN and PD would remain at follow‐up. Methods: Secondary analyses were conducted on a sample of women who engaged in recurrent self‐induced vomiting (n = 68; 52.9% BN; 47.1% PD). Women completed diagnostic interviews and questionnaires at baseline and at a mean (SD) of 5.95 (1.58) years follow‐up (range = 2.51–9.62; retention rate = 75%). Results: Negative urgency did not predict eating disorder diagnostic status, recovery status, or global eating pathology at follow‐up (p's =.06–.83). There were no significant differences in negative urgency across women with BN and PD at follow‐up (p =.16). However, post hoc analyses indicated that negative urgency was not stable across time (ICC =.102). Increases in negative urgency from baseline to follow‐up were associated with greater global eating pathology at follow‐up (p =.002). Conclusion: Results suggest negative urgency does not predict long‐term eating disorder maintenance. Negative urgency may not be a stable personality trait but rather an indicator of overall poor emotion regulation. Future research should confirm that changes in negative urgency predict chronic eating pathology over long durations of follow‐up in women who have increasing negative urgency across time. [ABSTRACT FROM AUTHOR]

Background: Lisdexamfetamine dimesylate (LDX) has demonstrated safety and efficacy for treatment of Binge Eating Disorder (BED). However, to date, trials have not included participants with co-occurring psychiatric disorders. This study explores how LDX affects eating disorder psychopathology, symptoms of common psychiatric comorbidities of BED (ADHD, depression, anxiety), and psychological quality of life, in people with moderate to severe BED. Methods: These are secondary analyses of an open-label LDX trial conducted in 41 adults (18–40 years) over eight-weeks. Participants received LDX titrated to 50 or 70 mg. Clinical assessments and self-report questionnaires were conducted at baseline and 8-week follow-up. Results: Eating disorder psychopathology and psychological quality of life improved after 8-weeks of LDX. No significant group-level changes in depression, anxiety or ADHD severity scores were observed. However, the majority within the small subsets with elevated depression and ADHD symptoms experienced reduced depressive and inattentive symptom severity, respectively. Conclusions: We provide proof-of-concept evidence that LDX may provide broader psychological benefits to individuals with BED, beyond reducing their BE frequency. Effects of LDX on anxiety should be monitored closely by clinicians. Early indications suggest that LDX may be effectively used in people with BED, with and without co-occurring psychiatric conditions, however tolerability may be lower in highly complex cases. Trial registration: Australian and New Zealand Clinical Trials Registry (anzctr.org.au) #ACTRN12618000623291. Plain English summary: Lisdexamfetamine dimesylate (LDX) has been shown to reduce binge eating frequency among those with Binge Eating Disorder (BED). However, little is known about how LDX affects symptoms of common co-occurring conditions (ADHD, depression, anxiety) and mental health more broadly. In this study, 41 people with BED received an 8-week course of LDX and their symptoms were monitored before and after treatment. Overall, people experienced a robust improvement in eating disorder psychopathology and psychological quality of life. For those with higher levels of depression and ADHD, LDX had the additional benefit of improving depressive symptoms and inattentive symptom severity, respectively. The effect of LDX on anxiety symptoms appears to be more complex, with an equal proportion of people experiencing a decrease or an increase in anxiety over the course of treatment. Those who experienced reductions in anxiety during treatment tended to have greater concurrent reductions in binge eating frequency. This study provides preliminary evidence that for people with BED, LDX may be effective at improving co-occurring symptoms of eating disorder psychopathology and psychological well-being, and potentially ADHD and depression symptoms when present at an elevated level. More research is needed among a larger sample to verify these findings. [ABSTRACT FROM AUTHOR]

Objective Method Results Discussion Public Significance Understanding the perspectives of behavioral weight loss (BWL) participants could inform whether, how, and for whom BWL should be offered.All 126 participants in a clinical trial of BWL for adults with binge‐eating disorder (BED) and overweight/obesity were contacted about a qualitative study. 45 participants, 11 of whom had dropped out of the parent study, completed qualitative interviews. The interview guide was developed using data from a survey of providers who offer Health at Every Size and other weight‐neutral lifestyle interventions. Questions were phrased to invite even the most negative responses. Questions focused on participants' experiences of weight stigma during treatment, perceptions of BWL's calorie and WL goals, and opinions of BWL and weight‐neutral interventions.We identified four themes using thematic analysis: (1) BWL did not perpetuate weight stigma. (2) Calorie and WL goals did not exacerbate participants' binge eating. (3) Patients should have the right to pursue any treatment that aligns with their personal goals. (4) BWL can improve participants' overall health.BWL participants with BED and overweight/obesity want others to have access to a program that can reduce both weight and binge eating. Participants emphasized that no treatment works for everyone, and they all agreed that BWL had not perpetuated weight stigma. Fewer than 20% of participants considered the program's calorie and WL goals to be harmful; most participants viewed those goals as achievable and helpful, and many asserted that their participation in BWL had improved their overall health.We interviewed adults with binge‐eating disorder and overweight/obesity who had participated in a behavioral weight loss (BWL) program. Our participants wanted others in their position to have access to BWL because it aims to reduce both weight and binge‐eating frequency. Efforts should be made to provide patients, clinicians, and policymakers with the knowledge that supervised, evidence‐based BWL is an effective and desired treatment choice for this population. [ABSTRACT FROM AUTHOR]

Objectives: Both disordered eating and disturbed sleep represent significant threats to mental health. Accumulating evidence suggests that disordered eating behaviors and sleep problems co-occur. A majority of current research, however, has focused on these behaviors as components of eating disorder diagnoses, rather than investigating the independent associations of transdiagnostic disordered eating behaviors and sleep. The present study sought to examine fasting, binge eating, self-induced vomiting, laxative or diuretic misuse, and driven exercise as predictors of sleep quality complaints. Method: An online sample of 648 U.S. adults completed the Eating Disorder Examination - Questionnaire, the Pittsburgh Sleep Quality Index, and the Patient Health Care Questionnaire-2 as part of a larger parent study. Results: Results of a hierarchical linear regression revealed that, collectively, disordered eating behaviors predicted worse sleep quality [R2 = 0.30, F(7, 640) = 31.21, p <.001], and that both binge eating and fasting, but not other compensatory behaviors, accounted for unique variance in sleep quality after controlling for BMI and depression. Conclusions: Overall, findings suggest that transdiagnostic disordered eating behaviors are associated with sleep quality complaints. Improved understanding of the specific relationships between individual eating behaviors and sleep characteristics can help refine the identification of individuals at high risk for sleep disturbance and address the potential reciprocal influence of sleep quality on disordered eating behaviors. Plain English Summary: Both disordered eating and problematic sleep negatively impact mental health. Many times they occur together and it is likely that worse sleep may intensify disordered eating symptoms and vice versa. Previous research tends to be limited to assessing sleep based on the presence or absence of an eating disorder diagnosis, rather than exploring associations between sleep and different types of eating disorder behaviors, such as fasting, binge eating, self-induced vomiting, laxative or diuretic misuse, and driven exercise. Thus, the current study examined symptoms of eating disorders that may occur across different eating disorder diagnoses and how they relate to sleep quality complaints. Six hundred forty-eight adults completed online questionnaires related to sleep, eating, and depression. Results of the current study found that higher weight, depression, fasting, and binge eating were most strongly related to worse sleep quality. Eating disorder symptoms such as binge eating and fasting may occur across eating disorder diagnoses, suggesting the importance of examining eating disorder behaviors, rather than diagnoses only. Continued understanding of particular risk factors for sleep problems within disordered eating will help identify high risk individuals who may need additional support for both problematic eating and sleep. [ABSTRACT FROM AUTHOR]

Background: Eating disorders in adolescence are associated with high psychological distress, impaired function and high comorbidity. Despite the severity, eating disorders remain highly underdiagnosed and untreated. Digital technology provides promising opportunities for treatment, however studies focusing on digital treatments for adolescents with eating disorders are lacking. The main aim of this study was to explore the perspectives of adolescents with lived experience of eating disorders on factors they deemed to be relevant in the development of a novel digital treatment. Methods: A qualitative intervention development study using semi-structured individual interviews. Data collection, coding and analysis were conducted using the principles of reflexive thematic analysis. Participants were adolescents aged 16–19 years, with a self-reported diagnosis of anorexia nervosa, bulimia nervosa or binge eating disorder, currently in the final phase or completed psychological treatment for an eating disorder within the last five years. Results: A total of 16 adolescents participated in the study, all females. Mean age was 17 ½ years (SD = 1.01). An in-depth understanding of the adolescents' perspectives was developed into three themes: Facilitating self-awareness and readiness to change; Strengthening interpersonal relationships and decreasing social isolation; Ensuring feeling seen and motivating regular use. Conclusions: This study provides a unique insight into the perspectives of adolescents with lived experience of eating disorders. The uptake and engagement can be optimized in a novel digital treatment for eating disorders by taking the adolescents perspectives into consideration. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the potential associations between clinical/socio-demographic variables and the presence of purging/binge-eating episodes in eating disorders (EDs). Clinical/socio-demographic variables and psychometric scores were collected. Groups of patients were identified according to the presence or absence of purging or objective binge-eating episodes (OBEs) and compared through t-test and chi-square tests. Binary logistic regression analyses were run. A sample of 51 ED outpatients was recruited. Patients with purging behaviors had a longer duration of untreated illness (DUI) (t = 1.672; p = 0.019) and smoked a higher number of cigarettes/day (t = 1.061; p = 0.030) compared to their counterparts. A lower BMI was associated with purging (OR = 0.881; p = 0.035), and an older age at onset showed a trend towards statistical significance (OR = 1.153; p = 0.061). Patients with OBEs, compared to their counterparts, were older (t = 0.095; p < 0.001), more frequently presented a diagnosis of bulimia or binge-eating disorder (χ2 = 26.693; p < 0.001), a longer duration of illness (t = 2.162; p = 0.019), a higher number of hospitalizations (t = 1.301; p = 0.012), and more often received a prescription for pharmacological treatment (χ2 = 7.864; OR = 6.000; p = 0.005). A longer duration of the last pharmacological treatment was associated with OBE (OR = 1.569; p = 0.046). In contrast to purging, OBE was associated with a more complicated and severe presentation of ED. A lower BMI and a later age at onset, as well as long-lasting previous pharmacological treatments, may predict the presence of purging/binging. Further research is needed to thoroughly characterize ED features and corroborate our preliminary findings. [ABSTRACT FROM AUTHOR]

Background: Adolescents' early responses and overall outcomes during anorexia nervosa (AN) treatment may differ by patient gender, raising the question of whether evaluating clinical data during AN treatment may require different criteria. Methods: We investigated, using patient records, whether young men and young women with AN differed in terms of early treatment response (defined as weight change and variability within the first 14 days) and whether early treatment responses predicted treatment outcomes similarly across genders. Results: Weight changes predicted patient discharge weight across all gender groups. Weight variability predicted higher disordered eating psychopathology and higher body image insecurities at discharge. Gender differences emerged only for weight gain, which was more pronounced for young men, and gender modulated the effects of weight gain and variability on general psychopathology outcomes. Conclusions: The present findings suggest that early weight changes and weight variability are similarly important predictors of AN treatment outcomes in adolescents but also hint at possible gender differences in terms of the link between weight change and, respectively, variability on general psychopathology. [ABSTRACT FROM AUTHOR]

Introduction: Web‐based guided self‐help cognitive behavioral therapy‐enhanced (CBT‐E) is a 12‐weeks, 12‐sessions, digitalized version of part II of the self‐help book Overcoming Binge Eating. This intervention is effective when offered under controlled circumstances in a randomized‐controlled‐trial. It is unknown how patients with binge‐eating disorder (BED) respond to this intervention when offered in real‐world clinical‐settings. The aim of this study is to examine post‐intervention effectiveness of guided self‐help CBT‐E for BED in real‐world settings. Method: The present study used a cohort‐design examining the effectiveness of web‐based guided self‐help CBT‐E according to an intention‐to‐treat (ITT) analysis. BED patients (n = 278) were assessed pre‐ and post‐intervention. The primary outcome was reduction in binge‐eating episodes. Other outcomes were full‐recovery (EDE‐Q score <2.77 and abstinence from binge‐eating episodes), impaired psychosocial functioning, defined as secondary impairment, and general psychopathology post‐intervention. Results: The number of binge‐eating episodes reduced by an average of 16 binge‐eating episodes per 4 weeks pre‐intervention to five binge‐eating episodes during the last 4 weeks of treatment. Abstinence from binge eating was reported by 30%, and 28% reported full recovery. Effect sizes (Cohen's d) were large (d ≥ 1.0) for all outcome measures. There were no differences in outcomes between the ITT and the completers sample. Discussion: Guided self‐help CBT‐E is associated with significant improvements. The effects of guided self‐help CBT‐E offered in a real‐world‐setting are comparable to self‐help CBT‐E offered in a randomized‐controlled‐trial. However, it should be noted that comparisons with randomized‐controlled‐trials requires caution. Longer‐term follow‐up data are necessary to measure persistence of treatment benefits. Public Significance: Offering CBT‐E as a web‐based guided self‐help intervention has several benefits for patients with BED. Guided self‐help CBT‐E is associated with significant improvements on the short term when offered in real‐world clinical settings. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Multiple factors are related to lower weight loss after bariatric surgery. This review and meta‐analysis evaluates the influence of several mental and behavioral factors on weight loss. Method: Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non‐moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow‐up moments were analyzed separately. Results: In total, 75 articles were included in the review; 12 meta‐analyses were conducted. Higher postoperative compliance to follow‐up was associated with 6.86%–13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24‐ and 36‐month follow‐up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms. Conclusion: Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric‐metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss. [ABSTRACT FROM AUTHOR]

Abdominal compartment syndrome (ACS) is typically attributed to critically unwell patients with trauma, burns, post surgery, and massive ascites. A rare but fatal cause of ACS is bulimia nervosa (BN), which is an eating disorder characterized by bingeing, followed by methods to avoid weight gain, including purging. We present a case of a 20-year-old woman who presented with abdominal pain and distension after consuming a large quantity of food the previous night and was unable to purge. She was initially managed conservatively and discharged home, but returned subsequently on the same day with clinical features of ACS secondary to acute gastric distension. Decompression resulted in life-threatening reperfusion injury with critical electrolyte abnormalities and fatal cardiac arrest in the operating theatre. A systematic review of the literature found only 11 case reports of ACS secondary to BN, of which only 6 patients survived due to early diagnosis and decompression. Inability to purge and lower limb ischemia appeared to be associated with increased mortality. As BN is a common emergency presentation, the case and systematic review highlights the need to consider ACS as a potentially life-threatening complication of binge eating, particularly when there is unsuccessful purging. [ABSTRACT FROM AUTHOR]

Objective Method Results Discussion Public Significance Despite unique experiences that may increase eating disorder risk, U.S. military service members are an understudied population. The current study examined incidence and prevalence of eating disorder diagnoses in U.S. military personnel.This retrospective cohort study utilized Military Health System Data Repository (MDR) data on eating disorder diagnoses (2016–2021). Active duty, Reserve, and National Guard U.S. military service members who received care via TRICARE Prime insurance were identified by ICD‐10 eating disorder diagnostic codes.During the 6‐year surveillance period, 5189 Service members received incident eating disorders diagnoses, with a crude overall incidence rate of 6.2 cases per 10,000 person‐years. The most common diagnosis was other/unspecified specified eating disorders, followed by binge‐eating disorder, bulimia nervosa, and anorexia nervosa. There was an 18.5% overall rise in total incident cases across the surveillance period, but this trend was not statistically significant (p = 0.09). Point prevalence significantly increased across the 6‐year timeframe for total eating disorders (p < 0.001). Period prevalence for 6‐year surveillance period was 0.244% for total eating disorders, 0.149% for other/unspecified eating disorder, 0.043% for bulimia nervosa, 0.038% for binge‐eating disorder, and 0.013% for anorexia nervosa.Overall crude incidence estimates for total eating disorders were higher than reported in prior research that included only active duty Service members and required an eating disorder diagnosis code in the first or second diagnostic position of the medical record. Comprehensive and confidential studies are needed to more thoroughly characterize the nature and scope of eating disorder symptomatology within U.S. military personnel.U.S. military service members are a vulnerable population with regard to eating disorder symptoms. Previously reported incidence and prevalence estimates using data from the Military Health System may have been underestimated due to overly stringent case definitions. Given personal and occupational barriers (e.g., career consequences), confidential studies of military personnel may provide more complete data on the scope of eating disorders to inform screening and clinical practice guidelines for military populations. [ABSTRACT FROM AUTHOR]

Heightened trait impulsivity in both subclinical and pathological senses is becoming increasingly recognised in Parkinson's disease (PD). Impulsive behaviours and impulse control disorders (ICDs) are a consequence of perturbation to the rewards pathway leading individuals to conduct activities in a repetitive, excessive, and maladaptive fashion. Commonly linked to PD, heightened trait impulsivity has been found to primarily manifest in the forms of hypersexuality, pathological gambling, compulsive shopping, and binge eating, all of which may significantly impact social and financial standing. Subsequent burden to quality of life for both individuals with PD and caregivers are common. Although risk factors and indicators for ICDs in PD are currently lacking, it is recognised that the condition is often precipitated by dopamine replacement therapies, primarily dopamine agonist administration. While this nonmotor symptom is being increasingly diagnosed in PD populations, it remains relatively elusive in comparison to its motor counterparts. Through discussion of impulsivity characteristics, neuroanatomy, and neurochemistry, in addition to reviewing existing research on the potential contributing factors to impulsivity in PD, this review highlights impulsivity as a significant and detrimental PD symptom. Thus, emphasising the imperative need to establish efficacious diagnostic tools and treatments. [ABSTRACT FROM AUTHOR]

Background: Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by avoidance/restriction of food intake by volume and/or variety. The emergence of shape/weight-related eating disorder symptoms in the longitudinal course of ARFID is an important clinical phenomenon that is neither robustly documented nor well understood. We aimed to characterize the emergence of eating disorder symptoms among adults with an initial diagnosis of ARFID who ultimately developed other eating disorders. Method: Thirty-five participants (94% female; Mage = 23.17 ± 5.84 years) with a history of ARFID and a later, separate eating disorder completed clinical interviews (i.e., Structured Clinical Interview for DSM-5 – Research Version and Longitudinal Interval Follow-Up Evaluation) assessing the period between ARFID and the later eating disorder. Participants used calendars to aid in recall of symptoms over time. Descriptive statistics characterized the presence, order of, and time to each symptom. Paired samples t-tests compared weeks to emergence between symptoms. Results: Most participants (71%) developed restricting eating disorders; the remainder (29%) developed binge-spectrum eating disorders. Cognitive symptoms (e.g., shape/weight concerns) tended to onset initially and were followed by behavioral symptoms. Shape/weight-related food avoidance presented first, objective binge eating, fasting, and excessive exercise occurred next, followed by subjective binge eating and purging. Conclusions: Diagnostic crossover from ARFID to another (typically restricting) eating disorder following the development of shape/weight concerns may represent the natural progression of a singular clinical phenomenon. Findings identify potential pathways from ARFID to the development of another eating disorder, highlighting possible clinical targets for preventing this outcome. Plain English Summary: Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by avoidance/restriction of food intake by volume and/or variety. In contrast to other eating disorders (e.g., anorexia nervosa, bulimia nervosa), dietary restriction in ARFID is not motivated by shape and weight concerns. Instead, it is driven by sensory sensitivities, fear of aversive consequences, and lack of interest in food/eating. The emergence of other eating disorder symptoms - such as shape and weight concerns - in the longitudinal course of ARFID is an important clinical phenomenon that is neither robustly documented nor well understood. Following ARFID history, 71% of participants in our study developed a restricting eating disorder and 29% developed a binge-spectrum eating disorder. Cognitive symptoms of other eating disorders (e.g., shape/weight concerns) onset prior to behavioral symptoms (e.g., food avoidance). Diagnostic crossover from ARFID to another eating disorder following the development of shape/weight concerns represents an interesting and important clinical phenomenon. Our findings suggest potential pathways by which ARFID may lead to the development of a subsequent eating disorder, in turn highlighting critical targets that may be intervened on to prevent this trajectory. [ABSTRACT FROM AUTHOR]

Introduction: Binge Eating Disorder (BED) are recurrent episodes of binge eating (BED) that must occur, on average, at least once a week for three months. The objective of this research is to understand and identify the emotional triggers that trigger binge eating. Materials and Methods: Integrative bibliographical research, in the BVS, Google Scholar and Scielo databases, based on the following descriptors: “Food and Emotion”, “Compulsion to Eat”, “Obesity”. Results and Discussion: Some emotional triggers found were dietary restrictions, negative feelings related to body weight, body shape to food, boredom, anguish, depression, negative affect, anger, deprivation of pleasure, guilt, disgust, accentuated anguish, depressed mood, anxiety, depression, low selfesteem, among others. Conclusion: Some eating habits are linked to pleasure, where food is a conductor of affection that compensates for feelings such as anger, sadness, anguish, anxiety, among others, which can be emotional triggers that trigger binge eating and/or obesity. This study may add knowledge to professional practice and may contribute to the understanding and prior identification of symptoms that are linked to emotions that affect eating habits and behaviors in order to alleviate the physical and psychological suffering caused by ACT, CA and obesity. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether one session of transcranial direct current (tDCS) stimulation alone or combined with aerobic exercise (AE) could reduce food consumption and the perception of hunger and satiety in patients with binge eating disorder. Materials and Methods: Adult individuals with BED were recruited in a randomized, controlled, double-blind study. Participants received one session (1) active tDCS, (2) placebo and AE tDCS or (3) active tDCS and AE. tDCS was applied at 2mA / 20 min, with the anode over the right dorsolateral prefrontal cortex and the cathode over the contralateral supraorbital region. The AE was performed on a treadmill after tDCS, with initial warm-up and intensity of 60-65% of HRmax, repeating the evaluations at the end. Primary outcomes included measures of food intake and perceptions of hunger, satiety and desire. Results: The tDCS group had lower values of lean mass and triglycerides compared to the other groups. However, in relation to food intake, hunger, satiety throughout the day, and uncontrollable desire to eat, tDCS alone or combined were equally effective. Conclusions: tDCS alone or combined with AE improved clinical outcomes in patients with BED. To our knowledge, to date, this is the first study showing that the association of tDCS with aerobic exercise to relieve symptoms of patients with BE. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that disrupts brain functioning and is characterized by hyperactivity, impulsivity, and inattention. With varying presentations and complex etiological factors contributing to the development of ADHD, along with its persistence into adulthood, ADHD must be studied. Researchers have taken an interest in the relationship between ADHD and suicide, which is a serious public health concern with increasing prevalence rates in the Americas. The current literature reveals conflicting views on the importance of psychiatric comorbidities in the development of suicidal behaviours in ADHD patients. Therefore, this study aimed to determine whether there were significant differences between adult ADHD patients with suicide risk and adult ADHD patients without suicide risk. This study was a naturalistic retrospective chart review pilot study that used a sample of adults with a confirmed diagnosis of ADHD from January 2023 to August 2023. Using convenience sampling and sets of inclusion and exclusion criteria, patient data were sequentially collected from Med Access electronic medical records. The control and experimental groups each consisted of 50 patients (100) ranging from 19 to 58 years old. Our quantitative data were analyzed using non-parametric statistical tests, including the Chi-Square test and the Mann–Whitney U test. The results showed significant associations between ADHD patients with suicide risk and (1) borderline personality disorder; (2) binge eating disorder; (3) seven specific psychosocial risk factors; and (4) a higher number of antidepressant medication trials. No significant associations were found with other psychiatric disorders; however, there are important sex differences in terms of the risk factors. Our pilot study reveals several significant differences between adult ADHD patients with suicide risk and those without suicide risk. However, given our limited sample size and limitations, we hope our study encourages larger-scale studies to further investigate this relationship to improve its generalizability. [ABSTRACT FROM AUTHOR]

In this article, I argue that various epistemic challenges associated with eating disorders (EDs) can negatively affect the care of already marginalized patient groups with various EDs. I will first outline deficiencies in our understanding of EDs—in research, healthcare settings, and beyond. I will then illustrate with examples cases where discriminatory misconceptions about what EDs are, the presentation and treatment of EDs, and who gets EDs, instantiate obstacles for the treatment of various ED patient groups. [ABSTRACT FROM AUTHOR]

Background: Timely intervention is beneficial to the effectiveness of eating disorder (ED) treatment, but limited capacity within ED services means that these disorders are often not treated with sufficient speed. This service evaluation extends previous research into guided self-help (GSH) for adults with bulimic spectrum EDs by assessing the feasibility, acceptability, and preliminary effectiveness of virtually delivered GSH using videoconferencing. Method: Patients with bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding and eating disorders (OSFED) waiting for treatment in a large specialist adult ED out-patient service were offered virtually delivered GSH. The programme used an evidence-based cognitive behavioural self-help book. Individuals were supported by non-expert coaches, who delivered the eight-session programme via videoconferencing. Results: One hundred and thirty patients were allocated to a GSH coach between 1 September 2020 and 30 September 2022; 106 (82%) started treatment and 78 (60%) completed treatment. Amongst completers, there were large reductions in ED behaviours and attitudinal symptoms, measured by the ED-15. The largest effect sizes for change between pre- and post-treatment were seen for binge eating episode frequency (d = –0.89) and concerns around eating (d = –1.72). Patients from minoritised ethnic groups were over-represented in the non-completer group. Conclusions: Virtually delivered GSH is feasible, acceptable and effective in reducing ED symptoms amongst those with bulimic spectrum disorders. Implementing virtually delivered GSH reduced waiting times, offering a potential solution for long waiting times for ED treatment. Further research is needed to compare GSH to other brief therapies and investigate barriers for patients from culturally diverse groups. [ABSTRACT FROM AUTHOR]

There is an emerging view that the increased availability of energy-dense foods in our society is contributing to excessive food consumption which could lead to food addiction-like behavior. Particularly, compulsive eating patterns are predominant in people suffering from eating disorders (binge-eating disorder, bulimia and anorexia nervosa) and obesity. Phenotypically, the behavioral pattern exhibits a close resemblance to individuals suffering from other forms of addiction (drug, sex, gambling). Growing body of evidence in neuroscience research is showing that excessive consumption of energy-dense foods alters the brain circuits implicated in reward, decision-making, control, habit formation, and emotions that are central to drug addiction. Here, we review the current understanding of the circuits of food addiction-like behaviors and highlight the future possibility of exploring those circuits to combat obesity and eating disorders. [ABSTRACT FROM AUTHOR]

Objective: Reward‐based eating drives are putative mechanisms of uncontrolled eating implicated in obesity and disordered eating (e.g., binge eating). Uncovering the genetic and environmental contributions to reward‐related eating, and their genetic correlation with BMI, could shed light on key mechanisms underlying eating and weight‐related disorders. Method: We conducted a classical twin study to examine how much variance in uncontrolled eating phenotypes and body mass index (BMI) was explained by genetic factors, and the extent that these phenotypes shared common genetic factors. 353 monozygotic twins and 128 dizygotic twins completed the Reward‐based Eating Drive 13 scale, which measures three distinct uncontrolled eating phenotypes (loss of control over eating, preoccupation with thoughts about food, and lack of satiety), and a demographic questionnaire which included height and weight for BMI calculation. We estimated additive genetic (A), common environmental (C), and unique environmental (E) factors for each phenotype, as well as their genetic correlations, with a multivariate ACE model. A common pathway model also estimated whether genetic variance in the uncontrolled eating phenotypes was better explained by a common latent uncontrolled eating factor. Results: There were moderate genetic correlations between uncontrolled eating phenotypes and BMI (.26–.41). Variance from the uncontrolled eating phenotypes was also best explained by a common latent uncontrolled eating factor that was explained by additive genetic factors (52%). Discussion: These results suggest that uncontrolled eating phenotypes are heritable traits that also share genetic variance with BMI. This has implications for understanding the cognitive mechanisms that underpin obesity and disordered eating. Public Significance: Our study clarifies the degree to which uncontrolled eating phenotypes and BMI are influenced by shared genetics and shows that vulnerability to uncontrolled eating traits is impacted by common genetic factors. [ABSTRACT FROM AUTHOR]

Objective: Screen time has been reported to be associated with binge‐eating disorder (BED) among adolescents in the US; however, potential mediators remain unclear. This study aimed to evaluate depression symptoms as a mediator of the prospective association between screen time and BED. Method: We utilized data from 9465 children (aged 9–11 years at baseline) from the Adolescent Brain Cognitive Development (ABCD) study (2016–2021). A generalized structural equation model was used to examine the prospective association between average daily screen time at baseline and BED at year 2, adjusting for baseline BED diagnosis, and other potential covariates (e.g., age, sex, and income). Mediation was examined using bias‐corrected (BC) 95% confidence intervals for the indirect effect of baseline screen time on year 2 BED through depression symptoms (change from baseline to year 1). Results: One hundred and one participants (42.7% male, 49.4% racial/ethnic minority) met the criteria for BED in year 2. Participants were 9.9 years of age on average at baseline, 51.3% identified as male, and 43.1% identified as a racial/ethnic minority. Adjusting for covariates, screen time was prospectively associated with BED (OR = 1.09, 95% CI [1.03, 1.14], p =.005). Depression symptoms (B =.19, BC 95% CI [0.10, 0.28]) partially mediated (9.2%) the prospective association between screen time and BED. Discussion: Among US adolescents, higher baseline screen time was prospectively associated with BED diagnosis at year 2, and this relationship was partially mediated by increased depression symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents. Public significance: Among U.S. adolescents, higher screen time was prospectively associated with the incidence of BED. This association was partially mediated by the change in depressive symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents. [ABSTRACT FROM AUTHOR]

Objective: Our ability to predict responsiveness to digital interventions for eating disorders has thus far been poor, potentially for three reasons: (1) there has been a narrow set of predictors explored; (2) prediction has mostly focused on symptom change, ignoring other aspects of the user journey (uptake, early engagement); and (3) there is an excessive focus on the unique effects of predictors rather than the combined contributions of a predictor set. We evaluated the univariate and multivariate effects of outcome predictors in the context of a randomized trial (n = 398) of digitally delivered interventions for recurrent binge eating. Method: Thirty baseline variables were selected as predictors, ranging from specific symptoms, to key protective factors, to technological acceptance, and to online treatment attitudes. Outcomes included uptake, early engagement, and remission. Univariate (d) and multivariate (D) standardized mean differences were calculated to estimate the individual and combined effects of predictors, respectively. Results: At the univariate level, few predictors produced an effect size larger than what is considered small (d >.20) across outcomes. However, our multivariate approach enhanced prediction (Ds =.65 to 1.12), producing accuracy rates greater than chance (63%–71% accuracy). Less than half of the chosen variables proved to be useful in contributing to predictions in multivariate models. Conclusion: Findings suggest that accuracy in outcome prediction from digitally delivered interventions may be better driven by the aggregation of many small effects rather than one or several largely influential predictors. Replication with different data streams (sensor, neuroimaging) would be useful. Public Significance: Our ability to predict who will and will not benefit from digital interventions for eating disorders has been poor. We highlight the viability of a multivariate approach to outcome prediction, whereby prediction may be better driven by the aggregation of many small effects rather than one or a few influential predictors. [ABSTRACT FROM AUTHOR]

The explore/exploit trade‐off is a decision‐making process that is conserved across species and balances exploring unfamiliar choices of unknown value with choosing familiar options of known value to maximize reward. This framework is rooted in behavioral ecology and has traditionally been used to study maladaptive versus adaptive non‐human animal foraging behavior. Researchers have begun to recognize the potential utility of understanding human decision‐making and psychopathology through the explore/exploit trade‐off. In this article, we propose that explore/exploit trade‐off holds promise for advancing our mechanistic understanding of decision‐making processes that confer vulnerability for and maintain eating pathology due to its neurodevelopmental bases, conservation across species, and ability to be mathematically modeled. We present a model for how suboptimal explore/exploit decision‐making can promote disordered eating and present recommendations for future research applying this framework to eating pathology. Taken together, the explore/exploit trade‐off provides a translational framework for expanding etiologic and maintenance models of eating pathology, given developmental changes in explore/exploit decision‐making that coincide in time with the emergence of eating pathology and evidence of biased explore/exploit decision‐making in psychopathology. Additionally, understanding explore/exploit decision‐making in eating disorders may improve knowledge of their underlying pathophysiology, informing targeted clinical interventions such as neuromodulation and pharmacotherapy. Public Significance Statement: The explore/exploit trade‐off is a cross‐species decision‐making process whereby organisms choose between a known option with a known reward or sampling unfamiliar options. We hypothesize that imbalanced explore/exploit decision‐making can promote disordered eating and present preliminary data. We propose that explore/exploit trade‐off has significant potential to advance understanding of the neurocognitive and neurodevelopmental mechanisms of eating pathology, which could ultimately guide revisions of etiologic models and inform novel interventions. [ABSTRACT FROM AUTHOR]

Objective: Individuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life‐threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent. Method: Women with BE and/or purging (N = 81) completed self‐report measures assessing habit strength of BE and purging. Then, they completed a 14‐day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day. Results: Habitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE. Discussion: Overall, these findings suggest that purging may be maintained by habitual stimulus–response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent. Public significance: This study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging. [ABSTRACT FROM AUTHOR]

Objective: Prominent theories of binge‐eating (BE) maintenance highlight dietary restriction as a key precipitant of BE episodes. Consequently, treatment approaches for eating disorders (including binge‐eating disorder; BED) seek to reduce dietary restriction in order to improve BE symptoms. The present study tested the hypothesis that dietary restriction promotes BE among 112 individuals with BED. Methods: Participants completed a 7‐day ecological momentary assessment (EMA) protocol before and after completing 17 weeks of either Integrative Cognitive‐Affective Therapy or guided self‐help cognitive behavioral therapy. Analyses examined whether dietary restriction on 1 day of the baseline EMA protocol predicted risk for BE later that same day, and on the following day. Changes in dietary restriction over the course of treatment were also evaluated as a predictor of change in BE from pre‐treatment to post‐treatment. Baseline dietary restraint was examined as a moderator of the above associations. Results: Dietary restriction did not predict BE later the same day, and changes in restriction were not related to changes in BE across treatment, regardless of baseline dietary restraint levels. Restriction on 1 day did predict increased BE risk on the following day for individuals with higher levels of dietary restraint, but not those with lower levels. Discussion: These findings challenge the assumption that dietary restriction maintains BE among all individuals with BED. Rather, results suggest that dietary restriction may be largely unrelated to BE maintenance in this population, and that reducing dietary restriction generally does not have the intended effect on BE frequency. [ABSTRACT FROM AUTHOR]

Objective: The United Kingdom Eating Disorders Genetics Initiative (EDGI UK), part of the National Institute for Health and Care Research (NIHR) Mental Health BioResource, aims to deepen our understanding of the environmental and genetic etiology of eating disorders. EDGI UK launched in February 2020 and is partnered with the UK eating disorders charity, Beat. Multiple EDGI branches exist worldwide. This article serves the dual function of providing an in‐depth description of our study protocol and of describing our initial sample including demographics, diagnoses, and physical and psychiatric comorbidities. Method: EDGI UK recruits via media and clinical services. Anyone living in England, at least 16 years old, with a lifetime probable or clinical eating disorder is eligible to sign up online: edgiuk.org. Participants complete online questionnaires, donate a saliva sample for genetic analysis, and consent to medical record linkage and recontact for future studies. Results: As of September 2022, EDGI UK recruited 7435 survey participants: 98% female, 93.1% white, 97.8% cisgender, 65.9% heterosexual, and 52.1% have a university degree. Over half (57.8%) of these participants have returned their saliva DNA kit. The most common diagnoses are anorexia nervosa (48.3%), purging disorder (37.8%), bulimia nervosa (37.5%), binge‐eating disorder (15.8%), and atypical anorexia nervosa (7.8%). Conclusion: EDGI UK is the largest UK eating disorders study and efforts to increase its diversity are underway. It offers a unique opportunity to accelerate eating disorder research. Researchers and participants with lived experience can collaborate on projects with unparalleled sample size. Public Significance Statement: Eating disorders are debilitating and costly for society but are under‐researched due to underfunding. EDGI UK is one of the largest eating disorder studies worldwide with ongoing recruitment. The collected data constitute a resource for secondary analysis. We will combine data from all international EDGI branches and the NIHR BioResource to facilitate research that improves our understanding of eating disorders and their comorbidities. [ABSTRACT FROM AUTHOR]

Objective: The comorbidity of binge eating and heavy drinking (BE + HD) is concerning due to high prevalence and associated consequences. Affective pathways may maintain BE + HD, yet more micro‐level research is needed. This study used ecological momentary assessment (EMA) to examine between‐person and day‐level relationships between positive and negative affect and binge eating or heavy drinking episodes in BE + HD. Methods: Participants (N = 53) were adults with binge‐spectrum eating disorders who completed between 7 and 14 days of EMA prior to a treatment for binge eating. Results: Anxiety was highest on days with both binge eating and heavy drinking, while excitement and confidence were highest on days with only heavy drinking episodes for BE + HD. Global negative affect was relatively stable surrounding binge eating episodes. Guilt significantly increased prior to binge eating, and sadness significantly decreased following binge eating. Global positive affect significantly decreased prior to and stopped decreasing following heavy drinking episodes. Discussion: Results support binge eating being negatively reinforced by specific aspects of negative affect, while heavy drinking may be positively reinforced by global positive affect for individuals with BE + HD. Clinicians should incorporate interventions that focus on specific negative affect dimensions and that promote alternative rewarding activities besides heavy drinking. Highlights: In individuals with binge eating and heavy drinking, guilt worsens before binge eating episodes, while sadness decreases afterwards.Individuals with co‐morbid binge eating and heavy drinking may experience less anhedonia than commonly seen in binge eating samples.However, trajectories of positive affect suggest that heavy drinking may be positively reinforced in individuals with binge eating and heavy drinking. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to compare the estimated prevalence, sociodemographic features and impacts of Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Other Specified Feeding or Eating Disorder (OSFED; BN or BED of low frequency and/or limited duration) when comparing the DSM‐5 with the broader ICD‐11 diagnostic criteria for size and specifiers of binge‐eating episodes in a general population epidemiological sample. Methods: 2977 individuals (1524 women and 1453 men) aged ≥15 years from randomly selected households in South Australia were interviewed in person. Participants were asked questions relating to sociodemographic features, symptoms of eating disorder pathology, physical and mental health‐related quality of life (HRQoL; SF‐12) and role impairment. Results: The estimated prevalence of only one diagnosis, namely BED, was lower when applying DSM‐5 criteria than when applying ICD‐11 criteria, largely due to the Criterion B binge‐eating specifiers of the DSM‐5. There were no significant differences in participants' demographic features, HRQoL, or role impairment between the comparable diagnosis of either scheme. Conclusions: There were few differences in distribution and similar levels of health impacts when applying either diagnostic scheme in this epidemiological study. However, cases of BED may be missed when using the stricter criteria of DSM‐5 in epidemiological surveys. Further studies are needed to assess the clinical utility of the DSM‐5 and ICD‐11 diagnostic specifiers of binge‐eating. Highlights: In a representative sample of the Australian general population the estimated prevalence of BED was significantly lower when applying DSM‐5 criteria than when applying ICD‐11 criteria.The estimated prevalence of BN or OSFED did not differ when applying DSM‐5 criteria or when applying ICD‐11 criteria.Participants with a BN, BED or OSFED diagnosis experienced similar levels of health impacts when either DSM or ICD criteria were applied. [ABSTRACT FROM AUTHOR]

Objective: Alcohol and cannabis use are prevalent among individuals with binge‐spectrum eating disorders (B‐ED) and vary in terms of frequency and associated problems. The current study aimed to identify latent classes of alcohol and cannabis use patterns among B‐ED and examine associations between latent classes and demographic characteristics, eating disorder symptoms, and personality features. Methods: Participants (N = 236) were treatment‐seeking adults with B‐ED who completed a clinical interview of eating pathology and self‐report measures of alcohol and cannabis use in the past 3 months, alcohol and cannabis‐related problems, and personality features (i.e., impulsivity, affect lability). Results: Latent class analysis identified three heterogeneous classes, labelled as (a) Low Alcohol, (b) Moderate Drinking and Problems with Occasional Cannabis Use, and (c) No Alcohol and Cannabis Use. Latent classes significantly differed in terms of substance use engagement and problems, demographic characteristics, dietary restraint, impulsive personality features, and affect lability. Conclusions: Study findings support heterogeneity in alcohol and cannabis use among B‐ED and suggest patient characteristics and clinical severity associated with specific substance use presentations. Future research should replicate results using larger, diverse samples engaging in a broader range of alcohol and cannabis use symptoms. Highlights: Individuals with binge‐spectrum eating disorders (B‐ED) exhibit heterogeneity in alcohol and cannabis use patterns in terms of frequency and problems of use.Latent classes differed in terms of demographics, dietary restraint, impulsive personality features, and affect lability, but not other eating disorder symptoms.More research is needed to explore heterogeneity in larger, diverse samples and to assess the effect of heterogeneous classes of substance use on binge eating treatment outcomes. [ABSTRACT FROM AUTHOR]

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time. Examine 1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and 2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating. In n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to invstigate our objectives. Baseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support 1) problematic alcohol use as a prospective risk factor for binge eating, 2) shame as an additive predictor of binge eating, and 3) shame as a positive moderator of binge eating prediction from problem drinking. Addressing shame and problematic alcohol use may be warranted in binge eating interventions for college women. • College women are at high risk for both problematic alcohol use and binge eating. • The longitudinal relationship between them is less studied among college women. • Problematic alcohol use prospectively predicted greater binge eating. • The relationship was stronger at higher levels of shame. [ABSTRACT FROM AUTHOR]

Background: Some preliminary research suggests higher rates of gastrointestinal disease in individuals with eating disorders (EDs). However, research is limited, and it remains unknown what etiologic factors account for observed associations. This was the first study to examine how EDs and dimensional ED symptoms (e.g. body dissatisfaction, binge eating) are phenotypically and etiologically associated with gastrointestinal disease in a large, population-based twin sample. Methods: Adult female (N = 2980) and male (N = 2903) twins from the Michigan State University Twin Registry reported whether they had a lifetime ED (anorexia nervosa, bulimia nervosa, or binge-eating disorder) and completed a measure of dimensional ED symptoms. We coded the presence/absence of lifetime gastrointestinal disease (e.g. inflammatory bowel disease) based on responses to questions regarding chronic illnesses and medications. We first examined whether twins with gastrointestinal disease had higher rates of EDs and ED symptoms, then used correlated factors twin models to investigate genetic and environmental contributions to the overlap between disorders. Results: Twins with gastrointestinal disease had significantly greater dimensional ED symptoms (β = 0.21, p < 0.001) and odds of a lifetime ED (OR 2.90, p = 0.001), regardless of sex. Shared genetic factors fully accounted for the overlap between disorders, with no significant sex differences in etiologic associations. Conclusions: Comorbidity between EDs and gastrointestinal disease may be explained by overlap in genetic influences, potentially including inflammatory genes implicated in both types of disorders. Screening for gastrointestinal disease in people with EDs, and EDs in those with gastrointestinal disease, is warranted. [ABSTRACT FROM AUTHOR]

Objective Method Results Discussion Public Significance Although rates of weight discrimination are on‐par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight‐based discrimination in youth, including on disordered eating. Knowing whether experiences of weight‐based discrimination, including in youth with multiply‐marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts.Youth (N = 11,875) ages 10–11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross‐sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge‐eating, vomiting, weight‐gain fear, weight self‐worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used.Rates of weight‐based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight‐based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination.Weight‐based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight‐based discrimination, is a critical intervention target to prevent and treat eating disorders.Experiences of discrimination contribute to poorer health; however, weight‐based discrimination is relatively understudied. Data from a large sample of youth ages 10–11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply‐marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight‐based discrimination is a critical target to prevent and treat eating disorders, especially in multiply‐marginalized youth. [ABSTRACT FROM AUTHOR]

Feeding and eating disorders (FEDs) are common and have been shown to be influenced by both genetic and environmental factors. Avoidant/restrictive food intake disorder, anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) are all heritable and genome-wide association studies (GWASs) reveal both psychiatric and metabolic/anthropometric genetic risk factors for AN. GWASs for other FEDs are underway. AN, BN, and BED might diverge etiologically in their genetic relation with metabolic and anthropometric traits. Functional genomic tools will enable translation of variants to genes, genes to pathways, and pathways to metabolic outcomes to convert genetic findings into medically actionable outcomes. This work is poised to yield the first interventions for FEDs that are informed by disorder-specific biology. Feeding and eating disorders (FEDs) are heterogenous and characterized by varying patterns of dysregulated eating and weight. Genome-wide association studies (GWASs) are clarifying their underlying biology and their genetic relationship to other psychiatric and metabolic/anthropometric traits. Genetic research on anorexia nervosa (AN) has identified eight significant loci and uncovered genetic correlations implicating both psychiatric and metabolic/anthropometric risk factors. Careful explication of these metabolic contributors may be key to developing effective and enduring treatments for devastating, life-altering, and frequently lethal illnesses. We discuss clinical phenomenology, genomics, phenomics, intestinal microbiota, and functional genomics and propose a path that translates variants to genes, genes to pathways, and pathways to metabolic outcomes to advance the science and eventually treatment of FEDs. [ABSTRACT FROM AUTHOR]

Current eating disorder treatments include a range of psychological interventions, such as cognitive behavioural therapy, family therapy, or more structured specialised treatments such as Maudsley model of anorexia treatment for adults (MANTRA), and some off-label pharmacological interventions. Even with best available treatments, remission rates remain suboptimal and many patients go on to develop long-term treatment-refractory disorders. It is, therefore, crucial that novel treatments are developed, in attempts to significantly speed up and improve remission rates. Neuromodulation, virtual reality therapy, psychedelics, and leptin analogues are among emerging treatments that may help improve patient outcomes. Eating disorders (EDs) are common mental health conditions that carry exceedingly high morbidity and mortality rates. Evidence-based treatment options include a range of psychotherapies and some, mainly adjunctive, pharmacological interventions. However, around 20–30% of people fail to respond to the best available treatments and develop a persistent treatment-refractory illness. Novel treatments for these disorders are emerging, but their efficacy and clinical relevance need further investigation. In this review article, we first outline the evidence-base for the established treatments of the three 'classical' EDs [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)]. We then review research on some of the most promising emerging treatment modalities, discussing the questions and challenges that remain. [ABSTRACT FROM AUTHOR]

The diagnostic criteria for Other Specified Feeding or Eating Disorder (OSFED) have been arbitrary and are not always research driven. Therefore, for atypical anorexia nervosa (AAN), there are inconsistencies in defining low weight, weight loss, and the timing of weight loss. For purging disorder (PD), it is unclear whether subjective binge-eating episodes and loss of control over eating need to be included. For night eating syndrome (NES), comorbidity with binge-eating disorder (BED) and other sleep-related disorders complicate diagnosis. For subthreshold bulimia nervosa (Sub-BN)/BED, the frequency and duration of symptoms has not been defined. Agreed-upon diagnostic standards for OSFED are needed for consistent study results. Atypical anorexia nervosa (AAN), purging disorder (PD), night eating syndrome (NES), and subthreshold bulimia nervosa and binge-eating disorder (Sub-BN/BED) are the five categories that comprise the 'Other Specified Feeding or Eating Disorder' (OSFED) category in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). In this review, we examine problems with the diagnostic criteria that are currently proposed for the five OSFED types. We conclude that the existing diagnostic criteria for OSFED are deficient and fall short of accurately describing the complexity and individuality of those with these eating disorders (EDs). Therefore, to enhance the quality of life of people with OSFED, diagnostic criteria for the condition should be applied uniformly in clinical and research settings. [ABSTRACT FROM AUTHOR]

Experiences of tension and difficulties in emotion regulation have been linked to eating pathology in clinical samples and are targeted in respective treatment approaches. The present study aimed to investigate the impact of tension on engagement in disordered eating behaviors (DEBs) and potential moderating effects of trait emotion regulation in young people from the general population. A subsample of 971 adolescents and young adults from an epidemiological cohort study reported on levels of tension and four different DEBs (skipping eating, restrained eating, eating large amounts of food, loss‐of‐control‐eating) via ecological momentary assessment (EMA), as well as on trait emotion regulation via questionnaire. In multilevel models, momentary tension did not predict levels of subsequent DEBs. However, higher average levels of tension across the EMA period predicted higher levels of all DEBs. No interactions with emotion regulation emerged. Individuals experiencing overall higher levels of tension appear to be more prone to engaging in DEBs. [ABSTRACT FROM AUTHOR]

Objectives: Binge spectrum disorders are prevalent worldwide. Psychiatric and medical comorbidities are common, and societal costs are significant. Evidence-based treatment remains underutilized. Cognitive behavioral therapy is the recommended first-line treatment, but pharmacotherapy may be easier to access. Interventions: Meta-analytic evidence directly comparing cognitive behavioral therapy with pharmacotherapy is lacking. We aimed to compare the effects of cognitive behavioral therapy interventions with any pharmacological treatment for binge spectrum disorders. We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov and reference lists for randomized controlled trials comparing cognitive behavioral therapy with any pharmacotherapy for bulimia nervosa/binge eating disorder and performed pairwise meta-analytic evaluations. Primary Outcomes: Primary outcomes are remission and frequency of binges. Secondary outcomes are frequency of purges, response, eating disorder psychopathology, weight/body mass index, depression, anxiety, quality of life and dropouts. Results: Eleven randomized controlled trials comparing cognitive behavioral therapy with fluoxetine/imipramine/desipramine/methylphenidate/sibutramine were identified (N = 531). Cognitive behavioral therapy was superior to antidepressants in terms of remission, frequency of binges and eating disorder psychopathology. There were no statistically significant differences for any of the individual cognitive behavioral therapy vs drug comparisons in terms of response/depression/anxiety/weight/quality of life/dropouts. Cognitive behavioral therapy was not superior to sibutramine/methylphenidate for the primary outcomes. Conclusions: Data are scarce, comparisons underpowered and, considering the inherent methodological limitations of psychotherapy trials, questions arise regarding the presumed superiority of cognitive behavioral therapy. Further research is needed. [ABSTRACT FROM AUTHOR]

Though a relationship between sexual assault and suicidal thinking is established, fewer studies explore complex coping mechanisms for these college student treatment issues. We hypothesized that the relationship between sexual assault and suicide ideation was mediated by binge eating concerns and that treatment for recent sexual assault would also result in greater change in eating concerns and suicidal thoughts. An eating concerns subscale and an item assessing suicidal thoughts from the Collegiate Center for Mental Health (CCMH) 2018–2019 data set were completed during treatment (n = 53,016). Results supported the hypotheses, revealing eating concerns as a significant partial mediator. Moreover, recent sexual assault survivors, particularly men, experienced greater changes during treatment than clients with other presenting concerns. Findings suggest problematic coping strategies that may increase the likelihood of suicidal thinking following sexual assault. Practitioners should monitor students' eating concerns and emphasize emotional regulation strategies to reduce suicidality. Limitations of correlational methodology and small effect sizes are also discussed. [ABSTRACT FROM AUTHOR]

Objective: Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups. Method: United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non‐eating‐disorder controls (NCs, n = 5876). Generalized and linear mixed‐effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions. Results: Atypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge‐eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group. Discussion: Findings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care. Public Significance: College students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge‐eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students. [ABSTRACT FROM AUTHOR]

Objective: Some individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge‐eating disorder (BED) provided additional information on psychological functioning. Methods: Archival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM‐5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder‐related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM‐5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson–Mackinnon J test. Analyses were pre‐registered (https://osf.io/2ejcd). Results: Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder‐related impairment (p =.02; n = 271), but not physical, psychological, or social quality of life (p's ≥.33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross‐sectional models predicting purging (p =.02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's ≥.08; n's = 633–647). Discussion: The current data support retaining the DSM‐5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis. Public Significance: The current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained. [ABSTRACT FROM AUTHOR]

Background: Temperament has long been described as the biological dimension of personality. Due to advancing brain-imaging technology, our understanding of temperament has deepened and transformed over the last 25 years. Temperament combines genetic, neurobiological and trait research. Temperament has been included peripherally in some eating disorder (ED) treatment approaches but has been ignored by most. Temperament fills a fundamental treatment gap by clarifying who is more vulnerable to develop ED and why some individuals are susceptible to specific ED symptoms while others are not. In addition, temperament targets possible treatment solutions. Main text: There is a need for a novel model that incorporates and explores the role of temperament in ED treatment intervention. This paper is a metaphoric temperament model to inform treatment intervention. It describes how temperament traits influences new decisions which impact new behavioural responses. In turn, it neurobiologically tracks how and why the brain efficiently transforms new decisions into new habits. This model integrates both temperament and habit research to explore (a) what temperament is; (b) how new decisions develop into habits neurobiologically; (c) that the brain wires destructive symptoms into habits in the same way that it wires healthy/productive behaviours into habits; (d) traits that trigger ED symptoms are the same traits that influence productive behaviours; and in regard to treatment implications (e) when treatment structure and intervention target client temperaments, the potential for new healthy "trait-syntonic" habits could develop. Conclusions: This paper introduces a metaphoric model that synthesizes and integrates temperament neurobiological and trait findings with ED symptoms, habits, and client trait-based solutions. The model synthesizes and integrates different research domains to establish a brain-based foundation to inform treatment intervention. The model targets clients' temperament traits as central collections of innate self-expressions that could be utilized as tools to redirect client trait-syntonic ED responses into trait-syntonic productive outcomes. The brain bases of temperament and habit formation serve as a biological foundation for ED treatment intervention. Plain English summary: Temperament is the biological, or brain-basis of our personality. It defines who we are and who we are not. Temperament influences how each person thinks, feels, and responds differently. Traits are one's natural personality expressions. For example a person may have natural tendencies, or traits, to be extroverted and determined. A person could express the same traits differently ranging from healthy/productive through unhealthy/destructive responses. Research has found that some traits, when expressed in destructive ways, influence the development of eating disorder symptoms. Some of those traits include perfectionism, impulsivity, and anxiety. However, these very same traits could be expressed in productive ways. In essence, traits are the biological triggers beneath one's responses and set the stage for productive to destructive habitual behaviours. Persons cannot eliminate their traits, but they can express them differently. Treatment could capitalize on client traits to help clients explore productive responses instead of turning to destructive habitual symptoms. Productive habits that are aligned with one's traits could more naturally persist and form long-term habits. Working with a client's temperament, verses overlooking it, holds hope for habitual productive change to replace ED symptoms. [ABSTRACT FROM AUTHOR]

This document contains meeting abstracts from the 2022 ANZAED conference, focusing on research studies related to eating disorders and their treatment. The abstracts cover a wide range of topics, including the development of assessment tools, interventions for parents and carers, team-based treatment approaches, barriers to evidence-based care, workforce characteristics, and the impact of the COVID-19 pandemic on service delivery. The studies provide valuable insights into various aspects of eating disorders and can inform treatment and prevention strategies. [Extracted from the article]