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OBJECTIVE: Bulimia nervosa (BN) is associated with loss-of-control (LOC) eating episodes that frequently occur in response to negative emotions. According to recent neurocomputational models, this link could be explained by a failure to accurately update beliefs about the body in states of high arousal. Specifically, these interoceptive inference models suggest that under-relying on signals from ones body about sensory experience (low sensory precision) and/or over-relying on previously held beliefs (excessively precise priors) lead to inaccurate perception and maladaptive behaviors. We conducted an initial test of these core predictions of the interoceptive inference model in BN using self-report measures. METHODS: We compared women with BN (n = 30) and age-, BMI-, and full-scale IQ-matched controls (n = 31) on trust in sensory information from the body and two types of beliefs about what can be done to regulate high negative affect. Within the BN group, we tested interrelations among these measures and explored their associations with LOC eating frequency. RESULTS: Compared with healthy controls, the BN group reported lower levels of trust in sensory information and stronger beliefs that once upset, there is little one can do, apart from eating, to self-regulate. These beliefs were associated with each other and with lower body trust. Beliefs about the uncontrollability of emotion were associated with more frequent subjective binge-eating episodes. CONCLUSIONS: Findings provide initial support for the core predictions of an interoceptive inference account of BN: low trust in sensory information (sensory precision) may promote an overreliance on maladaptive prior beliefs about the effects of eating on negative emotions, ultimately interfering with accurate updating of beliefs about other strategies that could regulate emotions and maintain LOC eating. Low body trust, strong expectations about emotions, and their neurocomputational underpinnings could be promising combined treatment targets for BN.

ABSTRACT Objective Design Setting Population Methods Main Outcome Measures Results Conclusions We examined the risk of adverse neonatal outcomes among children born to mothers with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).Cohort study.Population‐based using Danish national registers.We included 1 517 839 singletons born between 1991 and 2015 in Denmark.For each ED subtype, we compared children born to mothers with a recent (≤ 2 years before conception and during pregnancy) or past (> 2 years before conception) diagnosis, with children born to mothers who had not been diagnosed with the ED of interest before the index delivery.Using multinomial logistic regression, we estimated relative risk ratios (RRRs) and 95% confidence intervals (CIs) for gestational age, birthweight, weight‐for‐gestational age, low Apgar score, Caesarean section, congenital malformations and postpartum haemorrhage.Both recent and past AN were associated with increased risk of low birthweight (recent: RRR = 2.36 [95% CI = 1.76–3.18]; past: 1.22 [1.04–1.43]), small‐for‐gestational age (recent: 1.52 [1.01–2.26]; past: 1.37 [1.16–1.62]), and preterm birth (recent: 1.83 [1.37–2.45]; past: 1.17 [1.00–1.36]), with more pronounced risks in recent AN. Recent (but not past) BN was associated with increased risk of low Apgar score (1.44 [1.03–2.00]). Recent (but not past) EDNOS was associated with increased risk of SGA (1.53 [1.04–2.27]).Children born to mothers with EDs have an increased risk of some adverse neonatal outcomes, with more pronounced risks in recent than past EDs. These results underscore the need for improved prevention of maternal EDs and enhanced monitoring throughout pregnancy to mitigate adverse outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion We aimed to compare use of, and outcomes from, programme‐led and focused interventions (guided self‐help and 10 session cognitive behavioral therapy for eating disorders [CBT‐T]) relative to other psychological therapies (including group and individual CBT for eating disorders [CBT‐ED]) in a national sample of emerging adults receiving early intervention for a non‐underweight binge/purge eating disorder.Data were drawn from 54 English eating disorder services using the First Episode Rapid Early Intervention for Eating Disorders (FREED) model. Participants (N = 1097) had a mean age of 18.95 years (SD 2.42) and diagnoses of bulimia nervosa (n = 506; 45%), binge eating disorder (n = 121; 11%), another specified feeding or eating disorder (n = 460; 42%), or an eating disorder, unspecified (n = 10, 1%). Linear mixed models were used to assess for effects of time and treatment on binge eating and purging, eating disorder psychopathology, depression/anxiety, and body mass index.11% (n = 117) of patients received guided self‐help and 24% (n = 268) received CBT‐T. Baseline eating disorder psychopathology and depressive/anxiety symptoms did not differ significantly across the guided self‐help, CBT‐T, group CBT‐ED, and individual CBT‐ED conditions. All treatments were associated with significant reductions in symptoms over time. GSH and CBT‐T performed comparably to longer CBT‐ED.We provide additional evidence for the effectiveness of GSH and CBT‐T in the treatment of non‐underweight binge/purge eating disorders. Programme‐led and focused interventions may be under‐utilized and future research should explore when they are offered, and when not, both within and outside of early intervention settings. [ABSTRACT FROM AUTHOR]

Ghrelin is a hormone consisting of 28 amino acids. Growth hormone secretagogue receptor (GHSR) is a receptor for ghrelin, which is expressed in the brain, pituitary gland, and adrenal glands, especially in the hypothalamus. The binding of ghrelin to the receptor 1a subtype mediates most of the biological effects of ghrelin. Ghrelin has a close relationship with the onset of psychosis. Ghrelin can affect the onset of psychosis by regulating neurotransmitters such as dopamine, γ‐aminobutyric acid (GABA), and 5‐hydroxytryptamine (5‐HT) through the hypothalamus–pituitary–adrenal (HPA) axis, brain–gut axis, the mesolimbic dopamine system, and other ways. Ghrelin activates neuropeptide Y (NPY) in the hypothalamic arcuate nucleus (ARC) through the GHSR. Ghrelin binds to neurons in the ventral tegmental area (VTA), where it promotes the activity of dopamine neurons in the nucleus accumbens (NAcs) in a GHSR–dependent way, increasing dopamine levels and the reward system. This article summarized the recent research progress of ghrelin in depression, anxiety, schizophrenia, anorexia nervosa (AN), and bulimia nervosa (BN), and emphasized its potential application for psychiatric disorders treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion Bulimia nervosa (BN) is a highly prevalent psychiatric disorder that has negative effects on the physical and psychological health of sufferers. Father‐specific factors have been understudied in the context of BN. This systematic review aims to understand the psychosocial and psychopathological features of fathers of people with BN and their associations with the offspring's outcomes.A literature search on APA PsycINFO, ISI Web of Science, PubMed, Google Scholar, ResearchGate, and Open Science Framework yielded 2421 studies. These papers were independently evaluated based on the eligibility criteria. 29 studies were included in this review. The Joanna Briggs Institute Critical Appraisal Tools were used for the assessment of the methodological quality of the eligible studies.Across studies, no significant differences were found in perceptual body‐size distortion, self‐ideal discrepancy, eating‐/weight‐/body‐related attitudes, several personality and ED traits, and general psychological functioning between fathers of the BN group and those of the comparison groups. However, significant differences were found in certain psychological aspects (e.g., impulse regulation) and ED‐associated features (e.g., body dissatisfaction). Finally, significant relationships were found between the fathers' food attitudes, muscularity ratings, personality traits, and substance abuse and their offspring's risk of developing BN, greater body dissatisfaction, ED symptoms, and poor end‐of‐treatment outcome.Although the existing literature does not seem to strongly suggest a particular paternal factor pertaining to BN, several father‐specific variables may be associated with the offspring's BN symptomatology and related characteristics. Further research is necessary to clearly understand paternal features in the context of BN. [ABSTRACT FROM AUTHOR]

Background: Eating disorders (ED) involve dysfunctional attitudes towards food intake, affecting physical and psychosocial well-being. These disorders significantly impact various domains of life and can lead to a decrease in health-related quality of life (HRQoL). Recent studies emphasize the importance of addressing HRQoL in ED treatment, particularly in the context of social isolation and loneliness, but this aspect is currently poorly evaluated. Methods: A sample of 220 people with an ED was enrolled for the study from different centers specialized in the treatment of ED and compared to 151 people from the general population. Different validated questionnaires were used to evaluate eating psychopathology, HRQoL, and loneliness. Partial correlation analyzes adjusted for marital status and regressions were used to evaluate the relationships between constructs and the differences between groups. Results: Higher feelings of loneliness were associated with a poorer HRQoL in patients and controls. In the ED group, both loneliness and eating psychopathology were significant predictors of HRQoL. Meanwhile, the duration of the disorder predicted HRQoL specifically in underweight patients, and BMI was a predictor of HRQoL in individuals with normal or above-normal weight. Conclusions: These findings highlight the importance of considering both HRQoL and loneliness in EDs, particularly among younger individuals. This approach aligns with the increasing focus on the role of interpersonal relationships in the recovery process. Additionally, the data confirm a link between weight and loneliness, suggesting that this connection, especially the differences between underweight patients and those of other weights, deserves further investigation. [ABSTRACT FROM AUTHOR]

Background: There has been recent evidence to suggest that people who suffer from eating disorders (EDs) or other eating behavior disturbances, such as emotional eating (EE), are particularly vulnerable post-COVID-19. This narrative literature review aims to comprehensively analyze and scrutinize the existing clinical studies regarding the effects of the COVID-19 pandemic on people with EDs or EE. Moreover, due to the COVID-19 pandemic, it is very important to find out whether a person's emotional state may lead them to wrongly confront their emotional behavior with food consumption. Methods: A thorough search of several databases (PubMed, Scopus, Web of Science, Public Library of Science, Google Scholar, CINAHL Complete, PsycINFO, and Academic Search Complete) was performed to identify available clinical studies on the COVID-19 pandemic published between 2020 and 2024 using relevant keywords. Results: There is substantial evidence that the COVID-19 pandemic exerted negative effects on persons suffering from EDs, including those who are symptomatic, those who are in remission, and those with an EE behavior. Characteristically, people diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) showed considerable symptomatic worsening after the first wave of the COVID-19 pandemic. Clinical studies investigating the effects of the COVID-19 pandemic on persons suffering from EE have also clearly demonstrated that their mood disturbances negatively affected their eating behaviors. These studies have also shown that vulnerable people were at greater risk of EE development and progression during the COVID-19 pandemic. Conclusion: The COVID-19 pandemic seems to have exerted a significant deleterious effect on people who have a history of suffering from EDs or EE. The COVID-19 pandemic has been related to the frequency of dysfunctional eating behaviors, thus decreasing therapeutic intervention efficiency in people with EDs as well as in those with disturbed eating behaviors such as EE. In this aspect, further clinical studies are strongly recommended to investigate the exact effects of the COVID-19 pandemic as well as to explore their potential long-term deleterious complications in the post-pandemic period. Public strategies and policies should be applied to provide special healthcare for this group of patients. [ABSTRACT FROM AUTHOR]

Objective: The Nine Item ARFID Scale (NIAS) is a widely used measure assessing symptoms of avoidant/restrictive food intake disorder (ARFID). Previous studies suggest that individuals with eating disorders driven by shape/weight concerns also have elevated scores on the NIAS. To further describe NIAS scores among individuals with diverse current and previous eating disorders, we characterized NIAS scores in a large sample of individuals with eating disorders and evaluated overlap in symptoms measured by the NIAS and the Eating Disorder Examination‐Questionnaire (EDE‐Q) version 6.0. Method: Our sample comprised 9148 participants from the Eating Disorders Genetics Initiative Sweden (EDGI‐SE), who completed surveys including NIAS and EDE‐Q. NIAS scores were calculated and compared by eating disorder diagnostic group using descriptive statistics and linear models. Results: Participants with current anorexia nervosa demonstrated the highest mean NIAS scores and had the greatest proportion (57.0%) of individuals scoring above a clinical cutoff on at least one of the NIAS subscales. Individuals with bulimia nervosa, binge‐eating disorder, and other specified feeding or eating disorder also demonstrated elevated NIAS scores compared to individuals with no lifetime history of an eating disorder (ps < 0.05). All subscales of the NIAS showed small to moderate correlations with all subscales of the EDE‐Q (rs = 0.26–0.40). Discussion: Our results substantiate that individuals with eating disorders other than ARFID demonstrate elevated scores on the NIAS, suggesting that this tool is inadequate on its own for differentiating ARFID from shape/weight‐motivated eating disorders. Further research is needed to inform clinical interventions addressing the co‐occurrence of ARFID‐related drivers and shape/weight‐related motivation for dietary restriction. [ABSTRACT FROM AUTHOR]

Objective: In cross‐sectional and retrospective research, parental binge eating is associated with their children's eating psychopathology. The current study extended the evidence by cross‐sectionally and longitudinally examining the relation between parental binge eating and binge eating and weight‐control behaviors in the next generation of their adolescent children and young adult children in a population‐based sample. Methods: Adolescents (Time 1: M = 14.5, SD = 2.0 years) (n = 2367), followed into adulthood (Time 2: M = 22.1, SD = 2.0 years), and their parents (n = 3664) were enrolled in EAT 2010–2018 and Project F‐EAT 2010. The current study examined parental binge eating, and child binge eating and weight‐control behaviors. Adjusted models covaried for child gender, age, and race/ethnicity. Results: Approximately 7% of adolescents at Time 1 had at least one parent who reported binge eating with no differences by child's age, gender, or race/ethnicity. Having at least one parent experiencing binge eating at Time 1 (vs. not) was associated cross‐sectionally with adolescent children's use of extreme weight‐control behaviors (9.6% vs. 4.8%; Risk Difference [RD] = 4.9%) and associated longitudinally with binge eating during young adulthood (21.1% vs. 11.6%; RD = 9.5%). Other associations did not reach statistical significance. Conclusions: Children of parents with binge eating appear to have elevated risk of extreme weight‐control behaviors during adolescence and binge eating in young adulthood. Clinicians should assess whether eating psychopathology extends to other family members, and offer additional support to parents with binge eating. Further research is needed to identify risk factors in the children of parents with binge eating and to assess strategies for prevention. [ABSTRACT FROM AUTHOR]

Objective: Despite substantial research indicating difficulties with emotion regulation across eating disorder presentations, emotion regulation has yet to be studied in adults with avoidant/restrictive food intake disorder (ARFID). We hypothesized that (1) those with ARFID would report greater overall emotion regulation difficulties than nonclinical participants, and (2) those with ARFID would not differ from those with other eating disorders on the level of emotion regulation difficulty. Methods: One hundred and thirty‐seven adults (age 18–30) from an outpatient clinic with ARFID (n = 27), with other primarily restrictive eating disorders (e.g., anorexia nervosa; n = 34), and with binge/purge eating disorders (e.g., bulimia nervosa; n = 51), as well as nonclinical participants (n = 25) recruited via Amazon Mechanical Turk (MTurk) completed the Difficulties in Emotion Regulation Scale (DERS). We compared DERS scores across groups. Results: In line with expectations, patients with ARFID scored significantly higher than nonclinical participants on the DERS Total (p = 0.01) with a large effect size (d = 0.87). Also as hypothesized, those with ARFID did not differ from those with other primarily restrictive (p = 0.99) or binge/purge disorders (p = 0.29) on DERS Total. Discussion: Adults with ARFID appear to exhibit emotion regulation difficulties which are greater than nonclinical participants, and commensurate with other eating disorders. These findings highlight the possibility of emotion regulation difficulties as a maintenance mechanism for ARFID. [ABSTRACT FROM AUTHOR]

Objective: Binge eating and self‐induced vomiting are common, transdiagnostic eating disorder (ED) symptoms. Efforts to understand these behaviors in research and clinical settings have historically relied on self‐report measures, which may be biased and have limited ecological validity. It may be possible to passively detect binge eating and vomiting using data collected by continuous glucose monitors (CGMs; minimally invasive sensors that measure blood glucose levels), as these behaviors yield characteristic glucose responses. Method: This study developed machine learning classification algorithms to classify binge eating and vomiting among 22 adults with binge‐spectrum EDs using CGM data. Participants wore Dexcom G6 CGMs and reported eating episodes and disordered eating symptoms using ecological momentary assessment for 2 weeks. Group‐level random forest models were generated to distinguish binge eating from typical eating episodes and to classify instances of vomiting. Results: The binge eating model had accuracy of 0.88 (95% CI: 0.83, 0.92), sensitivity of 0.56, and specificity of 0.90. The vomiting model demonstrated accuracy of 0.79 (95% CI: 0.62, 0.91), sensitivity of 0.88, and specificity of 0.71. Discussion: Results suggest that CGM may be a promising avenue for passively classifying binge eating and vomiting, with implications for innovative research and clinical applications. [ABSTRACT FROM AUTHOR]

Background: Psychotic‐like anomalous self‐experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED. Methods: Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic‐like anomalous self‐experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE‐Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology. Results: Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE‐Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image. Discussion: Anomalous interoceptive processes may represent the first step of a maladaptive process‐impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early‐shared vulnerability of severe disorders characterized by embodiment alterations. [ABSTRACT FROM AUTHOR]

The Danish Health Care Registers rely on the International Statistical Classification of Diseases and Related Health Problems (ICD)-classification and stand as a widely utilized resource for health epidemiological research. Eating disorders are multifaceted syndromes where two distinctive diagnoses are defined, anorexia nervosa (AN) and bulimia nervosa (BN). However, the validity of the registered diagnoses remains to be verified. Manuel chart review is often the method for validation of diagnosis codes, but there is limited research on how natural language processing (NLP) models could enhance this process. To investigate the accuracy of the clinical use of ICD-10 diagnosis codes F50.0, F50.1, F50.2, and F50.3 in the Danish Health Care Registers, using a manual chart review assisted by NLP. From a cohort of all individuals attending hospitals in Region of Southern Denmark with registered electronic health information, we extracted medical information from the electronic health journal on 100 individuals with each of the four diagnosis codes. After extraction, an NLP model with regular expression search patterns identified relevant text passages for manual chart review. Overall, 372 of the 400 diagnosis codes (93%) were correct. A diagnosis code for AN was correct in 90% of instances, 96% for atypical AN, 96% for BN and 90% for an atypical BN diagnosis code. We found that the accuracy of a diagnosis code F50.0, F50.1, F50.2, and F50.3 to be high. This confirms that the generally well-documented validity of the Danish health care registers also applies to the eating disorder diagnoses. [ABSTRACT FROM AUTHOR]

Research shows eating disorders increase the mortality rate: anorexia nervosa has the highest mortality rate and yet an accurate morbidity rate of bulimia nervosa remains hidden. However, research on the endopsychic structural dynamics that perpetuate in patients with eating disorders is scant. This essay depicts the use of Fairbairn's theory of endopsychic personality structure in understanding anorexia nervosa, binge eating disorder and bulimia nervosa. Fairbairn, of the independent group of British object relations theorists, provides a picture of the endopsychic structure based on the conscious and unconscious psychodynamics between partial ego/part‐object dyads. Using three case histories, the following pages illustrate the incessantly present endopsychic permutations of the aforementioned dynamics and the possibility of the entrapment in one of these or swinging from one to the other in eating disorders. The essay also shows that early traumatic experiences are present in the case history of individuals with any one of these eating disorders and despite their manifested behavioural differences, they result from the widening of fissures in the universal split in the psyche due to emotional and/or physical abuse. Finally, using Fairbairn's theory, the analysis in the essay explains the comorbidity of certain eating disorders and borderline personality structure. [ABSTRACT FROM AUTHOR]

Aims: The review aimed to summarise and discuss findings focused on therapeutic probiotic and prebiotic interventions in eating disorders (ED). Methods: Using PubMed/MEDLINE, Cochrane Library, and Web of Science all published studies were retrieved until February 2023, following PRISMA guidelines. From the 111 initial studies, 5 met the inclusion criteria for this review. Results: All studies included in this narrative review were focused on anorexia nervosa (AN). Three longitudinal, randomised, controlled trials aimed to evaluate interventions with probiotics (Lactobacillus reuteri, yoghurt with Lactobacillus, and Streptococcus) in children and adolescents. These studies primarily emphasised medical outcomes and anthropometric measures following the administration of probiotics. However, the findings yielded mixed results in terms of short‐term weight gain or alterations in specific immunological parameters. With a lower level of evidence, supplementation with synbiotics (probiotic + prebiotic) has been associated with improvements in microbiota diversity and attenuation of inflammatory responses. Conclusions: Research on probiotics and prebiotics in ED is limited, primarily focussing on anorexia nervosa (AN). Their use in AN regarding medical and anthropometric outcomes needs further confirmation and future research should be warranted to assess their impact on psychological and ED symptomatology, where there is a notable gap in the existing literature. Highlights: Research based on probiotic and prebiotic therapeutic interventions in eating disorders (ED) is still scarce.Available evidence comes particularly from randomised controlled trials in anorexia nervosa (AN), evaluating the effects of probiotics on medical outcomes and anthropometric measures.Future studies should explore the impact of probiotic and prebiotic interventions specifically on eating psychopathology in AN and other ED. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Method Results Conclusions Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under‐resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly–insured youth with EDs in California and potential disparities for youth with additional marginalized identities.Participants were identified from the full sample of California Medicaid/Medi‐Cal beneficiaries aged 7–18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language).Outpatient individual and family therapy service utilization was low across ED diagnoses (4–7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth.Publicly–insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth. [ABSTRACT FROM AUTHOR]

Background: Despite a growing literature demonstrating the significant impacts of climate change on mental health, research is urgently needed to investigate how climate change-related concerns may contribute to the development, exacerbation, or re-emergence of eating disorders, as well as affect the effectiveness of existing interventions. This case report contributes to this scant knowledge base by offering empirical evidence for how responses to climate change can influence eating disorder symptoms and, importantly, limit the effectiveness of evidence-based treatments such as Cognitive Behavior Therapy-Enhanced (CBT-E). Case presentation: A 24-year-old female graduate student studying environmental science presented to a specialized eating disorder clinic with worsening bulimia nervosa. Her symptoms initially improved with CBT-E; however, after three months, concerns about food waste significantly impeded further progress. The therapist, identifying symptoms of eco-anxiety, adapted standard CBT-E strategies to include psychoeducation about eco-anxiety, cognitive restructuring of beliefs about food waste and other eating-related eco-concerns, relevant exposures related to such concerns, and problem-solving to increase social support. These adaptations led to resumed progress, with the patient achieving nutritional adequacy by treatment end (38 sessions) and maintaining treatment gains through one year follow-up. Conclusions: To our awareness, this is the first case report on the co-occurrence of eco-anxiety and eating disorders. This case underscores the importance of screening for concurrent eco-anxiety, suggests ways in which eating disorders and eco-anxiety can influence one another longitudinally, describes how coexisting eco-anxiety can limit standard CBT-E's effectiveness, and provides examples of successful treatment adaptations tailored to address eco-anxiety-related concerns. [ABSTRACT FROM AUTHOR]

Background: Evidence on how persons with and in remission from an eating disorder experience their oral health is limited. Dental treatment in Sweden today is often postponed until medical rehabilitation has been completed, but this carries risks. For the patient, the risk is severely impaired oral health and additional suffering, and for both society and the patient, higher costs than might have been necessary. Methods: Ten female informants aged 21–51 years (mean age = 36.7, standard deviation 12.7) in remission from an eating disorder with a median duration of 12.5 (range 4–25) years of illness, were questioned in semi-structured interviews about their perceptions of oral health. All participants had been referred to a specialist dental clinic and needed oral rehabilitation. 10% of the patients had been diagnosed with anorexia nervosa and 90% with bulimia nervosa. All had been in remission from the eating disorder for at least one year. Transcripts of the interviews were analyzed with thematic analysis using an inductive approach. Results: One overarching theme emerged from the analysis: dental damage persisted as a visible, lingering scar during remission of the eating disorder, reminiscent of the disease and its consequences. The three major themes identified were (1) Physical impact, (2) Psychological impact, and (3) Impact on daily living. The first major theme included erosive tooth wear and impaired oral function and aesthetics. Interviewees described the second as feelings of stigma, guilt, shame, anxiety, and worry, in particular concerning self-inflicted dental damage through self-induced vomiting. The last major theme covered avoidance strategies such as limiting smiling and laughing and minimizing social situations such as eating with others, pursuing a wanted career, and meeting a partner. Conclusions: The participants in this study expressed a profound negative impact on daily life and a two-fold burden of stigma of having suffered from both an eating disorder and poor oral health. Plain English summary: Research has established a link between eating disorders and poor oral health, such as erosive tooth wear. One knowledge gap, however, is how patients with and after recovery from an eating disorder experience their oral health. In Sweden, dental treatment is often postponed until after medical rehabilitation, but this carries risks. For the patient, the risk is severely impaired oral health and additional suffering, and for both society and the patient, higher costs than might have been necessary. The self-reports of the patients in their interviews witnessed to their suffering from two sources: the diagnosis of a mental disorder and poor oral health. Many reported feelings of stigma, shame, and guilt over, for example, self-induced vomiting, which was a predominant factor in dental damage. Tooth damage emerged as a visible, lingering scar that reminded the patient of the disease long after remission. [ABSTRACT FROM AUTHOR]

Objective: To compare all other specified feeding or eating disorders (OSFED) groups (atypical anorexia nervosa [AN], purging disorder [PD], night eating syndrome [NES], subthreshold bulimia nervosa [sub‐BN], and subthreshold binge‐eating disorder [sub‐BED]) to threshold eating disorders (EDs [AN, BN, and BED]) and control groups (CGs) on measures of eating and general psychopathology. Method: We conducted a comprehensive search in PsycINFO, Medline, Embase, and CINAHL on all published studies from January 2013 to February 2024 using DSM‐5 diagnostic criteria via clinical interviews or well‐established diagnostic tools. We also undertook a quality appraisal using an adapted version of the Downs and Black criteria and registered the review with PROSPERO (ID: CRD42022314495). Results: Overall, our meta‐analyses (n = 33 eligible studies) indicated that the combined OSFED and several specific OSFED subtypes displayed comparable levels of eating psychopathology to full‐threshold EDs. Our systematic review (n = 33 eligible studies) found individuals with OSFED to have comparable levels of eating and general psychopathology to full‐threshold EDs, but higher levels of eating and general psychopathology than CGs. These findings were specifically attributed to atypical AN and NES. There was a lack of evidence available for sub‐BN and sub‐BED. Studies mainly met the quality appraisal criteria. The main limitations identified in the included studies were insufficient reporting of their statistical power (78%) and no adjusting for potential confounding factors (67%). Discussion: Findings support the conceptualization of atypical AN, and NES as clinically significant EDs with similar severity to full‐threshold EDs. [ABSTRACT FROM AUTHOR]

The results of Dang et al.'s recent systematic review and meta‐analysis suggested that individuals diagnosed with other specified feeding or eating disorder (OSFED) and those diagnosed with specified eating disorders (EDs, such as bulimia nervosa) endorse similar, elevated levels of ED‐related cognitions (but not behaviors). The DSM has traditionally conceptualized EDs primarily as disturbances in eating behavior, and the diagnostic boundaries for EDs are based on objective markers, such as behavioral frequencies and weight. Although focusing on objective markers for ED diagnoses and severity indices has advantages (e.g., clinical communication, measurement), pitfalls include diagnostic migration and low emphasis on ED cognitions. Dang et al.'s findings provide a basis for rethinking DSM's conceptualization of EDs as primarily behavioral. This commentary discusses the potential merits and challenges of emphasizing subjective cognitions when assigning ED diagnoses. We explore how objective markers (e.g., behavioral frequency, weight) and subjective experience (e.g., fear of weight gain) may be balanced to improve the clinical utility of ED diagnoses. In all, research that more deeply phenotypes the subjective experiences of people with EDs across contexts, identities, and cultures will enrich our understanding of eating pathology and may inform diagnostic revisions. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have indicated that virtual treatments for eating disorders (EDs) are roughly as effective as are in‐person treatments; the present nonrandomized study aimed to expand on the current body of evidence by comparing outcomes from a virtual day treatment program with those of an in‐person program in an adult ED sample. Method: Participants were 109 patients who completed at least 60% of day treatment sessions (n = 55 in‐person and n = 54 virtual). Outcome measures included ED and comorbid symptoms, and motivation. Results: Linear mixed models showed that global EDE‐Q scores decreased during treatment (AIC = 376.396, F = 10.94, p = 0.002), irrespective of treatment modality (p = 0.186). BMI significantly increased over time (AIC = 389.029, F = 27.97, p < 0.001), with no effect of treatment modality (p = 0.779). Discussion: Our findings suggest that the virtual delivery of day treatments produces comparable outcomes to those obtained using in‐person formats, and that virtual formats may represent a pragmatic treatment option, especially in situations in which access to in‐person care is limited. [ABSTRACT FROM AUTHOR]

Existing evidence suggests that anterior insula plays a crucial role in cognitive control and emotional regulation and is implicated in the onset and maintenance of bulimia nervosa (BN). However, it remains unclear how structural and functional abnormalities in specific subregions of anterior insula contribute to BN. In this study, we analyzed structural MRI and resting-state functional MRI data from 54 BN patients and 56 healthy controls (HCs). We conducted voxel-based morphometry, amplitude of low frequency fluctuation (conventional band: 0.01–0.08 Hz, slow-5: 0.01–0.027 Hz) and seed-based whole-brain functional connectivity (FC) analysis of the anterior insula subregions for both groups. Additionally, we investigated the correlation between neuroimaging findings and clinical characteristics in the BN group. Our findings revealed that BN patients exhibited reduced gray matter volume in the right dorsal anterior insula (dAI) and bilateral ventral anterior insula (vAI) and demonstrated decreased ALFF in slow-5 band of bilateral dAI. The BN group also showed increased FC between bilateral dAI and precuneus or right superior frontal gyri which significantly correlated with the severity of BN or its key symptom. In addition, the decreased FC between bilateral vAI and anterior cingulate and paracingulate gyri and/or median cingulate and paracingulate gyri were both significantly correlated with the severity and its restrained eating behavior. Our findings further indicate that the functional separation of anterior insula subregions may underlie the pathophysiology of BN. Notably, the vAI associated with emotional processing may serve as a promising neuroimaging biomarker which could inform therapeutic strategy. • Bulimia nervosa (BN) selectively reshapes the structure and intrinsic function of anterior insula (AI) subregions. • The functional separation of anterior insula subregions may underlie the pathophysiology of BN. • The ventral AI associated with emotional processing may serve as a promising neuroimaging biomarker. [ABSTRACT FROM AUTHOR]