Search

ObjectiveOutcome measurement in youth with eating disorders relies heavily on self-report, which is problematic in a population that may deny or minimize symptoms. Caregiver-report measures are lacking. This study examined the psychometric and clinical properties of a newly-developed measure designed to assess short-term change in eating disorder symptomatology as observed by caregivers-the Eating Disorder-15 for Parents/Caregivers (ED-15-P).MethodAt initial presentation to an outpatient eating disorders assessment, 206 families (primary caregiver and their child up to 18 years old) completed psychological measures.ResultsThe ED-15-P demonstrated excellent reliability, preliminary evidence of discriminant and concurrent validity, and good sensitivity to change early in treatment (first 8 weeks). Agreement between primary caregivers and children on eating disorder psychopathology was moderate, while agreement between pairs of caregivers was relatively strong. Level of agreement varied across behaviors and informants, with poorer caregiver-child agreement on dieting and driven exercise.DiscussionAgreement was stronger within caregiver pairs than caregiver-child pairs, indicating that caregivers and their children have related but unique perspectives on eating disorder symptoms, highlighting the importance of multi-informant assessment. The ED-15-P complements a parallel youth report measure to more comprehensively assess eating disorder psychopathology, with high utility for measuring change over time.

ObjectiveDespite evidence supporting the use of measures to track ongoing progress and outcome in treatment, there is a relative absence of measures that are appropriate for this purpose in youth with eating disorders. This study examined the psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y) scale, including its ability to detect short-term change in symptomatology.MethodYouth (N = 203) ages 8-18 years completed self-report questionnaires and semi-structured diagnostic interviews upon initial presentation for an outpatient eating disorders assessment at an academic medical center.ResultsThe ED-15-Y demonstrated excellent reliability (internal consistency, split-half reliability) and high sensitivity to change early in treatment (change from sessions 1 to 8, adjusting for baseline score). Further, these data demonstrate that the ED-15-Y has excellent convergent validity, being highly correlated with a well-tested, longer measure of eating disorders psychopathology-the Eating Disorders Examination-Questionnaire (EDE-Q). These data also support good discriminant and concurrent validity, differentiating between youth without an eating disorder or with ARFID and youth with eating disorders involving weight and shape concerns (e.g., anorexia nervosa, bulimia nervosa).DiscussionThe ED-15-Y may be a useful tool to briefly assess eating disorder psychopathology in youth as young as 8 years old. Its sensitivity to change very early in treatment suggests that it has the potential to be used as a routine outcome measure in the context of treatment.

This editorial reports on an anonymous survey question posed to eating disorders researchers about changes the International Journal of Eating Disorders (IJED) should implement to support the eating disorders research community affected by COVID-19. The editorial accompanies an IJED article that details responses to the larger survey focusing more broadly on COVID-19-related research disruptions. Survey invitations were sent to editorial board members of eating disorders journals, members of eating disorder scientific organizations (e.g., Eating Disorders Research Society), and individuals who provided at least three IJED reviews in the prior 12 months. We reviewed the responses of 187 participants and identified three categories of changes that: (a) had already been implemented by the journal, (b) cannot be implemented because they fall outside the scope of IJED, or (c) will be implemented in coming weeks or months. The latter category includes publishing topical COVID-19 papers, making some COVID-19-related content available open access, revising statistical guidelines, and issuing author guidance on reporting protocol changes caused by COVID-19-related disruptions. IJED recognizes the disruptive impacts that COVID-19 has on all activities in our field, including clinical work, teaching, and advocacy, and is committed to supporting authors during this difficult time while striving to publish high-quality research.

Objective: This experimental study investigated the weight loss parameters and resulting end weight that influence clinician confidence in diagnosing atypical anorexia nervosa (AAN). Methods: Clinicians (N = 67) read a series of vignettes where patient weight loss and end weight varied, then rated their confidence in an AAN diagnosis and alternatives. Using repeated measures ANOVAs, we examined patient (weight loss, end weight) and the possible relationship between clinician (e.g., age, profession) characteristics and confidence in diagnosing AAN. Results: Clinicians were most confident in an AAN diagnosis when patients had lost 10% or 15% of their body weight, leaving them at a high or normal weight. Clinicians considered 5% as significant weight loss for AAN, but only when the patient ended at a high or normal weight. However, they did not clearly differentiate AAN from unspecified feeding and eating disorder (UFED) when there was a 5% weight loss resulting in high or normal end weight. Clinician characteristics did not impact on confidence in diagnoses. Conclusion: The DSM's 'significant weight loss' criterion leaves room for clinicians to interpret it idiosyncratically. The lack of a clear pattern of UFED and AAN diagnosis has important clinical implications, as UFED tends to be dismissed as being less serious. Highlights: Case vignettes were used to assess patient and clinician characteristics that impact clinician confidence in assigning an atypical anorexia nervosa (AAN) diagnosis.Clinicians were most confident in diagnosing AAN when patients had lost 10% or 15% of their body weight.The 'significant weight loss' criterion of DSM‐5 leaves substantial room for clinicians to interpret it idiosyncratically, which has implications for diagnosis, identified prevalence levels, and service demands. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Atypical Anorexia Nervosa (AAN) is an ill‐defined diagnosis. Little is known about how eating disorder clinicians perceive the utility of the diagnosis, and what changes they believe would add to that utility. This qualitative study aimed to explore clinicians' perspectives on refining the DSM‐5 AAN diagnosis.Content analysis of text was used to categorise 47 responses to the questions: “What changes are required to the DSM‐5 definition of AAN?”, and “How do you think significant weight loss should be defined?”.Over 27% of clinicians advocated removing the AAN diagnosis or combining it with Anorexia Nervosa, while nearly 15% reported concerns about the requirement for ‘significant weight loss’. Over 87% of clinicians suggested ways (often inconsistent across clinicians) to define ‘significant weight loss’, with emphasis on the need for a specified rate (i.e., amount of loss/time) and consideration of physical health impacts.Clinicians broadly agree that revisions are necessary to the current AAN definition. However, while some propose specific modifications (e.g., defining ‘significant weight loss’), others advocate for the complete removal of the diagnosis. The breadth of suggestions for how to define ‘significant weight loss’ highlights the ongoing lack of consensus on AAN's relevance as a diagnostic entity. [ABSTRACT FROM AUTHOR]

People with eating disorders are often placed on lengthy waitlists for treatment. This is problematic, as increased time spent on waitlists has been shown to predict dropout. We examined whether providing brief interventions to people on a waitlist improved retention or outcomes in treatment. Participants (N = 85) were referred to a university training clinic for 10-session cognitive behavioural therapy for non-underweight patients with eating disorders (CBT-T). While waitlisted for CBT-T, participants were randomised to one of two waitlist interventions or a control condition. In one waitlist intervention (CRT-Brief), participants received a cognitive remediation therapy session at the start of the waitlist period. In the other waitlist intervention (brief contact), participants were sent a short supportive email and psychoeducation halfway through the waitlist period. The control condition was waitlist as usual. There was no evidence to suggest that the waitlist interventions improved symptoms during the waitlist period or CBT-T. However, participants who received a waitlist intervention were three times more likely to complete treatment. The present study suggests that providing even brief contact while people are waitlisted for eating disorder treatment significantly improves retention. However, replication in a more adequately powered study is required. [ABSTRACT FROM AUTHOR]

Objective: Interpersonal problems have been identified as a plausible mechanism underlying the onset and maintenance of eating disorders. The Interpersonal Relationships in Eating Disorders (IR‐ED) scale is the first eating disorders‐specific measure of interpersonal problems, which was developed in a nonclinical sample. The aims of the current study were to (a) confirm the factor structure of the IR‐ED within a large clinical sample, (b) investigate measurement invariance of the IR‐ED across nonclinical and clinical samples, (c) examine the convergent validity of the IR‐ED using a generic measure of interpersonal problems, and (d) investigate the incremental clinical utility of the IR‐ED in uniquely predicting eating disorder symptomatology. Method: Treatment‐seeking individuals (N = 437) completed the IR‐ED at their initial assessment appointment at a specialist eating disorder outpatient service. Results: A multiple‐group confirmatory factor analysis supported an invariant bifactor structure comprising a general interpersonal problems factor and two group factors—Avoidance of Body Evaluation and Food‐Related Interpersonal Tension. Convergent validity was demonstrated by a large, statistically significant correlation with a generic measure of interpersonal problems (r = 0.62, p < 0.001). A series of structural equation models further revealed unique incremental predictive utility of the IR‐ED for eating disorder symptomatology. Discussion: The IR‐ED has strong psychometric properties and may prove beneficial in the assessment, formulation, and treatment of eating‐specific interpersonal problems among patients with eating disorders. [ABSTRACT FROM AUTHOR]

Background: There is currently a limited understanding of the identification, nature, and treatment of Atypical Anorexia Nervosa (AAN). Recent systematic reviews have identified only small numbers of candidate papers, and some areas lack any meaningful review so far – particularly treatment outcomes. A key issue is the lack of clarity in the literature regarding the definition of weight loss criteria. Objectives: This scoping review aimed to determine the nature and extent of our knowledge of AAN, in order to assist in the development of future systematic reviews and meta‐analyses, as well as indicating what further research is needed. Method: Following the identification of 6747 records, 317 records using the term AAN or a defined equivalent were identified from six databases, including the 'grey' literature. Results: Of the 317 studies, 111 provided participant characteristics, and only 10 provided discrete treatment outcomes. Each of these subsets of the data are tabulated and supported with supplementary material, so that future systematic reviewers can access this resource. Discussion: The pattern and content of the existing studies allows recommendations to be made regarding future reviews, research and clinical practice. There is a particular need for clear weight/weight loss criteria and adequate interventions. Highlights: Our identification of Atypical Anorexia Nervosa (AAN) and associated interventions lacks the evidence‐based clarity that can be provided by effective reviews of the field.Relatively few studies provide discrete characteristics or treatment outcomes of AAN.Guidance is outlined regarding reporting criteria for such studies for authors and journals. [ABSTRACT FROM AUTHOR]