Feeding and eating disorders in the DSM-5 era: a systematic review of prevalence rates in non-clinical male and female samples

Serum levels of adiponectin differentiate generalized lipodystrophies from anorexia nervosa

PURPOSE

The differential diagnosis of lipodystrophy involves other disorders characterized by severe fat loss and may be sometimes challenging. Owing to the rarity of lipodystrophy, it is relevant to search for tools and assays that differentiate it from other diseases that may mimic it. We conducted a study on leptin and high molecular weight (HMW) adiponectin serum concentrations in a series of patients diagnosed with lipodystrophy and compared them with those found in anorexia nervosa, one of the illnesses that may be cause of a missed diagnosis of lipodystrophy.

METHODS

Leptin and HMW adiponectin serum concentrations were measured in six patients diagnosed with generalized lipodystrophy (GL), six with progeroid syndromes (PS), 13 with familial partial lipodystrophy type 1 (FPLD1, Kobberling syndrome), 10 with familial partial lipodystrophy type 2 (FPLD2, Dunnigan syndrome), 18 with acquired partial lipodystrophy (APL) and 12 affected by anorexia nervosa (AN). Measurements were compared to those obtained in 12 normal weight healthy subjects.

RESULTS

Serum leptin concentrations were reduced to a similar degree in GL, PS and AN, proportionally to the extent of fat loss. Serum concentrations of HMW adiponectin were found extremely low in patients with GL and PS, while comparable to normal weight subjects in patients with AN.

CONCLUSION

Serum HMW adiponectin can be regarded as a useful tool to discriminate between generalized lipodystrophy syndromes (including PS) and AN.

Functional seizures and binge eating disorder: A cross-sectional study

OBJECTIVE

Functional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored. We aimed to assess BED prevalence in individuals with FS, anxiety/depression (AD), and healthy subjects (HS), to investigate dissociation's link to binge eating, and to explore psychological characteristics of FS individuals.

METHOD

Participants underwent evaluations based on ILAE guidelines and DSM-5 criteria, including questionnaires assessing binge eating, dissociation, anxiety, depression and personality traits. Inclusion criteria were age > 18 years, no history of substance abuse, no history of epilepsy, and no use of medications inducing eating disorders.

RESULTS

We found significantly more frequent and severe binge-eating symptoms in individuals with FS and AD compared to HS. Depression and dissociation correlated with binge-eating symptoms in both AD and FS groups. The PID-5 facet 'Perseveration' predicted binge-eating attitudes only in FS individuals; they reported more childhood emotional neglect and increased disinhibition compared do AD people.

DISCUSSION

This study underscores the commonality of binge-eating symptoms in FS individuals, emphasizing its association with dissociation symptoms. This finding support the hypothesis of a link between dissociation and eating disorders. Unique clinical characteristics in individuals with FS were identified, as a compulsive dimension related to binge-eating symptoms, providing a comprehensive understanding of their psychological profile and guiding targeted therapeutic interventions.

Influence of the COVID-19 pandemic on the incidence of eating disorders

INTRODUCTION

Eating disorders (EDs) develop more frequently in young females. Following the COVID-19 pandemic, there has been evidence of an increase in children and adolescents, with an earlier onset and a worse body weight and nutritional status. The aim of this study was to determine whether this trend has also been observed in our region over the past 6 years.

MATERIAL AND METHODS

We conducted a retrospective and descriptive cohort study in paediatric patients with a diagnosis of ED, referred during the 3 years preceding and following the declaration of the state of alarm due to the pandemic. We analysed and compared clinical, anthropometric and laboratory variables and bioelectrical impedance and bone density data.

RESULTS

Of the 129 patients in the sample, 28 were referred before the lockdown period and 101 after. When we compared these groups, we found a longer time elapsed from onset to the initial assessment (mean delay, 11.87 [SD, 6.75] vs. 6.64 [SD, 4.36] months), a greater hospitalization rate (14.1% vs. 10.1%), and lower vitamin D values (mean level, 28.19 [SD, 9.95] vs. 34.39 [SD, 11.87] ng/mL) in the post-lockdown group. We also found a greater frequency of self-harm suicide attempts in these patients.

CONCLUSIONS

This study confirms the increasing trend in EDs in children and adolescents in our area. Moreover, we found differences in the clinical characteristics and time elapsed to diagnosis compared to the patients referred to the hospital before the pandemic.

The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders

BACKGROUND

Risk factors for eating disorders are multifaceted and complex, so it is crucial to elucidate the role of executive functions, including impulsivity and metacognition, and coping strategies in the severity of eating behaviors. The study aims were threefold: (1) to analyze gender differences in impulsivity, metacognition, coping strategies, emotion regulation, and eating disorders; (2) to examine the correlation between the study variables; and (3) to test the mediating role of coping and emotion-regulation strategies in the relationship between metacognition, impulsivity, and eating disorders.

METHODS

A total of 1076 participants (Mage = 21.78, SD = 5.10; 77.7% women) completed a set of questionnaires. Two mediation analyses were conducted to test the mediating role of coping strategies, including emotion regulation, in the relationship between executive functions (i.e., impulsivity and metacognition) and eating disorders.

RESULTS

Women displayed higher coping strategies, specifically emotional expression, wishful thinking, and social support, whereas men presented greater social withdrawal. Mediational analyses showed a significant association between impulsivity, metacognition, and eating disorders, whose relationship was partially mediated by coping strategies and mainly by emotion regulation.

CONCLUSION

Interventions based on coping strategies and emotion regulation could be a feasible and effective option to deal with eating disorders among the young population.

Treatment of Binge-Eating Disorder Across the Lifespan: An Updated Review of the Literature and Considerations for Future Research

PURPOSE OF REVIEW

The present review describes the recent literature on treatment for binge-eating disorder (BED) in adults and youth, with a particular focus on research gaps, emerging treatments, and future research directions.

RECENT FINDINGS

Evidence supports the efficacy of several treatment modalities in adults, including self-help treatment, clinician-led psychotherapy, and pharmacotherapy; the largest effect sizes have been found for psychotherapies, most of which were cognitive-behavioral in orientation. Adapted psychotherapies for youth also show promise but lack a robust body of evidence. Predictors, moderators, and mediators of treatment outcome remain poorly understood; individuals with BED continue to experience significant barriers to treatment; and research is needed to address suboptimal treatment response. Recent work has highlighted the potential of adaptive interventions and investigation of novel mechanisms to address these gaps. Research on BED treatment continues to grow, though critical questions must be answered to improve treatment efficacy across the lifespan.

Comparative utility of the DSM-5 and ICD-11 diagnostic classifications of eating disorders of recurrent binge eating in an Australian community-based sample

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.

SIRT1 Serum Concentrations in Lipodystrophic Syndromes

Lipodystrophies (LDs) are rare, complex disorders of the adipose tissue characterized by selective fat loss, altered adipokine profile and metabolic impairment. Sirtuins (SIRTs) are class III NAD+-dependent histone deacetylases linked to fat metabolism. SIRT1 plays a critical role in metabolic health by deacetylating target proteins in tissue types including liver, muscle, and adipose. Circulating SIRT1 levels have been found to be reduced in obesity and increased in anorexia nervosa and patients experiencing weight loss. We evaluated circulating SIRT1 levels in relation to fat levels in 32 lipodystrophic patients affected by congenital or acquired LDs compared to non-LD subjects (24 with anorexia nervosa, 22 normal weight, and 24 with obesity). SIRT1 serum levels were higher in LDs than normal weight subjects (mean ± SEM 4.18 ± 0.48 vs. 2.59 ± 0.20 ng/mL) and subjects with obesity (1.7 ± 0.39 ng/mL), whereas they were close to those measured in anorexia nervosa (3.44 ± 0.46 ng/mL). Our findings show that within the LD group, there was no relationship between SIRT1 levels and the amount of body fat. The mechanisms responsible for secretion and regulation of SIRT1 in LD deserve further investigation.

An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: An attempt to increase diagnostic clarity

OBJECTIVE

Anorexia nervosa (AN) is a serious illness with a high mortality rate and multiple physiological complications. The vague definition of atypical AN allows for subjective interpretation. This retrospective study aimed to focus future research on the operational definition of atypical AN by examining four factors associated with atypical AN at admission to higher level of care treatment.

METHODS

Adults with atypical AN (n = 69) were examined within sample analyses among four groups: (1) >10% versus ≤10% weight loss; (2) weight loss within the previous 3 months versus >3 months; (3) engaging in purging behaviors versus absence of purging behaviors; and (4) endorsing versus not endorsing significant cognitive aspects of AN.

RESULTS

Patients with atypical AN endorsed elevated ED cognitions on the Eating Disorder Examination-Questionnaire and depressive symptoms; a lack of association was found between weight loss severity and weight loss time frame with depressive symptoms, eating concern, and restraint. Purging behavior was associated with a higher expected body weight percentage (%EBW) and dietary restraint, while greater AN cognitions were associated with a higher EBW and weight loss percentage. Few patients demonstrated bradycardia, hypophosphatemia, or amenorrhea.

DISCUSSION

This study demonstrated the severity of ED cognitions and depressive symptoms in this atypical AN sample and provided directions for future studies in the nosology of atypical AN. It may be important to distinguish between individuals with atypical AN who are purging and those who are not. Atypical AN was associated with a low frequency of physiological disturbances.

PUBLIC SIGNIFICANCE

This study provides further clarification regarding the operational definition of atypical AN; currently, a constellation of symptoms under Other Specified Feeding or Eating Disorders. This study was consistent with previous research in reporting severe eating disorder cognitions in adults with atypical AN, and noted the potential importance of distinguishing a purging distinction. A minority of patients in this study had physiological impairments.

Prevalence of Eating Disorders and Comorbidity With Depression Among Adolescents in Saudi Arabia: A Cross-Sectional Study

Background Patients diagnosed with eating disorders (EDs) have demonstrated elevated levels of eating psychopathology, including distorted body image, and general psychopathology, encompassing depression, anxiety, impulsivity, and low self-esteem, surpassing anticipated levels. However, the measurement of EDs' prevalence related to depression and mental disorders in Saudi society remains insufficient. There is a clear need for additional studies to establish and substantiate the relationship between these issues and their frequency. In response to this gap, the current study delves into the psychosocial implications of disordered eating in Saudi Arabian adolescents and adults. The primary objective of this study is to contribute to an expanded understanding of the psychosocial effects associated with EDs, shedding light on their prevalence and interconnectedness with mental health concerns among adolescents in Saudi Arabia. Methodology A cross-sectional study was conducted in Saudi Arabia among adolescents based on self-report questionnaires, including the Patient Health Questionnaires for Eating Disorders and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the presence of EDs. To analyze the obtained data, we calculated the responses from participants who met the following criteria: adolescents (ages 10 to 18 years) from all regions in Saudi Arabia who were ethnically Saudi and included both male and female individuals. Those older than 18 years were excluded from the study. Results We collected data from 422 participants; however, 43 responses were excluded because the respondent was under 10 years or over 18 years old. According to the Patient Health Questionnaire 9 (PHQ-9), the prevalence of depression was 83.9%; 36.7% of the participants had severe depression, 23.2% had moderate depression, and 24% had mild depression. According to the Patient Health Questionnaire Eating Disorders Scale, the prevalence of EDs was 23.5%, with the prevalence of binge eating disorder and bulimia nervosa being 14.8% and 8.7%, respectively. We found a significant correlation between EDs and depression, and the severity of depression (P=0.005). The prevalence of depression among patients with EDs was 93.3%: 17.9% of patients with EDs had mild depression, 21.3% had moderate depression, and 54.1% had severe depression. Conclusion There is an alarming finding of the high prevalence of both EDs and depression among young adolescents in elementary school, which requires urgent intervention. The study found a significant relationship between EDs and depression: the more severe the depressive symptoms, the higher the prevalence of EDs.

Cognitive and motor impulsivity in the healthy brain, and implications for eating disorders and obesity: A coordinate-based meta-analysis and systematic review

Alterations in the impulse-control balance, and in its neural bases, have been reported in obesity and eating disorders (EDs). Neuroimaging studies suggest a role of fronto-parietal networks in impulsive behaviour, with evaluation and anticipatory processes additionally recruiting meso-limbic regions. However, whether distinct facets of cognitive and motor impulsivity involve common vs. specific neural correlates remains unclear. We addressed this issue through Activation Likelihood Estimation (ALE) meta-analyses of fMRI studies on delay discounting (DD) and go/no-go (GNG) tasks, alongside conjunction and subtraction analyses. We also performed systematic reviews of neuroimaging studies using the same tasks in individuals with obesity or EDs. ALE results showed consistent activations in the striatum, anterior/posterior cingulate cortex, medial/left superior frontal gyrus and left supramarginal gyrus for impulsive choices in DD, while GNG tasks elicited mainly right-lateralized fronto-parietal activations. Conjunction and subtraction analyses showed: i) common bilateral responses in the caudate nucleus; ii) DD-specific responses in the ventral striatum, anterior/posterior cingulate cortex, left supramarginal and medial frontal gyri; iii) GNG-specific activations in the right inferior parietal cortex. Altered fronto-lateral responses to both tasks are suggestive of dysfunctional cortico-striatal balance in obesity and EDs, but these findings are controversial due to the limited number of studies directly comparing patients and controls. Overall, we found evidence for distinctive neural correlates of the motor and cognitive facets of impulsivity: the right inferior parietal lobe underpins action inhibition, whereas fronto-striatal regions and the left supramarginal gyrus are related to impulsive decision-making. While showing that further research on clinical samples is required to better characterize the neural bases of their behavioural changes, these findings help refining neurocognitive model of impulsivity and highlight potential translational implications for EDs and obesity treatment.

Identifying overcontrol and undercontrol personality types among young people using the five factor model, and the relationship with disordered eating behaviour, anxiety and depression

BACKGROUND

Overcontrol and undercontrol personality types have been associated with an increase in eating pathology, depression and anxiety. The aim of the research was to explore whether latent overcontrol and undercontrol personality types could be identified using cluster analysis of the facets of the five factor model (FFM). We further aimed to understand how these personality types were associated with eating pathology, depressed mood and anxiety.

METHODS

A total of 561 participants (394 women and 167 men), aged 16-30 years in Australia completed a survey designed to assess disordered eating, FFM personality traits, anxiety, depression and stress. A systematic four-step process using hierarchical, k-means, and random forest cluster analyses were used to identify a meaningful 3-cluster solution.

RESULTS

The results revealed a cluster solution that represented overcontrol, undercontrol and resilient personality types, and highlighted facets of the FFM that were associated with each type. Both overcontrol and undercontrol personality types were associated with increased clinical symptoms compared to the resilient types.

CONCLUSIONS

It was concluded that FFM facets may potentially be more meaningful than broad domains in identifying personality types, and that both overcontrol and undercontrol personality types are likely associated with increased clinical symptoms.

A Retrospective Chart Review Suggests That Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration

Purpose

The objective of this study was to conduct a secondary data analysis of clinical information documented in the electronic medical record to assess the clinical outcomes of patients who received three different treatment approaches on clinical outcomes for treatment of patients with anorexia nervosa (AN).

Patients and methods

Historical electronic medical record (EMR) data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes [body mass index for adults (BMI), body mass index percentile (BMI%ile) for pediatric patients] defined AN severity and weight restoration. EMR data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively.

Results

Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). In addition, patients receiving care from 1 to 2 providers (OR = 1.006, 95% CI [1.003, 1.010], p = 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011], p = 0.021) had significantly higher odds of weight restoration per provider visit day compared with patients receiving hospital-based services only.

Conclusion

This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting.

Eating disorder hospitalizations among children and youth in Canada from 2010 to 2022: a population-based surveillance study using administrative data

BACKGROUND

Eating disorders (EDs) are severe mental illnesses associated with significant morbidity and mortality. EDs are more prevalent among females and adolescents. Limited research has investigated Canadian trends of ED hospitalizations prior to the COVID-19 pandemic, however during the pandemic, rates of ED hospitalizations have increased. This study examined rates of ED hospitalizations among children and youth in Canada from 2010 to 2022, by sex, age, province/territory, length of stay, discharge disposition and ED diagnosis.

METHODS

Cases of ED hospitalizations among children and youth, ages 5 to 17 years, were identified using available ICD-10 codes in the Discharge Abstract Database from the 2010/11 to 2022/23 fiscal years. The EDs examined in this study were anorexia nervosa (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa (F50.2), other EDs (F50.3, F50.8) and unspecified EDs (F50.9). Both cases of total and first-time ED hospitalizations were examined. Descriptive statistics and trend analyses were performed.

RESULTS

Between 2010/11 and 2022/23, 18,740 children and youth were hospitalized for an ED, 65.9% of which were first-time hospitalizations. The most frequent diagnosis was anorexia nervosa (51.3%). Females had significantly higher rates of ED hospitalization compared to males (66.7/100,000 vs. 5.9/100,000). Youth had significantly higher rates compared to children. The average age of ED hospitalization was 14.7 years. Rates of ED hospitalizations were relatively stable pre-pandemic, however during the pandemic (2020-2021), rates increased.

INTERPRETATION

Rates of pediatric ED hospitalizations in Canada increased significantly during the pandemic, suggesting that there may have been limited access to alternative care for EDs or that ED cases became more severe and required hospitalization. This emphasizes the need for continued surveillance to monitor how rates of ED hospitalizations evolve post-pandemic.

Structure and factorial invariance of a brief version of the Eating Attitudes Test in Peruvian university students

Background

University students often experience significant changes in their eating habits, which can increase the risk of developing eating disorders (ED). This situation calls for the creation of brief assessment tools to identify college students who may be most at risk. The aim of the study was to determine the psychometric properties of the Eating Attitudes Test-8 (EAT-8) in a Peruvian university population; additionally, the possible differences in the scores of the instrument according to sociodemographic variables, such as gender and age, were examined.

Methods

A psychometric study was conducted on 610 participants (M = 24.3, SD = 2.16, and 61.5% female), aged 19 to 31 years, belonging to four universities of different professional careers.

Results

The unidimensional eight-item model was found to have fit indices that confirm acceptable factorial validity (X2/df = 3.23, CFI = 0.984, TLI = 0.977, RMSEA = 0.061, SRMR = 0.049) and an internal consistency of 0.833 for the Cronbach's alpha coefficient and 0.838 for the McDonald's omega coefficient. In addition, the EAT-8 was reported to be invariant according to gender and age; likewise, there were no significant differences in the age and gender categories.

Conclusion

The EAT-8 has solid psychometric properties, including validity, reliability, and invariance, in the Peruvian university population, which supports its ability to assess the risk of developing ED in this specific group.

Adaptive learning from outcome contingencies in eating-disorder risk groups

Eating disorders are characterised by altered eating patterns alongside overvaluation of body weight or shape, and have relatively low rates of successful treatment and recovery. Notably, cognitive inflexibility has been implicated in both the development and maintenance of eating disorders, and understanding the reasons for this inflexibility might indicate avenues for treatment development. We therefore investigate one potential cause of this inflexibility: an inability to adjust learning when outcome contingencies change. We recruited (n = 82) three groups of participants: those who had recovered from anorexia nervosa (RA), those who had high levels of eating disorder symptoms but no formal diagnosis (EA), and control participants (HC). They performed a reinforcement learning task (alongside eye-tracking) in which the volatility of wins and losses was independently manipulated. We predicted that both the RA and EA groups would adjust their learning rates less than the control participants. Unexpectedly, the RA group showed elevated adjustment of learning rates for both win and loss outcomes compared to control participants. The RA group also showed increased pupil dilation to stable wins and reduced pupil dilation to stable losses. Their learning rate adjustment was associated with the difference between their pupil dilation to volatile vs. stable wins. In conclusion, we find evidence that learning rate adjustment is unexpectedly higher in those who have recovered from anorexia nervosa, indicating that the relationship between eating disorders and cognitive inflexibility may be complex. Given our findings, investigation of noradrenergic agents may be valuable in the field of eating disorders.

Family-based treatment takes longer for adolescents with mental health comorbidities: findings from a community mental health service

Children and adolescents diagnosed with an eating disorder often meet the diagnosis of another mental health disorder. In addition to eating disorders, individuals with comorbid disorders have higher suicide rates and more severe and chronic eating disorder symptoms. The present research aimed to investigate the influence of comorbid conditions on the treatment outcomes of children and adolescents that attended a public community mental health service. It was hypothesised that the patients with comorbidities would have a more extended treatment duration, slower rates of weight restoration, more hospital admissions for medical compromise, and poorer functioning than those without comorbidities. Data from 78 past patients at the Eating Disorder Program in Queensland, Australia, were analysed. Patients with comorbidities demonstrated similar recovery rates to those without comorbidities. However, those with comorbid conditions had longer episodes of treatment. The study's results support using Family Based Treatment for patients with and without comorbidities. The implications of the findings for public mental health services and directions for future research are discussed.

Estimated prevalence of DSM-5 eating disorders in Norwegian adolescents: A community based two-phase study

OBJECTIVE

Little is known about the prevalence of DSM-5 eating disorders (EDs) in adolescents. In Norway, the most recent community-based prevalence study in adolescents was published more than 20 years ago. The aim of this study was to assess the prevalence of DSM-5 EDs in Norwegian adolescents using a two-phase design.

METHOD

A total of 1558 upper secondary school students (827 girls and 730 boys) (ages 16-19) were screened for at-risk ED pathology using the Eating Disorder Examination-Questionnaire short version (EDE-QS). A sub-sample of 99 adolescents (87 girls and 12 boys) subsequently participated in a clinical interview using the Eating Disorder Assessment for DSM-5 (EDA-5).

RESULTS

Eating pathology was common, with 19.9% of participants scoring at or above the applied EDE-QS cut-off. The estimated prevalence of any ED was 9.4% in the total sample, and 16.4% in girls. The number of boys who took part in the diagnostic interview was low, thus, diagnostic data from boys were not analyzed separately. Prevalence estimates of AN, BN, BED, and OSFED in girls were 2.7%, 1.1%, 1.9%, and 10.7%. Atypical AN was the most frequently assigned diagnosis in girls.

DISCUSSION

Sampling biases limit generalizability of results. Additional population-based studies are warranted to assess the prevalence of EDs in Norwegian youth.

PUBLIC SIGNIFICANCE STATEMENT

In this study, 1558 adolescents, aged 16-19, were screened for ED pathology. A subsample completed a diagnostic interview using DSM-5 criteria. Results showed that one in five adolescents displayed problematic eating behaviors and cognitions. The estimated prevalence rate of any ED was 9.4%. Sampling biases limit generalizability of results. Additional population-based studies are warranted to assess the prevalence of EDs in Norwegian youth.

Update on the epidemiology and treatment of eating disorders among older people

PURPOSE OF REVIEW

We reviewed the recent literature on the epidemiology and treatment of eating disorders among middle-aged and older women and men.

RECENT FINDINGS

Recent studies show that among older female persons, the prevalence rates with full diagnoses of eating disorders based on DSM-IV or DSM-5 criteria are between 2.1 and 7.7%, and among older men less than 1%. These studies show that the prevalence of eating disorders decreases by age in women, but it does not get towards zero even in very high age. Middle age, with a peak around 50, is also a critical time for the occurrence of eating disorders in men. Women who reported severe menopausal symptoms showed more eating disorder pathology compared with those with low symptoms during menopausal transition.

SUMMARY

Eating disorders do occur in middle and older age of both sexes. Shame and stigmatization have decreased, and medical awareness and explicit assessment of eating behavior in all age groups have developed. What puberty is for eating disorders in adolescence and young age is menopausal transition for midlife women. Also in men, associations with hormonal disturbances are possible. Treatment approaches should consider treatment strategies tailored to older women and men, addressing the context of midlife and aging.

The Relationship between the Family Environment and Eating Disorder Symptoms in a Saudi Non-Clinical Sample of Students: A Moderated Mediated Model of Automatic Thoughts and Gender

Eating disorders are a global burden and present personal, family, and societal costs. Most evidence in the literature is based on the relationship between a poor family environment and eating disorders, and the evidence of gender interaction in eating disorders is inconsistent. This study aimed to investigate the relationship between family environment and eating disorder symptoms, the mediating role of negative automatic thoughts, and the moderating role of gender using a non-clinical sample of students. A sample of 440 (70.9% females, aged 18-21) participated in this study. They completed the Eating Attitudes Test (EAT-26), the Automatic Thoughts Questionnaire (ATQ negative), and the Brief Family Relationship Scale (BFRS). PROCESS MACRO was used to study these relationships. The main findings revealed that family environment was negatively associated with eating disorder symptoms and that this relationship was mediated by automatic thoughts. Moreover, gender moderated those relationships, and more intensely in females. The results of this study indicate that the prevention of eating disorders should be directed at training individuals to challenge negative thoughts and encourage healthy individuals to be gender mindful.

Differences in the Factor Structure of the Eating Attitude Test-26 (EAT-26) among Clinical vs. Non-Clinical Adolescent Israeli Females

In recent years, the diagnostic definitions of eating disorders (EDs) have undergone dramatic changes. The Eating Attitudes Test-26 (EAT-26), which is considered an accepted instrument for community ED studies, has shown in its factorial structure to be inconsistent in different cultures and populations. The aim of the present study was to compare the factor structure of the EAT-26 among clinical and non-clinical populations. The clinical group included 207 female adolescents who were hospitalized with an ED (mean age 16.1). The non-clinical group included 155 female adolescents (mean age 16.1). Both groups completed the EAT-26. A series of factorial invariance models was conducted on the EAT-26. The results indicate that significant differences were found between the two groups regarding the original EAT-26 dimensions: dieting, bulimia and food preoccupation, and oral control. Additionally, the factorial structure of the EAT-26 was found to be significantly different in both groups compared to the original version. In the clinical group, the factorial structure of the EAT-26 consisted of four factors, whereas in the non-clinical sample, five factors were identified. Additionally, a 19-item version of the EAT-26 was found to be considerably more stable and well suited to capture ED symptoms in both groups, and a cutoff point of 22 (not 20) better differentiated clinical samples from non-clinical samples. The proposed shortening of the EAT from 40 to 26 and now to 19 items should be examined in future studies. That said, the shortened scale seems more suited for use among both clinical and non-clinical populations. These results reflect changes that have taken place in ED psychopathology over recent decades.

Co-producing principles to guide health research: an illustrative case study from an eating disorder research clinic

BACKGROUND

There is significant value in co-produced health research, however power-imbalances within research teams can pose a barrier to people with lived experience of an illness determining the direction of research in that area. This is especially true in eating disorder research, where the inclusion of co-production approaches lags other research areas. Appealing to principles or values can serve to ground collaborative working. Despite this, there has not been any prior attempt to co-produce principles to guide the work of a research group and serve as a basis for developing future projects.

METHODS

The aim of this piece of work was to co-produce a set of principles to guide the conduct of research within our lived experience led research clinic, and to offer an illustrative case for the value of this as a novel co-production methodology. A lived experience panel were recruited to our eating disorder research group. Through an iterative series of workshops with the members of our research clinic (composed of a lived experience panel, clinicians, and researchers) we developed a set of principles which we agreed were important in ensuring both the direction of our research, and the way in which we wanted to work together.

RESULTS

Six key principles were developed using this process. They were that research should aim to be: 1) real world-offering a clear and concrete benefit to people with eating disorders, 2) tailored-suitable for marginalised groups and people with atypical diagnoses, 3) hopeful-ensuring that hope for recovery was centred in treatment, 4) experiential-privileging the 'voice' of people with eating disorders, 5) broad-encompassing non-standard therapeutic treatments and 6) democratic-co-produced by people with lived experience of eating disorders.

CONCLUSIONS

We reflect on some of the positives as well as limitations of the process, highlighting the importance of adequate funding for longer-term co-production approaches to be taken, and issues around ensuring representation of minority groups. We hope that other health research groups will see the value in co-producing principles to guide research in their own fields, and will adapt, develop, and refine this novel methodology.

The psychometric properties of Binge Eating Scale among overweight college students in Taiwan

BACKGROUND

The Binge Eating Scale (BES) is a widely used measuring tool to assess binge eating problems in Western countries. However, the psychometric properties of such scales among cross-cultural youth groups are insufficient, and the factor structure continues to be debated; therefore, further research is needed. The aim of this study was to examine the properties of BES among overweight college students in Taiwan.

METHODS

A cross-sectional design and convenience sampling were adopted to recruit 300 overweight students from five universities. A translated Traditional Chinese version of BES was used for the survey, and the validity of the scale was tested using the Confirmatory Factor Analysis (CFA) and Bulimic Investigatory Test, Edinburgh (BITE). The reliability was evaluated using internal consistency and test-retest reliability.

RESULTS

The CFA results showed a reasonable model fit. The first-order two-factor model was consistent with that of the original BES and significantly correlated with the criterion of BITE score. Cronbach's α value, representing internal consistency reliability, and the intraclass correlation coefficient of repeated measures made one month apart were both 0.83, indicating good reliability and stability. Significant correlations were observed between the BES score and sex and BMI; however, no correlation was observed between BES scores and age.

CONCLUSION

The BES presents sound psychometric properties, has good cross-cultural applicability, and can be used as a first-line screening tool by mental health professionals to identify the severity of binge eating behavior among overweight college students in Taiwan. It is recommended that participant diversity and obesity indicators be incorporated into the scale in the future to establish a universal psychometric tool.

Brain Correlates of Eating Disorders in Response to Food Visual Stimuli: A Systematic Narrative Review of FMRI Studies

This article summarizes the results of studies in which functional magnetic resonance imaging (fMRI) was performed to investigate the neurofunctional activations involved in processing visual stimuli from food in individuals with anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). A systematic review approach based on the PRISMA guidelines was used. Three databases—Scopus, PubMed and Web of Science (WoS)—were searched for brain correlates of each eating disorder. From an original pool of 688 articles, 30 articles were included and discussed. The selected studies did not always overlap in terms of research design and observed outcomes, but it was possible to identify some regularities that characterized each eating disorder. As if there were two complementary regulatory strategies, AN seems to be associated with general hyperactivity in brain regions involved in top-down control and emotional areas, such as the amygdala, insula and hypothalamus. The insula and striatum are hyperactive in BN patients and likely involved in abnormalities of impulsivity and emotion regulation. Finally, the temporal cortex and striatum appear to be involved in the neural correlates of BED, linking this condition to use of dissociative strategies and addictive aspects. Although further studies are needed, this review shows that there are specific activation pathways. Therefore, it is necessary to pay special attention to triggers, targets and maintenance processes in order to plan effective therapeutic interventions. Clinical implications are discussed.

The association between night eating syndrome and health-related quality of life in Korean adults: a nationwide study

PURPOSE

Quality of life may be influenced by the presence of eating disorders. This study investigated the association between night eating syndrome (NES) and health-related quality of life in the general population.

METHODS

Data were from the 2019 Korea Community Health Survey. The presence of NES was determined using the Night Eating Questionnaire. Health-related quality of life was measured using the 3-level EuroQoL-5 Dimension Index. Multivariable linear regression analyses assessed the association between NES and health-related quality of life. Subgroup analyses were performed based on daily sleep duration.

RESULTS

A total of 34,434 individuals aged 19 years or older were included in the study population. Participants with NES (β = - 4.85, p < 0.001) reported poorer health-related quality of life scores than those without NES. Decreases in health-related quality of life scores among those with NES were greatest in those who slept over 8 h daily (β = - 12.03, p = 0.004), followed by those who slept less than 6 h (β = - 5.90, p = 0.006) and participants who slept between 6 and 8 h (β = - 3.40, p = 0.026) daily.

CONCLUSION

Individuals with NES were more likely to have a lower health-related quality of life than those without NES. These findings highlight the potential importance of considering NES in investigating the health-related quality of life.

LEVEL OF EVIDENCE

Level III, well-designed case-control analytic studies.

"I don't want them to judge me": Separating out the role of fear of negative evaluation, neuroticism, and low self-esteem in eating disorders

Fear of negative evaluation (FNE) is a transdiagnostic risk factor that has an important role in eating disorder (ED) onset and maintenance, as well as other psychopathologies. However, no research has explored whether FNE has associations with probable ED status when accounting for related vulnerabilities, and whether this relationship changes across gender and weight status. The current study sought out to explore how FNE explains probable ED status above and beyond heightened neuroticism and low self-esteem, with gender and BMI serving as potential moderators of this relationship. Participants were 910 university students (85 % females) aged 18-26 years (M_age = 19.90; SD_age = 2.06) living in Australia, who completed measures of psychological distress, personality, self-esteem, FNE, and ED status. Logistic regression analysis showed that FNE was associated with probable ED status. This relationship was stronger among individuals with underweight and healthy-weight, whilst an interaction with gender was not significant. These findings shed light on the unique role FNE has in probable ED status across gender, which appears to be more pronounced in those with a lower BMI. Therefore, FNE should be considered as a potential target in ED screening and early intervention alongside other important transdiagnostic risk factors.

Parenting styles, maladaptive coping styles, and disturbed eating attitudes and behaviors: a multiple mediation analysis in patients with feeding and eating disorders

Background

Although preliminary studies support the roles of unhealthy parenting styles and maladaptive coping styles in increasing rates of disturbed eating attitudes and behaviors (EAB) and clinically significant feeding and eating disorders (FED), underlying mechanisms have not been well-recognized. This study aims to investigate the factors associated with disturbed EAB and the mediating roles of overcompensation and avoidance coping styles in the relationship between different types of parenting styles and disturbed EAB among patients with FED.

Methods

A total of 102 patients with FED in Zahedan, Iran, participating in this cross-sectional study (from April to March 2022) completed a sociodemographic information form and self-report measures of parenting styles, maladaptive coping styles, and EAB. Model 4 of Hayes' PROCESS macro in SPSS was employed to identify and explain the mechanism or process that underlies an observed relationship between study variables.

Results

The results showed that authoritarian parenting style, overcompensation and avoidance coping styles, and female gender might be related to disturbed EAB. The overall hypothesis that overcompensation and avoidance coping styles mediated the effect of fathers' and mothers' authoritarian parenting styles on disturbed EAB was also supported.

Conclusions

Our findings highlighted the necessity of evaluating particular unhealthy parenting styles and maladaptive coping styles as the important possible risk factors in the development and maintenance of higher level of disturbance in EAB among patients with FED. However, more research is needed to explore individual, family, and peer risk factors for disturbed EAB among these patients.

Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) in the Orthodox and Secular Jewish Communities in Israel

Symptoms related to avoidant/restrictive food intake disorder (ARFID) are not well defined in the general population. The aim of this study was to determine whether differences exist in the presentation of ARFID-related eating disturbances between healthy, religious and secular Jewish children in Israel. Sixty-four families participated in this study. Parents completed standardized questionnaires to assess ARFID behaviors of children, parental feeding problems and overall functioning, anxiety and sensory-aversion. No significant between-group differences were found for almost all assessments. However, sensory-related pleasure and sensory-seeking behavior was greater in secular children. Overall, religious and non-religious Israeli children do not differ in parental-reported ARFID-related feeding and eating behaviors.

The prevalence and correlates of bulimia nervosa, binge-eating disorder, and anorexia nervosa: The Saudi National Mental Health Survey

OBJECTIVE

Limited studies have been conducted in the Kingdom of Saudi Arabia on eating disorders (EDs). This study presents national epidemiological survey data on the prevalence and correlates of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and their association with other mental health disorders, impairment in role functioning, and individual help-seeking behaviors in the Saudi National Mental Health Survey (SNMHS).

METHOD

A face-to-face survey was conducted in a nationally representative household sample of Saudi citizens aged 15-65 (n = 4004). The Composite International Diagnostic Interview (CIDI 3.0) was used to produce estimates of lifetime and 12-month prevalence and treatment of common DSM-IV mental disorders.

RESULTS

Twelve-month prevalence of any of the three EDs was 3.2%; the overall lifetime prevalence was 6.1%. Education and marital status were significantly associated with both 12-month and lifetime EDs prevalence. Significant mental health comorbidities associated with 12-month EDs were anxiety, mood, and impulse-control disorders, while lifetime EDs were significantly related to all disorders. A similar percentage of respondents that reported having ED-related treatment at some point in their lifetime utilized healthcare and nonhealthcare sector. There was a significant relationship between body mass index category, and lifetime BED and BN.

DISCUSSION

The 12-month prevalence of EDs in the Saudi population was higher than the EDs rates reported worldwide. These findings can help healthcare experts, and policymakers in the implementation of initiatives for raising awareness of EDs among the Saudi population, and the development of a country-wide plan for the prevention of EDs.

PUBLIC SIGNIFICANCE STATEMENT

The study presents data on the prevalence, correlates, and help-seeking behaviors of AN, BN, and BED, in the Saudi National Mental Health Survey (SNMHS). Obtaining information on this underrepresented region is essential due to the large differences in cross-national data in addition to cultural beliefs about mental illness and treatment seeking to exert an important influence on eating disorders. Such knowledge could provide a better understand of mechanisms underlying the development of eating disorders and thereby improve prediction, prevention, and treatment.

Worldwide prevalence of DSM-5 eating disorders among young people

PURPOSE OF REVIEW

Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders) affect young people worldwide. This narrative review summarizes key studies conducted on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eating disorders among young people in 2013-22.

RECENT FINDINGS

In Western settings, a substantial proportion of young people have reported an eating disorder. Overall, 5.5--17.9% of young women and 0.6-2.4% of young men have experienced a DSM-5 eating disorder by early adulthood. Lifetime DSM-5 anorexia nervosa was reported by 0.8-6.3% of women and 0.1-0.3% of men, bulimia nervosa by 0.8-2.6% of women and 0.1-0.2% of men, binge eating disorder by 0.6-6.1% of women and 0.3-0.7% of men, other specified feeding or eating disorders by 0.6-11.5% of women and 0.2-0.3% of men, and unspecified feeding or eating disorders 0.2-4.7% of women and 0-1.6% of men. Gender and sexual minorities were at particularly high risk. Emerging studies from Eastern Europe, Asia, and Latin America show similar high prevalences. During the COVID-19 pandemic, the incidence of eating disorders has still increased.

SUMMARY

Eating disorders are a global health concern among young people. Improved detection, management, and prevention methods are urgently needed.

[Prevalence and factors associated with eating disorders in Peruvian Human Medicine students in the context of the COVID-19 pandemic: a multicentre study]

INTRODUCTION

Eating disorders (ED) are serious conditions that have diverse consequences, associated with high morbidity and mortality: Among the factors associated with their development are, being female, and stress, which increased during the pandemic, and was higher in medical students. Our objective was to identify the prevalence and factors associated with ED in medical students.

METHODS

Cross-sectional study, conducted with an online questionnaire, between January 1 and 31, 2021, in 22 universities, using the Eating Disorder Scale (EAT-26) and the Family Communication Scale (FCS). Generalized logistic regressions were used to identify the association between variables.

RESULTS

A total of 1224 participants were recruited, and the prevalence was 12.5%. Associated factors included a poor perception of health in 34.3%, having a family and/or social environment member with an eating disorder in 21.7%, and medium or low satisfaction with family communication in 57.3% and 34.9% respectively, in addition to the academic year, dieting, concern for body image and the perception of inadequate eating.

CONCLUSIONS

Our results show that, in the context of the COVID-19 pandemic, 1-2 out of 10 Human Medicine students had an ED. The associated factors that influenced development of the condition included a fair or poor perception of health, the academic year completed, and medium or low satisfaction with family communication.

Dysfunction of Inflammatory Pathways and Their Relationship With Psychological Factors in Adult Female Patients With Eating Disorders

The attempts to clarify the origin of eating disorders (ED) have not been completely successful and their etiopathogenesis remains unknown. Current research shows an activation of the immune response in neuropsychiatric diseases, including ED. We aimed to investigate immune response parameters in patients with ED and to identify psychological factors influencing the inflammatory response. The relationship between inflammation markers and impulsivity and affective symptomatology was explored as well. Thirty-four adult female patients with current diagnosis of ED, none of them under psychopharmacological treatment (excluding benzodiazepines), were included in this study. Patients were compared with a healthy control group of fifteen adult females. The levels of inflammatory markers and indicators of oxidative/nitrosative stress were evaluated in plasma and/or in peripheral blood mononuclear cells (PBMCs). Subjects were assessed by means of different ED evaluation tools. Additionally, the Barratt Impulsiveness Scale, the Montgomery-Asberg Depression Rating Scale and the Hamilton Anxiety Rating Scale were also employed. Patients with ED shown increased plasma levels of the pro-inflammatory nuclear factor kappa B (NFκB) and the cytokine tumor necrosis factor-alpha (TNF-α), among other factors and an increment in the oxidative/nitrosative stress as well as increased glucocorticoid receptor (GR) expression levels in their PBMCs. Moreover, the inflammatory prostaglandin E₂ (PGE₂) correlated with impulsiveness and the anti-inflammatory prostaglandin J₂ (15d-PGJ₂) correlated with depressive symptomatology. Our results point towards a relationship between the immune response and impulsiveness and between the immune response and depressive symptomatology in female adult patients with ED.

Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating

Objective

Previous literature shows an increased risk for eating disorders in autistic individuals. This study tested whether fussy eating contributes to the association between childhood autistic traits and adolescent eating disorder behaviours.

Method

Using data from the Avon Longitudinal Study of Parents and Children, we estimated the intercept and slope of parent‐rated autistic traits and fussy eating between 7 and 14 years (N = 8982) and their association with self‐reported eating disorder behaviours at age 14 years, including the indirect path from autistic traits to eating disorder behaviours via fussy eating. Analyses were adjusted for child sex, maternal age at delivery, maternal body mass index and maternal education.

Results

Analyses found a small indirect pathway from autistic traits intercept to eating disorder behaviours via fussy eating slope (b = 0.017, 95% CI = 0.002–0.032, p = 0.026), with higher levels of autistic traits at age 7 years being associated with a shallower decline in fussy eating, which in turn was associated with greater eating disorder behaviours.

Conclusion

Findings point towards fussy eating as a potential link between childhood autistic traits and later disordered eating. Addressing fussy eating patterns before they become entrenched may decrease risk for eating disorders later in development.

There is evidence that high levels of autistic traits are associated with an increased likelihood of experiencing an eating disorder.

The current study sought to test whether the link between autism and eating disorders could in part be explained by variation in fussy eating.

In a large prospective cohort study, we found a significant indirect effect of fussy eating, such that higher childhood autistic traits were associated with a shallower decline in fussy eating between childhood and adolescence, which in turn was associated with higher levels of eating disorder behaviours in adolescence.

The translation and psychometric assessment of the SCOFF eating disorder screening questionnaire: the Persian version

BACKGROUND

Eating Disorders (EDs) are defined by abnormal eating habits. The SCOFF (Sick-Control-One stone-Fat-Food) is a simple screening questionnaire for EDs. This study was conducted to translate and evaluate the psychometric properties of the SCOFF questionnaire in Iranian university students.

METHODS

A total of 310 Iranian students of the Shahid Beheshti University of Medical Sciences completed a test battery of questionnaires including the well-known screener of eating disorder symptoms, the SCOFF. All measures were presented to the participants in Persian. The 5-item SCOFF questionnaire was translated to Persian using the forward-backward method. The face, content, criterion, and construct validity of the Persian version of the SCOFF were assessed. The validity and reliability of the Persian version of the SCOFF was assessed and factor analysis was conducted.

RESULTS

All five items of the translated questionnaire were approved after face validity. Content validity ratio was 0.73 (range 0.66-0.83) and content validity index was 0.96 (range 0.91-1), so all items were approved. Exploratory factor analysis revealed a 2-factor structure, which explained 52.47% of the variance. Confirmatory factor analysis showed a very good goodness-of-fit for the 2-factor model. 2-factor and 1-factor models indicate a very good goodness-of-fit in females and adequate goodness-of-fit in males. Criterion validity showed an acceptable correlation between the SCOFF and the EDE-Q. Reliability was acceptable based on the stability [ICC = 0.905(95% CI .760-.962 p < 0.001)] and the internal consistency (KR20 = 0.4).

CONCLUSION

Appropriate psychometric properties of the 5-item Persian version of the SCOFF (both models) were confirmed, suggesting its use as a valid questionnaire in EDs screening.

An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis

OBJECTIVE

To update the prevalence of eating disorders in the general population before 2021 and to analyze the distribution characteristics at different times and in different regions and sexes, as well as the diagnostic criteria.

METHODS

Based on the method from a previous report by the authors, studies were identified from the following databases: PubMed/Medline, PsycINFO, ISI Web of Knowledge, Ovid and the 4 most important Chinese databases. Articles in English and Chinese before 2021 were retrieved. The data retrieved at this time were pooled with the data from a previous report for analyses.

RESULTS

Thirty-three studies were identified, which included 18 studies supplemented in this retrieval. The pooled lifetime and 12-month prevalence of eating disorders were 0.91% (95% CI, 0.48-1.71) and 0.43% (95% CI, 0.18-0.78), respectively. The pooled lifetime and 12-month prevalence of the subgroup EDs (any), which covers all types of eating disorders, were 1.69% and 0.72%, respectively. The lifetime prevalence of AN, BN and BED was 0.16% (95% CI, 0.06-0.31), 0.63% (95% CI, 0.33-1.02) and 1.53% (95% CI, 1.00-2.17), respectively. The lifetime prevalence of EDs in Western countries was 1.89%, and was high at 2.58% in females. Prevalence studies using DSM-5 criteria were scarce.

CONCLUSIONS

The prevalence of eating disorders might be underestimated thus far. Not all types of EDs were included in a majority of epidemiological surveys, and the prevalence rates of the new types of EDs were significantly higher. Eating disorders were especially common in Western countries and in females. New diagnostic criteria should be used to comprehensively assess all types of eating disorders.

LEVEL OF EVIDENCE

1, systematic review and meta-analysis.

Psychometric Properties of the Eating Disorder Inventory-3 (EDI-3) in Chilean Youth

The aim of this study was to analyze the psychometric properties of the Eating Disorder Inventory (EDI)-3 test to evaluate eating disorders in young Chilean population. Methods: The sample consisted of 1,091 Chilean adolescents and young people (i.e., 476 men and 615 women) between 15 and 28 years old, from the metropolitan region, and four regions from the coast and south-central zone of the country. The reliability and factorial structure of the instrument were analyzed, replicating the confirmatory factor analyses of Brookings et al. (2020), evaluating four additional models that included bifactor exploratory structural equation modeling (ESEM), bifactor, and two-bifactor. Results: A majority of the subscales presented alphas and omegas equal to or greater than 0.70, with the exception of asceticism (α = 0.543, ω = 0.552) and interpersonal alienation (α = 0.684, ω = 0.695) scales, which are consistent with the values of the Spanish and Mexican non-clinical samples. The best fit indices were obtained by the ESEM two-bifactor model, with twelve specific factors corresponding to the EDI-3 subscales and two general orthogonal factors (i.e., risk subscales and psychological subscales), consistently with the theoretical basis.

Eating Disorders and Sexual Satisfaction: The Mediating Role of Body Image Self-consciousness during Physical Intimacy and Dissociation

Women with eating disorders experience difficulties related to sexual activity, yet little is known about the indirect association between eating disorders and sexual satisfaction. This study examined the indirect association between eating disorders and sexual satisfaction using body image self-consciousness during physical intimacy and dissociation as mediators. Online questionnaires were answered by 985 Israeli women. Of them, 98 were identified as likely to have eating disorders (study group). A matching control group (n = 98) was selected from the remaining respondents. Participants in the study group had significantly higher body image self-consciousness and dissociation than the matched controls, as well as significantly lower sexual satisfaction. The research model revealed that body image self-consciousness during physical intimacy mediates the link between eating disorders and sexual satisfaction, while dissociation does not. Women with eating disorders have higher levels of self-consciousness about their body during sexual activity, which may distract them from their own sexual needs and desires and those of their partners, and this, in turn, is associated with sexual dissatisfaction. Findings highlight the need for improved evidenced-based assessment and management of the sexual satisfaction of women with eating disorders.Abbreviations: ED: eating disorders; AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder.

EEG Biomarkers in Children and Adolescents With Feeding and Eating Disorders: Current Evidence and Future Directions

INTRODUCTION

Electroencephalography (EEG) represents a powerful tool to detect abnormal neural dynamics in child and adolescent psychiatry. Feeding and Eating Disorders (FEDs), such as anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and avoidant restrictive food intake disorder (ARFID) onset in childhood and adolescence. EEG has rarely been used to examine cortical brain activity in children and adolescents with FEDs. This review aims to summarize EEG findings in FEDs amongst children and adolescents, and to highlight areas deserving further research.

METHODS

We searched the literature for EEG studies on children and adolescents with FEDs using Google Scholar, PsycINFO, Medline, and PubMed.

RESULTS

Twelve studies were identified, the majority focusing on AN (N = 10). The identified studies suggest reduced action monitoring control (preparatory waves, N200, P300), specific perceptual-cognitive styles to body/face perception (late positive potentials/early posterior negativity), as well as fundamental changes in posterior theta oscillations in AN. Behavioral traits of BN/BED (i.e., loss of control eating, emotional eating), and AN seem to be associated with an increased attentional reactivity (P300) to visual food stimuli.

CONCLUSION

Electroencephalography research in children and adolescents with FEDs is limited and mostly focused on AN. While EEG abnormalities seem consistent with a reduced top-down control and attentional allocation deficits in AN, altered attention specific to food cues emerges across FEDs. Overcoming conventional EEG analyses, and investigating spatial properties (i.e., electrical neuroimaging), will enhance our understanding of FEDs neurobiology.

Correlates and impact of DSM-5 binge eating disorder, bulimia nervosa and recurrent binge eating: a representative population survey in a middle-income country

PURPOSE

Binge eating disorder (BED), bulimia nervosa (BN) and recurrent binge eating (RBE) are binge eating spectrum conditions causing a significant impact in individual's health and functioning. Information regarding those conditions came mostly from high-income countries. The objective of this study was to assess the prevalence of DSM-5 BED, BN and RBE and correlates in a representative sample from a metropolitan area of a middle-income country.

METHODS

The data were obtained from a cross-sectional population-based household survey in two stages in Rio de Janeiro, Brazil. Noninstitutionalized residents aged 18-60 years were assessed by lay interviewers using the Questionnaire of Eating and Weight Patterns-5 (QEWP-5). Positive cases and a paired sample screen-negative cases were reassessed by phone with the Eating Disorders Section of SCID-I-P (adapted for DSM-5). The data were collected from September 2019 to February 2020.

RESULTS

Overall, 2297 individuals were interviewed. Prevalence of BED was 1.4%, BN 0.7%, RBE 6.2%. Psychiatric comorbidities, such as depression, anxiety and ADHD were significantly more prevalent in people with BED, BN and RBE than in people without these eating problems. Several medical conditions, when controlling for body mass index, were significantly more prevalent in people with BED, BN and RBE. People with BED and BN had marked impairments in work/school, social and family life, reduced mental and physical HRQoL and under half had sought treatment.

CONCLUSION

As in high income countries, in Rio de Janeiro, Brazil, BED, BN and RBE are prevalent conditions and are associated with elevated BMI, functional impairment, psychiatric and medical comorbidity and poorer HRQoL.

Eating disorders symptoms and excessive internet use in adolescents: the role of internalising and externalising problems

BACKGROUND

Both eating disorders and excessive internet use represent significant health issues for contemporary adolescents. Yet, the link between them has seldom been investigated. We aim to study this association through their common underlying psychological factors: internalising problems and externalising problems.

METHODS

A representative sample of 7,083 adolescents (M_age = 13.48 years; SD_age = 1.32; 50.3% girls) from Slovakia was obtained from the Health Behaviour in School-aged Children (HBSC) project in 2018. Study variables included the Excessive Internet Use Scale (EIU) and the Strength and Difficulties Questionnaire (SDQ). Eating disorders symptoms (EDS) were assessed by SCOFF and selected items from the Eating Disorder Screen for Primary Care (ESP). Data were analysed separately for boys and girls with Structural Equation Modelling.

RESULTS

There was a partial correlation between EDS and EIU (r = 0.36 for boys and r = 0.29 for girls) after controlling for the internalising and externalising of problems. Internalising and externalising problems were positively associated with EDS, while EIU was only associated with externalising problems. The results were comparable for both genders.

CONCLUSION

The study provides evidence that, during adolescence, EDS and EIU are related and have a tendency to occur together. Also, they are related even when controlled for their shared underlying psychological factors, namely the emotional and attentional/behavioural difficulties.

Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa

PURPOSE OF REVIEW

To review the recent literature on the epidemiology of anorexia nervosa and bulimia nervosa in terms of incidence, prevalence and mortality.

RECENT FINDINGS

Although the overall incidence rate of anorexia nervosa is considerably stable over the past decades, the incidence among younger persons (aged <15 years) has increased. It is unclear whether this reflects earlier detection or earlier age of onset. Nevertheless, it has implications for future research into risk factors and for prevention programs. For bulimia nervosa, there has been a decline in overall incidence rate over time. The lifetime prevalence rates of anorexia nervosa might be up to 4% among females and 0.3% among males. Regarding bulimia nervosa, up to 3% of females and more than 1% of males suffer from this disorder during their lifetime. While epidemiological studies in the past mainly focused on young females from Western countries, anorexia nervosa and bulimia nervosa are reported worldwide among males and females from all ages. Both eating disorders may carry a five or more times increased mortality risk.

SUMMARY

Anorexia nervosa and bulimia nervosa occur worldwide among females and males of all age groups and are associated with an increased mortality risk.

Assessment of avoidant restrictive food intake disorder, pica and rumination disorder: interview and questionnaire measures

PURPOSE OF REVIEW

This article reviews available assessment instruments for three of the feeding and eating disorder diagnostic categories: avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD). It includes an overview of the current status of screening tools, questionnaire measures, and diagnostic instruments.

RECENT FINDINGS

Screening instruments are available for all three disorders; however, for pica and RD, these typically include single screening items only and do not cover any specific features of these presentations. Only one questionnaire suitable for clinical populations is included, covering ARFID only. Standardized diagnostic interviews are limited to two covering both pica and RD, only one of which provides further clinical information. Of the five diagnostic instruments for ARFID described here, two include diagnostic items as well as allowing more detailed assessment of clinical features.

SUMMARY

There are a limited number of assessment measures available for all three disorders, with instruments for ARFID being the greatest in number and widest in terms of scope. A commonly encountered difficulty is that many assessment instruments do not adequately cover diagnostic exclusion criteria, which raises the likelihood of false positive findings. All currently available measures require further study to determine their reliability and validity.

Inhabiting the Body(ies) in Female Soccer Players: The Protective Role of Positive Body Image

In a social and sports world dominated by weight-centred beliefs and highly exigent and gendered athletic and beauty body standards, the vulnerability for eating pathology, i.e., disordered eating and eating disorders (EDs), is elevated among women athletes. The aim of this study was to explore body image facets and ED risk among female athletes in masculinised sports such as soccer. Forty-five federated amateur female soccer players from Spain participated in this study, voluntarily complying with an extensive evaluation protocol on attitudes towards body and appearance and eating practises. The participants overall reported self-representations of their bodies that corresponded to their reality as athletes, but their body ideals were also more demanding in terms of low fat and muscularity, in association with the functionality of their body and the physical demands of their athletic activity. Despite having a fairly high positive body image and body satisfaction, they also expressed negative attitudes towards their bodies. Around 2 out of 10 players were at risk of suffering from an ED. Players with negative attitudes towards their bodies had an odd 12 times likely to develop an ED compared to those with lower self-devaluation, after adjusting for BMI and body perceptions (OR = 12.3, p < 0.01). On the contrary, players who appreciate their bodies and hold a positive body image had an odd 83% lower to suffer from eating pathology, after adjusting for BMI and body satisfaction (OR = 0.17, p < 0.05). Our findings support the healthy and protective role of positive body image in sports contexts. Body attitudes should be addressed in preventive and therapeutic efforts for reducing the prevalence of EDs in women's sports, within both a "negative" and a "positive" paradigm of body image.

Irritable Bowel Syndrome and Eating Disorders: A Burgeoning Concern in Gastrointestinal Clinics

Irritable bowel syndrome affects 10% to 15% of the population, and up to 90% of patients with irritable bowel syndrome exclude certain foods to improve their gastrointestinal symptoms. Although focused dietary restrictions are a normal, adaptive response, restrictions can spiral out of control and result in maladaptive restriction. Dietary therapies are rapidly becoming first-line treatment of irritable bowel syndrome, and gastroenterologists need to be aware of red flag symptoms of maladaptive eating patterns and the negative effects of prescribing restrictive diets. There is also growing awareness of the association between eating disorders and gastrointestinal symptoms, including irritable bowel syndrome symptoms.

Digital Hazards for Feeding and Eating: What We Know and What We Don't

PURPOSE OF REVIEW

We aimed to accrue recent evidence exploring effects of modern online activities (e.g., Internet use) on feeding and eating disorder symptoms, and related traits. We examined available evidence to ascertain any direct influences from online activities on feeding and eating disorders, thereby shedding light on putative mechanisms by which those influences may occur.

RECENT FINDINGS

Many facets of problematic usage of the Internet correlate cross sectionally with eating disorder and related psychopathology. There is evidence to suggest that significant effects do exist in the direction of specific Internet activities contributing to eating disorder symptoms, viewed dimensionally. Putative mechanisms are discussed. However, a significant number of eating disorder phenotypes and Internet-related activities remain under-researched. Specific facets of engagement with the online environment appear to confer risk for feeding and eating problems, evidence being strongest for non-clinical studies using dimensional measures. More research is required to rigorously confirm causal effects, including in patients meeting formal diagnostic criteria for eating disorders. We also highlight the need for high-quality evidence to explore how eating disorder phenotypes are commonly as well as uniquely affected by different online activities. Such research is needed in order that scientific understanding in this area can be translated to protect those most at risk of disordered eating, including through changes in public health approaches and clinical practice.

Depression and social anxiety mediate the relationship between parenting styles and risk of eating disorders: A study among Arab adolescents

In multicultural Israel, the prevalence of eating disorders (EDs), a common chronic disorder among Western adolescents (especially females), has risen for Arab adolescents, who belong to an Eastern collectivist society. The study examines family and psychological factors that may increase the risk of EDs among Muslim Arab adolescents. We expected social anxiety and depressive symptoms to mediate the association between parenting styles and risk of EDs, with possible gender differences in the mediation model. Participants were 613 Muslim adolescents (394 females and 219 males); mean age = 15.4 ± 1.6; range = 12-19. The analyses revealed that the severity of depressive symptoms and especially social anxiety mediate the relationship between authoritarian parenting style and risk of EDs. Females reported higher levels of risk of EDs, social anxiety, depression and authoritative parenting style than males; no differences appeared for authoritarian or permissive parenting styles. The research sheds new light on risk factors for EDs and the likelihood of authoritarian parenting style and social anxiety being involved in the aetiology of EDs among Arab adolescents. The outcomes meaningfully add to understanding of specific psychological processes that may be associated with the risk of EDs in this population.

Prevalence of autism spectrum disorder and autistic traits in children with anorexia nervosa and avoidant/restrictive food intake disorder

BACKGROUND

Autism spectrum disorder (ASD) and feeding and eating disorders (FEDs) such as anorexia nervosa (AN) are strongly linked as evidenced by frequent comorbidity and overlapping traits. However, eating and social behaviors are shaped by culture, so it is critical to examine these associations in different populations. Moreover, FEDs are heterogeneous, and there has been no examination of autistic traits in avoidant/restrictive food intake disorder (ARFID).

METHODS

Therefore, we investigated the prevalence of ASD and autistic traits among Japanese children with AN (n = 92) or ARFID (n = 32) from a prospective multicenter cohort study using the Autism Spectrum Quotient Children's version (AQC) and Children's Eating Attitudes Test (ChEAT26).

RESULTS

ASD prevalence was high in both AN and ARFID (16.3 and 12.5%, respectively). The AN group exhibited significantly higher scores on all AQC subscales than an age-matched healthy control (HC) group, but there were no significant correlations between AQC scores and ChEAT26 scores. In the AFRID group, AQC scores did not differ from HCs, but significant correlations were found between total AQC and ChEAT26 scores and between several AQC and ChEAT26 subscales.

CONCLUSIONS

Both the AN and ARFID groups had high prevalence rates of ASD. The AN group showed a significantly higher degree of autistic traits than the HC group; however, no difference was found between the ARFID and HC groups. Clinicians need to be aware of these rates when working with children with ED.