Eating Disorders and Subthreshold Symptoms in Pregnancy and the Postpartum Period: an Overview of Recent Research and Future Directions for Researchers and Clinicians.

Previous epidemiological studies of bulimia nervosa have generated differing estimates of the incidence and prevalence of the disorder. These differences are attributable, in part, to varying definitions of the illness and a range of methodologies. The authors sought to define the prevalence of bulimia nervosa in a nonclinical community sample, examine the clinical significance of DSM-III-R threshold criteria, and examine comorbidity. Subjects across Ontario (N = 8,116) were assessed with a structured interview, the World Health Organization Composite International Diagnostic Interview, with specific questions added for bulimia nervosa. Subjects who met DSM-III-R criteria for bulimia nervosa were compared with those who were missing only the frequency criterion (two or more binge-eating episodes per week for 3 months). In this sample, the lifetime prevalence of bulimia nervosa was 1.1% for female subjects and 0.1% for male subjects. The subjects with full- and partial-syndrome bulimia nervosa showed significant vulnerability for mood and anxiety disorders. Lifetime rates of alcohol dependence were high in the full-syndrome group. Rates of parental psychopathologies were high in both bulimic groups but tended to be higher in the subjects with full-syndrome bulimia nervosa. Both bulimic groups were significantly more likely to experience childhood sexual abuse than a normal female comparison group. This study confirms other prevalence estimates of bulimia nervosa and its comorbid diagnoses from studies that were based on sound methodologies. It also points to the arbitrary aspects of the frequency of binge eating as a diagnostic threshold criterion for the disorder.

The COVID-19 Pandemic and Eating Disorders: A Wake-Up Call for the Future of Eating Disorders Among Adolescents and Young Adults

ObjectiveThis review aimed to examine the validity of self‐report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity.MethodFive databases were searched from inception to September 2020 for studies assessing validation of self‐report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013).ResultsTwenty‐seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge‐eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16–.88, specificity = .62–1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07–1.0, specificity = .0–1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge‐Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general.DiscussionQuestionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co‐morbid EDs and overweight/obesity.Public SignificanceIndividuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.

Eating disorders symptoms in pregnancy: A longitudinal study of women with recent and past eating disorders and obesity

The presence of subthreshold psychotic symptoms in adolescents with eating disorders is poorly described. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables. Ninety-four adolescents diagnosed with eating disorders were interviewed, focusing on clinical anamnesis and sociodemographic data collection. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to assess the presence (HR+) or absence (HR-) of subthreshold psychosis. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders. Attenuated psychotic symptoms were highly frequent (84% of subjects). HR+ patients experienced more frequently purging behaviors and dysmorphophobia and received a greater amount of antipsychotic drugs. Compared to HR- counterparts, HR+ patients reported higher eating disorders severity and psychological symptoms (i.e., ineffectiveness, interpersonal and affective problems) associated with eating disorders. Finally, a significant correlation between global social functioning and eating disorders severity emerged only for HR- subjects. These descriptive data are warranted to identify a potential psychotic core in eating disorders, mainly concerning body image and weight as well as specific psychological features. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms.

Subthreshold autism spectrum disorder in patients with eating disorders

To identify associations between eating disorder (ED) attitudes and behaviors and scores on the MMPI-2-RF in college students. The study included 425 undergraduate students (38.5% males and 61.5% females) with a mean age of 19.13 (SD = 1.77). Measures included the MMPI-2-RF and the Eating Disorder Examination Questionnaire. Correlations and relative risk ratios were computed between MMPI-2-RF scores and ED variables. Scores on several MMPI-2-RF Scales were associated with the presence of subthreshold ED symptoms. Manifestations of emotional/internalizing dysfunction were associated with all ED symptom presentations. The results of this study identified narrowly defined personality and psychopathology constructs relevant to, and found across college students experiencing various subthreshold ED symptoms. Considering this additional information in ED screening or treatment planning could reduce the likelihood of subthreshold symptoms worsening and increase the effectiveness of ED interventions with at-risk college student populations. Level III, evidence obtained from well-designed cohort or case-control analytic studies.

Treatment of Eating Disorders in Children, Adolescents, and Young Adults

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

BackgroundThe perinatal period can be a challenging time for women with current or historical eating disorder (ED) experience. Maternal EDs are associated with risks to both the mother and the child. During pregnancy, women are more likely to disengage with ED behaviours for the good of their growing baby. However, the postpartum period is a particularly risky period for the re-emergence or worsening of ED behaviours, irrespective of women’s pre-pregnancy ED status. Little is known about the factors which influence ED symptomology during the postpartum period. The aim of this study was to develop an understanding of the factors operating in the postpartum experience that influence ED symptomology.MethodsSemi-structured interviews were conducted with 12 women who had experience of an ED before becoming pregnant. Interview took place during or after the postpartum period, with women reflecting specifically on the postpartum period. Interviews were analysed using Reflexive Thematic Analysis.ResultsFour themes were developed within the interview data; (1) Embracing the self, (2) Motherhood: an ED enabler or protector?, (3) ED as a ‘plaster’ for emotional distress, and (4) The influential voices of others. Theme 1 captures participants’ reports of the primary ED recovery facilitator, with a focus on self-awareness, self-understanding, self-compassion, and self-identity. Themes 2–4 describe a ‘triangle of powers’ which interacted with one another to influence participants’ ED symptomology both positively and negatively during the postpartum period.ConclusionA new model is proposed which predicts that ED symptomology during the postpartum period is influenced by a complex interaction between various internal and external factors. Health care professionals encountering women with EDs during the perinatal period should be aware of these factors, to provide attuned and individualised care and improve outcomes for mothers and babies. Increased awareness how EDs may present during the postpartum period is needed.

Childhood sexual abuse (CSA) is implicated in the etiology of eating disorders (ED) and health problems in females, but prospective evidence is limited. ED symptoms are widespread but often undertreated, potentially contributing to subsequent ED-related health problems. Using data from Trickett and colleagues’ Female Growth and Development Study, the present report investigated the prospective associations among CSA, ED symptomatology in adolescence, and ED-related health problems in adulthood. Females with substantiated CSA and demographically-matched comparisons (N = 135) were followed at mean ages 11 through 24. Symptom counts and diagnoses of anorexia nervosa (AN) and bulimia nervosa (BN) over the lifetime were assessed in adolescence. Self-reported physical health problems were assessed in adulthood. Controlling for depression, anxiety, and age, CSA participants reported more symptoms and related health problems of BN, but not AN, relative to comparisons. CSA was not associated with the likelihood of receiving a diagnosis for either ED. BN symptom count accounted for a portion of the association between CSA and increased BN-related health problems. This report provided prospective evidence for the associations between CSA and BN symptoms and BN-related health problems. These findings support the recommendations to bolster resources and expertise for trauma-informed ED screening and treatment, ED treatments for patients with subthreshold symptoms, and enhanced treatments addressing ED and health problems for sexual abuse survivors.

To examine suicide risk by eating disorder severity and symptom presentation in a nationwide sample of college students. The Healthy Minds Study is the largest mental health survey of college populations in the United States. We analyzed the most recent available data (2015-2017) with 71,712 randomly selected students from 77 campuses. We estimated associations between two measures of suicidality (ideation and attempts) and three validated measures of eating disorder symptoms (the SCOFF, weight concerns scale, and the eating disorder examination questionnaire binge and purge items). Importantly, we also controlled for co-occurring symptoms of depression and anxiety, based on validated screening tools. The large, diverse sample provided a unique opportunity to assess whether certain individual characteristics were associated with increased risk. Eating disorder symptoms, even at subthreshold levels, were highly predictive of suicidality. Relative to students with no apparent eating disorder symptoms, students with the highest symptom levels (a SCOFF score of 5) had 11 times higher odds of attempting suicide, while those with subthreshold symptoms had two times higher odds. We also observed a strong association between suicide attempts and eating disorder presentations that included purging. Students from marginalized backgrounds, particularly gender and sexual minorities, were at increased risk for suicide and eating disorders. In the largest known study to date, findings suggest that eating disorders should be a priority within broader campus suicide prevention efforts, should be assessed along a continuum of severity and symptom presentation, and should focus on reaching vulnerable students.

Background/Objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children’s health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation. Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother’s health and baby’s health and development accessed through the Pregnant Women’s Health Bulletin and the Child and Youth Health Bulletin using the national health records. Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers. Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood.

Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9–4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2–1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6–2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1–1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.

Previous work suggests that eating disorder symptoms diminish with pregnancy. However, little prospective study has been conducted, and little is known about pregnancy symptoms in eating disorder not otherwise specified. This research prospectively studies both eating behaviors and disordered eating cognitions in pregnant women with various eating disorder diagnoses. Forty-two participants became pregnant during 4-year follow-up of 385 women with full or subthreshold anorexia nervosa, bulimia nervosa, or binge eating disorder. Participants completed the Eating Disorders Examination (EDE) at 6-month intervals. Mixed modeling procedures were used to examine change in eating disorder cognitions, binge eating, and purging. EDE restraint, EDE shape concerns, EDE weight concerns, binge eating, and purging diminished from prepartum to intrapartum, but returned to approximately baseline levels postpartum. In this longitudinal sample of women with diverse eating disorder diagnoses, eating disorder symptoms improved during pregnancy, but worsened postpartum. These results highlight pregnancy as a potential time for eating disorder interventions.