Anorexia nervosa (AN) and autism are distinct conditions, yet individuals with AN often exhibit elevated autistic traits. These traits are linked to complex clinical presentations, but their impact on AN remains unclear. This longitudinal study investigates associations between autistic traits, AN symptoms, and weight recovery in adolescents with first-onset AN. The study compared 66 females with first-onset AN and 64 typically developing (TD) controls. Autistic traits, AN symptoms, and weight recovery were assessed using the Social Responsiveness Scale (SRS), Eating Disorder Examination (EDE),and standardized deviation score for weight-for-height (SDS weight-for-height). Measurements at baseline and 1year later were analyzed using linear regression models. Adolescents with AN exhibited higher baseline autistic traits than TD controls. Over 1year, AN symptoms and SDS weight-for-height improved significantly in the AN group, while autistic traits remained stable. No significant associations were found between baseline autistic traits and clinical outcomes or between changes in autistic traits, AN symptoms, and SDS weight-for-height. The stability of autistic traits despite improvements in AN symptoms and weight suggests these traits may not influence the initial trajectory of first-onset AN in adolescence. Further longitudinal research is needed to explore their long-term impact on AN progression.

Our aim was to evaluate the diagnostic accuracy of the Eating Disorder Examination Questionnaire (EDE-Q) scores and establish general and context-specific cut-off points for anorexia nervosa (AN) in Australian women. The sample included 67 women with AN, 41 women with a history of AN and restored weight, 100 women with self-reported AN, 27 sisters of individuals with AN, 73 healthy controls, and 597 community controls. ROC analysis assessed the EDE-Q's accuracy and determined cut-off scores in different contexts. The EDE-Q showed varying discriminative ability, with cut-off scores differing by context. In the most realistic scenario-diagnosed AN versus community controls drawn from the general population, reflecting typical screening contexts-, the Area Under the Curve (AUC) was 0.88, and a cut-off score of 2.775 yielded sensitivity of 0.91 and specificity of 0.71, recommended as the general cut-off for AN in Australian women. These findings indicate the EDE-Q is useful for identifying individuals at risk of AN but has limited diagnostic capacity due to moderate specificity. While the EDE-Q can guide initial screening using a 2.775 cut-off on the Global score, it is primarily a screening tool and should be complemented by further assessment to confirm diagnosis. Overall, our study provides evidence-based guidance for establishing a general EDE-Q cut-off for AN and informs the definition of context-specific thresholds.

Orthorexia nervosa versus anorexia nervosa: Comparison of diagnostic and behavioral features in at-risk young adults.

The current study aimed to investigate the mediating mechanisms linking adverse childhood experiences (ACEs) to anorexia nervosa (AN) and to examine whether distinct patterns of ACE exposure are associated with differential risks and mediation pathways. Data for 9746 female individuals were collected from nationally representative Japanese surveys. ACEs were assessed using a 15-item Japanese ACE questionnaire, and AN was identified via self-reported physician diagnosis. Causal mediation analysis and structural equation modelling were used to examine indirect pathways, while latent class analysis (LCA) was used to identify ACE patterns. Greater ACE exposure was significantly associated with a higher AN prevalence. In mediation analyses, loneliness, psychological distress, and brooding rumination were the most influential mediators, forming a latent "negative affectivity" factor that significantly mediated ACEs and AN. The LCA identified four ACE profiles: "low adversities", "psychological abuse", "poverty", and "multiple adversities". Relative to the "low adversities" group, other classes showed higher AN prevalence, although class differences in prevalence and mediators were modest. We demonstrated that the number of ACEs, rather than their patterns, increases AN risk. Negative affectivity was a consistent strong mediator across ACE patterns; thus, it can be an important target for intervention in trauma-exposed individuals with AN.

Anorexia nervosa (AN) is a severe psychiatric disorder with high morbidity and increased relative mortality compared to the general population. Involuntary treatment (IT) is implemented after exhausting voluntary treatment options. This study investigates mortality in patients with AN following IT, using IT as an indicator of patient vulnerability. A register-based cohort study including individuals diagnosed with AN (ICD-10: F50.0, F50.1) from 2000 to 2016 at any Danish hospital and with an inpatient admission following their AN diagnosis. The exposure was the first instance of any IT event and categories of IT after AN. IT could be associated with AN or any other diagnosis. The outcome was mortality; all-cause and divided into deaths from diseases and medical conditions, external causes, or suicide. Excess mortality was estimated as hazard ratios (HR) using Cox proportional hazards regression. The model was adjusted for sex, age at AN diagnosis, birth year, prior IT, self-harm, and other psychiatric morbidities. Over the study period 4425 individuals (93.3% female; mean age at diagnosis = 22, SD = 12) were included in the study. Of these, 821 individuals received IT (18.5%) and 206 individuals (4.7%) died. The HRs were elevated for all-cause mortality (HR = 2.21, [95% CI: 1.54-3.17]), external causes (HR = 3.88, [95% CI: 1.94-7.77]), and suicide (HR = 5.30, [95% CI: 2.07-13.54]). The analysis of IT categories only showed an elevated HR for electroconvulsive therapy and somatic concerns (HR = 1.96, [95%CI: 1.04-3.67]). Despite IT primarily being used to safeguard the life of the most vulnerable patients, mortality for those who received IT was elevated. The results indicate that this patient group requires sustained clinical attention.

Anorexia nervosa (AN) is a severe psychiatric disorder displaying an altered gut microbiome. Faecal microbiome transplantation (FMT) has emerged as a powerful research tool and potential treatment option in AN due to the microbiome-gut-brain axis. Current studies are limited and reveal variable FMT protocols. This leads to heterogeneous outcomes and complicates drawing definitive conclusions from existing literature. This review aims to compile and assess the different protocols and develop recommendations on ideal donors, handling of faeces, recipients, duration/frequency of FMT, and measuring transfer success for future FMT studies regarding AN. We systematically screened three databases (Pubmed, Embase, Web of Science), identifying 13 studies, including two human case reports, one human study protocol, and 10 animal studies. While all studies demonstrated microbial alterations in the recipients, not all animal studies successfully induced an AN/underweight phenotype, suggesting that precise coordination of study protocol components to allow further refinement is essential. Researchers should prioritise clear, comprehensive, and transparent documentation to ensure the interpretability and reproducibility of FMT procedures. Detailed reporting will enable more meaningful comparisons across studies, deepen our understanding of the microbiome's role in AN, and help identify methodological factors that influence outcomes. Ultimately, completeness of documentation in FMT studies in AN has substantial potential to support future clinical applications and improve patient care.

Sleep disorders are frequently reported in individuals with anorexia nervosa (AN). Autism spectrum disorder (ASD) is strongly associated with both anorexia nervosa and sleep disturbances. We study the possible influence of the association of ASD to AN to the development of sleep disorders. A retrospective cohort study design was used, including all patients followed for AN or ASD in the child and adolescent psychiatric unit at the Salvator hospital, Marseille, between January 2019 and January 2024. We had included 491 patients, mean age was 15.16years±3.11years. Sleep was assessed with the PSQI, ESS and ISI; autistic traits with the Autism-Spectrum Quotient (AQ). Sleep disorders were significantly more prevalent in the anorexia nervosa binge/purge subtype group than the Anorexia nervosa restrictive subtype or the ASD groups with pathological scores in the PSQI in 78% (p<10-3), ISI in 46.3% (p=0.035) and in the ESS in 58.5% (p=0.017). The prevalence of sleep disorders was significantly higher in AN patients having pathological AQ score. However, when controlling for confounding factors, this association was no more significant. Our findings were inconclusive in establishing a clear association between autistic traits and sleep disorders in individuals with anorexia nervosa. However, a potential influence cannot be ruled out.

Compulsive exercise is a common behaviour among persons with eating disorders, particularly in those with anorexia nervosa (AN) and bulimia nervosa (BN). In the current study, we examined psychometric properties of a German version of the eight-item Commitment to Exercise Scale (CES) with a four-point scale response format. Data of N=2424 persons with AN and BN who completed the CES among other measures as part of the routine diagnostic assessment at admission to and discharge from inpatient treatment were analysed based on a preregistered protocol (https://doi.org/10.17605/OSF.IO/Z2RYW). The CES had high internal consistency and a one-factor structure with measurement invariance across age and diagnostic groups. Large correlations with other measures of compulsive exercise supported convergent validity and small-to-moderate correlations with other measures supported divergent validity. Scores on the CES were sensitive to change as they moderately decreased during inpatient treatment, with changes in compulsive exercise being larger in males and persons with AN that in females and persons with BN. The CES has sound psychometric properties in persons with AN and BN. Given its brevity, it may be favoured over lengthier instruments for assessing compulsive exercise in research and clinical practice.

Anorexia nervosa - commonly referred to as anorexia - is a significant mental health condition characterised by excessive weight loss and distorted body image. However, although anorexia may be regarded primarily as a mental health issue, nurses from all fields and specialties should have the necessary knowledge and skills to identify and care for individuals with the condition in the community and non-specialist healthcare settings. This article outlines the aetiology of anorexia and considers how individuals with the condition might be identified in primary care or emergency settings. It details the relevant assessment methods and appropriate management of anorexia, including refeeding. The article also considers the role of families and carers in providing support.

Autistic people report poorer treatment outcomes for their eating disorder (ED) in comparison to non-autistic peers. Eating disorder focused family therapy (FT-ED) is the leading outpatient intervention for adolescents with Anorexia Nervosa (AN). The aim of this study was to explore the experiences of parents of autistic young people who have received FT-ED, and any recommended adaptations to treatment. Parents of an autistic young person who had received FT-ED within the last 3years were invited to take part in interviews. Transcripts were analysed using reflexive thematic analysis. Twelve parents of autistic young people with AN completed interviews and analysis generated four core themes: (1) Questioning the principles of FT-ED, (2) Navigating the FT-ED process, (3) Parental (dis)empowerment, (4) Adapting FT-ED. This paper is the first exploration of parents of autistic young peoples' experience of FT-ED for AN, and it highlights possible treatment adaptations for this population. It is part of a larger body of work to consider adaptations to FT-ED, with the aim of making ED treatments more effective, accessible and acceptable for autistic young people and their families.

Transdiagnostic Prevalence and Characteristics of Suicidality Across the Spectrum of Restrictive Eating Pathology.

Cognitive and emotional deficits are common in eating disorders (EDs), especially anorexia nervosa (AN) and bulimia nervosa (BN), and can hinder engagement and recovery. This pilot single-group pre-post study examined the feasibility and preliminary outcomes of group-based Cognitive Remediation and Emotion Skills Training (CREST) for adult women with AN/BN in a day care programme setting. Fifty seven women enroled; 32 completed the 5-week, 10-session programme. Completers and non-completers were compared to identify predictors of adherence. Emotional functioning was assessed using symptom and trait self-report measures, including the TAS-20, Zung Self-Rating Anxiety Scale, BDI-II, EDE-Q, TEQ, and the Self-Compassion Scale. Feasibility was evaluated based on enrolment, completion rates, and treatment adherence. Preliminary analyses indicated decreases in anxiety (SAS, p<0.001) and depression (BDI-II, p<0.001), alongside higher self-compassion (SCS, p<0.001). Results should be interpreted cautiously given the absence of a control group and notable attrition; improvements may reflect combined effects of CREST and standard multidisciplinary care. Higher BMI and shorter illness duration were associated with completion; in regression, only more previous hospitalisations remained significant. Pilot findings suggest that group-based CREST may represent a feasible adjunctive intervention for patients with AN and BN. Further controlled studies are required to disentangle its specific effects from standard care to confirm its effectiveness.

Anorexia Nervosa (AN) is a severe psychiatric disorder marked by excessive restriction and automatic avoidance of fat and high-caloric foods, driven by fear of weight gain and guided by negative encoding of some foods that are essential for health. These impairments seem to reflect a conflict between willingness-to-eat and fear of negative outcomes, leading to maladaptive decisions prioritizing hypocaloric foods. We developed an experimental paradigm to investigate the link between these cognitive disturbances by monitoring gaze during three tasks evaluating the health, taste, and preference values of three food categories: hypocaloric, hypercaloric, and intermediate calorie foods. We evaluated the reject rate and quantity wanted of each food item to compose their meal. To consider different patients profiles, we applied this protocol to 67 subjects across two subtypes: AN-Restrictive (n = 37), and AN-Binge-Purge (n = 30) and 37 healthy controls. Both AN subtypes showed lower hedonic ratings for high-calorie foods and strong correlations between taste and health perceptions (absent in controls), though AN-BP provided lower overall health ratings than AN-R. Eye-tracking revealed subtype-specific patterns: AN-BP exhibited reduced gaze on food images and increased non-stimulus area fixation during preference evaluations, while AN-R showed greater fixation on food names during willingness-to-eat decisions. Furthermore, presentation context modulated food selection in both patient groups: intermediate foods were preferentially chosen over hypercaloric alternatives but rejected in favor of hypocaloric options, demonstrating that choices are relative rather than absolute. By shedding light on mechanisms of food restriction and avoidance, this study holds promise for refining therapeutic strategies; contextual manipulation of food choices may offer intervention potential with intermediate-calorie foods potentially serving as a bridge during nutritional rehabilitation.

Prevalence of eating disorders, eating disorder risk, and body image dissatisfaction across Africa: A systematic review and meta-analysis.

Psilocybin has been shown to induce fast and sustained symptoms improvements across various psychiatric conditions, yet its long-term mechanisms of action are not fully understood. Initial evidence suggests that longitudinal functional and structural brain changes implicate fronto-striatal-thalamic (FST) circuitry, a broad system involved in goal-directed behavior and motivational states. Here, we performed secondary analyses and applied computational modeling to resting-state fMRI data from a within-subject longitudinal psilocybin trial in psychedelic-naïve healthy volunteers. We first showed that dynamic FST activity increased 4 weeks after a full dose of psilocybin. We then proceeded to mechanistically account for these changes by providing tentative model-based support that reductions in the structure-function coupling contribute to increased dynamic FST activity postpsilocybin. Finally, we used computational approaches to show that psilocybin induces longitudinal increases in bottom-up and reduced top-down modulation of FST circuits. We then used publicly available receptor maps to show that cortical reductions in top-down modulation are linked to regional 5-HT2A receptor availability, while increased information outflow via subcortical and limbic regions relates to local D2 receptor availability. Together, these findings suggest that increased FST flexibility weeks after a high dose of psilocybin is linked to serotonergic-mediated decreases in top-down information flow and dopaminergic-mediated increases in bottom-up information flow. This long-term functional re-organization of FST circuits may represent a common mechanism contributing to the potential clinical efficacy of psilocybin across various neuropsychiatric disorders including substance abuse, major depression, and anorexia nervosa.

BACKGROUND Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for type 2 diabetes and chronic weight management in adults meeting clinical criteria. Appetite suppression and gastrointestinal intolerance can markedly reduce intake. This report describes a 30-year-old woman with tirzepatide-associated euglycemic ketoacidosis after unsupervised use of tirzepatide obtained without a prescription for weight loss, despite having no history of obesity or diabetes. CASE REPORT A 30-year-old woman with a body mass index of 24.8 kg/m² and no known diabetes presented with 4 days of severe nausea, approximately 10 vomiting episodes daily, poor intake, and periumbilical abdominal pain. She had self-administered tirzepatide 2.5 mg once weekly and increased the dose to 5 mg 1 week before presentation. Initial testing showed high anion gap metabolic acidosis with a pH of 7.15, bicarbonate level of 10.5 mEq/L, and an anion gap of 24. Lactate was in the normal range. Urine ketones were positive, serum ketones measured 4.5 mmol/L, and glucose level was 4.2 mmol/L. Acidosis persisted after administration of 1.5 L crystalloid, prompting intensive care unit admission. Tirzepatide was stopped. She received 10% dextrose, lactated Ringer's solution, thiamine, antiemetics, electrolyte monitoring and replacement, and gradual refeeding. The anion gap closed and ketones normalized within 36 hours, without bicarbonate therapy or insulin infusion. CONCLUSIONS Tirzepatide-related nausea, vomiting, and caloric deprivation can be associated with significant euglycemic ketoacidosis even without diabetes or obesity. Clinicians should consider starvation ketoacidosis in tirzepatide users with vomiting, poor intake, abdominal pain, and high anion gap metabolic acidosis.

GLP-1 receptor agonists and surgical care: implications for bariatric Procedures, perioperative Outcomes, and nutritional optimization.

The global rise in obesity is predominantly driven by energy dense foods consumption and sedentary lifestyles that contribute to a growing burden of metabolic and neuroinflammatory comorbidities. Obesity is linked to a chronic low-grade inflammatory profile, as well as to a localized neuroendocrine imbalance and inflammatory response in the brain, including regions regulating energy homeostasis, reward and motivational centers. Anti-obesity medications that reduce body weight are being extensively used across the world, and the specific cerebral mechanisms underlying its action are yet to be clarified. We investigated the cerebral and systemic effects inherent to obesity development and treatment with celastrol, an anti-obesity and anti-inflammatory agent, in a murine model of diet-induced obesity (DIO) using a multimodal approach. We characterized obesity progression and celastrol acute treatment by comparing body weight (BW), food intake, changes in brain microstructure by in vivo magnetic resonance imaging (MRI) and ex vivo by immunofluorescence (IF), investigated its metabolic rearrangements using 1H high-resolution magic angle spinning spectroscopy and draw the hormonal profiles between DIO and control animals, with or without treatment. Our findings indicate that obesity induces detectable neuroinflammation, evident through diffusion MRI alterations and increased glial activation, with quantifiable morphological changes. Treatment resulted in significant BW reduction, diffusion MRI signal changes, particularly in the hypothalamus, a decrease in glial activation, a regularization of cerebral osmolyte concentrations, decreased cellular proliferation and astrocytic metabolism markers, and anti-inflammatory cytokine changes. These results support the role of celastrol as an anti-obesity treatment, with anti-inflammatory effects in the hypothalamus and associated cerebral metabolic rearrangements, and prove MRI techniques as valid tools to characterize its effects.

Evolutionarily conserved neural circuits evolved that mediate switching between feeding and foraging for food, depending on environmental conditions such as food scarcity and internal state [1-3]. Activity-based anorexia is a phenomenon observed ubiquitously in normal mammals that emerges under conditions of time-restricted food availability and continuous access to running wheels. Under these experimental conditions, rodents progressively lose body weight and develop paradoxical hypophagia and compulsive wheel running, which can prove fatal if left unchecked. On the other hand, rodents survive indefinitely under conditions of either time-restricted food access or running wheel availability. In this review, we discuss preclinical studies within the past decade which used modern genetic circuit-dissecting tools including chemogenetic, optogenetic, and calcium imaging, to dissect the neural circuitry modulating activity-based anorexia. We highlight how circuits interconnecting the hypothalamus, prefrontal cortex, amygdala, mesolimbic system, and monoaminergic nuclei, interact to modulate animals' decision to feed or forage in the activity-based anorexia paradigm. We then highlight how these recent findings have aided in identifying pathophysiological mechanisms underlying neuropsychiatric disorders characterized by the maladaptive prioritization of exercise over feeding. Finally, we suggest approaches for the development of targeted therapeutics for anorexia nervosa, which has no approved pharmacological treatments.

Maladaptive exercise is a common symptom of eating disorders (EDs). While several measures exist to assess current maladaptive exercise, there are no validated self-report tools to assess maladaptive exercise history-an important symptom domain among individuals with lifetime EDs. Using data from a large sample of individuals with at least one lifetime ED diagnosis across four countries (N=31,670), the current study aimed to validate and refine the Eating Disorders 100,000 Questionnaire-version 3 exercise items to create a brief measure of lifetime and current maladaptive exercise, suitable for large-scale epidemiological research and clinical screenings. Five non-redundant operationalisations of maladaptive exercise were identified ('Any Maladaptive Exercise', 'Regular Maladaptive Exercise', 'Compensatory Exercise', 'Excessive Exercise', 'Current Maladaptive Exercise'). Maladaptive exercise history was present across all lifetime ED presentations assessed, though endorsement levels varied based on scoring operationalisation. Individuals reporting a history of anorexia nervosa reported the highest levels of endorsement of most constructs, closely followed by bulimia nervosa. Compensatory exercise was endorsed most frequently among those reporting a history of bulimia nervosa relative to other diagnostic groups. Six key items were recommended as a brief screening assessment to capture maladaptive exercise history in EDs. EDGI is a registered clinical trial (clinicaltrials.gov ID: NCT04378101).