Change in self-esteem after weight-loss treatment. Alexithymia as a psychological mechanism.

The addicted brain: How processed foods hijack reward pathways.

Craving in eating disorders: Mapping the concept through a systematic review.

ABSTRACT Ethics consultation’s (EC) role in supporting healthcare professionals, patients, and families confronted by eating disorders (ED) is under-described in the literature. We used qualitative conceptual content analysis to characterize the ethical issues and contextual features of EC involving patients with Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-Eating Disorder (BED), Avoidant Restrictive Food Intake Disorder (ARFID), or Other Specified Feeding or Eating Disorder (OSFED) and compared adult vs. pediatric settings at a single institution from 2015 to 2024. We identified 40 consultations (14 adult, 26 pediatric) for 25 patients (12 adult, 13 pediatric). Most were female (n = 18, 72%), White (n = 20, 80%), non-Hispanic (n = 23, 92%), and diagnosed with AN (n = 13, 52%); none were diagnosed with BED or OSFED. The primary ethical issue overall (n = 23, 57%) and in the pediatric setting (n = 20, 77%) was patient assent/treatment over objection. No single ethical issue was prominent in the adult setting. The most common contextual feature overall (n = 21, 52%) and within adult (n = 7, 50%) and pediatric (n = 14, 53%) settings was legal involvement. EC patterns suggest differences in ethical concerns based on setting and age; a tailored approach may be warranted. Our results raise concerns that EC is underutilized within subsets of the ED population, necessitating further research.

Binge-eating disorder (BED) frequently co-occurs with dissociative symptoms and psychiatric comorbidities, yet potential neurological underpinnings remain underexplored. We report an 18-year-old female with BED presenting with frequent binge episodes accompanied by memory lapses and altered consciousness. Initially attributed to dissociation, comprehensive evaluation revealed previously undiagnosed absence epilepsy, confirmed by EEG and neuroimaging. Neuropsychological assessment demonstrated significant impairments in working memory, processing speed, and divided attention. Treatment with lamotrigine (200mg/day) resulted in complete remission of binges occurring during absence seizures and substantial cognitive improvements across multiple domains. This case highlights the critical importance of neurological evaluation in eating disorder patients presenting with altered consciousness or memory lapses. The temporal relationship between seizures and binge episodes, coupled with treatment response, suggests potential neurobiological mechanisms linking epileptic activity to disinhibited eating behaviors. Clinicians should maintain heightened awareness of possible epilepsy-eating disorder comorbidity and consider integrated treatment approaches addressing both neurological and psychiatric components.

BackgroundEating difficulties are increasingly prevalent among young people, yet service capacity remains limited. Digital interventions may provide accessible, scalable support, particularly for those with mild, subthreshold, or early-stage symptoms who do not meet criteria for specialist care. Low self-esteem is widely recognized as a key psychological risk factor in the onset and persistence of eating disorders, and negative self-evaluation, particularly around body image and social acceptance, can heighten vulnerability to the maladaptive thoughts and behaviors seen in conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. Clarifying this relationship is essential for developing effective prevention and early intervention strategies.ObjectiveThis pilot case series reports on 5 individuals aged 19-25 (mean 22, SD 2.19) years with mild eating disorders who used the Worth Warrior app, a mobile intervention incorporating principles of enhanced cognitive behavioral therapy strategies targeting low self-esteem, body image concerns, and disordered eating behaviors.MethodsAn uncontrolled 3-phase design (baseline, post–app familiarization, and follow-up) was used. Participants completed standardized self-report tools, including the Eating Disorder Examination Questionnaire and Rosenberg Self-Esteem Scale. Feedback on usability, acceptability, and safety was also collected via online questionnaires.ResultsOutcome measures at follow-up showed improvements in eating disorder symptomatology in 3/5 cases, and in self-esteem in 4/5 cases; those with milder symptomatology indicated the most benefit. Reductions in eating concerns, weight concerns, and related behaviors were observed in most, though not all, cases. Participants valued interactive enhanced cognitive behavioral therapy features and journaling functions, while noting areas for improvement such as reminders and incentives for use and preventions for maladaptive use of the free-text facilities.ConclusionsFindings suggest the Worth Warrior app may be suited as an acceptable and effective standalone tool for individuals with mild eating disorder symptoms, and used as an adjunct to traditional treatment alongside clinician supervision for those with more severe presentations to promote the greatest patient safety. These exploratory case study findings suggest that the app has the potential to support improvements in self-esteem and mild eating disorder symptomatology; however, as a preliminary case series, these results are not generalizable but provide a foundation for larger, controlled studies of digital early intervention.

We aimed to determine if the high co-occurrence rates between food addiction (FA) and binge-spectrum eating disorders (BSEDs) are partially due to their respective measures assessing similar symptoms. Specifically, we aimed to clarify whether the Yale Food Addiction Scale 2.0 (YFAS 2.0) assesses a distinct symptom profile from common BSED measures (e.g., measures of binge-eating disorder (BED) or bulimia nervosa). Because FA does not include compensatory behaviors, our comparison focused specifically on FA and binge-related features of BSEDs. We conducted a content analysis on the YFAS 2.0 and five of the most cited BSED measures. Five trained coders inductively assigned symptom codes to every item from each measure. Because FA does not include compensatory behaviors, we removed compensatory-behavior items from the BSED measures prior to coding to focus on binge-related content. We then calculated Jaccard similarity coefficients to quantify symptom overlap between measures. The YFAS 2.0 showed very low symptom overlap with the BSED measures (Jaccard range = 0.08-0.19). However, nearly half (47%) of its symptoms were captured by at least one BSED measure. The symptoms assessed by the YFAS 2.0 and not the BSED measures tended to focus on the impairment and consequences of eating behavior, whereas the BSED measures focused more on the cognitive features of eating behavior. This comparison revealed both differences and similarities between FA and BSED measures. Although the YFAS 2.0 showed limited overlap with any single BSED measure, about half of its symptoms were represented in at least one BSED measure, indicating partial shared content. The FA and BSED measures also reflect different theoretical emphases, with FA focusing on impairment and BSEDs emphasizing cognitive and behavioral features. Further clarifying how FA and BED relate will require integrating measurement patterns with evidence on mechanisms and clinical course.

This study is the first to comprehensively examine psychometric characteristics of the three main DSM-5 eating disorder (ED) diagnoses (Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED)) amongst adult ED patients. Data was collected via an online survey from 126 licensed therapists treating an adult with an ED. Therapists provided an ED DSM-5 diagnosis for a randomly selected patient, as well as endorsed the presence of symptoms from a list of DSM criteria. Criteria endorsement varied across both the entire sample and within diagnoses. Convergence and cohesion also varied within diagnoses. The first factor analysis for DSM-5 ED criteria yielded a five-factor solution for ED criteria accounted for 78.3% of variance: (1) Binge eating, (2) Compensatory and purging behaviors, (3) Shape/weight overvaluation, (4) Drive for thinness, and (5) Absence of binging and purging. Finally, diagnostic efficiency statistics were consistent with this factor model. Overall, our findings support a new, transdiagnostic model with fear of weight gain and weight being main aspects of self-evaluation as common underlying factors amongst all EDs.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40337-025-01512-7.

The enterolimbic axis represents a novel conceptual framework which redefines gut-brain interactions by integrating gastrointestinal physiology, microbiota, incretin signaling, and affective regulation. Recent advances demonstrate that gut-derived signals influence reward processing, eating behavior, and emotional states through hierarchical circuits linking the enteric nervous system, vagal afferents, and limbic regions. Short-chain fatty acids (SCFAs) and incretins such as glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide modulate hypothalamic and mesolimbic pathways, highlighting the gut as a central regulator of metabolism. GLP-1 receptor agonists and dual gastric inhibitory polypeptide/GLP-1 agonists demonstrate profound effects on weight reduction, glycemic control, and hedonic eating, suggesting their early adoption in managing obesity, metabolic dysfunction-associated steatotic liver disease, type 2 diabetes, and binge eating disorders. We propose that gastroenterologists embrace these agents as first-line therapies, leveraging the unique endocrine role of the gut in metabolic regulation. This review integrates molecular, clinical, and therapeutic insights to outline diagnostic and precision-medicine opportunities arising from enterolimbic modulation.

Pioneer studies suggested the effectiveness of food-specific electroencephalography (EEG) and real-time functional near-infrared spectroscopy (rtfNIRS) neurofeedback (NF) trainings in the treatment of binge-eating disorder (BED). These trainings aim to improve participants' neurophysiological self-regulation. However, pretreatment neurophysiological activity, a supposed key predictor of NF outcomes, remains unexplored. This preregistered analysis (https://osf.io/xsrj3) used data from a randomized-controlled trial (DRKS00014752) on 47 adults (47 ± 13 years, 81% women) with interview-assessed BED having undergone food-specific EEG- or rtfNIRS-NF (12 sessions, over 8 weeks). Bayesian linear models explored pretreatment fronto-central high beta power (23-28 Hz; indicating increased attention) in EEG, pretreatment prefrontal oxygenation in fNIRS (indicating increased cognitive control), and rapid response (RR; early reductions in binge eating) as predictors of treatment outcomes reflecting mental and physical health at posttreatment and 6-month follow-up. Higher high beta power during passive viewing of food pictures, lower high beta power, and less oxygenation during regulatory NF tasks, as well as RR predicted more favorable primary outcomes, including reduced objective binge-eating episodes and increased abstinence from binge eating. Overall, neurophysiological predictors-especially EEG activity-showed greater predictive value than RR. The preliminary findings suggest the relevance of neurophysiological activity in the prediction of NF treatment outcomes in BED. While patients with increased involuntary attention in response to food stimuli profited most from EEG-NF, those with greater difficulties in voluntary recruitment of food-related cognitive control profited most from rtfNIRS-NF. The predictors identified could guide future treatment allocation and represent a first step toward more individualized therapy approaches.

Binge Eating Disorder (BED) is the most prevalent eating disorder and is associated with psychiatric comorbidities, health impairments, and decreased quality of life. Emerging evidence suggests that psilocybin-assisted therapy may promote cognitive and emotional flexibility and disrupt maladaptive behavioral patterns, making it a promising candidate for BED treatment. This open-label pilot study evaluated the feasibility, safety, and preliminary therapeutic effects of a single 25mg dose of psilocybin administered in the context of Acceptance and Commitment Therapy (ACT)-based psychotherapy in adults with BED (N = 5). Primary outcomes included safety measures, and exploratory outcomes included self-reported binge eating frequency, depression, anxiety, psychological flexibility, anthropometric indices, and neuroimaging biomarkers assessed over a 14-week follow-up. Psilocybin was well tolerated, with no serious adverse events. Reductions in self-reported binge eating frequency were observed across all participants and sustained through week 14. Improvements were also noted in depression, anxiety, and psychological inflexibility. Three participants showed reductions in body mass index and waist circumference. Given the open label design and small sample size, causality cannot be inferred. fMRI analyses generated preliminary signals of change-such as increased functional activation from pre- to post-intervention in the middle frontal gyrus, angular gyrus, and supramarginal gyrus in response to processed versus unprocessed food cues. Psilocybin-assisted therapy was feasible and well-tolerated in individuals with BED. The clinical and neurobiological observations provide directions for future adequately powered trials.

Binge eating disorder (BED) is one of the most common eating disorders. It is more common in young women than in other groups and can lead to adverse physical and psychological problems. Previous studies have revealed that aerobic exercise is effective in reducing overeating, but it is not clear which exercise intensity works best. This study, therefore, compared the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on body composition and mental state of young women with BED. 30 BED young women (Mage = 20.07 years, SD = 0.20) who didn't regularly participate in physical activity were selected from a Chinese university and randomly divided into 2 groups: the HIIT group (H, n=15) and the MICT group (M, n=15). Both interventions were performed twice a week for 8 weeks with the same exercise volume. During the experiment, heart rate and ratings of perceived exertion (RPE) of subjects were monitored, and the exercise volume increased gradually. Specific exercises were as follows: (1) H: treadmill exercise, 60-89% (heart rate reserve, HHR) for 4 min alternating 40-59% HHR for 3 min, and (2) M: treadmill exercise, 40-59% HHR. Binge eating scale (BES) scores, number of binges in the last week (NBLW), and the depression, anxiety, and stress scales-21 (DASS-21) scores were collected by validated questionnaires; Body mass index (BMI) and percentage of body fat (PBF) were measured by DXA before and after the experiment. Independent t-tests, Mann-Whitney U tests, two-way repeated measures ANOVA, and post-hoc tests were used in data analysis. (1) Before the intervention, there were no significant differences in age, weight, BES, NBLW, DASS-21, BMI, or PBF between the 2 groups. (2) After the experiment, all 5 clinical parameters mentioned above decreased significantly (p < 0.01) in both groups. (3) Compared to H, the BMI (1.14±0.56 vs 0.52±0.45, p < 0.05) and PBF (1.63±0.61 vs 0.96±0.58, p < 0.05) were reduced more significantly in M after the intervention. In accordance with previous findings, this study supported that aerobic exercise could treat, suggesting that both MICT and HIIT for 8 weeks could improve the body composition and mental state of BED young women, with MICT having a more significant impact on body composition. This study provided a scientific basis for making exercise prescriptions for BED patients. But more of different ages and genders, and clinical parameters should be included in future research.

Efficacy of brain-based neurofeedback interventions for binge eating: a systematic review and meta-analysis of randomized controlled trials.

Eating disorder treatment programs compared to controls for adolescents and young adults: Systematic review and three-level meta-analyses.

This umbrella review and meta-analysis synthesized recent evidence on the efficacy of psychotherapy for adults with non-underweight eating disorders (EDs). PsycINFO, Scopus, PubMed, and ProQuest Dissertations and Theses Global were searched for meta-analyses of randomized controlled trials comparing psychotherapy to treatment as usual (TAU) or control conditions in non-underweight adults with EDs (published January 2020-September 2025). Standardized mean differences (SMDs) for ED psychopathology and objective binge episode (OBE) frequency were pooled using second-order random-effects models. Subgroup analyses examined specific diagnoses and delivery format. Quality was assessed with the A MeaSurement Tool to Assess systematic Review (AMSTAR 2). Data were synthesized with Covidence and analyzed using R. Ten meta-analyses (71 RCTs) were included. Most participants were female, White, and diagnosed with bulimia nervosa or binge eating disorder. Psychotherapy yielded significant medium-to-large improvements in ED psychopathology (SMD = 0.74, 95% CI: 0.67-0.82, Q p = 0.79, I 2 = 0.0% [95% CI: 0.0%- 56.6%]) and OBE frequency (SMD = 0.64, 95% CI: 0.52-0.77, Q p = 0.40, I 2 = 4.5% [95% CI: 0.0%- 66.4%]) relative to TAU/control, with low heterogeneity. Effects were comparable across sub-group analyses. Nine of 10 meta-analyses were rated as critically low regarding confidence in results, as per the AMSTAR 2. Psychotherapy is efficacious for non-underweight adults with eating disorders, including when delivered using program-led focused interventions. The use of the AMSTAR-2 tool is encouraged to guide high-quality, transparent reporting of future meta-analyses in our field.

Relaxin-3 is a two-chain neuropeptide of the insulin/relaxin superfamily and the cognate ligand for the G protein-coupled receptor RXFP3. Since its discovery, the relaxin-3/RXFP3 signaling system has emerged as a key regulator of feeding behavior, stress responses, arousal, addiction, and cognitive function. Recent structural studies, including the first cryo-electron microscopy structures of RXFP3 bound to relaxin-3 and small molecules, have provided significant insights into ligand-receptor interactions. Together with mutagenesis and pharmacological studies, these advances have facilitated the design of diverse RXFP3 ligands, ranging from simplified and/or stapled single-chain analogs of relaxin-3 to grafted scaffolds and small-molecule modulators. Such tools have been instrumental for probing relaxin-3 biology in vivo and highlight the system's therapeutic potential for treating anxiety, depression, obesity, binge eating, and alcohol use disorder. However, challenges remain, particularly regarding blood-brain barrier penetration, receptor subtype selectivity, pharmacokinetic optimization, and safe long-term modulation. This review summarizes current knowledge of relaxin-3 structure, receptor interactions, and pharmacology and highlights how advances in peptide chemistry, structural biology, and small-molecule design are enabling the rational development of RXFP3-targeted therapeutics.

Introduction: Polycystic ovarian syndrome (PCOS) poses a significant challenge in contemporary medicine, with its prevalence on the rise despite limited understanding and awareness. Objectives: This study seeks to assess undergraduate medical students’ awareness of PCOS and investigate lifestyle behaviors among female students that may be linked to the condition. Methods: A 5-month cross-sectional survey study was carried out with undergraduate medical students at Ras Al Khaimah Medical and Health Science University. Participants completed an anonymous, self-administered questionnaire covering demographics, PCOS awareness, and lifestyle factors. Results: The findings indicate that 66.0% of medical students had a low-to-moderate level of awareness about PCOS, with a mean score of 16±7.8 out of 30. Female participants showed significantly higher mean scores of awareness in all categories (P<001). Less than one-third (30.1%) of students were unaware of menstrual cycle irregularities, while 32.2% did not recognize hormonal imbalance as a risk factor. More than half (55.4%) were unaware of endometrial cancer as a potential complication, and 51.5% did not recognize the psychological ramifications of binge eating disorder. Almost one-third (33.5%) of students were unaware of the role of regular exercise in PCOS prevention. Regarding lifestyle behaviors, 70.7% of females reported regular consumption of junk food, while 56.1% engaged in regular exercise. There was no association between lifestyle behaviors and level of awareness (P>0.05). Conclusion: The study identified gaps in knowledge regarding PCOS among undergraduate medical students, emphasizing the need for increased awareness and education. Lifestyle behavior modifications, including dietary habits and stress management, are essential for enhancing understanding and promoting preventive strategies among medical students.

Suicidal ideation represents a serious experience common in individuals with eating disorders. To inform screening and clinical assessment and advance theoretical work, the current study compared clinical characteristics between adult women with and without current suicidal ideation and examined whether binging, fasting, and purging behaviors are uniquely associated with suicidal ideation above and beyond existing psychiatric diagnoses. Data come from four studies conducted between 2000 and 2023 (N = 732) that evaluated current suicidal ideation in all participants. Participants completed diagnostic interviews assessing lifetime psychiatric diagnoses and current eating disorder diagnoses and behavioral symptom frequencies. Five hundred and fifty-three participants had DSM-5 eating disorders (54.6% bulimia nervosa, 15.0% purging disorder [PD], 28.2% other specified [excluding PD], 1.4% anorexia nervosa, and 0.7% binge-eating disorder). Individuals with current suicidal ideation had a greater prevalence of most psychiatric diagnoses and greater frequency of binging, fasting, and purging. Additionally, purging frequency was associated with current suicidal ideation independent of binging, fasting, and lifetime psychiatric comorbidities. Results support prior work suggesting that purging may fall on the self-harm continuum with nonsuicidal self-injury. Further, findings support screening for purging and suicide risk assessment in individuals with eating disorders.

Exploring Reward Sensitivity as a Central Mechanism in Binge-Eating Behavior.

The effect of transcranial direct current stimulation and nutritional counseling therapy on attentional bias to food cues: A randomized clinical trial.