Bulimia Research Articles

Clinical Characteristics of US Adolescents Hospitalized for Eating Disorders 2010-2022.

Eating disorders (EDs) affect a substantial number of American adolescents, with an increasing number seeking care for EDs during the coronavirus disease 2019 pandemic. We assessed the prevalence and clinical characteristics of adolescents hospitalized with EDs during 2010 to 2022. We used data from a national database of 12 children's hospitals (PEDSnet). Adolescents aged 12 to 21 years hospitalized for ED, disordered eating, binge ED, anorexia nervosa, bulimia nervosa, avoidant-restrictive food intake disorder (ARFID), or other EDs were included. Patients with complex or chronic illness or with EDs hospitalized for another reason were excluded. We analyzed demographic data, clinical characteristics, cardiac manifestations, coexistence of psychiatric conditions, and hospital stay characteristics. We included 13 403 hospitalizations by 8652 patients in this study. We found a gradual increase in hospitalizations for patients with EDs before the pandemic and a large increase during the pandemic. Mean age was 15.8 years with 85.9% described as female and 71.8% as white. Anorexia nervosa was the most common ED (57.5%), though hospitalization for patients with ARFID is increasing. Patients' median BMI percentage was 90.3%. Patients' malnutrition was classified as none (50.9%), mild (25.0%), moderate (18.6%), or severe (5.4%). Significant numbers of patients had a diagnosis of depression (58.5%) or anxiety (57.0%); 21.9% had suicidal thoughts. Nearly one-quarter (23.6%) required rehospitalization for ED treatment within 1 year. Hospitalizations for EDs among American adolescents are increasing, with a spike during the coronavirus disease 2019 pandemic. Significant numbers of patients hospitalized with EDs have suicidal thoughts. Trends in patients with ARFID require monitoring.

Endocrinology-informed neuroimaging in eating disorders: GLP1, orexins, and psilocybin

The neurobiology of eating disorders [EDs; anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)] remains poorly understood. Here, I describe how neuroimaging, accompanied by peripheral endocrine measures, can provide insights into the neurobiological drivers of eating disorders. Orexins/hypocretins, glucagon-like peptide-1 receptor (GLP1R) agonists, and psilocybin are highlighted as avenues for investigation.

Efficacy of therapy for non-suicidal self-injurious behavior in a bulimia nervosa patient (a clinical case report)

Non-suicidal self-injurious behavior is almost never monosymptomatic. It is frequently combined with eating disorders, in particular bulimia nervosa. A description of a clinical case of improvement in the condition of a patient with non-suicidal self-injurious behavior and bulimia nervosa when using topiramate as part of combination therapy is presented.

Synchronized Cyclograms to Assess Inter-Limb Symmetry during Gait in Women with Anorexia and Bulimia: A Retrospective Study

Anorexia nervosa (AN) and bulimia nervosa (BN) are eating diseases characterized by extreme eating behaviours impacting both mental and physical health. Aberrant musculoskeletal adaptations due to malnutrition affect motor abilities such as postural control and gait. To date, limited data is available with regards to gait symmetry in AN and BN. The aim of this study was to characterize inter-limb asymmetry during gait in two cohorts affected by AN and BN, respectively, using the synchronized cyclograms and to compare it with a healthy weight group. A total of 14 AN, 17 BN, and 11 healthy-weight females were assessed via 3D gait analysis. Gait spatio-temporal parameters were computed together with angle–angle diagrams, which were characterized in terms of their geometric features. Individuals with AN and BN were characterized by reduced speed and cadence and an abnormal increase in the duration of the double support phase with respect to the healthy controls. With respect to inter-limb symmetry, asymmetries were detected in both groups, with individuals with BN exhibiting significantly larger cyclogram areas at the hip joint with respect to the other groups (323.43 degrees2 vs. 253.74 degrees2 vs. 136.37 degrees2) and significantly higher orientation angle and Trend Symmetry at both knee and ankle joint. The cyclogram analysis suggests the presence of an altered gait symmetry in individuals with BN. In the AN group, it is possible to observe a similar trend; however, this is not statistically significant. Overall, the findings of this study may provide a novel perspective on the motor control dysfunction linked to eating disorders and aid clinicians in selecting a suitable rehabilitation scheme targeted at enhancing motor stability and control.

Impact of the COVID-19 pandemic on care for anorexia and bulimia nervosa in US military-connected adolescents and young adults.

This study examined the impact of the COVID-19 pandemic on healthcare engagement for anorexia nervosa (AN) and bulimia nervosa (BN) in a large, geographically diverse population. This repeated monthly, cross-sectional study queried Military Health System records of individuals aged 10-21 before and during the pandemic (February 2019-January 2022). ICD-10 codes identified encounters for AN and BN. Monthly rates of care were modeled as the number of unique individuals with an ICD-10-identified eating disorder-related encounter per month divided by the enrolled population. Poisson regression analysis evaluated rates of care stratified by eating disorder, clinical setting, and sex. In a population of 1.76 million adolescents and young adults, 1629 individuals with AN or BN received care during the pre-pandemic period; 3256 received care during the pandemic. The monthly rate of care for females with AN during the pandemic increased in inpatient settings (adjusted relative risk [aRR]: 1.31 [1.16-1.49]) and outpatient settings (aRR: 1.42 [1.37-1.47]); monthly care rates in males with AN increased in the outpatient setting (aRR: 1.46 [1.28-1.67]). Females with BN had increased engagement in outpatient settings (aRR: 1.09 [1.03-1.16]); BN care for males showed no significant monthly changes during the pandemic period in either healthcare setting. With increased rates of AN and BN disorder-related care during the pandemic, screening for eating disorder symptomatology may allow for timely diagnosis and intervention in periods of heightened stress. Pandemic-related increases in healthcare engagement may strain limited resources, emphasizing a need to expand accessibility of clinical expertise. This study indicates that monthly rates of healthcare engagement during the COVID-19 pandemic for AN and BN varied based on clinical setting and sex in an adolescent and young adult population. The increased number of individuals seeking eating disorder-related care, especially outpatient care, attributed to heightened stressors necessitates accessible professionals with eating disorder clinical expertise.

Subtypes of exercise are differentially associated with baseline eating disorder pathology and treatment outcome among individuals with bulimia nervosa.

Individuals with bulimia nervosa (BN) engage in both maladaptive (i.e., compulsive and/or compensatory) and adaptive exercise (e.g., for enjoyment). No research has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting intervention efficacy. We examined associations of baseline exercise engagement with baseline and posttreatment BN pathology among 106 treatment-seeking adults (Mage = 37.4, SDage = 12.95, 87.74% female, 68.87% White) enrolled across four clinical trials of outpatient enhanced cognitive behavioral therapy for BN (range: 12-16 sessions). Analysis of covariances examined associations between baseline exercise type and baseline/posttreatment global eating pathology, dietary restraint, loss-of-control (LOC) eating, and purging frequency. Those engaging in only adaptive exercise reported lower global eating pathology compared to those engaging in compulsive-only exercise (Est = -1.493, p = .014, Mdiff = -.97) while those engaging in baseline compulsive exercise reported less LOC eating compared to those not engaging in exercise (Est = -22.42, p = .012, Mdiff = -12.50). Baseline engagement in compulsive-only exercise was associated with lower posttreatment global eating pathology compared to baseline engagement in no exercise (Est = -.856, p = .023, Mdiff = -.64) and both compulsive and compensatory exercise (Est = .895, p = .026, Mdiff = -1.08). Those engaging in compulsive, compensatory, adaptive, and no exercise exhibit different patterns and severity of BN pathology. Future research is needed to position treatments to intervene on maladaptive, while still promoting adaptive, exercise. No research to date has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting targeted intervention efforts. We found that those engaging in compulsive, compensatory, and adaptive exercise exhibit different patterns of BN pathology and that adaptive exercise engagement was related to lower cognitive eating disorder symptoms at baseline.

Risk of positive screening for anorexia nervosa, bulimia nervosa and night eating syndrome and associated risk factors in medical fellows in Northeastern Mexico: a multicenter study

BackgroundEating disorders and food ingestion (EDs) are serious mental illnesses with a higher prevalence in young adults, with difficult diagnoses that cause serious morbidity and mortality problems. There is not much information about the risk of positive screening for EDs, specifically, anorexia nervosa (AN) and bulimia nervosa (BN) and night eating syndrome (NES) in undergraduate medical interns (UMI) and medical residents (MR) in Mexico.AimTo determine the risk of AN, BN and NES and to determine the risk factors of such conditions such as age, body mass index (BMI) and gender of MR and UMI with AN/BN and NES at four private hospitals in northeastern Mexico.MethodsA cross-sectional, descriptive, non-randomized survey in MR and UMI in four hospitals in Northeastern Mexico was conducted using an electronic questionnaire that included: informed consent signature, SCOFF questionnaire for AN and BN screening, NES questionnaire. Also, a survey on general sociodemographic data of each participant was included. Chi-square test and a logistic regression model were computed for analyses.ResultsThe population included a total of 129 MR and UMI. It was observed that 48.8% were positive for AN or BN and 32.6% were positive for the NES. There was no difference between age, sex, BMI, or medical specialty (if they were MR); however, MR from the first year had a higher risk of AN or BN (OR 23.7, 95% CI 1.181–475.266).ConclusionsThere was a higher risk of positive screening for AN or BN and NES in UMI and MR in our population. In the case of MR, those in first year have a higher risk of AN and BN. Timely diagnosis and treatment are mandatory in this population.

Obesity and eating disorders: an interactive and complex coexistence

Obesity is the medical condition most frequently observed in people with eating disorders. It often coexists with binge-eating disorder and with some cases of bulimia nervosa, night eating syndrome, and atypical anorexia nervosa. Obesity can precede the onset of eating disorders, sometimes representing a risk factor for their onset, or can be in part the consequence of recurrent binge-eating episodes. Eating disorders and obesity, when they coexist, tend to interact negatively with each other and make treatment more problematic. Weight loss is always contraindicated when obesity coexists with bulimia nervosa and atypical anorexia nervosa. Still, it is not contraindicated when it coexists with binge-eating disorder or night eating syndrome. However, the weight loss outcome with current treatments is often unsatisfactory. A potential strategy to improve this poor outcome is an integrated treatment combining the new incretin-based medications for the treatment of obesity with enhanced cognitive behavior therapy (CBT) of binge-eating disorder and CBT of obesity.

The value of plasma cell-free DNA levels as biomarker in patients with eating disorders: A preliminary study

ObjectiveCirculating cell-free DNA (cfDNA) holds promise as a rapid and convenient biomarker for identifying individuals with eating disorders. To investigate this hypothesis, we measured plasma cfDNA in patients with different eating disorders. MethodsIn this study, 110 participants (98 patients with eating disorders divided into 30 patients with bulimia nervosa, 33 patients with anorexia nervosa (AN) Restricting subtype, 35 patients with AN Binge-eating/purging subtype and 12 controls) were enrolled. We measured both cell-free nuclear DNA (cf-nDNA) and cell-free mitochondrial DNA (cf-mtDNA) from plasma using two specific droplet digital PCR assays each, referring to two amplicon sizes. ResultsLevels of plasma cf-nDNA and cf-mtDNA showed no significant differences between control participants and those with eating disorders. However, we observed a higher proportion of long cf-nDNA fragments in patients with eating disorders, suggesting its potential as a biomarker for eating disorders. ConclusionThis is the first study of cfDNA in patients with eating disorders. Our findings highlight the potential for qualitative exploration of cfDNA, although not of quantitative interest. Full characterization of cfDNA may serve as a valuable biomarker for eating disorders and provide some insights into the hidden mechanisms underlying the chronic development of these conditions. Future studies are needed to confirm or refute this hypothesis.

Pediatric Patients Hospitalized With Eating Disorders in Ontario, Canada, Over Time

Understanding the evolving characteristics of pediatric patients hospitalized for eating disorders is important to ensure that services and treatments align with patient needs. To examine temporal trends in the rates of hospitalizations for pediatric eating disorders by clinical and demographic characteristics in Ontario, Canada, over a 17-year period. This population-based, repeated, cross-sectional study used linked health administrative and demographic databases in Ontario, Canada, to identify individuals aged 5 to 17 years hospitalized with eating disorder diagnoses from April 1, 2002, to March 31, 2020. Data analyses were performed from May 2021 to June 2023. Fiscal year (April 1-March 31) of eating disorder hospitalization. Outcomes of interest were absolute and relative changes in pediatric eating disorder hospitalization rates overall and stratified by patient sex, age groups, and eating disorder diagnostic groups. Over the study period, there were 11 654 pediatric eating disorder hospitalizations, of which 5268 (45.2%) were for anorexia nervosa and 1374 (11.8%) were for bulimia nervosa. There were a total of 10 648 hospitalizations (91.4%) among female patients, and the median (IQR) age was 15.0 (14-0-16.0) years. Hospitalization rates increased 139% from 2002 to 2019, from 2.0 per 10 000 population to 4.8 per 10 000 population. The largest relative changes were observed among male patients (416%; from 0.2 per 10 000 population to 1.1 per 10 000 population), individuals aged 12 to 14 years (196%; from 2.2 per 10 000 population to 6.6 per 10 000 population), and individuals with eating disorders other than anorexia or bulimia nervosa (255%; from 0.6 per 10 000 population to 2.1 per 10 000 population). Male patients, younger adolescents, and individuals with other eating disorders also represented larger proportions of hospitalizations by fiscal 2019. In this cross-sectional study of eating disorder hospitalizations, pediatric hospitalizations increased over time, particularly among populations traditionally considered atypical. Existing eating disorder programs must adapt to accommodate changing patient presentations and increased volumes to ensure effective care delivery.

Efficacy of pharmacotherapies for bulimia nervosa: a systematic review and meta-analysis

ObjectiveThe main purpose was to evaluate the efficacy and tolerability of different medications used to treat bulimia nervosa (BN).MethodsRandomized controlled trials (RCTs) were identified from published sources through searches in PubMed, Cochrane Library, Web of Science, and Embase from inception to November 2022. Primary outcomes were changes in the frequency of binge eating episodes and vomiting episodes from baseline to endpoint. Secondary outcomes were differences in the improvement of scores in depressive symptoms, tolerability (dropout due to adverse events) and weight change.ResultsThe literature search ultimately included 11 drugs, 33 studies and 6 types of drugs, 8 trials with TCAs (imipramine, desipramine), 14 with SSRIs (fluoxetine, citalopram and fluvoxamine), 6 with MAOIs (phenelzine, moclobemide and brofaromine), 3 with antiepileptic drugs (topiramate), 1 with mood stabilizers (lithium), and 1 with amphetamine-type appetite suppressant (fenfluramine). The reduction in binge eating episodes was more likely due to these drugs than the placebo, and the SMD was -0.4 (95% CI -0.61 ~ -0.19); the changes in the frequency of vomiting episodes (SMD = -0.16, 95% CI -0.3 ~ -0.03); weight (WMD = -3.05, 95% CI -5.97 ~ -0.13); and depressive symptoms (SMD = -0.32, 95% CI -0.51 ~ -0.13). However, no significant difference was found in dropout due to adverse events (RR = 1.66, 95% CI 1.14 ~ 2.41).ConclusionsThis meta-analysis indicates that most pharmacotherapies decreased the frequency of binge-eating and vomiting episodes, body weight, and depressive symptoms in BN patients, but the efficacy was not significant. In each drug the efficacy is different, treating different aspects, different symptoms to improve the clinical performance of bulimia nervosa.

Are dietary intakes linked to interoception and gastric myoelectric activity in women with binge eating disorder and bulimia nervosa?

Are dietary intakes linked to interoception and gastric myoelectric activity in women with binge eating disorder and bulimia nervosa?

Association of gastric myoelectric activity and body composition in women with binge eating disorder and bulimia nervo-sa

Association of gastric myoelectric activity and body composition in women with binge eating disorder and bulimia nervo-sa

Barriers to access treatment for eating disorders: Literature review

Eating disorders (EDs) are disabling, potentially fatal, and costly mental disorders. According to recent data, Chile has the highest prevalence of both anorexia nervosa (AN) and bulimia nervosa (BN) in Latin America. However, there is no published data regarding the barriers experienced by patients with EDs in Chile until they start treatment. To review and synthesize the literature regarding barriers to access to treatment for patients with EDs. A search was conducted through PubMed/ Medline, PsychInfo, Web of Science, Scopus, Embase, Scielo, and Google Scholar. Seventy-two studies were selected for full-text reading. 53 studies were included, all conducted in developed countries. A wide range of barriers was found, which can be classified according to their role. These barriers were predominantly at the level of the patient with an ED, the family and social environment, the health professionals, the sociocultural context, and the healthcare system. The barriers most commonly found in studies were the patient's ego-syntonic behaviors and the social stigma associated with EDs. The national context calls for discussing access problems in patients with EDs in Chile. The barriers found in this study should be considered when designing public policies, although the role of the cost of treatment should be more emphasized in Chile.

Maternal Eating Disorders and Adverse Birth Outcomes: A Systematic Review and Meta-Analysis.

Previous systematic reviews have reported on the relationship between eating disorders (EDs) and birth outcomes, but there are no existing meta-analyses on this topic. This systematic review and meta-analysis examines the association between lifetime maternal EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) with low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), and miscarriage. Four databases were systematically searched for quantitative literature on maternal EDs that preceded birth outcomes. Eighteen studies met the inclusion criteria and were included in the review. The meta-analyses included 6 studies on miscarriage, 11 on PTB, 4 on LBW, 9 on SGA, and 4 on LGA. The Mantel-Haenszel random effects model was used to test the associations between EDs and birth outcomes. The results showed significant positive associations between AN and LBW (OR 1.74, 95% confidence interval (CI) 1.49, 2.03), AN and SGA (OR 1.39, 95% CI 1.17, 1.65), BN and PTB (OR 1.19, 95% CI 1.04, 1.36), and BED and LGA (OR 1.43 95% CI 1.18, 1.72). EDs were not significantly correlated with miscarriage. These findings reveal the importance of screening for and treating EDs in pregnant women.

Intervention and Treatment of Adolescent Anorexia Nervosa and Eating Disorder

This paper focuses on the medical complication on anorexia nervosa and bulimia nervosa, which is mainly study in the area of adolescents. First, this article illustrates the negative impact of anorexia nervosa and bulimia nervosa. The seriousness could even cause death but most symptoms are malnutrition and gastric disease. Previous studies find that these disorders have several causes, including culture factors, media influence and family influence. The culture would influence the symptoms of the binge eating of bulimia nervosa. For example, the Africans would prefer binge eating privately to avoid others. While Asians are likely to eat under a fast speed. The media of diet eating and even some videos about binge eating would deliver an unhealthy mind to the individual who are watching them, especially the adolescents. Their minds and attitudes are easy to be influenced and changed. Then listing out some therapy ways like cognitive therapy and several medicine that would work well. Afterwards, the paper has figured out that the fluoxetine would be perfect suitable for treatment bulimia nervosa. This paper laid out the factors and symptoms of the eating disorders, and selected the therapies to the disorders. Future research should conduct more researches on the mechanism ways in cognitive treatment.

Plant-based recovery from restrictive eating disorder: A qualitative enquiry

ObjectivesPlant-based/vegan diets are growing in popularity. There are growing numbers of individuals adopting plant-based diets and there are legitimate concerns from professionals that this can enable food restriction or mask disordered eating. The aim of this study was to examine the role a plant-based diet can play for those in recovery from restrictive eating disorders (anorexia and bulimia nervosa). MethodsInterviews conducted with fourteen individuals who identified as having a restrictive eating disorder for which a plant-based diet played/plays an important part in their recovery. Semi-structured interviews explored the individual's lived experiences and motivations of adopting a plant-based diet, and perceptions of the role it played in recovery. Data was transcribed verbatim and analyzed using thematic analysis (Braun & Clarke, 2006). ResultsThree key themes with six contributory subthemes were identified. Key themes were plant-based as a gateway to recovery, the changing value of food, and the function of control. Theme content highlighted an evolving role of identity and community, with a shift in meaning and value of food described, and for some, the development of a new relationship with their body. This facilitated a de-coupling of anxieties about food and promoted positive experiences of eating, esteem and empowerment. ConclusionsThese findings present a unique insight into the role that plant-based eating may play in recovery for some restrictive eating disorders. The data demonstrated that motivations to control food intake may contribute to the decision to eat plant-based. However, for these individuals it provided a “gateway” to a new more meaningful relationship with food. These findings highlight some of the risks and benefits of eating plant-based in recovery and an important role for health professionals in understanding/supporting individuals during recovery. w/c 280

A Comprehensive Literature Review of Borderline Personality Disorder: Unraveling Complexity From Diagnosis to Treatment.

Borderline personality disorder (BPD) is a severe mental illness marked by unpredictable feelings, behaviors, and relationships. Symptoms like emotional instability, impulsivity, and poor social connections are the basis for diagnostic criteria. A noteworthy discovery highlights the clinical overlap between BPD and several psychotic disorders by arguing that BPD and psychotic symptoms raise the risk of psychopathology. According to neuroimaging evidence, structural and functional brain changes, notably in regions controlling affective regulation and impulse control, are seen in BPD patients. Adolf Stern, a psychoanalyst, used the word "borderline" in 1938 to describe patients who exhibited increased symptoms during therapy and displayed masochistic tendencies. Modern BPD research has highlighted the complexity of symptoms like boredom, a former diagnostic criterion associated with feelings of emptiness. Though there are still unanswered problems regarding its precise, practical components, the treatment technique known as Schema therapy (ST) has shown promise in treating BPD. It's interesting to note that BPD displays complex relationships with other illnesses; for instance, some neurochemical pathways coincide with those in bulimia nervosa, pointing to a deeper level of interconnection. Concerning diagnosis, BPD's defining symptoms include, among others, the fear of abandonment, identity disruption, and recurrent suicidal conduct. The range of treatment options includes pharmacological interventions and psychotherapies like dialectical behavior therapy (DBT). Even though antidepressants like selective serotonin reuptake inhibitors (SSRIs) are routinely prescribed, research on their efficacy is ongoing, underlining the significance of thorough treatment planning. In conclusion, BPD continues to be a complex condition that calls for early detection, especially considering that it usually manifests in adolescence. While many patients report symptom relief, lingering problems still exist, emphasizing the value of comprehensive and personalized treatment strategies.

Bidirectional association between eating disorder and temporomandibular joint disorder: A retrospective longitudinal nationwide population-based cohort study

Background/purposeAn increasing body of evidence indicates correlations between the symptoms of temporomandibular disorder and those of eating disorder (ED). However, further investigation is required to elucidate the temporal and causal relationships between the aforementioned disorders. Materials and methodsThis retrospective cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Temporomandibular joint disorder (TMJD) was analyzed both as the cause and consequence of ED. We collected the data (from January 1, 1998, to December 31, 2011) of patients with antecedent TMJD (N = 15,059) or ED (N = 1219) and their respective controls (1:10), matched by age, sex, income level, residential location, and comorbidities. This study included patients who had received a new diagnosis of an ED or a TMJD between January 1, 1998, and December 31, 2013. Cox regression models were used to assess the risk of ED or TMJD development in patients with antecedent TMJD or ED. ResultsTMJD patients had an approximately 3.70-fold (95 % confidence interval [CI]: 1.93–7.10) risk of ED development. Similarly, patients with ED had an approximately 4.78-fold (95 % CI: 2.52–9.09) risk of TMJD development. Subgroup analyses based on ED subtypes indicated antecedent TMJD and bulimia nervosa as the predictors of increased bulimia nervosa and TMJD risks (hazard ratios: 6.41 [95 % CI: 2.91 to 14.11] and 5.84 [95 % CI: 2.75 to 12.41]), respectively. ConclusionPrevious TMJD and ED are associated with increased risks of subsequent ED and TMJD; these findings suggest the presence of a bidirectional temporal association between TMJD and ED.

Trajectories of therapeutic skills use and their dynamic relations to symptom change during cognitive-behavioral therapy for bulimia nervosa.

To examine trajectories of therapeutic skills use and weekly relations between skills use and symptom change during the enhanced version of cognitive-behavioral therapy (CBT-E) for bulimia nervosa (BN). Fifty-five adults (M age: 39.0 ± 14.1; 83.9% female; 64.3% White, 93.6% non-Hispanic/Latino) receiving CBT-E for BN-spectrum eating disorders (EDs) self-monitored their use of five therapeutic skills (i.e., regular eating, eating enough to prevent excessive hunger and eating a range of macronutrients, breaking dietary rules, urge management strategies, and mood management strategies) several times per day during treatment. Patients also self-reported their ED symptoms (i.e., frequency of binge eating, compensatory behaviors, and dietary restraint) weekly. We examined trajectories of use of each CBT-E skill and temporal relations between skills use and ED symptoms from week-to-week during treatment. Participants showed significant increases in eating enough to prevent excessive hunger and eating a range of macronutrients from week-to-week (p < .05). Regular eating, eating enough to prevent excessive hunger, and eating a range of macronutrients 1 week predicted lower binge eating and compensatory behaviors the same week and the following week, and urge management strategy use predicted greater binge eating the same week and the following week (p < .05). Results showed temporal relationships between therapeutic skills use and symptom change on a weekly level, with evidence that using skills targeting dietary restraint was associated with lower BN symptoms. Findings highlight the promise of future work to elucidate the most potent CBT-E skills for symptom improvement and inform more targeted interventions. Findings showed weekly relationships between therapeutic skills use and symptom change during treatment, with evidence that using CBT-E skills aimed to reduce dietary restraint (i.e., regular eating, eating enough to prevent excessive hunger, and eating a range of macronutrients) was associated with lower BN symptoms. Future work has the potential to identify the most potent CBT-E skills for symptom improvement and inform more targeted interventions.