Bulimia Research Articles

Bulimia Nervosa and Depression, from the Brain to the Gut Microbiota and Back.

Bulimia nervosa (BN) is a condition marked by a typical cyclical behavioural activity, characterized by restrictions, binges and vomiting, as well as a disturbance of the emotional value of food. Food stimuli acquire excessive relevance, giving rise to a succession of states of excitement and anxiety. The depressive condition accompanies very often BN. Most people with BN also experience one or more anxiety disorders. The aim of the review is to identify a link at a central and peripheral level that connects an eating disorder with a mood state. Altered nervous mechanisms are involved in BN. Among the cerebral areas, the insula is functionally compromised in BN. The insula is also implicated in depressive states. The insula is the primary gustatory cortex, where gustatory sensory information such as taste discrimination and higher cognitive functions such as food anticipation and reward are processed. The insula is anatomically connected to a wide range of cortical, limbic and paralimbic structures, and functionally implicated in high-order cognition, emotional responses, and empathic processes. The insula plays a crucial role in empathy, or in the ability to share the emotional states of others, and in particular negative emotions. In fact, the insular cortex is also activated in conditions of anxiety and depression. One of the pathophysiological factors that influences bulimia and depression is the composition of gut microbiota, as there is a strong association between the microbial signature and the brain function. Gut dysbiosis condition may contribute to the development of eating disorders, including BN. Dysbiosis may promote intestinal inflammation, alter gut permeability, and trigger immune reactions in the hunger/satiety regulation center contributing to the pathophysiological development of eating disorders. From this emerges the importance of adequate probiotic integration as a preventive and/or therapeutic tool in these pathologies.

Increased Prevalence of Binge Eating Disorder and Bulimia Nervosa in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.

Polycystic ovary syndrome (PCOS) is associated with disordered eating/eating disorders, but prior meta-analyses are limited by small numbers. To inform the 2023 International PCOS Guideline, we performed a systematic review and meta-analysis evaluating the prevalence of disordered eating/eating disorders among women with and without PCOS. Ovid MEDLINE, EMBASE, PsycInfo, and All EMB were searched from inception through February 1, 2024, for studies that compared prevalences of eating disordered/disordered eating in adolescent or adult women. Random effects meta-analyses were used to estimate the pooled odds ratios (OR) or standardized mean differences (SMD) of outcomes in women with PCOS compared to controls. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias. Of 1352 articles identified, 20 were included, with a total of 28 922 women with PCOS and 258 619 controls. Individuals with PCOS had higher odds of any eating disorder (OR: 1.53 [1.29, 1.82], 8 studies), which persisted in studies where PCOS was diagnosed by Rotterdam criteria (OR: 2.88 [1.55, 5.34], 4 studies). Odds of bulimia nervosa, binge eating disorder, and disordered eating, but not anorexia nervosa, were increased in PCOS. Mean disordered eating scores were higher in PCOS (SMD: 0.52 [0.28, 0.77], 13 studies), including when stratified by normal and higher weight body mass index. Most included studies were of moderate quality, with no evidence of publication bias. Our study informs the 2023 PCOS Guideline recommendations for consideration of the risk of disordered eating/ eating disorders in care of women with PCOS, regardless of weight, especially during providing lifestyle counseling.

Assessing Avoidant/Restrictive Food Intake Disorder (ARFID) Symptoms Using the Nine Item ARFID Screen in >9000 Swedish Adults With and Without Eating Disorders.

The Nine Item ARFID Scale (NIAS) is a widely used measure assessing symptoms of avoidant/restrictive food intake disorder (ARFID). Previous studies suggest that individuals with eating disorders driven by shape/weight concerns also have elevated scores on the NIAS. To further describe NIAS scores among individuals with diverse current and previous eating disorders, we characterized NIAS scores in a large sample of individuals with eating disorders and evaluated overlap in symptoms measured by the NIAS and the Eating Disorder Examination-Questionnaire (EDE-Q) version 6.0. Our sample comprised 9148 participants from the Eating Disorders Genetics Initiative Sweden (EDGI-SE), who completed surveys including NIAS and EDE-Q. NIAS scores were calculated and compared by eating disorder diagnostic group using descriptive statistics and linear models. Participants with current anorexia nervosa demonstrated the highest mean NIAS scores and had the greatest proportion (57.0%) of individuals scoring above a clinical cutoff on at least one of the NIAS subscales. Individuals with bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorder also demonstrated elevated NIAS scores compared to individuals with no lifetime history of an eating disorder (ps < 0.05). All subscales of the NIAS showed small to moderate correlations with all subscales of the EDE-Q (rs = 0.26-0.40). Our results substantiate that individuals with eating disorders other than ARFID demonstrate elevated scores on the NIAS, suggesting that this tool is inadequate on its own for differentiating ARFID from shape/weight-motivated eating disorders. Further research is needed to inform clinical interventions addressing the co-occurrence of ARFID-related drivers and shape/weight-related motivation for dietary restriction.

"Protective Factors of Bulimia Nervosa in Pregnant Women: A Case Observational Report"

"Protective Factors of Bulimia Nervosa in Pregnant Women: A Case Observational Report"

TO EAT, OR NOT TO EAT? A PSYCHOANALYTIC VIEW ON THE FOOD‐PARENT

Research shows eating disorders increase the mortality rate: anorexia nervosa has the highest mortality rate and yet an accurate morbidity rate of bulimia nervosa remains hidden. However, research on the endopsychic structural dynamics that perpetuate in patients with eating disorders is scant. This essay depicts the use of Fairbairn's theory of endopsychic personality structure in understanding anorexia nervosa, binge eating disorder and bulimia nervosa. Fairbairn, of the independent group of British object relations theorists, provides a picture of the endopsychic structure based on the conscious and unconscious psychodynamics between partial ego/part‐object dyads. Using three case histories, the following pages illustrate the incessantly present endopsychic permutations of the aforementioned dynamics and the possibility of the entrapment in one of these or swinging from one to the other in eating disorders. The essay also shows that early traumatic experiences are present in the case history of individuals with any one of these eating disorders and despite their manifested behavioural differences, they result from the widening of fissures in the universal split in the psyche due to emotional and/or physical abuse. Finally, using Fairbairn's theory, the analysis in the essay explains the comorbidity of certain eating disorders and borderline personality structure.

Stimulant medications in the management of bulimia nervosa and anorexia nervosa in patients with and without comorbid attention deficit hyperactivity disorder: A systematic review.

People with attentional problems are at increased risk of eating disorders. This paper aimed to systematically review and synthesize the existing evidence on stimulant medication in the management of patients with bulimia nervosa (BN) or anorexia nervosa (AN) with or without comorbid attention deficit hyperactivity disorder (ADHD). A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A protocol for the review was registered with Open Science Framework (OSF) Registry and critical appraisal of the literature was conducted using Joanna Briggs Institute (JBI) Critical Appraisal Tools. Thirteen articles met inclusion criteria including two quasi-experimental studies, one randomized controlled trial, four case series, and six case reports. 26 cases were included from studies and 32 from case series/reports. Only two cases from a single case report had a diagnosis of AN, while the remainder had BN. Stimulants included methylamphetamine, lisdexamfetamine, methylphenidate, dextroamphetamine sulphate and mixed amphetamine salt. In nearly all cases of BN there were reported reductions in eating disorder symptoms. The rates of adverse effects were high and included weight loss, decreased appetite, tachycardia, dry mouth, fatigue, insomnia, restlessness, nausea, bruxism, headache, palpitations, blood pressure changes, irritability, anxiety, depressed mood, and diaphoresis. There is currently insufficient evidence to support the use of stimulant medications to treat symptoms of BN or AN. The authors recommend considering screening patients with BN for ADHD.

Evaluation of Subjective and Objective Voice Characteristics in Patients With Bulimia Nervosa

ObjectiveThe present study aims to examine subjectively and objectively the voice changes in Bulimia Nervosa patients at different stages of treatment. MethodThe study was conducted with a study group including 10 patients followed up with a diagnosis of Blum,ia Nerrvosa and a control group consisting of 10 healthy participants of a similar age group without eating disorders. The reflux symptom index was used for stroboscopic evaluation. The fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio (NHR) were determined during acoustic voice analysis. Maximum phonation time was analysed. A subjective evaluation was performed using the Voice Handicap Index-10 (VHI-10). ResultsJitter, Shimmer, VHI-10 Score, and RFS values showed a statistically significant difference in the patient and control groups (p<0.05). The mean values of Jitter, Shimmer, VHI-10 Score, and RFS were higher in the patient group than in the control group. MPT did not differ between goups (p>0.05)Age and F0 (Hz) values showed no statistically significant difference in the patient and control groups (p>0.05). ConclusionIn BN patients, the laryngopharyngeal reflux mechanism causes negative effects on vocal cord examination and acoustic sound analysis parameters, leading to subjective dissatisfaction.

The Inpatient Management of Adolescents with Eating Disorders.

Eating disorders affect individuals of all ages, genders, sexual orientations, ethnicities, races, and socioeconomic statuses. They can lead to serious medical complications that require inpatient treatment. The eating disorders that are most likely to lead to medical complications requiring medical inpatient stabilization include anorexia nervosa, atypical anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa, and purging disorder. There are criteria that can help determine if a patient requires inpatient stabilization. Nearly all body systems may be affected. Patients are often treated by following a refeeding protocol that reduces the risk of developing refeeding syndrome, a dangerous and life-threatening state of metabolic derangements that can arise when a malnourished individual begins a renourishment process. Following stabilization, patients should receive further care through a number of different treatment options directed at their underlying eating disorder and by working with a multidisciplinary team. [Pediatr Ann. 2024;53(8):e283-e287.].

The Role of Genetics, Neurobiology, and Psychosocial Factors in the Development and Treatment of Eating Disorders: A Systematic Review

Eating disorders are severe complications affecting peoples’ eating patterns, with erratic practices like purging behaviors, binge eating, and avoidance of food. These disorders result from different causes, including neurotransmitter imbalance, psychological factors like body-shaming, and genetic inheritance. The present review focuses on genetic, neurobiology and psychological factors to provide an understanding of the development of eating disorders and subsequent treatment. The present review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist that guided the evidence collection in the review to ascertain high quality. The Participant, Interventions, Comparison, Outcomes, and Studies (PICOS) protocol guided the establishment of potential studies' inclusion criteria. The Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence from the individual studies. Two independent reviewers were tasked with study selection, data collection, and study risk of bias assessed. The reviewers used the Cochrane risk of bias tool to assess the risk of bias in the included studies. Fifteen studies met the eligibility tests and were included in the review. A review of the evidence obtained from the included studies revealed that neurobiology, genetics and psychological factors influence the development of eating disorders like binge eating disorders, anorexia nervosa, and bulimia nervosa. In genetics, familial integration and heredity revealed the passing of the genes responsible for the development of anorexia nervosa in subsequent generations. Psychological factors and neurobiology affect self-esteem or body shaming and affect the balance of neurotransmitters in the brain, respectively. The treatment interventions aim to restore neurotransmitter levels and confidence after losing confidence and self-body hate due to bad shape. Genetics, neurobiological factors and psychological status are responsible for the development of eating disorders. Bulimia nervosa, binge eating disorder and purging behaviors result from unregulated 5-HT depletion, can be inherited or can result from body shaming. The evidence shows that eating disorders can be treated based on the aetiologies and pathophysiology. Keywords: Eating disorders, treatment, neurobiological factors, genetics, binge eating disorder, bulimia nervosa.

Associations of Adult ADHD symptoms with binge eating spectrum conditions, psychiatric and somatic comorbidity, and healthcare utilization in a metropolitan Brazilian city.

To investigate the associations among symptoms of attention deficit hyperactivity disorder (ADHD) with binge eating spectrum conditions - BESC - [binge eating disorder (BED), bulimia nervosa (BN), and recurrent binge eating (RBE)], and psychiatric and somatic comorbidity and healthcare utilization in a representative sample of a Brazilian city. A household survey with 2,297 adults and residents in Rio de Janeiro was conducted. The Adult Self-Rating Scale Screener was used to assess ADHD symptoms. BESC was assessed using the Questionnaire of Eating and Weight Patterns 5 and confirmed by telephone interview. Standardized questionnaires were used to assess psychiatric comorbidity. Close-ended questions investigated somatic comorbidity and healthcare utilization. ADHD symptoms were highly associated with BESC [BED, OR=13.2, 95%CI= 4.3-40.6; BN, OR=27.5, 95%CI= 5.9-128.7; RBE, OR=5.8, 95%CI= 2.9-11.4). However, with further adjustment for psychiatric comorbidity (depression, anxiety, alcohol use and impulsivity), the ORs were no longer significant. Healthcare resource utilization was significantly higher in participants with ADHD and BESC but lost significance after controlling for the psychiatric comorbidity. ADHD was associated with an increased prevalence of BESC, and healthcare utilization. Nonetheless, there was an essential interplay among psychiatric comorbidity in the associations of ADHD and BESC.

Intuitive eating in the COVID-19 era: a study with university students in Brazil

BackgroundThe recurrence of weight gain is attributed to the homeostatic regulation of hunger and satiety signals, influenced by metabolic state, nutrient availability, and non-homeostatic mechanisms shaped by reinforced consequences from experiences. In response, Evelyn Tribole and Elyse Resch proposed Intuitive Eating (IE) in 1980, countering restrictive diets. IE, inversely correlated with Body Mass Index (BMI), binge eating, and anxiety/depression symptoms, fosters mind–body-food harmony by recognizing hunger and satiety cues. IE encourages meeting physiological, not emotional, needs, permitting unconditional eating, and relying on internal signals for food decisions. Amidst university students’ stress, exacerbated during the COVID-19 pandemic, understanding their eating behavior, particularly intuitive eating levels, becomes crucial.ObjectiveThis study aimed to assess the IE level of Brazilian students during the COVID-19 pandemic.MethodsThis cross-sectional study, the first to analyze the Intuitive Eating of students in Brazil during the pandemic, was conducted using an online questionnaire.ResultsThe sample comprised 1335 students, most of whom were women (82.17%), with a mean age of 26.12 ± 7.9 years, and a healthy nutritional status (57.58%). The mean IE score was 3.2 ± 0.6. A significant association was found between the confinement situation, the type of housing unit, and the IE subscale-Unconditional Permission to Eat (p = 0.043). However, there was no association between the other subscales and the total IE scale. Regarding self-reported mental and eating disorders, the most frequent were anxiety (21.2%), depression (6.5%), and binge eating disorder (BED) (4.7%). IE was negatively associated with BED (B = − 0.66; p < .001), bulimia nervosa (B = − 0.58; p < .001), body mass index (BMI) (p < .001) and self-reported anxiety (B = − .102; p = 0.16). The male sex showed a higher IE score compared with the female sex (p < .001).ConclusionWhile no significant association was found between IE and the confinement situation, a significant association was found between housing type and the Unconditional Permission to Eat subscale.

Psychological Impact of Eating Disorders- A Comprehensive Review

Eating disorders (EDs) are severe mental health conditions characterized by dysfunctional eating behaviors and cognitions, significantly impacting psychological well-being. This comprehensive review explores the psychological impact of eating disorders, focusing on anorexia nervosa, bulimia nervosa, and binge-eating disorder. The review synthesizes current literature on the prevalence, risk factors, comorbidities, and psychological consequences of EDs. Key psychological impacts discussed include anxiety, depression, obsessive-compulsive behaviors, body dysmorphia, and impaired social functioning. The review also examines therapeutic interventions and their efficacy in addressing these psychological issues. By highlighting the complex interplay between EDs and psychological health, this paper aims to inform clinical practice and future research directions.

Circadian copeptin and oxytocin profiles in anorexia nervosa: Exploring the interplay with neurohypophysis opioid tone.

Neurohypophysis (NH) function in eating disorders (ED) remains poorly elucidated. Studies on vasopressin and oxytocin display inconclusive findings regarding their levels and associations with psychological complications in ED. The profile of opioid tone, a crucial NH activity regulator, is also unknown. To characterise the circadian profile of NH hormones and NH opioid tone using positron emission tomography/MRI (PET/MRI) imaging in patients with ED compared to healthy controls. Twelve-point plasma circadian profiles of copeptin and oxytocin, alongside nutritional and psychological scores, were assessed in age-matched female participants: 13 patients with anorexia nervosa restrictive-type (ANR), 12 patients recovered from AN (ANrec), 14 patients with bulimia nervosa and 12 controls. Neurohypophysis PET/MRI [11C] diprenorphin binding potential (BPND) was evaluated in AN, ANrec and controls. Results revealed lower copeptin circadian levels in both ANR and ANrec compared to controls, with no oxytocin differences. Bulimia nervosa exhibited elevated copeptin and low oxytocin levels. [11C] diprenorphin pituitary binding was fully localised in NH. Anorexia nervosa restrictive-type displayed lower NH [11C] diprenorphin BPND (indicating higher opioid tone) and volume than controls. In ANR, copeptin inversely correlated with osmolarity. Neurohypophysis [11C] diprenorphin BPND did not correlated with copeptin or oxytocin. Copeptin demonstrated significant group differences, highlighting its potential diagnostic and prognostic value. Oxytocin levels exhibited conflicting results, questioning the reliability of peripheral blood assessment. Increased NH opioid tone in anorexia nervosa may influence the vasopressin or oxytocin release, suggesting potential therapeutic applications.

Weight stereotypes in eating disorder recognition

ABSTRACT Objective We investigated weight stereotypes in the recognition and referral of eating disorders (EDs) by assessing if recognition, health care referral, perceived acceptability, perceived distress, and perceived prevalence of an ED differ depending on the weight of the subject in the vignette. Method Community participants (N = 180, age = 19–74) read three different vignettes describing three females with different EDs [anorexia nervosa/atypical anorexia nervosa (AN/AAN), bulimia nervosa (BN), binge eating disorder (BED)] and were randomized to three different experimental conditions concerning an individual with a different weight (overweight, normal, and underweight). Results Across EDs, participants were more likely to recognize a problem, refer for treatment, and rate a higher perceived level of distress in the vignettes of overweight individuals than in the vignettes of normal weight individuals. For BED, a larger proportion of participants in the overweight condition classified the issue described in the vignette as a form of eating pathology compared to the normal weight condition. Discussion These results highlight several weight stereotypes that exist in the recognition and health care referral of EDs. Future ED education and awareness programs should emphasize that EDs can occur in any individual, regardless of their weight.

The Impact of High Levels of Compensatory Exercise on Treatment Outcomes in Threshold and Subthreshold Bulimia Nervosa.

Bulimia nervosa (BN) and other specific feeding or eating disorders with subthreshold BN symptoms (OSFED-BN) are characterized by recurrent binge eating episodes accompanied by compensatory behaviors, including excessive exercise. We aimed to examine the role of compensatory exercise on several clinical disorder-related variables and the treatment outcomes. The sample included 478 patients diagnosed with either BN or OSFED-BN admitted for a 16-week eating disorder-specific treatment program. A battery of questionnaires was administered to evaluate eating and general psychopathology, and personality traits. Other clinical disorder-related data, including levels of compensatory exercise, were assessed through a semi-structured clinical interview. Between-group comparisons of compensatory exercise levels were analyzed, as a predictive model of risk of poor treatment outcomes. Path analysis was conducted using structural equation models to estimate the direct and indirect effects between the main variables. Higher levels of self-reported compensatory exercise were associated with greater eating psychopathology, general psychopathology, and more dysfunctional personality traits and were a predictor of poor treatment outcomes. Additionally, these levels achieved a mediating role in several paths contributing to a higher likelihood of a poor outcome. Further research is required to determine how psychotherapeutic approaches can be optimized to adequately include adaptive exercise for these patients.

Bidirectional Associations between Probable Eating Disorders and Mental Health Conditions Among Military Service Members and Veterans.

Although prior research has examined the prevalence of eating disorders (EDs) such as binge eating disorder (BED) and bulimia nervosa (BN) among military personnel, less is known regarding temporal associations between EDs and other mental health conditions. Using longitudinal data from 179,694 service members and veterans from the Millennium Cohort Study, temporal associations between EDs (BN, BED) and mental health conditions (posttraumatic stress disorder, anxiety, depression, and problem drinking) were investigated using a cross-lagged panel model approach. Results indicated consistent bidirectional associations between most mental health conditions and EDs; however, the magnitude of these cross-lagged associations varied across BN and BED. Cross-lagged effects of mental health conditions on subsequent BED were significantly stronger than BED to mental health condition cross-lagged effects. In contrast, cross-lagged effects of BN on subsequent mental health conditions were stronger than mental health conditions to BN. Preventive screening for those at risk for BN may have a stronger impact on mitigating downstream mental health conditions, while interventions among those with mental health conditions may play a greater role in eliminating maladaptive coping strategies including binge eating. Study findings underscore the importance of early detection of mental health conditions and EDs to maximize readiness among service members.

Prevalence and Risk Factors for the Development of Bulimia Nervosa and Binge Eating Disorder in a Large U.S. Military Cohort.

While bulimia nervosa (BN) and binge eating disorder (BED) are prevalent in military populations, an understanding of risk and protective factors is limited by a lack of longitudinal population-based epidemiological research. This study examined the prevalence of BN and BED among active duty service members and identified military and psychosocial factors associated with their development. Millennium Cohort Study participants were followed for up to 15 years and prevalence was ascertained using survey and electronic medical record data. Longitudinal multivariable logistic regression models evaluated risk factors associated with the development of bulimia nervosa (n=96,245) or binge eating disorder (n=113,733). Weighted prevalence estimates from survey data (range, 0.80%-4.80%) were higher than those from medical records (0.04%-0.14%). Military factors significantly associated with increased risk for BN and BED included active duty component (vs Reserve/Guard); serving in the Army, Marines, or Navy/Coast Guard (vs Air Force); and combat deployment (vs deployment without combat). Associated psychosocial factors included lack of social support, experiencing at least one life stressor, and screening positive for posttraumatic stress disorder or problem drinking. Findings highlight the critical need for disordered eating screening and prevention efforts that bolster coping skills, which can ultimately improve service member functioning and readiness.

Exploring the Psychological Impact of Childhood-Onset Psoriasis: A Systematic Review.

Childhood-onset psoriasis (COP) is often associated with various psychological challenges. While numerous studies have delved into the connection between adult-onset psoriasis and its potential to heighten a patient's susceptibility to various psychological challenges, less has been written about the influence of childhood psoriasis on psychological disorders, particularly anxiety and depression, eating disorders, and substance abuse. In this study, we delve into studies that shed light on these associated risks. A systematic literature review was conducted using PubMed, focusing on the psychological impacts of childhood-onset psoriasis. From an initial pool of 313 articles, we utilized Covidence for screening and selection, adhering to strict exclusion criteria such as psoriasis in adulthood and incorrect study designs. This process refined our focus to 12 relevant articles, which were critically analyzed to understand the psychological comorbidities associated with childhood-onset psoriasis. Our review reveals a significant link between childhood-onset psoriasis and increased instances of depression and anxiety. Notably, children with psoriasis demonstrate higher frequencies of suicidal thoughts and behaviors, as well as a marked propensity for substance abuse and addiction. The study also uncovers a strong connection between psoriasis in children and the development of eating disorders like anorexia nervosa and bulimia nervosa. COP significantly affects the psychological wellbeing of children, with heightened risks for depression, anxiety, suicidality, substance abuse, and eating disorders. These findings underscore the need for comprehensive management strategies that encompass not only the physical symptoms but also the mental health and psychological support for children with psoriasis. Early intervention and regular screenings are crucial in mitigating these risks and improving the quality of life for pediatric patients with psoriasis.

The role of actual-ideal weight discrepancy in the relationships between perfectionism, self-esteem, self-compassion and eating pathology in adolescents with eating disorders

Understanding factors associated with adolescent eating disorders is important for improving treatment outcomes. Actual-ideal weight discrepancy refers to the discrepancy between actual weight and the ideal weight an individual wants to achieve. Actual-ideal weight discrepancy is associated with poorer treatment outcome in eating disorders. It is important to understand factors associated with weight discrepancy to identify targets for treatment to improve outcomes. The aim of this study was to examine self-related constructs associated with actual-ideal weight discrepancy. The specific aim was to determine if perfectionism, self-esteem, and self-compassion contribute to eating disorder symptoms in adolescents, both independently, and through the mediating pathway of actual-ideal weight discrepancy. Participants comprised 114 female adolescents, aged 12–17 years with an eating disorder (40% anorexia nervosa, 33% atypical anorexia nervosa, 16% bulimia nervosa, 5% other specified and 5% unspecified feeding and eating disorders). Higher actual-ideal weight discrepancy, higher perfectionism, lower self-esteem, and lower self-compassion were associated with greater eating disorder symptoms. When the predictors of perfectionism, self-esteem, and self-compassion were included together in a path model predicting eating disorder symptoms, the model explained 59% of variance, and self-esteem and actual-ideal weight discrepancy were the only significant predictors of eating disorder symptoms. Lower self-esteem predicted greater eating disorder symptoms directly and through the mediator of actual-ideal weight discrepancy.

Racial, Ethnic, and Sex Differences in Eating Disorder Onset Among U.S. Military Service Members.

Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. The present study examined independent associations and interactions between sex, race, ethnicity, and probable BED and BN onset. The sample included 91,413 and 96,245 service members from the Millennium Cohort Study for BED and BN analyses, respectively. Up to four datapoints (from 2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, Multiracial, Black, and Asian/Pacific Islander (API) while BED was less likely among Black and API versus non-Hispanic/Latinx White (NHW) service members. Interactions revealed greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed amongst racially and ethnically diverse groups in preventing and detecting EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.