Current Eating Disorder Research Articles

Are Suicide-Specific Interventions Required to Reduce Suicidal Ideation? An Empirical Examination in a Clinical Sample of Eating-Disorder Participants

In this research, we examined whether non-suicide-specific treatments effectively reduced suicidal ideation (SI) among a clinical sample of eating-disorder (ED) patients ( N = 3,447, of whom 50.9% presented with SI). All participants met criteria for a current ED diagnoses based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and were administered a combination of evidence-based treatments in inpatient, residential, partial hospitalization, and intensive outpatient ED treatment facilities. Mediation analyses tested whether SI at discharge decreased specifically through standardized residual change scores in ED symptoms. Both SI and ED symptoms decreased over the course of treatment without clinically meaningful differences by ED diagnosis. ED symptom improvement partially mediated the relationship between SI at admission and discharge, suggesting that treating ED symptoms with evidence-based treatments can be an effective way to reduce SI, at least partially, for many patients. These findings demonstrate the importance of facilitating evidence-based-treatment referrals for specific disorders as a component of broad-based suicide outreach and prevention strategies.

Eating disorder risk among Australian youth starting a diet in the community

Dieting is a potent risk factor for eating disorder (ED) symptoms and development, which typically occur in late adolescence. However, as diets are often motivated by body image concerns (another core ED risk factor), dieters may already carry heightened ED risk. Thus, the current study aimed to document ED risk among young people starting a diet in the community. Young people (16–25 years) starting or intending to start a self-initiated diet (N = 727) provided data via a screener questionnaire, assessing containing sociodemographic factors, past and current ED symptoms and behaviours. Over a third (36.9%) screened using a validated instrument were found to be at-risk of a current ED, with 10% above the clinical cut-off. Consistent with this finding, over 10% of the sample self-reported experiencing a lifetime ED, while nearly a quarter reported symptoms consistent with an ED diagnosis with no reported formal diagnosis. Findings suggest a high level of ED risk among young people starting a diet in the community and point to the need for more proactive measures targeted at this cohort (e.g., screening, monitoring). Further education on the risks of dieting and encouragement for help-seeking in young people is indicated.

Suicidal thoughts and attempts in a transdiagnostic eating disorder sample: Do diagnostic severity criteria predict risk?

Eating disorders (EDs) are associated with elevated suicide. Low body mass index (BMI) and frequency of purging and binge eating represent severity criteria for EDs and distinguish full-threshold EDs from other specified feeding and eating disorders (OSFED). However, no work has taken a transdiagnostic approach to studying whether severity of these or other features is associated with suicidal ideation (SI) and attempts. We examined diagnostic status, ED features, and SI and attempts in a large, transdiagnostic, community sample of 257 women with EDs and 45 controls without a current or past ED in the United States using the EDs Examination interview and the Structured Clinical Interview for the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). SI and suicide attempts (SA) were elevated in OSFED compared to controls but did not differ between OSFED and full-threshold EDs. Higher BMI predicted increased SI. Number of purging methods, but not frequency, was related to history of SA. Binge episode frequency and size were not significant predictors. OSFED presents with elevated SI and SA, and ED severity criteria that distinguish OSFED from full-threshold EDs do not predict SI or SA. Suicide risk assessments should be implemented universally across EDs in clinical practice.

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.

Mental health and body image among SGM youth engaged with a digital eating disorder intervention

Sexual and gender minority (SGM) teens may experience body image concerns and eating disorders (EDs) at higher rates than their non-SGM peers. The current investigation examined differences in baseline survey responses by SGM and non-SGM youth who participated in a pilot randomized controlled trial of a digital intervention for EDs. Eligible teens (N = 147) aged 14–17 years old who screened positive or at high risk for an ED completed a baseline survey to assess current ED symptoms, mental health comorbidities, and ED treatment history. The majority of participants (mean age 16.021 years) screened positive for symptoms of a clinical/subclinical ED (n = 98, 66.7%), 123 endorsed severe anxiety (83.7%), and 81 endorsed severe depression (55.1%). A total of 72.1% (n = 106) identified as SGM and were more likely to report severe symptoms of depression (p = 0.01), any symptoms of anxiety (p = 0.03), social anxiety disorder (p = 0.02), and lifetime suicide attempts (p<.001), compared with non-SGM peers. Qualitative feedback on the intersection of SGM identities and body image concerns were also reported among SGM teens. Future eating disorder interventions provided to SGM youth should include content on comorbidities like depression and anxiety, which may be barriers to ED recovery among SGM teens.

Body Dissatisfaction Is Central to Military Eating Disorder Pathology: A Multi-Time-Point Network Analysis

Military membership may put individuals at risk for eating disorders (EDs) due to military specific risk factors such as strict physical fitness requirements, increased salience of weight, and exposure to trauma. Current ED assessments and treatments do not account for these military-specific risk factors. Empirically identifying maintaining factors for EDs can clarify which specific ED symptoms may be efficacious treatment targets for service members and veterans. Thus, we employed network analysis within a military sample to identify central ED symptoms and compare if these symptoms changed across three time-points. We hypothesized that body dissatisfaction and overexercise would be identified as central symptoms across all three time-points. Individuals in the military (73.7% male, 84.8% active duty, Mage = 30.74) completed the Eating Pathology Symptom Inventory (EPSI; Forbush et al., 2013) at baseline (n = 216), and at 1-month (n = 191) and 3-month follow-up (n = 176). We computed cross-sectional graphical LASSO networks and found that the most central symptoms were related to body dissatisfaction, overexercise, binge eating and diet pill/diuretics; these symptoms were largely stable across multiple time-points. Body dissatisfaction was identified as central across all three time-points and overexercise, binge eating, and diet pill/diuretics were identified as central across two timepoints. These findings are in line with network studies among men and clinical patients that find weight/shape concerns consistently emerge as central ED symptoms. Given that overexercise and diuretics are both central symptoms and frequently employed by military populations, providers should assess these symptoms and work to treat them in a culturally responsive way when they arise.

Relative Energy Deficiency in Sports (RED-S)

This overview intends to show a possible diagnostic/treatment pathway for athletes with an energy deficiency. This is based on the IOC statement paper (13), which was recently revised in 2023. An interdisciplinary approach is important to reach all aspects. In order to achieve a successful treatment, it is important to involve the whole environment of the affected athlete. The earlier the intervention takes place, the less chronic consequences will occur. However, abnormalities such as primary and secondary amenorrhea, susceptibility to infection or lack of training success should always be considered as possible indications and should be subject to further examination. In addition, it is also important to recognize a current or incipient eating disorder so that professional treatment can be initiated as soon as possible with the primary goal of enabling the athlete to train and compete at the highest level.

A preliminary study of collaborative group intervention with recovered peer supporters for eating disorders: Analyses including comparisons between in‐person and online sessions

AbstractAimsThis study aimed to evaluate the impacts of a single‐session group intervention for individuals with an eating disorder that involved collaborations between peer supporters, who had recovered from an eating disorder, and psychological professionals. We also compared intervention effects between in‐person and online settings.MethodsParticipants with an eating disorder were recruited through online platforms and public promotional materials. The inclusion criteria involved individuals who had current eating disorders and were willing to openly share their experiences during the session in which the Reflecting Team method was applied.ResultsThe analysis included 103 participants (75 in‐person and 28 online). We found significant time‐based effects (F(1, 101) = 70.390, p &lt; 0.001, ηG2 = 0.083), which indicated that participants experienced reductions in feelings of isolation, hopelessness associated with their eating disorder, and belief in the incurability of their disorder following the group interventions. No significant differences were observed between in‐person or remote sessions (F(1, 101) = 0.087, p = 0.768, ηG2 = 0.001).ConclusionsOur findings suggest that peer supporters serve as a source of hope for individuals with eating disorders, even within group settings. Furthermore, the similar outcomes across in‐person and online sessions show the promise of remote group sessions as a novel means of support for individuals with eating disorders, regardless of their geographical location. However, future randomized controlled trials of continuous group therapy sessions are essential to confirm their effectiveness.

Lifetime and current mental health based on avoidant/restrictive food intake disorder history versus other eating disorder history in the Healthy Minds Study.

Research on psychiatric comorbidities associated with avoidant/restrictive food intake disorder (ARFID) primarily compares ARFID versus anorexia nervosa (AN). Little is known about comorbidities associated with mixed ARFID/other eating disorder (ED) history or ARFID comorbidities relative to EDs beyond AN. This study assessed lifetime and current psychiatric factors in a large college sample with varying ED histories. Participants were United States students from the 2021/2022 Healthy Minds Study who endorsed lifetime professionally diagnosed EDs (N = 4657). Chi-square tests compared lifetime ED groups (ARFID, ARFID + Non-ARFID ED, Non-ARFID ED) on lifetime neurodevelopmental, anxiety, obsessive-compulsive, trauma/stressor-related, and depressive disorder prevalence, and suicidality and counseling/therapy receipt. Multivariate analysis of variance evaluated current depressive, anxiety, and ED symptom differences. Lifetime neurodevelopmental and anxiety disorders were less prevalent in "Lifetime Non-ARFID ED" than ARFID groups. Lifetime depressive, trauma/stressor-related, and obsessive-compulsive disorders were relatively more prevalent in "Lifetime ARFID + Non-ARFID ED." This group demonstrated relatively greater current depressive symptoms and past-year suicide attempts. Lifetime ARFID groups demonstrated relatively greater current anxiety. All groups differed on current ED symptoms. Effects were small. Historical ARFID is associated with neurodevelopmental disorders and historical/current anxiety. Mixed ARFID/non-ARFID ED history may indicate increased propensity toward varied psychopathology. This study replicated findings that ARFID is associated with neurodevelopmental and anxiety disorders in the lifespan through young adulthood. Extending prior work, results suggest a history of ARFID is associated with increased anxiety in young adulthood. Finally, a history of both ARFID and other eating pathology is associated with increased risk for a wide range of psychiatric difficulties (e.g., obsessive-compulsive symptoms, suicide attempts) in the lifespan through young adulthood.

Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches.

It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.

Motives for using social networking sites: a uses & gratifications perspective amongst people with eating disorder symptoms

Studies investigating motives for social networking sites (SNS) use amongst people with eating disorder (ED) symptoms are scarce. The uses and gratifications theory states that people actively select media content to gratify their individual needs and this may help to explain why individuals with eating disorder symptoms choose to expose themselves to specific media content and how they choose to respond. Some evidence exists that readiness to change may be a factor related to SNS use patterns in this population. The aim of the present study was to investigate the potential relationship between readiness to change ED cognitions/behaviors and SNS use motives in individuals with current or past ED symptoms, employing a uses and gratifications theory perspective. Participants were recruited from ED recovery websites; 103 individuals (16–55 years old) provided complete data. As hypothesized, ED symptom severity was inversely associated with readiness to change and time spent on (specific) SNS was not associated with ED symptom severity. The results of hierarchical regression analyses further suggested that if individuals felt less capable of overcoming their dysfunctional cognitions/behaviors about their body/eating (i.e., were less ready to change), they were more likely to be motivated to use SNSs for the purpose of impressing others and reputation management. The clinical implication is that high amounts of SNS use may not necessarily be harmful for people with EDs or recovering from EDs, whereas using SNSs for the purposes of impression management could potentially be related to being less ready to recover.

Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: a cross-sectional study

BackgroundAvoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen.MethodsAmong 50,082 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined.Results2378 (4.7%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than most other diagnoses and higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%).ConclusionsFindings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders, at risk for an eating disorder, or at low risk. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.

Cognitive flexibility and DSM-5 severity criteria for eating disorders: assessing drive for thinness and duration of illness as alternative severity variables

BackgroundThe severity criteria for eating disorders (EDs) proposed in the DSM-5 have been established without sufficient empirical support. Drive for thinness (DT) and duration of illness have been proposed as two alternative severity measures, however their empirical evidence is also limited. To date, no research has assessed the validity of current eating disorder (ED) severity criteria regarding cognitive flexibility factors. Cognitive flexibility is often impaired in EDs, becoming a possible severity symptom. The current study assessed for the first time (1) whether the severity indexes for EDs proposed in the DSM-5 were associated with deficits in cognitive flexibility and, (2) whether drive for thinness and illness duration, acted as an alternative, more meaningful severity indices for deficiencies in cognitive flexibility.MethodsParticipants were 161 patients diagnosed with an ED, who were categorized according to DSM-5 severity categories, DT and duration of illness. Discriminative capacity of each classification was assessed for cognitive flexibility measured by Wisconsin card sorting test (WCST).ResultsThe findings for the DSM-5 classification comprised: (a) In the anorexia nervosa (AN) group, patients with moderate severity showed better scores in WCST than patients with mild and severe/extreme severity. Also, patients with moderate severity showed lower percentage of cognitive flexibility deficits than the other two severity categories; (b) For the binge spectrum disorders (BSD) group, the patients with mild severity showed a higher percentage of cognitive flexibility deficits than did the moderate and severe/extreme categories. When assessing the alternative severity index of DT, no differences were found in cognitive flexibility in any of the groups. Regarding illness duration, in the AN group the task performance of the patients with longer illness duration was worse than the performance of the short duration group and, in the BSD group, patients with longer duration also showed more deficits in cognitive flexibility than the patients with shorter duration of illness.ConclusionsOur findings point out the limitations of the DSM-5 severity criteria to categorize cognitive flexibility in EDs and support illness duration as an alternative severity approach for EDs.

Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study

BackgroundEating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study aimed to identify potential differences in the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, in order to contribute to a better understanding of their diverse needs and experiences.MethodsThe study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 years) with bulimia nervosa or binge-eating disorder (BN/BED) enrolled in the Binge Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and their current mental health and gastrointestinal symptoms. Untreated participants (n = 291, 38%) were compared with treated participants (n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives.ResultsUntreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent eating disorder symptoms over their lifetime, and greater body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. A history of anorexia nervosa was positively associated with treatment engagement. Individuals self-reporting a history of inpatient or residential treatment exhibited the most severe illness history, those with outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history.ConclusionsHistorically overlooked and marginalized populations self-reported lower treatment access rates, while those who accessed treatment reported more severe eating disorder and comorbid mental health symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not represent individuals with milder symptoms or racial and ethnic diversity, and males. Community-based recruitment is crucial for improving the ability to apply research findings to broader populations and reducing disparities in medical research.Trial Registration ClinicalTrials.gov NCT04162574 (https://clinicaltrials.gov/ct2/show/NCT04162574).

Acceptability and perceived harm of calorie labeling and other obesity policies: A cross-sectional survey study of UK adults with eating disorders and other mental health conditions.

We assessed perceptions of recently proposed UK obesity policies (mandatory calorie labeling, banning of advertisements of unhealthy food and drinks online and before 9 pm on TV, and banning "buy one get one free" deals for unhealthy food and drinks) in people with an eating disorder (ED) and other mental health conditions. A total of 1273 participants with a self-reported lifetime mental health condition (N = 583 with an ED) completed an online survey in September-November 2022. Multinomial logistic regression was used to examine support for and potential adverse effects of policies in participants with and without an ED. A qualitative analysis of the potential effects of the policy on current ED symptoms was also conducted to better understand how and why policies may be damaging or beneficial. Participants with an ED had a lower level of support for the implementation of the calorie labeling policy compared to those without an ED (43% vs. 58%). Half of the participants with an ED (55%) reported that labeling may worsen their ED symptoms. Qualitative data indicated perceived potential harm (e.g., a gateway to relapse, negative effects on mood) and perceived benefits (e.g., feeling informed and reassured) of calorie labeling in participants with an ED. No differences in support or perceived harms of the other two policies were observed between participants with versus without an ED. Future studies are warranted to explore the potential effects of calorie labeling and how to mitigate negative impacts on people with an ED. This research is the first to assess the perceptions of UK obesity-related policies in people with an ED and other mental health conditions. Participants with an ED (vs. without) were more likely to disagree with the government implementing the calorie labeling policy. These findings highlight the potentially harmful effects of calorie labeling in people with an ED and the need for future research to understand how to mitigate negative impacts.

Breastfeeding and pumping as maladaptive weight control behaviors.

It is well recognized by the general public that breastfeeding expends calories. In our clinical practice, a number of postpartum women with a history of or a current eating disorder (ED) report using breastfeeding and/or pumping breast milk to influence their body shape and weight. This appears to be either a form of weight control behavior or, in some cases, a compensation for perceived overeating or binge eating. Breastfeeding and pumping have not generally been identified as maladaptive weight control behaviors, nor have they been a subject of research to date. We suggest that this practice should be investigated to determine how common it is, its potential role in maintaining EDs or contributing to relapse in the postpartum period, and to better understand other potential harms it may cause to both the mother and infant/child. PUBLIC SIGNIFICANCE: Breastfeeding and pumping may be used as maladaptive methods of weight control by women with EDs. This behavior is under-recognized in clinical practice and has received little research attention. We argue that maladaptive breastfeeding and pumping warrant further investigation, as the behaviors may play an important role in maintaining an ED or in contributing to relapse during the postpartum period and may also indirectly harm the infant/child.

A Serious Game for Patients With Eating Disorders (Maze Out): Pilot User Experience and Acceptance Study.

Eating disorders (EDs) are severe mental disorders associated with notable impairments in the quality of life. Despite the severity of the disorders and extensive research in the field, effective treatment for EDs is lacking. Digital interventions are gaining an evidence-based position in mental health, providing new perspectives in psychiatric treatment. Maze Out is a serious game coproduced by patients and therapists that focuses on supporting patients with EDs. The aim of this study was to investigate the experiences of engaging in and acceptability of Maze Out among patients with EDs and therapists. This study is a qualitative pilot study involving data collected through focus groups and individual interviews and user analytics collected through the game. The participants were recruited from the Odense Mental Health Service of the Region of Southern Denmark. Qualitative interviews analyzed by thematical analysis and interpreted by interpretative phenomenological analysis were used to evaluate the acceptance and experience of Maze Out among patients and therapists. The mobile health evidence reporting and assessment checklist was used to describe the content, context, and technical features of the game in a standardized manner for mobile health apps. The participants found Maze Out to be engaging, easy to use, and a good platform for reflecting on their disorder. They primarily used Maze Out as a conversational tool with their close relationships, giving them insights into the experiences and daily life struggles of someone with EDs. Maze Out seems to be a promising tool supplementing the current ED treatment. Further research should focus on evaluating the effectiveness of the game and its potential to support patients with different types of EDs.

"How Do I Exist in This Body…That's Outside of the Norm?" Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia.

Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark's thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings.

Perceptions and experiences with eating disorder treatment in the first year of COVID-19: A longitudinal qualitative analysis.

The COVID-19 pandemic created significant challenges in accessing and receiving treatment for individuals with eating disorders (EDs). The purpose of this study is to explore perceptions of and experiences with ED treatment during the first year of the pandemic among individuals with past and self-reported EDs in the United States. Online surveys were administered to adults (N=510) with a past or current self-reported ED at 13 timepoints between April 2020 and May 2021. Using longitudinal qualitative analysis, 5651 free-text responses were examined to capture experiences with ED treatment and generate inferences of change over time. We categorized results into four sequential, temporal quarters and identified patterns that explained participants' perceptions of facilitators, barriers, and experiences with ED treatment over time: Quarter 1. Treatment Disruption and Reorienting Recovery; Quarter 2. Accumulating COVID-19 Stress and Virtual Treatment Woes; Quarter 3. A Continuation of Inadequate Care; and Quarter 4. Ongoing Adaptation and Adjustment to Uncertainty. Participant experiences were marked by numerous barriers to accessing care, challenges adjusting to virtual treatment, unmet treatment needs, and beginning acceptance of telehealth. Our findings present a timeline to help evaluate challenges related to navigating the switch to virtual care which created significant disruption to ED recovery. Participants spent much of the first year trying to adjust to unemployment, loss of insurance, and lack of access to in-person treatment. Future research should identify additional strategies to improve the receipt and experience of care for EDs. Our findings suggest that individuals with eating disorders were significantly challenged by accumulating COVID-19 stress, worsening symptomatology, and limited access to effective treatment during the first year of the pandemic. This knowledge can guide clinicians, treatment centers, and policy makers in addressing the behavioral health needs of individuals impacted by disordered eating amidst emergent public health crises.

Co-occurrence of nonsuicidal self-injury and eating disorder pathology in adolescents.

Little is known about the co-occurrence of nonsuicidal self-injurious (NSSI) behaviors and eating disorder (ED) pathology in community samples of adolescents. A total of 1558 Norwegian upper secondary school students (Grades 11, 12, and 13) completed the Deliberate Self-Harm Inventory and a measure of ED pathology. Adolescents (53.1% F, 46.9% M) were a mean age of 17.1 years. A higher level of ED pathology was reported (12.1 vs. 5.3, p< .001) among adolescents who had a history of NSSI. Significantly higher levels of ED pathology were found among females who reported hitting themselves until bruised, head banging, severe scratching, and burning with a lighter, but not cutting, or the other forms of self-injury. Of adolescents with a history of NSSI, 60% of females and 15% of males scored above a cutoff for ED pathology. Of adolescents scoring above a cutoff for ED pathology, 42.5% of females and 37.1% of males had engaged in lifetime NSSI. Adolescents-in particular, females- with a history of NSSI reported significantly greater ED pathology. Notably, a higher proportion of males with ED pathology reported lifetime self-injury than vice versa, underscoring the importance of carefully screening for the presence of self-harm among males with ED pathology. Over 1500 upper secondary school students with an average age of 17 years completed an online survey assessing current ED pathology and lifetime NSSI. Adolescents, particularly females, with a history of self-harm reported significantly more ED pathology. Findings also indicated the need to carefully screen for self-harm among males with ED pathology. Parents, schools, and health professionals should be aware that self-harm and ED pathology commonly co-occur and warrant assessment.