Diagnostic Criteria For Anorexia Nervosa Research Articles

Eating and feeding disorders in adults with intellectual developmental disorder with and without autism spectrum disorder.

The present observational cross-sectional study aimed at investigating the prevalence of feeding and eating disorders (FEEDs) in adults with intellectual disability (ID)/intellectual developmental disorder (IDD) with or without autism spectrum disorder (ASD) and specific problem behaviours (PBs). Two hundred six adults with ID/IDD consecutively attending residential and rehabilitative facilities, 59.2% of which had co-occurring ASD, were assessed for presence of FEEDs by a structured interview specifically developed for the study and Diagnostic Manual - Intellectual Disability criteria. The 4.3% of the sample fully met the diagnostic criteria for anorexia nervosa, 6.7% for bulimia nervosa (BN) and 22.8% for binge eating disorder (BED). Furthermore, at least one observable symptom of these disorders was found in higher percentages of the sample. A higher prevalence of FEEDs was found in ID/IDD plus ASD than in ID/IDD alone. PBs were also significantly higher in participants with co-occurring ASD and had a positive correlation with the number of FEED symptoms, especially for BN and BED. The study enriches previous literature and considers novel aspects such as the behavioural/observable presentation of symptoms as well as the association with ASD and PBs. These issues deserve a specific consideration within standard psychiatric assessment and future research, especially in persons with major communication and/or cognitive difficulties.

Knowledge and perceived confidence of Brazilian psychiatrists about eating disorders´ diagnosis and treatment recommendations.

To investigate Brazilian psychiatrists ́ knowledge and perceived confidence, both in diagnosis and in evidence-based treatments for eating disorders (ED). In this cross-sectional study, 259 psychiatrists filled out an online form including: sociodemographic data, questions about ED diagnosis and management based on standard guidelines. Descriptive statistics described sample characteristics and levels of ED knowledge and perceived confidence. Sample was composed mainly by women (65,64%), with mean age of 42.86, from the Southeast of Brazil (56,37%), working predominantly in private practice (59,85%), with less than ten years of experience in Psychiatry (51,74%). We found that 33.21% of participants correctly chose diagnostic criteria for anorexia nervosa (AN); 29.73% for bulimia nervosa (BN), and 38.22% for binge eating disorder (BED). Correct answers for therapeutic options were similar in BN and BED (20.8%), being considerably lower for AN (2.7%). Additionally, reported ED training were: 15.1% during medical school; 59.8% during medical residency/postgraduate studies; 58.7% as complementary training. Only 8.89% felt satisfied with their ED training; 50.97% felt confident diagnosing ED and 37.07% in managing ED patients. These results demonstrated an important gap in ED knowledge of Brazilian psychiatrists, and its consequences on their confidence and competence in managing ED patients.

Body image disturbance in eating disorders

Body image disturbance (BID) is a frequent symptom in patients with eating disorders. The symptom occurs mainly in patients with anorexia nervosa continuing to perceive themselves as average weight or even overweight despite being severely underweight.[1] An altered perception of one's body and a severe state of bodily dissatisfaction characterizing the body image disturbance. This symptom is included among the diagnostic criteria for anorexia nervosa in DSM-5 (criterion C).[2] The disturbance is associated with significant bodily dissatisfaction and is a source of severe distress, often persists in eating disorders after treatments,[3][4] and is considered hard to treat.[3] Thus, effective body image interventions could improve the prognosis in patients with ED, as Hilde Bruch suggested.[5] Unfortunately, there is no hard evidence that current treatments for body image disturbance effectively reduce eating disorders' symptoms.[6] Furthermore, pharmacotherapy is ineffective in reducing body misperception and it has been used to focus on correlated psychopathology (mood or anxiety disorders).[7] However, to date, research and clinicians are developing new therapies as virtual reality experiences,[8][9] mirror exposure[10] or multisensory integration body techniques,[11][12] which are showing promising results.

The improvement effect of food additive analysis in patients with anorexia nervosa

BackgroundAnorexia nervosa is a severe psychological disorder, and current treatment of anorexia nervosa relies on psychotherapy and medical nutritional support. The study applied food additives to the relevant treatment, aiming to help improve the patients’ diet.Subjects and MethodsPatients who met the diagnostic criteria of anorexia nervosa were randomly selected and divided into experimental and control groups, with 25 patients in each group. The experimental group received food additive-assisted treatment, while the control group received only conventional treatment. Before and after treatment, the patients’ body mass index (BMI) and height were measured, and eating disorders were assessed using the EDE-Q. The resultant data were analyzed using SPSS22.0.ResultsAfter treatment, the BMI of the experimental group was significantly higher than that before treatment (F=18.42, P<0.05), while the BMI of the control group did not change significantly (F=9.71, P>0.05). In the EDE-Q scale assessment, the experimental group scored lower than the control group in terms of frequency of binge eating, frequency of emesis, and restriction of eating factor, and the difference was statistically significant (P<0.05).ConclusionsAfter treatment, patients in the experimental group showed a significant increase in BMI, and the frequency of binge eating, frequency of emetic, and restriction of eating factor scores were lower than those of the control group. This suggests that food additives may have potential efficacy in alleviating the symptoms of anorexia nervosa.

Social support across eating disorder diagnostic groups: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

IntroductionPrevious studies have suggested the positive influence of social support on the treatment and recovery of eating disorders (EDs). Yet, more research is needed on how objective and subjective social support differ between ED diagnostic groups using nationally representative data. Therefore, the current secondary data analysis examined associations between EDs and objective and subjective social support using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study. MethodsParticipants completed measures of lifetime and past year diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and items assessing objective social support (i.e., number of close friends and close relatives) and subjective social support (i.e., perceptions of availability of support). ResultsCompared to those without EDs, those with AN, BN, and BED had poorer subjective social support—or lower perceptions of social support. However, there were fewer differences regarding objective social support. Individuals with BN reported a lower number of close relatives compared to those without EDs and those with AN, but there were no differences in the number of close friends between ED groups. Those who experienced remission from EDs had higher perceptions of social support compared to those with past year EDs. DiscussionThe findings show deficits in subjective social support across EDs but only lower objective social support in BN. This highlights the clinical utility of increasing perceptions of social support across EDs. The findings also show the importance of perceived social support in recovery from EDs.

Genetic investigation of the contribution of body composition to anorexia nervosa in an electronic health record setting

Anorexia nervosa (AN) is a psychiatric disorder defined by anthropometric symptoms, such as low body weight, and cognitive-behavioral symptoms, such as restricted eating, fear of weight gain, and distorted body image. Recent studies have identified a genetic association between AN and metabolic/anthropometric factors, including body mass index (BMI). Although the reported associations may be under pleiotropic genetic influences, they may represent independent risk factors for AN. Here we examined the independent contributions of genetic predisposition to low body weight and polygenic risk (PRS) for AN in a clinical population (Vanderbilt University Medical Center biobank, BioVU). We fitted logistic and linear regression models in a retrospective case-control design (123 AN patients, 615 age-matched controls). We replicated the genetic correlations between PRSBMI and AN (p = 1.12 × 10−3, OR = 0.96), but this correlation disappeared when controlling for lowest BMI (p = 0.84, OR = 1.00). Additionally, we performed a phenome-wide association analysis of the PRSAN and found that the associations with metabolic phenotypes were attenuated when controlling for PRSBMI. These findings suggest that the genetic association between BMI and AN may be a consequence of the weight-related diagnostic criteria for AN and that genetically regulated anthropometric traits (like BMI) may be independent of AN psychopathology. If so, individuals with cognitive-behavioral symptomatology suggestive of AN, but with a higher PRSBMI, may be under-diagnosed given current diagnostic criteria. Furthermore, PRSBMI may serve as an independent risk factor for weight loss and weight gain during recovery.

What is OSFED? The predicament of classifying 'other' eating disorders.

The transition from DSM-IV to DSM-5 relaxed diagnostic criteria for anorexia nervosa and bulimia nervosa, and recognised a third eating disorder, binge eating disorder. However, a large proportion of cases remain in the ill-defined category of 'other specified feeding and eating disorders'. We sought to investigate the utility of a proposed solution to classify this group further, subdividing based on the dominant clinical feature: binge eating/purging or restraint. Cluster analysis failed to identify clusters in a treatment-seeking sample based on symptoms of restraint, binge eating, purging and over-evaluation of shape and weight. Further investigation of this highly heterogeneous group is required.

ANALYSING ANOREXIA NERVOSA: DIGITAL LOGIC PROVIDES ALTERNATIVE MEANINGS OF ITS NATURE, LEADING TO ALTERNATIVE FORMS OF PSYCHOTHERAPY

The purpose of this article is to apply innovative analogue and digital thinking processes that, first, negate DSM (III to 5th Eds.) understandings of anorexia, and then formulate a bases which encapsulates alternative understandings of the universal patterns of behavior, understandings that honour and embrace the patterns of behavior expressed by each person. Published research of lived experiences of persons who exhibit patterns of behavior and attitudes towards food, weight, body shape and size, that are deemed to be diagnostic criteria of anorexia nervosa, provides evidence that those patterns of behavior serve as coping mechanisms against the suffocating forces of unwanted, specific, and personal discourses in their lives. As a consequence of this application, the article argues that these universal patterns of behavior and attitudes to food, weight and body image, expressed uniquely by each person, are expressions, images and ideas of a specific form of an archetype, with each person having their personal and unique reasons for their behavioral expressions. This analyses indicates that these persons do not “suffer from” a mental eating disorder called anorexia, and that psychotherapeutic approaches for each person should focus on the problems in their lives, problems that cause them to express the images and ideas of a universal archetype.

Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine

BackgroundFamily-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with Anorexia Nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery. Face-to-face therapy is subject to geographic, temporal and human factors, rendering it particularly susceptible to inequities and disruption. This has resulted in poorer service provision for rural and regional families, and recently a significant challenge to providing face-to-face services during the COVID-19 global pandemic. The present study examines whether FBT for AN can be successfully translated to a digital delivery platform to address these access issues.MethodForty young people aged 12 to 18 years who meet DSM-5 diagnostic criteria for AN, and live in a rural or regional setting, will along with their family be recruited to the study. Trained therapists will provide 18 sessions of FBT over 9 months via telemedicine to the home of the young person and their family. The analysis will examine treatment effectiveness, feasibility, acceptability, and cost-effectiveness.DiscussionThe study addresses the treatment needs of families not able to attend face-to-face clinical services for evidence-based treatment for eating disorders. This might be due to several barriers, including a lack of local services or long travel distances to services. There has been a recent and unprecedented demand for telemedicine to facilitate the continuity of care during COVID-19 despite geographical circumstances. If delivering treatment in this modality is clinically and economically effective and feasible, it will facilitate access to potentially lifesaving, evidence-based treatments for families formerly unable to access such care and provide evidence for the continuity of services when and where face-to-face treatment is not feasible.

Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort

BackgroundExtreme anorexia nervosa (AN) is defined as a BMI < 15 kg/m2 in those meeting DSM-V diagnostic criteria for AN. This study seeks to define the frequency of medical complications in this group of patients in order to help inform the care of individuals < 65% ideal body weight who seek treatment for their extreme eating disorders.MethodsThrough retrospective chart review and computerized data collection, we obtained the baseline characteristics and medical findings of 281 adult patients, with AN restricting and binge-purge subtypes, admitted to the ACUTE unit for medical stabilization between May 2013 and August 2018.ResultsIn this population, with a mean admitting BMI of 12.1 kg/m2 (range = 7.5–15.7), 56% admitted with bradycardia, 45% demonstrated increased liver function tests (LFTs) on admission, 64% admitted with leukopenia, 47% with anemia, and 20% presented with thrombocytopenia. During admission, 38% developed hypoglycemia, 35% developed refeeding hypophosphatemia, nearly 33% of patients developed edema, and low bone mineral density was diagnosed in almost 90% of the patients. Highly elevated LFTs (>3x upper limits of normal) predicted hypoglycemia, and low BMI predicted refeeding hypophosphatemia (p = .001).ConclusionsAlthough conclusions drawn from the findings presented in this descriptive study must be tempered by relevant clinical judgement, these findings showcase that patients with extreme AN are at significantly increased risk for many serious medical complications secondary to their state of malnutrition and also with initial refeeding.

Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery

ObjectiveThis study aimed to explore the experiences of women who had developed excessively restrictive eating behaviours following bariatric surgery.MethodFive female participants, who were at least nine months post-bariatric surgery and exhibiting restrictive eating behaviours, were recruited from Bariatric Surgery Psychology Services and asked to complete qualitative face-to-face semi-structured interviews. The data was analysed using interpretative phenomenological analysis (IPA).ResultsThree super-ordinate themes emerged: (1) experiences of weight stigma and weight history on self, (2) the impact of loose skin, (3) thoughts about food and disordered eating patterns. These captured the impact of past weight-related experiences—including weight stigma, intense fears of weight gain, negative cognitions about the self, the impact of excess skin, changes in the way the women thought about food and restrictive eating behaviours.DiscussionThis study is one of the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. The findings of this study may offer helpful aspects for professionals to hold in mind when identifying individuals with problematic restrictive eating behaviours following bariatric surgery. Body contouring surgery, internalised weight bias and weight stigma are explored in relation to the post-bariatric surgery treatment pathway. The current diagnostic criterion for anorexia nervosa are discussed to highlight difficulties in diagnosing this presentation in the post-bariatric surgery population, where people can have BMIs over 25 kg/m2 but are severely restricting energy intake.

Increased urge for movement, physical and mental restlessness, fundamental symptoms of restricting anorexia nervosa?

ObjectiveContinued mobility in the presence of severe weight loss is a well known, yet insufficiently researched characteristic of anorexia nervosa (AN). This study was designed to assess the prevalence of the drive for activity, here operationalized as an increased urge for movement, physical restlessness, and mental restlessness.MethodParticipants were 83 female consecutively admitted adolescent patients qualifying for a diagnosis of AN (ICD‐10), restricting subtype. Information collected included responses to a questionnaire inquiring retrospectively about physical and psychological reactions after significant weight loss (on average 12.5 kg) and to measures of psychiatric and eating disorder pathology and exercise behaviors at hospital admission.ResultsOver 80% of AN patients reported experiencing, at least partly, either, an increased urge for movement, physical or mental restlessness after significant weight loss. Altogether 95.1% reported, at least partly, one or a combination of two or all three symptoms. The sensations coexisted with equally high levels of fatigue and loss of energy, typically observed in starvation. The increased urge for movement and physical restlessness were foremost associated with reported actual physical activity and with weight loss. By contrast, mental restlessness was strongly linked to the degree of eating disorder pathology and to the severity of psychiatric symptoms.DiscussionThis is the first investigation of the presence of an increased urge for movement, physical restlessness, and mental restlessness after significant weight loss in patients with acute AN. The symptoms, given their high frequency and specificity, are likely pathogenic for AN and, if replicated, deserve to be considered for inclusion as diagnostic criteria for AN.

Eating Disorder Symptoms in Australian Actors and Performing Artists.

Anecdotal evidence suggests that actors and other performing artists are under great pressure to conform to idealized appearances and body types. The pursuit of such appearances may trigger eating disorder symptoms, such as unhealthy attitudes towards body weight and shape. Thus far, there has been no dedicated empirical study of the prevalence of such problems in Australian actors and performing artists specifically. Therefore, this study sought to examine eating disorder symptomatology in Australian actors and performing artists. An online survey was distributed to the Equity Foundation membership representing Australian actors and performing artists, of whom 573 individuals completed the survey. This survey gauged demographic information and eating disorder symptoms using the psychometrically validated Eating Disorder Diagnostic Scale (EDDS). A large proportion of actors reported unhealthy attitudes such as 'feeling fat' even though they are of normal weight or underweight; reported an extreme fear of gaining weight; and evaluated their self-worth based on their body weight and shape, particularly women. Results also showed that 2.5% of women in the study met the diagnostic criteria for anorexia nervosa and 13% met diagnostic criteria for bulimia nervosa based on their scores on the EDDS. Performers may be a particularly at-risk population for the development and/or maintenance for a range of eating disorders.

Applying a multidimensional model of craving to disordered eating behaviors: Development of the Food Approach and Avoidance Questionnaire.

Despite revisions to the DSM-5, current diagnostic criteria poorly capture the phenomena of eating disorders. The construct of food craving may help to explain the range of disordered eating and compensatory behaviors, but current measures do not fully capture the construct. Borrowing from the substance use literature and emphasizing both approach and avoidance craving inclinations, the ambivalence model of craving (AMC) provides a useful framework for predicting broad patterns of disordered eating behaviors. This study sought to develop and preliminarily validate a multidimensional AMC-based measure of food craving. Items for the Food Approach and Avoidance Questionnaire were generated and development and validation data were collected via online survey from community-based adults and university students (N = 1,070). Exploratory factor and item response theory analyses were used for measure development. Linear regressions were used to examine convergent and discriminant validity. Exploratory sensitivity analyses included logistic regressions and receiver operating characteristic curves. As hypothesized, a 2-factor measure was supported. No sex differences emerged in item functioning. The approach factor was associated with greater trait food craving, more uncontrolled eating, and greater likelihood of meeting self-reported diagnostic criteria for bulimia nervosa and binge eating disorder. The avoidance factor was associated with higher levels of restrained eating, drive for thinness, and an increased likelihood of meeting self-reported diagnostic criteria for anorexia nervosa and bulimia nervosa. Preliminary data support a new multidimensional measure of approach and avoidance food craving with potential for a transdiagnostic conceptualization of disordered eating and compensatory behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perceptual Not Attitudinal Factors Predict the Accuracy of Estimating Other Women's Bodies in Both Women With Anorexia Nervosa and Controls.

Disturbance in how one’s body shape and size is experienced, usually including over-estimation of one’s own body size, is a core feature of the diagnostic criteria of anorexia nervosa (AN). Is this over-estimation specific to women with AN’s judgments of their own body? Or is it just a general feature of their judgments about all bodies? If the latter, it would be consistent with a general error in the perception of body size potentially linked to the use of a different set of visual cues for judging body size. If the former, then this suggests that the over-estimation of own body size has a strong attitudinal component and may be part of the psycho-pathology of their condition. To test this hypothesis, 20 women with AN and 80 control observers estimated the body size of 46 women. The results show a strong effect of perceptual factors in estimating body size for both controls and women with AN. This result is consistent with size over-estimation of own body in AN having a strong attitudinal basis and being a core feature of the psycho-pathology of the condition.

Micronutrients Deficiencies in 374 Severely Malnourished Anorexia Nervosa Inpatients.

Introduction: Anorexia nervosa (AN) is a complex psychiatric disorder, which can lead to specific somatic complications. Undernutrition is a major diagnostic criteria of AN which can be associated with several micronutrients deficiencies. Objectives: This study aimed to determinate the prevalence of micronutrients deficiencies and to compare the differences between the two subtypes of AN (restricting type (AN-R) and binge-eating/purging type (AN-BP)). Methods: We report a large retrospective, monocentric study of patients hospitalized in a highly specialized nutrition unit between January 2011 and August 2017 for severe malnutrition treatment in the context of anorexia nervosa. Results: Three hundred and seventy-four patients (360 (96%) women, 14 (4%) men), age: 31.3 ± 12.9 years, Body Mass Index (BMI): 12.5 ± 1.7 kg/m2 were included; 253 (68%) patients had AN-R subtype while, 121 (32%) had AN-BP. Zinc had the highest deficiency prevalence 64.3%, followed by vitamin D (54.2%), copper (37.1%), selenium (20.5%), vitamin B1 (15%), vitamin B12 (4.7%), and vitamin B9 (8.9%). Patients with AN-BP type had longer disease duration, were older, and had a lower left ventricular ejection fraction (LVEF) (p < 0.001, p = 0.029, p = 0.009), when compared with AN-R type, patients who instead, had significantly higher Alanine Aminotransferase (ALT) and Brain Natriuretic Peptide (BNP) levels (p < 0.001, p < 0.021). In the AN-BP subgroup, as compared to AN-R, lower selenium (p < 0.001) and vitamin B12 plasma concentration (p < 0.036) were observed, whereas lower copper plasma concentration was observed in patients with AN-R type (p < 0.022). No significant differences were observed for zinc, vitamin B9, vitamin D, and vitamin B1 concentrations between the two types of AN patients. Conclusion: Severely malnourished AN patients have many micronutrient deficiencies. Differences between AN subtypes are identified. Micronutrients status of AN patients should be monitored and supplemented to prevent deficiencies related complications and to improve nutritional status. Prospective studies are needed to explore the symptoms and consequences of each deficiency, which can aggravate the prognosis during recovery.

Dysmorphic concern in anorexia nervosa: Implications for recovery

Body image disturbance (‘dysmorphic concern’) is a key diagnostic criterion for anorexia nervosa (AN). While dysmorphic concern has been described as a relapse predictor, relatively little is understood about the prevalence in AN, and the consequences upon wellbeing. The present study examined the rates of dysmorphic concern in a sample of treatment-seeking adults with AN (N = 39), and explored the associations with general mental health, disability and eating disorder symptoms. The majority of participants (61.5%) had clinically significant levels of dysmorphic concern. Furthermore, higher dysmorphic concern scores were associated with increased symptoms of anxiety, depression and eating disorder symptomatology. There was also a trend towards associations between dysmorphic concern and age of onset and stages of change (pre-contemplation, contemplation, preparation, action, maintenance), although replication is required. These findings suggest that strategies which specifically address body image distortions should be a key feature of treatment for anorexia nervosa to support long-term recovery and wellbeing.

Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report

BackgroundNeuromyelitis optica spectrum disorders are severe autoimmune inflammatory diseases of the central nervous system associated with the presence of immunoglobulin G antibodies against the water channel protein aquaporin-4. During exacerbation, specific aquaporin-4 immunoglobulin G may be produced intrathecally. We measured extracellular aquaporin-4 microparticles in the cerebrospinal fluid of a patient who later developed the typical symptoms and signs of a neuromyelitis optica spectrum disorder.Case presentationA 17-year-old South American girl developed acute severe motor and vocal tics and difficulties in walking, peripheral numbness, muscle pain, and bilateral headache. At age 22, she had a multitude of motor and psychiatric symptoms. Over the years, she fulfilled the diagnostic criteria for anorexia nervosa, depression, sleep disorder, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, development coordination disorder, attention-deficit/hyperactivity disorder, hypomania, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, conversion disorder, psychosis, and schizotypal personality syndrome. At age 24, she was found to have elevated titers of aquaporin-4 antibodies in serum, suggestive of probable neuromyelitis optica. She subsequently developed visual impairment, and swollen optic nerves were verified by magnetic resonance imaging. She was thus treated with a chimeric monoclonal antibody targeted against the pan-B-cell marker CD20 (rituximab), and almost all symptoms, including the psychiatric symptoms, rapidly decreased. We found a significant increase of extracellular microparticles of aquaporin-4 in cerebrospinal fluid sampled from our patient when she was 22 years old, 2 years before the full clinical development of neuromyelitis optica.ConclusionsMicroparticles of aquaporin-4 represent subcellular arrangements that may influence the pathogenesis of neuromyelitis optica spectrum disorders and may serve as biomarkers for the underlying cellular disturbances. The increase of aquaporin-4 microparticles in cerebrospinal fluid may be used for early diagnostic purposes; for prevention; and for evaluation of effective treatment, long-term follow-up studies, and elucidating the pathophysiology in neuromyelitis optica spectrum disorders. Further studies of aquaporin-4 microparticles in cerebrospinal fluid of patients with neuromyelitis optica and similar neuropsychiatric disorders are thus called for.

Is laxative misuse associated with binge eating? Examination of laxative misuse among individuals seeking treatment for eating disorders.

Our research focuses on laxative misuse, which has been understudied in previous eating disorders (ED) research, to understand its prevalence and correlates among individuals seeking ED treatment. We also test the association between laxative misuse and binge eating to examine the assumption that laxative misuse is intended to compensate for binge eating. Participants were 2,295 ED treatment-seeking adults (29.5 ± 10.5) who self-reported their disordered eating behaviors on the Eating Disorder Questionnaire. Participants met DSM-5 diagnostic criteria for anorexia nervosa (AN: 11.5%, n = 264), bulimia nervosa (BN: 39.0%, n = 896), binge-eating disorder (14.9%, n = 343), or other specified feeding or eating disorder (34.5%, n = 792). Nearly 25% of participants (n = 571) reported misusing laxatives during the last month. Laxative misusers with AN reported significantly higher frequency of laxative misuse relative to misusers with BN (F(1,440) = 5.226, p = .023, ηp2= .012). Among laxative misusers, there was no association between frequency of binge eating and frequency of laxative misuse. Laxative misusers with AN tend to misuse laxatives more frequently than those with BN. Binge eating was not related to laxative misuse in our sample. Future research may use real-time data collection to understand the function of laxative misuse and to validate our cross-sectional findings.

A randomised controlled trial of three psychological treatments for anorexia nervosa

There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy. A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25-40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment. Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up. The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) http://www.anzctr.org.au/.