Field Of Eating Disorders Research Articles

Reporting racial and ethnic diversity in eating disorder research over the past 20 years.

Recent public awareness of racial and ethnic disparities has again brought to light issues of diversity, equity, and inclusion in the eating disorders field. However, empirical information on racial and ethnic representation in eating disorders research is limited, making it difficult to understand where improvements are needed. This study reviewed all studies including human participants published in the International Journal of Eating Disorders in 2000, 2010, and 2020. Differences in likelihood of reporting race and ethnicity were calculated based on study year, location, and diagnostic categories. Out of 377 manuscripts, 45.2% reported information on the race and ethnicity of study participants. Studies conducted in the United States were more likely to report (128/173), and those conducted in Europe were less likely to report (5/61) on race and ethnicity than those conducted outside of those regions. Rates of reporting increased from 2000 to 2020. White participants made up approximately 70% of the samples that reported race and ethnicity data. Hispanic participants made up approximately 10% of samples reporting race and ethnicity. Participants from all other races and ethnicities made up less than 5% each. Although rates of reporting race and ethnicity increased over time, most participants were White. Rates of reporting also differed by the geographical region, which may reflect variability in how information on race and ethnicity is collected across countries. More attention toward capturing the cultural background of research participants and more inclusivity in research are needed in the eating disorders field.

Gender-Affirmative Eating Disorder Care: Clinical Considerations for Transgender and Gender Expansive Children and Youth.

Transgender and gender expansive (TGE) children and youth suffer staggering rates of discrimination and are at higher risk of developing eating disorder symptoms and behaviors than cisgender youth. This article presents an overview of current research on identified risk factors for the development of eating disorders for TGE children and youth; provides clinical considerations for professionals in providing gender-affirming, collaborative eating disorder care; outlines specific concepts for staff training and for developing gender-affirming systems of care including policies and practices; and identifies numerous resources for TGE children and youth and their families. The clinical considerations and suggested practices reflect current research and clinical practice. Both the gender-affirmative clinical field and the eating disorder field are constantly evolving, and the recommendations and resources will need ongoing updates to reflect developments in these fields. [Pediatr Ann. 2021;50(9):e371-e378.].

Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature.

Currently, there is debate in the eating disorders field regarding how to define atypical anorexia (AAN), how prevalent it is in community and clinical settings, and how AAN rates compare with low-weight AN. This systematic review assesses AAN literature from 2007 to 2020, to investigate: (a) the demographic characteristics of AAN studies, (b) the prevalence of AAN compared with AN, (c) the range of operational definitions of AAN and the implications of these definitions, and (d) the proportion of patients with AAN and AN represented in consecutive admission and referral samples. PsychINFO, CINAHL, PubMed, Greylit.org, and ProQuest databases were searched according to methods for Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic reviews, yielding 3,184 potential articles. Seventy-five eligible studies were coded for sixty-one variables. Clinical samples predominantly included younger, female, white samples with limited diversity. In epidemiological designs, AAN was typically as common or more common than AN, and AAN rates varied significantly based on the population studied and operational definitions. In consecutive clinical samples, AAN was frequently less represented. Although AAN appears to occur more frequently than AN in communities, fewer patients with AAN are being referred and admitted to eating disorder specific care, particularly in the United States. Given the significant medical and psychosocial consequences of AAN, and the importance of early intervention, this represents a crucial treatment gap. Additionally, results suggest the need for fine-tuning diagnostic definitions, greater diversity in AAN studies, and increased screening and referral for this vulnerable population.

Valuing the voice of lived experience of eating disorders in the research process: Benefits and considerations

Although the inclusion of individuals with lived experience is encouraged within the research process, there remains inconsistent direct involvement in many mental health fields. Within the eating disorders field specifically, there is a very strong and increasing presence of lived experience advocacy. However, due to a number of potential challenges, research undertaken in consultation or in collaboration with individuals with lived experience of an eating disorder is scarce. This paper describes the significant benefits of the inclusion of individuals with lived experience in research. The specific challenges and barriers faced in eating disorders research are also outlined. It is concluded that in addition to existing guidelines on working with lived experience collaborators in mental health research, more specific procedures are required when working with those with eating disorders.

Genetics of eating disorders in the genome-wide era.

Enabled by advances in high throughput genomic sequencing and an unprecedented level of global data sharing, molecular genetic research is beginning to unlock the biological basis of eating disorders. This invited review provides an overview of genetic discoveries in eating disorders in the genome-wide era. To date, five genome-wide association studies on eating disorders have been conducted - all on anorexia nervosa (AN). For AN, several risk loci have been detected, and ~11-17% of the heritability has been accounted for by common genetic variants. There is extensive genetic overlap between AN and psychological traits, especially obsessive-compulsive disorder, and intriguingly, with metabolic phenotypes even after adjusting for body mass index (BMI) risk variants. Furthermore, genetic risk variants predisposing to lower BMI may be causal risk factors for AN. Causal genes and biological pathways of eating disorders have yet to be elucidated and will require greater sample sizes and statistical power, and functional follow-up studies. Several studies are underway to recruit individuals with bulimia nervosa and binge-eating disorder to enable further genome-wide studies. Data collections and research labs focused on the genetics of eating disorders have joined together in a global effort with the Psychiatric Genomics Consortium. Molecular genetics research in the genome-wide era is improving knowledge about the biology behind the established heritability of eating disorders. This has the potential to offer new hope for understanding eating disorder etiology and for overcoming the therapeutic challenges that confront the eating disorder field.

Understanding the effects of reductionist biological views of eating disorder etiology on patient attitudes and behavior.

While eating disorders were historically considered to be a result of psychological or environmental causes, current evidence suggests that eating disorders are the product of complex gene-environment interactions wherein heritable vulnerabilities are activated by multiple exposures to environmental stimuli over the lifespan. Despite the fact that this integrated biopsychosocial etiological view of eating disorders is accepted among many professionals in the eating disorder field, evidence suggests that the general public and some clinicians are susceptible to dualist, or reductionist, views of psychopathology. Currently, little is known about (a) the prevalence of reductionist biological views of eating disorder etiology in those with eating disorders (this view attributes the cause of eating disorders to predominantly biological factors but does not acknowledge psychosocial factors as important contributors), (b) the effects of reductionist biological views on clinical outcomes, and (c) the most effective methods for modifying these views. In this article, we present the results of a preliminary investigation on the relationship between perceived causes of eating disorders and the attitudes and behaviors of those with eating disorders. We then go on to propose specific avenues for further research on uncovering the effects of reductionist biological views of eating disorder etiology.

Eating disorders genetics in Asia.

A complete understanding of the genetic architecture of eating disorders requires adequately large sample sizes from individuals of all ancestries. Failure to include representative samples truncates understanding and may even exacerbate health disparities. Several countries in Asia have made rich contributions in psychiatric genetics; however, the eating disorders field requires concerted global efforts to increase representation from Asian ancestry populations to ensure that our global efforts accurately reflect the true distribution of eating disorders around the world and across ancestries.

ANZAED eating disorder treatment principles and general clinical practice and training standards

IntroductionEating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers; (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector; (3) an extensive open access online consultation process; and (4) consultation with key professional and consumer/carer stakeholder organisations.RecommendationsThe resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential; (2) co-ordination of services is fundamental to all service models; (3) services must be evidence-based; (4) involvement of significant others in service provision is highly desirable; (5) a personalised treatment approach is required for all patients; (6) education and/or psychoeducation is included in all interventions; (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment; (2) the multidisciplinary care team; (3) a positive therapeutic alliance; (4) knowledge of evidence-based treatment; (5) knowledge of levels of care; (6) relapse prevention; and (7) professional responsibility.ConclusionsThese principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.

Editorial introductions

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Hans W. HoekHans W. HoekDr Hans W. Hoek is Professor of Psychiatry at University Medical Center Groningen, the Netherlands, and has an adjunct position as Professor of Epidemiology at Columbia University, New York, USA. He is based in The Hague where he is Director of the psychiatric residency program and Dean of the Parnassia Academy, part of Parnassia Psychiatric Institute, a large mental health institute with branches throughout the Netherlands. Dr Hoek has a long-term interest in both schizophrenia and eating disorders. In the schizophrenia field he has been involved in studies on schizophrenia spectrum disorders after prenatal exposure to famine and on first episode psychosis among immigrants in The Netherlands, with research ongoing in rural South Africa. Dr Hoek's main publications in the eating disorder field relate to the epidemiology and treatment of eating disorders. Dr Hoek has been chair of the work group that developed the recent Dutch practice guideline for the treatment of eating disorders. Dr Hoek participated in the revision of DSM–5 as member of both the Eating Disorders Work Group and the Impairment and Disability Study Group. He has been consultant for the development of the WHO Disability Assessment Schedule (WHODAS 2.0). He is past president of the Eating Disorders Research Society and was the recipient of the Academy for Eating Disorders Leadership Award in Research 2011. Anna Keski-RahkonenAnna Keski-RahkonenDr Anna Keski-Rahkonen, MD, PhD, MPH is a psychiatrist, an epidemiologist, and a sexologist. She currently works as a Professor of Mental Health at the University of Helsinki in Finland. She is board certified in public health, psychiatry, and medical education. She received her medical training at the University of Helsinki and studied public health at Columbia University in New York, USA. She has published over 70 original articles on various aspects of eating disorders and has received many awards for her teaching and mentoring. She has also written several books on eating disorders for the general audience. She is particularly interested in the epidemiology of eating disorders and body image. Richa BhatiaRicha BhatiaRicha Bhatia, MD is a Child, Adolescent and Adult psychiatrist, dual Board certified in Child, Adolescent and General Psychiatry by the American Board of Psychiatry and Neurology. She serves as Section Editor for the Child and Adolescent Psychiatry issue of Current Opinion in Psychiatry. She has also served as an Associate Editor for the journal, Current Psychiatry, and presently serves as a member of its editorial board. She is a former faculty member in the departments of psychiatry at Harvard Medical School, USA, and Geisel School of Medicine at Dartmouth, USA. She completed her child and adolescent psychiatry fellowship from Children's National Medical Center / George Washington University in Washington, DC, USA. Dr Bhatia has been the recipient of Marian Butterfield Award by the Association of Women Psychiatrists, and has been recognized as a Fellow of the American Psychiatric Association. She is the author of two books on psychiatry: Demystifying Psychiatric Conditions and Treatments and 65 Answers about Psychiatric Conditions. She has been an active member of the Anxiety and Depression Association of America and the American Psychiatric Association. She has chaired and lectured at workshops at various psychiatric conferences. Some of her areas of interest are global mental health, compassion cultivation, and integration of psychotherapy and psychopharmacology into clinical practice. Her expert professional opinions have been quoted in prominent news media such as CNBC, The Guardian, US News and World Report.

First episode rapid early intervention for eating disorders (FREED): From research to routine clinical practice.

Eating disorders are serious psychiatric disorders with high rates of morbidity and mortality. Early intervention can improve treatment outcomes and reduce disruption to psychosocial development. However, early intervention is not well established in the eating disorder field. First episode rapid early intervention for eating disorders (FREED) was developed to address barriers to early, effective eating disorder treatment in emerging adults aged 16 to 25 years. Since 2014, FREED has progressed from a single-site research project to an evidence-based care approach in nine eating disorder services. This paper aims to summarize key learning from the scaling of FREED to date, with attention to how this learning may generalizes to other models of care. We describe the development, scaling and implementation of FREED with reference to the RE-AIM (reach; effectiveness/efficacy; adoption; implementation; maintenance) framework. We also summarize challenges and learning in each of the RE-AIM domains. FREED has demonstrated real-world validity across diverse clinical contexts, geographical regions and populations. Key outcomes are seen for each of the RE-AIM domains. FREED provides an example of effective, non-commercial scaling of an early intervention eating disorder care pathway. This work is likely to be particularly relevant to others looking to scale-up early intervention models and for those working in secondary and tertiary mental health settings.

Prevention of eating disorders: 2019 in review

ABSTRACTThis article reviews 11 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2019. Two models from the 2018 review continue to frame this analysis: (1) the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into rationale, theory, and methodology → clarification of risk factors → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. These articles illustrate how the theoretical complexity and rigorous methodological demands of prevention science are manifest in the eating disorder field. A subset of articles also demonstrates the importance of working with researchers and community stakeholders to improve our understanding of how ethnicity, class, and gender intersect with planning for improvements in all phases of prevention. Other subsets show the need to expand the list of relevant risk factors, and how the traditional schema of masculinity creates both maladaptive biases in case identification and obstacles to an effective and compassionate understanding of EDs. Finally, implications of the absence of efficacy, effectiveness, and dissemination studies are discussed.

What role can accredited exercise physiologists play in the treatment of eating disorders? A descriptive study

ABSTRACT Including exercise alongside other therapeutic approaches may help to address dysfunctional exercise use and improve eating disorder treatment outcomes. However, traditional treatment teams often lack the expertise needed to safely prescribe exercise. The aims of this study were to explore the perceptions and experiences of Accredited Exercise Physiologists (AEPs) relating to working with clients diagnosed with eating disorders to identify the role they play in the treatment of eating disorders and identify future training needs. Individual semi-structured telephone interviews were conducted with 12 (n = 9 females) AEPs working in the eating disorders field. Thematic analysis was conducted to extract major themes from the interview transcripts. Five major themes were identified: (1) The role of AEPs in the treatment of individuals with eating disorders is comprehensive; (2) Treatment is more effective when all components are addressed; (3) The absence of therapeutic exercise within standard treatment protocols reflects limitations of traditional scope of practice and knowledge about the role of AEPs; (4) Methods of acquiring further knowledge are insufficient for those in current practice; and (5) Accredited comprehensive training is currently unavailable but needed. This qualitative study showed that AEPs believe they can play a major role in the treatment of eating disorders and that treatment outcomes for individuals are likely to be greatly enhanced when dysfunctional exercise is addressed. Multidisciplinary training is needed.

Editorial introductions

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Hans W. HoekHans W. HoekDr Hans W. Hoek is Professor of Psychiatry at University Medical Center Groningen, the Netherlands, and has an adjunct position as Professor of Epidemiology at Columbia University, New York, USA. He is based in The Hague where he is Director of the psychiatric residency program and Dean of the Parnassia Academy, part of Parnassia Psychiatric Institute, a large mental health institute with branches throughout the Netherlands. Dr Hoek has a long-term interest in both schizophrenia and eating disorders. In the schizophrenia field he has been involved in studies on schizophrenia spectrum disorders after prenatal exposure to famine and on first episode psychosis among immigrants in The Netherlands, with research ongoing in rural South Africa. Dr Hoek's main publications in the eating disorder field relate to the epidemiology and treatment of eating disorders. Dr Hoek has been chair of the work group that developed the recent Dutch practice guideline for the treatment of eating disorders. Dr Hoek participated in the revision of DSM–5 as member of both the Eating Disorders Work Group and the Impairment and Disability Study Group. He has been consultant for the development of the WHO Disability Assessment Schedule (WHODAS 2.0). He is past president of the Eating Disorders Research Society and was the recipient of the Academy for Eating Disorders Leadership Award in Research 2011. Anna Keski-RahkonenAnna Keski-RahkonenDr Anna Keski-Rahkonen, MD, PhD, MPH is a psychiatrist, an epidemiologist, and a sexologist. She currently works as a Professor of Mental Health at the University of Helsinki in Finland. She is board certified in public health, psychiatry, and medical education. She received her medical training at the University of Helsinki and studied public health at Columbia University in New York, USA. She has published over 70 original articles on various aspects of eating disorders and has received many awards for her teaching and mentoring. She has also written several books on eating disorders for the general audience. She is particularly interested in the epidemiology of eating disorders and body image. Richa BhatiaRicha BhatiaRicha Bhatia, MD is a Child, Adolescent and Adult psychiatrist, dual Board certified in Child, Adolescent and General Psychiatry by the American Board of Psychiatry and Neurology. She serves as Section Editor for the Child and Adolescent Psychiatry issue of Current Opinion in Psychiatry. She has also served as an Associate Editor for the journal, Current Psychiatry. In addition, she serves on the editorial board of other psychiatry journals such as Culture, Medicine and Psychiatry. She is a former faculty member in the departments of psychiatry at Harvard Medical School, USA, and Geisel School of Medicine at Dartmouth, USA. She completed her child and adolescent psychiatry fellowship from Children's National Medical Center / George Washington University in Washington, DC, USA. Dr Bhatia has been the recipient of Marian Butterfield Award by the Association of Women Psychiatrists, and has been recognized as a Fellow of the American Psychiatric Association. She is the author of two books on psychiatry: Demystifying Psychiatric Conditions and Treatments and 65 Answers about Psychiatric Conditions. She has been an active member of the Anxiety and Depression Association of America and the American Psychiatric Association. She has chaired and lectured at workshops at various psychiatric conferences. Some of her areas of interest are global mental health, compassion cultivation, and integration of psychotherapy and psychopharmacology into clinical practice.

Rigor and reproducibility in genetic research on eating disorders

We explored both within-method and between-method rigor and reproducibility in the field of eating disorders genetics. We present critical evaluation and commentary on component methods of genetic research (family studies, twin studies, molecular genetic studies) and discuss both successful and unsuccessful efforts in the field. Eating disorders genetics has had a number of robust results that converge across component methodologies. Familial aggregation of eating disorders, twin-based heritability estimates of eating disorders, and genome-wide association studies (GWAS) all point toward a substantial role for genetics in eating disorders etiology and support the premise that genes do not act alone. Candidate gene and linkage studies have been less informative historically. The eating disorders field has entered the GWAS era with studies of anorexia nervosa. Continued growth of sample sizes is essential for rigorous discovery of actionable variation. Molecular genetic studies of bulimia nervosa, binge-eating disorder, and other eating disorders are virtually nonexistent and lag seriously behind other major psychiatric disorders. Expanded efforts are necessary to reveal the fundamental biology of eating disorders, inform clinical practice, and deliver new therapeutic targets.

A summary of reporting guidelines and evaluation domains for using single-case experimental designs and recommendations for the study of eating disorders.

The insights and activities that regularly occur in clinical settings are an underutilized wellspring of potential scientific advances. Single-case experimental designs (SCEDs) include a collection of methods for testing hypotheses in one individual (or a small number of individuals) at a time that are particularly well suited to clinical settings. Their strengths include their potential for maximizing both internal and external validity by way of tight experimental control over threats to internal validity and flexibility in application and inclusion criteria. Despite these advantages, the eating disorder field has not made use of SCEDs to a similar extent as other research areas, providing an opportunity for expansion. Recent advances in organizing SCED standards have resulted in the publication of two sets of reporting guidelines relevant to eating disorders research. These guidelines are integrated and summarized alongside descriptions of domains for evaluating their methodological rigor. Example research questions of potential interest to the eating disorder field are illustrated with SCEDs, and several issues to consider when using SCEDs in eating disorders research are described. It is recommended that researchers aiming to use SCEDs refer to this paper and the resources cited herein when designing and reporting their work. Finally, it is hoped that individuals with access to clinical samples use this paper as a source of inspiration for testing their unique clinical insights.

Research for leveraging food policy in universal eating disorder prevention.

Policy and legislation have emerged as important levers for universal prevention efforts in the context of eating disorders. However, to date, little attention has been paid to generating research that will inform opportunities to regulate the food environment, specifically the way that food is produced and marketed. The present paper aims to lay out a framework for research that will examine (1) the ways in which food industry may influence risk for eating disorders and (2) the impact of legislative efforts on eating disorder cognitions and behaviors. For these two pathways, specific examples of research that would serve to inform policy efforts aiming to decrease the risk for eating disorders by targeting the food environment are proposed. Overall, the present paper aims to issue a call for the eating disorder field to become involved in food policy and regulation.

Eating disorders symptoms in sexual minority women: A systematic review.

Although the literature consistently shows increased levels of psychological distress in the gay population, less evidence-and with contrasting findings-is available with regard to lesbian women. The aim of the present study is to review the literature in the eating disorders (EDs) field in order to provide further data on the frequency of EDs symptoms in sexual minority women. A systematic review of the studies identified by electronic database search (PubMed, Ovid, ScienceDirect, and Google Scholar) up to August 2017. Fourty-five studies were found, conducted on 372,256 women. Only 7 studies investigated patients with lifetime diagnosis of ED. As for the symptomatology of EDs, 39 studies were found, which presented huge differences in the scales used for the assessment (e.g., Eating Disorders Inventory and Eating Attitudes Test-26). A higher number of diagnoses of EDs were found in sexual minority women, with a symptomatology characterized by higher occurrence of binge eating and purging, as well as lower body dissatisfaction and drive for thinness, compared with heterosexual peers.

Speed of Processing Time Slowing in Eating Disorders

ABSTRACTWe applied Brinley (1965) plot analysis to the eating disorders field. Across 23 studies and 165 experimental conditions [experienced by a total of 773 eating disorder (ED) participants, including anorexia nervosa (AN), binge eating (BE), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS) and 995 controls], the best-fit regression equation was Y (ED) = 1.08 X (CONTROL) – 31. This equation accounted for 98.2% of the variance. Thus, the ED subjects were only 1.08 times slower than the control subjects, suggesting little processing speed slowing in ED. We also examined simple reaction time [SRT; Y (ED) = .91 X (CONTROL) + 63; variance accounted for = 93.6%] and choice reaction time (CRT; Y (ED) = 1.12X (CONTROL) – 43, variance accounted for = 99.7%). These slopes are significantly different. ED subjects are more impacted when the task involves a decision component (CRT) than when it does not (SRT).

Eating disorders: A 25-year perspective

ABSTRACTI founded Eating Disorders: The Journal of Treatment & Prevention 25 years ago, and its character, reputation, and success are highly attributable to Arnold Andersen, John Foreyt, and Margo Maine, the three original senior editors, whose perspectives follow in this article. Having made the decision to retire from the journal, I asked the senior editors to transition to the emeritus board along with me, which I explain further in my own Last Word, “Goodbye, Eating Disorders,” in this volume (Cohn, 2017). Over our 25 years of collaboration, the senior editors have acquired unique insights into the evolution of the eating disorders field; so, I asked them to contribute retrospective essays in which they also look forward within their primary areas of expertise—presented here in alphabetical order.– Leigh Cohn, Editor-in-Chief

Goodbye, Eating Disorders

ABSTRACTIn 1977, I fell in love at first sight, and since then eating disorders have been a central part of my life. As I step down after 25 years as editor of Eating Disorders: The Journal of Treatment and Prevention, I am also saying goodbye to the eating disorders field and moving on to retirement and other areas of interest. In this Last Word article, I will write about my history with the journal and the field and use this forum to thank a few of the people I’ve known along the way.