Eating Disorder Symptoms Research Articles

Influence of Gut Microflora on Eating Disorders

Eating disorders (EDs) have attracted extensive attention worldwide as a disease that seriously affects eating behaviour and weight control. The impact and pathogenesis of the gut microbiota in EDs remain important research directions and have sparked interest in developing treatments for these conditions. This review examines the intricate interactions between the gut microbiota and the gut-brain (GB) axis, and Eds focuses on bulimia nervosa (BN), binge eating disorder (BED), and anorexia nervosa (AN). According to the findings, the pathophysiology of AN and BED is correlated with lower levels of short-chain fatty acids (SCFAs) and beneficial bacteria in the gut microbiota. In addition, as a key mediator, the GB axis affects the neural pathways and behaviours between the brain and the gut, thereby exacerbating EDs symptoms. This review highlights the potential of gut microbiota-targeted therapies as adjunctive treatments for EDs. However, this study also has certain limitations. For example, more investigation is required to explore the clear mechanism and causal relationship between the gut microbiome and other EDs. Future studies should clarify the function of gut bacteria in EDs and advance treatment strategies.

The role of weight stigma and food literacy in eating behaviour

Abstract Background Overweight/obesity is associated with negative health outcomes that may be caused by experience and internalization of weight stigma. Weight stigma seems to diminish weight control efforts and may be associated with unhealthy eating behaviours. Moreover, lack is known about the protective factors against stigmatization. We aimed to assess the role of weight stigma and food literacy in eating behaviour in people with overweight and obesity controlling for sociodemographic and clinical variables. Methods A total of 189 participants with overweight/obesity (52.9% female; mean age 48.8±14.5 years; body-mass index (BMI) 32.6±6.5 kg/m2; waist-to-height ratio (WHtR) 0.6±0.1) completed the Experienced Weight Stigma Questionnaire and the Weight Self-Stigma Questionnaire. To examine eating behaviours including cognitive restraint, uncontrolled eating, and emotional eating we used the Three Factor Eating Questionnaire. Multiple linear regression analyses were performed. Results Higher WHtR and BMI were associated with emotional eating and uncontrolled eating. Experienced weight stigma was associated with emotional eating but was no longer significant when self-stigmatization was added to the regression model. Self-stigmatization was associated with emotional eating and uncontrolled eating. This association attenuated when food literacy was added to the final models. Low food literacy was significantly associated with emotional and uncontrolled eating. No role of weight-related measures, stigma or food literacy in the cognitive restrain was found. The explained variance in the final regression models for emotional eating and uncontrolled eating was 41%, and 32.7%, respectively. Conclusions Emotional eating and uncontrolled eating may represent crucial components to address in health and weight management. Nutrition literacy may have a positive effect on diminishing associations between weight stigma and unhealthy eating patterns. [Funding: VEGA: 1/0748/22]. Key messages • Eating disorder symptoms and their association with obesity should be considered when designing public health interventions. • Interventions targeting weight stigmatization and food literacy may mitigate the negative impact of weight stigma on eating behaviours.

Safety behavior reduction for appearance concerns: A randomized controlled trial of a smartphone-based intervention.

Appearance concerns are a core feature of multiple psychiatric disorders (i.e., body dysmorphic disorder, eating disorders, and social anxiety disorders). Individuals with these concerns commonly engage in appearance-related safety behaviors (ARSB), behaviors intended to avoid, prevent, or manage the negative evaluation of one's physical appearance. The present study evaluated a brief ARSB reduction intervention for appearance concerns. Women with elevated appearance concerns (N = 203) were recruited from across the United States and randomized to receive one of two 1-month smartphone-based interventions targeting ARSBs or unhealthy behaviors (UHBs). Both consisted of daily text messages with links to behavior checklists and reminders to avoid the respective behaviors. Participants in both treatments saw substantial reductions in symptoms. Though the UHB fading condition showed significantly better treatment adherence than ARSB fading, ARSB fading led to significantly lower appearance concerns (sr² = .028, p = .014) and eating disorder symptoms (sr² = .024, p = .020) at posttreatment, and lower appearance concerns (sr² = .041, p = .004), eating disorder symptoms (sr² = .029, p = .006), social anxiety (sr² = .048, p = .005), and appearance importance at 1-month follow-up (sr² = .042, p = .011), relative to UHB fading. Changes in ARSBs were found to partially mediate the effect of treatment on appearance concerns. These preliminary findings provide novel evidence for the efficacy of targeting ARSBs and suggest that this text-based intervention may be an efficacious and accessible intervention for women with elevated appearance concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Movement Awareness Therapies in Eating Disorders: A Systematic Review and Meta-Analysis.

Given the rising prevalence and complexity of eating disorders, a comprehensive multidisciplinary holistic approach is necessary. This work aimed to assess the effectiveness of body and movement awareness therapies in patients with eating disorders. Search strategy was undertaken using several scientific health databases. Articles were eligible if they were randomized controlled trials analyzing the effects of movement and body awareness therapies in eating disorders. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for systematic reviews was followed and the risk of bias was assessed using the "Cochrane Collaboration Tool to assess the risk of bias." 11 articles met the inclusion criteria, including 437 patients. No high-quality randomized controlled trials were found. Forest plot analysis of the Eating Disorder Examination scale showed a difference favors to body awareness therapies but not significantly neither homogeneous. The interventions analyzed included yoga, body awareness therapy, dance, and psychomotor therapy. Body awareness therapies provide some additional benefits for eating disorder symptoms, such as emotion regulation, self-criticism, self-confidence, self-compassion, anxiety, body attitude, eating disorder symptoms, and quality of life.

The role of eco-anxiety in the presentation of bulimia nervosa: a case report

BackgroundDespite a growing literature demonstrating the significant impacts of climate change on mental health, research is urgently needed to investigate how climate change-related concerns may contribute to the development, exacerbation, or re-emergence of eating disorders, as well as affect the effectiveness of existing interventions. This case report contributes to this scant knowledge base by offering empirical evidence for how responses to climate change can influence eating disorder symptoms and, importantly, limit the effectiveness of evidence-based treatments such as Cognitive Behavior Therapy-Enhanced (CBT-E).Case presentationA 24-year-old female graduate student studying environmental science presented to a specialized eating disorder clinic with worsening bulimia nervosa. Her symptoms initially improved with CBT-E; however, after three months, concerns about food waste significantly impeded further progress. The therapist, identifying symptoms of eco-anxiety, adapted standard CBT-E strategies to include psychoeducation about eco-anxiety, cognitive restructuring of beliefs about food waste and other eating-related eco-concerns, relevant exposures related to such concerns, and problem-solving to increase social support. These adaptations led to resumed progress, with the patient achieving nutritional adequacy by treatment end (38 sessions) and maintaining treatment gains through one year follow-up.ConclusionsTo our awareness, this is the first case report on the co-occurrence of eco-anxiety and eating disorders. This case underscores the importance of screening for concurrent eco-anxiety, suggests ways in which eating disorders and eco-anxiety can influence one another longitudinally, describes how coexisting eco-anxiety can limit standard CBT-E’s effectiveness, and provides examples of successful treatment adaptations tailored to address eco-anxiety-related concerns.

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders

BackgroundDespite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.MethodsAdolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.ResultsResults suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.ConclusionsData from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

Do Swedish rock-climbers exhibit more eating disorder and body dissatisfaction symptoms than non-climbers? A cross-sectional study

ObjectivesThe inclusion of rock-climbing in the Olympic Games has increased participation in the sport and attention to athletes' health. In sports where the importance of low body weight is considerate,...

A Pilot Study of Factors Influencing Engagement with an mHealth Intervention Among Teens with Eating Disorder Symptoms

A Pilot Study of Factors Influencing Engagement with an mHealth Intervention Among Teens with Eating Disorder Symptoms

Eye movement desensitization and reprocessing (EMDR) therapy for the treatment of eating disorders: A systematic review of the literature

AbstractEye movement desensitization and reprocessing (EMDR) has demonstrated promise as a treatment for eating disorders (ED). The present study aimed to systematically evaluate the current evidence regarding the use of EMDR therapy in the treatment of EDs, ED symptomatology and body image concerns. Included articles were original studies that described the use of EMDR therapy in the treatment of EDs, published in the English language in a peer‐review journal. The search was conducted using four electronic databases: PsycINFO, MedLine, Embase, and Web of Science. Two independent reviewers conducted screening, selection, risk of bias assessment and data extraction. Of the initial search of 109 potential studies, eight met inclusion criteria, including six case studies, one quasi‐experimental study, and one randomised control trial (RCT). The RCT indicated that including an EMDR component did not have benefits over standard treatment for core ED symptoms, whereas the quasi‐experimental study demonstrated some benefits for inclusion of EMDR as a treatment adjunct for anorexia nervosa patients. Case studies indicated some promising outcomes for patients with various presentations. Despite EMDR being an available treatment for several decades now, there is limited clinical evidence regarding its efficacy in the treatment of EDs. These findings highlight a critical need for more clinical research in this area to ensure clinical practice is guided and supported by evidence‐based outcomes.

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.

Orthorexia nervosa tendencies and risk of eating disorders among culinary arts students: A comparative study with dietetics students.

Students pursuing food-related academic fields such as dietetics have higher orthorexia nervosa (ON) tendencies and are at a greater risk of developing eating disorders (EDs). However, there is limited research available on ON tendencies and on the risk of EDs in the culinary arts field, which also revolves around food. The present study explored ON tendencies and the risk of EDs among culinary arts students and compared them with those of dietetics students. A cross-sectional study was conducted in France, using the eating habits questionnaire (EHQ) to measure ON tendencies, and the SCOFF as well as the eating disorders examination questionnaire (EDEQ) to evaluate the risk of EDs and ED symptoms. The study also included questions about sports practice. In total, 267 students participated in the study, including 144 culinary arts students (51 women, 92 men and one other) and 123 dietetics ones (106 women, 15 men and two others). Culinary arts students exhibited similar means of EHQ scores as dietetics ones (32.99 vs. 33.34) but higher SCOFF scores (52.8% vs.39.8%). In addition, a gender difference was evidenced: women in culinary arts showed higher EHQ, SCOFF and EDEQ scores than men in culinary arts. Linear regression models showed no effect of the type of academic field (culinary arts vs. dietetics) on the EDEQ score but revealed effects of gender, body mass index and hours of sports practice. The study emphasises the need to monitor culinary students and implement interventions to prevent EDs. It also suggests a correlation between food-related education and the risk of EDs, which requires further research.

Enhancing Understanding of Eating Psychopathology: A Network Analysis Study

Compassion Focused Therapy for eating disorders (CFT-E) has been shown to be effective in treating eating psychopathology. Exploring which processes identified by the CFT-E model are most linked with eating disorder symptoms could help develop targeted treatments. However, the relationship between these variables requires further investigation. This study explores the interconnections between eating disorder symptoms and processes identified by the CFT-E using a network analysis approach. Participants were 497 individuals (77.3% female) from a community sample who completed measures to assess body dissatisfaction, shape and weight overvaluation, cognitive restraint, bingeing, emotional eating, purging, self-compassion, social comparison through appearance, self-criticism, appearance-related shame, guilt and pride, and positive and negative affect. A regularized partial correlation network was estimated. Appearance-related shame, inadequate self and body dissatisfaction emerged as the central nodes in the network. These findings support the use of interventions targeting shame and self-criticism for the treatment of eating disorder symptoms. Studies with diverse samples are needed to further examine the interconnections between eating psychopathology and the key processes identified by the CFT-E theoretical model.

Delving into the role of reward and punishment sensitivity in anorexia nervosa: Punishment responsivity as the only predictor of eating disorder symptom persistence in adolescents.

This study differentiated between self-reported punishment responsivity (PR) and motivation to avoid punishment (MP) and examined their relationship with anorexia nervosa (AN) and its course in a combined cross-sectional and longitudinal approach. We explored whether inconsistent findings regarding reward sensitivity may be explained by previous research not differentiating between reward responsivity (RR) and motivation to approach reward (MR). Participants were 69 adolescents with AN and 69 adolescents without AN matched on age, sex and educational level. Eating disorder (ED) symptom severity, PR, MP, RR, and MR were assessed at the start of treatment and 1year later. Only PR was higher in patients with AN than in the comparison group. Both PR and MP decreased over the course of 1year, however, only the reduction in PR was related to the reduction in ED symptoms. Lastly, only higher baseline PR was independently related to less improvement in ED symptoms over the course of 1year. There was no support for the involvement of RS or its specific dimensions in AN. Most critical, the findings suggest that specifically the PR dimension of punishment sensitivity is related to the persistence of AN and could be an important target for treatment.

Is visual information use during facial emotion recognition related to eating disorder symptoms in college-aged men and women? An experimental study

BackgroundPrevious studies of emotion recognition abilities of people with eating disorders used accuracy to identify performance deficits for these individuals. The current study examined eating disorder symptom severity as a function of emotion categorization abilities, using a visual cognition paradigm that offers insights into how emotional faces may be categorized, as opposed to just how well these faces are categorized.MethodsUndergraduate students (N = 87, 50 women, 34 men, 3 non-binary) completed the Bubbles task and a standard emotion categorization task, as well as a set of questionnaires assessing their eating disorder symptomology and comorbid disorders. We examined the relationship between visual information use (assessed via Bubbles) and eating disorder symptomology (EDDS) while controlling for anxiety (STAI), depression (BDI-II), alexithymia (TAS), and emotion regulation difficulties (DERS-sf).ResultsOverall visual information use (i.e. how well participants used facial features important for accurate emotion categorization) was not significantly related to eating disorder symptoms, despite producing interpretable patterns for each emotion category. Emotion categorization accuracy was also not related to eating disorder symptoms.ConclusionsResults from this study must be interpreted with caution, given the non-clinical sample. Future research may benefit from comparing visual information use in patients with an eating disorder and healthy controls, as well as employing designs focused on specific emotion categories, such as anger.

“To exercise sustainably” – Patients’ experiences of compulsive exercise in eating disorders and the Compulsive Exercise Activity Therapy (LEAP) as a treatment: a qualitative interview study

BackgroundCompulsive exercise is common in eating disorders (EDs), but a systematic treatment model is lacking. The CompuLsive Exercise Activity TheraPy (LEAP) is a cognitive behavioral therapy treatment for compulsive exercise in EDs, delivered by trained therapists in groups over four consecutive weeks (8 groupsessions and 1 individual session), aiming to promote healthy physical activity. LEAP is currently evaluated in a randomized efficacy trial. In parallel, it is crucial to learn more about how it is perceived by qualitatively investigating participants’ subjective experiences.MethodsNine patients with various EDs participating in the LEAP trial were interviewed about their experiences of taking part in LEAP and about compulsive exercise as an ED symptom using a semi-structured interview guide. The interview transcripts were analyzed according to thematic analysis.ResultsThe informants expressed that compulsive exercise had not been addressed in their standard ED treatment and that LEAP as such provided an important complement, spurring reflection, awareness, and changed feelings and behaviors in relation to compulsive exercise. Initially, increased PA was triggered for some, but this side effect was transitory. A wish for more treatment time, in terms of longer or additional sessions, was expressed.ConclusionsOverall, LEAP seemed to fill an important treatment need and seemed both acceptable and feasible to patients. However, treatment time and the initial increase in PA may need further investigation and attention in order to optimize this treatment.Trial registrationThe trial is registered with the ISRCTN registry (registration date 20200325), trial ID ISRCTN80711391.

Repetitive transcranial magnetic stimulation (rTMS) in the treatment and diagnosis of eating disorders in athletes and patients: a systematic review

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive technique used to treat and diagnose eating disorders (EDs) by targeting brain regions like the dorsolateral prefrontal cortex, which is involved in impulse control and emotion regulation. Particularly beneficial for athletes, rTMS can reduce symptoms of EDs. Therefore, this study aimed to carry out a systematic review of the scientific literature on the therapeutic or diagnostic use of rTMS in athletes and patients with EDs, with an emphasis on binge eating disorder (BED), anorexia nervosa (AN), and bulimia nervosa (BN). A literature survey was carried out in the Directory of Open Access Journals (DOAJ), Medline, Directory of Open Access Scholarly Resources (ROAD), Academic Search Premier, Wiley-Blackwell Full Collection, Nature Open Access, BioMed Central Open Access, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). A total of 26 original papers published until November 21, 2021, were included. The selected studies were grouped for each respective protocol: total number of patients or athletes, sociodemographic aspects of the participants, parameters performed in rTMS: type of coil, intensity, frequency, number of pulses, stimulation site, preliminary results, and incidence of adverse effects. Recent evidence suggests a low rate of side effects with the technique and a substantial high frequency rTMS response in both the dorsolateral prefrontal cortex and the ventromedial region, especially in studies where internal comparison was performed. The great tolerance and safety of neuromodulatory treatment with rTMS encourage the application of the technique, especially in patients with refractory eating disorders. In addition to the therapeutic potential, rTMS is an essential diagnostic tool in elucidating the complex neurobiology of eating disorders. A more significant increase in publications on the subject is expected in a controlled, blind, and randomized manner, leading to a homogenization of results and generalization of its potential use. Keywords: Eating disorders, Neurology, Neuromodulation, Psychology, Psychiatry, Noninvasive brain stimulation.

Influence of Nutrition, Lifestyle Habits, and Socio-Demographic Determinants on Eating Disorder Symptoms in the Spanish Young Adult Population: A Cross-Sectional Nationwide Survey.

Eating disorders represent a complex and multifaceted public health challenge, highly prevalent among young people. Background and Objectives: To examine the prevalence of eating disorders in the Spanish young adult population aged 18-30 years, and their correlation with various eating habits and lifestyle factors. Materials and Methods: A descriptive, cross-sectional survey was carried out using a non-probabilistic snowball sample. The valid and reliable NutSo-HH Scale was employed to collect data on nutrition, lifestyle, and health habits. Results: Data were collected from 9692 Spanish young adults, of which 101 (1.04%) were diagnosed with anorexia nervosa and 71 (0.73%) with bulimia nervosa. The prevalence of anorexia and bulimia was significantly higher (p < 0.001) in women than in men, regardless of socio-demographic variables such as educational level, income, region, and size of city of residence. A considerable percentage of participants showed possible symptoms of eating disorders. Nutritionally, individuals with eating disorders consumed less fast food and fried or ultra-processed food but tended to consume coffee and energy drinks more frequently. Additionally, sleep quality and duration were more adversely affected in individuals with eating disorders compared to the general population. Sedentary lifestyles did not significantly differ between those with eating disorders and healthy individuals, though physical activity increased in people with bulimia. Conclusions: The interplay between young adults' dietary habits, lifestyle factors, and mental health underscores the urgent need for targeted interventions to effectively address these complex public health challenges.

Shame, Guilt, and Pride Moderate the Relationship between Social Appearance Anxiety and Eating Disorder Symptoms

Shame, Guilt, and Pride Moderate the Relationship between Social Appearance Anxiety and Eating Disorder Symptoms

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.

Personalized assessment of eating disorder cognitions during treatment: A new measure of cognitive pathology change

ObjectiveModifying cognitive distortions, or thinking errors, is crucial in eating disorders (ED) treatment. To address the lack of a personalized measure for ED cognitions, the Thought Inventory was developed. The study aimed to establish its feasibility and validity, identify thinking error contents and types, examine changes in belief of irrational thoughts, and investigate associations with change in ED symptoms. Hypotheses, procedure, and planned analyses were pre-registered to ensure transparency. MethodsParticipants (N = 55) completed the Thought Inventory, the Eating Disorder Examination Questionnaire, the Eating Pathology Symptom Inventory, the Frost Multidimensional Perfectionism Scale, the Beck Depression Inventory, and the Penn State Worry Questionnaire at pre-and post-ten weeks of treatment. Using the Thought Inventory, participants collaborated with study therapists to identify ED-related thinking errors and rate the degree of belief in these thoughts on a scale of 0 to 100 %. ResultsCognitions primarily contained self-judgments, food rules, and concern over shape, while catastrophizing/fortune telling, emotional reasoning, and should/must statements were the most common types of thinking errors. Belief in cognitions significantly decreased over treatment and change in thought belief was positively associated with change in ED symptoms. ConclusionThe Thought Inventory shows promise as a personalized measure. Future research should explore whether ED cognitions, assessed in this manner, are a mechanism of change in ED treatment.