Treatment Of Eating Disorders Research Articles

An in-depth understanding of stakeholders' experiences about their participation in the co-production of 'Maze Out': a serious game for the treatment of eating disorders.

Co-production is increasingly used in mental health research and clinical settings. Maze Out is a digital game co-produced by clinicians, patients with eating disorders (EDs), an art director with lived experience in EDs, and a game-developing company. Maze Out is based on everyday challenges when suffering from EDs and is currently being evaluated as a supplement tool in EDs treatment. Several studies on co-producing mental health interventions focus on design and effectiveness, but the experiences of those involved in the co-production process remain unexplored. An in-depth exploration of stakeholders' experiences offers valuable insights into the impact of co-production on different groups and generates crucial knowledge for successful implementation. This study evaluated and explored the co-production process and the meaning that EDs patients, clinicians, and game designers attributed to their participation in the co-production of Maze Out. The objectives were to determine (1) how stakeholders experienced their collaboration in the co-production of Maze Out.; and (2) to what extent the stakeholders involved in developing Maze Out followed Cahn's principles of equality, diversity, accessibility, and reciprocity. Five stakeholders (two patients, two clinicians, and a game designer) who participated in the co-production completed semi-structured interviews. Two patients and one clinician's diaries supplemented the interviews. Reflexive thematic analysis was used to interpret the data. The results of this study highlight the importance of building a common language between clinicians, patients, and other professionals involved in developing new forms of treatment and interventions. A recommendation for researchers and clinicians to implement co-production in the future is that Cahn's principles: equality, reciprocity, accessibility, and diversity, serve as a strong foundation for successful co-production. In this study, three and partially one of the four Cahn's principles about co-production were identified: equality, reciprocity, and accessibility. When applied in an ED context, these principles provided stakeholders with valuable insights, enriching practice-based knowledge, using the knowledge applicable to clinical practice, and demonstrating their crucial role in fostering effective co-production processes.

A Mixed Method Systematic Review Into the Impact of ED Treatment in Autistic People and Those With High Autistic Traits.

Our understanding of the impact of eating disorders (ED) treatment in Autistic people remains elusive. Research has begun to explore ED treatment outcomes and experiences in this population, however current understandings are poorly integrated. The current review therefore sought to explore the impact of ED treatment on Autistic people and those with higher Autistic traits. A convergent, segregated approach was used, independently evaluating quantitative then qualitative studies before integrating findings into a coherent narrative synthesis. Autistic people and people with higher Autistic traits report poorer experiences of treatment and may be at increased risk of inpatient admission and prolonged inpatient treatment, possibly explained by difficulties with treatment timeframes and a lack of autism-informed support. Both groups reported similar improvements in ED symptoms and BMI. Higher rates of psychosocial difficulties pre-and post-treatment were reported in those with higher Autistic traits, and emotion-focused interventions were felt to be particularly relevant to Autistic presentations of EDs. Concerns were reported as to how well aligned group-based programs and cognitive-based interventions are for Autistic individuals and those reporting higher Autistic traits. Future research in diagnosed autism samples is urgently needed to develop a more robust understanding of Autistic outcomes and experiences. Review findings demonstrate the need for increased understanding of ED presentations and the possible need for treatment adaptations, for Autistic people or those with higher Autistic traits.

From Silos to Synergy: A Scoping Review of Team Approaches to Outpatient Eating Disorder Treatment.

This scoping review synthesizes the available evidence on team outpatient eating disorder treatment, focusing on team composition, reported health and service outcomes, and reported principles of Interprofessional Collaborative Practice (IPCP), a synergistic healthcare approach characterized by shared values and ethics, clear roles, communication, and teamwork. A comprehensive search was conducted across five databases, targeting studies published between January 2004 and August 2024 that discussed team-based outpatient eating disorder treatment. Peer-reviewed and gray literature were included if they detailed team composition, characteristics, dynamics, experiences, processes, or outcomes. Forty-five studies met the inclusion criteria; nearly half were case reports or lacked primary data. Treatment teams commonly comprised mental health professionals, dietitians, and medical practitioners. Clinical outcomes, such as body mass index and psychopathology, were the most frequently reported, while satisfaction and organizational outcomes were underrepresented. IPCP principles were inconsistently reported, with "Roles/Responsibilities" and "Communication" most frequently mentioned but often superficially addressed. The evidence base for team outpatient eating disorder treatment lacks rigor and depth. Future research should focus on refining the integration of roles across disciplines, developing comprehensive outcome measures for benchmarking, and applying IPCP principles more systematically.

Beyond body image: Self-face recognition and negative self-face evaluations in women at high risk for an eating disorder.

Although one's face represents a core aspect of one's physical appearance, it remains underexplored in eating disorder (ED) populations. The current study examined whether self-face recognition accuracy and evaluations differ in those at high (vs. low) ED risk. We also explored whether recognition accuracy and evaluations are related, and whether this relationship is moderated by ED risk status. Participants included 222 women of East/Southeast Asian (61%) and Caucasian (39%) ethnicity, stratified into low-ED-risk (n=124) and high-ED-risk (n=98). Participants completed measures of self-face recognition accuracy (difficulty recognizing their face and sensitivity to seeing their facial image) and evaluations (including perceived facial adiposity and attractiveness, and head dissatisfaction). Partially consistent with hypotheses, regression analyses revealed that participants at high (vs. low) risk showed poorer self-face recognition accuracy (greater difficulty) and more negative self-face evaluations (higher perceived adiposity, lower perceived attractiveness, greater head dissatisfaction). However, ED risk was not significantly associated with self-face recognition sensitivity. Inconsistent with expectations, whilst greater self-face recognition difficulty was associated with more negative self-face evaluations, ED risk failed to moderate such effects. Findings suggest the potential value of considering face and body image disturbances in ED research and interventions. Further research is encouraged.

Hard stop: reestablishing the significance of abstinence in the treatment of late stage ultra-processed food addiction

Addiction is a complex neurobiological disorder characterized by compulsive drug-seeking and use despite harmful consequences. While abstinence-based approaches have long been the cornerstone of addiction treatment, recent years have seen legitimate challenges from harm reduction clinicians, and within the food addiction realm, the eating disorder treatment practitioners. This perspective emphasizes the role of abstinence in food addiction recovery using the Koob model and its concept of hyperkatifeia despite these reservations. However, further research is essential before abstinence can be recommended. We need to 1) identify what qualifies as abstinence in relation to ultra-processed food, 2) clarify suitable situations and disease progression for optimal implementation of this approach, 3) provide clear guidelines when it is harmful, and 4) conduct clinical studies to confirm the effectiveness of this strategy for long-term recovery from late-stage food addiction.

Managing Eating Disorders Within Medicaid-Funded Health Care Systems in California.

This study describes the current management of patients with eating disorders (EDs) served by publicly-funded Medicaid behavioral health systems. Behavioral health leaders across nine counties in California met on a quarterly basis to share experiences, challenges, and lessons in the management of EDs within publicly-funded service systems. Detailed notes were taken, and a qualitative content analysis was undertaken to identify key themes. County leadership noted insufficient outpatient capacity and difficulty building capacity for ED treatment, in addition to extraordinary challenges when facilitating admission to out-of-network higher level of care programs, at significant expense. Several challenges were identified in building an internal ED workforce, including the fact that many providers weren't eager to treat EDs due to training burden, patient complexity, and high levels of clinician burnout. When a higher level of care was required due to lack of outpatient resources or patient symptom severity or complexity, leaders dedicated significant resources to identify and contract with an appropriate program and secure the necessary funds. Our study supports the need for specialized ED treatment and case management, as well as standardized processes and centralized resources, in Medicaid-managed care. Findings also indicate the importance of protecting against clinician burnout, possibly through reduced caseload expectations, financial incentives, or increased support. Future policy change could reduce administrative burden and clinician burnout by facilitating admission to and reimbursement for higher levels of care.

Changes in insomnia and binge-eating symptom severity before and after treatment of eating disorders in individuals with non-low-weight binge-spectrum disorders.

Although emerging research suggests insomnia is a significant problem among people with eating disorders, little is known about how insomnia symptoms may serve as risk factors for eating disorder symptoms, treatment outcome, and relapse. University students with non-low-weight eating disorders (N = 89) completed a mobile guided self-help cognitive behavioural intervention for eating disorders. Insomnia and binge-eating symptoms were assessed at pre-treatment and end-of-treatment using the Insomnia Severity Index and Eating Pathology Symptoms Inventory. Multiply imputed datasets were used to test associations between insomnia and binge eating before, during and after treatment. Insomnia was positively associated with binge-eating symptoms prior to treatment (r = 0.47). Baseline insomnia symptoms were associated with binge-eating symptoms at end-of-treatment (est = 0.269). Eating disorder treatment modestly reduced insomnia (d = -0.38); however, about half of people with clinically significant insomnia prior to treatment remained symptomatic. Insomnia symptoms and binge-eating symptoms did not change concurrently during treatment. Overall, results support an association between insomnia and binge eating. Although eating disorder treatment may impact insomnia, many individuals remained symptomatic for sleep problems, suggesting the need for follow-up treatments, such as cognitive behavioural therapy for insomnia, or the development of integrated insomnia-eating disorder treatments. Future studies are needed to examine causal links between insomnia and eating disorder symptoms, and test if insomnia predicts relapse after eating disorder treatment.

Fathers' impact on outcomes in the treatment of eating disorders: A scoping review.

Male caregivers' participation in eating disorder (ED) treatment for their affected children is less consistent than female caregivers', with unclear effects. To clarify the impact, this scoping review examined literature on male caregiver involvement in ED treatment, focusing on its impact on fathers, treatment processes, and their affected children. A search encompassing English and French peer-reviewed articles from 1990 to 2022 was conducted. Studies distinguishing between mothers and fathers, addressing Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases ED diagnoses, and involving active interventions were included. From 1651 initially identified articles, 251 were retained after abstract and title review, and 45 metall criteria. Documented outcomes indicated fathers' engagement in ED treatment improved their well-being and family functioning, but these gains were not consistently tied to treatment outcomes. Father attendance, improved caregiving skills, and their expectations of treatment correlated with better outcomes for their affected child. Father involvement in ED treatment remains under-explored. This review emphasises fathers' positive impact while highlighting the need to better understand the link with overall patient outcomes. We call for proactive exploration of how to surmount barriers to fathers' involvement and ensure that paternal contributions are optimised in ED treatment alongside those of female caregivers.

The Loss of Autonomy in Eating Disorder Treatment: A Patient Perspective.

In this text, the author's lived experiences as a youth with anorexia nervosa, anxiety, and depression are explored. Experiences with accessing North American health services, both in specialized eating disorder (ED) and disordered eating (DE) settings, as well as in healthcare more broadly are shared. This work seeks to shed light on a patient perspective in mental health and to draw attention to some of the ways that the current framings of EDs and DE within the biomedical system might perpetuate harm. In this piece, a collection of the author's lived-experiences and interactions with the healthcare system are explored. The medical framing of EDs as a defect of both mind and body can jeopardize one's autonomy and contribute to a sense of hopelessness. As mental health treatment increasingly prioritizes evidence-based approaches and standardized practices, there is a growing concern that this shift risks undermining the autonomy of those it aims to support. The dualistic conceptualizations of mental and physical health in ED/DE treatment, at times, can cause harm, particularly for those who do not present with the physical manifestations of an ED/DE but remain largely affected in day-to-day life. The imposition of rigid treatment regimens can inadvertently diminish personal agency, overshadowing the nuanced, individualized needs and preferences of patients. Lived experience narratives encompass the personal, subjective insights of individuals navigating mental health challenges, in turn, providing invaluable insight that conventional methods may overlook.

Study finds many eating disorder clients kept treatment gains

More than 50% of individuals in an eating disorder program entered treatment at or above a normal weight, dispelling myths that people who are underweight will require intervention, according to a new eating disorder treatment outcomes study released by one of the country's leading eating disorder treatment providers.

Weight Stigma in the Development, Maintenance, and Treatment of Eating Disorders: A Case Series Informing Implications for Research and Practice.

Weight-centric health practices are based on the principle that excess weight predicts chronic disease, informing a growing sociopolitical movement to address an "obesity epidemic." This hyper-focus on preventing obesity may contribute to weight stigma (i.e., the devaluation and discrimination of individuals based on body size) and other iatrogenic outcomes for youth, including the development and maintenance of eating disorders (EDs). Current evidence-based treatments for EDs include language and practices that may reinforce fears of fatness, body shame, and unhealthy dietary restriction without guidance on addressing weight stigma. Here, we present case examples from three adolescent patients across ED presentations and body sizes to (1) elucidate the role of weight stigma in ED development, (2) highlight the ubiquity and harms of weight stigma within ED treatments, and (3) outline thoughtful protocol adaptations to avoid further harm and facilitate recovery. We conclude with a call for immediate action to advance research characterizing the harms of weight-centric approaches in existing ED interventions to reduce the risk of iatrogenic effects on youth with EDs and advance weight-inclusive approaches to ED treatment.

Effectiveness of the Maudsley Model of Anorexia Nervosa Treatment for Adults: A systematic review.

Maudsley Model of Anorexia nervosa (AN) Treatment for Adults (MANTRA) is recommended by NICE for the treatment of adults with AN. However, despite this fact, the approach remains relatively understudied. The aim of this study was to systematically update the research evidence regarding the use of the MANTRA in the treatment of Eating Disorders (ED). The databases used were Web of Science, Scopus, and PsycInfo, including studies up to 31 May 2023. PRISMA guidelines were followed, and Cochrane tools were used to assess the risk of bias. The search focused on identifying published articles that discussed the usefulness of MANTRA as a component of treatment for ED, following PICO criteria. Nine studies spanning the period from 2011 to 2023 were included. Findings suggested that MANTRA was effective in improving body mass index (BMI), eating symptomatology and emotional state. There were generally no significant differences compared to other treatment conditions. Limitations to interpreting this systematic review include the methodological quality of included studies and the elevated risk of bias. This review was the first to examine the effectiveness of MANTRA. The results indicate that MANTRA has shown effectiveness similar to other treatments for adults AN patients in addressing key clinical variables. It has been used in different populations (adolescents, males, inpatients) and formats (group, online) However, more research is needed to determine its effectiveness.

Thematic and intertextual analysis from a feasibility study of the Bonny Method of Guided Imagery and Music with clients in eating disorder treatment.

Eating disorders (ED) are characterized by serious and persistent disturbances with eating, weightcontrol, and body image. Symptoms impact physical health, psychosocial functioning, and can be life-threatening. Individuals diagnosed with an ED experience numerous medical and psychiatric comorbidities due to issues caused by or underlying the ED. Therefore, it is vital to address the complex nature of an ED, as well as the comorbid and underlying issues. This necessitates a psychotherapeutic approach that can help to uncover, explore, and support working through unresolved emotions and experiences. Guided Imagery and Music (GIM) is an in-depth music psychotherapy approach utilizing therapist-programmed music to support the client in uncovering and examining underlying and unresolved issues. The literature surrounding the use of GIM with clients in ED treatment is anecdotal and comprised primarily of clinical case studies. This secondary analysis, based on a descriptive feasibility study that integrated GIM sessions into the client's regular ED treatment and examined 116 transcripts from a series of sessions of eight clients. Thematic analysis of the transcripts identified nine subthemes and three themes that emerged. These themes include emotional landscape (feeling stuck, acknowledging emotions, and working through unresolved emotions), relationships (self, others, and eating disorders), and transformation and growth (finding strength, change, and empowerment). A short series of GIM sessions helped ED clients identify and address issues underlying the ED and to gain or reclaim a sense of self that enabled them to make choices for their life that support their recovery and sense of empowerment. Intertextual analysis revealed imagery indicative of the Hero's Journey. Further, how engagement in this embodied aesthetic experience stimulates perceptual, cognitive, and affective brain functions which are key in fostering behavioural and psychological change is explicated as it relates to ED treatment and recovery.

Discovering a “sense of community”: patient experiences of connection in intentionally remote eating disorder care

BackgroundWhile some findings indicate high levels of patient satisfaction with remote eating disorder treatment, others reflect feelings of disconnection due to unique telehealth treatment challenges. The COVID-19 pandemic presented circumstances that likely impacted the findings established thus far. As such, the present study sought to understand patient experiences of connection in an intentionally remote eating disorder treatment program, specifically in a context outside of pandemic transition.MethodsA secondary analysis of de-identified qualitative data previously obtained for quality improvement purposes via a client satisfaction survey was conducted. Adult patient responses (N = 38) were analyzed via reflexive thematic analysis within a critical realist framework.ResultsFour themes were generated from the data: (1) Embracing one’s humanity paves the way for connection, (2) Discovering a “sense of community” in remote care, (3) “They made me feel I was worth recovering”: connection as a vehicle for healing, and (4) Aligning expectations and reality: reconceptualizing the journey to connection in remote eating disorder care.ConclusionsOverall, findings suggest that it is possible for patients to form strong, impactful connections in remote treatment. Importantly, patient perspectives indicated that there were shifts in how these connections were experienced as a result of the remote care environment (e.g., how support could be provided and by whom). Considerations unique to remote care (e.g., offering training to improve clients’ comfort with technology) may be important to fostering connection, thereby contributing to improved patient experiences and treatment outcomes.

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.

Systematic Reviews on Eating Disorders and Autism Spectrum Disorder Emphasize a Call to Further Expand High-Quality Research.

Two recent systematic reviews provide important insights into the current state of the eating disorder literature regarding autistic traits, ASD prevalence, and experience with accessing treatment, with a specific focus on anorexia nervosa (AN). The extant literature provides converging evidence for elevated autistic traits in individuals with AN, while evidence for increased prevalence of ASD in AN is less robust. Presence of autistic traits or a formal ASD diagnosis both appear to elevate the potential for a more complicated experience during eating disorder treatment. Together, this work provides compelling justification to expand the breadth of inquiry regarding eating disorders and ASD, with a specific call for increased methodological rigor when designing and conducting future research. My commentary calls for specific steps to advance our understanding of ASD and eating disorders.

07 Partnering with patients with living and lived experience of eating disorders to improve inpatient care on an acute paediatric medicine unit

Abstract Background Since the COVID-19 pandemic, hospitals nationally are seeing a growing number of adolescent patients with eating disorders requiring acute medical stabilization, which is often a time of crisis in the trajectory of this ego-syntonic disorder. The complexity of these admissions often lead to safety events for patients and moral distress for clinicians. Medical admissions can also be an opportunity to engage youth and families. Patient partners are a pillar in healthcare quality improvement, but historically we have not engaged adolescent patient partners in improving acute eating disorder treatment. We gathered the experience of patients and families with living and lived experience of eating disorder treatment to improve their quality of care in an acute paediatric medicine unit. Objectives We aimed to describe the experience of patients and families with living and lived experience of eating disorder treatment, specifically acute medical stabilization, through a quality improvement patient engagement project. Design/Methods We used a mixed-methods design of semi-structured interviews and a focus group with adolescents with eating disorders and their caregivers in an acute medical unit at a tertiary paediatric hospital in British Columbia. We employed opportunity sampling by distributing recruitment flyers through patient experience councils, outpatient clinics, other non-acute units, and to all patients admitted with a medically unstable eating disorder at our hospital during the study period. The interviews consisted of open-ended questions, yes/no questions, and Likert scales related to four categories: admission process, inpatient experience, team communication, and discharge process. Two reviewers analyzed the qualitative data using thematic analysis, and the quantitative data was analyzed descriptively. Quality improvement projects are exempt from Research Ethics Board approval. However, we utilized the "A Project Ethics Community Consensus Initiative" (ARECCI) Ethics Guideline and Screening Tool and presented our proposal at the hospital's quality improvement and research oversight committees. Results We completed 8 interviews with patients with current living experience admitted to our acute medical unit. We also completed 1 interview with a patient with past lived experience and 1 focus group with patients and caregivers. Primary themes identified included uncertainty about their overall treatment journey and stress due to the sudden new expectations on the inpatient unit, such as activity restriction, meal plans by the hospital, and bathroom access after meal times. Patients identified the importance of relational care, inclusion in treatment planning, acknowledgement of the demanding nature of eating disorders, and individualized care. Due to variability in training, resource allocation, and gaps in communication, these patient-identified priorities are not always met. While 100% of participants stated they understood the reasons and goals for admission, participants averaged 3.7 on a 1 (lowest) to 5 (highest) Likert scale when asked to rate their satisfaction with the information they received. Five out of eight adolescents felt that there was consistency in communication within the team. Conclusion We demonstrate the complex needs of patients with eating disorders who require acute medical stabilization. Targeted knowledge mobilization initiatives through admission orientation documents and family-centered rounds could better meet those needs. We are currently developing an admission pamphlet and journal for patients admitted with a new eating disorder to our medical unit. Patient partners exhibited a high willingness to participate in our study and readily acknowledged the importance their contributions could hold for other patients.

Improving adult inpatient eating disorder treatment: perspectives of a sample of individuals in Canada with lived experience

Plain English SummaryEating disorders (EDs) are common and can be deadly, yet treatment approaches are not currently meeting the needs of individuals in Canada requiring care. As noted in the existing literature, ED treatment is largely inaccessible in Canada and can be ineffective in facilitating long-term recovery. Recent research has suggested that improvement to publicly funded, hospital-based ED treatment for adults is necessary and that those in Canada with lived experience should be involved in the process of doing so. This paper is based on a study that set out to explore ED treatment and gather potential recommendations from eleven individuals in Canada with lived experience. Several recommendations were identified to improve ED treatment in Canada, while simultaneously addressing harmful stigma about people with lived experience with EDs. These recommendations included providing interim support, ensuring individualized care, offering dignified treatment, increasing resources, and directly targeting stigma. From this study, it is suggested that current ED treatment methods must change to improve health outcomes and reduce stigma, and exploring the perspectives of those with lived experience is a promising method for doing so.

Eating disorders, school professionals, and understanding family theory

AbstractEating disorders have substantially risen in school‐aged youth, especially in a post‐pandemic world. Impacting children and adolescents across races, ethnicities, genders, and sexual orientations, prevalence rates suggest that eating disorders do not discriminate. Interestingly, despite the rising prevalence rates and increase of eating disorders, many school‐based mental health providers feel ill‐equipped to support children, adolescents, and their families seeking eating disorder treatment due to lack of knowledge or skill. Given the evidence‐based focus on family‐based treatment, many school‐based providers wonder what is best approach to support individuals within a school‐system, for how to best intertwine family‐based recommendations and collaboration with relevant outside clinicians. Given this uncertainty, this piece explores the role of school‐based mental health in supporting family‐based treatment, exploring two prominent systems theories and how providers within schools can adopt these approaches to most ethically aid students within the bounds of competence within a school setting.

Eating disorders of the perimenopause.

Except for psychosis, women's mental health problems across the reproductive lifespan are common. There are periods in a woman's life, associated with significant sex hormone fluctuations, that render her particularly susceptible to mood disturbance and mental health illnesses, including eating disorders. Whilst eating disorders are usually conceptualized as diseases afflicting adolescence and young adults, there is increasing evidence to suggest the landscape for eating disorders has considerably changed and includes a peak in midlife, correlating with the perimenopause. Inpatient admissions and outpatient clinic attendances have increased amongst older women. It is likely this increasing trend is the result of numerous biopsychosocial factors. A diagnosis of an eating disorder in midlife may be more common in those women simultaneously navigating the perimenopause than in midlife women who remain pre-menopausal owing to the significant ovarian hormonal fluctuations encountered in the perimenopause. Eating disorders are serious illnesses associated with significant morbidity and mortality, which are exacerbated when present at older ages. Research is beginning to recognize the importance of including this typically under-represented cohort of middle-aged women in empirical studies, which is critical to a complete etiological understanding. Recognizing and treating these varied presentations and establishing effective treatments for chronic, recurrent and new-onset eating disorders in midlife women is crucial.