Restrictive Eating Disorders Research Articles

Weight/Shape concerns in youth with Avoidant/Restrictive Food Intake Disorder (ARFID)

ABSTRACT Avoidant/restrictive food intake disorder (ARFID) is distinct from other restrictive eating disorders in that body image disturbance or fear of weight gain do not drive restrictive eating. ARFID occurs across the full weight spectrum and youth with ARFID may still experience body weight/shape concerns, not necessarily pathological like body image disturbance is, but research is currently very limited. The current study examined how body weight/shape concerns vary across the full weight spectrum in youth with ARFID. As an exploratory aim, this study also assessed whether body weight/shape concerns differ by ARFID subtypes, age, and gender. Participants included 272 youth between the ages of 8 and 19 presenting for ARFID care at an urban pediatric hospital. Non-parametric Kruskal–Wallis tests were used to examine relations between weight/shape concerns and weight status (i.e. underweight, normal weight, overweight/obesity), ARFID subtypes, age, and gender. Results showed that youth with ARFID and overweight/obesity weight status endorsed greater weight/shape concerns than those with ARFID and normal and underweight statuses (p = .009). Youth who identified as gender identity other than male or female endorsed greater weight/shape concerns than those identifying as cis-male or cis-female (p = .01). However, there were no differences in weight/shape concerns by age or ARFID subtype. These findings demonstrate body weight/shape concerns among youth with ARFID, especially those with overweight/obesity weight status and who are gender diverse.

A comprehensive review on the co-occurrence of scurvy and anorexia nervosa.

Scurvy, a rare disease resulting from vitamin C deficiency, can occur in individuals with restrictive eating disorders like anorexia nervosa (AN), leading to severe health complications. This review explores the complex relationship between scurvy and AN, highlighting the overlapping symptoms and challenges in diagnosis and treatment. Vitamin C is essential for collagen synthesis, immune function, and neurotransmitter production, and its deficiency manifests as fatigue, gingival bleeding, joint pain, and perifollicular hemorrhages. AN exacerbates these symptoms through extreme food restriction, causing severe nutritional deficiencies. Analyzing nine case reports, this review reveals that patients with co-occurring AN and scurvy often present with gastrointestinal, psychiatric, and dermatological symptoms. Treatment with vitamin C supplementation typically results in rapid symptom improvement. However, the malnutrition inherent in AN complicates the clinical picture, making timely diagnosis and intervention crucial. This review underscores the importance of a comprehensive, multidisciplinary approach to managing these conditions, emphasizing the need for early recognition and treatment to prevent severe complications. Future research should include a more diverse patient population to enhance understanding of the interplay between AN and scurvy, aiming to improve patient outcomes through tailored treatment strategies.

Difficulties in Emotion Regulation in Avoidant/Restrictive Food Intake Disorder.

Despite substantial research indicating difficulties with emotion regulation across eating disorder presentations, emotion regulation has yet to be studied in adults with avoidant/restrictive food intake disorder (ARFID). We hypothesized that (1) those with ARFID would report greater overall emotion regulation difficulties than nonclinical participants, and (2) those with ARFID would not differ from those with other eating disorders on the level of emotion regulation difficulty. One hundred and thirty-seven adults (age 18-30) from an outpatient clinic with ARFID (n = 27), with other primarily restrictive eating disorders (e.g., anorexia nervosa; n = 34), and with binge/purge eating disorders (e.g., bulimia nervosa; n = 51), as well as nonclinical participants (n = 25) recruited via Amazon Mechanical Turk (MTurk) completed the Difficulties in Emotion Regulation Scale (DERS). We compared DERS scores across groups. In line with expectations, patients with ARFID scored significantly higher than nonclinical participants on the DERS Total (p = 0.01) with a large effect size (d = 0.87). Also as hypothesized, those with ARFID did not differ from those with other primarily restrictive (p = 0.99) or binge/purge disorders (p = 0.29) on DERS Total. Adults with ARFID appear to exhibit emotion regulation difficulties which are greater than nonclinical participants, and commensurate with other eating disorders. These findings highlight the possibility of emotion regulation difficulties as a maintenance mechanism for ARFID.

Treatment adherence and nasogastric tube use in hospitalized youth with anorexia nervosa and premorbid overweight/obesity

ABSTRACT Youth with restrictive-eating disorders (EDs) often experience significant distress and difficulty with treatment adherence during nutritional rehabilitation. This study assessed whether youth with restrictive EDs and premorbid overweight/obesity admitted for inpatient nutritional rehabilitation experience greater psychological distress and difficulty with treatment adherence than youth with premorbid BMI <85th percentile. A retrospective chart review examined 150 youth hospitalized for medical complications of restrictive EDs. Rates of nasogastric tube (NGT; used when youth could not complete meals), agitation medication use, and disposition recommendation were compared across premorbid BMI groups. Patients with premorbid overweight/obesity were three times more likely to require NGT feeds. These findings suggest greater challenges with nutritional rehabilitation, specifically consuming nutrition orally, in patients with premorbid overweight/obesity, highlighting the need for early and individualized psychological support for this vulnerable patient population.

The clinical characteristics of autistic women with restrictive eating disorders.

Autistic women are at high risk of developing restrictive eating disorders (REDs), such as anorexia nervosa. This study provides an overview of the clinical characteristics of autistic women with REDs to (i) enhance understanding of increased risk, and (ii) support the identification of autistic women in eating disorder services. We compared self-reported autistic and disordered eating characteristics of: autistic participants with REDs (Autism + REDs; n = 57); autistic participants without REDs (Autism; n = 69); and women with REDs who are not autistic (REDs; n = 80). We also included a group of women with high autistic traits (HATs) and REDs, but no formal autism diagnosis (HATs + REDs; n = 38). Autism + REDs participants scored similarly to Autism participants in terms of autistic characteristics and to REDs participants in terms of experiencing traditional disordered eating symptoms. Autism + REDs participants were distinguished from both groups by having more restricted and repetitive behaviours and autism-specific eating behaviours related to sensory processing, flexibility and social differences. HATs + REDs participants showed a similar pattern of scores to Autism + REDs participants, and both also presented with high levels of co-occurring mental health difficulties, particularly social anxiety. The presentation of autistic women with REDs is complex, including both traditional disordered eating symptoms and autism-related needs, as well as high levels of co-occurring mental health difficulties. In eating disorder services, the REDs presentation of autistic women and those with HATs should be formulated with reference to autism-specific eating behaviours and co-occurring difficulties. Treatment adaptations should be offered to accommodate autistic characteristics and related needs.

Xeropthalmia and optic neuropathy secondary to ARFID: a case report

BackgroundPatients with avoidant/restrictive food intake disorder (ARFID) commonly present with loss of weight or faltering growth in the setting of poor nutrition. However, patients with ARFID can present with micronutrient deficiencies without weight loss. In patients with ARFID, clinicians should be vigilant for micronutrient deficiencies and their presentations.Case presentationWe report a unique case of ARFID in a twelve-year-old girl, who developed micronutrient deficiencies and presented with acute visual loss with a preceding history of impaired night vision. Ophthalmic examination revealed xerophthalmia and bilateral optic neuropathy. Investigations showed severe Vitamin A and folate deficiencies which accounted for her clinical findings. In addition, she was also found to have low Vitamin B12, copper, and Vitamin D levels. She had a history of selective eating from a young age with a diet consisting largely of carbohydrates, with no regular intake of meat, dairy, fruit and vegetables. This was not driven by weight or body image concerns. The patient’s symptoms improved significantly with appropriate vitamin replacement and continued multidisciplinary care.ConclusionsThis report describes a patient with ARFID presenting with visual complaints. In this case, the selective eating behaviours resulted in xeropthalmia and optic neuropathy. Micronutrient deficiencies are uncommon in developed countries. When these deficiencies are suspected, eating disorders, such as ARFID, should be considered. Similarly, clinicians caring for patients with restrictive eating disorders including ARFID should be familiar with the clinical presentations of various micronutrient deficiencies and consider evaluation and treatment for micronutrient deficiencies when clinically indicated.

Adolescent leisure-time physical activity and eating disorders: a longitudinal population-based twin study

PurposeHigh levels of physical activity have been documented in eating disorder patients. Our aim was to examine whether adolescent leisure-time physical activity is prospectively associated with eating disorders in adolescence and young adulthood.MethodsFinnish twins born in 1983–1987 reported their physical activity frequency at ages 12, 14, and 17. A subsample of participants underwent structured, retrospective interviews for eating disorders at the mean age of 22.4 years. Associations between female twins’ physical activity and future eating disorders (571–683 twins/wave) were investigated with the Cox proportional hazards model. To illustrate the physical activity similarity of the co-twins in a twin pair, we used cross-tabulation of eating disorder–discordant twin pairs (13–24 pairs/wave).ResultsAfter adjusting for several covariates, we found no statistically significant longitudinal association between physical activity and eating disorders. This applied when all eating disorders were combined but also when assessed separately as restrictive and non-restrictive eating disorders. Co-twins’ physical activity in adolescence tended to be similar irrespective of their future eating disorder, supporting the results of the regression analysis.ConclusionWe observed no evidence of adolescent physical activity frequency being prospectively associated with eating disorders in female twins. Further longitudinal studies with larger sample sizes and more detailed physical activity data are needed.Level of evidence: III, evidence obtained from cohort or case–control analytic studies.

High-calorie refeeding in adolescents with anorexia nervosa: a narrative review.

Recent studies about refeeding in anorexia nervosa (AN) suggest starting with a high calorie diet. This narrative review aims to understand the initial refeeding management in hospitalized children and adolescents with AN and to develop a practical protocol. We performed a comprehensive database search in June 2023 for abstracts published between January 2010 and May 2023 in different databases: Pubmed, The Cochrane Library and Embase with the terms refeeding syndrome, energy intake, diet therapy, weight restoration, hypophosphatemia, nutritional rehabilitation, anorexia nervosa, restrictive eating disorders, child, adolescent and young adult. Fifteen papers were included in this review. Twelve studies were retrospective or observational. Only 3 randomized controlled trials were found. Initial energy intake varies within a wide range between 500 and 2800 kcal per day but generally begins with higher calories than current recommendations. Only hypophosphatemia was often described without clinical refeeding syndrome. Initial weight restoration was better with high calorie refeeding (HCR). Length of stay was shorter with HCR in some studies. Long term outcomes were unknown. Only two studied severely malnourished patients (< 70 % mBMI). In adolescents with AN and with a low risk of RS, high calorie refeeding is possible under close medical monitoring and with prompt electrolyte correction. Robust studies with a unified protocol are needed to confirm the safety of high calorie refeeding especially in severely malnourished adolescents with AN.

Salud mental y enfermedad psiquiátrica en las tiroidopatías y otras endocrinopatías

Both hypothyroidism and hyperthyroidism are linked to an increased risk of anxiety and depression, although the causal relationship is unclear. The efficacy of the treatment of both varies and is controversial. In addition, certain psychotropic drugs such as antipsychotics and lithium can influence thyroid function. In patients with eating disorders, especially restrictive eating disorders, low energy intake together with the low fat mass associated with lower leptin production may affect the hypothalamic-pituitary axis. This can cause hypogonadism with secondary osteoporosis and also alters other hormonal axes such as the somatotropic axis or oxytocin production, for example. Many psychiatric diseases are associated with a greater vitamin D deficiency and, thus, osteoporosis. There is a bidirectional relationship between depression on the one hand and obesity and type 2 diabetes on the other. Also, in patients with schizophrenia or bipolar disorder, there is a higher prevalence of diabetes, obesity, and metabolic syndrome, mainly related to a sedentary lifestyle and the use of antipsychotics (mainly clozapine and olanzapine). In fact, the main cause of death is cardiovascular disease in both psychiatric disorders.

Variation in care for inpatients with avoidant restrictive food intake disorder leads to development of a novel inpatient clinical pathway to standardize care

IntroductionThere is limited evidence to guide management of patients with avoidant restrictive food intake disorder (ARFID) admitted for medical stabilization. We describe variations in inpatient care which led to the development of a multidisciplinary inpatient clinical pathway (ICP) to provide standardized management and examine differences after the ICP was implemented.MethodsA retrospective review of patients with ARFID admitted to Adolescent Medicine, Gastroenterology, and General Pediatrics at a single academic center was conducted. We compare hospital utilization and use of consulting services during the pre-ICP (2015–2017) and post-ICP (2018–2020) periods.Results110 patients were admitted with ARFID (n = 57 pre- vs. n = 53 post-ICP). Most presented with moderate/severe malnutrition (63% pre vs. 81% post; p = 0.11) and co-morbid anxiety and/or depression (74% pre vs. 92% post; p = 0.01). There was some variation in use of enteral tube feeding by service in both periods (p = 0.76 and p = 0.38, respectively), although overall use was consistent between periods (46% pre vs. 58% post; p = 0.18). Pre-ICP, use of the restrictive eating disorder protocol differed across services (p < 0.001), with only AM using it. Overall, utilization of the restrictive eating disorder protocol decreased from 16% pre-ICP to 2% post-ICP (p = 0.02). There was variation by service in psychiatry/psychology (range 82–100% by service; p = 0.09) and social work consultations (range 17–71% by service; p = 0.001) during the pre-ICP period, though variation was reduced in the post-ICP period (p = 0.99 and p = 0.05, respectively). Implementation of the ICP led to improvements in these consultative services, with all patients in the post-ICP period receiving psychiatry/psychology consultation (p = 0.05) and an increase in social work consults from 44 to 64% (p = 0.03). Nutrition consults were consistently utilized in both periods (98% pre vs. 100% post; p = 0.33).ConclusionThe ICP was developed to standardize inpatient medical stabilization for patients with ARFID. In this single center study, implementation of the ICP increased standardized care for inpatients with ARFID with variation in care reduced: there were improvements in the use of consulting services and a reduction in the use of the restrictive eating disorder protocol. The ICP demonstrates the potential to further standardize and improve care over time.

Stomach size in anorexia nervosa: A new challenge?

Changes in stomach size may impact eating behaviour. A recent study showed gastric dilatation in restrictive eating disorders using computed tomography scans. This study aimed to describe stomach size in the standing position in women with anorexia nervosa (AN). Women treated for AN at our institution were retrospectively included if they had undergone upper gastrointestinal radiography (UGR) after the diagnosis of AN. Two control groups (CG1 and CG2) were included, both comprising female patients: CG1 patients were not obese and underwent UGR for digestive symptoms of other aetiologies, and CG2 comprised obese individuals who had UGR before bariatric surgery. A UGR-based Stomach Size Index (SSI), calculated as the ratio of the length of the stomach to the distance between the upper end of the stomach and the top of the iliac crests, was measured in all three groups. Gastromegaly was defined as SSI >1.00. 45 patients suffering from AN (28 with restrictive and 17 with binge/purge subtype), 10 CG1 and 20 CG2 subjects were included in this study. Stomach Size Index was significantly higher in AN (1.27±0.24) than in CG1 (0.80±0.11) and CG2 (0.68±0.09); p<0.001, but was not significantly different between patients with the restrictive and binge/purge subtypes. Gastromegaly was present in 82.2% of patients with AN and not present in the control groups. In patients with AN, gastromegaly was present in 12/15 patients without digestive symptoms (80.0%) and in 25/30 patients with digestive complaints (83.3%) at time of UGR (p=0.99). In the AN group, no significant relationship was found between SSI and body mass index. Gastromegaly is frequent in AN and could influence AN recovery. This anatomical modification could partially explain the alterations of gastric motility previously reported in AN.

Transdiagnostic inflammatory and oxidative biomarkers with predictive capacity of self-injurious behavior in impulsive and unstable disorders

IntroductionAlterations in inflammatory processes have previously been reported in impulsive and unstable disorders, as well as in other psychiatric conditions. In order to investigate transdiagnostic biomarkers associated with various phenotypic features of these disorders, this study is designed to identify biomarkers of inflammatory and oxidative endophenotypes related to autolytic behavior. MethodsPeripheral blood mononuclear cells were collected from 35 patients with borderline personality disorder (BPD), 29 patients with restrictive eating disorder (rED), 21 patients with purging eating disorder (pED) and 23 control subjects. Plasma levels of different inflammatory and oxidative factors were measured by ELISA and the expression of selected proteins was by Western Blot. Principal component analysis (PCA) was performed to categorize the different inflammatory factors. Additionally, Ancova was performed to observe the differences in the principal components among the different groups and logistic regression analysis was conducted to assess the predictive capacity of these components for autolytic behaviors. ResultsWe found two inflammatory/oxidative components were associated with BPD, characterized by high levels of JNK and ERK and low levels of GPx, SOD and Keap1; and two other inflammatory/oxidative components were linked to pED, associated with more JNK, TBARS and TNF-α and less GPx and SOD. Two components, with more JNK and ERK and less GPx, SOD and Keap1, predicted non-suicidal self-injury and three components, with higher JNK, TBARS and TNF-α levels and lower GPx, SOD and iNOS levels, predicted suicide attempts. ConclusionsThese results strongly support the endophenotypic characterization of impulsivity and the identification of transdiagnostic inflammatory/oxidative biomarkers relevant to autolytic behavior in impulsive and unstable disorders. These dates lay the groundwork for developing of screening tests for these biomarker components to rapidly detect biological risk factors for specific impulse control disorders and future self-injurious behaviors.

Early childhood appetitive traits and eating disorder symptoms in adolescence: a 10-year longitudinal follow-up study in the Netherlands and the UK

Obesity and eating disorders commonly co-occur and might share common risk factors. Appetite avidity is an established neurobehavioural risk factor for obesity from early life, but the role of appetite in eating disorder susceptibility is unclear. We aimed to examine longitudinal associations between appetitive traits in early childhood and eating disorder symptoms in adolescence. In this longitudinal cohort study, we used data from Generation R (based in Rotterdam, the Netherlands) and Gemini (based in England and Wales). Appetitive traits at age 4-5 years were measured using the parent-reported Child Eating Behaviour Questionnaire. At age 12-14 years, adolescents self-reported on overeating eating disorder symptoms (binge eating symptoms, uncontrolled eating, and emotional eating) and restrictive eating disorder symptoms (compensatory behaviours and restrained eating). Missing data on covariates were imputed using Multivariate Imputation via Chained Equations. Ordinal and binary logistic regressions were performed in each cohort separately and adjusted for confounders. Pooled results were obtained by meta-analyses. Sensitivity analyses were performed on complete cases using inverse probability weighting. The final study sample included 2801 participants from Generation R and 869 participants from Gemini. Pooled findings after meta-analyses showed that higher food responsiveness in early childhood increased the odds of binge eating symptoms (odds ratio [OR]pooled 1·47, 95% CI 1·26-1·72), uncontrolled eating (1·33, 1·21-1·46), emotional eating (1·26, 1·13-1·41), restrained eating (1·16, 1·06-1·27), and compensatory behaviours (1·18, 1·08-1·30) in adolescence. Greater emotional overeating in early childhood increased the odds of compensatory behaviours (1·18, 1·06-1·33). By contrast, greater satiety responsiveness in early childhood decreased the odds of compensatory behaviours in adolescence (0·89, 0·81-0·99) and uncontrolled eating (0·86, 0·78-0·95) in adolescence. Slower eating in early childhood decreased the odds of compensatory behaviours (0·91, 0·84-0·99) and restrained eating (0·90, 0·83-0·98) in adolescence. No other associations were observed. In this study, higher food responsiveness in early childhood was associated with a higher likelihood of self-reported eating disorder symptoms in adolescence, whereas greater satiety sensitivity and slower eating were associated with a lower likelihood of some eating disorder symptoms. Appetitive traits in children might be early neurobehavioural risk factors for, or markers of, subsequent eating disorder symptoms. MQ Mental Health Research, Rosetrees Trust, ZonMw.

Novel Cocrystal Structures of Peptide Antagonists Bound to the Human Melanocortin Receptor 4 Unveil Unexplored Grounds for Structure-Based Drug Design.

Melanocortin 4 receptor (MC4-R) antagonists are actively sought for treating cancer cachexia. We determined the structures of complexes with PG-934 and SBL-MC-31. These peptides differ from SHU9119 by substituting His6 with Pro6 and inserting Gly10 or Arg10. The structures revealed two subpockets at the TM7-TM1-TM2 domains, separated by N2857.36. Two peptide series based on the complexed peptides led to an antagonist activity and selectivity SAR study. Most ligands retained the SHU9119 potency, but several SBL-MC-31-derived peptides significantly enhanced MC4-R selectivity over MC1-R by 60- to 132-fold. We also investigated MC4-R coupling to the K+ channel, Kir7.1. Some peptides activated the channel, whereas others induced channel closure independently of G protein coupling. In cell culture studies, channel activation correlated with increased feeding, while a peptide with Kir7.1 inhibitory activity reduced eating. These results highlight the potential for targeting the MC4-R:Kir7.1 complex for treating positive and restrictive eating disorders.

Adolescent utilization of eating disorder higher level of care: roles of family-based treatment adherence and demographic factors

BackgroundOutpatient family-based treatment (FBT) is effective in treating restrictive eating disorders among adolescents. However, little is known about whether FBT reduces higher level of care (HLOC) utilization or if utilization of HLOC is associated with patient characteristics. This study examined associations between utilization of eating disorder related care (HLOC and outpatient treatment) and reported adherence to FBT and patient characteristics in a large integrated health system.MethodsThis retrospective cohort study examined 4101 adolescents who received care for restrictive eating disorders at Kaiser Permanente Northern California. A survey was sent to each medical center to identify treatment teams as high FBT adherence (hFBT) and low FBT adherence (lFBT). Outpatient medical and psychiatry encounters and HLOC, including medical hospitalizations and higher-level psychiatric care as well as patient characteristics were extracted from the EHR and examined over 12 months post-index.Results2111 and 1990 adolescents were treated in the hFBT and lFBT, respectively. After adjusting for age, sex, race/ethnicity, initial percent median BMI, and comorbid mental health diagnoses, there were no differences in HLOC or outpatient utilization between hFBT and lFBT. Females had higher odds of any utilization compared with males. Compared to White adolescents, Latinos/Hispanics had lower odds of HLOC utilization. Asian, Black, and Latino/Hispanic adolescents had lower odds of psychiatric outpatient care than Whites.ConclusionsReported FBT adherence was not associated with HLOC utilization in this sample. However, significant disparities across patient characteristics were found in the utilization of psychiatric care for eating disorders. More efforts are needed to understand treatment pathways that are accessible and effective for all populations with eating disorders.

Mental health providers' perceptions of restrictive eating disorders: Relationship with client body weight.

This study investigated whether mental health providers have different diagnostic impressions and treatment recommendations for patients with restrictive eating disorders, depending on the patient's body weight. Participants were given one of three versions of a vignette depicting a patient who meets DSM-5 criteria for anorexia nervosa (AN) or atypical AN with the patient's weight described as either below, within, or above the average range for her age and height. Participants were then asked to respond to a series of questions about diagnosis, symptoms, and treatment recommendations. Results were compared between the three weight conditions with the goal of better understanding how a patient's body weight may influence different aspects of participants' clinical impressions. Participants given the low weight version of the vignette were more likely to identify the presenting problem as an eating disorder and to agree that the patient experienced dietary restriction and weight loss, weight gain avoidance, and body image concerns. Participants given the low weight description were also more likely to recommend specialized eating disorder treatment and medical follow-up. Findings suggest that mental health providers were generally more responsive to restrictive eating disorder symptoms when the patient was at a lower body weight. These results are concerning because they suggest patients with atypical AN may be less likely to receive an accurate diagnosis or adequate treatment compared to underweight patients with AN, despite experiencing the same symptoms. Restrictive eating disorders like AN and atypical AN can cause comparable physical and psychological symptoms in people of any body weight. Despite having the same symptoms, people with a higher body weight are less likely to receive a diagnosis or treatment. This study compared mental health providers' reactions to a description of a patient with an eating disorder at different body weights and found differences in diagnosis, detection of symptoms, and treatment recommendations.

Avoidant/restrictive food intake disorder differs from anorexia nervosa in delay discounting

BackgroundAvoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are the two primary restrictive eating disorders; however, they are driven by differing motives for inadequate dietary intake. Despite overlap in restrictive eating behaviors and subsequent malnutrition, it remains unknown if ARFID and AN also share commonalities in their cognitive profiles, with cognitive alterations being a key identifier of AN. Discounting the present value of future outcomes with increasing delay to their expected receipt represents a core cognitive process guiding human decision-making. A hallmark cognitive characteristic of individuals with AN (vs. healthy controls [HC]) is reduced discounting of future outcomes, resulting in reduced impulsivity and higher likelihood of favoring delayed gratification. Whether individuals with ARFID display a similar reduction in delay discounting as those with AN (vs. an opposing bias towards increased delay discounting or no bias) is important in informing transdiagnostic versus disorder-specific cognitive characteristics and optimizing future intervention strategies.MethodTo address this research question, 104 participants (ARFID: n = 57, AN: n = 28, HC: n = 19) completed a computerized Delay Discounting Task. Groups were compared by their delay discounting parameter (ln)k.ResultsIndividuals with ARFID displayed a larger delay discounting parameter than those with AN, indicating steeper delay discounting (M ± SD = −6.10 ± 2.00 vs. −7.26 ± 1.73, p = 0.026 [age-adjusted], Hedges’ g = 0.59), with no difference from HC (p = 0.514, Hedges’ g = −0.35).ConclusionOur findings provide a first indication of distinct cognitive profiles among the two primary restrictive eating disorders. The present results, together with future research spanning additional cognitive domains and including larger and more diverse samples of individuals with ARFID (vs. AN), will contribute to identifying maintenance mechanisms that are unique to each disorder as well as contribute to the optimization and tailoring of treatment strategies across the spectrum of restrictive eating disorders.

The impact of continuous calorie restriction and fasting on cognition in adults without eating disorders.

Research into the effects of calorie restriction continues to intrigue those interested in whether it may allow humans to live longer and healthier lives. Animal studies of continuous calorie restriction (CCR) and fasting have demonstrated substantial advantages to health and longevity. However, concerns remain about the impact of restricting calorie intake on human health and cognition. Given the emerging evidence of cognitive impairments in eating disorders, studies investigating restricted calorie intake in healthy humans (in an ethical way) may also have implications for understanding restrictive eating disorders. In this review, the published literature on the impact of CCR and fasting on cognitive function in healthy human participants is synthesized. Of the 33 studies of CCR and fasting in humans identified, 23 demonstrated significant changes in cognition. Despite variation across the cognitive domains, results suggest CCR benefits inhibition, processing speed, and working memory, but may lead to impairments in cognitive flexibility. The results of fasting studies suggest fasting is associated with impairments in cognitive flexibility and psychomotor abilities. Overall, the results of these studies suggest the degree (ie, the severity) of calorie restriction is what most likely predicts cognitive improvements as opposed to impairments. For individuals engaging in sustained restriction, this may have serious, irreversible consequences. However, there are mixed findings regarding the impact of CCR and fasting on this aspect of human functioning, suggesting further research is required to understand the costs and benefits of different types of calorie restriction.

Understanding community provider practices in diagnosing and treating atypical anorexia nervosa: A mixed methods study.

There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions. A variety of providers (N = 141; 96.4% female) completed an online survey pertaining to diagnostic and treatment practices with atypical AN. Descriptive statistics were computed to characterize provider-based practices and Fisher's exact tests were used to test for differences in diagnostic practices by professional discipline. Thematic analysis was used to examine open-ended questions. Most (63.97%) providers diagnosed atypical AN in the absence of any weight loss if other AN criteria were met, but doctoral-level psychologists and medical professionals were less likely to do so compared to nutritional or other mental health professionals. Most providers found weight gain was only sometimes necessary for atypical AN recovery. Qualitative responses revealed providers found atypical AN to be a stigmatizing label that was not taken seriously. Providers preferred to use an individualized approach focused on behaviors, rather than weight when diagnosing and treating atypical AN. Lack of diagnostic clarity and concrete treatment guidelines for atypical AN may result in substantial deviations from the DSM-5-TR criteria in real-world practice. Clinically useful diagnostic definitions for restrictive eating disorders and evidence-based treatment guidelines for TW and/or other relevant recovery metrics are needed. The current study found variability in how community providers diagnose and determine target recovery weight for atypical anorexia nervosa (atypical AN). Many providers viewed the diagnosis of atypical AN as stigmatizing and preferred to focus on behaviors, rather than weight. This study underscores the importance of creating a clinically useful diagnostic definition and guidelines for recovery for atypical AN backed by empirical evidence that providers may implement in practice.

Predictors of psychopathology response in atypical anorexia nervosa following inpatient treatment: A propensity score matching study of weight suppression and weight loss speed.

This study examines weight suppression (WS) and weight loss speed (WLS) in atypical anorexia nervosa (AN) and its implications for treatment outcomes, compared to people with AN and bulimia nervosa (BN). A mixed cross-sectional and prospective design was employed, assessing WS and WLS in people with atypical AN, AN, and BN. Participants were matched for age, gender, age of onset, and disorder duration. Clinical measurements and eating disorders questionnaire (EDE-Q) scores were employed to evaluate the response to treatment. Individuals with atypical individuals exhibited WS patterns similar to AN, distinct from BN. Rapid WLS predicted clinical responses in atypical AN and BN, underscoring its treatment relevance. Atypical AN showed higher eating psychopathology scores than AN or BN, emphasizing the need for a reframed diagnosis. Understanding atypical AN's connection to restrictive behaviors and weight loss informs screening, assessment, and treatment practices. Recognition of atypical AN's severity and adoption of tailored approaches are essential for recovery. This study highlights the significance of WS and WLS in atypical AN treatment outcomes, offering insights into clinical practice and care. The proposal to reframe atypical AN as a restrictive eating disorder emphasizes its clinical relevance. The phenomenon of weight suppression, involving the discrepancy between past highest weight and current weight, has garnered attention due to cultural pressures emphasizing fitness and appearance. This study focuses on its implications in atypical anorexia nervosa, aiming to uncover the relationship between WS, its speed, and treatment outcomes. The investigation contributes insights into tailored interventions for atypical anorexia nervosa and enriches the understanding of this complex disorder's dynamics.