ABSTRACT Hospital-at-home (HaH) programmes are emerging as alternatives to inpatient care for adolescents with eating disorders (EDs). The objective of this scoping review was to identify and map the existing evidence on HaH programmes targeting adolescents with EDs in vulnerable positions. Systematic searches were conducted on the MEDLINE, Embase, and CINAHL for studies describing HaH programmes targeting adolescents (aged between 10 and 19) suffering from EDs. Eight studies met the inclusion criteria. Data are reported descriptively and narratively. Despite an overall focus on EDs, all studies included adolescents with anorexia nervosa. HaH programmes were generally associated with improved BMI, symptom severity, quality of life, and motivation to change, as well as decreased admission or readmission rates. HaH programmes targeting adolescents with EDs (here, anorexia nervosa) showed positive outcomes compared to typical treatment in terms of improved BMI, symptom severity, quality of life, and motivation to change, alongside reduced admission or readmission rates.

ABSTRACT Posttraumatic stress disorder (PTSD) is associated with eating disorders (EDs) and serves as a marker of higher severity and comorbidity. However, the role of complex PTSD (CPTSD) in EDs has been relatively unexplored. Recently, a PTSD Checklist for DSM-5 (PCL-5) total score ≥51 has been reported to be a reliable indicator of probable CPTSD. Participants were 2390 patients (91% female) admitted to residential treatment for a DSM-5 defined ED who gave written informed consent. Patients completed self-report assessments for symptoms of EDs, depression, state-trait anxiety, PTSD, and quality of life. Three trauma groups were compared based on PCL-5 total scores: 1) PCL-5 < 33 (no PTSD, n = 1104), 2) ≥33 and <51 (provisional PTSD, n = 651), and 3) ≥51 (probable CPTSD, n = 635). Groups were compared using multivariant analyses of variance with age, admission BMI, gender, race, and ED diagnosis as covariates. There were significant differences between trauma groups in all measures (p ≤ .001). Post-hoc comparisons revealed significant differences between all trauma groups for all assessments. Patients with probable CPTSD (27%) showed earliest ED onset and highest trauma dose and symptom severity followed by those with provisional PTSD (27%), then those with no PTSD (46%). Probable CPTSD occurred in 27% of patients with EDs and was associated with significantly greater ED-related psychopathology and younger age of ED onset compared to provisional PTSD and no PTSD groups. These results support the clinical utility of diagnosing probable CPTSD and emphasize the importance of thorough assessment procedures and integrated treatment approaches that address the full spectrum of trauma-related symptoms.

ABSTRACT Telehealth-based intermediate level of care programs for eating disorders largely yield comparable outcomes to in-person settings. However, extant research is primarily based on programs that transitioned to virtual formats in response to the COVID-19 pandemic, rather than those intentionally designed for remote delivery. Additional research is needed to evaluate programs specifically created for telehealth environments (i.e. intentionally-remote) and to understand how outcomes vary across age groups. In this retrospective chart review, clinical outcomes at end-of-treatment for 116 patients enrolled in an intentionally-remote eating disorder treatment program were analyzed, including eating disorder symptomatology, quality of life impairment, depressive symptoms, trait anxiety, body mass index, and percentage of ideal body weight. Mixed ANOVAs revealed significant improvements (ps < .001) from admission to discharge across all outcomes with large effects and no interaction by age, suggesting similar effectiveness across groups. By discharge, mean eating disorder symptomatology scores were below the clinical cut-off, quality of life impairment was within the minor to moderate range, depressive symptoms were mild, and weight restoration benchmarks were achieved for all age groups. While these findings support the potential of remote care as an accessible means of offering effective eating disorder treatment, further research is needed to determine generalizability to diverse populations, assess the impact of program features, and examine longitudinal outcomes.

ABSTRACT Body-focused repetitive behaviors (BFRBs) and eating disorders (EDs) involve persistent, self-directed behaviors causing distress and impairment. Despite similarities, the relationship between the two is understudied. We examined clinical and subclinical BFRB prevalence in individuals with EDs, tested associations with ED and obsessive-compulsive (OC) symptoms, and compared BFRB occurrence between ED subtypes. The sample included 95 female adults and adolescents in residential ED treatment (51% anorexia nervosa-restricting, 37% anorexia nervosa-binge-eating/purging, 9% bulimia nervosa, 3% other EDs). The Habit Questionnaire, Eating Disorder Examination Questionnaire, and Dimensional Obsessive-Compulsive Scale assessed BFRBs, ED symptoms, and OC symptoms, respectively. BFRBs were highly prevalent in the sample, with 37% meeting clinically significant levels and 31% displaying subclinical BFRBs. The most common clinically significant BFRBs were skin picking (28%), mouth chewing (10%), and hair pulling (9%). Higher ED and OC symptom severity were both associated with the presence of any presence of a co-occurring BFRB. BFRB prevalence did not differ between restricting and binge-eating/purging ED subtypes. Overall, co-occurring BFRBs were common in this residential ED sample, highlighting the need for routine screening. Both ED and OC symptom severity were uniquely related to BFRB occurrence. Future research should explore the underlying mechanisms to better understand the relationship between BFRBs and EDs.

ABSTRACT A broad array of important and diverse studies surrounding the treatment of eating disorders were published in Eating Disorders: The Journal of Treatment & Prevention in 2024. Anorexia nervosa is the most lethal and arguably the most well-studied eating disorder, yet treatment outcomes have been slow to advance. Herein, we review advances to both measuring AN symptom severity specifiers, identifying key treatment targets, and overview treatment advances. With regards to binge spectrum eating disorders, we review how purging and non-purging compensatory behaviors impact illness severity, and carefully review evidence relating to treatment outcomes. In this review, we also review novel treatment developments including yoga-based and ayahuasca-based interventions, as well as novel treatments for augmenting weight restoration in restrictive eating disorders. Additionally, we review evidence relating to eating disorder comorbidities, elucidating the impact on illness severity and treatment outcomes, and evidence addressing access to care for specialized eating disorder treatment, and lastly, how non-outpatient levels of eating disorder care may augment outcomes. Overall, the articles published in Eating Disorders: The Journal of Treatment & Prevention in 2024 evidence the promise of treatment advances in the field and requires further work to address the development of efficacious treatments to achieve greater outcomes for those with eating disorders.

ABSTRACT With an elevated prevalence of disordered eating in low-income settings, efforts to optimize the detection of eating disorders (EDs) in such settings are necessary. A significant barrier relates to the scarcity of training for clinicians not working in specialized ED settings. This manuscript assessed the impact of an ED screening tool and an ED assessment workshop upon the detection of EDs in publicly insured psychiatry settings. Leveraging a case series design to assess 165 consecutive adult patients in outpatient psychiatry settings, we indexed the prevalence of ED diagnoses rendered by psychiatrists when assessing patients (i) without prior knowledge of ED symptoms, (ii) after being made aware of patient scores from an ED screening measure, and (iii) after undergoing an ED assessment workshop, and being made aware of patient screening scores. While 27% of the sample reported clinically significant ED symptoms on the screening measure, ED diagnoses were only rendered in 2% of the sample when psychiatrists were not made aware of ED symptoms prior to assessment. In contrast, incorporating a screening tool altered the rates of ED diagnoses, with 18% of the sample receiving an ED diagnosis. Moreover, the combinatorial introduction of both the ED screening measure and an ED assessment workshop further altered diagnostic practice—with this resulting in ED diagnoses in 27% of the sample. The findings suggest that ED screening and training workshops can have significant impacts on diagnostic accuracy and, with little cost, can provide patients with diagnoses that would otherwise go undetected.

ABSTRACT Peer support is where individuals with the same shared experience provide mutual support. Using a non-controlled repeated measure design, this study evaluates initial efficacy of one-to-one email peer support. Young people with an eating disorder were matched with a recovered volunteer befriender, for up to one year, providing 1–3 email contacts a week. All participants completed measures (self-esteem, self-efficacy, wellbeing) at start of service, two and four-month intervals for recipients (n = 92) and peer befrienders (n = 86) respectively, and at end of service. Recipients also completed measures of social connectedness, impact of eating disorder, and goal-based outcomes. Multilevel mixed-effects linear regression models indicated significant improvements across all outcomes for recipients by 4 months, apart from self-esteem, and improvements self-efficacy, eating disorder impact and goal-based outcomes maintained at end of service. Peer befrienders did not show changes in self-esteem or self-efficacy, but there was a small significant reduction in wellbeing. The study provides evidence for email peer support for young people with eating disorders and highlights the need for robust support for befriending roles.

ABSTRACT Young cisgender sexual minority women (e.g. lesbian, queer) in the U.S. are at risk for disordered eating behaviors (DEB). Minority stress theory proposes sexual minority stressors (SMS; e.g. discrimination) related to marginalized statuses are culturally specific stressors that may explain engagement in these behaviors. However, little is known about daily SMS-DEB associations. We conducted a 14-day daily diary study of 321 U.S.-based sexual minority cisgender women ages 19–35 who were in a relationship with a woman. SMS were assessed using an 8-item daily measure of distal SMS (e.g. heard anti-LGBT talk, verbal harassment), and DEB with single items capturing dietary restraint, overeating, loss of control eating, and emotional eating. Multi-level models revealed on days when women experienced SMS, they were more likely to report dietary restraint and emotional eating, but not overeating or loss of control eating. Women who generally reported more frequent SMS were more likely to report all four DEB. There were no significant couple-level SMS-DEB associations. These findings expand our understanding of how SMS is associated with DEB in the daily lives of cisgender sexual minority women. Future studies are needed to explore the temporal sequencing of the associations. Findings may also help to inform the design of culturally tailored interventions aimed at reducing DEB among sexual minority women.

ABSTRACT The aim of this study was a systematic review and meta-analysis of the relationship between eating disorders and mortality. Based on this, eating disorders were investigated concerning all causes of mortality. Information sources including PubMed, Scopus, and Web of Science were used based on a systematic search. Google Scholar and Research Gate were also searched. The search in these databases started without a time limit and was done until December 2023. This search was done in English. The results extracted were pooled together based on the Standardized Mortality Ratio (SMR) with a 95% confidence interval. The random effects method was used to pool studies together. An analysis was performed based on eating disorders and mortality, and the relationship between three types of eating disorders and mortality was reported as subgroups. Sixty studies were included in the meta-analysis. The obtained results showed that eating disorders have a significant relationship with the risk of mortality; SMR was 4.42 (CI 3.55–5.50; Z = 13.31; p < .001; I 2 = 96.3%). Anorexia nervosa has a significant relationship with the risk of mortality, SMR was 5.31 (CI 4.15–6.79; Z = 13.30; p < .001; I 2 = 93.1%). For bulimia nervosa the risk of mortality was SMR 2.69 (CI 1.85–3.91; Z = 5.16; p < .001; I 2 = 66.6%). For eating disorders not otherwise specified the risk of mortality was SMR 2.50 (CI 1.45–4.33; Z = 3.28; p = .001; I 2 = 91.8%). From the findings of this research, it was determined how serious the risk of death is in patients with eating disorders. Therefore, it is necessary to pay more attention to this issue in the processes of prevention, screening, and treatment of eating disorders.