ABSTRACT Objective Body image flexibility is a clinically relevant protective process linked to lower eating disorder psychopathology and better psychological functioning, yet its longitudinal role in shaping psychological risk and resilience remains unclear, particularly across women and men in non‐Western contexts. This study examined its bidirectional associations with thinness‐ and muscularity‐oriented disordered eating, eating‐related psychosocial impairment, and psychological distress among Chinese adults. Method Chinese adults completed baseline ( N = 800; 400 women and 400 men) and eight‐month follow‐up ( N = 491; 246 women and 245 men) online surveys. Cross‐lagged panel models were used to examine bidirectional associations. Results Higher body image flexibility at T1 was related to lower levels of thinness‐oriented disordered eating, muscularity‐oriented disordered eating, eating‐related psychosocial impairment, and psychological distress at T2. Conversely, higher levels of thinness‐oriented disordered eating, muscularity‐oriented disordered eating, eating‐related psychosocial impairment, and psychological distress at T1 were related to lower body image flexibility at T2. These bidirectional associations were consistent across women and men. Discussion Body image flexibility can function both as a protective resource and as a process susceptible to psychological strain. Intervention efforts should be gender inclusive and target multidimensional forms of eating disorder psychopathology alongside psychological well‐being.

ABSTRACTObjectiveA significant proportion of patients with eating disorders (EDs) also meet criteria for posttraumatic stress disorder (PTSD). Guidelines recommend exposure‐based treatments for PTSD, including prolonged exposure (PE) and eye movement desensitisation and reprocessing (EMDR). Investigating therapist‐related factors could lead to improve their use when ED and PTSD co‐occur.MethodA cross‐sectional survey was conducted among 81 EDs therapists (88% female; M age = 40.4, SD = 10.4) in 2023 in the Netherlands. Hierarchical multiple regression analyses assessed predictors of excluding patients with EDs and comorbid PTSD from exposure‐based treatments for PTSD.ResultsTherapists held more favourable beliefs about EMDR (M = 10.5, SD = 7.5) than PE (M = 13.9, SD = 6.9), and were less likely to exclude patients with EDs and comorbid PTSD from EMDR (M = 15.5, SD = 9.3) than PE (M = 17.7, SD = 9.3) (t(80) = 3.47, p < 0.002). Beliefs about exposure‐based interventions predicted the likelihood of exclusion from both PE (β = 0.56, p < 0.002) and EMDR (β = 0.69, p < 0.002).ConclusionsTherapists' beliefs influence the use of exposure‐based treatments for PTSD in patients with EDs and comorbid PTSD. Addressing these beliefs in training, may support broader implementation.

ABSTRACTPurposeInterventions embedded within eating disorder day hospital programmes are often provided on a rolling basis with flexible entry and exit points. This clinical audit examined the acceptability of one such intervention: a rolling Introduction to Compassion Focused Therapy for Eating Disorders (CFT‐E) group.MethodsAcceptability was assessed across 22 sessions, over 5 months. Using anonymous feedback forms, participants rated each session using Likert scales and open‐ended responses.ResultsAcross 112 total attendances, session ratings indicated good acceptability, particularly for improving motivation, knowledge of compassion‐focused principles, and personal and supportive group connections (all mean scores > 4.0). The trajectory of the mean ratings across each session also pointed to consistent and enduring acceptability. CFT‐E theory (n = 62) was the most frequently reported helpful category, followed by group process factors (n = 47), and improved self‐awareness (n = 9). Openness from the group, particularly regarding discussing eating disorders, was referred to in a positive light across various analyses. Some engagement issues (n = 12) were also highlighted.ConclusionsThe demonstrated acceptability of this rolling Introduction to CFT‐E group supports its continued provision and justifies further evaluation of similar introductory, compassion‐focused formats in eating‐disorder services. Engagement issues offer room for improvement.

ABSTRACTBackgroundEating disorders (EDs) impair education, work and social functioning. First Episode Rapid Early Intervention for Eating Disorders (FREED) is a nationally implemented early intervention service model in England for young people (16–25 years) with an ED duration of three years or less. This study evaluated the impact of FREED on functional outcomes using data from the multi‐site FREED‐Upscaled (FREED‐Up) study.MethodsA longitudinal design analysed data from 278 patients recruited in 2017–2018 across four specialist ED services. Work, education and social functioning were assessed using the Psychological Outcome Profile (PSYCHLOPS) and the Work and Social Adjustment Scale (WSAS) at baseline, 3, 6 and 12‐month. ED psychopathology and depression/anxiety were also measured. Linear mixed models examined WSAS and PSYCHLOPS changes, with correlations calculated between outcomes.ResultsAt baseline, 63% of patients reported work/education or social‐related issues on the PSYCHLOPS. WSAS and PSYCHLOPS scores significantly improved over time, with greater long‐term gains in treatment completers. WSAS reductions correlated with improvements in other clinical measures.ConclusionsTreatment within FREED is associated with significant improvements in work, education, and social functioning, alongside clinical gains. These findings underscore the value of early intervention in reducing functional impairments in young people with EDs.

ABSTRACTBackgroundAt a phenotypical level, the repeated occurrence of binge eating episodes clearly differentiates individuals with binge eating disorder (BED) from individuals with overweight but without BED. Their neural profiles during food‐related inhibition, however, indicate prefrontal hypoactivation in both groups. The present study investigated differential neural activations in upper lateral (right dorsolateral prefrontal cortex [DLPFC]) and inferior (right inferior frontal gyrus [IFG]) control regions during food‐related inhibition by functional near‐infrared spectroscopy (fNIRS). In addition, activity in reward‐related brain regions (orbitofrontal cortex [OFC]) during stimulus processing was measured.MethodIndividuals with BED (n = 32), a control group of individuals with overweight and without BED (OWC, n = 21), and a control group of individuals with normal weight and without BED (NWC; n = 31) underwent a Go/No‐Go (GNG) and a stimulus degradation task during fNIRS, both with food and non‐food stimuli in counterbalanced order.ResultsMost predicted outcomes were not significant. Neural recordings during GNG underscore prefrontal hypoactivation in both BED and OWC relative to NWC, however, with differential alterations: In the Food‐NoGo condition, the BED group displayed hypoactivation in the IFG, while the OWC showed hypoactivation in the DLPFC.ConclusionsThe results suggest differential requirements for DLPFC and IFG recruitment during food‐related inhibition in individuals with BED and overweight.

ABSTRACTBackgroundSelf‐guided interventions may broaden the dissemination of evidence‐based prevention and treatment protocols for eating disorders. We conducted a meta‐analysis comparing self‐guided prevention and treatment approaches for eating disorders to (1) control groups and (2) professionally guided self‐help programs.MethodsForty‐six trials were included. Interventions ranged from web, to app, to CD‐ROM to book‐based programs. Random effects meta‐analyses were conducted on numerous symptom and risk outcomes.ResultsOnly four trials recruited an unselected sample, with self‐guided programs reducing shape/weight concerns over control groups (g = 0.18). Among high risk/symptomatic samples (k = 25), self‐guided interventions reduced several behavioural and cognitive symptoms (gs = 0.31–0.50) over control groups, with effects being robust when adjusting for higher risk of bias and small sample trials. Among clinical samples (k = 17), evidence for the effectiveness of self‐guided interventions over control groups on symptom measures was only found for binge‐eating disorder, as too few studies sampled other diagnostic subtypes. Among 10 trials that compared guided to unguided self‐help, we observed a significant effect in symptom reduction in favour of guided self‐help (g = −0.26). Dropout did not differ between guided and unguided self‐help (OR = 0.97).ConclusionSelf‐guided interventions may be an effective, low intensity intervention format for high risk individuals or for binge‐eating disorder presentations.

ABSTRACTBackgroundPoor rates of retention associated with digital interventions necessitate understanding of factors influencing engagement. This study presents a secondary analysis of a three‐arm, randomised controlled trial of an online self‐help treatment for bulimia nervosa (clinician‐supported, self‐help and waitlist control).AimsThe study aimed to understand the effect of added clinician‐support, or lack of support, upon user experience and therapeutic alliance.MethodAt post‐treatment, 61 participants completed a battery of self‐report questionnaires assessing user experience and therapeutic alliance. Data were analysed using mixed methods (regression and thematic analyses).ResultsQuantitative analyses indicated clinician‐supported participants reported higher levels of treatment satisfaction and therapeutic alliance, however differences were not significant after controlling for covariates. Intervention effectiveness ratings were positively associated with post‐treatment reductions in binge episodes and eating disorder psychopathology. Qualitative data were organised into four themes: (1) human support, (2) content, structure and digital set up, (3) process of therapeutic change and (4) positive feedback.ConclusionsOverall, the intervention was found to have positive ratings of user experience and therapeutic alliance in both supported and unsupported versions. The qualitative analyses revealed a strong preference for human support. The findings shed light on the complex interactions between digital and human elements of blended treatment delivery.Trial RegistrationThe trial was pre‐registered with the Australia New Zealand Clinical Trials Registry (ACTRN12619000123145p)

BackgroundThe network approach in the eating disorder (ED) field has confirmed important links between EDs and posttraumatic stress disorder (PTSD) symptoms. However, studies including comorbid symptoms are scarce, which limits our understanding of potentially important connections. We hypothesised that anxiety, depression and poor quality of life (QOL) would provide a more complete picture of central, maintaining factors.MethodsNetwork analysis using R was performed in 2178 adult ED patients (91% female) admitted to residential treatment. Assessments included the ED Examination Questionnaire (EDEQ), the Eating Disorders Inventory (EDI‐2), the PTSD Checklist for DSM‐5 (PTSD clusters (PCL‐5)), the Patient Health Questionnaire (PHQ‐9), the Spielberger State‐Trait Anxiety Scale (STAI), and the ED QOL Scale (EDQOL), which measure symptoms of EDs, PTSD, major depression, state‐trait anxiety, and QOL, respectively.ResultsEDI‐2 ineffectiveness showed the highest centrality (expected influence) followed by EDI‐2 interoceptive awareness, STAI state anxiety, EDEQ shape concern, EDQOL psychological subscale, and PTSD cluster D (hyperarousal) symptoms. Eating Disorder Quality of Life psychological and physical‐cognitive subscales and PHQ‐9 major depressive, STAI state anxiety and PCL‐5 PTSD cluster E (negative alterations in mood and cognition) symptoms showed the highest bridge expected influence, suggesting their interactive role in maintaining ED‐PTSD comorbidity.ConclusionsThis is the first network analysis of the interaction between ED and PTSD symptoms to include the comorbid measures of depression, anxiety, and QOL in a large clinical sample of ED patients. Our results indicate that several symptom clusters are likely to maintain ED‐PTSD comorbidity and may be important targets of integrated treatment.