Involuntary treatment may be a life-saving option for extremely severe anorexia nervosa (AN) in the context of life-threatening conditions and refusal of care. The long-term outcomes of patients undergoing involuntary treatment for AN are poorly understood. This study aims to explore quality of life, long-term outcomes and attitudes towards involuntary treatment in patients involuntarily treated for extremely severe AN. 23 patients involuntarily admitted for extremely severe AN (I-AN), and 25 voluntarily admitted patients (V-AN) were compared for body mass index (BMI), residual symptoms, quality of life, and attitudes towards treatment almost four years after discharge. In I-AN, clinical variables were also compared between admission and follow-up. At follow-up, weight restoration was higher in V-AN (p=0.01), while differences in quality of life, BMI, and mortality rates were not significant between I-AN and V-AN (p>0.05). In I-AN, BMI increased and weight-controlling strategies decreased at follow-up (p<0.05). Despite negative experiences of involuntary treatment, the perception of the necessity of treatment increased from admission to follow-up (p<0.01) and became comparable to V-AN (p>0.05). Involuntary treatment for AN does not appear to be a barrier to weight gain and clinical improvement, nor to long-term attitudes towards treatment.

Evidence suggests reduced sensitivity to pain due to high pain threshold in anorexia and bulimia nervosa and a possible role of depression, alexithymia and interoceptive awareness on pain experience. This study examined whether self-report and real-time evoked pain experience were mediated by depression, alexithymia and interoceptive awareness in a comprehensive sample of patients with eating disorders (ED). 145 participants (90 ED, 55 healthy controls (HC)) underwent a real-time evoked examination of pain and completed self-report questionnaires for pain (Pain Detect Questionnaire (PD-Q), PD-Q VAS, Leeds Assessment of Neuropathic Symptoms and Signs), depression (BDI-II), interoceptive awareness Multidimensional Assessment of Interoceptive Awareness (MAIA), and alexithymia (TAS-20). Three mediation models, with ED diagnosis as independent variable, and BDI, MAIA and TAS-20 as mediators, were tested. Participants with ED and HC exhibited similar pain type and intensity (self-report and real-time). Eating disorders diagnosis was associated with lower self-report pain intensity and non-neuropathic like pain experience (model 1-2). Depressive symptoms partially (model 1-2) or fully (model 3) mediated the association between ED diagnosis and pain experience, alone (model 1) or via alexithymia (model 3). Interoceptive awareness did not influence pain symptomatology. ED diagnosis is associated with non-neuropathic and lower pain experience. However, concurrent depression and alexithymia are associated with higher pain symptoms and neuropathic features. These results could inform clinicians about the influence of psychopathology on pain experience in ED.

This study assessed the factorial, divergent, and criterion-related validity of the Youth-Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (Y-NIAS) in a paediatric clinical sample at initial evaluation for an eating disorder (ED). Participants included 310 patients (82.9% female, 77.4% White, Age M=14.65) from a tertiary ED clinic. Confirmatory factor analysis (CFA) evaluated the three-factor of the Y-NIAS. One-way analysis of variance compared Y-NIAS scores across diagnoses. A receiver operating curve analysis assessed the ability of each subscale to identify ARFID presentations from the full sample. Two logistic regressions assessed the criterion-related validity of the obtained Y-NIAS cut-scores. CFA supported the original three-factor structure of the Y-NIAS. Clinically-elevated scores were observed in all diagnostic groups except for binge-eating disorder. Subscales were unable to discriminate ARFID cases from other ED diagnoses. Cut scores were identified for picky eating subscale (10) and Fear subscale (9), but not for Appetite subscale. In combination with the ED Examination Questionnaire (EDE-Q), classification accuracy was moderate for ARFID (62.7%) and other EDs (89.4%). The Y-NIAS demonstrated excellent factorial validity and internal consistency. Findings were mixed regarding the utility of the Y-NIAS for identifying clinically-significant ARFID presentations from other ED diagnoses.

The integration of sensory, motor, and cognitive systems is embodied cognition, according to which mind and body are not separate and distinct, and our body (and our brain, as part of the body) contributes to determining our mental and cognitive processes. In spite of limited data available, Anorexia nervosa (AN) appears as a condition in which embodied cognition is altered, in particular, if we consider bodily sensations and visuospatial information processing. We aimed to evaluate the ability to correctly identify body parts and actions in both full (AN) and atypical AN (AAN), looking at the role of the underweight status. A group of 143 females (AN=45, AAN=43, unaffected women=55) was enrolled. All participants performed a linguistic embodied task to evaluate the association between a picture-showing a bodily action-and a written verb. Additionally, a subsample of 24 AN participants performed a retest after stable weight recovery. Both AN and AAN demonstrated an abnormal ability to evaluate the picture-written verb associations, especially if the involved bodily effectors were the same in both stimuli (i.e., pictorial and verbal) and needed a longer response time. Specific embodied cognition linked to body schema seems to be impaired in persons with AN. The longitudinal analysis showed a difference between AN and AAN only in the underweight condition, suggesting the presence of an abnormal linguistic embodiment. More attention should be devoted to embodiment during AN treatment to improve bodily cognition, which might, in turn, diminish body misperception.

Multi-family therapy (MFT-AN) is a promising group-based treatment for adolescent anorexia nervosa. This study aimed to explore how young people and parents perceived change to occur during MFT treatment. Young people (10-18years) diagnosed with anorexia nervosa or atypical anorexia nervosa and their parents who completed MFT-AN alongside family therapy for anorexia nervosa within the preceding 2years were eligible for this study. Semi-structured qualitative interviews were conducted. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. Twenty-three participants (8 young people, 10 mothers and 5 fathers) completed interviews. Five main themes were identified; (1) Powerful connection, (2) Intensity, (3) New learning and perspective shifts, (4) Comparisons, and (5) Discharge is not recovery. There was a strong sense that being with others in a similar position in an intense environment were key factors in promoting change. Comparisons were inevitable and could promote insight and foster motivation, but could also be unhelpful at times. Participants spoke about how recovery continues beyond service use and requires ongoing attention and support. Through the mechanisms of connection, intensity, new learning and comparisons change is perceived to occur in MFT-AN. Some of these are considered unique to this treatment format.

The aim of the present study was to test the usefulness of an add-on serious video game approach (i.e., Playmancer) to treatment as usual (TAU) on reducing impulsive behaviours and psychopathology in individuals diagnosed with an eating disorder (ED). Thirty-seven patients diagnosed with an ED according to the DSM-5 were included in the present randomized clinical trial (RCT; study record 35,405 in ClinicalTrials.gov) and were randomly assigned to either the TAU or TAU+Playmancer group. All participants completed a clinical interview. Impulsivity (UPPS-P self reported questionnaire and Stroop task) and general psychopathology (SCL-90-R) measures were assessed at:baseline, 4weeks into treatment, at the end of TAU (after 16weeks), and follow-up (2years). In addition, patients in the experimental group underwent a total of nine sessions with Playmancer over the span of 3weeks. Patients in both treatment groups (TAU+Playmancer or TAU) improved on Stroop task performance and psychological distress. Additionally, patients in TAU-Playmancer improved on the impulsive traitdomain of lack of perseverance. No statistical differences were foundregarding treatment outcomes (i.e., treatment adherence and remission of eating symptomatology) when comparing the two treatment groups. Our results suggest that the impulsivity associated with EDs should be addressed and could be modified, as some facets of trait impulsivity improved after Playmancer add-on treatment. Yet, there were no significant differences in treatment outcomes when comparing the two groups and further research needs to be conducted.

ObjectiveEating disorders are associated with significant illness burden and costs, yet access to evidence‐based care is limited. Greater use of programme‐led and focused interventions that are less resource‐intensive might be part of the solution to this demand‐capacity mismatch.MethodIn October 2022, a group of predominantly UK‐based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme‐led and focused interventions for eating disorders in an attempt to bridge the demand‐capacity gap.ResultsSeveral key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme‐led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal.ConclusionsProgramme‐led and focused interventions are a viable option to close the demand‐capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.

Utilisation of intensive inpatient treatment for eating disorders (EDs) has climbed in the last decade, illuminating a need for better consensus on what constitutes effective treatment and context-appropriate progress/outcome monitoring during residential stays. The novel Progress Monitoring Tool for Eating Disorders (PMED) measure is specifically designed for inpatient settings. Previous research supports the factorial validity and internal consistency of the PMED; however, additional work is needed to determine its appropriateness for complex patient populations. This study used measurement invariance (MI) testing to determine if the PMED administered at programme admission measures the same items in similar ways across patients with anorexia nervosa restricting- and binge-purge subtypes (AN-R; AN-BP) and bulimia nervosa (BN, N=1121; Mage =24.33years, SD=10.20; 100% female). Progressively constrained models were used to determine the level of invariance upheld between the three groups. Results indicated that, while the PMED meets configural and metric MI, it does not display scalar invariance. Said otherwise, the PMED similarly assesses constructs and items across AN-R, AN-BP, and BN, however the same score overall may reflect different levels of psychopathology for patients in one diagnostic category versus another. Comparisons of severity between different EDs should be made with caution, however the PMED appears to be a sound tool for understanding the baseline functioning of patients with EDs in an inpatient setting.

Insecure attachment is considered a general risk factor for eating disorders (ED). Emotion dysregulation has been proposed as one of the possible mechanisms by which attachment insecurity may affect ED psychopathology. Aim of the present study was to investigate whether difficulties in acceptance of emotions or emotional clarity may mediate the connection between insecure attachment and ED psychopathology. One hundred and twenty patients participated and completed the Italian version of Eating Disorder Inventory-2, Experience in Close Relationship questionnaire and Difficulties in Emotion Regulation Scale. A mediator path model was performed, in which insecure attachment dimensions were set as independent variables, ED specific psychopathology measures as dependent variables, and non-acceptance of emotion and lack of emotional clarity as mediators. The association between both attachment avoidance and anxiety and ED specific symptoms was mediated by emotional non-acceptance, but not by emotional clarity. This study showed the importance to address emotion regulation in individuals with ED, focussing on improving emotional acceptance. Exploring early developmental processes which lead to non-acceptance of emotions could improve this psychological trait in people with ED.

This study evaluated the severity ratings for anorexia nervosa (AN) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and an alternative severity rating based on overvaluation of weight/shape, on a range of psychological and biological variables. A sample of 312 treatment-seeking patients with AN (mean age=25.3, SD=7.6; mean BMI=16.8kg/m2 , SD=2.4) were categorised using both DSM-5 severity levels (mild/moderate/severe/extreme) and weight/shape (low/high) overvaluation. The severity categories were compared on a range of psychological (e.g., eating psychopathology) and biological (e.g., sodium) variables. Results showed that the overvaluation of weight/shape appeared better at indexing the level of severity in psychological variables among patients with AN compared to the DSM-5 severity rating with moderate to large effect sizes. Moreover, the DSM-5 mild and moderate severity groups experienced significantly higher eating and general psychopathology than the severe and extreme groups. Finally, neither the DSM-5 nor the weight/shape severity groups differed on any of the biological variables. This study provided no support for the DSM-5 severity rating for AN, while initial support was found for the weight/shape overvaluation approach in indexing psychological but not biological correlates.