Changing cannabis legislation in Canada and a longitudinal look at "regular" cannabis use in patients with eating disorders.

Regular cannabis use (CU), defined as "weekly or more often", is associated with a number of negative mental health outcomes. In the last decade, Canada legalized first medical and then recreational CU. Despite higher prevalence in mental health populations, little research has documented changes in frequency of CU with progressive legalization of cannabis. This study examined rates of CU in a sample of 843 treatment-seeking patients with eating disorders (ED) in an outpatient setting between 2004 and 2020. Across ED diagnoses, segmented regression indicated a significant break-point in regular CU in 2014, commensurate with the relaxation of medical cannabis laws. Regular CU increased from 4.9 % to 23.7 % from 2014 to 2020; well above the stable 6 % found in the general population. No significant break-point was observed in either alcohol or illicit substance use over the same time period. Significant increases in regular CU were found in patients with anorexia nervosa and binge eating disorder, while regular use remained stable in patients with bulimia nervosa. Comorbid psychiatric diagnoses did not increase odds of regular CU. Findings suggest certain patient groups with mental illness may be at risk of engaging in high frequency use in the context of legislation implying medical benefits of cannabis.

Assessing the feasibility of an intervention for adolescents and parents transitioning out of paediatric eating disorder services: A mixed methods study.

OBJECTIVE: To assess the feasibility of a new intervention designed to support adolescents and parents in the transition from paediatric eating disorder (ED) treatment to adult mental health services. METHOD: Pre-transition adolescents with EDs, and their parents, were invited to complete up to five transition intervention components over 3 months. A mixed methods design was used to assess intervention feasibility, comprised of acceptability and preliminary effectiveness. A single-arm pre-post design was used to collect and analyse quantitative survey and feasibility data. Individual qualitative interviews and written reflections were collected and analysed using content analysis. RESULTS: This study yielded a 33% (10/31) recruitment rate and 68% (13/19) retention rate. On average, participants completed 75% of the expected components in under 3 months, with varied completion of each expected intervention component (40%-100%). Participants found the intervention convenient and helpful. Parents reported a significant decrease in guilt (Z = -2.02, p = 0.04, d = -0.83). By 1-month post-transition, three adolescents transitioned to interim supports and none started specialist adult treatment. CONCLUSIONS: Although this transition intervention did not demonstrate adequate feasibility, its acceptability and effectiveness should be evaluated after an update based on participant feedback. Other solutions to bridge the transition gap for adolescents with EDs should continue to be identified. CLINICAL TRIAL REGISTRATION NUMBER: NCT04888273.

Enhancing eating disorder recovery: Weight control beliefs predict body dissatisfaction in group cognitive behavioural therapy for body image.

Body dissatisfaction is one of the strongest predictors of eating disorder relapse. Yet, a dearth of research exists on factors that facilitate change in body dissatisfaction following treatment focused on symptom interruption. Recent research points to the role of weight control beliefs in predicting outcomes in patients with eating disorders. The primary objective of this research was therefore twofold: 1) To investigate the impact of group cognitive behavioural therapy (GCBT) on weight control beliefs and body dissatisfaction and 2) to examine the influence of weight control beliefs on body dissatisfaction over time. Participants were 50 adults with a recent eating disorder diagnosis who completed 10 sessions of GCBT for body image following GCBT for eating disorders. All participants completed the Eating Disorder Inventory and Weight Control Beliefs Questionnaire at baseline and post-treatment. Body dissatisfaction and weight control beliefs improved from pre- to post-treatment. Hierarchical linear regression analyses revealed that increases in lifestyle control beliefs, a subtype of weight control beliefs, predicted decreases in body dissatisfaction. Results underscore the utility of fostering healthy weight control beliefs to cultivate a positive body image in patients navigating the eating disorder recovery process.

Disgust sensitivity and behavioural inhibitory systems in binge eating disorder: associations with eating pathology.

Disgust sensitivity refers to how unpleasant a disgusting experience is to an individual and is involved in the development of many psychiatric conditions. Given its link with food ingestion, there is an interest in understanding how an individual's susceptibility to disgust relates to dietary habits. One possible mechanism giving rise to this association is through the effects negative emotions have on high-order cognitive processes, but few studies take this model into account. The aim of this study was to characterize general disgust sensitivity in a clinical binge eating disorder (BED) population, and explore whether disgust sensitivity relates to inhibitory control and eating pathology. Following a case-controlled study design, our results show that: (1) disgust sensitivity and its subscales do not differ between BED and healthy controls, (2) higher disgust sensitivity in BED relates to greater behavioural inhibition, (3) inhibitory control reaction times relate to aspects of eating pathology, and (4) inhibitory control does not mediate relationships between disgust sensitivity and BMI among participants with BED. Understanding the role of disgust sensitivity in BED may allow us to understand how negative emotion systems maintain dysregulated eating behaviours with the potential to inform emotion-regulation treatment approaches. Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Weight control beliefs in the treatment of binge-eating disorder: Why might they matter?

OBJECTIVE: The belief in personal control over weight (BCWeight) is positively associated, while the belief in control over healthy lifestyle with weight acceptance (BCLifestyle) is negatively associated with disordered eating, body dissatisfaction, and low self-esteem. This study examined how weight control beliefs are impacted by cognitive behavior therapy (CBT) for binge-eating disorder (BED) that provides evidence and choice regarding weight management options; and assessed whether changes in weight control beliefs are associated with treatment outcomes. METHOD: Participants were 57 patients consecutively referred to an outpatient eating disorder clinic from 2013-2017 for BED treatment. Using retrospective self-reported program-evaluation data, baseline to post-CBT changes in weight control beliefs were evaluated, as well as whether these changes were associated with the change in the drive for thinness, body dissatisfaction, fear of loss of control over eating, and self-esteem. RESULTS: BCLifestyle significantly increased over CBT; BCWeight significantly decreased. Increases in BCLifestyle were associated with the reduced drive for thinness, body dissatisfaction, and fear of loss of control overeating. Decreases in BCWeight were associated with improved self-esteem. DISCUSSION: BED CBT that provides science on weight management options is associated with positive changes in weight control beliefs, which are associated with measures of recovery from BED. PUBLIC SIGNIFICANCE STATEMENT: Cognitive behavior therapy (CBT) for binge-eating disorder decreases the belief that one can and should control one's weight, and increases the belief that one should strive for a healthy lifestyle and accept one's weight. These changes in beliefs are associated with improved treatment outcomes. CBT that gives patients evidence on different weight management options addresses patient obesity concerns and is related to positive change in weight control beliefs.

Systematic review of the effects of acute stress in binge eating disorder.

Binge eating disorder (BED) is characterized by recurrent episodes of eating an excessive amount of food over a discrete time period, while feeling a loss of control over one's eating. Although stress is one of the most commonly reported triggers of binge eating in individuals with BED, there has been little work examining the stress response specifically in individuals with the disorder. In this review, we examine what is known about how individuals with BED respond to acute stressors. A systematic literature search identified 14 relevant articles that report on the effects of experimentally induced stress on objective measures. Dependent measures that have been examined include changes in the levels of hormones such as cortisol and ghrelin, cardiovascular function, ad libitum food intake and eating rate. In this review, we describe the published findings and discuss their implications in the context of the wider literature. Overall, we found partial evidence that BED is associated with a heightened response to stress. Given the inconsistencies between studies, we suggest that reported differences between individuals with and without BED might be driven by factors that are correlated with, but not specific to, BED. We suggest that two priorities for this research area are to identify factors that modulate the stress response in individuals with BED, and to address the underrepresentation of males in this literature.

Neuroticism and introversion: a risky combination for disordered eating among a non-clinical sample of undergraduate women.

Recent evidence suggests that people who score low on measures of sociability may be at risk for certain types of psychopathology, including mood and anxiety disorders. In an attempt to extend these findings to other forms of psychopathology, we examined levels of neuroticism and extraversion in relation to eating problems in a non-clinical sample of undergraduate women. The Eysenck Personality Questionnaire (EPQ), Eating Disorders Inventory (EDI), and the Eating Attitudes Test (EAT-26) were completed by 196 first-year undergraduate females. We found that high neuroticism was related to high scores on both of the EDI subscales (Bulimia and Drive for Thinness) as well as high scores on the EAT-26 measure, replicating previous work. In addition, neuroticism served as a moderator such that lower extraversion (i.e., introversion) was related to greater disordered eating, but only for those women who scored high on neuroticism. Thus, a combination of neuroticism and introversion may be a risk-factor for symptoms of eating disorders in a non-clinical sample of university women.