Non-interpersonal traumatic events in patients with eating disorders: a systematic review.

Objectives: The purpose of the systematic review was to synthesize literature on eating disorders (ED) and non-interpersonal traumatic events (NTE) and consolidate the reported prevalence of NTE in patients with an ED. Methods: The literature search was performed in Embase, PsycInfo, and PubMed. The keywords in the search were "eating disorder," "trauma" and "non-interpersonal," using index-terms and free-search keywords related to NTE and ED. The PRISMA guidelines were followed. Relevant studies were screened using Rayyan. Results: Of the 16 studies included in the quantitative synthesis, five overall types of NTE were identified: accidents, illness, injury, natural disaster and war. Findings provided tentative evidence for illness and injury being more prevalent in patients suffering from an ED compared to controls. The remaining subtypes of NTE did not show a higher prevalence in patients with an ED when compared to controls. Findings also suggest that those with binge/purge subtype of anorexia nervosa (AN) had a higher prevalence of non-interpersonal traumatic events compared to the restrictive subtype of AN. Discussion: This systematic review provided a clear synthesis of previous findings related to NTE among patients with an ED. Noteworthy, is that many studies do not take into account if the trauma happened prior or after to ED onset, which may affect the association. Furthermore, the body of research on NTE in patients with ED is exceedingly limited, and more research is needed.

Effects of exposure to plus-size fashion models on weight-related attitudes in bulimia nervosa: Findings from an exploratory study.

BACKGROUND AND OBJECTIVES: Eating disorders are often linked to the internalization of the thin-ideal and weight stigma. The present exploratory study investigates the effects of plus-sized fashion media on weight-related attitudes in bulimia nervosa (BN). METHODS: Women with BN (n=27) and without an eating disorder (n=28) were exposed to 17 pictures of plus-size fashion models. Participants rated the attractiveness of the models. Before and after the exposure task, participants completed questionnaires on their attitudes towards people with higher weight as well as thin-ideal media. RESULTS: The BN group rated the bodies of the plus-size fashion models as less attractive than controls, whereas no group differences were found in attractiveness ratings for the models' faces or full images. In both groups, negative attitudes about people with higher weight significantly decreased after viewing plus-size model pictures. Attitudes toward thin-ideal media remained unchanged, with scores higher for BN than controls. LIMITATIONS: This exploratory study has several limitations, such as the lack of a control condition, small sample size, and reliance on only self-report data. CONCLUSIONS: These exploratory results imply that the positive effects of plus-sized model images on reducing negative assumptions about people with high weight may not be limited to healthy individuals but also seem to extend to women with BN. Further controlled studies with larger samples and long-term assessments are needed to confirm these findings.

Efficacy of Pharmacotherapies for Bulimia Nervosa: A Systematic Review and Meta-Analysis.

Objective: The main purpose was to evaluate the efficacy and tolerability of different medications used to treat bulimia nervosa (BN). Methods: Randomized controlled trials (RCTs) were identified from published sources through searches in PubMed, Cochrane Library, Web of Science, and Embase from inception to November 2022. Primary outcomes were changes in the frequency of binge eating episodes and vomiting episodes from baseline to endpoint. Secondary outcomes were differences in the improvement of scores in depressive symptoms, tolerability (dropout due to adverse events) and weight change. Results: The literature search ultimately included 11 drugs, 33 studies and 6 types of drugs, 8 trials with TCAs (imipra-mine, desipramine), 14 with SSRIs (fluoxetine, citalopram and fluvoxamine), 6 with MAOIs (phenelzine, moclobemide and brofaromine), 3 with antiepileptic drugs (topiramate), 1 with mood stabilizers (lithium), and 1 with amphetamine-type appetite suppressant (fenfluramine). The reduction in binge eating episodes was more likely due to these drugs than the placebo, and the SMD was -0.4 (95% CI -0.61 ∼ -0.19); the changes in the frequency of vomiting episodes (SMD = -0.16, 95% CI -0.3 ∼ -0.03); weight (WMD = -3.05, 95% CI -5.97 ∼ -0.13); and depressive symptoms (SMD =-0.32, 95% CI -0.51 ∼ -0.13). However, no significant difference was found in dropout due to adverse events (RR = 1.66, 95% CI 1.14 ∼ 2.41). Conclusions: This meta-analysis indicates that most pharmacotherapies decreased the frequency of binge-eating and vomiting episodes, body weight, and depressive symptoms in BN patients, but the efficacy was not significant. In each drug the efficacy is different, treating different aspects, different symptoms to improve the clinical performance of bulimia nervosa.Appeared originally in BMC Pharmacol Toxicol 2023; 24:72.

Outcomes of a Virtual Day Treatment Program for Adults With Eating Disorders-Comparison With In-Person Day Treatment.

OBJECTIVE: Previous studies have indicated that virtual treatments for eating disorders (EDs) are roughly as effective as are in-person treatments; the present nonrandomized study aimed to expand on the current body of evidence by comparing outcomes from a virtual day treatment program with those of an in-person program in an adult ED sample. METHOD: Participants were 109 patients who completed at least 60% of day treatment sessions (n = 55 in-person and n = 54 virtual). Outcome measures included ED and comorbid symptoms, and motivation. RESULTS: Linear mixed models showed that global EDE-Q scores decreased during treatment (AIC = 376.396, F = 10.94, p = 0.002), irrespective of treatment modality (p = 0.186). BMI significantly increased over time (AIC = 389.029, F = 27.97, p < 0.001), with no effect of treatment modality (p = 0.779). DISCUSSION: Our findings suggest that the virtual delivery of day treatments produces comparable outcomes to those obtained using in-person formats, and that virtual formats may represent a pragmatic treatment option, especially in situations in which access to in-person care is limited.

Medical Considerations and Consequences of Eating Disorders.

Eating disorders may result in medical complications that affect every body system with both acute and chronic consequences. Although some medical complications may require acute medical hospitalization to manage, other complications, such as low bone mineral density, may not present until malnutrition has become chronic. It is critical for team members to be aware of the early clinical signs of malnutrition and disordered eating behaviors, as well as longer-term complications that may affect their patients. When identifying eating disorder concerns, appropriate colleagues from the medical, nutrition, and psychiatric fields can be engaged in order to collaborate on stabilizing and improving the health of patients.

Psychopharmacology Review for Eating Disorders Among Children, Adolescents, and Adults.

This article reviews the latest research on pharmacological management of eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and avoidant/restrictive food intake disorder. Recent literature for both youth and adult populations obtained through a PubMed search was included. American Psychiatric Association guidelines, National Institute for Health and Care Excellence guidelines, Canadian practice guidelines, and World Federation of Societies of Biological Psychiatry guidelines were also included. First-line recommendations were focused on therapy because the evidence for medication management of eating disorders continues to be limited. Some limited evidence was found for antipsychotic use for AN, selective serotonin reuptake inhibitors and topiramate use for BN, and stimulant and topiramate use for BED. Further medication trials are needed to help with complex eating disorder presentations in adults and youth.

Bulimia Nervosa and Binge-Eating Disorder Across the Lifespan.

This article aims to review the current evidence-based psychotherapy and psychopharmacological treatments for adults and youths with bulimia nervosa (BN) and binge-eating disorder (BED). Treatments for adults and for children and adolescents are discussed separately, including developmental considerations in the management of these disorders among youths. Although several evidence-based psychotherapy and psychopharmacological treatment options have been established for adults with BN or BED, there is much less empirical support for the management of these eating disorders among children and adolescents. This review concludes by discussing promising modalities and innovations, highlighting the potential utility of integrating technology into treatment approaches. Despite decades of treatment development and testing, a sizable proportion of individuals with BN or BED do not respond to the current evidence-based treatments, highlighting the need for continued research in these domains. Future research should focus on testing psychotherapy treatments among diverse samples in large, randomized controlled trials, as well as on treatments that can be easily scaled and implemented in community settings.

Building Confidence in Discussing Genetics With Patients With Eating Disorders and Their Families.

Many individuals with eating disorders and their family members are well-informed about advances in science that could affect the treatment and outcome of these illnesses. They appropriately apply this knowledge to evaluate available treatments and advocate for the best possible evidence-based care. They ask hard questions that many clinicians are often ill-prepared to answer. Genetics has advanced our understanding of eating disorders and provides a novel lens through which to understand these pernicious illnesses. Clinicians can now update their understanding of the etiology of eating disorders and abandon outdated etiological theories, some of which have done harm to patients and their families. Without becoming expert in psychiatric genetics, psychiatrists and other mental health care professionals can develop a general overview of the science, understand what it can and cannot offer, incorporate genetic factors into their case conceptualizations, and boost their confidence in discussing these topics with patients and families.

Why Don't You Just Eat? Neuroscience and the Enigma of Eating Disorders.

Eating disorders are severe psychiatric illnesses that are associated with high mortality. Research has identified environmental, psychological, and biological risk factors that could contribute to the psychopathology of eating disorders. Nevertheless, the patterns of self-starvation, binge eating, and purging behaviors are difficult to reconcile with the typical mechanisms that regulate appetite, hunger, and satiety. Here, the authors present a neuroscience and human brain imaging-based model to help explain the detrimental and often persistent behavioral patterns seen in individuals with eating disorders and why it is so difficult to overcome them. This model incorporates individual motivations to change eating, fear conditioning, biological adaptations of the brain and body, and the development of a vicious cycle that drives the individual to perpetuate those behaviors. This knowledge helps to explain these illnesses to patients and their families, and to develop more effective treatments, including biological interventions.

Racial, Ethnic, and Sex Differences in Eating Disorder Onset Among U.S. Military Service Members.

Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. The present study examined independent associations and interactions between sex, race, ethnicity, and probable BED and BN onset. The sample included 91,413 and 96,245 service members from the Millennium Cohort Study for BED and BN analyses, respectively. Up to four datapoints (from 2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, Multiracial, Black, and Asian/Pacific Islander (API) while BED was less likely among Black and API versus non-Hispanic/Latinx White (NHW) service members. Interactions revealed greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed amongst racially and ethnically diverse groups in preventing and detecting EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.

Intentional vomiting as a rare cause of hypercalcemia and consequent acute renal failure: a case report.

Two most common causes of elevated serum calcium levels, which together account for nearly 90% of all cases, are primary hyperparathyroidism and malignancy. Thus, it is necessary to consider other disorders in the diagnostic evaluation of patients with hypercalcemia. We report the case of a 40-year-old female patient with an intellectual disability who was admitted to the Emergency Department with severe symptomatic hypercalcemia and acute renal failure, caused by recurrent intentional vomiting. The aim of this report is to help clinicians make an accurate diagnosis by considering recurrent vomiting habits as a potential cause of hypercalcemia and acute renal failure. Our case provides a comprehensive diagnostic work-up and multidisciplinary treatment strategies for patients with symptomatic hypercalcemia.

Gender stereotypes in eating disorder recognition.

PURPOSE: Eating disorder (ED) awareness is low. We assessed if ED symptom recognition, perceived need for treatment, perceived distress, perceived acceptability, and perceived prevalence differed depending on the gender of the individual with the ED. METHODS: 276 community participants were randomly assigned to one of three gender conditions (female, male, and non-binary), read three vignettes describing three different individuals with ED symptoms [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)], and then answered a series of questions related to participants ED symptom recognition, perceived need for treatment, perceived distress associated with having ED symptoms, perceived acceptability (e.g., the extent to which it may not be too bad to have an ED), and perceived prevalence. Mixed ANOVAs and chi-square analyses were conducted to examine differences between groups. RESULTS: There were no significant main effects of gender condition across the outcome variables. There were main effects of ED type for problem recognition, perceived need for treatment, perceived level of distress, and perceived prevalence, with participants being more likely to recognize a problem in the AN and BN vignettes than the BED vignettes, refer for treatment and rate a higher perceived level of distress in then AN vignette than the BN and BED vignettes, and perceive a higher prevalence rate in the BN vignette than the AN vignette. There was a significant gender by condition interaction for perceived prevalence, with participants rating a higher prevalence of AN in women and non-binary individuals than men and a higher prevalence of BN in women than non-binary individuals and men. CONCLUSION: These results highlight the importance of education on EDs and awareness that EDs can occur in any individual, regardless of their gender identification. LEVEL OF EVIDENCE: Level I, experimental study with randomization.

Weight History Correlates of Resting Energy Expenditure in Women With Bulimia Nervosa.

OBJECTIVE: Among those with bulimia nervosa, weight suppression has been associated with illness severity and treatment prognosis. Although significant weight loss is known to reduce metabolic rate, the relation between weight suppression and resting energy expenditure (REE) in bulimia nervosa has not been examined. This study tested the hypothesis of an inverse relation between weight suppression and REE in a sample of women with bulimia nervosa (N = 84). METHODS: In primary analyses, linear regressions were conducted between weight suppression and REE, corrected for fat-free mass. In follow-up, exploratory analyses, stepwise linear regressions were conducted to explore the main and interaction effects of weight history and weight suppression on REE. RESULTS: Neither traditional (TWS) nor developmental weight suppression (DWS) correlated with REE. Results from exploratory analyses, however, revealed a medium-to-large inverse relation between several weight history variables and REE (highest past weight, sr2 = 0.05; lowest postmorbid weight, sr2 = 0.07; current weight, sr2 = 0.05). Additionally, DWS interacted with current (sr2 = 0.08) and highest premorbid (sr2 = 0.05) z-BMI to influence REE with a medium-to-large effect. For individuals low in current and premorbid z-BMIs, higher DWS associated with lower REE levels. However, for individuals at higher premorbid z-BMIs, higher DWS unexpectedly associated with greater REE levels. DISCUSSION: In this sample of women with bulimia nervosa, reduced REE associated with higher weights across all timepoints. If the interaction effect between DWS and z-BMI history persists in future studies, this may indicate unique challenges faced by individuals low in z-BMI and high in DWS related to weight gain and normalization of eating.

Sleep quality in eating disorders: A systematic review and meta-analysis.

Eating disorders (ED) are psychological disorders characterized by dangerous eating behaviours, including protracted fasting and binge eating. Mental disorders comorbidities (e.g., anxiety and depression), as well as sleep difficulties, are common and might interfere with treatment response. This work investigated sleep quality, circadian preferences, and sleep disorders in ED patients compared to healthy controls (HC) and the impact of ED treatment on patients' sleep. A literature search on Pubmed, Web of Science, Medline, and PsychInfo included 27 studies. Random effect analyses were performed (sample eating disorders = 711; sample healthy controls = 653) and subgroup analyses were calculated based on the ED subgroups: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder. Whole sample analyses showed poorer physiological and subjective sleep quality in patients. Subgroup analyses showed that poorer physiological sleep was present only in anorexia nervosa. Two studies reporting circadian preferences and sleep disorders showed higher evening preference in patients and no differences in apnea prevalence between patients and healthy controls, respectively. Some studies suggested that specialized eating disorder treatments (e.g., Cognitive Behavioural Therapy for ED) can improve sleep quality in patients. Although these findings highlight poorer sleep in patients with ED compared to healthy controls, the mechanisms underlying sleep alterations in eating disorders remain to be identified.

Circadian copeptin and oxytocin profiles in anorexia nervosa: Exploring the interplay with neurohypophysis opioid tone.

CONTEXT: Neurohypophysis (NH) function in eating disorders (ED) remains poorly elucidated. Studies on vasopressin and oxytocin display inconclusive findings regarding their levels and associations with psychological complications in ED. The profile of opioid tone, a crucial NH activity regulator, is also unknown. OBJECTIVE: To characterise the circadian profile of NH hormones and NH opioid tone using positron emission tomography/MRI (PET/MRI) imaging in patients with ED compared to healthy controls. METHODS: Twelve-point plasma circadian profiles of copeptin and oxytocin, alongside nutritional and psychological scores, were assessed in age-matched female participants: 13 patients with anorexia nervosa restrictive-type (ANR), 12 patients recovered from AN (ANrec), 14 patients with bulimia nervosa and 12 controls. Neurohypophysis PET/MRI [11C] diprenorphin binding potential (BPND) was evaluated in AN, ANrec and controls. RESULTS: Results revealed lower copeptin circadian levels in both ANR and ANrec compared to controls, with no oxytocin differences. Bulimia nervosa exhibited elevated copeptin and low oxytocin levels. [11C] diprenorphin pituitary binding was fully localised in NH. Anorexia nervosa restrictive-type displayed lower NH [11C] diprenorphin BPND (indicating higher opioid tone) and volume than controls. In ANR, copeptin inversely correlated with osmolarity. Neurohypophysis [11C] diprenorphin BPND did not correlated with copeptin or oxytocin. CONCLUSION: Copeptin demonstrated significant group differences, highlighting its potential diagnostic and prognostic value. Oxytocin levels exhibited conflicting results, questioning the reliability of peripheral blood assessment. Increased NH opioid tone in anorexia nervosa may influence the vasopressin or oxytocin release, suggesting potential therapeutic applications.

Using Continuous Glucose Monitoring to Passively Classify Naturalistic Binge Eating and Vomiting Among Adults With Binge-Spectrum Eating Disorders: A Preliminary Investigation.

OBJECTIVE: Binge eating and self-induced vomiting are common, transdiagnostic eating disorder (ED) symptoms. Efforts to understand these behaviors in research and clinical settings have historically relied on self-report measures, which may be biased and have limited ecological validity. It may be possible to passively detect binge eating and vomiting using data collected by continuous glucose monitors (CGMs; minimally invasive sensors that measure blood glucose levels), as these behaviors yield characteristic glucose responses. METHOD: This study developed machine learning classification algorithms to classify binge eating and vomiting among 22 adults with binge-spectrum EDs using CGM data. Participants wore Dexcom G6 CGMs and reported eating episodes and disordered eating symptoms using ecological momentary assessment for 2 weeks. Group-level random forest models were generated to distinguish binge eating from typical eating episodes and to classify instances of vomiting. RESULTS: The binge eating model had accuracy of 0.88 (95% CI: 0.83, 0.92), sensitivity of 0.56, and specificity of 0.90. The vomiting model demonstrated accuracy of 0.79 (95% CI: 0.62, 0.91), sensitivity of 0.88, and specificity of 0.71. DISCUSSION: Results suggest that CGM may be a promising avenue for passively classifying binge eating and vomiting, with implications for innovative research and clinical applications.

Bulimia nervosa selectively reshapes the structure and intrinsic function of anterior insula subregions associated with cognition-emotion integration.

BACKGROUND: Existing evidence suggests that anterior insula plays a crucial role in cognitive control and emotional regulation and is implicated in the onset and maintenance of bulimia nervosa (BN). However, it remains unclear how structural and functional abnormalities in specific subregions of anterior insula contribute to BN. METHODS: In this study, we analyzed structural MRI and resting-state functional MRI data from 54 BN patients and 56 healthy controls (HCs). We conducted voxel-based morphometry, amplitude of low frequency fluctuation (conventional band: 0.01-0.08 Hz, slow-5: 0.01-0.027 Hz) and seed-based whole-brain functional connectivity (FC) analysis of the anterior insula subregions for both groups. Additionally, we investigated the correlation between neuroimaging findings and clinical characteristics in the BN group. RESULTS: Our findings revealed that BN patients exhibited reduced gray matter volume in the right dorsal anterior insula (dAI) and bilateral ventral anterior insula (vAI) and demonstrated decreased ALFF in slow-5 band of bilateral dAI. The BN group also showed increased FC between bilateral dAI and precuneus or right superior frontal gyri which significantly correlated with the severity of BN or its key symptom. In addition, the decreased FC between bilateral vAI and anterior cingulate and paracingulate gyri and/or median cingulate and paracingulate gyri were both significantly correlated with the severity and its restrained eating behavior. CONCLUSIONS: Our findings further indicate that the functional separation of anterior insula subregions may underlie the pathophysiology of BN. Notably, the vAI associated with emotional processing may serve as a promising neuroimaging biomarker which could inform therapeutic strategy.

A feasibility randomized controlled trial of culturally adapted Getting Better Bite-by-Bite (Ca-GBBB) intervention for individuals with eating disorders in Pakistan.

BACKGROUND: Eating disorders (EDs) are serious mental health conditions that affect a person physically and psychologically. In the past, EDs were only recognized as a cultural phenomenon/societal by-product of the West. However, research evidence marks its presence in non-western countries also, including South Asia. This study aims to evaluate the feasibility and acceptability of a manualized psychological intervention called Getting Better Bite by Bite (GBBB) in individuals who screened positive on measures of EDs in Pakistan. METHODS: The proposed study is a feasibility randomized controlled trial (fRCT). The study will be conducted at five sites across Pakistan: Karachi, Hyderabad, Lahore, Rawalpindi, and Multan to recruit a total of 80 participants. Eligible participants will be randomized to either (1) the intervention group; in which they will receive one-to-one sessions of GBBB along with routine care or (2) the routine care group; in which they will only have access to the routine care. We have received ethics approval by the National Bioethics Committee. The study is registered at clinicaltrials.gov (NCT05724394). The study team has received permission from recruitment centers: hospitals (i.e. the psychiatry department of public and private hospitals based in these cities), fitness centers (i.e., gyms), educational institutes (i.e., colleges and universities), and community settings (i.e. community health clinics). Self-referrals from General Practitioners and community settings will be accepted. The intervention manual has been translated into Urdu and a multidisciplinary team including service users has culturally adapted the content of intervention for local context. DISCUSSION: This study will provide evidence on feasibility and acceptability of a culturally adapted intervention for individuals who screen positive on measures of EDs. The findings of this study will inform a fully powered Randomized Controlled Trial of the proposed intervention. TRIAL REGISTRATION: The study is registered on clinicaltrials.gov (NCT05724394). Protocol version (1.0. 1st June 2022).

Avaliação da influência da pandemia de Covid-19 no risco de desenvolvimento de transtornos alimentares em mulheres / Assessment of the influence of the Covid-19 pandemicon the risk of developing eating disorders in women

Objetivo: verificar a influência da pandemia de Covid-19 no risco de desenvolvimento de transtornos alimentares em mulheres. Metodologia: pesquisa quantitativa, com mulheres com acesso ao computador, a celular e à internet. A coleta de dados foi realizada a partir de um questionário on-line contendo 60 perguntas, com respostas fechadas, que visavam conhecer a sua relação com a alimentação. Foram verificados o consumo alimentar e o risco de desenvolvimento de anorexia nervosa (Eating Attitudes Test - EAT-26) e bulimia nervosa (Bulimic Investigatory Test, Edinburgh- BITE). Resultados: participaram da pesquisa 92 mulheres, sendo que 81,50% (n=75) referiram que ficaram em casa durante a pandemia. Sobre a ingestão de alimentos, 45,70% (n=42) relataram que consumiram diariamente frutas e hortaliças, 55,40% (n=51) ingeriram de 1 a 2 vezes/semana bolachas, salgadinhos, doces e guloseimas e 62,00% (n=57) consumiam embutidos pelo menos 1 vez/semana. Ainda, 18,50% (n=17) apresentaram risco para o desenvolvimento de anorexia nervosa e 83,60% (n=73) risco de bulimia nervosa. Entretanto, analisando se esse risco estava associado à pandemia, verificou-se que não houve diferença significativa entre o grupo que permaneceu em casa e o grupo que saiu para trabalhar (p > 0,05). Conclusão: portanto, grande parte das voluntárias apresentaram um risco de desenvolver algum transtorno alimentar, entretanto, não houve uma relação entre o possível risco de desenvolver transtornos alimentares influenciado pela pandemia.

Objective: to verify the influence of the Covid-19 pandemic on the risk of developing eating disorders in women. Methodology: quantitative research, with women with access to a computer, cell phone and internet. Data collection was carried out using an online questionnaire containing 60 questions, with closed answers, which aimed to understand their relationship with food. Food consumption Abstract and the risk of developing nervous anorexia (Eating Attitudes Test - EAT-26) and nervous bulimia (Bulimic Investigatory Test, Edinburgh - BITE) were verified. Results: 92 women participated in the research, with 81.50% (n=75) reporting that they stayed at home during the pandemic. Regarding food intake, 45.70% (n=42) reported that they consumed fruits and vegetables daily, 55.40% (n=51) ate cookies, snacks, sweets and sweets 1 to 2 times/week and 62, 00% (n=57) consumed sausages at least once/week. Furthermore, 18.50% (n=17) were at risk for developing nervous anorexia and 83.60% (n=73) were at risk for nervous bulimia. However, analyzing whether this risk was associated with the pandemic, it was found that there was no significant difference between the group that remained at home and the group that went out to work (p > 0.05). Conclusion: therefore, most of the volunteers presented a risk of developing an eating disorder, however, there was no relationship between the possible risk of developing eating disorders influenced by the pandemic.

Direct and indirect effects of psychological well-being and therapeutic alliance on therapy outcome in eating disorders.

Introduction: Outcome research in eating disorders (EDs) is commonly focused on psychopathological dysfunction. However, Ryff's model of psychological well-being (PWB) has shown promising-yet preliminary-results with ED patients. Additionally, despite substantial evidence highlighting the association between the therapeutic alliance and treatment outcome, findings in ED samples remain unclear. The present study aimed at exploring the direct effect of PWB dimensions and the early therapeutic alliance on ED patients' individual treatment responses, as well as the mediating role played by the early therapeutic alliance in the relationship between PWB dimensions and overall pre-post symptom change. Methods: A sample of N = 165 ED patients assigned female at birth, who were receiving treatment in a residential program, completed the Psychological Well-Being Scale at treatment intake and the Working Alliance Inventory after the first four psychotherapy sessions. Patients also completed the Outcome Questionnaire-45.2 at the same time point and during the week prior to discharge. Results: The PWB dimensions of autonomy, positive relations, and self-acceptance were associated with clinically significant change, while the dimensions of personal growth and self-acceptance were associated with reliable change. The early therapeutic alliance showed both direct and indirect effects on therapy outcome, predicting clinically significant and reliable symptom reduction. It also emerged as a significant mediator in the relationship between all PWB dimensions and overall symptomatic change. Conclusion: The identification of individual, adaptive characteristics in ED patients that might influence their development of an early therapeutic alliance may help therapists to predict relationship ruptures and tailor their interventions to enhance treatment effectiveness.