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.

Mechanisms underlying the development of eating disorders and disordered eating in adolescent females with type 1 diabetes.

OBJECTIVE: People with Type 1 diabetes (T1D) face an increased risk of eating disorders/disordered eating (ED/DE), with adolescents being particularly vulnerable. Empirical knowledge on the mechanisms underlying development of ED/DE in T1D is crucial for evolving prevention strategies. RESEARCH DESIGN AND METHODS: Fourteen semi-structured interviews with adolescent females with T1D and ED/DE between 14 and 18 years were conducted and analyzed using reflexive thematic analysis. RESULTS: Analyses identified four main themes; 'Interconnected afflictions', 'Judgment', 'Feeling Different', and 'Chaos & Control', These themes explore the interconnectedness of T1D and ED/DE, with shame and guilt emerging as common underlying mechanism. The development of a biopsychosocial model was based on the integration of these data with existing models. CONCLUSIONS: The study extends previous developmental pathways of ED/DE in adolescents with T1D. We propose a biopsychosocial model that incorporates various factors: predisposing factors such as parental management of T1D and weight gain during adolescence; precipitating factors including comments on weight, frequency of weighing, perceptions of surveillance; the perpetuating bilateral influence of ED/DE and T1D and finally highlighting the protective mechanisms of disease acceptance encompassing parental handling of diagnosis and the contribution of healthcare professionals (HCP's) role in psychoeducation. The present study highlight the vulnerability of adolescence in the presence of T1D, particularly concerning issues related to eating, weight, and body. It offers clinically relevant insights, with the aim to improve communication and management strategies for this very specific group.

Eating Disorder and Other Psychiatric Hospitalizations in New Zealand During the COVID-19 Pandemic.

OBJECTIVE: An unprecedented rise in eating disorder presentations has been documented in several countries during the COVID-19 pandemic. We explored this phenomenon by analyzing nationwide psychiatric admissions over 5 years, controlling for demographic variables. METHODS: We retrospectively analyzed all hospitalizations in New Zealand with a primary psychiatric diagnosis from 2017 to 2021, using Poisson regression to calculate admission rates by diagnosis, before and during the pandemic. Using Fisher's exact test and Poisson modeling, national data were validated against a manually collected sample of eating disorder admissions. RESULTS: Eating disorder admissions rose significantly during the pandemic (RR 1.48, p < 0.0001), while other diagnoses remained unchanged or decreased slightly. Anorexia nervosa in 10 to 19-year-old females drove increases, with persistent elevations noted in the 10-14 age group. Pandemic-associated increases were more striking for Maori (RR 2.55), the indigenous Polynesian population, compared with non-Maori (RR 1.43). CONCLUSIONS: Eating disorder hospital presentations increased during the COVID-19 pandemic, while other psychiatric presentations to hospital remained relatively unchanged. Possible drivers include disrupted routines, barriers to healthcare access, altered social networks, and increased social media use. Clinical services require additional resources to manage the increased disease burden, especially in vulnerable pediatric and indigenous populations. Ongoing monitoring will be required to establish the time-course of pandemic-related clinical demand.

The Mediating Role of Emotion Dysregulation in the Association Between Perfectionism and Eating Psychopathology Symptoms.

INTRODUCTION: This study explored the possible mediating role of emotion dysregulation in the association between perfectionism and eating psychopathology symptoms. METHOD: One hundred forty-two outpatients with eating disorders (EDs) were enrolled. Perfectionism, emotion dysregulation, ED psychopathology, anxious and depressive symptoms were assessed. Correlation, mediation and 95% bias corrected and accelerated (BCa CI) bootstrapped analyses were run. RESULTS: Emotion dysregulation was found to mediate the association between concern over mistakes perfectionism and restraint (indirect effect: 0.093, BCa CI: 0.001-0.02, adjusted R2 = 0.3324, p < 0.001), shape concern (indirect effect: 0.0130, BCa CI: 0.004-0.03, adjusted R2 = p < 0.001) and weight concern (indirect effect: 0.0142, BCa CI: 0.004-0.03, adjusted R2 = 0.2986, p < 0.001). CONCLUSION: Among ED outpatients, emotion dysregulation may be involved in the association between concern over mistakes perfectionism and persistence of eating psychopathology symptoms. Emotion dysregulation could be considered as possible therapeutic target to reduce the persistence, and severity, of eating psychopathology symptoms among ED patients with concern over mistakes perfectionism.

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.

Impact of emotional abuse on eating disorder psychopathology: A multiple mediation analysis.

INTRODUCTION: Childhood maltreatment, particularly emotional abuse (EA), has been identified as a significant risk factor for the development of eating disorders (EDs). This study investigated the association between EA and ED symptoms while considering multiple potential mediators. METHODS: Participants included 151 individuals with Anorexia Nervosa (AN), 115 with Bulimia Nervosa (BN), and 108 healthy controls. The Childhood trauma questionnaire, the Toronto Alexithymia scale, the Behavioral inhibition System, and the Eating Disorder Inventory 2 scale were completed before treatment. A mediator path model was conducted in each group: EA was set as independent variable, eating symptoms as dependent variables and ineffectiveness, sensitivity to punishment, alexithymia, and impulsivity as mediators. RESULTS: In individuals with AN, impulsivity emerged as a significant mediator between EA and desire for thinness and bulimic behaviors. Conversely, in individuals with BN, sensitivity to punishment was found to mediate the association between EA and dissatisfaction with one's body. Ineffectiveness and difficulty identifying emotions were identified as transdiagnostic mediators in both clinical groups. No mediation effect was found in healthy individuals. DISCUSSION: The simultaneous assessment of multiple mediators in a unique model outlines the complex interplay between childhood EA and ED psychopathology. Improving ineffectiveness, emotion identification, sensitivity to punishment and impulsivity and exploring their relations with early emotional abuse may represent treatment targets in individuals with EDs and childhood trauma.

Attitude and experience of obstetricians and gynecologists toward eating disorders assessment and management in Japan: A nationwide survey.

AIM: To investigate the attitudes and experiences of obstetricians and gynecologists in treating women with eating disorders (EDs) in Japan. METHODS: Members of the Japan Society of Obstetrics and Gynecology were invited to participate in a web-based survey from March 1 to 31, 2022. We asked about the attitudes of obstetricians and gynecologists toward women with weight loss-related amenorrhea and their experiences in treating EDs. We also assessed the characteristics of physicians who see many ED patients. RESULTS: A total of 662 ob/gyns. responded to the survey. While treating weight loss-related amenorrhea, 25.8% reported screening patients for EDs. 88.5% of respondents reported having treated ED patients. The main medical concerns described when treating pregnant women with ED were fetal growth restriction and preterm delivery. The most common type of ED encountered by participants in both perinatal and infertility care settings was anorexia nervosa. Characteristics of physicians who treated 10 or more EDs per year were being board certified in women's health care and not providing delivery services (OR = 4.809, 1.896). The most common comment regarding optimizing the management of patients with EDs in obstetrics and gynecology practice was the need to implement guidelines for ED management. CONCLUSIONS: Many obstetricians and gynecologists in Japan treat patients with ED. Standardized guidelines for the management of EDs for obstetricians and gynecologists are needed.

A naturalistic study of plasma lipid alterations in female patients with anorexia nervosa before and after weight restoration treatment.

BACKGROUND: Plasma lipid concentrations in patients with anorexia nervosa (AN) seem to be altered. METHODS: We conducted a naturalistic study with 75 adult female patients with AN and 26 healthy female controls (HC). We measured plasma lipid profile, sex hormones and used self-report questionnaires at admission and discharge. RESULTS: Total cholesterol (median (IQR): 4.9 (1.2)) and triglycerides (TG) (1.2 (0.8)) were elevated in AN at admission (BMI 15.3 (3.4)) compared with HC (4.3 (0.7), p = 0.003 and 0.9 (0.3), p = 0.006) and remained elevated at discharge (BMI 18.9 (2.9)) after weight restoration treatment. Estradiol (0.05 (0.1)) and testosterone (0.5 (0.7)) were lower in AN compared with HC (0.3 (0.3), p = < 0.001 and 0.8 (0.5), p = 0.03) and remained low at discharge. There was no change in eating disorder symptoms. Depression symptoms decreased (33 (17) to 30.5 (19), (p = 0.007)). Regression analyses showed that illness duration was a predictor of TG, age was a predictor of total cholesterol and LDL, while educational attainment predicted LDL and TG. CONCLUSION: Lipid concentrations remained elevated following weight restoration treatment, suggesting an underlying, premorbid dysregulation in the lipid metabolism in AN that persists following weight restoration. Elevated lipid concentrations may be present prior to illness onset in AN. LEVEL OF EVIDENCE: III: Evidence obtained from well-designed cohort or case-control analytic studies.

Fat is essential for the human body. Too much fat in the blood can be a sign of underlying illness including heart disease. This study investigated how plasma lipids (fats) are affected in individuals with anorexia nervosa (AN). We included 75 adult female individuals with AN and 26 healthy female controls, and measured lipids, sex hormones, and used questionnaires upon admission and discharge from treatment. We found that low-weight individuals with AN had higher lipids than the healthy controls, and these lipids remained elevated after weight restoration treatment. Additionally, individuals with AN had lower levels of sex hormones (estradiol and testosterone) at their low weight, and they stayed low even after weight restoration treatment. Eating disorder symptoms remained unchanged, but depression symptoms decreased during treatment. In conclusion, the study suggests that individuals with AN have changes in their lipid metabolism, which persists even after weight restoration treatment. We don't know the reason behind these elevated lipids, and therefore, this should be investigated further in future study.

Charting a Path Toward Improving Detection and Clinical Outcomes for Eating Disorders in Cismales and Gender-Diverse Patients.

Historically, eating disorders (EDs) have been conceptualized from a female-centric lens. However, consistent research demonstrates that EDs afflict individuals across the gender spectrum, including cismales and gender-diverse individuals. Despite this evidence, a consensus regarding gender-sensitive assessment practices, theoretical formulations, and treatment considerations has yet to be established. The present review briefly summarizes research to date on the presentation of EDs in cismales and gender-diverse individuals, suggests appropriate assessment and treatment practices, and offers recommendations for gender-inclusive ED treatment. To effectively serve patients with EDs across the gender spectrum, more research is needed to validate gender-sensitive assessment tools, comprehensively study ED pathology within gender-representative samples, and conduct randomized controlled trials that serve cismales and gender-diverse patients. In doing so, clinicians and researchers may better detect EDs across the gender spectrum and implement gender-appropriate, evidence-based interventions, thereby reducing impairment and mortality related to EDs for all patients.

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.

Innovative and Emerging Treatments for Anorexia Nervosa.

Unlike psychopharmacologic interventions for other psychiatric conditions, few medications have emerged as helpful in improving eating disorder cognitions and evidence-based psychotherapies fail many patients. Novel treatments are urgently needed to address anorexia nervosa (AN), which is increasingly prevalent and difficult to treat. This article provides an overview of preliminary investigations into cannabidiol, psilocybin therapy, ketamine and the ketogenic diet, transcranial magnetic stimulation, and vagus nerve stimulation in individuals with AN. These pilot studies underscore the need for larger clinical trials that include more participant diversity in order to rapidly translate findings to real-world clinical practice.

Mental Health, and Eating Disorders in Patients After Roux-en-Y Gastric Bypass Surgery (RYGB).

<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.

Late Positive Potential Elicited by Monetary Reward Feedback Predicts Changes of Disordered Eating From Age 11 to Age 12 in Community-Dwelling Girls.

OBJECTIVE: Early adolescence is marked by elevated psychopathology, including disrupted eating attitudes and behaviors. Reward processing is an identified mechanism in portending eating pathology, that is, aberrant reward responsivity may contribute to disrupted reward-seeking behaviors (e.g., food consuming). This literature has focused on adults or mid-to-late adolescents, with little work done on early adolescence. We examined the linkages between reward feedback processing, indexed by event-related potentials (ERPs), and changes of emerging disordered eating in community-dwelling early adolescents. METHOD: At T1, 115 youths (66 girls, mean/SD age = 11.00/1.16 years) completed an EEG monetary reward Doors task. Youths completed the Eating Disorder Examination-Questionnaire Short at T1 and ~6 months (T2) and ~12 months (T3) after T1. In the ERP data, we isolated a reward positivity (RewP) and a late positive potential (LPP) via principal component analysis. We applied multilevel modeling to examine whether baseline ERPs interacted with Time in predicting disordered eating and whether these interactions varied by sex. RESULTS: We found a significant Time × LPP interaction in girls but not boys. Among girls, only those with a smaller LPP toward the losses (versus wins), which might reflect suboptimal evaluation and regulatory processes in undesired situations, showed increases in disordered eating from T1 to T3. DISCUSSION: We provided preliminary yet novel evidence concerning the prospective associations between reward processing and changes of disordered eating in early adolescents. Future studies along this line will be critical for understanding the early mechanisms of eating pathology, identifying youths at risk, and developing prevention strategies.

Identification of State Markers in Anorexia Nervosa: Replication and Extension of Inflammation-Associated Biomarkers Using Multiplex Profiling.

Background: Proteomics offers potential for detecting and monitoring anorexia nervosa (AN) and its variant, atypical AN (atyp-AN). However, research has been limited by small protein panels, a focus on adult AN, and lack of replication. Methods: In this study, we performed Olink multiplex profiling of 92 inflammation-related proteins in females with AN/atyp-AN (n = 64), all of whom were ≤90% of expected body weight, and age-matched healthy control individuals (n = 44). Results: Five proteins differed significantly between the primary AN/atyp-AN group and the healthy control group (lower levels: HGF, IL-18R1, TRANCE; higher levels: CCL23, LIF-R). The expression levels of 3 proteins (lower IL-18R1, TRANCE; higher LIF-R) were uniquely disrupted in participants with AN in our primary model. No unique expression levels emerged for atyp-AN. In the total sample, 12 proteins (ADA, CD5, CD6, CXCL1, FGF-21, HGF, IL-12B, IL18, IL-18R1, SIRT2, TNFSF14, TRANCE) were positively correlated with body mass index and 5 proteins (CCL11, FGF-19, IL8, LIF-R, OPG) were negatively correlated with body mass index in our primary models. Conclusions: Our results replicate the results of a previous study that demonstrated a dysregulated inflammatory status in AN and extend those results to atyp-AN. Of the 17 proteins correlated with body mass index, 11 were replicated from a previous study that used similar methods, highlighting the promise of inflammatory protein expression levels as biomarkers of AN disease monitoring. Our findings underscore the complexity of AN and atyp-AN by highlighting the inability of the identified proteins to differentiate between these 2 subtypes, thereby emphasizing the heterogeneous nature of these disorders.

We examined 73 inflammation proteins in adolescent girls with anorexia nervosa (AN) and atypical AN and compared them with age-matched healthy control girls. Significant differences were found, driven by 5 key proteins (lower: HGF, IL-18R1, TRANCE; higher: CCL23, LIF-R). Three proteins (TRANCE, LIF-R, IL-18R1) uniquely distinguished low-weight participants with AN from control participants. Our study reveals distinct inflammation patterns in AN and atypical AN and sheds light on potential state-specific factors that underlie these disorders.

Food Addiction Screening, Diagnosis and Treatment: A Protocol for Residential Treatment of Eating Disorders, Substance Use Disorders and Trauma-Related Psychiatric Comorbidity.

Food addiction, or ultra-processed food addiction (UPFA), has emerged as a reliable and validated clinical entity that is especially common in individuals seeking treatment for eating disorders (EDs), substance use disorders (SUDs) and co-occurring psychiatric disorders (including mood, anxiety and trauma-related disorders). The clinical science of UPFA has relied on the development and proven reliability of the Yale Food Addiction Scale (YFAS), or subsequent versions, e.g., the modified YFAS 2.0 (mYFAS2.0), as well as neurobiological advances in understanding hedonic eating. Despite its emergence as a valid and reliable clinical entity with important clinical implications, the best treatment approaches remain elusive. To address this gap, we have developed and described a standardized assessment and treatment protocol for patients being treated in a residential program serving patients with psychiatric multi-morbidity. Patients who meet mYFAS2.0 criteria are offered one of three possible approaches: (1) treatment as usual (TAU), using standard ED treatment dietary approaches; (2) harm reduction (HR), offering support in decreasing consumption of all UPFs or particular identified UPFs; and (3) abstinence-based (AB), offering support in abstaining completely from UPFs or particular UPFs. Changes in mYFAS2.0 scores and other clinical measures of common psychiatric comorbidities are compared between admission and discharge.

Predictive Model of the Relationship between Appearance, Eating Attitudes, and Physical Activity Behavior in Young People amid COVID-19.

This cross-sectional study conducted in Poland explored the relationship between the fear of negative appearance evaluations, eating disorders, and physical activity objectives, particularly during the COVID-19 pandemic. The Fear of Negative Appearance Evaluation Scale (FNAES), the Eating Attitude Test (EAT-26), and the Physical Activity Goals Inventory (IPAO) were administered to 644 participants (455 males with a mean age of 35.2 ± 6.2 years and 189 females with a mean age of 30.18 ± 5.7 years). This study explored the effects of gender, age, and body mass index (BMI) on FNAES, EAT-26, and IPAO scores. The results of this study demonstrated that females scored higher on fear of negative appearance, peaking at 41-50 years of age. Distinct BMI categories were associated with different negative appearance fear scores, eating attitudes, and physical activity objectives. Significant correlations were also found between the fear of negative appearance, dietary attitudes, and physical activity goals. Eating attitudes completely moderated the relationship between the fear of negative appearance and physical activity objectives. A significant interaction effect of age and body mass index on physical activity objectives was also revealed. These results highlight the relevance of considering gender, age, and body mass index when examining the associations between the fear of negative appearance, eating attitudes, and physical activity objectives.

Resilience eDBT: Development and Usability Evaluation of a Dialectical Behavior Therapy Skills Training App for Eating Disorders.

OBJECTIVE: Dialectical behavior therapy (DBT) is an evidence-based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability. METHODS: Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. RESULTS: Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement. DISCUSSION: A novel DBT-based app may serve as an acceptable, low-intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted.

Validation of the Interpersonal Relationships in Eating Disorders (IR-ED) Scale in an Eating Disorder Sample.

OBJECTIVE: Interpersonal problems have been identified as a plausible mechanism underlying the onset and maintenance of eating disorders. The Interpersonal Relationships in Eating Disorders (IR-ED) scale is the first eating disorders-specific measure of interpersonal problems, which was developed in a nonclinical sample. The aims of the current study were to (a) confirm the factor structure of the IR-ED within a large clinical sample, (b) investigate measurement invariance of the IR-ED across nonclinical and clinical samples, (c) examine the convergent validity of the IR-ED using a generic measure of interpersonal problems, and (d) investigate the incremental clinical utility of the IR-ED in uniquely predicting eating disorder symptomatology. METHOD: Treatment-seeking individuals (N = 437) completed the IR-ED at their initial assessment appointment at a specialist eating disorder outpatient service. RESULTS: A multiple-group confirmatory factor analysis supported an invariant bifactor structure comprising a general interpersonal problems factor and two group factors-Avoidance of Body Evaluation and Food-Related Interpersonal Tension. Convergent validity was demonstrated by a large, statistically significant correlation with a generic measure of interpersonal problems (r = 0.62, p < 0.001). A series of structural equation models further revealed unique incremental predictive utility of the IR-ED for eating disorder symptomatology. DISCUSSION: The IR-ED has strong psychometric properties and may prove beneficial in the assessment, formulation, and treatment of eating-specific interpersonal problems among patients with eating disorders.

Morbid hunger and hyperphagia post-traumatic brain injury in a young male: good prognosis with escitalopram and multidisciplinary rehabilitation.

OBJECTIVE: Morbid hunger and hyperphagia (MHH) is a rare neurological disorder that can manifest following damage to the right frontal and temporal lobes. It can lead to detrimental short and long-term complications such as electrolyte imbalances, obesity, and cardiovascular diseases. This report details the case of a young male patient who developed MHH five months post-traumatic brain injury. METHOD: Single-case report. The patient exhibited colossal appetite, overeating, food-demanding behavior, and rapid weight gain. The prescription of quetiapine to manage his visual and auditory hallucinations was suspected of exacerbating the hyperphagia. A comprehensive, multidisciplinary rehabilitation approach was implemented, encompassing a meticulous dietary regime, environmental modifications, behavioral management, physical activities, therapeutic exercises, and pharmacological interventions, which included switching the anti-psychotics and introducing low-dose escitalopram. RESULTS: Over the course of 6 months, the MHH gradually subsided, and the patient achieved the target bodyweight. The Glasgow Outcome Scale-Extended improved from 3 to 5. CONCLUSION: This is the first report on the use of escitalopram to manage secondary eating disorders. Our findings underscore the necessity to formally catalog and recognize disorders like MHH in diagnostic classifications to facilitate the systematic study of their pathophysiology, natural history, prognosis, and management strategies.