Research into the factors that drive the development, maintenance, and recovery from eating disorders (EDs) has established that social processes play an integral part in helping or hindering one's recovery from an ED. In a world where social processes have increasingly moved online, this research aimed to better understand themes within ED recovery content on TikTok. A thematic analysis of  312 of the most popular TikTok videos about ED recovery was conducted using a snowball sampling method to find common hashtags related to ED recovery and a codebook to compile deductive and inductive codes. Content related to suicide/self-harm or pro-anorexia beliefs was uncommon across the videos, but four themes were generated from the inductive thematic analysis: recovery milestones, the social nature of ED recovery, bodies as evidence of recovery, and the all-powerful ED. The findings from this research contribute to understandings about the shifting online landscape for ED recovery, where platforms like TikTok are increasingly becoming a source of support and community. The findings of this research will assist individuals in ED recovery and those supporting them when deciding whether engaging with recovery content on TikTok is right for their recovery journey.

The present study aimed to comprehensively evaluate the psychometric properties and clinical utility of the revised Eating Disorder Core Beliefs Questionnaire (ED-CBQ-R) in a clinical sample of individuals seeking treatment for an eating disorder (ED), as well as to examine potential differences in ED core beliefs across distinct diagnostic groups. Treatment-seeking adults (150) were recruited from specialist ED private practices throughout Australia and New Zealand, as a part of the Clinical Quality Registry for Eating Disorder Treatment (the "TrEAT Registry", Australian Register of Clinical Registries: #ACSQHC-ARCR-279). Further, undergraduate data ( = 294) was collected at T1 and T2 (after a four-week interval) to examine test-retest reliability of the ED-CBQ-R. In the treatment-seeking sample, the total ED-CBQ-R, Self-loathing, Unassertive, Demanding and Abandoned subscales displayed good internal consistency, discriminative ability, and the four-factor structure showed acceptable to good fit. Treatment-seeking participants displayed significantly higher scores on all ED-CBQ-R subscales than those in the undergraduate sample. There were no significant differences on the ED-CBQ-R between diagnostic groups, except for the AN-R group displaying higher self-loathing than those with BED. Finally, the ED-CBQ-R demonstrated good test-retest reliability in the undergraduate sample. The outcomes of the present study support the validity, reliability, and clinical utility of the ED-CBQ-R in those seeking treatment for an ED and supports researchers and clinicians in utilising the ED-CBQ-R to identify and monitor critical cognitive targets for treatment and guide clinical decision making.

This acceptability and feasibility study utilized a mixed methods approach to examine patient and clinician perspectives on telehealth across multiple eating disorder presentations and evidence-based treatment modalities. Youth ages 6-19 received psychotherapy for eating disorders in an outpatient specialty clinic. The Telehealth Expectations Questionnaire (TEQ) assessed baseline expectations of telehealth. Satisfaction with telehealth was assessed monthly through the Telehealth Satisfaction Questionnaire (TSQ). Experiences with telehealth were measured at end of treatment through the Telehealth Usability Questionnaire (TUQ) and Implementation of Telehealth Treatment Questionnaire. The Eating Disorder Examination Questionnaire (EDE-Q) measured clinical improvement. Use of telehealth services was associated with clinically significant reductions in eating disorder symptoms. Qualitatively, patients and families reported advantages of telehealth, specifically saving time and ease of use, and identified disadvantages, including technological difficulties and feeling disconnected from therapists. Clinicians reported benefits of telehealth, such as insight into the home environment, and challenges, such as managing distractions and reading body language. Clinicians identified specific adaptations for telehealth when conducting one-on-one time with patients and taking weights. The perspectives of youth, families, and clinicians highlight important clinical considerations in the utilization of telehealth to promote accessible and effective care for eating disorders.

Early intervention is key to improving prognosis for youth with eating disorders (EDs). Caregiver groups may be an effective way to intervene early in the treatment of youth with EDs, in conjunction with speciality medical care. A 12-session online caregiver skills group (CARE Skills Group) was designed and offered to caregivers of youth with recent onset, newly diagnosed restrictive EDs at two different Canadian sites. The CARE Skills group integrated family-based treatment (FBT) principles and was led by experienced ED clinicians. The group was feasible, with some preliminary evidence that youth whose caregivers participated in the CARE Skills Group benefited in terms of weight restoration. The CARE Skills Group model represents a brief, and replicable early intervention model that has potential utility for implementation in community-based ED settings.

Perfectionism and flexible thinking are frequently reported as impaired in anorexia nervosa (AN), however, the role of perfectionism and cognitive flexibility in eating disorder (ED) symptoms is unclear. Further, it is unclear how individuals with AN may differ in these domains compared to the general community with high or low ED symptoms. Sixty-seven individuals with lifetime AN, 112 community controls with high ED symptoms (high ED-CCs) and 111 community controls with low ED symptoms (low ED-CCs) completed an online survey examining perfectionism, cognitive flexibility, and divergent thinking. Participants with lifetime AN and high ED-CCs showed significantly elevated perfectionism compared to low ED-CCs. Participants with lifetime AN also reported significantly poorer cognitive flexibility. No group differences were found for divergent thinking. A mediation analysis across the entire sample revealed that perfectionism mediated the relationship between cognitive flexibility and ED symptoms, but did not remain significant when only the AN group was included in the model. This study provides a greater understanding of self-reported cognitive flexibility and perfectionism in AN which can be used to enhance treatments that focus on improving specific thinking skills. Further, it highlights different types of perfectionism and provides potential avenues for treatment personalisation.

Family-based treatment (FBT) is the recommended approach for adolescents with eating disorders (EDs), but long waitlists hinder its delivery. This study aimed to explore the feasibility and acceptability of a brief 5-week outpatient FBT psychoeducation group for parents/caregivers of adolescents with anorexia nervosa (AN). The secondary aim of this study was to examine its preliminary effectiveness of increasing parental self-efficacy and decreasing expressed emotion and accommodation of the eating disorder. Eighteen parents/caregivers of adolescents ( = 9; aged 9-18) with AN were recruited. Parental accommodation, parental self-efficacy, and expressed emotion were assessed at baseline, end of treatment (week 5), and 1-month follow-up (week 9). Qualitative interviews were collected weekly. Quantitative results were analysed using linear mixed modelling, while qualitative interviews underwent reflexive thematic analysis. Numerical evaluation of feasibility/acceptability included rates of enrollment, retention, and attendance. Parental self-efficacy significantly improved during treatment, with gains sustained at 1-month follow-up ( < .001). Parental accommodation also significantly decreased across treatment ( < .001) but significantly resurfaced at 1-month follow-up ( = .001). Qualitative results demonstrated high acceptability of the group; participants found this intervention to be helpful and better equipped them to address their child's ED after group completion. Feasibility/acceptability metrics showed moderate enrollment (75%), high retention (94.4%), and attendance (97%). A modified 5-week FBT group for parents/caregivers of adolescents with AN shows preliminary feasibility and acceptability, informing future FBT treatment planning and service provision for ED providers.

Intelligence Quotient (IQ) scores, typically considered stable throughout life, may be impacted by anorexia nervosa (AN). This study investigated whether IQ scores change following treatment in adolescents with AN ( = 110; age = 14.65 ± 2.49 years; 85% female). We analyzed changes in vocabulary, matrix reasoning, and full-scale IQ (FSIQ-2) scores on the Wechsler Abbreviated Scale of Intelligence, with developmental weight suppression and duration of illness as covariates. Results indicated end of treatment improvements in vocabulary ((1, 107) = 7.46,  = .01, η = .07), matrix reasoning ((1, 107) = 4.44,  = .04, η = .04), and FSIQ-2 ((1, 107) = 11.00,  < .01, η = .09) scores. A shorter illness duration was associated with greater gains in vocabulary ( = .04) and FSIQ-2 ( = .02) scores. These findings suggest that IQ scores can improve throughout treatment, with shorter illness duration linked to greater improvements, underscoring the importance of early nutritional intervention.

We investigated how the COVID-19 pandemic shift impacted access to and quality of eating disorder (ED) care via telehealth (TH) for adolescents and young adults (AYA), focusing on demographic trends for patients in the pre- and pandemic periods. Retrospective analysis of patients aged 10-26 with ED-related ICD-10 codes at a tertiary care hospital in Northern California was conducted. Using electronic health record data, we compared care access (visit types, missed appointments) and quality (hospital length of stay, readmissions) across pre-pandemic (Feb 2018-Feb 2020) and pandemic (June 2020-June 2022) periods. Outpatient visits increased 29% in the pandemic ( = 740 vs. 575). Hispanic patient representation rose by 59%, while non-Hispanic White and Asian patients decreased. During the pandemic, 531 patients used TH, and 209 were seen in person visits. In-person patients had over twice the odds of missing appointments. No differences were found in hospital length of stay (LOS) or readmission rates between TH and in-person care. TH use increased significantly during the pandemic, improving appointment adherence and access while maintaining care quality. The rise in Hispanic patients and changes in insurance patterns highlight the need for further research into equity and the long-term implications of TH in ED treatment.

People who have experienced trauma are at higher risk of developing an eating disorder than those who have not suffered a traumatic event. While the association between posttraumatic stress disorder (PTSD) symptoms and anorexia nervosa (AN) symptomatology is widely discussed, research on complex PTSD (CPTSD) in relation to AN symptoms is scarce. In this context, we investigated the specific relationship between CPTSD symptoms (defined by ICD-11 criteria) and restrictive and binge-purging AN, in a clinical sample. We also tested, as possible explanatory mechanisms of these relationships, dissociative symptoms and emotion dysregulation. The questionnaire was completed by 91 participants, all patients in Austrian and German hospitals and clinics in departments for eating disorders, all with a diagnosis of AN. The sample comprised predominantly of women (80%) with a mean age of 20.84. Participants completed scales assessing CPTSD, restrictive AN, binge-purging AN, and dissociative symptoms, and emotion dysregulation. Our findings show that CPTSD symptoms are more strongly associated than PTSD symptoms with restrictive and binge-purging AN. Moreover, CPTSD symptoms are a significant predictor of both AN manifestations. Further findings indicate that dissociative experiences fully mediate the link between CPTSD symptoms and restrictive and binge-purging AN. However, emotion dysregulation did not mediate these relationships, as expected. Therefore, for patients diagnosed with anorexia nervosa, regardless of its type, screening and interventions for CPTSD symptomatology and dissociative experiences can contribute to treatment and recovery.

Recent prospective studies identified risk factors that predict future onset of anorexia nervosa (AN), but none have differentiated between those predicting restrictive (AN-R) versus binge-eating/purging (AN-BP) AN subtypes. Identifying shared versus unique risk factors may clarify whether these subtypes reflect distinct subtypes of AN or phases of the same disorder. This exploratory study combined data from four eating disorder prevention trials involving young women at risk for eating disorders ( = 1,952, mean age = 19.7 years) and collected annual diagnostic data over a 3-year follow-up. We assessed which baseline variables predicted future onset of AN-R and AN-BP, including subthreshold cases classified as Other Specified Feeding and Eating Disorder. Over 3-year follow-up, 34 participants developed AN-R and 24 developed AN-BP. Elevated negative affect and low BMI emerged as shared risk factors for both AN subtypes. Unique risk factors for AN-R were elevated thin-ideal internalization, fear of weight gain, and dietary restraint. Psychosocial impairment was the only unique predictor for AN-BP. The presence of distinct risk factors suggests that AN-R and AN-BP represent distinct subtypes rather than developmental stages of the same disorder. Shared risk factors should be prioritized as targets in prevention efforts for AN, particularly negative affect, and low prodromal BMI.

Dialectical behaviour therapy (DBT) has a developing evidence base for treating complex multi-diagnostic eating disorder presentations, including for individuals with long-standing eating disorders. A retrospective analysis of pre- and post-test data collected at 12 months from 16 adult participants in a "DBT for Multi-diagnostic Eating Disorders" (MED-DBT) programme run in New Zealand was conducted. Psychological outcomes were assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21) and Difficulties with Emotion Regulation Scale (DERS). Clinical indicators consisted of body mass index (BMI) and scores on the Eating Disorder Examination Questionnaire (EDE-Q). Significant differences were found for difficulties with emotion regulation scores ( = 8.571,  = .007), eating disorder examination questionnaire global scores ( 47.5, .003), and anxiety scores ( = 42.0,  .040), favouring those who completed the 12 months of the MED-DBT programme including the skills group. No significant differences were found for depression or stress symptoms. BMI increased for those who completed 12 months of the programme ( = 1.265) and decreased ( = -.580;  = 6.0,  = .019) for non-completers. The findings suggest that completing 12 months of MED-DBT including the group component may result in clinically meaningful change when compared to non-completion. Although participants were still experiencing eating disorder symptoms at the end of 12 months, these were significantly reduced and were paired with improved emotional wellbeing.

We examined associations between potentially traumatic events (PTEs) and lifetime eating disorders (EDs) in the Eating Disorders Genetics Initiative-Mexico [EDGI-MX;  = 298; 174 cases, 124 controls, ages 13-78 years ( = 28.9 SD = 11.3), 81% cisgender women]. ED diagnoses and symptoms were from an online questionnaire capturing DSM-5 diagnoses via algorithm; PTEs were assessed with the Life Events Checklist for DSM-5; and depression, anxiety, and obsessive-compulsive (OC) symptoms with validated self-report measures. Logistic regressions and analyses of covariance were adjusted for age and gender. PTEs were reported by 75% of cases and 53% of controls (adjusted odds ratio [aOR] 3.6; 95% confidence interval [CI] 2.04, 6.62), including fire/explosions (13.6; 1.30, 141.76), transportation accident (2.1; 1.13, 4.06), serious accidents (10.0; 2.03, 49.64), sexual assault (5.9; 2.57, 13.91), other uncomfortable sexual experiences (3.2; 1.68, 6.41), and other stressful event (4.3; 1.95, 9.76). Although PTEs were not significantly associated with greater depression, anxiety, or OC symptoms in cases, these co-occurring symptoms may still be relevant clinically. Results highlight the importance of assessing PTEs in Mexican individuals with EDs and encourage exploration of timing of PTE exposure to clarify their role in ED development and course.

Eating disorders (EDs) are prevalent mental health conditions that occur globally and affect all population subgroups. Despite their severity and widespread impact, EDs are frequently underdiagnosed and undertreated, particularly among individuals from minoritized racial and ethnic backgrounds, and groups that have been historically excluded from ED research. Early intervention (EI) has been shown to improve outcomes by reducing untreated illness duration, yet its implementation remains limited. This commentary examines patient-, clinician-, and systemic-level barriers to the timely detection and treatment of EDs, with an emphasis on how these barriers impact individuals from minoritized backgrounds. Evidence-based strategies to improve access to EI are also discussed as pathways to more equitable and effective care. Increasing access to EI and culturally informed treatments is essential to mitigating the burden of EDs and improving outcomes across populations.

Cognitive Behavioural Therapy Ten (CBT-T) is a new intervention for non-underweight eating disorders (EDs), developed as a cost-effective alternative to current NICE recommended interventions. We present a mixed methods review of the implementation of CBT-T in a large moderate-severe adult ED NHS service. This includes qualitative feedback from clinicians and patients alongside data on outcomes. Clinician and patient feedback demonstrated CBT-T as realistic, feasible and acceptable to implement in NHS settings. Statistical analysis showed that CBT-T was effective across diagnoses on a range of measures. For anorexia nervosa (AN) and bulimia nervosa (BN), there was a significant reduction in concern around weight, shape and eating; with further reductions around eating restraint, total Eating Disorder Examination Questionnaire (EDE-Q) scores, and bingeing frequency. For BN, there were also significant improvements in psychological functioning and depression, with significant decreases in vomiting and exercise frequency. Findings demonstrate the usefulness of CBT-T as a cost-effective alternative intervention for non-underweight EDs and highlight areas for further research such as for binge eating disorder (BED).

Yoga is associated with improvements in factors that protect against the development of eating disorders (EDs), such as mindfulness, self-compassion, and body appreciation. Additionally, yoga is associated with lower body dissatisfaction (BD) and disordered eating. However, research on how yoga reduces BD and ED symptoms is limited. This study examined how protective factors such as mindfulness, self-compassion, and body appreciation may mediate the relationship between yoga self-efficacy, BD, and ED symptoms. A sample of 174 college students with previous yoga experience (age = 20.10, 2.49) and varying degrees of BD and ED symptoms participated. Mediations were performed using Hayes PROCESS (Model 6) and were significant ( = .012 and  < .0001). Yoga self-efficacy predicted lower BD and ED symptoms through increased mindfulness, which predicted higher self-compassion and then greater body appreciation. Findings suggest yoga self-efficacy could reduce BD and ED behaviors through increased awareness of internal and external cues, leading to increased self-kindness and appreciation for one's body. Given our current findings, ED prevention or treatment programs incorporating yoga could focus on elements including mindfulness, self-compassion, and body appreciation.

Disordered eating (DE) often begins in early adolescence and follows heterogeneous developmental patterns. This study had two main objectives: (1) to identify homogeneous developmental trajectories of DE in adolescents aged 11-16 years and (2) to investigate factors predicting the likelihood of belonging to specific developmental trajectories. Data from a four-wave longitudinal study were analyzed, including participants aged 11 to 16 years (girls  = 167, boys  = 131). Using Growth Mixture Modeling based on the Children's Eating Attitude Test (ChEAT), three distinct developmental trajectories were identified: Low-Stable (16% of participants, exhibiting few DE symptoms that remained stable), High-Stable (36% of participants, consistently displaying high levels of DE), and Medium-Increasing (48% of participants, experiencing moderate DE that increased with age). Important gender differences emerged: more girls belonged to the High-Stable and more boys to the Low-Stable trajectory. Multinomial logistic regression analysis showed that being a girl, higher BMI, perceived social pressure for thinness, and perfectionism were associated with an increased likelihood of belonging to the High-Stable trajectory. Among the ChEAT subscales, Body Concerns was the only one to exhibit exclusively stable trajectories over time. In conclusion, strongly manifested DE symptoms tend to follow a stable course between ages 11 and 16, whereas individuals with moderate DE are more likely to experience an increase in symptoms during this period. Identifying developmental trajectories and their associations with risk factors can facilitate early detection of adolescents in need of urgent attention or targeted interventions and improve the planning of preventive measures.

Even though appetitive traits are found to be related to thinness-oriented eating disorder (ED) symptomatology, findings are generally based on younger populations, such as children and young adults. Given both the global and China's rapidly aging population and the impacts of eating behaviors on malnutrition and geriatric health decline, identifying potential correlates for disordered eating is a public health priority. To our knowledge, the relationship between appetitive traits and thinness-oriented ED symptomatology in older adults remains unexamined. Given the strength of longitudinal designs in clarifying temporal directionality, this study investigated the prospective relationships of appetitive traits with thinness-oriented ED symptomatology among Chinese older adults. A sample of 202 Chinese older adults aged 56-76 years (45% women) participated in an online survey at baseline (T1) and one year later (T2). We conducted univariate and multivariable analyses to explore the prospective relationships of eight appetitive traits at T1 with thinness-oriented ED symptomatology at T2, controlling for covariates and outcome variables at T1. Univariate analyses showed that higher and higher at T1 were related to higher thinness-oriented ED symptomatology at T2. Multivariate analyses further revealed that higher at T1 was uniquely related to higher thinness-oriented ED symptomatology at T2. This study is the first to explore the prospective relationships of appetitive traits with thinness-oriented ED symptomatology in an older adult sample, underscoring the potential of targeting appetitive traits to promote eating behaviors in older adults.

Anorexia nervosa (AN) is a serious health condition with insufficient treatment options. Radically Open Dialectical Behavior Therapy (RO-DBT) offers a new treatment approach targeting maladaptive overcontrol, a proposed underlying mechanism in AN. This study evaluated the feasibility, acceptability, and the preliminary efficacy of a 32-week standard RO-DBT intervention for individuals with AN in an outpatient setting. Twenty-three participants with AN (median age 20 years; median illness duration 5 years; 95.7% female) were included. Feasibility was demonstrated by a high retention rate (83%) and satisfactory completion of outcome measures, while acceptability was demonstrated by high treatment satisfaction. Participation in RO-DBT was associated with significant reductions in eating disorder psychopathology (, Cohen's  = 0.90), significant increase in BMI (, Cohen's  = 0.74), and increased use of the emotion regulation strategy cognitive reappraisal (, Cohen's  = 0.70). These findings suggest that RO-DBT is a feasible, acceptable, and potentially effective treatment for AN.

Transgender and nonbinary (TGNB) individuals are at an increased risk for developing eating disorders (EDs) and ED-related symptoms. Despite this heightened vulnerability, research on clinical interventions is limited. This scoping review aims to map the extent and type of existing evidence related to clinical care and interventions for TGNB individuals with eating pathologies, while also focusing on the process and course of treatment at the individual level.

Telehealth-based intermediate level of care programs for eating disorders largely yield comparable outcomes to in-person settings. However, extant research is primarily based on programs that transitioned to virtual formats in response to the COVID-19 pandemic, rather than those intentionally designed for remote delivery. Additional research is needed to evaluate programs specifically created for telehealth environments (i.e. intentionally-remote) and to understand how outcomes vary across age groups. In this retrospective chart review, clinical outcomes at end-of-treatment for 116 patients enrolled in an intentionally-remote eating disorder treatment program were analyzed, including eating disorder symptomatology, quality of life impairment, depressive symptoms, trait anxiety, body mass index, and percentage of ideal body weight. Mixed ANOVAs revealed significant improvements (s < .001) from admission to discharge across all outcomes with large effects and no interaction by age, suggesting similar effectiveness across groups. By discharge, mean eating disorder symptomatology scores were below the clinical cut-off, quality of life impairment was within the minor to moderate range, depressive symptoms were mild, and weight restoration benchmarks were achieved for all age groups. While these findings support the potential of remote care as an accessible means of offering effective eating disorder treatment, further research is needed to determine generalizability to diverse populations, assess the impact of program features, and examine longitudinal outcomes.