Image- and video-based social media have been linked to body dissatisfaction and eating pathology, partly through increased appearance-based social comparison and self-focused attention. The Social Media Appearance Preoccupation Scale (SMAPS) assesses three behaviors relevant in this context: Online Self-Presentation, Appearance-Related Activity, and Appearance Comparison. Higher scores on these dimensions have been linked to more intensive social media use, increased anxiety, depressive symptoms, and disordered eating. However, research has largely relied on English-speaking, non-clinical samples. The present studies therefore aimed to translate and validate a German version of the SMAPS and to compare appearance-related social media behaviors between individuals with eating disorders and healthy controls. The scale was translated in a systematic translation-back-translation procedure and then examined in two cross-sectional studies. In Study 1, N = 363 young adults completed a survey with the aim of testing the factor structure of the German SMAPS and its associations with eating disorder pathology, general psychological distress, and problematic internet use. In Study 2, multivariate analysis of variance was used to compare German SMAPS scores between n = 21 outpatients with diagnosed eating disorders and n = 37 healthy controls. The three-factor structure of the German SMAPS showed acceptable model fit. All subscales exhibited good internal consistency (ω = 0.83-0.88). Of the three dimensions, Appearance Comparison was most strongly associated with eating disorder pathology and showed the most consistent associations with psychological distress and problematic internet use. It also significantly differentiated patients with eating disorders from healthy controls (p = .004, η²p = 0.14, 90
The systematic review by Sarda et al. synthesizes relationships among social media use, self-objectification, self-compassion, and body image concerns while evaluating evidence relevant to the revised objectification theory model proposed by Wollast and colleagues. This letter extends the authors' call for more rigorous examination of social media use by arguing for greater specificity in conceptualizing digitally mediated appearance experiences. Rather than treating social media as a single exposure or relying on a broad passive/active distinction, we propose examining configurations of content, communicative practices, interpersonal feedback, social comparison, and platform-level curation as "patterned communicative experiences." These experiences can be investigated through activity-specific measures, ecological momentary assessment, digital traces, content analysis, and longitudinal designs. Self-compassion should remain an intrapersonal psychological construct, while communication environments are better treated as contextual conditions that may facilitate or inhibit its activation. Integrating objectification theory, communication psychology, and social media literacy may therefore clarify when and how digital experiences contribute to body surveillance, body shame, and eating disorder risk.
Laboratory parameters and body weight are objective markers of physical stability in patients with severe and extreme anorexia nervosa. However, systematic analyses of trajectories during inpatient treatment with high-calorie refeeding and prophylactic phosphate supplementation remain limited in extremely underweight persons. Therefore, it is essential to gain a comprehensive understanding of changes in laboratory parameters, body mass index, and factors influencing these trajectories under this treatment approach in patients with severe and extreme anorexia nervosa, who are at particularly high risk of medical complications. Retrospective data of a six-week treatment period from 519 female inpatients of a specialized care unit with anorexia nervosa (body mass index at admission: M = 12.6 kg/m2, SD = 1.35) were analyzed. Laboratory parameters (hemoglobin, thrombocytes, leukocytes, aspartate aminotransferase, alanine aminotransferase, creatine kinase, sodium, potassium, and phosphate) and body weight were assessed weekly. More than one-third of patients showed leukopenia or hypertransaminasemia at admission. Most laboratory values and body mass index tended to ameliorate during the six-week treatment period. Lower body mass index at admission or longer illness duration was associated with larger changes in body mass index and several laboratory parameters (e.g., hemoglobin or aspartate aminotransferase). These findings provide a detailed characterization of laboratory changes during inpatient refeeding with prophylactic phosphate supplementation. The observed temporal patterns of laboratory stabilization may help inform individualized monitoring strategies and provide a basis for evaluating whether the frequency of routine laboratory testing can be tailored over a longer course of treatment according to clinical status and resolution of previous abnormalities. Furthermore, these findings may support the effectiveness and safety of inpatient refeeding protocols with prophylactic phosphate supplementation in patients with severe and extreme anorexia nervosa and an extremely low body mass index at admission (< 13 kg/m2). People with severe and extreme anorexia nervosa have very low body weight and often abnormal blood values, which are important signs of physical health. However, it is not well known how these values change during inpatient treatment with high-calorie nutrition and prophylactic phosphate supplementation. In this study, we looked at changes in body weight and blood test results over the first six weeks of treatment, as well as factors that might influence these changes. We analyzed data from 519 female patients. At the start of treatment, many patients had abnormal blood values. Over the six-week treatment period, most blood values improved, and patients gained weight. Patients with lower body weight or longer illness duration often showed greater changes. These findings improve our understanding of how blood values change during refeeding and may help clinicians decide how closely blood tests need to be monitored throughout treatment. They may also support the effectiveness and safety of inpatient high-calorie treatment with prophylactic phosphate supplementation, even for patients with very low body weight.
This commentary responds to Duggan, Hardy, and Waller’s systematic review and meta-analysis of cognitive-behavioural therapy (CBT) for outpatients with anorexia nervosa (AN). Although the review synthesises evidence of clinical benefit, it does not define, extract, or discuss iatrogenic harm or reasons for dropout. This omission limits what can be inferred from the review’s conclusions. Effectiveness and safety are distinct evidentiary domains: improvement in weight or eating disorder (ED) symptoms does not demonstrate absence of iatrogenic harm, especially when clinical trials have not systematically defined, monitored, or reported treatment-related risks. Evidence-based care requires not only evidence of effectiveness, but also evidence about safety. This commentary argues that evidence syntheses may produce an unduly favourable account of treatment impact when they quantify and emphasise benefit without equivalent attention to iatrogenesis, weakening informed consent and obscuring patient-reported experiences that may not be captured by symptom or weight outcomes alone. The paper considers methodological, clinical, ethical, epistemic, and intersectional implications of this asymmetry. It recommends that future ED clinical trials and systematic reviews evaluate benefit and harm together, undertake balanced assessments of benefits versus risks, use clearer harm definitions and patient-reported measures, report reasons for dropout, assess longer-term outcomes, and involve lived experience contributors substantively in study design, interpretation, and translation.
Abstract Background Muscle dysmorphia (MD) is characterized by an excessive concern of not being muscular enough. Sociocultural influences appear to play a central role in the internalization of muscular beauty ideals and the development of MD. No study has examined the potential mediating pathways from sociocultural pressure sources through internalized beauty standards to an algorithm-defined MD diagnosis in the general German population. Methods A cross-sectional survey was conducted among adults (≥ 18 years) in Germany via the Online Platform Prolific ® . Participants completed standardized questionnaires assessing sociocultural influences and internalization of different beauty standards (SATAQ-4R) and a clinically algorithm-defined MD, operationalized using criteria by Pope et al. [4], following the approach described by Mitchison et al. [14]. Data were weighted to approximate representativeness for the German population across the key demographics age and gender. Results In the total sample, a binary logistic regression indicated that internalization of the beauty standards Thin/Low body fat, Muscularity, and General Attractiveness significantly predicted algorithm-defined MD, whereas sociocultural pressure sources such as Family, Peers, Significant Others, and Media were not significant. In linear regression models, Media pressures predicted all forms of internalization, while Peer pressure predicted only Muscularity internalization. Mediation analyses indicated that internalization, particularly internalization of ideals of Muscularity, significantly mediated the relationship between Media and Peer pressures and algorithm-defined MD. Gender-specific analyses also showed Muscularity internalization as the key mediator for both men and women. In men, internalization of General Attractiveness ideals additionally mediated the relationship between Media pressure and MD. In women, only Family had a significant effect on algorithm-defined MD, mediated via Muscularity Internalization. Discussion Our findings highlight that internalization, particularly of the Muscularity ideal, appears to be a core mechanism linking sociocultural pressures to algorithm-defined MD. These results provide empirical evidence that interventions for MD need to focus on modifying internalized appearance ideals, especially the Muscularity ideal, to reduce MD symptoms in both men and women, with additional attention to General Attractiveness internalization in men.
Research has identified many risk factors, ranging from individual to sociocultural believed to contribute to the development of eating disorders. However, the majority of studies are quantitative and tend to focus on anorexia nervosa exclusively, while prioritizing the voices of experts over those with lived experience’s descriptions of causes. This is problematic because individuals with eating disorders have been found to hold different perceptions regarding the cause of their condition compared to individuals without an eating disorder. In this study, we address these gaps. We focus on the voices of individuals with lived experience rather than experts, take a qualitative approach to get richer, fuller accounts of individuals’ experiences than may be allowed by quantitative data alone, and investigate the onset of a spectra of eating disorders rather than limit focus to one particular type. The purpose of this qualitative study is to explore the perceived origins of eating disorders from the perspective of women with lived experience. We interviewed 21 women to elicit their eating disorder life story narratives. Women’s eating disorder life story narratives were analyzed using reflexive thematic analysis. Analysis identified two origin story themes: Eating Disorder as Response to Childhood Trauma (i.e., private threats to the self) and Eating Disorder as Response to Negative Social Self (i.e., public threats to the self). Taken together, these two origin story themes help situate women’s eating disorder beginnings in their private and public contexts. Study results are discussed as holding both academic and practical significance. Academically, this study advances eating disorder research in five ways. First, it extends research on eating disorder causes. Second, it advances the area’s feminist efforts. Third, it increases lived experience perspectives. Fourth, it accelerates the area’s reflexive turn. Fifth, it addresses diverse eating disorder experiences. Practically, study results hold utility for women with eating disorders and eating disorder professionals by better contextualizing women’s eating disorder beginnings and aiding in sense-making. Many risk factors contribute to the development of eating disorders, from individual characteristics to broader social pressures. Research in this area often prioritizes expert viewpoints and leans on quantitative methods. Here, we foreground lived experiences and shift the methodological approach. In this study, we listen to women who identify as having had an eating disorder and explore what they believe contributed to the development of their eating disorder qualitatively. Through analysis of interviews with 21 women, we found that the eating disorder originated as Responses to Private and Public Threats to the Self. The first theme, Eating Disorder as Response to Childhood Trauma, captures the ways participants traced the origins of their disorder to early life family trauma. In the second theme, Eating Disorder as Response to Negative Social Self, participants traced the beginnings of their eating disorder to public rather than private threats to the self, which we refer to as a negative social self. Taken together, these two themes help situate women’s eating disorder beginnings in their private and public contexts. Considering causes from the perspective of individuals with first-hand experience of the condition has become increasingly important in both research and clinical practice.
Abstract Background In response to individual and systemic barriers hindering the timely and effective treatment of eating disorders (EDs), the Australia & New Zealand Academy for Eating Disorders (ANZAED) introduced an eating disorder credential for clinicians in June 2022. The Credential aims to enhance treatment access, quality, and outcomes. While the Credential has been well received by stakeholders, its effectiveness from the perspective of those with lived experience of an ED needs to be more fully understood. The current study aims to explore the experiences and perspectives of people living with an ED in relation to their treatment experiences provided by Credentialed Eating Disorder Clinicians (credentialed clinicians) and non-credentialed clinicians. Methods An exploratory mixed-methods cross-sectional study was conducted involving 100 participants with personal lived experience of an ED. Participants were recruited via Australian eating disorder services and organisations, including the ANZAED and National Eating Disorders Collaboration (NEDC) membership databases, with recruitment information distributed through their email and social media platforms. Participants completed a survey with open- and closed-ended questions on their attitudes towards the Credential and experiences of treatment by a credentialed clinician or non-credentialed clinician. Descriptive statistics and Mann–Whitney U tests were used to examine differences in attitudes, treatment experiences, and helpfulness ratings between participants who had seen credentialed and non-credentialed clinicians, alongside inductive thematic analysis of open-ended survey responses. Results Irrespective of their own clinicians’ credentialing status, participants valued the Credential; almost two thirds identified that their most helpful treatment experience was with a credentialed clinician. Three themes were generated from open-ended survey responses that explored the treatment experiences of those with lived experience of an ED: (1) Expertise , Accessibility , and Continuity of Care , (2) A Collaborative Approach , and (3) Personalised and Effective Treatment Delivered with Understanding , Compassion , and Respect. Conclusions The current study adds to the ED literature by highlighting the perceived value of the ANZAED Eating Disorder Credential by individuals with lived experience. Further, it supports existing research that identifies clinician’s expertise, a collaborative approach to treatment, and the provision of individualised treatment as key factors contributing to positive treatment outcomes. However, barriers to accessibility, including the cost of treatment and availability of credentialed clinicians, remain and need to be addressed for individuals to receive the full benefits of the Credential.
Eating disorder treatment and recovery are often framed as matters of individual responsibility, with change positioned as dependent on the person’s motivation, insight, and willingness to recover. While agency remains important, this paper argues that such framings are too narrow and can obscure the wider conditions that shape both illness and the possibility of recovery. Drawing on ecological systems theory, ecosocial approaches to health, evolutionary psychiatry, and lived experience, this paper develops an account of eating disorders as phenomena that arise within interacting systems of biological vulnerability, interpersonal relationships, sociocultural pressures, institutional arrangements, and political economy. It argues that individualistic models of illness and recovery may contribute to shame, stigma, epistemic injustice, and what is described here as hyper-responsibilisation, particularly where care is fragmented, delayed, or unequally distributed. In contrast, an ecological perspective allows eating disorders to be understood as embodied and socially patterned forms of suffering that cannot be adequately addressed through individual behaviour change alone. The paper concludes that if eating disorders are ecological in their production and maintenance, then responsibility for responding to them must also be ecological. Recommendations are made to support more collective, relational, and structurally informed approaches to prevention, treatment, and recovery. Eating disorders are often talked about as if recovery mainly depends on the individual trying hard enough, wanting to get better, or being motivated to change. This paper argues that this is too simplistic. Eating disorders do not develop or continue only because of personal choices or psychology. They are shaped by a much wider set of influences, including biology, relationships, life experiences, social pressures, stigma, access to care, and the environments in which people live. Drawing on theory, research, and lived experience, the paper shows that recovery is also affected by whether people are recognised, believed, and supported in ways that fit their actual circumstances. When too much responsibility is placed on the individual, important parts of the picture can be missed and people may be blamed for struggles that are not fully within their control. The paper argues for a more collective approach, where responsibility for prevention, care, and recovery is shared more honestly across services, communities, and society.
Therapist actions, qualities and strategies are a potentially modifiable factor influencing outcome in psychological therapies for eating disorders. This study aims to hear the perspectives of those with lived experience, to identify therapist actions and behaviours which were helpful or unhelpful in change and recovery, and to construct a theory of the processes by which these therapist actions might impact on recovery. Eighteen participants who had undergone various psychological therapies for EDs took part in semi-structured interviews. They described helpful and unhelpful therapist behaviours, their emotional and cognitive impacts, and how these influenced recovery. Using a constructivist grounded theory approach, data were analysed through initial and focused coding, comparative methods, theoretical sampling, and memo-writing to develop a theoretical model. Participants described two interacting major categories of therapist actions, strategies and qualities: therapist ‘style and stance’ along with ‘tasks of therapy’. These were described as having some direct pathways of influence on ‘change processes and recovery’, but also acted through three core categories of interacting intervening processes: ‘the person seen heard and cared for’, ‘trust and openness to therapy’ and ‘turning towards change’. These processes are the core of the model, acting to catalyse (or block) change. Elements of therapist style and the tasks of therapy influence recovery both directly and through key intervening processes: feeling seen, heard and cared for; developing trust and openness to therapy; and turning towards change. The constructed model and categories are considered in light of psychotherapy theory. The identified aspects of therapist style and tasks are relevant to clinicians and can inform the co-production of guidance for future use in training and delivery of ED therapies. Therapists play an important role in helping people recover from eating disorders, but we still know relatively little about which therapist behaviours are most helpful, and how they support change. This study explored these questions by listening to the experiences of people who had received psychological therapy for an eating disorder. Eighteen adults took part in in-depth interviews about what their therapists did that helped or hindered their recovery, how this made them feel and think, and how it influenced their willingness and ability to change. We analysed these interviews to develop a model explaining how therapist actions may affect recovery. Participants described two main aspects of therapy that mattered: the therapist’s style and personal approach (such as warmth, respect, and collaboration) and the tasks of therapy (what the therapist focused on). These influenced recovery both directly and by shaping three key experiences: feeling seen, heard and cared for; developing trust and openness to therapy; and turning towards change. These findings highlight therapist behaviours that may help create the conditions needed for recovery and can inform future training and delivery of eating disorder therapies.
Eating disorders are prevalent among young women and entail negative personal and societal consequences. Investing in prevention programs could make a meaningful difference. The Body Project is a dissonance-based prevention program with extensive empirical support for improving eating disorders’ symptomatology, risk factors, and protective factors. This study is the first to evaluate the efficacy and feasibility of the Body Project in Portugal. It is also the first to explore long-term modality differences in efficacy and whether matching participants to their preferred modality moderates intervention outcomes. A total of 147 female university students with body concerns, aged 18 to 30 years, were randomly assigned to one of the peer-led Body Project interventions –in-person or virtual – or to a waitlist control. Participants in the in-person and virtual Body Project reported high satisfaction with the intervention and showed significant improvements from pre- to posttest across outcomes compared to the waitlist, except for self-esteem in the virtual group. Improvements remained significant at 6- and 12-month follow-ups, except for negative affect and dieting behaviors at 12-month follow-up in the in-person group. While both interventions produced comparable outcomes, the in-person group showed larger immediate reductions in eating disorder symptomatology, whereas the virtual group showed delayed reductions. Matching participants to their preferred modality significantly moderated the effect of delivery modality on changes from pre- to posttest in thin-ideal internalization, dieting behaviors, eating disorder symptomatology, and body appreciation. Exploratory analyses suggested that matched participants tended to show larger gains in the in-person intervention, whereas unmatched participants tended to show larger gains in the virtual intervention. Implications, limitations, and recommendations are discussed. Eating disorders are relatively common among young women and can seriously affect quality of life and increase societal costs, making prevention important. This study tested the Body Project, a group intervention designed to improve body image and eating-related problems, in Portugal, for the first time. It also compared whether the program works differently when delivered in person or virtual, and whether participating in the preferred delivery format makes a difference. A total of 147 female university students with body concerns were placed into an in-person, virtual, or waitlist control group. Both delivery formats were well received and led to improvements in body image and eating-related problems compared to the control group. Overall, these improvements were maintained for up to one year. However, the virtual group took longer than the in-person group to achieve similar results in eating-related problems. In the in-person group, participants tended to improve more when they got the format they preferred, while in the virtual group, those who did not get their preferred format tended to improve more.
Avoidant restrictive food intake disorder (ARFID) was introduced to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 and current guidelines recommend multidisciplinary care, however there are few evaluations of such pathways. This study aims to enhance the study stage of the plan-do-study-act (PDSA) cycle using qualitative methods to improve the development, refinement, and implementation of a novel pilot ARFID pathway in a community eating disorder service. Semi-structured interviews were conducted with 17 participants with experience of the pathway (7 service users:10 staff members) according to an interview schedule. Reflexive, codebook thematic analysis was used to analyse the interview data. Gaps in understanding and treating ARFID were revealed, leading to feelings of uncertainty and frustration. The establishment of a specialist multidisciplinary team (MDT) improved knowledge and efficiency but created challenges related to team integration and resource allocation. Barriers for service user engagement and communication demonstrated the need for service user consultation and pathway co-creation. Service user consultation, treatment adaptations for neurodiversity and cross-service working were identified to improve the pathway as part of the act stage of the PDSA cycle. Future ARFID pathways should prioritise service user agency and access to multidisciplinary care and incorporate consultation from external eating disorder service, as well as lived experience experts. People who have avoidant restrictive food intake disorder (ARFID) have very limited diets and struggle to eat enough or certain kinds of food. This can cause problems with their health and daily life. A new pilot pathway in a community eating disorder service was set up to help adults with these eating difficulties. To help improve this pathway we asked patients and staff what they thought about it. Seven patients and ten staff members were interviewed, and we organized what they said into key messages. Both staff and patients said they were often unsure about what might be most helpful for people with ARFID. Having a team of different professionals made things easier, but it also brought some challenges. Patients said it was important to be involved in planning their care. The study shows that care works best when patients are listened to, teams work together, and support is flexible to fit each person’s needs.
Since the COVID-19 pandemic there has been a rise in the incidence and severity of eating disorders (ED). The Hospital of the University of Pennsylvania (HUP) and University of Michigan Hospital System (UMHS) have similarly seen a rise in the incidence and severity of patients admitted with eating disorders. Until 2023, no formal pathway existed for the treatment of malnutrition in adult patients with ED at either hospital system. The Consolidated Framework for Implementation Research (CFIR) was used by program leads at both HUP and UMHS for the identification of barriers and facilitators influencing the implementation of a treatment pathway for adult patients with eating disorders admitted to the medical floors. The pathways at UMHS and HUP were overall remarkably similar and many of the same barriers and facilitators impacting the implementation of the treatment pathways were identified within both programs. Both programs consist of care bundles involving structured, observed meals with daily calorie goals for patients, frequent electrolyte monitoring, and daily blind weights. These treatment pathways address the treatment of malnutrition in adults with eating disorders admitted to inpatient medical floors in general hospital settings with no prior history of eating disorder expertise, and both have been successfully implemented at HUP and UMHS thereby providing much-needed services for this patient population. The manuscript expands on existing literature by describing the facilitators and limitations of the implementation of an eating disorder protocol in a general adult hospital setting. Both the Hospital of the University of Pennsylvania and the University of Michigan Hospital System have seen a rise in the incidence and severity of adult patients with a diagnosis of an eating disorder admitted to medical floors with malnutrition. In response, both hospitals implemented pathways to treat malnutrition for these adult patients on the medical floors. This manuscript explores the remarkably similar facilitators and barriers to the implementation of these pathways at both hospital systems. These treatment pathways address the treatment of malnutrition in adults with eating disorders admitted to inpatient medical floors in general hospital settings with no prior history of eating disorder expertise.
Carers of individuals with eating disorders (EDs) often experience high levels of psychological distress, which can lead to anxiety and depressive symptoms. While several interventions have been developed to support carers, the effectiveness on their mental health remains unclear. We performed a systematic review of randomized controlled trials (RCTs) assessing mental health interventions for carers of individuals with EDs, with anxiety and depressive symptoms defined as outcomes of interest. Searches were performed across major electronic databases up to 31 October 2025. Twelve RCTs met the inclusion criteria. Structured narrative synthesis indicated that statistically significant effects were infrequent, outcome-specific, and generally small in magnitude. Interventions based on the Cognitive-Interpersonal Maintenance Model (CIMM) were the most frequently evaluated. However, only one trial demonstrated significant improvements in depressive symptoms (p = 0.010), with no significant effect on the Depression Anxiety Stress Scale (DASS-21) total scores (p = 0.06) or on the anxiety subscale (p = 0.50). In addition, Cognitive Behavioural Therapy (CBT)-based interventions showed some promising effects on the Hospital Anxiety and Depression Scale (HADS) total score (p = 0.033), but these results were not consistently replicated across guided and unguided formats. Among the other approaches, a video-based skills-training intervention produced a measurable reduction in carer distress, but this effect was observed only when combined with professional support (p = 0.030). Overall, interventions incorporating professional or peer support appeared more promising than fully self-directed approaches, although direct comparisons between guided and unguided formats did not consistently show statistically significant differences. Quality assessment showed at least an average standard of quality for all the included trials. Interventions for carers of individuals with EDs are conceptually well-founded, yet current evidence provides only limited support for their effectiveness in reducing anxiety and depressive symptoms. Future research should prioritize interventions that combine more structured mental health strategies with guided self-help programmes and workshops, providing tailored support to address the various needs of carers. Caring for someone with an eating disorder can be emotionally overwhelming and may affect the carer’s own mental health. This review looked at whether support programmes for carers can help reduce feelings of anxiety, low mood, and emotional strain. We examined studies that tested different kinds of support for carers, including online programmes, workshops, guided self-help, and skills-based training. Overall, these interventions were often helpful in giving carers information, practical strategies, and a better understanding of how to support their loved one. However, the evidence that they improve carers’ own anxiety and depression was limited. Indeed, only a few studies showed significant benefits, and these were usually small, specific to one outcome, or observed only when additional professional support was provided. Programmes that included guidance from a professional or trained supporter seemed more helpful than those completed alone. This suggests that carers may benefit most from support that is not only informative, but also personal and interactive. More research is needed to develop programmes that directly support carers’ mental health, while also helping them care for someone with an eating disorder.
Individuals with anorexia nervosa are at increased risk of renal impairment, but assessing renal function in this population remains challenging. Cystatin-C, which is less affected by nutritional status than creatinine, may provide a more reliable biomarker. However, equations based on cystatin-C (CKiD‑U25, EKFC, and CKD-EPI) have not yet been evaluated against isotopic scintigraphy in individuals with anorexia nervosa. This study aimed to compare the performance of creatinine-based and cystatin-C-based equations (CKiD-U25, EKFC, CKD-EPI) against 99mTc-DTPA renal scintigraphy as the reference standard in adolescents with restrictive anorexia nervosa. Glomerular filtration rate was measured using renal scintigraphy and estimated with creatinine-based and cystatin-C-based equations. Serum cystatin-C and creatinine were measured at hospital admission (day 0), whereas renal scintigraphy was performed as soon as feasible after admission (mean of 5 days), in adolescents with restrictive anorexia nervosa. Correlation coefficients, mean bias, root mean square error, and Bland–Altman plots were assessed. Across all equations, cystatin-C-based formulas consistently outperformed creatinine-based ones in terms of correlation, bias, and precision. The CKiD-U25 using cystatin-C equation showed the strongest correlation with renal scintigraphy (r = 0.77; bias = – 11.5 mL/min/1.73 m2). At admission for restrictive anorexia nervosa, cystatin-C-based equations, particularly the CKiD-U25, demonstrate superior agreement with renal scintigraphy compared to creatinine-based equations, making cystatin-C-based equations more reliable in this context. Individuals with anorexia nervosa are at higher risk for renal problems, but it can be difficult to measure how well their kidneys are functioning. The most common test uses a blood marker called creatinine, which depends on muscle mass and protein intake. Another blood marker, called cystatin-C, is not affected by muscle mass loss and or protein intake and may provide a more accurate result. In this study, we compared several methods of estimating renal function in adolescents hospitalized for anorexia nervosa. We found that equations using cystatin-C were more reliable than those using creatinine. Among these, the CKiD-U25 formula proved to be the most effective. Our results suggest that formulas using cystatin-C could be useful for estimating renal function in adolescents hospitalized for anorexia nervosa.
Anorexia nervosa (AN) is an eating disorder (ED) characterised by restrictions in energy intake, intense fear of weight gain and distorted body image. AN may coexist with attention-deficit/hyperactivity disorder (ADHD), a neurotype characterised by differences in attention and/or impulsivity and hyperactivity. Despite increasing recognition of neurodivergence in EDs, the co-occurrence of ADHD and AN remains markedly under-researched. Clarifying their interaction will improve diagnostic accuracy, tailor treatments, and ultimately enhance outcomes for individuals living with both neurobiological profiles. The objective of this study is to investigate how features of ADHD and AN influence the lived experience of adults with both profiles. Fifteen adults with co-occurring ADHD and AN participated in semi-structured interviews exploring how features of each profile shaped their experience. Qualitative data was analysed using Braun and Clarke’s reflexive thematic analysis. Four themes were developed. The interaction and overlap of features of ADHD and AN as well as challenges teasing the two apart was central for participants. ADHD and AN features were intentionally and unintentionally instrumentalised, perpetuating the co-occurring profile and making participants’ experiences of co-occurring ADHD-AN challenging to navigate. Participants experienced profound shame resulting from ADHD-related systemic factors which in some cases appeared to predispose them to the development of AN. Overall, participants emphasised the importance of making ADHD-AN visible, highlighting the need for both this research and clinical attunement and dexterity to support individual patient experiences. To our knowledge, this is the first qualitative study providing evidence of how the features of ADHD and AN interact. The findings emphasise shared challenges in living with the co-occurring profiles, highlighting the need for increased understanding and greater recognition of ADHD-AN. This research explores the lived experiences of adults with both Attention-deficit/hyperactivity disorder (ADHD) and Anorexia Nervosa (AN). While it is increasingly recognised that these two profiles often occur together, very little research has looked at how the two interact and affect a person’s daily life. To investigate how ADHD and AN interact, researchers interviewed 15 adults with a lived experience of both profiles. Findings show that features of ADHD can influence AN and vice versa, making the presence of both profiles challenging to navigate for both people with a lived experience and the clinicians working with them. Participants particularly highlighted how the features of ADHD can make the symptoms of AN worse, how AN can in some circumstance improve ADHD related challenges and in other cases worsen them and the importance of health professionals better understanding the overlap in order to improve diagnosis and support. As the first study to explore the lived experience of the interaction between ADHD and AN, this research highlights the nuanced interaction between the two profiles, revealing the specific challenges faced by people living with both, and calls on health providers to increase their awareness and understanding of these issues.
Abstract Background Avoidant/Restrictive Food Intake Disorder (ARFID) is a possible comorbidity in patients with Inflammatory Bowel Disease (IBD). Early detection and intervention are crucial to prevent malnutrition and related complications. However, ARFID often remains undiagnosed due to its subtle presentation. Methods: This multicenter study enrolled 235 patients with IBD at German tertiary referral centers between March and September 2025. The Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS), a screening tool for ARFID, was translated into German and administered at baseline and follow-up. The validity and reliability of the NIAS German were assessed via hypothesis testing and Cronbach’s α coefficient. Results The NIAS German demonstrated excellent internal consistency (Cronbach’s α = 0.810) and test-retest reliability (p < 0.001). A significant correlation was found between the initial and follow-up NIAS scores for all items (p < 0.001). Furthermore, the intraclass correlation coefficient of 0.896 (95% CI: 0.846–0.931) confirmed the reliability of the German questionnaire version. Notably, women with IBD scored significantly higher on the NIAS and its subscales, indicating a greater likelihood and severity of ARFID symptoms, as screened by the NIAS (Md [IQR]: women = 13 [7–17]; men = 10 [6–15]; p = 0.007). Conclusions The German version of the NIAS demonstrated good reliability and initial evidence supporting its use as a screening instrument in German-speaking men and women with IBD. The findings of this study highlight the importance of sex-specific assessment and suggest that IBD women may be at higher risk of developing ARFID. Early detection and targeted interventions are essential to prevent malnutrition and related complications in this vulnerable population.
Eating disorders are a global health concern, yet research in this field has historically been underfunded and sometimes perceived as “niche”. To attempt to address these challenges, the international charity Consortium for Research in Eating Disorders (CoRe-ED) was launched in September 2024. CoRe-ED aims to promote innovations in eating disorders research by empowering all voices and supporting the development of new therapies. The present study examined the characteristics of individuals who joined CoRe-ED over the first 15 months, their engagement with consortium initiatives and their expected benefits and experiences. Between 25 September 2024 and 31 December 2025, CoRe-ED registrants completed an online registration form and consented to the use of deidentified, aggregated data for research. Data were analysed for registrant characteristics, including primary country of residence and role(s) (e.g., researcher, health professional, lived experience), and for perceived expectations and experiences, using inductive thematic analysis. Survey feedback from ten CoRe-ED events, engagement with collaborative CoRe-ED initiatives, and an overarching survey capturing overall registrant experiences were also analysed. A total of 960 individuals from 37 countries across five continents registered with CoRe-ED, representing researchers, health professionals, individuals with lived experience, advocates, not-for-profit representatives and industry professionals. Registrants’ expectations included networking and community building, research contribution and collaboration, learning and professional development, advocacy, facilitation of innovation, integration of lived experience into research, global collaboration and mentorship. CoRe-ED also implemented a structured “Next Big Research Idea” initiative, which involved 18 internationally distributed multidisciplinary teams across 20 countries in collaborative research proposal development. Event-specific and overall feedback indicated high satisfaction with CoRe-ED activities, particularly valuing the diversity of presenters, global perspectives, inclusive environment and opportunities to learn and connect. Over the first 15 months, CoRe-ED engaged a diverse, international registrant group and developed activities consistent with early registrant expectations. The consortium implemented initiatives intended to support cross-disciplinary research collaboration, knowledge exchange and innovation, while expanding international representation. Future research should examine longer-term experiences, including impacts on research outputs, mentorship, co-design and policy translation, to better understand how the consortium evolves in response to the needs of its international community. Eating disorders are a global health concern, but research and support in this area are limited. To attempt to address this, the international charity Consortium for Research in Eating Disorders (CoRe-ED) was launched in September 2024 to bring together people from different countries, professions and experiences. Over the first 15 months, 960 individuals from 37 countries joined, including researchers, health professionals, people with lived experience, advocates, not-for-profit workers and industry representatives. Registrants reported wanting to build networks, contribute to research, access learning and professional development, engage in advocacy, support innovation, integrate lived experience into research, participate in global collaborations and receive mentorship. CoRe-ED also launched a “Next Big Research Idea” initiative, which brought together 18 multidisciplinary teams across 20 countries to develop collaborative eating disorders research proposals. Feedback on events and the overall consortium was very positive, with registrants highlighting the diversity of presenters, inclusive environment, global perspectives and learning opportunities. These findings potentially suggest CoRe-ED engaged a diverse, international group and implemented initiatives aligned with registrants’ expectations. Future research should examine longer-term experiences to better understand how the consortium responds to the needs of its international community.
The study aims to conduct a bibliometric analysis of eating disorders in adolescents. In this study, the terms TS=(“adolescent” OR “youth” OR “teenagers” OR “adolescence”) AND (eating disorder OR anorexia nervosa OR bulimia nervosa) were systematically searched in the Web of Science database. The R bibliometric package was used to analyze the search results. This study systematically maps the field for the period 2016–2025 by employing co-authorship, bibliographic coupling, keyword co-occurrence, and citation analyses to identify leading contributors, publication outlets, countries, influential works, and thematic structures. The analysis covered the period from 2016 to 2025, with publication numbers fluctuating over the years. The number of publications peaked in 2021. Research activities were concentrated in the United States, Germany, Australia, and Canada. The leading journals included the International Journal of Eating Disorders and the Journal of Eating Disorders, followed by Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, European Eating Disorders Review, and Eating Behaviors. Frequently used keywords included anorexia nervosa, eating disorders, adolescents, and bulimia nervosa. This bibliometric analysis demonstrates that the literature on eating disorders in adolescents has evolved over time in response to global events, research funding, and changing clinical priorities. In particular, publication output increased markedly during the COVID-19 pandemic period, with the most prolific authors focusing on key topics such as family-based treatment and eating disorders in males. Countries including the United States, Germany, Australia, Canada, and the United Kingdom emerged as leading contributors in terms of research productivity. Additionally, publications were largely concentrated in a limited number of core journals with high impact factors.
Studies on eating disorders (EDs) examining differences in the perception of family structures among patients with anorexia nervosa (AN) and bulimia nervosa (BN) are rare. In particular, intrafamilial differences in the assessment of family functioning and their potential therapeutical consequences remain underrepresented in current research. Our sample comprised 540 patients diagnosed with ED and their parents, including 184 mothers and 156 fathers, who participated in the FamFINED study. Using the total score of the General Family Questionnaire (Allgemeiner Familienbogen; FBa), we compared the perceptions of family functioning among patients diagnosed with AN (n = 269) or BN (n = 271) including their respective parents. Among the study cohort, significant correlations were found between the total FBa scores of patients and their mothers (n = 180, r = 0.186, p = 0.012) as well as between patients and fathers (n = 155, r = 0.440, p < 0.001). Furthermore, the total FBa score was significantly linked to the difference to the desired weight (n = 449, r = 0.174, p < 0.001). Individuals with BN perceived greater family dysfunction, as indicated by a significantly higher total FBa score, compared to those with AN (59.37 ± 6.97 vs. 57.77 ± 8.28, p = 0.015). Similarly, mothers and fathers of AN patients reported lower total FBa scores than the parents in the BN group, but these differences did not reach statistical significance. Multiple linear regression analysis adjusted for patient age, body-mass index (BMI), presence of siblings, and highest educational attainment confirmed the significant association between the patient´s total FBa score and ED diagnosis (β = 1.92, 95
Anorexia Nervosa (AN) can be a complex condition to treat, often complicated by high chronicity, complexity and comorbidity. Treatments for AN with comorbidity and complexity are limited, with carers having to take a large role in supporting these individuals. Carer distress can be high, impacting carer wellbeing and contributing to familial dynamics which can also perpetuate AN behaviours as a way of coping. This study evaluated a novel carers group, the CAREFREE programme, for the specific needs of carers of Moderate to Severe AN (MS-AN: adults with AN who have not responded to previous treatments, have a complex comorbidity, and/or complex aetiology), using schema therapy-focused coaching to improve carer distress and family functioning. A non-concurrent group case series design was employed. Outcome measures included carer distress, expressed emotion, family functioning and communication, mood, and attachment-related anxiety and avoidance. Outcomes were analysed at 4-timepoints, (i.e. pre-intervention, mid-point [6 weeks], post-intervention [12-weeks] and 3-month follow-up), using multi-level modelling. 53 carers commenced the programme in the study across 5 groups. Carer distress, expressed emotion, family functioning, mood and attachment-related avoidance significantly improved after the end of the group and remained significantly improved at follow-up. Attachment-anxiety did not lead to statistically significant changes, although a trend of improvement was seen. Preliminary evidence suggests improvements in carer wellbeing and family functioning following participation in the CAREFREE programme for carers of MS-AN. Attachment outcome measures that did not lead to statistically significant change may be related to the time-limited nature of the intervention and the group intervention itself, with greater change in attachment outcomes often requiring individualised and more intensive interventions. Future research is required to explore what impact this has on patient outcomes. Trial registration This study was registered with clinicaltrials.gov (ClinicalTrials.gov ID: NCT06624397). This study evaluated a specialist intervention for carers of adults with moderate to severe anorexia (MS-AN), whereby individuals may have suffered from the illness for several years and/or experience additional complex mental or physical health diagnoses alongside their eating disorder. A novel 12-session online group programme was developed to target the specific needs of parents and partners in their role as carers for adults with MS-AN. The programme provided an opportunity for carers to gain an in-depth understanding of MS-AN and their own experience of burnout through the lens of ‘parts’ of self, including coping mechanisms that emerge in response to unmet emotional needs. A range of therapeutic tools were incorporated to facilitate healthy coping and to enhance communication with the person with MS-AN. Results showed that carers rated positive improvements in distress, mood, and family functioning over the course of the programme. Further, unhelpful communication patterns statistically significantly reduced. Future research is needed to compare this programme with other carers interventions to better understand its benefits for carers of MS-AN.
