OBJECTIVE:Chronic malnutrition, hypothermia, and hormonal imbalance in anorexia nervosa (AN) may impair capillary structure and perfusion. This study aimed to describe the nailfold videocapillaroscopy (NVC) findings in adolescents with AN and atypical AN (AAN), to assess their association with Raynaud's phenomenon (RP), and evaluate longitudinal capillary changes following medical remission. METHODS:We evaluated the NVC findings of 26 adolescents with AN, 24 with AAN and 9 with primary RP as a control group (12-18 years). Additionally, 23 patients with AN and AAN were reevaluated after achieving medical remission and weight restoration. RESULTS:While both the AN and AAN group had significant capillary changes, most NVC parameters were comparable between the groups, except for a higher prevalence of early scleroderma pattern in AN (p = 0.037). RP was associated with higher enlarged capillary scores in AN (p = 0.018) and higher prevalence of early scleroderma pattern in AAN (p = 0.007). Univariate analysis showed vital instability significantly heightened odds of having hemorrhages (OR = 5.79), giant capillaries (OR = 3.93) and tortuosity (OR = 3.82). Longitudinal assessment showed improvement in almost all capillary changes, with all early scleroderma patterns completely resolving after medical remission (p = 0.001). DISCUSSION:Our findings suggest the presence of microvascular alterations in adolescents with AN, particularly during the acute phase. Although weight restoration improved microvascular changes, long-term monitoring is necessary to determine whether all findings resolve over time or there is an increased risk of developing sequelae in the future.
OBJECTIVE:Theoretical models and empirical research suggest that identity plays a pivotal role in the development of anorexia nervosa (AN), however, limited research has been conducted on how identity is connected to the expression of eating disorder (ED) symptoms. One possible connecting mechanism is body image disturbance (BID). As such, the current study aimed to investigate the potential mediating role of BID between identity disturbance and ED symptoms in those with AN. METHOD:A sample of 178 women with self-reported current AN or partially recovered AN (with persistent psychological symptoms) completed measures of identity disturbance (Self-Concept and Identity Measure), BID (Body Image Disturbance Questionnaire), and ED symptoms (Eating Disorders Examination Questionnaire). A structural equation modelling approach was used, considering scales rather than items for the measurement models due to sample size. RESULTS:Identity disturbance was found to be significantly related to ED symptoms and BID was found to partially mediate the relationship between identity disturbance and ED symptoms. DISCUSSION:Findings suggest BID plays a mediating role between identity disturbance and ED symptoms in those with AN, highlighting the importance of body image in the relationship between identity and AN along with the potential usefulness of targeting these concepts in treatment.
OBJECTIVE:To characterise the clinical and phenotypic profile of the Comprehensive Risk Evaluation for Anorexia nervosa in Twins (CREAT) cohort, identify candidate risk and illness-related correlates of AN, and establish a foundation for forthcoming biological, neuroimaging, endocrinological, and microbiota studies. METHODS:MZ twins discordant for lifetime AN (44 individuals) and control MZ twin pairs (42 individuals) were recruited. Analyses included total-sample associations with AN, between-group comparisons (affected, unaffected co-twins, controls), and within-pair analyses of discordant twins. RESULTS:Affected twins, most of whom were weight-restored and non-acute, differed markedly from unaffected co-twins and controls. Lifetime AN was associated with higher perfectionism, goal-directed drive, neuroticism, behavioural inhibition, impulsivity, broader psychiatric symptoms, teasing history, autism symptoms, and lower quality of life. Within-pair analyses implicated perfectionism, goal-directed drive, and competency-related teasing as candidate individual-specific risk factors for AN, with evidence of additional associations with impulsivity, behavioural inhibition, neuroticism, broader psychiatric symptoms, and autism symptoms. CONCLUSION:Findings support a multifactorial model of AN involving individual-specific influences and shared familial liability. Perfectionism, goal-directed drive, and competency-related teasing emerged as candidate individual-specific risk factors, while the pattern of elevations, with unaffected co-twins often falling between affected twins and healthy controls, suggests that several clinical and phenotypic features may reflect familial liability for AN.
BACKGROUND:Carers are essential in their young person's recovery during transition from child to adult eating disorder services. Despite recommendations, carer's own needs can be overlooked in transition planning. Subsequently, carers experience distress in supporting their young person and navigating the transition. This study is part of the initial phase of a larger co-production project aiming to develop a new intervention supporting young people with eating disorders and their families in transitioning to adult services. This study explored the lived experiences of carers to deepen our understanding of carers experiences and needs during the transition. METHOD:Eleven semi-structured interviews were conducted online, with carers who had experience of their young person transitioning from child and adolescent to adult eating disorder services, across two NHS sites in England. RESULTS:Reflexive Thematic Analysis was used to analyse the data and five key themes were generated: (1) the forgotten stakeholders, (2) navigating the transition in the dark, (3) managing the intricacies of transition, (4) a plethora of service criteria and (5) negotiating the power dynamics. CONCLUSIONS:Carers continue to articulate concerns that corroborate and reinforce the wider transitional care literature, with few carers feeling supported in the process. Prioritising the co-development of interventions supporting carers wellbeing during transition is key to ensure carers distress is not perpetuated.
BACKGROUND:Disordered eating behaviours (DEBs) can be normalised by elite sports values and norms, obscuring risk for DEBs. OBJECTIVES:This scoping review mapped (1) how DEBs are conceptualised in elite sport, (2) the values, norms, and institutional mechanisms that normalise them, and (3) the barriers that obstruct recognition and care. METHODS:The search was conducted using Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, encompassing eight databases with no date limits. A protocol was registered; 3497 records were screened (1153 duplicates were removed), 283 full texts were reviewed, and 128 studies were included. RESULTS:Study designs are largely crosssectional, based on self-report, and variably specific to particular sports. (1) DEBs are framed as a continuum ranging from functional practices to pathology, with tipping points linked to seasonality, injury and selection processes. (2) Normalisation mechanisms of DEBs stem from sports-specific values and norms, constituting an elite sporting ethic, body ideals, coach/team culture, institutional surveillance and public/media scrutiny. (3) Barriers for assessment and help-seeking include the moralisation of restrictive behaviours, stigma, 'toughness' norms, knowledge gaps, coach gatekeeping, organisational constraints and gendered assumptions. CONCLUSIONS:System-level safeguards are needed and athlete-centred, protective initiatives should be prioritised over performance-oriented outcomes. Future research should prioritise longitudinal designs, elite sports-sensitive measures, and equity-oriented sampling.
OBJECTIVE:Reinforcement learning has been implicated in eating disorders, but findings remain inconsistent. This study compared reinforcement learning performance in anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC) using the Probabilistic Reward Task (PRT), and explored clinical, cognitive, and metabolic correlates. METHOD:The sample included 31 AN, 20 BN, and 25 HC participants. PRT performance, working memory, and pre-task blood glucose were assessed. Group differences were tested using ANOVA and repeated-measures GLM. Exploratory correlations and follow-up regression examined correlates of response bias indices. RESULT:Groups did not differ in total response bias or change in response bias, and no block or block × group effects emerged for response bias. Discriminability changed across blocks, but similarly across groups. Accuracy and reaction times did not differ. In AN, blood glucose was positively associated with change in response bias, and this association remained significant after correction. Follow-up regression showed that blood glucose explained 46.7% of the variance in change in response bias. DISCUSSION:Findings do not support generalized diagnostic differences in reward-based response bias in AN or BN. However, the association between blood glucose and response bias change in AN suggests that acute metabolic context may influence reward-related task performance.
OBJECTIVE:This qualitative study aimed to explore paediatric providers' perspectives on the acceptability, feasibility, and appropriateness of the Transition Intervention for Eating Disorders (TIDE) within existing specialised paediatric eating disorder (ED) programs to inform its refinement and implementation in real-world clinical settings. METHOD:A Qualitative Description study was conducted in Ontario paediatric ED programs; clinicians and administrative staff participated in virtual focus groups and transcripts were analysed inductively using conventional content analysis. RESULTS:Twenty-four staff from five Ontario paediatric ED programs participated. TIDE was viewed as valuable and addressing unmet transition needs. Providers endorsed its components but emphasised tailoring to developmental readiness, family structures, and local service contexts. Peer support, structured transition meetings, navigation resources, and primary care involvement were seen as beneficial. Feasibility concerns centred on limited staffing, time, and coordination infrastructure, with many indicating willingness to implement selected components rather than the full model. CONCLUSIONS:TIDE was considered a promising framework, but successful implementation depends on contextual adaptation and organisational support. Flexible delivery that preserves core functions of TIDE may enhance its scalability and improve continuity of care for youth transitioning to adult ED services.
BACKGROUND:Anorexia nervosa (AN) is often characterised by high levels of shame and self-criticism. Compassion-Focused Therapy (CFT) is a transdiagnostic intervention targeting these emotional vulnerabilities, yet its application in adolescent eating disorder services remains underexplored. METHODS:This project examined a group-based CFT intervention delivered within an Intensive Day Treatment Programme at a specialist, outpatient child and adolescent eating disorder service. Quantitative outcomes were assessed using the Self-Compassion Scale (SCS) and Adolescent Shame-Proneness Scale (ASPS). Qualitative feedback was also collected and analysed using conversational content analysis. RESULTS:Twenty-eight adolescents with restrictive eating disorders completed a brief CFT group between April 2024 and February 2025. Statistically significant improvements were observed in self-compassion (particularly reductions in uncompassionate self-responding) and subscales related to self-judgement, isolation, and over-identification (all p < 0.001). No significant changes were found in shame-proneness (p = 0.107). Qualitative analysis identified themes of increased emotional insight, reduced self-criticism, and appreciation for the group's sensory and reflective elements. Some participants reported challenges related to session length and the application of self-compassion in daily life. CONCLUSIONS:Findings suggest that CFT may enhance self-compassion in adolescents with AN and may serve as a valuable adjunct to existing treatment pathways. Further controlled trials are recommended to evaluate long-term outcomes and optimise integration into routine care.
BACKGROUND:Loss-of-control eating (LOCE) is present across multiple eating disorder (ED) diagnoses and is associated with greater eating pathology in the general population. Initial research suggests differences in motivation to approach rewards in individuals with LOCE, but few studies directly compare disorder-relevant and general rewards. The current study explored motivation for food and monetary rewards in women with and without LOCE. METHODS:Undergraduate women with LOCE (n = 23) and no ED symptoms (n = 24) completed food and money versions of the Effort Expenditure for Rewards Task (EEfRT). On each trial, participants chose between a low-effort/low-reward task and a high-effort/high-reward task with varying levels of reward and probability. RESULTS:Participants with LOCE showed greater effort exertion for money with medium (but not low or high) probability of receipt compared to controls. Participant groups did not differ in their performance on the food EEfRT. CONCLUSIONS:These results suggest that individuals with LOCE will work for a larger monetary reward with a lower probability of receipt compared to controls, indicating heightened motivation for non-food rewards. Future research should explore whether individuals with LOCE show alterations in other aspects of reward processing across stimuli to more precisely identify reward-related treatment targets.
OBJECTIVE:Autistic people with an eating disorder (ED) report more negative experiences of ED treatment and are at greater risk of requiring higher intensity services. Current ED treatment options do not fully meet underpinning drivers of autistic people's experiences of EDs. There remains little guidance or understanding on how autism-informed adaptations are implemented. This paper aims to explore clinician-perceived barriers and enablers to implementing autism-affirming adaptations in UK ED services. METHOD:Semi-structured interviews were conducted with 12 clinicians in multidisciplinary roles across UK ED services who were beginning to implement autism-affirming care. Data were analysed using critical realist thematic analysis. RESULTS:Clinicians described many barriers associated with implementing autism-affirming care underpinned by longstanding beliefs about the risks of accommodating ED behaviours. This contributed to anxiety about making adaptations to care and the potential to over- or under-accommodate autistic needs. An underlying assumption that evidence-based practice solely equates to manualised treatment for EDs constrained adaptation. A commitment to individualised formulation and care, regardless of diagnosis, and valuing a diverse multidisciplinary team were key enablers. System-level barriers included siloed autism and ED resources and training. CONCLUSIONS:Autism-affirming adaptations challenge some core underpinning messages historically embedded in siloed ED services.
OBJECTIVE:Accumulating evidence suggests that people with eating disorders experience mainly negative impacts of out-of-home calorie labelling. This study explored eating disorder clinician perspectives on how such labels affect individuals with eating disorders, and their views on implementation of this policy. METHOD:Semi-structured 1:1 interviews were conducted with 20 eating disorder clinicians from different professional disciplines across adolescent and adult services. Reflexive thematic analysis was used to analyse interview transcripts. RESULTS:Four themes and nine subthemes were generated. Themes were: (1) Reinforcing disordered eating; (2) 'Informed choice'; (3) Managing exposure; (4) Policy recommendations. Clinicians mainly identified negative impacts of calorie labelling, such as facilitating dietary restriction, although they also recognised some positives, such as reassurance. Within treatment, clinicians either shielded their patients from out-of-home calorie labels or facilitated exposure to such labels. Clinicians supported implementation options which promote individual autonomy about whether to view calorie information in out-of-home settings. CONCLUSION:Eating disorder clinicians predominantly describe negative impacts of out-of-home calorie labelling on their patients but also identify positives for some individuals. Findings highlight the importance of clinicians tailoring strategies to individuals' needs based on factors including developmental and recovery stage.
OBJECTIVE:This retrospective cohort study sought to determine whether higher levels of engagement with the Recovery Record (RR) app were associated with better outcomes on eating disorder (ED) symptoms (Eating Disorder Examination-Questionnaire) (EDE-Q), depression (Patient Health Questionnaire-9), and generalised anxiety (GAD-7) for individuals receiving ED treatment. METHOD:Participants were 4852 adolescents and young adults receiving treatment between March 2021 and August 2024. RR was made available to all patients during their treatment. RESULTS:Cluster analysis identified three distinct groups: engagement, low engagement, and no engagement. After controlling for baseline severity and treatment duration, engagement was correlated with lower EDE-Q scores at discharge compared to low engagement (β = -0.18, p = 0.010). Engagement was also correlated with significantly lower PHQ-9 scores at discharge relative to both low (β = -0.93, p = 0.004) and no engagement (β = -0.84, p = 0.015) groups. Engagement was associated with lower GAD-7 scores at discharge compared to low engagement (β = -0.90, p = 0.003). Greater average daily logging in the RR app was associated with incremental improvements in all outcomes: EDE-Q (β = -0.042, p = 0.030), PHQ-9 (β = -0.287, p = 0.001), and GAD-7 (β = -0.216, p = 0.010). CONCLUSIONS:Findings suggest that engagement with the RR app is associated with better outcomes in terms of ED symptoms, depression, and anxiety.
OBJECTIVE:Anorexia nervosa (AN) is a complex disorder associated with significant morbidity and mortality. Some people with AN require medical admissions to manage physical complications. Currently, little is known about how these medical admissions are experienced, despite an increase in the number of individuals being hospitalised. METHOD:Interpretative phenomenological analysis was employed to explore adults' lived experience of medical admissions for AN, with data collected through individual interviews. Ten individuals with experience of medical admissions directly related to a diagnosis of AN took part. FINDINGS:Six themes were identified. Admissions were often lifesaving. Gratitude was expressed for medical intervention and, for some, for an intensification of care. However, hospitalisation left many feeling scared and overwhelmed. Participants felt misunderstood and stigmatised and their illness identity continued to dominate. Mental and physical health services were experienced as disconnected and close others sometimes had to shoulder significant responsibility for care. CONCLUSIONS:Recommendations are offered regarding the value of enhancing training on AN amongst medical professionals to improve care experiences and the potential importance of a more collaborative and holistic approach that considers patients' comorbidities and personal histories. Future research should explore whether therapeutic techniques may support development of a non-anorexic identity during or after medical admissions and what aspects of treatment can render hospitalisation harmful.
BACKGROUND:Emotional difficulties are common among individuals with Eating Disorders (EDs). Following Panksepp's theoretical model, which conceptualises primary emotional systems as the evolutionary foundation of personality, this study aimed to identify distinct profiles of primary emotional systems within a clinical eating disorder (ED) sample. It further examined differences in sociodemographic, clinical, and psychopathological characteristics across profiles, as well as associations between clinical features and profile membership. METHODS:In this cross-sectional study, data were obtained from the Regional Centre for ED registry at the University Hospital of Verona. Measures included the Affective Neuroscience Personality scales, the Eating Disorder Examination, the Symptom CheckList-90-Revised, the Life Stressor Checklist-Revised, and the Impact of Event Scale-Revised. A Latent Profile Analysis was conducted, followed by inferential analyses. RESULTS:Among 122 patients, three profiles emerged: (1) high FEAR and SADNESS, and low SEEKING and PLAY; (2) low negative primary emotional systems and CARE; (3) high positive primary emotional systems and high SADNESS and ANGER. Profiles differed by age, sex, illness duration, trauma burden, depressive-anxiety symptoms, and ED severity. DISCUSSION:Findings revealed emotional heterogeneity among ED patients, underscoring the importance of considering individual emotional differences in treatment planning. Study limitations and directions for future research are discussed.
OBJECTIVE:Weight bias internalisation (WBI) has been associated with poorer health-related quality of life (HRQoL), however, evidence in community-based adolescent samples remains scarce. Family meals have shown protective effects on adolescent health, yet their role in the relationship between WBI and HRQoL has not yet been explored. This study investigated associations between WBI, HRQoL, and family meals in Spanish adolescents. METHOD:We conducted a cross-sectional study with a representative sample of 1016 adolescents aged 11-16 from Terrassa, Spain (random multistage cluster sampling). Validated instruments were used to assess WBI (WBIS-M), HRQoL (KIDSCREEN-27), and family dinner quality and frequency. Anthropometric data were objectively measured. Adjusted regression models were conducted. RESULTS:Lower WBI and a higher frequency and quality of family dinners were associated with higher HRQoL scores across KIDSCREEN-27 domains. Further analyses revealed that family dinners moderated the effect of WBI on two HRQoL factors, attenuating its negative impact. However, this moderating impact became substantially weaker at higher levels of WBI. CONCLUSIONS:This study of Spanish adolescents is the first to show a negative association between WBI and HRQoL and that this relationship is moderated by the frequency and quality of shared family meals, suggesting that supportive family environments can buffer WBI's negative impact, although this protective role is attenuated at the highest levels of WBI, highlighting the vital need for early prevention, and warranting further investigation.
OBJECTIVE:Ultra-processed foods have been associated with adverse health outcomes, but their relationship with eating disorders remains unclear. This scoping review mapped the available evidence on the association between ultra-processed food intake and eating disorders in adolescents and adults. METHOD:Following Joanna Briggs Institute recommendations and PRISMA-ScR guidelines, searches were conducted in PubMed, PsycINFO, and Embase up to March 2026. Eligible studies were original quantitative research assessing ultra-processed food intake, defined by the Nova classification or equivalent descriptions, in relation to eating disorders. Two reviewers independently conducted study selection, data extraction, and methodological appraisal. RESULTS:Of 930 records identified, seven cross-sectional studies met the inclusion criteria, comprising 47,758 adolescents and adults. Across studies, positive associations were more often reported for nonrestrictive symptoms, including binge eating, bulimic symptoms, night eating, and loss-of-control eating. One study reported that foods consumed during binge-eating episodes were entirely ultra-processed. Findings for restrictive disorders were fewer and less consistent. CONCLUSIONS:Current evidence suggests a possible relationship between ultra-processed food intake and nonrestrictive eating disorder symptoms and presentations. However, the small number of studies, their cross-sectional design, and methodological heterogeneity limit stronger inferences. Longitudinal and experimental studies are needed to clarify mechanisms and inform future interventions.
OBJECTIVE:Knowledge of family functioning (FF) for those with eating disorders (EDs) is driven by research with females, resulting in an overly gendered perception of FF. The current study: (1) descriptively examined FF among male adolescents with EDs, (2) compared FF among males with anorexia nervosa-restricting subtype (AN-R), AN-binge/purge subtype (AN-BP), and avoidant/restrictive food intake disorder (ARFID), and (3) compared FF between males and females with these EDs. METHOD:Participants were 175 males and 175 females who completed the Family Assessment Device (FAD). RESULTS:Males scored above the clinical cutoffs on most FAD subscales. No differences in FF were found among males across ED diagnoses. Significant differences were found between males and females with AN-R on four FAD subscales (affective involvement [OR = 4.70], affective responsiveness [OR = 2.52], communication [OR = 2.78], and general functioning [OR = 2.22]), with males reporting worse FF (all ps < 0.03). Differences between males and females with AN-BP or ARFID were not large enough to meet statistical significance. CONCLUSIONS:This study increases understanding of FF in EDs from a more diverse standpoint. Male adolescents with EDs experience poor FF. Qualitative studies could clarify possible reasons behind poor FF for adolescent males with EDs and help to identify specific targets for treatment.
OBJECTIVE:This study examined the effects of multi-family therapy (MFT-AN); delivered as 10 treatment days over one year; on weight, eating disorder behaviours and emotional problems in adolescents with anorexia nervosa. The added benefit of a 1-year duration compared to 6 months was evaluated. Finally, the outcomes between stand-alone MFT-AN and MFT-AN combined with inpatient treatment were compared. METHOD:Self-reported data from 230 adolescents (aged 9-18 years) and their families were collected at baseline (T0), 6 months (T6), and 12 months (T12). Percentage median BMI was calculated at all time points. Data were analysed using (generalised) linear mixed models. RESULTS:Significant improvements were observed in percentage median BMI, anorectic symptoms and parent-reported emotional problems, from T0 to T6 and T12 (p < 0.001) and from T6 to T12 (p = 0.002-p = 0.014). Ineffectiveness, body dissatisfaction, interoceptive awareness and drive for thinness (p < 0.001), fear of adulthood (p = 0.003) and perfectionism (p = 0.04) showed a significant improvement from T0 to T6 and T12, and from T6 to T12 (p = 0.008-p = 0.021). Interpersonal distrust showed only a significant improvement between T6 and T12 (p = 0.004). Interaction effects between time and inpatient treatment were significant only for percentage median BMI (p = 0.006) and interoceptive awareness (p = 0.008). Treatment satisfaction was high. CONCLUSIONS:MFT-AN is an effective treatment for adolescents with anorexia nervosa. Continued improvement supports the added value of a 1-year duration. MFT-AN can be implemented both as a stand-alone and adjunctive intervention.
OBJECTIVE:This feasibility randomised controlled trial (RCT) evaluated Purrble, a socially assistive robot for emotion regulation, as a low-intensity adjunct during waitlist periods in adult eating disorder services. METHOD:Adults waiting for outpatient eating disorder treatment were randomised to four weeks of Purrble use or waitlist-as-usual. The primary outcome was emotion regulation, assessed with the Difficulties in Emotion Regulation Scale; secondary outcomes included sensory sensitivity, anxiety, depression, and motivation for change. Analyses were conducted using paired t-tests and linear mixed-effects models. Acceptability was explored via a qualitative survey. RESULTS:39 participants were enrolled in the trial and 37 participants were retained (19 Purrble, 18 control). A significant group × time interaction emerged for depression, with greater reductions in symptoms among Purrble participants. No significant interactions were found for emotion regulation, sensory sensitivity, motivation, or anxiety, though the Purrble group showed small-to-moderate improvements in emotion regulation, sensory sensitivity, and anxiety, and a significant within-group increase in motivation. Qualitative findings identified four categories: situational use during distress, sensory comfort and emotional connection, design limitations/barriers, and continued use with integration into self-care. CONCLUSIONS:Purrble proved acceptable and feasible as a waitlist adjunct in adult eating disorder outpatient services. A significant between-group effect on depression and a within-group improvement in motivation provide preliminary support for a fully powered trial.
OBJECTIVE:Temperament-Based Treatment with Supports (TBT-S) is an intensive treatment for patients with eating disorders (EDs) integrating neurobiological insights and family dimensions with the involvement of supports. Previous studies report high acceptability among both patients and their supports, and improvements in clinical outcomes and family functioning. The present study investigated acceptability and short-term outcomes of TBT-S intervention as adjunctive to ongoing, specialised treatment for anorexia nervosa (AN) in late adolescent and young adult patients and their supports. METHOD:Thirty-two patients (mean age = 21.44, SD = 4.72), 29 mothers, and 22 fathers participated in eight TBT-S interventions in Greece. ED symptomatology, patients' and supports' psychological distress, and supports' emotional and behavioural responses were assessed immediately before and after participation in TBT-S intervention. Also, acceptability of TBT-S intervention was assessed. RESULTS:TBT-S intervention was found to be highly acceptable among patients and their supports. Patients reported significant reductions in ED restraint symptomatology and depression. Mothers displayed significant reductions in depression, stress, criticism, and accommodating and enabling behaviours. Conversely, fathers displayed significant increases in depression and anxiety. CONCLUSIONS:TBT-S intervention demonstrated high acceptability among patients and supports, and was associated with several short-term outcomes as adjunctive to ongoing treatment for AN.
