Eating disorders (EDs) are a growing public health concern in the United States, yet advocacy for improved treatment and awareness remains underexplored in academic research. While advocacy movements in fields such as HIV/AIDS or breast cancer have received sustained attention, eating disorder advocacy has rarely been studied beyond program evaluation or prevention campaigns. This study examines the roots and practices of ED advocacy in the United States, focusing on how advocates describe their strategies, motivations, and encounters with systemic barriers. A qualitative design was employed, using five semi-structured interviews with U.S.-based eating disorder advocates recruited from nonprofit organizations. Data were analyzed through reflexive thematic analysis, informed by conceptual lenses of medicalization and neo-pluralist interest group theory. Three main themes emerged: (1) Stigma as both barrier and motivator: advocates drew on lived experience to expose stereotypes and push for more inclusive approaches to care, (2) Navigating structural constraints: participants emphasized how fragmented and uneven insurance systems restrict access to treatment, aligning with critiques of managed care; (3) Strategic repertoires: advocates deployed storytelling, cost-based arguments, education, and coalition-building to influence public opinion and policy. ED advocacy reflects a paradox: while it challenges stigma and promotes inclusion, it also operates within a healthcare system shaped by profit-driven logics and resource scarcity. Lived experience lies at the heart of advocacy, serving simultaneously as a source of personal healing and as a form of political leverage. Future research could examine relationships between advocates and healthcare practitioners, the transition from patient to advocate, and the evolving role of social media in shaping advocacy strategies. Eating disorders affect millions of people in the United States, yet access to care is still limited and uneven. Advocacy groups have become central in raising awareness, reducing stigma, and pushing for changes in healthcare and policy. This study draws on five interviews with eating disorder advocates to understand the roots, tactics, and challenges of eating disorder advocacy in the United States. This study underlines the priorities of advocates and shows how their voices shed light on both the progress made and the work still needed to improve access to fair and effective, long term eating disorder care. Although the findings point to global patterns, they emphasize the ways in which the U.S. healthcare system and political landscape influence what advocates can achieve.
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
Eating disorders (EDs) and disordered eating (DE) occur at disproportionately high rates among populations with elevated psychosocial risk factors, such as Indigenous people, LGBTQIA individuals and those with trauma or mental illness, all of whom are overrepresented in forensic and correctional settings. Despite these risks, research on ED/DE in these contexts remains limited. This review maps literature on ED/DE in forensic and correctional settings, summarising research on prevalence, co-occurring factors, criminogenic needs, guidelines and treatment approaches. Following PRISMA-ScR guidelines, the protocol was registered on Open Science Framework (registration DOI https://doi.org/10.17605/OSF.IO/BR8QU). Five databases were searched (MEDLINE, PsycINFO, Scopus, CINAHL, ProQuest), identifying peer-reviewed studies reporting on ED/DE among individuals with any forensic or correctional involvement. Of 1,314 articles, 29 met inclusion criteria: one case study, one ethnography, and 27 quantitative studies, focusing mostly on women in prisons with limited data on men, and none on transgender or gender-diverse individuals. Findings show high ED/DE prevalence with frequent co-occurrence of past trauma and past substance use. No management guidelines were found and lived experience perspectives were largely unexamined. Despite ED/DE being prevalent among those in forensic and correctional settings, no setting-specific guidelines exist, leaving a critical gap in evidence-based care in mental health and rehabilitation. This review revealed a lack of consistent data collection tools, lack of diversity in samples and limited understanding of links to criminal behaviour. It highlights the urgent need for targeted research and development of interventions for ED/DE in forensic and correctional settings. People in prisons and other forensic and correctional settings frequently experience high rates of mental illness, trauma, and substance use difficulties, all of which are linked to ED/DE risk, yet little is known about ED/DE in forensic and correctional settings. This review identified 29 studies exploring ED/DE in these settings and found they are common, especially among women, however there is limited information on men, and no information on trans or gender diverse people. There are no clear guidelines for identifying or treating ED/DE in these environments and little research has explored lived experience and staff perspectives. In the community, eating disorders are often supported through access to multiple levels of care, engagement with evidence-based treatments and adjunct recovery supports, however these services remain inaccessible to people who are incarcerated, the majority of individuals considered in the studies reviewed. The review highlights a major gap in understanding and responding to ED/DE in forensic and correctional settings and calls for better screening, inclusive research, trauma-informed care, and development of appropriate prevention and treatment protocols. Without further research, it remains unclear how eating disorders affect people in the forensic and correctional systems, what forms of support may be most beneficial, and how these factors might influence rehabilitation. ED/DE prevalence rates vary, but trend high in forensic and correctional settings, particularly in women’s prisons. No forensic or correctional specific ED/DE guidelines or validated screening tools exist. ED/DE behaviours are being responded to in institutional settings by implementing suicide/self-harm protocols (such as seclusion and restraint). Recommendations include routine ED/DE screening, evidence-based eating disorders targeted intervention and staff training. Further research on prevention and treatment for ED/DE in forensic and correctional settings is required.
There are few effective treatments for eating disorders (EDs). The MED-FED survey queried adults with self-reported EDs about their recent prescription and non-prescription drug use and the perceived benefits and harms of each drug used. Top-line survey responses highlighted benefits of cannabis for managing ED symptoms. Here, we provide a more detailed analysis of the subset of MED-FED data pertaining to cannabis. This study recruited adults self-reporting a diagnosed ED or undiagnosed disordered eating causing distress. The survey quantified frequency of cannabis use, products used, cannabinoid content of products, self-reported effects of cannabis on ED symptoms and general mental health, adverse effects of cannabis products, and use of other drugs. Daily and intermittent cannabis users were compared to non-users. Optional open-ended responses around cannabis use were subjected to thematic analysis. Cannabis was the third most commonly used drug after caffeine and alcohol. Of 5383 respondents, 3018 (56.1
Eating disorders are an emerging public health concern among adolescents and are often associated with unhealthy eating behaviors. Eating behavior phenotypes such as restrained, emotional, and external eating may increase vulnerability to eating disorder. However, evidence from low- and middle-income countries, including Bangladesh, remains limited. This study examined the associations between these eating behaviors and the risk of eating disorders among urban adolescents in Bangladesh. A school-based cross-sectional study was conducted among 428 adolescents aged 12–17 years from selected secondary schools in Dhaka South City Corporation area between February and August 2025. The participants were selected using a multistage cluster random sampling design. Data were collected via a structured questionnaire that included socio-demographic and lifestyle information, the Dutch Eating Behavior Questionnaire, and the Eating Attitudes Test-26. Eating disorder risk was defined as an EAT-26 score ≥ 20. Group differences were examined using independent-samples t tests and chi-square tests. Logistic regression analyses were performed to estimate crude and adjusted odds ratios after controlling for age, sex, BMI category, breakfast skipping, sleep duration, screen time, physical activity, and household income. Among the 428 adolescents, 123 (28.7
Nutritional treatment is a cornerstone in treatment of anorexia nervosa (AN). However, the interplay between diet and appetite hormones in the gut-brain axis remains poorly understood in AN, particularly during treatment. This study assessed the effects of 12-week inpatient treatment on appetite-related biomarker profiles in patients with AN, compared these profiles with healthy controls (HCs), and explored associations between appetite-related biomarkers, clinical characteristics and diet. In this exploratory study, we included 42 patients with AN undergoing inpatient treatment and 42 age-matched HCs from the Norwegian Microbiota Study in AN (NORMA). Data was collected at baseline, after 6 and 12 weeks of treatment for patients with AN, and at baseline for HCs. Appetite-related biomarkers were measured in serum using Luminex technology and dietary intake was recorded via a 3-day digital food diary/interview. Statistical analyses included group comparisons, regression models, mixed-effects models, and correlation analyses. Compared to HCs, patients exhibited significantly lower levels of adipsin, leptin, insulin, and resistin, and higher levels of adiponectin and glucose-dependent insulinotropic polypeptide (GIP) at baseline, with a trend for ghrelin (p = 0.08). Group differences in glucagon-like-peptide-1 (GLP-1) and glucagon were higher in older patients. No baseline differences were observed for C-peptide, plasminogen activator inhibitor-1, or visfatin. After 12 weeks, mean BMI had increased significantly in patients with AN from 15.5 to 18.2 kg/m², adipsin, leptin, insulin, and C-peptide increased while ghrelin decreased and approached that of HCs. Glucagon, adiponectin, GIP, and GLP-1 were largely resistant to change. Notably, BMI alone did not fully account for biomarker differences; dietary composition, particularly fiber and fat, appeared important for hormone regulation in AN. Prior to treatment, appetite-related biomarkers differed markedly between patients with AN and HCs. Although inpatient treatment increased body weight and normalized several biomarkers, BMI for most patients with AN remained below the healthy range and several biomarkers displayed limited responsiveness to treatment, suggesting continued gut–brain axis dysregulation. Whether it is possible to target unresponsive hormones by nutritional and/or pharmacological therapies to improve treatment success of AN remains to be investigated. Trial registration clinicaltrials.gov, NCT06144905, registered Sep 22, 2023 Gaining weight through proper nutrition is a key part of treating anorexia nervosa (AN). However, we still do not fully understand how the body’s appetite signals change during recovery. Appetite is partly controlled by signals between the gut and the brain. These signals affect hunger, fullness, and how the body uses energy. In this study, we examined many appetite-related markers in 42 patients with AN and compared them with 42 healthy individuals. We looked at how the markers changed during 12 weeks of treatment and how they were related to diet and weight. Before treatment, people with AN had different levels of appetite markers compared to healthy individuals suggesting that the regulation of appetite is disrupted. During treatment, body mass index (BMI) increased and some appetite markers moved towards healthy levels. However, the BMI remained below the healthy range for most patients with AN and some appetite markers did not change much or diverged more from healthy individuals. It also mattered what people ate—not just the amount of food. The results indicate that patients with AN have a lasting disruption in the system controlling the body’s appetite which may be important to address through nutrition and/or medical therapies.
Smoking commonly co-occurs with eating disorders (EDs) but less is known about the relationship between EDs and vaping. We investigated associations of lifetime vaping and smoking as forms of nicotine use with lifetime ED diagnoses (i.e., anorexia nervosa [AN], bulimia nervosa [BN], and binge-eating disorder [BED]) and ED behaviors. Participants (N = 6,128, 95
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.
Eating disorders (ED) are serious mental health conditions characterised by disordered eating behaviour and associated emotional distress. EDs are associated with high rates of mortality and morbidity, yet rates of help-seeking remain low. There is a misconception that EDs only affect “skinny, white, affluent girls” (SWAG) although anyone can be affected. Likewise, despite similar rates in minoritised ethnic communities, studies suggest that help-seeking from these populations remain low. The aim of this review was to identify key barriers and facilitators to accessing ED treatment in the United Kingdom (UK) and explore whether experiences vary by ethnicity. A systematic review of qualitative and mixed methods studies was conducted following PRISMA guidelines. PsycINFO, Embase, Medline and CINAHL databases were searched for relevant studies published since 2013. Two independent reviewers screened titles/abstracts and reviewed full texts. Eligible articles were coded in NVivo to generate themes following Braun and Clarke’s thematic analysis framework. Out of 14 included studies, two focused exclusively on experiences of minoritised ethnic individuals. Across the studies, commonly shared barriers to accessing care included rigid ED guidelines, negative healthcare professional experiences, difficulty in self-recognising ED, low accessibility and awareness of services, and negative social relationships. Reported facilitators included improving education and recognition of EDs, informed and accessible delivery of care, and supportive communities. Two studies with participants of South Asian heritage highlighted additional barriers, such as concerns about doctor-patient confidentiality, and marriage-related pressures linked to beauty standards. Unique facilitators included suggestions for raising awareness of EDs through culturally relevant platforms. A more holistic approach is required from services and guidelines to tackle stigma associated with EDs and make services more accessible. There is a lack of primary research focusing on minoritised ethnic communities, and further research is required. Eating disorders are serious mental health conditions that can be life-threatening. However, few people seek help for these conditions, and this problem is even worse among ethnic minority groups—even though they experience eating disorders at similar rates to white populations. This paper reviewed previous research to identify what stops and helps people from getting treatment for eating disorders in the UK. The review paid special attention to whether ethnic minorities face different challenges. 14 studies were examined, only 2 focused specifically on ethnic minority experiences. The common barriers that prevent people from accessing care are: strict guidelines that exclude people from treatment, bad experiences with healthcare professionals, difficulty recognising eating disorder symptoms, trouble finding about available services, and lack of support from family and friends. What helped people access care included: better education about eating disorders, easier-to-understand information about symptoms, easy to access healthcare services, and supportive communities. The studies exploring the experiences of people of South Asian heritage revealed barriers specific to their communities including concerns about doctor-patient confidentiality, and pressures linked to marriage and beauty standards. These studies also suggested that raising awareness about eating disorders through culturally familiar channels could help more people seek treatment.
To evaluate the effectiveness of universal secondary-school interventions targeting core eating disorder (ED) psychopathology and at least one additional psychological risk factor. A systematic search of databases was conducted, including Scopus, CINAHL, Embase, PsycINFO, MEDLINE and Google Scholar in March 2025. Eligible randomised controlled trials (RCTs) reported quantitative outcomes (e.g., ED psychopathology, body dissatisfaction, dieting behaviors) following universal secondary-school interventions addressing weight, shape, or eating concerns and another psychological risk factor in non-clinical adolescents aged 11–18. Results were synthesized narratively, and study quality was evaluated using the Cochrane Risk of Bias (RoB-2). Seventeen RCTs were included. Eleven studies were conducted in Europe, most participants were female and in middle adolescence. Overall, most universal school-based ED interventions produced some immediate improvement in ED symptoms or well-being but effects were generally small or rarely sustained at follow-up. There were no significant changes in BMI. However, the high risk of bias limits the confidence of findings. These improvements were short term, and their effects were mostly small. Future research would benefit from adopting active comparison groups and longer follow-ups. Whilst core ED psychopathology in addition to the risk factors of body image dissatisfaction, dieting, self-esteem, and social media appear consistent factors to include in universal interventions, further understanding of the most effective risk factors to target in this population is needed. Adolescence is a time of significant change, and this period often coincides with the greatest increase in symptoms of disordered eating and eating disorders. Universal programs are commonly used in schools to help with early identification and prevention of such difficulties. This systematic review explores the effectiveness of universal, school-based interventions that target core symptoms and risk factors associated with eating disorders in adolescent populations. Seventeen research papers were included in the review. Overall, the findings show mixed results on how well the interventions reduce eating disorder symptoms and improve general well-being, with no changes found in BMI. We need to better understand which risk factors are most important to focus on for helping young people.
The Diabetes Eating Problem Survey–Revised (DEPS-R) has been widely studied in children and adolescents with type 1 diabetes mellitus (T1D), but fewer studies have validated the DEPS-R in adults. Therefore, this study aimed to examine the factor structure, internal consistency, and criterion validity of the Finnish version of the DEPS-R in adolescents over 16 years of age and adults with insulin dependent diabetes (T1D and T2D). The sample consisted of 201 patients with insulin dependent diabetes, including individuals with T1D (93
This study aimed to examine the frequency of probable Avoidant/Restrictive Food Intake Disorder (ARFID), restrictive eating patterns, and their associations with mood and anxiety symptoms, chemosensory pleasure, and demographic factors among community-dwelling Turkish older adults. A cross-sectional survey was conducted with 118 adults aged ≥ 65 years. Participants completed the Nine-Item ARFID Screen (NIAS), the Chemosensory Pleasure Scale (CPS), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Eating Attitudes Test-26 (EAT-26). Probable ARFID was identified using established NIAS subscale cutoffs (picky eating ≥ 10, low interest/appetite ≥ 9, or fear of aversive consequences ≥ 10) after excluding participants with probable weight/shape-related eating disorders based on EAT-26 scores (≥ 20). Comparisons between participants with probable ARFID and the non-ARFID group, as well as correlation analyses between NIAS scores and behavioral, affective, and sensory variables, were performed. Across the whole sample, NIAS scores were negatively correlated with body mass index (BMI) (r = − 0.239, p = 0.011) and pleasure associated with natural odors (r = − 0.353, p < 0.001) but not with mood/anxiety symptoms. Prevalence of probable ARFID was 13.3
This study aimed to systematically identify, evaluate, and synthesise evidence on nutritional rehabilitation in patients with anorexia nervosa, both domestically and internationally, to provide references for clinical practice. Relevant evidence was retrieved from domestic and international guideline websites, professional association websites, and databases, guided by the 6 S pyramid model. The search covered publications up to October 31, 2025. Four researchers independently assessed methodological quality and extracted and summarised evidence by theme. Nineteen studies were included: two clinical decision-making documents, one evidence summary, 15 guidelines, and one expert consensus. From these, 36 best-evidence items were synthesised across nine domains: multidisciplinary nutritional rehabilitation teams, nutritional rehabilitation goals, nutritional assessment, refeeding plans, approaches and principles of nutritional rehabilitation, behavioural management, complication management, psychotherapy, and nutritional education. This study systematically reviews the best available evidence for nutritional rehabilitation in patients with anorexia nervosa. In the subsequent process of evidence translation, relevant stakeholders should select evidence in a targeted manner by considering patient preferences and clinical contexts in their respective countries or regions, so as to ensure the scientificity and effectiveness of patients’ nutritional rehabilitation and ultimately improve patient outcomes. Clinical trial registration Registered with the Center for Evidence-Based Nursing, Fudan University (registration number ES20258339). This study is a synthesis of best evidence and does not involve clinical trials; therefore, no clinical trial number applies. This study aims to facilitate the recovery of patients with anorexia through safe and effective nutritional therapy. We reviewed international research to seek strong scientific evidence, aiming to make the nutritional recovery of these patients more scientific and beneficial. We found that successful nutritional recovery is based on several important factors, such as care provided by a team comprising different health professionals, clear nutritional rehabilitation goals, regular nutritional assessments, safe feeding plans, appropriate nutritional support methods and principles, correction of unhealthy eating behaviours, management of potential health issues, and provision of psychological support and nutritional education. Our findings can assist doctors and nurses in providing better treatment and care for patients with anorexia and support them in achieving better recovery.
ADHD is overrepresented in clinical eating disorder (ED) services, and patients with ADHD present to services with increased ED psychopathology, psychological distress, and functional difficulties. They are also more likely to drop out of treatment and have poorer outcomes. Although previous studies have explored patients with ADHD’s perspectives on their ED and treatment, clinician accounts remain underexplored, despite clinicians shaping recognition, formulation, and treatment adaptation in routine care. This study therefore explored ED clinicians’ perspectives on working with patients with ADHD. Semi-structured interviews were conducted with 19 multidisciplinary ED clinicians and analysed using reflexive thematic analysis through a neuro-affirming lens. Three themes were developed: (1) ADHD as pervasive life chaos; (2) Harnessing energy, alliance, and creativity; and (3) Navigating service boundaries. Clinicians described ADHD-related disorganisation, reward-seeking, and emotional volatility as underpinning ED behaviours and disrupting therapeutic processes, highlighting the importance of supporting structure and planning during treatment. Strength-based, collaborative, and creative approaches were also emphasised. However, challenges around recognising, diagnosing, and medicating ADHD were particularly salient, highlighting the need for greater collaboration and knowledge exchange between ED and ADHD services, alongside better use of existing multidisciplinary and dual expertise within ED teams. ADHD is more common in people receiving treatment for eating disorders than in the general population. People with co-occurring ADHD and eating disorders often experience more severe symptoms and poorer treatment outcomes. While some research has explored the experiences of people with co-occurring ADHD and eating disorders, less is known about clinicians’ experiences of working with this group. This study interviewed 19 clinicians from different professional backgrounds working in eating disorder services (for example psychiatrists and dieticians). The interviews explored their experiences of supporting patients with ADHD. Three main findings were identified. First, clinicians described ADHD as creating difficulties with organisation, emotions, and daily routines, which could affect eating behaviours and make treatment harder to follow. Supporting structure, routines, and emotional stability was therefore seen as important for recovery. Second, clinicians highlighted strengths often associated with ADHD, such as energy, social skills, and creativity, and described working collaboratively and flexibly with patients to use these strengths in treatment. Third, clinicians reported limited communication between eating disorder and ADHD services, creating challenges around ADHD diagnosis and medication. Overall, the findings suggest that stronger collaboration within eating disorder teams and between eating disorder and ADHD services may help improve care for this group.
Eating disorders (EDs) substantially impair physical health, psychological well-being, and social functioning. Shorter untreated illness duration has been proposed to be associated with better outcomes, though evidence for this relationship remains mixed. Nonetheless, delays in accessing treatment remain common and contribute to prolonged suffering and risk of lasting harm. This study aimed to estimate the duration of untreated eating disorder (DUED) and examine potential moderators. A PRISMA 2020-compliant systematic review and meta-analysis was conducted. Searches were performed from inception to March 2026 in PubMed, Embase, PsycINFO, and CINAHL. Random-effects models were used to estimate pooled DUED of available studies, with subgroup and meta-regression analyses to explore moderators. Study quality and risk of bias were assessed using National Institutes of Health (NIH) tools. Of 2,776 records identified, 29 studies (n = 17,433) were included. The pooled DUED of available studies was 21.9 months (95
Globally, research shows increasing rates of eating disorders as well as a changing demographic profile of people with eating disorders. Few studies have examined recent nationally representative data on young adult patients with eating disorders in the United States and whether hospitalizations differ by race, ethnicity, sex, and primary payer status. This study characterized the risk of death for young adult hospitalizations with eating disorder diagnoses by race, ethnicity, sex, length of stay, and primary payer. This study is a retrospective national population-based analysis of the Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) data from 2016 to 2019. Hospitalizations of young adults ages 18–30 years of age with eating disorder diagnoses were extracted from the nationally representative National Inpatient Sample. The study’s primary variable, eating disorders, was characterized overall. Additional covariates included sex, race and ethnicity, age, primary payer, death, and length of stay. Bivariate analyses, Chi-squared tests and Fisher’s exact test were used to examine the risk of death by race, ethnicity, sex, length of stay and primary payer. For the 9,626 hospitalizations with an eating disorder diagnosis for young adults ages 18–30 years between 2016 and 2019, 24 resulted in death during hospitalization (0.2
Avoidant restrictive food intake disorder (ARFID) is a recently recognised eating disorder and is largely under-researched. Given the paucity of research examining the neurobiological and cognitive correlates of ARFID, the present systematic review aimed to synthesise and summarise existing ARFID data to highlight directions for future research. Using PRISMA guidelines, five databases (Cochrane, Embase, Medline, PsycInfo, Web of Science), in addition to hand searches of reference lists and ProQuest Dissertations and Theses Global, were searched for studies that investigated evidence relating to the neurobiological and cognitive correlates of ARFID. Twelve papers met inclusion criteria. Twelve studies met inclusion criteria for this systematic review with a total of n = 548 ARFID participants across all studies. Neurobiological studies (k = 6) highlighted differences in regions including orbitofrontal and prefrontal cortices, and, in acute cases, midline diencephalic regions. Cognitive studies (k = 6) findings highlighted impaired executive function, specifically related to cognitive flexibility, impulsivity, visual processing skills, central coherence and inhibition. Research into the neurobiology of ARFID is nascent. The results of this review contribute to improved understanding of the possible underlying neurobiological and cognitive differences within ARFID, which in turn will inform translational research aimed at better understanding and treating individuals with this illness. Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder diagnosis and has not yet been widely studied. As a result, there is limited understanding of how ARFID may change how individuals may think, reason and process information, as well as whether there may be changes in how the brain responds physiologically during ARFID. This systematic review aims to summarise existing research on these features, and to identify important areas for future research. Using established review guidelines, we searched multiple databases as well as conducted hand searches and identified 12 studies meeting inclusion criteria. Six studies examined brain-related differences and found changes in areas involved in decision-making, self-control, and reward processing, particularly in the prefrontal and orbitofrontal regions of the brain. In more severe or acute cases, differences were also observed in brain regions involved in basic bodily regulation. Six studies examined cognitive functioning and consistently found differences with executive functioning, including reduced cognitive flexibility, problems with impulse control, differences in visual-spatial processing, and difficulties with inhibition. Our systematic review is the first to comprehensively review and synthesise information related to the possible brain-based changes observed when individuals meet criteria for ARFID. We hope that these findings improve understanding of possible mechanisms underlying ARFID and may help guide future research and treatment development.
Co-occurring Bulimia Nervosa (BN) and Borderline Personality Disorder (BPD) affect a substantial population in the United Kingdom. This study explored how individuals experience recovery from these conditions, with a focus on interpreting how individuals with such experiences make sense of themselves. Semi-structured interviews were conducted with twelve individuals with lived experience of recovery from BN and BPD. Data were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified: (1) Ambivalence around recovery, reflecting conflicting messages from care systems; (2) Controlled chaos and support, capturing emotional volatility, relational instability, and the non-linear nature of recovery; and (3) Identity, stigma, and the search for self, highlighting developing self-compassion, agency, and identity shifts. Recovery was described as an evolving, relational process shaped by ambivalence and self-redefinition. Therapeutic trust and authentic connection facilitated recovery, while invalidating environments, trauma, and service limitations acted as barriers. Recovery from co-occurring BN and BPD is a complex, relational process involving identity reconstruction and emotional integration. Findings suggest that recovery-oriented services should prioritise compassionate, trauma-informed, and relationally attuned care, with particular attention to reducing diagnostic stigma, fostering collaborative therapeutic relationships, and supporting the development of a meaningful sense of self beyond illness. Bulimia nervosa (an eating disorder) and borderline personality disorder (a condition linked to intense emotions and relationship difficulties) often occur together. However, we know very little about how people experience recovery when living with both conditions. This study explored the personal experiences of 12 people in the UK who described themselves as being in recovery. Participants shared that recovery is not a simple or straightforward process. Instead, it is often confusing, emotional, and involves both progress and setbacks. Many described feeling unsure about who they were without their difficulties, as these had become part of their identity over time. Letting go of these behaviours could feel both hopeful and frightening. Supportive relationships, especially with therapists, friends, and family, were seen as very important. Feeling understood, accepted, and not judged helped people move forward. In contrast, negative or dismissive experiences within services made recovery harder. Overall, recovery was described as a gradual process of rebuilding a sense of self, learning to cope with emotions in new ways, and developing self-compassion.
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.
Adolescents with Type 1 diabetes are at increased risk of eating disorders, which have been associated with suboptimal metabolic control and an increased risk of complications. Reliable and culturally adapted screening tools are essential for early identification. However, the parent-reported version of the Diabetes Eating Problem Survey–Revised (DEPS-R) has not yet been validated in Turkish; therefore, this study aimed to evaluate its validity and reliability in adolescents aged 10–17 years years with type 1 diabetes. This methodological validation study included 96 adolescents (45 boys, 51 girls) aged 10–17 years with Type 1 diabetes and their parents. Linguistic and cultural adaptation procedures were conducted in accordance with standard cross-cultural validation guidelines. Parents completed the parent-reported DEPS-R and the Problem Areas in Diabetes–Parents of Teens (P-PAID-T). Adolescents completed the self-reported DEPS-R. Construct validity was assessed using correlation analyses. Exploratory and confirmatory factor analyses were performed to evaluate structural validity. Internal consistency was assessed using Cronbach’s alpha, and test–retest reliability was examined using intraclass correlation coefficients (ICC). The parent-reported DEPS-R demonstrated good internal consistency (Cronbach’s α = 0.852; McDonald’s ω = 0.851) and good test–retest reliability (ICC = 0.83), with a strong correlation between the two administrations (r = 0.89). Exploratory and confirmatory factor analyses supported a single-factor structure and demonstrated with acceptable model fit (χ²/df = 1.629; RMSEA = 0.080; CFI = 0.874; TLI = 0.848). Parent-reported DEPS-R scores were correlated with self-reported DEPS-R scores (r = 0.506, p < 0.001) and P-PAID-T scores (r = 0.458, p < 0.001), supporting construct validity. A positive correlation was also observed between duration of diabetes and DEPS-R scores (r = 0.223, p = 0.029). No significant associations were observed between DEPS-R scores and metabolic indicators, including HbA1c, ketoacidosis episodes, or diabetes-related hospital visits. The Turkish parent-reported DEPS-R is a valid and reliable instrument for screening disordered eating behaviors in adolescents with Type 1 diabetes. Its use in both clinical and research settings may facilitate early detection and improve understanding of the relationship between eating behaviors and metabolic outcomes in this high-risk population. Disordered eating has been reported to be more common among adolescents with type 1 diabetes than among their healthy peers. In this group, disordered eating may lead to poorer metabolic control and make diabetes management more difficult. However, questionnaires completed by adolescents may not always fully reflect actual behaviors, as young people may underreport certain behaviors or may not always be fully aware of them. For this reason, parent-reported assessments such as the parent reported Diabetes Eating Problem Survey–Revised (DEPS-R) may provide an additional and useful perspective for identifying eating-related problems in adolescents with type 1 diabetes. In this study, we evaluated a parent-reported version of the DEPS-R in Turkish families of adolescents with type 1 diabetes. Our findings suggest that this parent-reported version is a reliable tool for identifying possible eating-related problems. Using parent-reported assessments of disordered eating may help healthcare professionals recognize problems earlier and provide timely support for adolescents with type 1 diabetes and their families.
