Abstract Purpose Body image disturbances (BID) are central to anorexia nervosa (AN), influencing its development, maintenance and relapse. While mirror exposure (ME) has been shown to reduce BID in adults, research in adolescents is limited. This pilot randomized controlled trial examined the feasibility and effects of ME, added to treatment as usual (TAU), in adolescent inpatients with AN. In addition, we explored changes in body-related attentional bias as a potential mechanism of change. Methods Adolescent female inpatients with AN were randomized to receive either 12 ME sessions over 4 weeks (ME group, n = 11) or TAU (n = 13) in a pre-post design. Primary outcomes were global measures of BID and eating disorder (ED) pathology. Attentional bias was assessed using two eye-tracking paradigms. Results Relative to TAU, ME did not improve BID or ED pathology. Both groups showed reductions in BID over time. Exploratory post-hoc analyses indicated reductions in body control and avoidance behaviors in the ME but not the TAU group. An attentional bias toward self-defined unattractive body parts was present but did not change over time in either group. Discussion In this pilot trial, ME did not provide additional benefits over TAU in improving global BID or ED pathology in adolescent inpatients with AN. Improvements in BID may reflect general therapeutic effects of inpatient treatment. Exploratory analyses indicated potential effects on specific body-related behaviors but require cautious interpretation due to limited power. Future research should examine for whom and at what stage body image–focused interventions may be beneficial. Level of evidence Level I, randomized controlled trial. Trial registration The study is registered on the German Clinical Trial Register (DRKS; registration number: DRKS0019104).

Binge eating disorder (BED) is characterized by repeated episodes of binge eating accompanied by a loss of control. Although the neurobiological underpinnings of binge eating (BE) episodes are not fully understood, there are indications that variability in nucleus accumbens (NAcc) responses could lead to increased variability in food intake. Here, we assessed whether BED is associated with higher intra-individual variability in behavioral and neuroimaging indices of reward responses. To this end, patients with BED (n = 35, MBMI = 33.2 kg/m2 ± 6.8), participants with subsyndromal BED (n = 21, MBMI = 29.0 kg/m2 ± 7.2), and individuals without symptoms of binge eating (n = 23, MBMI = 32.3 kg/m2 ± 6.5) completed an effort allocation task with concurrent functional magnetic resonance imaging. In line with our hypothesis, we found that patients with BED had higher variability in subjective wanting ratings of food (F34,21 = 1.48, pboot = 0.024), but not effort exertion (F34,21 = 1.13, pboot = 0.30). Crucially, trial-by-trial variability in NAcc responses during the presentation of cues was associated with a higher BMI (b = 0.11, 95%CI [0.03, 0.19], BF10 = 11.1) and disinhibited eating (b = 0.19, 95%CI [0.01, 0.36], BF10 = 4.0) across groups, whereas NAcc variability was only marginally elevated in patients with BED (b = 0.12, 95%CI [-0.04, 0.29], BF10 = 1.2, P > 0|data = 88%). Our results support the idea that BMI and disinhibited eating are associated with more variable NAcc responses, which may contribute to the symptoms of BED. However, this association is only weakly indicative of clinical severity of BED.

Bulimia nervosa (BN) has been linked to biases in self-body processing. Due to the particular importance of attentional biases, the aim of the current study was to further investigate their robustness in a large sample of females with BN or subthreshold BN (BN group) and a control group with low body dissatisfaction (LBD group) and comparable age and body mass index. Using a combined eye-tracking and electroencephalogram paradigm, we assessed overt attention orienting while viewing images of the self-body and neurophysiological correlates of attentional, emotional, and motivational processes when self-defined most unattractive body parts were fixated first. As hypothesized, the BN group (n = 69) exhibited a stronger attention bias toward self-defined most unattractive body parts compared with the LBD group (n = 37), as indicated by a higher number of fixations and longer fixation time on these regions relative to the self-defined most attractive body parts. Event-related potentials showed a higher mean amplitude of the early posterior negativity in the BN group (n = 59) compared with the LBD group (n = 27), indicating higher emotional salience of self-defined most unattractive body parts. Although the late positive potential is also typically modulated by the intensity of emotional stimuli, there were no group differences in late positive potential amplitude. This could reflect attentional avoidance and reduced elaborative processing at later stages following an initially increased attention allocation in the BN group. Future studies should aim to test this interpretation. Overall, our findings provide evidence for biased self-body processing in individuals with BN. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Cognitive phenomena such as the Spatial-Numerical Association of Response Codes (SNARC) effect can arise in the fronto-parietal cortical network. Prior neuromodulation studies with cathodal transcranial direct current stimulation (tDCS) over the left prefrontal cortex (PFC) reduced the SNARC effect. Prior neuroimaging studies with functional nearinfrared spectroscopy (fNIRS), however, showed signatures of the SNARC effect in the posterior parietal cortex (PPC). In this study, we investigated the distant neural effect of prefrontal neuromodulation on hemodynamic activity in the parietal cortex by combining cathodal tDCS with fNIRS. The SNARC effect and the numerical distance effect (NDE) were assessed in an event-related cross-over design (N 1/4 45), when cathodal tDCS of 1 mA at the left PFC was applied simultaneously during the measurement of fNIRS covering the bilateral PPC. At the behavioral level, prefrontal tDCS did not significantly reduce the SNARC effect, indicating that the replication failed here. Crucially, at the neuronal level, prefrontal tDCS reduced left parietal activation associated with the SNARC effect but not with the NDE. This neuronal effect of tDCS in a remote site was shown in preregistered primary region-of-interest analyses and in secondary all-channel analyses. The results showed how the combination of neuromodulation and neuroimaging shed light on the fronto-parietal network responsible for numerical cognition, and how fNIRS can assess the distant neural effects of cathodal tDCS.

Psychische Gesundheit wird maßgeblich durch soziale, kulturelle und geschlechtsspezifische Faktoren beeinflusst. Der Artikel beleuchtet die Relevanz von Geschlecht in der psychotherapeutischen Praxis und zeigt, wie stereotype Erwartungen Diagnostik und Behandlung verzerren können. Anhand von Suchterkrankungen und Essstörungen wird deutlich, wie stark gesellschaftliche Normen psychische Belastungen prägen. Konzepte wie Doing Gender, Intersektionalität und feministische Psychotherapie bieten wertvolle Perspektiven für eine diskriminierungssensible Versorgung. Sie ermöglichen es, strukturelle Ungleichheiten zu reflektieren und individuelle Lebensrealitäten differenziert zu erfassen. Der Beitrag plädiert für eine stärkere Integration von Genderaspekten in Ausbildung, Diagnostik und Therapie, um psychotherapeutische Verfahren gerechter und wirksamer zu gestalten. Ein Fazit für die Praxis bietet konkrete Handlungsempfehlungen für Behandler:innen, um geschlechtersensible Ansätze in den klinischen Alltag zu integrieren.

BACKGROUND:The dissemination of evidence-based techniques is critical for the successful treatment of eating disorders in clinical practice. A growing number of studies suggests that body exposure is an effective technique to treat body image disturbance in eating disorders. However, the dissemination of body exposure among psychotherapists in clinical practice remains unclear. METHODS:An online survey was conducted among licensed psychotherapists in Germany. The dissemination of body exposure in clinical practice, psychotherapists' characteristics (such as clinical training, attitudes towards exposure, confidence), and therapists' experiences with benefits and side-effects of body exposure were assessed. RESULTS:Data of 230 psychotherapists were analysed. More than half of them (58.3%) applied body exposure in their clinical practice. Yet, body exposure was only offered to 37.3% of their eating disorder patients. Moreover, 56.7% of psychotherapists delivering body exposure indicated that they have not received any training in this technique. Self-reported confidence in delivering body exposure correlated significantly with the number of patients treated with body exposure. Psychotherapists who applied body exposure reported minor side-effects and that the majority of their patients profited from this technique. CONCLUSIONS:Our results offer insights into the dissemination of body exposure in clinical practice in Germany. Overall, body exposure is still underused considering the empirical evidence demonstrating the potential of body exposure to treat body image disturbances effectively. Moreover, with regard to potential barriers of using body exposure, our data suggest that training opportunities for clinicians may facilitate the dissemination of this technique in clinical practice.

Trait body dissatisfaction (BD) represents a pivotal factor in the development and maintenance of eating disorders and is associated with a range of other mental health sequelae. While mostly studied as a trait, recent research indicates that BD fluctuates on a momentary basis, which is linked to alterations in other state factors. Since previous studies have solely focused on a single association with a specific factor, this pre-registered study evaluated state BD and a multitude of state factors simultaneously to examine both concurrent and prospective associations.Using Ecological Momentary Assessment (EMA), n = 92 female participants with high trait BD (m = 23.74 years, sd = 3.53) completed a short questionnaire on their own smartphones at three semi-random time points a day for 10 weeks. The query contained 51 items pertaining to state BD and hypothesized associated contextual factors. As hypothesized, we found significant concurrent associations of state BD with mood, rumination, acceptance, self-esteem, perceived stress, food intake, physical activity (duration), sleep quality and body checking. In exploratory analyses, concurrent associations with state BD were found for social media content, social comparisons (frequency and direction), craving, sexual motivation, body complaints and the mid-luteal phase. Mood, acceptance, self-esteem, perceived stress, social media (content), body checking, social comparisons (direction), craving and body complaints prospectively predicted state BD. When controlling for other time-lagged variables, social media content and sleep-quality predicted state BD within days.A variety of state-level factors are concurrently and prospectively associated with state BD in everyday life. This study is the first to enable direct comparisons between effects of different factors in an ecologically valid setting. Associated factors may contribute to the maintenance of BD as a state and, as a consequence, to the stabilization of trait BD in the long term. Implications for future research and development of interventions for state BD are discussed.

OBJECTIVE:Binge eating disorder (BED) is maintained by increased food-related incentive salience, which is reflected by an attentional bias for food. Oxytocin acutely attenuates this bias in patients with anorexia nervosa and reduces food intake in males with normal or increased body weight. However, results in individuals with BED have been inconclusive. We assessed the acute effect of oxytocin on food stimulus processing and reward-driven eating behavior in females with or without BED in a double-blind, placebo-controlled cross-over study. METHOD:Females with BED (n = 48) and female control participants with overweight (n = 46) or normal weight (n = 40) received intranasal oxytocin (24 IU) and, respectively, placebo, after an overnight fast and a standardized breakfast. In participants with a natural menstrual cycle, sessions were scheduled during consecutive luteal phases. Participants completed a food-related dot-probe task with concurrent eye tracking and a bogus taste test measuring snack intake. RESULTS:Oxytocin compared to placebo increased dwell time bias on food stimuli in the BED relative to the overweight control group, in which this effect was reversed. Contrary to our hypothesis, oxytocin increased calorie intake across groups. Exploratory analyses indicated that the latter effect focused on females taking hormonal contraception. DISCUSSION:These results indicate disorder- and, respectively, sex-specific effects of oxytocin on food-related incentive salience and food intake and point to a role of oxytocin in binge eating pathology. They moreover suggest that sex hormones determine the acute effect of oxytocin on eating behavior in females.

Background: Body image dissatisfaction in childhood is linked to psychopathological risks, such as increased vulnerability to eating disorders. While cognitive-behavioral models suggest body-related cognitions and self-schemas contribute to body dissatisfaction, these mechanisms remain understudied in children. We hypothesized that children with body dissatisfaction would report higher public body awareness and show stronger body- and appearance-related attributions in negative scenarios, particularly when self-referenced.Methods: 431 children aged 8 to 13 years filled in questionnaires on body-related cognitions. Results: Children with body dissatisfaction showed significantly greater public body awareness and made more appearance- and body-related attributions under self-reference, but not under other-reference.Conclusion: These findings support cognitive models of body image dissatisfaction in preadolescents and highlight early-emerging cognitive distortions as potential targets for prevention and intervention.

Das Ausprobieren von Diäten zur Gewichtsreduktion und zur Verbesserung des Selbstbildes ist in der Bevölkerung weit verbreitet und in vielen Fällen weitgehend harmlos. Bei der Anorexia nervosa wird das Abnehmen durch Hungern, exzessiven Sport und andere schädliche Maßnahmen jedoch zum zentralen Lebensinhalt. Das Streben danach, dünn zu sein, wird zum ständigen Begleiter; die Annäherung an ein oft nicht erreichbares Selbstbild bestimmt den Alltag der Betroffenen. Die körperlichen und psychischen Folgeerscheinungen der Anorexie sind vielfältig und schwergradig. Der Ratgeber klärt Betroffene und Angehörige über das Krankheitsbild der Anorexia nervosa auf und informiert über deren Verlauf, Ursachen und Behandlungsmöglichkeiten. Der Ratgeber beschreibt, woran man eine Anorexie erkennt und wie sie sich von anderen Essstörungen unterscheidet. Er geht auf Faktoren ein, die bei der Entstehung einer Anorexie eine wichtige Rolle spielen und die dazu beitragen können, dass die Anorexie bestehen bleibt. Darauf aufbauend stellt der Ratgeber die zentralen Schritte zur Bewältigung einer Anorexia nervosa dar, wobei der Schwerpunkt auf den psychotherapeutischen Behandlungsmöglichkeiten liegt. Betroffene erhalten zudem Informationen dazu, wo sie Hilfe finden können. Ein Kapitel des Buches widmet sich zudem der Frage, wie Angehörige Betroffene bestmöglich unterstützen können. Der Ratgeber will keinesfalls eine dringend angezeigte professionelle Behandlung der Anorexia nervosa ersetzen, möchte jedoch mögliche Behandlungsängste abbauen und kann als Begleiter zu einer Therapie genutzt werden.

OBJECTIVE:Body dissatisfaction is an important factor for the etiology and maintenance of eating disorders such as bulimia nervosa (BN). At the behavioral level, body dissatisfaction often manifests itself in excessive body-related avoidance, thought to act as a negative reinforcer. The Approach-Avoidance Task (AAT) is an implicit measure of avoidance behavior, but the literature on body-related avoidance measured by the AAT is inconclusive. In the present study, we considered self-reference and cognitive load as important dimensions to better understand AAT-evoked biases. METHOD:Adult female participants with BN (n = 21), high body dissatisfaction (n = 20), and healthy controls (n = 20) completed a novel, slider-based AAT with task-irrelevant self-depicting body pictures and scrambled versions of these pictures as control stimuli. We further induced cognitive load through a flanker task to assess possible moderating effects. RESULTS:There was no significant Group × Picture Type × Motion Direction interaction for either motion onset or motion duration. The results further revealed a standard flanker effect in that participants reacted faster to compatible trials; but this was independent of Group membership, Picture Type, and Motion Direction. DISCUSSION:In sum, the AAT did not yield evidence of body-related avoidance behavior. Future studies should control for the occurrence of body checking (i.e., increased focus on disliked body parts which could activate approach-biases) during AAT, manipulate the strength of self-reference, e.g., by presenting/omitting facial cues in self-depicting body pictures, and consider the task relevance of (and thus overt attention to) the body pictures.

Loss of control eating (LOC-E) is the most common form of disordered eating in childhood and adolescence. Negative emotions and stress play a crucial role in its development and maintenance. The purpose of this study is to experimentally test the escape from self-awareness model, which proposes that LOC-E occurs because individuals attempt to reduce their emotional distress by shifting their focus from an aversive self-perception to the immediate environment, such as food. We investigated the effect of stress (false negative or positive performance feedback) and self-awareness (opened or closed full-body mirrors) inductions on desire to eat (DTE) and food intake in adolescents with and without LOC-E. While there were no effects of stress on DTE irrespective of group membership, participants with and without LOC-E ate less (rather than more, as hypothesized) in the high stress condition. Neither of these effects interacted with the self-awareness condition. Because the stress induction had the unintended effect of increasing participants' self-awareness, we found evidence that participants decreased their food intake when experiencing stress and high self-awareness concurrently. The results of this study contribute to a further understanding of the role of stress and self-awareness on DTE and food intake in children and adolescents with and without LOC-E.

While the hierarchical model of approach-avoidance motivation suggests a heightened food-specific approach behavior for individuals with binge eating disorder (BED), empirical evidence does not confirm the postulated food approach bias. This discrepancy may be related to the studied samples, which were partially in treatment, but also to the fact that previous studies tested for an approach bias under low cognitive load. Therefore, the present study assessed the food-specific approach behavior in an untreated sample with BED under high and low cognitive load, in comparison to a weight-matched and a normal weight control group. To this end, 50 individuals with BED, 20 individuals with overweight and 21 individuals with normal weight completed an approach avoidance task. In each trial, participants were instructed to either push or pull a slider device, dependent on the orientation of an arrow, which was superimposed on a picture. The underlying picture either depicted a high calorie food item or a neutral stimulus. Cognitive load was manipulated by two flanking arrows that either pointed in the same or the opposite direction to the task-relevant central arrow. First, and contrary to our hypothesis, the food-specific approach bias was not stronger in the group with BED compared to both control groups. Post-hoc tests further revealed no food-specific approach bias in any of the three groups. Moreover, and contrary to our hypothesis, cognitive load did not show a group specific impact on the food approach behavior. However, cognitive load did increase the food approach behavior across groups. The results of this study, in conjunction with previous studies suggest, that there is no clear food approach bias in individuals with BED, at least when movement direction is not explicitly contingent on picture content.

OBJECTIVES:Brain stimulation treatments for eating disorders are rapidly emerging as neurobiologically driven interventions, including low-threshold electric stimulation with transcranial direct current stimulation (tDCS). Previous research has targeted inhibitory control and food craving with tDCS with different electrode placements-targeting the right prefrontal cortex (PFC) either unilaterally, or bilaterally with opposite polarity at the left and right PFC. There is, however, no systematic evidence showing whether unilateral and bilateral tDCS are equally effective, or whether (concurrent) cathodal tDCS might show detrimental effects. MATERIALS AND METHODS:We systematically manipulated electrode placement and randomized healthy participants after at least three hours of fasting in four tDCS groups (bilateral, unilateral left/right, and sham). We analyzed food- and non-food-related false alarms in a stop-signal task before, during, and after tDCS. We further quantified participants' global stop-signal reaction time (SSRT) and state food craving. All placements were modeled computationally. RESULTS:Our main analyses did not show an effect of tDCS. A post hoc contrast indicated opposite trajectories of SSRT during unilateral cathodal tDCS (impaired) and anodal tDCS (improved), but with immediate recovery after stimulation. Computational modeling indicated that electric fields in inferior frontal regions were denser for unilateral tDCS than for bilateral tDCS. DISCUSSION:Possible effects of tDCS are subtle and transient. For more robust results, individual targeting might be considered. Reaching inferior frontal regions might be crucial for modulating inhibitory control. The neural and behavioral consequences of bilateral vs unilateral tDCS should be critically considered in future research.

Restrained eaters (RE) are individuals that regularly show disinhibited food intake despite attempts of cognitive dietary restraint. This disinhibition is often attributed to an abundance of food cues in the environment that repeatedly draw attention, although the literature remains ambiguous. One source of ambiguity is the influence of different food cue modalities (pictures, words) on attentional processes. The current study therefore investigates the effect different modalities have on attentional bias to food cues in RE (n = 70) compared to unrestrained eaters (URE; n = 74). After a standardized lunch, participants completed a Rapid Serial Visual Presentation task with concurrent electroencephalography. Trials consisted of streams of pictures or words, with task-irrelevant food and animal distractors at lag 2 before an animal target appeared. Model comparisons indicated a significant Group × Distractor Type interaction. Specifically, RE were more accurate at identifying targets that were preceded by food compared to animal stimuli than URE. Exploratory analyses indicated that this was especially due to food pictures. This finding was not accompanied by changes in event related potentials. Furthermore, we found a significant Modality × Distractor Type interaction. In the picture, but not in the word condition, participants correctly identified targets preceded by a food distractor more often than when preceded by an animal distractor. This finding was accompanied by an increased P300 after food cues. In all, we showed that RE more effectively ignore food cues, especially in the image condition. This contributes to a body of research that demonstrates increased inhibitory control over food cues in RE. Future studies have to determine under which conditions inhibition of food cues is successful in RE.

OBJECTIVE:Anorexia nervosa (AN) typically manifests during adolescence and is linked to significant psychological and physical sequelae. A better understanding of the underlying maintenance mechanisms of adolescent AN is therefore crucial. Cognitive behavioral theories emphasize the influence of cognitive biases in the processing of disorder-relevant stimuli. METHOD:The current study investigated attentional bias to high- and low-calorie food in female adolescents with AN (n = 31) and without AN (n = 35). An event-related potentials study utilizing prolonged stimulus presentation in an attention task was conducted. RESULTS:Against our hypotheses, the results suggest an early avoidance of (i.e., reduced early posterior negativity) and an increased motivated attention (i.e., enhanced P300) towards high-calorie food in females with AN relative to controls. DISCUSSION:The automated early avoidance indicates a decline in the positive incentive value of high-calorie food, which signals a loss of the appetitive character of these foods. The increased top-down attention towards food may be due to an increased negative emotional salience activating aversive motivational systems.