Publications by authors named "Janet Treasure"

478 Publications

Perspectives on psychedelic treatment and research in eating disorders: a web-based questionnaire study of people with eating disorders.

J Integr Neurosci 2021 Sep;20(3):551-560

Community Mental Health Team, St Ann's Hospital, N15 3TH London, UK.

Approximately 1.25 million people in the UK suffer from an eating disorder, yet the treatment options show limited efficacy, warranting the need for novel approaches. This study aimed to investigate the perspectives of people with eating disorders on the use of complementary therapies and psychedelic research and treatment. Two hundred participants with eating disorders took part in this web survey study. The majority of participants (70%) had used a complementary treatment to manage their eating disorder. Participants believed that psychedelic research was worthwhile in the context of a moderate level of concern. The most popular solutions to meet these concerns included providing education around psychedelics and their effects and use in psychiatry and experiencing endorsement from professionals in the area. Moreover, participant responses emphasized the need for a safe, monitored environment and the patient-therapist rapport in the context of psychedelic treatment. The findings are explored concerning future trials of psychedelics as a treatment for eating disorders.
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http://dx.doi.org/10.31083/j.jin2003059DOI Listing
September 2021

I change my mind to get better: Process tracing-based microanalysis of food choice processes reveals differences between Anorexia Nervosa and bulimia nervosa during inpatient treatment.

Appetite 2021 Oct 8:105745. Epub 2021 Oct 8.

Department of Psychology and Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.

Food choice and its underlying processes is understudied in Bulimia Nervosa (BN) and Anorexia Nervosa (AN). Thus, we examined cognitive processes during food choice through mouse tracing in AN (n = 36) and BN (n = 27) undergoing inpatient treatment. Both patient groups and matched healthy controls (HC, n = 59) made 153 binary food choices before rating all foods on their liking and calorie density. Choice outcomes and corresponding mouse movements were modelled as a function of inpatient treatment stage in our analyses. Compared to patients with BN and HC, those with AN showed a clear calorie avoidance on most trials. Yet, mouse paths in AN patients early in treatment, revealed a late direction reversal ('change of mind', CoM) on high-calorie choices. AN patients later in treatment, by contrast, showed fewer CoM alongside more choices for - and liking of - high-calorie foods. Patients with BN showed more CoM trials during low-calorie choices and low-calorie choices were more frequent in patients later in treatment. Thus, relative to patients early in treatment, patients who are later in treatment show less of the overall group pattern of consistently choosing low-calorie food (AN) or high-calorie food (BN). Less cognitive regulation (fewer CoM trials) went along with higher liking for high-calorie foods in AN. These cross-sectional differences between AN early and late in treatment might reflect the formation of healthier habits. In addition, clear patient group differences suggest more specific treatment strategies.
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http://dx.doi.org/10.1016/j.appet.2021.105745DOI Listing
October 2021

COVID-19 and UK family carers: policy implications.

Lancet Psychiatry 2021 10;8(10):929-936

Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers.
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http://dx.doi.org/10.1016/S2215-0366(21)00206-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445736PMC
October 2021

A multifaceted study of interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders and healthy controls.

J Affect Disord 2021 Jul 19;295:397-404. Epub 2021 Jul 19.

Department of General Psychology, University of Padova, Italy.

Background: Cognitive biases towards social stimuli have been identified as one of the putative modifiable mechanisms to remediate interpersonal difficulties in adolescents with mental disorders. However, evidence for these biases in adolescents with eating disorders is scarce.

Methods: This study assessed interpersonal sensitivity, cognitive biases towards social stimuli, and quantity and quality of social group memberships in adolescents with eating disorders (n = 80), compared to healthy controls (n = 78), and examined whether a negative interpretation bias would mediate the relationship between interpersonal sensitivity, eating disorder symptoms and positive group memberships.

Results: Adolescents with eating disorders displayed greater interpersonal awareness, negative interpretation biases of ambiguous social information and poorer quality relationships with their social groups compared to healthy controls. In a simple mediation model, interpersonal awareness predicted eating disorder symptoms, and this effect was partially mediated by a negative interpretation bias.

Conclusions: Psychological interventions which aim to reduce a negative interpretation bias might help to reduce the severity of eating disorder symptoms in adolescents with eating disorders.
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http://dx.doi.org/10.1016/j.jad.2021.07.013DOI Listing
July 2021

A pilot randomized control trial of online exposure for eating disorders and mechanisms of change delivered after discharge from intensive eating disorder care: A registered report.

Int J Eat Disord 2021 Sep 4. Epub 2021 Sep 4.

Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA.

More than 50% of individuals with an eating disorder (ED) will readmit to treatment within 6 months of treatment discharge and often due to persistent cognitive ED pathology. Interventions addressing unremitted cognitive ED pathology following discharge from intensive treatment are crucial to prevent readmission. Imaginal exposure therapy facilitates the approach of feared stimuli not accessible in everyday life (e.g., rapidly gaining weight). In the current pilot randomized control trial (RCT), participants will be randomly assigned to a five-session online imaginal exposure condition (n = 65) or a control online writing and thinking intervention (n = 65) within a month of discharge from intensive treatment. Exposure participants write about and imagine an ED fear and control participants will write about their ED generally. We will examine the feasibility and acceptability of the treatment conditions and whether imaginal exposure is more effective in preventing readmission than the control condition. We will test the efficacy of the imaginal exposure treatment in reducing ED symptoms and fears of food and weight gain, and whether fear learning is a mechanism of change related to ED pathology. Ultimately, this research will lead to the development of an easily deployable readmission prevention treatment based on fear conditioning targets.
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http://dx.doi.org/10.1002/eat.23603DOI Listing
September 2021

Fear conditioning in women with anorexia nervosa and healthy controls: A preliminary study.

J Abnorm Psychol 2021 Jul;130(5):490-497

Institute of Psychiatry, Psychology and Neuroscience.

Anorexia nervosa is characterized by anxiety-driven behaviors, such as food avoidance and distressing persistent thoughts about weight gain and body image. The present study used a classical fear conditioning procedure to test the processes of fear acquisition and generalization, extinction, and renewal in patients with anorexia nervosa and healthy controls. An app-based fear conditioning procedure was administered remotely to 64 patients and 60 healthy controls, over two sessions. A human female scream served as the unconditioned stimulus (US) and two neutral shapes were used as either the paired conditioned stimulus (danger cue; CS+) or the unpaired conditioned stimulus (safe cue; CS-). Patients with anorexia nervosa reported greater threat expectancy in response to the danger cue during the extinction and renewal phases and overall higher levels of negative affect throughout the task, compared with controls. Future research is warranted to replicate these findings and highlight the role that anxiety plays in explaining fear conditioning responses in patients with anorexia nervosa. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/abn0000549DOI Listing
July 2021

Reduced MIP-1β as a Trait Marker and Reduced IL-7 and IL-12 as State Markers of Anorexia Nervosa.

J Pers Med 2021 Aug 20;11(8). Epub 2021 Aug 20.

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.

Alterations in certain inflammatory markers have been found in individuals with anorexia nervosa (AN). However, their relation to clinical characteristics has not been extensively explored, nor is it clear whether they are trait or state features of the disorder. This cross-sectional study measured serum concentrations of 36 inflammatory markers in people with acute AN ( = 56), recovered AN (rec-AN; = 24) and healthy controls (HC; = 51). The relationship between body mass index (BMI), eating disorder psychopathology, depression symptoms and inflammatory markers was assessed. Statistical models controlled for variables known to influence cytokine concentrations (i.e., age, ethnicity, smoking status and medication usage). Overall, most inflammatory markers including pro-inflammatory cytokines were unchanged in AN and rec-AN. However, in AN and rec-AN, concentrations of macrophage inflammatory protein (MIP)-1β were lower than HCs. Interleukin (IL)-7 and IL-12/IL-23p40 were reduced in AN, and concentrations of macrophage-derived chemokine, MIP-1α and tumor necrosis factor-α were reduced in rec-AN compared to HC. In conclusion, a reduction in MIP-1β may be a trait marker of the illness, whereas reductions in IL-7 and IL-12/IL-23p40 may be state markers. The absence of increased pro-inflammatory cytokines in AN is contradictory to the wider literature, although the inclusion of covariates may explain our differing findings.
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http://dx.doi.org/10.3390/jpm11080814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399452PMC
August 2021

Reply to Allison et al.: All-age eating disorder services.

Australas Psychiatry 2021 Oct 15;29(5):561-562. Epub 2021 Jul 15.

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http://dx.doi.org/10.1177/10398562211028650DOI Listing
October 2021

Lifetime Weight Course as a Phenotypic Marker of Severity and Therapeutic Response in Patients with Eating Disorders.

Nutrients 2021 Jun 13;13(6). Epub 2021 Jun 13.

Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 08907 L'Hospitalet de Llobregat, Spain.

The association between lifetime weight fluctuations and clinical characteristics has been widely studied in populations with eating disorders (ED). However, there is a lack of literature examining the potential role of weight course as a transdiagnostic factor in ED so far. Therefore, the aim of this study is to compare ED severity and treatment outcomes among four specific BMI profiles based on BMI-trajectories across the lifespan: (a) persistent obesity (OB-OB; ( = 74)), (b) obesity in the past but currently in a normal weight range (OB-NW; = 156), (c) normal weight throughout the lifespan (NW-NW; = 756), and (d) current obesity but previously at normal weight (NW-OB; = 314). Lifetime obesity is associated with greater general psychopathology and personality traits such as low persistence and self-directedness, and high reward dependence. Additionally, greater extreme weight changes (NW-OB and OB-NW) were associated with higher psychopathology but not with greater ED severity. Higher dropout rates were found in the OB-OB group. These results shed new light on the BMI trajectory as a transdiagnostic feature playing a pivotal role in the severity and treatment outcome in patients with ED.
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http://dx.doi.org/10.3390/nu13062034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231878PMC
June 2021

Addressing weight stigma and anti-obesity rhetoric in policy changes to prevent eating disorders.

Lancet 2021 07 3;398(10294):7-8. Epub 2021 Jun 3.

Department of Psychology, Dickinson College, Carlisle, PA, USA.

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http://dx.doi.org/10.1016/S0140-6736(21)01109-0DOI Listing
July 2021

An examination of social group memberships in patients with eating disorders, carers, and healthy controls.

Eur Eat Disord Rev 2021 Sep 3;29(5):733-743. Epub 2021 Jun 3.

Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

This study compared the quantity and quality of social group memberships in patients with anorexia nervosa (n = 30), carers of patients with anorexia nervosa, unrelated to those patients (n = 30), and two cohorts of healthy controls (n = 60) age-matched to these focal groups. A secondary aim was to examine the associations between the quality of group relationships and severity of eating disorder and depression symptoms in patients; and depression symptoms in carers. Participants completed the online Social Identity Mapping Tool, which was used to measure the quantity and quality of social group memberships (e.g., number of social groups, number of groups rated 'highly positive'). Participants also completed self-report measures of clinical symptoms. Compared to controls, patients reported fewer social groups when eating disorder-related groups were included, and significantly fewer social groups, and community groups in particular, when eating disorder-related groups were excluded. Number of positive groups was negatively associated with severity of eating disorder and depression symptoms in patients when eating disorder-related groups were excluded. Carers reported fewer groups overall, fewer family groups, and fewer positive and supportive groups compared to healthy controls. There was a weak association between the number of positive groups and the severity of depression symptoms in carers. Positive group memberships might play a protective role towards developing more severe eating disorder and depression symptoms.
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http://dx.doi.org/10.1002/erv.2840DOI Listing
September 2021

Socio-cognitive processing in people with eating disorders: Computerized tests of mentalizing, empathy and imitation skills.

Int J Eat Disord 2021 08 31;54(8):1509-1518. Epub 2021 May 31.

Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.

Objective: Eating disorders are psychiatric illnesses characterized by extreme eating behaviors, such as sustained food restriction or loss of control over eating. Symptoms are thought to be maintained by a variety of mechanisms, one of which may be the socio-cognitive impairments associated with eating disorders. While some previous work has addressed socio-cognitive impairments in eating disorders, this work has relied mostly on self-report data.

Method: Here we employed computerized tests of (a) mentalizing (ability to infer the mental states of others); (b) empathy (the degree to which the emotional states of others can be identified and the degree to which the states of others impact one's own emotional state); and (c) imitation (the degree to which observation of another's actions prompts the performance of those actions); in a group of 78 women with an eating disorder and a matched control group of 66 healthy women.

Results: People with eating disorders showed both hyper- and hypo-mentalizing and reduced accuracy of emotional and cognitive mental state inference. They displayed less imitation of observed actions, but no differences in empathy compared to healthy controls. Although anxiety and depressive symptoms had significant effects on mentalizing, most of the observed inter-group differences persisted.

Discussion: Women with eating disorders have difficulties mentalizing and imitating observed actions despite intact non-social automatic imitation, compared to healthy controls. These findings provide an indication that intervention modules to strengthen specific areas of social cognition might be helpful to improve patients' social skills.
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http://dx.doi.org/10.1002/eat.23556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453969PMC
August 2021

The relationship between working alliance with peer mentors and eating psychopathology in a digital 6-week guided self-help intervention for anorexia nervosa.

Int J Eat Disord 2021 08 27;54(8):1519-1526. Epub 2021 May 27.

Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.

Objective: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa.

Method: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n = 14) or a peer mentor (n = 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model.

Results: WA with peer mentors was slightly higher than WA with students (ES = 0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology.

Discussion: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders.
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http://dx.doi.org/10.1002/eat.23559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453826PMC
August 2021

The Sit Up Squat Stand test and Hand Grip Strength: What is the role of tests of muscle power in risk assessment in Anorexia Nervosa?

Eur Eat Disord Rev 2021 Jul 5;29(4):670-679. Epub 2021 May 5.

Department of Medicine, University College London (UCL), London, UK.

Objectives: To investigate the validity and reliability of two variants of the Sit Up Squat Stand Test (SUSS) and Hand Grip Strength (HGS) in predicting BMI and BMI risk level in hospitalised patients with Anorexia Nervosa (AN).

Methods: 25 inpatients with AN were tested roughly weekly for up to 16 weeks. Muscle power was assessed by two independent researchers.

Results: Intra-class coefficients (ICCs) indicated high Inter-Rater Reliability (IRR) for the HGS (10 participants). Cohen's Kappa showed moderate IRR for the SUSS test (25 participants). Stepwise multiple regression showed that the SUSS tests plus HGS predicted BMI and BMI risk level explaining about two-third of the variance. Each test individually had lower predictive value. There was a little difference between the two versions of the SUSS tested.

Conclusions: HGS and SUSS are valid and reliable measurements of muscle power in AN. Together, the SUSS tests and the HGS represent a useful and effective measure of muscle power and hence one aspect of physical risk in Anorexia Nervosa. In the light of Covid restrictions, the SUSS test is one way that physical state can be monitored on video link in a way that is hard to falsify.
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http://dx.doi.org/10.1002/erv.2839DOI Listing
July 2021

Does a Skills Intervention for Parents Have a Positive Impact on Adolescents' Anorexia Nervosa Outcome? Answers from a Quasi-Randomised Feasibility Trial of SUCCEAT.

Int J Environ Res Public Health 2021 04 27;18(9). Epub 2021 Apr 27.

Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria.

Skills trainings for caregivers of patients with anorexia nervosa (AN) have been proven to be effective in improving caregiver skills and reducing caregivers' psychopathology. The effects on patients, especially adolescents, are largely unknown. The aim of this study was to evaluate the effectiveness of a caregivers' skills training program (Supporting Carers of Children and Adolescents with Eating Disorders in Austria, SUCCEAT, workshop or online version) on adolescents with AN delivered as workshops (WS) or online (ONL). Outcomes are Body-Mass-Index (BMI) percentile, eating psychopathology (Eating Disorder Examination, EDE), attitudinal and behavioural dimensions of eating disorders (Eating Disorder Inventory-2), motivation to change (AN Stages of Change Questionnaire), emotional and behavioural problems (Youth Self-Report) and quality of life (KINDL). All outcome variables significantly improved across both SUCCEAT groups (WS and ONL) and were sustained at 12-month follow-up. The online and workshop delivery of SUCCEAT were equally effective. Most effect sizes were in the medium-to-high range. Full or partial remission was observed in 72% (WS) and 87% (ONL) of patients. Caregiver skills trainings, either delivered as workshops or online modules, are highly recommended to complement treatment as usual.
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http://dx.doi.org/10.3390/ijerph18094656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124826PMC
April 2021

Lower pattern recognition memory scores in anorexia nervosa.

J Eat Disord 2021 Apr 17;9(1):49. Epub 2021 Apr 17.

Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.

Background: There is extensive evidence for volumetric reductions in the hippocampus in patients with anorexia nervosa (AN), however the impact on function is unclear. Pattern separation and recognition are hippocampus-dependent forms of learning thought to underlie stimulus discrimination.

Methods: The present study used the Mnemonic Similarity Task to investigate pattern separation and recognition for the first time in patients with AN (N = 46) and healthy controls (N = 56). An Analysis of Covariance examined between-group differences, controlling for age, antidepressant use and method of task delivery (remote vs. in person).

Results: When controlling for covariates, pattern recognition memory scores were lower in the AN group with a medium effect size (d = 0.51). In contrast, there was a small effect whereby patients with AN had a greater pattern separation score than controls (d = 0.34), albeit this difference was not significant at the p = 0.05 threshold (p = 0.133). Furthermore, pattern separation and recognition memory abilities were not related to age, body mass index, eating disorder psychopathology or trait anxiety levels.

Conclusions: This preliminary study provides initial evidence for an imbalance in pattern separation and recognition abilities in AN, a hippocampus-dependent cognitive ability. Further studies should endeavour to investigate pattern separation and recognition performance further in AN, as well as investigate other hippocampus-dependent functions.
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http://dx.doi.org/10.1186/s40337-021-00406-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052530PMC
April 2021

Characterising binge eating over the course of a feasibility trial among individuals with binge eating disorder and bulimia nervosa.

Appetite 2021 09 2;164:105248. Epub 2021 Apr 2.

Centre for Cognitive Neuroscience, Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria.

Binge eating disorder and bulimia nervosa are eating disorders that are characterized by recurrent binge eating episodes. The highly contextualized nature of binge eating makes naturalistic research a particularly suitable means of understanding the context within which binge eating occurs. The present study aimed to characterise binge eating days with regards to the frequency and probability of negative affect, food craving, meal skipping, and dietary restriction. In addition, it aimed to examine whether a combined intervention that targets the experience of 'loss of control' over eating can decrease these potential maintenance factors that often precede binge eating episodes. Seventy-eight participants with bulimia nervosa (N = 40) or binge eating disorder (n = 38), who were randomly allocated to a food-specific or general intervention combining inhibitory control training and implementation intentions, completed mood and food diaries over four weeks. Results suggest that negative affect and food craving were elevated on binge eating days, but that dietary restraint and meal skipping did not characterise binge eating days. Moreover, meal skipping, binge eating, restriction, and compensation decreased throughout the intervention period, while negative affect and food craving did not. This suggests that some interventions may successfully reduce binge eating frequency without necessarily decreasing negative affect or food craving, thus pointing to the different routes to targeting binge eating and providing implications for future interventions.
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http://dx.doi.org/10.1016/j.appet.2021.105248DOI Listing
September 2021

A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in people with type 1 diabetes mellitus.

Diabet Med 2021 Jul 6;38(7):e14578. Epub 2021 May 6.

Diabetes Research Group, Weston Education Centre, King's College London, London, UK.

Aims: This qualitative study aimed to develop the first cognitive behavioural therapy model outlining the development and maintenance of disordered eating in type 1 diabetes and report on recovery strategies and resilience factors to improve previous theoretical models of type 1 diabetes and disordered eating.

Methods: Twenty-three women (n = 9 with type 1 diabetes and disordered eating, n = 5 with type 1 diabetes recovering from disordered eating, and n = 9 with type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using grounded theory and individual cognitive-behavioural formulations were developed for each participant to inform the development/maintenance and resilience models.

Results: The development/maintenance model summarises commonly experienced vicious cycles of thoughts, feelings and behaviours in type 1 diabetes and disordered eating. The resilience model summarises strategies and knowledge acquired by those with type 1 diabetes in recovery from disordered eating and individuals with type 1 diabetes who did not develop disordered eating. Early adverse life events, past psychiatric history, perfectionist personality traits, difficult experiences around type 1 diabetes diagnosis and its relentless daily management sensitise individuals to eating, weight and shape cues. Alongside physical symptoms/complications, unhelpful interpersonal reactions and inadequate healthcare, vicious cycles of thoughts, feelings and behaviours develop. 'Good enough' psychological adaptation to type 1 diabetes, integrating type 1 diabetes into one's identity, self care and compassion around eating, weight and shape were key protective/post-traumatic resilience factors.

Conclusions: This first cognitive behavioural therapy model of type 1 diabetes and disordered eating informed by personal experience will inform an intervention for type 1 diabetes and disordered eating.
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http://dx.doi.org/10.1111/dme.14578DOI Listing
July 2021

Emotional regulation in eating disorders and gambling disorder: A transdiagnostic approach.

J Behav Addict 2021 Mar 13. Epub 2021 Mar 13.

1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain.

Background And Aims: Difficulties in Emotion Regulation (ER) are related to the etiology and maintenance of several psychological disorders, including Eating Disorders (ED) and Gambling Disorder (GD). This study explored the existence of latent empirical groups between both disorders, based on ER difficulties and considering a set of indicators of personality traits, the severity of the disorder, and psychopathological distress.

Methods: The sample included 1,288 female and male participants, diagnosed with ED (n = 906) and GD (n = 382). Two-step clustering was used for the empirical classification, while analysis of variance and chi-square tests were used for the comparison between the latent groups.

Results: Three empirical groups were identified, from the most disturbed ER profile (Subgroup 1) to the most functional (Subgroup 3). The ER state showed a linear relationship with the severity of each disorder and the psychopathological state. Different personality traits were found to be related to the level of emotion dysregulation.

Discussion And Conclusion: In this study, three distinct empirical groups based on ER were identified across ED and GD, suggesting that ER is a transdiagnostic construct. These findings may lead to the development of common treatment strategies and more tailored approaches.
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http://dx.doi.org/10.1556/2006.2021.00017DOI Listing
March 2021

Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment.

Int J Eat Disord 2021 07 24;54(7):1278-1282. Epub 2021 Mar 24.

Department of Psychological Medicine, Kings College London, London, UK.

Objective: To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome.

Method: From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-month follow-up data. Predictors included global EDE-Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale).

Results: Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline.

Discussion: Further work that can identify sub-groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches.
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http://dx.doi.org/10.1002/eat.23508DOI Listing
July 2021

Physical exercise-related endophenotypes in anorexia nervosa.

Int J Eat Disord 2021 07 12;54(7):1181-1188. Epub 2021 Mar 12.

Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France.

Background: The persistence of physical exercise in anorexia nervosa (AN) despite underweight and its maintaining factors are poorly understood. The aim of this study was to explore the attitudes toward physical exercise and its effects on emotions, cognitive functioning, and body image perception in patients with AN, and to search for exercise-related endophenotypes of the pathology.

Methods: Physical exercise dependence, quantity, and dysregulation were assessed by the Exercise Dependence Scale (EDS), the Godin Leisure Time Exercise Questionnaire (GLTEQ) and a standardized effort test in 88 patients with AN, 30 unaffected relatives and 89 healthy controls. Changes in positive and negative affect, cognitive rigidity, and body image distortion were measured before and after the effort test in the three groups.

Results: Patients with AN had higher scores on the EDS and the GLTEQ and used more effort in the standardized effort test. These three measures of physical exercise correlated with negative emotions at baseline. After the effort test, patients with AN had marked emotional improvement, a moderate increase in body image distortion and a small increase in cognitive rigidity compared to HC. Unaffected relatives also had a significant postexercise increase of positive emotion.

Discussion: The mood-related drive for physical exercise has the characteristics of an endophenotype of the disorder. Excessive and driven physical exercise may be state-associated features of AN, driven by the positive effect on emotional wellbeing.
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http://dx.doi.org/10.1002/eat.23503DOI Listing
July 2021

A systematic review of interventions to support transitions from intensive treatment for adults with anorexia nervosa and/or their carers.

Eur Eat Disord Rev 2021 May 9;29(3):355-370. Epub 2021 Mar 9.

Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Aim: In the short term, intensive treatment focusing on restoring weight for anorexia nervosa can remediate many symptoms. However, there is a high level of relapse after discharge. This paper examines interventions developed to bridge the transition from intensive to less intensive forms of treatment for adult anorexia nervosa.

Method: We undertook a systematic review of the literature on interventions aimed at providing transition support. The Template for Intervention Description and Replication was used to describe components of the transition interventions. Patient's drop-out rates, weight, eating disorder psychopathology and mood data were extracted at end of treatment and follow-up to describe preliminary efficacy.

Results: Fourteen studies were selected: nine used psychological interventions delivered through face-to-face talking therapy or guided self-help, three examined the use of fluoxetine and two assessed stepped-care approaches. Transition support was delivered to patients in 11 studies, to patients and carers in two studies, and carers alone in another study.

Conclusions: There was a great heterogeneity in the content and structure of the transition interventions evaluated. Overall, drop-out rates were lower for psychological support than pharmacological interventions or stepped-care approaches. Changes in eating disorder outcomes and mood were small to moderate throughout for studies that included a comparison group.
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http://dx.doi.org/10.1002/erv.2824DOI Listing
May 2021

Optimising care pathways for adult anorexia nervosa. What is the evidence to guide the provision of high-quality, cost-effective services?

Eur Eat Disord Rev 2021 May 24;29(3):306-315. Epub 2021 Feb 24.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain.

The aim of this paper is to consider how changes in service planning and delivery might improve the care pathways for adult anorexia nervosa. Although anorexia nervosa has a long history in Europe, its framing as a mental disorder is quite recent. The changing forms and increasing epidemiology of eating disorders has led to the expansion of specialised services. Although some services provide care over the entire clinical course, more often services are divided into those that care for children and adolescents or adults. The transition needs to be carefully managed as currently these services may have a different ethos and expectations. Services for adults have a broad range of diversity (diagnostic subtype, medical severity, comorbidity, stage of illness and psychosocial functioning) all of which impacts on prognosis. A tailored, approach to treatment planning could optimise the pathway. Facilitating early help seeking and rapid diagnosis in primary care and reducing specialised services waiting lists for assessment and treatment could be a form of secondary prevention. The use of precision models and /or continuous outcome monitoring might reduce the third of patients who require more intensive care by applying augmentation strategies. Finally, gains from intensive care might be sustained by relapse prevention interventions and community support to bridge the transition home. Together these measures might reduce the proportion of patients (currently a third) with ill health for over 20 years. For this group rehabilitation strategies may improve functioning until new treatment emerge.
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http://dx.doi.org/10.1002/erv.2821DOI Listing
May 2021

Adding maintaining factors to developmental models of anorexia nervosa: An empirical examination in adolescents.

Eur Eat Disord Rev 2021 Jul 23;29(4):548-558. Epub 2021 Feb 23.

School of Psychology, Autonomous University of Madrid, Biological and Health Psychology Department, Madrid, Spain.

Objective: A biopsychosocial approach has been proposed to explain the pathogenesis of anorexia nervosa (AN), despite only a few of the existing etiological models having received empirical support. The aim of this study was to empirically investigate Herpertz-Dahlmann, Seitz, and Konrad (2011, https://doi.org/10.1007/s00406-011-0246-y)'s developmental model and to consider if interpersonal reactions to the illness might serve as maintaining factors following the model proposed by Treasure and Schmidt (2013, https://doi.org/10.1186/2050-2974-1-13) METHOD: One hundred adolescents and their families were participated in the study: 50 diagnosed with AN, paired by age and parents' socio-economic status with 50 adolescents without a pathology. Biological, psychological and familial variables were assessed using ten questionnaires and a blood analysis test. Additionally, structural equation modeling was conducted to assess two hypothetical models.

Results: The fit of both models was good after the addition of two covariate parameters (e.g., Comparative Fit Index > 0.96 and Tucker-Lewis Index > 0.95). Premorbid traits were linked to body dissatisfaction and to the number of stressful life events; this in turn was linked to AN symptoms. Biological and familial consequences reinforced this pathology.

Conclusions: Our findings provide support for both models, suggesting that inter relationships between bio-psycho-familial variables can influence the course of AN during adolescence.
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http://dx.doi.org/10.1002/erv.2826DOI Listing
July 2021

Value of treatment for eating disorders.

Eur Eat Disord Rev 2021 May 18;29(3):303-305. Epub 2021 Feb 18.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL and CIBEROBN, Barcelona, Spain.

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http://dx.doi.org/10.1002/erv.2827DOI Listing
May 2021

The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept.

Eur Eat Disord Rev 2021 May 18;29(3):499-513. Epub 2021 Feb 18.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.

Objective: There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes.

Methods: A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness.

Results: Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits.

Conclusions: Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.
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http://dx.doi.org/10.1002/erv.2822DOI Listing
May 2021

Length of stay for anorexia nervosa: Systematic review and meta-analysis.

Eur Eat Disord Rev 2021 May 6;29(3):371-392. Epub 2021 Feb 6.

Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Objective: Evidence regarding global trends in length of stay for patients with anorexia nervosa is limited. The aim of this study is to conduct a meta-analysis examining the length of stay for anorexia nervosa patients globally, and to investigate moderators of the variance.

Method: Medline, EMBASE and PsycINFO were searched for studies published up to January 2019. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria. A meta-analysis was performed to calculate a pooled mean length of stay using the random-effects model. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity between studies.

Results: Of 305 abstracts reviewed, 71 studies met the inclusion criteria, generating 111 datasets. The pooled mean length of stay (95% confidence interval) was 76.3 days (73.3, 79.4) using the random-effects model, with marked variation across countries and time. Heterogeneity between studies was explained by age and admission body mass index.

Conclusions: This meta-analysis found that although clinical features do contribute to length of admissions for anorexia nervosa, there are also global and temporal variations. Future research should provide an in-depth analysis of why and how this variation exists and what the impact is on the well-being of people with anorexia nervosa.
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http://dx.doi.org/10.1002/erv.2820DOI Listing
May 2021

The value of including families in the treatment of anorexia nervosa.

Eur Eat Disord Rev 2021 May 22;29(3):393-401. Epub 2020 Dec 22.

South London and Maudsley NHS Foundation Trust, Adult Inpatient Eating Disorders Service, Tyson West 2, Bethlem Royal Hospital, Beckenham, UK.

The aim of this paper is to consider family and wider carer involvement in the treatment of anorexia nervosa, and how this can be used to add value to services. We discuss widely adopted interventions involving the family that have been manualised and studied in trials that have outcome measures that are of relevance to illness costs. The therapeutic targets of these interventions range from a focus on feeding to the wellbeing of the whole family. The theoretical models that underpin interventions involving the family/wider carers include both intra and interpersonal processes, with the exception of family-based therapy, which in its original form holds an agnostic stance towards aetiology. Although formal evaluation of the cost effectiveness of these interventions is minimal, there is evidence that involving the family can reduce bed use and improve the wellbeing of both patients and family members. Moreover, for the most part, these interventions are acceptable to patients and carers. Finally, we consider how these approaches can be disseminated and scaled up more widely into services.
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http://dx.doi.org/10.1002/erv.2816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246805PMC
May 2021

Hippocampal volume, function, and related molecular activity in anorexia nervosa: A scoping review.

Expert Rev Clin Pharmacol 2020 Dec 25;13(12):1367-1387. Epub 2020 Nov 25.

Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK.

Introduction: Anorexia nervosa (AN) is a serious and persistent eating disorder, characterized by severe dietary restriction and weight loss, with a third of patients developing a  severe-enduring form. The factors contributing to this progression are poorly understood, although there is evidence for impairments in neural structures such as the hippocampus, an area particularly affected by malnutrition and chronic stress.

Areas Covered: This study aimed to map the evidence for alterations in hippocampal volume, function, and related molecular activity in anorexia nervosa. PubMed, PsycINFO, and Web of Science were searched for studies related to hippocampal function and integrity using a range of methodologies, such as neuropsychological paradigms, structural and functional magnetic resonance imaging, and analysis of blood components.

Expert Opinion: Thirty-nine studies were included in this review. The majority were neuroimaging studies, which found hippocampus-specific volumetric and functional impairments. Neuropsychological studies showed evidence for a specific memory and learning impairments. There was some evidence for molecular abnormalities (e.g. cortisol), although these were few studies. Taken together, our review suggests that the hippocampus might be a particular region of interest when considering neurobiological approaches to understanding AN. These findings warrant further investigation and may lead to novel treatment approaches.
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http://dx.doi.org/10.1080/17512433.2020.1850256DOI Listing
December 2020

Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self-care behaviour and emotion.

Diabet Med 2021 02 23;38(2):e14446. Epub 2020 Nov 23.

Diabetes Research Group, King's College London, Weston Education Centre, London, UK.

Objectives: Glycaemia in people with type 1 diabetes and disordered eating is not well characterised. We explored the glycaemia, self-care behaviour and emotional state of women with type 1 diabetes and disordered eating.

Research Design And Methods: In all, 13 women with and 10 without disordered eating and type 1 diabetes participated in this case-control study. We used a mixed-methods approach with a 7-day blinded continuous glucose monitoring and real-time record of non-prompted capillary glucose (CG), emotion, activity and physical symptoms on a diabetes diary using a smartphone application (mySugr®). We compared groups using Mann-Whitney U test or Fisher's exact test. We conducted thematic analyses of free-text diary entries (NVivo®) and quantitative analysis of emotion/symptom tags.

Results: People with type 1 diabetes and disordered eating spent longer time above range in level 2 hyperglycaemia (>13.9 mmol/L, Median [interquartile range]: 21% [16,60] vs 5% [2,17], p = 0.015). They had lower time in range and similar time below range compared to those without disordered eating. The standard deviation of CG was significantly higher in the disordered eating group (4.7 mmol/L [4.5, 6.1] vs 3 [2.8, 3.2], p = 0.018). The median of the percentage of rising sensor glucose trends was three times higher in the disordered eating group. They also had higher negative emotional and physical symptoms associated with high blood glucose (>15 mmol/L).

Conclusions: Disordered eating has a significant impact on the glycaemia and emotion of a person with type 1 diabetes.
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http://dx.doi.org/10.1111/dme.14446DOI Listing
February 2021
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