Publications by authors named "Sasha Gorrell"

40 Publications

Expressed emotion and long-term outcome among adolescents with anorexia nervosa.

Int J Eat Disord 2021 Sep 22. Epub 2021 Sep 22.

Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.

Objective: The purpose of the current study is to examine expressed emotion (EE) and long-term treatment outcome among adolescents participating in a randomized controlled trial (RCT) for treatment of anorexia nervosa (AN). It was hypothesized that patients with high EE parents at baseline would show more severe symptoms at end-of-treatment, 12-month follow-up, and 4-year follow-up than patients from low EE families.

Method: Secondary data analysis was conducted of original RCT data from a two-site eating disorder treatment trial conducted in the United States. Participants were 121 adolescents with AN who completed measures of EE, eating disorder psychopathology, depression, and self-esteem.

Results: Generalized estimating equations showed that participants who were in the Low EE group achieved a more accelerated drop in depression scores in the context of treatment (first 12 months) than participants in the High EE group. No other significant Group × Time interactions were found.

Discussion: Findings suggest that high parental EE at baseline does not indicate that adolescent patients with AN will fare poorly 4 years later.
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http://dx.doi.org/10.1002/eat.23613DOI Listing
September 2021

Registered report: A pilot investigation of acute exercise response among girls and young women with and without eating disorders.

Int J Eat Disord 2021 Jul 29. Epub 2021 Jul 29.

Department of Psychiatry and Behavioral Sciences, University of California - San Francisco, San Francisco, California, USA.

Objective: Driven exercise (DEx) is a serious and common feature of eating disorders (EDs), but current understanding of factors that give rise to and maintain DEx is limited. DEx may be reinforced through its effects on the threat reduction and reward systems. The current protocol is designed to evaluate acute psychobiological response to exercise among female participants (age 16-22) with and without EDs.

Method: Twenty medically-stable participants with restrictive-spectrum EDs and 20 healthy control (HC) participants will complete study screening and three task visits which will include two 30-minute bouts of aerobic exercise.

Results: We aim to validate and demonstrate feasibility of two tasks capturing exercise response in this sample. Further, we will estimate the degree to which a bout of exercise impacts state body image, affect, and circulating concentrations of biological markers among participants, and we will examine whether the impact of exercise on psychological outcomes may differ across ED and HC groups.

Discussion: Completion of this project will contribute to the conceptualization of DEx and how individuals' acute biological and affective responses to exercise contribute to risk for and maintenance of DEx.
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http://dx.doi.org/10.1002/eat.23587DOI Listing
July 2021

Gender-based clinical differences in evidence-based treatment for adolescent anorexia nervosa: analysis of aggregated randomized controlled trials.

Eat Weight Disord 2021 Jun 25. Epub 2021 Jun 25.

Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.

Purpose: Boys represent a small proportion of samples in randomized clinical trials (RCT) investigating evidence-based treatment for adolescents with anorexia nervosa (AN). Consequently, knowledge of potential gender differences in clinical characteristics and treatment response in adolescents is considerably limited.

Methods: Secondary analyses of aggregated data from two RCTs were used to characterize baseline and end-of-treatment clinical features in male and female adolescents with AN (n = 228, 10.53% male). Mixed analyses of variance were used to investigate potential gender differences in treatment response relative to weight outcomes (% median BMI) and eating disorder cognitions (Eating Disorder Examination Global scores; EDE).

Results: There were no significant gender differences in prior inpatient care, illness duration, psychiatric comorbidity, or psychotropic medication use at baseline. Nor were there significant gender differences in binge eating, purging, or driven exercise at baseline or end-of-treatment. Girls reported elevated weight and shape concern compared to boys at baseline but overall reduction in EDE Global scores over the course of treatment did not differ according to gender. Boys gained more relative weight during treatment than girls, but this difference was statistically non-significant.

Conclusion: Overall findings do not suggest significant differences in treatment outcome relative to weight or ED cognitions, by gender. Current evidence suggests that, with the exception of shape and weight concerns, boys present with cognitive and behavioral symptoms as severe as their female counterparts which underscores the need for increased accuracy in assessment of these disorders in boys and young men.

Level Of Evidence: Level 1, secondary data analysis of randomized controlled trials.
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http://dx.doi.org/10.1007/s40519-021-01257-7DOI Listing
June 2021

Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern.

Behav Ther 2021 07 24;52(4):830-846. Epub 2020 Oct 24.

University at Albany, State University of New York.

Body checking is a repeated behavior conducted in an attempt to gain information about one's shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants' body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants' self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants' state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.
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http://dx.doi.org/10.1016/j.beth.2020.10.005DOI Listing
July 2021

Understanding outcomes in family-based treatment for adolescent anorexia nervosa: a network approach.

Psychol Med 2021 05 6:1-12. Epub 2021 May 6.

Stanford University School of Medicine, Division, Stanford, CA, USA.

Background: Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes.

Methods: Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms).

Results: The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission.

Conclusions: Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.
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http://dx.doi.org/10.1017/S0033291721001604DOI Listing
May 2021

Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review.

Int J Eat Disord 2021 08 4;54(8):1358-1376. Epub 2021 May 4.

Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.

Objective: Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association.

Method: We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME.

Results: Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME.

Discussion: Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.
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http://dx.doi.org/10.1002/eat.23524DOI Listing
August 2021

Registered report: Initial development and validation of the eating disorders safety behavior scale.

Int J Eat Disord 2021 04 27;54(4):660-667. Epub 2021 Feb 27.

Department of Psychiatry, University of Wisconsin, Madison, Wisconsin, USA.

Anxiety and eating disorders (EDs) often co-occur, prompting calls to explore anxiety-related maintenance processes in ED samples. Safety behaviors, which function to prevent a feared outcome from occurring or to reduce anxiety associated with a feared stimulus, are observed across anxiety disorders and, along with overt avoidance behaviors, are an important target in treatment. Data suggest that individuals with EDs also engage in safety behaviors. However, no existing assessments provide a comprehensive measure of eating-disorder-specific overt avoidance and safety behaviors. The goal of this Stage 1 Registered Report is to develop a comprehensive self-report measure of ED-specific safety behaviors. In Study 1, we will recruit 50 women with EDs to complete the scale and provide feedback on the response scale. Feedback from these participants will be used to refine the measure. In Study 2, we will evaluate the psychometric properties of the measure in a large sample of women with EDs (n dependent on the size of measurement) and a community sample without current or a history of ED symptoms. We will explore the measure factor structure, known-groups validity by comparing scores from women with EDs to healthy controls, internal consistency, and convergent and divergent validity with other psychological instruments.
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http://dx.doi.org/10.1002/eat.23479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044048PMC
April 2021

Dopaminergic activity and exercise behavior in anorexia nervosa.

OBM Neurobiol 2020 23;4(1). Epub 2020 Mar 23.

Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.

Driven exercise (i.e., the tendency to exercise in excess to influence weight/shape or regulate emotion) is difficult to manage in the context of anorexia nervosa, and is associated with poorer treatment outcomes, and psychological and medical severity. Driven exercise is observed in a considerable number of those diagnosed with anorexia nervosa; however, to date, this hallmark symptom remains poorly understood. Dopamine signaling is implicated in motivating and maintaining appetitive behavior among patients with eating disorders; but, much less is known about the role of dopamine signaling specific to the symptom of driven exercise. An improved understanding of this biobehavioral mechanism may inform the etiology of driven exercise in anorexia nervosa, with the potential to impact future research and treatment efforts. This review describes the role that dopamine serves in maintaining symptoms in the context of anorexia nervosa, and synthesizes current relevant evidence on exercise in AN and related dopaminergic activity. Throughout, theoretical implications are discussed, along with critical directions for future research.
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http://dx.doi.org/10.21926/obm.neurobiol.2001053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872149PMC
March 2020

"Excessive exercise" in eating disorders research: problems of definition and perspective.

Eat Weight Disord 2021 May 2;26(4):1017-1020. Epub 2021 Jan 2.

Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.

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http://dx.doi.org/10.1007/s40519-020-01075-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068596PMC
May 2021

A call to experimentally study acute affect-regulation mechanisms specific to driven exercise in eating disorders.

Int J Eat Disord 2020 Dec 1. Epub 2020 Dec 1.

Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.

Driven exercise (i.e., feeling compelled to exercise to control one's weight or shape, to obtain other positive consequences of exercising, or to avoid other negative consequences of not exercising) is a common phenomenon in individuals with eating disorders (EDs), typically associated with negative clinical outcomes. Current theoretical models of driven exercise highlight the short-term affect-regulating outcome of acute driven exercise, which is implicated to maintain this symptom either by positive or negative reinforcement. However, few studies have actually investigated cognitive, affective, and psychobiological mechanisms related to acute driven exercise. In particular, experimental studies that directly test mechanisms leading to the short-term affective improvement after acute driven exercise are scarce. In this article, we therefore propose potential cognitive, affective, and psychobiological mechanisms that could explain the affect-regulating function of driven exercise in individuals with EDs. In addition, we suggest examples of experimental studies that could directly test these mechanisms in individuals with EDs, as recent studies have demonstrated the safety of supervised exercise in EDs research. Our aim of stimulating research on the underlying causes and maintenance factors of driven exercise in EDs has the potential to critically inform treatment development for this high-risk population.
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http://dx.doi.org/10.1002/eat.23427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166956PMC
December 2020

Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research.

Clin Psychol Rev 2021 02 11;83:101952. Epub 2020 Nov 11.

University of Minnesota, United States of America.

Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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http://dx.doi.org/10.1016/j.cpr.2020.101952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868093PMC
February 2021

Eating disorder pathology and compulsive exercise during the COVID-19 public health emergency: Examining risk associated with COVID-19 anxiety and intolerance of uncertainty.

Int J Eat Disord 2020 12 24;53(12):2049-2054. Epub 2020 Oct 24.

Department of Psychology, University at Albany, State University of New York, Albany, New York, USA.

Objective: COVID-19 has led to disruptions in daily living and increased uncertainty about physical, financial, social, and psychological consequences, which may contribute to anxiety, eating disorder (ED) pathology, and compulsive exercise. Individual factors, such as intolerance of uncertainty, may impact risk for ED pathology and CE in response to COVID-19 anxiety. The current study examined associations between COVID-19 anxiety, trait intolerance of uncertainty, and COVID-19 intolerance of uncertainty and ED pathology and compulsive exercise.

Method: Undergraduate participants (N = 295) completed a series of online questionnaires between March and April of 2020.

Results: COVID-19 anxiety and intolerance of uncertainty were associated with ED pathology, but not compulsive exercise. Additionally, both trait and COVID-19 intolerance of uncertainty moderated associations between COVID-19 anxiety and compulsive exercise and ED pathology. COVID-19 anxiety was more strongly related to compulsive exercise and ED pathology for individuals with lower intolerance of uncertainty.

Discussion: COVID-19 anxiety may increase risk for ED pathology and may be specifically important in determining risk for ED pathology and compulsive exercise among individuals with lower intolerance of uncertainty. These results contribute to a growing body of research aimed at understanding the mental health consequences of the COVID-19 and suggest that individual factors (e.g., anxiety and intolerance of uncertainty) are important in determining risk for ED pathology and compulsive exercise in the context of the pandemic.
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http://dx.doi.org/10.1002/eat.23395DOI Listing
December 2020

Psychotropic medication use in treatment-seeking youth with eating disorders.

Eur Eat Disord Rev 2020 11 14;28(6):739-749. Epub 2020 Sep 14.

Department of Psychiatry, University of California, San Francisco, California, USA.

Objective: Psychotropic medication use in youth with eating disorders (EDs) is poorly understood despite high co-occurrence of psychiatric disorders. This study examined characteristics associated with medication use in treatment-seeking youth with EDs.

Method: Youth up to age 18 reported on medication use when presenting to an academic medical center outpatient ED service in the United States. Data presented were collected between 1998-2015.

Results: The sample (N = 604) was predominantly female (90.6%) with a mean age of 15.3 years (SD = 2.3). Approximately one-third (30%, n = 173) were taking psychotropic medications (40%, n = 70, were taking multiple medications). Antidepressant use was most common (26%, n = 152), followed by atypical antipsychotics (8%, n = 43). Adjusting for co-occurring psychiatric disorders, non-Hispanic Whites who had received prior treatment (psychotherapy, hospitalization) were significantly more likely to be using medication. Longer illness duration and prior treatment were associated with greater antidepressant use. For atypical antipsychotics, prior hospitalization was associated with greater use.

Conclusions: Findings confirm moderate psychotropic medication use among young patients with EDs despite a lack of clarity regarding optimally effective pharmacologic interventions in this population. Pharmacological trials examining the efficacy of medications for young patients with EDs are warranted to inform future prescribing practice.
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http://dx.doi.org/10.1002/erv.2788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903243PMC
November 2020

Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting.

Eat Weight Disord 2021 Jun 7;26(5):1345-1356. Epub 2020 Jun 7.

Department of Psychology, University at Albany, State University of New York, Albany, NY, USA.

Objective: There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample.

Method: The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD) = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients' medical charts.

Results: In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not.

Conclusions: Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation.

Level Of Evidence: Level IV, uncontrolled intervention.
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http://dx.doi.org/10.1007/s40519-020-00939-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903880PMC
June 2021

Investigating Early Response to Treatment in a Multi-Site Study for Adolescent Bulimia Nervosa.

Front Psychiatry 2020 28;11:92. Epub 2020 Feb 28.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.

Background: This secondary data analysis seeks to replicate and extend findings that early response to treatment in adolescent bulimia nervosa (BN) predicts outcome, resulting in earlier identification of patients who might need a different treatment approach.

Methods: Participants were 71 adolescents ( ± : 15.69 ± 1.55 years; 93% female; 75% non-Hispanic) with a Diagnostic and Statistical Manual of Mental Disorders, 4 Edition (DSM-IV) diagnosis of BN or partial BN enrolled in a two-site treatment study. Participants were randomized to cognitive behavioral therapy for adolescents (CBT-A), family-based treatment for BN (FBT-BN), or supportive psychotherapy (SPT). The Eating Disorder Examination was administered at baseline, end-of-treatment (EOT), 6-month, and 12-month follow-up. Binge eating and purge symptoms were self-reported at each session. Outcome was defined as abstinence of binge eating and compensatory behaviors (self-induced vomiting, laxative use, diet pills, diuretics, compensatory exercise, fasting) in the 28 days prior to assessment. Receiver operating characteristic (ROC) analyses were utilized to assess the viability of predicting treatment outcomes based on reduction of symptoms within the first 10 sessions of treatment.

Results: ROC analyses suggest that reduction in purging at session 2 (AUC =.799, < .001) and binge eating at session 4 (AUC =.750, < .01) were independently related to abstinence of symptoms at EOT, regardless of treatment type. Symptom reduction later in treatment predicted outcome at follow-up, as change in binge eating at session 8 and purging at session 9 were the strongest predictors of abstinence at 6-month follow-up (AUCs =.726-.763, s < .01). Change in binge eating, but not purging behaviors, was significantly related to abstinence at 12-month follow-up (AUC =.766, < .01). Only slight differences emerged based on treatment group, such that reductions in symptoms most predictive of abstinence at EOT occurred one session sooner in FBT-BN than SPT.

Conclusion: Reductions in binge eating and purge symptoms early in adolescent BN treatment suggest better outcome, regardless of treatment modality. Additional research with larger samples is needed to better understand which treatments, if any, contribute to earlier change in BN symptoms and/or likelihood of improved patient response.
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http://dx.doi.org/10.3389/fpsyt.2020.00092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058584PMC
February 2020

Remission in adolescents with bulimia nervosa: Empirical evaluation of current conceptual models.

Eur Eat Disord Rev 2020 07 4;28(4):445-453. Epub 2020 Mar 4.

Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.

Objective: The few randomized clinical trials (RCTs) investigating adolescent treatment for bulimia nervosa (BN) suggest variability in both rates of, and criteria for remission. The current study examined reactivity in remission rates, relative to various conceptualizations of remission in a single RCT data set.

Method: A data set of adolescents with BN who participated in an RCT (N = 110) was used to evaluate remission models based upon behavioral symptoms (e.g., binge eating), psychological symptoms (Eating Disorder Examination [EDE] scores), and combinations of these criteria.

Results: At end-of-treatment (EOT), a remission model defined by behavioral symptom abstinence plus meaningful reduction in EDE global scores yielded comparable remission rates to a model defined by behavioral abstinence alone (i.e., 29% remitted). Participants with higher EOT EDE global scores were less likely to be abstinent from behavioral symptoms at 6- and 12-month follow-up (ps < .001).

Discussion: Reduction in psychological symptoms with behavioral abstinence did not inform remission status at EOT, over and above behavioral symptom change alone. However, psychological symptom improvement by EOT may predict positive prognosis in posttreatment assessment. Results underscore the necessity of including psychological symptom improvement, as well as consistency across research and practice, in defining remission in adolescent BN.
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http://dx.doi.org/10.1002/erv.2729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311246PMC
July 2020

Associations between ergogenic supplement use and eating behaviors among university students.

Eat Disord 2020 Mar 4:1-17. Epub 2020 Mar 4.

Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.

Ergogenic supplements to improve athletic performance are commonly used among college athletes, but little is known about their association with eating disorder symptoms. The objective of this study was to examine associations between ergogenic supplement use and disordered eating attitudes and behaviors among university students, and to compare differences by sex. Undergraduate students from 10 top-ranked National College Athletics Association (NCAA) Division I colleges completed an online survey on supplement use, athletic activities, and eating attitudes and behaviors. Among 1633 university students, males (38.9%) reported higher rates of current supplement use than females (15.2%) ( < .001). In linear regression models adjusting for athletic status and body mass index, current supplement use was associated with higher Eating Disorders Examination-Questionnaire (EDE-Q) Global, Shape Concern, and Restraint scores in both males and females. Supplement use was associated with driven/compelled exercise (OR 2.00, 95% CI 1.33-2.99) in males and diuretic (OR 6.39, 95% CI 2.02-20.22) and diet pill use (OR 3.07, 95% CI 1.79-5.27) in females. Results suggest ergogenic supplement use is common in undergraduates and associated with disordered eating attitudes and behaviors. Clinicians should screen for disordered eating behaviors particularly in young adults who use ergogenic supplements.
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http://dx.doi.org/10.1080/10640266.2020.1712637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483647PMC
March 2020

Delivery of Family-Based Treatment for Adolescent Anorexia Nervosa in a Public Health Care Setting: Research Versus Non-Research Specialty Care.

Front Psychiatry 2019 22;10:1001. Epub 2020 Jan 22.

Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.

Comparing evidence-based psychotherapy (EBP) to usual care typically demonstrates the superiority of EBPs, although this has not been studied for eating disorders EBPs such as family-based treatment (FBT). The current study set out to examine weight outcomes for adolescents with anorexia nervosa who received FBT through a randomized clinical research trial (RCT, = 54) or non-research specialty care ( = 56) at the same specialist pediatric eating disorder service. Weight was recorded throughout outpatient treatment (up to 18 sessions over 6 months), as well as at 6- and 12-month follow-up. Survival curves were used to examine time to weight restoration [greater than 95% median body mass index (mBMI)] as predicted by type of care (RCT vs. non-research specialty care), baseline clinical and demographic characteristics, and their potential interaction. Results did not indicate a significant main effect for type of care, but there was a significant effect for baseline weight ( = .03), such that weight restoration was achieved faster across both treatment types for those with a higher initial %mBMI. These data suggest that weight restoration achieved in non-research specialty care FBT was largely similar to that achieved in a controlled research trial.

Clinical Trial Registration: http://www.anzctr.org.au/, identifier ACTRN12610000216011.
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http://dx.doi.org/10.3389/fpsyt.2019.01001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987240PMC
January 2020

Family-based treatment for adolescent anorexia nervosa: What happens to rates of comorbid diagnoses?

Eur Eat Disord Rev 2020 05 29;28(3):351-357. Epub 2020 Jan 29.

Department of Psychiatry, University of California, San Francisco, CA.

Objective: Rates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa, but little is known about how psychiatric comorbidity changes following family-based treatment (FBT).

Methods: Adolescents with anorexia nervosa (N = 107) enrolled in a randomized controlled trial comparing two forms of FBT completed the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline and end of treatment. Analyses tested whether baseline comorbid diagnoses predicted the presence of comorbid diagnoses at end of treatment and if baseline eating disorder psychopathology impacted this association.

Results: Rates of comorbid diagnoses decreased from 54% at baseline to 26% at end of treatment. Logistic regression analyses indicated that individuals with multiple comorbid diagnoses at baseline were more likely to meet criteria for a comorbid condition at end of treatment (b = 2.00, p < .05). Individuals with reported psychotropic medication use were less likely to meet criteria for a comorbid condition at end of treatment (b = -1.63, p = .04). Diagnostic rates for major depressive disorder, generalized anxiety disorder, and panic disorder/agoraphobia decreased following FBT.

Conclusions: Findings suggest that FBT for adolescent anorexia nervosa may aid in the resolution of some co-occurring psychiatric diagnoses. Continued research is needed to understand factors contributing to comorbid symptom improvement throughout treatment.
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http://dx.doi.org/10.1002/erv.2725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192783PMC
May 2020

Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology.

J Clin Sport Psychol 2020 Jan 16;46. Epub 2019 Sep 16.

University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA.

Objective: Maladaptive exercise relates to eating disorder (ED) pathology and impairment in clinical and non-clinical populations. At present, two different conceptualizations of maladaptive exercise are often studied in relation to ED pathology: compulsive exercise and exercise dependence. Compulsive exercise functions to avoid negative affect (e.g., guilt and anxiety) associated with not exercising, whereas exercise dependence is associated with tolerance to exercise benefits and avoidance of exercise withdrawal. At present, clinicians and researchers struggle to determine the most appropriate term for describing problematic exercise in individuals with ED pathology. This study aimed to directly compare these conceptualizations of maladaptive exercise in relation to severity of ED pathology.

Design: This study examined cross-sectional data.

Method: Undergraduate participants ( =235, 78% female) with elevated ED pathology completed the Eating Disorder Examination Questionnaire (EDE-Q), Compulsive Exercise Test (CET), and Exercise Dependence Scale (EDS). Multiple linear regression analyses evaluated associations between EDE-Q and CET and EDS scores and dominance analysis determined which qualities of exercise were uniquely associated with EDE-Q scores.

Results: Results suggest that compulsive qualities of exercise, including exercise to control shape and weight and to avoid negative affect are more strongly associated with severity of ED pathology than qualities of exercise dependence.

Conclusions: Clinicians and researchers working with ED populations can benefit from prioritizing assessments that capture compulsive qualities of exercise. Additionally, these results suggest that interventions that effectively target other compulsive behaviors (e.g., exposure and response prevention) may be promising treatment options for problematic exercise in the context of EDs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174529PMC
January 2020

Compulsive exercise and weight suppression: Associations with eating pathology in distance runners.

Eat Behav 2020 01 19;36:101358. Epub 2019 Dec 19.

University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, USA.

Some athletes, particularly those who participate in activities that emphasize leanness such as competitive running, are at greater risk for eating disorder (ED) pathology. Compulsive exercise (CE) is linked with ED pathology among female athletes, with evidence that CE for weight control is most strongly correlated with ED thoughts and behaviors. Weight suppression (WS), the discrepancy between highest adult weight and current weight, is also linked with ED symptoms. Taken together, runners with greater WS may be more likely to engage in CE to influence their weight or shape and may subsequently report other associated ED symptoms. As such, the current study investigated associations between CE and ED pathology in a mixed-gender sample of adult distance runners (N = 277, 51% female), and tested the impact of WS on this association. Results indicated that females reported greater CE and ED pathology, whereas males reported greater WS. A significant interaction effect for CE x WS, (p < .05) indicated that the relation between CE and ED scores was stronger among male runners who reported higher WS. In contrast, WS did not impact the association between CE and ED pathology for female runners. Results from the current study have important implications for the assessment and treatment of ED in athletes, specifically runners, and suggest that WS is an important factor to consider when working with male athletes.
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http://dx.doi.org/10.1016/j.eatbeh.2019.101358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927975PMC
January 2020

Eating behavior and reasons for exercise among competitive collegiate male athletes.

Eat Weight Disord 2021 Feb 28;26(1):75-83. Epub 2019 Nov 28.

Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Purpose: Research concerning eating disorders among adolescent and young adult male athletes is limited compared with female counterparts, but increasing evidence indicates that they may be at unique risk for unhealthy exercise and eating behavior. The current study aimed to characterize unhealthy exercise and eating behavior according to competitive athlete status, as well as per sport type.

Method: Collegiate male athletes (N = 611), each affiliated with one of the 10 National College Athletics Association (NCAA) Division I schools in the United States, completed an online survey, reporting on eating and extreme weight control behaviors, and reasons for exercise.

Results: Competitive athletes endorsed increased driven exercise and exercising when sick. Baseball players, cyclists, and wrestlers emerged as the sports with the most players reporting elevated Eating Disorder Examination-Questionnaire scores in a clinical range, and basketball players reported the highest rates of binge eating. overall, baseball players, cyclists, rowers, and wrestlers appeared to demonstrate the greatest vulnerability for unhealthy eating and exercise behavior.

Conclusion: Findings revealed differences between competitive and non-competitive male athletes. Among competitive athletes, results identified unique risk for unhealthy eating and exercise behavior across a variety of sport categories and support continued examination of these attitudes and behaviors in a nuanced manner.

Level Ii: Evidence obtained from well-designed controlled trials without randomization.
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http://dx.doi.org/10.1007/s40519-019-00819-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253316PMC
February 2021

The feasibility of a behavioral group intervention after weight-loss surgery: A randomized pilot trial.

PLoS One 2019 21;14(10):e0223885. Epub 2019 Oct 21.

Geisinger Clinic, Geisinger, Danville, Pennsylvania, United States of America.

Background: Formal psychosocial support programs after weight-loss surgery are limited in scope and availability.

Objective: This randomized pilot study evaluated the feasibility of a postoperative behavioral intervention program.

Materials And Methods: Postoperative weight-loss surgery patients (N = 50) were recruited from February 2017-July 2017 and randomized to a four-month behavioral program or usual care wait-list. Outcomes evaluated in addition to feasibility included health-related quality of life (Short Form -36), psychosocial functioning and adherence. Secondary outcomes included within-group changes for each outcome.

Results: Out of eight possible sessions, intervention participants attended a mean of 4.2 sessions. Intervention group participants experienced greater improvements in the social functioning domain of health-related quality of life compared to usual care. Self-reported dietary adherence in the intervention group remained stable, while usual care group dietary adherence declined. Within the intervention group, participants also reported gains in the physical function, pain and general health aspects of quality life from baseline to post-treatment. No differences in weight, mood or other eating behaviors (e.g., loss of control, emotional eating) were evident between groups.

Conclusion: Though participation in a postoperative behavioral intervention varied, the program helped participants to maintain aspects of quality of life and self-reported adherence to dietary recommendations.

Trial Registration: ClinicalTrials.gov NCT03092479.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223885PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802820PMC
March 2020

Attributes of children and adolescents with avoidant/restrictive food intake disorder.

J Eat Disord 2019 12;7:31. Epub 2019 Sep 12.

5Department of Psychiatry, University of California, San Francisco, CA USA.

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) is a comparatively new DSM-5 diagnosis. In an effort to better understand this heterogeneous patient group, this study aimed to describe the physical and psychological attributes of children and adolescents with ARFID, and to compare them to patients with full-threshold or atypical anorexia nervosa (AN).

Methods: Children and adolescents aged 7-to-19 years ( = 193) were examined upon presenting at a pediatric eating disorder center between July 2015 and December 2017. Data included diagnosis assessed via the semi-structured Eating Disorder Examination interview along with measures of anthropometrics, depression, anxiety, self-esteem, perfectionism and clinical impairment.

Results: Compared to AN and atypical AN ( = 87), patients with ARFID ( = 106) were significantly younger (12.4 vs. 15.1 years,  < .0001), male (41% vs. 15%,  < .0002), and were more likely to be diagnosed with at least one co-morbid DSM-5 diagnosis (75% vs. 61%,  = .04). Patients with ARFID were less likely to be bradycardic (4.7% vs. 24.1%,  < .0001), amenorrheic (11.1 and 34.7%,  = .001), admitted to the hospital (14.2% vs. 27.6%,  = .02), and have a diagnosis of depression (18.9% vs. 48.3%,  < .0001). Patients with ARFID were significantly less likely to experience acute weight loss vs. chronic weight loss as compared with those with AN or atypical AN ( = .0001). On self-report measures, patients with ARFID reported significantly fewer symptoms of depression, anxiety, perfectionism, clinical impairment, concerns about weight and shape, and higher self-esteem than patients with AN or atypical AN (all s < .0001). No differences were observed by race, anxiety disorder, orthostatic instability, suicidal ideation, and history of eating disorder treatment.

Conclusions: Study results highlight the clinical significance of ARFID as a distinct DSM-5 diagnosis and the physical and psychological differences between ARFID and AN/atypical AN. The novel finding that ARFID patients are more likely than those diagnosed with AN to experience chronic, rather than acute, weight loss suggests important related treatment considerations.
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http://dx.doi.org/10.1186/s40337-019-0261-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739995PMC
September 2019

Eating Disorders in Males.

Child Adolesc Psychiatr Clin N Am 2019 10 11;28(4):641-651. Epub 2019 Jul 11.

Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address:

Eating disorders are serious psychiatric disorders, associated with significant psychiatric and medical consequences. Although traditionally considered a female disorder, more recent evidence has determined that EDs among males are not uncommon and are equally severe in symptom presentation. Among youth and adolescent males, certain factors increase the risk for ED, including muscularity-focused body image concerns and sexual orientation. Future study of these and other factors that may increase the risk for or maintain EDs among adolescent males is critical to improving screening, assessment, and precision treatment efforts.
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http://dx.doi.org/10.1016/j.chc.2019.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785984PMC
October 2019

Update on Treatments for Adolescent Bulimia Nervosa.

Child Adolesc Psychiatr Clin N Am 2019 10 4;28(4):537-547. Epub 2019 Jul 4.

Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; The University of Chicago, Chicago, IL, USA. Electronic address:

There are few systematic studies of treatment of bulimia nervosa (BN) in adolescents. Although family-based treatment has demonstrated preliminary evidence to support involvement of caregivers in treatment, there is significant opportunity for improvement in mitigating binge-eating and purging symptoms among adolescents afflicted with BN. When caregivers are unable to participate in treatment, there is evidence that BN-specific cognitive behavioral therapy approaches are helpful for some adolescents. Further research is needed to determine for whom, and under what conditions certain types of family involvement might be most effective in adolescent treatment of BN.
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http://dx.doi.org/10.1016/j.chc.2019.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709693PMC
October 2019

Female Athlete Body Project Intervention with Professional Dancers: A Pilot Trial.

Eat Disord 2021 Jan-Feb;29(1):56-73. Epub 2019 Jun 24.

Department of Psychology, University at Albany, State University of New York , Albany, NY, USA.

As aesthetic athletes, professional dancers have increased vulnerability for eating disorders (EDs), with three times higher risk than non-dancers. Among ballet dancers, generalized risk for EDs associated with internalization of western cultural female beauty ideals is compounded by idealization of a ballet-specific body ideal, a combination that confers unique vulnerability for eating pathology. Empirical support has been established for an athlete-specific intervention promoting body acceptance and reduced eating pathology among general populations of young-adult women and female collegiate athletes; the current study adapted this intervention for pilot implementation among professional ballet dancers. Participants from two elite ballet companies ( = 19) were randomized to a control and intervention condition. All participants self-reported eating pathology and related variables pre- and post-intervention, and at six-week follow-up. Post-intervention, participants receiving the intervention demonstrated reductions in body dissatisfaction, = .005, = -.63, dietary restraint, = .008, = -.59, and eating pathology, = .007, = -.60, as compared to control group counterparts; significant differences were retained at follow-up. Results provide preliminary evidence that this intervention has the potential to provide a feasible and acceptable means of ED prevention in female professional ballet dancers. Barriers to feasibility are identified and discussed.
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http://dx.doi.org/10.1080/10640266.2019.1632592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928448PMC
September 2021

Family-based Treatment of Eating Disorders: A Narrative Review.

Psychiatr Clin North Am 2019 06 3;42(2):193-204. Epub 2019 Apr 3.

Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; The University of Chicago, Chicago, IL, USA. Electronic address:

Eating disorders (EDs) are serious psychiatric illnesses that typically develop during adolescence or young adulthood, indicating that individuals with EDs may benefit from early intervention. Family-based treatment is the leading treatment of youth with anorexia nervosa, with increasing evidence of its efficacy for youth with bulimia nervosa. This review describes the role of family engagement within family-based treatment of EDs, followed by a summary of current empirically supported, family-based ED interventions. It concludes with discussion of the ways in which family interventions are expanding and adapting to improve the breadth and scope of ED treatment in adolescence and young adulthood.
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http://dx.doi.org/10.1016/j.psc.2019.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764593PMC
June 2019

A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders.

Behav Res Ther 2019 06 15;117:54-64. Epub 2019 Feb 15.

Department of Psychology, University at Albany, State University of New York, USA.

Recent literature suggests that individuals with eating disorders demonstrate altered interoceptive processing, which may relate to the maintenance of symptoms and thus represent a salient treatment target. Adopting treatment techniques effective for other conditions characterized by disturbed interoceptive processes (e.g., anxiety disorders) could aid in improving the outcomes of psychological interventions for eating disorders. The current investigation was a naturalistic case series (N = 4) that examined adjunctive interoceptive exposure (IE) for eating disorders, with an emphasis on evaluating the feasibility, acceptability, and impact of this intervention on anxiety sensitivity, interoceptive deficits, and eating disorder symptoms. Results suggested that all individuals who received 4 consecutive sessions of traditional and eating-disorder-specific IE exercises demonstrated decreases in interoceptive deficits and subjective distress. Results for anxiety sensitivity and eating disorder symptoms were encouraging yet more mixed. Findings also generally suggested that the intervention was feasible and acceptable, yet between-session practice compliance varied considerably among participants. Overall, we describe how IE may be used to target interoceptive deficits in eating disorders and provide preliminary evidence of how this may be accomplished within naturalistic intensive outpatient settings.
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http://dx.doi.org/10.1016/j.brat.2019.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815515PMC
June 2019
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