@article{pmid42410482,

title = {Shared and Distinct Clinical Features in Treatment-Seeking Adults With Avoidant/Restrictive Food Intake Disorder or Anorexia Nervosa Subtypes},

author = {Vittoria Trolio and Linda Booij and Samantha Ginsberg and Sarah E Racine and Howard Steiger},

doi = {10.1002/eat.70167},

issn = {1098-108X},

year  = {2026},

date = {2026-07-01},

journal = {Int J Eat Disord},

abstract = {OBJECTIVE: Available studies comparing clinical features in treatment-seeking adults with avoidant/restrictive food intake disorder (ARFID) to anorexia nervosa (AN) often do not distinguish between AN-restricting (AN-R) and AN-binge-eating/purging (AN-B/P) subtypes, rely on retrospective ARFID diagnoses, and include unequal group sizes. Across relatively balanced study groups, we compared eating disorder symptoms, concurrent psychiatric symptoms, and Big Five personality traits in treatment-seeking adults with ARFID, AN-R, or AN-B/P to identify unique and shared features.nnMETHODS: Participants were adults (29 ARFID, 39 AN-R, 45 AN-B/P) diagnosed via semi-structured clinical interviews at the start of outpatient treatment. Data were analyzed with general linear models.nnRESULTS: On measures of shape-/weight-centered eating pathology and depression, individuals with ARFID scored lower than did those with AN-R (ps < 0.05) or AN-B/P (ps < 0.001). On measures of anxiety, individuals with ARFID scored lower than did those with AN-B/P (p < 0.001) but not AN-R (p = 0.075). Compared with AN groups, the ARFID group had less total emotion-regulation difficulties (p < 0.001). There were no group differences on Big Five personality traits (p = 0.173), including neuroticism.nnDISCUSSION: Treatment-seeking adults with ARFID reported less shape-/weight-centered eating pathology, depression, anxiety, and emotion-regulation difficulties than did individuals with AN but did not differ on endorsement of Big Five personality traits. Findings suggest that individuals with ARFID display less pronounced psychopathology on assessed domains than do those with AN and highlight potential directions for future ARFID research.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41765047,

title = {World Federation of Societies of Biological Psychiatry (WFSBP) consensus statement on candidate biomarkers for anorexia nervosa},

author = {Hubertus Himmerich and Johanna Louise Keeler and Joseph A King and Stefan Ehrlich and Lisa-Katrin Kaufmann and Cynthia M Bulik and Sarah Cohen-Woods and Tracey Wade and Howard Steiger and Linda Booij and Palmiero Monteleone and Giammarco Cascino and Alessio Maria Monteleone and Ulrich Cuntz and Ulrich Voderholzer and Selamawit Alemayehu Tessema and Yael D Lewis and Magnus Sjögren and Johannes Hebebrand and Jochen Seitz and Marta Tyszkiewicz-Nwafor and Olga Karpenko and Hiba Mutwalli and Sergueï O Fetissov and Isabelle Mack and Namrata Dhopatkar and Sabrina Mörkl and Carol Kan and Maria M Uribe and Kazuhiro Yoshiuchi and Nadine Abuobeid and Dimitrios Kapogiannis and Daniel Stein and Sevgi Bektas and Daniel J Müller and Philip Gorwood and Philibert Duriez and Chloé Tezenas du Montcel and Elżbieta Paszyńska and Susan L McElroy and Wiesława Dominika Wranik and Fernando Fernandez-Aranda and Philip S Mehler and Hana Papežová and Radka Roubalová and Petra Procházková and Rebecca Morris and Piotr Lewczuk and Christoph Hiemke and Michael Berk and Andreas Karwautz and Janet Treasure and Siegfried Kasper and  and },

doi = {10.1080/15622975.2026.2626934},

issn = {1814-1412},

year  = {2026},

date = {2026-04-01},

journal = {World J Biol Psychiatry},

volume = {27},

number = {4},

pages = {257--348},

abstract = {OBJECTIVES: This World Federation of Societies of Biological Psychiatry (WFSBP) consensus paper aims to summarise and evaluate the published study results on objectively measurable biological markers associated with anorexia nervosa (AN).nnMETHODS: The relevant literature was reviewed by the WFSBP Task Forces on Eating Disorders and on Biological Markers, and a consensus regarding the significance of the published evidence was reached.nnRESULTS: Candidate biological markers that have been associated with AN include clinical (e.g. body weight), molecular (e.g. genetic, epigenetic, hormonal, immunological, metabolomic), cellular (e.g. leukocytes), neuroimaging (e.g. structure, function, connectivity), digital, cardiac and neurophysiological parameters. Some clinical and laboratory parameters are risk markers in clinical practice. Biological markers have pathophysiological relevance in understanding the biological and metabolic pathophysiology of AN and its physical health consequences. Few studies have examined pharmacogenetics or therapeutic drug monitoring as tools to monitor and guide the treatment of AN.nnCONCLUSIONS: Biological markers will hopefully soon enable clinicians to intervene earlier in a more targeted manner to mitigate treatment resistance. However, the current scientific basis for most biological markers are group comparisons only. Studies on sensitivity, specificity and the prognostic value of these markers are lacking.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41708267,

title = {Atypical (Other or Unspecified) Feeding or Eating Disorders: Diagnosis, Clinical Implications, and Treatment},

author = {Howard Steiger and Linda Booij},

doi = {10.1016/j.psc.2025.08.003},

issn = {1558-3147},

year  = {2026},

date = {2026-03-01},

journal = {Psychiatr Clin North Am},

volume = {49},

number = {1},

pages = {37--49},

abstract = {Atypical eating disorders (EDs) appear to be comparable to classical eating-disorder variants with regard to eating-symptom severity, illness burden, concurrent mental-health problems, medical complications, etiology, and treatment needs. It remains to be determined to what extent atypical EDs are truly distinct from classical variants, or simply represent early or residual phases of these disorders. Available evidence suggests that, except for variants for which symptom-specific treatment elements are indicated, conventional eating-disorder treatments are also well-suited for the treatment of atypical EDs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41776720,

title = {Effectiveness of a Low-Intensity Self-Guided Psychoeducational Intervention for Individuals Waitlisted for Specialised Eating-Disorder Treatment: A Randomised Controlled Trial},

author = {Linda Booij and Barbara Barth and Micaël Thériault and Bronwyn Raykos and Peter McEvoy and Howard Steiger},

doi = {10.1002/erv.70093},

issn = {1099-0968},

year  = {2026},

date = {2026-03-01},

journal = {Eur Eat Disord Rev},

abstract = {OBJECTIVE: Gaining access to evidence-informed treatment for eating disorders (EDs) is challenging, and this creates interest in the possible benefits of self-help treatment methods. We investigated the effectiveness of receiving evidence-informed self-guided psychoeducation, delivered to individuals while on a waitlist for specialised ED care.nnMETHOD: While waitlisted for treatment, 62 adults were randomised to one of two 4-week conditions: (a) Weekly psychoeducation related to EDs via email (Experimental condition); or (b) No psychoeducation (Control condition). Participants completed weekly measures of ED attitudes (ED-15), body satisfaction (Body Satisfaction Scale) and motivation to change (Readiness Ruler).nnRESULTS: Participants in the experimental condition showed a greater reduction in ED-15 scores after 4 weeks of exposure to the psychoeducational materials compared to control participants. Effect sizes were in the small-to-medium range, with the strongest effects observed among individuals who were engaging in binge/purge behaviours. There were no effects on body satisfaction or motivation to change. Participants reported being reasonably engaged and satisfied with the materials.nnCONCLUSIONS: Delivering low-intensity self-guided psychoeducation appears to be effective in reducing ED attitudes and preoccupations among people waitlisted for specialised ED services, especially those presenting with bulimic symptoms. However, the intervention seemed not to impact motivation for change.nnTRIAL REGISTRATION: The trial was registered retroactively at Clinicaltrials.gov (NCT07319936).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40037661,

title = {Elevated plasma B and betaine levels in women with anorexia nervosa: possible role in illness pathophysiology and epigenetic regulation},

author = {Howard Steiger and Kevin F Casey and Jessica Burdo and Valerie Marcil and Maegan Harvison and Juliana Meyerfreund and Édith Breton and Zsofia Nemoda and Lea Thaler and Annie St-Hilaire and Mimi Israel and Chloe Paquin-Hodge and Luis B Agellon and Véronique Bélanger and Linda Booij},

doi = {10.1503/jpn.240155},

issn = {1488-2434},

year  = {2025},

date = {2025-01-01},

journal = {J Psychiatry Neurosci},

volume = {50},

number = {2},

pages = {E85--E91},

abstract = {BACKGROUND: Phenomenology in anorexia nervosa (AN) appears to be subject to epigenetic regulation via DNA methylation. The micronutrients B and betaine contribute directly to DNA methylation and have been shown to be abnormally elevated in blood samples from people with AN.nnMETHODS: We measured plasma B and betaine levels, as well as leukocyte DNA methylation levels, among women with active AN (AN-active group), those in 1-year remission from AN (AN-remitted group), and those who had never experienced an eating disorder (NED group). We compared the groups on micronutrient levels and on the strength of association between micronutrients and methylation.nnRESULTS: We included 64 women in the AN-active group, 49 in the AN-remitted group, and 49 in the NED group. Relative to those with NED (B: mean 339.6 [standard deviation (SD) 224.3] μmol/L; betaine: mean 33.74 [SD 17.10] μmol/L), participants with active AN showed high B and betaine (B: mean 571.0 [SD 505.2] μmol/L; betaine: mean 43.73 [SD 22.50] μmol/L); AN-remitted participants had elevated B alone (B: mean 588.2 [SD 379.9] μmol/L; betaine: mean 33.50 [SD 19.20] μmol/L). There were also group-based differences in the strength of association between B and site-specific DNA methylation at genes regulating insulin function, glucose metabolism, cell regulation, and neurotransmitter function. These associations between B and methylation levels were generally stronger among those without an ED than among those with either active or remitted AN.nnLIMITATIONS: The extent to which plasma nutrient levels provide a meaningful proxy to cellular processes affecting DNA methylation is uncertain and the sample size limits the stability of results. We included only biological females in this investigation.nnCONCLUSION: Elevated B levels in AN resemble elevations reported among people with autoimmune, neoplastic, or other disorders. Such elevations imply that plasma B levels may misrepresent nutritional status among people with AN. Observed associations between levels of B and methylation at certain gene regions have ambiguous importance, but may indicate an influence of nutritional status on epigenetic mechanisms or may be the coincidence of separate processes that independently affect levels of micronutrients and DNA methylation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39548958,

title = {Examining Dimensionality and Item-Quality of the Eating Disorder Examination Questionnaire in Individuals With Eating Disorders Using Item Response Theory Analysis},

author = {Rachel Dufour and Howard Steiger and Linda Booij},

doi = {10.1002/eat.24330},

issn = {1098-108X},

year  = {2024},

date = {2024-11-01},

journal = {Int J Eat Disord},

abstract = {OBJECTIVE: The Eating Disorder Examination Questionnaire (EDE-Q) is a widely-used measure of eating-disorder symptoms. However, inconsistent replication of the subscale structure raises concern about validity. To provide a rigorous test of the EDE-Q's dimensionality and item-quality, we applied modern and classical test theory approaches to data obtained from a large, transdiagnostic sample of people with clinical eating disorders.nnMETHOD: We analyzed data from 1197 individuals (M = 27.9 years, SD = 10.08, 95% female) with various eating disorders, who had been assessed for treatment at a specialized program. Exploratory analyses (including Parallel Analyses), Confirmatory Factor Analyses (CFA) and graded-response Item Response Theory (IRT) analyses, were conducted with Mplus.nnRESULTS: Factor analyses showed inappropriate fit to the original EDE-Q subscales, as well as for alternative 1,2,3, and 4-factor solutions. Parallel analyses suggested a one-dimensional structure as best fit. IRT analyses showed substantial variability in EDE-Q-item quality and indicated that five items (fear of weight gain, feeling fat, desire to lose weight, importance of weight, importance of shape) were most pertinent to determining severity. The construct validity of the five EDE-Q items was confirmed by a CFA, showing excellent fit.nnDISCUSSION: Our results suggest that EDE-Q scores are best interpreted as spanning a one-factor continuum. IRT results suggest that some items are more pertinent than others for determining eating-disorder severity. Results could be useful for establishing short EDE-Q versions, such as a five-item version, which, in turn, would be helpful for measurement-based clinical practice and for data-collection in epidemiological and experimental studies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38997243,

title = {Outcomes of a Virtual Day Treatment Program for Adults With Eating Disorders-Comparison With In-Person Day Treatment},

author = {Lea Thaler and Linda Booij and Annie St-Hilaire and Chloé Paquin-Hodge and Nesrine Mesli and Hope Burko and Viveca Lee and Stephanie Oliverio and Mimi Israël and Howard Steiger},

doi = {10.1002/eat.24263},

issn = {1098-108X},

year  = {2024},

date = {2024-10-01},

journal = {Int J Eat Disord},

volume = {57},

number = {10},

pages = {2135--2140},

abstract = {OBJECTIVE: Previous studies have indicated that virtual treatments for eating disorders (EDs) are roughly as effective as are in-person treatments; the present nonrandomized study aimed to expand on the current body of evidence by comparing outcomes from a virtual day treatment program with those of an in-person program in an adult ED sample.nnMETHOD: Participants were 109 patients who completed at least 60% of day treatment sessions (n = 55 in-person and n = 54 virtual). Outcome measures included ED and comorbid symptoms, and motivation.nnRESULTS: Linear mixed models showed that global EDE-Q scores decreased during treatment (AIC = 376.396, F = 10.94, p = 0.002), irrespective of treatment modality (p = 0.186). BMI significantly increased over time (AIC = 389.029, F = 27.97, p < 0.001), with no effect of treatment modality (p = 0.779).nnDISCUSSION: Our findings suggest that the virtual delivery of day treatments produces comparable outcomes to those obtained using in-person formats, and that virtual formats may represent a pragmatic treatment option, especially in situations in which access to in-person care is limited.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37769672,

title = {International consensus on patient-centred outcomes in eating disorders},

author = {Amelia Austin and Umanga De Silva and Christiana Ilesanmi and Theerawich Likitabhorn and Isabel Miller and Maria da Luz Sousa Fialho and S Bryn Austin and Belinda Caldwell and Chu Shan Elaine Chew and Sook Ning Chua and Suzanne Dooley-Hash and James Downs and Carine El Khazen Hadati and Beate Herpertz-Dahlmann and Jillian Lampert and Yael Latzer and Paulo P P Machado and Sarah Maguire and Madeeha Malik and Carolina Meira Moser and Elissa Myers and Iris Ruth Pastor and Janice Russell and Lauren Smolar and Howard Steiger and Elizabeth Tan and Eva Trujillo-Chi Vacuán and Mei-Chih Meg Tseng and Eric F van Furth and Jennifer E Wildes and Christine Peat and Tracy K Richmond},

doi = {10.1016/S2215-0366(23)00265-1},

issn = {2215-0374},

year  = {2023},

date = {2023-12-01},

journal = {Lancet Psychiatry},

volume = {10},

number = {12},

pages = {966--973},

abstract = {The effectiveness of mental health care can be improved through coordinated and wide-scale outcome measurement. The International Consortium for Health Outcomes Measurement has produced collaborative sets of outcome measures for various mental health conditions, but no universal guideline exists for eating disorders. This Position Paper presents a set of outcomes and measures for eating disorders as determined by 24 international experts from professional and lived experience backgrounds. An adapted Delphi technique was used, and results were assessed through an open review survey. Final recommendations suggest outcomes should be tracked across four domains: eating disorder behaviours and cognitions, physical health, co-occurring mental health conditions, and quality of life and social functioning. Outcomes are collected using three to five patient-reported measures. For children aged between 6 years and 12 years, the measures include the Children's Eating Attitude Test (or, for those with avoidant restrictive food intake disorder, the Eating Disorder in Youth Questionnaire), the KIDSCREEN-10, and the Revised Children's Anxiety and Depression Screener-25. For adolescents aged between 13 years and 17 years, the measures include the Eating Disorder Examination Questionnaire (EDE-Q; or, for avoidant restrictive food intake disorder, the Nine-Item Avoidant Restrictive Food Intake Disorder Screener [NIAS]), the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), the two-item Generalised Anxiety Disorder (GAD-2), the seven-item Generalised Anxiety Disorder (GAD-7), and the KIDSCREEN-10. For adults older than 18 years, measures include the EDE-Q (or, for avoidant restrictive food intake disorder, the NIAS), the PHQ-2, the PHQ-9, the GAD-2, the GAD-7, the Clinical Impairment Assessment, and the 12-item WHO Disability Assessment Schedule 2.0. These questionnaires should be supplemented by information on patient characteristics and circumstances (ie, demographic, historical, and clinical factors). International adoption of these guidelines will allow comparison of research and clinical interventions to determine which settings and interventions work best, and for whom.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37694494,

title = {"You mean it's more than just an eating disorder?": Commentary on Wade et al. (2023)},

author = {Howard Steiger},

doi = {10.1002/eat.24060},

issn = {1098-108X},

year  = {2023},

date = {2023-09-01},

journal = {Int J Eat Disord},

abstract = {Drawing from literature on measurement-based care and prognostic indices in eating disorder (ED) treatment, Wade et al. offer an algorithm for treating co-occurring mental-health conditions (i.e., psychiatric comorbidity) in people with EDs, and for studying effects of comorbidity-oriented treatments. Advocating session-by-session measurement to inform adaptive treatment, their proposal outlines a process for adjusting conventional ED treatment to situations in which comorbidity impedes treatment progress. The plan is methodical and responsive to evidence suggesting that peoples' early in-treatment change has more power, prognostically, than do indices of comorbidity. In the absence of data to inform practices in some areas, the authors intentionally leave key questions unanswered until future results are in. But this means that they reserve comment on how to determine that comorbidity is interfering with treatment response, or to select the best-fitting of available comorbidity-oriented options. Likewise, the proposal draws most of its inspiration from literature on individual (mainly cognitive-behavioral) psychotherapy and, as a result, does not fully represent biopsychosocial perspectives, or elaborate upon the place in comorbidity management of biological treatments, family, and carer involvement, or more complex integrated approaches. Considerations on how to apply the latter methods would broaden the plan's scope.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37644511,

title = {Development of a transdiagnostic digital interactive application for eating disorders: psychometric properties, satisfaction, and perceptions on implementation in clinical practice},

author = {Linda Booij and Mimi Israël and Manuela Ferrari and Annie St-Hilaire and Chloé Paquin-Hodge and Melissa Allard and Amélie Blaquière and Julia Dornik and Shiri Freiwald and Shawna A Long and Marika Monarque and William D Pelletier and Lea Thaler and Miriam Yaffe and Howard Steiger},

doi = {10.1186/s40337-023-00871-3},

issn = {2050-2974},

year  = {2023},

date = {2023-08-01},

journal = {J Eat Disord},

volume = {11},

number = {1},

pages = {146},

abstract = {BACKGROUND: Given limited availability of informed treatments for people affected by eating disorders (EDs), there has been increasing interest in developing self-administered, technology-based ED interventions. However, many available interventions are limited to a specific ED diagnosis or assume that participants are ready to change. We developed a digital self-help application (called ASTrA) that was explicitly designed to be transdiagnostic and to help increase motivation for change. The aim of the present study was to describe the development and examine the psychometric properties, user satisfaction and rated potentials for practical use of our application.nnMETHODS: The content of our application was based on concepts derived from self-determination theory, the transtheoretical model of change, and cognitive theory. The application was developed by a multidisciplinary team of clinicians, researchers, staff members and individuals with lived ED experience, each being involved in all steps of the application's development. We tested validity, reliability, satisfaction and perceived feasibility for clinical implementation in an independent sample of 15 patients with an ED and 13 clinicians specialized in ED treatment. Psychometric properties were evaluated using descriptive statistics, correlations, content validity indices and intraclass coefficients. Differences in satisfaction ratings and perceived potential for clinical implementation of the application between clinicians and patients were examined using Mann-Whitney U tests.nnRESULTS: The digital application showed excellent validity (mean i-CVI: .93, range: .86-.96) and internal reliability (all Cronbach alpha's > .88). Patients and clinicians both considered the application acceptable, appropriate, and feasible for use in clinical practice.nnCONCLUSIONS: Findings suggest that our transdiagnostic interactive application has excellent psychometric properties. Furthermore, patients and clinicians alike were positive about the possible use of the application in clinical practice. The next step will be to investigate the application's effectiveness as an intervention to promote autonomous motivation and to facilitate remission in people on the waitlist for specialized ED treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36180648,

title = {Barriers and Facilitators to the Implementation of an Eating Disorders Knowledge Exchange Program for Non-specialist Professionals},

author = {Lea Thaler and Chloé Paquin-Hodge and Anne-Gaëlle Leloup and Aimée Wallace and Stephanie Oliverio and Shiri Freiwald and Mimi Israel and Howard Steiger},

doi = {10.1007/s11414-022-09822-3},

issn = {1556-3308},

year  = {2023},

date = {2023-07-01},

journal = {J Behav Health Serv Res},

volume = {50},

number = {3},

pages = {365--380},

abstract = {Despite availability of evidence-based treatments for eating disorders (EDs), individuals with EDs often do not receive informed treatment. Training of non-specialized clinicians by experienced professionals through knowledge exchange (KE) programs is an effective way to enhance accessibility to evidence-based treatments for EDs. The authors conducted a qualitative analysis of factors that facilitated or impeded the uptake of an ED-focused KE program. Semi-structured interviews were conducted with mental health professionals (n = 43) and managers (n = 11) at 13 community mental-health sites at which the KE program was offered. Data were analyzed using a qualitative content analysis. Key facilitators identified were management support for the program and building competence through ongoing supervision of clinicians. Main barriers were limited access to ED patients to treat and having insufficient time to apply ED interventions in front-line settings. The results provide insights into the practical imperatives involved in implementing a KE initiative for ED treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35703085,

title = {DNA methylation in people with anorexia nervosa: Epigenome-wide patterns in actively ill, long-term remitted, and healthy-eater women},

author = {Howard Steiger and Linda Booij and Lea Thaler and Annie St-Hilaire and Mimi Israël and Kevin F Casey and Stephanie Oliverio and Olivia Crescenzi and Viveca Lee and Gustavo Turecki and Ridha Joober and Moshe Szyf and Édith Breton},

doi = {10.1080/15622975.2022.2089731},

issn = {1814-1412},

year  = {2023},

date = {2023-03-01},

journal = {World J Biol Psychiatry},

volume = {24},

number = {3},

pages = {254--259},

abstract = {OBJECTIVES: Recent studies have reported altered methylation levels at disorder-relevant DNA sites in people who are ill with Anorexia Nervosa (AN) compared to findings in people with no eating disorder (ED) or in whom AN has remitted. The preceding implies state-related influences upon gene expression in people with AN. This study further examined this notion.nnMETHODS: We measured genome-wide DNA methylation in 145 women with active AN, 49 showing stable one-year remission of AN, and 64 with no ED.nnRESULTS: Comparisons revealed 205 differentially methylated sites between active and no ED groups, and 162 differentially methylated sites between active and remitted groups ( < 0.01). Probes tended to map onto genes relevant to psychiatric, metabolic and immune functions. Notably, several of the genes identified here as being differentially methylated in people with AN (e.g. , , ) have figured in previous studies on AN. Effects also associated illness chronicity and lower BMI with more pronounced DNA methylation alterations, and remission of AN with normalisation of DNA methylation.nnCONCLUSIONS: Findings corroborate earlier results suggesting reversible DNA methylation alterations in AN, and point to particular genes at which epigenetic mechanisms may act to shape AN phenomenology.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35366169,

title = {Barriers and facilitators to providing autonomy supportive counselling to individuals seeking treatment for an eating disorder},

author = {Stephanie Oliverio and Howard Steiger and Annie St-Hilaire and Chloé Paquin-Hodge and Anne-Gaëlle Leloup and Mimi Israel and Lea Thaler},

doi = {10.1007/s40519-022-01395-6},

issn = {1590-1262},

year  = {2022},

date = {2022-10-01},

journal = {Eat Weight Disord},

volume = {27},

number = {7},

pages = {2919--2929},

abstract = {PURPOSE: Self-determination theory suggests that autonomous motivation for change (i.e., motivation that is internal and self-endorsed) can be enhanced in therapeutic contexts by clinicians acting in an autonomy supportive manner. While previous research has established a link between autonomy support (AS) and autonomous motivation in enhancing outcomes in eating disorder (ED) treatment, few studies have examined factors that support or hinder therapists' ability to be autonomy supportive in the context of an ED therapeutic encounter. The goal of the present study was to conduct a qualitative analysis of personal and contextual factors that facilitated or hindered therapists' ability to provide autonomy supportive interventions.nnMETHODS: Semi-structured interviews were conducted with 10 therapists conducting outpatient psychotherapy at a specialized eating disorders treatment program. Data were analyzed using thematic analysis.nnRESULTS: The most frequently noted facilitators were organizational support of AS interventions and patients' engagement and motivation for treatment. The most frequently noted barriers were patients' personality variables such as patients that exhibit passive and help-rejecting behaviours, as well as therapists feeling overwhelmed due to a high workload.nnCONCLUSION: Our results provide insight into the factors that facilitate and impede the utilization of an autonomy supportive approach in specialized ED treatment and can be used to inform future quantitative research on such factors.nnLEVEL OF EVIDENCE: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34971014,

title = {Predictors of non-completion of a day treatment program for adults with eating disorders},

author = {Lea Thaler and Linda Booij and Nuala Burnham and Samantha Kenny and Stephanie Oliverio and Mimi Israel and Howard Steiger},

doi = {10.1002/erv.2879},

issn = {1099-0968},

year  = {2022},

date = {2022-03-01},

journal = {Eur Eat Disord Rev},

volume = {30},

number = {2},

pages = {146--155},

abstract = {Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non-completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge-eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating-disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff-initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff-initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi-diagnostic day treatment programs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34904742,

title = {In-person versus virtual therapy in outpatient eating-disorder treatment: A COVID-19 inspired study},

author = {Howard Steiger and Linda Booij and Olivia Crescenzi and Stephanie Oliverio and Ilana Singer and Lea Thaler and Annie St-Hilaire and Mimi Israel},

doi = {10.1002/eat.23655},

issn = {1098-108X},

year  = {2022},

date = {2022-01-01},

journal = {Int J Eat Disord},

volume = {55},

number = {1},

pages = {145--150},

abstract = {OBJECTIVE: Findings show virtual therapy (conducted using internet-based videoconferencing techniques) to be a viable alternative to in-person therapy for a variety of mental-health problems. COVID-19 social-distancing imperatives required us to substitute virtual interventions for in-person sessions routinely offered in our outpatient eating disorder (ED) program-and afforded us an opportunity to compare the two treatment formats for clinical efficacy.nnMETHODS: Using self-report assessments, we compared outcomes in a historical sample of 49 adults with heterogeneous EDs (treated in-person over 10-14 weeks in individual and group therapies) to those of 76 patients receiving comparable virtual treatments, at distance, during the COVID-19 outbreak. Linear mixed models were used to study symptom changes over time and to test for differential effects of treatment modality.nnRESULTS: Participants in both groups showed similar improvements on eating symptoms, levels of weight gain (in individuals in whom gain was indicated), and satisfaction with services.nnDISCUSSION: Our results suggest that short-term clinical outcomes with virtual and in-person ED therapies are comparable, and point to potentials of virtual therapy for situations in which geographical distance or other barriers impede physical access to trained therapists or specialized treatments.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32954512,

title = {Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta-analysis},

author = {Jeanne Sansfaçon and Linda Booij and Lise Gauvin and Émilie Fletcher and Farah Islam and Mimi Israël and Howard Steiger},

doi = {10.1002/eat.23376},

issn = {1098-108X},

year  = {2020},

date = {2020-12-01},

journal = {Int J Eat Disord},

volume = {53},

number = {12},

pages = {1879--1900},

abstract = {OBJECTIVE: Identifying modifiable predictors of outcomes following treatment for eating disorders may help to tailor interventions to patients' individual needs, improve treatment efficacy, and develop new interventions. The goal of this meta-analysis was to quantify the association between pretreatment motivation and posttreatment changes in eating disorder symptomology.nnMETHOD: We reviewed 196 longitudinal studies reporting on change on indices of overall eating-disorder symptomatology, weight gain, binge-eating, vomiting, anxiety/depression, and treatment adherence. Meta-analyses were performed using two complementary approaches: (a) combined probability analysis using the added Z's method; (b) effect size analyses. Using random-effect models, effect sizes were pooled when there were at least three studies with the same type of statistical design and reporting statistics on the same outcome. Heterogeneity in study outcome was evaluated using Q and I statistics. Studies were reviewed qualitatively when the number of studies or reported data were insufficient to perform a meta-analysis.nnRESULTS: Forty-two articles were included. Although samples and treatments differed substantially across studies, results across studies were remarkably consistent. Both combined-probability and effect-size analyses indicated positive effects of pretreatment motivation on improvement in general eating-disorder symptoms (Cohen's r = .17), and an absence of effects on anxiety/depression symptoms. Remaining outcome indices were subject to selective reporting and/or small sample size bias.nnDISCUSSION: Our findings underscore the importance of incorporating treatment engagement approaches in the treatment of eating disorders. Optimal reporting of study findings and improving study quality would improve future efforts to obtain an in-depth understanding of the relationship between motivation and eating disorder symptoms.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32576735,

title = {Applying epigenetic science to the understanding of eating disorders: a promising paradigm for research and practice},

author = {Linda Booij and Howard Steiger},

doi = {10.1097/YCO.0000000000000632},

issn = {1473-6578},

year  = {2020},

date = {2020-11-01},

journal = {Curr Opin Psychiatry},

volume = {33},

number = {6},

pages = {515--520},

abstract = {PURPOSE OF REVIEW: Studies indicate that environmental factors, acting at various moments throughout the life cycle, can result in epigenetically mediated alterations in gene expression. In this article, we review recent findings on the role of epigenetic factors in eating disorders, address methodological issues that need to be considered when interpreting research findings, and comment on possible clinical applications.nnRECENT FINDINGS: Evidence suggests that eating disorders implicate alterations of methylation in genes involved in the mental status, metabolism, anthropometric features and immunity. Furthermore, some research in individuals with anorexia nervosa suggests the presence of reversible, malnutrition-induced epigenetic alterations that 'reset' as patients recover.nnSUMMARY: Epigenetic studies in the eating disorders corroborate the idea that eating disorder cause is multifactorial, and identify markers that could help inform our understanding of illness staging and subtyping that may explain the commonly progressive course of these disorders, and that may provide insights towards the development of novel interventions. Already, there is evidence to suggest that, in people with eating disorders, epigenetically informed interventions help reduce stigma and shame, and increase self-acceptance and hopes of recovery. Although findings are intriguing, further research is required as, to date, studies apply modest sample sizes and disparate methodologies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32211873,

title = {Late and Instable Sleep Phasing is Associated With Irregular Eating Patterns in Eating Disorders},

author = {Outi Linnaranta and Clément Bourguignon and Olivia Crescenzi and Duncan Sibthorpe and Asli Buyukkurt and Howard Steiger and Kai-Florian Storch},

doi = {10.1093/abm/kaaa012},

issn = {1532-4796},

year  = {2020},

date = {2020-09-01},

journal = {Ann Behav Med},

volume = {54},

number = {9},

pages = {680--690},

abstract = {BACKGROUND: Sleep problems are common in eating disorders (EDs).nnPURPOSE: We evaluated whether sleep-phasing regularity associates with the regularity of daily eating events.nnMETHODS: ED patients (n = 29) completed hourly charts of mood and eating occasions for 2 weeks. Locomotor activity was recorded continuously by wrist actigraphy for a minimum of 10 days, and sleep was calculated based on periods of inactivity. We computed the center of daily inactivity (CenDI) as a measure of sleep phasing and consolidation of the daily inactivity (ConDI) as a measure of daily sleep rhythm strength. We assessed interday irregularities in the temporal structure of food intake using the standard deviation (SD) of frequency (IFRQ), timing (ITIM), and interval (IINT) of food intake. A self-evaluation of other characteristics included mood, anxiety, and early trauma.nnRESULTS: A later phasing of sleep associated with a lower frequency of eating (eating frequency with the CenDI rho = -0.49, p = .007). The phasing and rhythmic strength of sleep correlated with the degree of eating irregularity (CenDI with ITIM rho = 0.48, p = .008 and with IINT rho = 0.56, p = .002; SD of CenDI with ITIM rho = 0.47, p = .010, and SD of ConDI with IINT rho = 0.37, p = .048). Childhood Trauma Questionnaire showed associations with variation of sleep onset (rho = -0.51, p = .005) and with IFRQ (rho = 0.43, p = .023).nnCONCLUSIONS: Late and variable phasing of sleep associated robustly with irregular pattern of eating. Larger data sets are warranted to enable the analysis of diagnostic subgroups, current medication, and current symptomatology and to confirm the likely bidirectional association between eating pattern stability and the timing of sleep.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32427359,

title = {Plasma levels of one-carbon metabolism nutrients in women with anorexia nervosa},

author = {Jessica Burdo and Linda Booij and Esther Kahan and Lea Thaler and Mimi Israël and Luis B Agellon and Evan Nitschmann and Linda Wykes and Howard Steiger},

doi = {10.1002/eat.23292},

issn = {1098-108X},

year  = {2020},

date = {2020-09-01},

journal = {Int J Eat Disord},

volume = {53},

number = {9},

pages = {1534--1538},

abstract = {OBJECTIVE: People who are ill with anorexia nervosa (AN) show altered availability of key plasma nutrients. However, little is known about the patterning of alterations that occurs across diverse nutrients during active phases of illness or about the persistence of any such alterations following remission of illness.nnMETHOD: We compared plasma levels of one-carbon metabolism nutrients across women with active AN (AN-Active: n = 53), in remission from AN (AN-Remitted: n = 40), or who had no eating-disorder history (NED: n = 36). We also tested associations between body mass index (BMI) changes and changes in pre- to posttreatment nutrient levels, and explored the association between nutrient levels, on the one hand, and BMI and eating symptoms, on the other. Choline, betaine, and methionine were analyzed using mass spectrometry. Folate and B12 were analyzed using the AccuBind® ELISA kit. Eating-disorder symptoms were assessed by interview and self-report.nnRESULTS: Compared to NED individuals, AN-Active individuals exhibited significantly elevated B12 and (less-reliably) betaine. In AN-Active individuals, lower BMI was associated with higher B12.nnDISCUSSION: The observed alterations run contrary to the intuition that plasma nutrient levels should be directly responsive to nutritional status and suggest, instead, the existence of compensatory adaptations to malnutrition in individuals with active AN. Further study is required to clarify mechanisms that underlie such effects.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}