@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{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{pmid36482144,

title = {Pathways of association between disordered eating in adolescence and mental health outcomes in young adulthood during the COVID-19 pandemic},

author = {Tianna Loose and Marie Claude Geoffroy and Massimiliano Orri and Nicholas Chadi and Sara Scardera and Linda Booij and Edith Breton and Richard Tremblay and Michel Boivin and Sylvana Coté},

doi = {10.17269/s41997-022-00715-8},

issn = {1920-7476},

year  = {2023},

date = {2023-02-01},

journal = {Can J Public Health},

volume = {114},

number = {1},

pages = {22--32},

abstract = {OBJECTIVES: The COVID-19 pandemic has been associated with increased mental health problems. We investigated (1) associations between disordered eating in adolescence and mental health problems after one year of the pandemic and (2) the mechanisms explaining associations.nnMETHOD: We analyzed data from a population-based birth cohort in Quebec, Canada (557 males and 759 females). High and low levels of disordered eating symptom trajectories were previously estimated (age 12, 15, 17, and 20 years). Anxiety, depression, non-suicidal self-injury, and suicidal ideation were assessed at 23 years (March-June 2021). Putative mediators included loneliness and social media use (age 22 years, July-August 2020). Analyses controlled for mental health and socio-economic status at age 10-12 years and were conducted for males and females separately.nnRESULTS: Females in the high-level disordered eating symptom trajectory were at increased risk for non-suicidal self-injury (OR 1.60; 95% CI 1.02-2.52) and suicidal ideation (2.16; 1.31-3.57), whereas males were at increased risk for severe anxiety (2.49; CI 1.11-5.58). Males and females in the high-level trajectory were more likely to report severe depression (2.26; 1.14-5.92 and 2.15, 1.36-3.38 respectively). Among females, associations were partially explained (17-35%) by loneliness during the first 4 months of the pandemic.nnCONCLUSION: Young adults who experienced disordered eating as adolescents were at increased risk of mental health problems during the pandemic. Loneliness partially mediated the effect, suggesting that pandemic mitigation resulting in increased social isolation may have exacerbated mental health problems among women with a history of disordered eating.},

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{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}

}

@article{pmid32375223,

title = {Eating Disorders, Heredity and Environmental Activation: Getting Epigenetic Concepts into Practice},

author = {Howard Steiger and Linda Booij},

doi = {10.3390/jcm9051332},

issn = {2077-0383},

year  = {2020},

date = {2020-05-01},

journal = {J Clin Med},

volume = {9},

number = {5},

abstract = {Epigenetic mechanisms are believed to link environmental exposures to alterations in gene expression, and in so doing, to provide a physical substrate for the activation of hereditary potentials by life experiences. In keeping with this idea, accumulating data suggest that epigenetic processes are implicated in eating-disorder (ED) etiology. This paper reviews literature on putative links between epigenetic factors and EDs, and examines ways in which epigenetic programming of gene expression could account for gene-environment interactions acting in the EDs. The paper also presents evidence suggesting that epigenetic processes link malnutrition and life stresses (gestational, perinatal, childhood, and adult) to risk of ED development. Drawing from empirical evidence and clinical experience, we propose that an epigenetically informed understanding of ED etiology can benefit patients, caregivers, and clinicians alike, in the sense that the perspective can reduce judgmental or blameful attitudes on the part of clinicians and caregivers, and increase self-acceptance and optimism about recovery on the part of those affected.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31823473,

title = {Methylation of the OXTR gene in women with anorexia nervosa: Relationship to social behavior},

author = {Lea Thaler and Sarah Brassard and Linda Booij and Esther Kahan and Kevin McGregor and Aurelie Labbe and Mimi Israel and Howard Steiger},

doi = {10.1002/erv.2703},

issn = {1099-0968},

year  = {2020},

date = {2020-01-01},

journal = {Eur Eat Disord Rev},

volume = {28},

number = {1},

pages = {79--86},

abstract = {DNA methylation allows for the environmental regulation of gene expression and is believed to link environmental stressors to psychiatric disorder phenotypes, such as anorexia nervosa (AN). The oxytocin receptor (OXTR) gene is epigenetically regulated, and studies have shown associations between OXTR and social behaviours in various samples, including women with AN. The present study examined differential levels of methylation at various CG sites of the OXTR gene in 69 women with active AN (AN-Active), 21 in whom AN was in remission (AN-Rem) and 35 with no eating disorder (NED). Within each group, we explored the correlation between methylation and measures of social behaviour such as insecure attachment and social avoidance. Hypermethylation of a number of CG sites was seen in AN-Active participants as compared with AN-Rem and NED participants. In the AN-Rem sample, methylation at CG27501759 was significantly positively correlated with insecure attachment (r = .614, p = .003, permutation Q = 0.008) and social avoidance (r = .588, p = .005, permutation Q = 0.0184). Our results highlight differential methylation of the OXTR gene among women with AN, those in remission from AN, and those who never had AN and provide some evidence of associations between OXTR methylation and social behaviour in women remitted from AN.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30693739,

title = {A longitudinal, epigenome-wide study of DNA methylation in anorexia nervosa: results in actively ill, partially weight-restored, long-term remitted and non-eating-disordered women},

author = {Howard Steiger and Linda Booij and `Esther Kahan and Kevin McGregor and Lea Thaler and Emilie Fletcher and Aurelie Labbe and Ridha Joober and Mimi Israël and Moshe Szyf and Luis B. Agellon and Lise Gauvin and Annie St-Hilaire and Erika Rossi},

doi = {10.1503/jpn.170242},

issn = {1488-2434},

year  = {2019},

date = {2019-05-01},

journal = {J Psychiatry Neurosci},

volume = {44},

number = {3},

pages = {205--213},

abstract = {BACKGROUND: This study explored state-related tendencies in DNA methylation in people with anorexia nervosa.nnMETHODS: We measured genome-wide DNA methylation in 75 women with active anorexia nervosa (active), 31 women showing stable remission of anorexia nervosa (remitted) and 41 women with no eating disorder (NED). We also obtained post-intervention methylation data from 52 of the women from the active group.nnRESULTS: Comparisons between members of the active and NED groups showed 58 differentially methylated sites (Q < 0.01) that corresponded to genes relevant to metabolic and nutritional status (lipid and glucose metabolism), psychiatric status (serotonin receptor activity) and immune function. Methylation levels in members of the remitted group differed from those in the active group on 265 probes that also involved sites associated with genes for serotonin and insulin activity, glucose metabolism and immunity. Intriguingly, the direction of methylation effects in remitted participants tended to be opposite to those seen in active participants. The chronicity of Illness correlated (usually inversely, at Q < 0.01) with methylation levels at 64 sites that mapped onto genes regulating glutamate and serotonin activity, insulin function and epigenetic age. In contrast, body mass index increases coincided (at Q < 0.05) with generally increased methylation-level changes at 73 probes associated with lipid and glucose metabolism, immune and inflammatory processes, and olfaction.nnLIMITATIONS: Sample sizes were modest for this type of inquiry, and findings may have been subject to uncontrolled effects of medication and substance use.nnCONCLUSION: Findings point to the possibility of reversible epigenetic alterations in anorexia nervosa, and suggest that an adequate pathophysiological model would likely need to include psychiatric, metabolic and immune components.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30776161,

title = {Age-specific associations between oestradiol, cortico-amygdalar structural covariance, and verbal and spatial skills},

author = {Tuong-Vi Nguyen and Sherri Lee Jones and Tricia Gower and Jimin Lew and Matthew D Albaugh and Kelly N Botteron and James J Hudziak and Vladimir S Fonov and D Louis Collins and Benjamin C Campbell and Linda Booij and Catherine M Herba and Patricia Monnier and Simon Ducharme and Deborah Waber and James T McCracken},

doi = {10.1111/jne.12698},

issn = {1365-2826},

year  = {2019},

date = {2019-04-01},

journal = {J Neuroendocrinol},

volume = {31},

number = {4},

pages = {e12698},

abstract = {Oestradiol is known to play an important role in the developing human brain, although little is known about the entire network of potential regions that might be affected and how these effects may vary from childhood to early adulthood, which in turn can explain sexually differentiated behaviours. In the present study, we examined the relationships between oestradiol, cortico-amygdalar structural covariance, and cognitive or behavioural measures typically showing sex differences (verbal/spatial skills, anxious-depressed symptomatology) in 152 children and adolescents (aged 6-22 years). Cortico-amygdalar structural covariance shifted from positive to negative across the age range. Oestradiol was found to diminish the impact of age on cortico-amygdalar covariance for the pre-supplementary motor area/frontal eye field and retrosplenial cortex (across the age range), as well as for the posterior cingulate cortex (in older children). Moreover, the influence of oestradiol on age-related cortico-amygdalar networks was associated with higher word identification and spatial working memory (across the age range), as well as higher reading comprehension (in older children), although it did not impact anxious-depressed symptoms. There were no significant sex effects on any of the above relationships. These findings confirm the importance of developmental timing on oestradiol-related effects and hint at the non-sexually dimorphic role of oestradiol-related cortico-amygdalar structural networks in aspects of cognition distinct from emotional processes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}