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1. Comparing eating disorder characteristics and treatment in self‐identified competitive athletes and non‐athletes from the National Eating Disorders Association online screening tool

   https://doi.org/10.1002/eat.23415  

   Flatt, Rachael E. ; Thornton, Laura M. ; Fitzsimmons‐Craft, Ellen E. ; Balantekin, Katherine N. ; Smolar, Lauren ; Mysko, Claire ; Wilfley, Denise E. ; Taylor, C. Barr ; DeFreese, J. D. ; Bardone‐Cone, Anna M. ; et al ( November 2020 , International Journal of Eating Disorders)

   We compared eating disorder (ED) characteristics and treatment seeking behaviors between self‐identified competitive athletes and non‐athletes in a large, community‐based sample.

   During the 2018 National Eating Disorders Awareness Week, 23,920 respondents, 14.7% of whom identified as competitive athletes, completed the National Eating Disorders Association online screen. Data were collected on demographics, disordered eating behaviors, probable ED diagnosis/risk, treatment history, and intent to seek treatment.

   The sample was predominantly White (81.8%), female (90.3%), and between 13 and 24 years (82.6%). Over 86% met criteria for an ED/subthreshold ED, and of those, only 2.5% were in treatment. Suicidal ideation was reported in over half of the sample. Athletes reported a significantly greater likelihood of engaging in and more frequent excessive exercise episodes than non‐athletes. Athletes also reported a significantly lower likelihood of engaging in and less frequent binge‐eating episodes compared with non‐athletes. Athletes were more likely to screen positive for an ED/subthreshold ED than non‐athletes, but percentages across all probable ED diagnoses were similar. No significant differences between athletes and non‐athletes emerged on treatment history or intention to seek treatment post‐screen (less than 30%).

   Although the distribution of probable ED diagnoses was similar in athletes and non‐athletes, symptom profiles related to disordered eating behavior engagement and frequency may differ. Athletes may be less likely to seek treatment due to stigma, accessibility, and sport‐specific barriers. Future work should directly connect survey respondents to tailored treatment tools and increase motivation to seek treatment.

    

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2. Comparing self‐harming intentions underlying eating disordered behaviors and nonsuicidal self‐injury : Replication and extension in adolescents

   https://doi.org/10.1002/eat.24043  

   Kline, Kiki M. ; Jorgensen, Saskia L. ; Lawson, W. Cole ; Ohashi, Yuri‐Grace B. ; Wang, Shirley B. ; Fox, Kathryn R. ( August 2023 , International Journal of Eating Disorders)

   Eating disorder (ED) behaviors are often characterized as indirect forms of self‐harm. However, recent research has found less clear demarcations between direct self‐harming behaviors (e.g., nonsuicidal self‐injury [NSSI], suicidal behaviors) than previously assumed. The aim of this study was to replicate findings of this prior research on adult populations in adolescents with a history of restrictive eating.

   A total of 117 adolescents between ages 12–14 were included in the study. Participants reported the presence and frequency of binge eating, compensatory, restrictive eating, and NSSI. Participants also reported thoughts of and intentions to hurt and kill themselves when engaging in each behavior on average. Thet‐tests and linear effects models were conducted to compare self‐harming thoughts and intentions across behaviors.

   Participants reported at least some intent to hurt themselves physically in the moment and in the long‐term when engaging in all ED behaviors and NSSI, and reported engaging in these behaviors while thinking about suicide. Direct self‐harming knowledge and intentions were most frequently reported with NSSI and longer‐term knowledge and intentions via NSSI and restrictive eating. Additionally, participants reported some suicidal thoughts and intentions across behaviors.

   This study replicates prior research, suggesting that adolescents engage in ED behaviors and NSSI with non‐zero self‐harming and suicidal thoughts and intentions. ED behaviors and NSSI may better be explained on a continuum. Implications include the recommendation of safety planning during ED treatment.

   This study highlights the overlap between eating disorder (ED) behaviors, nonsuicidal self‐injury (NSSI), and suicide. Though clear distinctions typically exist for motives of self‐harming behavior between ED behaviors (i.e., indirect, in the long run) and NSSI (i.e., direct, in the moment), this research suggests that intentions for self‐harming and suicide may exist on a continuum. Clinical ED treatment should consider safety planning as part of routine interventions.

    

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3. Implicit attitudes toward eating stimuli differentiate eating disorder and non‐eating disorder groups and predict eating disorder behaviors

   https://doi.org/10.1002/eat.22843  

   Smith, April R. ; Forrest, Lauren N. ; Velkoff, Elizabeth A. ; Ribeiro, Jessica D. ; Franklin, Joseph ( February 2018 , International Journal of Eating Disorders)

   The current study tested whether people with and without eating disorders (EDs) varied in their implicit attitudes toward ED‐relevant stimuli. Additionally, the study tested whether implicit evaluations of ED‐relevant stimuli predicted ED symptoms and behaviors over a 4‐week interval.

   Participants were people without EDs (N =85) and people seeking treatment for EDs (N =92). All participants completed self‐report questionnaires and a version of the affect misattribution procedure (AMP) at baseline. The AMP indexed implicit evaluations of average body stimuli, eating stimuli, and ED‐symptom stimuli. Participants with EDs completed weekly follow‐up measures of ED symptoms and behaviors for 4 weeks.

   Contrary to predictions, the anorexia nervosa (AN) group did not differ from the no ED group on implicit attitudes toward ED‐symptom stimuli, and the bulimia nervosa (BN) group had less positive implicit attitudes toward ED‐symptom stimuli relative to the no ED group. In line with predictions, people with AN and BN had more negative implicit attitudes toward average body and eating stimuli relative to the no ED group. In addition, among the ED group more negative implicit attitudes toward eating stimuli predicted ED symptoms and behaviors 4 weeks later, over and above baseline ED symptoms and behaviors.

   Taken together, implicit evaluations of eating stimuli differentiated people with AN and BN from people without EDs and longitudinally predicted ED symptoms and behaviors. Interventions that increase implicit liking of eating‐related stimuli may reduce ED behaviors.

    

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4. Realizing the untapped promise of single‐session interventions for eating disorders

   https://doi.org/10.1002/eat.23920  

   Schleider, Jessica L. ; Smith, Arielle C. ; Ahuvia, Isaac ( February 2023 , International Journal of Eating Disorders)

   Multilevel treatment barriers prevent up to 80% of individuals experiencing eating disorders (EDs) from accessing care. This treatment gap creates a critical need to identify interventions that are accessible, easily completable, and optimized for effectiveness by targeting core mechanisms linked to ED onset and maintenance. We propose single‐session interventions (SSIs) as a promising path toward catalyzing innovation in the development of accessible, effective ED interventions. SSIs are structured programs that intentionally involve one encounter with a program or provider; they may serve as stand‐alone or adjunctive clinical supports. All SSIs are built to acknowledge that any session might be someone's last—and that any single session can nonetheless yield meaningful clinical benefit.

   We define SSIs, summarize research supporting their utility for ED symptoms and other mental health problems, and recommend future directions for work in this domain.

   Single‐session interventions may hold promise to reduce some ED symptoms and risk factors, including restrictive eating and negative body image. Steps toward realizing this promise include (1) testing whether existing evidence‐based SSIs (e.g., for depression) can also reduce EDs, risk factors, and symptoms; (2) developing novel SSIs that target modifiable ED risk factors and symptoms largely unaddressed by SSIs, such as purging and binge eating; (3) studying diverse implementation pathways; (4) capitalizing on SSIs' transdiagnostic utility to broaden funding opportunities; and (5) educating ED researchers and clinicians about SSIs.

   Understanding the strengths and limits of mechanism‐targeted SSIs for ED‐related problems could be a low‐risk, high‐reward avenue toward reducing EDs at scale.

   Most individuals experiencing EDs never access any form of treatment, creating an urgent need to identify ED interventions built to overcome barriers to engaging with care. This Forum article introduces SSIs as a promising path to rapidly developing and testing accessible, evidence‐based ED supports; supplementing existing ED treatment models; and reducing the individual, familial, and societal burdens of EDs at scale.

    

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5. Associations between household income and disordered eating differ across sex and racial identity in a population‐based sample of adults

   https://doi.org/10.1002/eat.23948  

   Mikhail, Megan E. ; Ackerman, Lindsay S. ; Anaya, Carolina ; Culbert, Kristen M. ; Burt, S. Alexandra ; Klump, Kelly L. ( March 2023 , International Journal of Eating Disorders)

   Most research on socioeconomic status (SES) and eating disorders (EDs) has focused on young White women. Consequently, little is known regarding how SES may relate to EDs/disordered eating in older adults, men, or people with different racial identities. We examined whether associations between SES and EDs/disordered eating differed across age, sex, and racial identity in a large, population‐based sample spanning early‐to‐later adulthood.

   Analyses included 2797 women and 2781 men ages 18–65 (M_age = 37.41, SD = 7.38) from the population‐based Michigan State University Twin Registry. We first examined associations between SES and dimensional ED symptoms, binge eating (BE), and self‐reported ED diagnoses across age and sex in the full sample. We then examined the impact of racial identity on associations by conducting within‐ and between‐group analyses among Black and White participants.

   In the full sample, lower SES was associated with significantly greater odds of BE and lifetime EDs in men, but not women, across adulthood. The association between lower SES and greater BE risk was stronger for Black men than for White men, though significant in both groups. Conversely, Black women showed apositiveassociation between SES and dimensional ED symptoms that significantly differed from effects for Black men and White women.

   Associations between socioeconomic disadvantage and EDs/disordered eating may be particularly robust for men in adulthood, especially men with a marginalized racial identity. Oppositely, Black women may encounter social pressures and minority stress in higher SES environments that could contribute to somewhat heightened ED risk.

   Little is known regarding how associations between socioeconomic status (SES) and eating disorders (EDs) may differ across age/sex or racial identity. We found lower SES was associated with greater odds of a lifetime ED or binge eating in men only, with a particularly strong association between lower SES and binge eating for Black men. Results highlight the importance of examining how SES‐ED associations may differ across other aspects of identity.

    

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