[COPY] Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 151: (i) New Book, Part 2; (ii) Big Picture: BIDs; (iii) FAD, Part 1 (n = 2); (iv) Psychometrics; (v) DE, Part 3 (n = 2); and (vi) April - May Treatment Interlude, Part 7 (n = 4)
Colleagues (N now = 1369 in 50 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
Everything-is-Advocacy
REQUEST FOR RESEARCH PARTICIPATION BY AND/OR ASSISTANCE RECRUITING
Researchers Whose Scholarly Work Primarily Focuses on Eating Disorders (>50% of your outputs), including PhD students, early-career researchers, and senior academics
to participate in a study (ML, paraphrasing, has) entitled
Researchers Views on the Use of Generative Artificial Intelligence (e.g., ChatGPT) in Eating Disorder Research
Received yesterday, 11 June 2025 (California time), via an email from our own Dr. Ruth Striegel Weissman (USA), Editor-in-Chief of the International Journal of Eating Disorders, on behalf of one of her Associate Editors, our own Dr. Jake Linardon (Australia).
ML NOTE 1: Drs. Weissman and Linardon and I would appreciate it if you (a) participate in this research, if interested and eligible; and/or (b) pass this along to any and all (i) people who might be eligible and/or (ii) clinicians, physicians, nurse practitioners, dietitians, parents who care about/work with people who are eligible and might be interested.
[Dr. Weissman writes; bold-for-emphasis added by ML]
On behalf of the International Journal of Eating Disorders (IJED) Executive Committee, we invite you to participate in a brief (~10-minute), anonymous survey exploring your views on the use of generative artificial intelligence (e.g., ChatGPT) in eating disorder research.
We are particularly interested in your experience with generative AI tools and your perspectives on their potential – both positive and negative – in relation to publishing, peer review, and research design. We also welcome your thoughts on how generative AI may shape the future of the field.
Our broader aim is to use these insights to inform the development of field-specific guidelines for the safe, effective, and transparent use of generative AI in eating disorder research. We plan to share findings from this study at the upcoming Eating Disorders Research Society (EDRS) conference, on behalf of IJED.
Who can participate?
We are seeking researchers whose scholarly work primarily focuses on eating disorders (>50% of your outputs), including PhD students, early-career researchers, and senior academics. Please feel free to share the survey link with members of your research team or other colleagues in the field.
To access the survey and plain language statement, please click below:
https://researchsurveys.deakin.edu.au/jfe/form/SV_4TkMuB16qfxwj6m
Participation is entirely voluntary, and responses are anonymous. If you have any questions about the study, please feel free to contact Dr. Jake Linardon at Jake.Linardon@deakin.edu.au.
This study has been approved by the Deakin University Human Research Ethics Committee (Approval ID: 2025/HE000211)
We greatly appreciate your time and valuable insights.
Ruth Striegel Weissman, Dipl. Psych., Ph.D. | Professor of Psychology, Emerita, Wesleyan University | Editor-in-Chief, International Journal of Eating Disorders
BODY IMAGE | ADVOCACY-IN-ACTION PODCAST
Appearance Matters Podcast
Episode 101: Appearance, Sexuality, and Gender
with [all are our own] Dr. Maia Thorton (England), Dr. Ginny Ramseyer Winter (USA), and Savannah Roberts (USA)
ML NOTE 2: The Appearance Matters Podcast series is one of many resources offered by the Centre for Appearance Research (CAR) at the University of West England in Bristol. The Podcast series’ senior producer, and the developer/producer of this episode, is our own Bolder Model and Force-To-Be-Reckoned-With, Dr. Nadia Craddock (England). Her co-hosts and co-producers (all in England) are Ms. Bruna Costa, our own Dr. Maia Thornton, and Ms. Abbi Matthews.
ML NOTE 3: Dr. Ginny Ramseyer-Winter (USA) and Savannah Roberts (USA) are also members of this Newsletter Group.
Episode 101: Appearance, Sexuality, and Gender
Link to the podcast episode (#101, ~39.3 min) here:
Episode Description: Welcome back to Appearance Matters: the podcast!
In this episode, Maia speaks to Ginny Ramseyer-Winter, an Associate Professor at the University of Minnesota, and Savannah Roberts, a PhD student at the University of Pittsburgh. This episode focuses on appearance and body image through the lens of sexuality, sexual health, and gender.
Tune in to hear a great discussion reflecting on the role of appearance ideals and body image in the context of sexual health and relationships, appearance norms across different sexualities and genders, and the importance of intersectionality.
To find out more about the Centre for Appearance Research, follow us:
• On Instagram: www.instagram.com/car_uwe/
• On Facebook: www.facebook.com/AppearanceResearch
Research Publication Categories in This Newsletter
(i) New Book, Part 2; (ii) Big(ger) Picture: Body Image Disorders; (iii) Food, Alcohol, Body Image, and “Disturbance”, Part 1 (n = 2); (iv) Psychometrics; (v) Disordered Eating, Part 3 (n = 2); and (vi) April - May Treatment Interlude, Part 7 (n = 4)
CONGRATULATIONS to our own
Dr. Andrea Phillipou (Australia) and colleagues for publication of the Big(ger) Picture: Body Image Disorders research article in #2.
Dr. J. Kevin Thompson (USA) for publication of the Food and Alcohol Disturbance article in #3.
Drs. Kelsie Forbush, Dr. Kelsey Hagan, Sarah Johnson-Munguia, Dr. Kara Christensen Pacella, Dr. Angela Bottera, A. R., Mari Thomeczek, Dr. Brittany Bohrer, Sonakshi Negi, and Anjali Sharma and colleagues for publication of the Psychometrics research article in #5. [All are working in the USA]
Drs. A. Janet Tomiyama (USA) and Jeffrey Hunger (USA) and colleagues for publication of the Disordered Eating research article in #6.
Dr. Zachary Soulliard (USA) and Conor Elbe (USA) and colleague for publication of the Disordered Eating research article in #7.
Dr. Renee Reinecke (USA), Alan Duffy (USA), and Dr. Thomas Joiner (USA) and colleagues, including distinguished scientist-practitioner-mentor Dr. Philip S. Mehler (USA), for publication of the Treatment research article in #10.
Drs. Deborah Mitchison (Australia), Long Le (Australia), and Philippa Hay (Australia) and colleagues, including distinguished health economist Dr. Cathrine Mihalopoulos (Australia), for publication of the Treatment research article in #11.
And CONGRATULATIONS (!) Are Also in Order for
our own Dr. Janet Lydecker (USA)
who has been promoted to
Associate Professor at Yale University School of Medicine
ML NOTE 4: This long overdue promotion is a good thing for Janet and for Yale. It is also a most excellent development for the field. When I am asked the following question “Do you know anyone who is really smart, skilled, and compassionate, who works in an Eating Disorders and Weight Clinic, and who is really knowledgeable about binge eating disorder, weight stigma, obesity, and adolescent/adult development?”, the only person who immediately comes to my mind, in addition to her mentor and colleague Dr Carlos Grilo, is Janet Lydecker . . . .
And CONGRATULATIONS Are Also in Order for a
NEW BOOK entitled
Yoga as Embodied Mindfulness: Integrating Research and Practice
Edited by [our own] Drs. Catherine Cook-Cottone (USA) and Tracy Tylka (USA)
Publication date: Late May 2025 [Part 2 of 3]
1. Cook-Cottone, C., & Tylka, T. L. (Eds.). (2025). Yoga as embodied mindfulness: integrating research and practice. Springer Nature. (419 pp., Hardcover ISBN Hardcover ISBN978-3-031-83417-2)
Publisher’s website: https://link.springer.com/book/10.1007/978-3-031-83418-9
Description at the publisher’s website: see website and/or Newsletter NO. 150.
CHAPTERS AUTHORED BY MEMBERS of this Newsletter Group
Part 2
7. The Assessment of Body Appreciation (pp. 111-125), by Tracy L. Tylka and Nichole Wood-Barcalow (USA). Email address for correspondence: tylka.2@osu.edu
8. The Experience of Embodiment Scale (pp. 127-140), by Niva Piran (Canada), Tanya Luanne Teall, and Alyssa Counsell. Email address for correspondence: niva.piran@utoronto.ca
9. The Functionality Appreciation Scale (pp. 141-154), by Jesssica Alleva (The Netherlands). Email address for correspondence: jessica.alleva@maastrichtuniversity.nl
10. Embodied Mindfulness and Yoga Measures (pp. 155-182), by Freitas Rodrigues, M. V., Cottone, M., and Catherine Cook-Cottone. Email address for correspondence: cpcook@buffalo.edu
11. Mindful Self-Care Scale (pp. 183-201), by Catherine Cook-Cottone, Ellen Halady, and Wendy M. Guyker. Email address for correspondence: cpcook@buffalo.edu
Part 3
12. Diversity, Equity, and Inclusion in Yoga (pp. 205-233), by Jennifer B. Webb (USA), Erin Vinoski Thomas (USA), Courtney B. Rogers (USA), and Daheia J. Barr-Anderson. Email address for correspondence: jennifer.webb@charlotte.edu
13. Best Practices in Yoga Research Protocols (pp. 235-259), by Sofie Scaletta and Catherine Cook-Cottone. Email address for correspondence: cpcook@buffalo.edu
14. Yoga and Body Image (pp. 261-279), by Tracy L. Tylka and Jessica Alleva. Email address for correspondence: tylka.2@osu.edu
15. Yoga for Eating Disorderss (pp. 281-312), by Catherine Cook-Cottone and Chelsea Roff. Email address for correspondence: cpcook@buffalo.edu
16. Yoga and Substance Abuse (pp. 313-325), by Sofie Scaletta, Carly Lua Pershyn, and Catherine Cook-Cottone. Email address for correspondence: cpcook@buffalo.edu\
BIG(GER) PICTURE - Body image Disorders: A New Theoretical Model Supporting the Reclassification
2. Arocha, R. M. A. D., Hauck-Filho, N., Caurin, N. B., & Phillipou, A. (2025).
Body image Disorders: A new theoretical model supporting the reclassification.
Eating Behaviors, 57, 101988. https://doi.org/10.1016/j.eatbeh.2025.101988
Email address for correspondence: rafamoreton@hotmail.com
ABSTRACT. The present study aims to test a new theoretical model for grouping Anorexia nervosa (AN), bulimia nervosa (BN), body dysmorphic disorder (BDD), and muscle dysmorphia (MD) as Body Image Disorders. In a sample composed of 579 individuals from the community, we used exploratory bifactor modeling to investigate the presence of a higher-order general component in these disorders and identify shared and unique components within each condition. Additionally, we explored the relationships between the assessment instruments' total scores and external variables to assess the distinctiveness of the factors in our model.
Our findings indicate the existence of a common general factor encompassing body image disturbance across these disorders. Furthermore, the factor decomposition reveals distinct factors for BDD, MD, and AN/BN, supporting the notion that these are separate conditions despite their shared central element. Other commonalities and differentiation points between the disorders are also identified through decomposition analysis. The external correlations examined provide further support for the bifactor modeling findings.
Our evidence supports the recommendation for reclassification of AN, BN, BDD, and MD as Body Image Disorders, which may enable a more precise theoretical understanding that emphases this central component of these conditions.
FOOD, ALCOHOL, BODY IMAGE, AND “DISTURBANCE”, Part 1 of 2
3. Thompson, J. K. (2025). Food, Alcohol, and Body Image Disturbance (FABID): A reconceptualization of Food and Alcohol Disturbance (FAD), adding body image as a core component. Body Image, 54. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.101904
Email address for correspondence: Joelkevinthompson@gmail.com
ABSTRACT. Food and Alcohol Disturbance (FAD) was proposed in 2018 to more accurately specify a particular nexus of eating and alcohol-related problematic behaviors consisting of restricting food intake prior to engaging in alcohol use, in order to limit overall caloric consumption and/or enhance the intoxicative effects of alcohol use. In recent years, a good body of research has emerged to address the diagnostic integrity of FAD, along with suggestions of measurement modification, theoretical examination, and clinical intervention.
In this paper, it is suggested that the original conceptualization of FAD should be altered to include a core component of body image in the model, thus Food, Alcohol, and Body Image Disturbance (FABID). Support for this modification will be provided by reviewing recent research and providing an extant body image and eating related conceptual model (Tripartite Influence Model) to collectively organize multiple elements into a testable guide for further analysis of the FABID variables.
4. Di Tata, D., Bianchi, D., Rossi, F., Fatta, L. M., Sette, S., & Laghi, F. (2024). Past body shaming experiences and food and alcohol disturbance in young adults: indirect effects via psychological distress. Eating and Weight Disorders, 29, 60. https://doi.org/10.1007/s40519-024-01687-z
Full text available for download at: https://tinyurl.com/bd6vhz27
ABSTRACT. Purpose: This study investigated the associations between retrospective reports of body image victimization (i.e. body shaming) perpetrated by peers and by parents during childhood or adolescence, and food and alcohol disturbance (FAD) in young adulthood, considering the possible mediating role of psychological distress (i.e. subthreshold symptoms of anxiety and depression). Methods: The study involved 1624 young adults aged between 18 and 30 (69% women), who completed an online survey.
Results: Our findings revealed that participants who reported more frequent body image victimization episodes during childhood and adolescence exhibited higher levels of psychological distress and, in turn, higher scores of FAD in young adulthood. Conclusions: This result represents a novel contribution to understanding the psychological correlates of FAD in youths. Limitations and implications are discussed. Level of evidence: Level V, descriptive study.
PSYCHOMETRICS: The Eating Pathology Clinical Outcomes Tracker
5. Forbush, K. T., Chen, Y., Joo, S., Chapa, D. A. N., Hagan, K. E., Richson, B. N., Johnson-Munguia, S., Christensen Pacella, K. A., Bottera, A. R., Thomeczek, M. L., Bohrer, B. K., Perko, V., Negi, S., Sharma, A. R., Like, E. E., Morgan, R. W., Vanzhula, I. A., Tregarthen, J., Palacios, J., & Gould, S. R. (2025). Preliminary development and validation of the Eating Pathology Clinical Outcomes Tracker. Psychological Assessment. Advance online publication. https://doi.org/10.1037/pas0001388
ABSTRACT. There are few routine outcomes monitoring (ROM) tools available to track changes in eating-disorder (ED) symptom expression. Given that ROM is critical for providing measurement-based care, there is a pressing need to develop ROM tools for EDs. The present study developed and validated the Eating Pathology Clinical Outcomes Tracker (EPCOT). Study 1 included administering the initial EPCOT item pool to college students (N = 380). In Study 2 (Recovery Record), a revised EPCOT item pool was administered to adolescents and adults with an ED (N = 2,196). Participants were retested at 1- to 2-week (n = 964) and 1-month (n = 473) follow-up. Finally, Study 3 (Mechanical Turk sample) was a longitudinal study of community adults who were tested at baseline (N = 305), 1-week (n = 240), and 6-month (n = 172) follow-up.
Analyses included exploratory and confirmatory analysis and item response theory to identify differential item functioning across weight categories and ED diagnostic groups. The final version of the EPCOT had 24 items and eight scales. The EPCOT showed evidence for moderate-to-good test–retest reliability and good-to-excellent internal consistency, discriminant and convergent validity, and criterion-related validity. Finally, in Study 3, several EPCOT scales demonstrated predictive validity for predicting general and ED-specific psychiatric impairment at 6-month follow-up. The EPCOT showed initial promise as a tool that can be used to help clinicians track progress in therapy over time and may have utility in research contexts.
Impact Statement: The Eating Pathology Clinical Outcomes Tracker is a 24-item scale that showed initial evidence for excellent psychometric properties and clinical utility that may provide clinicians with much-needed tools to improve end-of-treatment outcomes.
DISORDERED EATING, Part 3 of 5
6. Parker, J. E., Enders, C. K., Tomiyama, A. J., & Hunger, J. M. (2025). Gendered racial microaggressions, self-silencing, and disordered eating in Black women. Body Image, 54. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.101901
Email address for correspondence: jordanparker@g.ucla.edu
ABSTRACT. Gendered racial microaggressions are defined as the nuanced expressions of oppression that Black women can encounter at the intersection of their racial and gender identities. In the present study, we tested the hypothesis that greater frequency of gendered racial microaggressions will be associated with higher body dissatisfaction, drive for thinness, and binge eating and examined whether self-silencing mediated this association.
Participants were 570 U.S.-based Black women (age M = 37.51 years) who completed an online survey on Prolific. Women completed self-reported measures of disordered eating, self-silencing, and the frequency of four specific dimensions of gendered racial microaggressions: (a) Assumptions of Beauty and Sexual Objectification, (b) Silenced and Marginalized, (c) Strong Black Woman stereotype, and (d) Angry Black Woman stereotype.
Results indicated that greater frequency of gendered racial microaggressions in all four domains were associated with greater disordered eating. Self-silencing mediated this association across all domains except the Angry Black Woman stereotype. The results of the study not only highlight associations between gendered racial microaggressions and disordered eating, but additionally elucidate a potential mechanism through which this occurs—self-silencing—offering a promising avenue for future research oriented toward intervention among Black women, a population at elevated risk for disordered eating.
7. Soulliard, Z. A., Manning III, R. B., & Elbe, C. I. (2025). Intraminority stress, body image, and community connectedness: Associations with disordered eating among sexual minority men. Journal of Eating Disorders, 13, 99. https://doi.org/10.1186/s40337-025-01298-8
Full text available for download at: https://tinyurl.com/4vrcb9r3
ABSTRACT. Background: Sexual minority men (SMM) experience high rates of disordered eating, potentially related to stressors stemming from within the SMM community. The present cross-sectional study examined associations among intraminority gay community stress, body image, and community connectedness in relation to disordered eating (i.e., binge eating, purging, restricting, excessive exercise, and muscle building).
Methods: A total of 314 SMM (Mage = 34.56, SDage = 8.13) were recruited via Qualtrics Survey Panel between May and June 2024. Participants completed the Eating Pathology Symptoms Inventory, Gay Community Stress Scale, Appearance Evaluation and Appearance Orientation subscales of the Multidimensional Body-Self Relations Questionnaire, and Connectedness to the LGBT Community Scale. The associations between gay community stress and disordered eating were examined via partial correlations. Three-way interaction terms (i.e., gay community stress*appearance evaluation*SMM community connectedness; gay community stress*appearance orientation*SMM community connectedness) were tested in moderated-moderation analyses to assess interactive effects on disordered eating.
Results: Greater gay community stress was associated with higher levels of disordered eating even when controlling for body image variables, SMM community connectedness, race, relationship status, and perceived weight status. High appearance evaluation buffered the association between gay community stress and binge eating in the presence of high community connectedness. Low community connectedness amplified the effect of gay community stress and high appearance orientation on excessive exercise and muscle building.
Conclusions: Findings suggest a sense of belongingness may mitigate the effects of gay community stress and body image concerns on disordered eating. Results highlight the role of intraminority stressors faced by SMM. Both intraminority stressors and group-level resilience factors (e.g., community connectedness) warrant further consideration in eating disorder research and clinical interventions with SMM.
APRIL - MAY TREATMENT INTERLUDE, Part 6 of many
8. Heinzmann, S., Etzler, S., Hartmann, A., Klein, E. M., Herpertz, S., Pape, M., Heinzmann, S., Doering, S., Hofmann, T., Rose, M., Imbierowicz, K., Geiser, F., Bierling, A., Weidner, K., Rademacher, J., Michalek, S., Morawa, E., Erim, Y, Skoda, E. M, Teufel, M., . . . Zeeck, A. (2025). Personality functioning in inpatients with eating disorders: Association with symptom severity and treatment outcome. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.3183.
Full text available for download at: https://tinyurl.com/2dnhyabc
ABSTRACT. Objective: Impairment in personality functioning (PF) has been linked to a number of mental disorders, including eating disorders (EDs). However, the precise relationship between PF and symptom severity, as well as the potential impact on outcome, remains unclear. The study aimed to analyse the association of PF and its change with severity of ED symptomatology as well as outcome of hospital treatment.
Method: The sample consisted of 397 patients with EDs, treated in 19 university hospitals for Psychosomatic Medicine and Psychotherapy in Germany between 1/2019 and 12/2020. PF was measured with the Structure Questionnaire of the Operationalised Psychodynamic Diagnosis (OPD-SQ, short version), eating psychopathology with the ED examination questionnaire (EDE-Q). Outcome was defined as a change in the EDE-Q total score. We used Latent Change Score Modelling to analyse changes in ED pathology during treatment and a 1-year follow-up period.
Results: A higher level of impairment in PF at admission correlated with more eating psychopathology and a less favourable outcome. Additionally, greater improvement in PF correlated with greater improvements in ED symptomatology at discharge. Conclusion: Impairment in PF needs to be part of diagnostic assessments and should be considered an important treatment target for psychotherapeutic interventions. Trial Registration: The MEPP study was registered in the German Clinical Trials Register (DRKS, www.drks.de; ID: DRKS00016412)
9. Everhart, S. A., Han, S. C., & Durazo-Arvizu, R. (2025). Family-based treatment in higher levels of care: A systematic review and meta-analysis. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.3208
Email address for correspondence: severhart@mcw.edu
ABSTRACT. Objective: Family-Based Treatment (FBT) is the gold standard outpatient eating disorder treatment for children and adolescents with eating disorders. Especially within the past decade, higher levels of care (HLOC) programs including inpatient medical settings and partial hospitalisation programs have incorporated elements of FBT to improve the effectiveness of their treatments. The present study aimed to systematically review the state of the research on FBT adaptations in HLOC and describe the outcomes of those treatment programs.
Method: Articles were identified via a systematic search of three databases (PsycINFO, PubMed, Cochrane Database of Randomized Controlled Trials) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Results: Forty articles were identified including 35 studies and 5 programme descriptions, representing 17 inpatient and 23 partial hospitalisation and/or intensive outpatient programs. Thirty quantitative studies and five qualitative studies were included. Findings supported suitability and effectiveness of treatments in improving weight, eating disorder and mental health symptoms and family functioning.
Conclusions: Burgeoning research supports the effectiveness of FBT adapted to HLOC, with the most evidence for improving weight and eating disorder symptoms. The present review identifies further areas of research needed to expand on the current evidence, such as with controlled trials with sufficient follow-up data.
10. Udupa, N. S., Jeon, M. E., McClanahan, S., Riddle, M., Manwaring, J., Rienecke, R. D., Duffy, A., Mehler, P. S., Blalock, D. V., Hahm, H. C., & Joiner, T. J. (2025). Treatment outcomes for typical and atypical anorexia nervosa across Asian and non-Asian patients in United States higher level of care facilities. Journal of Psychiatric Research, 188, 10-18. https://doi.org/10.1016/j.jpsychires.2025.05.049
Email address for correspondence: udupa@psy.fsu.edu
ABSTRACT. Asian patients with Anorexia Nervosa (AN) face unique barriers to recovery, but may also disproportionately experience constitutional thinness. The current study compared weight-gain and psychopathology treatment outcomes between Asian and non-Asian patients, and compared patients who reached their Expected Body Weight (EBW) by discharge to those who did not.
We collected data from Asian (n = 25 adults, 40 adolescents) and non-Asian (n = 966 adults, 1067 adolescents) patients in higher levels of care at United States eating disorder treatment facilities. We conducted multivariate, two-way, and mixed model ANOVAs to compare symptom severity for Asian versus non-Asian adults and adolescents at admission, discharge, and across treatment. We additionally conducted mixed model ANOVAs to compare change in psychopathology across treatment for Asian and non-Asian patients who did and did not meet their EBW by discharge.
No significant differences emerged between Asian and non-Asian patients, although some differences were noted between age groups at admission and discharge. For non-Asian patients only, those who reached their EBW by discharge had, on average, significantly higher levels of restriction, shape and weight concerns, and global concerns. Results suggest that Asian and non-Asian patients similarly benefit from treatment for AN.
11. Day, S., Mitchison, D., Tannous, W. K., Conti, J., Gill, K., Le, L., Mannan, H., Mihalopoulos, C., Ramjan, L., Rankin, R., & Hay, P. (2025). Longitudinal effects of residential treatment for eating disorders: Symptom trajectories and predictors of functional outcomes. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24448
Full text available for download at: https://tinyurl.com/27vap3nb
ABSTRACT. Objective: Residential treatment for eating disorders addresses the gap between inpatient and outpatient care, but evidence for longer-term and functional outcomes remains limited. The current study examined both clinical and functional outcomes from admission to a 6-month follow-up from Australia's first residential service for eating disorders.
Method: Measures of eating disorder symptoms, body mass index (BMI), anxiety, depression, general and eating disorder-specific health-related quality of life (HRQoL), and functional disability were completed at pretreatment, posttreatment, and 3- and 6-month follow-ups by 81 individuals with eating disorders (Mage = 25.78 years).
Results: Linear mixed effects modeling found that change in outcomes over time was best modeled by a cubic growth curve, such that participants showed a steep improvement from pretreatment to posttreatment followed by a worsening of symptoms by 3 months post-discharge, which tapered off by 6 months post-discharge. Pairwise comparisons indicated significant improvement between pretreatment and posttreatment for all outcomes, and between pretreatment and 6 months post-discharge for all outcomes except mental HRQoL.
Treatment gains were maintained after discharge for shape and weight concerns, anxiety, general and eating disorder-specific HRQoL, and functional disability. Greater in-treatment improvement in eating disorder symptoms predicted steeper in-treatment improvement and posttreatment deterioration in eating disorder-specific HRQoL, mental HRQoL, and functional disability. Greater post-discharge mental health support predicted steeper improvement in functional disability.
Discussion: Results support the longitudinal effectiveness of residential treatment for clinical and functional outcomes. However, not all outcomes may maintain the degree of improvement seen at discharge, highlighting the importance of appropriate step-down care.