Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 162: (i) Prevention-Related; (ii) Advocacy; (iii) Neurodiverg, EDs/DE, Part 1 (n = 2); (iv) Trauma/Maltreat, Part 1 (n = 2); (v) Soc Media, Part 2 (n = 2); and (vi) EDs, Part 3 (n = 3)
Colleagues (N now = 1385 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.
RECOVERY/SUPPORT-ADVOCACY-IN-ACTION
Free CHAT in THE LIVING ROOM:
MONDAY, July 14, 2025 - 7:00 p.m. - 8:00 p.m. Eastern | 4:00 p.m. - 5:00 p.m. Pacific | 12:00 a.m - 1:00 a.m. UTC
SPECIAL TOPIC: Acceptance and Commitment
hosted by and, this time, featuring [our own] Ms. Sondra Kronberg, MS, RD, CDN, CEDRD (Founder of the Chats Program)
Received 7 July 2025 (California time via a Chats in the Living Room email from my friend and Bolder Model, our own Ms. Sondra Kronberg (USA), Founder and Host of Chats in the Living Room.
ML NOTE 1: PLEASE FORWARD AND OFFER THIS RESOURCE TO PATIENTS & Colleagues to add to their support - it is a completely collegial, non-competitive, non-promotional joint effort by experts.
ML NOTE 2: For information about previous Chats, various forms of support for recovery and self-care, and other resources that Ms. Kronberg and her staff provide, go to: https://www.chatsinthelivingroom.com/
ML Note 3: For information about Sondra and her multifaceted work and contributions to the field, see Sondra Kronberg
Professionals across the eating disorder field are coming together to support your recovery, healing, and growth in these challenging times. From the comfort of your home, and anonymously, join us on Zoom for…
Choose Support • Choose Connection • Choose Recovery
CHATS in THE LIVING ROOM
developed and hosted by Sondra Kronberg
FREE! - live on Monday 14 July 2025, 7:00 p.m. - 8:00 p.m. Eastern | 4:00 p.m. - 5:00 p.m. Pacific | 12:00 a.m - 1:00 a.m. UTC
SPECIAL TOPIC: Acceptance and Commitment
RSVP through by clicking the following to sign up and receive your Zoom invite via email: https://www.chatsinthelivingroom.com/sign-up
RECOVERY/ADVOCACY RESOURCE
The National Association of Anorexia Nervosa and Associated Disorders (ANAD)
has made available a free webinar (recorded 7 July 2025)
Speaking Up: Patient Advocacy in Eating Disorders Treatment
with Rebecca J. Lester, Ph.D., LCSW (USA)
Received 8 July 2025 an email from the National Association of Anorexia Nervosa and Associated Disorders (ANAD).
ML NOTE 4: In my experience Dr. Lester’s written work is invariably thought-provoking and informative from the perspective of therapists, caregivers, and people who have an eating disorder.
Eating disorder recovery can feel overwhelming and impossible. It doesn't help that some medical settings can feel quite intimidating. That's why it's no wonder why folks may feel discouraged or lose hope in healing. That's why we're committed to patient advocacy and education!
Check out our most recent event with Dr. Rebecca J. Lester now OR browse the ANAD Learning Library now to learn more.
Webinar title — Speaking Up: Patient Advocacy in Eating Disorders Treatment
Recorded 7 July 2025)
Listen/watch for free (~59 minutes): https://www.youtube.com/watch?v=vtNbd9O-bJI
Research Publication Categories in This Newsletter
(i) Prevention-Related; (ii) Epidemiology; (iii) Neurodivergence, EDs, & DE, Part 2 (n = 2); (iv) Trauma & Maltreatment, Part 2 (n = 2); (v) Disordered Eating/Eating Pathology, Part 1 (n = 2); and (vi) Nature, Course, and Correlates of EDs, Part 4 (n = 3)
CONGRATULATIONS to our own
Arielle Smith (USA) and Drs. Andrea Kass Graham (USA) and Jessica Schleider (USA) and colleagues for publication of the Prevention/Risk Factor Reduction research article in #1.
Drs. Phillipa Hay (Australia) and Deborah Mitchison (Australia) and colleagues for publication of the Neurodivergence and EDs research article in #4.
Drs. Wesley Barnhart (USA — and CONGRATUATIONS (!), DR. Barnhart on completing your Ph.D. in Clinical Psychology at Bowling Green State University), Jason Nagata (USA), and Jinbo He (Hong Kong/China) and colleagues for publication of Disordered Eating/Eating Pathology research articles in #7 and #8.
Dr. Sasha Gorrell (USA) and Dr. Elizabeth Dougherty (USA) and Maya Day (USA) and Dr. Lisa Anderson (USA) of the Nature and Correlates of Eating Disorders research article in #10.
PREVENTION-RELATED
1. Smith, A. C., Ahuvia, I. L., Zapata, J. P., Cohen, K. A., Graham, A. K., & Schleider, J. L. (2025). Randomized trial of a digital single-session intervention for body image and mood concerns among LGBTQ+ adolescents. Behaviour Research and Therapy. Advance online publication. https://doi.org/10.1016/j.brat.2025.104809
Email address for correspondence: arielle.smith@northwestern.edu
ABSTRACT. LGBTQ+ youth experience disproportionately high rates of mental health concerns, including eating disorders (EDs) and depression. Body dissatisfaction is a shared risk factor for EDs and depression. Given the limited nature of accessible, affirming resources, LGBTQ+ youth often seek mental health support online. Promising research has been conducted on LGBTQ-affirmative interventions, but this work has focused on adults and digital delivery has been limited.
To reduce body dissatisfaction at-scale, we developed a digital, single-session intervention (SSI)—Project Body Neutrality. A total of 218 LGBTQ+ adolescents (ages 13–17) with body image and mood concerns were recruited online and randomized to Project Body Neutrality or to a control (a structurally similar digital SSI designed to mimic supportive therapy).
Both conditions were highly acceptable, and a qualitative analysis of open-ended feedback elucidates what participants found most helpful about Project Body Neutrality. Compared to control participants, intervention participants reported significantly greater immediate positive changes in body satisfaction, functionality appreciation, hopelessness, and perceived agency. At 3-month follow-up, these differences were not sustained. Across the full sample, there were no significant differences between groups in 3-month reductions in ED psychopathology or depression symptoms.
However, an exploratory analysis indicates that the intervention had a significant effect on ED psychopathology among participants at-risk for EDs (as opposed to those above the clinical threshold). Future research would benefit from further investigation of when, for whom, and within what treatment-seeking context Project Body Neutrality may be most impactful (ClinicalTrials.gov ID: NCT06172452)
EPIDEMIOLOGY
ML NOTE 5: The article described bellow in #2 is a commentary on the following, as presented 15 April 2025 in Newsletter NO. 134 (#2).
Lee, J. J., & Chi, G. (2025). Five decades of eating disorder research: A bibliometric analysis of publication trends, research themes, and the relationship between public and academic attention (1975–2024). International Journal of Eating Disorders. Advance online publicatiion. https://doi.org/10.1002/eat.24436
Full text available for download at: https://tinyurl.com/3nt6v73z
ML NOTE 6: In my experience, anything by distinguished epidemiologist — and arguably the world’s foremost epidemiologist in the area of eating disorders — Dr. Hans Hoek is worth reading. In this regard see/listen to (~35.75 min) Dr. Kathy Pike’s Big Ideas in Eating Disorders Podcast interview with Dr. Hoek at https://www.youtube.com/watch?v=w6F4YG8nNGw
Hoek, H. W. (2025). The incidence and prevalence of eating disorders between 1975 and 2024: A commentary on Lee and Chi (2025). International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24495
Full text available for download at: https://tinyurl.com/2s36xz8c
ABSTRACT. Over the past five decades (1975–2024), research on eating disorders (EDs) has expanded significantly, as evidenced by the bibliometric analysis by Lee and Chi (2025). This growth reflects heightened public and academic interest, likely influenced by several key developments in the classification and epidemiology of EDs. The Diagnostic and Statistical Manual for Mental Disorders has progressively included more ED diagnoses, such as bulimia nervosa, binge-eating disorder (BED), and avoidant/restrictive food intake disorder (ARFID) between 1975 and 2024. Recognition of EDs among males and older individuals has improved, although these groups remain underrepresented in clinical settings and in research.
Global studies indicate rising ED prevalence in Asian countries. While anorexia nervosa remains relatively rare in Latin America and Africa, bulimia nervosa and BED are also common disorders on these continents. Epidemiological data in the Netherlands suggest that, overall, ED incidence has not increased between 1975 and 2024; however, a notable exception is the significant increase in anorexia nervosa among 10- to 14-year-old girls. Emerging evidence indicates that since the onset of and during the COVID-19 pandemic, there has been a global rise in reported cases of EDs.
NEURODIVERGENCE, EDs, AND DE: Part 2 of now 3
3. Halls, D., Leppanen, J., Williams S., & Tchanturia K (2025) Longitudinal study of socio-emotional cognitive processing in individuals with anorexia nervosa and the impact of autistic characteristics on neural processing. Frontiers in Psychology, 16, 15834173417. https://doi.org/10.3389/fpsyg.2025.1583417
Full text available for download at: https://tinyurl.com/53y2h3m9
ABSTRACT. Background: Difficulties in socio-emotional cognitive processing are a key feature in individuals with anorexia nervosa (AN); however, the underlying neural processing, particularly longitudinal, is poorly understood. Compounding difficulties is the presence of overrepresented autistic characteristics, and it is unclear how these impact socio-emotional cognitive neural processing in individuals with AN.
Method: A total of 92 participants, including 65 individuals with AN and 27 controls, took part in a longitudinal assessment at two time points, approximately 2 years apart, by undertaking socio-emotional cognitive tasks while undergoing functional magnetic resonance imaging (fMRI). A multivariate approach was used to predict autistic characteristics from generated maps from the AN group.
Results: A group-by-time interaction effect was demonstrated in several brain regions in response to tasks, with the regions with the strongest evidence being the right frontal operculum/pole. The multivariate approach revealed a wide distribution of brain regions contributing to autistic characteristics.
Conclusion: Neural changes over time in the right frontal operculum/pole potentially represent a compensatory mechanism for cognitive difficulties. Autistic characteristics in individuals with AN are instantiated and impact a wide distribution of neural regions, particularly during socio-emotional cognitive processing.
4. Alford, C., Wallis, A., Hay, P., & Mitchison, D. (2025). Understanding the child and adolescent eating disorder treatment experiences of autistic people and parents. Journal of Eating Disorders, 13, 128. https://doi.org/10.1186/s40337-025-01331-w
Full text available for download at: https://tinyurl.com/3k6d2r9r
ABSTRACT. Background: Autistic people are overrepresented in eating disorders services and often require more intensive and extended treatment. Little is known about the eating disorder treatment experiences of autistic young people. The aim of this research was to understand the child and adolescent eating disorder treatment experiences of autistic people and parents of autistic young people.
Methods: Constructivist grounded theory was employed. Nine autistic people with lived experience of an eating disorder as an adolescent as well as nine parents of autistic young people engaged in paediatric eating disorders treatment were recruited through purposive sampling and then interviewed using a semi-structured design. Each interview was transcribed and analysed to identify themes and develop emergent theory directly from the data.
Results: Two major themes emerged (1) Misunderstood and (2) Safe and supportive eating disorder treatment for autistic young people and their families. Being ‘Misunderstood’ was found to occur across eight different domains including problems related to diagnosis, misattribution, neuro-normative definitions of eating and recovery, a one size fits all approach, siloed expertise, limited expertise and treatment options for eating disorders outside of anorexia nervosa, family neurodivergence and autism not being accommodated.
The effects of being misunderstood included an increased burden of case management and advocacy, distress and trauma, mistrust of health professionals, identity disruption, and setbacks in recovery. ‘Safe and supportive eating disorders treatment for autistic young people and their families’ is informed by lived experience and built on a foundation of general care principles and autism-specific elements.
Conclusions: Being misunderstood is a recursive process that occurs across multiple aspects of eating disorder care. Autistic young people and their families desire and need safety and understanding. This is achieved through care characteristics that promote connection and nuance, and autism specific adaptations and accommodations that provide optimal support conditions and strengthen therapeutic alliance. Trial registration: This research was approved for prospective registration on Open Science Framework (OSF) on the 8th December 2023.
TRAUMA AND MALTREATMENT, Part 2 of 3
5. Moccia, L., Serantoni, C., Ambrosecchia, M., Conte, E., Maulucci, G, Janiri, D, Kotzalidis, G. D., Di Giorgio, V, Conti, F., De Spirito, M., Gallese, V., & Sani, G. Interoceptive impairments in early-stage anorexia nervosa: Exploring the impact of childhood trauma and heart rate variability. Journal of Eating Disorders, 13(1), 101. https://doi.org/10.1186/s40337-025-01255-5
Full text available for download at: https://tinyurl.com/4wen29xt
ABSTRACT. Background: Anorexia nervosa, restricting subtype (AN-R), is a severe psychiatric disorder, with abnormal interoception, autonomic nervous system disturbances, and increased exposure to childhood traumatic experiences (CTEs), frequently observed as correlates. This is the first study exploring the impact of CTEs and heart rate variability (HRV; i.e., an index reflecting parasympathetic arousal) on interoceptive accuracy (IA; i.e., the ability to track changes in bodily signals) in AN.
Methods: Twenty-five patients with AN-R within a year of onset and 25 matched healthy controls were recruited. IA was assessed through the heart beat detection task. HRV was measured before and after the task. Participants also completed the Childhood Trauma Questionnaire. We performed a to detect significant differences between groups in HRV reactivity and IA, and a linear regression to test the effect of factors of interest on IA.
Results: Patients with AN-R displayed significantly increased HRV reactivity and decreased IA compared to HCs. They also reported significantly more CTEs. Furthermore, childhood emotional neglect significantly predicts IA impairments. Conclusions: Although the pathway linking emotional neglect to abnormal interoception in AN-R remains to be clarified, an embodiment-informed framework may show promise in the treatment of individuals with eating disorders who experienced childhood maltreatment.
6. Ritz, L., Mauny, N., Montcharmont, C., Dessommes, N., Jacquet, D., & Lemercier-Dugarin, M. (2025). Indirect association between childhood maltreatment and food and alcohol disturbance through insecure attachment in university students. Journal of Eating Disorders, 13(1), 126. https://doi.org/10.1186/s40337-025-01321-y
Full text available for download at: https://tinyurl.com/3c3t65nv
ABSTRACT. Background: Food and Alcohol Disturbance (FAD) is characterized by a functional relationship between disordered eating behaviors and problematic alcohol use. Childhood adversity has been found to be associated with FAD, but its potential impacts on attachment profiles and FAD behaviors have never been examined. The present study tests a model in which insecure attachment mediates the relationship between childhood maltreatment and FAD.
Methods: University students (N = 629) participated in the study, completing questionnaires on FAD, childhood maltreatment history, and adult attachment. Structural equation modeling was used to test the mediated effect of childhood maltreatment through attachment on FAD behaviors.
Results: Insecure attachment and childhood maltreatment were related; however, only insecure attachment was directly related to FAD behaviors. A history of childhood maltreatment was indirectly related to FAD, mediated by insecure attachment. Attachment insecurity, particularly preoccupied and fearful patterns, was directly related to FAD behaviors in students and mediated the relationship between childhood maltreatment and FAD.
Conclusions: These findings may explain how early experiences of child maltreatment can be related to attachment style, and later, in adulthood, influence FAD behaviors in students. Clinicians should adapt treatment and preventions strategies to help patients transition from insecure attachment to a more secure pattern and regulate their negative emotions.
DISORDERED EATING/EATING PATHOLOGY, Part 1 of 2
7. Xiao, Y., Barnhart, W. R., Wu, S., Jiang, Z., Nagata, J. M., & He, J. (2025). Exploring longitudinal associations between thinness- and muscularity-oriented eating and body image disturbances in Chinese adult women and men. Body Image, 54. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.101933
Email address for correspondence: anlfhe@gmail.com
ABSTRACT. Individuals striving for socially promoted thin and muscular body ideals are at risk of developing thinness- and muscularity-oriented eating and body image disturbances. Thinness and muscularity are not mutually exclusive but rather interconnected components of contemporary body ideals. However, prior studies have largely examined these associations within each category (e.g., body fat dissatisfaction with thinness-oriented disordered eating or muscularity dissatisfaction with muscularity-oriented disordered eating), which neglects potential cross-category relationships.
The present study, which addressed this research gap, explored these cross-category longitudinal associations at baseline (T1) and 6 months later (T2). Employing gender-specific cross-lagged models, we analyzed data from an online sample of 799 Chinese women and men. We examined four cross-category reciprocal relationships: (1) body fat dissatisfaction with muscularity dissatisfaction, (2) body fat dissatisfaction with muscularity-oriented disordered eating, (3) thinness-oriented disordered eating with muscularity dissatisfaction, and (4) thinness-oriented disordered eating with muscularity-oriented disordered eating.
Results revealed gender-specific cross-category associations. Particularly, positive, bidirectional associations were observed among women between thinness- and muscularity-oriented eating and body image disturbances. Among men, the associations were unidirectional, with muscularity-oriented eating and body image disturbances at T1 predicting greater thinness-oriented disordered eating at T2, but not vice versa.
These findings advanced existing knowledge of the cross-category relationships between thinness- and muscularity-oriented eating and body image disturbances, with important implications for gender-specific interventions in non-clinical adults. For women, programs should address the reciprocal reinforcement between thinness- and muscularity-oriented eating and body image disturbances, while for men, targeting muscularity-oriented disturbances may help reduce subsequent thinness-oriented disordered eating.
8. Jiang, Z., Wang, S., Barnhart, W. R., Wang, P., Wu, S., Nagata, J. M., & He, J. (2025).Validating the revised male body attitudes scale and examining its prospective associations with eating disorder psychopathology and muscle dysmorphia symptoms in Chinese adult men. Body Image, 54. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.101931
Email address for correspondence: anlfhe@gmail.com
ABSTRACT. In the present study, we translated and validated the Revised Male Body Attitudes Scale (MBAS-R) and examined its longitudinal associations with thinness- and muscularity-oriented eating disorder (ED) psychopathology and muscle dysmorphia symptoms in Chinese adult men. A total of 400 Chinese adult men (Mage = 30.24 years, SD = 8.55) were recruited to participate in two sequential phases: a baseline survey and a 6-month follow-up.
Using baseline data, exploratory and confirmatory factor analyses supported the original three-factor structure of the MBAS-R (i.e., muscularity, body fat, and height subscales), with the removal of one item. The MBAS-R total scale and subscales showed good internal consistency (McDonald’s ω =.81–.93), adequate test-retest reliability (ICC =.86–.95), and strong construct validity as demonstrated by significant positive associations with eating and body image disturbances, as well as weight and height actual-ideal discrepancies.
Using both baseline (N = 400) and follow-up (N = 254) data, longitudinal analyses showed that higher MBAS-R total and/or subscale scores at baseline were significantly associated with higher levels of thinness-oriented ED psychopathology and muscle dysmorphia symptoms at follow-up, but not muscularity-oriented ED psychopathology. The findings of the present study support the sound psychometric properties of the MBAS-R and its use in Chinese adult men, highlighting the prospective role of disturbed body attitudes in relation to greater ED psychopathology and muscle dysmorphia symptoms in Chinese men.
NATURE, COURSE, AND CORRELATES OF EDs, Part 4 of now 6
9. Barber, K. E., Woolley, M. G., Knudsen, F., Lensegrav-Benson, T., Quakenbush, B., & Twohig, M. P. (2025). The prevalence and clinical correlates of body-focused repetitive behaviors in eating disorders. Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2025.2519902
Full text available for download at: https://tinyurl.com/3ppf4hk9
ABSTRACT. Body-focused repetitive behaviors (BFRBs) and eating disorders (EDs) involve persistent, self-directed behaviors causing distress and impairment. Despite similarities, the relationship between the two is understudied. We examined clinical and subclinical BFRB prevalence in individuals with EDs, tested associations with ED and obsessive-compulsive (OC) symptoms, and compared BFRB occurrence between ED subtypes.
The sample included 95 female adults and adolescents in residential ED treatment (51% anorexia nervosa-restricting, 37% anorexia nervosa-binge-eating/purging, 9% bulimia nervosa, 3% other EDs). The Habit Questionnaire, Eating Disorder Examination Questionnaire, and Dimensional Obsessive-Compulsive Scale assessed BFRBs, ED symptoms, and OC symptoms, respectively.
BFRBs were highly prevalent in the sample, with 37% meeting clinically significant levels and 31% displaying subclinical BFRBs. The most common clinically significant BFRBs were skin picking (28%), mouth chewing (10%), and hair pulling (9%). Higher ED and OC symptom severity were both associated with the presence of any presence of a co-occurring BFRB. BFRB prevalence did not differ between restricting and binge-eating/purging ED subtypes.
Overall, co-occurring BFRBs were common in this residential ED sample, highlighting the need for routine screening. Both ED and OC symptom severity were uniquely related to BFRB occurrence. Future research should explore the underlying mechanisms to better understand the relationship between BFRBs and EDs.
10. Gorrell, S., Ramappa, S, Richson, B, Dougherty, E., Singh, S., Lindstrom, K., Day, M., Rasmussen, E., & Anderson, L. M. (2025). Evidence of altered biobehavioral threat processes in adolescents with eating disorders: A scoping review. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24485
Email address for correspondence: sapna.ramappa@ucsf.edu
ABSTRACT. Objective: Etiological models of eating disorders (EDs) suggest there is considerable overlap between anxiety and EDs. In particular, shared clinical features across these psychiatric diagnoses suggest that common threat processes (i.e., changes in affect, cognition, and physiology, or behavior in response to a feared stimulus) underlie their maintenance. Compared to anxiety disorders, however, less is known about the neurobiological bases of threat that may give rise to and maintain ED symptoms, particularly among adolescents. Addressing this knowledge gap will aid in informing future research and interventional efforts.
Methods: We searched four online databases to review studies published through March 2025 comprising all potential types of assessment of biobehavioral activity associated with threat (e.g., neuroimaging, skin conductance) in clinical samples of adolescents with EDs.
Results: From 2546 articles identified, N = 19 studies met inclusion criteria. A majority of investigations employed functional neuroimaging to study adolescent girls with anorexia nervosa, compared with age-matched controls. We classified and synthesized evidence within categories of non-ED-specific threat (harm avoidance) or ED-specific threat (bodily- or food-related threat, or their combination). Most studies demonstrated altered ED-specific threat processing in adolescent girls with anorexia nervosa compared to controls, as well as associations between neural threat response and ED symptomology. The study focused on non-ED-specific threat found no noted differences in threat response in cases versus controls.
Discussion: Given the apparent relevance of threat processing in EDs, future inquiry is needed to resolve remaining questions and yield new insights with clinical relevance across transdiagnostic adolescent ED presentations.
11. Spix, M., & Jansen, A. (2025). Unravelling the knot: Investigating avoidance learning in anorexia nervosa. Behaviour Research and Therapy, 192, 104779. https://doi.org/10.1016/j.brat.2025.104779
Full text available for download at: https://tinyurl.com/ycx4t879
ABSTRACT. Restrictive eating - a core symptom of anorexia nervosa (AN) - has been conceptualized as a learned avoidance behaviour driven by anorectic fears. The present study aims to unravel the learning processes contributing to food avoidance in individuals with AN. We expect that 1) individuals with AN acquire aversive conditioned responses for stimuli predicting food intake, 2) learned avoidance behaviours persist when no food is offered anymore and 3) avoidance behaviours initially reduce threat expectancies and fear but maintain conditioned responses long-term.
20 patients with AN and 23 healthy controls (HCs) completed an avoidance learning task with high-calorie food, monetary rewards, and an aversive scream as the unconditioned stimuli (US). Patients showed more avoidance, greater fear, reduced eating desires and less liking for the stimulus predicting food-intake than HCs. After learning that no food was delivered anymore, patients continued to use avoidance behaviours. This prevented a further reduction of US-expectancies and fear. Differences in learning between patients and HCs were specific to the US-food.
These findings suggest that learned food avoidance is persistent and hinders the extinction of eating-related threat beliefs and fears. Consequently, interventions for AN focusing on the reduction of fear e.g., exposure therapy, should also address avoidance behaviours.