Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 221: Muscularity & Eating Pathology; (ii) BDD/MDD, Part 1 (n = 2); (iii) Media, Part 1 (n = 2); (iv) Caregivers, Part 1 (n = 2); and (v) October-November Treatment Interlude, Part 4 (n = 4)
Colleagues (N now = 1431 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 - I
from our own Dr. Tracy Tylka, FAED (USA), Editor-in-Chief of Body Image
for Self-Nomination for the Journal’s new
Early Career Researcher (ECR) [Reviewer] Board
Nomination Deadline: 20 December 2025
Received yesterday, 3 December 2025, via an everything-is-advocacy email from our own distinguished research scientist-author-mentor Dr. Tracy Tylka (USA), Editor-in-Chief of Body Image (see #2 and #5 below).
ML NOTE 1: Dr. Tylka, the Associate Editors of Body Image*, and I would appreciate it if you would pass this opportunity along to any and all who might be eligible and interested and/or those who supervise, mentor, work with, and otherwise know such people.
*[all of whom are members of this Newsletter Group: Drs. Jessica Alleva (The Netherlands), Matthew Fuller-Tyszkiewicz (Australia), Jake Linardon (Australia), Kate Mulgrew (Australia), Sarah Murnen (USA; Kenyon College - just sayin’ . . . . see next section), Rachel Rodgers (USA/France), Erin Vinoski Thomas (USA), and Jennifer Webb (USA)]
[Dr. Tylka writes:]
Body Image: An International Journal of Research (Impact Factor: 5.4) is modifying its reviewer system. In addition to our Editorial Board, we are developing a new Early Career Researcher (ECR) Board. We are recruiting individuals for the ECR Board.
Status is reserved for early career researchers (those with at least an advanced degree working towards their doctorate, all the way up to 7-years post-PhD) who would like to become more involved with the journal. A consistent pattern of providing high-quality reviews over at least a 3-year period may result in promotion to the Editorial Board.
What you need to do:
To nominate yourself or others, please complete the brief survey (link below) by December 20 to:
https://osu.az1.qualtrics.com/jfe/form/SV_bQot8emrFYHVDZc
Tracy L. Tylka, Ph.D., FAED | Professor | Department of Psychology | The Ohio State University | Editor-in-Chief, Body Image: An International Journal of Research
EVERYTHING-IS-ADVOCACY REQUEST - II
from Jeannie Cook (Kenyon College, Class of 2026),
who is seeking
To Secure a Paid Research Assistant Position Beginning in Summer 2026
Received 2 December 2026 via an everything-is-advocacy email from Jeannie Cook (Kenyon College, Class of 2026; cook4@kenyon.edu).
ML NOTE 2: Jeannie, her Kenyon advisors (my former colleagues), and I would appreciate it if you would (a) reach out to her if you have an available position or if you know of someone who does; and (b) pass this along to any and all researchers who might be interested or who work with people who might be interested.
(Jeannie writes; bold-for-emphasis added by ML:)
My primary goal is to secure a paid research assistant position beginning in summer 2026. That’s the timeline I’m most focused on as I plan my post-graduation path. If it would be helpful for onboarding or early training, I’m also open to doing a small amount of work during winter break or the spring semester, but my main aim is a summer 2026 start.
I’m hoping to gain hands-on experience in data collection, data management/cleaning, statistical analysis, and literature review, while continuing to strengthen my quantitative skillset. I’m also excited about the opportunity to contribute meaningfully to active research projects.
I bring a strong foundation in psychology and neuroscience, including experimental design; proficiency in R (tidyverse, linear and mixed models), Qualtrics, and basic NLP tools; and behavioral research experience in language analysis, group decision-making, and animal behavior. I’m also highly organized, reliable, detail-oriented, and an effective writer and communicator.
Please let me know (cook4@kenyon.edu) if it would be helpful for me to send along my CV or any additional materials. I’d be happy to provide anything useful.
EVERYTHING-IS-ADVOCACY INVITATION
from our own Dr. Matthew Pugh (England) and distinguished scientist-practitioner-mentor Dr. Lucy Serpell (England)
to participate in the University College London’s (UCL’s)
Eating Disorder Discussion Group (EDDG)
Received 2 December 2025 via an everything is advocacy email from our own Dr. Matthew Pugh (England) and distinguished scientist-practitioner-mentor Dr. Lucy Serpell (England).
ML NOTE 3: Dr. Pugh, Serpell, and I would appreciate it if you would pass this opportunity along to any and all who might be interested and/or those who supervise, work with, and otherwise know people who might be interested.
ML NOTE 4: In regard to the first paragraph of the Dr. Pugh’s invitation below, Drs. Glenn Waller (England) and Janet Lydecker (USA) are members of this Newsletter Group.
[Dr. Pugh writes; bold-for-emphasis added by ML:]
The University College London (UCL) Eating Disorder Discussion Group (EDDG) is a friendly and informal online meeting where clinicians, researchers, and students can come together to hear about the latest developments in eating disorder research and practice. We meet once per month (usually the first Monday of each month, 13:00 UK time - ML NOTE 5: 8:00 a.m. EST | 5:00 a.m. PST | 12:00 p.m. UTC) and host a different guest speaker at each meeting. Our past presenters have included Professor Glenn Waller, Janet Lydecker, and Simona Calugi.
Our next guest speaker is Stella Kozmér* (PhD candidate, University of Exeter) who will be joining us on January 19 2026. She will be providing a start-of-the-art lecture about Binge Eating Disorder and Bulimia Nervosa treatment in primary care – what’s happening and where to next. If you would like to be added to our mailing list and receive Zoom invites to our forthcoming meetings, please email m.pugh@ucl.ac.uk.
We hope to see you there! – Professor Lucy Serpell and Dr. Matthew Pugh.
Dr. Matthew Pugh | Senior Clinical Psychologist, CBT Psychotherapist, Advanced Schema Therapist | Honorary Teaching Fellow, PGCert. in CBT for Eating Disorders | University College London
*ML NOTE 6: See, for example, the following, as presented 26 October 2025 in Substack Newsletter NO. 204(#10).
Kozmér, S., O’Rouke, C., Lawrence, N. S., Smith, J. R., & van Beurden, S. B. (2025). Identification and management of binge-eating disorder and bulimia nervosa in primary care settings: A qualitative systematic review of healthcare professionals’ and patients’ perception. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24568 [Full text available for download at: https://tinyurl.com/379tzews]
Research Publication Categories in This Newsletter
(i) Muscularity Concerns and Eating Pathology; (ii) BDD/MDD, Part 1 (n = 2); (iii) Media, Part 1 (n = 2); (iv) Caregivers, Part 1 (n = 2); and (v) October-November Treatment Interlude, Part 4 (n = 4)
CONGRATULATIONS to our own
Jade Portingale (Australia) and Dr. Isabel Krug (Australia) and colleagues for publication of the MDD/BDD research articles in #2 and #3 and the Media research article in #5.
Sarah Rowland (New Zealand) and colleagues for publication of the Caregivers research article in #6.
Taylor Politi (USA) and Dr. Pamela Keel (USA) and colleague for publication of the Media research article in #4.
Dr. Timothy Brewerton and colleagues for publication of the Treatment research article in #8.
Drs. Jocelyn Lebow (USA) and Leslie Sims (USA) and colleagues for publication of the Treatment research article in #10.
Suzanne Mares (The Netherlands) and colleagues for publication of the Treatment research article in #11.
MUSCULARITY CONCERNS AND EATING PATHOLOGY
1. White, C., Maraun, M., & Zaitsoff, S. (2025). How do I evaluate myself? The importance of examining overevaluation of muscularity in risk for eating disorder symptoms. Journal of Eating Disorders, 13, 233. https://doi.org/10.1186/s40337-025-01419-3
Full text available for download at: https://tinyurl.com/25f6
ABSTRACT. Background: The extent to which individuals view, think and feel about their shape and weight in relation to their self-esteem is understood as a risk factor for eating disorders. However, muscularity has yet to be examined as an appearance category that individuals may base their self-esteem on. Thus, this study examined whether evaluating oneself based on muscularity (overevaluation of muscularity) may be relevant to men and women’s self-esteem and whether this form of self-evaluation may relate to eating disorder symptoms most prominently in men, who frequently present with muscularity concerns.
Method: Young adults (N = 290; 50.3% cisgender women) were recruited from a Canadian university and completed a modified version of the Shape and Weight Based Self-Esteem Questionnaire and a measure of eating disorder symptoms.
Results: Men endorsed greater overevaluation of muscularity than women, although women endorsed greater overevaluation of shape and weight than men. Despite differences in the forms of appearance on which men and women based their self-esteem, multi-group structural equation models demonstrated that there were no differences in the associations between overevaluation of shape-, weight-, and muscularity and eating disorder symptoms across men and women. However, overevaluation of shape-, weight-, and muscularity were associated with distinct eating disorder symptoms.
Conclusions: Altogether, results provide nuanced information regarding the importance of assessing self-evaluation based on muscularity, alongside shape- and weight, as increased self-evaluation based on these appearance domains may confer risk for eating disorder symptoms.
MUSCLE DYSMOPRHIA/BODY DYSMORPHIC DISORDER, Part 1 of 2
2. Portingale, J., Krug, I., & Butler, D. (2026). Weakened self-other boundaries during multisensory integration in men with body dysmorphic disorder symptoms. Body Image, 56. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.102002
ABSTRACT. Disturbances in bodily self-perception, particularly self-face perception, characterize body dysmorphic disorder (BDD). However, the mechanisms underlying these disturbances and potential ways to modify them remain unclear. To address these gaps, we investigated whether alterations in self-face representation and underlying multisensory experiences—indexed via an enfacement illusion—are linked to symptoms of BDD or its subtype muscle dysmorphia (MD).
We also explored whether experiencing the enfacement illusion can reduce face and body image disturbance. Sixty-two male participants (M = 22.6 years, SD = 3.5) completed synchronous (illusion inducing) and asynchronous (control) visuo-motor stimulation between their own face and an unfamiliar person’s face.
Results showed that elevated BDD symptoms predicted greater objective enfacement (shifts in self-face recognition thresholds during a self-other morphing task) and exclusively predicted subjective enfacement (self-reported shifts in face recognition), whereas MD symptoms were unrelated to enfacement susceptibility. Synchronous visuo-motor stimulation reduced head, body, and muscularity dissatisfaction across the sample, while asynchronous stimulation produced inconsistent effects on body image. BDD and MD symptom levels did not moderate most body image changes.
These findings suggest that BDD may reflect abnormalities in the visual and multisensory integration processes underlying self-face representation, contributing to weakened self–other boundaries. These insights may advance understanding of bodily identity and social-cognitive difficulties in BDD. While enfacement-based interventions show modest therapeutic potential, future refinements are needed.
3. Portingale, J., Krug, I., & Butler, D. (2025). Self-face perception in men With elevated body dysmorphic and muscle dysmorphia symptoms: Subjective recognition difficulty and negative appearance evaluation. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70039
Email address for correspondence: jade.portingale@unimelb.edu.au
ABSTRACT. Objective: Self-face perception, including recognising one’s face as one’s own and evaluating its appearance, is important to physical self-concept. Yet how body dysmorphic disorder (BDD) and muscle dysmorphia (MD) symptoms relate to these processes remains underexplored, particularly in men. This study examined how self-face recognition accuracy and self-face appearance evaluations are influenced by the severity of BDD and MD symptoms in men.
Methods: Sixty-eight male participants (Mage = 22.6 years, SD = 3.5; White and East/Southeast Asian) from the community performed a self-face recognition task during which their faces were digitally morphed with an unfamiliar male face, providing an index of objective self-face recognition sensitivity. Participants also completed measures of BDD and MD symptomatology, subjective self-face recognition difficulty, and self-face evaluations (attractiveness, adiposity, and dissatisfaction).
Results: Higher levels of BDD symptoms and MD-related appearance intolerance symptoms were associated with greater subjective self-face recognition difficulty and more negative self-face evaluations (lower attractiveness, greater dissatisfaction). Neither symptom dimension predicted objective self-face recognition sensitivity or perceived facial adiposity.
Conclusion: These findings reveal a theoretically informative dissociation: men with higher levels of BDD and MD symptoms experience greater subjective self-recognition difficulties and negatively biased facial appearance evaluations despite intact objective self-recognition performance. This pattern suggests that self-face disturbances in BDD and MD may reflect cognitive-affective biases rather than perceptual abnormalities, at least at non-clinical severity levels. Future research in clinical samples is needed to determine whether perceptual deficits emerge at higher symptom severity and establish causality.
MEDIA, Part 1 of 3
4. Fernandez, A. M., Politi, T. M., & Keel, P. K. (2025). From friends to followers: How social media influences the relationship between friends’ behaviors and disordered eating in adult men and women. Eating Behaviors. Advance online publication. https://doi.org/10.1016/j.eatbeh.2025.102064
Email address for correspondence: amfernandez@psy.fsu.edu
ABSTRACT. Objective: The transformation framework conceptualizes social media as reshaping traditional peer influences and could enhance understanding of disordered eating. This cross-sectional study examined (1) independent associations of friend dieting and social media exposure with eating pathology, (2) whether social media exposure moderates the relationship between friend dieting and eating pathology, and (3) explored whether sex and age moderate independent and combined effects of friend dieting and social media exposure on eating pathology.
Method: A large sample of men and women (N = 1860) ranging in age from 28 to 69 years (M = 47.24 years, SD = 10.71), completed surveys assessing friends’ behaviors, social media exposure, and eating pathology.
Results: Friend dieting and social media exposure showed independent associations with bulimic symptoms and drive for thinness. Greater social media exposure strengthened the relationship between friend dieting and bulimic symptoms in younger men and older women, and between friend dieting and drive for thinness in younger men and men at the mean age.
Discussion: Findings partially support hypotheses from the transformation framework, with the most consistent support found for younger men. Future work should examine how social media exposure amplifies the frequency, immediacy, and impact of peer influence on disordered eating to inform social media literacy programs tailored to adults.
5. Lin, J., Portingale, J., & Krug, I., (2026). Virtual feasts and their impact: A pilot study on the influence of mukbang videos on eating behaviours, body image, and emotional wellbeing. Body Image, 56. Advance online publication. https://doi.org/10.1016/j.bodyim.2025.102004
Full text available for download at: https://tinyurl.com/4fkzshpr
ABSTRACT. Mukbangs (i.e., ‘eating broadcast’) is a food-related social media trend often featuring a host consuming large amounts of food. This pilot study used the first pre-post experimental design to examine the immediate effects of watching a mukbang video on eating intentions, body image, affect, and anxiety, while exploring behavioural impulsivity as a potential moderator.
Participants recruited from an Australian university (N = 327; M age = 19.5 years, SD = 2.8; 59.6 % female) completed a baseline survey assessing demographic information and current mukbang engagement (e.g., frequency, duration). Participants then completed a computerised paradigm (Go/No-Go Task) as a measurement of behavioural impulsivity. Following the task, participants’ state-level urges to engage in disordered eating (DE), body dissatisfaction (BD), affect, and anxiety were measured prior and post-exposure to a 10-minute mukbang video (featuring a gender-matched mukbang host).
Results showed significant reductions in DE urges and positive affect following exposure. Specifically, females showed a decrease in dietary restraint, and males in urge to overeat and exercise for weight control. No significant changes were observed for BD, negative affect, or anxiety, and no moderating effects emerged for behavioural impulsivity.
These findings suggest that the effects of mukbang exposure may vary across specific DE urges and differ by gender, as examined in separate analyses. The absence of impulsivity effects further implies that trait impulsivity may have a limited influence in brief, low-stakes media contexts. Future research should explore potential moderators such as social comparison and habituation and employ longitudinal designs to evaluate the cumulative impact of mukbang viewing
CAREGIVERS, Part 1 of 2
ML NOTE 7: The article described below in #6 came to my attention 2 December 2025 via an “everything-is-advocacy” email from our own Sarah Rowland (New Zealand), Co-Founder & Chairperson of Eating Disorders Carer Support NZ (EDCS) — Support, Resources & Advocacy for Carers in New Zealand/ Aotearoa. Email: sarah.r@edcs.co.nz | Facebook: https://ww.facebook.com/EDCSNZ/.
At the bottom of the email I received from her in regard to this article, it states that “EDCS represents and supports parents and carers of people who have eating disorders. Our Aim is to provide Lived Experience Peer support, educational materials, awareness and education at all levels for ongoing system improvements.
Charity Reg No. CC60989.”
6. Donkin, L., Sinclair, R., Rowland, S., McDougall, K., & Landon, J. (in press/2025). “It’s never ending and overwhelmingly difficult”: A mixed-methods survey of the impact of caregiving for a loved one with an eating disorder in New Zealand. Journal of Eating Disorders. Advance online publication. https://doi.org/10.1186/s40337-025-01474-w
Full text available for download at: https://tinyurl.com/3p8cuda7
ABSTRACT. Background: Caregivers of people with eating disorders (EDs) often support refeeding, behavioural monitoring, and co-ordinate therapeutic and medical appointments. Available support is often focused on the person with the ED and rarely on the caregiver. This study examined the impact of caregiving in New Zealand (NZ).
Methods: Current and previous caregivers completed an online, anonymous survey exploring their experience of caregiving and its psychological impact using the Depression, Anxiety, and Stress Scale (DASS-21), the Eating Disorders Symptom Impact Scale (EDSIS), and questions about the long-term impact of caregiving on caregivers’ mental health. A comparison was made with data on Australian caregivers.
Results: Current caregivers reported higher levels of depression and stress than those not currently caregiving, as well as higher levels of depressive symptoms than Australian caregivers. The impact of ED symptoms were also generally higher in NZ participants compared with Australian caregivers. The perceived impact of the ED was associated with the psychological distress experienced by caregivers with greater impact being linked to more distress. Of those whose loved ones were in recovery, more than 25% experienced ongoing post-traumatic symptoms related to their caregiving experience.
Conclusion: NZ caregivers reported ongoing effects related to caregiving even when the person with the ED had recovered. NZ caregivers experience a high level of distress and burden that can persist once recovery is achieved. Comprehensive ED support should include interventions to improve caregivers’ wellbeing.
7. Lorenzo, R., Rovatti, M., Bottone, C., Rubini, I., Covezzi, R., Rovesti, S., & Ferri, P. (2025). Emotional burden and family functioning among caregivers of individuals with eating disorders. Journal of Eating Disorders, 13, 252. https://doi.org/10.1186/s40337-025-01365-0
Full text available for download at: https://tinyurl.com/pu6m9tr3
ABSTRACT. Background: The involvement of a caregiver is fundamental in the process of caring for a person with eating disorders (ED). The aim of this study is to evaluate the functioning of family unit and the emotional burden of caregivers of individuals with ED treated at an outpatient service.
Materials and methods: We contacted by telephone the caregivers of individuals in care at ED Centre of the AUSL-Modena and selected a sample of 50 caregivers of 42 individuals with ED, who provided their informed consent. The following scales were administered to caregivers: caregiver burden inventory (CBI), Beck’s depression inventory (BDI), family assessment device (FAD), depression, anxiety and stress-scale (DASS-21).
The following scales were administered to the care recipients: global assessment of functioning and clinical global impression severity scale. Demographic variables relating to the individuals with ED and their caregivers were collected: sex, age, employment situation, marital status, number of family members, living condition, family role. Clinical variables of care recipients were collected: body mass index, ED diagnosis, duration of ED and treatment and care at ED centre, medical complications, psychiatric comorbidities, substance use. The data was statistically analyzed.
Results: All caregivers were the parents of individuals with ED, in particular the mother (76%), and were employed. Caregivers reported a mild to moderate emotional burden in CBI and mild to severe depressive symptoms in BDI in 62% of cases. Family functioning reported by FAD scale was slightly altered in the areas of “communication”, “roles” and “affective involvement”.
Most care recipients were females (98%), suffering from anorexia nervosa (85.6%) with an average age of 18.54 ± 4.74. At multiple linear regression, two statistically significant associations were underscored with CBI score (dependent variable): the age of individuals in a negative way and the psychiatric comorbidities of the individuals with ED in a positive way.
Conclusions: The parents of sons with ED represented their caregivers, who suffered from a mild emotional burden and depressive symptoms and lived in altered family functioning, especially in communications. Ensuring psychological support for the caregiver may be useful for improving both caring and family relationships.
OCTOBER - NOVEMBER TREATMENT INTERLUDE, Part 4 of 8
8. Dennis, K., Nguyen, C., Bishop, N., Bilenker, D., & Brewerton, T. D. (2025). First do no harm: The impact of assessing for ultra-processed food addiction on dietary restraint in patients with and without eating disorders during residential treatment.Journal of Eating Disorders, 13, 242. https://doi.org/10.1186/s40337-025-01427-3
Full text available for download at: https://tinyurl.com/6jmf639e
ABSTRACT. Background: Ultra-processed food addiction (UPFA) is increasingly recognized but remains controversial among eating disorder (ED) clinicians, partly due to concerns that introducing food addiction concepts might intensify dietary restraint, a core feature of EDs. This study examined whether integrating UPFA assessment, psychoeducation and treatment into residential treatment (RT) impacts ED symptomatology, particularly dietary restraint.
Methods: Adults (N = 132) admitted to RT completed the Eating Disorder Examination Questionnaire (EDE-Q) and the modified Yale Food Addiction Scale 2.0 (mYFAS2.0) at admission and discharge. Changes in EDE-Q global scores and EDE-Q restraint subscale scores were analyzed using repeated-measures analysis of variance (RANOVA) with ED diagnosis as a between-subjects factor and age, gender identity, sexual orientation, and admission BMI as covariates. Pearson correlations between mYFAS2.0 and EDE-Q scores were calculated at both time points to assess construct overlap.
Results: Both EDE-Q global and EDE-Q restraint scores decreased significantly in the ED patients (p ≤ 0.001) and remained low in the non-ED patients. mYFAS2.0 scores were not significantly correlated with EDE-Q restraint scores at either admission or discharge, while they were weakly correlated with EDE-Q global scores at both time points.
Conclusions: UPFA-informed assessment, psychoeducation and/or treatment did not increase EDE-Q restraint scores. Instead, they declined significantly in ED patients, with no worsening observed. Modest post-treatment correlations between UPFA and EDE-Q global scores but not EDE-Q restraint scores suggest partial but incomplete overlap between EDs and UPFA symptomatology, with caloric restraint confined to EDs alone. These results support their nosological distinction and the feasibility of concurrent treatment without worsening ED-related dietary restraint.
9. Bendall, C., Winderlich, J., Anderson, A., Caughey, M., Hoy, J., Coleman, J., & Bennett, C. J. (2025). Meal plan inclusions and exclusions in the inpatient, outpatient and community setting for adolescent and adult eating disorder care: A scoping review. Journal of Eating Disorders, 13, 220. https://doi.org/10.1186/s40337-025-01410-y
Full text available for download at: https://tinyurl.com/2d5ty52e
ABSTRACT. Background/Aim: Minimal research has been conducted on meal plan food exclusions and there is limited evidence to guide introduction of feared foods in eating disorder treatment. This scoping review aimed to explore the evidence on food inclusion and exclusions in inpatient, outpatient, and community settings for adolescents and adults.
Methods: A scoping review was performed and reported according to Preferred Reporting Items for Systematic and Scoping Review guidelines. All English language primary research studies from the earliest time point exploring meal plan exclusions in people aged > 12 years old with an eating disorder were included. The search was conducted in January 2025 in six databases with no date limits.
Results: Of the 3693 studies screened, eight studies were included. Non-randomised intervention studies comprised 50% (n = 4), 62% (n = 5) of studies involved consumers and 38% (n = 3) were clinician-led. Clinician-led practices varied with most permitting exclusions for religious or medical reasons i.e. allergy, or lifelong dislikes. Vegetarianism and veganism were inconsistently permitted amongst clinicians. Various meal planning approaches were utilised to improve dietary variety including meal preparation (n = 1), menu planning (n = 2), and food cards (n = 2) in consumer-led studies.
Conclusion: This review outlined the various approaches utilised in meal plan exclusion rationale across inpatient, outpatient, and community settings. Findings highlight there is limited literature exploring meal plan exclusion rationale in the treatment of eating disorders. Of the available literature, no consensus could be concluded due to high heterogeneity. Evidence-based practice recommendations for meal plan exclusions should be included in future eating disorder guidelines to facilitate consistency in clinical practice.
10. Lebow, J., Croghan, I., Sauver, J. S., Jaconbson, R. M., Storm, M., Gregory, S. W., Kruse, S., Siddig, A. A., Masrud, J., & Sim, L. (2025). Adapting family-based treatment for primary care (FBT-PC) for treating child and adolescent restrictive eating disorders in rural settings: A case series. Journal of Eating Disorders, 13, 275. https://doi.org/10.1186/s40337-025-01443-3
Full text available for download at: https://tinyurl.com/38wpjn8c
ABSTRACT. Background: Access to eating disorder care for child and adolescent patients is challenging especially for patients from rural and/or lower-resourced health systems. In order to improve the availability of eating disorder treatment, we developed Family-Based Treatment for Primary Care (FBT-PC), for primary care delivery. Although research has shown that FBT-PC has a significant effect on young patients’ eating disorder symptoms, the model has not been evaluated in rural settings.
The purpose of this study was to establish proof-of concept of an adaptation of FBT-PC for rural settings, in preparation for a pilot feasibility/acceptability trial. Methods: This study describes adaptations made to the FBT-PC protocol for implementation in small town and rural areas, as well as a case series of six children and adolescents with restrictive eating disorders who received FBT-PC in these settings.
Results: Findings from this case series establish proof-of-concept for FBT-PC implementation in rural primary care clinics. Specifically, the majority of patients either completed treatment (n = 3) or were referred to standard FBT (n = 1) which is consistent with the intention of FBT-PC as offering a lower-step eating disorder intervention. Conclusions: These promising preliminary cases support further evaluation of FBT-PC in rural settings. Future research is needed to assess clinical outcomes and acceptability of the intervention. Trial Registration: Clinicaltrials.gov #22-011880
11. Ten Napel-Schutz, M. C., Karbouniaris, S., Mares, S. H. W., Abma, T. A., & Arntz, A. (2025). Implementing adjunct trauma-focused imagery rescripting in Inpatient treatment for patients who are underweight with comorbid eating disorders and PTSD: Therapist challenges and the supporting role of peer group supervision. Behaviour Research and Therapy, 195, 104912. https://doi.org/10.1016/j.brat.2025.104912
Full text available for download at: https://tinyurl.com/2dthxyxb
ABSTRACT. Background: Trauma-focused therapies like Imagery Rescripting (ImRs) are seldom offered to patients who are underweight with comorbid eating disorders (uED) and PTSD, due to doubts about their emotional and cognitive capacities. However, high rates of PTSD comorbidity in this group highlight the need for tailored trauma interventions. This study examines therapists’ experiences applying ImRs in this population, with a focus on specific challenges and how Peer Group Supervision sessions (PGSs) supported treatment delivery.
Method: A qualitative thematic analysis was conducted using 11 semi-structured therapist interviews and 32 PGS recordings. Data were analyzed, summarized and classified within a thematic framework.
Results: Therapists initially used PGSs to validate their application of ImRs. Over time, PGSs facilitated skills development through role-play, peer exchange, and reflective dialogue. Four main themes emerged: 1) determining the right moment to start rescripting; 2) challenges specific to uED; 3) topics related to ImRs sessions in which patients had to rescript; 4) the therapists’ progress.
Conclusion: With appropriate protocol modifications and PGSs, ImRs appears both feasible and valuable for uED patients with PTSD. This study aims to inform the feasibility of applying ImRs in this population, with a focus on specific challenges and practical suggestions that supported treatment delivery. Trial registration: International Clinical Trials Registry Platform (ICTRP) (NTR6094), registered 09/23/2016.