Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 152: (i) New Bk, Pt 3; (ii) Feminism, Wt. Stigma, BI, & DE; (iii) Online Objectificat; (iv) FAD, Pt 2 (n = 2); (v) DE, Pt 4 (n = 2); (vi) Comorbidity; & (vii) Apr - May Tx Interlude, Pt 8 (n = 3)
Colleagues (N now = 1372 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.
BODY IMAGE LITERACY
[our own] Ms. Robyn Goldberg's (USA)
The Eating Disorder Trap Podcast - Episode #187:
Body Image Inside Out
featuring Deb Schacter, MSW (USA) and Whitney Otto, MA, PCC (USA)
Retrieved from the website (https://theeatingdisordertrap.com/the-eating-disorder-trap-podcast/) of the The Eating Disorder Trap Podcast, created and moderated by our own Ms. Robyn L. Goldberg, RDN, CEDRD-S (USA; http://www.askaboutfood.com).
ML NOTE 1 (paraphrasing from the website): If you have any questions regarding the topics discussed on this podcast—and/or, I would add, if you believe you could contribute as a guest of this podcast, as have a number of members of this Group (e.g.,
Dr. Charlotte Markey in Episode 179, Dr. Adele Lafrance in Episode 170, and Dr. Karen Samuels in Episode 138)—please reach out to Robyn directly via email a rlgrd@askaboutfood.com
ML NOTE 2: For more information about Deb Schachter, MSW, see https://debschachterlicsw.com/. For more information about Whitney Otto, see http://whitneyottocoaching.com/about
Episode #187: Body Image Inside Out, with Deb Schacter, MSW (USA) and Whitney Otto, MA, PCC (USA)
Listen (~23.5 min) at: https://theeatingdisordertrap.com/187-body-image-inside-out-with-deb-schachter-whitney-otto/
IN THIS EPISODE
We discuss topics including:
Understanding what is Body Image?
What are BBIM’s (Bad Body Image Moments)
What to do when you have a BBIM?
You are not your body image and body image is not how we look
What is the rotary?
Understanding body image muscles
The importance of naming what is wrong
Having compassion for yourself
SHOW NOTES:
bodyimageinsideout.com
RECOVERY/SUPPORT and EATING DISORDERS/TREATMENT/CULTURAL LITERACY
[our own] Ms. Rachelle Heinemann's (USA)
Understanding Disordered Eating Podcast - Episode #172:
Impostor Syndrome and Eating Disorders
ML NOTE 3: All episodes in our own Ms. Rachel Heinemann's (USA) podcast series can be found at: https://www.rachelleheinemann.com/podcast.
Episode 172: Impostor Syndrome and Eating Disorders
Listen (~22.5 min) at: https://www.rachelleheinemann.com/podcast/imposter-syndrome-and-ed
If imposter syndrome were a person . . . . most of us would be in a very toxic, on-again-off-again relationship with it. And just like any clingy ex, it loves to show up at the worst possible time—like, say, the first day of a new job, or every single time we try to feel confident about our bodies. Fun, right?
In this episode, I’m diving deep into the overlap between imposter syndrome and complicated relationships with food and body image. From the masks we wear to feel “enough,” to the inner critic that just won’t shut up, we’re peeling back the layers of what it means to doubt ourselves, hard, while trying to appear like we’ve got it all together.
You’ll hear some very real, very relatable reflections a gentle call-out on shrinking yourself in more ways than one, and a compassionate nudge toward being just a bit bolder—even if you’re still figuring things out (which, spoiler alert: we all are).
So if you’ve ever wondered, “Who am I to be doing this?” or thought, “Someone else would definitely do this better,” trust me—you’re in the right place.
In this episode, we’re talking about:
How imposter syndrome shows up in both our professional lives and our relationships with food and body.
The version of ourselves who doesn’t feel like a fraud.
The gap between where we are now and the confident, self-assured version of ourselves we want to be.
The masks we wear to hide feelings of inadequacy and how those behaviors might manifest (hello, shrinking ourselves—literally and metaphorically).
My own experiences with imposter syndrome.
Why imposter syndrome lingers even when we do have the skills, experience, or knowledge.
The connection between imposter syndrome and disordered eating or body image struggles.
How shame, silence, and isolation make imposter syndrome worse—and what to do instead.
Why the “I’m not good enough” narrative often leads us to quiet ourselves or overcompensate.
How external expectations and internal self-criticism can both fuel imposter syndrome.
The ways we manipulate our appearance, eating habits, or presence to feel more “in control.”
That persistent inner critic that says we’re inadequate—and how it parallels disordered eating thoughts.
How imposter syndrome can persist no matter how much experience we gain—just in new forms.
The power of turning to safe, supportive relationships to process and push through self-doubt.
Why compassionate curiosity (not just judgmental overanalysis) is key to understanding our insecurities.
How courage and small bold actions are required to bridge the gap between insecurity and self-acceptance.
Why trying to "kill" imposter syndrome isn’t the goal—learning from it is.
How to take brave steps that align with the version of yourself you want to be, without relying on food, exercise, or control as a crutch.
Research Publication Categories in This Newsletter
(i) New Book, Part 3; (ii) Feminism, Weight Stigma, Body Image, and Disordered Eating; (iii) Online Objectification; (iv) Food, Alcohol, Body Image, and “Disturbance”, Part 2 (n = 2); (v) Disordered Eating, Part 4 (n = 2); (vi) Lived Experience of Comorbidity; and (vii) April - May Treatment Interlude, Part 8 (n = 3)
CONGRATULATIONS to our own
Drs. Brooke Bennett (USA), Allison Wagner (USA), Rebecca Puhl (USA), and Janet Latner (USA) and colleague for publication of the Feminism, Weight Stigma, Body Image, and Disordered Eating research article in #2.
Drs. Emily Choquette (USA) and Diana Rancourt (USA) and colleagues for publication of the Food, Alcohol, Body Image,, and “Disturbance” review article in #4.
Drs. Jason Nagata (USA), Emilio Compte (Chile/Mexico), Jason Lavender (USA), Tiffany Brown (USA), and Kelsie Forbush (USA) colleagues for publication of the Disordered Eating research article in #6.
Dr. Elizabeth Claydon (USA) and colleagues for publication of the Disordered Eating research article in #7.
Drs. Deborah Mitchison (Australia) and Philippa Hay (Australia) and colleagues for publication of the Treatment research article in #9.
Dr. Janet Treasure (England) and colleagues, including distinguished scientist-practitioner Drs. Hubertus Himmerich (England), for publication of the Treatment research article in #11.
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 3 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 4
19. Trauma-Informed Approaches in the Teaching of Yoga (pp. 361-382), by Catherine Cook-Cottone and Maya Cottone. Email address for correspondence: cpcook@buffalo.edu
20. Best Practices for Contexual Considerations for Positive Embodiment (Yoga Spaces and Community) (pp. 383-401), by Catherine Cook-Cottone, Carly Lua Pershyn, and Ashlye Borden. Email address for correspondence: cpcook@buffalo.edu
FEMINISM, WEIGHT STIGMA, BODY IMAGE, AND DISORDERED EATING
2. Bennett, B. L., Wagner, A. F., Puhl, R. M., Lamere, A., & Latner, J. D. (2025). Feminism and its associations with weight stigma, body image, and disordered eating: A risk or protective factor? Obesities, 5, 40. https://doi.org/10.3390/obesities5020040
Full text available for download at: https://tinyurl.com/545wne6p
ABSTRACT. The feminist perspective is relevant to the understanding, prevention, and treatment of disturbances in eating and body image. However, limited empirical research has explored the relationship between feminist identity and weight stigma. The present study examined the associations between feminist beliefs, externalized weight bias, internalized weight bias, body image, and eating disturbances.
Two hundred sixty-five racially and ethnically diverse young women were recruited from a university in the Pacific Rim. Participants completed questionnaires online and interrelationships were examined using a series of regressions. Externalized weight bias was significantly negatively associated with both feminist beliefs and identification as a feminist. However, stronger feminist beliefs and identity were significantly associated with higher internalized weight bias, worse body dissatisfaction, and greater incidence of eating disturbances.
The results of the present study suggest that structural change driven by feminist values and principles may be effective for reducing weight bias and possibly other risk factors present in broader society but potentially less effective on an individual level. Longitudinal research is needed to confirm the direction of these relationships and to understand which components of feminist theory and feminist values can be most helpful in reducing weight bias on an individual level, while still addressing structural change.
ONLINE OBJECTIFICATION
3. Zhang, T., Jiang, F., & He, X. q. (2025). The influence of online sexual objectification experience on female college students’ disordered eating: The mediator of body surveillance and the moderator of physical exercise. Journal of Eating Disorders, 13, 98. https://doi.org/10.1186/s40337-025-01296-w
Full text available for download at: https://tinyurl.com/9ze73kky
ABSTRACT. Background: Previous studies have shown that sexual objectification experience is closely related to eating disorders in adolescent female students, but the mechanisms and conditions under which online sexual objectification experience influences disordered eating in female college students need to be further explored. Therefore, this study aimed to explore the mediating and moderating variables of the relationship between online sexual objectification experience and disordered eating, and to provide suggestions for the prevention of disordered eating among female college students.
Methods: A total of 651 female college students were tested with Online Sexual Objectification Experience Scale, Body Surveillance Scale, Physical Exercise Scale and Disordered Eating Scale. The mediating role of body surveillance and the moderating role of physical exercise were examined using the latent structural equation approach and Model 15 in version 3.5 of the Process macro program, respectively.
Result: Online sexual objectification experience, body surveillance, and female college students’ restrictive eating, emotional eating, and exogenous eating were significantly and positively correlated with each other; body surveillance mediated the relationship between online sexual objectification experience and female college students’ restrictive eating, emotional eating, and exogenous eating, respectively; physical exercise significantly and negatively moderated the relationship between online sexual objectification experience and female college students’ restrictive eating, and the higher the level of physical exercise, the lower the predictive effect of online sexual objectification experience on female college students’ restrictive eating.
Conclusions: Body surveillance mediated the relationship between online sexual objectification experience and disordered eating among female college students, and physical exercise only moderated the relationship between online sexual objectification experience and restrictive eating among female college students.
FOOD, ALCOHOL, BODY IMAGE, AND “DISTURBANCE”, Part 2 of 2
ML NOTE 4: In regard to the article described below in #4, see also
Shepherd, C. B., Berry, K. A., Ye, X., & Li, K (2023). Food and alcohol disturbance among US college students: A mixed methods scoping review. Journal of American College Health, 71(6), 1715-1731. https://doi.org/10.1080/07448481.2021.1947300 [Email address for correspondence: cshepherd@smith.edu]
4. Berry, K. A., Choquette, E. M., Looby, A., & Rancourt, D. (2025). Unification of the food and alcohol disturbance literature: A systematic review. Clinical Psychology Review, 113. Advance online publication. https://doi.org/10.1016/j.cpr.2024.102486
Full text available for download at: https://tinyurl.com/22kvsc9a
ABSTRACT. Food and alcohol disturbance (FAD) reflects the functional relationship between disordered eating and alcohol use. There are two motivations underlying FAD - to enhance the effects of alcohol and/or to compensate for alcohol-related calories. Yet, most FAD studies have failed to adequately measure the motives underlying these behaviors, leading to inconsistent and imprecise findings. The aim of the current systematic review was to thematically consolidate FAD research findings by motive, identify limitations of the existing literature, and highlight next steps for FAD researchers. Eighty-one publications, presenting data from 38,536 participants, were included in the current review.
Prevalence rates for the caloric compensation and alcohol enhancement motives range from 5.6% - 88.7% and 4.7% - 81.7%, respectively. Alcohol use and disordered eating were the primary correlates of FAD for both motives, and alcohol-related consequences were positively associated with both FAD motives cross-sectionally. Major limitations of the literature include inconsistent operationalization and imprecise measurement of FAD.
Primary recommendations include adopting the terminology of and operationalization of FAD presented here, ensuring attention to FAD motive in developing and testing research questions, and moving beyond cross-sectional studies. Findings from this review can be used to contribute to more rigorous and unified FAD research.
5. Ritz, L., Mauny, N., Mange, J., Margas, N., & Leconte, P. (2024). Distinct profiles of university students engaged in food and alcohol disturbance behaviors. Eating Disorders, 1–23. https://doi.org/10.1080/10640266.2024.2347740
Email address for correspondence: ludivine.ritz@unicaen.fr
Full text available for download, perhaps for a limited time, at: https://www.tandfonline.com/doi/full/10.1080/10640266.2024.2347740
ABSTRACT. The present study aimed at exploring the combined effect of risk of eating disorders (ED), alcohol use, physical activity, and social and psychological traits in Food and Alcohol Disturbance (FAD) behaviors. Nine-hundred and seventy-six college students were included in the study. They were then divided into two groups based on the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS): students with a FAD positive score and student with a FAD negative score. Both groups of participants were compared on the risk of ED, alcohol and physical activity variables, as well as social and psychological dimensions. A cluster analysis was performed on the FAD positive group to determine distinct subgroups and to explore the involvement of social and psychological dimensions in FAD behaviors.
The comparison between FAD and non-FAD students demonstrated a more severe alcohol use, risk of ED, a higher level of impulsivity, anxiety, depression and more drinking motives as well as a lower self-esteem in students engaged in FAD behaviors compared with non-engaged students. The cluster analysis identified four clusters: the asceticism FAD subgroup, the damage control FAD subgroup, the emotional FAD subgroup and the recreational FAD subgroup. Overall, results reveal that FAD should not be considered as a unitary behavior but rather as a more complex pattern involving distinct psychological profiles.
DISORDERED EATING, Part 4 of 5
6. Nagata, J. M., Otmar, C. D., Kim, A. E., Compte, E. J., Lavender, J. M., Brown, T. A., Forbush, K. T., Flentje, A., Lubensky, M. E., Lunn, M. R., & Obedin-Maliver, J. (2025). Factor structure, internal consistency, and measurement invariance of the Eating Pathology Symptoms Inventory (EPSI) in a national U.S. sample of cisgender gay men and lesbian women. Journal of Eating Disorders, 13, 83. https://doi.org/10.1186/s40337-025-01277-z
Full text available for download at: https://tinyurl.com/595xyke8
ABSTRACT. Background: The Eating Pathology Symptoms Inventory (EPSI) is a questionnaire that assesses the severity of eating-disorder symptoms. This study aimed to examine the factor structure and measurement invariance of the EPSI in a large national U.S. sample of cisgender gay men and lesbian women. Methods: The sample consisted of 1,498 cisgender sexual minority adults, including cisgender gay men (n = 925) and cisgender lesbian women (n = 573), who completed online self-report surveys. Using a split-half approach, exploratory factor analysis (EFA) was conducted in the first subset of each sample to identify underlying factor structures, followed by confirmatory factor analysis (CFA) to confirm model fit in the second subset of each sample. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across the two sexual minority groups.
Results: The EPSI eight-factor structure was supported across both cisgender sexual minority groups with strong model fit: cisgender gay men (CFI = 0.96, RMSEA = 0.04, SRMR = 0.06) and cisgender lesbian women (CFI = 0.94, RMSEA = 0.05, SRMR = 0.07). Measurement invariance analyses indicated that the EPSI was invariant across groups. Internal consistency, assessed using McDonald’s omega, was acceptable for all scales (ωs = 0.75 to 0.95). Conclusions: This study provides support for the utility of the EPSI in cisgender gay men and lesbian women populations, including measurement invariance that allows for meaningful comparisons across groups. Specifically, the EPSI performs reliably and consistently as a measure of eating pathology across adult cisgender gay men and cisgender lesbian women.
7. Claydon, E. A., Ward, R. M., Geyer, R. B., & Weekley, D. (2025). Mapping anxiety symptoms and disordered eating using the EPSI: A latent profile analysis accounting for peak alcohol use. Journal of Eating Disorders, 13, 96. https://doi.org/10.1186/s40337-025-01299-7
Full text available for download at: https://tinyurl.com/363dpz5j
ABSTRACT. Objective: Disordered eating (DE) is associated with a plethora of psychological risk factors, including anxiety and substance use disorders. The Eating Pathology Symptoms Inventory (EPSI) is a validated questionnaire to assess DE. There are no latent profile analyses (LPA) of the EPSI that also examines these profiles with regards to important psychological risk factors. The purpose of this study was to fill that gap by examining latent profiles of the EPSI subscales with respect to anxiety, distress tolerance, anxiety sensitivity, and alcohol use.
Methods: The sample comprised of 1,362 college students from a midwestern university who participated in an online health survey. The EPSI scale profiles were identified using LPA with robust maximum likelihood estimation, and analyses were run to determine if the profiles differed across anxiety, anxiety sensitivity, distress tolerance, and alcohol use.
Results: A five-profile solution was found to be optimal (entropy > 0.96). Profile 1 (9.7%) is defined as Excessive Exercise & Muscle Building; Profile 2 (54.1%) is a profile of Low Disordered Eating. Profile 3 (20.2%) was Body Dissatisfaction & Binge Restrict Cycle, which illustrated a potential Anorexia Binge-Purge subtype. Profile 4 (8%) was defined by Moderate Disordered Eating and Bingeing. Finally, Profile 5 (7.9%) was expressed as High Disordered Eating and was associated with high levels of anxiety and alcohol problems.
Conclusions: Several latent profiles were found for the EPSI subscales and Profile 5 represented the most problematic levels. Identifying this subgroup of college students may help understand the unique presentations of DE among this population and lead future directions for how to address these intersectional student mental health concerns.
LIVED EXPERIENCE OF COMORBIDITY
8. Bäck, M., Gustafsson, S.A., Jacobson, K., Ljung, T., Holmqvist, R., & Andersson, G. (2025). A way of relating to life; myself and others - a thematic analysis of patients’ experience of having an eating disorder. Journal of Eating Disorders, 13, 88. https://doi.org/10.1186/s40337-025-01291-1
Full text available for download at: https://tinyurl.com/yjzpwuhk
ABSTRACT. Background: Eating disorders are psychiatric conditions that extend beyond concerns with weight, body and shape, encompassing complex issues related to self-esteem, emotion regulation and interpersonal functioning. Moreover, co-occurring depression, often undiagnosed, is a common complicating factor. Gaining an in-depth understanding of living with an eating disorder is vital both theoretically and for identifying factors that maintain or inhibit recovery. Patient-centred studies offer valuable insights into the lived experience of eating disorders, highlighting their impact and interaction with various life phenomena.
Methods: This qualitative study aimed to capture the meaning and experience of living with an eating disorder from a patient perspective. Semi-structured interviews were conducted with 15 women suffering from eating disorders and comorbid depressive symptoms, prior to the start of treatment. Data were analysed using reflexive thematic analysis.
Results: Two dimensions of relating to the eating disorder emerged. The first dimension, “Relating to the eating disorder over time”, followed a temporal trajectory with four themes: “The eating disorder as a way to handle other difficulties”, “From control to a consistent loss of control”, “The whole existence revolves around the eating disorder” and “Hard to see a life without the eating disorder”. The second dimension, “Having an eating disorder– a relentless relating”, focused on the present experience and was divided into two themes: “The eating disorder’s impact on relating to myself” and “The eating disorder’s impact on relating to others”.
Conclusions: Living with an eating disorder involves a constant, entangled and conflicted relationship with the disorder, leading to alienation from significant others and one’s own body. This pervasive presence of disordered thoughts and behaviours makes it challenging to relate to oneself and the external world without their influence. Over time, the disorder becomes increasingly ego-syntonic, rendering it difficult to envisage a life without it.
Treatment should, therefore, aim to externalise the disorder—to foster new life goals, enhance social engagement, and improve interpersonal skills. Further research is needed to elucidate how co-occurring depressive symptomatology influences an individual’s relationship with their eating disorder, as these factors may be crucial in tailoring effective interventions.
APRIL - MAY TREATMENT INTERLUDE, Part 8 of 8
9. Day, S., Mitchison, D., Tannous, W. K., & Hay, P. (2025). PTSD and complex PTSD in residential treatment for eating disorders: Moderating effects on symptom severity and outcome trajectory. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24465
Full text available for download at: https://tinyurl.com/4y7jwazn
ABSTRACT. Objective: Eating disorders (EDs) and symptoms of trauma commonly co-occur, yet research is limited on how trauma affects ED treatment outcomes. This is particularly true for complex post-traumatic stress disorder (CPTSD). Differentiating between the treatment impacts of PTSD and CPTSD (which includes both PTSD symptoms and disturbances in self-organization [DSO]) may help ED providers address this common comorbidity.
Method: The current study included 95 women (Mage = 26 years) with EDs (largely anorexia nervosa) who received residential treatment (M = 81 days). Participants completed measures of ED symptoms, anxiety, depression, body mass index (BMI), ED-specific health-related quality-of-life (ED-HRQoL) impairment, functional disability, and trauma symptoms at admission, week 4 of treatment, discharge, and 6 months post-discharge.
Results: All outcomes except BMI were more severe at admission and week 4 of treatment for individuals with comorbid trauma (based on probable CPTSD or exceeding the clinical threshold for PTSD and DSO symptom domains); however, these differences resolved by discharge and remained non-significant at follow-up. Some forms of comorbid trauma moderated outcome trajectories for anxiety, depression, and disability (but not ED symptoms), such that individuals with comorbid trauma showed slower improvement early in treatment, steeper improvement later in treatment, and greater resurgence after discharge.
Discussion: These findings highlight that PTSD and CPTSD symptom domains may be associated with more severe ED outcomes early in residential treatment that resolve by discharge, and may predict differential treatment response for secondary outcomes. Implications are discussed for clinical assessment and treatment of comorbid trauma-related disorders in residential care. Trial Registration: The study was prospectively registered on the Australian and New Zealand Clinical Trials Registry in November 2021, registration number ACTRN12621001651875
10. Bowers, E. M., Petersen, J. M., Lensegrav-Benson, T., Quakenbush, B., & Twohig, M. P. (2025). Outcomes and moderators of shame in residential treatment for eating disorders in females. Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2025.2498249
Full text available for download at: https://tinyurl.com/3m4d5p4k
ABSTRACT. Shame is a painful, self-conscious emotion that is implicated in the onset and maintenance of eating disorders. However, there is a dearth of research examining shame outcomes in clinically acute eating disorder samples. The primary purpose of this study is to evaluate the outcomes and moderators of internal shame in female (adolescent and adult) residential patients diagnosed with a range of eating disorders. Participants (N = 176) were attending residential eating disorder treatment for eating disorders and were assessed for internal shame, self-esteem, eating disorder diagnosis, duration of eating disorder, body mass index, depression, and anxiety. Multilevel models were use to explore outcomes and moderators of shame from intake to discharge.
Shame (g = 1.21) and self-esteem (g = -0.86) significantly improved from intake to discharge. Changes in shame were moderated by eating disorder diagnosis, BMI, depression, and anxiety, but not duration of eating disorder. These findings suggest that shame and self-esteem significantly improve during eating disorder residential treatment, with specific eating disorder diagnoses and baseline psychological characteristics moderating these changes. Future research is needed to replicate these findings in larger samples to further explore the mechanisms underlying changes in shame in eating disorder residential treatment.
11. Morris, R., Keeler, J., Treasure, J., & Himmerich, H. (2025). The pharmacological treatment of anxiety in people with eating disorders: A systematic review. Pharmacological Research, 216, 107782. https://doi.org/10.1016/j.phrs.2025.107782
Full text available for download at: https://tinyurl.com/43x5e6ep
ABSTRACT. People with eating disorders experience high rates of psychiatric comorbidities, including anxiety disorders such as generalised anxiety disorder, social anxiety disorder and specific phobias. Anxiety can influence the prognosis of an eating disorder, by worsening symptoms, and acting as a barrier to treatment. Therefore, targeting treatment efforts towards anxiety may improve eating disorder outcomes.
The primary aim of this systematic review was to summarise the evidence base for the pharmacological treatment of anxiety symptoms in people with eating disorders. An electronic search of three databases (PubMed, Medline, and PsycInfo) was conducted. Papers were included if they investigated pharmacotherapy (antidepressants, antipsychotics, antianxiety, psychedelics, etc.) in eating disorder samples, with primary or secondary outcomes of anxiety. A total of 51 studies were included, and results were mixed across drug classes documenting both favourable and non-significant anxiety outcomes.
There was evidence for the use of fluoxetine for anxiety in anorexia and bulimia nervosa, but not for binge eating disorder. Evidence for the use of olanzapine was documented for anxiety in AN, and preliminary case reports suggested its use in ARFID for anxiety symptoms. Preliminary evidence for developing pharmacological agents, such as psilocybin and ketamine, reported favourable outcomes in AN patients. More RCTs are required to explore efficacy and safety of pharmacological agents in treating anxiety in people with eating disorders.