Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 161: (i) Advocacy; (ii) Neurodiverg, EDs, & DE, Part 1 (n = 2); (iii) Trauma/Maltreat, Part 1 (n = 2); (iv) Soc Media, Part 2 (n = 2); (v) Nature of EDs, Part 3 (n = 4); and (vi) Access to Tx
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.
Appearance Matters/Summer Short Podcast
Appearance-Inclusive University
featuring with [our own] Dr. Nadia Craddock in conversation with
[our own] Emma Waite, BPsych, MSc Health Psychology
ML NOTE 1: 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 2: The article being discussed by Nadia and Emma was presented in 7 November 2024 in Substack Newsletter NO. 83 (#1). Drs. Jade Parnell, Diana Harcourt, and Amy Slater, all of whom are at CAR, are also members of this Substack Group.
1. Waite, E., Parnell, J., Guest, E., Harcourt, D., Stokes, R., & Slater, A. (2024). “Make sure that everybody feels there is a space for them”: Understanding and promoting appearance inclusivity at university. Body Image, 51, 101809. https://doi.org/10.1016/j.bodyim.2024.101809 [Full text available for download at: https://tinyurl.com/3y896efa]
ML NOTE 3: More information about Emma Waite and her work is available at https://people.uwe.ac.uk/Person/EmmaWaite
Appearance Matters/Summer Short Podcast
Appearance-Inclusive University, with our own Emma Waite, Research Fellow at the Centre for Appearance Research (CAR), Bristol, England
Listen (~12.25 min) at: https://tinyurl.com/2rk39vdr
Welcome to our 2025 Summer Short Series! We're back with bitesize episodes showcasing recent work from our team at the Centre for Appearance Research!
In this episode, we are joined by Emma Waite, Research Fellow at CAR, who tells us about her recent paper entitled: “Make sure that everybody feels there is a space for them”: Understanding and promoting appearance inclusivity at university." Emma discusses this qualitative piece of work and what it tells us about how we can improve appearance inclusivity in universities in a meaningful way.
To read the full paper follow this link: https://www.sciencedirect.com/science/article/pii/S1740144524001311
Cover image by Nada via Unsplash
Music by Sian Evans & John Landau: toplinefilm.com
Episode developed and produced by Maia Thornton
EATING DISORDERS LITERACY
[our own] Ms. Robyn Goldberg's (USA)
The Eating Disorder Trap Podcast - Episode #184:
Eating Disorders Group Therapy, with
Adina Silverman, MS, RD, LDN (USA) and Carolyn Karoll, LCSW-C, CEDS-S (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 4 (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.co
Episode #184: Eating Disorders Group Therapy, with Adina Silverman, MS, RD, LDN (USA) and Carolyn Karoll, LCSW-C, CEDS-S (USA)
Listen (~29 min) at: https://theeatingdisordertrap.com/184-eating-disorder-group-therapy-with-carolyn-karoll-and-adina-silverman/
IN THIS EPISODE
Adina Silverman, MS, RD, LDN is a Registered Dietitian specializing in the treatment of eating disorders.
She is passionate about helping adolescents, teenagers, and adults heal their relationships with food and their bodies. She supports her clients to have the courage to cultivate the relationship with food that feels best to them and reject mainstream diet culture messaging. Her thorough and compassionate approach has impacted many individuals and families and distinguished her as a leader in her professional community.
Carolyn Karoll, LCSW-C, CEDS-S, is a highly regarded therapist dedicated to the treatment of eating disorders. Carolyn’s insights are featured in various media outlets, including her Psychology Today blog, “Eating Disorder Recovery: Understanding and Overcoming Eating Disorders.”
Adina and Carolyn are co-authors of the book, Eating Disorder Group Therapy: A Collaborative Approach, published in April 2024. Adina and Carolyn co-facilitate the “Thrive” eating disorder recovery group, which they have been leading together since 2016.
We discuss topics including:
How to screen for group therapy
The importance of screening for people that are “recovery focused”
Understanding when cognitive defusion strategies are used and what are they?
The importance of hearing about other people’s lived experience
Being aware the one’s “stuck point”
Tools of ACT
SHOW NOTES:
Research Publication Categories in This Newsletter
(i) Advocacy-in-Action; (ii) Neurodivergence, EDs, & DE, Part 1 (n = 2); (iii) Trauma & Maltreatment, Part 1 (n = 2); (iv) Social Media, Part 2 (n = 2); (v) Nature, Course, and Correlates of EDs, Part 3 (n = 3); and (vi) Access to Treatment
CONGRATULATIONS to our own
Dr. S. Bryn Austin (USA) and colleagues for publication of the Advocacy-in-Action research article in #1.
Dr. Rachel Rodgers (USA/France) and colleagues, including distinguished media researcher Dr. Kristen Harrison (USA), for publication of the Social Media research article in #7.
Marley Billman Miller (USA) and Drs. Shelby Ortiz (USA), Jamal Essayli (USA), Thomas Joiner (USA), April Smith (USA), and Lauren Forrest (USA) and colleagues for publication of the Nature/Correlates of Eating Disorders research article in #9.
Dr. Siân A. McLean (Australia) and colleagues and colleagues for publication of the Access to Treatment research article in #11.
ADVOCACY-IN-ACTION
1. Yergaliyev, K. A., Fresina, L., Ayaganova, A., & Austin, S. B. (2025). Power Prism framework for health advocacy: A case of dietary supplements for weight loss and muscle building sold to youth in Massachusetts municipalities. Electronic Journal of General Medicine, 22(4), em662. https://doi.org/10.29333/ejgm/16371
Full text available for download at: https://tinyurl.com/23rbcwrr
ABSTRACT. This study applied the Power Prism advocacy framework as a strategy design tool to inform an 18-month case study conducted in four Massachusetts municipalities (USA). The case study addressed the weak regulation and easy access to potentially dangerous weight-loss and muscle-building dietary supplements for youth in Massachusetts municipalities. The Power Prism advocacy framework is made up of six “power tools”: research and data collection, coalition building and maintenance, fundraising and development, grassroots advocates and key contacts, media advocacy, and decision-maker advocacy.
Based on the case study, a municipality-targeted advocacy strategy was developed for Harvard University’s strategic training initiative for the prevention of eating disorders to support their efforts to persuade policymakers to strengthen regulation of weight-loss and muscle-building supplements sold to youth. The detailed application of the framework provides a replicable and innovative model.
NEURODIVERGENCE, EDs, AND DE: Part 1 of 2
2. Downs, J., & Adams, M. (2025). Re-imagining connection: The role of late autism diagnosis in eating disorder recovery and social support. Journal of Eating Disorders, 13, 120. https://doi.org/10.1186/s40337-025-01271-5
Full text available for download at: https://tinyurl.com/ybe77nsa
ABSTRACT. This paper explores the complex relationship between autism, social connection, and eating disorder recovery, drawing on the lived experiences of two late-diagnosed autistic adults with histories of longstanding and severe eating disorders. Using narrative and autoethnographic methods, we examine how delayed autism diagnosis intersects with the social dimensions of illness, and the process of treatment and recovery. We identify unique barriers autistic individuals with eating disorders face in building meaningful social connections, navigating support systems, and accessing appropriate care.
By integrating personal insights with existing research, we advocate for earlier autism screening and neurodiversity-affirming treatment approaches that embrace and value autistic differences, including the strengths inherent in neurodivergence. This requires a shift in how social support is conceptualised within eating disorder care, prioritising the creation of meaningful connections that address the unique social and emotional needs of autistic individuals. We argue for clinical practices that not only recognise the challenges faced by neurodivergent individuals but also embrace the strengths they bring, fostering environments where autistic individuals can engage authentically in their recovery process. This approach ultimately benefits patients and treatment providers alike, promoting more inclusive, empathetic, and effective care for all.
3. Tchanturia, K., Chubinidze, D., Duffy, F., Nimbley, E., Li, Z., & Holliday, J. (2025). Implementation insights from the PEACE Pathway Across UK Eating Disorder Services. Nutrients, 17(9), 1532. https://doi.org/10.3390/nu17091532
Full text available for download at: https://www.mdpi.com/2072-6643/17/9/1532
ABSTRACT. Background/Objectives: Autistic individuals with eating disorders (ED) face socio-emotional, sensory, and communication difficulties that influence engagement and treatment outcomes. We examined how the PEACE Pathway—an autism-informed approach to ED treatment—addresses these challenges through tailored adaptations in clinical care. Methods: A qualitative multiple case studies design was employed, drawing data from clinical documentation, stakeholder feedback, and service evaluations.
Results: We identified eight core domains essential for implementation: pathway knowledge, assessment and planning, psychological interventions, sensory management, nutritional care, lived-experience feedback, family/community engagement, and staff training. These domains informed the development of the PEACE Self-Assessment Checklist to support the wider adoption of the pathway. Conclusions: The PEACE Pathway offers a structured approach to adapting ED treatment for autistic individuals. The checklist provides practical guidance for implementing autism-friendly adaptions.
TRAUMA AND MALTREATMENT, Part 1 of 3
3. Wu, Q., He, J., Chi, P., Lin, X., & Chen, C. (2025). Longitudinal associations of childhood emotional maltreatment with disordered eating behaviors: Linking mechanisms of repetitive negative thinking and body dissatisfaction. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24492
Email address for correspondence: ccq0213@outlook.com
ABSTRACT. Objective: The relationship between childhood emotional maltreatment and disordered eating behaviors (DEBs) has been well documented. However, the mechanisms that link these associations are underexplored, and most studies have focused on the roles of emotion-related symptoms or processes. Based on the stress process model, the present study investigated how childhood emotional maltreatment exerts long-term effects on DEBs in adulthood by examining the mediating roles of repetitive negative thinking (RNT) and body dissatisfaction.
Method: Four-wave and self-report survey data were collected from 668 Chinese young adults (66.8% female, Mage = 19.96 years, SD = 1.25) with a 6-month between-wave interval. Data were collected on childhood emotional maltreatment (i.e., emotional abuse and neglect), RNT (i.e., past-oriented: rumination; future-oriented: worry), body dissatisfaction, loss of control eating, and restrained eating.
Results: Childhood emotional abuse recalled at T1 was positively associated with loss of control eating at T4 via worry at T2 and with restrained eating at T4 via a serial mediating pathway from worry at T2 to body dissatisfaction at T3. No significant indirect effects emerged for childhood emotional neglect and rumination or indirect pathways involving body dissatisfaction alone.
Discussion: Negative cognitive processes toward the future and body dissatisfaction are important mechanisms in the associations of early emotional threat with DEBs. The type of childhood maltreatment and RNT are important in this transmission. Interventions aimed at reducing loss of control over eating and restrained eating could work on decreasing worry and alleviating body dissatisfaction, particularly for people with experiences of early emotional threat
4. Santoro, G., Cannavò, M., Schimmenti, A., & Barberis, N. (2025). Childhood trauma and eating disorder risk among young adult females: The mediating role of mentalization. Developmental Psychopathology. Advance online publication. https://doi.org/10.1017/S0954579425100205
Full text available for download at: https://tinyurl.com/3xt9fkj2
ABSTRACT. Eating disorders (EDs) are particularly prevalent among young adult females. Previous research has shown that childhood trauma and reduced mentalizing abilities are involved in ED symptoms. The current study was aimed at testing the mediating effects of failures in mentalizing on the relationship between childhood trauma and ED risk among young adult females. The sample consisted of 409 Caucasian young adult females, aged between 18 and 30 years old (M = 23.45, SD = 2.76). The reported mean body mass index was within the normal range (M = 22.62; SD = 4.35). Self-report instruments were administered to assess the variables of interest.
Structural equation modeling revealed that childhood trauma predicted increased failures in mentalizing (β = .36) and ED risk (β = .30), that failures in mentalizing predicted an increased ED risk (β = .35), and that the positive association between childhood trauma and ED risk was partially mediated by failures in mentalizing (indirect effect: β = .13). These findings suggest that ED symptoms might result from unprocessed and painful feelings embedded in child abuse and neglect. Clinical interventions focused at improving mentalizing abilities might reduce the ED risk among young adult females who have been exposed to childhood trauma.
MASS AND SOCIAL MEDIA, Part 2 of 2
6. Comabella-Costa, M., Consuegra-Fernández, M., & Burguera-Serra, J.-G. (2025). Narrativas mediáticas sobre los trastornos de la conducta alimentaria en la prensa española (2012-2022): Representación, discursos y estigmatización (Media narratives on eating disorders in the Spanish press (2012-2022): Representation, discourse, and stigmatization). Revista Mediterránea de Comunicación, 16(2):e29182. https://doi.org/10.14198/MEDCOM.29182
Texto completo disponsible para descargar en (Full text available for download [in Spanish and English] at): https://tinyurl.com/4p8ccjmn
ABSTRACT. Purpose: To analyze how the Spanish press represents eating disorders (EDs) through personal narratives and to assess the impact of these media portrayals on social perceptions of these conditions. Methodology: A content analysis was conducted on 136 articles published in four Spanish newspapers (El País, ABC, La Vanguardia, and El Mundo) between 2012 and 2022, identifying representation patterns and protagonist characteristics.
Results and conclusions: Findings confirm that ED stories in the media predominantly feature women (93.38%), particularly young individuals aged 20 to 35 (52.94%). Anorexia nervosa is the most frequently portrayed disorder (63.24%), whereas bulimia nervosa (17.65%) and binge-eating disorder (15.44%) receive significantly less coverage. The analyzed testimonies mostly focus on well-known public figures (74.26%), linking EDs with the entertainment industry and reinforcing sociocultural stereotypes that may contribute to stigmatization.
Novelty: This study provides a critical perspective on the role of the media in shaping narratives about EDs and highlights the need for communication strategies that avoid reductionist approaches and promote a more comprehensive and empathetic understanding of these disorders.
7. Alper, M., Rodgers, R. F., Rauchberg, J., Simpson, E., & Harrison, K. (2025). “Actually an ED and not jus a quirky aspect of autism”: TikTok as a forum and mediator of autistic food issues and eating disorders. New Media & Society. Advance online publication. https://doi.org/10.1177/14614448251339408
Full text available for download at: https://tinyurl.com/3x65r4hu
ABSTRACT. Restrictive eating disorders (EDs) have among the highest mortality rate of any psychiatric disorder. To date, little research has investigated the role of digital media in sharing ED experiences and promoting recovery for autistic individuals, despite high autism rates among those with EDs and the potential for social media (SM) to provide resources and support for adolescent girls and young women living with EDs. Given this gap, we undertook an exploratory study to assess content pertaining to autistic people’s difficulties with food and eating on the leading SM app TikTok. We identified four main themes: (a) EDs and autism; (b) cognitive, sensory, and behavioral dimensions.
NATURE, COURSE, AND CORRELATES OF EDs, Part 3 of 5
8. Chiu, B.-Y., Tseng, M.-C. M., & Liu, Y.-H. (2025). Multidimensional assessments of impulsivity in women with bulimia nervosa, bipolar disorders, and comorbidity. Journal of Eating Disorders, 13, 115. https://doi.org/10.1186/s40337-025-01319-6
Full text available for download at: https://tinyurl.com/3fzuz7k2
ABSTRACT. Background: This study investigated the shared and distinct features of emotional dysregulation and impulsivity in women with bulimia nervosa (BN) and bipolar disorder (BD) as well as their relationship with comorbidity between the two conditions. Method: This study included data from 115 women with BN and 76 women with BD, including 37 individuals with comorbid BN–BD, from a psychiatric outpatient clinic as well as 72 healthy female controls. All participants underwent a diagnostic interview and completed several self-administered assessments of mood and impulsivity. Statistical analyses were conducted to compare mood and impulsivity across the BN-only, BD-only, BN–BD comorbid, and control groups.
Results: The disorder groups exhibited significantly higher levels of affective lability, attentional impulsivity, sensitivity to punishment, negative urgency, and both internally and externally directed impulsive behaviors compared with the control group. Comorbidity with BN–BD was further associated with increased severity in anger, attentional impulsivity, reward sensitivity (fun seeking), and externally directed impulsive behaviors relative to the BN-only group. Among these shared psychopathological features, negative urgency was significantly higher in the BN-only and BN–BD comorbid groups than in the BD-only group, indicating its unique relevance to binge eating.
Attentional impulsivity was the only parameter that demonstrated significantly greater severity in the comorbidity group than in both the BN-only and BD-only groups. This finding implies that attentional impulsivity is associated with an elevated risk of externally directed impulsive behaviors in the BN–BD comorbid group relative to the BN-only group.
Conclusions: BN and BD share overlapping affect dysregulation and impulsivity profiles. Negative urgency and attentional impulsivity may make major contributions to binge eating and external impulsive behaviors, respectively, in individuals with comorbid BN–BD. Our findings highlight the importance of targeting emotion regulation skills as well as behavioral control of binge eating and associated impulsive behaviors when treating individuals with BN and BD comorbidity.
9. Abber, S. R., Billman Miller, M. G., Hamilton, A., Ortiz, S. N., Jacobucci, R. C., Essayli, J. H., Joiner, T. E., Smith A. R., & Forrest, L. N. (2025). Bulimia nervosa severity levels based on shape/weight overvaluation explain more variance in clinical characteristics than DSM-5 severity levels. Psychological Medicine, 55, e181. https://doi.org/10.1017/S0033291725100597
Full text available for download at: https://tinyurl.com/yrf4w4a8
ABSTRACT. Background: DSM-5 specifies bulimia nervosa (BN) severity based on specific thresholds of compensatory behavior frequency. There is limited empirical support for such severity groupings. Limited support could be because the DSM-5's compensatory behavior frequency cutpoints are inaccurate or because compensatory behavior frequency does not capture true underlying differences in severity.
In support of the latter possibility, some work has suggested shape/weight overvaluation or use of single versus multiple purging methods may be better severity indicators. We used structural equation modeling (SEM) Trees to empirically determine the ideal variables and cutpoints for differentiating BN severity, and compared the SEM Tree groupings to alternate severity classifiers: the DSM-5 indicators, single versus multiple purging methods, and a binary indicator of shape/weight overvaluation.
Methods: Treatment-seeking adolescents and adults with BN (N = 1017) completed self-report measures assessing BN and comorbid symptoms. SEM Trees specified an outcome model of BN severity and recursively partitioned this model into subgroups based on shape/weight overvaluation and compensatory behaviors. We then compared groups on clinical characteristics (eating disorder symptoms, depression, anxiety, and binge eating frequency).
Results: SEM Tree analyses resulted in five severity subgroups, all based on shape/weight overvaluation: overvaluation <1.25; overvaluation 1.25-3.74; overvaluation 3.75-4.74; overvaluation 4.75-5.74; and overvaluation ≥5.75. SEM Tree groups explained 1.63-6.41 times the variance explained by other severity schemes.
Conclusions: Shape/weight overvaluation outperformed the DSM-5 severity scheme and single versus multiple purging methods, suggesting the DSM-5 severity scheme should be reevaluated. Future research should examine the predictive utility of this severity scheme.
10. Lin, C. Y., Tseng, M. M., Chiou, K. R., Shao, J. Y., Liu, H. Y. (2025). Bulimia nervosa and risk of cardiovascular outcomes: A longitudinal matched cohort study in Taiwan. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24461
Email address for correspondence: mctseng20222@tmu.edu.tw
ABSTRACT. Objective: Bulimia nervosa (BN), a prevalent eating disorder characterized by recurrent binge–purge cycles, may contribute to long-term cardiovascular (CV) complications. However, evidence regarding these outcomes remains limited. This study investigated CV risks in patients with BN and the risk trajectory across varying follow-up periods by using a nationwide Taiwanese cohort.
Methods: Data from the National Health Insurance Research Database (2010–2022) were analyzed. Patients with BN aged 10–59 years were matched with controls at a 1:10 ratio on the basis of sex, age, socioeconomic status, urbanization, and index year through propensity score matching. The composite CV outcomes included atherosclerosis, cardiac arrest, cardiomyopathy, conduction disorders, congestive heart failure, inflammatory heart diseases, ischemic heart diseases, stroke, valve diseases, and venous thromboembolism. Hazard ratios (HR) were estimated using Cox regression models adjusted for baseline psychiatric and physical comorbidities.
Results: The cumulative incidence of composite CV outcomes among patients with BN (n = 11,682) was 10.0% after 10 years of follow-up. Patients with BN demonstrated a modest but significantly increased risk of composite CV outcomes (adjusted HR [aHR] 1.13 [95% CI, 1.03–1.23]), specifically those with psychiatric comorbidities (aHR 1.15 [95% CI, 1.03–1.29]) and with psychiatric hospitalization (aHR, 1.81 [95% CI, 1.25–2.61]). The risks of composite CV outcomes progressively increased across most follow-up intervals. Conclusion: Patients with BN exhibited a modest but persistently elevated CV risk. CV monitoring is particularly important for BN individuals with psychiatric comorbidities and those in need of psychiatric hospitalization for timely detection and management.
ACCESS TO TREATMENT
11. Spiel, E. C., Barns, R., Heruc, G. A., Hurst, K., Trobe, S., & McLean, S. A. (2025). Outcomes of professional development to support capacity to provide eating disorder treatment and exploration of service level barriers. Journal of Eating Disorders, 13(Suppl 1), 116. https://doi.org/10.1186/s40337-025-01308-9
Full text available for download at: https://tinyurl.com/449bs5yj
ABSTRACT. Background: The prevalence of eating disorders is increasing, with substantial impacts upon the person with the eating disorder, families, supports, and communities, as well as broad social and economic impacts. Most people who have an eating disorder either do not receive treatment, or experience substantial delay between symptom onset and treatment.
To address the increasing prevalence and widespread impacts of eating disorders, both effective and accessible treatment interventions are required. There has been considerable focus on developing effective treatment interventions for eating disorders, but less attention has been given to increasing provision of treatment. This study reports on the impact of professional development for clinicians in increasing capacity to provide eating disorder treatment and perceived organisational barriers to doing so.
Methods: Australian mental health professionals and dietitians (N = 397) completed an online survey exploring perceived level of skill, knowledge and willingness to provide safe, effective treatment for people experiencing eating disorders before and after completing one of three sequences of training and/or supervision, allocated based on their prior training and experience in eating disorder treatment. Participants also reported on perceived organisational barriers to the provision of eating disorder treatment.
Results: Participants reported significantly higher levels of knowledge, skill, and willingness to treat eating disorders after receiving professional development than at baseline. There were no differences in the degree of skill and knowledge change based on the type of professional development received, however, the change in willingness to treat eating disorders after receiving professional development was higher among participants who received supervision only than among those who received introductory training, treatment model training and supervision. Lack of knowledge, skills, and abilities in staff and lack of funding were the most strongly endorsed barriers. Greater endorsement of barriers was associated with lower willingness to treat eating disorders at the end of the program.
Conclusions: Low cost, large scale professional development in eating disorder treatment has the potential for widespread impact on workforce capacity and subsequent availability of evidence-based treatment. Further exploration to address the impact of organisational barriers on implementation is needed.