Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 242: (i) Sociocul Factors, Part 1 (n =2); (ii) Epidemiol, Part 3 (n = 2); (iii) BDD, Part 4 (n = 2); (iv) Profession Issu, Part 2 (n = 2); & (v) Nature, Course, & Correlates of EDs, Part 3 (n = 3)
Colleagues (N now = 1448 in 49 countries),
Please continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications, etc.
REQUEST FOR RESEARCH PARTICIPATION BY AND/OR ASSISTANCE RECRUITING
English-speaking U.S. Adolescents ages 13-17 years old who (a) have body image concerns; and (b) own a mobile phone
from our own Nathalie Gullo, research coordinator at Washington University at St. Louis (USA), working with our own Dr. Ellen Fitzsimmons-Craft (USA)
for a study (ML, paraphrasing, has) entitled
The EMBody Study: Testing a Digital Program for Teens with Body Image Concerns
Received 3 March 2026 via an email from our own Nathalie Gullo (USA) on behalf of our own Dr. Ellen Fitzsimmons-Craft (USA).
ML NOTE 1: Nathalie, Dr. Fitzsimmons-Craft, and I would appreciate it if you would pass this request along to any and all you know who are eligible, and to anyone you know who parents, teaches, coaches, or otherwise works with adolescents who are eligible.
[Nathalie writes:]
Dr. Ellen Fitzsimmons-Craft at Washington University in St. Louis is currently conducting a study, called the EMBody study. The study aims to test a digital program for teens who have body image concerns. Eligible participants will complete 3 online surveys and will receive access to a digital chatbot program through the Wysa app. Participants may be compensated up to $45 for their participation.
Eligibility Criteria:
a) 13-17 years old
b) English speaking
c) Living in the United States
d) Owns a mobile phone
e) Have body image concerns
To prescreen, please click on the following link: https://washu.qualtrics.com/jfe/form/SV_0PX2BXw3bYrT1rM?Source=MichaelLevine
If you have any questions or concerns, please don’t hesitate to contact the principal investigator, Ellen Fitzsimmons-Craft at: fitzsimmonse@wustl.edu
And please feel free to share within your networks as well!
SUPPORT AND TREATMENT LITERACY [and SPENDING TIME WITH WISE, COMPASSIONATE, SKILLED PEOPLE]
Free CHAT in THE LIVING ROOM:
Monday, 9 March 2026: 7:00 p.m. - 8:00 p.m. Eastern | 4:00 p.m. - 5:00 p.m. Pacific | 11:00 p.m. - 12:00 a.m. UTC
Mind on Your Side
hosted by and featuring our own
Sondra Kronberg, MS, RD, CDN, CEDRD (USA)
(Founder and Host of the Chats Program)
Received yesterday (California time), 4 March 2026, via a Chats in the Living Room email from my friend and Bolder Model, our own Ms. Sondra Kronberg.
ML NOTE 2: Quoting Sondra, 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 3: For information about previous Morningside Chats, various forms of support for recovery and self-care, and other resources that Sondra and her staff provide, go to: https://www.chatsinthelivingroom.com/
Choose Support • Choose Connection • Choose Recovery
CHATS in THE LIVING ROOM, developed and hosted by Sondra Kronberg
FREE! - live on 9 March 2026, 7:00 pm ET | 4:00 pm PT | 11:00 pm UTC
RSVP through by clicking the following to sign up and receive your Zoom invite via email: https://www.chatsinthelivingroom.com/sign-up
EATING DISORDERS LITERACY
[our own] Ms. Robyn Goldberg’s (USA)
The Eating Disorder Trap Podcast - Episode #206:
What Weight Suppression Is Doing to Your Hormone Levels , with
[our own] Dr. Pamela Keel, FAED (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., Carolyn Costin in Episode 199, 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
ML NOTE 5: [our own] Dr. Pamela Keel, Fellow and Past President of the Academy for Eating Disorders, has long been one of the world’s most productive and informative scientist-practitioner-mentors working in the eating disorders field. In my experience, based on knowing her and reading her work since the late 1990s, anything she says or writes is worth paying attention to and learning from. In this regard, see also #6 below.
Episode #206, What Weight Suppression Is Doing to Your Hormone Levels, with [our own] Dr. Pamela Keel, FAED (USA)
Listen (~22.5 min) at: https://tinyurl.com/mvcefvwn
IN THIS EPISODE
Dr. Pamela Keel is Distinguished Research Professor in the Department of Psychology, Florida State University and the 2025-2026 Robert O. Lawton Distinguished Professor at Florida State University – the highest honor FSU faculty can award.
She directs the Eating Behaviors Research Clinic, co-directs the NIMH-funded Integrated Clinical Neuroscience Training Program, and leads efforts to enhance faculty recruitment and mentorship at Florida State University and has attracted over $55 million in external funding to FSU since joining their faculty in 2008. Her NIH-funded research examines the nosology, biology, epidemiology, and longitudinal course of eating disorders, and she has over 250 peer-reviewed journal articles and authored four books.
Dr. Keel identified Purging Disorder as a new disorder of eating by revealing its clinically significant impact on the lives of those with the condition and demonstrating distinct postprandial gut peptide responses linked to purging in the absence of binge eating.
Her groundbreaking work contributed to Purging Disorder’s inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Dr. Keel was honored with the AED Leadership Award in Research for the global impact of her work identifying Purging Disorder as a life-threatening illness affecting 1 in 50 women worldwide person does not.
We discuss topics including:
Understanding the long-term outcome for bulimia nervosa (one person gets better and one person does not)
Discussing what is weight suppression?
Hormones including Leptin and Glucagon Peptide 1 (GLP-1)
What happens when GLP-1 is released?
What does lower leptin levels mean?
SHOW NOTES:
Research Publication Categories in This Newsletter
(i) New Book: Handbook of Diversity in Body Image, Part 1; (ii) Sociocultural Factors, Part 2 (n = 3); (iii) Binge Eating, Part 1 (n = 2); (iv) Professional Issues, Part 3 (n = 2); and (v) Nature, Course, and Correlates of EDs, Part 4 (n = 3)
CONGRATULATIONS to our own
Dr. Rachel Rodgers (USA/France) and colleague for publication of the Sociocultural Factors commentary article in #3.
Julia Vitagliano USA) and Drs. Amanda Raffoul (Canada) and S. B. Austin (USA) and colleagues for publication of the Sociocultural Factors research article in #4.
Naomi Hill (USA) and Dr. Elizabeth Lampe (USA) and colleagues, including distinguished scientist-practitioner-mentors Dr. Stephanie Manasse (USA) and Dr. Adrienne Juarascio (USA), for publication of the Binge Eating research article in #5.
Drs. Thomas Joiner (USA) and Pamela Keel (USA) and colleagues for publication of the Binge Eating research article in #6.
Dr. Amelia Austin (Canada) and colleagues, including distinguished scientist-practitioner-mentor Dr. Gina Dimitropoulos, for publication of the Professional Issues research article in #7.
Dr. Diana Rancourt (USA) and colleagues for publication of the Nature of Eating Disorders research article in #10.
And CONGRATULATIONS (!) Are Also in Order for a
NEW BOOK entitled
Handbook of Body Image Diversity
Edited by [our own] Dr. Viren Swami (England/Malayasia) and [our own] Dr. Tracy Tylka (USA)
Publication date: late February - early March 2026
ML NOTE 6: Many of the contributors to this unique handbook are members of this Newsletter Group. To acknowledge this and give credit to those contributors, the information below is the first of a 3-part series. Assume that, unless otherwise noted, all names in bold would be preceded by Dr.
1. Swami, V., & Tylka, T. L. (Eds.). (2026). Handbook of body image diversity. Academic Press [ISBN 978-0-443-32896-1, 418 pages ] https://doi.org/10.1016/C2023-0-52529-7
Publisher’s website: https://tinyurl.com/jts6z8da
Description at the publisher’s website: The Handbook of Diversity in Body Image addresses the urgent need for inclusive body image research and practice. This volume fills a critical gap by comprehensively examining how body image develops and is maintained and negotiated in various cultural, geographic, and social contexts.
This book begins by tracing the historical trajectory of body image research and practice, highlighting the evolution from past perspectives to our current understanding. It then presents in-depth reviews of body image research in a range of geographic regions around the world. The volume also includes chapters that review the intricate intersections of identity, including discussions on body image in racialized minority groups, indigenous communities, minoritized sexual and gender identities, men, diverse religious identities, and those experiencing food insecurities.
This handbook also presents chapters that consider diversities in life experiences, including body image across the lifespan, as well as in people with visible differences, disabilities, illness, neurodivergence, and larger bodies. Each chapter highlights the importance of understanding and embracing diversity in body image practice, emphasizing the significance of intersectionality in both research and real-world applications.
Handbook of Diversity in Body Image empowers researchers, clinicians, and educators to broaden their understanding of and approach to body image discussions. By highlighting marginalized voices and presenting innovative frameworks, this volume equips the audience with the tools to advance research, improve clinical practice, and foster inclusivity in the study and promotion of positive body image worldwide.
SECTIONS I [INTRODUCTION] and II [DIVERSITIES IN CULTURE AND GEOGRAPHY]
Chapter 1 - Body image research and practice: Where we were and where we are, by Viren Swami (England/Malayasia) and Tracy L. Tylka (USA), pages. 3-25
Chapter 2 - Body image in East Asia, by Todd Jackson (China), Yusu Yue and Amy Shaw, pages 19-37
Chapter 3 - Body image in South and Southeast Asia, by Viren Swami, pages 39-52
Chapter 4 - Body image in South America and the Caribbean, by Emilio Juan Compte (Chile/Mexico) and Pedro Henrique Berbert de Carvalho (Brazil), pages 53-65.
SOCIOCULTURAL FACTORS, Part 2 of 4
2. Jawad, M., Nawaz, J., Zohra, U., Khan, M. A., Khalil, A., Tahir, H. (2025). Prevalence of eating disorders among media persons such as actors, models, hosts, anchors and celebrities. Pakistani Journal of Public Health, 15(3), 90-94. https://pjph.org/pjph/article/view/1653
Full text available for download at: https://pjph.org/pjph/article/view/1653
ABSTRACT. Background: People in media usually faced immense pressure to maintain their body shape and particular appearance to meet societal standards of beautification. It led to a higher level of stress in these individuals to strictly control their weight. This study aimed to figure out the prevalence of eating disorders in people attached to media including actors, TV anchors, models, hosts and celebrities.
Methodology: This study utilized a cross-sectional design to investigate the prevalence of eating disorders among media professionals. Simple random sampling technique was utilized to select the participants from the targeted population. A total of (N = 60) samples were collected, half of them were males and the other half were females by using Taro Yamini formula.
Results: A total of 60 participants (mean age 22.45 ± 3.33 years) were enrolled for the study, with equal gender ratios (50% male, 50% female). In regards to participant BMI classifications, 6.7% were identified as underweight, 51.7% normal, 35.0% overweight, and 6.7% obese. Using EAT-26 scoring, 58.3% of participants were identified as having an eating disorder. Behavioral patterns reflected binge-eating, self-induced vomiting, use of weight-control medications, and excessive exercise at varying frequencies with just a handful, 1-2.% of participants reporting extreme forms of behavioral patterns daily.
Analyzing BMI categories and eating disorder status through chi-square analysis did not reveal an association (p > 0.05). Independent sample t-tests confirmed substantial gender differences in current weight, highest weight, lowest weight, and ideal weight (all p < 0.01), with men reporting higher weight across the board. Conclusion: This study concluded that the prevalence of eating disorders was high in media personnels, while males reported higher weight metric when compared with females.
3. Çili, S., & Rodgers, R. F. (2026). The impact of fashion and fashion industry practices on body image. In S. Çili, A. Bardey, & A. Khaderoo (Eds.), Applied psychology in fashion: A research-informed approach (pp. 145-178). Palgrave Macmillan.
Email address for correspondence: s.cili@fashion.arts.ac.uk
ABSTRACT. This chapter explores the impact of fashion and fashion industry practices on body image. It starts with an overview of clothing and appearance ideals in the twentieth and twenty-first centuries, highlighting how the thin-ideal has been a constant presence. It then presents the main theoretical frameworks on the development of body image and the factors that influence it. Specifically, it focuses on sociocultural theories, objectification theory, and theories of positive body image.
Next, the authors explore three main pathways through which the fashion industry and its practices can affect body image in consumers and individuals who work in the industry: (1) fashion imagery and fashion shows, (2) social media, and (3) the nature of fashion items. Discussing the nature of the items produced by the industry, they focus on how sexualised children’s clothing, limited clothing availability or accessibility, restrictive clothing, and issues with clothing size and fit can impact body image across the lifespan—especially among women. The chapter concludes with recommendations for policies and practices that can promote diversity and sustain positive body image.
4. Kavanaugh, J. R., Bulens, A. J., Vitagliano, J. A., Harshaw, M., Raffoul, A., Egan, N., & Austin, S. B. (2025). Commercial funding of randomized controlled trials of weight-loss interventions using dietary supplements: A rapid review. Accountability in Research. Advance online publication. https://doi.org/10.1080/08989621.2025.2600404
Email address for correspondence: jill.kavanaugh@childrens.harvard.edu
ABSTRACT. Background: Nutrition research funded by commercial entities may be subject to bias. To date, no study has examined the prevalence of commercial funding in clinical trials of dietary supplements for weight loss. Objective: To estimate the prevalence of commercial funding of randomized controlled trials (RCTs) of dietary supplement interventions for weight loss.
Methods: We conducted a rapid review of English-language RCTs published between 1 January 2023, testing dietary supplements for weight loss. Funding sources were extracted from full texts and categorized as industry, nonprofit, trade association, academic, government, or other. Commercial funders, trade associations, and nonprofits were further reviewed for ties to supplement sales.
Results: Of 74 articles reviewed, 59% (n = 44) reported commercial funding, involving 64 unique funders and 118 instances of commercial involvement. More than half of funders sold dietary supplements or had affiliated companies that did, though some affiliations could not be verified due to limited transparency. No nonprofit funders had ties to supplement sales. Conclusions: The majority of RCTs evaluating dietary supplements for weight loss reported commercial funding. Further research is needed to assess whether such funding influences study findings.
BINGE EATING, Part 1 of 4
5. Hill, N. G., Lampe, E. W., Juarascio A, Manasse, S. M. (2026). Pre-treatment fear of weight gain is associated with engagement in a greater degree of pre-treatment maladaptive exercise among individuals with binge-spectrum eating disorders. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70090
Full text available for download at: https://tinyurl.com/2p9rd2e6
ABSTRACT. Objective: Individuals with binge-spectrum eating disorders (EDs) engage in varying degrees of maladaptive and adaptive exercise. Elevated shape/weight concern is associated with engagement in maladaptive and adaptive exercise. No research has examined whether specific facets of shape/weight concern (e.g., fear of weight gain) are associated with degree of maladaptive versus adaptive exercise engagement.
Method: Participants were 124 adults with binge-spectrum EDs enroled in outpatient trials of Enhanced Cognitive Behaviour Therapy. Linear regression models examined associations between each facet of shape and weight concern concurrently at pre-treatment and degree of maladaptive versus adaptive exercise at pre-treatment (i.e., percentage maladaptive exercise episodes of total exercise episodes). We explored these relationships across treatment and diagnostic groups.
Results: Greater pre-treatment fear of weight gain was associated with a greater degree of pre-treatment maladaptive exercise (p = 0.027). This pattern was marginally significant in the longitudinal model (p = 0.057) and was upheld within the BN-spectrum (p’s < 0.041) but not the BED-spectrum group.
Discussion: Accounting for all other facets, fear of weight gain may function as a risk factor for engagement in a greater degree of maladaptive exercise pre- and post-treatment. Future research should examine the mechanisms underlying associations between fear of weight gain and maladaptive exercise engagement.
6. Spinner, H. K., Prostko, S., Joiner, T. E., & Keel, P. K. (2025). Suicidal ideation in adult women: The unique roles of binging, purging, and restricting. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.70022
Email address for correspondence: keel@psy.fsu.edu
ABSTRACT. Objective: Suicidal ideation represents a serious experience common in individuals with eating disorders. To inform screening and clinical assessment and advance theoretical work, the current study compared clinical characteristics between adult women with and without current suicidal ideation and examined whether binging, fasting, and purging behaviors are uniquely associated with suicidal ideation above and beyond existing psychiatric diagnoses.
Method: Data come from four studies conducted between 2000 and 2023 (N = 732) that evaluated current suicidal ideation in all participants. Participants completed diagnostic interviews assessing lifetime psychiatric diagnoses and current eating disorder diagnoses and behavioral symptom frequencies. Five hundred and fifty-three participants had DSM-5 eating disorders (54.6% bulimia nervosa, 15.0% purging disorder [PD], 28.2% other specified [excluding PD], 1.4% anorexia nervosa, and 0.7% binge-eating disorder).
Results: Individuals with current suicidal ideation had a greater prevalence of most psychiatric diagnoses and greater frequency of binging, fasting, and purging. Additionally, purging frequency was associated with current suicidal ideation independent of binging, fasting, and lifetime psychiatric comorbidities.
Discussion: Results support prior work suggesting that purging may fall on the self-harm continuum with nonsuicidal self-injury. Further, findings support screening for purging and suicide risk assessment in individuals with eating disorders.
PROFESSIONAL ISSUES, Part 3 of 4
7. Austin, A., Williams, E. P., Kimber, M., Burns, A., Karnabi, P., Dimitropoulos, G., & Coelho, J. S. (2025). Clinician knowledge and perceptions of evidence-based practice in pediatric eating disorders in Western Canada. Journal of Eating Disorders, 13, 270. https://doi.org/10.1186/s40337-025-01452-2
Full text available for download at: https://tinyurl.com/2texbf8e
ABSTRACT. Background: Evidence-based practice (EBP) for pediatric eating disorders (EDs), including the strongly recommended family-based treatment (FBT), is not always available to children, adolescents or emerging adults and their families. Our aim was to investigate clinician knowledge and perspectives of EBP, including FBT, and explore barriers and facilitators to its implementation.
Methods: Clinicians working in Western Canada who were engaged in care for pediatric EDs were invited to participate. A multimethod design was employed using an online survey and subsequent phone interview for data collection. Descriptive data was summarized using means and frequencies. Qualitative data was analysed using a mixed approach encompassing inductive and deductive techniques.
Results: Eighty-four clinicians completed the survey and 24 completed the interview. A total of 64% of clinicians providing therapy were offering FBT in their practice. Of these, 12.5% had no formal training in the modality. Clinicians identified a range of barriers and facilitators to EBP, including FBT, such as service-centered reasons (inadequate training, staff beliefs around which professionals should be involved, program mandates, and private practice therapists struggling to get other professionals on the ‘same page’ in FBT), clinician-centered reasons (desire to offer more holistic care, lack of inclusion of dietetics, belief that FBT was better suited to hospital settings), and patient/family-centered reasons (co-occurring conditions in parents or children, lack of financial privilege).
Conclusions: The barriers to delivering EBP, and low rates of formal FBT training indicate a need to improve capacity building efforts for pediatric ED clinicians, including improved access to training and consultation.
8. Williams-Ridgway, AM., McNeil, S., Leung, N., Hamilton, D., Bilkhu, S., Winston, A. P., & Tuomainen, H. (in press/2026). Healthcare professionals’ perspectives on minoritised ethnic young people’s access to eating disorder services in the West Midlands, United Kingdom: A qualitative study. Journal of Eating Disorders. Advance online publication. https://doi.org/10.1186/s40337-026-01546-5
Full text available for download at: https://tinyurl.com/ycye3yet
ABSTRACT. Minoritised ethnic individuals have comparable eating disorder rates to White populations in the United Kingdom (UK) yet face inequalities in treatment access and experiences. Understanding healthcare professional perspectives is essential for addressing these disparities. This study explores health care professional views on the access of minoritised ethnic young people to specialist eating disorder services through Levesque’s bidirectional access framework, which considers both supply and demand factors.
Methods: Semi-structured qualitative interviews were conducted with 12 health care professionals from diverse personal and professional backgrounds, recruited from four National Health Service (NHS) community specialist eating disorder services in the West Midlands - the UK’s second most ethnically diverse region. Participants completed sociodemographic questionnaires and online interviews via Microsoft Teams. Transcripts were analysed using reflexive thematic analysis.
Results: Health care professionals observed that young people of minoritised ethnic backgrounds accessed specialist eating disorder services less frequently than White British peers. Analysis revealed six interconnected themes spanning service-level and service-user-level factors.
At the service level, systemic barriers included gatekeeping mechanisms (particularly GP referral requirements), service invisibility within minoritised ethnic communities, and inaccessible locations. Cultural and linguistic barriers were prominent, with communication challenges extending beyond language proficiency to fundamental differences in expressing distress. Health care professionals identified critical gaps in developing culturally sensitive services, citing limited resources, lack of workforce diversity, top-down organizational constraints, and insufficient cultural humility training.
At the service-user level, education and awareness emerged as key barriers, with lower mental health literacy and limited eating disorder knowledge within minoritised ethnic communities as hindering recognition and help-seeking. Shame and stigma compounded these challenges, driven by eating disorder stereotypes and cultural beliefs about mental health that discouraged disclosure and treatment-seeking. Health care professionals noted that these barriers disproportionately affected minoritised ethnic individuals compared to their White British peers.
Conclusions: Findings highlight multilevel barriers to accessing eating disorder services requiring comprehensive system changes including removing gatekeeping barriers, enhancing workforce diversity and cultural competency, developing targeted educational initiatives, and challenging eating disorder stereotypes. Culturally responsive services integrating these interventions are essential to improve access and outcomes for minoritised ethnic young people.
NATURE, COURSE, AND CORRELATES OF EATING DISORDERS, Part 4 of Many
9. Walsh, B. T., Golden, N. H., Attia, E., First, M. B., & Pike, K. M. (2026). Diagnostic criteria for atypical anorexia nervosa: A proposal. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.70020
Email address for correspondence: btw1@cumc.columbia.edu
ABSTRACT. Objective: To review the history of the term atypical anorexia nervosa and the challenges surrounding its current description and to propose a new name and diagnostic criteria. Method: We review the use of the term “atypical” in the literature on eating disorders and in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) and note several terms in the current description that are in need of clarification. We also describe how the ICD-11 has grappled with atypical anorexia nervosa.
Results: The first use of atypical anorexia nervosa was by Hilde Brȕch to describe individuals who had lost substantial weight but who lacked the characteristic psychological features of anorexia nervosa. In the section on Eating Disorders Not Otherwise Specified, the DSM-IV included a description of a disorder very similar to the description of atypical anorexia nervosa; the DSM-5 slightly changed the wording and applied the term atypical anorexia nervosa. Features in the description in need of definition include “significant weight loss” and “normal or above normal weight,” and the current name is problematic.
Discussion: We discuss these issues and several potential options for defining features in the current description and for a new name. Following other examples in the DSM-5-TR, we propose the disorder be named “anorexia nervosa-like eating disorder (weight in normal or above normal range)” (acronym: ANLED) and suggest diagnostic criteria which could be included in the DSM-5-TR section on Conditions for Further Study.
10. Hobbs, J., Salley, S., & Rancourt, D. (2026). Orthorexia nervosa versus anorexia nervosa: Comparison of diagnostic and behavioral features in at-risk young adults. Appetite, 222. https://doi.org/10.1016/j.appet.2026.108515
Email address for correspondence: jemimahobbs@usf.edu
ABSTRACT. Orthorexia nervosa (ON) has garnered increasing attention as a potential diagnostic entity, yet its nosological status remains unresolved. Given overlapping features between ON and anorexia nervosa (AN)/atypical AN, this study examined the extent to which consensus-based ON diagnostic criteria and distinguishing features of AN/atypical AN were endorsed by college students at risk for one, both, or neither syndrome. Participants (N = 916; 72.5% cisgender women; 73.9% Non-Latino) completed an online survey assessing ON symptoms, AN/atypical AN risk, and related clinical and behavioral features.
The four groups were compared across syndrome features. Approximately 25% of the sample was at risk for AN/atypical AN, ON, or both syndromes. Individuals at risk for ON endorsed fewer body-related concerns compared to those at risk for AN/atypical AN, yet did not differ on dietary restriction, health anxiety, wellbeing, gender, or body mass index. Dietary patterns likewise largely overlapped across at-risk ON and AN/atypical AN groups, with effect sizes generally among the smallest observed.
Findings indicate that ON may represent a non-fat-phobic or denial-based presentation of AN/atypical AN rather than a distinct syndrome, suggesting the utility of conceptualizing restrictive eating disorders along a spectrum of presentation and severity.
11. Kim, J. O., An, Z., Kim, M., & Kim, Y. R. (2025). Clinical characteristics and personality traits of pediatric and adult patients with avoidant/restrictive food intake disorder and anorexia nervosa-restricting type. Psychiatry Investigations, 22(12), 1379-1388. https://doi.org/10.30773/pi.2025.0038
Full text available for download at: https://tinyurl.com/2mswtr2y
ABSTRACT. Objective: This study investigated the clinical features and personality traits of pediatric and adult patients with avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa-restricting type (RAN) in a Korean hospital cohort, and the distinct characteristics of ARFID in a non-Western sample.
Methods: This retrospective cohort study included 392 Korean outpatients with ARFID (n = 68) or RAN (n = 324) at an eating disorders clinic. Clinical characteristics including eating and general psychopathology, and personality traits based on the five-factor model and behavior inhibition/activation systems were assessed. The eating and general psychopathology and personality traits of pediatric and adult patients with ARFID were retrospectively investigated alongside those of pediatric and adult RAN patients.
Results: Patients with ARFID had an earlier onset age, a longer illness duration, and lower levels of eating and general psychopathology compared to those with RAN. ARFID patients also reported lower levels of neuroticism and behavioral inhibition. Pediatric ARFID patients showed less severe general psychopathology than adult patients with ARFID, while personality traits were consistent across age groups. However, pediatric RAN patients demonstrated higher dietary restraint and lower levels of general psychopathology compared to adult patients.
Conclusion: This study highlights distinct psychopathology and personality traits between ARFID and RAN. These findings emphasize the importance of age-specific interventions for ARFID. Compared to pediatric patients, adult patients with ARFID require interventions targeting psychological difficulties. The results underscore the need to improve recognition of ARFID in Korea.