Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 90: (i) Prevention-Related (n = 3); (ii) Potential Risk Factors (N = 2); (iii) Athletes and EDs; (iv) DE, Part 3 (n = 2); and (v) Neurodivergence & EDs, Part 2 (n = 2)
Colleagues (N now = 1242 in 48 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
RECOVERY/SUPPORT-ADVOCACY-IN-ACTION
Free CHAT in THE LIVING ROOM:
MONDAY, November 25, 2024
7:00 p.m. - 8:00 p.m. Eastern | 4:00 p.m. - 5:00 p.m. Pacific
[and once again] featuring
Ms. Hannah Juliano, BS, RYT, Nutritionist
[sitting in for our own] Ms. Sondra Kronberg, MS, RD, CDN, CEDRD (Founder and Host of the Chats Program)
Received 22 November 2025 via a Chats in the Living Room email. from my friend and Bolder Model, our own Ms. Sondra Kronberg
ML NOTE 1: The content of the Morningside Chats email I received was prefaced by the following (bold and CAPS in the original).
PLEASE FORWARD AND OFFER THIS RESOURCE TO PATIENTS & Colleagues to add to their support - it is a completely collegial, non-competitive, non-promotional joint effort by experts.
ML NOTE 2: For information about Ms. Hannah Juliano, BS, RYT, Nutritionist, see, for example, https://www.linkedin.com/in/hannahjuliano/.
ML NOTE 3: For information about previous Chats, various forms of support for recovery and self-care, and other resources that Ms. Kronberg and her staff provide, go to: https://www.chatsinthelivingroom.com/
Professionals across the eating disorder field are coming together to support your recovery, healing, and growth in these challenging times. From the comfort of your home, and anonymously, join us on Zoom for CHATS in THE LIVING ROOM developed and hosted by Sondra Kronberg
Choose Support • Choose Connection • Choose Recovery
FREE! - live on Monday evening 25 November 2025, 7:00 pm ET | 4:00 pm PT
RSVP through by clicking the following to sign up and receive your Zoom invite via email: https://www.chatsinthelivingroom.com/sign-up
JOB OPPORTUNITY
Psychologist Specializing in Eating Disorders at
Phoenix Children’s Hospital
Specialization in pediatric psychology, with specific expertise in eating disorders required.
Received 20 November 2024 via an Academy for Eating Disorders’ “Job Flash” email.
ML NOTE 4: Please pass this along to any and all who might be qualified for and interested in this position, as well as to those who supervise, mentor, and otherwise work with such people.
Description for Psychologist Specializing in Eating Disorders at Phoenix Children’s Hospital
The Division of Psychology, in collaboration with Adolescent Medicine at Phoenix Children’s is seeking a psychologist specializing in eating disorders to join our dedicated team. This position will focus on providing specialized psychological care to children, adolescents, and young adults with eating disorders in an outpatient setting.
Primary Responsibilities:
Conduct comprehensive psychological assessments for youth (and some young adults) with eating disorders.
Provide evidence-based individual and family psychotherapy tailored to the needs of patients and families managing eating disorders.
Collaborate closely with medical colleagues to integrate psychological care into multidisciplinary treatment plans.
Participate actively in multidisciplinary team meetings and rounds to discuss patient progress and treatment planning.
Collaborate with our inpatient medical teams to ensure continuity/coordination of care following medical stabilization.
Contribute to the development and implementation of psychosocial programs within the Eating Disorders Clinic to enhance patient and family support.
Additional responsibilities:
Supervise psychology trainees within our APA-Accredited Psychology Doctoral Internship Program, with a focus on pediatric psychology.
Engage in clinical research activities related to eating disorders, contributing to the advancement of treatment approaches and outcomes.
Participate in the education of medical residents and fellows, fostering a collaborative learning environment.
Maintain active involvement in professional development activities, including conferences, workshops, and continuing education opportunities.
Qualifications: Doctoral degree (Ph.D. or Psy.D.) in Clinical Psychology or related field.
Specialization in pediatric psychology, with specific expertise in eating disorders required.
ABPP certification or eligibility preferred.
Proven ability to collaborate effectively with medical professionals and multidisciplinary teams.
Strong communication skills and a commitment to patient advocacy and family-centered care.
Demonstrated commitment to clinical excellence, diversity, and inclusion.
Certification in evidence-based interventions for eating disorders, such as FBT.
Preferred Skills: Experience in program development and enhancement of psychosocial support services | Proficiency in Spanish is advantageous | Experience with other evidence-based psychological interventions, such as DBT or ACT.
Benefits: Competitive compensation package | Comprehensive benefits including retirement contributions, vacation, CME funds, health, dental, disability, and life insurance | Opportunities for academic appointment through affiliations with University of Arizona-Phoenix College of Medicine, Creighton University School of Medicine, and Mayo School of Medicine.
Location: Enjoy living in the vibrant Phoenix Valley area with year-round sunshine and diverse recreational activities.
Application Process: Interested candidates should visit https://careers.phoenixchildrens.com/Positions/Posting/862949 to apply.
For questions and inquiries, please contact David Blaha (Provider Talent Acquisition Partner, Phoenix Children’s): dblaha@phoenixchildrens.com
Job ID: 74779521
Research Publication Categories in This Newsletter
(i) Prevention-Related (n = 3); (ii) Potential Risk Factors (n = 2); (iii) Sports, Athletes, and Disordered Eating; (iv) Disordered Eating, Part 3 (n = 2); and (v) Neurodivergence and Eating Disorders, Part 2 (n = 2)
CONGRATULATIONS to our own
Ms. Jade Portingale (Australia) and, Dr. Isabel Krug (Australia) and colleague for publication of the Potential Risk Factor research article in #4.
Drs. Phillipa Hay (Australia) and Deborah Mitchison (Australia) and colleagues for publication of the Sports, Athletes, and Disordered Eating research article in #6.
Dr. Mitchell Cunningham (Australia) — and CONGRATULATIONS (!) DR. Mitchell for completing your Ph.D. in Clinical Psychology at the University of Sydney — and colleagues for publication of the Disordered Eating research article in #8.
Dr. Cynthia Bulik (USA/Sweden) and colleagues for publication of the Neurodivergence and Eating Disorders article in #9.
Dr. Helen Sharpe (Scotland) and colleagues, including distinguished scientist-practitioner-mentor Dr. Kate Tchanturia, for publication of the Neurodivergence and Eating Disorders article in #10.
Prevention-Related
1. Zhao, W., Liu, X., Deng, Y., & Wu, A. M. S. (2024). The effect and mechanism of acceptance and commitment therapy for young adults’ appearance-based rejection sensitivity and social comparison based on appearances: A randomized controlled trial. Journal of Contextual Behavioral Science. Advance online publication. https://doi.org/10.1016/j.jcbs.2024.100848
Email address for correspondence: wenzhao@swust.edu.cn
ABSTRACT. This study tested the effect and mechanism of acceptance and commitment therapy (ACT) on young adults’ appearance-based rejection sensitivity (ARS) and social comparison based on appearance (SCBA). A sample of 190 university students (Mage = 18.35, SD = 0.78; 56.62% female) was randomly assigned to either the ACT group (n = 94) or an active control group (n = 96), which focused on interpersonal discussions about experiences of appearance-based rejection. Participants completed six weekly group interventions, as well as three surveys: a baseline assessment before the intervention (T1), a post-test immediately after the intervention (T2), and a 3-month follow-up (T3).
Clinically significant decreases in ARS and SCBA were observed in the ACT group from baseline to both the post-test and follow-up. Comparisons at each phase indicated that the ACT group outperformed the control group in reducing ARS and SCBA, as well as in improving psychological inflexibility and cognitive fusion. Furthermore, the parallel mediation models supported the mediating roles of psychological inflexibility and cognitive fusion between the ACT intervention and ARS/SCBA. These findings suggest that ACT is effective in reducing ARS and SCBA by improving psychological inflexibility and cognitive fusion. Future research should further explore the effects and mechanisms of ACT on ARS and its related constructs using diversified samples and multiple long-term follow-ups.
2. Westrupp, E. M. (2024). The case for participant payments in mental health prevention research. Mental Health & Prevention. Advance online publication. https://doi.org/10.1016/j.mhp.2024.200373
Email address for correspondence: elizabeth.westrupp@deakin.edu.au
ABSTRACT. [none]
3. de Stigter, R. W.–., Nelen, W., Delsing, M., de Berk, A., Koojmans, R., Offerman, E., Asselman, M., Nijhof, K., Lindauers, R., & Helmond, P. (2024). Implementing a school-wide trauma-informed education approach: An evaluation of student-outcomes during the first year of implementation. Journal of Child and Adolescent Trauma. Advance online publication. https://doi.org/10.1007/s40653-024-00663-0
Email address for correspondence: rianne.destigter@youz.nl
ABSTRACT. Trauma-informed education is an internationally and widely adopted approach to support traumatized students in their needs in schools. In this two-year longitudinal pre-posttest design study, the outcomes of a school-wide trauma-informed approach during a baseline year and first year of implementation in two regular primary and six special primary and secondary schools were examined with six measurement waves. We examined students’ perception of school class climate, more specifically class atmosphere, quality of student relationships, quality of teacher-student alliance and order in the classroom. In addition, we examined posttraumatic stress symptoms, internalizing, externalizing, attention and total behavioral problems, executive functioning, and resilience.
Results of the piecewise latent growth curve models showed more positive scores for atmosphere in the classroom and resilience at the end of the first implementation year compared to the end of the baseline year. In addition, there was an increase in youth-reported classroom atmosphere during the implementation year. After the first year of implementing the trauma-informed educational approach initial modest positive outcomes begin to emerge.
Potential Risk Factors
4. Portingale, J., Krug, I., & Butler, D. (2024). Beyond body image: Self-face recognition and negative self-face evaluations in women at high risk for an eating disorder. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.3150
Email address for correspondence: jade.portingale@unimelb.edu.au
ABSTRACT. Background: Although one's face represents a core aspect of one's physical appearance, it remains underexplored in eating disorder (ED) populations. Aims: The current study examined whether self-face recognition accuracy and evaluations differ in those at high (vs. low) ED risk. We also explored whether recognition accuracy and evaluations are related, and whether this relationship is moderated by ED risk status.
Materials & Methods: Participants included 222 women of East/Southeast Asian (61%) and Caucasian (39%) ethnicity, stratified into low-ED-risk (n = 124) and high-ED-risk (n = 98). Participants completed measures of self-face recognition accuracy (difficulty recognizing their face and sensitivity to seeing their facial image) and evaluations (including perceived facial adiposity and attractiveness, and head dissatisfaction).
Results: Partially consistent with hypotheses, regression analyses revealed that participants at high (vs. low) risk showed poorer self-face recognition accuracy (greater difficulty) and more negative self-face evaluations (higher perceived adiposity, lower perceived attractiveness, greater head dissatisfaction). However, ED risk was not significantly associated with self-face recognition sensitivity. Inconsistent with expectations, whilst greater self-face recognition difficulty was associated with more negative self-face evaluations, ED risk failed to moderate such effects. Discussion & Conclusion: Findings suggest the potential value of considering face and body image disturbances in ED research and interventions. Further research is encouraged.
5. Dahlin, K., Järvholm, K., Rydberg Dobrescu, S., Dahlgren, J., & Wentz, E. (2024). Neuropsychological profile in young girls at high risk of developing anorexia nervosa. European Eating Disorders Review. Advance online publication.
Full text available for download at: https://onlinelibrary.wiley.com/doi/full/10.1002/erv.3151
ABSTRACT. Objective: Previous research has shown anorexia nervosa (AN) to be associated with a specific neuropsychological profile, including set-shifting and central coherence deviances. A similar profile has been shown in adult unaffected relatives. The aim of this study was to examine whether poor set-shifting and central coherence abilities could be detected in children at high risk of developing AN.
Method: Twenty-eight biological healthy daughters of women with previous or current AN and 42 biological daughters of healthy women, all between six and 12 years of age, participated in the study. A neuropsychological test battery (Wechsler Intelligence Scale for Children, Wisconsin Card Sorting Test, Trail Making Test and Rey Complex Figure Test) was used to assess set-shifting and central coherence abilities.
Results: No differences in set-shifting or central coherence performance were detected between the high-risk group and the comparison group. Adjustments for age and intelligence quotient (IQ) did not affect the results. Conclusions: Our results did not support the notion of preexisting neuropsychological deficits in AN-related cognitive domains among high-risk girls.
Sports, Athletes, and Disordered Eating
6. Fatt, S. J., George, E., Hay, P., Jeacocke, N., & Mitchison, D. (2024). Comparing population-general and sport-specific correlates of disordered eating amongst elite athletes: A cross-sectional study. Sports Medicine - Open, 10, 123. https://doi.org/10.1186/s40798-024-00791-9
Full text available for download at: https://tinyurl.com/2rxypnmm
ABSTRACT. Background: Despite the high prevalence of disordered eating and eating disorders amongst elite athletes, it remains unclear whether risk factors and psychological processes align with those in the general population or if there are unique sport-factors associated with heightened risk. This cross-sectional study investigated if sport-specific factors (including pressures and psychological processes) explained additional variance in elite athletes’ disordered eating symptoms, controlling for established population-general risk factors.
Current elite athletes (N = 178, 72.4% female, mean age = 23.9, standard deviation age = 7.0) completed online surveys assessing disordered eating, body dissatisfaction, perfectionistic traits, population-general and sport-specific pressures, as well as general (thin-ideal, muscular-ideal) and athlete-specific (drive for leanness for performance, athletic identity) psychological processes.
Results: Disordered eating was highly prevalent, with 78.2% of athletes reporting at least moderate risk, 46.4% at least high risk, and 20.6% very high risk. Controlling for demographic covariates and population-general pressures, sport-specific pressures explained significant additional variance (13.5%) in disordered eating. Even when controlling for perfectionistic traits, greater weight pressures in sport (β = .35) was uniquely associated with greater disordered eating.
In a separate multivariate analysis controlling for covariates and general psychological processes, athlete-specific psychological processes explained significant additional variance (15.5%) in disordered eating. Even when controlling for body dissatisfaction, greater drive for leanness for performance (β = .17) and athletic identity (β = .13) were uniquely associated with greater disordered eating.
Conclusions: These findings support evidence that elite athletes may experience dual pressures and psychological processes associated with disordered eating: those congruent with appearance-oriented models and others independent of appearance. This duality should be considered in the modification of interventions for disordered eating in elite athletes.
Key points
Disordered eating was highly prevalent in a sample of 178 elite adult athletes, with 78.2% reporting at least moderate risk for having related symptoms or behaviours.
Greater weight pressures in sport was significantly associated with greater disordered eating, even when controlling for demographic covariates and population-general appearance-related pressures from family and the media.
Both appearance-based (drive for thinness, body dissatisfaction) and non-appearance (drive for leanness for performance, athletic identity) psychological processes were uniquely associated with greater disordered eating.
Disordered Eating, Part 3 of now 4
7. Pereira, R., Araújo, J., Severo, M., Ramos, E., & Oliveira, A. (2024). Disordered eating profiles in adolescence to early adulthood and future cardiometabolic health. Pediatrics. Advance online publication. https://doi.org/10.1542/peds.2024-066076
Email address for correspondence: acmatos@ispup.up.pt
ABSTRACT. Background and Objectives: Evidence is scarce on the clustering patterns of disordered eating dimensionsor symptoms and their effects on future cardiometabolic health. This study examines associations of disordered eating trajectory profiles (from 13 to 21 years), with BMI and related cardiometabolic features at ages 21, 24 and 27.
Methods: Participants are from the Epidemiological Health Investigation of Teenagers cohort (Porto, Portugal). At 13, 17 and 21 years, 3 Eating Disorder Inventory subscales were assessed (drive for thinness, bulimia and body dissatisfaction), and a latent class analysis derived trajectory profiles. Associations with BMI and having ≥1 metabolic syndrome feature at 21 (n = 1619), 24 (n = 916) and 27 years (n = 720) were tested using generalized linear models and binary logistic regressions.
Results: The following 4 profiles were obtained: “higher” levels (highest severity of symptoms at all ages, 16-19%), “increasing” (especially of body concerns, 26-28%), “decreasing” (18-19%), and “lower” (highest proportion of individuals with low/without disordered eating, 35-37%). Compared with the lower levels profile, both sexes with higher and increasing disordered eating presented heightened BMI at 21, 24 and 27 years. Women in the higher levels profile had higher odds of having ≥1 metabolic syndrome feature at 21 and 24 years, while men with higher and increasing disordered eating presented increased odds at 21, 24 and 27 years.
Conclusions: Individuals, particularly males, with higher or increasing disordered eating levels from 13 to 21 years of age presented a higher risk of worsened cardiometabolic health up to 6 years later in adulthood.
8. Mazaraki, J., Bussey, K., Cunningham, M., Jewell, T., & Trompeter, N. (2024). Muscularity-oriented disordered eating: Investigating body image concerns and the moderating role of emotion dysregulation in cyclists. Journal of Eating Disorders, 12, 189. https://doi.org/10.1186/s40337-024-01109-6
Full text available for download at: https://tinyurl.com/bd6a9hu5
ABSTRACT. A lean muscular body of low weight is often associated with performance for cyclists and can be difficult to achieve. Disordered eating for some cyclists may develop in the pursuit of lean muscularity which is perceived to be beneficial to performance. Further, emotion dysregulation may exacerbate negative feelings about body image, increasing the risk of developing disordered eating as a means of controlling weight and shape. While research in athlete populations has been substantial, disordered eating in cyclists is relatively under-explored.
The current study examined whether shape and weight concern and drive for leanness were associated with muscularity-oriented disordered eating and whether these relationships were moderated by emotion dysregulation. Interactions between these factors were also investigated. Participants were 139 Australian competitive cyclists (112 males, 27 females, aged 18–68 years) who completed a self-report questionnaire comprised of measures of shape and weight concern, drive for leanness, muscularity-oriented eating and emotion dysregulation variables.
Both shape and weight concern and drive for leanness had a unique association with muscularity-oriented disordered eating. Emotion dysregulation was found to have a unique association with muscularity-oriented disordered eating when controlling for drive for leanness, but not when shape and weight concern was controlled. Additionally, emotion dysregulation moderated the association between shape and weight concern and muscularity-oriented disordered eating, whereby the relationship was intensified at higher levels of emotion dysregulation.
Our study has extended the literature by indicating that cyclists’ desire to attain a lean body is associated with muscularity-oriented disordered eating. Further, emotion dysregulation moderated this link, suggesting it could be a maintaining factor worth addressing.
Plain English Summary: Disordered eating is prevalent among athletes, especially those competing in endurance sports such as cycling. This study explored the relationship between body image concerns, emotion dysregulation and muscularity-oriented disordered eating (e.g., protein consumption and compensatory exercise) in cyclists. Results highlight how body dissatisfaction for cyclists is associated with the engagement of muscularity-oriented disordered eating. Additionally, the link between body image and muscularity-oriented disordered eating may be more pronounced amongst cyclists with higher emotion dysregulation.
Neurodivergence and Eating Disorders, Part 2 of 2
9. Christiansen, G. B., Petersen, L. V., Chatwin, H., Yilmaz, Z., Schendel, D., Bulik, C. M., Grove, J., Brikell, I., Semark, B. D., Holde, K., Abdulkadir, M., Hübel, C., Albiñana, C., Vilhjálmsson, B. J., Børglum, A. D., Demontis, D., Mortensen, P. B., & Børglum, J. T. (2024). The role of co-occurring conditions and genetics in the associations of eating disorders with attention-deficit/hyperactivity disorder and autism spectrum disorder. Molecular Psychiatry. Advance online publication. https://doi.org/10.1038/s41380-024-02825-w
Full text available for download at: https://www.nature.com/articles/s41380-024-02825-w#citeas
ABSTRACT. Eating disorders (EDs) commonly co-occur with other psychiatric and neurodevelopmental disorders including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); however, the pattern of family history and genetic overlap among them requires clarification. This study investigated the diagnostic, familial, and genetic associations of EDs with ADHD and ASD.
The nationwide population-based cohort study included all individuals born in Denmark, 1981–2008, linked to their siblings and cousins. Cox regression was used to estimate associations between EDs and ADHD or ASD, and mediation analysis was used to assess the effects of intermediate mood or anxiety disorders. Polygenic scores (PGSs) were used to investigate the genetic association between anorexia nervosa (AN) and ADHD or ASD.
Significantly increased risk for any ED was observed following an ADHD or ASD diagnosis. Mediation analysis suggested that intermediate mood or anxiety disorders could account for 44%–100% of the association between ADHD or ASD and ED. Individuals with a full sibling or maternal half sibling with ASD had increased risk of AN compared to those with siblings without ASD. A positive association was found between ASD-PGS and AN risk whereas a negative association was found between AN-PGS and ADHD.
In this study, positive phenotypic associations between EDs and ADHD or ASD, mediation by mood or anxiety disorder, and genetic associations between ASD-PGS and AN and between AN-PGS and ADHD were observed. These findings could guide future research in the development of new treatments that can mitigate the development of EDs among individuals with ADHD or ASD.
10. Nimbley, E., Sharpe, H., Maloney, E., Gillespie-Smith, K., Tchanturia, K., & Duffy, F. (2024). A mixed method systematic review into the impact of ED treatment in autistic people and those with high autistic traits. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24311
Full text available for download at: https://onlinelibrary.wiley.com/doi/full/10.1002/eat.24311
ABSTRACT. Objective: Our understanding of the impact of eating disorders (ED) treatment in Autistic people remains elusive. Research has begun to explore ED treatment outcomes and experiences in this population, however current understandings are poorly integrated. The current review therefore sought to explore the impact of ED treatment on Autistic people and those with higher Autistic traits. Method: A convergent, segregated approach was used, independently evaluating quantitative then qualitative studies before integrating findings into a coherent narrative synthesis.
Results: Autistic people and people with higher Autistic traits report poorer experiences of treatment and may be at increased risk of inpatient admission and prolonged inpatient treatment, possibly explained by difficulties with treatment timeframes and a lack of autism-informed support. Both groups reported similar improvements in ED symptoms and BMI. Higher rates of psychosocial difficulties pre-and post-treatment were reported in those with higher Autistic traits, and emotion-focused interventions were felt to be particularly relevant to Autistic presentations of EDs. Concerns were reported as to how well aligned group-based programs and cognitive-based interventions are for Autistic individuals and those reporting higher Autistic traits.
Discussion: Future research in diagnosed autism samples is urgently needed to develop a more robust understanding of Autistic outcomes and experiences. Review findings demonstrate the need for increased understanding of ED presentations and the possible need for treatment adaptations, for Autistic people or those with higher Autistic traits.