Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 264: (i) Dietary Restriction & FA; (ii) Professional Educat; (iii) Family, Part 1 (n = 2); (iv) Soc Media, Part 1 (n = 3); (v) Binge Eating, Part 1 (n = 2); and (vi) Comorbidity, Part 2 (n = 3)
Colleagues (N now = 1458 in 49 countries),
ML NOTE 1: I have, due my hiatus in Connecticut recently, a backlog of requests for assistance in research recruitment and participation, as well as many other items (e.g., Podcasts) to share that are not research articles. I will send them out as soon as I am able, given space limitations.
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.
REQUEST FOR RESEARCH PARTICIPATION BY AND/OR ASSISTANCE RECRUITING
(Minimum eligibility requirements) U.S. Residents Ages 18 or older who have
Expertise in the Treatment of Eating Disorders in one or more of the following areas: clinical practice, education/training, research, and/or advocacy.
from our own Dr. Taylor Irvine, Department of Counseling at Nova Southeastern University
for a study (ML, paraphrasing, has) entitled
Revisiting and Revising Existing Eating Disorder Psychotherapy Competencies
Received 22 April 2026 via an everything-is-advocacy email from our own Dr. Taylor Irvine (USA), on behalf of her colleagues, our own Dr. Adriana Labarta (USA) and Dr. Jennifer Hightower.
ML NOTE 2: Drs. Irvine, Labarta, and Hightower and I would appreciate it if you would (a) participate in this study if eligible; and/or (b) pass this request along to any and all who might be interested in participating in this survey and qualified to do so, or who work or otherwise know with such people.
If you have questions or concerns, contact Dr. Taylor J. Irvine (she/her), Ph.D., LMHC, NCC, ACS | Assistant Professor, Department of Counseling | Nova Southeastern University | ti48@nova.edu | (954) 262-5742
[Dr. Irvine writes:]
Dear colleagues,
We are excited to invite you to participate in an important research study aimed at revisiting and revising existing eating disorder psychotherapy competencies (Williams & Haverkamp, 2010) using a Q-sort method. This study has received IRB approval NSU IRB Protocol #2025-406).
The purpose of this study is to better understand which psychotherapy competencies clinicians consider most important when working with individuals experiencing eating disorder concerns. Your professional insight is essential to this effort and will help inform the development of more effective clinical training and treatment practices.
To participate in this survey, please see the minimum eligibility criteria below: [1] At least 18 years of age or older; [2] Reside in the United States; and [3] Have expertise in the treatment of eating disorders in one or more of the following areas: clinical practice, education/training, research, and/or advocacy.
What participation involves:
The study consists of two parts:
A Qualtrics survey (approx. 5–10 min) including questions about your professional background and perspectives on providing psychotherapy to individuals with eating disorders.
A Q-sort task (approx. 45 min) where you will be presented with a list of psychotherapy competencies. You will be asked to sort these from least to most important based on your professional perspective and clinical experience.
To participate, please use the following link:
https://novapsy.sjc1.qualtrics.com/jfe/form/SV_9tMtfyOMjBCvTcW
Your participation in this study is completely voluntary, and you may refuse to answer any questions or stop your participation at any time. Rest assured that your information will be kept confidential, and no personally identifiable information will be collected!
If you have any questions or concerns, please don’t hesitate to contact the research team at ti48@nova.edu. We are more than happy to provide you with any additional information you may need. Thank you for considering this invitation and for your potential contribution to this important research!
Dr. Taylor Irvine – Principal Investigator | Dr. Adriana Labarta – Co-Investigator | Dr. Jennifer Hightower – Co-Investigator
REQUEST FOR RESEARCH PARTICIPATION BY AND/OR ASSISTANCE RECRUITING
Researchers with Expertise in Mental Health and School-Based interventions, Living in the UK
from our own soon-to-be Dr. Mia Morgan (England) and Dr. Melissa Atkinson (England) at the University of Bath
for a study [ML, freely paraphrasing, has] entitled
A Delphi Study to Clarify Priorities for School-Based Digital Microinterventions Aimed at Reducing Mental Health (anxiety, depression, disordered eating) Risk in Teenagers
Received 23 April 2026 via an everything-is-advocacy email from our own soon-to-be Dr. Mia Morgan (England) who will be doing her postdoctoral research at the University of Bath under the direction of our own Dr. Melissa Atkinson (England), Department of Psychology/Bath Centre for Mindfulness and Compassion.
ML NOTE 3: Mia, Dr. Atkinson, and I would appreciate it if you would pass this request along to any and all people in the UK who are qualified, as well as to anyone you know who supervises, collaborates with, or otherwise works with people in the UK who are qualified.
A Delphi Study to Clarify Priorities for School-Based Digital Microinterventions Aimed at Reducing Mental Health (anxiety, depression, disordered eating) Risk in Teenagers
Are you a researcher with expertise in mental health and school-based interventions, living in the UK? Would you like to share your views on what should be prioritised in school-based digital microinterventions aimed at reducing mental health (anxiety, depression, disordered eating) risk in teenagers?
If so, please consider taking part in our Delphi study! Participation will involve completing two or three separate separate online surveys, spaced approx. 2–3 weeks apart. Each will take approx. 30 mins to complete. Surveys will ask you to:
a) Rate the importance of targeting different transdiagnostic risk factors in these digital microinterventions, and
b) Rate the importance of including different features (engagement and delivery methods) in these microinterventions, and
c) Rate the importance of different factors in influencing student engagement in the digital support tools
Findings from this study will help researchers at the University of Bath create a set of digital microinterventions (made available through secondary schools)!
We don’t expect there to be any disadvantages to taking part. However, some of the questions could feel sensitive. Support information will be given at the end of every survey, and you can stop the survey at any time. You’ll receive a small compensation for your time.
If you are interested in taking part and would like to find out more and/or have any questions, then please do not hesitate to email the researchers Mia Morgan and Dr Melissa Atkinson: BOOST@bath.ac.uk
FULL-TIME CLINICAL RESEARCH COORDINATOR POSITION open
in the EMBARK LAB
under our own Dr. Katherine Schaumberg at the University of Texas at Austin
Received 24 April 2026 via an everything-is-advocacy email Ava Heyrman, current Research Coordinator at the EMBARK LAB, which is directed by our own Dr. Katherine Schaumberg (USA), at the University of Texas at Austin.
ML NOTE 4: Ava, Dr. Schaumberg, and I would appreciate it if you would pass this along to anyone who might be qualified and interested. Knowing Dr. Schaumberg’s background and her research/mentoring, I am willing to bet a fair amount of money that experience in this position would position a person very well for admission to a Ph.D. program, for example, in Clinical Psychology.
POSITION: Clinical Research Coordinator for the EMBARK Lab under Dr. Katherine Schaumberg at the University of Texas at Austin.
Coordinator Schedule: Full-time (40 hours/week) | Location: Hybrid (Austin, TX)
Required Qualifications: Bachelor’s Degree required, preferably in Psychology or a related field (e.g. Population Health, Nutrition, Exercise Science) | Preferred Qualifications: Experience with human research subjects preferred; Experience with phlebotomy and blood processing preferred; Experience with data management in R preferred
You can find the full job posting here and the link for applications submission at: https://tinyurl.com/28j84923
Research Publication Categories in This Newsletter
(i) Dietary Restriction and Food Addiction; (ii) Professional Education: Dietitians; (iii) Family, Part 1 (n = 2); (iv) Social Media, Part 1 (n = 3); (v) Binge Eating, Part 1 (n = 2); and (vi) Comorbidity, Part 2 (n = 3)
CONGRATULATIONS to our own
Dr. David Wiss (USA) and colleague for publication of the Dietary Restriction/Food Addiction Theoretical/Review article in #1.
Dr. Nadia Micali (Denmark/England) and colleagues for publication of the Family Factors research article in #3.
Dr. Cheri Levinson (USA) and colleagues for publication of the Family Factors research article in #4.
Drs. Eva Kemps (Australia) and Ivanka Prichard (Australia) and colleague for publication of the Social Media research article in #5.
Dr. Jinbo He (China) and colleagues for publication of the Social Media research article in #6.
Drs. Rachel Rodgers (USA/France), Charlotte Markey (USA), Jacinthe Dion (Canada), Naomi Hayami-Chisuwa (Japan), Hannah White (England), Carolyn Plateau (England), Matthew Fuller-Tyszkiewicz (Australia), and Marita McCabe (Australia) and colleagues for publication of the Social Media research article in #7.
DIETARY RESTRICTION and FOOD ADDICTION
1. Wiss, D. A., & Logan, A. C. (2026). A unified theory of restrictive and addictive eating: a life course model integrating generational transmission, neurodevelopmental risk, and ultra-processed food use disorder—a theoretical review. Journal of Eating Disorders. Advance online publication. https://doi.org/10.1186/s40337-026-01618-6
Full text available for download at: https://tinyurl.com/yty2xfu5
ABSTRACT. Background: Eating disorders (EDs) and ultra-processed food use disorder (UPFUD) have traditionally been examined as separate entities, resulting in ongoing tension between two primary perspectives: (1) dietary restraint as the main driver of loss-of-control eating pathology, and (2) the influence of the contemporary food environment, combined with stressors, as the driver of addiction-like food consumption. Both perspectives acknowledge developmental trauma as a key predisposing factor.
Methods: Drawing from relevant articles in the PubMed, Scopus, PsycINFO, and Google Scholar databases, this theoretical review combines evidence from trauma, neurodevelopmental, eating disorder, and addiction research. Relevant articles are synthesized to propose a unified life course model. The model integrates these perspectives by outlining developmental trajectories that originate from shared risk factors, diverge along distinct pathways, and may ultimately converge into similar behavioral presentations.
Results: The Restrictive Eating Pathway typically progresses from generational trauma through parental symptoms of rigid/disordered eating patterns and/or obsessive-compulsive disorder (OCD) familial traits. In this context, adverse childhood experiences (ACEs) may further influence conditions conducive to dieting and eating disorder (ED) symptoms. This may culminate in pathologically restrictive eating patterns, which may include addictive processes. The Addictive Eating Pathway similarly progresses from generational trauma through parental symptoms of substance use disorders (SUDs) and/or attention-deficit/hyperactivity disorder (ADHD) familial traits. In this context, ACEs may further influence conditions conducive to hedonic eating, which can progress to UPFUD symptoms and other addictive processes, such as SUDs.
Both pathways share generational trauma and ACEs as foundational risk factors. Familial OCD symptoms versus familial ADHD symptoms represent divergent predisposing legacies that can highlight differential risk when parental mental health assessment is available. Individual-level SUD frequently co-occurs in both pathways and, when present, may serve as a point of convergence or crossover, connecting or reflecting trajectories.
Conclusions: This model emphasizes bidirectionality across constructs, conceptualizes eating pathology as a dimensional continuum rather than discrete categories, and acknowledges that individuals may transition between pathways throughout the lifespan. Implications for clinical assessment, treatment planning, prevention strategies, and the emerging fields of precision neurodiversity and metabolic psychiatry are discussed. This framework establishes a foundation for the understanding of mixed restrictive-addictive presentations and offers testable hypotheses for future longitudinal and mechanistic research.
PROFESSIONAL EDUCATION: DIETITIANS
2. Hill, C. A., Rabbering, T., Dann, K. M., Singh, J. K., Moerbeck, M., & Maguire, S. (2026). Essential training for an essential role: Dietitians and eating disorder care. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70115
Full text available for download at: https://tinyurl.com/5n7x95cb
ABSTRACT. Aims: Dietitians are critical members of the multidisciplinary eating disorder treatment team. Dietitians frequently encounter clients with undiagnosed or undisclosed eating disorders; however, many graduate dietitians lack specialised eating disorder training. This study evaluates the effectiveness of the Dietitian Essentials eLearning program to increase dietitians’ self-reported knowledge, skills, and confidence to treat clients with eating disorders.
Methods: Health professionals (N = 613) consented to participate in the evaluation between January 2019 and March 2025. Change in self-reported pre- and post-training knowledge, skills, confidence, and willingness to treat eating disorders were analysed using paired-sample t-tests (N = 438), and differences by remoteness of work setting and years of eating disorder clinical experience were assessed with repeated measures ANOVA. Feedback on program feasibility, acceptability, and most and least helpful aspects of the course were collected.
Results: Participants were mostly dietitians working in generalist settings with less than 2 years of experience working with eating disorders, however 80% reported they were currently treating clients with eating disorders. Large post-training improvements (Cohen’s d = 0.9–1.7) were observed across all learning outcomes, with the largest gains for treatment-specific knowledge and professional issues. Dietitians with the least eating disorder clinical experience showed the greatest improvements.
Discussion: Dietitian Essentials meets a critical workforce training gap for dietitians by providing dietitian-specific eating disorder training which is essential to safe clinical practice. Dietitians are often the first responders for eating disorder care−equipping community dietitians with core competencies may facilitate earlier identification and contribute to minimising harm and improving outcomes for this at-risk population.
FAMILY FACTORS, Part 1 of 2
3. Aicoboaie, S., Borsarini, B., Pappaianni, E., Konstantopoulou, S., & Micali, N. (2026). Characterising the psychopathological profile of children at high-risk for eating disorders. European Child & Adolescent Psychiatry. Advance online publication. https://doi.org/10.1007/s00787-026-03005-7
Full text available for download at: https://tinyurl.com/5n7my89z
ABSTRACT. Children at familial high-risk (FHR) for eating disorders (EDs), i.e. born to mothers with EDs, are at increased risk of psychiatric morbidity, especially emotional and behavioural disorders. However, less is known about broader psychopathology and specific effects of maternal diagnoses. This study aimed to characterise the psychopathological profile of children at FHR for EDs, compared to healthy children at no familial risk (HC, i.e., with a mother with no ED).
Sixty (60) children at FHR (median age 10; range = 7) and 63 HC (median age 12; range = 4) were assessed for psychopathology using the Development and Well-Being Assessment, the State and Trait Anxiety Inventory, the Strength and Difficulties Questionnaire and the Social Aptitude Scale respectively. Children at FHR exhibited more psychiatric disorders than HC (p = .02 and p = .01 respectively). Children at FHR showed more emotional disorders (p = .01) and overall more mental health difficulties, with elevated levels of emotional symptoms (p < .001), hyperactivity/inattention (p = .04), and peer relationship problems (p =. 004). However, no significant differences were observed between groups in terms of state/trait anxiety. Moreover, post-pubertal development was associated with higher emotional distress and higher state anxiety levels than pre-pubertal development.
Children at FHR are at increased risk of developing psychiatric disorders and psychopathology, especially in the emotional domain. Puberty may also be a critical window of risk for this group. Our findings suggest that children at FHR face an increased psychopathological burden and warrant development of interventions to support them, especially during puberty.
4. Faulkner, L. M., Levinson, C. A., Klein, D. N., & Bufferd, S. J. (2026). Impact of parent lifetime depression and anxiety on youth body dissatisfaction and disordered eating symptoms during adolescence. Behavior Therapy. Advance online publication. https://doi.org/10.1016/j.beth.2026.01.005
Email address for correspondence: loie.faulkner@louisville.edu
ABSTRACT. Eating disorders (ED) are dangerous psychiatric conditions that can emerge in youth. In previous work, child psychopathology increased risk for elevated body dissatisfaction and ED. Although parent psychopathology contributes to a range of psychological disorders, it has not yet been tested as a risk factor for youth body dissatisfaction and ED symptoms.
The current prospective study tested whether lifetime parent anxiety and depression (measured when the child was ages 3 and 9) predicted adolescent body dissatisfaction at age 12 and 15 and symptoms of anorexia nervosa (AN) or bulimia nervosa (BN) at age 15 in a community sample of youth. We also examined whether child psychopathology at age 3 or 6 (anxiety, depression, and oppositional defiant disorder [ODD]) moderated, and body dissatisfaction mediated, these relationships.
Maternal anxiety and depression predicted youth body dissatisfaction at age 12, and maternal and paternal depression predicted youth body dissatisfaction at age 15. Preregistered moderation and mediation analyses (https://osf.io/s8a6y) identified that child ODD moderated relationships between maternal anxiety and youth AN symptoms at age 15 and between paternal anxiety and youth body dissatisfaction at age 12. In addition, youth body dissatisfaction at age 12 mediated relationships between both maternal anxiety and depression and youth AN symptoms at age 15.
The present study demonstrates additional vulnerability factors in early childhood that may increase risk for the development of body dissatisfaction and ED symptoms in early and middle adolescence. These data suggest that parent psychopathology should be an area of focus when evaluating early childhood risk factors for EDs.
SOCIAL MEDIA, Part 1 of 3
5. Pryde, S., Kemps, E., & Prichard, I. (2026). The unfiltered truth about social media: Associations between popular platforms and women’s body image. Body Image, 57. https://doi.org/10.1016/j.bodyim.2026.102092
Email address for correspondence: Samantha.pryde@flinders.edu.au
ABSTRACT. Research on the impact of social media on body dissatisfaction reveals inconsistent findings and lacks platform-specific data, particularly for TikTok, Snapchat, and Instagram. This study examined the associations between social media use across different platforms and body image, mood, exercise behaviours, and internalisation of thin and fit appearance ideals. A sample of 282 women aged 17–30 years from Australia completed an online questionnaire about their social media use, body image, mood and exercise behaviours.
Results indicated that greater frequency of social media use significantly correlated with appearance comparison and thin ideal internalisation. Greater frequency of image-based platform use (TikTok, Instagram, Snapchat and YouTube) significantly related to greater appearance comparison, thin ideal internalisation, fit ideal internalisation, and anxiety, but not with body dissatisfaction. By contrast, frequency of text-based platform use (Facebook, X) showed no significant associations.
Following thin-idealised social media content (e.g., fashion, beauty) was associated with greater thin ideal internalisation, whereas following fit-idealised content (e.g., fitspiration) was associated with greater fit ideal internalisation and compulsive exercise. Appearance comparison and thin ideal internalisation mediated associations with individual platform use, whereas thin ideal internalisation and fit ideal internalisation mediated associations with following thin-idealised and fit-idealised social media content. No mediations were found for image-based platform use.
These findings highlight the contributions of social media use and appearance-focussed social media content engagement to negative body image, emphasising the roles of thin and fit ideal internalisation and appearance comparison in shaping women’s perceptions of their bodies and mental health.
6. Feng, J., He, J., Huang, X., Xu, S., & Xu, Y. (2026). Editing selfies, eroding satisfaction: Random-intercept cross-lagged panel analyses of bidirectional links between photo-editing behaviors and body satisfaction in women. Body Image, 57. Advance online publication. https://doi.org/10.1016/j.bodyim.2026.102083
Email address for correspondence: yin.xu@scu.edu.cn
ABSTRACT. Photo-editing is widely used on social media and consistently linked to poorer body satisfaction, yet the directionality and underlying mechanisms of this association remain unclear. To address this gap, we analyzed three-wave longitudinal data collected over one year from 1160 Chinese women (aged 16–43 years). Participants completed measures of photo-editing (frequency and extent), body satisfaction, and relevant covariates (e.g., social media appearance comparisons) at 6-month intervals. We employed random-intercept cross-lagged panel models (RI-CLPMs) to investigate the bidirectional within-person links between photo-editing behaviors and body satisfaction.
The model fit indices were good for both models regarding the frequency and extent of photo-editing behaviors and body satisfaction. The results revealed that increases in both the frequency and extent of photo-editing behaviors consistently predicted subsequent declines in body satisfaction across all time intervals (βs = -0.25 to -0.45 ps <.001; large cross-lagged effects). In contrast, body satisfaction did not predict subsequent photo-editing from T1 to T2 (for frequency, β = -0.04, p = .415; for extent, β = 0.07, p = .176; small cross-lagged effects) but lower body satisfaction at T2 significantly predicted increases in photo-editing behaviors (both frequency and extent) at T3 (βs = -0.15 to -0.21, ps <.001; large cross-lagged effects).
Together, these findings indicate a reinforcing within-person cycle between photo-editing behaviors and body satisfaction, highlighting photo-editing as a potential target for body image interventions.
7. Lo Coco, G., Rodgers, R., Harris, E. A., Markey, C., Sicillia, A., Aimé, A., Dion, J., Salerno, L., Hayami-Chisuwa, N., White, H. J., Plateau, C. R., Granero-Gallegos, A., Maïno, C., Manzoni, G. M., Pietrabissa, G.., Bégin, C., Blackburn, M.-É., Strodl, E., Fuller-Tyszkiewicz, M., & McCabe, M. (2026). Investigating the relation between social media, dating app use and body image dimensions: A cross‐country study. British Journal of Health Psychology, 31(2), e70067. https://doi.org/10.1111/bjhp.70067
Full text available for download at: https://tinyurl.com/y9anebv8
ABSTRACT. Objectives: Social media emphasize appearance ideals, and their use may be associated with body dissatisfaction. To date, however, data on the relationships specific to certain platforms such as dating apps are scarce, as are cross-country comparisons and studies including men. Thus, this study examined the relationship between social media and dating app use and body image among young adults across eight countries and considered gender and country as potential moderators.
Methods: A sample of 5933 young adults (mean age = 21.54 years; 67.6% female) from Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States completed an online survey. Mixed-effects regression models tested the effects of time on social media and dating apps on body image outcomes.
Results: Longer time on social media was associated with lower body satisfaction and body appreciation, and a higher drive for leanness, thin-ideal internalization and appearance comparison. Longer time spent on dating apps was associated with lower body appreciation and appearance comparison, and a higher drive for muscularity. The associations between time spent on social media, dating apps and drive for muscularity were stronger for men than for women. Few variations across countries emerged. Conclusions: Greater social media and dating app use may be related to poor body image and related indicators across countries, particularly among young men.
BINGE EATING, Part 1 of 3
8. Kose, J., Godart, N., Pastorello, A., Huas, C., Rouquette, A., & EpiCov Study Group. (2026). Sex differences in social, health, and lifestyle characteristics associated With binge-eating behaviors: Results from a French national random population-based study. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.70113.
Full text available for download at: https://tinyurl.com/3u7em5sc
ABSTRACT. Objective: To explore sex differences in social, health and lifestyle characteristics associated with binge-eating behaviors in a large population-based study.
Method: This study included 84,995 participants (women 52.1%) aged ≥ 15 years from the French national random population-based EpiCov cohort. We assessed binge-eating (BE) behaviors (No BE; BE without compensatory behavior [BE-]; BE with a compensatory behavior [BE+]) using the Patient Health Questionnaire Eating Disorder module in 2021. After testing interactions between exposures (self-reported social, health and lifestyle characteristics) and sex for BE behaviors, weighted multinomial logistic regressions were performed to explore the associations between exposures and BE behaviors stratified by sex.
Result: The prevalence of BE- and BE+ was higher among women (3.4 [3.2-3.7]% and 1.2 [1.1-1.3]%, respectively) than among men (2.1 [1.9-2.3]% and 0.7 [0.6-0.8]%, respectively). Sex modified the associations that were observed between BE- and poor perceived health status (adjusted odds ratio [95% CI]: men 2.43 [1.90-3.09], women 1.53 [1.29-1.80], interaction p = 0.008), and between BE+ and obesity (vs. normal weight; men 6.15 [3.92-9.64], women 2.15 [1.54-3.01], interaction p = 0.002). No other effect modification of sex was observed.
Discussion: In this large study based on a national random sample from the French general population, the prevalence of binge eating was higher in women than in men. However, the associations between BE- and perceived health status, and between BE+ and obesity, were greater in men than women. The results highlight the need for targeted prevention strategies for BE accounting for sex differences.
9. Melisse, B., Marcic-van Doornik, S. F. W., & van Elburg, A. (2026). Design, implement, sustain: Advancing program-led interventions for binge eating, a narrative review. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70118
Full text available for download at: https://tinyurl.com/zjzypf2k
ABSTRACT. Objective: Most individuals with binge eating never receive treatment, partly due to a lack of specialists and long waitlists. Program-led interventions are scalable, and their therapeutic content and guidance are embedded within the program itself. However, they are not widely implemented in routine care. Strategies are proposed to overcome key barriers, to enhance the implementation, adherence, and reach of program-led interventions in routine care for binge eating. Methods: Recent evidence from a structured keyword-based search on program-led interventions for recurrent binge eating is synthesised, and strategies are proposed to optimise their design, personalisation, and implementation.
Results: Successful implementation of program-led interventions depends on intervention format, support, and user characteristics. Specialist-guided models reduce dropout rates, enhance adherence and acceptance, and support monitoring of adverse events. Brief, personalised digital interventions with synchronised therapist–user contact may reduce dropout probability and increase user and therapist adherence. Training and supervision promote therapist adherence and acceptance within routine care.
Conclusion: Program-led interventions offer scalable, cost-effective care, but require balance between guidance, automation, contextual fit, and scalability. Challenges include resource demands, technological infrastructure, and applicability across diverse populations. Future research should test hybrid and algorithmically guided strategies, assess feasibility, equity, safeguard safety and privacy to support sustainable implementation.
COMORBIDITY, Part 3 of 4
10. Dell’Osso, L., Nardi, B., Pini, S., Massoni, L., Pustynnikova, M., Bonelli, C., Masimetti, G., Cremone, I. M., Della Rocca, B., Fiorillo, A., & Carpita, B. (2026). Borderline personality disorder and eating disorders are characterized by specific patterns of autistic traits, post-traumatic and catatonic symptoms. Eating and Weight Disorders. Advance online publication. https://doi.org/10.1007/s40519-026-01827-7
Full text available for download at: https://tinyurl.com/pbpva46w
ABSTRACT. Purpose: The present study aims to clarify the relationships between autistic traits, post-traumatic symptoms, and catatonic features in individuals with BPD and FED. Specifically, we sought to identify whether distinct patterns of autistic and trauma-related features characterize these conditions and to examine their predictive role in the development of catatonic manifestations.
Methods: 49 subjects with BPD, 55 subjects with FED, specifically anorexia nervosa (AN) or bulimia nervosa (BN)/binge-eating disorder (BED) and 55 non-clinical subjects (NCs) were recruited and assessed with the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Catatonia Spectrum (CS), and the Trauma and Loss Spectrum Self-Report (TALS-SR).
Results: Both FED and BPD groups scored higher on AdAS, CS and TALS-SR than NC, while BPD group scored higher than FED on TALS-SR “Personal Characteristics and Risk Factors” domain. AN significantly differed from BN/BED in specific AdAS and CS domains. A positive correlation among AdAS spectrum, CS and TALS-SR domains was reported. Both AdAS and CS total score were predictors for the inclusion in BPD or FED group, with some specific differences in the predictive role of single domains. For the FED group, only AdAS symptoms predicted greater catatonic symptoms, while for the BPD one, both AdAS and TALS-SR were predictors of greater catatonic features.
Conclusions: Both BPD and FED subjects exhibit more frequent autistic traits, stress-related symptoms, and catatonic manifestations compared to controls, with specific patterns of features associated with each condition. Level of evidence: Level V, Descriptive studies.
11. Kot, E., Skimina, E., Pietras, T., Gromadzka-Ostrowska, J., & Mokros, Ł. (2026). Dietary patterns and emotion dysregulation in borderline personality disorder and eating disorders as a shared mechanism underlying symptom severity. Scientific Reports, 16, 6010. https://doi.org/10.1038/s41598-026-36068-2
Full text available for download at: https://tinyurl.com/mr2xt5b9
ABSTRACT. Borderline personality disorder (BPD) and eating disorders (EDs) are often comorbid and share a core feature of emotion dysregulation (EDys). While diet has been linked to mental health, its relationship with EDys and symptom severity in these groups remains understudied. This study investigated dietary intake in BPD, EDs, and their comorbidity, and examined whether EDys mediates the relationship between diet and symptom severity. Female inpatients with BPD (n = 40), ED (n = 22), and BPD with comorbid ED (BPD + ED; n = 37), along with healthy controls (HCs; n = 37) completed Food Frequency Questionnaire (FFQ-6), Emotion Dysregulation Scale (EDS), and clinical self-report measures.
Dietary patterns differed between groups. Clinical groups consumed sources of omega-3 polyunsaturated fatty acids and Mediterranean diet (MD) foods less frequently than HCs. EDys fully mediated the link between dietary patterns and symptom severity in most models. The mediation was partial when omega-3 intake predicted ED severity in the ED group. Women with BPD and BPD + ED showed poorer diet quality, especially regarding omega-3 and MD-aligned foods. EDys mediated the association between low-quality diet and symptom severity, suggesting a transdiagnostic mechanism. Nutritional interventions may positively influence emotion regulation, thereby reducing the risk of developing and maintaining symptoms of BPD and EDs.
ML NOTE 5: I remain uncertain about sharing the basics of the article described below in #12, and I do under the assumption that those of you who are interested will read/evaluate it critically.
On the one hand, skimming the study suggests the purposes and the methodology are not all that different from many studies in general and many that I have shared in this Newsletter over the years. On the other hand, the following statistics from a non-clinical sample are too large for me to find this study credible:
[From the ABSTRACT] “a notable 22.2% reported a formal diagnosis of BPD. The prevalence of EDs among the participants was found to be 67.9%. The findings revealed that BED was the most prevalent EDs among participants (45.03%), followed by BN at 22.17% . . .”
12. Mansoury, M. M. S., Alsufyani, S. A., & Alghamdi, F. S. (2025). Examining the association among eating disorders and borderline personality disorder: Evidence from youth in Saudi Arabia. Journal of Eating Disorders, 13, 276. https://doi.org/10.1186/s40337-025-01455-z
Full text available for download at: https://tinyurl.com/2zj2yhdy
ABSTRACT. Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition manifest by persistent instability in emotions, relationships, self-perception, and behavior. Eating disorders (EDs) are multifaceted neuropsychiatric conditions involving dysfunctional eating behaviors and psychological impairments, leading to adverse health outcomes and reduced quality of life. They are also associated with some of the highest mortality rates in psychiatry. EDs are typically classified to three main types: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Personality disorders are reflected as potential risk factors in the development of EDs. This study aimed to investigate the association between EDs and BPD among youth in Saudi Arabia.
Methods: A total of 433 participants aged 18–34 were included in this study. The research employed a quantitative, cross-sectional design, conducted between September and November 2024. Data were collected via an online questionnaire comprising three sections: demographic and health-related information, the McLean Screening Instrument (MSI-BPD) for BPD, and the Eating Disorder Questionnaire-Online (EDQ-O) for EDs. The design aimed to validate self-reported BPD symptoms and explore their association with EDs.
Results: The majority of the participants were female and educated Saudi persons who had no chronic illnesses; a notable 22.2% reported a formal diagnosis of BPD. The prevalence of EDs among the participants was found to be 67.9%. The findings revealed that BED was the most prevalent EDs among participants (45.03%), followed by BN at 22.17%, while AN was the least common (0.69%), indicating a higher occurrence of BED in the studied population. MSI-BPD screening results showed that 150 participants (34.64%) tested positive for BPD, with a higher prevalence among females (37.17%) compared to males (18.64%).
A notably higher prevalence of EDs, particularly BED (74.67%) and BN (42.67%), was observed among participants with BPD, while AN remained rare in both groups. Pearson correlation analysis revealed statistically significant correlations (p < 0.01) between BPD and each EDs subtype (AN, BN, and BED), and the overall EDs symptom score. Conclusion: This study indicates a notable comorbidity between BPD and EDs, particularly BED and BN, reinforcing the strong tendency of these disorders to co-occur.