Objective: Loss of control (LOC) eating is a salient indicator of eating disorder psychopathology in adolescents and is associated with marked distress. While research has focused on the relevance of episode size, clinical significance of LOC eating frequency has rarely been explored. Therefore, this study aimed at identifying LOC eating prevalence with respect to its recurrence and associated variables in a community-based sample. Method: Participants were 1643 adolescents, aged 12-20 years (62.4% female). Based on EDE-Q self-report, participants were categorized as those reporting recurrent (N = 156; 9.5%), non-recurrent (N = 226; 13.8%) and no LOC eating (N = 1261; 76.7%). Results: Adolescents with recurrent LOC eating reported clinically relevant and significantly greater eating disorder psychopathology, functional impairment and distress because of LOC eating, and a significantly higher body mass index (BMI, kg/m2) than adolescents with non-recurrent and those without LOC eating. Discussion: These results underline that LOC eating is a common eating behavior among adolescents in the community associated with clinical characteristics of eating disorders, and could therefore be a risk factor for developing full- or partial-syndrome eating disorders. Further research on the classification of eating disorders in adolescents with LOC eating and severity indicators is warranted.

A sizeable body of research has documented Expressed Emotion (EE) to predict clinical outcomes in various psychiatric disorders, including eating disorders. Patients’ perceptions of relative’s EE, however, were found to play an important role in the processing of EE. This study aimed to examine the level of perceived EE in adolescent binge-eating disorder (BED) and its impact on eating disorder psychopathology. Adolescents (12 – 20 years) seeking treatment for BED (n = 40) were compared to adolescents without current or lifetime eating disorder (CG; n = 40). Both groups were stratified according to age, sex, body mass index (BMI, kg/m2), and socio-economic status. The Five Minute Speech Sample (FMSS) and the Brief Dyadic Scale of EE were administered to assess patients’ perceived maternal EE. Additionally, adolescents and mothers completed questionnaires on eating disorder and general psychopathology. On the FMSS, 37.5% of patients with BED perceived their mothers as high EE (vs. 12.5% in the CG). On the Brief Dyadic Scale of EE, patients with BED reported significantly higher levels of perceived maternal criticism, emotional overinvolvement, and lower levels of perceived warmth than controls. After controlling for the diagnosis of BED, perceived criticism and warmth, as assessed by questionnaire, significantly explained adolescents’ global eating disorder psychopathology. Negative perceptions of maternal behavior and emotional atmosphere towards the child are characteristic of adolescent BED. As documented for other eating disorders, family factors are likely to have substantial implications for the maintenance and treatment of adolescent BED.

Background: Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Objectives: This study sought to investigate the prevalence of BED and NES and associations with various forms of non-normative eating behavior and psychopathology in prebariatric patients. Setting: Within a consecutive multicenter registry study, patients in six bariatric surgery centers in Germany were recruited. Methods: Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures. Results: Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Comorbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED. Conclusions: BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with non-normative eating behavior and psychopathology point to their clinical significance and discriminant validity.

Objective: Emerging prospective evidence from mixed samples, mostly covering short-term follow-up periods, suggests that childhood loss of control (LOC) eating predicts significant impairment in mental and physical health. This study sought to investigate the natural course of childhood LOC eating over the long term and in relation to binge eating disorder (BED) diagnosis, psychopathology, and body weight trajectory in the community. Method: A total of 60 children (8-13 years) with LOC eating within the past three months and 60 demographically-matched children without LOC history were assessed with the Eating Disorder Examination adapted for Children and self-report questionnaires over a 5.5 year follow-up period. Missing data were imputed. Results: Over follow-up, 38.3% of children showed persistent LOC eating, and 28.3% revealed an onset of LOC eating. Persistent LOC eating significantly predicted onset of partial-/full-syndrome BED at follow-up. Negative prognostic effects on eating disorder psychopathology, depressive symptoms, and body mass index were non-significant. Discussion: The results indicate a moderate stability of LOC eating over the long term. LOC eating, especially if stable, was suggested as a variable risk factor of clinically relevant eating disturbances. In contrast, a prognostic value for psychopathology and body mass index was not confirmed.

Essstörungen sind prävalente psychische Störungen mit schwerwiegenden, oftmals langfristigen Auswirkungen auf die psychische und körperliche Gesundheit. Eine zunehmende Anzahl von klinischen Studien dokumentiert die Wirksamkeit verschiedener psychotherapeutischer Ansätze für spezifische Essstörungen. Im vorliegenden Themenheft 5 werden die Wirksamkeit von neuen Ansätzen zur Einzeltherapie und zur internet-basierten Rückfallprophylaxe, die Patientensicht auf die Therapie sowie die Relevanz von Faktoren des therapeutischen Prozesses bei verschiedenen Essstörungen beleuchtet. Weiterer Forschungsbedarf besteht insbesondere hinsichtlich des Prozesses und der Dissemination evidenzbasierter Psychotherapie für Essstörungen. / Eating disorders are prevalent psychiatric disorders with severe and longstanding 15 implications for mental and physical health. An increasing number of clinical studies documents the efficacy of certain psychotherapeutic approaches for specific eating disorders. This special issue addresses the efficacy of novel approaches in face-to-face individual therapy and Internet-based relapse prevention, patient views of treatment, and the relevance of therapeutic process factors for diverse eating disorders. Further research is particularly 20 warranted regarding the process and dissemination of evidence-based psychotherapy for eating disorders.

Hintergrund. Für die durch wiederkehrende Essanfälle gekennzeichnete Binge Eating-Störung (BES) wurde die Kognitive Verhaltenstherapie (KVT) als Behandlungsmethode der Wahl etabliert. Zum Psychotherapieprozess, welcher das Therapieergebnis beeinflusst, ist jedoch wenig bekannt. Fragestellung. Da Untersuchungen zum Prozessaspekt der therapeutischen Adhärenz Unterschiede zwischen Patienten eines Therapeuten sowie zwischen verschiedenen Therapeuten belegen, soll der Einfluss von Patienten- und Therapeutenmerkmalen auf die therapeutische Adhärenz geprüft werden. Methode. In einer prospektiven, multizentrischen, randomisiert-kontrollierten Behandlungsstudie zum Wirksamkeitsvergleich von KVT und Internet-basierter angeleiteter Selbsthilfe (INTERBED) wurde die therapeutische Adhärenz in der KVT durch unabhängige Rater erfasst. Patienten- und Therapeutenmerkmale wurden mittels Interview und Selbstbericht erhoben. Ergebnisse. Soziodemografische Merkmale wie ein geringeres Bildungsniveau der Patienten und weibliches Geschlecht der Therapeuten wurden als signifikante Prädiktoren einer höheren therapeutischen Adhärenz identifiziert. Störungsspezifische Merkmale der Patienten waren nicht mit der therapeutischen Adhärenz assoziiert. Therapeutenmerkmale wie ein geringerer Ausbildungsgrad, eine geringere erlebte therapeutische Kompetenz und höhere Erwartungen sowie ein höheres emotionales Wohlbefinden der Therapeuten sagten eine höhere therapeutische Adhärenz vorher. Diskussion. Die etablierte hohe therapeutische Adhärenz erschien unabhängig vom Patienten, während einige Therapeutenmerkmale als Prädiktoren identifiziert wurden. Ungünstige Einflüsse auf die therapeutische Adhärenz bedürfen weiterer Erforschung und einer stärkeren Berücksichtigung in der Ausbildung von Therapeuten. / Background. Cognitive-behavioral therapy (CBT) has been established as the treatment of choice for binge-eating disorder (BED) which is characterized by recurrent binge eating episodes. However, only little is known about the impact of the psychotherapeutic process on treatment outcomes. Objectives. While studies concerning the process aspect of therapist adherence found differences between patients from one therapist as well as differences between therapists, the impact of patient and therapist characteristics on therapist adherence will be investigated. Methods. In a prospective multicenter randomized-controlled trial comparing CBT to Internet-based guided self-help (INTERBED), the therapist adherence to CBT was determined by independent raters. Patient and therapist characteristics were obtained via interview and self-report questionnaires. Results. Sociodemographic characteristics including lower education in patients and female sex in therapists were identified as predictors of higher therapist adherence. Disorder-specific characteristics of patients were not associated with the therapist adherence. Therapist characteristics including less postgraduate therapist training, lower self-rated therapeutic competence, and higher expectations as well as higher emotional well-being of therapists predicted higher therapist adherence. Conclusions. The high level of therapist adherence was mostly independent from patients, while some therapist characteristics were identified as predictors. Adverse impacts on therapist adherence should be investigated further and might be considered in therapeutic training.

Während Leitlinien „Gold-Standards“ für die Psychotherapie bei bulimischen Essstörungen (Bulimia Nervosa und Binge-Eating-Störung) empfehlen, ist über psychotherapeutische Prozessfaktoren bei Essstörungen wenig bekannt. Ziel war es, mit Hilfe des etablierten Generic Model of Psychotherapy zur Systematisierung psychotherapeutischer Prozessfaktoren die aktuelle Literatur zum Einfluss dieser Faktoren auf den Therapieerfolg, operationalisiert als Symptomreduktion oder -remission, auf Basis einer systematischen Datenbanksuche zu sichten. Während der Einfluss des therapeutischen Settings nach bisheriger Forschungslage kaum Schlüsse hinsichtlich des Therapieerfolgs zulässt, konnte dieser durch spezifische Interventionen, frühe Symptomreduktionen und eine gute therapeutische Beziehung vorhergesagt werden. Weitere Forschung zu Prozessfaktoren bei bulimischen Essstörungen erscheint notwendig, um die praktische psychotherapeutische Arbeit zu unterstützen und Behandlungen effektiver gestalten zu können. / While guidelines recommend gold standards for psychotherapy in bulimic eating disorders (bulimia nervosa and binge eating disorder), less is known about psychotherapeutic process aspects. We aimed to summarize the current literature on the impact of process aspects on significant symptom reductions and/or abstinence as treatment outcome using the Generic Model of Psychotherapy. A systematic literature search was conducted. While effects of treatment settings can not yet be estimated, specific interventions, rapid response, and the therapeutic bond repeatedly predicted outcome. Process-outcome research in bulimic eating disorders will be necessary to support clinical practice and to enhance treatment efficacy.

Objective: For eating disorders, a vast number of investigations have demonstrated the efficacy of psychological treatments. However, evidence supporting the impact of therapeutic process aspects on outcome (i.e., process-outcome research) has not been disentangled. Method: Using the Generic Model of Psychotherapy (GMP) to organize various process aspects, a systematic literature search was conducted on psychological treatment studies for anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified. Results: Improved outcomes resulted for family-based treatment compared to individual treatment, for individual compared to group treatment, booster sessions, and positive patient expectations (GMP contract aspect); for nutritional counseling and exercising but not exposure with response prevention as adjunct interventions (therapeutic operations); for highly motivated patients and, to a lesser extent, for therapeutic alliance (therapeutic bond); as well as for rapid response and longer overall treatment duration (temporal patterns). Regarding other GMP aspects, studies on self-relatedness were completely lacking and in-session impacts were rarely investigated. Discussion: As most studies assessed only a limited number of process aspects, the ability to draw conclusions about their overall impact regarding outcome is rather limited. Therefore, future process-outcome research is needed beyond investigations of treatment efficacy for eating disorders.

Bakgrund: Ett av sex par har någon gång upplevt problem relaterat till fertilitet under sina reproduktiva år och efter 30 års ålder är infertilitet vanligare hos kvinnor än hos män. Flera delar av menstruationscykeln består av energikrävande processer som exempelvis ägglossning och produktion av könshormoner. Näringsbrist och låg energitillgänglighet leder till brist på substrat till dessa energikrävande processer och i västvärlden orsakas låg energitillgänglighet vanligen av en ätstörning som anorexia nervosa, vilket kan leda till funktionell hypotalamisk amenorré (FHA) hos kvinnor. FHA resulterar i en minskad frisättning av könshormonerna östrogen och progesteron vilket kan leda till infertilitet. En av 20 kvinnor har erfarenhet av ätstörning under graviditeten men få studier har undersökt hur en historik med ätstörning påverkar fertilitet och graviditet. Syfte: Syftet med studien var att undersöka om FHA hos kvinnor med anoreci leder till nedsatt fertilitet och komplikationer vid en eventuell graviditet. Metod: En litteratursökning genomfördes på PubMed och Web of Science med sökorden amenorrhea, fertility, eating disorders, anorexia nervosa, reproduction (1999-2021). Resultat: Åtta studier inkluderades och resultatet visade att kvinnor med anorexi födde färre barn och hade större sannolikhet för att ha genomgått fertilitetsbehandling än friska kvinnor i kontrollgruppen. Vidare visade resultatet att kvinnor med anorexi oftare rapporterade komplicerade graviditeter med till exempel lägre fostertillväxt, prematur födsel och kejsarsnitt. Slutsats: Utifrån resultatet i den aktuella litteraturstudien kan konkluderas att kvinnor med FHA på grund av en ätstörning har lägre fertilitet än friska kvinnor. Kvinnor med ätstörning upplever i högre utsträckning mer komplicerade graviditeter och även fosterutvecklingen verkar påverkas negativt och därför kan tätare kontroller under och efter graviditet vara nödvändigt för dessa kvinnor. Resultatet kan vidare tolkas som att den negativa påverkan på reproduktionsförmågan kan vara reversibel när ätstörninssymptomen behandlats. / Background: One in six couples has sometime during their reproductive years experienced problems related to fertility and after the age of 30, infertility is more common in somen than in men. Several parts of the menstrual cycle require a lot of energy, such as ovulation and the production of sex hormones. Malnutrition and low energy availability is usually caused by an eating disorder such as anorexia nervosa, which can lead to functional hypothalamic amenorrhea (FHA) in women. FHA leads to a reduced release of the sex hormones estrogene and progesterone, which leads to infertility. One in 20 women have experience of an eating disorder during pregnancy, but few studies have examined how a history og eating disorder affects fertility and pregnancy. Aim: The aim of this study was to investigate whether FHA in women with anorexia nervosa leads to reduced fertility and complications in a potential pregnancy.  Method: A literature search was made on PubMed and Web of Science with the keyword´s amenorrhea, fertility, eating disorders, anorexia nervosa reproduction (1999-2021). Results: Eight studies were included, and the results showed that women with anorexia gave birth to fewer children and were more likely to have experienced fertility treatment than healthy women in the control group. Furthermore, the results showed that women with anorexia more often reported more complicated pregnancies with, e.g., lower fetal growth, premature birth, and cesarean section. Conclusion: Based on the results of the current literature study, it can be concluded that women with FHA due to an eating disorder have lower fertility than healthy women. Women with an eating disorder experience more complicated pregnancies and fetal development also seems to be negatively affected and therefore more frequent checks during and after pregnancy may be necessary fore these women. The results can further be interpreted as that the negative impact on reproductive health is reversible when symptoms of eating disorder are treated.

Syfte: Syftet med studien var att undersöka extra- och intraorala kliniska tecken hos individer med ätstörningen bulimi. Metod: Litteratursökningen har utförts i vetenskapliga databaser; Medline, CINAHL och Dentistry & Oral Sciences Source. Artiklar publicerade mellan år 2000–2021 var inkluderade. Totalt valdes det ut 10 vetenskapliga artiklar för denna litteraturstudie. Resultat: Resultatet visar att de vanligaste kliniska tecknen var reducerat salivflöde, lågt pH-värde i saliven, dentala erosioner, svullnad och erytem i gommens slemhinna, torra och nariga läppar och svullna Glandula Parotis salivkörtlar, dock fanns det ingen statistisk signifikans gällande karies och parodontala sjukdomar. Slutsats: Resultaten visar att intra- och extra kliniska tecken kan ses hos individer med bulimi, framförallt svullna Glandula Parotis salivkörtlar, reducerat salivflöde, lägre pH-värde i saliven och dentala erosioner. Kunskap om extra- och intraorala kliniska tecken hos tandvårdspersonal möjliggör tidig identifiering av sjukdomen bulimi och att preventiva insatser tillgodoses i ett tidigt stadie för att minska lidande hos patienten. / Aim: The aim of this study was to investigate extra- and intraoral clinical signs in individuals with the eating disorder bulimia. Material and method: An advanced search of literature has been completed in data bases as; Medline, CINAHL and Dentistry & Oral sciences source. Articles published in 2000-2021 were included. A total of 10 articles were included in this study. Results: The results show that the most common clinical signs were hyposalivation, low pH in the saliva, dental erosion, swelling and erythema in the palate mucosa, dry lips and swollen Glandula Parotid salivary glands. There were no statistically significant results in caries and periodontal diseases. Conclusions: There are some intra- and extraoral clinical signs that can be seen in individuals with bulimia, above all swollen Glandula Parotid salivary glands, reduced salivary flow, low pH in the saliva and dental erosions. Knowledge in extra- and intraoral clinical signs in dental staff makes it possible for early identification of the disease bulimia and preventive efforts can be offered in an early stage to reduce suffering for the patient.