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.

Objective: Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. Method: Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. Results: The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. Discussion: Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.

Obesity is a serious public health crisis and recent estimates of its incidence are the highest in United States history, with 35% and 17% of American adults and children affected, respectively. The clinical definition of adult obesity is operationalized as a body mass index (BMI) greater than 30 kg/m2. Although the prevalence of common obesity has increased dramatically over the past 30 years–largely thought to be due to changes in the environment, such as high calorie diets and sedentary lifestyles—twin and family studies have shown consistently that relative body weight is under considerable genetic influence in both children and adults, with heritability estimates ranging from 40% to 90%. Elucidating the genetic and environmental liability to relative body weight is an important public health endeavor. To further our understanding of the genetics of BMI and common complex obesity, several studies are described that integrate clinical, twin, and genome-wide association (GWAS) methodology in the context of genetic risk scores, clinical risk prediction, development across adolescence into adulthood, and comorbidity with depression symptoms and smoking behavior. First, in two cross-sectional genetic association studies, the utility of genetic risk sum scores (GRSS) were assessed, which summarize the total number of risk alleles, as an alternative form of replication and for potential clinical utility for obesity risk prediction. Next, since there has been only limited research on when during development BMI-associated variants begin influencing BMI, a longitudinal twin study was utilized to assess the effects of adult-validated BMI-SNPs across adolescence into adulthood. In addition, obesity is comorbid with numerous medical conditions including cardiovascular disease, insulin-resistance and some forms of cancer, as well as, various psychiatric disorders including eating disorders, mood disorders, and substance use. The next series of studies aimed to understand phenotypic and genetic associations between BMI/obesity and binge eating disorder (BED), depression symptoms and smoking behavior. Using a clinical sample of overweight and obese women with and without BED, the relationship of BED, food intake and internalizing symptoms of depression and anxiety was examined. Next, twin study methodology was used to investigate if shared genetic and/or environmental liability was responsible for phenotypic associations found between BMI, depression symptoms, and impulsivity. Finally, a genetic association study aimed at investigating whether genetic variants were associated with multiple behaviors, body composition and smoking behavior, or were trait-specific is presented. By utilizing several samples and methodologies and by pursuing methods development, a comprehensive approach is presented that is hoped to represent a more powerful evidence-based strategy to understanding the genetic and environmental determinants of BMI and common complex obesity, along with associated depression symptoms and smoking behavior.

Disordered eating, including bingeing, dieting, purging, and clinical and subclinical forms of anorexia nervosa, bulimia nervosa, and binge eating disorder, is prevalent among college-aged women. To date, few interventions have successfully reduced risk factors related to disordered eating. One promising intervention utilizes principles of cognitive dissonance to reduce thin-ideal internalization among women at risk for eating disorders. Additionally, the benefits of yoga, including increased awareness of bodily processes, offer hope that this practice might reduce disordered eating symptomatology. The current study compared cognitive dissonance and yoga interventions for disordered eating attitudes and behaviors. Hierarchical regression analyses revealed that there were no significant differences between the yoga and control groups. However, participants in the dissonance group had significantly lower scores than both other groups on measures of disordered eating symptoms as well as thin-ideal internalization, body dissatisfaction, alexithymia, and anxiety. These findings have important implications for potential interventions on college campuses.

The aim of this thesis is to summarize findings of causes and consequences of obesity, the most common health problem in the world. The theoretical part deals with many key issues of obesity, from definition through the epidemiology, etiology and obesity prevention and treatment. However the main topics of this thesis are the psychological characteristics that are associated with obesity. It includes personality factors of obese people, willpower and self-control and specific psychopathology. The research part of this thesis is mapping the occurrence of a specific psychopathological phenomena focusing on the emotional eating disorder, night eating syndrome and binge eating and symptoms of eating disorder. Applied methods were "Eating Behavior and Emotionality Questionnaire" (JICHEM), "The Eating Disorder Examination Questionnaire 6.0" (EDE - Q) and "The Night Eating Questionnaire" (NEQ). The data of quantitative research was evaluated by standard statistical methods. Keywords: Obesity Psychopathology Eating Disorder Night Eating Syndrome Emocional eating theory

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.

Abstract Title: Daughters experience of growing up with a mother with eating disorder   Authors: Malin Schelin and Caroline Westberger   Daughters risk negative identity development if they grow up with mothers with EA. Previous research shows how children of parents with mental illness easily are forgotten. This thesis investigates daughters experience of growing up with mothers with eating disorder (EA) and if and how their identity development got affected. A qualitative text analysis was carried out of six newspaper articles and nine chat posts from four chat forums. The articles and the posts were written from the daughters perspective. The result showed that the daughters felt forgotten. That they took an adult responsibility for themselves and their mothers, several of the daughters wished that they would have been given information of the mothers illness. The daughters emphasized a feeling of guilt and several of them have developed an EA. They describe that they handled their upbringing by increasing the distance to their mother, and by defining the mother's disease differently. / Sammanfattning Titel: Döttrars upplevelse av uppväxten med en mamma med ätstörning   Författare: Malin Schelin and Caroline Westberger   Döttrar riskerar negativ identitetsutveckling om de växer upp med en mamma med ätstörning. Tidigare forskning har uppmärksammat hur barn till föräldrar med psykisk ohälsa bortprioriteras. Uppsatsens syfte var att undersöka döttrars upplevelse av uppväxten med en mamma med ätstörning samt om och hur döttrarnas identitetsutveckling påverkats. En kvalitativ textanalys genomfördes av sex tidningsartiklar och nio chattinlägg från fyra chattforum. Både tidningsartiklarna och chattinläggen var skrivna utifrån döttrarnas perspektiv. I resultatet framkom att döttrarna upplevt sig bortglömda och att de tog ett vuxenansvar för sig själva och sin mamma. Flera av döttrarna önskade att vuxna i deras närhet gett dem information om mödrarnas sjukdom. Döttrarna framhåller en stark skuld och flera av dem har själva utvecklat en ätstörning. En del av döttrarna beskriver att de hanterat sin uppväxt dels genom att öka distansen till sin mamma, dels genom att definiera mammans sjukdom på ett annorlunda sätt.

Está bem estabelecido que o Transtorno Alimentar (TA), uma patologia predominantemente compulsiva, e o Transtorno de Déficit de Atenção/Hiperatividade (TDAH), uma patologia predominantemente impulsiva, coocorrem em uma frequência maior do que esperado ao acaso. A avaliação fenotípica e o estudo detalhado de pacientes que apresentam ambas as patologias (TA-TDAH) oferecem a oportunidade de compreender melhor o tipo de interação entre esses dois traços comportamentais, fundamentais no entendimento das patologias dos comportamentos aditivos. Este é um estudo transversal com 63 mulheres com diagnóstico atual de Anorexia Nervosa (AN) ou Bulimia Nervosa (BN) recrutadas do Programa de Transtorno Alimentar do Hospital de Clínicas de Porto Alegre e 254 mulheres com diagnóstico de TDAH provenientes do Programa de Déficit de Atenção e Hiperatividade do mesmo hospital, entre os anos de 2002 e 2016. A coocorrência TA-TDAH foi diagnosticada em ambos os grupos através de entrevista clínica e instrumentos validados. A partir destes achados, o grupo TA-TDAH foi comparado em termos de perfil demográfico, sintomatologia clínica e comorbidades psiquiátricas, com sua contraparte com TDAH e sem TA e com TA sem TDAH. Nossos resultados mostraram que os indivíduos com TA-TDAH apresentam aumento da prevalência de transtorno de ansiedade generalizada e transtorno obsessivo compulsivo quando comparado ao grupo com TDAH. Ainda, o grupo de TATDAH apresenta aumento das taxas de comorbidades com uso de substâncias psicoativas (SPA) e uso de bebida alcoólica quando comparados com ambos os grupos, TA e TDAH. Este aumento excedeu o efeito meramente aditivo encontrado no padrão para as comorbidades inicialmente descritas, demonstrando um padrão sinérgico, resultante provavelmente da interação entre os comportamentos compulsivos e impulsivos. Se considerando a avaliação de funcionalidade, o grupo TDAH-TA apresentou piores escores nas áreas de lazer quando comparado ao grupo TDAH e nas áreas de finanças e cognição quando comparado ao grupo com TA. Estes resultados são relevantes clinicamente pois demonstram que a coocorrência de TA e TDAH está associada ao desenvolvimento de um perfil clínico mais severo, que provavelmente exija uma abordagem diferenciada para este tipo de paciente. / It is well established that an Eating Disorder is a predominantly compulsive pathology, and that the Attention Deficit Hyperactivity Disorder (ADHD) is a predominantly impulsive pathology, which occur at a frequency deemed higher than what one would expect for events occurring at random. The phenotype assessment and the detailed study of patients diagnosed with both pathologies provide us with the opportunity to better understand the type of interaction between these two behavioral traits, which are essential to the understanding of the pathologies related to addictive behaviors. This is a cross-sectional study involving 63 women who have been currently diagnosed with Anorexia Nervosa (AN) or Bulimia Nervosa (BN), recruited from the Eating Disorder Program at Hospital das Clínicas de Porto Alegre, was well as 254 women diagnosed with ADHD from the Attention Deficit Hyperactivity Disorder Program at the same hospital, carried out between 2002 and 2016. From clinical interviews and the use of validated instruments, we have been able to attest the co-occurrence of Eating Disorders and ADHD in both groups. Then, from these findings, a comparison was made in terms of demographics, clinical symptomatology and psychiatric comorbidities: the group diagnosed with an Eating Disorder and ADHD with the group diagnosed with ADHD without an Eating Disorder and the group with an Eating Disorder without ADHD. Our results have shown that individuals with an Eating Disorder and ADHD have presented higher numbers of generalized anxiety disorder and obsessive-compulsive disorder, when compared to the group diagnosed solely with ADHD. Moreover, the group diagnosed with an Eating Disorder and ADHD presented an increase in comorbidity rates with the use of psychotropic drugs and alcohol, when compared to the groups diagnosed solely with an Eating Disorder or ADHD. This increase has exceeded the purely addictive effect found in the patterns related to the comorbidities initially described, showing a synergistic pattern, most likely resulting from the interaction between compulsive and impulsive behaviors. When taking into account the assessment of functionality, the group diagnosed with an Eating Disorder and ADHD presented the lowest numbers in leisurely areas, when compared to the group diagnosed solely with ADHD, and the lowest number in financial and cognitive areas, when compared to the group diagnosed solely with an Eating Disorder. These results are relevant from a clinical standpoint, since they demonstrated that the co-occurrence of an Eating Disorder and ADHD is linked to the development of a more serious clinical profile, which will likely demand a unique approach towards these patients.

Bakgrund: Anorexia nervosa (AN) räknas idag till en av de allvarligaste psykiska störningar eftersom sjukdomen är förenad med allvarliga komplikationer. Vanligaste åldern för insjuknande är 14–19 år. Tonårsflickor med AN upplever nedsatt hälsa och välbefinnande samt ökat lidande. Sjuksköterskans roll vid AN syftar till att normalisera vikten samtidigt som tonårsflickorna påtalar en önskan om att sjuksköterskan ska inge stöd och motivation. Syfte: Att beskriva tonårsflickors upplevelser av att leva med Anorexia nervosa. Metod: Självbiografiska blogginlägg har analyserats utifrån en manifest kvalitativ innehållsanalys med en induktiv ansats. Resultat: I resultatet framkom fyra huvudkategorier som beskriver tonårsflickors upplevelser av att leva med AN. Dessa innefattar Att leva i ständig konflikt med sig själv, Att leva med en förändrad kropp, Känslan av psykisk påfrestning och dess konsekvenser samt Att vilja bli frisk och fri. Konklusion: Att möta tonårsflickor som lever med AN kan upplevas svårt och kan innebära en utmaning för sjuksköterskan. Vidare påvisas att tonårsflickors behov och önskemål inte överensstämmer med sjuksköterskans roll vid AN. Som sjuksköterska är det angeläget att se till tonårsflickors behov och önskemål för att kunna öka upplevelsen av hälsa och välbefinnande, lindra lidande samt främja tillfrisknande. / Background: Anorexia nervosa (AN) is considered one of the most serious mental disorders since the disease is associated with serious complications. The most common age for AN is 14–19 years. Teenage girls with AN experience impaired health and well-being and increased suffering. The nurse's role aims to normalize the bodyweight. Teenage girls needs support and motivation from the nurse. Aim: To describe teenage girls' experiences of living with Anorexia nervosa. Method: Autobiographical blog entries have been analyzed based on a manifest qualitative content analysis with an inductive approach. Results: The result revealed four main categories that include Living in constant conflict with oneself, Living with a changed body, The feeling of mental stress and its consequences and Wanting to be healthy and free. Conclusion: Meeting teenage girls who live with AN can be a difficult experience for the nurse. Furthermore, it is shown that the needs of teenage girls do not correspond to the nurse's role in AN. As a nurse, it is important to look at the needs of teenage girls in order to increase the experience of health and well-being, alleviate suffering and promote recovery.

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.