Eating disorders are serious psychological disorders associated with debilitating lifestyle, multiple health problems and high rates of suicidality and mortality. Despite extensive research, the aetiology of eating disorders still remains unclear. Amongst the identified risk factors for eating disorders, stress has been frequently studied. The purpose of the present study was to explore the possibility that tail-pinch administered to rats could provide an animal model of stress-induced eating disturbances in humans, and whether environmental enrichment might ameliorate the effects of stress. In Experiment 1, we compared eating behaviours of rats that were reared in either enriched or standard environments and later exposed to tail-pinch and allowed to eat when food deprived. The study showed that a single exposure to tail-pinch induced eating disturbances in most of the rats. When rats were not food deprived, but were conditioned to eating when placed in test chamber, tail-pinch suppressed eating in all rats, but significantly more for rats reared under standard than in enriched conditions. Experiment 2 used a between-subjects design in which rats were reared in either a standard or enriched environment, and were either exposed to tail-pinch or not exposed during sessions in which they were not food deprived and allowed to eat. Tail-pinch suppressed the food intake of rats reared in enriched but not standard environments. Although this finding appeared to contradict results of Experiment 1, analysis of body weight revealed that exposure to tail pinch suppressed increases in weight gain across sessions more for rats reared in standard than enriched environments. The suppression of food intake during test sessions for enriched but not standard rats exposed to tail-pinch was attributed to differences in contextual conditioning and discrimination of the test chamber from home cages. Overall, results of the present study suggest that rats reared in enriched environments were more resilient to the effects of tail-pinch as a stressor. Implications of these findings for the understanding of human eating disorders are discussed.

This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.

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.

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.