XXIVth Annual Meeting of the Eating Disorders Research Society

Printable Program

October 25-27, 2018
Novotel Sydney Manly Pacific
Sydney, Australia

Thursday, October 25, 2018

9:00 - 12:00 PMClarendon/Norfolk
Publishing in IJED and JED and EEDR

Chair(s): Ruth Weissman, Fernando Fernandez Aranda, Stephen Touyz & Phillipa Hay
9:00 - 12:00 PMCutler/Barton
The New Statistics: Estimation, Open Science, and Beyond


Chair(s): Geoff Cumming
1:00 - 1:15 PMGrand Ballroom

Chair(s): Tracey Wade
1:15 - 2:15 PMGrand Ballroom
Keynote Session

Chair(s): Scott Crow
Future Thoughts And Behavior Change
Gabriele Oettingen
New York University

2:15 - 3:15 PMGrand Ballroom
Jim Mitchell Lecture

Chair(s): Anja Hilbert
Cost-Effectiveness Of Models Of Care For Young People With Eating Disorders In The Uk And Republic Of Ireland (Costed): A National Surveillance Study
Sarah Byford
Institute Psychiatry, Psychology and Neuroscience

3:15 - 3:45 PMFoyer
Coffee Break

3:45 - 5:15 PMGrand Ballroom
Anorexia Nervosa Genetics Initiative: Advancing Genomic Discovery in Eating Disorders

Chair(s): Cindy Bulik
Achieving Angi Goals By Building The Angi Community
Nick Martin
Berghofer Queensland Institute for Medical Research

Genome-Wide Association Study Meta-Analysis Approach And Results
Hunna Watson
University of North Carolina at Chapel Hill

Beyond Gwas
Zeynep Yilmaz
University of North Carolina at Chapel Hill

Angi: The Future
Cynthia Bulik1, 2
1University of North Carolina at Chapel Hill, 2Karolinska Institutet

5:15 - 6:45 PMGilberts Room
Poster Session #1

Chew And Spit (Chsp): A Preliminary Presentation Of Prevalence In A Large Adolescent Sample
Phillip Aouad1, Deborah Mitchison2, Phillipa Hay3, Nerissa Soh4, Stephen Touyz5
1University of Sydney, Sydney, Australia, 2Macquarie University, Sydney, Australia, 3Research Centre for Health, School of Medicine, Western Sydney University, New South Wales, Australia, 4University of Sydney, Sydney, Australia, 5University of Sydney, Sydney, Australia

A recent study into the general population prevalence of Chew and Spit(CHSP) behavior in adults found a 0.4% prevalence. The current study explored this further examining this in adolescents. 13 schools agreed to participate in the study. It consisted of psychometric measures including EDE-Q, EDB, NEQ, ARFID-Q, BDD-Q, and demographic, personal, and reflective-questions. Participants (N=5184) were all aged 12-19 with approx. equal numbers of males (n=2241) and females (n=2494); 383 participants were classified as underweight(<5th-percentile). Over 5% of all participants indicating engaging in CHSP at least once in the 28-days prior to participating in the study. Several eating disorder(ED) groups-the number of individuals with diagnosable EDs -that are likely to report engaging in CHSP included: Anorexia Nervosa(AN; 33%); AN-Broad(28%); Bulimia Nervosa(BN; 34%); Binge Eating Disorder(BED; 13%); Atypical-AN(66%); subclinical-BN(sBN; 36%); sBED(19%); Avoidant/Restrictive Food Intake Disorder(ARFID; 19%); Unspecified Feeding or Eating Disorder(UFED; 33%). Associations with  physiological distress and QoL will be presented. This study highlights the high frequency of CHSP behavior in adolescents with an ED and the need for clinicians to screen for it. More importantly, to aid ED specialists in asking about CHSP, it should be included as a notable symptom in future revisions of the DSM. Future studies should examine potential treatment options in order to target CHSP more directly.

Can Recovery Be Measured? Introducing The Eating Disorders Recovery Questionnaire (Edrq)
Rachel Bachner-Melman, Shay Lee Lev
Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel

Although eating disorders (ED) have high mortality rates, most people affected recover partially or fully. There is no standard definition of recovery from ED, and no standard way to assess it. We propose a 56-item scale based on Noordedbos & Seubring (2006) to measure the degree of recovery from an ED, the Eating Disorders Recovery Questionnaire (EDRQ). We examined similarities and differences in how people with a history of an ED, their relatives, and ED clinicians view recovery using the EDRQ, and assessed this scale’s factor structure. Methods: The EDRQ was completed online by 200 men (n=28) and women, who were asked to what extent each item was relevant to recovery from ED. Respondents were 81 people with an ED history, 58 ED clinicians, 81 relatives of people with an ED history, and 37 relatives with a personal ED history. The factor structure of the EDRQ was examined using exploratory factor analysis and the resulting subscale scores compared across groups. Results: Four subscales were identified: 1. Physical recovery; 2. Symptomatic behavior; 3. Acceptance of self and body; and 4. Social and emotional factors. All groups ranked these subscales in the following order from most the most to the least important: 2, 3, 4, 1. Conclusions: Clinicians, relatives, and people in recovery from ED tend to agree about the components of recovery and their importance. The EDRQ is a promising measure of recovery from ED that should be investigated as a clinical tool.. 

Detecting Binge-Eating Disorder From Obesity Alone.
Eunice Y Chen
Temple University, Philadelphia, United States

Introduction: Is binge eating disorder (BED) behaviorally and genetically distinct from obesity alone? What test most accurately detects BED status? BED is the most frequently occurring eating disorder and confers greater medical and psychological risks than obesity alone, including a higher incidence of depression, diabetes, and hypertension. Relative to the overeating distinguishing obesity, BED is distinguished by regular episodes of loss of control during the consumption of large amounts of food. Up to 40% of individuals with BED meet criteria for obesity and longitudinal studies suggest that BED may represent a distinct pathway to weight gain. Methods: The study used a balanced two-factor (BED x obesity status) design with 60 women. Features examined included reward sensitivity, taste sensitivity and hedonics, executive functioning and memory functioning, mood regulation, weight regulation and body image concerns; and included self-report, behavioral and neuropsychological tasks, and genetic alleles. Results: Using machine learning models, this study showed that self-reported ‘food addiction’ symptoms and diagnosis on the Yale Food Addiction Scale most parsimoniously and best detected BED status with a mean test accuracy of 73.38% (sd=11.99%), and that this differed from features discriminating obesity status. These findings support the conceptualization of BED as a ‘food addiction’ but require replication.

Evidence-Based Practice In Assigning Patients To Level Of Care: The Short Treatment Allocation Tool For Eating Disorders
Jennifer Coelho1, Josie Geller2,3, Emily Seale4, Leanna Isserlin5, Megumi Iyar2,3, Suja Srikameswaran2,3, Mark Norris5
1BC Children's Hospital, Vancouver, BC, Canada, 2St. Paul's Hospital, Vancouver, BC, Canada, 3University of British Columbia, Vancouver, BC, Canada, 4Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada, 5Children's Hospital of Eastern Ontario, Ottawa, ON, Canada

Introduction: There is little consensus or consistency in how patients with eating disorders (ED) are assigned to the most helpful and cost-effective level of care. The Short Treatment Allocation Tool for Eating Disorders (STATED) is a new evidence-based algorithm developed to ensure empirical evidence is used in matching patients to treatment. It uses three patient dimensions: medical stability, symptom severity, and readiness. This study examined the extent to which current practices are in alignment with STATED recommendations. Methods: Healthcare professionals providing care for youth and/or adults with EDs (N = 179) were recruited online and completed a survey assessing the extent to which each patient dimension (medical stability, symptom severity, and readiness) was considered suited to each of five levels of care. Results: A priori hypotheses based on STATED recommendations were tested, and 22/24 of these were statistically significant in the direction of STATED recommendations. A coding scheme examining the extent to which responses were inconsistent with the STATED revealed the following mean proportion of inconsistent responses: medical stability (9%), symptom severity (40%) adult readiness (58%), and family readiness (66%). Conclusion: Response patterns were generally in alignment with the STATED, with lowest consistency for the readiness dimension. Future research is needed to determine the impact of training on the STATED, and the role of adolescent readiness.

General And Eating Disorder Specific Flexibility In Anorexia Nervosa, Bulimia Nervosa And Binge Eating Disorder: Development And Psychometric Properties Of The Eating Disorder Flexibility Index (Edflix) Questionnaire
Camilla L Dahlgren , Trine Wiig-Hage, Kristin Stedal
Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway

Introduction.Studies investigating cognitive flexibility in individuals with eating disorders (EDs) are inconsistent, and although neuropsychological tests are commonly used to measure these skills, they may not be particularly effective in predicting every day functioning. The aim of this study was to investigate the psychometric properties of a newly developed questionnaire called the Eating Disorder Flexibility Index (EDFLIX) Questionnaire. Methods.A sample of 207 adult individuals with EDs (AN:55%, BN:29%, BED:16%) responded to a 51-item, pilot questionnaire on ED specific and general flexibility. In addition, the Shift subscale from the Behavior Rating Inventory of Executive Functioning was administered. Results.An exploratory factor analysis yielded a 36-item, 3-factor solution capturing general flexibility (EDFLIX-GF), flexibility related to food and exercise (EDFLIX-FoEx), and flexibility concerning body shape and weight (EDFLIX-ShWe). Results showed good to excellent internal consistency for the EDFLIX scores (Chronbach’s α [range] 0.863-.0913), and significant correlations between EDFLIX total and subscale scores and the BRIEF Shift score. Generally, EDFLIX scores were significantly higher in participants with BN and BED, in younger participants, in participants with higher BMI and in participants with shorter duration of illness. Conclusions.The EDFLIX was found to be a reliable and valid measure of ED specific and general flexibility in individuals with EDs.

Validation Of The Norwegian Version Of The Repetitive Eating- Questionnaire (Rep(Eat)-Q) In College-Aged Men And Women
Camilla L. Dahlgren 1, Joe Wonderlich1,2, Gro Syversen1, Ingela L. Kvalem3, Deborah L. Reas1,3
1Regional Department of Eating Disorders, Oslo University Hospital Ullevål, Oslo, Norway, 2Department of Psychology, George Mason University, Fairfax, VA, United States, 3Institute of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway

Introduction: The Repetitive Eating Questionnaire (Rep(eat)-Q) is a 12-item self-report measure of compulsive and non-compulsive grazing behaviors (i.e., eating small/modest amounts of food in a repetitive and unplanned manner). We aimed to translate and validate the Rep(eat)-Q in a community sample, and to run a confirmatory factor analysis to validate the proposed 2-factor model. Methods: 190 university students (78% female) were administered the Rep(eat)-Q along with other measures of eating behaviour. Mean age was 22.6 (SD 4.2, 19-43) and mean BMI was 22.4 (SD=2.9, 17-37). Results: Initial findings revealed good fit indexes for the 2-factor model by CFA. Cronbach’s alphas were excellent for the total and 2 subscales (.92, .91, and .86). The mean score of 0.98 (SD:0.89), was lower than 1.59 (SD: 1.22) reported by Conceicåo et al. (2017). Females scored significantly higher than males [M = 1.06 (.95) vs 0.65 (.57), t (189) 3.42, p <.001). Age and BMI did not correlate significantly with the Rep(eat)-Q, but moderate to strong correlations (>.4) were found between measures of disordered eating (EDDS and YFAS) and the Compulsive Grazing (GC) subscale , whereas lower correlations (<.4) were found for Repetitive Eating (RE). Conclusions: This study confirmed the proposed factor structure of the Rep(eat)-Q in a community sample, offering support to the conceptual distinction between compulsive (marked by loss of control) and repetitive (non-compulsive) eating.

Stuck In The Middle Again: A Latent Trait Analysis Using Dsm-5 Eating Disorder Criteria In A Community Sample
Alexis C Exum, Kelsie T Forbush, Jonathan Templin
University of Kansas, Lawrence, KS, United States

DSM-5 implemented new dimensional severity indices to inform prognosis and facilitate treatment planning. Although there is a burgeoning literature on the utility of DSM-5 severity indices, to our knowledge, no previous studies have tested the clinical utility of the diagnostic criteria for distinguishing among ED severity levels. Latent variable methods, such as item-response theory (IRT), can be used to evaluate the clinical utility of symptoms in defining an unobservable construct. The purpose of the current study was to use latent variable methods to test the information value of individual ED symptoms and criteria for distinguishing among people across the full continuum of ED severity. Community adults (N=656) were screened for inclusion in a longitudinal study for EDs. Participants completed the Eating Disorders Diagnostic Scale (EDDS). EDDS items were analyzed using an IRT graded-response model. Results demonstrated that the EDDS performed well (had a high information value) when participants had mild or severe levels of ED psychopathology. However, the EDDS provided little information at moderate severity levels. In conclusion, our results suggested that the DSM-5 criteria do not provide useful diagnostic information for people with moderate levels of ED severity. Future research is needed to develop more psychometrically sound diagnostic criteria for EDs, and/or develop novel diagnostic measures that better assess EDs across the full range of severity.

Transdiagnostic Presence Of Pathological Buying And A Spanish Validation Data Of The Pathological Buying Screener (Pbs): From Eating To Gambling Disorders
Fernando Fernández-Aranda1,2,3, Roser Granero2,4, Gemma Mestre-Bach1,2, Trevor Steward1,2, Astrid Müller 5, Matthias Brand6, Teresa Mena-Moreno1,2, Cristina Vintró-Alcaraz1,2, Amparo del Pino-Gutiérrez 1,7, Laura Moragas 1, Mallorquí-Bagué Nuria1,2, Neus Aymamí1, Mónica Gómez-Peña 1, Maria Lozano-Madrid1,2, José M Menchón 1,3,8, Susana Jiménez-Murcia1,2,3
1Department of Psychiatry. Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 2Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III , Barcelona, Spain, 3Department of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain, 4Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona , Barcelona, Spain, 5Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover , Germany, 6General Psychology: Cognition, University of Duisburg-Essen, Duisburg, Germany Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, , Essen, Germany, 7Departament d’Infermeria de Salut Pública, Salut Mental i Maternoinfantil. Escola Universitària d’Infermeria, Barcelona, Spain, 8CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain

Pathological buying (PB) is a behavioral addiction that is comorbid to several mental disorders. Despite the increase in the prevalence estimates of PB, few self-rating scales have been developed to specifically assess this problem. Apart from examining the psychometric properties of the Spanish version of the Pathological Buying Screener (PBS), the aim of this study was to explore the associations between PB, psychopathology and personality traits. 511 participants, including gambling disorder (GD), eating disorder (ED) patients and healthy controls (HC), took part in the study. Higher PB prevalence was obtained in ED patients than in the other two groups (ED 12.5% vs. 1.3% for HC and 2.7% for GD). Confirmatory Factor Analysis (CFA) verified the 13-item structure of the PBS, and indexes of convergent and discriminant capacity were estimated. CFA confirmed the structure in two factors with excellent internal consistency. Good convergent capacity was obtained with external psychopathology and personality measures (positive correlations with novelty seeking and negative associations with self-directedness and harm avoidance merged). Good discriminative capacity was obtained to differentiate between the study groups. This study confirms the reliability and validity of the Spanish adaptation of the PBS and the higher prevalence of PB in ED patients, when compared with GD and HC. Female sex, higher impulsivity and higher psychopathology were associated with PB.

Specific Food Addiction Phenotypes Using Sociodemographic And Clinical Clustering Analysis
Susana Jimenez-Murcia1,2,3, Fernando Fernandez-Aranda1,2,3, Roser Granero2,4, Zaida Aguera1,2, Trevor Steward1,2, Isabel Sanchez1, Nadine Riesco1, Gemma Mestre-Bach1,2, José M Menchón1,3,5
1Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, , Barcelona, Spain, 2Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain, 3Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain, 4Department of Psychobiology and Methodology. University Autònoma of Barcelona, Spain., Barcelona, Spain, 5Ciber Mental Health (CIBERsam) Instituto Salud Carlos III, Barcelona, Spain

Food addiction has been associated with greater levels of psychopathology and impulsivity, but no study to date has transdiagnositically considered food addiction correlates in eating disorder (ED) patients using clustering.   Methods: A total sample of 290 participants [140 with bulimia nervosa, 45 with binge eating disorder, 70 with other specified feeding or eating disorder and 35 with obesity] was included. All participants completed the Temperament and Character Inventory-Revised, the Eating Disorder Inventory-2, the Symptom Checklist-90-Revised and the Yale Food Addiction Scale (YFAS 2.0). Results: Three clusters were identified. Cluster 1, labeled here the adaptive cluster, was characterized by a high prevalence of obese subjects (without ED) and low levels of ED severity and general psychopathology. Cluster 2, the moderate cluster, was less functional than Cluster 1, showed a high prevalence of BED and OSFED, and moderate levels of ED severity and an intermediate position in psychopathology levels compared to Clusters 1 and 3. Finally, Cluster 3, the dysfunctional cluster, was characterized by the highest prevalence of bulimia nervosa and the highest scores in ED severity and general psychopathology, and more dysfunctional personality traits. Conclusions: This study identified three distinct clusters of ED patients with food addiction. Future studies should address whether food addiction categories are indicative of therapy outcome.

Integrating Neuroimaging And Real-Time Mobile Assessments: Review Of A Novel And Expanding Literature
Jason M Lavender
University of California, San Diego, San Diego, CA, United States

Introduction: Driven by technological and societal shifts (eg, advances in fMRI, increasing ubiquity of smartphones), the past two decades have seen substantial progress in research on (a) altered brain function in psychiatric illness and (b) real-time clinical phenomena in daily life. Among other benefits, real-time data allows for examination of within-person dynamics and variability, and may facilitate identification of associations with underlying brain function. Methods: A literature search was conducted to identify empirical studies of psychiatric disorders that integrated data collected via fMRI and real-time mobile assessments. Results: Studies examined multiple psychiatric illnesses (eg, psychosis, substance use disorders, affective disorders, eating disorders). For fMRI, both task-evoked and resting-state methods were represented; reward and self-regulatory-related regions were most commonly investigated. Approaches to data integration included basic associations between neural (ROI activation, connectivity, balance of activation across ROIs) and real-time variables, as well as moderation of real-time symptom associations by neural variables. Conclusions: Integrating neuroimaging and mobile assessments represents an innovative approach to identifying biomarkers, synthesizing data across units of analysis (e.g., from circuits to in vivo behavior), and characterizing how altered brain function relates to real-time, clinically salient phenomena in eating disorders. 

Clinical Utility Of The Proposed Icd-11 And Dsm-5 Diagnostic Schemes For Eating Disorders Characterized By Recurrent Binge Eating
Marly A Palavras1,2, Phillipa Hay3, Angelica M Claudino1
1Eating Disorders Program, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil, 2School of Medicine, Western Sydney University, Sydney, Australia, 3Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia

: DSM-5 and provisional ICD-11 have aimed to improve the clinical utility, notably by reducing the use of an Other Specified or Unspecified Eating Disorder diagnosis (OSFED/UFED). Our aims were to compare the clinical utility of the DSM-5 and the proposed ICD-11 criteria applied to participants diagnosed with Bulimia Nervosa (BN) and Binge Eating Disorder (BED), and to compare the severity of clinical features and mental health-related quality of life (MHRQoL) across the diagnostic schemes. Method: A clinical sample of 107 volunteers to a trial testing psychological treatments for clinical and/or subclinical BN or BED in overweight people were evaluated with EDE using the DSM-5 and the provisional ICD-11 diagnostic guidelines. Results: The provisional ICD-11 included 102 participants (95%) in the clinical BN or BED compared to 85 (79%) in DSM-5. Fewer individuals received OSFED/UFED diagnosis with the ICD vs the DSM scheme (5% vs 21%). No significant statistical differences in demographic, clinical features or MHRQoL of participants diagnosed with complete or partial BN or BED were found between groups. Conclusion: The present study found both DSM-5 and the provisional ICD-11 had a minority of participants in this clinical sample with an OSFED/UFED diagnosis. The proposed ICD-11 was more inclusive, but did not appear to include people with less severe and potentially less clinically relevant symptoms. 

What Is The Desired Outcome Of Cognitive Remediation Therapy (Crt) For Eating Disorders And How Should It Be Measured? - A Scoping Review And Reccomendations For Future Clinical Trials
Siri Weider1,2, Nils Inge Landrø3,4,5, Camilla L Dahlgren6
1Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway, 2Specialised Unit for Eating Disorder Patients, Department of Psychiatry, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway, 3Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway, 4National Competence Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway, 5Clinical Neuroscience Group, Department of Psychology, University of Oslo, Oslo, Norway, 6Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF. , Oslo, Norway

Introduction.CRT for eating disorders (EDs) is an intervention focusing on acquiring new thinking skills through metacognitive processes. Historically, a number of studies have investigated pre-and post CRT functioning using an array of performance based tests, clinical measures and patient feedback forms. Evidence of feasibility and patient satisfaction exists, but as a minority of studies are randomized controlled trials, the effect of CRT is still elusive. Also, there is presently no consensus in how to measure CRT outcome. The aim of the present study was to investigate how outcome has been measured in CRT for EDs, and to make recommendations for future CRT trials. Methods.A systematic literature search was conducted using the data bases PubMed, Web of Science and PsycINFO. The review was performed in accordance with PRISMA guidelines, with 30 studies meeting inclusion criteria. Results.Results revealed that 43 different outcome measures had been used, the majority of which were clinical outcome measures (n=20) and neuropsychological tests (n=16). Conclusion.The plethora of outcome measures used in the evaluation of CRT for EDs makes comparisons between studies, and generalization difficult. Also, it raises a specific question, i.e. “What is the desired outcome of CRT for EDs”? To ensure valid findings, we need to reach consensus regarding the desired outcome of CRT, which will inform how treatment outcome is best measured. Specific recommendations will be delineated. 

Prevalence And Correlates Of Eating Disorders Among U.S. Male College Students
Jennifer R Bleck, Rita D DeBate
University of South Florida, Tampa, FL, United States

Introduction. Many males experience eating disorders, yet there is a lack of preventative efforts. Males in college face high risk for changes in eating patterns including development of disordered behaviors. To inform intervention development, this study aimed to determine the prevalence of eating disorders and disordered behaviors and correlated demographics among U.S. male college students. Methods. Secondary analysis using data from 165,968 male students who completed the American College Health Association’s National College Health Assessment survey between 2011 and 2015. Outcomes included self-reported past 12 month diagnoses and 30 day behavior. Associations with a range of demographic characteristics were explored. Results. Overall 0.7% (n=1,128) of male students reported a diagnosis of Anorexia or Bulimia. Additionally, 0.9% (n=1,462) reported vomiting or using laxatives and 2.0% (n=3,391) reported using diet pills to lose weight. However, 3.4% (n=5,643) reported their academic performance was effected by an eating disorder/problem. Higher prevalence of a diagnosed eating disorder or disordered behaviors was found among male students who: were Gay or Bisexual, Black or Asian, 1st or 2nd years, enrolled part-time, living in a Fraternity house, and had a lower GPA (all p<.001). Conclusions. This study provides a first step into identifying characteristics of specific at-risk subsets of male college students that can be used for targeted prevention and interventions. 

"Compulsive" Grazing - A New Problematic Eating Behaviour? Associations With Eating Disorders, Weight And Quality Of Life In The Australian Population
Andreea I Heriseanu1, Phillipa Hay2, Stephen Touyz1
1University of Sydney, Sydney, Australia, 2Western Sydney University, Sydney, Australia

Grazing is an eating pattern of recent interest; there is evidence that grazing, especially a "compulsive" subtype involving a sense of loss of control (LOC) is associated with eating disorder (ED) psychopathology and decreased mental health-related quality of life (MHRQoL). Little is known about the epidemiology and clinical correlates of grazing in non-clinical populations. A population-based interview of individuals aged≥15 (n=3047) obtained frequency of grazing in general and of LOC grazing, demographics, DSM-5 EDs and HRQoL, and associations were examined. In this representative sample, 1494 (49.2%) participants reported grazing and 416 (13.7%) LOC grazing. Grazing was positively correlated with BMI and negatively correlated with MHRQoL with a stronger association for LOC grazing. Those with BN and BED-Broad were more likely to graze than those without these EDs. In 2238 participants without an ED/binge eating, grazing was still prevalent: 880 (39.4%) grazed, and 127 (5.7%) had LOC grazing; MHRQoL was lower in those who grazed, supporting the notion that grazing is a potentially problematic behaviour that is not bound by an existing ED. In conclusion, grazing is common within the Australian population, and LOC grazing occurs in 1 in 7 individuals. Those with BN/BED-Broad were more likely to engage in grazing/LOC grazing, however this was common also outside of EDs. Results support the notion of a "compulsive" grazing subtype associated with higher BMI and lower MHRQoL.

Determinants Of Binge Eating Disorder Among Normal Weight And Overweight Female College Students In Korea
Youl-Ri KIM1,2, Gi Young Lee2, Bo In Hwang2, Kyung Hee Kim3, Mirihae Kim4, Kwang Kee Kim5, Jong Won Kim6, Kyung Hwa Kwag2, Janet Treasure7
11Department of Neuropsychiatry, Seoul Paik Hospital, Inje University,, Seoul, Korea, 22Institute of Eating Disorders and Mental Health, Inje University, Seoul, Korea, 33Department of Food and Nutrition, Duksung Women’s University, Seoul, Korea, 44Department of Psychology, Duksung Women’s University, Seoul, Korea, 55Graduate School of Public Health, Inje University, Busan, Korea, 6Department of Helathcare Information Technology, Inje University, Gimhae, Korea, 7Section of Eating Disorders, Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom

Purpose: The aim of the present study was to describe the clinical features of binge eating disorder (BED) in normal weight and overweight undergraduate Korean women. Methods: 117 overweight (BMI ≥ 25 kg/m2) and 346 normal weight (18 kg/m2 ≤ BMI <25 kg/m2) undergraduate Korean women completed questionnaires to assess for BED. Their emotional eating behaviors, binge eating related behaviors, a spectrum of compulsive behaviors such as substance abuse and obsessive-compulsive disorder, and psychological profiles were evaluated through personal interviews and questionnaires. The features of those with BED were compared to those without BED in the overweight and the normal weight groups. Results: Both normal weight and overweight BED women had higher levels of functional impairment, eating disorder psychopathology including emotional and external eating behaviors, and neuroticism than their non-BED counterparts. In the normal weight group, BED women had more frequent alcohol consumption and obsessive-compulsive symptoms than non-BED women. In the overweight group, BED women had higher levels of depression and lower extraversion than non-BED women. Conclusions: BED is associated with global functional impairment and mental health problems. Thus, the association with high functional impairments and psychiatric comorbidities suggest that people with BED may benefit from treatment.

Perinatal Factors And Risk Of Eating Disorders
Janne T Larsen1,2, Cynthia M Bulik3,4, Laura M Thornton3, Susanne V Koch5,6, Liselotte Petersen1,2
1National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark, 2Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark, 3Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 5Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Copenhagen, Denmark, 6Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

Introduction Several associations between perinatal characteristics and eating disorder risk have been identified, but few have been replicated in different samples, possibly due to small sample sizes. This study investigates the potential associations between a range of perinatal factors and risk of eating disorders in a large population-based cohort. Methods Utilizing the nationwide Danish registers, all individuals born in Denmark 1989-2010 were identified (N=1,166,955, 49% female) and followed from their 6th birthday until emigration, death, or first registered ICD-10 diagnosis of anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. Exposure to perinatal factors was defined using registers, and relative rates were estimated using survival analysis. Results We identified increased risks of anorexia and bulimia for increasing parental ages. Higher birth weight relative to the gestational age was associated with increased bulimia risk, and multiple birth was associated with increased risk of anorexia. We further identified positive associations between several perinatal conditions and risks of anorexia and eating disorder not otherwise specified. Conclusions There appear to be some evidence of associations between perinatal characteristics and later risk of eating disorders, but most factors were not significantly associated with eating disorder risk. Any effect may likely work in interaction with other factors.

Sub-Threshold Eating Disorder Symptoms Associated With Suicidality Among College Students
Kendrin R Sonneville, Sarah K Lipson
University of Michigan School of Public Health, Ann Arbor, MI, United States

Introduction: Full-syndrome eating disorders, while relatively rare on a population level, are associated with substantially elevated risk of suicidality. We sought to examine risk of suicidality in students exhibiting more prevalent sub-threshold eating disorder symptoms. Methods: Participants were 5,848 students at 7 U.S. colleges and universities participating in the Healthy Minds Study. In logistic regressions controlling for age, race/ethnicity, gender, sexual orientation, and weight status, we examined risk of past-year suicidality in individuals with sub-threshold eating disorder symptoms (Weight Concern Scale score: 47-59, binge eating: 1-3 times in past month, purging: 1-3 times in past month). Results: The sample was 74% undergraduates, 57% white, and 50% female. Compared to students with low/no weight concerns, those with moderate weight concerns were at increased risk of past-year suicidal ideation (odds ratio [95% confidence interval]=1.59 [1.16-2.17]) and suicide plan (2.17 [1.35-3.50]). Sub-threshold binge eating was associated with increased risk of suicide plan (1.57 [1.07-2.31]) and sub-threshold purging was associated with increased risk of both suicidal ideation (1.95 [1.15-3.32]) and suicide plan (2.56 [1.20-5.44]). Conclusions: Sub-threshold eating disorder symptoms in college students are a significant risk factor for suicidality. Findings provide support for integration of mental health prevention and early intervention efforts on college campuses.

Gender, Self-Identification And Help-Seeking For An Eating Disorder: Findings From A General Population Sample.
Priyanka Thapliyal1, Deborah Mitchison2, Jonathan Mond3, Phillipa Hay1
1PhD, Sydney, Australia, 2Dr, Sydney, Australia, 3Dr, Tasmania, Australia, 4Prof, Sydney, Australia

Introduction: This study compared gender differences in Eating Disorder (ED) and other features and examined the role of gender as a predictor of help-seeking in a general population sample. Methods: Demographic, ED symptoms and related data were collected during household interviews of individuals of over 3000 individuals aged >15 years. Two groups of participants were identified; 164 people with an ED syndrome, and 312 people who self-identified with any of three ED vignettes. Results: Men with an ED were younger than women and had lower levels of purging and overvaluation but similar functional impairment, and level of binge eating and strict dieting. Compared to women, men who self-identified with a vignette of a person with BED had a higher BMI. In univariate analyses, males in general, but not males with an ED, were significantly less likely than females to seek help for an ED. In multivariate analysis of people with an ED, only BMI was significantly associated with treatment seeking in people with an ED. Conclusion: Functional health impairment and common ED behaviours were similar for men and women with EDs.  Gender may not be a primary reason to be more or less likely to seek help for an ED. Rather, other features, most notably, a higher BMI, appeared to better account for ED help-seeking.  

The Importance Of Cholesterol Levels In Patients With Eating Disorders
Leanne J Barron1, Robert FJ Barron0, Shannon RB Ward0, Cameron JB Ward2,3,4
1Queensland University of Technology, Brisbane, Australia, 2University of Queensland, Brisbane, Australia, 3Lady Cliento Children's Hospital, Brisbane, Australia, 4Mater Medical Research Institute, Brisbane, Australia

  Objective : to  further investigate  changes in cholesterol (chol) levels in patients (pts) with eating disorders (EDs) to understand their significance and relevance in recovery.   Backgound : previous research has recognized elevated levels of chol in some pts with EDs. As a consequence, many pts with EDs  have been placed on low fat diets. Our previously published data (https://doi.org/10.1186/s40337-017-0158-y) demonstrated a very unusual bimodal distribution, clustering at both upper and lower ends with 19% below and 21% above the reference range.  High levels of chol are known to be generated under stress.    Methods:  Serial paired chol and BMI levels will be compared in pts.   Results: Our observation is that there are a number of pts (likely the most unwell) who present with significantly elevated chol levels, which steadily fall with improved nutrition/recovery and seemingly paradoxically chol ingestion. On the other hand, those pts with initially low chol demonstrate  an increase in levels.   Conclusions: Low levels of chol are seen in pts with established EDs whereas high levels are seen in pts as they decompensate under nutritional stress. Irrespective of chol levels, all pts with EDs  should thus be placed on high caloric diets with no limitation on fat.                    

Sarcopenia In Patients With Eating Disorders Predicts Low Bone Mineral Density And Prolonged Hospital Stay
Anne Drabkin1, Micol Rothman2, Michelle Laging1, Ashlie Watters1, Margherita Mascolo1, Phillip S Mehler1,3
1Denver Health Medical Center, Denver, CO, United States, 2University of Colorado, Denver, CO, United States, 3Eating Recovery Center, Denver, CO, United States

Sarcopenia, or the loss of muscle mass, strength and function, relates to low bone mineral density (BMD), falls and high hospital costs, but has not been evaluated in patients with eating disorders (ED). Muscle atrophy, myopathy and low muscle force are seen in anorexia nervosa (AN). We aim to identify sarcopenia in ED and evaluate its link to BMD and length of hospital stay (LOS). Patients hospitalized for an ED were retrospectively evaluated for appendicular lean mass (ALM), BMD, grip strength (Gr) and gait speed (Ga). Sarcopenia (S) and severe sarcopenia (SS) were defined as the presence of low muscle mass plus low grip strength (S) plus low gait speed (SS). 96 patients (83 females) were evaluated (median age 23). 56% had SS and 39% had S. Females had a higher likelihood of SS than males. ALM and Gr positively correlated to Z-scores of the hip (p<.0001, p=.002) when evaluated as a cohort and by sex (females: p=.0002, p=.03; males: p=0.04, p=.02). ALM and Gr negatively correlated with LOS (p=.03, p=.04) and patients with SS had longer LOS (p=0.01). There was no difference between the ED type and ALM, Gr or Gs (p=.07, p=.26, p=.08). The majority of hospitalized patients with ED is severely deconditioned and may be at high risk for permanent disability. Rigorous physical therapy, microbiome modulation and selective androgen receptor modulators should be further evaluated as protective factors against low BMD, falls, fractures, and prolonged LOS.

The Relationship Between Sense Of Self And Pathology In Eating And Body Image
Chris J Basten1,2, Stephen Touyz1
1University of Sydney, Sydney, Australia, 2Macquarie University, Sydney, Australia

Introduction This paper aims to investigate the links between weak sense of self (SOS) and eating disorder (ED) symptoms. It is postulated that SOS can be stunted by developmental invalidation or trauma. Poor SOS has long been associated with eating disorders but there have been no sound empirical investigations. Methods A new measure (the SOSI) was administered to 43 adult women with anorexia nervosa and 85 female university students. In addition to the SOSI, the Eating Disorders Inventory (EDI) and Concerns About Change Scale (CCS) were also used. Results  In both samples, the total SOSI score was strongly correlated (p<.001) with the Drive for Thinness and Body Dissatisfaction scales of the EDI. In both groups a high SOSI score equally correlated with EDI Ineffectiveness, as was hypothesized. In the patient group, the SOSI score correlated strongly with the Loss of Identity subscale of the CCS. The SOSI scores did not correlate significantly with weight or frequency of bingeing or purging, suggesting that SOS is not influenced by the effects of weight loss. Conclusions The findings lend some support for the idea that that EDs occur in those whose SOS and identity is weak. Further investigation is warranted to determine whether this applies to various ages and diagnoses. The correlation with fears of Loss of Identity points to ED symptoms becoming subsumed into a person’s identity, which will be prized and protected in a person whose sense of self is already impoverished.

Does Heightened Attention To Detail Differentiate Anorexia Nervosa And Avoidant/Restrictive Food Intake Disorder?
Kendra R Becker 1,2, Franziska Plessow3,4, Ani C Keshishian1, Laura T Germine2,5, Lauren Breithaupt6, Nadia Micali7, Elizabeth A Lawson3,4, Kamryn T Eddy1,2, Jennifer J Thomas1,2
1Eating Disorder Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States, 2Department of Psychiatry, Harvard Medical School, Boston, MA, United States, 3Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States, 4Department of Medicine, Harvard Medical School, Boston, MA, United States, 5McLean Hospital Institute for Technology and Psychiatry, Belmont, MA, United States, 6Department of Psychology, George Mason University, Fairfax, VA, United States, 7Child and Adolescent Psychiatry Division, Geneva University Hospital and University of Geneva, Geneva , Switzerland

Increased attention to detail is implicated in the pathogenesis of dietary restriction in anorexia nervosa (AN). Restrictive eating is also a hallmark characteristic of avoidant/restrictive food intake disorder (ARFID). However, cognitive processing style in ARFID has not yet been investigated. The aim of this study was to compare attentional bias to detail between AN and ARFID in an outpatient clinical sample. Methods: 38 individuals with AN (age: M=21.3, SD=4.7) and 31 individuals with ARFID (age:M=16.7; SD=5.6) completed a questionnaire battery and a computerized task requiring attention to detail or focus on the big picture (Navon task) as part of a clinical evaluation. We conducted mean comparisons on attentional bias to detail, controlling for age and anxiety, both known to impact processing style. Results: Individuals with ARFID showed a more pronounced attentional bias to detail than individuals with AN (p=.032). Conclusions: Our findings indicate that a heightened reliance on local-level processing may also be a part of ARFID symptomatology. Further studies are required to replicate this novel finding and test if possible differences exist across ARFID presentations. These results suggest that similarities and differences in cognitive functioning between AN and ARFID should be further explored, as they may represent important risk or maintenance factors in ARFID and help differentiate restrictive eating disorders. 

The Lived Experience Of Severe And Enduring Anorexia Nervosa
Catherine L Broomfield, Paul Rhodes, Stephen Touyz
The University of Sydney, Sydney, Australia

INTRODUCTION. Individuals with an experience of Anorexia Nervosa (AN) for a period of seven or more years, fall into the recently constructed category of ‘severe and enduring’. Despite this label implying a life-long battle with the illness, little research has explored the stories of these women, including the cycles of their illness, their resilience, and their views on recovery. The current research presentation discusses preliminary data gathered through the innovative method of photovoice, to explore the lived experience of women who endure this form of AN. METHODS. Nine women (age range=30-67 years, M=40) were interviewed to explore their individual experience with AN. Photovoice, a method that allows for deeper exploration of experience, was adapted to assist with data collection. Transcripts were then analysed using a narrative inquiry approach to detect common themes that arose throughout these unique experiences. RESULTS. Common themes that were found included turning points within the journey, the sense of embodiment/disembodiment, recovery/resilience, and the failure of health and support systems. CONCLUSIONS. This study promotes the empowerment of women, who have previously been suppressed into silence. Along with exploring the lived experience of severe and enduring AN, this presentation promotes discussion surrounding healing, hope, and the strength to move forward despite traditional approaches to treatment failing these women in their recovery. 

InhiBition Of Return For Body Images In Individuals With Shape/Weight Based Self-Worth 
Alexandra Cobb1, Elizabeth Rieger2, Jason Bell3
1ANU, Canberra, Australia, 2ANU, Canberra, Australia, 3UWA, Perth, Australia

Attentional biases for body shape and weight information have been found in people with eating disorders, indicating disorder-specific changes in the way this information is processed. To date, the literature has focused on the initial capture of attention with little research on attentional maintenance. The current study aims to investigate the occurrence of attentional maintenance through the use of an Inhibition of Return task. Three groups of female participants undertook an Inhibition of Return task with target images of female bodies and control images of animals. The groups were an eating disorder group (n = 20), a High shape/weight based self-worth group (n = 23), and a Low shape/weight based self-worth group (n = 26). The results indicated differential patterns of Inhibition of Return between the High and Low shape/weight based self-worth groups. The High group displayed increased inhibition of return for the shape/weight relative to control stimuli, while the Low group displayed reduced inhibition of return for the shape/weight compared to control stimuli. The current findings indicate that young women without an eating disorder who base their self-worth on shape/weight display a pattern of avoidance of shape/weight stimuli that was in direct contrast to those at low risk of developing eating disorders. The possible implications of these specific patterns of inhibition of return  are discussed along with their implications for intervention approaches. 

Viewing Patterns During Facial Emotion Recognition In Recovered Anorexia Nervosa: An Eye-Tracking Study
Lisa Dinkler1, Sandra Rydberg Dobrescu1, Maria Råstam1,2, Carina I. Gillberg1, Christopher Gillberg1, Elisabet Wentz3, Nouchine Hadjikhani1,4
1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden, 2Department of Child and Adolescent Psychiatry, Institute of Clinical Sciences, Lund University, Lund, Sweden, 3Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden, 4MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States

Introduction: Deficits in facial emotion recognition (FER) have been observed in acute and recovered anorexia nervosa (AN). These deficits might be due to deviant viewing patterns, which have not yet been thoroughly investigated in AN. We used a sensitive task including low-intensity emotion expressions to reflect real social contexts. Methods: 16 women recovered from AN for on average 27 years (recAN) and 34 age-matched control women (CON) completed a FER task on an eye-tracking computer. The task involved matching basic emotions (anger, fear, happiness) at different levels of expression intensity (low, medium, high) with a full emotional expression. Accuracy, response time and eye gaze were recorded. Results: We found earlier that recAN were less accurate than CON in recognizing anger and fear at low expression intensity. The present study investigates if deviant viewing patterns can explain these subtle FER deficits using eye-tracking methodology. We hypothesize that recAN show reduced attention to the eye region in expressions of anger and fear, where the eyes provide critical information for FER. Saccade and fixation metrics will be analyzed in relation to FER accuracy and response time. Conclusions: FER deficits may negatively impact on the social interaction skills of women with AN and may therefore contribute to the maintenance of AN. Understanding the underlying mechanisms of FER deficits in AN may facilitate the development of FER training in the treatment of AN.

Patients’ Endorsement Of The Pros And Cons Of Anorexia And Its Relationship With Illness Severity And Motivation For Recovery
Eva C. Gregertsen1, Ian Frampton2, Paul Robinson1, William Mandy1, Lucy Serpell1
1University College London, London, United Kingdom, 2University of Exeter, Exeter, United Kingdom

Anorexia nervosa (AN) is a serious illness with detrimental effects
, yet AN patients often resist treatment. In understanding this, the egosyntonic nature of AN, that is, the fact that AN is often highly valued, has been identified as a possible culprit. Research has identified perceived benefits of AN, such as feeling special, as well as perceived costs, such as health costs (Serpell, 1999).   Based on these themes, the P-CAN, a scale measuring both pros and cons of AN, was developed and validated (Serpell et al., 2004). A link between illness severity and endorsement of pros of AN was showed. However, the validity the P-CAN has not been established fully. Concurrent validity could be assessed by administering the P-CAN alongside motivational measures. Further, diagnostic information was lacking for the majority of participants in the original study.   This study will establish the concurrent validity of the P-CAN in a sample of diagnosed AN patients, examining its relationship to ED symptoms, BMI, AN subtype diagnosis, and motivational measures. Assessing motivation is of significant clinical relevance as valuing specific facets of AN may be a path through which reluctance towards recovery is enforced. 100 female outpatients suffering from a DSM-V diagnosis of AN will complete the P-CAN, EDE-Q, CCS, ANSOCQ, and RMQ. BMI and subtype will be obtained through clinical records.   Concurrent validity will be assessed by correlating the abovementioned measures with the P-CAN.

Does State Or Trait Anxiety Matter? Differences In Neuropsychological Profiles By Anxiety Condition In Patients With Anorexia Nervosa
Anne M Haase1, Ian J Frampton2
1University of Bristol, Bristol, United Kingdom, 2Exeter University, Exeter, United Kingdom

Introduction: Neuropsychological profiles have been identified in anorexia nervosa (AN). State and trait anxiety may be reflected in differences within set-shifting, central coherence and visuo-spatial memory. Thus we aim to test predictions of the NORA hypothesis that trait anxiety is associated with impaired executive functioning in AN. Methods: 157 patients with AN completed measures on state and trait anxiety, OCD and the full Ravello neuropsychological battery. The relationship between state/trait anxiety and neuropsychological and obsessive-compulsive characteristics was explored. Results: Patients with high state anxiety reported significantly higher scores on compulsions, obsessions and vocabulary tests, while patients with high trait anxiety reported significantly higher scores on a test of inhibition as well as compulsions and obsessions, and vocabulary tests.  Vocabulary correlated with trait anxiety (r=0.23, p=0.01) and with state anxiety (r=0.19, p=0.02).  In addition, trait anxiety correlated with inhibition (r=0.18, p=0.04). Conclusions: Overall, hypotheses of the NORA model are partially supported, suggesting a refinement of the theory my be necessary.  The tests reveal an inconsistent pattern with respect to trait anxiety and state anxiety, potentially impacting on different levels of functioning.  Considering anxiety type during treatment may not necessarily have implications for neurocognitive processes in patients with AN.

Social Identity Mapping In Anorexia Nervosa 
Carol Kan1, James Adamson2, Tegan Cruwys3, Valentina Cardi1, Janet Treasure1
1King's College London, London, United Kingdom, 2South London and Maudsley NHS Foundation Trust, London, United Kingdom, 3University of Queensland, St Lucia, Australia

Introduction: Social identity mapping (SIM) is a novel procedure for visually representing personal perception of group memberships. Belonging to multiple social groups has been identified to be important for health and psychological well-being whereas loneliness has been associated with a higher prevalence of mental health disorders. In this exploratory study, we aimed to explore the feasibility and acceptability of producing visual representation of social networks in patients with anorexia nervosa admitted for inpatient care.

Methods: Seventeen adults with severe enduring anorexia nervosa were recruited to participate in this study. They completed the SIM and standardised measures of well-being upon admission and discharge.

Results: Participants spent between 20 and 30 minutes completing their SIM under the guidance of a clinician. The core SIM constructs (number of groups, number of important groups, number of positive groups and number of high quality relationships) were all highly correlated (r=0.60-0.88, p<0.05). The number of online groups in their social networks was moderately associated with social adjustment (work and social adjustment scale; r=0.47, p=0.06).

Conclusions: This exploratory study demonstrates the potential of using SIM to capture information about social networks in people with anorexia nervosa. These results tentatively suggest that patients with poorer social adjustment are more likely to be a member of online groups.

Identifying Sociocultural Influences And Psychological Processes That Influence The Body Image Of Women In Midlife To Inform Eating Disorder Prevention Efforts
Helena Lewis-Smith1, Phillippa C Diedrichs1, Rod Bond2, Diana Harcourt1
1Centre for Appearance Research, University of the West of England, Bristol, United Kingdom, 2School of Psychology, University of Sussex, Brighton, United Kingdom

Introduction: Eating disorder onset occurs during midlife, however, few preventive interventions target this age group. The Tripartite Influence Model identifies social influences (peers, family and media) and psychological influences (internalisation of the thin ideal, appearance comparisons) on body image. It has received empirical support among adolescents and young adults, but has not been evaluated comprehensively among midlife women. This study evaluated this model among midlife women to inform the development of eating disorder prevention programs. Methods: A community sample of 323 British women (Mage=47.6 years) completed online validated measures of media, partner, family and peer influences, internalisation, appearance comparisons, and body image. Results: Structural equation modelling indicated the model was a satisfactory fit to the data (2(44)=108.24, p<.001; CFI=.97, RMSEA=.08; SRMR=.02). Media had indirect effects on body image, through internalisation and appearance comparisons, whilst friends had a direct effect on body image. Conclusions: Overall, findings indicate that media and friends, and psychological processes of internalisation and appearance comparisons, affect women’s body image and may provide fruitful targets for eating disorder prevention interventions among women in midlife. These findings suggest that interventions developed to address these factors among young women may be usefully adapted and delivered to midlife women.

Momentary Self-Criticism And Interpersonal Problems Are Associated With Cognitive And Physiological Components Of Appetite
Tyler B Mason 1, Kathryn E Smith2,3, Scott G Engel2,3, Stephen A Wonderlich2,3, Ross D Crosby2,3
1University of Southern California, Los Angeles, CA, United States, 2Neuropsychiatric Research Institute, Fargo, ND, United States, 3University of North Dakota, Fargo, ND, United States

Intra- and inter-personal factors have broadly been implicated in relation to binge eating pathology, and these factors have been identified as important maintenance factors for binge eating using ecological momentary assessment (EMA). However, less research has identified physiological and cognitive processes that link momentary intra- and inter-personal factors and binge eating in the natural environment. Method: In the current study, women with binge eating pathology completed a 14-day EMA protocol where they responded to five random signals throughout the day. During these signals, they completed an appetite scale assessing hunger, urges to eat, and preoccupation with thoughts of food and items assessing self-criticism and interpersonal problems. Multilevel models were used to examine independent associations between momentary self-criticism and interpersonal problems and hunger, urges to eat, and preoccupation with thoughts about food. Results: Momentary interpersonal problems were associated with greater hunger (p = .048). Momentary self-criticism was related to greater urges to eat (p <.001) and preoccupation with thoughts of food (p <.001). Discussion: These findings indicate that interpersonal problems were associated with the physiological component of appetite whereas self-criticism was associated with the cognitive component of appetite. These results have important implications for momentary pathways to binge eating in women.

An Investigation Of Attentional Bias Regarding High- And Low-Calorie Food Stimuli In An Overweight And Obese Sample Using The Visual-Search Paradigm
Kimberlee McFarlane1, Jason Bell2, Elizabeth Rieger1
1Research School of Psychology, Australian National University, Canberra, Australia, 2School of Psychological Science, University of Western Australia, Perth, Australia

Selective attention to food stimuli has been proposed as a vulnerability factor for weight gain leading to overweight and obesity, yet research on attentional bias in the context of overweight/obesity has produced mixed findings. To assist in clarifying the nature of these attentional biases, the present study examined attentional subcomponents (i.e., accelerated orienting and increased distraction). Moreover, high-calorie, low-calorie, and non-food stimuli were employed to discern the impact of caloric content on allocation of attention. Finally, the study sample included distinct healthy-weight, overweight, and obese groups, and excluded participants with symptoms indicative of an eating disorder. The sample consisted of 50 participants in the healthy-weight range, 41 participants in the overweight range, and 46 participants in the obese weight range. Results indicated that all weight groups engaged in accelerated orienting to high- and low-calorie food stimuli. The obese group displayed a significantly reduced food bias (decreased orienting to food versus non-food stimuli) compared with the healthy-weight and overweight groups, which could represent an avoidance of food in early attentional processing with the aim of limiting the likelihood of cravings, (over)consumption, and associated weight gain. Increased distraction did not alter as a function of weight group, with all participants displaying maintained attention for food versus non-food stimuli. 

Relationships Between Social Media Motivations And Disordered Eating And Weight And Shape Concern: Mediating Role Of Selfie Activities 
Siân A McLean1, Alayne Cummins2, Bianca Pruscino2
1Institute for Health & Sport, Victoria University, Melbourne, Australia, 2Victoria University, Melbourne, Australia

Engagement with appearance-focused social media activities is associated with disordered eating and body dissatisfaction. Research is needed to understand what motivates use of potentially harmful social media and consequent negative effects. In this cross sectional study, 312 women (Mage = 23.1, SD = 3.8) completed measures of motivations to use social media, specific social media self-photo (selfie) activities, and disordered eating and weight-shape concern. Regression analyses showed that disordered eating was statistically predicted by seeking approval from others and appearance reassurance, as well as editing selfies before posting and emotional investment in selfie posting. Weight-shape concern was statistically predicted by seeking approval from others, high frequency of sharing selfies, and emotional investment in selfie posting. The relationships from seeking approval from others and from seeking appearance reassurance to disordered eating were mediated by both emotional investment in, and editing of selfies. In addition, the relationship between seeking approval from others and weight-shape concern was mediated by selfie sharing and by emotional investment in selfie posting. This study adds to the literature regarding effects of specific social media activities on disordered eating and body dissatisfaction. Importantly, understanding the role of motivations in driving maladaptive social media engagement contributes useful insights for intervention. 

Reward Sensitivity, Cognitive Inflexibility And Expectancies: Correlates Of Objective Binge-Eating
Susan M Murray, Eunice Y Chen
TEDp Temple University, Philadelphia, PA, United States

Introduction. One model of binge eating posits that greater reward sensitivity may lead to overeating. Binge eating is also conceptualized as negatively reinforcing by regulating or distracting from negative mood. In addition, cognitive rigidity may contribute to binge eating due to inflexible food beliefs. This study examines the contribution of these models. Methods. Undergraduate students (N=410) completed: Reward subscale of the Behavioral Activation Scale (BAS), Eating Expectancy Inventory (EEI), Detail and Flexibility questionnaire (Dflex), and Eating Disorders Examinations Questionnaire (EDE-Q). A hierarchical logistic regression was conducted to determine which variables would predict at least one objective binge eating episode (OBE) in the past month. Results. Neither BAS nor Dflex scores were associated with OBE (p=.98 and .88). All EEI subscales except for “eating is pleasurable and useful as a reward" (p=.51) were associated with OBE; “eating alleviates negative affect” (p<.01), “eating alleviates boredom” (p<.001), “eating enhances cognitive competence” (p<.05), an “eating leads to feeling out of control” (p<.05). Conclusions. These data suggest that binge eating is motivated by beliefs that this behavior will relieve negative affect and distract from boredom but do not provide strong support for binge eating being motivated by reward or cognitive rigidity.

Compliance In A Self-Control Training Additional To An Inpatient Childhood Obesity Program: Barriers-To-Treatment
Tiffany Naets, Leentje Vervoort, Caroline Braet
Ghent University, Department of Developmental, Personality and Social Psychology, Ghent, Belgium

Worldwide, 42 million children suffer from overweight and over 60% of them grow out to be overweight adults. The current golden standard for intervention is a family-based Multidisciplinary Obesity Treatment (MOT), but the amount of drop-out and weight regain remains high. Recently, self-control ability (guiding goal-directed behavior towards tempting environmental cues such as food) showed to be an important underlying mechanism that fortunately can be trained in both adults and children. Since these interventions are very innovative, thorough investigation of their feasibility is crucial. The barriers-to-treatment model already provided an important framework for childhood MOT compliance, showing that perceived barriers predict drop-out. We investigated the feasibility of a self-control ability training on top of inpatient MOT (Zeepreventorium vzw, Belgium) in 33 participants (14-18y old). We compared a low-compliance with a high-compliance group, and primarily hypothesized that the low-compliance group would report higher scores on an extended Barriers-To-Treatment-Participation-Scale, but results however showed no significant differences. Further qualitative item analysis did display that this group frequently reports barriers in terms of time management and motivation. We conclude that there was no significant difference between groups, but these two daily issues can be important to take into consideration when implementing innovative training strategies.

Relationship Between Desired Weight And Eating Disorder Pathology In Eating Disorders In A Treatment-Seeking Sample
Yoshikatsu Nakai1, Kazuko Nin2, Stephen, A Wonderlich3
1Kyoto Institute of Health Sciences, Kyoto, Japan, 2School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan, 3Department of Clinical Neuroscience, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, United States

Introduction: In order to investigate the potential impact of desired weight on the normalization of eating disorder pathology, we examined the relationship between desired weight and eating disorder pathology in anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED) in a treatment-seeking sample. Method: Participants were 304 women with DSM-5 eating disorders (111 AN patients, 103 BN patients and 90 BED patients), diagnosed using semi-structured clinical interviews. Desired BMI and BMI difference percentage (BDP; desired BMI minus actual BMI divided by actual BMI multiplied by 100) were calculated with self-reported desired weight. Results: Patients with AN wanted to gain their weight, but BN and BED patients wanted to lose their weight. Desired BMI of BED patients was the greatest among the 3 groups. Desired BMI was associated with eating disorder pathology in BN patients, but not associated with it in AN and BED patients. BDP was associated with drive for thinness and bulimia subscales of the Eating Disorder Inventory (EDI) in AN patients, whereas BDP was associated with body dissatisfaction subscale of the EDI and weight concern subscale of the Eating Disorder Examination-Questionnaire in BN and BED patients. Discussion: These results suggest that desired BMI and BDP may be important indicators of eating disorder pathology in the AN, BN and BED groups. There seemed to be some differences in the interpretation of these indicators among the 3 groups.

Predicting Weight Loss, Disordered Eating, And Quality Of Life Outcomes In Post-Bariatric Patients Using A Network Analysis Approach. 
Christine M. Peat1, Irina A. Vanzhula2, Cheri A. Levinson2, James E. Mitchell3
1University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 2University of Louisville, Louisville, KY, United States, 3University of North Dakota, Grand Forks, ND, United States

Current understanding of how pre-surgical eating pathology and other psychiatric symptoms impact post-surgical bariatric outcomes is limited. Network analyses might improve current understanding as they allow for a nuanced exploration of which individual symptoms may maintain psychopathology. Thus, the current study aims to identify core symptoms of pre-surgical psychopathology and explore if these symptoms predict post-surgical outcomes. The analysis population includes women and men (N=2458) enrolled in the Longitudinal Assessment of Bariatric Surgery (LABS-2) study. Baseline data on disordered eating, depression, and anxiety will be used to develop network models. Analyses will be conducted in Rusing the qgraphpackage and bootnetpackage to estimate glassonetworks and determine stability of the networks. We will estimate measures of centrality (e.g., betweenness, closeness, and strength) to identify which items are core symptoms. Core symptoms from each network will be used to predict post-surgical outcomes of disordered eating, weight loss, and quality of life at 1, 2, and 5 years post-surgery. Using network analyses to predict bariatric outcomes in a large, longitudinal dataset may elucidate a potential symptom profile of bariatric candidates who are at risk for suboptimal outcomes. Such data would be highly valuable in developing targeted assessments and interventions for this population. 

Harm Minimization In Chronic Anorexia Nervosa: The Harmoni Program (Harmoni = Harm Minimisation In Orexic Nutritional Illness)
Janie Russell1,2, Angelique Ralph1, Hayley Bennett1, Brooke Donnelly1
1Royal Prince Alfred Hospital, NSW Statewide Eating Disorders Service, Sydney, Australia, 2The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia

1.The persistence of anorexia nervosa (AN) is well-documented in the literature with approximately 20-25% of patients not remitting in the long-term. This sub-group have often experienced multiple failed treatment attempts and adverse experiences with eating disorder services. Such patients often exhibit low motivation to change, a tendency to prematurely end treatment and high levels of disability. We aimed to pilot a program that enhanced patients’ mental flexibility, global thinking strategies, recognition and tolerance of emotions, and quality of life. 2. Patients with a history of AN for a minimum of 10 years since adulthood were invited to participate in an 8-week program involving cognitive remediation training, emotion skills training and Yoga Nidra delivered in a weekly two-hour session, facilitated by a Clinical Psychologist and a Clinical Nurse Consultant. Pre-and post-treatment measures were collected as well as qualitative feedback. 3. Participants reported that the program was a positive treatment experience, stimulating, interesting and enjoyable. Participants self-reported increased positive alternations in their daily routines and increased awareness of their cognitive thinking styles. Preliminary analysis revealed modest improvements in mental flexibility and quality of life. 4.The HARMONI program may be beneficial in improving the mental flexibility, global thinking, emotional skills and quality of life of patients with severe and enduring AN.

30 Years After Teenage-Onset Anorexia Nervosa; Perinatal Status And Psychiatric Health In Offspring
Sandra Rydberg Dobrescu1, Lisa Dinkler1, Carina Gillberg1, Christopher Gillberg1, Maria Råstam1, 2, Elisabet Wentz3
1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden, 2Department of Child and Adolescent Psychiatry, Institute of Clinical Sciences, Lund University, Lund, Sweden, 3Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

Introduction: Few studies have investigated the psychiatric health in children of mothers with a history of eating disorders (EDs). This study aims to examine perinatal status and psychiatric health of the offspring of women with teenage-onset anorexia nervosa (AN). Methods: 48 women (mean age=44 years) with a history of AN, originally recruited after community screening 30 years ago, and 48 matched comparison women (COMP) were invited to take part in interviews regarding the psychiatric health of their offspring. Offspring psychiatric disorders were measured using validated parental interviews; the Developmental and Well-Being Assessment and M.I.N.I. International Neuropsychiatric Interview. Perinatal outcome measures, from the Swedish Medical Birth Register, included birth weight, Apgar score, preterm birth and instrumental delivery. A ponderal index (kg/m3) was also calculated. Results: 78% of the mothers of the AN group and 93% of the mothers of the COMP group enrolled in the interviews. Preliminary results indicate that EDs were overrepresented and psychiatric disorders were more common in the offspring of mothers with a history of AN. A lower birth weight and ponderal index was also found in the offspring of the AN group. Statistical analyzes are still under preparation. Conclusions: A history of AN has implications on perinatal status of the offspring. In addition, our results suggest that the offspring exhibits an increased risk of general psychopathology and EDs.

Examining The Roles Of Emotion Dysregulation, Impulsivity, And Self-Efficacy In The Relationship Between Psychological Trauma And Eating Pathology
Lauren M. Schaefer1, Kathryn E. Smith1,2, Li Cao1, Ross D. Crosby1,2, Stephen A. Wonderlich1,2
1Neuropsychiatric Research Institute, Fargo, ND, United States, 2University of North Dakota, Grand Forks, ND, United States

Introduction: Emotion dysregulation and impulsivity are theorized mediators of the relationship between psychological trauma and eating disorders (EDs). However, work is needed to (1) clarify the relative significance of these experiences in the maintenance of EDs and (2) examine possible moderators of these relationships.
Methods: 204 women with bulimia nervosa spectrum disorders completed measures of childhood trauma, emotion dysregulation, impulsivity, self-efficacy, and ED pathology. Path analysis was used to examine emotion dysregulation and impulsivity as mediators of the relationship between trauma and ED pathology. Self-efficacy was examined as a moderator of the pathways from emotion dysregulation and impulsivity to ED pathology. Results: The initial model provided poor fit to the data (CFI=.07, RMSEA=.48, SRMR=.24). Self-efficacy was not a significant moderator, and was removed from the model. Inclusion of a path from emotion dysregulation to impulsivity resulted in excellent model fit (CFI=.99, RMSEA=.04, SRMR=.02). Paths linking trauma and ED pathology via emotion dysregulation (β’s .24-.40) were stronger than paths involving impulsivity (β’s .11-.14). Conclusions: Although emotion dysregulation and impulsivity were both significant mediators, findings suggested that emotion dysregulation may represent an especially powerful process through which trauma relates to EDs. Self-efficacy may not lessen the impact of emotion dysregulation and impulsivity on EDs.

Processes Of Change Identified By Adults In Recovery From Restrictive-Type Eating Disorder: A Narrative Theory And Repertory Grid Analysis
Jane Townshend2,3, Cordet Smart3, Lynn Olver1,2, Ian Frampton1,2, Rudi Dallos3
1University of Exeter, Exeter, United Kingdom, 2Cornwall Partnership NHS Trust, Truro, United Kingdom, 3University of Plymouth, Plymouth, United Kingdom

Ambivalence about recovery may represent a contributory factor to the chronicity and poor outcomes associated with restrictive-type eating disorders. The aim of the current research was to investigate how adults defining themselves as ‘in recovery’ from a restrictive-type eating disorder make sense of the process of their recovery, with particular focus on changes in self-construal as a potential mechanism for change.  Five participants were recruited through an NHS specialist adult community eating disorders service. Participants were adults aged 24+ who were approaching discharge from treatment and who defined themselves as being ‘in recovery’. Two interviews with each participant were conducted and analysed using a narrative theory approach, to identify how participants made sense of the temporal sequence of their recovery, including attributions of cause and effect. Repertory grids were used in the second interview to identify the shifts in self-construal participants associated with entering and maintaining recovery.  Initial findings suggest that participants understand their recovery in terms of a complex interaction of factors, including shifts in self-construal on dimensions including self-awareness, sense of worth, and assertiveness. The implications for treatment and for the use of repertory grids in clinical practice and research are explored. 

Self- And Peer-Perceived Social Status In Adolescence And Eating Pathology In Early Adulthood
Daphne van Hoeken1, Frederique R Smink1, Jan K Dijkstra2, 3, Mathijs Deen1, Albertine J Oldehinkel4, Hans W Hoek1,4,5
1Parnassia Psychiatric Institute, The Hague, Netherlands, 2Dept. of Sociology, University of Groningen, Groningen, Netherlands, 3Interuniversity Center for Social Sciences, Groningen, Netherlands, 4Dept. of Psychiatry, University of Groningen, Groningen, Netherlands, 5Dept. of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States

INTRODUCTION: Low self-esteem is a well-established risk factor for eating pathology. In adolescence self-esteem is to a great extent shaped by social comparison with, and social support from, peers. Little is known about social status as perceived by others and its role in the onset of eating pathology. We examined associations between early adolescent self-esteem and self- and peer perceptions with eating pathology in young adulthood. METHODS: This study is part of TRAILS (Tracking Adolscents Individual Lives Survey), a prospective longitudinal cohort study which follows a community sample from age 11 into adulthood. The study sample consisted of 732 participants with peer nominations for being liked, social standing, academic competence and physical attractiveness at age 13, who had complete measures on the Self-Perception Profile for Children (SPPC, Harter, 1982) at age 11 and on the Eating Disorders Diagnostic Scale (EDDS, Stice, Telch & Rizvi, 2000) at age 22. RESULTS: Eating pathology at age 22 was predicted by lower self-perceived Physical appearance at age 11, and higher peer-perceptions of Likeability and lower peer-perceptions of Popularity at age 13. CONCLUSIONS: Both self-perceptions and peer status in early adolescence are significant predictors of eating pathology in young adults. Specific measures of self-esteem and peer-perceived status may be more relevant to the prediction of eating pathology than a global measure of self-esteem.

The Identity Disruption Model Of Disordered Eating  
Lenny R Vartanian
UNSW Sydney, Sydney, Australia

Negative early life experiences are a known risk factor for eating disorders, but less is known about the mechanisms underlying that association. I have developed a conceptual model (the Identity Disruption Model) that can help to explain the connection between early adversity and disordered eating. According to this model, early adversity can disrupt normal identity development, which in turn increases vulnerability to sociocultural risk factors (e.g., internalization of societal beauty standards) that are known to contribute to body dissatisfaction and disordered eating. In an initial test of this model, a community sample (N = 1,023, 52% women) completed a series of questionnaires assessing the core components of the model. Structural equation modeling indicated that self-reported early adversity was associated with lower self-concept clarity, which in turn was associated with greater internalization of beauty ideals and more frequent appearance comparisons. Internalization and appearance comparisons were associated with body image concerns, which in turn were associated with disordered eating and compulsive exercise. These findings provide initial support for the Identity Disruption Model and extend previous models of disordered eating to include processes that occur earlier in life. This model could also potentially be used to explain the association between negative early life experiences and other forms of psychopathology (e.g., depression, substance use).

Investigating The Effects Of Compulsive Exercise On Quality Of Life And Motivation To Change In Adults With Anorexia Nervosa
Sarah Young1, Stephen W Touyz1, Caroline Meyer2,3, Jon Arcelus4,5, Paul Rhodes1, Sloane Madden1,6, Kathleen M Pike7, Evelyn Attia7,8, Ross D Crosby9.10, Phillipa Hay11
1University of Sydney, Sydney, Australia, 2University of Warwick, Warwick, United Kingdom, 3University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom, 4University of Nottingham, Nottingham, United Kingdom, 5Leicestershire Adult Eating Disorders Service Leicestershire NHS Trust, Leicester, United Kingdom, 6Sydney Children's Hospital Network, Sydney, Australia, 7Columbia University, New York, NY, United States, 8Weill Cornell Medical College, New York, NY, United States, 9Neuropsychiatric Research Institute , Fargo, ND, United States, 10University of North Dakota, Fargo, ND, United States, 11Western Sydney University, Sydney, Australia

Introduction: Compulsive exercise is associated with poor clinical outcomes in anorexia nervosa (AN), including higher levels of eating disorder (ED) psychopathology and greater risk of relapse. However, there is a paucity of research examining its relationship to patients’ quality of life (QOL) and motivation to change in treatment. This study aimed to investigate if severity of compulsive exercise at baseline predicts QOL, motivation to change and/or psychological distress (mood, anxiety and obsessive-compulsive symptoms) during treatment. It also aimed to determine whether ED psychopathology serves as a mediator in these relationships. Methods: Participants were 78 adults with AN, enrolled in a multi-site randomized controlled trial of psychological treatments for AN. At three time points (baseline, after 10 sessions and after 20 sessions), participants completed questionnaires examining compulsive exercise, ED psychopathology, QOL, motivation to change and psychological distress. Results: Regression analyses indicated that severity of compulsive exercise predicted poorer motivation to change and greater obsessive-compulsive symptomatology after 20 sessions of treatment. These effects were not mediated by ED psychopathology. Discussion: It is integral to address compulsive exercise in AN to improve engagement throughout treatment and to enhance clinical outcomes for patients.

Compassion Focused Therapy To Treat Body Weight Shame For Indiviuals Who Are Overweight Or Obese: A Randomised Controlled Trial
Alicia Carter1, Tegan Cruwys2, Paul Gilbert3, James Kirby1, 4
1University Queensland, Brisbane, Australia, 2Australian National University, Canberra, Australia, 3University of Derby, Derby, Australia, 4Stanford University, Stanford, CA, United States

Introduction: Individuals who are obese are at increased risk for mental health vulnerabilities, particularly depression, anxiety, and body weight shame. To date, there have been no randomized controlled trails (RCT) specifically designed to treat body weight shame for individuals with obesity that do not have a clinical condition, such as binge eating disorder or depression. Here we outline a protocol for an RCT that will test for the first time the efficacy of Compassion Focused Therapy (CFT) to help a non-clinical population of obese individuals with body weight shame.   Methods: The CFT intervention is a 12-session/2 hour group program that is aimed to directly target shame and self-criticism by cultivating compassion. Seventy participants who meet criteria for obesity (BMI > 30) will be randomised to either the CFT or a waitlist control condition. Measurements will occur at pre, post, and 6-month follow-up. The primary outcome measure is body weight shame. Secondary outcome measures include, symptoms of depression, compassion, self-criticism, and the physiological measure of heart rate variability. Results: The RCT is a prospectively registered study. Discussion: If CFT is found to be efficacious, this could address future practice and research within health psychology.

7:00 - 9:00 PMManly Skiff Sailing Club
Welcome Reception - Manly Skiff Sailing Club

Appetizers will be provided and a cash bar will be available. Guests are required to sign in when entering the club, so please make sure to have a photo ID with you. Transportation is not provided.

Friday, October 26, 2018

8:30 - 10:00 AMGrand Ballroom
Agreeing on a Definition of Recovery for Research

Chair(s): Tracey Wade
Tracey Wade
Flinders University

Defining Recovery In Eating Disorder Research: Is A Consensus Definition Possible?
Ross Crosby
Sanford Research

Recovery In Eating Disorders: A Bit Of The Past And A Peek At Our Own Perspectives
James Lock
Stanford University

Recovery Criteria From A Patient Perspective
Eric van Furth
Rivierduinen Eating Disorders Ursula


10:00 - 10:30 AMFoyer
Coffee Break

10:30 - 12:00 PMGrand Ballroom
Cognitive Remediation Therapy for Weight and Eating Disorders: What Gaps it Addresses and Where Are Remaining Gaps?

Chair(s): Kate Tchanturia
Cognitive Remediation For Obesity Randomized Treatment Trial –Australian Study
Jayanthi Raman1, 2
1University of Technology Sydney (UTS), 2Western Sydney University (WSU)

Who Benefits Most From Cognitive Remediation Therapy? Results From The Trecogam Study
Sylvie Berthoz1, 2
1French National Institute of Health and Medical Research, 2Institut Mutualiste Montsouris

Impact Of Autistic Characteristics On Cognitive Remediation Therapy Outcomes
Kate Tchanturia
King’s College London

Longitudinal Effect Of Cognitive Remediation Therapy In A Group Setting For Patients With Anorexia Nervosa – Danish Study
Gry Kjærsdam Telléus
Aalborg University Hospital

James Lock
Stanford University

12:00 - 1:00 PMFoyer
Lunch On Your Own

1:00 - 2:00 PMGrand Ballroom
Keynote Session

Chair(s): Kathy Pike
When, Why And How Social Relationships Shape Disordered Eating
Tegan Cruwys
The Australian National University

2:00 - 2:30 PMFoyer
Coffee Break

2:30 - 4:00 PMClarendon/Norfolk
Parallel Paper Session: Interventions

Chair(s): Tim Brewerton
Olanzapine Vs Placebo For Adult Outpatients With Anorexia Nervosa: Impact On Weight, Psychological Symptoms, Metabolic Factors, And Somatic Symptoms During A 16-Week Randomized Clinical Trial
Evelyn Attia1,2, Joanna Steinglass1, B Timothy Walsh1, Angela Guarda3, Allan S Kaplan4, Marsha Marcus5
1Columbia University Medical Center, New York, NY, United States, 2Weill Cornell Medical College, New York, NY, United States, 3Johns Hopkins Medical School, Baltimore, MD, United States, 4Center for Addiction & Mental Health, Toronto, ON, Canada, 5University of Pittsburgh, Pittsburgh, PA, United States

PURPOSE: This study examines the benefits of olanzapine vs placebo for adult outpatients with AN. METHODS: An RCT was conducted at 5 sites in North America. Participants were randomized 1:1 to receive olanzapine or placebo for 16 weeks. Rate of change in body weight and in obsessionality, using the Yale Brown Obsessive Compulsive Scale (YBOCS) were assessed as primary outcomes. Other psychological symptoms, and somatic effects were additionally examined. RESULTS:75 participants were randomized to receive olanzapine and 77 to placebo. There was a significant treatment by time interaction (F[1,1435] = 4.98; p = 0.026) indicating that the increase in BMI over time was greater in the olanzapine group (0.259 + 0.051 vs 0.095 + 0.053 kg/m2 per month). There was no significant difference between groups in change in YBOCS-obsessions over time (-0.325 vs -0.017 units per month; F[1,93] = 0.27; p = 0.60), nor in the frequency of abnormal blood tests to assess metabolic abnormalities (including serum concentrations of cholesterol, triglycerides, hepatic transaminases and Hgb A1c) during the study period. CONCLUSIONS: The study documented a therapeutic effect of olanzapine vs placebo on weight in patients with AN . The effect was modest and there was no significant benefit on the psychological symptoms; nevertheless, it is notable as achieving change in weight has been notoriously challenging in AN. Olanzapine may be of use as an ancillary intervention in the treatment of adults with AN. 

Efficacy Of Eeg Neurofeedback For The Reduction Of Binge-Eating Episodes
Marie U Blume1, Ricarda Schmidt1, Jennifer Schmidt2, Alexandra Martin2, Anja Hilbert1
1Integrated Research and Treatment Center AdiposityDiseases, Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Germany, Leipzig, Germany, 2University of Wuppertal, Wuppertal, Germany

Background. Although binge-eating disorder (BED) involves specific alterations in electroencephalography (EEG)-based brain activity, there is a lack of treatments directly addressing these neuronal processes. This study examined feasibility and efficacy of two EEG neurofeedback paradigms for the reduction of binge-eating episodes. Method. Adults with BED and overweight were randomly assigned to either a general EEG neurofeedback paradigm, training the up- and downregulation of slow cortical potentials, or a BED-specific paradigm, training the downregulation of beta activity and upregulation of theta activity over frontal cortices after food cue exposure. Following a waiting period of 6 weeks, both paradigms consisted of 10 treatment sessions. All patients were examined at baseline, pre- and post-intervention, and 3-month follow-up. Results. In within-group comparisons, preliminary analysis of N=28 patients showed a significant reduction of binge-eating episodes in the BED-specific paradigm, while this effect was marginally significant for the general paradigm. However, between-group comparisons did not indicate any differences in the reduction of binge-eating episodes between paradigms. Both paradigms were highly accepted by patients and related to high attrition (83%). Conclusion. The results indicate the feasibility of EEG neurofeedback in the treatment of adults with BED. The specific mechanisms of improvement through EEG neurofeedback have yet to be investigated.

Cognitive-Behavioral Therapy For Binge-Eating Disorder In Adolescents
Anja Hilbert, David Petroff, Petra Neuhaus, Ricarda Schmidt
University of Leipzig, Leipzig, Germany

Binge-eating disorder (BED) is a prevalent eating disorder in adolescents, but evidence-based treatments are widely lacking. This randomized clinical trial sought to determine the efficacy of age-adapted cognitive-behavioral therapy (CBT) for adolescents with BED - the most well-established treatment for adults with BED. Methods. In a prospective single-center, assessor-blind superiority trial, 73 adolescents (12-20 years, 82% girls) with age-adapted DSM-IV or DSM-5 diagnosis of BED (including BED of low frequency and/or limited duration) were centrally randomized to four months (20 sessions) of individual CBT (n=37) or a waiting-list control condition (WL, n=36). The WL group was subsequently offered CBT and contributed to 12 and 24-month follow-up analyses. Patients were assessed with clinical interview (Eating Disorder Examination) and questionnaires. Results. In intent-to-treat analyses, the CBT group had significantly fewer binge-eating episodes, a higher rate of binge-eating abstinence (51.4%), and a lower global eating disorder psychopathology at post-treatment than the WL group. These therapeutic gains in CBT were maintained at 12 and 24-month follow-up. A significant reduction in depression and stabilization of weight status were not specific for CBT. Conclusions. This confirmatory study uniquely established the short and long-term efficacy of age-adapted CBT for binge-eating outcome in adolescents with BED, with similar effects as in adults with BED.

Two Year Follow-Up Of Schema Therapy And Appetite-Focused Cognitive Behaviour Therapy Versus Cognitive Behaviour Therapy For Transdiagnostic Binge Eating
Jennifer Jordan1,2, Virginia VW McIntosh3, Janet D Carter3, Christopher MA Frampton1, Peter R Joyce1
1University of Otago, Christchurch, Christchurch, New Zealand, 2Canterbury District Health Board, Christchurch, New Zealand, 3University of Canterbury, Christchurch, New Zealand

Introduction: Current psychotherapies for bulimia nervosa (BN) and binge eating disorder (BED) such as cognitive behaviour therapy (CBT) are effective but outcomes for a sizable minority remain limited. Our randomised trial compared two novel applications: schema therapy (emphasising early life experiences related to the eating disorder); and CBT-A (incorporating retraining awareness of appetite) to CBT to try to improve outcomes for BN and BED. This study examines outcomes 2 years post-therapy. Methods: Participants were 112 women aged 16-65 years with current BN or BED who had attended the 12 month outpatient psychotherapy programme (McIntosh et al, 2016). Outcomes were binge eating frequency, eating disorder diagnoses and symptomatology, and psychosocial functioning. ANCOVAS, paired t tests and chi-square analyses were used to examine outcomes at 2 years and change from pre-treatment. Results: Compared to pre-treatment, large ES remained for all outcomes apart from body dissatisfaction (moderate ES), and BMI which was not statistically different from pre-treatment. There were no significant differences among therapies for any outcomes. Conclusions: All three therapies remained effective at 2 year follow-up. Although ST and CBT-A were not superior to CBT outcomes during treatment or by 2 year follow-up, these innovative applications may offer alternative treatments addressing patient preferences. Replication is required.

Body Mass Index Trajectories In Anorexia Nervosa
Carol Kan1, John Hodsoll1, Elizabeth Goddard2, Simone Raenker3, Pamela Macdonald1, Gillian Todd2, Ulrike Schmidt1, Janet Treasure1
1King's College London, London, United Kingdom, 2South London and Maudsley NHS Foundation Trust, London, United Kingdom, 3University College London, London, United Kingdom

Introduction: A range of treatments are available for anorexia nervosa but treatment response varies widely amongst individuals and patients have advocated for a more personalised approach. Method: Secondary data analysis was conducted on a multi-centre randomised controlled trial evaluating the effectiveness of adjunct guided self-help for carers of adults with severe enduring anorexia nervosa (CASIS; n=176). BMI-trajectory clusters were identified from monthly BMI up to 16-months post-discharge, using longitudinal non-parametric k-means cluster analysis. Baseline predictors of BMI-trajectory clusters were detected using penalized model selection. Results: Two BMI-trajectory clusters were identified. The “poor-response” cluster (n=82; mean baseline BMI=14.0kg/m2) showed limited improvement in BMI at both 1- (15.6kg/m2) and 2- (16.0kg/m2) year follow-up whereas the “fast-response” cluster (n=53; baseline BMI=15.2kg/m2) showed sustained improvement at both follow-ups (1-year=19.7kg/m2; 2-year=19.9kg/m2). Living with others (β=1.03) and level of perceived expressed emotions within the family (β=-0.11) were identified as potentially important predictors for BMI-trajectory clusters. Conclusion: Our preliminary findings suggest strengthening the social network and encouraging positive interactions within these networks, thereby reducing expressed emotions, may be constructive to the long-term recovery for people with anorexia nervosa.

The Influence Of Oxytocin On Eating Behaviours And Stress In Bulimia Nervosa And Binge Eating Disorder
Monica R Leslie, Jenni Leppanen, Yannis Paloyelis, Janet Treasure
King's College London, London, United Kingdom

Introduction: Previous research has found that a single dose of oxytocin reduces feeding in animals, and specifically reduces hedonic eating in humans. The current study aimed to test whether intranasal oxytocin reduces binge eating and 24-hour caloric intake in women with bulimia nervosa and binge eating disorder. This study examined the hedonic and stress-related components underpinning this effect. Methods: We recruited 25 women with bulimia nervosa or binge eating disorder, and 27 weight-matched comparison women without history of an eating disorder. We employed a double-blind, placebo-controlled crossover design in which each participant attended the lab for two experimental sessions, receiving a divided dose of 64IU intranasal oxytocin in one session and equivalent volume of placebo nasal spray in the opposite session. Caloric consumption in a “taste test” was then measured in the lab, and participants were requested to keep a food diary over the following 24 hours. Results: We did not find that oxytocin significantly affected any of the measurements of eating behaviour or subjective stress. There was, however, a trend towards greater reduction of 24-hour calorie consumption in women with bulimia nervosa and binge eating disorder (d = 0.24). Conclusion: We recommend that future studies test the dose-response effect of oxytocin on eating behaviour in human populations with eating disorders to further clarify the moderating factors for oxytocin’s effect on eating.

2:30 - 4:00 PMCutler/Barton
Parallel Paper Session: Risk and Comorbidity

Chair(s): Howard Steiger
Dna Methylation Age As A Possible Marker For Stage Of Illness And Remission Of Anorexia Nervosa: Preliminary Findings
Linda Booij1,2,3, Esther Kahan4,5, Kevin Casey1,2, Jessica Burdo4,5, Kevin McGregor6, Lea Thaler3,4,5, Aurelie Labbe7, Luis B. Agellon8, Linda Wykes8, Mimi Israel3,4,5, Moshe Szyf9, Emilie Fletcher4,5, Ridha Joober3,5, Howard Steiger3,4,5
1Department of Psychology, Concordia University, Montreal, QC, Canada, 2CHU Sainte-Justine Hospital , Montreal , QC, Canada, 3Department of Psychiatry, McGill University, Montreal, QC, Canada, 4Eating Disorders Program, Douglas University Institute, Montreal, QC, Canada, 5Research Centre, Douglas University Institute, Montreal, QC, Canada, 6Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada, 7Department of Decision Sciences, Montreal, QC, Canada, 8School of Human Nutrition, McGill University, Montreal, QC, Canada, 9Department of Pharmacology and Therapeutics, Montreal, QC, Canada

Purpose of the study: Numerous studies have shown that a higher DNA methylation (DNAm) age -- an indicator of biological ageing based on someone’s DNA methylation pattern -- is associated with a greater risk for a variety of physical and mental health problems. DNAm age has also been predictive of mortality risk, independently of chronological age and other health risk factors. Here, we present data of an ongoing study, in which we test the hypothesis that Anorexia Nervosa (AN) is associated with accelerated DNAm age. Methods: At present, we have estimated DNAm age from whole blood DNA in 55 young women (age 18-25 years) with AN, and in 25 age-matched controls. DNAm age was estimated using the method developed by Horvath (2013). Associations between DNAm age and clinical variables were examined using linear mixed effects models, while controlling for chronological age. Results: Preliminary findings suggest that women with AN tended to have a slightly higher DNAm age compared to controls (t(77)=1.77, p=0.08, Cohen’s D=1.3). Notably, within the AN sample, a higher DNAm age correlated with a higher BMI (p<.01), fewer body shape concerns (p<.03) and a trend towards lower eating disorder severity (p=.07). Conclusions: These preliminary results suggest that AN may affect DNAm age. In addition to increasing sample size, longitudinal analyses are presently ongoing to better understand the clinical relevance of DNAm age as a marker for illness stage and remission of AN.

Physical Activity In Patients With Anorexia Nervosa: Effect On Clinical Outcome And Factors Explaining Its Variability
Verena K Haas1, Julia Grosser1, Tobias Hofmann2, Andreas Stengel2,3, Almut Zeeck4, Sibylle Winter1, Christop U. Correll1
1Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany, 2Department of Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany, 3Department of Psychosomatic Medicine, Universität Tübingen, Tübingen, Germany, 4Department of Psychosomatic Medicine, Freiburg, Germany

Introduction: Physical activity (PA) plays a role in the development and course of anorexia nervosa (AN). Method: PA was assessed with accelerometry (SenseWear Armband; step count; time spent in very light, light, moderate, and vigorous PA using specific MET cut-offs) in 17 adults and 33 adolescents with AN. Clinical (body mass index (BMI)), biological (fat mass, by bioimpedance analysis), psychological (by PA questionnaires) parameters, as well as energy and macronutrient intake (3day food diary) were assessed on admission to inpatient treatment. Results:  Compared to adolescents, adults had more steps/d (13,076 vs. 8,218, p=0.006) and more time in moderate PA (154 vs. 70 min, p<0.001). Greater presence of light PA was associated with low BMI on admission and discharge (ρ=-0.592, p <0.001; ρ = -0.413, p = 0.003). BMI change was inversely associated with step count (ρ=-0.339, p = 0.016) and moderate PA (ρ=-0.394, p = 0.005). While relationships between PA and psychological scores were weak, fat mass was inversely associated with light PA (ρ=-0.539, p<0.001). Subjects with high step count had lower energy (1530 vs. 1910 kcal/d, p=0.021) and lower fat intake (46 vs. 75g/d, p=0.02). Conclusion: PA was associated with low BMI and only marginally with subjective scores assessed with questionnaires related to PA. Body composition and food intake showed associations with PA. Future investigations should differentiate PA subtypes to address the complexity of altered PA in AN.

Changes In Appetite Perception, Gastrointestinal Function And State Anxiety In Adolescent Anorexia Nervosa During Short-Term Refeeding
Gabriella A. Heruc1,2, Michael R. Kohn3, Tanya J. Little1, Sloane Madden2, Simon D. Clarke3, Michael Horowitz1, Christine Feinle-Bisset1
1University of Adelaide, Adelaide, Australia, 2The Children's Hospital at Westmead, Sydney, Australia, 3Westmead Hospital, Sydney, Australia

Introduction: Changes in polypeptide gastrointestinal (GI) hormones occur in obesity with impact on appetite. This study assessed these changes in anorexia nervosa (AN) and the effect of GI symptoms and anxiety on appetite disturbance. Methods: 22 female adolescents with AN studied on admission and at week 2 (Wk2) of high-calorie refeeding, were compared with 17 matched healthy controls (HCs). Peptide tyrosine tyrosine (PYY), ghrelin, cholecystokinin (CCK), pancreatic polypeptide (PP), appetite perception, anxiety and GI symptom responses to a mixed-nutrient test meal (479 kcal) were assessed over 2 hours. Results: Compared to HCs, AN patients had higher baseline PYY, ghrelin, fullness, bloating, state anxiety and lower hunger and higher postprandial ghrelin, bloating, anxiety and lower hunger (P<0.05), but no difference in CCK or PP. At Wk2, baseline PYY, fullness and anxiety decreased, and baseline and postprandial hunger increased (P<0.05), with no changes in baseline or postprandial ghrelin or bloating. Conclusions: Higher PYY may explain greater fullness perceived in AN. With acute refeeding PYY and fullness returned towards HC levels and appetite regulation may be a continuum from AN to health to obesity. While high baseline ghrelin and low hunger levels appeared disconnected in starvation, hunger increased in line with ghrelin after refeeding. Bloating persisted with refeeding and future research might target this as a contributor to treatment difficulty and relapse.

Profiling The Use Of Eating Disorder-Related Online Discussion Forums: A Text-Mining And Network Analytic Approach
Duncan McCaig1, Mark Elliott1, Cynthia Siew2, Lukasz Walasek1, Caroline Meyer1,3,4
1WMG, University of Warwick, Coventry, United Kingdom, 2Department of Psychology, University of Warwick, Coventry, United Kingdom, 3Warwick Medical School, University of Warwick, Coventry, United Kingdom, 4University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom

Introduction: While research has tended to examine eating disorder-related (EDR) online discussion forums in isolation, profiling the groups in terms of the other forums in which they post could provide valuable insights. This study aimed to identify in which other forums EDR forum commenters posted by using text-mining and network analysis. Methods: All public EDR forums on a large online discussion platform (Reddit) were identified. A list of unique commenters on these forums was compiled (N=14,024), and used to identify all forums in which they had posted. Only forums with ≥1000 comments between March 2017 and February 2018 were included. Network analyses were conducted using the commenter overlap between 50 forums, which were selected based on their number and proportion of EDR forum commenters. Subgroup analyses (e.g. pro-eating disorder) were also conducted. Results: The findings indicated that pro-eating disorder, pro-recovery and thinspiration communities were relatively distinct. Distinct groups also emerged within these communities, such as separate groups of pro-eating disorder commenters who posted on either self-harm, appearance, or body-related forums, and groups of thinspiration commenters who posted on either eating and body-related, or pornographic forums. Conclusions: The findings suggest that people are likely to engage with EDR forums for relatively distinct reasons. The findings also have implications for the design of online interventions.

A Comparison Of Negative Affect And Emotion Regulation Networks Between Individuals With And Without Eating Psychopathology
Kathryn E. Smith1,2, Tyler B. Mason3, Jason M. Lavender4, Lauren M. Schaefer1, Li Cao1, Nicholas L. Anderson5, Stephen A. Wonderlich1,2, Ross D. Crosby1,2
1Neuropsychiatric Research Institute, Fargo, ND, United States, 2University of North Dakota, Fargo, ND, United States, 3University of Southern California, Los Angeles, CA, United States, 4University of California San Diego, San Diego, CA, United States, 5California School of Professional Psychology, Fresno, CA, United States

. Theoretical and empirical work suggests negative affect and emotion regulation (ER) deficits are relevant in the etiology and maintenance of eating disorders (EDs), though further work is necessary to elucidate the interplay between specific ER strategies that attenuate or exacerbate negative affect in EDs. To elucidate such processes we used a network approach to characterize and compare emotion networks of individuals with and without ED symptoms, as ER strategies have not been examined in ED networks. We hypothesized that the ED group would evidence greater connectivity (i.e., global strength) and differences in network structure compared to the non-ED group. Methods. Undergraduates (74.9% female) completed questionnaires assessing ED symptoms, negative affect, and ER. Regularized partial correlation networks were estimated among those who did (N=141) and did not (N=122) endorse regular (≥once/week) ED behaviors. Results. In the ED group only, thought suppression evidenced highest strength centrality. Global network strength was greater in the ED group (p=.025), but there was not evidence of network structure invariance (p=.262). Conclusions. Results suggest that thought suppression may be centrally important to emotional dysfunction in EDs, and that the overall degree of connectivity within a network, rather than the particular structure of connections, may be a marker of greater severity that reflects increased risk for symptom activation and maintenance.

Are There Signs Of Neuronal Injury 30 Years After Anorexia Nervosa Onset? Investigation Of Serum Neurofilament Light Chain Protein.
Elisabet Wentz1, Sandra Rydberg Dobrescu2, Lisa Dinkler2, Carina Gillberg2, Christopher Gillberg2,3, Kaj Blennow1, Maria Råstam2,4, Henrik Zetterberg1
1Department of psychiatry and neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden, 2Gillberg Neuropsychiatry Centre, Institute of Neurosience and Physiology, University of Gothenburg, Gothenburg, Sweden, 3Department of Child and Adolescent Psychiatry, Strathclyde University, Glasgow, United Kingdom, 4Department of Child and Adolescent Psychiatry, Institute of Clinical Sciences, Lund University, Lund, Sweden

Purpose: Increased serum levels of neurofilament light chain protein (NfL), a biochemical marker for neuronal injury, have been observed in individuals with faster rates of brain atrophy. Little is known about the long-term consequences of anorexia nervosa (AN) in terms of neuronal injury. The purpose of the present study was to assess NfL 30 years after AN onset. Methods: 47 individuals with adolescent-onset AN and 51 matched comparison cases (COMP) were followed up 30 years after onset of AN. Blood samples were collected from 34 and 41 individuals of the AN and COMP group, respectively. NfL was measured in serum using an ultrasensitive in house Single molecule array (Simoa) method. The individuals were asked if they or their parents had been assigned a diagnosis of dementia. Results: There was a tendency towards higher serum levels of NfL in the AN group (AN group: 27.7 pg/ml; COMP group: 21.0 pg/ml; p= 0.057). None of the participants was diagnosed with dementia. Serum NfL concentrations did not differ between those who showed full eating disorder recovery compared with those who did not, in the AN group. There was a significant negative correlation between serum NfL concentrations and current BMI in the AN group (p= 0.01). Conclusions: This is to our knowledge the first time that serum NfL has been assessed in middle-aged individuals with a history of adolescent-onset AN. The study does not support the notion of increased axonal degeneration as a sequel of AN.

4:15 - 5:45 PMClarendon/Norfolk
Parallel Paper Session: Assessment, Risk and Course

Chair(s): Nadia Micali
The Validation Of The Parent Pica, Arfid And Rumination Disorder Interview (Pardi)
Rachel Bryant-Waugh1, 2, Lucy Cooke1,2, Nadia Micali2,3, Kamryn Eddy4,5, Jennifer Thomas4,5
1Great ormond Street Hospital NHS Foundation Trust, London, United Kingdom, 2University College London, London, United Kingdom, 3University of Geneva, Geneva, Switzerland, 4Massachusetts General Hospital, Boston, MA, United States, 5Harvard Medical School, Boston, MA, United States

Introduction: Avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder, were added to a combined DSM-5 Feeding and Eating Disorders chapter in 2013. We developed a clinical interview to diagnose and assess severity of these disorders in a UK/US collaboration: the PARDI (Pica, ARFID and Rumination Disorder Interview). A version for parents is currently being validated. Methods: Parents of children attending a feeding disorders service were invited to take part. As well as routine clinical assessment, participants were interviewed using the PARDI. Correlational analyses were used to establish construct validity of three ARFID profiles (sensory-based avoidance; lack of interest in eating/food; fear-based avoidance) against existing instruments measuring similar constructs. Further analyses tested criterion validity against clinical diagnosis, and clinical utility against clinician severity rating. Results: To date, parents of 52 children have participated. The PARDI Sensory Sensitivity and Lack of Interest profiles correlated significantly with established questionnaire measures. Clinician-rated impact on nutrition, social development/functioning, and family functioning correlated significantly with ARFID severity scores (all ps<0.05). Agreement between clinician and PARDI diagnoses was good. Conclusions: Preliminary testing shows validity of the PARDI and will inform further refinement of the instrument which will be subjected to larger-scale testing.

Neural White Matter Fibers Distinguish Between Obese Females With Bed, Obese Non-Bed Women And, Normal Weight Individuals: Preliminary Results
Nara M Estella1, Mara F Maranhão1, Marcelo Q Hoexter2, Iain C Campbell3, Ulrike Schmidt3, Angelica M Claudino1
1UNIFESP, São Paulo, Brazil, 2USP, São Paulo, Brazil, 3King's College London, London, United Kingdom

 Obesity is not part of the diagnosis of binge eating disorder (BED) but both are frequently associated. Based on a set of white matter (WM) variables we investigated how the study groups were distinguished and, the predictors importance in the distinctions was evaluated.
 Groups were matched by age: (BED=16) and normal weight control (NWC=16) and, the obese non-BED control (OBC=11) group was matched by age and body mass index.
WM fibers with connections to limbic structures were set a priori as regions of interest (ROIs). The average values from the diffusion imaging parameters for the ROIs were extracted and a discriminant analysis performed.
 The analysis generated two functions that predicted 98% of the variability between the groups and maximized the differences between the OBC and NWC and, between the BED and OBC groups. High value of longitudinal diffusion in the cingulate gyrus was the most important predictor for the distinction between the OBC and NWC groups and, a characteristic of the OBC group. Higher mean diffusivity in the inferior frontal occipital fasciculus and in the uncinate fasciculus were predictors in the distinction between the BED and OBC groups and, a feature of the BED group.
 Impairment in WM fibers involved in conflict-responses defined the OBC group in relation to NWC. The main feature of the BED group and its distinction from the OBC group is the impairment of WM fibers involved in flexible behaviors and overall decision-making.

Cohort Effects On Bulimia Nervosa Trajectories Over 10-Year Follow-Up
Pamela K. Keel1, K. Jean Forney1, Madeline Wick1, Todd F. Heatherton2
1Florida State University, Tallahassee, FL, United States, 2Dartmouth College, Hanover, NH, United States

PURPOSE: Epidemiological data from Europe and the US indicate significant changes in bulimia nervosa (BN) incidence and point prevalence. No prior study has examined whether these cohort effects translate into changes in outcomes. METHODS: Three cohorts (70% female) originally assessed at a mean (SD) age of 20 (2) years for BN in 1982 (n=900), 1992 (n=800), and 2002 (n=783) were followed 10 years later at a mean (SD) age of 30 (2) years (>75% retention). Computer algorithms of DSM-5 BN were used to ensure consistent diagnoses across cohorts and over time. RESULTS: The significant decline in DSM-III-R BN point prevalence was replicated for DSM-5 BN point prevalence across cohorts at baseline;
c2(2)=47.12, p<.001. With regard to BN trajectories, significant cohort effects were found. BN onset at follow-up was significantly higher in the 1982 cohort (3.3%) compared to the 1992 (0.8%) and 2002 cohorts (0.9%); c2(2)=14.51, p=.001. In contrast, BN maintenance was significantly greater in the 1992 cohort (33%) compared to the 1982 (4%) and 2002 cohorts (0%); c2(2)=10.68, p=.005. CONCLUSIONS: Results suggest that individuals born in the early 1960s carry increased risk for developing BN in late adolescence and adulthood but follow a more favorable course than those born in the early 1970s. Those born in the 1980s benefit from both lower risk for illness and greater chances of recovery, potentially reflecting progress in both prevention and treatment efforts over time.

Eating Disorders: An Underdiagnosed Comorbidity In Patients With Bipolar Disorder
Claire McAulay1, Stephen W Touyz1, Jonathan M Mond2, Tim Outhred3,4, Gin S Malhi3,4
1Clinical Psychology Unit, University of Sydney, Sydney, Australia, 2Centre for Rural Health, University of Tasmania, Hobart, Australia, 3Sydney Medical School, The University of Sydney, Sydney, Australia, 4CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia

As well as poor physical health, around 30% of people with Bipolar Disorder also meet criteria for an eating disorder (BD+ED); little is known about why. This study sought to compare individuals with BD with and without ED comorbidity, to explore implicated mechanisms and identify risk factors. Participants with a formal diagnosis of Bipolar Disorder (N=71) completed questionnaires assessing their eating disorder status, physical and psychiatric health, current medications, bipolar disorder features, and psychological variables including emotion regulation and impulsivity.  A third of the sample (n=24) had a probable eating disorder; 42% described moderate or severe binge eating. No medical or diagnostic factors differentiated the two groups, but BD+ED was associated with poorer emotion regulation abilities (M=19.9, t(66)=3.2, p=.002), more ED-specific cognitions (M=13.08, t(66)=3.4, p=.001), poorer quality of life (M=11.85, t(67)=4.45, p<.0001), and current psychological distress (M=6.76, t(65)=2.94, p=.005). Difficulties in emotion regulation and cognitions central to binge eating best predicted level of eating disorder symptoms in a multiple linear regression (F2,64=17.851, R2=.36, p<.0001). Antipsychotic use was not associated with binge eating severity. Patients with BD+ED experience elevated psychosocial impairment and are likely undertreated. Better understanding this comorbidity is vital to improve psychosocial functioning and physical health in this group. 

Associations Between The Use Of Smokeless Tobacco (Snus) And Disordered Eating, Weight Satisfaction, And Satisfaction With General Appearance In Adolescents.
Kristn Stedal1, Line Wisting1, Camilla Lindvall Dahlgren1, Deborah L. Reas1,2
1Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital-Ullevål, Oslo, Norway, 2Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway

Introduction: Little is known about the use of Swedish moist snuff (snus) and its associations with disordered eating and weight satisfaction. Snus use has increased dramatically in Scandinavia, becoming more prevalent than smoking in young people. The aim was to investigate whether disordered eating pathology, including meal skipping, as well as weight and appearance satisfaction differed between non-, occasional, and daily snus users. Methods: A total of 23,622 males and females aged 15-19 years from 12 upper secondary schools participated in an online health survey (Ungdata). Results: Irregularity in meal frequency was evident among occasional and daily users, with significantly lower proportions of male and female users consuming daily breakfast, lunch, and dinner. Post-hoc tests revealed that female occasional users had significantly greater levels of ED pathology (EAT-8) than non-users, and occasional and daily use was associated with higher levels of physical appearance and weight dissatisfaction. Weight dissatisfaction was also detected among male users, yet dissatisfaction related to weighing “too little” rather than “too much”. Conclusions: In females, snus use was broadly associated with greater ED pathology and meal skipping, as well as weight and appearance dissatisfaction. In males, only meal skipping and weight dissatisfaction (feeling “too thin”) were associated with snus use, revealing a distinct gender-specific pattern of findings.

Illness Activity, Plasma Nutrient Levels, And Dna Methylation Levels In People With Anorexia Nervosa
Howard Steiger1,2, Linda Booij3,4, Esther Kahan1,2, Jessica Burdo1,2, Kevin McGregor3, Luis Agellon2, Lea Thaler1,2, Aurelie Labbe3, Mimi Israel1,2, Moshe Szyf2, Emilie Fletcher1,2, Ridha Joober1,2, Linda Wykes2
1Douglas Institute, Verdun, QC, Canada, 2McGill University, Montreal, QC, Canada, 3University of Montreal, Montreal, QC, Canada, 4Concordia University, Montreal, QC, Canada

Anorexia Nervosa (AN) appears to be influenced by epigenetic processes such as DNA methylation. This study examines genome-wide methylation in people with Anorexia Nervosa (AN), with special attention to effects of illness activity and nutritional status (reflected by plasma methionine, choline, betaine, B12 and folate levels). We have obtained pre-treatment methylation data from 124 actively ill women (AN-Active), 36 women in 12-month remission (AN-Remitted), and 48 women with no eating disorder history (NED). We have followed 66 of the AN-Active women through partial weight restoration, and have measured plasma nutrients in a subset of 46 AN-Active, 33 AN-Remitted and 35 NED women. Ongoing sampling will increase ns further. Interim analyses (using False Discovery Rate-corrected comparisons) identify multiple sites at which AN-Active women differ from AN-Remitted or NED women, and associate methylation changes with genes influencing serotonin and glutamate activity, lipid and glucose metabolism and immune function. Findings associate active illness with hypermethylation and remission with de-methylation. Nutrient data show elevations of plasma betaine and B12 in AN-Active women, and inverse correlation of methionine and methylation levels in all except the AN-Active group. Findings suggest that methylation profiles may be responsive to both illness activity and nutritional state, and point to nutrigenomic effects that could inform etiological modelling and treatment.

The Neural Correlates Of Altered Emotion Regulation In Obesity: A Multi-Modal Fmri Study
Trevor Steward1,2, Maria Picó-Pérez1,3, Gemma Mestre-Bach1,2, Ignacio Martínez-Zalacaín1, Maria Suñol1,3,5, Nuria Vilarrasa6,7, Amador García-Ruiz-de-Gor8, Susana Jiménez- Murcia1,2,3, Jose M Menchón1,5, Roser Granero2,4, Carles Soriano-Mas1,4,5, Fernando Fernandez-Aranda1,2,3
1Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain, 2Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III , Barcelona, Spain, 3Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain, 4Department of Psychobiology and Methodology. University Autònoma of Barcelona, Barcelona, Spain, 5Ciber Mental Health (CIBERsam) Instituto Salud Carlos III , Barcelona, Spain, 6Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, , Barcelona, Spain, 7CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain, 8Bariatric and Metabolic Surgery Unit, Service of General and Gastrointestinal Surgery, University Hospital of Bellvitge-IDIBELL, , Barcelona, Spain

Maladaptive emotion regulation contributes to overeating. Our study aimed to compare cognitive reappraisal in adult women with obesity (OB) and healthy controls (HC) using functional magnetic resonance imaging (fMRI). Adult women with OB and HC carried out a cognitive reappraisal task during fMRI. Resting-state connectivity between activation peaks from the task was assessed. Diffusion tensor imaging (DTI) examined differences in white matter structure. Women in the OB group (n=24) presented less activation in the ventromedial prefrontal (vmPFC) cortex than HC (n=25) during cognitive reappraisal (p<0.05, AlphaSim-corrected), while the OB group had heightened activation in the extrastriate visual cortex. Psychophysiological interactions (PPI) analyses to assess vmPFC functional connectivity identified reduced connectivity to the globus palidus in OB participants, along with increased connectivity to the occipital lobe and the cerebellum. vmPFC peak activations during the cognitive reappraisal task were negatively correlated with DERS total scores in the OB group. OB patients displayed decreased functional connectivity between the vmPFC and the temporal pole during resting state. Significantly decreased uncinate fasciculus fractional track volume was found in subjects with OB compared to HC.  Our findings are indicative of emotion regulation deficits in obesity being underpinned by dysfunctional hypoactivity in the vmPFC and hyperactivity in the extrastriate visual cortex.

The Dynamic Interplay Between Self-Regulation And Affectivity In Explaining Binge Eating Among Adolescents
Eva Van Malderen1, Lien Goossens1, Sandra Verbeken1, Elisa Boelens1, Eva Kemps2
1Ghent University, Ghent, Belgium, 2Flinders University, Adelaide, Australia

Binge eating among adolescents is associated with negative developmental outcomes. From a dual process perspective, the role of impaired self-regulation is increasingly being emphasized as underlying mechanism of binge eating; whereas the affect regulation model proposes that negative affectivity is a key factor in explaining binge eating. However, studies combining both mechanisms are scarce. Therefore, the aim of the current study was to investigate joint contributions of both self-regulation and affectivity in explaining binge eating in adolescents. Methods: Participants were 228 adolescents (10-18 years; 67.3% girls; Mage = 14 years; SD = 2.01) from the general community. Adolescents self-reported on binge eating behavior (both objective and subjective episodes) and affectivity (both positive and negative). Self-regulatory capacities were also assessed using a questionnaire, both by the adolescents and their parents. Results: Preliminary results revealed a significant interaction between self-regulation and negative affectivity in explaining objective binge eating; whereas self-regulation and positive affectivity interacted in explaining subjective binge eating episodes. Conclusions: Results seem to suggest that self-regulation and affectivity dynamically interact in explaining both subjective and objective binge eating among adolescents. Keywords: adolescents; binge eating; self-regulation; inhibitory control; affectivity

Examination Of The Shared Genetic Basis Of Anorexia Nervosa And Obsessive-Compulsive Disorder
Zeynep Yilmaz
University of North Carolina, Chapel Hill, NC, United States

Presented on behalf of the Eating Disorders and Tourette/Obsessive-Compulsive Disorder Working Groups of the Psychiatric Genomics Consortium. Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are often comorbid and likely to share genetic risk factors. We examine their shared genetic background using a cross-disorder GWAS meta-analysis of 3,495 AN cases, 2,688 OCD cases and 18,013 controls. We confirmed a high genetic correlation between AN and OCD (rg=0.49 ± 0.13, p=9.07x10-7) and a sizable SNP heritability (SNP h2=0.21 ± 0.02) for the cross-disorder phenotype. Although no individual loci reached genome-wide significance, the cross-disorder phenotype showed strong positive genetic correlations with other psychiatric phenotypes (e.g., bipolar disorder, schizophrenia, neuroticism) and negative correlations with metabolic phenotypes (e.g., BMI, triglycerides). Although AN and OCD overlap heavily in their shared risk with other psychiatric phenotypes, the  relationship with metabolic and anthropometric traits is markedly stronger for AN than for OCD. We further tested if shared genetic risk for AN-OCD was associated with particular tissue or cell-type gene expression patterns and found that basal ganglia and medium spiny neurons were most enriched for AN-OCD risk, consistent with neurobiological findings for both disorders. Our results confirm and extend genetic epidemiological findings of shared risk between AN and OCD and suggest that larger GWASs are warranted.

4:15 - 5:45 PMCutler/Barton
Parallel Paper Session: Interventions

Chair(s): Jennifer Wildes
Sustained Child Weight Loss Related To Increased Restraint For Parents And Children Enrolled In Family-Based Treatment For Obesity
Dawn M Eichen1, David R Strong2, Kyung E Rhee1, Kerri N Boutelle1,2,3
1University of California, San Diego, Department of Pediatrics, La Jolla, CA, United States, 2University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States, 3University of California, San Diego, Department of Psychiatry, La Jolla, CA, United States

Introduction: Family-based treatment for obesity (FBT) is the gold-standard treatment for child weight loss; however, 75% of children who lose weight initially remain overweight as adults. It is important to evaluate eating disorder (ED) symptoms as ED symptoms are prevalent (17-79%) in overweight youth and may affect weight loss. This study evaluated whether ED symptoms as measured by the Eating Disorder Examination-Questionnaire (EDE-Q) and EDE related to child BMIz after treatment and during follow-up. Methods: 150 children ages 8-12 and their parent participated in 6-month FBT treatment, with 6- and 18-months post treatment follow-up. Children completed the full EDE-Q and overeating section of EDE and parents completed the Restraint subscale at pre- and post-treatment. Results: A Linear Mixed Effects model showed that both parent and child restraint were related to child BMIz overtime, such that higher restraint in parents (t=-3.7, p<.001) and children (t=-2.8, p=.007 following treatment, was related to lower child BMIz after treatment and during follow-up. No other child ED symptoms or changes in child ED symptoms over treatment (ps >.05) were related to child BMIz. Conclusion: Increasing levels of restraint in both parents and children over treatment resulted in sustained child weight loss overtime and may be an important treatment target to improve weight loss maintenance. Other ED symptoms were not related to long-term weight loss nor did they increase over time.

Insula H-Coil Deep Transcranial Magnetic Stimulation In Treatment Resistant Anorexia Nervosa: A Pilot Study
1Centre for Addiction and Mental Health , Toronto, ON, Canada, 2University of Toronto , Toronto, ON, Canada

Purpose of Study
: Anorexia Nervosa (AN) is a complex disorder of unknown etiology, characterized by obsessions and compulsions around body shape and weight, and calorie intake. In the course of AN, 10-30% will recover, while the rest will develop a treatment resistant course (TrAN), with mortality rate highest in psychiatry due to AN-related complications. The insula is a brain region of considerable interest in AN due to its role in gustatory modulation, feeding behavior, and processing of interoceptive stimuli. Recent advances in neurophysiology of AN suggest insula dysfunction as a potential biomarker for people with severe TrAN. Deep transcranial magnetic stimulation (dTMS) is of particular interest in TrAN because of its ability to target deep areas of the brain. Methods: We conducted a pilot study to investigate the feasibility, and safety of insula dTMS in subjects with TrAN. Results: We found that dTMS is a safe and well-tolerated treatment. We also found reduction in AN-related obsessions and compulsions, depression and anxiety scores from baseline to end of trial completion. Conclusions:  Preliminary evidence suggests that dTMS is safe and well tolerated and may have some therapeutic potential in anorexia nervosa.

Novel Methods Of Enhancing Inhibitory Control In Eating And Weight Disorders: Gamification And Virtual Reality
Stephanie M Manasse, Adrienne S Juarascio, Diane H Dallal, Rebecca J Crochiere, Meghan L Butryn, Evan M Forman
Drexel University, Philadelphia, PA, United States

Introduction: Enhancing inhibitory control (IC; i.e., the ability to withhold a prepotent response) through computerized inhibitory control trainings (ICTs) has the potential to reduce problematic eating, but outcomes are mixed. Gamification of ICTs may increase adherence to long doses of daily training and virtual reality (VR) may increase transfer of IC improvements to everyday life via stronger recruitment of inhibitory processes.   Methods: In Study 1, 71 overweight participants were put on a non-sweets diet for 9 weeks and received 42 daily and 2 weekly home computer-based 10-minute trainings. In a 2x2 factorial design, participants received either active ICT or sham, and either a gamified or non-gamified version. In Study 2, a prototype VR ICT for binge eating was created and feasibility/acceptability testing is ongoing.   Results: In Study 1, ICT showed a weight loss advantage over sham, but only when gamification was absent (F=4.59, p=.04). IC improved with ICT (t=4.91, p<.01), and was associated with weight loss (r=.34). Compliance was equivalent across conditions. For study 2, we will present the VR ICT paradigm and its initial feasibility, acceptability, and qualitative feedback from participants (projected n=10).   Conclusions: While enhancing IC appears to facilitate behavior change, gamification does not augment (and may even detract) from outcomes. The initial promise of VR ICT will be discussed, as will implications for the design of future ICT paradigms.

Prevalence, Incidence, Clinical Significance And Health Service Use Of Eating Disorders And Osfed Syndromes In Australian Adolescents
Deborah Mitchison1,2, Nora Trompeter1, Jonathan Mond3, Kay Bussey1, Scott Fatt1, Phillipa Hay2
1Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia, 2School of Medicine, Western Sydney University, Sydney, Australia, 3Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Australia

1. OBJECTIVE. The prevalence and relative clinical significance of the “Other Specified Feeding and Eating Disorder” (OSFED) syndromes remains unclear. This study investigated the prevalence, 12 month incidence, health service use and impairment associated with the major eating disorders and OSFED syndromes (atypical anorexia nervosa, subthreshold bulimia nervosa/binge eating disorder, purging disorder and night eating syndrome) in adolescents.  2. METHODS. N = 5,191 12-19 year-olds completed a survey on eating disorder symptoms, health service use, distress and quality of life in 2017, and a one-year follow-up survey in 2018 (data collection underway).    3. RESULTS. Baseline point prevalence estimates were 1.0% for anorexia nervosa, 4.6% for bulimia nervosa and 1.3% for binge eating disorder. For the OSFED syndromes, point prevalence ranged between 0.5% for subthreshold binge eating disorder and 4.6% for night eating syndrome. Health service utilization among participants with eating disorders and OSFED was low, and predicted by female gender, self-recognition of an eating disorder problem and non-migrant status. Eating disorders were associated with distress and quality of life impairment. Diagnostic and gender differences will be presented as well as 12-month incidence rates (data currently being collected).
4. CONCULSIONS. OSFED syndromes are as prevalent and impairing as major eating disorders, warranting further research attention to establish diagnostic criteria. 

Adherence As A Predictor Of Dropout In Internet-Based Guided Self-Help For Adults With Binge-Eating Disorder And Overweight Or Obesity
Hans-Christian Puls1, Ricarda Schmidt1, Stephan Herpertz2, Stephan Zipfel3, Brunna Tuschen-Caffier4, Hans-Christoph Friederich5, Frauke Schmidt6,7, Andreas Mayr8, Tony Lam9, Carmen Schade-Brittinger10, Martina de Zwaan6,7, Anja Hilbert1
1Department of Medical Psychology and Medical Sociology, Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig Medical Center, Leipzig, Germany, 2Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum, Bochum, Germany, 3Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tuebingen, Germany, 4Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany, 5Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany, 6Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany, 7Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Erlangen, Erlangen, Germany, 8Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany, 9NetUnion sarl, Lausanne, Switzerland, 10Coordinating Centre for Clinical Trials (KKS), Philipps-University Marburg, Marburg, Germany

Introduction. Internet-based guided self-help (GSH-I) is a promising therapy option for adults with binge-eating disorder (BED) and higher body weight. Although easy to attend and complete, some patients prematurely drop-out from GSH-I. However, little is known about the factors explaining dropout in GSH-I, including patient’s adherence to therapy. Method. In N=89 patients with BED and overweight/obesity, adherence to a 24-week, 11-module GSH-I therapy was assessed via automatic monitoring. Using logistic regression, it was examined whether objective measures of adherence (days spent per module, diary entries per week, number of messages exchanged; step 1) and subjective therapy evaluation (difficulty, comprehensibility, applicability; step 2) predicted dropout from GSH-I which was defined as having 5 or less modules completed. Cut-offs with optimal sensitivity and specificity were determined based on Receiver Operating Characteristics curves analyses on dropout. Results. A total of n=22 (24.7%) patients dropped out from GSH-I. All objective measures of adherence, but not patient's GSH-I evaluation, significantly predicted dropout from GSH-I. Patients who spent 20 days or more on module 3 (i.e., focusing on cues to overeat) were most likely to drop out from GSH-I (area under the curve: .71, sensitivity: .75, specificity: .79). Discussion. Patients at risk for dropout from GSH-I can be easily and reliably identified via automatic monitoring of objective adherence variables.

Brief Cognitive Behavioural Therapy For Non-Underweight Eating Disorders: Factors Associated With Reliable Clinical Change
Glenn Waller1, Elana Moore1, Hannah Turner2, Madeleine Tatham3
1Department of Psychology, University of Sheffield, Sheffield, United Kingdom, 2Southern Health NHS Trust, Southampton, United Kingdom, 3Norfolk Eating Disorders Service, Norwich, United Kingdom

Objective: Two previous studies have found that a ten-session form of cognitive behavioural therapy (CBT-T) can be as effective in reducing eating pathology and comorbid pathology, as longer versions of CBT for non-underweight adult patients with eating disorders. However, it is important to determine whether such change is clinically meaningful. In this replication and extension study, Reliable Change Indices (RCI) are calculated, and factors that might moderate or mediate such clinical change are explored. Method: A new case series of 105 non-underweight adult eating-disordered patients received CBT-T, delivered by clinical assistants. Outcome measures included: eating pathology, depression, anxiety, working alliance, and suitability of treatment. Intention to treat analyses were used.   Results: Reliable change indices (RCI) were calculated for all key variables, and demonstrated comparable findings to the previous studies, confirming that the changes made in CBT-T are clinically meaningful. The impact of early change as a mediator and pre-treatment factors as moderators is also explored.   Discussion: Brief CBT-T has the potential to provide less expensive and more easily delivered therapy for a large proportion of non-underweight patients, via understandable mechanisms. The potential of this novel form of CBT to enhance access to healthcare is considered, and possible barriers are outlined.

Premature Termination Of Inpatient Eating Disorder Treatment - Timing Matters
D Blake Woodside, Sarah Smith
Toronto General Hospital, Toronto, ON, Canada

Purpose of the study:
  Premature termination of treatment is a serious problem in the treatment of eating disorders. This study explored the potential effect of timing of treatment termination.    Methods:  Participants were 125 patients admitted voluntarily to an inpatient eating disorder program.  At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation.  Body weight was measured weekly.    Results:  Results showed significant relationships between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Trends were found for laxative use and severity of emotional dysregulation.   Post-hoc analyses revealed that patients who left treatment early were more likely to have the binge purge subtype of anorexia. These patients had more severe eating disorder cognitions than those who completed and higher rates of excess vomiting.  They also had more severe depressive symptoms and difficulties with emotional dysregulation that those who terminated later or completed treatment.   Conclusions:  Timing of premature termination of treatment matters.  Patients who terminate inpatient treatment early in their admissions differ from patients who terminate later and those who complete treatment. Potential clinical implications of these findings will be discussed. 

Reducing The Stigma Associated With Anorexia Nervosa: An Evaluation Of A Social Consensus Intervention Among Australian And Chinese Young Women
Elizabeth Rieger, Yuwen Yan, Yiyun Shu
Research School of Psychology, Australian National University, Canberra, Australia

 Stigmatising attitudes and behaviours toward people with anorexia nervosa are common in Western cultural contexts, but remain unevaluated in non-Western settings such as mainland China. Moreover, anti-stigma reduction efforts to date have had limited success. The current study examined the effectiveness of a novel approach for reducing stigma toward individuals with anorexia nervosa (AN), namely, a social consensus intervention, in young women from Australia and mainland China. Methods: Participants were female students from the Australian National University (= 97) and Central China Normal University (= 76) who reported their levels of stigma towards a fictional person with AN before and after receiving normative information regarding attitudes toward this person. Three experimental conditions of normative information were utilized: in-group, out-group, and neutral. Results: Chinese participants reported higher levels of baseline stigma across all measures than Australian participants. Normative information indicating that in-group members held positive beliefs toward the individual with AN was effective in reducing most types of AN stigma. The effectiveness of the social consensus approach was not moderated by nationality. Conclusions: A social consensus approach holds potential as an additional strategy for reducing AN stigma, with its benefits extending across diverse cultural settings.

Using Deep-Brain Stimulation And Neuroethics To Understand And Treat Severe Enduring Anorexia Nervosa (Se-An):  Clinical Outcomes Of Dbs To The Anterior Limb Of The Internal Capsule At The Nucleus Accumbens,   Including The First Double Blind Dbs On-Off Data And Patient Experience.
Rebecca J Park, Jessica Scaife, Tipu Aziz
University of Oxford, Oxford, United Kingdom

  1: Research suggests self-starvation in Anorexia Nervosa is a consequence of aberrant  reward circuitry, leading to compulsivity -a transdiagnostic factor. Neural mechanisms underpinning both reward and compulsivity involve cortico-striatal circuits, central to which is the Nucleus Accumbens. Deep Brain Stimulation (DBS) to Nucleus Accumbens  improves SE-OCD and addictions, and in rats increases food intake. We predict DBS to the Nucleus Accumbens may benefit  SE-AN.     2: The study protocol and ethics gold standard are published and registered with clinicaltrials.gov. NCT01924598, with ethical/ HRA approval (Project ID 128658):  DBS was applied to the anterior limb of the internal capsule at the Nucleus Accumbens. Neural processes were tracked using MEG, with parallel neuropsychological and behavioural measures taken monthly over a 15 months, including  double-blind crossover phases of DBS on/off.   3: We report a case series of four. In two patients,  DBS was associated with marked (50-75%)  reductions in YBOCS, Anxiety, Depression and EDE  pathology  and increased BMI, with temporary relapse in the double blind DBS  'off' phase. These patients reported DBS as ‘ life changing ‘ and liberating’.  In the other two improvements were less marked. There were no serious adverse events or side effects. Qualitative reports suggest mechanisms of change. 4: DBS to the Nucleus Accumbens is feasible in SE-AN and appears effective in half of patients but a neuro-ethical gold standard is crucial.

5:45 - 7:00 PMGilberts Room
Poster Session #2

Age And Symptom-Related Subcortical Shape Abnormalities In Adolescents And Adults With Bulimia Nervosa
Laura A Berner1, Zhishun Wang2, Mihaela Stefan2, Seonjoo Lee2, Zhiyong Huo2, Marilyn Cyr2, Rachel Marsh2
1Department of Psychiatry, University of California, San Diego, San Diego, CA, United States, 2Department of Psychiatry, Columbia University and New York State Psychiatric Institute/Columbia University Medical Center, New York, NY, United States, 3Key Laboratory of Image Communication and Image Processing, Nanjing University of Posts and Telecommunications, Nanjing, China

Introduction: Bulimia nervosa (BN) is associated with functional abnormalities in frontostriatal and limbic circuits that likely underlie impaired control over eating behaviors and emotions. Although structural alterations in the frontal portions of these circuits have been observed in BN, subcortical alterations remain relatively uninvestigated. Methods: Anatomical MRI scans were acquired from 62 females with full and subthreshold BN (18.73±3.98 years) and 65 matched healthy controls (19.31±5.71 years). General linear models controlling for age compared groups on the shape and volume of 15 subcortical structures; associations with illness severity and duration were assessed in the BN group (p <0.05, FWE-corrected). Results: Subcortical volumes did not differ across groups, but vertex-wise analyses revealed inward shape deformations (i.e., concavities) on the surface of the pallidum in BN relative to control participants that were associated with binge eating frequency and illness duration. Inward deformations on the caudate were associated with self-induced vomiting frequency, and inward deformations on the thalamus and amygdala were more pronounced with advancing age in the BN group. Conclusions: These findings point to localized deformations on limbic and basal ganglia structures that are more pronounced in older participants and in those with the most severe symptoms. Such subcortical abnormalities may contribute to the reward and control deficits associated with BN.

Associations Between Eating Disorder Symptoms And Autistic Traits - A Neuropsychological Study 
Malin Björnsdotter1,2,3, Monika Davidovic2, Louise Karjalainen2, Elisabet Wentz2, Håkan Olausson1
1Center for Social and Affective Neuroscience (CSAN), Linköping, Sweden, 2Department of Psychology, University of Gothenburg, Sweden, Göteborg, Sweden, 3Department of clinical neuroscience, Karolinska Institutet, Sweden , Stockholm, Sweden

The eating disorder anorexia nervosa (AN) is associated with behaviors typically linked to with the neurodevelopmental condition autism spectrum disorder (ASD). In the current study, we asked whether AN and ASD may also share resting state connectivity alterations. Specifically, we examined default mode network (DMN) and salience network (SN) connectivity in women with ASD and AN. 

We examined DMN and SN connectivity using resting state functional magnetic resonance imaging (fMRI) data in (i) 25 women with AN and 25 control women, and (ii) 29 women with ASD and 47 control women from the Autism Brain Imaging Data Exchange (all 16-25 years). Levels of autistic traits were assessed through the autism spectrum quotient (AQ).

We found no significant DMN effects in either group. In the SN, we found that women with AN had significantly reduced connectivity between the ACC and the left and right insular cortex, and the middle frontal gyrus. In the ASD sample, women with ASD also had significantly reduced connectivity, but between the ACC and the right angular gyrus, right parietal cortex and left superior temporal gyrus. 

We found similar effects in the DMN and SN networks in AN and ASD: there were no significant alterations in the DMN, and decreases in SN connectivity for both AN and ASD patients compared to their control groups. Detailed examination of region-of-interests is necessary to further characterize potential similarities and differences in brain connectivity in AN and ASD.  

Nationwide Study Of Exposure To Infections In Childhood And The Risk Of Eating Disorders In Females 
Lauren Breithaupt1, Ole Köhler-Forsberg2,3,4, Janne Tidselbak Larsen3,5, Michael E. Benros5,6, Laura M. Thornton7, Cynthia M. Bulik7,8,9, Liselotte Petersen3,5
1Department of Psychology, George Mason University, Fairfax, VA, United States, 2Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark, 3The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus University, Aarhus, Denmark, 4Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark, 5Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark, 6National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark, 7Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark, 8Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 9Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 10Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

Introduction. Infections and inflammation are recognized as playing a role in the risk for psychiatric disorders. We evaluated the association of hospital-treated infections and anti-infective prescriptions on the risk of eating disorders. Methods. A nationwide, prospective cohort study of over a half million girls born between 1989 and 2006 and followed-up until December 31, 2012 was conducted using Danish longitudinal registers. Data were analyzed using survival analysis models. Results. Infections requiring hospitalization increased the risk of anorexia nervosa by 22%, bulimia nervosa by 35%, and the remaining other eating disorders by 39%. Infections treated with anti-infective agents increased the risk of anorexia nervosa by 23%, bulimia nervosa by 63%, and other eating disorder by 45%. Temporal and dose-response relationships were evident (p <0.005 - <0.01): The risk for eating disorders was strongest during the first three months after discharge from a hospital admission for an infection or after an anti-infective agent prescription, and, as the number of hospitalizations for infections or anti-infective agent prescriptions increased. Conclusions. Hospital-treated infections and less severe infections treated with anti-infective agents are associated with substantially increased risk for subsequent eating disorders. Future studies need to investigate whether these associations are causal and the exact mechanisms between infections, inflammation, and eating disorders.

Links Between Preadolescents’ Social Media Use And Their Body Image And Eating Pathology: The Moderating Roles Of Gender And Pubertal Development 
Jasmine Fardouly, Natasha R Magson, Ella L Oar, Carly J Johnco, Ronald M Rapee
Centre for Emotional Health, Macquarie University , Sydney, Australia

Introduction.More than half of preadolescents use social media, on which they can engage in numerous appearance-related activities. Body dissatisfaction and eating pathology can emerge during preadolescence but research is yet to examine links between preadolescent social media use and these concerns and behaviours. Methods.We examined the associations between 10-12 year old boys’ and girls’ (N= 525) use of different social media platforms, engagement in different appearance-related activities on social media (e.g., appearance comparisons), and their body satisfaction and eating pathology. We also examined the moderating roles of gender and pubertal development on those relationships. Results.Users of Instagram and Snapchat reported lower body satisfaction and more eating pathology than did non-users. Engaging in more appearance-related activities on social media (e.g., making appearance comparisons or editing images) was associated with lower body satisfaction and more eating pathology. Making upward appearance comparisons on social media was associated with less body satisfaction for girls who had experienced more pubertal development. In addition, engaging in more appearance investing behaviours on social media was associated with less body satisfaction for boys who had experiences less pubertal development. Conclusions.These findings suggest that social media literacy and disordered eating intervention programs may need to be delivered prior to the adolescent period.

Type 2 Diabetes And Cognitive Impairment In An Elderly Sample With Obesity And Metabolic Syndrome: A Cross-Sectional Analysis Of The Predimed-Plus Study
Fernando Fernández-Aranda1,2,3, Núria Mallorquí-Bagué1,2, Lozano-Madrid María 1,2, Dolores Corella2,4, Jordi Salas-Salvado2,5, Aida Cuenca-Royo2,6, Ramón Estruch2,7, Francisco J Tinahones2,8, Xavier Pintó2,9, Emilio Ros2,10, Roser Granero2,11, Mònica Bulló2,5, Montserrat Fitó2,6, Susana Jiménez-Murcia1,2,3 , Miguel A. Martínez-González2,12,13, Rafael De la Torre2,6,14
1Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain, 2CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain, 3Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain, 4Department of Preventive Medicine, University of Valencia, Valencia, Spain, 5Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, Rovira i Virgili University, Reus, Spain. , Reus, Spain, 6Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, Spain, 7Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain, 8Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Malaga University, Malaga, Spain, 9Lipid Unit, Department of Internal Medicine, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain, 10Lipid Clinic, Endocrinology and Nutrition Service, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain, 11Departament de Psicobiologia i Metodologia. Universitat Autònoma de Barcelona, Barcelona, Spain, 12University of Navarra, Department of Preventive Medicine and Public Health, Medical School, and Navarra Institute for Health Research (IdiSNA), , Pamplona, Spain, 13Harvard TH Chan School of Public Health, Dpt. Nutrition, Harvard, University, Boston, MA, United States, 14Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain. , Barcelona, Spain

This study examines: (a) the association of type 2 diabetes with executive functioning (EF); (b) the effect of body mass index (BMI) on both type 2 diabetes and EF; and (c) the association between glycemic control and EF in type 2 diabetes. 6823 older adults with overweight/obesity and metabolic syndrome (mean age: 65 years; 48.6% women; 27.2% type 2 diabetes) participating in the PREDIMED-PLUS study, were assessed with a battery of cognitive tests. BMI, serum glucose and glycated haemoglobin (HbA1c) concentrations were measured. Significantly worse EF performance in type 2 diabetes vs. non-diabetic individuals was found. Two models were generate using Structural Equation Modeling (SEM): (1) in the whole sample, the presence of type 2 diabetes, depressive symptoms and BMI had a direct negative effect on EF, while apnea had an indirect negative effect; (2) in the type 2 diabetes subsample, higher illness duration was associated with worse EF performance. Participants with type 2 diabetes and HbA1c<7% (<53mmol/mol) had better overall cognitive performance when compared to those with HbA1c≥7% (>53mmol/mol). Our results provide a controlled, comprehensive model that integrates relevant neuropsychological and physical variables in type 2 diabetes. The model suggests that, to improve treatment adherence and quality of life, cognitive decline prevention strategies should be implemented that monitor depressive symptoms, BMI and glycemic control.

Aberrant Fronto-Limbic Dynamic Connectivity For Fear Processing In Anorexia Nervosa And Body Dysmorphic Disorder
Jamie D Feusner1, Rangaprakash Deshpande1, Cara Bohon2, Katherine Lawrence1, Teena Moody1, Francesca Morfini1, Sahib Khalsa3,4, Jessica Goldbeck1, Michael Strober1
1UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, United States, 2Department of Psychiatry and Behavioral Sciences, Stanford University, Los Angeles, CA, United States, 3Laureate Institute, Tulsa, OK, United States, 4Oxley College of Health Sciences, University of Tulsa , Tulsa, OK, United States

Purpose: Anorexia nervosa (AN) and body dysmorphic disorder (BDD) share distorted perceptions of appearance and negative emotions, yet their neural phenotypes of emotion processing remain underexplored, and they have never been directly compared. We sought to determine if shared and disorder-specific 
fronto-limbic connectivity patterns characterize these disorders.  Methods: fMRI data were obtained from three unmedicated groups: BDD (n=32), weight-restored AN (n=25), and healthy controls (HC; n=37), while they viewed fearful faces and rated their own degree of fearfulness. We performed dynamic effective connectivity modeling between medial prefrontal cortex (mPFC), rostral anterior cingulate cortex, and amygdala, and assessed associations with clinical variables. Results: HCs exhibited significant within-group bidirectional mPFC-amygdala connectivity, which increased across the blocks. However, BDD participants exhibited only significant mPFC-to-amygdala connectivity and AN participants lacked significant prefrontal-amygdala connectivity in either direction. Across participants, mPFC-to-amygdala connectivity was associated with greater subjective fear ratings (R2=0.11), and in AN with eating disorder symptoms (R2=0.33) and anxiety (R2=0.29). Conclusions: Our findings suggest a complex nosological relationship, and have implications for understanding emotion regulation circuitry in these related disorders. Results may have relevance for current and novel therapeutic approaches.

Associations Between Age And Structural Brain Regeneration Over The Course Of Treatment In Women With Anorexia Nervosa
Lisa-Katrin Kaufmann1,2,3, Jürgen Hänggi2, Lutz Jäncke2,4,5, Volker Baur1, Marco Piccirelli6, Spyros Kollias6, Ulrich Schnyder1, Chantal Martin-Soelch3, Gabriella Milos1
1Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland, 2Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland, 3Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Friboug, Switzerland, 4International Normal Aging and Plasticity Imaging Center (INAPIC), University of Zurich, Zurich, Switzerland, 5University Research Priority Program (URPP) , Zurich, Switzerland, 6Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland

Neuroimaging studies on anorexia nervosa (AN) have consistently reported globally reduced grey matter in acute AN patients. While some studies on recovered patients provide evidence for the reversibility of these impairments, longitudinal studies investigating temporal patterns of recovery processes are scarce.
  T1-weighted magnetic resonance images of adult patients with severe AN and closely matched healthy controls (HC) were analysed using surface-based morphometry. The longitudinal design comprised three time points, capturing the course of treatment in AN patients at distinct stages of weight gain. Correlations between structural brain changes and clinical variables were assessed.   Linear-mixed effect models revealed the reversibility of the reduced cortical thickness and reduced subcortical volumes observed in AN patients, with significant residual differences remaining in superiorfrontal brain regions even after weight restoration. The broad restoration of cortical thickness in AN patients showed a strong negative association with age.    Temporal patterns of structural brain recovery in adult AN patients suggest partial restoration of cortical thickness with patients’ age as a strong predictor of brain restitution, potentially indicating decreases of brain plasticity across the lifespan. These results strengthen the importance of an early start of therapy in young age as well early weight restoration and a sufficient period of weight stabilisation.  

The Absence Of Association Between Blood Hemoglobin And Bold Signal Amplitude In Anorexia Nervosa
E. Caitlin Lloyd1, Tamara J. Sussman2,3, Jonathan Posner2,3, Joanna E. Steinglass2,4
1Centre for Exercise Nutrition and Health Sciences, University of Bristol, Bristol, United Kingdom, 2Department of Psychiatry, Columbia University Medical Center, New York , NY, United States, 3Division of Child Psychiatry, New York State Psychiatric Institute, New York, NY, United States, 4New York State Psychiatric Institute, New York, NY, United States

Introduction: Functional magnetic resonance imaging (fMRI) blood oxygenation level dependent (BOLD) imaging is used to study the neural mechanisms of Anorexia Nervosa (AN). BOLD signal indexes change in oxygenated hemoglobin (Hgb) concentration in the blood, as a measure of brain activity. Individuals with AN can have low Hgb as a function of illness. Does low Hgb create a reduced BOLD response that is independent of underlying neuronal activity? To address this question, we examined the relationship between Hgb and BOLD signal magnitude, via amplitude of low frequency fluctuations (ALFF) in resting state data, in individuals with AN. Method: A secondary analysis of the relationship between Hgb and ALFF, using data collected from individuals receiving specialist inpatient treatment for AN, was completed. Linear regression models assessed whether Hgb predicted ALFF at admission (T1; n=59) and upon weight recovery (T2; n=44). In addition, ALFF was compared in individuals with low and normal levels of Hgb, by independent sample t-tests. Results: Twenty-five percent of AN had low Hgb, and this did not change with weight restoration. ALFF was not predicted by Hgb at T1 or T2. There were no differences in ALFF between those with low and normal Hgb. Conclusion: The lack of association between Hgb and BOLD signal magnitude is reassuring since it suggests observed differences in the brain activity of AN and healthy controls are not significantly affected by blood Hgb concentration.

Diffusion Tensor Imaging In Anorexia Nervosa: White Matter Microstructure In Acute And Remitted Patients, Their Unaffected Sisters, And Unrelated Controls
Amy E. Miles1,2, Aristotle N. Voineskos1,2, Leon French1,2, Allan S. Kaplan1,2
1Centre for Addiction and Mental Health, Toronto, ON, Canada, 2Institute of Medical Science, University of Toronto, Toronto, ON, Canada

Purpose: White matter microstructure is a heritable phenotype that subserves complex processing. We assess indices of white matter microstructure in adult women with and without histories of and genetic risk factors for AN: acute (acAN) and remitted (recAN) patients, their unaffected sisters (sibAN), and unrelated controls (HC). Methods: DTI (60 gradient directions) was acquired on a 3T scanner and processed with FSL TBSS. Group differences in voxel-wise, brain-wide FA and MD were tested with separate univariate analyses of covariance including age as nuisance variable. Statistical inference was made with nonparametric permutation and threshold-free cluster enhancement. Results: We detected a significant main effect of group (F = 18.1, pFWE <.01: acAN, recAN > HC) on peak MD in almost 10% of white matter tested, and post-hoc analyses revealed comparable effects of group on cluster-wise axial (AD) and radial (RD) diffusivity. We did not detect a significant main effect of group on peak FA. General cognitive impairment was significantly associated with voxel-wise MD (r = 0.51) in more than half of the aforementioned cluster. Conclusions: Site-specific microstructural impairment, consistent with de/dysmyelination, axon damage or disorganization, and edema or inflammation, was common to patients with a lifetime diagnosis of AN, independent of disease state, and negatively associated with cognitive performance. Replication in a larger sample is warranted.

A Biomarker For Anorexia Nervosa
Andrea Phillipou1,2,3,4, Larry A Abel5, David J Castle2,3, Caroline Gurvich6, Susan L Rossell1,3,6
1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia, 2Department of Psychiatry, The University of Melbourne, Melbourne, Australia, 3Deparment of Mental Health, St Vincent's Hospital, Melbourne, Australia, 4Deparment of Mental Health, Austin Health, Melbourne, Australia, 5Deparment of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia, 6Monash Alfred Psychiatry Resarch Centre, Melbourne, Australia

Anorexia nervosa (AN), like other mental illnesses, is diagnosed based on a patient’s description of symptoms and a clinician’s judgment. The subjective nature of making psychiatric diagnoses is further confounded in AN by the persistent denial of illness symptoms and the secretive nature of the illness. Thus, establishing a reliable and valid objective marker or ‘biomarker’ for AN is critical. Our recent research identified a potential biomarker for AN; an atypical type of eye movement called square wave jerks (SWJs). The aim of this study was to validate this biomarker by replicating this finding in individuals currently with AN (c-AN), and identifying if this biomarker is also present in those who are recovered from AN (rec-AN). 20 c-AN, 20 rec-AN and 20 healthy controls (HC) were assessed for the presence of SWJs with an EyeLink1000 eyetracker. An increased rate of SWJs were found in c- and rec-AN, relative to HC (p<.05). SWJs were identified as a promising biomarker for AN. Establishing a biomarker is critical to: 1- provide an objective diagnostic measure for identifying AN; 2- enable early identification of the illness; 3- identify those at risk of developing AN; and 4- provide insight into the underlying biological mechanisms underpinning AN. As eye movements utilise very specific neural circuitry, the presence of SWJs also provides potential targets for neurobiological treatments, including medications and brain stimulation.

Implicit And Explicit Motivational Responses To High- And Low-Calorie Food In Women With Disordered Eating
Sarah E Racine1, Léah Suissa-Rocheleau1, Stephen D. Benning2
1McGill University, Montreal, QC, Canada, 2University of Nevada Las Vegas, Las Vegas, NV, United States

Eating disorders and their component symptoms have been associated with altered implicit and explicit motivational responding to high-calorie food. This includes increased startle blink and postauricular reflex reactivity as well as both increased and decreased valence, arousal, and craving ratings. No study has examined reflexive responding to low-calorie food in individuals with disordered eating. We compared motivational responding to high- and low-calorie food, assessed both implicitly via the startle blink and postauricular reflexes and explicitly via self-report ratings. Participants were 75 women recruited based on the presence or absence of binge eating and restrictive eating. High-calorie (i.e., sweet and savoury food) and low-calorie (i.e., fruits, vegetables) images were selected from the Open Library of Affective Foods and the internet. Startle blink reflexes during both high- and low-calorie food images were significantly lower than during neutral images, whereas only high-calorie food images were associated with greater postauricular reactivity than neutral images. Craving and arousal ratings were significantly greater for high- than low-calorie food, while valence ratings were similar for both food types. Neither binge eating nor restrictive eating moderated these associations. Research with patients with eating disorders and healthy controls can add to our understanding of physiological and self-reported motivational reactions to high- and low-calorie food.

Appearance Ideal Internalization, Appearance Pressures, And Eating Disorder Pathology Among Heterosexual, Bisexual, And Lesbian Women
Lauren M. Schaefer1, Vivienne M. Hazzard2, Katherine Schaumberg3, Anna M. Bardone-Cone3, David A. Frederick4, Kelly L. Klump5, Drew A. Anderson6, J. Kevin Thompson7
1Neuropsychiatric Research Institute, Fargo, ND, United States, 2University of Michigan, Ann Arbor, MI, United States, 3University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 4Chapman University, 5Michigan State University, East Lansing, MI, United States, 6University at Albany-State University of New York, Albany, NY, United States, 7University of South Florida, Tampa, FL, United States

Introduction: It has been proposed that sexual minority females may be less susceptible to sociocultural appearance pressures and therefore at lower risk for eating disorders (EDs) than their heterosexual peers. Findings exploring this theory have been inconsistent, but few studies have examined differences between sexual minority subgroups. Methods: Heterosexual (n=1535), bisexual (n=90), and lesbian (n=281) undergraduate women completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 and the Eating Disorder Examination Questionnaire. Differences by sexual orientation in appearance pressures, internalization of appearance ideals, and ED pathology were examined via analysis of variance tests. Relationships between these variables were examined with multigroup path analysis, controlling for age and body mass index. Results: ED pathology was highest among bisexual women, followed by heterosexual and lesbian women. Bisexual and heterosexual women reported higher levels of peer appearance pressures than lesbian women. Further, peer appearance pressures and thin ideal internalization were more closely related to ED pathology for bisexual women compared with their heterosexual and lesbian peers. Conclusions: These findings suggest bisexual women may be at elevated risk for EDs. Higher levels of peer appearance pressures, as well as stronger associations of peer pressures and thin ideal internalization with disordered eating, may contribute to this increased risk.

Exploring Social Reward And Avoidance In Adolescents With Anorexia Nervosa
C. Alix Timko1, 2, Gregor Kohls3, Anushua Bhattacharya2, John D. Herrington1, 2
1University of Pennsylvania, Philadelphia, PA, United States, 2Children's Hospital of Philadlephia, Philadelphia, PA, United States, 3RWTH Aachen University, Aachen, Germany

Disruptions in the neural reward circuitry may be central to etiology and maintenance of anorexia nervosa (AN). AN usually begins in adolescence, a time of increased social interactions with peers and heightened social reward saliency. As AN progresses, the naturally rewarding nature of social situations is disrupted and often reversed, such that social situations become aversive. Examining approach and avoidance of social reward during illness has not been examined in adolescents with AN. Methods: Adolescents with AN are compared to age-matched healthy controls (HC). All participants perform a social incentive delay task [IDT] while undergoing functional MRI. The IDT allows for separating reward approach and avoidance within the same task framework and for disentangling appetitive (“wanting”) and consumptive (“liking”) processes. Results: To date, 10 adolescents with AN have undergone study procedures. We will enroll a total of 20 patients with AN and matched HC. We will present functional fMRI data with a special focus on the nucleus accumbens (Nacc) as our region-of-interest. We anticipate significant activation differences in Nacc between adolescents with AN and HC in response to social reward approach and avoidance. Conclusions: Understanding disruptions in social reward circuitry may critically inform our understanding of the etiology of AN, facilitate the early identification of risk factors for AN, and improve targeted interventions.

The Relation Of Naturalistic Light Exposure And Eating Disorder Psychopathology And The Mediating Role Of Depression
Kyle P De Young, Alexandra M Thiel, Angeline R Bottera
University of Wyoming, Laramie, WY, United States

Limited research has suggested a relation between bright light exposure and binge eating (BE). We tested this by measuring exposure to natural light over 48 hours in 150 students. Preliminary results are based on 50 individuals. Participants completed the EDE-Q and Center for Epidemiological Studies Depression Scale (CESD-R) prior to 48 hours of ambulatory ambient light exposure monitoring. Sinusoidal curves were fit to light exposure data; the area under the curve (AUC) indicates total exposure and the peak indicates diurnal timing. Lower AUC was associated with higher likelihood of past-month BE (OR=0.46, p=.032), while controlling for gender, BMI, light exposure peak, and the fit of sinusoidal curves. Similarly, lower AUC was associated with higher EDE-Q Global (Beta=-0.393, p=.032). Light exposure peak was not associated with BE or EDE-Q Global. CESD-R was then tested as a mediator of the relation of AUC and EDE-Q Global. The indirect effect of AUC on EDE-Q Global scores going through CESD-R scores was significant (est.=-0.18, 95%CI=-0.38, -0.03) and the direct effect was not (est.=-0.11,
p=.382), indicating that depression mediated the relation between light exposure and eating disorder pathology. Final analyses will be conducted on all 150 individuals. Results offer preliminary support for the relation of naturalistic light exposure and eating disorder/BE pathology and preliminary evidence of the mediating effect of depression on this relationship. 

A New Interpersonal Model For Non-Suicidal Self-Injury Behaviours And Disordered Eating Symptoms: A Case-Control Study
Isabel Krug1, Mercedes Delgado Arroyo1,2, Tara De Paoli1, Janet Treasure3, Matthew Fuller-Tyszkiewicz4
1The University of Melbourne, Melbourne, Australia, 2Hospital Universitario Vall d'Hebron, Barcelona, Spain, 3King's College London, Lodnon, United Kingdom, 4Deakin University, Melbourne, Australia

To assess a new interpersonal model of non-suicidal self-injury (NSSI) behaviours and disordered eating (DE) symptoms (including drive for thinness and bulimic symptoms), whereby insecure attachment and maladaptive schemas were related to NSSI and DE through affect dysregulation, impulsivity, self-esteem and body dissatisfaction. A further aim was to assess whether the model was invariant across an eating disorder (ED) and control sample.   Method: Participants comprised 125 ED patients ascertained from various ED units and organizations across Australia and 674 controls, who were asked to fill in an online survey assessing the constructs included in the model.   Results: Path analyses confirmed the proposed model was a good fit for the data (chi square(df=14) = 21.75, p = .08, CFI = .998, RMSEA = .026), and that the model was invariant across ED patients and controls. Both maladaptive schemas and body dissatisfaction were found to explain a substantial variance in self-reported NSSI behaviours and DE symptoms, ranging from 35% for NSSI to 59% for drive for thinness. Insecure attachment styles exerted influence on these outcomes via direct effects on maladaptive schemas and body dissatisfaction.   Conclusion: It seems that maladaptive schemas and body dissatisfaction are important factors to consider in both understanding and treating NSSI behaviours and DE symptoms and that the importance of these factors seems to be similar for ED patients and controls.    

Eating Disorder Symptoms In Children And Adolescents: Consideration Of Sex Differences 
Jennifer S Coelho1,2, Janet Suen2, Tiffany Lee2, Alex Burns2, Pei-Yoong Lam1,3, Sheila Marshall4, Josie Geller2,5
1Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada, 2Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, 3Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada, 4School of Social Work, University of British Columbia, Vancouver , BC, Canada, 5Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada

Introduction. Gaps have been identified in the understanding of clinical presentation of males with eating disorders. Two studies were conducted to evaluate sex differences in eating disorder presentation in a pediatric tertiary care setting. Methods. Study 1: A retrospective chart review was conducted, comparing all males who entered treatment between 2010-2015 (n = 41) with a subset of females (n = 251). Study 2: A prospective study recruited males (ages 8-24) and matched females. A total of 24 males (and 21 matched females) have been recruited to date. Changes in eating disorder symptoms over the course of treatment were assessed, including male-relevant concerns (e.g., muscularity). Results. Study 1: Male youth were younger at admission than were females. Females were more likely to be diagnosed with anorexia nervosa or bulimia nervosa than were males. Study 2: Preliminary results demonstrate a significant main effect of time on eating disorder symptoms, with scores on the EDE-Q and Body Change Index decreasing over treatment. There was a trend for an interaction between sex and time on scores on the Male Body Attitudes Scale, such that males (but not females) had a tendency to report lower scores over treatment. No significant sex differences emerged for medical stability at admission. Conclusions. The sex differences that emerged in these studies replicate and extend previous research. The heterogeneity of the clinical presentation of males will be discussed. 

Eating Disorder Symptomatology Throughout Adolescence: Identifying Distinct Developmental Trajectory Classes
Margaux Verschueren1, Laurence Claes1,2, Nina Palmeroni1, Annabel Bogaerts1, Amarendra Gandhi1, Koen Luyckx1
1Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium, 2Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium

Introduction. Eating disorder (ED) symptomatology is highly prevalent in adolescence and is regarded an important precursor of clinical EDs. The present longitudinal study aims to (1) examine the development of ED symptomatology in adolescence, (2) identify latent trajectory classes, and (3) examine whether psychosocial development varies among these classes. Methods. The study comprised three annual waves, with a total of 528 high school students participating at Time 1 (50.6% female; Mage=15 years; range 11-19) by filling out self-report questionnaires. Latent growth curve modeling and latent class growth analysis (LCGA) were performed. Results. At the group level,  stable trajectories of drive for thinness and body dissatisfaction were found, whereas bulimia and Body Mass Index significantly increased over time. Important gender differences were found, with girls experiencing higher ED symptomatology than boys. Subsequently, LCGA were conducted separately for girls and boys, pointing to more diverse trajectory classes in girls (4 classes) than in boys (2 classes). Finally, class membership was related to the development of identity confusion, internalizing symptoms, and effortful control. Conclusions. The present study underscores the importance of identifying vulnerable adolescents that experience greater ED symptomatology, as they seem to experience the worst psychosocial development. 

Taste Less, Eat More: Blunted Sensitivity To Sweet Taste Is Associated With Binge Eating In Women
Kristen M. Cubert, Kimberly S. Stevens, Megan M. Shope
Department of Psychology, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, United States

The ability to perceive sweet taste and hedonic responses to sweet stimuli could contribute to binge eating (BE). Indeed, individuals who are less sensitive to the oral detection of sweet taste and/or who experience a greater hedonic (pleasure) response have been posited to be at increased risk for excess consumption of foods high in sugar. Methods: The current study examined whether women who exhibit BE, assessed across the dimensional symptom spectrum (N = 185) and at the extreme end of severity (n = 43 cases with clinical BE vs. n = 46 controls), show blunted perceived sweet taste intensity and greater hedonic response to sweeter taste stimuli. Well-validated measures were used to assess BE symptoms (e.g., eating concerns, loss of control) and the presence/frequency of clinical BE episodes over the past three months. Sweetness intensity and likability ratings were collected during a standardized sweet taste test (sucrose concentrations: 0.05, 0.10, 0.21, 0.42, 0.83M). Results: No associations were detected between BE and hedonic response to sweet taste stimuli. However, dimensional and categorical measures of BE were associated with a blunted capability to perceive sweet taste, independent of several potential confounds (e.g., body mass index, satiation, time of day). Conclusions: Blunted oral sweet taste detection may be part of a key biological pathway (e.g., gastrointestinal system; brain reward regions) critical to the onset and/or maintenance of BE.

Neuroimaging In Binge Eating: A Systematic Review
Brooke Donnelly1,2, Stephen Touyz1, Phillipa Hay3, Amy Burton1, Janice Russell2, Ian Caterson4
1School of Psychology, University of Sydney, Sydney, Australia, 2Peter Beumont Tertiary Eating Disorder Service, Royal Prince Alfred Hospital, Sydney, Australia, 3Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia, 4Boden Institue of Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia

Purpose With advances in neuroimaging techniques, there has been growing interest in ways to explore structural and functional brain changes that occur in people with eating disorders, most comprehensively in Anorexia Nervosa. However, this field of research in Bulimia Nervosa (BN) and Binge Eating Disorder (BED) is not as substantial. Therefore, a systematic review examining neuroimaging literature BN and BED was warranted. Methods A systematic literature search was completed across five databases. For inclusion, papers had to be an original human research study; English language; used samples or participants with a diagnosed eating disorder; include a control sample. Overall, 32 studies met criteria. Data & Results A number of findings emerged: both volume reduction and increase across a range of regions; hypoactivity in the frontostriatal circuits; aberrant responding in several regions to a range of different stimuli or tasks; a link between illness severity in BN and neural changes; diminished attentional capacity and early learning; and increased rCBF in relation to disorder-related stimuli. Conclusions Further research is required to determine whether neural differences based on clinical severity may be linked to treatment response. Additional research is required to extend findings of reduced cortical volumes and diminished activity in frontostriatal circuits. Lastly there is a clear need to recruit males with BN or BED in future neuroimaging research.

Text-Mining As A Methodology To Assess Eating Disorder-Relevant Factors: Comparing Mentions Of Fitness Tracking Technology Across Online Communities
Caroline Meyer1, Sudeep Bhatia2, Mark Elliott1, Duncan McCaig1, Lukasz Walasek1
1University of Warwick, Coventry, United Kingdom, 2University of Pennsylvania, Pennsylvania, PA, United States

Purpose: Survey-based research has indicated that fitness tracker usage might contribute to the maintenance of eating disorders. In order to methodologically triangulate these findings, this study used text-mining to compare interest in fitness trackers across eating disorder and health-related online communities. Methods: A list of fitness tracker terms was developed, and communities (i.e., ‘subreddits’) on a large online discussion platform (Reddit) were compared regarding the frequency with which these terms occurred. The corpus comprised all comments posted between May 2015 and January 2018 on six subreddits; three eating disorder-related, and three relating to either fitness, weight-management or nutrition. All comments relating to the same ‘thread’ (i.e., conversation) were concatenated, and formed the cases used in this study (N=377,276). Results: Within the eating disorder-related subreddits, the findings indicated that a ‘pro-eating disorder’ subreddit, which is less recovery focused than the other eating disorder subreddits, had the highest frequency of fitness tracker terms. Across all subreddits, the weight-management subreddit had the highest frequency of the fitness tracker terms’ occurrence, and MyFitnessPal was the most frequently mentioned fitness tracker. Conclusions: The findings suggest that interest in fitness trackers are related to a person’s eating disorder readiness to change, which was in line with previous survey-based findings.

Fitness Tracking And Food Intake Monitoring: Links With Disordered Eating, Compulsive Exercise And Psychological Wellbeing
Caroline Meyer1, Carolyn Plateau2
1University of Warwick, Coventry, United Kingdom, 2Loughborough University, Loughborough, United Kingdom

Purpose:  To explore the relationships between the use of food and fitness monitors with compulsive exercise, eating psychopathology and psychological wellbeing. Methods: Participants (n = 352; mean age 21.90 years) indicated their use of fitness and food intake monitoring tools, and completed the Compulsive Exercise Test (CET), Eating Disorders Examination Questionnaire (EDE-Q) and the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Results: Monitoring tool use was linked with significantly higher CET EDE-Q scores. Monitoring tool use for weight loss purposes was linked to higher levels of pathology than use for health and fitness reasons. Monitoring was found to be a unique predictor of CET Weight Control and EDE-Q Restraint scores. Conclusions: Compulsive exercise and eating psychopathology are elevated among users of food and fitness monitoring tools; and particularly when used for weight and shape purposes. Further research is needed to explore the longitudinal relationships and mechanisms between the use of food and fitness intake monitoring tools with eating psychopathology and compulsive exercise.

Peer Influences On Eating Psychopathology In Female Dancers
Carolyn R Plateau, Fiona Connolly
Loughborough University, Loughborough, United Kingdom

Introduction: The prevalence of disordered eating is considerably elevated among female dancers. Peers are an important source of influence on disordered eating practices among adolescent females, however have yet to be explored among dancers. This study aimed to explore relationships between perceived peer influences with eating psychopathology and wider psychological wellbeing among female dancers. Method: Two-hundred and sixty-eight female dancers (Mean 20years; range 16-28) were recruited from UK dance schools and university clubs. Participants completed an online questionnaire, which included measures of peer influence (Perceived Friend Preoccupation with Weight and Dieting; Appearance Conversations with Friends; Friends as a Source of Influence), anxiety and depression (Hospital Anxiety and Depression Scale) and eating psychopathology (Eating Disorders Inventory-2).   Results: Correlation analysis revealed significant associations between all measures of peer influence with eating psychopathology, anxiety and depression; peer influences were also found to significantly predict eating psychopathology. Anxiety and depression significantly, partially mediated the relationship between peer influences and eating psychopathology. Conclusions: Peer influences are linked to disordered eating and poor psychological wellbeing among female dancers. Dancers may benefit from interventions that facilitate positive eating attitudes, behaviours and group dynamics. 

Interoceptive Exposure For Eating Disorders: Findings From A Clinical Case Series Study
Lisa M Anderson1,2, Drew A Anderson1, Jennifer M Oswald1, Erin E Reilly1,3, Sasha Gorrell1,4, James F Boswell1
1University at Albany, State University of New York, Albany, NY, United States, 2University of Minnesota, Minneapolis, MN, United States, 3University of California - San Diego, San Diego, CA, United States, 4University of California - San Francisco, San Francisco, CA, United States

Individuals with eating disorders (ED) demonstrate altered interoceptive processing, which may relate to symptom maintenance and thus represents a salient treatment target. Adapting treatment techniques effective for other conditions characterized by interoceptive deficits may aid in improving intervention outcomes for ED. The current work outlines a case series detailing adjunctive interoceptive exposure (IE) treatment for ED, with an emphasis on evaluating the feasibility and impact of this intervention on interoceptive deficits, anxiety sensitivity, ED symptoms.
Methods: Nine treatment-seeking adults with a principal ED recruited from an intensive outpatient program (IOP) were randomized to a no-IE control condition or one of three IE conditions (Traditional IE, ED-specific IE, Traditional + ED-specific IE). All participants completed measures of anxiety sensitivity, ED symptoms, and interoceptive deficits for 5 weeks, and 1-month post-intervention follow-up.
Results: Individuals who received IE reported decreases in anxiety sensitivity, interoceptive deficits, and eating pathology through 1-month follow-up.  Generally, IE appeared feasible and acceptable.
Conclusions: Results from this case series suggest IE may be an effective adjunctive treatment approach for targeting anxiety and ED symptoms linked with interoceptive deficits. Overall, we will discuss how IE may be used to target interoceptive deficits among adult patients with ED in IOP settings.

Mental Health And Obesity (The Mhoby Study). A Transdisciplinary Approach To Obesity Treatment
Trine T Eik-Nes1,2, KariAnne Vrabel4, Siri Weider3,2, Kristin Stedal5, Camilla Lindvall Dahlgren5, Kjersti Hognes Berg2, Bård Kulseng6
1Norwegian University of Science and Technology. Department of Neuromedicine and Behavioral Sciences, Trondheim, Norway, 2Levanger Hospital, Stjørdal, Norway, 3Norwegian University of Science and Technology, Department of Psychology, Trondheim, Norway, 4Modum Bad, Vikersund, Norway, 5Oslo University Hospital, Oslo, Norway, 6Norwegian University of Science and Technology, Department of Cancer Research and Molecular Medicine, Trond,

INTRODUCTION: The project addresses a startling ineffectiveness of current best practice with a ‘one- size-fits-all’ treatment approach in both pediatric and adult obesity. About 85% of adult patients regain weight, and effectiveness of pediatric obesity treatment is even lower. There are fundamental limitations of obesity treatment where traditional treatment assume that eating behavior and weight can be changed without reference to psychological factors. AIMS: Principal objectives will be to implement psychological health information in obesity treatment and evaluate treatment outcomes of Cognitive Behavioral Therapy and Compassion Focused Therapy compared to traditional treatment. METHODS:This study aims to include 588 patients and will include implementation of a psychological triage and two large pilot studies with a 2-year follow. Participants will be screened with psychological and physiological examinations. The data will be linked with the National Register of Bariatric Surgery and medical records. RESULTS:The effective treatment response will be defined as a reduction in BMI Standard Deviation Score of ≥ 0.25 from baseline to 24 months. Biological and psychological characteristics (genes, gut microbiota, appetite hormones, activity patterns, disordered eating and quality of life) will be gathered. CONCLUSIONS:Findings from the MHOBY study will support development of preventive measures, diagnostics and treatment for patients with obesity and disordered eating.

Applying The Engineering System Of Reinforcement Learning To The Optimize The Treatment Of Eating And Weight Disorders
Evan M Forman, Stephanie G Kerrigan, Adrienne S Juarascio, Stephanie M Manasse
Drexel University, Philadelphia, PA, United States

Introduction. Treatments for eating and weight disorders are costly because they require extended care by expert clinicians. Optimization solutions (eg stepped care) have shown mixed success. The engineering principle of reinforcement learning offers a new and more sophisticated form of optimization in which outcomes are tracked and each participant’s intervention is continuously adjusted depending on patterns of response. In this pilot, we evaluated feasibility, acceptability and whether optimization would achieve equivalent benefit at a reduced cost. Methods. Adults with overweight (N=51) completed an in-person weight loss program and then (Phase II) were randomly assigned to receive 3 months of twice-weekly interventions that were non-optimized (NO; 10-minute phone calls) or optimized (O), i.e., a combination of phone calls, text exchanges, and automated messages selected based on past performance (a “reward score” made up of digitally-collected weight loss, calorie, tracking and physical activity data) of each intervention for each participant. Results. The system was feasible and acceptable. As hypothesized, we achieved equivalent Phase II weight losses (O=4.5%, NO=4.4%) at a fraction of the cost (1.74 vs 4.38 coaching hours/participant). Conclusions. The reinforcement learning system demonstrated strong promise by yielding equivalent outcomes at one-third the cost. Methods for applying reinforcement learning to the treatment of eating disorders will be discussed.

The Use And Perceived Therapeutic Benefits Of Complementary Medicine Compared To Evidence Based Treatmemts In An Eating Disorder Symptomatic Sample Of Community Women
Nasim Foroughi1, Kevin Chen Yu Zhu1, Caroline Smith2, Phillipa Hay1,3
1School of Medicine, Western Sydney University, Sydney, Australia, 2NICM, Western Sydney University, Sydney, Australia, 3Translational Health Research Institute, Western Sydney University, Sydney, Australia

Introduction. We aimed to investigate the personal usage of Complementary Medicine (CM) in an eating disorder symptomatic sample of community women; and to identify how CMs were rated compared to evidence based treatments. Method. Electronic and paper-based surveys were distributed to a pre-existing cohort of community women (n=100, age ≥18) with mean global EDEQ scores 1 standard deviation above the community mean (Mond et al, 2004; global EDE-Q: 1.42±1.04). The survey included questions about the perception of Complementary Medicine (CMs) benefits in eating disorders and whether CM(s) had helped the participant’s personal health. Result. The majority of respondents (62%) reported using CMs either currently or in the past twelve months. The most frequently used CMs were massage (72.6%), vitamins (61.3%), meditation (43.5%), yoga (40.3%), minerals (38.7%), and relaxation (35.5%). There was a somewhat positive or greater positive regard for the usage of CMs (91.9%). If given one option of alternative therapy, most people highly recommended cognitive behavior therapy (CBT) (48%). Conclusion. The positive response from the majority of people utilizing CMs is an indication that they may have some clinical relevance as overall treatment for eating disorders. Highly recommending CBT may be due to the strong campaign in Australia for depression, where CBT is one of the treatments that is favourably advocated by leading Australian mental health organizations.

The Effects Of Mirror Exposure Therapy On Body Image: A Systematic Review And Meta-Analysis
Melanie French, Eunice Chen
TEDp Temple University, Philadelphia, PA, United States

Introduction: Body image dissatisfaction is widespread and considered a risk and maintenance factor for eating disorder symptomology. Mirror exposure therapy (ME) is a promising treatment for body dissatisfaction. The present meta-analysis uses a random-effects model to estimate the effect size of mirror exposure therapy in samples with eating disorders or subclinical samples with high body dissatisfaction. Methods: The inclusion criteria specified that studies 1) must have included a pretest and posttest measure and 2) used ME as a stand-alone intervention (although psychoeducation and video recordings of body were allowed) or compared standard treatment with and without ME. Effect sizes were calculated using standard mean differences (SMD) and corrected based on sample size. Results: 9 publications with 13 different mirror exposure interventions were included in the final analysis (N =245). There were no differences between studies with and without control groups, so the data was combined. ME had a significant moderate effect at reducing body dissatisfaction (SMD=-.651). There were no differences between subtypes of mirror therapies or those with or without eating disorders. Post-hoc power-analysis relevant sufficient power (.945) to detect these effects, assuming moderate homogeneity. Conclusions: Although more randomized control trials are needed, our preliminary meta-analysis confirms the efficacy of mirror exposure therapy for improving body image. 

The Effects Of Mirror Exposure Therapy On Body Image: A Systematic Review And Meta-Analysis
Melanie N French, Eunice Y Chen
Temple University, Philadelphia, PA, United States

Introduction: Body image dissatisfaction is widespread and considered a risk and maintenance factor for eating disorder symptomology. Mirror exposure therapy (ME) is a promising treatment for body dissatisfaction. The present meta-analysis uses a random-effects model to estimate the effect size of mirror exposure therapy in samples with eating disorders or subclinical samples with high body dissatisfaction. Methods: The inclusion criteria specified that studies 1) must have included a pretest and posttest measure and 2) used ME as a stand-alone intervention (although psychoeducation and video recordings of body were allowed) or compared standard treatment with and without ME. Effect sizes were calculated using standard mean differences (SMD) and corrected based on sample size. Results: 9 publications with 13 different mirror exposure interventions were included in the final analysis (N =245). There were no differences between studies with and without control groups, so the data was combined. ME had a significant moderate effect at reducing body dissatisfaction (SMD=-.651). There were no differences between subtypes of mirror therapies or those with or without eating disorders. Post-hoc power-analysis relevant sufficient power (.945) to detect these effects, assuming moderate homogeneity. Conclusions: Although more randomized control trials are needed, our preliminary meta-analysis confirms the efficacy of mirror exposure therapy for improving body image. 

Can We Identify Signs Of What’S To Come? Preliminary Findings On The Longitudinal Outcome Of Inpatients With Anorexia Nervosa
Deborah R. Glasofer1,2, Teresa Rufin1,2, Yuanjia Wang1,3, Peng Wu1,3, Joanna Steinglass1,2, B. Timothy Walsh1,2, Evelyn Attia1,2,4
1NY State Psychiatric Institute, New York, NY, United States, 2Columbia University Irving Medical Center, New York, NY, United States, 3Mailman School of Public Health, Columbia University, New York, NY, United States, 4Weill Cornell Medical College, New York, NY, United States

Introduction. Our field has begun important work to define and understand stages of illness, remission, and recovery in anorexia nervosa (AN). Yet, empirical data remain limited. Estimates of recovery are inconsistent and outcome predictors remain elusive. The aim of this study is to describe an emerging, longitudinal database of adolescents and adults with AN who received inpatient treatment. Methods. Beginning in 2009, all hospitalized individuals have been contacted annually. Data collection includes measures of physical, behavioral and cognitive health, including the Clinical Impairment Assessment (CIA). We are using longitudinal analyses to examine the trajectory of follow-up weight and CIA by fitting a mixed effects model that uses all available data. We will explore whether the rates of change in weight and CIA differ by patient demographics, discharge weight, and subtype by including these as covariates. Results. One hundred and forty-one patients with AN (46.1% restricting-type) participated from June 2009 to April 2018, providing follow-up data for up to 5 years. One-year follow-up data are available from 126 individuals. Data analysis is ongoing. Conclusions. Longitudinal data are critical for evaluating the predictive validity of physical, behavioral, and cognitive components of outcome. Empirical, longitudinal assessment helps our field move towards consensus on the measurement of outcomes. 

The “Recovery From Eating Disorders For Life” Food Guide (Real Food Guide) - The Development Of A Food Pyramid For Adults With An Eating Disorder
Susan Hart1, 2, Caitlin Mcmaster2, Claire Marnane3, Angela Thomas4
1St Vincent's Hospital, Darlinghurst, Australia, 2The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders , Sydney, Australia, 3Newtown Nutrition Private Practice, Newtown, Australia, 4Central Coast Eating Disorder Outpatient Service, Toukley, Australia

To investigate the acceptability, usefulness and nutritional adequacy of a tailored nutrition education tool for individuals with eating disorders. A pyramid with four layers and key nutrition messages was developed to address gaps in nutrition education. Feedback was obtained from 20 consumers receiving treatment regarding the acceptability and usefulness of the REAL Food Guide. A database was developed to reflect the types of foods patients are likely to select and was used to assess nutrition adequacy of weight gain and maintenance patterns. The Guide is acceptable to individuals with eating disorders, with a clear preference for the REAL Food Guide as an aid to recovery. Consumers felt the content was more relevant than general nutrition guidelines and felt reassured at seeing foods they were encouraged to have as part of treatment. Meal patterns were adequate in energy, macronutrients and most micronutrients except for the vegan meal pattern that was inadequate in vitamin D. Practice guidelines and broad recommendations are available but there is an absence of standardized nutrition material used for education on the details of healthy eating for eating disorder consumers. The REAL Food Guide is a simple and user-friendly guide that all clinicians including non-dietitians can use for education on the basics of nutrition that meets energy and nutritional requirements, while reinforcing messages tailored to the beliefs and concerns of individuals with eating disorders.

Using In-Session Exposures To Improve Distress Tolerance And Emotion Regulation
Adrienne S Juarascio, Stephanie Manasse, Kelsey Clark, Helen Murray
Drexel University, Philadelphia, PA, United States

Distress intolerance and emotion dysregulation are factors widely identified as associated with etiology and maintenance of eating pathology. While treatments that provide skills that target such factors (e.g., ACT, DBT) are promising, research suggests patients attempt to utilize these therapeutic skills <50% of the time during acute distress"perhaps due to difficulties translating skills learned in the “calm” of therapy to the cognitive-affective “storm” of everyday life. An underutilized
method that could facilitate real-world skill utilization is in-session exposures to induce negative affect and provide opportunities to practice distress tolerance and emotion regulation skills. Our team recently developed and is currently evaluating a three-session exposure module for BN as part of a larger acceptance-based behavioral treatment. Exposures were designed to induce the type of negative affect identified as most likely to trigger a binge-eating episode (e.g., shame"eating high calorie food in public, deprivation"throwing extra food away) and included affective writing exercises designed to induce negative mood (e.g., writing about a memory that invokes sadness).  During the exposure sessions, patients practice distress tolerance and emotion regulation skills learned in previous sessions. Preliminary data (n=13, projected n by October 2018=20) suggest this module is feasible, acceptable, and perceived as helpful by patients and therapists.

Using Wearable Sensors To Detect And Intervene On Triggers For Disordered Eating Behaviors
Adrienne S Juarascio, Maddy Lagacey, Megan Parker, Tinashe Tapera, Rebecca Crochiere, Evan Forman
Drexel University, Philadelphia, PA, United States

When patients with bulimia nervosa (BN) and binge eating disorder (BED) acquire and utilize the treatment skills targeted in CBT, substantial reductions in symptoms are observed. One possible method for improving skill acquisition and utilization in CBT could be the addition of just-in-time adaptive interventions (JITAIs), which use smartphone technology to deliver real-time interventions during moments of need.  Current JITAIs typically determine the delivery of interventions using data captured from ecological momentary assessments (EMA), an active form of data collection that requires high rates of participant compliance. However, the long-term use of EMA to power JITAI systems has limited acceptability in clinic settings. The feasibility of JITAI systems likely relies on the development of passive data collection technologies that can provide on-going objective data to inform the timing and content of intervention delivery. We will review existing wearable sensors that can passively collect data relevant to eating pathology and will discuss two ongoing projects from our team that are evaluating whether wearable sensor technology can detect relevant eating behaviors (continuous glucose monitoring to detect regular eating compliance) or risk factors for disordered eating episodes (a wearable device that tracks physiological signals associated with affect).  We will also discuss how wearable devices could be integrated with existing JITAI systems to enhance outcomes in CBT.

The Relevance Of Body Image Disturbance For Outcomes Of Outpatient Treatment In Patients With Anorexia Nervosa: Results From The Antop Study
Florian Junne1, Beate Wild2, Gaby Resmark1, Katrin Giel1, Martin Teufel3, Peter Martus4, Katrin Ziser1, Wolfgang Herzog2, Stephan Zipfel1, and the ANTOP Study Group1
1Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Germany, Tuebingen, Germany, 2Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany, Heidelberg, Germany, 3Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Germany, 4Institute for Clinical Epidemiology and Applied Biometry, Medical Faculty Tuebingen,Tuebingen, Germany, Tuebingen, Germany

Study Purpose
This study investigates the role of body image in predicting the outcomes of outpatient psychotherapy in patients with Anorexia nervosa (AN). The study was conducted as secondary analysis of the ANTOP-Trial on outpatient psychotherapy in patients with AN. Methods Multiple linear regression analyses and a path-analysis model were applied to test the study hypotheses that body image self-appraisal at baseline predicts treatment outcomes (at follow-up) via the factors of perceived stress and co-morbid symptoms of depression and/or anxiety. Results The analyses were conducted as secondary analyses of the ANTOP-cohort with N = 242 patients with AN. The path-analyses confirmed the hypothesized sequential pathways in the sense that Negative Evaluation of the Body (NEB) at baseline predicts perceived stress during psychotherapy (beta = 0.25, p <.05) which in turn predicts depressive symptoms at the end of therapy (beta = 0.35, p <.001) which again predicts the outcomes BMI (beta = - 0.24, p <.05) and EDI-2 sum score (beta = 0.31, p <.001) at 12 months follow-up. Conclusion In consequence body image disturbance can be seen as confirmed as a central target of psychotherapeutic interventions for patients with AN. However, as the results of this study show, specific body image directed interventions should incorporate an explicit focus on stress-reduction efforts to avoid adverse effects on comorbid affective symptoms and outcomes for patients with Anorexia nervosa.

Palliative Care For Anorexia Nervosa: Ethical Dilemmas And Clinical Implications
Allan S Kaplan
Center for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada

Purpose: This study identified the published  papers in a database of  medical, psychiatric and  bioethics journals on the ethical and clinical challenges inherent  in utilizing a palliative care approach as opposed to imposition of treatment  for severe and enduring anorexia nervosa ( SE-AN)  .  Methods: The published literature related to palliative care for SE-AN  was critically  reviewed.  25 papers  were identified in the PubMed database and  161  papers were identified in  BELIT, the Bioethics Research Database.  These papers were  then carefully examined  to identify the potential ethical and clinical challenges such an approach entails.   Results: This review identified significant clinical and ethical challenges in utilizing a palliative care approach, compared to treatment imposition,  for SE-AN.  These include the challenges of force feeding ,  the risk of  iatrogenesis,  the risk  of imminent death, as well as  the need to carefully evaluate  the cognitive  and mental competence of such patients as it applies to capacity to consent to treatment.        Conclusions:  At a time when physician aided  death is both topical and  controversial , this study identified  ethical and clinical dilemmas facing the clinician in deciding to utilize a palliative care approach for these  patients. The concepts of "a good death" and of "primum non nocere" were  identified in the literature and  need   to be considered in this  decision. Input from bioethicists is critical to best practice in making this determination.      

Supplementary Motor Area Rtms In People Diagnosed With Eating Disorders For Obsessiveness And Compulsivity (Smart-Study). Study Protocol For A Pilot Randomized Controlled Trial.
Yuliya Knyahnytska1,2, Daniel Blumberger1,2, Jeff Daskalakis1,2, Allan Kaplan1,2
1Centre for Addiction and Mental Health , Toronto, ON, Canada, 2University of Toronto , Toronto, ON, Canada

Background. Eating disorders (ED) are severe and chronic conditions with uncertain etiologies and often poor prognosis; associated with an elevated mortality risk and substantial psychological and physiological morbidities. The economic impact of eating disorders is substantial as the effect of EDs is likely to persist over the lifespan. There is growing interest in targeting the underlying neurobiological abnormalities present in patients with ED. Psychopathological, neurobiological, pharmacological, and epidemiological data demonstrates that ED and OCD may share a common brain behavioral pathway reflecting deficits in inhibition through the cortico-striato-thalamo-cortical circuits. Transcranial brain stimulation (TMS) is a non-invasive technique used to elicit critical neurophysiological changes. Proposal. We hypothesize that low frequency (1 Hz) rTMS administered 5 days per week for 4 weeks applied bilaterally over SMA in patients with ED will result in a reduction in symptoms of ED-related obsessions and compulsions. Discussion. We propose a two-armed, sham-controlled, pilot randomized controlled trial (RCT). The primary outcome measure will be clinical response rate as measured by a reduction in YBC-EDS score over 25%. Safety and tolerability of treatment will be measured by evaluating attrition rate. Secondary outcome measures include decrease in comorbid symptoms such as (a) depression, as measured by HDRS-17 and MADRS; and (b) anxiety as measured by BAI.

Understanding The Neural Mechanisms Of Lisdexamfetamine Treatment For Binge-Eating Disorder
Michael Kohn1,2, Simon Clarke1,2, Kristi Griffiths2, Stephen Touyz2, Phillippa Hay3, Jenny Yang2
1Western Sydney LHD, Sydney, Australia, 2University of Sydney, Sydney, Australia, 3Western Sydney University, Sydney, Australia

In January 2018, the TGA approved lisdexamfetamine dimesylate (LDX) as an indication for moderate to severe binge-eating disorder (BED) in Australia. The exact mode of its therapeutic action, in particular its neurobiological mechanism, remains unknown as there are few published neuroimaging studies to date. This study will utilise imaging connectomics, a cutting-edge field which allows the activity and connectivity of neural networks related to appetite, reward and inhibitory control to be examined simultaneously. It will also investigate the effects of LDX on objective laboratory-based measures of cognition to determine whether its benefits extend more broadly to non-food inhibitory control, incentive processing and reward sensitivity. 40 adults aged 18 to 40 with moderate to severe BED will be given an open-label treatment of LDX, with dosage titrated from 30mg daily for 2 weeks, 50mg daily for 2 weeks, then 50mg or 70mg daily for 4 weeks depending on symptom severity. Outcomes will be assessed at week 0 (pre-treatment) and week 8 (on-treatment), with clinical safety and dose checks at weeks 2 and 4. A healthy control group of 22 adults matched for age, gender and BMI will be assessed at week 0 to act as a baseline for between-group comparisons. The combination of neuroimaging and cognitive measures will provide a sophisticated and comprehensive explanation of the neural mechanisms by which LDX improves BED symptomology.

Sex Differences In Atypical Antipsychotic Prescription Patterns In Adolescents With Eating Disorders
Stacy Mcallister1, Rebecka Peebles1,2, Anne Claire Grammer1, Laurel Weaver1,2, C. Alix Timko1,2
1Children's Hospital of Philadelphia, Philadelphia, PA, United States, 2University of Pennsylvania , Philadelphia, PA, United States

Introduction: Atypical antipsychotic medications are prescribed off-label in the care of eating disorders (EDs).  Limited data suggest no improvement in weight gain but possible subjective benefit during weight restoration. Better understanding of why and for whom atypical antipsychotics are prescribed in the treatment of EDs can inform future research and practice parameters. Methods: A retrospective chart review of patients presenting for treatment of ED at Children’s Hospital of Philadelphia from January 1, 2014 to December 31, 2015 was conducted. Results: 474 cases were reviewed. 67 adolescents (13 male, 53 female, 1 transgender) met inclusion criteria and were prescribed an atypical antipsychotic, 81% received olanzapine. 80% had a diagnosis of anorexia nervosa. The average age was 13.2 ± 3.1 years with an average BMI z score -1.6 ± 1.3. T-tests compared males and females who were prescribed olanzapine. No significant differences were observed in age, BMI z-score, initial or maximum dose; however, males were prescribed medication sooner than females (17.8 days versus 86.0 days, p<.05).  Data abstraction for matched ED controls is ongoing. Conclusion: There appear to be sex differences in adolescents with ED who are prescribed atypical antipsychotics. Future work to be presented includes examining possible differences between adolescents prescribed atypical antipsychotics and controls in demographics, length of illness, rate of weight gain, and psycho-social functioning

An Evaluation Of The Quality Of Nutritional Information In Manualised Psychological Therapies For Adult Outpatients With An Eating Disorder
Caitlin M McMaster1, Susan D Hart1,2, Janet Franklin3, Tracey D Wade4
1Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia, 2St Vincent's Hospital, Sydney, Australia, 3Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney, Australia, 4College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia

Introduction: Both psychological and dietetic intervention are essential components of multidisciplinary eating disorder (ED) treatment. This study evaluates the quality of nutritional information in manualised treatments which guide outpatient therapy for adult patients with an ED. Methods:  Treatment manuals were evaluated if they were published after 1990; written in English by a clinician; were to be used by a clinician to deliver therapy (not self-help or for clinician education) and designed for use with adult patients individually. The authors devised a criteria to independently rank each manual in each of the following domains (1) Inclusion of dietitian in treating team; (2) Nutritional assessment; (3) Quality of dietary advice; (4) Nutritional adequacy of dietary advice; (5) Monitoring of nutritional status; (6) Quality of nutrition education; (7) Inclusion of skills. Results: 28 treatment manuals were evaluated. Of a total possible score of 32, most manuals scored less than 10 with the highest score given being 27. Treatment manuals for bulimia nervosa and binge ED were more likely to include nutritional information and to give more detailed advice compared to treatment manuals for anorexia nervosa. Conclusions: Nutritional information is lacking in current manualised psychological treatments for adult outpatients with an ED and if provided, is often of poor quality. Furthermore, few treatments recommended the inclusion of a dietitian in adult outpatient treatment.

Functional Body Satisfaction, Investment And Appreciation In Adults: Measurement Development And Relations With Intuitive Eating And Well-Being
Kristen Murray1, Patricia M Brown1, Iain Walker1, Elizabeth Rieger2
1University of Canberra, Canberra, Australia, 2Australian National University, Canberra, Australia

Body image is a complex multidimensional construct, but limited studies have investigated the role of functional experiences in health and well-being. Such a focus could enhance current understandings of body image and intervention given its potential protective influence. The current study aimed to assess the suitability of the Embodied Image Scale (EIS), developed to assess the cognitive, affective and behavioural components of aesthetic and functional body image in adolescents, and a newly developed positive body image scale assessing appreciation of functional experiences (AFES), for use in an adult population.  Methods: The sample included 498 adults (n=249 males and n=249 females) aged 18 to 74 years recruited via Prolific Academic to complete a self-report survey online.  Results: Initial analyses suggest two, not three, factors reflecting satisfaction and investment in aesthetic and functional domains on the EIS, and one factor for the AFES. All scales were independently associated with intuitive eating, body appreciation, self-esteem and depression, except aesthetic investment which was not related to self-esteem or depression. Differences according to age, gender and body mass index will also be reported. Conclusions: The study has implications for research in body image, highlighting the need to assess the complexity of the construct in order to understand how our relationship with body function, not just appearance, influences health and well-being.

A Single-Arm Pilot Study Of Guided Self-Help Treatment Based Cognitive Behavioral Therapy For Bulimia Nervosa In Japan
Michiko Nakazato1,2, Rikukage Setsu3, Kenichi Asano 4, Noriko Numata4, Mari Tanaka3, Hanae Ibuki3, Tetsuya Yamamoto5, Ryoko Uragami6, Junko Matsumoto7, Yoshiyuki Hirano4, Masaomi Iyo2,5, Eiji Shimizu3,4
1Department of Psychiatry, International University of health and Welfare, Narita , Japan, 2Department of Psychiatry, Chiba Univeristy Graduate Scool of Meidicine, Chiba , Japan, 3Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan, 4Research Center for Child Mental Development, Chiba University, Chiba, Japan, 5Center for Forensic Mental Health, Chiba University, Chiba, Japan, 6Institute for Psychological research, Meiji Gakuin University, Tokyo, Japan, 7 Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan

Guided self-help treatments based on cognitive behavioral therapy (CBT-GSH) are regarded as a first-line effective treatment for bulimia nervosa (BN). With limited application for CBT-GSH in Japanese clinical settings, we conducted a single arm pilot study in order to confirm the acceptability and availability of CBT-GSH in Japan. 25 women with BN received 16-20 sessions of face-to-face CBT-GSH. Primary outcomes were the completion rate of intervention and abstinence rates from objective bingeing and purging as assessed by the Eating Disorder Examination (EDE). Secondary outcomes were other self-report measurements of the frequency of bingeing and purging, and characteristic psychopathologies of eating disorders. Assessments were conducted before CBT as baseline as well as after CBT. 92% of the participants completed the CBT sessions. After CBT-GSH, 40% of the participants (intention-to-treat) achieved symptom abstinence. The mean binge and purge episodes during the previous 28 days improved from 21.88 to 10.96 (50% reduction) and from 22.44 to 10.88 (52% reduction), each (before CBT-GSH to after CBT-GSH), and the within-group effect sizes were medium (Cohen’s d = 0.67, 0.65, each).  Our study provided a preliminary evidence about the feasibility of CBT-GSH in Japanese clinical settings for the future.

Study Protocol For A Randomised Controlled Trial Investigating Two Different Refeeding Formulations To Improve Safety And Efficiency Of Hospital Management Of Adolescent And Young Adults Admitted With Anorexia Nervosa. 
Elizabeth K Parker1,2, Mark Halaki2, Frances Wilson3, Christine Wearne4, Linette Gomes5, Gail Anderson5, Simon Clarke5, Elizabeth Frig6, Janice Russell7, Michael Kohn5,8, Victoria Flood2,9
1Department of Dietetics & Nutrition, Westmead Hospital, Sydney, Australia, 2Faculty of Heath Sciences, The University of Sydney, Sydney, Australia, 3Department of Psychiatry, Westmead Hospital, Sydney, Australia, 4Department of Medical Psychology, Westmead Hospital, Sydney, Australia, 5Department of Adolescent & Young Adult Medicine, Westmead Hospital, Sydney, Australia, 6Department of Nutrition & Dietetics, RPAH, Sydney, Australia, 7Department of Psychiatry, RPAH, Sydney, Australia, 8Sydney Medical School, The University of Sydney, Sydney, Australia, 9Westmead Hospital, Western Sydney Local Health District, Sydney, Australia

Background: Providing effective nutritional rehabilitation to patients hospitalised with anorexia nervosa is challenging, partly due to conservative recommendations advocating feeding patients at low energy intakes to prevent the possible development of refeeding complications. Of particular concern, the reintroduction of carbohydrate in a starved patient can lead to electrolyte derangement and increased risk of developing organ dysfunction.    This proposed trial builds on earlier research that establishes the safety of more rapid refeeding. In that context, it aims to test the efficacy and safety of a lower carbohydrate enteral formula (28% carbohydrate) against a standard enteral formula (54% carbohydrate), in patients (aged 15-25 years), hospitalised with anorexia nervosa. Methods & Analysis: A double blind randomised controlled trial will be used.   Recruitment will occur in two hospitals in NSW. Participants will be randomly allocated to receive a standard enteral feeding formula (containing 1.5kcal/mL, 54% carbohydrate) or a lower carbohydrate enteral feeding formula (containing 1.5kcal/mL, 28% carbohydrate).  Assessments will be conducted during the first 3 weeks of hospital admission.  The primary outcome measure will be incidence of hypophosphatemia. Ethics Approval:Institutional ethics approvals were granted.

Changes In Resting Energy Expenditure In Female Adolescent Patients Hospitalised With Anorexia Nervosa During Higher Caloric Nutritional Rehabilitation: A Pilot Study.
Elizabeth K Parker1, Lana Hirth2, Lucinda Sharp2, Sonia Faruquie3, Gail Anderson4, Linette Gomes4, Christine Wearne5, Simon Clarke4,6, Michael Kohn4,6
1Department of Dietetics & Nutrition, Westmead Hospital, Sydney, Australia, 2School of Medicine, University of Wollongong, Wollongong, Australia, 3Department of Endocrinology & Diabetes, Westmead Hospital, Sydney, Australia, 4Department of Adolescent & Young Adult Medicine, Westmead Hospital, Sydney, Australia, 5Department of Medical Psychology, Westmead Hospital, Sydney, Australia, 6Centre for Research into AdolescentS’ Health (CRASH), Sydney, Australia

Aims: This study examines changes in resting energy expenditure (REE) during the first two weeks of higher caloric nutritional rehabilitation in 10 hospitalised female adolescent patients (aged 15-18) with anorexia nervosa (DSM-5). Methods: REE was measured at baseline, Week 1, and Week 2, using indirect calorimetry (Cosmed FitMate™ v2.3), and compared against 10 age and sex matched healthy controls. Results: The mean age of subjects was 16.2 years (±0.8). During the first 2 weeks of inpatient treatment, mean daily energy intake increased from 2590kcal (±202) to 4110kcal (±749), which equated to 54.5kcal/kg (±6.4) at baseline and 79.5kcal/kg (±17.9) at Week 2. Mean weight increased from 47.9kg (±4.8) to 52.3kg (±4.4), median %BMI increased from 82.7% (±5.9) to 90.5% (±5.3).  REE was significantly lower at baseline compared with healthy controls (1367kcal/day (±248) vs. 1653kcal/day (±209), p=0.012). There was a significant increase in REE from baseline to week 1 (1367kcal/day (±248) vs.1656kcal (±220), p=0.013). There was no significant difference in REE between groups at week 2. Conclusion: REE is depressed in patients with AN. It increases after 1 week of inpatient higher caloric nutritional rehabilitation, and is similar to healthy controls within 2 weeks of inpatient treatment.

Manualized Cognitive-Behavioral Therapy For Anorexia Nervosa - Use Of Modules In The Antop Study
Gaby Resmark, Brigid Kennedy, Maria Mayer, Katrin Giel, Florian Junne, Stephan Zipfel
University Hospital Tuebingen, Tuebingen, Germany

Using a standardized treatment manual facilitates therapy planning and enhances comparability for research purposes. Within the ANTOP study, the largest multisite outpatient intervention trial in Anorexia nervosa (AN) to date, manualized Enhanced Cognitive-Behavioral Therapy (CBT-E) was offered as one treatment arm. The manual consisted of 9 modules, of which Motivation, Nutrition, Formulation and Relapse Prevention were compulsory. Within each module, homework worksheets were also provided, to ensure the transfer of therapeutic improvements to daily life. The current study investigated the use of modules and worksheets, in order to explore practice styles of trained therapists in the treatment of AN. This secondary analysis was based on log sheets (n=2604) CBT-E therapists completed after each session. Frequencies of modules and worksheets used across all sessions were calculated. Relationships, such as between use of module and duration of illness, were examined. The most commonly used module was Motivation. In chronic patients, the module Self-Esteem seemed to be particularly important. The worksheet “Scales” balancing the pros and cons of AN was prioritized by therapists. The results underline the importance of motivational work in the treatment of AN, including validating the ambivalence experienced by most AN patients. With increasing duration of illness, resource-oriented elements, such as self-esteem stabilization, should be of focus.

Food Industry Literacy: A Potential Protective Factor For Eating Disorders
Rachel F Rodgers1,2, Kendrin Sonneville3
1APPEAR, Northeastern University, Boston, MA, United States, 2Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France, 3Department of Nutritional Sciences, University of Michigan School of Public Health , Ann Arbor, MI, United States

Purpose:The food industry has been suggested to increase risk for eating disorders though multiple pathways, including the refinement of highly-processed foods that are difficult to eat in moderation, the marketing of “diet” foods, and the aggressive marketing and omnipresence of highly-processed foods. In the context of other for-profit industries recognized to contribute to heightened eating disorder risk, increasing literacy, specifically media and dieting/beauty industry-related literacy has been shown to be protective of eating disorder risk. However, to date it is unknown whether literacy specific to the food industry might be similarly protective. Methods: Models of media and industry literacy were identified and reviewed, including those pertaining to areas such as the media and smoking. In addition, industry practices specific to the food industry were collected through a literature review. Results: Four broad areas with relevance to the food industry were identified: (1) critical deconstruction of messaging and practices, (2) identification of persuasive intent; (3) identification of values and viewpoints; and (4) awareness of power and profit motives. Subcategories were further identified in each of these areas. Conclusions: Food industry literacy has a high potential as a protective factor for eating disorder risk. Future work developing successful ways of assessing food industry literacy and confirming it’s usefulness as an intervention target is warranted. 

Saturday, October 27, 2018

9:00 - 10:30 AMGrand Ballroom
Top Abstracts and Awards

Chair(s): Tracey Wade
The Course Of Eating Disorders Involving Bingeing And Purging Among Adolescents: Prevalence, Stability, And Transitions
Kimberly B Glazer1, Kendrin R Sonneville2, Nadia Micali3, Sonja A Swanson4, Ross Crosby5, Nicholas J Horton6, Kamryn T Eddy7, Alison E Field1,8
1Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States, 2Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI, United States, 3Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and Institute of Child Health, University College London, New York, NY, United States, 4Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Department of Epidemiology, Erasmus Medical Center, Boston, MA, United States, 5Neuropsychiatric Research Institute, and Department of Psychiatry and Behavioral Science, Fargo, ND, United States, 6Department of Mathematics and Statistics, Amherst College, Amherst, MA, United States, 7Eating Disorders Clinical and Research Program, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, United States, 8Department of Pediatrics, Warren Alpert Medical School, Providence, RI, United States

Introduction: Studying fluctuation in adolescent bingeing and purging behavior clarifies eating disorder (ED) course during ages of peak incidence. Most research has evaluated treatment-seeking samples, limiting generalizability. We examined ED stability and transition in a population-based sample of adolescent and young adult females in the United States. Methods: Using 11 prospective assessments of 9,031 females age 9-15 at baseline of the Growing Up Today Study, we considered six ED classifications involving bingeing/purging: bulimia nervosa (BN), binge eating disorder (BED), purging disorder (PD), and subthreshold variants with monthly versus weekly symptomology. We measured probability of crossing between disorders, maintaining the same symptom profile, or resolving all symptoms in consecutive surveys. Results: Study lifetime prevalence was 2.1% for BN and 6% each for BED and PD. 26% of ED cases crossed between classifications. Among full threshold disorders, transition from BN to PD was most prevalent (12.9% of BN cases). Within each ED phenotype, 20-40% of cases moved between sub- and full threshold criteria. Conclusions: A substantial minority of females with an ED transitioned between disorders. Patterns of crossover from BN to PD support consideration of a diagnostic category of disorders that involve purging. The prevalence of changes in symptom frequency suggests a continuum or staging approach may increase prognostic and therapeutic utility of ED classification. 

Does Length Of Stay Matter? A Comparison Of Longer And Shorter Inpatient Treatment On Outcome In Adults With Anorexia Spectrum Disorders.
Mimi Israel1,2, Chloe Paquin Hodge1,2, Annie St-Hilaire1,2, Michelle Azzi1, Esther Kahan1, Howard Steiger1,2
1Douglas Institute, Verdun, QC, Canada, 2McGill University Department of Psychiatry, Montreal, QC, Canada

Hospitalisation may be necessary for individuals with anorexia nervosa who are medically or psychiatrically unstable. Yet, beyond medical stabilization, there is a lack of consensus regarding the benefits of lengthening hospitalisation until weight restoration is reached. The aim of this study was to compare the treatment outcome of two inpatient protocols; a longer treatment focused on weight restoration, and a time-limited treatment focused on medical stabilization and progressive return to normal functioning without necessarily achieving full weight restoration. We compared data from 35 patients who participated in the time-limited protocol to a historical sample of 35 patients who were treated using the weight restoration protocol. Participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale-32 at admission, discharge and follow-up. Body mass indexe (BMI) were also obtained at these different time points. At discharge, the weight restoration protocol led to significantly improved BMI and BASIS-32 total score, but similar EDE-Q total score, compared to the time-limited protocol. At follow-up, both protocols led to similar treatment outcomes in terms of BMI, EDE-Q total score and BASIS-32 total score. Our results suggest that shorter inpatient stays focused on medical stabilization and a return to normal functioning do not compromise treatment outcomes.

 Severe And Enduring Anorexia Nervosa?  Illness Severity And Duration Are Unrelated To Outcomes From Enhanced Cognitive Behavioral Therapy.
Bronwyn Raykos1, David Erceg-Hurn1, 2, Peter McEvoy1, 2, Anthea Fursland1, 3, Glenn Waller 4
1Centre for Clinical Interventions, Perth, Australia, 2School of Psychology and Speech Pathology, Curtin University, Perth, Australia, 3Western Australia Eating Disorders Outreach & Consultation Service, Perth, Australia, 4Department of Psychology, University of Sheffied, Sheffield, United Kingdom

Purpose: The present study aimed to examine whether Anorexia Nervosa (AN) illness severity or duration is associated with retention or treatment response in outpatient, enhanced cognitive behavioural therapy (CBT-E).  Methods: Patients with a confirmed AN diagnosis (N = 134) completed measures of eating disorder symptoms and quality of life, and had their BMI objectively measured before, during, and after treatment.  We evaluated whether illness severity or duration predicted treatment outcomes, using longitudinal regression models.  Results: Greater levels of illness severity and duration were not associated with retention or poorer treatment outcomes.  Conclusions: Patients with more severe or long-standing AN illness did just as well in CBT-E as any other patient starting treatment.  Therefore, classifying individuals as ‘severe and enduring’ appears to lack clinical utility in CBT-E.  Clinicians should continue to administer evidence-supported treatments such as CBT-E for patients with AN, regardless of duration or severity of AN illness.

Cognitive-Behavioral Therapy For Avoidant/Restrictive Food Intake Disorder (Cbt-Ar): A Pilot Study Demonstrating Feasibility, Efficacy, And Acceptability
Jennifer J. Thomas1,2, Kendra R. Becker1,2, Olivia Wons3, Ani Keshishian1, Rachel Liebman1,2, Reitumetse Pulumo3, Elisa Asanza3, Sabine Wilhelm2, Madhusmita Misra3,4, Elizabeth A. Lawson3,4, Kamryn T. Eddy1,2
1Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States, 2Department of Psychiatry, Harvard Medical School, Boston, MA, United States, 3Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States, 4Department of Medicine, Harvard Medical School, Boston, MA, United States

 Little is known about the treatment of avoidant/restrictive food intake disorder (ARFID). Methods: We developed a manualized cognitive-behavioral therapy for ARFID (CBT-AR) comprising 20-30 outpatient sessions (family-based or individual). Males and females (10-22 years) diagnosed with ARFID via the Pica, ARFID, and Rumination Disorder Interview (N=21) began CBT-AR delivered by one of 3 PhD therapists. Results: One patient dropped out, 13 completed, and 7 are being treated currently and will complete by October 2018. Clinicians have rated all completers (n=13) as “much improved” or “very much improved” on the Clinical Global Impression Scale. Patients incorporated a mean of 17.2 (SD=5.0) new foods from pre- to post-treatment, primarily from groups under-represented in their diets including fruits, vegetables, and protein. Food neophobia (p=.02, d=1.1) and food fussiness (p<.01, d=2.2) significantly decreased, while enjoyment of food showed a trend-level increase (p=.06, d=0.7). The underweight subgroup (n=9) gained an average of 11.8 lbs (SD= 7.5, p=.002). Patients and families endorsed high ratings of treatment credibility (patients: M=24.1 on a 30-point scale, SD=5.4; parents: M=24.8, SD= 3.8) and satisfaction (patients: M=31.0 on a 32-point scale, SD=1.3; parents: M=29.8, SD=1.6). Conclusions: CBT-AR is demonstrating promising feasibility, efficacy, and acceptability for heterogeneous presentations of ARFID. Randomized controlled trials are needed.

Child Body Image Outcomes From The Confident Body, Confident Child Parent Resource: An 18-Month Follow-Up
Laura M Hart, Katherine Hill, Stephanie R Damiano, Susan J Paxton
School of Psychology and Public Health, Melbourne, Australia

Introduction: Confident Body, Confident Child (CBCC) is a resource for parents of 2- to 6-year-old children designed to promote body satisfaction and healthy eating in early childhood. A randomised controlled trial (RCT) has previously been conducted to examine whether CBCC influenced parent attitudes and behaviours. The aim of this study was to determine whether CBCC had a positive impact on children’s body image at 18-month follow-up. Methods: Participants were parents (N=103) and children (N=91) from the initial RCT from each of the four groups: (A) CBCC resource + workshop, (B) CBCC resource, (C) nutrition-only resource and (D) delayed intervention control. Parents completed measures of parenting variables relevant to child body image and eating patterns. Children completed an interview regarding their body satisfaction, weight bias and eating patterns. Results: Children of parents who received CBCC reported greater body satisfaction and lower external eating compared to those receiving a nutrition-only resource. Parents who received CBCC reported improved knowledge of strategies to promote body satisfaction and healthy eating compared to those receiving a nutrition-only resource. Parents’ knowledge of promoting child body satisfaction was associated with child body satisfaction, weight bias and eating patterns. Conclusions: CBCC appears to positively impact child and parenting variables associated with childhood risk for body dissatisfaction and unhealthy eating.

Brain Water Diffusion Changes In Adolescent Girls With Anorexia Nervosa
Beatriz Martin Monzon1, Luke A Henderson2, Vaughan Macefield1, Sloane Madden2,3, Stephen Touyz2, Perminder Sachdev4, Simon Clarke2,3, Michael Kohn2,3, Nasim Foroughi1, Phillipa Hay1
1Western Sydney University, Sydney, Australia, 2University of Sydney, Sydney, Australia, 3Children's Hospital at Westmead, Sydney, Australia, 4University of New South Wales, Sydney, Australia

Introduction: We previously found adolescent girls with anorexia nervosa (AN) to have widespread reductions in grey matter (GM) volumes. After weight recovery, GM volume recovered in the prefrontal, insular, mid- and posterior cingulate cortices, left hippocampus and in the right anterior thalamus. In this study, we aimed to extend these findings by exploring changes in free-water diffusion using Diffusion Tensor Imaging (DTI) as a marker of neuroanatomical change. Method: A set of DTI brain scans (32 directions, 2x2x2.5mm voxels) were acquired in 26 underweight AN, 20 healthy controls (HC) and in 10 AN after weight recovery. Mean diffusivity (MD) brain maps were calculated and normalized to the Montreal Neurological Institute template and smoothed (6mm). Differences in MD between AN pre- and post-weight recovery were determined using a two-sample, random effects, voxel-by-voxel analysis (p<0.05, corrected). Results: All underweight AN had increased MD in frontal, temporal, parietal and occipital cortices and in the caudate nuclei, corpus callosum and fornix. After weight recovery, MD decreased and begins to normalize towards HC. Conclusion: Water diffusivity changes in MD improve after weight recovery and may indicate a possible mechanism explaining psychological and cognitive improvements seen in AN with treatment.

10:30 - 11:00 AMFoyer
Coffee Break

11:00 - 12:30 PMGrand Ballroom
Influencing obesity prevention policy from an Eating Disorders perspective

Chair(s): Dasha Nicholls
The Imperatives For Obesity Policy
Russell Viner
UCL Institute of Child Health

The Prevalence, Causes And Consequences Of Weight Bias: Implications For Health Practice And Policy
Phillippa Diedrichs
UWE Bristol

Reflections On ‘Tackling Childhood Obesity’ At A State Level
Louise Baur
University of Sydney

Leveraging Food Policy For The Prevention Of Eating Disorders: Getting A Seat At The Table
Rachel Rodgers
Northeastern University

12:30 - 1:00 PMGrand Ballroom
Business Meeting

All are welcome to attend!