XXIVth Annual Meeting of the Eating Disorders Research Society

Printable Program

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

Friday, September 17, 2021

8:00 - 12:00 PMRoom 1
Pre-Conference Workshop: Open-Science in Eating Disorders

Chair(s): Lauren Breithaupt
Welcome & Overview
Lauren Breithaupt

Open-Science In Neuroimaging
Laura Holsen, Laura Berner

Open-Science In Genetics
Zeynep Yilmaz


Open-Science In Epidemiology
Nadia Micali

Open-Science In Statistics
Nassim Tabri, Shirley Wang

Skill Workshop
Mohamed Abdulkadir, Kevin Yang, Shirley Wang

Lauren Breithaupt

12:00 - 1:00 PMRoom 1
IJED Board Meeting

By Invitation Only

1:00 - 2:30 PMRoom 1
Conference Welcome / James Mitchell Lecture

Chair(s): Kamryn Eddy
Neuroendocrinology Of Eating Disorders
Madhusmita Misra
Massachusetts General Hospital, Boston, MA, United States

2:30 - 4:00 PMRoom 1
Poster Session 1

Psychometric Properties Of A Measure Of Behaviorally-Focused Addictive-Like Eating In Two Samples
Kaitlin Bentkowski
University of Calgary, Calgary, AB, Canada

: Is addictive-like eating (ALE) parallel to substance or behavioral addiction? This question has implications for treatment of ALE. The Eating Addiction Questionnaire (EAQ) was developed to measure behaviorally-focused ALE. This study investigated the EAQ’s temporal stability and construct validity in two samples. Methods: Community adults (N = 90) recruited via online message boards and university students (N = 188) completed the EAQ, Addiction-Like Eating Behaviour Scale, Yale Food Addiction Scale 2.0, Reward-based Eating Drive Scale, Grazing Scale, Craving Questionnaire, and Eating Pathology Symptoms Inventory (EPSI). We grouped participants by presence versus absence of self-reported recurrent distressing or impairing problematic overeating (PO). Results: Two-week test-retest reliability was good (r = .89). Re construct validity, participants in both samples reporting PO reported significantly higher EAQ scores than those without PO, t(127.50) = 8.80, p<.001 (university);  t(76)=-5.38, p<.001 (community). After controlling for EPSI Purging and Body Dissatisfaction, Grazing and, in the university sample, Craving scores, EAQ scores explained 8% (university) to 27% (community) of unique variance in EPSI binge eating scores. Conclusions: Findings support the EAQ’s temporal stability and construct validity and suggest it is a useful measure of one form of ALE--eating addiction—that may be validly used to investigate ALE from a behavioral perspective.

An Exploratory Structural Equation Modeling (Esem) Of The Ede-Q In Bariatric Patients
Kayla Costello1, Robyn Sysko1, Andreas Michaelides2, Daniel Herron1,3, Tom Hildebrandt1
1Icahn School of Medicine at Mount Sinai, New York, NY, United States, 2Noom, Inc., New York, NY, United States, 3Mount Sinai Hospital, New York, NY, United States

Introduction: Several studies in clinical and non-clinical populations have suggested differences between rationally and empirically derived subscales for the Eating Disorder Examination Questionnaire (EDE-Q), including in samples of patients seeking bariatric surgery.  The aim of this study is to use a relatively novel approach, exploratory structural equation modeling (ESEM), to estimate the factor structure of EDE-Q in a sample of patients with obesity enrolled in a bariatric surgery program. Method:  Adolescents and adults completed the EDE-Q and a psychiatric evaluation after contacting our clinic and prior to undergoing a surgical procedure.  Data from 352 participants will be analyzed using confirmatory factor analysis with 3 and 4 factor models with an orthogonal (no cross-loading items) structure consistent with published research.  Exploratory structural equation modeling will also be used to examine cross-loadings within the latent structure. Results:  Our hypotheses are that: (1) a cross-loading EDEQ model derived from ESEM will provide better overall fit to the data than 3 or 4 factor CFA models, and (2) there will be group differences (i.e., sex, ethnicity, age) on EDE-Q subscale scores as well as latent factor differences after controlling for item loading and intercept differences across groups. Conclusions: Data from these analyses will inform use of the rationally and empirically derived EDE-Q subscales in patients preparing for bariatric surgery.

Hidden Symptoms Of Eating Disorders In Adolescent Psychiatric Inpatients - Scoff As Valide Diagnostic Screening Tool?
Inken Kirschbaum-Lesch, Theresa Meinert, Martin Holtmann, Tanja Legenbauer
LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Ruhr-University Bochum, Hamm, Germany

Eating disorders often begin in adolescence and are highly associated with other mental disorders. To improve the treatment outcome, an early detection of eating disorder-specific symptoms is necessary. But until now a screening instrument is missing and little is known about prevalent rates of pathological eating behavior in adolescent inpatients. These gaps will be filled with this study by checking the psychometric properties of the 5-item screening questionnaire "SCOFF" (Sick, Control, One stone, Fat, Food). 723 inpatients (aged 13-18 years) completed the SCOFF and the Eating Disorder Examination-Questionnaire (EDE-Q) at admission to the hospital. Prevalent rates of eating disorder-specific symptoms with the generally used cut-off of 2 were investigated. Furthermore, sensitivity and specificity analyses were performed separately for a cut-off of 2 and a cut-off of 3. Correlations between the SCOFF and the EDE-Q subscales were tested. 5,1% were clinically diagnosed with an eating disorder, whereas 47,3% reported  symptoms of a eating disorder. Comparing the two cut-off-values revealed better psychometric properties for the cut-off of 3. High correlations were found between the SCOFF and the EDE-Q subscales (rs = .455 to .577). In clinical adolescent populations a cut-off of 3 should be used. Using the SCOFF as screening instrument may help to identify subclinical eating disorder symptoms which allows an early treatment and might reduce chronicity and long-term impairments.

Concordance Of The Ede-Q And Parent Ede-Q In An Outpatient Eating Disorder Specialty Setting
Megan C Kuhnle1, 2, Kathryn Pasquariello3, Melissa J Dreier1, Olivia B Wons4, Catherine Drury5, Katharine Loeb5, Helen Burton Murray1,6, Lauren Breithaupt1, Kendra R Becker1, Debra L Franko1,7, Kamryn T. Eddy1,8, Jennifer J Thomas1,8
1Massachusetts General Hospital Eating Disorders and Clinical Research Program, Boston, MA, United States, 2Massachusetts General Hospital Neuroendocrine Unit, Boston, MA, United States, 3Massachusetts General Hospital Neuropsychology Testing Center, Boston, MA, United States, 4Drexel University Department of Psychology, Philadelphia, PA, United States, 5Fairleigh Dickinson University, Teaneck, NJ, United States, 6Massachusetts General Hospital GI group, Boston, MA, United States, 7Northeastern University, Boston, MA, United States, 8Harvard Medical School Department of Psychiatry, Boston, MA, United States

Introduction: The Eating Disorder Examination-Questionnaire (EDE-Q) is a well-established self-report measure, but there is limited research on measures that ask parents to report on their children’s eating behavior. We assessed concordance between the EDE-Q and the Parent Eating Disorder Examination-Questionnaire (P-EDE-Q). Methods: Patients (n=107, mean age=14.1±2.3), evaluated at an outpatient eating disorder clinic where they received a DSM-5 eating disorder diagnosis, and their parent completed the EDE-Q and P-EDE-Q, respectively. We used intraclass correlation coefficients to evaluate concordance between the EDE-Q and P-EDE-Q. Results: Among all parent-child dyads, 94.7% answered the questionnaires, suggesting feasibility and acceptability. There was excellent agreement for the global score [ICC = 0.864]. Among 20 patients with BN, BED, rumination, or OSFED agreement was excellent [ICC = .840]. Among 32 patients with anorexia nervosa (including restricting, binge purge, or atypical diagnoses) agreement was good [ICC = .652]. Among 55 patients with avoidant/restrictive food intake disorder (ARFID) agreement was fair [ICC = .570]. Conclusions: The EDE-Q and P-EDE-Q demonstrate good concordance. Parent report of eating disorder symptoms in children may be helpful to accompany self-report in clinical and research settings. Concordance was lower for restrictive eating disorders, particularly ARFID, suggesting the need for new ARFID-specific parent and child assessment tools.

Transdiagnostic Aspects Of Body Image Disturbances – A Naturalistic Study In Adolescent Inpatients With Diagnosed Anorexia Nervosa Or Depressive Disorder
Tanja Legenbauer1, Laura Mokros1, Kristofor McCarty2, Martin Tovee2, Martin Holtmann1, Piers Cornelissen2
1LWL University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany, 2Department of Psychology, Faculty of health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom

Adolescence is a vulnerable phase for the development of body image disturbance (BID) and eating disorders (EDs). Recent research indicates that BID also occurs in depression (DEP) and is associated with negative self-esteem/symptom severity. In EDs, perceptual and attitudinal aspects of BID have been described, but this is limited to the attitudinal domain in DEP. The aim of the present study is to capture different facets of BID in a naturalistic psychiatric inpatient setting and compare patients with anorexia nervosa (AN) and DEP. 
A Method of Adjustment Task (MoA) for BID perception + self-report for ED psychopathology and cognitive-affective and behavioral BID components were given routinely to patients with AN or DEP admitted to inpatient treatment. Data collection is ongoing. So far, 45 patients (AN=31, DEP=14) have been recruited.  Both patient groups report similar levels of eating psychopathology (EDE-Q) and cognitive-affective BID as well as significant overestimation of body size in the MoA. DEP report higher body related avoidance behavior (BCAQ) compared to AN.  BID is a transdiagnostic feature that is prevalent in adolescent girls with depression and seem to be accompanied by (subthreshold) ED symptoms. A healthy, age matched control group and a clinical group of depressive patients without eating disturbance will be recruited to provide further information about BID in this age group. 

Exploring Differential Item Functioning On Eating Disorder Measures By Food Security Status
Shannon M. O'Connor1, Vivienne M. Hazzard2, Hana F. Zickgraf3
1Montclair State University, Montclair, NJ, United States, 2Sanford Research, Fargo, ND, United States, 3University of South Alabama, Mobile, AL, United States

Food insecurity is associated with elevated eating disorder (ED) pathology, yet commonly used ED measures may not fully capture ED pathology in the context of food insecurity. The present study used differential item functioning (DIF) analyses to explore whether item endorsement on two commonly used ED questionnaires differed by food security status. Methods: Participants were 634 cisgender women recruited through Amazon’s Mechanical Turk. DIF was explored for items on the Short Eating Disorder Examination Questionnaire (S-EDE-Q) and the Eating Disorder Diagnostic Scale for DSM-5 (EDDS-5). DIF analyses used a hybrid ordinal logistic regression/item response theory approach, with the presence of both statistical (p<.01) and clinical significance (pseudo ΔR2≥.035) indicating DIF. Results: There was no evidence of clinically significant DIF within the S-EDE-Q. Two items on the EDDS-5 exhibited statistically and clinically significant DIF, with moderate effect sizes. Specifically, compared to food-secure participants, food-insecure participants were more likely to report (1) eating large amounts of food when not physically hungry and (2) feeling disgusted, depressed, or guilty about overeating at lower levels of overall ED pathology but less likely to report these experiences at higher levels of overall ED pathology. Conclusions: Findings highlight a potential need to adapt ED measures to fully capture ED pathology in food-insecure populations.

Somatomap 3-Dimensional Visual Assessment Of  Body Image Perceptual Accuracy Related To  Eating Disorder Symptoms In Male Fashion Models  
Christina Ralph-Nearman1, Armen C. Arevian2, Valentina Cazzato3, Ashleigh Bellard3, Gabrielle Davis1,4, Sahib S. Khalsa5, Jamie D. Feusner2
1Department of Psychological and Brain Science, University of Louisville, Louisville, KY, United States, 2Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, United States, 3School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom, 4Department of Counseling and Human Development, University of Louisville , Louisville, KY, United States, 5Laureate Institute of Brain Research, Tulsa, OK, United States

Body image disturbances and eating disorder symptoms co-occur; often assessed by self-report or clinical judgment. Here, we used Somatomap to assess the accuracy of body part size estimation in male fashion models vs nonmodels, related to eating disorder symptoms. Methods: 108 men (n=68 professional fashion models, age=23±4yrs; n=40 nonmodels, age=24±5yrs) provided body image ratings using a three-dimensional (3D) avatar. Seven body areas (shoulder, bust, bicep, waist, hip, thigh, calf) were sculpted to reflect current perceived body shape. Accuracy (perceived minus actual measurements) were evaluated using multivariate analysis of covariance followed by linear regressions between each score and eating disorder severity (EDEQ scores; range 0-4.3(M=1.2,SD=1.1) models; 0.2-3.2(M=1.5,SD=0.9) nonmodels). Results: Relative to nonmodels, models had significantly smaller waist, hip, and calf measurements, and they were more accurate in perceiving their waist and calves; Cohen’s fs≥.25,Ps≤.047). Regressions with each body part discrepancy score showed that models’ waist discrepancy was positively associated with eating disorder symptoms (R2=0.08, F(1,66)=5.98, P=0.017). Conclusion: This digital, 3D approach to visual assessment of body image and body perceptual accuracy revealed that male models are more accurate than nonmodels at perceiving specific body parts, yet eating disorder symptoms are associated specifically with the degree of inaccuracy at estimating waist size. 

Differences In The Factor Structure Of The Eating Attitude Test-26 (Eat-26) In Different Cultures In Israel: Jews, Muslims And Christians
Zohar Spivak-Lavi1, Ora Peleg1, Orna Tzichinsky1, Daniel Stein2, Yael Latzer3
1The Max Stern Yezreel Valley College, Yezreel Valley College, Israel, 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 3Faculty of Social welfare and Health Science, Haifa University, Haifa, Israel

Purpose of study: In recent years, there has been a shift in the clinical presentation and hence, the diagnostic definitions of eating disorders (EDs), reflected in the dramatic change in the diagnostic criteria of EDs in the DSM-5. The Eating Attitudes Test-26 (EAT-26) is currently considered an accepted instrument for community studies of EDs, although it features an inconsistent factorial structure in different cultures. Therefore, it is essential to investigate whether the EAT-26 can still be considered an adequate instrument for identifying risk of developing EDs in different cultures. The aim of the present study was to examine the construct validity and internal consistency of the EAT-26. Method: Using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among different cultural populations in Israel. Data and Results: Findings indicate different factors in different ethnic groups, most of which do not correspond with the original EAT-26 three-factor structure. Results The analysis yielded two main factors among Israeli Jews, four main factors among Israeli Muslim Arabs, and three main factors among Israeli Christian Arabs. Conclusion: These findings shed light on cultural factors affecting perceptions of the EAT-26 items. This calls for reconsideration of the generalization of the original three-factor structure of the questionnaire in different cultures.

I Am Feeling Fat: Characterizing Feeling Fat And Within Person Factors Underlying The Experience Of Feeling Fat
Paakhi Srivastava1, Stephanie Fan1, Olivia Clancy1,2, Adrienne Juarascio1,2
1Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, United States, 22Department of Psychology, Drexel University,, Philadelphia, PA, United States

Despite research showing an association between the experience of feeling fat and eating pathology, no research has characterized feeling fat and explored factors underlying these this experience in naturalistic contexts using real-time data. In the current study, 25 adult women with binge eating spectrum disorders completed ecological momentary assessments to record multiple daily ratings on feeling fat, negative affect and contexts that are known to increase body awareness (i.e., body checking, body comparison, food consumption, social media use and awareness of internal sensations such as bloating or cramps) over two weeks. On average, within a day, an individuals’ feeling of fatness changed by 1.84 (out of 5) points from its level at a preceding time point, representing a typical change of 37% on the available scale range (M.S.S.D=1.84, S.D.=0.88). Multivariate generalized estimated equations model using a gamma link function and AR1 serial autocorrelation was estimated. Results indicated that both greater than one’s usual level of negative affect (b=0.47, p=0.01, R2=0.34) and social media use (b=0.45, p=0.02, R2=0.32) prospectively predicted of greater than one's average levels of of feeling fat, over and above engagement in body checking, body comparison, food consumption and awareness of internal sensations. Our results suggest that negative affect and spending time on social media as potential underlying factors maintaining the experience of feeling fat may be worthy of future research. 

A Meta-Analysis Of Cognitive Function In Children And Adolescents With Anorexia Nervosa
Kristin Stedal1, Catherine Broomfield2, Phillipa Hay3, Stephen Touyz2, Ronny Scherer4
1Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway, 2School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia, 3Translational Health Research Institute, Western Sydney University, Sydney, Australia, 4Centre for Educational Measurement at the University of Oslo (CEMO), Oslo, Norway

Introduction: Despite an increasing number of young individuals with anorexia nervosa (AN), meta-analytic reviews specifically targeting this population are lacking. Our primary aim was therefore to assess the cognitive functioning of young people with AN compared to healthy controls. Our secondary aim was to explore potential moderators of the neuropsychological test performance differences. Methods: The research was conducted in accordance with the PRISMA guidelines, and the literature search included the databases MEDLINE, PsycINFO, ISI Web of Science, and Epistemonikos. The effect size of Hedges’ g was calculated from the standardized mean difference scores, and machine learning analyses were utilized to investigate the importance of moderators. Results:  Sixteen studies met inclusion criteria with a total of 1333 participants (665 with AN), and k = 186 NP effect sizes. Overall analyses revealed a small but significant cognitive underperformance in the patient group (g ̅ = -0.188, 95 % CI [-0.288, -0.088]), which was associated with age (older participants performed worse), country of study origin, and assessment quality. Conclusion: Our findings support the need for cognitive tests specifically targeted for younger participants, as opposed to utilizing measurements that have been developed for an adult population. The current review further highlights the lack of considering potentially confounding variables in primary studies. 

Evaluating Expectations Of Weight Loss Among Individuals With Versus Without Binge Eating
Claire Voss1, Jianyi Liu1, Angela Chang1, Jennifer E. Wildes2, Andrea K. Graham1
1Northwestern University Feinberg School of Medicine, Chicago, IL, United States, 2University of Chicago, Chicago, IL, United States

Introduction: Overvaluation of weight/shape distinguishes more severe forms of binge eating disorder. As a potential consequence of such overvaluation, people with binge eating may have more unrealistic weight loss goals and anticipate losing more weight in an intervention than those without binge eating. We tested the hypothesis that people with binge eating have higher weight loss expectations than those without.
Methods: Adults responded to a screener to assess eligibility for a RCT on self-tracking for binge eating and weight management. Respondents reported if they had ever experienced an episode of binge eating, if so, how many in the past 3 months, and the amount of weight loss they perceived would be reasonable and/or achievable in 4 months. Results: Among 761 participants (42.2% non-White; mean age=34.4y; 66.1% female), 68.1% endorsed ever experiencing binge eating. Those with binge eating expected higher weight loss over the next 4 months compared with those without binge eating (11.0% vs. 9.4%; t(759)=-3.52; p<0.001). There was a trend-level difference in average percent expected weight loss between those with vs. without clinical-threshold levels of binge eating (≥12 episodes in 3 months; 11.1% vs. 10.2%; t(759)=-1.97; p=0.05). Conclusions: Given the relation between binge eating and weight loss overestimation, future research should assess the potential mediating impact of overvaluation of weight/shape, and implications for weight change on treatment outcome.

Delay Discounting In Anorexia Nervosa
Joseph A. Wonderlich1,2, Joanna E. Steinglass1,2
1Columbia University Irving Medical Center, New York, NY, United States, 2New York State Psychiatry Institute, New York, NY, United States

Introduction: Individuals with anorexia nervosa
 (AN) are often characterized as having high levels of self-control given they override their drive to eat in order to lose weight, essentially forgoing immediate rewards in favor of longer-term goals. Delay discounting tasks examine the tendency to prefer smaller, immediate monetary rewards over larger, delayed rewards. However, studies of delay discounting in AN have provided mixed results. Thus, we examined delay discounting in a sample of individual with AN and healthy controls (HC).   Methods: Individuals with AN (n = 93) and healthy control subjects (HC, n =47) performed a monetary delay discounting task. The task consisted of a range of monetary choices with variable delay times, yielding individual discount rates—the rate by which money loses value over time.   Results: Results from the study showed there was a significant effect of age on delay discounting across the sample (B = -0.02, p = 0.42). However, individuals with AN did not differ from HC in terms of discount rate (B = 0.44, p = 0.87). Additionally, there were no differences in discount rate between individuals with AN restricting subtype and AN binge/purge subtype (B = -0.47, p = 0.78).   Conclusion: Thus, the results of this study indicate that individuals with AN are not more or less likely to choose longer rewards later than HCs. However, older individuals were more likely to wait for larger rewards than to take smaller immediate rewards.

Shifting To Task-Switching: Re-Evaluating Cognitive Flexibility In Bulimia Nervosa
Sophie R. Abber1,2, Evan M. Forman1,2, Christina E. Wierenga3, Stephanie M. Manasse2
1Department of Psychology, Drexel University, Philadelphia, PA, United States, 2WELL Center, Drexel University, Philadelphia, PA, United States, 3Department of Psychiatry, University of California, San Diego, San Diego, CA, United States

Introduction: Research examining deficits in cognitive flexibility (i.e., the ability to alter behavior in response to environmental changes) among individuals with bulimia nervosa (BN) has produced mixed results.  Prior work has relied on set-shifting paradigms, which do not effectively isolate cognitive flexibility.  Furthermore, it is possible that cognitive flexibility deficits in BN are disorder-specific (i.e., confined to food-related responses).  Thus, the present study sought to re-evaluate cognitive flexibility in BN using general and food-specific task-switching paradigms, which are better able to isolate cognitive flexibility.   Methods: 27 treatment-seeking individuals with BN and 39 healthy controls (HC) completed a cued color-shape switching task (CCSST) and a food-specific variant developed by our team.  We compared BN and HC on switch costs (reflective of short-term cognitive control) and mix costs (reflective of sustained cognitive control).   Results: Mix costs and switch costs were not significantly different between BN and HC in terms of both accuracy and reaction time (all Fs <2, all p
s > 0.10).   Conclusions: Our findings suggest that neither general nor food-specific cognitive flexibility is impaired in BN.  Behavioral rigidity in BN (e.g., continued engagement in compensatory behaviors despite psychoeducation that these behaviors are ineffective for weight loss) may be a result of other neurocognitive impairments rather than cognitive flexibility deficits.

Examining The Relationship Between Deficits In Self-Concept Clarity And Eating Disorder Presentation
Sarrah I. Ali, Pamela K. Keel
Florida State University, Tallahassee, FL, United States

Self-concept clarity (SCC) is the degree to which one has a confidently defined and stable sense of self. Prior research has demonstrated that SCC deficits are associated with poor body image and increased eating disturbances but has mainly used non-clinical samples. Methods: Using data from a sample of women with eating disorders (EDs) and healthy controls, this study examined the relationship between SCC deficits and ED specific and general psychopathology. Participants completed the Eating Disorder Examination (EDE), SCID-II Personality Questionnaire (SCID-II PQ), and measures of depression, anxiety, and impulsivity. Three SCID-II PQ items capturing identity disturbance were selected as a measure of SCC deficit. T-tests evaluated differences in SCC between women with EDs and controls and Spearman’s correlations evaluated associations between SCC and eating and general psychopathology. Results: Compared to controls, the ED group endorsed significantly worse SCC. In the ED group, SCC deficits were significantly correlated with EDE global and most subscale scores (with small effect sizes) but were not significantly correlated with behavioral symptom frequencies. Instead, SCC deficits were significantly correlated with depression, trait anxiety, and impulsivity with moderate-large effect sizes. Conclusions: SCC deficits may reflect a transdiagnostic feature related to severity of a range of mental health issues rather than severity of ED-specific symptoms.

The Perceived Costs Of Self-Control Among Individuals With Binge Eating
Laura A. Berner1, Thalia Viranda1, Xiaosi Gu1, Candace Raio2
1Icahn School of Medicine at Mount Sinai, New York, NY, United States, 2New York University Grossman School of Medicine, New York, NY, United States

A sense of "loss of control" distinguishes binge eating from non-pathological overeating, but the cognitive processes underlying this transdiagnostic symptom remain poorly understood. We examined whether individuals with binge eating show distinct decision-making that reveals an elevated perceived cost of exerting self-control in the presence of food rewards. Methods: Data were collected online from three demographically-matched groups (N=259): one with binge eating (BE), one with only overeating (OE), and one with no overeating (NOE) in the past month. Participants completed a task developed to quantify the subjective cost of self-control. They reported their willingness-to-pay, from a $10 endowment, to avoid spending variable amounts of time alone with foods that they rated as low, medium, or highly tempting. Results: Over 50% of all three groups were currently dieting, and, on average, all were willing to pay to avoid tempting foods. However, with increasing temptation levels, BE increased their bids more than NOE and OE groups (ps<0.0001). For highly tempting foods, BE were willing to pay significantly more to avoid (43% of the endowment) than OE (p=0.026) and NOE (p=0.0006). Conclusions: When individuals with binge eating are confronted with tempting foods, exerting self-control may not seem worth the costly effort. Particularly high subjective self-control costs could help explain loss-of-control eating and could be useful targets for treatment development.

Disordered Eating Behaviors And Attitudes Among Military Service Members 
Lisa J. Boden Felchle, Lisa Lilenfeld, Elana Maurin, Marinka Gadzichowski
The Chicago School of Professional Psychology, Washington, DC, United States

The Department of Defense body composition program may be harming female service members. This study examined how gender and BMI may be associated with disordered eating behavior within the military population. A sample of 666 participants, including military service members (n = 208), veterans (n = 221), and non-military persons (n = 237), completed the Eating Pathology Symptoms Inventory (EPSI; Forbush et al., 2013). A one-way ANOVA indicated that individuals actively serving in the military had significantly higher EPSI scores on excessive exercise, negative attitudes toward obesity, and muscle building, compared to those who never served in the military. Gender and BMI were two significant variables in military service members. A multinomial logistic regression found that military females had higher purging and excessive exercise than the control group. Females had significantly higher body dissatisfaction and cognitive restraint than males in the military. Over 56% engaged in disordered eating behavior (e.g., food and liquid restriction, diet pills, exercise) prior to a military weigh-in, with 54% engaging in multiple methods. Females who had a BMI>25 were twice as likely than males to engage in disordered eating behavior before a weigh-in. The military fosters an environment which encourages discipline, exercise, and muscle building. Unfortunately, females with a BMI>25 have an increased risk for eating disorders within the military.

The Role Of Letin And Ghrelin In The Vicious Cycle Of Eating Disorder Psychopathology 
Giovanni Castellini1, Emanuele Cassioli1, Eleonora Rossi1, Roberta Squecco2, Valdo Ricca1
1Department of Health Sciences. University of Florence, Florence, Italy, 2Department of Experimental and Clinical Medicine, Section of Physiological Sciences, University of Florence, Florence, Italy

Puropose of the study:   The aim of the present study was to evaluate the role of leptin and ghrelin as mainteining factors of Eating Disorders (EDs) psychopathology.   Methods: 73 patients with EDs and 52 healthy controls (HC) were evaluated before entering a psychological treatment, and after one year follow-up, in terms of leptin and ghrelin levels, and psychometric tests for general and EDs specific psychopathology, emotional eating, and childhood traumatic experiences. Results: Moderated linear regression models showed that, in the presence of high levels of ED psychopathology, leptin levels were negatively associated with dietary restraint and compensatory exercise, and positively with emotional eating and binge eating (adjusting for body mass index). Patients reporting a history of childhood trauma had higher ghrelin levels as compared to HC and other patients, and moderation analyses showed that ghrelin levels were associated with binge and emotional eating only for higher levels of childhood trauma. Follow-up evaluation seems to confirm baseline observations. Conclusions: These data seem to confirm the role of leptin in maintenance of pathological eating behaviours, and its involvement aberrant food-related reward mechanism in ED patients. Furthermore, it was supported the hypothesis that chronic alterations in ghrelin levels following childhood traumatic experiences could represent a neurobiological maintaining factor of pathological overeating behaviours in EDs.

The Administration Of Bright Morning Light Increases The Amplitude Of The Cortisol Awakening Response And Reduces The Urge To Binge Eat In Women With Clinically Significant Binge Eating
Kyle Patrick De Young, Angeline Bottera, P. Evelyna Kambanis, Christopher Mancuso
University of Wyoming, Laramie, WY, United States

Binge eating may be partly driven by disrupted circadian rhythms, which can be indexed using the cortisol awakening response (CAR) and altered by bright morning light. After baseline, in random order, we administered bright (10,000 lux) or normal (500 lux) light for 30 minutes on 10 consecutive mornings each to test for changes in CAR and urge to binge eat in women (N=28) with clinically significant binge eating (
≥2x/week for 3 months). Participants provided saliva 0-, 15-, and 30-minutes post-waking to characterize the CAR on six days: two baseline, last two of bright light, and last two of normal light. Generalized estimating equations tested whether CAR: (a) changed according to light condition compared to baseline; (b) explained urges to binge eat, accounting for condition order, wake-time variations, and electronically verified sample collection times. The CAR was steeper after bright light than at baseline (p=.003), increasing 1.80 times at 30 minutes, which is nearly normal. The CAR after normal light was intermediate to baseline and bright light, but did not significantly differ from either (p=.182 and .382). More blunted CAR predicted greater urge to binge eat (p=.032). Urge to binge eat reduced following bright light compared to baseline (p<.001), but not compared to normal light (p=.077). Bright light increased the amplitude of the CAR and reduced the urge to binge eat. Further, changes in the CAR accounted for some of the changes in the urge to binge eat.

Severity Of Loss-Of-Control (Loc) Eating And Time-Domain Heart Rate Variability (Hrv) In Healthy Youth
Loie M. Faulkner1, Lisa M. Shank1,2,3,4, Taylor N. Swanson1,4, Eliana Ramirez1, Esther A. Kwarteng1, Kweku G. Djan1, Sara Lemay-Russell1,2, Megan N. Parker1,2, Meghan E. Byrne1,2, Sheila M. Brady1, Shanna B. Yang5, Sara Turner5, Anna Zenno1, Marian Tanofsky-Kraff1,2,3, Jack A. Yanovski1
1Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States, 2Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 3Military Outcomes Cardiovascular Research, USU, 4301 Jones Bridge Road, Bethesda, MD, United States, 4Metis Foundation, 300 Convent St #1330, San Antonio, MD, United States, 5Nutrition Department, NIH Clinical Center, 10 Center Drive, Bethesda, MD, United States

Prior studies suggest that youth who have high adiposity and/or report LOC-eating demonstrate significantly reduced HRV, a marker of autonomic and metabolic dysfunction. We hypothesized that severity of youths’ reported LOC-eating during the meal would be associated with a reduction in HRV induced by the meal. Methods: HRV was measured using the square root of the mean squared differences of successive normal RR intervals (RMSSD) before and after a laboratory buffet meal designed to induce LOC-eating. Immediately after the meal, youth self-reported LOC-eating severity during the meal. A GLM was conducted with post-meal ln(RMSSD) as the dependent variable, LOC eating as an independent factor, and race, sex, age, and pre-meal ln(RMSSD) as covariates. A second GLM included percent fat mass (%FM) by DXA as an additional covariate. Results: Among 207 youth (12.7±2.8y; 54% female; 44% non-Hispanic White), LOC-eating severity was negatively related to post-meal RMSSD (p

Nonsuicidal Self-Injury Is Uniquely Associated With Current Suicidal Ideation In A Mixed Diagnostic Sample Of Individuals With Eds
Alyssa M. Izquierdo1, Jillian Nelson1, Alyssa Daza1, Rebecca Hardin2, Joanna Marino2, Alexandra Gasbarro2, Sarah Fischer1,2
1George Mason University, Fairfax, VA, United States, 2Potomac Behavioral Solutions, Arlington, VA, United States

Introduction. Suicidal ideation (SI), suicide attempts (SA), and nonsuicidal self-injury (NSSI) are associated with eating disorders (EDs), and most consistently with binge eating/purging. However, food restriction predicts SI in low weight adolescents and other samples (e.g., Wang et al., 2020). The current study expanded on these findings by examining predictors of current SI in a mixed diagnostic ED sample. Methods. Participants were 167 patients (ages 16-49) with EDs (AN-R, AN-BP, BN, BED, ARFID, or OSFED) seeking ED treatment at an outpatient center. Patients completed a structured clinical interview regarding lifetime and current (past 2 weeks) SI, SA, NSSI, ED, and other psychiatric symptoms. We ran logistic regression analyses with current SI (yes/no) as the outcome variable, and binge eating/purging, restriction, skipping meals, excessive exercise, NSSI, and past SA as predictors. Results. 24.6% of patients reported current SI, 18.0% reported past SA, and 29.5% reported NSSI. When ED symptoms were entered into the model, skipping meals was the strongest predictor of current SI. However, when NSSI and past SA were entered, this was no longer significant. NSSI was the strongest predictor of current SI. Conclusions. Findings may differ from other recent studies for several reasons. This mixed diagnostic sample was treatment seeking and thus may have had higher levels of behavioral dysregulation. Past studies may not have included predictors such as NSSI and SA.

The Role Of Dopamine And Metabolic Hormones In Food Reward In Bulimia Nervosa
Danielle Jongen1, Nathalie Weltens1, Patrick Dupont1, Jenny Ceccarini1, Koen Van Laere1,2, Elske Vrieze1, Lukas Van Oudenhove1
1KU Leuven, Leuven, Belgium, 2UZ Leuven, Leuven, Belgium

Bulimia Nervosa (BN) is characterized by abnormal reward responses to food stimuli. Dopamine (DA) and metabolic hormones play a key role in food reward, but their direct role in food reward has not been studied in BN. In the currently ongoing study, female BN patients and healthy controls undergo PET-MR scanning with the dopaminergic radioligand [18F]fallypride. Participants view images of palatable food while receiving sips of milkshake as well as viewing neutral control images while receiving sips of water. Functional MR data is simultaneously acquired to provide insights in the contribution of DA release to brain activity changes. Blood samples are taken during scanning to analyze metabolic hormone levels and their role in food reward responses. Preliminary results of 9 BN patients show significant DA release to food reward (versus control) in the caudate, insula*, anterior cingulate cortex*, orbitofrontal cortex (OFC)* and midbrain. BN patients show a trend towards less DA release in the amygdala*, insula*, midbrain, and part of the OFC compared to healthy controls. (qFDR corrected, *significant at strict voxel-based threshold) This is in line with several fMRI studies showing lower activity of the reward system to food stimuli in BN. Results from this ongoing study will improve our understanding of BN and might allow us to guide the optimization of behavioral treatment approaches or to identify new treatment targets at multiple levels of the gut-brain axis.

Probing Perceptions Of Dyspnea In Anorexia Nervosa Using Resistive Inspiratory Breathing Loads 
Rachel C Lapidus1,2,3, Paul W Davenport4, Andreas von Leupoldt5, Justin Feinstein1,6,7, Valerie Upshaw1, Sheridan Chappelle1,8, Daniel Guzman1,2, Jennifer L Stewart1,7, Sahib S Khalsa1,7
1Laureate Institute for Brain Research, Tulsa, OK, United States, 2The University of Tulsa, Department of Psychology, Tulsa, OK, United States, 3The University of California San Diego, Department of Psychiatry, San Diego, CA, United States, 4University of Florida, Department of Neuroscience , Gainsville, FL, United States, 5University of Leuven, Belgium, Research Group Health Psychology, Leuven, Belgium, 6Clinical Flotation, Maui, HI, United States, 7The University of Tulsa, Oxley College of Health Sciences, Tulsa, OK, United States, 8The University of California San Diego, School of Medicine, San Diego, CA, United States

Introduction: Abnormal interoception may maintain anorexia nervosa (AN) symptoms. This study evaluated perceptions of dyspnea in women with AN and healthy comparisons (HC) using inspiratory breathing loads. We predicted AN would rate dyspnea sensations as more intense, unpleasant, and fear-inducing than HC without differences in physiology. Methods: 20 weight-restored AN and 21 HC received 6 different loads presented for 10 breaths, each magnitude presented 4 times, and repeated on 2 visits separated by one week. Intensity and unpleasantness ratings were collected after the 1st, 5th, and 10th loaded breath. Fear ratings were collected before and after each 10-breath period. Physiological signals (heartrate, respiration rate, skin conductance level, O2 and CO2 concentrations) were collected throughout. Results: Linear mixed effects modeling demonstrated heightened fear in AN in response to dyspnea (F(1,3846)=12.06,p=0.001) that habituated between visits (F(1,3846)=10.62,p=0.001). Intensity and unpleasantness ratings were similar across groups. AN had lower O2 (F(1,39)=7.82,p=0.008) and higher COconcentrations overall (F(1,39)=9.62,p=0.004) without other physiological differences. Conclusions: Abnormal responding to dyspnea in AN is based on fearful evaluation rather than aberrant stimulus discrimination. Habituation of fear between sessions suggests potential clinical utility of interoceptive exposure. Further exploration of gas concentration differences in AN is warranted.

Altered Resting State Frontostriatal Circuitry Among Individuals With Anorexia Nervosa
Alexandra F Muratore1,2, Karin E Foerde1,2, E. Caitlin Lloyd1,2, Blair Uniacke1,2, Jonathan Posner1,2, Joanna E Steinglass1,2
1Columbia University Irving Medical Center, New York, NY, United States, 2New York State Psychiatric Institute, New York, NY, United States

Purpose: Patients with anorexia nervosa (AN) exhibit differential connectivity between the dorsal striatum and dorsolateral prefrontal cortex (DLPFC) when making decisions about what to eat, compared to healthy controls (HCs). Whether altered connectivity between these regions exists at rest remains unclear. To better characterize the neural architecture of AN, we compared dorsal frontostriatal connectivity at rest between a large sample of individuals with AN and HCs. Methods: Resting state fMRI data were combined across 3 studies including patients with AN (n=77) and HCs (n=77). MRI data were preprocessed and analyzed using the CONN Toolbox. Connectivity values between bilateral dorsal striatum seeds and 3-mm bilateral regions of interest within the DLPFC reported in prior research were compared between groups using independent samples t-tests. Ongoing analyses include harmonization of data using ComBat to control for scanner-specific effects and confirm results. Results: Compared to HCs, patients with AN exhibited decreased connectivity between the right dorsal striatum and right DLPFC (t(1,152)=2.18, p=.03). There were no differences in connectivity between left dorsal striatum and left DLPFC (t(1,152)=.39, p=.70). Conclusions: Results suggest that individuals with AN exhibit altered frontostriatal circuit connectivity at rest, indicating there may be a global, non-task specific disturbance in frontostriatal circuits. The DLPFC may be a useful target for novel mechanism-based interventions.

Altered Interoceptive Awareness Associated With Increased Eating Pathology In A Non-Clinical Sampe
Taylor R. Perry1, Kimberly M. Martinez1, Lisa M. Anderson2, Drew A. Anderson1
1University at Albany, Albany, NY, United States, 2University of Minnesota, Minneapolis, MN, United States

There is critical need to identify maintenance factors of elevated eating disorder (ED) pathology. Altered interoceptive awareness (IA), the ability to accurately detect and respond to internal body signals (e.g., hunger, satiety, pain). are associated with elevated ED psychopathology in EDs. However, there is limited research examining the associations between altered IA subcomponents and ED psychopathology in a non-clinical sample. This study examined whether IA subcomponents accounted for unique variance of ED psychopathology in a non-clinical sample or not. Undergraduate students (N=360) at a large Northeastern university completed self-report questionaries including the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2), and the Eating Pathology Symptoms Inventory (EPSI). Multiple linear regression analyses were run controlling for gender and BMI. Bonferroni correction controlled for multiple comparisons. In our models lower MAIA Not-Distracting, Not-Worrying, and Trusting accounted for unique variance in elevated EPSI Body Dissatisfaction, Binge Eating, Cognitive Restraint, Purging and Restriction (βs -.70- (-1.8)) all ps

The Impact Of Negative Affect On Reward Processing In Women With Binge Eating
Sarah E. Racine1, Stephen D. Benning2, Anna E. Weinberg1, Howard Steiger1,3
1McGill University, Montreal, QC, Canada, 2University of Nevada Las Vegas, Las Vegas, NV, United States, 3Douglas Mental Health University Institute, Montreal, QC, Canada

Introduction: Negative affect is a robust predictor of when someone will binge eat; however, mechanisms of this relationship are not understood. One possibility is that food increases in reward value under negative affect conditions, such that emotion-enhanced approach motivation and pleasure from food promote binge eating. We are testing this hypothesis in a multi-method study of women across the spectrum of binge eating severity. Methods: To date, 92 women without binge eating, with subthreshold binge eating, with bulimia nervosa, or with binge eating disorder have participated. Participants undergo a within-subjects mood manipulation in which stress and relaxed mood states are induced. They complete a picture viewing task and Effort Expenditure for Rewards Task under both mood conditions while physiological, behavioral, and self-report indices of food reward are obtained. Results: Preliminary results indicate that binge eating frequency and severity are associated with greater arousal and craving ratings and greater effort expenditure for high-calorie foods. Contrary to hypotheses, interactions between mood condition and binge eating frequency/severity are largely non-significant and, when present, reward processing of food appears to be reduced when stressed versus relaxed in women with more binge eating. Discussion: Data collection is ongoing, but initial results suggest that mechanisms other than reward processing may underlie the association between negative affect and binge eating.

Leaky Gut?: Morphological Gut Alterations In The Activity-Based Anorexia Model After Chronic Starvation
Stefanie Trinh1, Cordian Beyer1, Beate Herpertz-Dahlmann2, Jochen Seitz2
1RWTH University, Institute of Neuroanatomy, Aachen, Germany, 2RWTH University, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Aachen, Germany

Introduction: Gut barrier dysfunctions due to chronic food restriction may contribute to low-grade inflammation and an increased risk of autoimmune diseases in patients with anorexia nervosa. Using the translational activity-based anorexia model, morphological alterations of the intestinal tract that possibly contribute to a leaky gut were analyzed. Methods: Adolescent female rats were divided into 4 groups: limited food with running-wheel, limited food, controls with and without running-wheel. Food intake was reduced until a body weight reduction of 25% was reached and stabilized for two weeks to imitate chronic starvation.
Tissue slices of the intestinal tract were morphologically analyzed. The expression of tight-junction proteins, permeability and inflammatory markers were measured. Results: The thickness of the gut wall, height of the villi and depth of the crypts were decreased in food-deprived rats. The protein expression of the tight-junction protein occludin was decreased in food-restricted rats, while the levels of the gut permeability marker zonulin and the inflammatory marker NLRC4 were increased compared to controls. Conclusions: These alterations in the intestinal tract after chronic food restriction could contribute to increased gut permeability. A so-called leaky gut could facilitate microbial components or metabolites passing through the gut wall, thus entering blood circulation and potentially influencing immunologic processes and inflammation.

Midbrain Dopamine Function In Adolescents With Anorexia Nervosa: Neuromelanin-Sensitive Mri
Blair Uniacke1,2, Karin Foerde1,2, Kenneth Wengler1,2, Susie Hong1,2, Guillermo Horga1,2, Jonathan Posner1,2, Joanna Steinglass1,2
1Columbia University, New York, NY, United States, 2New York State Psychiatric Institute, New York, NY, United States

Purpose: Prior research suggests dopamine (DA) dysfunction in Anorexia Nervosa (AN), yet the nature and direction of this disturbance has not been clarified. Neuromelanin-sensitive magnetic resonance imaging (NM-MRI) is a high-resolution neuroimaging technique that provides a noninvasive proxy measure of DA function. This ongoing study examines DA in the substantia nigra (SN) and ventral tegmental area (VTA) in adolescents with AN as compared with healthy teens (HC).
Methods: NM-MRI data were collected in 14 adolescents with AN and 10 HC (ages 14-18 years); data collection is ongoing. Extracted NM signal (contrast-to-noise ratio) was averaged across the SN pars compacta (SNpc; SN region with greatest concentration of DA neurons) and the VTA. Independent samples t-tests were used to compare between-group differences and Hedge’s g to measure effect size. Results: Relative to HCs, participants with AN had lower NM signal within the SNpc (t1,22 = 2.07, p = 0.05; g = 0.86). Preliminary analyses also suggest lower NM signal in the VTA (t1,12.5 = 2.0, p = 0.067; g = 0.91), though this result does not reach significance in this small sample. Conclusions: Our preliminary results suggest reduced midbrain DA function in AN relative to HC. NM-MRI may provide a noninvasive approach to measuring dopamine function which can be used safely and routinely in pediatric and non-pediatric populations with AN.

Mathematical Modeling To Advance The Understanding And Treatment Of Eating Disorders
Shirley B Wang1, Rowan A Hunt2, Jennifer J Thomas3, 4, Kamryn T. Eddy3, 4, Matthew K Nock1
1Department of Psychology, Harvard University, Cambridge, MA, United States, 2Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States, 3Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States, 4Department of Psychiatry, Harvard Medical School, Boston, MA, United States

Many influential theories have informed our understanding and treatment of eating disorders (EDs). However, all ED theories to date have been instantiated verbally, which lacks details required for precise explanation due to the inherent imprecision of language. For instance, a verbal theory could posit that strict dieting causes binge eating. While likely correct, this verbal theory precludes precise deduction of theory-implied behavior (exactly when, how, and for whom we should expect dieting to lead to binge eating). Formalizing the theory mathematically (dB/dt=k(aD-B), where dB/dt=rate of change in binge eating, k=rate at which binge eating can change, a=effect of dieting on change in binge eating over time) and computationally (def f(t,y_vec,k,a): return k*(a*y_vec[0]-y_vec[1]); solve_ivp(f, [0, t], y_vec, args=(k,a)) allows us to simulate artificial data, which can be compared to empirical data to iteratively evaluate and refine theories over time. This presentation will first outline the differences between verbal and formal theories, and describe the process of formalizing theories mathematically and computationally. We will then present a formal model of the cognitive-behavioral theory of EDs as a system of ordinary differential equations. Finally, we will present simulated data based on this formal mathematical model, including a simulated CBT intervention, and discuss the potential for formal models to aid novel treatment development and testing in future research.

Examining Family Factors That May Exacerbate Or Buffer Associations Between Food Insecurity And Disordered Eating
Caroline E. West1, Vivienne M. Hazzard2, Katie A. Loth3, Nicole Larson4, Laura Hooper4, Dianne Neumark-Sztainer4
1Kent State University, Kent, OH, United States, 2Sanford Center for Biobehavioral Research, Fargo, ND, United States, 3University of Minnesota Medical School, Minneapolis, MN, United States, 4University of Minnesota, Minneapolis, MN, United States

Food insecurity (FI) has been found to be associated with disordered eating among youth, although findings are not consistent across studies. This study examined these associations and assessed whether such associations differ by family factors. Data were from an ethnically/racially and socioeconomically diverse sample of adolescents (Mage=14.5 years) and their parents/guardians (N=2,301 dyads) participating in EAT 2010 (Eating and Activity over Time). Adolescents reported FI, binge eating, and unhealthy weight control behaviors (UWCBs). Regression models were adjusted for demographic characteristics. Food-insecure adolescents were more likely to report binge eating (prevalence ratio [PR]=1.99; 95% confidence interval [CI]: 1.45–2.70) and UWCBs (PR=1.35; 95% CI: 1.22–1.50) than food-secure adolescents. A significant interaction with family meal importance (p=.03) indicated a weaker FI-UWCB association with higher reported family meal importance. Conversely, parental weight concern (p<.01), parental weight teasing (p=.01), and poor family communication (p<.01) significantly moderated the association between FI and UWCBs, such that the association was stronger in the absence of these known risk factors for UWCBs. No significant interactions were observed for binge eating. Findings suggest family meal importance may buffer the association between FI and UWCBs, while the association between FI and UWCBs may be less salient among youth experiencing known risk factors for UWCBs.

Thyroid-Related Biomarkers In Anorexia Nervosa: A Meta-Analysis
Ya-Ke Wu1,2, Hunna J Watson2,3,4, Sabrina L Hardin5, Hanh Le2, Kiara L Luna-Reyes6, Jessica H Baker2
1The University of North Carolina at Chapel Hill School of Nursing , Chapel Hill, NC, United States, 2The University of North Carolina at Chapel Hill Department of Psychiatry, Chapel Hill, NC, United States, 3Curtin University, School of Psychology, Curtin Perth, Australia, 4The University of Western Australia, School of Paediatrics, Division of Medicine, Crawley, Australia, 5Beth Israel Lahey Health, Integration Management Office, Boston, MA, United States, 6North Carolina Central University Psychology Department, Durham, NC, United States

Anorexia nervosa (AN) and hypothyroidism have clinical similarities. This study aimed to identify statistically significant and clinically meaningful thyroid-related biomarkers associated with AN using a meta-analytic approach. Following guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA, this meta-analysis focused on case-control comparisons of peripheral biomarkers for thyroid function. PubMed and PsycINFO were searched to identify studies published in English from inception until December 31, 2018. Inclusion criteria include quantitative studies in adults (age ≥ 18) with acute AN and non-AN controls. Exclusion criteria consisted of qualitative studies, literature reviews, expert opinions, and case reports. A quality appraisal of the selected studies was conducted. RevMan was used to analyzing the data. Twenty-four studies met the eligibility criteria with a total of 503 AN cases (mean age=24.5; mean BMI=15.6). A total of 6 biomarkers were compared between cases and controls: free triiodothyronine (FT3), free thyroxine (FT4), intact parathyroid hormone, parathyroid hormone, thyroid stimulating hormone, and thyrotropin. Meta-analyses showed that the levels of FT3 and FT4 were significantly lower in cases of AN compared with non-AN controls. Our findings suggest that abnormalities in thyroid hormones may be involved in AN pathophysiology. The low FT3 and FT4 should be potential treatment targets for patients with AN in future studies.

Body Uneasiness And Pathological Eating Behaviors In Persons With Gender Incongruence: A Two Years Follow Up Study 
Giovanni Castellini1, Emanuele Cassioli1, Eleonora Rossi1, Alessandra Fisher2, Jiska Ristori2, Valdo Ricca1
1Department of Health Sciences. University of Florence, Florence, Italy, 2Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy

Purpose: Persons with Gender Incongruence (GI) have been reported to often show eating disorders (EDs) psychopathology and body uneasiness. The aim of the present study was to assess whether hormonal treatment (HT) would be effective in reducing general and EDs psychopathology. Methods: A series of 72 persons with IG were studied in a 2-year follow-up, before and after HT.  A physical examination was performed, including body mass index, hair distribution, breast development and genital volumes. Several psychometric measures were used for the assessment of body uneasiness, general psychopathology, EDs specific psychopathology, and internalized transphobia, at four different follow-up points across 2 years. Results: CHT-induced body modifications were associated with a better psychological adjustment, and in both genders HT was found to reduce significantly body uneasiness, as well as pathological eating behaviors (e.g. severe diet attempts), and depressive symptoms. Internalized transphobia represented a moderator of outcome on EDs psychopathology, as those subjects reporting greater levels of this dimension did not show a significant reduction of pathological eating behaviors and body uneasiness across time. Conclusions: The results support the efficacy of CHT intervention in improving subjective perception of one’s own body. However, psychological interventions should be also focused on internalized transphobia which was responsible for persistence of EDs psychopathology. 

Social And Self-Evaluative Factors Influence The Relationship Between Eating Disorder Symptoms And Depressive Symptoms During Pregnancy
Caroline Christian, Cheri A. Levinson
University of Louisville, Louisville, KY, United States

One in eight pregnant women develop postpartum depression.  However less is known about how eating disorder (ED) symptoms impact depression during this transition period. Further, it is unknown how social risk (social appearance anxiety [SAA]) and protective factors (social support) and self-evaluative risk (maladaptive perfectionistic concerns [MPC]) and protective factors (self-compassion) influence this relationship. Methods. The current study (N = 343 pregnant women) tests the unique and moderating relations across ED symptoms, SAA, social support, MPC, and self-compassion on depression. Results. ED symptoms (ß=.21-47; p >.005), SAA (ß=.50; p<.001), social support (ß=-.33; p<.001), MPC (ß=.40; p<.001), and self-compassion (ß=-.53; p<.001) were uniquely related to depression. There were significant interactions between social support and ED symptoms (ß=.12; p=.009) and MPC and ED symptoms (ß=-.12; p=.004) on depression, such that when social support was low and when MPC was high, the association between ED symptoms and depression was stronger. Conclusion. These results suggest ED symptoms may heighten risk for postpartum depression.  Further, this association may be magnified by MPC and alleviated by social support. Thus, increasing social support and challenging maladaptive perfectionism may disrupt the relations between ED symptoms and postpartum depression. Future research should replicate these findings prospectively across the prenatal and postpartum period.

Body Dissatisfaction Mediates The Relationship Between Problematic Pornography Use And Disordered Eating Behavior In Men And Women.
Repairer Etuk1, Jessica Habashy 1, Kimberly Stevens1, Kristen M Culbert2, Shane W Kraus1
1University of Nevada, Las Vegas , Las Vegas, NV, United States, 2Wayne State University, Detroit, MI, United States

Preliminary research suggests problematic pornography use (PPU) is associated with increased risk for body dissatisfaction, and body dissatisfaction is a risk factor for disordered eating. Body dissatisfaction may help explain the relationship between PPU and disordered eating. The current study aimed to: (1) examine the direct effects of PPU and body dissatisfaction on disordered eating in a sample of university students (N=1499), and (2) determine whether body dissatisfaction may help explain the association between PPU and eating concerns. The Eating Disorder Examination Questionnaire 6.0 assessed body dissatisfaction (combined weight/shape concerns subscale) and disordered eating (eating concerns, restraint subscale), and the Brief Pornography Screen measured PPU. Multivariate regression analyses indicated that after adjusting for body dissatisfaction, PPU significantly predicted eating concerns (b=.03, t=4.44, p<.01) and trended toward significantly predicting restriction, b=.02, t=1.81, p=.07. Body dissatisfaction mediated the relationship between PPU and eating concerns (indirect effect b=.03, 95% CIs [.01, .04]) and restriction (indirect effect b=.04, 95% CIs [.01, .06]). Exploratory analyses revealed a significant effect in both men (R2=.43-.46) and women (R2=.46-.52). Taken together, body dissatisfaction may help explain the relationship between PPU and disordered eating.  

A Cognitive Behavioural Model Of Type 1 Diabetes Mellitus And Disordered Eating (T1De) Derived From Lived Experience
Amy Harrison1, Natalie Zaremba2, Jennie Brown3, Jacqueline Allan4, Emmanouela Konstantara5, David Hopkins6, Janet Treasure7, Khalida Ismail8, Marietta Stadler9
1University College London and King's College London, London, United Kingdom, 2King's College London, London, United Kingdom, 3King's College Hospital, London, United Kingdom, 4King's College London, London, United Kingdom, 5King's College London, London, United Kingdom, 6King's College Hospital, London, United Kingdom, 7King's College London, London, United Kingdom, 8King's College London, London, United Kingdom, 9King's College London, London, United Kingdom

Introduction This qualitative study aimed to improve existing theoretical models of type 1 diabetes (T1DM) and disordered eating (T1DE) by being the first cognitive behavioural model of T1DE to utilise lived experiences and report on resilience factors/recovery strategies.   Methods Semi-structured interviews were held with 23 females (n=9 with T1DE, n=5 in recovery from T1DE, and n=9 with T1DM). Data were analysed using grounded theory and individual cognitive behavioural formulations were developed for all participants.   Results The first CBT model explains how early adverse life events, past psychiatric history, perfectionism, difficult experiences around T1DM diagnosis and its relentless daily management sensitise individuals to eating, weight and shape cues. Alongside physical symptoms and unhelpful interpersonal reactions, vicious cycles of thoughts, feelings and behaviours develop. Fear of insulin/weight gain and hypoglycaemia are key T1DE variants. The second CBT model summarises strategies/knowledge acquired by those recovered from T1DE and those with T1DM without disordered eating. Good enough psychological adaptation to T1DM, integrating T1DM into one’s identity, self-care/compassion around eating, weight and shape were key protective/post-traumatic resilience factors.   Conclusions These new models depicting cycles of illness and resilience/recovery will inform the first cognitive behavioural therapy intervention for T1DE.

Self-Compassion Moderates The Relationship Between Post-Traumatic Stress Disorder And Eating Disorder Severity In Black Women
Ani C. Keshishian, Kayla Williams, Cheri A. Levinson
University of Louisville, Louisville, KY, United States

Greater symptoms of post-traumatic stress disorder (PTSD) is linked to higher eating disorder (ED) pathology. Self-compassion is associated with lower levels of ED severity. There is a lack of literature exploring the relationship between self-compassion, PTSD, and ED severity. Further, this relationship has not been studied in Black women, who are often underrepresented in ED research. Therefore, the current study aimed to explore whether self-compassion moderates the relationship between PTSD and ED severity in a sample of Black women. Methods: Sixty-four Black undergraduate females (age: M = 20.17; SD = 3.54) completed a questionnaire battery which included the PTSD Checklist Civilian Version, Self-compassion Scale, and Eating Disorder Examination Questionnaire. A cross-sectional linear regression was conducted to determine whether self-compassion moderates the relationship between PTSD and ED severity. Results: Self-compassion moderated the relationship between PTSD and ED severity, such that high PTSD severity and high self-compassion was associated with less ED severity compared to those with high PTSD severity but low self-compassion. Conclusions: Our findings suggest that self-compassion may be a buffering factor against comorbid PTSD and ED symptoms. Future research should examine the if interventions focused on self-compassion might decrease both PTSD and ED symptoms.

Sexual And Gender Minorities Present To Outpatient Eating Disorder Treatment At Younger Ages And With More Severe Depressive Symptoms Than Their Cisgender Heterosexual Peers
Matthew F. Murray1, Heather A. Davis2, Jennifer E. Wildes2
1Illinois Institute of Technology, Chicago, IL, United States, 2University of Chicago Medicine, Chicago, IL, United States

1. Purpose. Few studies have examined eating disorder (ED) symptomatology among treatment-seeking sexual and gender minority (SGM) patients, none in outpatient samples. Available evidence indicates higher ED severity at intake but similar clinical outcomes in SGM compared to cisgender heterosexual (CH) patients, suggesting a need to examine risk factors or comorbidities contributing to differential initial ED severity. 2. Methods. Retrospective data from 49 (18.6%) SGM and 211 (79.9%) CH ED outpatients were used to examine: (1) differences in ED, depression, and emotion dysregulation symptoms, and clinical impairment; (2) the moderating role of SGM identity on the associations between these variables. Objectives 1 and 2 were tested using Benjamini-Hochberg corrected independent samples t-tests and the PROCESS macro for SPSS, respectively. 3. Results. SGM patients presented at younger ages (MD = -4.52, p = .001) and reported more severe depressive symptoms (MD = 5.75, p = .007) than CH patients. There were main effects between ED and depressive symptoms, and ED symptoms and clinical impairment, but no moderation by SGM status. 4. Conclusions. While no differences in ED symptoms were observed, it is concerning that SGM patients presented with similar ED severity at younger ages than CH patients. Coupled with higher depressive symptom severity, results highlight a need for early assessment and recognition of EDs and comorbid psychopathology in SGM individuals.

A Network Comparison Of Ptsd And Eating Disorder Symptoms Before And During The Covid-19 Pandemic
Jillian D. Nelson, Alison Cuellar, Lawrence Cheskin, Sarah Fischer
George Mason University, Fairfax, VA, United States

Purpose: Posttraumatic Stress Disorder (PTSD) and eating disorders (EDs) commonly co-occur (Ferrell et al. 2020). 
The comorbidity is associated with greater symptom severity and worse clinical outcomes (Molendijk et al., 2017). ED symptoms may serve an emotion regulation function in those with PSTD (Brewerton, 2011). The aim of this study was to examine the stability of a PTSD and ED symptom network  before and during the COVID-19 pandemic.  Methods:  140 undergraduate students at a large Mid-Atlantic university enrolled in a longitudinal cohort study (Cuellar et al., in press)completed the EPSI (Forbush et al., 2013) and PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) in Fall 2019 (Time 1) and Fall 2020 (Time 2). Two partial correlational networks were estimated (Epskamp et al. 2012) and compared (van Borkulo et al., 2017) to detect differences in global network strength, node strength and edge strength between the Time 1 and Time 2 networks.  Results: The networks were stable over time. At Time 1, strong negative emotions and difficulty experiencing positive emotions were the strongest symptoms. At Time 2, physiological reactions and lack of interest were strongest. Conclusions: In undergraduates, the structure of the PTSD and ED symptom network remained stable prior to and during the COVID-19 pandemic. The strength of individual symptoms differed, suggesting that the pandemic may have differentially impacted symptoms of PTSD and EDs.

Eating Behaviors Of Women With Eating Disorders And Autism Spectrum Disorder
Sabrina Schröder1, Unna Danner2, Annelies Spek3, Annemarie van Elburg4
1Altrecht Eating Disorders Rintveld, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands, 2Altrecht Eating Disorders Rintveld, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands, 3Autism Expert Center, Eemnes, Netherlands, 4Altrecht Eating Disorders Rintveld, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands

Purpose. A large body of literature has focused on the role and clinical implications of autism spectrum traits that have been repeatedly found in eating disorder samples. On the one hand, elevated ASD traits have been associated with a more severe presentation of the ED and subsequently with poorer treatment outcome. On the other hand, recent results indicate that women with diagnosed ASD experience significantly more eating problems than controls, such as having eating rituals and sensory sensitivities, while also reporting more disordered eating behaviours. Research into the eating behaviours of women with both diagnosed ASD and an ED however is scarce. This study aims to gain insight into the eating behaviours of women with an ED and comorbid ASD by comparing their behaviours to women with an ED but without ASD and to women with ASD but without an ED). In addition to that, we are investigating whether their attitudes and behaviors towards food are associated with other (co-morbid) problems.
Methods. Cross-sectional design with 90 participants: 30 with ED and ASD, 30 with ED and 30 with ASD. Administering questionnaires about picky eating, ARFID, eating disorder related behaviors, eating behaviors related to ASD, other psychiatric problems and quality of life. Results and conclusions. Data collection is ongoing and results will be presented at the next EDRS.

Does Pubertal Development Moderate Associations Between Parenting And Binge Eating In Girls?
Carolina Anaya, S. Alexandra Burt, Kelly L. Klump
Michigan State University, East Lansing, MI, United States

Puberty is a period of increased risk for binge eating in girls. Previous studies have examined changes in genetic risk and other factors that could contribute to post-pubertal increases, but none have examined parent-child relationship variables (e.g., conflict) that change across development and contribute to youth outcomes. This study examined whether interactions between pubertal development and the quality of the parent-child relationship predict higher levels of binge eating during/after puberty in girls. Methods: Participants included cross-sectional sample of girls (N = 1,000; ages 8-16, M = 11.75, SD = 2.03) and their parents from the Michigan State University Twin Registry. Binge eating was measured using the Minnesota Eating Behaviors Survey, the Eating in the Absence of Hunger Scale, and the Emotional Eating Scale. Pubertal development was measured with the Pubertal Development Scale. Parent-child conflict was measured with the Parental Environment Questionnaire (PEQ), while parental care and overprotection was assessed using the Parental Bonding Instrument. Results: Although higher levels of parental overprotection and conflict, and lower levels of parental care, significantly predicted all binge eating measures, none of the associations were significantly moderated by pubertal development or age. Conclusions: The quality of the parent-child relationship is significantly associated with binge eating in girls regardless of youth developmental stage.

The Role Of Family Context And Emotion Regulation To Explain Food Refusal In Children
Lien Goossens1, Juliette Taquet1, Ellen Moens2, Sandra Verbeken1
1Ghent University, Gent, Belgium, 2Odisee University College, Gent, Belgium

Purpose: Food neophobia and picky eating constitute important barriers against the development of a healthy and varied eating pattern in children and may be related to adverse physical and psychosocial consequences. Guided by the Tripartite model of Sheffield-Morris et al. (2007), the present study aims to examine the mechanisms underlying food neophobia and picky eating from an emotion regulation framework. Methods: Parents (N = 170) of children aged 3 to 8 years (M = 5.45, SD = 1.69; 51.8% boys) reported on their child’s food neophobia, picky eating, and emotional undereating. Parents also self-reported on their own food refusal behavior, feeding practices (pressure to eat) and emotional acceptance of the child. Results: Mediation analyses showed that emotional undereating mediated the association between parental emotional acceptance of the child and both food neophobia and picky eating. Modelling and pressure to eat by parents were directly related to food refusal behaviors, but this association did not seem to operate via emotional undereating. Conclusion: Evidence was found for the role of the quality of the parent-child relationship and emotional undereating in explaining children’s food refusal behavior. Longitudinal research is needed to replicate these results and further investigate the role of other family context variables and emotion regulation strategies in explaining children’s food refusal behaviors.

Subclinical Binge Eating Symptoms During Early Adolescence And Its Preceding Characteristics: A Population-Based Study
Pauline Jansen1,2, Holly Harris1, Ivonne Derks1,2
1Erasmus MC, Rotterdam , Netherlands, 2Erasmus University, Rotterdam, Netherlands

    Purpose In line with DSM-5 diagnostic criteria, studies generally examine binge eating as a combined measure of overeating and loss of control (LOC) eating, although these symptoms can also present independently. The current study examined the prevalence and preceding factors of subclinical binge eating symptoms in early adolescence, when these symptoms start to emerge to become ingrained habits.   Methods Data from the population-based Generation R Study in the Netherlands were used. 3247 adolescents self-reported on binge eating symptoms and compensatory behaviors at 14 years.   Results Of the adolescents, 12.6% reported subclinical binge eating symptoms in the past three months (3.4% overeating, 7.0% LOC eating, 2.2% both, i.e. binge eating). The binge eating group showed most compensatory behaviors (e.g. exercising, skipping meals), followed by the LOC eating group. Emotional and behavioral problems, restrained eating and a higher BMI at age 10 years were associated with more LOC and binge eating at age 14 years, but not with overeating only. Emotional eating predicted later overeating, LOC and binge eating. Conclusions Among Dutch adolescents, binge eating and compensatory behaviors were quite common. Considering the overlapping correlates of LOC and binge eating compared to overeating only, LOC eating seems the most salient component of binge eating. Thus, prevention strategies should focus on LOC eating and its risk factors to hamper the development of binge eating.

Maternal Stress And Children’S Eating Style
Juliette A. H. Taquet1, Ellen Moens1,2, Sandra Verbeken1, Lien Goossens1
1Ghent University, Ghent, Belgium, 2Odisee, University of applied sciences, Ghent, Belgium

Purpose: Individual differences in eating styles are already observed at young ages. As they may place a child at risk for developing serious eating related problems, they may be considered an important source of distress among parents. The aim of this study was to explore association between maternal stress and different eating styles among non-clinical Belgian children. We further investigated whether these associations differ among gender. Methods: Questionnaires measuring the child’s eating style, by using the Child Eating Behavior Questionnaire (CEBQ) and parental stress, by using the Nijmeegse Ouderlijke Stress Index (NOSI) were completed by the mothers of 171 children (88 boys; 3-9 years of age). Results: the overall score of the NOSI was associated with the CEBQ subscales emotional overeating, satiety responsiveness, emotional undereating, food fussiness and food avoidance. When separating the data for boys and girls, the mothers’ stress index was associated with emotional undereating, emotional overeating, and food avoidance scales for both groups. Additionally, for boys we found a negative association with the enjoyment of food scale. Conclusion: Our results imply that maternal stress is associated with a number of problematic eating styles in children among which emotional overeating, emotional undereating and food avoidance appear the most prominent ones. To determine the direction of this association, additional longitudinal research is needed. 

Loss Of Control Over Eating, Substances And Non-Substances In Adolescence: A Transdiagnostic Dual-Pathway Perspective
Eva Van Malderen1, Eva Kemps2, Laurence Claes3,4, Sandra Verbeken1, Lien Goossens1
1Ghent University, Gent, Belgium, 2Flinders University, Adelaide, Australia, 3KU Leuven, Leuven, Belgium, 4University of Antwerp, Antwerpen, Belgium

Purpose: Psychopathology in which individuals experience loss of control (loss of control pathology: LOP) (e.g., binge eating, substance abuse), is prevalent among adolescents. Dual-pathway models propose that LOP is the result of an imbalance between immature regulatory combined with strong reactive processes; yet, interactions between these processes are rarely investigated. Moreover, research on these processes in different types of LOP is expanding but a transdiagnostic focus is lacking. This study examined whether a profile based on dual-pathway processes can be detected, making adolescents transdiagnostically vulnerable for LOP. Methods: A community sample of 341 adolescents (13-17 years) was recruited. Participants self-reported on their regulatory (inhibitory control) and reactive (reward sensitivity) processes. Participants also self-reported on LOP in the context of eating and substances (tobacco, cannabis, alcohol) but also in non-substance related contexts (gaming, social media, gambling, shopping). Results: To determine profiles based on dual-pathway processes, a latent profile analysis will be performed. To examine the associations between the profiles and LOP, univariate analysis of covariance will be used. Conclusions: The results of the current study as well as theoretical and practical implications will be discussed. This study is the first wave of a longitudinal design investigating the evolution of these profiles (wave 2 in 2022; wave 3 in 2023).  

Adult Picky Eating And Sensory Modulation Disorder
Ada H Zohar1,2, Dorin Barhum-Shapira1, Rachel Bachner-Melman1, Lilac Lev-Ari1,2
1Ruppin Academic Center, Emek Hefer, Israel, 2Lior Zfaty Center for Suicide and Mental Pain Research, Emek Hefer, Israel

Picky eating (PE) in adults is a form of disordered eating which may cause considerable distress and dysfunction. The purpose of this study was to explore potential difficulties in sensory over-responsiveness of adults who are selective and limited in their diet. Respondents are community volunteers, who report online on the Adult PE Questionnaire, the Disgust Propensity and Sensitivity Scale, the Food Disgust Scale, Obsessive-Compulsive Inventory, and the Retrospective Child-Feeding Questionnaire. The hypothesis tested is that considerable variance in adult PE will be accounted for by sensory modulation difficulties, retrospective report of pressure to eat as a child, disgust propensity, and obsessive compulsive symptoms, with the interaction of obsessive compulsive symptoms and food disgust adding additional explained variance. We will present preliminary results that suggest that pressure to eat may give rise to food disgust, which then contributes to adult PE and is compounded if obsessive compulsive tendencies are present, showing the long-term paradoxical infulence of pressuring a low-appetitive child to eat. Longitudinal studies are required to test this proposed model.

Racial/Ethnic Inequities In Use Of Deceptive "Wellness" Dietary Supplements During The Covid-19 Pandemic In The United States
S. Bryn Austin1,2,3, Ariel Beccia4, Julia Vitagliano1, Amanda Raffoul1, Vishnudas Sarda1, Jorge Chavarro5, Jaime Hart6
1Adolescent Medicine, Boston Children's Hospital, Boston, MA, United States, 2Dept. of Social and Behavioral Sciences, Boston, MA, United States, 3Dept. of Pediatrics, Boston, MA, United States, 4University of Massachusetts Medical School, Worchester, MA, United States, 5Dept. of Nutrition, Boston, MA, United States, 6Dept. of Epidemiology, Boston, MA, United States

Purpose: To examine racial/ethnic inequities in exposure to dangerous and deceptively marketed "wellness" dietary supplements during the pandemic. Methods: We analyzed 4 waves of data from the COVID-19 Pandemic Cohort (4/2020–1/2021, N=58,150), embedded within 3 prospective US national cohort studies, to examine patterns of weight-loss, "cleanse/detox," and immune supplement use during the pandemic in adults ages 23-75 years. Using multivariable GEE models that compared across race/ethnicity groups (African-American n=646, Asian n=753, Latina/o n=315, White n=50,944) and controlled for age and gender, we estimated OR and 95% CI and examined race/ethnicity-by-wave interactions to assess possible group differences over time. Results: Overall and across groups and waves, ranges in current use of supplements were 1.6%-7.0% for weight loss, 2.9%-9.8% for "cleanse/detox," and 18.1%-32.7% for immunity. Comparing to Whites, race/ethnicity group inequities were found in supplements sold for weight-loss (African-American: OR 2.8, 95% CI 2.0-4.0; Latina/o: 2.4, 1.3-4.4), "cleanse/detox" (African-American: OR 3.1, 95% CI 2.2-4.3; Asian-American: 1.9, 1.3-2.7; Latina/o: 2.3, 1.3-4.1) and immunity (African-American: 1.8, 1.4-2.1; Asian-American: 1.2, 1.0-1.5; Latina/o: 1.8, 1.4-2.5). Race/ethnicity-by-wave interactions were mostly nonsignificant. Conclusions: Findings add to the evidence of disproportionate health burdens on communities of color during the COVID-19 pandemic. 

"There Is A Paywall To My Happiness"—Unpacking The Role Of Socioeconomic Position In Transgender And Gender Diverse Young Adults’ Experiences With Eating Disorders
Jerel P. Calzo1,2, Scout Silverstein3, Ethan Lopez3, Jack Andrzejewski4, Samantha Kretschmer2, Allegra R. Gordon5
1San Diego State University School of Public Health, San Diego, CA, United States, 2Institute for Behavioral and Community Health, San Diego, CA, United States, 3Fighting Eating Disorders in Underrepresented Populations (FEDUP), New York, NY, United States, 4San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health, San Diego, CA, United States, 5School of Public Health, Boston University, Boston, MA, United States

Introduction: Transgender and gender diverse (TGD) individuals experience elevated risk for eating disorders (ED), possibly due to societal stigma towards transgender people and barriers to healthcare access. Less is understood about how socioeconomic position (SEP) contributes to ED risk in TGD populations. Method: Online focus groups with 66 TGD young adults recruited for an ED prevention study explored how SEP affects participants feelings about their bodies and how others perceive them. Participants were: 18-30 years old; 25% transgender women, 41% transgender men, 28% nonbinary, 6% another gender; 62% White, 13% Latinx, 13% Multiracial, 6% Asian, 6% Black; highest level of education: 12.7% did not graduate high school, 49.3% had attended some college but not graduated, 38% had at least a college degree; housing security: 12.7% experienced unstable housing in past 6 months. Results: Approximately 38% of participants—predominantly nonbinary individuals or transwomen of color—discussed SEP in ways implicated in ED risk (e.g., body image) and treatment (e.g., healthcare access). One participant shared: "It’s especially tough being a broke trans woman. Makeup, fashion, medication, legal stuff - it all adds up really fast…I’ve chosen between clothes, medical expenses (i.e., hormones & therapy), and food too many times." Conclusions: Economic injustice and intersectional oppression must be considered to address ED risk and treatment among TGD populations.

Eating Disorders And Deliberate Self-Harm In Adolescents - A Co-Occurring Problem? 
Camilla L. Dahlgren1, 2, B. Timothy Walsh3, Anne Louise Wennersberg2, Line Wisting2
1Department of Psychology, Bjørknes University College, Oslo, Norway, 2Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway, 3Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York State Psychiatric Institute, New York , NY, United States

Background. Self-harm behaviors are particularly prevalent among adolescents and in clinical samples, including EDs. The aim of this study was to assess the prevalence of co-occurring ED psychopathology and intentional self-harm in adolescents. Methods: 887 high school students (421 females and 466 males), 16-21 years, responded to an online mental health survey. A subset of students (N=56) participated in a diagnostic ED interview. The EDE-QS and the EDA-5 were used to assess ED psychopathology. The Deliberate Self-Harm Inventory was used to measure intentional self-harm. Results. 21% of the total sample scored at or above EDE-QS clinical cut-off. Females scored significantly higher than males. 42% of participants with a clinical EDE-QS scores reported having hurt themselves at some point in their life, and 71% of those with a clinical ED diagnosis reported engaging in self-harm behavior. Twenty percent reported that the use of social media (i.e. Instagram, SnapChat, TikTok) had led to increased self-harm behaviors. Self-harm was reported being used to cope with overwhelming emotions, and to control one’s body, emotions and thoughts. Conclusions. Co-occurring ED psychopathology and intentional self-harm is common in adolescents. ED professionals should be aware of these co-morbid conditions, and therapeutic work should focus on developing healthy coping skills and emotion regulation strategies.

Who Gets Treated For An Eating Disorder? Implications For Inference Based On Clinical Populations
Alison E Field1, Hannah N Ziobrowski2, Kamryn T. Eddy3, Kendrin R Sonneville4, Tracy K Richmond5
1Brown University, 2Harvard Medical School, 3Massachusetts General Hospital, 4University of Michigan, 5Boston Children's Hospital

Introduction: The minority of people with an eating disorder receive treatment. Little is known about predictors of receiving treatment.
Methods: We used 17 years of data from the Growing Up Today Study to identify predictors of receiving treatment for an eating disorder. The analysis was restricted to the 1237 female participants who engaged in binge eating and/or purging in at least one year between 1996 and 2013 and who answered the questions on treatment history. Generalized estimating equations were used to estimate odds ratios (OR). Results: Women who engaged in binge eating and purging at least weekly (bulimia nervosa, BN) were the most likely to have received treatment (42.7%) followed by women who purged at least weekly (purging disorder, PD: 20.7%). Only 11% of women who engaged in binge eating, but not purging (binge eating disorder, BED), and those who engaged in infrequent bulimic behaviors received treatment.  Independent of type of eating disorder, those who had received a diagnosis of depression were three times more likely (OR=3.20, 95% confidence interval (CI) 2.08-4.93) to receive eating disorder treatment. In contrast, women with obesity were 86% less likely to receive treatment (OR= 0.14, 95% CI 0.04-0.49). Conclusion: Many women meeting criteria for an eating disorder do not receive treatment. Women with obesity and a co-morbid ED are the least likely to receive treatment. Research is needed to understand their barriers to treatment.

The Relationship Between Weight Stigma During Adolescence And Intuitive Eating In Emerging Adulthood
Kelsey Gilbert1, Melissa Simone2, Vivienne Hazzard3, Laura Hooper4, Marla Eisenberg4, Dianne Neumark-Sztainer4
1University of Hartford, West Hartford, CT, United States, 2University of Minnesota Medical School, Minneapolis, MN, United States, 3Sanford Center for Biobehavioral Research, Fargo, ND, United States, 4University of Minnesota, Minneapolis, MN, United States

Purpose. Weight stigma has been linked with weight and shape concerns and may lead to overreliance on cognitive processes to regulate eating. As such, exposure to weight stigma may ultimately reduce subsequent intuitive eating (i.e., reliance on physiologic hunger and satiety cues). This study examined the longitudinal association between weight stigma in adolescence and intuitive eating in emerging adulthood. Methods. Data were collected from 1568 participants in EAT 2010-2018 (Eating and Activity over Time). Regression analyses, stratified by gender, tested the association between peer and family weight teasing exposure during adolescence (age=14.3±2.0 years) and subsequent intuitive eating (age=22.2±2.0 years). Covariates included prior intuitive eating, race/ethnicity, SES, and BMI. Results. In adolescence, 26.2% reported weight teasing from peers and 24.3% from family. Preliminary results indicated that exposure to peer weight teasing during adolescence predicted lower intuitive eating scores eight years later among males but not females. Family weight teasing was not significantly associated with intuitive eating for males or females. Additional analyses will be conducted. Conclusions. Findings suggest experiencing weight stigma in adolescence may have a lasting impact on intuitive eating for males, which should be considered in prevention and treatment.

An Investigation Of Binge Eating Prevalence And Correlates Among Older Adult Women
Lisa S Kilpela1, Victoria Marshall1, Robina Sandhu1, Savannah Hooper1, Pamela K Keel2
1UT Health San Antonio, San Antonio, TX, United States, 2Florida State University, Tallahassee, FL, United States

Introduction: Historically viewed as problems of youth, eating disorders are understudied in older women. Yet, disordered eating, especially binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older women. Aging-related factors (e.g., menopause symptoms, sleep disruptions, mood changes) represent potential risks for and consequences of BE unique in older women. 
  Method: Women (N = 227) aged 60-94 completed online self-report measures of BE severity and frequency, indices of psychological, physical, and social health, and retrospectively reported menopause symptom severity. Descriptive, correlational, and multivariable analyses were used to examine BE prevalence, health correlates, and the unique association between BE and health correlates controlling for key covariates.   Results: On the Binge Eating Scale, 18.1% of women reported ³ weekly BE; 10.1% met criteria for moderate-to-severe BE. BE severity was significantly correlated with poorer psychological, physical, and social health (p’s<.05). Retrospective menopause symptom severity predicted current BE severity (b=.22, p=.004). Associations remained significant in multivariable models.    Conclusion: BE is related to negative outcomes among older women, supporting the need for more research in this population. Menopausal symptoms may represent a biomarker of risk, in line with research implicating ovarian hormone function in the etiology of BE. Dr. Keel will serve as the sponsor.

Psychiatric Outcomes In Adolescents Diagnosed With Weight Loss And Underweight: A Community Based Study
Sim Leslie, Witte Micaela, LeMahieu Allison, Harbeck-Weber Cynthia, Geske Jennifer, Lebow Jocelyn
Mayo Clinic, Rochester, MN, United States

We sought to characterize a community-based cohort of adolescents diagnosed with weight loss and/or low BMI and determine their association with psychiatric outcomes over a 5-year period. Using the Rochester Epidemiological Project database, we identified adolescents diagnosed weight loss and/or low BMI from 2005 to 2017. Patients were excluded who presented with conditions commonly associated with weight loss. Primary outcomes were eating disorders (ED) and psychiatric diagnoses within 5 years of index visit. Of the 662 adolescents (M age = 15.8; 66% female; 76% Caucasian) who met study criteria, 107(17%) patients received an ED and 379 (60.6%) received a psychiatric diagnosis within 5 years. Median time to psychiatric diagnosis was 950 days, 95%CI = (667, 1288). Adjusting for sex and BMI, chief complaint of gastrointestinal (GI) symptoms (HR=1.9; p <.05) and diagnosis of GI symptoms (HR=1.8; p<.05) increased risk for later ED diagnoses. Age, race, and highest historical BMI% at index visit were associated with an increased risk for later psychiatric diagnoses. Adjusted models found prior psychiatric diagnosis was associated with a reduced risk for psychiatric disorders(HR=0.6; p <.001). The findings suggest weight loss and low BMI represent robust signs of later eating disorders and psychiatric disorders. The development of evidence-based guidelines to address these red flags may prompt timely intervention to prevent such adverse consequences.

Disordered Eating In Women With Induced Menopause – A Controlled Study
Barbara Mangweth-Matzek1, Sophia Vedova1, Vanessa Dunst1, Martin Daniaux2, Claudia Ines Rupp3
1Medical University Innsbruck, Psychiatry II, Innsbruck, Austria, 2Medical University Innsbruck, Radio-Diagnostic Center, Radiology, Innsbruck, Austria, 3Medical University Innsbruck, Psychiatry I, Innsbruck, Austria

Object: To assess eating behavior and body image in women with induced menopause (MP) as compared to women with pre- and postmenopause. Method: 658 women aged 40 - 60 years were included in the analyses based on an anonymous questionnaire that assessed demography, menopausal status (MRS), weight history, physical and psychological health, eating behavior including eating disorder symptoms (DSM 5) and body image. The three women groups (induced- (N=135), premenopause (N= 296) and postmenopause (N=135) were compared first, and then pairwise on the various variables. Results: Women with induced MP (mostly surgical induced) were in between pre- and postmenopausal women agewise, were significantly heavier as to their current BMI and reported significantly more somatic and psychological disorders (MP-diagnosis and eating disorders not included). They had twice the prevalence rate of disordered eating (N=9, 14%) including BMI <18.5, binges and purges, binge eating and purging only as compared to the other groups (p =.013). Body image  did not distinguish the three groups after adjusting for current BMI.
Discussion: Induced menopause is an abrupt and invasive intervention that is described to be associated with symptoms that are more severe than those in a natural menopausal transition. To our knowledge there are no data on eating behavior and little on psychological symptoms in women with induced menopause. Our data show strikingly higher rates of disordered eating in this group compared to women in pre or postmenopause. Further studies are needed to assess chronology and causality of this association. 

Pre-Pandemic Trends In The Prevalence And Incidence Of Eating Disorders In Specialty Care In Norway (2008-2019)   
Deborah L Reas1, Gunnar Rø2, Øyvind Rø1
1Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway, 2Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway

Purpose: Epidemiological data are useful in the surveillance of trends over time, and register-based data offer critical insight into help-seeking behaviour, detection and diagnostic practices. Methods: Cases admitted to specialty care between 2008-2019 registered in the Norwegian National Patient Register and data from the Statistics Bureau were used to calculate 12-month prevalence and incidence by age, diagnostic group, and gender.  Results: Overall, the 12-month prevalence increased in women by 3.1% and by 6.3% for men (ages 10-59). Incidence was stable for women with an annual increase of 0.1% but increased by 4.0% for men. For women, bulimia nervosa showed near-universal declines, whereas AN and unspecified ED remained stable overall. One exception were younger women (ages 10-20), who saw significant increases in AN and unspecified ED.  Conclusions:  An overall stable incidence and increased prevalence suggests that, as a whole, individuals are remaining in specialized treatment over a longer period of time. However, when adjusting for demographics and diagnostic group, it was notable that younger females showed an increase in AN and unspecified ED. The prevalence and incidence of ED among males remained low compared to females, yet rates increased at a far greater pace. This study confirms prior findings and contributes a valuable foundation for studying the subsequent impact of COVID-19 on rates of ED, and data have important implications for public health and healthcare provision.

Association Between Food Insecurity And Dysfunctional Eating Behaviors Among Puerto Rican Adults
Wanqing Xu1, Andrea López-Cepero2, H. June O'Neill2, Anna Plym1, S. Bryn Austin3,4, Josiemer Mattei2
1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States, 2Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States, 3Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States, 4Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States

Introduction: Food insecurity (FI) is highly prevalent in Puerto Rico. Emotional eating (EE) and uncontrolled eating (UE) are dysfunctional eating behaviors influenced by stress and have been associated with FI in US Latinos. It remains unclear if FI is associated with EE and UE in Puerto Rico. Methods: Data were obtained from adults attending the baseline visit in the PROSPECT cohort (n=865, aged 30-75 years). FI was measured with the USDA Adult Food Security Survey Module. EE and UE were assessed with the Three-Factor Eating Questionnaire R18-Version 2 and scores were categorized as no, moderate, or high EE or UE. Cross-sectional multinomial adjusted logistic models examined the associations between food insecurity and EE and UE. Another model included perceived stress as covariate. Results: The prevalence of FI was 20.3%. Adults with FI had higher odds of both moderate EE (OR: 1.92; 95% CI: 1.19-3.09) and high EE (OR: 2.85; 95% CI: 1.75-4.64), and both moderate UE (OR: 1.78; 95% CI: 0.90-3.49) and high UE (OR: 3.28; 95% CI: 1.70-6.33), in reference to no EE or UE, compared to food-secure adults. The associations were attenuated when perceived stress was added to the models. Conclusions: FI was associated with higher likelihood of having EE and UE among adults in Puerto Rico. Perceived stress may mediate this association. Longitudinal studies are warranted to clarify this and other potential pathways. Alleviating FI may help adults prevent dysfunctional eating behaviors.

Differential Genetic Associations Between Specific Eating Disorder Symptoms And Alcohol Involvement In Female Adolescent Twins
Baiyu Qi1, Laura M Thornton2, Courtney E Breiner3, Ralf Kuja-Halkola4, Jessica H Baker2, Paul Lichtenstein4, Sebastian Lundstrӧm5, Arpana Agrawal6, Cynthia M Bulik2,4,7, Melissa A Munn-Chernoff2
1Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 2Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 3Department of Psychology, University at Albany, State University of New York, Albany, NY, United States, 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 5Gillberg Neuropsychiatry Centre, University of Gothenburg, Gӧteborg, Sweden, 6Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States, 7Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

In women, a significant genetic correlation (rg) exists between bulimia nervosa symptoms and problem alcohol use, yet limited studies have included female adolescents or investigated other eating disorder (ED) symptoms. We examined genetic and environmental correlations between three ED dimensions and two indices of alcohol involvement in adolescent girls using bivariate twin models. Participants were 3,939 18-year old female twins from the Child and Adolescent Twin Study in Sweden. The Eating Disorder Inventory-2 assessed drive for thinness, bulimia, and body dissatisfaction. Alcohol involvement was assessed with the Alcohol Use Disorder Identification Test consumption (AUDIT-C) and problems (AUDIT-P) indices. Although the phenotypic correlation was modest at best (.14-.26) and genetic factors account for more than 50% of the variance of each trait, the strongest rg of .46 (95% CI: .37, .55) was between bulimia and AUDIT-P. This indicated that 86% of the genetic variance between bulimia and AUDIT-P overlapped. The rgs were higher between ED dimensions and AUDIT-P than for ED dimensions and AUDIT-C. Unique environmental correlations between ED dimensions and alcohol involvement were minimal. Findings in adolescent girls corroborate those in women, with the strongest genetic association occurring between bulimia and problem alcohol use. Early identification of this comorbid presentation is critical to prevent the negative sequela associated with EDs and alcohol use disorder.

Obesity After Kidney Transplantation (Ktx)
Martina de Zwaan1, Mariel Nöhre1, Lars Pape2, Mario Schiffer3
1Hannover Medical School, Hannover, Germany, 2University Hospital Erlangen, Erlangen, Germany, 3University Hospital Essen, Essen, Germany

Objective: We aimed to evaluate the course of weight after KTx and to assess the prevalence of post-transplant obesity in a large sample of German KTx patients Methods: In a structured post-transplant care program 433 KTx patients were evaluated. Information on the pre-transplant body weight was taken from the electronic patient charts. At post-transplant assessment body weight was measured in the transplant center. Results: Mean age was 51.3 years, 59% were male. Regarding somatic conditions 6.0% were suffering from type 2 diabetes mellitus (DM), 6.9% were affected by new-onset diabetes after transplantation (NODAT), and the mean estimated glomerular filtration rate (eGFR) was 47.7 ml/min/1.73m2. The prevalence rates of obesity before and after kidney transplantation were 14.8 and 19.9%, respectively. This represents an increase of 34%. Obesity after transplantation was associated with higher rates of type 2 DM and of NODAT. Additionally, there was an association between increasing pre-transplant as well as post-transplant BMI and decreasing eGFR. Higher age and female sex were associated with higher rates of post-transplant obesity. Conclusions: Our results suggest that obesity represents a serious problem in KTx patients, especially regarding the association between increasing BMI and decreasing graft functioning (eGFR). However, this aspect is often overlooked and information on effective treatment options for these patients are scarce making further research on this topic necessary.     

Metabolic Outcomes Of Weight Restoration Treatment For Anorexia Nervosa
Youngjung Kim1,2, Tom Hildebrandt1, Laurel E. S. Mayer3
1Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States, 2Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States, 3Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, United States

Objective. Recent advances in genomics highlighted a possible metabolic axis for anorexia nervosa (AN). This study was aimed at assessing the spectrum of metabolic dysfunction in WR-AN. Methods. A single-arm prospective trial was conducted in adult women with AN (N=26). Underweight patients with AN were admitted to the hospital for weight restoration treatment. Upon weight restoration, WR-AN were evaluated with NCEP-ATP III criteria for metabolic syndrome (MetS) and biomarkers associated with impaired metabolic health. Controls were healthy women (HC) matched to WR-AN by age, sex, and endpoint BMI (N=10). Results. None of the participants met full criteria for MetS. However, the WR-AN group had a significantly higher likelihood of meeting at least one MetS criteria compared to HC (RR=2.6, 95%CI=[1.2, 7.5], Fisher’s p=0.017). In addition, WR-AN demonstrated a reduction in metabolism-related biomarkers including free fatty acids (p=0.015, Hedges’ g=1.167), thyroid-stimulating hormone (p=0.014, Hedges’ g=0.961), and estradiol (p=0.00009, Hedges’ g=1.158). Conclusions. In this cohort of young normal weight women, our results highlight the existence of substantial metabolic abnormalities in women with AN who were recently weight-restored after a sustained period of starvation. The metabolic dysfunction that persists despite weight normalization suggests a need for further investigation into the metabolic axis of AN.

Changes In Urine Ph During The Nutritional Rehabilitation Of Adolescent And Young Adult Patients Hospitalised With A Restrictive Eating Disorder
Elizabeth K Parker1,2, Sylvia Tang3, Christine Wearne4, Gail Anderson5, Linette Gomes5, Simon Clarke5,6,7, Michael Kohn5,6,7
1Department of Dietetics & Nutrition, Westmead Hospital, Westmead, Australia, 2Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 3School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, Australia, 4Department of Medical Psychology, Westmead Hospital, Westmead, Australia, 5Department of Adolescent & Young Adult Medicine, Westmead Hospital, Westmead, Australia, 6Centre for Research into AdolescentS’ Health (CRASH), Westmead Hospital, Westmead, Australia, 7Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

Urine pH ≥ 7 has been reported in patients with restrictive eating disorders (EDs). However, published research is lacking. This study investigates the change of urine pH in malnourished adolescent and young adult patients hospitalised with restrictive EDs during an initial two weeks of nutritional rehabilitation. Methods. Retrospective chart review of ED patients (aged 14-25) admitted for nutritional rehabilitation for ≥ 14 days during 2018-2019. Linear mixed effects models were constructed to estimate weekly within patient change in urine pH and identify possible associations with degree of malnutrition, medical instability and purging status. Results. 79 patients (95% female) with mean age 17.7 ± 1.4 years were included. After 1 week of medical refeeding, significantly fewer patients had urine pH ≥ 7 (56.6% vs 29.9%, p=0.001). Mean urine pH decreased from 7.0 ± 0.9 at baseline to 6.6 ± 0.7 at day 7. Urine pH ≥ 7 was observed to be strongly associated with medical instability, lower % median BMI, and absence of purging behaviours. Conclusion. These findings suggest a change in urine pH from ≥ 7 to <7 can be observed after 1 week of nutritional rehabilitation. Further research is required to investigate mechanisms, including to determine whether pH could be a potential biomarker for the change from a catabolic state to an anabolic state during nutritional rehabilitation.

Eating Disorder Symptoms And Diagnoses In Adults With Celiac Disease 
Janet E. Schebendach1, 2, Anne R. Lee1, Yara Gholmie3, Randi L. Wolf3, Peter H.R. Green1, Joanna E. Steinglass1, 2
1Columbia University , New York, NY, United States, 2New York State Psychiatric Institute, New York, NY, United States, 3Teachers College, Columbia University , New York, NY, United States

Introduction: Celiac disease (CD) is an autoimmune disorder that requires lifelong intake of a gluten-free diet (GFD). A population-based study in Sweden reported a bidirectional association between CD and anorexia nervosa, and strict adherence to a GFD may contribute to eating disorders in vulnerable individuals. Purpose: to determine if ED symptoms or diagnoses were evident in outpatients with CD. Method: The Eating Pathology Symptoms Inventory (EPSI) and the Eating Disorder Diagnostic Scale (EDDS/DSM-5) were administered in a cross-sectional study of 15 males and 35 females (ages 18-45 yrs.) with stated adherence to a GFD for > 1 year. Results: Patients scored lower on EPSI subscales compared to normative values; however, females scored higher than males on body dissatisfaction (12.2+7.8 vs. 4.2+4, p<0.001), cognitive restraint (5+2.9 vs. 3.3+1.5, p=0.011), and purging (0.3+0.9 vs. 0+0, p=0.044). The mean EDDS symptom composite score for females was lower than the established gender cut-point of 16.5, and ns difference in the composite score of males and females was found (10+13.2 vs. 13.5+9.5, p=0.296). Females scored higher than males when asked if they felt fat (3.1+2 vs. 1+1.3, p<0.001), feared weight gain (2.9+2.1 vs. 0.8+1.3, p<0.001), and felt undue influence of weight/shape (3.0+1.9 vs. 1.7+1.8, p=0.034). Four patients met criteria for a DSM-5 ED using the EDDS. Conclusion: The EPSI and EDDS may be useful in screening for ED comorbidity in patients with CD.    

Network Analysis Of Nutritional Status Among Two Different Weight Loss Seeking Groups
Allison Boyar1, Robyn Sysko1, Andreas Michaelides2, Daniel Herron1,3, Tom Hildebrandt1
1Icahn School of Medicine at Mount Sinai, New York, NY, United States, 2Noom, Inc., New York, NY, United States, 3Mount Sinai Hospital, New York, NY, United States

Introduction: Evaluation of dietary practices for weight loss seeking individuals often relies on gross summary statistics of key variables (e.g., macronutrients, Kcals, etc.) to inform targeted dietary changes (e.g., reduce Kcals, etc.). These summaries often obscure a more complex interrelationship of nutritional markers that may have value for understanding group differences (e.g., nutritional subtypes, risk profiles, etc.) related to diet. We aim to explore intraindividual differences in network relationships between a broad set of nutritional indices derived from ASA24 in commercial weight loss and bariatric surgery candidates. Methods: Participants with BMIs that indicated obesity (BMI > 30) from two weight loss seeking populations (pre-surgery weight loss intervention vs. commercial weight loss intervention) filled out the ASA24. Network models will be used in an exploratory analysis of group differences by weight loss group, sex, medical illness (metabolic related disease vs. no disease). Network analysis will be applied to baseline self-report data from each and network characteristics will be compared between groups. Results: Expected results include the descriptive differences by group in network characteristics of nutrition information derived from ASA24 analysis of dietary behavior. Conclusion: Networks identified within analyzed subgroups may be useful in designing or personalizing weight loss strategies.

Core Eating Disorder Fears: Examining Prevalence Rates In Eating Disorder Fears Across Bmi
Mackenzie L. Brown, Cheri A. Levinson
University of Louisville, Louisville, KY, United States

Fear and anxiety are key aspects of eating disorder (ED) pathology. ED fear is multi-faceted, consisting of many fears, such as fear of food, weight gain, body/interoception fears, and social fears. Extending prior work examining ED fear by diagnosis, the current study examines if ED fear differs by weight status. Participants (N=229) completed the Eating Disorder Fear Interview (EFI), which assesses ED fear occurrence and intensity. Participants rate 31 possible fears and nominate their top three fears. The EFI includes six subscales, fear of food, weight gain, personal and social consequences, discomfort, and exercise-related fears. The top-rated ED fear frequencies were examined by BMI category, underweight (<18.4; n=63), normal (18.5–24.9; n=95), and overweight (>25.0; n=64). Overall, N=662 top fears were endorsed. Underweight participants most frequently endorsed fear of food (n=30;15.8%), normal weight: gaining weight (n=44;15.5%), and overweight: fear of judgment (n=24;12.8%). When examining EFI subscales, fear of social consequences was most frequently endorsed across BMI categories. These data support the heterogeneity of ED fears and extend previous findings to show differences in top endorsed fear by BMI categories. This work suggests, pending future longitudinal research, that the type of ED fear endorsed may change dependent on weight status. Identifying feared scenarios at the beginning of treatment could allow for delivery of personalized treatment.

Reporting Race And Ethnicity In Eating Disorders Research: From 2000 To 2020
Natasha L Burke1, Amy H. Egbert2, Rowan A. Hunt3, Kayla Williams4, Karen Jennings Mathis5
1Department of Psychology, Fordham University, Bronx, NY, United States, 2Department of Psychiatry and Human Behavior, The Miriam Hospital/Alpert Medical School of Brown University, Providence, RI, United States, 3Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States, 4Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States, 5College of Nursing, University of Rhode Island, South Kingston, RI, United States

Despite calls for better understanding the presentation of eating disorders (EDs) in underrepresented groups, a recent study reported that only 2.5% of articles published in the International Journal of Eating Disorders (IJED) from 1981-2020 had a primary focus on black, indigenous, persons of color (BIPOC) or examined how EDs might differ between BIPOC and others. Now, empirical research is needed to understand racial/ethnic representation in EDs research more broadly. We reviewed a sample of all qualitative and quantitative studies with human participants published in IJED over the course of the past 20 years (in 2000, 2010, 2020). A total of 378 studies were included. Only
45.2% reported race/ethnicity. Papers published in the United States were more likely to report race/ethnicity (74.5%) than other countries (20.5%). When race was reported, the majority of participants were White (78%), followed by Asian/Asian Indian (14%), Black/African American (12%), and other races (including indigenous groups from a variety of regions like Australia/New Zealand and South America; 8%). Although reported inconsistently, 12% of participants identified as Hispanic. Over time, rates of reporting race/ethnicity increased, but racial/ethnic composition did not change. Better reporting of racial/ethnic diversity is needed in EDs research. The field must address how to achieve more inclusive research populations on an international scale in order to better help all of those we aim to serve.  

Intra-Individual Structural Covariance Networks In Anorexia Nervosa: A Longitudinal Investigation
Enrico Collantoni1, Francesco Alberti1, Brigitte Dahmen2, Angela Favaro1,3, Beate Herpertz-Dahlmann2, Jochen Seitz2
1Department of Neurosciences, University of Padua, Padova, Italy, 2Child and Adolescent Psychiatry, RWTH University Hospital, Aachen, Germany, 3Padova Neuroscience Center, University of Padua, Padova, Italy

INTRODUCTION The present research aims to compute graph properties on cortical data at an individual level and to longitudinally evaluate them in an adolescent sample of patients with anorexia nervosa (AN) before and after  short-term weight restoration. METHODS 38 female adolescents with AN underwent MRI scans at baseline and after 2.5 months on average while 53 age-matched healthy controls (HC) were scanned once. The MRI data was processed using FreeSurfer. Regional data were normalized using the mean and SD of the HC sample and controlled for age and site of acquisition. Graph measures were extracted using the Brain Connectivity Toolbox and correlated with specific clinical measures. Group comparisons were performed using AUC. RESULTS Patients with acute AN displayed a lower global efficiency, modularity, and SWI than HCs. Weight recovered patients had higher modularity than at baseline. In patients with acute AN, transitivity was negatively associated with illness duration and positively associated with both BMI and BMI change, while the clustering coefficient correlated negatively with illness duration and positively with BMI. In the weight recovered group, BMI change was negatively associated with characteristic path length and positively with SWI. CONCLUSIONS Our results indicate a shift towards less modular and organized cortical thickness networks in patients with acute AN than in HC. At follow-up, the disarrangement seems to progress toward recovery.

Exploring The Experience Of Not Being "Sick" Enough: A Qualitative Study Of Women Previously Diagnosed With Anorexia Nervosa Or Atypical Anorexia Nervosa
Kari Eiring1, Trine Wiig Hage2, Deborah L Reas2
1Department of Psychology, University of Oslo, Oslo, Norway, 2Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway

Purpose: Despite common misconceptions, an individual may be seriously ill with a restrictive eating disorder without an outwardly recognizable physical sign of the illness. The aim of this qualitative study was to investigate the perspectives of individuals who have previously battled a restrictive eating disorder who were considered "not sick enough" by others (e.g., peers, families, healthcare professionals) at some point during their illness, and to understand the perceived impact on the illness and recovery. Methods: Seven women who had recovered from AN/AAN participated in semi-structured interviews. Interviews were transcribed and interpretive phenomenological analysis (IPA) was used. Results: Three main themes emerged: 1) the importance of being seen and understood, 2) the focus on  "physical" measures while battling a mental illness, and 3) project "perfect": feeling pressure to prove oneself. Participants reported that their symptoms were occasionally met with trivialization or disbelief, leading to shame, confusion, despair, and for some, a deterioration in eating disorder symptoms which drove further weight loss. In contrast, social support and being understood were viewed as essential for recovery.  Conclusions: Increased awareness of non-stereotypical presentations of a restrictive eating disorder is necessary to dissociate weight from the presence or severity of illness and facilitate early detection and treatment access. 

Eating Disorders In U.S. Active Duty Service Members: Conceptual Considerations And Review
Jason M Lavender1,2,3, Marian Tanofsky-Kraff1,2,4
1Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 2Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 3The Metis Foundation, San Antonio, TX, United States, 4Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States

Introduction: Active duty service members (ADSM) face a distinctive set of pressures and stressors that may increase eating disorder (ED) risk, including stringent body composition and fitness standards (assessed every 6 months), maintaining a ‘military appearance’, military-specific stressors (i.e., deployments, frequent relocations), and duties often promoting inconsistent and unpredictable eating patterns.
Methods: A conceptual overview of key ED theoretical models as applied to ADSM, and a literature review of peer-reviewed manuscripts and government/military reports (i.e., grey literature). Results: Few studies have examined EDs in ADSM, however limited evidence suggests that rates of EDs and ED symptoms (e.g., binge eating, unhealthy weight control methods) are equivalent to or higher than in civilians, and incidence in ADSM appears to be rising. Moreover, the gender disparity in EDs appears to be lower in ADSM versus civilians, which is notable given that 83% of ADSM are men. Common limitations of prior studies are reliance on outdated or inadequate surveys, narrow samples, and the potential confound of underreporting due to EDs being exclusionary for service and grounds for military separation. Conclusions: Assessment and screening tools designed specifically for ADSM are needed to provide precise ED prevalence estimates, which will help to reduce stigma and guide the development and delivery of targeted prevention and treatment programs for this at-risk population.

Impact Of Covid-19 Lockdown Measures On Eating Disorders Patients
Paulo PP Machado, Ana Pinto-Bastos, Rita Ramos, Tânia F. Rodrigues, Ana Vaz
University of Minho, Braga, Portugal

The purpose of the study was to assess the impact of lockdown measures on a cohort of eating disorder (ED) patients being followed as part of an ongoing study. Methods: Fifty-nine patients were interviewed by phone, 43 agreed to respond to a set of self-report measures, during the week after the end of the lockdown period. Results: Of the 26 patients currently in treatment: 8 remained unchanged, 7 deteriorated, and 11 reliably improved. Of the 17 participants not currently in treatment: 3 deteriorated, 9 remained unchanged, and 5 improved after the lockdown period. Most patients considered their routines moderately or extremely impacted, experienced stress related to coronavirus, and showed difficulty in maintaining physical exercise and feeding routines. Results suggest that higher impact of COVID-19 lockdown was significantly correlated with eating disorder symptoms and associated psychopathology, impulsivity, difficulties in emotion regulation and clinical impairment measured at post-lockdown. In addition, the impact of COVID-19 and lockdown measures on clinical impairment was mediated by difficulties in emotion regulation. Conclusions: Findings suggest that ED patients may be particularly affected by lockdown measures. Those struggling with ED may experience worsening of their condition, especially if associated with difficulties in emotion regulation, and these difficulties might be exacerbated in the context of a stressful crisis and lockdown measures.  

What About The Groceries? Parents Perceive An Immersive Grocery Shopping Tool To Maxmize Caloric Density 
Amanda Makara1, Holly Howe3, Marita Cooper1, Kerri Heckert1, Samantha Weiss1, Natalia Orloff1, Peter Ubel3, C. Alix Timko1, 2
1Children's Hospital of Philadelphia, Philadelphia, PA, United States, 2University of Pennsylvania, Philadelphia, PA, United States, 3Duke University , Durham, NC, United States

Rapid early weight gain is a prognostic marker of remission for adolescents with anorexia nervosa (AN). Family-based treatment charges parents with renourishment, often requiring significant adaptions to normal meal planning, grocery shopping, and cooking routines. A common challenge for parents is identifying foods that meet the high caloric needs of their child, a marked shift from society’s focus on low-calorie/low-fat foods. This project pilots an innovative tool (Open Science Online Grocery; OSOG) adapted to shape parent shopping habits post-hospitalization for AN. The tool visualizes the caloric density of >10,000 common grocery products, recommending higher caloric alternatives where relevant. We recruited 12 parents of adolescents with AN hospitalized for medical stabilization. Following an educational dietetics session, parent participants were oriented to OSOG. We conducted semi-structured interviews with parents, using thematic analysis to identify common themes. Preliminary analyses yielded three benefits including 1) visual learning 2) filling an important gap and 3) immediacy of feedback. Themes for improvement were 1) desire for real-world shopping links and 2) inability to modify for special dietary needs (e.g., allergies). Initial feedback indicates that parents appreciated additional support and guidance for meal planning post-discharge. The OSOG tool may act as a helpful clinical supplement during both ambulatory nutritional teaching and outpatient care. 

Videoconference Use During Covid-19 Pandemic Lockdown Increases Face Dissatisfaction And Body Checking Behaviors In Eating Disorder Patients In Argentina. 
Juana Poulisis1, Rocío Hauché2, Romina Tiberi3, Lucía Vaccarezza3, Valeria T Pedrón2,3
1Universidad Favaloro, CABA, Argentina, 2Laboratorio de Cognición y Políticas Públicas UAI - CONICET, CABA, Argentina, 3Universidad del Salvador, CABA, Argentina

The purpose of the present study was to evaluate the impact of videoconference exposure on face satisfaction and body checking behavior during the COVID-19 pandemic lockdown in Argentina in a sample of eating disorder patients (EDP). Participants with a diagnosis of eating disorders (EDP, N = 249) from Argentina, were recruited through social media and ongoing studies. They completed an online survey regarding their eating habits, use of videoconference, face and body image concern and a Spanish adaptation of the body checking questionnaire (BCQ) in August of 2020. Our results indicate that EDP patients who reported an increase in body image concerns had a significant increased their dieting behavior (p<0.001), binging (p<0.001), vomiting (p<0.001) behaviors and an excess in physical activity (p<0.05). We also observed an increase in guit regarding buying food (p<0.001), alcohol intake (p<0.05), tobacco use (p<0.01), and self medication (p<0.05). Regarding face satisfaction, EDP’s indicated an increase in face dissatisfaction because of videoconference use (p<0.001). Regarding body checking, EDP’s that increased their body image concerns showed higher scores in all the scales of the BCQ (p<0.001). Our findings agree with previous studies indicating that COVID-19 lockdown had a significant impact on body image and face satisfaction increasing the risk of worsening symptomatology in EDP.   Keywords: COVID-19, face satisfaction, body checking, eating disorders

The Association Between Trait Mindfulness And Body Checking
Margaret Sala1, Cheri Levinson2
1Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States, 2University of Louisville, Lousville, KY, United States

Introduction: Higher trait mindfulness (i.e., bringing one’s attention to the present moment with an attitude of acceptance) and most of its facets (acting with awareness, non-judging, non-reactivity, describing) are associated with lower eating disorder (ED) psychopathology (Sala et al., 2020). However, the extent to which mindfulness and its facets are related to ED behaviors such as body checking is not yet clear. It is also not clear how severity of ED psychopathology may moderate the relationship between mindfulness and body checking. Therefore, we tested the relationships between mindfulness facets and body checking. We also tested the extent to which these relationships are moderated by ED psychopathology. Methods: College students (N = 805, 76.7% female, mean age = 20.0) completed the Five Facet Mindfulness Questionnaire, the Body Checking Questionnaire, and the Eating Disorder Examination Questionnaire. Results: Higher acting with awareness, non-judging, and non-reactivity were uniquely associated with lower body checking, whereas higher observing was uniquely associated with higher body checking. The relation between non-judging and body checking was stronger for individuals who were higher in ED psychopathology. Conclusions: All mindfulness facets, except describing, show potential as processes that could be altered to reduce body checking, particularly for individuals higher in ED psychopathology.

Ethnic And Racial Differences In Disordered Eating Among Post-9/11 Male And Female Veterans 
Kelsey N. Serier1, Karen S. Mitchell1,2
1National Center for PTSD at the VA Boston Healthcare System, Boston, MA, United States, 2Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States

 Disordered eating (DE) is a significant issue for veteran populations, yet little research has examined DE in racially/ethnically diverse male and female veterans. Diverse groups experience high rates of DE but are less likely to be referred for treatment. Perceived discrimination negatively impacts DE, but this association has not been examined in veterans.  Methods: Recently separated male (364 non-Hispanic White, 79 Hispanic, and 42 non-Hispanic Black) and female veterans (449 non-Hispanic White, 102 Hispanic, and 142 non-Hispanic Black) completed the Eating Disorder Examination Questionnaire (EDE-Q), Clinical Impairment Assessment (CIA) and the Everyday Discrimination Scale (EDS). Data/Results: Regression analyses showed that Black women reported lower scores on the EDE-Q relative to White women (β = -0.137, p = .003). There were no racial/ethnic differences on the EDE-Q for male veterans or on the CIA for male or female veterans. Higher perceived discrimination was positively related to EDE-Q scores (male: r = .297, p = .001; female: r = .313, p = .002) and CIA scores (male: r = .353, p = .001; female: r = .365, p = .002) for Hispanic and Black male and female veterans. Conclusion: There were more similarities than differences in DE and DE impairment across race and ethnicity for male and female veterans, except that Black women reported less DE. Future research is needed to understand DE in veterans of color, as well as the role of perceived discrimination. 

Weight Stigma In Day-To-Day Life Associated With Eating Disorder Symptoms Among College Students
Kendrin R Sonneville1, Sarah K Lipson2
1University of Michigan School of Public Health, Ann Arbor, MI, United States, 2Boston University School of Public Health, Boston, MA, United States

Introduction: Weight-based bullying and other overt forms of weight stigma are associated with a range of negative health outcomes, including eating disorder symptoms. We sought to examine less overt, daily experiences of weight stigma and eating disorder risk among college students. Methods: Participants were 506 students participating in the Healthy Minds Study in the 2019-20 academic year who responded to the question: "In your day-to-day life, how often do people act as if they're better than you because of your weight?". We used logistic regression models controlling for age, gender, and weight perception to examine the association between daily experiences of weight stigma (always/often/sometimes vs. rarely/never) and eating disorder risk assessed using the SCOFF and any past-month purging (vomiting, laxatives, diuretics, compulsive exercise, and/or fasting) assessed using items from the Eating Disorder Examination Questionnaire. Results: The mean (SD) age of the sample was 23.2 (7.0) years; 26.5% identified as male, 70.9% identified as female, and 2.5% identified as a gender other than male or female. 19.4% of participants reported experiencing weight stigma in their day-to-day lives and these students were at increased risk of a positive SCOFF screen (OR: 2.57; 95% CI: 1.55, 4.25) and past-month purging (OR: 2.04; 95% CI: 1.18, 3.53). Conclusions: Findings implicate less overt, daily experiences of weight stigma as a potential risk factor for eating disorder symptoms.

Differences In Exercise Motives Between Individuals With Binge Spectrum Eating Disorders That Engage In Adaptive Exercise And Maladaptive Exercise
Olivia B Wons1,2, Elizabeth W Lampe1,2, Alex Pitts1, Adrienne S Juarascio1,2
1Center for Weight Eating and Lifestyle Science (WELL Center), Philadelphia, PA, United States, 2Department of Psychology, Drexel University, Philadelphia, PA, United States

 Maladaptive exercise (e.g., compensatory and/or driven exercise) is a common factor in the etiology, development, and maintenance of eating disorders (ED) yet, some individuals with EDs only engage in adaptive exercise (e.g., non-compensatory or driven exercise). Motivations for adaptive versus maladaptive exercise in EDs are understudied. The present study aims to assess differences in exercise motives between adaptive exercisers and those with >50% maladaptive exercise episodes. Methods Adults (N=56) with binge-spectrum EDs (n=38 adaptive & n=18 maladaptive exercisers) completed the Eating Disorder Examination Interview and the Exercise Motivations Inventory-2. ANCOVAs tested differences in motives by group controlling for BMI and exercise frequency. Results Maladaptive exercisers were significantly more motivated to exercise for challenge (F(1, 52)=6.21, p =.017, eta2=0.13), social recognition (F(1, 52)=17.39, p<.01, eta2=0.25), enjoyment (F(1, 52)=10.77, p<.01, eta2=.17), weight (F(1, 52)= 8.52, p<.01, eta2=0.14), and shape (F(1, 52)=4.95, p=.03, eta2=.08) compared to adaptive exercisers. Adaptive exercisers were not significantly more motivated than maladaptive exercisers in any category. Conclusion Maladaptive exercisers with EDs reported exercise motives commonly associated with adaptive exercise. Further assessment of the differences in motivations and function of adaptive and maladaptive exercise EDs is necessary.

Adapting The Body Project To A Non-Western Culture: A Dissonance-Based Eating Disorders Prevention Program For Saudi Women
Munirah AlShebali1&2, Carolyn Becker3, Stephen Kellett2, Ahmad AlHadi4, Glenn Waller2
1Basic Sciences and Studies Department, College of Community, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia, 2Department of Psychology, University of Sheffield, Sheffield, United Kingdom, 3Department of Psychology, Trinity University, Trinity , TX, United States, 4SABIC Psychological Health Research & Applications Chair, Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia

 The main aim of this study was to test the feasibility of an adapted version of the Body Project for young Saudi women as their eating and body issues are comparable to western culture and linked to internalization of westernization. The study also aims to assess predictors of attrition, and preliminary effectiveness. Method: The intervention was adapted to local culture in collaboration with a co-director of the Body Project Collaborative. 48 Saudi undergraduate females were recruited, mean age was 19.16 years (SD = 1.23), baseline BMI was (M = 24.42, SD = 5.46). Eating pathology, body image, and comorbidities were assessed pre and post the intervention with adapted self-report measures.  Results: The Body Project is feasible for young Saudi women. Participants were willing to enrol, they found the intervention useful, understandable, and enjoyable. There was no difference between completers and non-completers. The preliminary effect sizes are similar or higher than other effectiveness trials in other cultures. Conclusion: A cognitive dissonance–based eating disorders prevention can be applicable across cultures where westernization is an influence. The effectiveness is yet to be affirmed. Future research is needed to investigate effectiveness in further robust studies and a bigger sample.

Feeling "Fat" Or Negative Affect? Evaluating The Associations Between Momentary Levels Of Feeling Fat And Negative Affect In Individuals With Binge-Eating Disorder. 
Lisa M. Anderson1, Vivienne M. Hazzard1,2, Tyler B. Mason3, Heather Davis4, Dorian R. Dodd2, Ross D. Crosby2, Scott G. Engel2, Scott J. Crow1, 5, Stephen A. Wonderlich2, Carol B. Peterson1
1University of Minnesota, Minneapolis, MN, United States, 2Sanford Center for Biobehavioral Research, Fargo, ND, United States, 3University of Southern California, Los Angeles, CA, United States, 4University of Chicago, Chicago, IL, United States, 5The Emily Program, St. Paul, MN, United States

"Feeling fat" (FF) is a cognitive attribution error that maintains eating disorders via mislabeling of internal states (e.g., negative affect [NA]) as FF and misattributing FF with being fat. FF may also increase NA. This study examined momentary-level, bidirectional associations between FF and NA and whether shape/weight overvaluation moderates these associations. Methods: Prior to treatment, 112 treatment-seeking adults with binge-eating disorder (BED) completed the Eating Disorder Examination and a 1-week ecological momentary assessment protocol that measured FF and facets of NA (guilt, sadness, hostility, fear). Linear mixed models examined bidirectional within- and between-person associations between FF and NA facets and tested for moderation by baseline overvaluation. Results: Prospective and bidirectional within-person associations were found between FF and guilt, sadness, and hostility. Between-person effects were observed for all NA facets in relation to FF with the largest effect size for guilt. Moderation effects indicated that high overvaluation was associated with high within-person levels of FF irrespective of prior NA; low overvaluation was associated with higher within-person levels of FF following elevated within-person levels of guilt, sadness, and hostility. Conclusions: Findings highlight nuanced associations between FF and NA facets. Future studies should extend this work to examine associations among FF, NA, and eating disorder symptoms.  

Posttraumatic Stress Disorder Symptoms As A Link Between Military Sexual Trauma And Disordered Eating In Veterans
Rachel L Zelkowitz, Karen S Mitchell
Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States

Introduction: Military sexual trauma (MST) has been linked with disordered eating (DE) symptoms in veterans, but mechanisms of this relation are unclear. We tested posttraumatic stress disorder (PTSD) symptoms as a potential mediator of the association between MST exposure and DE in male and female veterans. Methods: Veterans who had recently separated from service (N = 1,390, 59.4% women) completed the Eating Disorders Examination Questionnaire and the PTSD Symptom Checklist for DSM-5 (PCL-5). MST exposure was also assessed via self-report. We used path analysis to test associations among MST, PTSD symptoms, and DE, adjusting for BMI and age. Results: MST was relatively common in men and women (27.3% and 55.6% respectively). DE symptoms were significantly associated with MST in both genders. A path model including both direct associations of MST with DE and indirect associations via PTSD symptoms fit the data well (RMSEA = 0.05, p = 0.47, CFI = 1.00, TFI = 0.97). Indirect associations from MST to DE via PTSD symptoms were significant in both genders (men: b = 0.19, SE = 0.04, p <.01, 95% CI: [0.11, 0.27] ; women: b = 0.32, SE = 0.05, p <.01, 95% CI: [0.23, 0.42]. Conclusions: MST was associated with DE for both male and female veterans. PTSD symptoms are one possible pathway from MST to DE.  Results underscore the importance of screening for DE in male and veterans with histories of MST and/or PTSD. 

Provisional Ptsd Is Associated With Greater Severity Of Eating Disorder And Comorbid Symptoms In Adolescents Treated In Residential Care 
Timothy D. Brewerton1,2,3, Ismael Gavidia3, Giulia Suro3, Molly M. Perlman3,4, Jessica Genet3, Douglas W. Bunnell3,5
1Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States, 2Monte Nido and Affiliates, Miami, FL, United States, 3Timothy D. Brewerton, MD, LLC, Mt. Pleasant, SC, United States, 4Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, FL, United States, 5Private Practice, New York, NY, United States

Introduction: Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (ED) in adults but remain understudied in adolescents. Methods: Adolescent  participants (ages 11-17 years and 96.5% female) with EDs entering residential treatment (RT) (n=647) at eight sites in the U.S. completed validated self-report assessments of ED, PTSD, major depression, anxiety disorders, and quality of life. Provisional DSM-5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews, and the PTSD Symptom Checklist for DSM-5. Results: PTSD+ occurred in 35.4% of participants, and those with ED-PTSD+ had significantly higher scores on all assessments (p<.001), including measures of ED psychopathology, major depression, anxiety disorders, and quality of life, as well as significantly higher rates of all forms of childhood trauma (sexual, physical and emotional abuse and emotional and physical neglect). Those with PTSD+ also exhibited a significantly higher percent median body mass index (%MBMI) for age and sex and a lower propensity toward anorexia nervosa, restricting type. Conclusions: Results confirm that adolescent patients in RT with ED-PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed in ED programs that treat adolescents.

Sexual Behaviors And Childhood Traumatic Experiences In Eating Disorders: A Two Year Follow Up  
Giovanni Castellini1, Emanuele Cassioli1, Eleonora Rossi1, Alessandra H Rellini2, Valdo Ricca1
1Department of Health Sciences. University of Florence, Florence, Italy, 2Department of Psychological Science, University of Vermont, Burlington, VT, United States

Purpose of the study: The aim of the present two-year follow-up study was to evaluate correlates of sexual dysfunctions and hypersexuality in eating disorders (EDs) and the role of adverse childhood experiences as moderators of the recovery of healthy sexuality after treatment. Methods: patients were evaluated by means of a clinical interview, and self-reported Qquestionnaires investigating general (SCL-90-R) and eating disorder-specific (EDE-Q) psychopathology, female sexuality (FSFI), hypersexuality (HBI), attachment style (ECR), and childhood traumatic experiences (CTQ). The assessment was repeated were was administered at baseline (T0) and after one (T1) and two years (T2) to 65 women with Anorexia and 54 Bulimia Nervosa treated with Enhanced Cognitive Behaviour Therapy. Results: Moderation analyses showed that hypersexuality was associated with emotion dysregulation and psychopathology only in those patients reporting childhood traumatic experiences. Avoidant attachment was associated with all domains of sexual dysfunction. Longitudinal analysis showed an improvement of sexual functioning at follow up. Moderation analysis indicated that sexual desire did not increase in participants with higher levels of avoidant attachment. Conclusions: This study highlighted the crucial role of childhood traumatic experiences in the relationship between risky sexual behaviors and EDs psychopathology, and the role of avoidant attachment in the maintenance of sexual dysfunctions in EDs.

The Interacting Roles Of Trauma And Body Image In Predicting Eating Disorder Pathology 
Emma L. Johnson1,2, Lauren M. Schaefer2,3, Dorian R. Dodd2, Vivienne M. Hazzard2, Li Cao2, Ross D. Crosby2,3, Stephen A. Wonderlich2,3
1North Dakota State University, Fargo, ND, United States, 2Sanford Center for Bio-Behavioral Research, Fargo, ND, United States, 3University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States

Trauma and body image disturbances are related to eating disorder (ED) pathology. Among individuals who have experienced sexual abuse, body image (i.e., body avoidance and body investment) may be especially related to ED pathology as individuals attempt to avoid trauma-related stimuli or control their experiences by controlling their appearance. This study used generalized linear modeling to test the moderating effect of sexual abuse history on the relationship between body image (avoidance and investment) and ED pathology among adult women (age: 38.07 ± 8.78 years) who were recruited for a history of sexual trauma (n=72) or no history of sexual trauma (n=25). Sexual abuse history interacted with body avoidance (β=.33; p=.02) and body investment (β=.52; p=.04) to predict ED pathology, such that the association between body image experiences and ED pathology was stronger for those with no history of sexual abuse than for those with a history of sexual abuse. Although these data are cross-sectional, retrospective, and obtained from a non-ED sample, results suggest that body image avoidance and investment may not be as potent of predictors of ED pathology for those who have experienced sexual trauma compared to those who have not. These results highlight the need for continued research to clarify key mechanisms of ED pathology among individuals with histories of sexual trauma. 

Stressful Life Events Among Individuals With A History Of   Eating Disorders: A Case-Control Comparison
Selma O. Lie1,2, Cynthia M. Bulik3,4,5, Ole A. Andreassen6,7, Øyvind Rø1,2, Lasse Bang1,8
1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital , Oslo, Norway, 2Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 4Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 5Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, NC, United States, 6NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 7Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway, 8Norwegian Institute of Public Health, Oslo, Norway

Stressful life events (SLEs) can negatively impact mental health and increase risk for psychiatric disorders including eating disorders (EDs). Previous research has shown that childhood sexual abuse is associated with some EDs, but less is known about the association between other SLEs and EDs. Method: A case-control study of individuals with (n = 495, age M±SD 29.1±9.8 years) and without (n = 395, age 30.2±11.7) a lifetime history of EDs was conducted to compare history of self-reported SLEs. Participants reported both sexual (e.g., rape, other sexual assault) and non-sexual (e.g., emotional abuse, assault, bereavement) life events. Individuals with EDs were divided into subtypes along the restricting – binge eating/purging spectrum to examine subtype differences. Logistic regressions were conducted to obtain odds ratios (ORs). Results: Exposure to any SLE was significantly more common in individuals with EDs than in controls (OR = 2.47, p <0.001). Specifically, rape, other sexual assault, and emotional abuse were significantly more common in binge-eating/purging EDs than in controls (ORs = 2.15-3.58, p’s <.01). Having had a life-threatening disease and bereavement were significantly associated with some ED subtypes. Conclusion: Both sexual and non-sexual SLEs were more prevalent in individuals with a history of binge-eating/purging EDs than in controls. Results highlight the importance of assessing a variety of past SLEs in risk assessment for different EDs.

Adverse Childhood Experiences Among A Treatment-Seeking Sample Of Adults With Eating Disorders
Renee D. Rienecke1,2, Craig Johnson1, Philip S. Mehler1,3,4, Daniel Le Grange5,6, Jamie Manwaring1, Alan Duffy1, Susan McClanahan1,2,7, Dan V. Blalock8,9
1Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, CO, United States, 2Northwestern University, Chicago, IL, United States, 3ACUTE at Denver Health, Denver, CO, United States, 4University of Colorado, Denver, CO, United States, 5University of California, San Francisco, San Francisco, CA, United States, 6The University of Chicago, Chicago, IL, United States, 7Durham Veterans Affairs Medical Center, Durham, NC, United States, 8Duke University School of Medicine, Durham, NC, United States

The purpose of the current study was to examine the prevalence of adverse childhood experiences (ACEs) in a treatment-seeking sample of adults with eating disorders (EDs), to assess whether experiencing a greater number of ACEs is associated with more severe ED psychopathology, and to determine whether ACEs predict treatment outcome.  Method: Participants were 1819 patients admitted to one of two treatment facilities at residential and partial hospitalization levels of care.  The Adverse Childhood Experiences Survey (ACES) and the Eating Pathology Symptom Inventory (EPSI) were completed at admission and discharge.  Results: Female patients reported higher ACEs than male patients (p = .03), and all diagnoses except avoidant/restrictive food intake disorder (ARFID) had significantly higher ACEs than patients with anorexia nervosa-restricting type (AN-R) (all p’s <.01).  Across diagnoses, higher ACEs were associated with decreases in binge eating scores during treatment, but were not associated with changes in the EPSI purge or restrict subscales.  Within diagnoses, higher ACEs scores were associated with decreases in the EPSI purge subscale for patients with AN-R and increases in the EPSI purge subscale for patients with binge eating disorder.  Conclusions:  Findings did not clearly show that higher ACEs predict worse treatment outcome.  

History Of Sexual Abuse Predicts Higher Rates Of Readmission To Intensive Treatment In Patients With Anorexia Nervosa
Irina A Vanzhula, Jennifer E Wildes
University of Chicago, Chicago, IL, United States

Childhood trauma, especially history of sexual abuse, is a risk factor for the development of eating disorders (EDs) and predicts poor treatment response and higher dropout rates. ED relapse rates remain high, and up to 48% of patients discharged from intensive care require at least one readmission, a large burden on both the patient and the healthcare system. The current study investigated history of childhood emotional, physical, and sexual trauma as predictors of readmission to intensive treatment. Participants were 194 patients with anorexia nervosa (AN) receiving intensive behavioral treatment (inpatient, day hospital, or both) who completed assessments at baseline, discharge, and three, six, and 12-months follow-ups. Binary logistic regression analysis found that history of sexual, but not emotional or physical, abuse predicted three times higher rate of re-admission to intensive treatment at 12-month follow-up (p = .020), while controlling for baseline ED symptoms and other known predictors of relapse (BMI, suicidal ideation, and AN subtype). No significant predictors were found at 3-month follow-up. Only lower BMI at baseline significantly predicted 35% higher rates of readmission at 6-months follow-up (p = .008). Along with severity of illness, childhood sexual abuse may play an important role in maintaining AN and contribute to high relapse rates. Screening for and treatment of comorbid PTSD in intensive care units may be beneficial. 

4:05 - 5:35 PMRoom 2
Symposium: From Neuroscience to Treatment in Eating Disorders: Translations and Collaborations

Chair(s): Joanna Steinglass
Beyond Activity-Based Anorexia – Advances In Animal Models Of Eating Disorders
Lori Zeltser
Columbia University

Neuroscience Of Behavior – How Cognitive Neuroscience Can Probe Illness-Specific And Generalized Disturbances
Karin Foerde 1,2
1Columbia University, 2New York State Psychiatric Institute

Applications In The Study Of Reward Systems In Anorexia Nervosa
Christina Wierenga

Of Mice And Mechanisms: How Translational Decision-Making Paradigms Can Increase The Precision Of Treatment Targets For Anorexia Nervosa
Ann Haynos
University of Minnesota

5:45 - 7:00 PMRoom 1
Keynote 1: Precision and Genomic Medicine

Chair(s): Melissa Munn-Chernoff
What Can We Learn From Other Areas Of Psychiatry To Advance Understanding Of And Treatments In Eating Disorders?
Jordan Smoller1,2
1Harvard Medical School, 2Massachusetts General Hospital

Saturday, September 18, 2021

8:00 - 9:30 AMRoom 1
Early Career Investigators Meeting: Recognizing and Navigating Unique Challenges for Women and Minorities

Speakers: Eva Trujillo, Christine Peat, Natasha Fowler

This event is open to the public.

Chair(s): Kendra Becker
9:45 - 11:00 AMRoom 1

Chair(s): Adrienne Juarascio
Super-Intensive Experience Sampling Of Everyday And Digital Life: Ideas For Discovering Moment-To-Moment Manifestation And Treatment Of Dysregulation
Nilam Ram
Stanford University

11:15 - 12:45 PMRoom 2
Symposium: Moving into the Next Frontier for Digital Interventions: Novel Research Collaborations to Increase Reach and Impact

Chair(s): Andrea Graham
Focusing On Stakeholder Perspectives To Increase Engagement: Applying User-Centered Design Methods
Andrea Graham
Northwestern University

Developing Effective Just-In-Time Adapted Interventions (Jitais) To Enable Powerful And Precise Real-Time Support For Disordered Eating
Stephanie Goldstein
Brown University

Leveraging Unique Partnerships To Increase Scale Of Digitally Delivered Eating Disorders Interventions
Ellen Fitzsimmons-Craft
Washington University School of Medicine

Reaching Underserved Populations Through Web-Based Dissemination Efforts
Erin Accurso
University of California, San Francisco

1:30 - 3:00 PMRoom 1
Paper Session 1: Epidemiology

Chair(s): Alison Field
Prevalence Of Symptomatic Deterioration Among Individuals With Eating Disorders And Obesity: A Systematic Review And Meta-Analysis
Gianluca Lo Coco1, Lucia Sideli2, Rubinia C. Bonfanti1, Bianca Borsarini3, Cristina Sechi4, Lucia Fortunato1, Nadia Micali3
1University of Palermo, Palermo, Italy, 2LUMSA University, Rome, Italy, 3Universitè de Genève, Geneva, Switzerland, 4University of Cagliari, Cagliari, Italy

Introduction: The COVID-19 pandemic has caused increases in mental distress in the general population. The aim of this meta-analysis is to estimate the impact of the COVID-19 lockdown on the prevalence of symptomatic behaviours and distress among individuals with eating disorders (EDs) and obesity.  Methods: We searched articles in biomedical databases. Prevalence estimates were pooled in a meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics.  Results: 26 studies met inclusion criteria (n= 3399, 85.7% female). The pooled prevalence of symptomatic deterioration was 66% (95% CI 48–81) in 10 studies on EDs. The pooled prevalence of increased weight was 52% (95% CI 25–78) among individuals with obesity in 4 studies. More than a half of the participants experienced depression and anxiety. At least 75% of individuals with EDs reported shape concerns, eating concerns, and increased thinking about exercising. However, pooled analyses of longitudinal studies which examined changes in symptoms before and during the pandemic showed no significant differences in BMI and ED symptoms. Only few studies suggested increased mental health distress among individuals with AN. Conclusions: The majority of individuals with EDs and obesity reported symptomatic worsening during the pandemic. However, further longitudinal studies are needed to examine which clinical groups experienced higher distress, as well as the long-term consequences of COVID-19.

Intersecting Gender Identity And Racial/Ethnic Disparities In Eating Disorder Symptoms Among College Students: A Multilevel Analysis
Ariel L. Beccia1,2, Allegra R. Gordon3,4,5, Sarah K. Lipson6
1Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States, 2Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States, 3Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States, 4Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States, 5Department of Pediatrics, Harvard Medical School, Boston, MA, United States, 6Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, United States

Purpose: There are documented disparities by gender and race/ethnicity in eating disorders (EDs). Yet, little is known about population-level prevalence at the intersection of diverse gender and racial/ethnic identities. Methods: Using data from the Healthy Minds Study 2015–2019 (N=251,310 U.S. university students), we conducted a Multilevel Analysis of Individual Heterogeneity & Discriminatory Accuracy (MAIHDA). Participants were nested in 35 intersectional strata given by all combinations of 5 gender and 7 racial/ethnic categories. Multilevel logistic models with participants at level 1 and intersectional strata at level 2 were used to estimate strata-specific predicted prevalence estimates for thin-ideal internalization and ED symptoms (>2 on the SCOFF). The variance partition coefficient (VPC) was calculated to quantify the contextual effect of the intersectional strata. Results: There were large disparities in both thin-ideal internalization and ED symptoms, with several strata including transgender participants of color having a higher predicted prevalence than expected based on the additive effects of gender and race/ethnicity. VPCs indicated that ~10% of the total variance in both outcomes was due to intersectional interactions between gender and race/ethnicity. Conclusion: Findings suggest that gender and racial/ethnic disparities in EDs are interrelated, underscoring the need to develop health equity interventions that center multiply marginalized populations.

Child Autistic Traits, Eating Problems And Nutrition-Related Outcomes In A Population-Based Cohort
Holly A. Harris1, Ivonne P. M. Derks1, 2, Pauline W. Jansen1, 2
1Erasmus MC, University Medical Center, Rotterdam, Netherlands, 2Erasmus University , Rotterdam, Netherlands

Children with autism have an increased risk of eating problems (e.g. food selectivity) and developing eating disorders. Autistic traits exist across a continuum of severity, yet little is known about how autistic traits are associated with eating problems in the general pediatric population. The current research presents a body of work describing: 1) the direction of the association between autistic traits and eating problems; and the impact of these processes on 2) diet quality; and 3) constipation.

Participants were children (N=2818-4092) in the population-based birth-cohort, the Generation R Study. Parents completed repeated assessments of child autistic traits, eating behaviors, diet and constipation from infancy to adolescence. Statistical analyses included structural equation modelling, regression and mediation analyses.

A small bidirectional association between autistic traits and eating problems was evident in the toddlerhood years. Autistic traits were associated with poorer diet quality and increased severity of constipation symptoms in mid-childhood, and food selectivity mediated both associations.

In the general population, toddlerhood may present a potential sensitive period to intervene in the developmental course of autistic traits or eating problems. Interventions intended to optimize nutrition-related outcomes in children with elevated autistic traits may integrate behavioral strategies to support parents’ responding to their child’s food selectivity.

Longitudinal Group And Individual Networks Of Eating Disorder Symptoms In Individuals Diagnosed With An Eating Disorder
Cheri A Levinson, Rowan Hunt, Caroline Christian, Brenna M Williams, Ani C Keshishian, Irina A. Vanzhula, Christina Ralph-Nearman
University of Louisville, Louisville, KY, United States

Eating disorders (EDs) are serious psychiatric illnesses with high mortality, morbidity, and societal cost. Precision treatments for EDs are needed that can intervene on individual maintenance factors targeted to the individual. The first step in such treatment development is identification of central treatment targets, both at the group (i.e., on-average) and individual level. The current study (N=102 individuals with an ED) utilized intensive longitudinal data to model several types of group-level and individual network models. Overall, we identified several group-level central symptoms, though they varied by model type, with the most common central symptoms of fear of weight gain, feeling like one is overeating, compensatory behaviors, excessive exercise, and feeling guilty. We also found that these symptoms, specifically, fear of weight gain, feeling like one is overeating, and feeling guilty predicted ED severity at a one- and six-month follow-up. Finally, we modeled 97 individual network models and found that central symptoms were highly heterogeneous, regardless of ED diagnosis. Overall, this work adds to the growing literature using intensive longitudinal data to model ED pathology and implicates fear of weight gain as a symptom needing further treatment development work. Additionally, this work contributes essential knowledge on how group and individual network modeling can be used to conceptualize the maintenance of EDs on the average and individual-level.

Sequencing Of Symptom Emergence In Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, And Purging Disorder And Relations Of Prodromal Symptoms And Risk Factors To Future Onset Of These Disorders
Yuko Yamamiya1, Christopher D. Desjardins2, Eric Stice3
1Temple University, Japan Campus, Tokyo, Japan, 2Saint Michael’s College, Colchester, VT, United States, 3Stanford University, Stanford, CA, United States

Both threshold and subthreshold Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), and Purging Disorder (PD) are harmful and chronic, so it is crucial to find at-risk individuals and implement preventions. We aimed to determine the emergence order of prodromal symptoms and predictive effects of prodromal symptoms and risk factors for the disorders. Methods: We collected data from 496 adolescent girls via a survey and monthly diagnostic interview over 7 years. Results: Among behavioral symptoms, compensatory weight-control behaviors, and as for cognitive symptoms, weight/shape overvaluation emerged first for all four disorders. Lower than expected BMI predicted AN onset, and weight/shape overvaluation, fear of weight gain, and feeling fat predicted BN, BED, and/or PD onset. BMI predicted AN and PD onset, and low social support, modeling of eating pathology, negative emotionality, thin-ideal internalization, pressure to be thin, dietary restraint, and body dissatisfaction predicted BN, BED, and/or PD onset. Predictive effects of prodromal symptoms and risk factors were similar though the former collectively showed higher predictive accuracy than the latter for all eating disorders. Conclusions: Cognitive symptoms and compensatory weight-control behavior seem to emerge first for eating disorders, suggesting it might be useful to screen youth for these early emerging symptoms and implement prevention programs that reduce these symptoms.

Bullying And Disordered Eating In Adolescent Girls: Evidence From A Twin Study
Lauren Breithaupt1,2, Baiyu Qi3, Laura M. Thorton3, Paul Lichtenstein4, Sebastian Lundstrӧm5, Cynthia M. Bulik 3,4, Melissa A. Munn-Chernoff3
1Massachusetts General Hospital, Boston, MA, United States, 2Harvard Medical School, Boston, MA, United States, 3University of North Carolina Chapel Hill, Chapel Hill, NC, United States, 4Karolinska Institutet, Stockholm, Sweden, 5University of Gothenburg, Gothenburg, Sweden

Weight-related teasing, a specific type of bullying, has been identified as a risk factor that moderates genetic vulnerability for disordered eating. Bullying is a modifiable environmental factor, thus, an ideal target for intervention. This study investigated genetic and environmental contributions underlying bullying and disordered eating in Swedish female twins.
Participants (3331 twin pairs) completed measures of bullying at age 15 and disordered eating at ages 15 and 18. For phenotypic correlations above a threshold of 0.20, we used a bivariate twin design to examine shared genetic and environmental risk between bullying and disordered eating. Only phenotypic correlations with bullying and disordered eating at age 15 met our threshold for twin modeling, and the best-fitting models included only genetic and unique environmental factors. The heritability of being a bully victim was 0.33 (95% CI: 0.29, 0.38); the heritability of disordered eating was 0.67 (95% CI: 0.64, 0.70). Genetic and unique environmental factors significantly influenced the association between bullying and disordered eating (genetic correlation=0.24 [95% CI: 0.17, 0.32], environmental correlation=0.19 [95% CI: 0.14, 0.25]).  We demonstrate that both genetic and environmental factors not shared between cotwins for bullying and disordered eating exist. Bullying represents a modifiable environmental factor for vulnerability to disordered eating.

1:30 - 3:00 PMRoom 2
Paper Session 2: Treatment

Chair(s): Jennifer Wildes
Using Digital Health Technology To Improve Skill Utilization And Acquisition In Cbt
Adrienne S Juarascio1,2, Emily Presseller1,2, Paakhi Srivastava1, Stephanie Manasse1, Evan Forman1
1Well Center, Drexel University, Philadelphia, PA, United States, 2Department of Psychology, Drexel University, Philadelphia, PA, United States

 Digital health technologies (DHTs) have high potential to promote between-session skill utilization and acquisition when used as a treatment augmentation to outpatient CBT for eating disorders, yet little is known about which specific technological components of DHTs may be beneficial. We completed a pilot study to test the independent efficacy of just-in-time adaptive interventions, a micro-intervention delivery system that collects real-time data about both triggers and behaviors and uses advanced algorithms to deliver tailored interventions. Methods Treatment-seeking adults (N=56) with bulimic spectrum disorders received 16 sessions of CBT and were randomized to also use a DHT called CBT+ that had JITAIs-Off or JITAIs-On. Results Across both conditions, we found high acceptability, low rates of drop-out, and high use of the app throughout treatment. The independent efficacy of JITAIs was partially supported such that the frequency of binge episodes was nearly twice as high by 3-month follow-up in the group that had JITAIs-Off compared to JITAIs-On but no difference was observed in global eating pathology. Patients with higher baseline impulsivity and higher emotion dysregulation had significantly larger improvements in global eating pathology if they received JITAIs. Conclusion JITAIs appear potentially effective at improving outcomes (particularly for certain subsets of patients) and are worthy of additional study as a treatment augmentation to CBT.

Hoop Training: A Novel Treatment Approach For Body Image Disturbance In Anorexia Nervosa
Anouk Keizer1, Manja Engel1, José Bonekamp2, Annemarie van Elburg1,2
1Utrecht University, Utrecht, Netherlands, 2Rintveld Centre for Eating Disorders Altrecht, Zeist, Netherlands

We previously showed that AN patients move their body as bigger than it actually is: The size of their body is stored in their brain as enlarged. When presented with feedback on actual body size the brain is able to update faulty representations. Pregnant women tend to underestimate their size and bump into objects, providing direct feedback for the brain. AN patients show the opposite, they overestimate their size and are thus unlikely to collide. Consequently, their brain misses direct feedback and the opportunity to adjust the stored size of the body. We developed and pilot tested a new intervention to tackle this issue. Patients faced different sized hoops. They were instructed to choose the hoop that would exactly fit around their body and challenged to step inside the hoop and move/squeeze through it. As such the brain was given very direct feedback about actual body size. Methods. We assessed cognitive, visual, tactile and body-scaled action aspects of body image disturbance before and after completion of hoop training. 12 AN patients completed treatment as usual (TAU), 14 completed hoop training in addition to TAU. Results. Patients who completed the hoop training improved more on body image disturbance tasks (tactile & body-scaled action) from baseline to follow-up than patients who completed only TAU. Conclusions. Taken together, an intervention in which the full spectrum of body image disturbances in AN is targeted has a unique added effect over TAU. 

Early Changes In Depressive Symptoms During Psychological Treatment Predict Recovery From Eating Disorders
Glenn Waller1, Peter Chang1, Caroline Bell2, Jaime Delgadillo1
1University of Sheffield, Sheffield, United Kingdom, 2Freed Beeches Eating Disorders Service, Worksop, United Kingdom

Purpose: Early response to psychotherapy is a key indicator of successful treatment outcomes in patients with eating disorders. However, the mechanisms underlying this link are not well understood. This study examined early response across multiple symptom domains.   Methods: Data from 141 patients accessing psychological treatment for eating disorders were analysed using hierarchical logistic regression, examining early response in eating disorder pathology (EDE-Q), depression (PHQ-9) and anxiety (GAD-7) as predictors of post-treatment recovery (reliable and clinically significant improvement in EDE-Q), controlling for baseline severity across all domains.   Results: Early changes in eating pathology appeared to be associated positively with treatment outcome. However, a fully adjusted multivariable regression analysis indicated that early change in depression was the single most reliable predictor of post-treatment outcomes. Patients showing early improvements in depression symptomology were at least four times (odds ratio = 4.68 [1.63, 13.44], p <.01) more likely to attain full remission of eating disorder pathology after treatment, compared to those without early response. Hidden formatting deleted.   Conclusions: The findings suggest that clinicians should routinely monitor early changes in depression symptoms as well as in eating pathology.

Elevated Reward Regions Responsivity To Thin Models, But Not High Calorie Foods, Predicts Persistence Of Eating Disorder Symptoms: A Prospective Fmri Study  
Sonja Yokum1, Eric Stice2
1Oregon Research Institute, Eugene, OR, United States, 2Stanford University, Palo Alto, CA, United States

1. Introduction.
 Because few studies have identified biological factors that predict persistence of eating pathology, we tested whether elevated responsivity of brain regions implicated in reward valuation to thin models and high-calorie binge foods would prospectively predict persistence of eating disorder symptoms. 2. Methods. We analyzed data from 120 women with threshold or subthreshold anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder who completed fMRI scans assessing neural response to thin models and high-calorie binge foods at baseline, were randomized to an eating disorder treatment or a waitlist control condition, and completed diagnostic interviews that assessed change in eating disorder symptoms over a 2.5-month follow-up.   3. Results. Elevated left ventrolateral prefrontal cortex response to thin models predicted future persistence of compensatory behaviors. Elevated parahippocampal gyrus and hippocampus response to thin models predicted future persistence of an eating disorder symptom composite. Elevated activation in the right hippocampus, extending into midbrain, in response to thin models predicted future persistence of binge eating. 4. Conclusions. Results suggest that overvaluation of the thin ideal, but not overvaluation of high-calorie foods, increases risk for persistence of eating disorder symptoms. Results imply that treatments should seek to reduce overvaluation of the thin ideal.

Accountability In Promoting Diversity Of Underrepresented Populations In The Eating Disorders Field
Karen Jennings Mathis1, Neha J Goel2, Amy Egbert3, Andrea K Graham4, Lauren E Breithaupt5, Kamryn T. Eddy5, Debra L Franko6
1University of Rhode Island, South Kingston, RI, United States, 2Virginia Commonwealth University, Richmond, VA, United States, 3Brown University, Providence, RI, United States, 4Northwestern University, Chicago, IL, United States, 5Harvard University, Boston, MA, United States, 6Northeastern University, Boston, MA, United States

. Promoting diversity in underrepresented populations in the eating disorders field has been discussed for decades, with limited change. We propose a reinforcing feedback loop such that individuals from dominant cultures conduct research and deliver treatment; participate in research; and then receive diagnoses and treatment. In turn, this insularity maintains underrepresentation: eating disorders in diverse populations are understudied, undetected and undertreated. Further, individuals of diverse backgrounds are less likely to pursue a career in eating disorders. Methods. From the EDRS 2020 Early Career Workshop, "Racial and ethnic diversity in the eating disorders field," this diverse group of workshop moderators and speakers collaborated to further examine the topic. Results. Recommendations for change were identified; though not inherently novel, accountability for their implementation has not occurred and thus is critical going forward. This paper serves as a think tank for spearheading a paradigm shift from equality to equity and diversity. We provide a theoretical framework, suggest means by which to break the cycle, and summarize action steps, all in the service of moving the field towards accountability. Conclusions. As a field we should develop and implement measurable metrics to assess our progress towards increasing diversity of underrepresented populations. We encourage focused efforts toward measurable and meaningful change.

Cognitive Behavior Therapy And Dialectical Behavior Therapy For Binge Eating Disorder: What Works For Whom?
Mirjam W. Lammers1,2, Maartje S. Vroling1,2, Ross D. Crosby3, Tatjana van Strien2
1GGNet-Amarum, Zutphen, Netherlands, 2Radboud University, Nijmegen, Netherlands, 3Sanford Center for Bio-Behavioral Research, Fargo, ND, United States

Introduction: The purpose of this study is to evaluate moderators of response to CBT and DBT for BED.
Methods: Patients with BED (N = 250) were treated with 20 weeks of group DBT or group CBT in a Dutch community eating disorder service. We chose moderators of treatment outcome that were previously found to moderate treatment outcome for BED, as well as moderators that are central to CBT and to DBT treatment models. Linear regression models (preliminary analyses) examined moderators of objective binge episodes at end of treatment and at 6-month follow-up after treatment. Results: Only overvaluation of body shape and weight interacted with treatment type to differentially predict outcome at end of treatment. Participants with low overvaluation of body shape and weight have better results in the CBT group at end of treatment. Other variables, including shape concerns, weight concerns, emotional eating, self-esteem and emotional dysregulation do not moderate treatment outcome. Conclusions: Individuals with BED and low overvaluation of body shape and weight may be more likely to benefit from CBT in the short term.

3:15 - 4:45 PMRoom 3
Symposium: Advances in Avoidant/Restrictive Food Intake Disorder (ARFID)

Chair(s): Elizabeth Lawson
Neurobiology Of Arfid
Jennifer Thomas
Massachusetts General Hospital

Behavioral Interventions For Young Children
William Sharp
Emory University School of Medicine

Family-Based Treatment For Arfid
James Lock
Stanford University School of Medicine

Rachel Bryant-Waugh

5:00 - 6:30 PMRoom 1
Paper Session 3: Neuroimaging

Chair(s): Sarah Fischer
In Vivo Amygdala Nuclei Volumes In Adolescents With Primary Restricting And Binge/Purge Profiles 
Lauren Breithaupt1,2, Amanda E. Lyall1,2,3, Clara Odilia Sailer1,2, Avery Van De Water3, Felicia Petterway1, Brynn Vessey3, Danielle L. Khan1, Kendra R. Becker1,2, Jennifer J. Thomas1,2, Franziska Plessow1,2, Laura Holsen2,3, Madhusmita Misra1,2, Elizabeth A. Lawson1,2, Kamryn T. Eddy1,2
1Massachusetts General Hospital, Boston, MA, United States, 2Harvard Medical School, Boston, MA, United States, 3Brigham and Women's Hospital, Boston, MA, United States

Anorexia nervosa(AN) and atypical AN(atAN) are defined by restriction and weight loss; half of patients will report binge/purge(BP) behaviors.These conditions effect the developing brain, particularly the amygdala. The amygdala includes 9 functionally distinct nuclei, although, prior research focuses only on the overall amygdala. We compared amygdala nuclei volumes in AN/atAN compared to healthy controls(HC). T1-weighted scans from females(aged 11-22 years) diagnosed with AN/atAN(N=63[37 AN, 26 atAN; 13 with BP]) and HC(N=32) were processed with FreeSurfer. We examined overall and between group differences in 9 amygdala nuclei. All models used false discovery correction at p <0.05. Individuals with AN and atAN had lower volume in the right cortico-amygdaloid transition area(CATA) compared to HC(p=0.003). Reductions in right CATA were most pronounced in AN/atAN with BP symptoms. CATA volume was negatively associated with drive to eat(r=-0.58, p=0.03) and positively associated with binge/purge frequency over the past 3-months(r=0.9, p=0.05) in the AN/atAN group. No other differences in amygdala subfields persisted after correction. No other between-group differences in amygdala nuclei were observed. Volume of the CATA, which is involved in assessment of negative emotions, was reduced in those with AN/atAN relative to controls. CATA volume reductions may contribute to inhibited expression and identification of negative emotions reported in low-weight eating disorders.

Structural Connectivity Within Frontostriatal And Frontolimbic Brain Circuits In Anorexia Nervosa
E. Caitlin Lloyd1,2, Karin E. Foerde1,2, Alexandra F. Muratore1,2, Natalie Aw1,2, David Semanek1,2, Jonathan Posner1,2, Joanna Steinglass1,2
1New York State Psychiatric Institute, New York, NY, United States, 2Columbia University Irving Medical Centre, New York, NY, United States

Purpose: Altered functional connectivity within frontostriatal and frontolimbic brain circuits is hypothesized to underlie symptoms of anorexia nervosa (AN). Abnormalities in functional connectivity may be related to structural connectivity between the same brain regions. Here we tested whether the strength of white matter tracts within frontostriatal and frontolimbic circuits differed among individuals with AN relative to healthy controls (HC), using data from a large, multi-study, sample. Methods: Diffusion-weighted MRI data acquired from females with AN (N = 143) and HC (N = 108) was combined across four studies. Probabilistic fiber tracking was completed, and full cortex connectomes describing streamline counts generated. Connectome data were harmonized to account for scanner differences across studies. Linear regression models compared AN and HC on streamline counts within 18 ipsilateral tracts of interest (9 per hemisphere) that connect prefrontal regions with striatal/limbic structures. Results: Patients with AN had a lower streamline count in the tract connecting the left medial orbitofrontal cortex (OFC) with the left amygdala, and in bilateral connections between the lateral OFC and caudate (p <0.05). Conclusions: Findings support reduced structural connectivity within certain frontostriatal/frontolimbic tracts amongst individuals with AN relative to HC. Identified differences may affect coordinated activation of brain regions, and in turn, AN pathology.

Altered Neurobehavioral Responses To One-Shot And Iterated Social Interactions In Bulimia Nervosa
Carrie J McAdams1, Yi Luo2, Carlisdania Mendoza1, Terry Lohrenz2, Xiaosi Gu3, P. Read Montague2
1UT Southwestern Medical Center, Dallas, TX, United States, 2Fralin Biomedical Research Institute, Roanoke, VA, United States, 3Icahn School of Medicine at Mount Sinai

Social stressors influence the development and maintenance of bulimia nervosa (BN), but the neural mechanisms that mediate these responses within individuals are unknown. Social behaviors require learning social norms through single transactions with many different people as well as repeated interactions with specific people to establish longer-term relationships. Methods: Two neuroeconomic games, the ultimatum game (UG) and a multi-round trust game (MRT), evaluated neurobehavioral responses from 24 women with BN and 26 healthy comparison women (HC). The UG probes responses to the one-shot social interactions that create expectations about a social environment, while the MRT investigates responses to improving or deteriorating of a specific relationship. Results: In the UG, BN rejected more better-than-expected offers than HC, with no difference for worse-than-expected offers. A region in medial orbitofrontal cortex that tracks prediction errors (PE) in healthy people was not modulated for positive PE in BN. In the MRT, more negative behavioral responses and stronger neural activations were observed in both cortical and subcortical regions in BN relative to HC, with no differences for positive interactions. Conclusions: Both reduced learning from positive social signals and increased responsivity for individual negative interactions may contribute to altered social behaviors in BN. Targeting these specific social cognitive problems may be important in treatment.

Higher Body Dissatisfaction Is Associated With Lower Cognitive Flexibility And Higher Neural Activation Of The Dorsolateral Prefrontal Cortex In Young Women With Eating Disorders Characterized By Dietary Restriction And/Or Excessive Exercise
Franziska Plessow1, Poornima Kumar2, Adrienne Romer2, Daifeng Dong2, Meghan Lauze1, Meghan Slattery1, Nadia Micali3, Diego Pizzagalli2, Madhusmita Misra1,4, Kamryn T. Eddy5
1Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States, 2Center for Depression, Anxiety, and Stress Research, Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, MA, United States, 3Child and Adolescent Psychiatry Division, Department of Psychiatry, Geneva University Hospitals and University of Geneva, Geneva, Switzerland, 4Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, United States, 5Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

Introduction: Individuals with eating disorders characterized by dietary restriction and/or excessive exercise (ED-R/E) show higher cognitive rigidity than controls. However, whether the extent of cognitive flexibility, a cognitive control function modifiable with neurocognitive interventions, is associated with the level of ED pathology is unclear but important to establish as a first step towards the potential use of neurocognitive interventions in this population. We hypothesized that body dissatisfaction as a key driver of ED behaviors would be associated with lower cognitive flexibility and altered activation in the underlying cognitive control network. Methods: Thirty-three young women with ED-R/E (14-32 years, mean age±SD: 22.0±4.1 years) completed a Task Switching Paradigm with functional magnetic resonance (fMRI) imaging. Results: Higher body dissatisfaction was associated with higher switch costs (reaction times; r=0.37, p=0.035) and more fMRI activation in the dorsolateral prefrontal cortex (r=0.39, p=0.029), both controlled for depressive symptoms (BDI-II Total Score). Conclusions: In young women with ED-R/E, higher body dissatisfaction is associated with lower cognitive flexibility accompanied by an increased activation of the main neural correlate of cognitive flexibility, indicating an enhanced neural effort that does not compensate for performance decrements. Follow-up studies are needed to establish the causality of this cross-sectional relationship.

Effects Of Autism On 30-Year Outcome Of Anorexia Nervosa
Elisabet Wentz1, Sandra Rydberg Dobrescu2, Lisa Dinkler2, Carina Gillberg2, Christopher Gillberg2,3, Maria Råstam 2,4, Søren Nielsen5
1Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden, 2Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden, 3Department of Child and Adolescent Psychiatry, University of Glasgow, Glasgow, United Kingdom, 4Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden, 5Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark

Purpose: To investigate the long-term consequences of autism (ASD) in individuals with anorexia nervosa (AN) Methods: In the 1980s, 51 adolescent-onset AN cases (AN group) and 51 matched controls (COMP group) were recruited from the community. They have been examined on five occasions. The four last assessments included the Morgan-Russell Outcome Assessment Schedule (MROAS) to assess outcome. The MROAS covers subscales pertaining to weight, dieting, menstruations, mental, psychosexual and socioeconomic state. At age 44, when 30 years had elapsed, MROAS data were compared with previous results. At age 16, 21, 24 and 32 years, a blinded rater checked whether ASD criteria were met. In the present study a dose-response model was used to evaluate the impact of ASD on MROAS. Results: Already ten years after AN onset, core anorectic symptoms in the AN group were on a par with the COMP group. The improvement was limited to those who never had had ASD. In all studies the AN group was more negative to sexual matters, and rated worse on ‘mental state’, ‘personal contacts’, ‘social contacts,’ and ‘employment record’, and the more often ASD had been present the worse the outcome regarding ‘personal contacts’, ‘social contacts,’ ‘employment record’ and ‘emancipation from family’ (only at ages 32 and 44). Conclusions: Mental health, psychosexual, and socioeconomic status are compromised up to 30 years after AN onset. Coexisting ASD contributes to the poor outcome. 

5:00 - 6:30 PMRoom 2
Paper Session 4: Biology

Chair(s): Debra Franko
Avoidance, Reward, And Flexibility (Oh My!): Latent Profile Analysis Of Putative Neurocognitive Maintenance Factors In Youth With Anorexia Nervosa
C. Alix Timko1, 2, Birkan Tunc1,2, Amanda Makara2, Marita Cooper2, John Herrington1,2, Benjamin E. Yerys1,2
1Dept. of Psychiatry, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States, 2Dept. of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Avoidant behavior, disruptions in reward, and inflexibility are hypothesized in the maintenance of anorexia nervosa (AN). However, it is unclear whether these traits are relevant to/impacted by the onset of AN in adolescence. We hypothesized that latent profile analysis (LPA) in youth with AN would yield profiles of these traits that are clinically salient and relate strongly to disease severity. Methods. 47 adolescents with AN (9 male; M age=15.79; SD=1.79) with a BMI z-score of -.50 (SD=.99) completed a baseline neurocognitive assessments as part of a larger study. Results. LPA (12 variables included) resulted in three distinct profiles (AIC: 1546.966, BIC: 1639.474). Profile 1 (N=6), had high avoidant behavior, low sensitivity to reward, and inflexibility. Profile 2 (N=15) had low avoidant behavior, moderate reward responsiveness, and strong flexibility. Profile 3 (N=26) had high avoidant behavior, high sensitivity to reward, and strong flexibility. BMI z-score and percent of goal weight were equivalent across groups. Profile 2 had significantly less eating disorder symptoms (EDE Global: M=1.70 SD=1.32) compared to Profile 1 (M=2.56, SD=2.13) and Profile 3 (M=3.51, SD=1.49, F(2,38)=5.70, p=.007, partial η2=.23). Conclusions. Preliminary analysis supports our premise that there may be latent profiles of vulnerability traits within the AN population, with distinct implications for etiology and treatment. 

The Gut Microbiota Is Differentially Associated With Weight Outcomes By Bariatric Surgery Type
Kristine Steffen2, Anthony Fodor3, Ian Carroll4, Dale Bond5, Heinberg Leslie1
1Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States, 2North Dakota State University, Fargo, ND, United States, 3University of North Carolina Charlotte, Charlotte, NC, United States, 4University of North Carolina Chapel Hill, Chapel Hill, NC, United States, 5Brown University, Providence, RI, United States

Introduction:  Bariatric surgery procedures’ weight outcomes differ among patients and by procedure. One potential mechanism for these variances is the gut microbiota.  This study explored whether pre-surgery (baseline) microbiota was associated with weight outcomes.  Methods:  Patients undergoing either a Roux-en-Y Gastric Bypass (RYGB) or sleeve gastrectomy (SG) at one of two clinical centers as part of an ongoing longitudinal trial provided fecal samples at baseline, 1 month, 6 months, and 12 months post-surgery for this analysis.  Samples were analyzed through metagenomic shot-gun sequencing and classified by the Kraken2 pipeline. Results:   Patients who underwent RYGB (n=52) lost 30.8% weight at 12 months post-surgery whereas those who underwent SG (n=30) lost significantly less weight at 24.7% (Wilcoxon p <0.001). At 1 month post-surgery we observed a significantly higher relative abundance of Proteobacteria associated with RYGB (Wilcoxon p<0.0001). Higher Proteobacteria relative abundance at one month was predictive of future percent weight change at months 6 (Kendall p<0.002; Spearman r = 0.34) and 12 post-surgery (p <0.0004; r=0.38).   Conclusions: Our results find that RYGB is more effective than SG and advance the hypothesis that part of this difference may be due to differences in the microbial community. These data suggest the future possibility of using the microbial community to predict patient outcome and inform procedure selection.

Differences In Taste (But Not Smell) Perception In Avoidant/Restrictive Food Intake Disorder Versus Healthy Controls
Stephanie G Harshman1,2,5, Madeline R Stull1,2, Megan Kuhnle1,2, Katherine Holman1, Olivia Wons1,2, Kristine Hauser1,2, Susan Erdman6, Madhusmita Misra1,2,4,5, Kamryn T. Eddy1,2,3, Nadia Micali7,8,9, Elizabeth A Lawson1,2,5, Jennifer J Thomas1,2,3
1Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States, 2Eating Disorders Clinical and Research Program, Boston, MA, United States, 3Department of Psychiatry, Harvard Medical School, Boston, MA, United States, 4Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, United States, 5Department of Medicine, Harvard Medical School, Boston, MA, United States, 6Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, United States, 7Great Ormond Street Institute of Child Health University College London, London, United Kingdom, 8Department of Psychiatry, Faculty of Medicine University of Geneva, Geneva, Switzerland, 9Department of Paediatrics Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland

Clinically, individuals with avoidant/restrictive (A/R) food intake disorder (ARFID) who present with sensory sensitivity describe an amplified sensitivity to smell and taste. However, this has not been systematically explored. We hypothesized that subjects with ARFID would have stronger olfactory and bitter taste perception compared to controls. We evaluated children/adolescents with ARFID (n=82, 46.2% female, 15.8±3.8yrs) and healthy controls (HC; n=30, 59.3% female, 17.0±4.5yrs). We measured olfactory performance by Sniffin' Sticks test; bitter taste perception by 6-N-Propythiouracil (PROP) taste test; ARFID profiles on the Pica, ARFID and Rumination Disorder Interview (PARDI); and food fussiness on the Adult Eating Behavior Questionnaire. Statistical analyses included t-test, Spearman’s correlations, and stepwise regression. There was no difference in olfactory performance between groups. However, greater severity of A/R eating (r=-0.3, p=0.01) and food fussiness (r=-0.2, p=0.03) were correlated with poorer olfaction. Subjects with ARFID had greater bitter taste perception (ARFID: 33.1±26.0; HC: 24.1±20.7;p=0.05). Stepwise regression found bitter taste perception was driven by the non-sensory A/R profiles. There were no significant correlations for olfaction or taste in HC. More research is needed to identify factors driving differences in chemo-sensory function in ARFID including the role of hormones, nutrition, genetics, and environment which may contribute to disease psychopathology.

Shifted Autonomic Indices Prior To Loss-Of-Control Eating: A Possible Biomarker 
Lisa M Ranzenhofer1,2, Soroosh Solhjoo3, E. Caitlin Lloyd1,2, Sharath Koorathota4, Brittany H. Kim1,2, B. Timothy Walsh1,2, Mark Haigney3
1New York State Psychiatric Institute, New York, NY, United States, 2Columbia University Irving Medical Center, New York, NY, United States, 3Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 4Columbia University, New York, NY, United States

PURPOSE: Stress and inhibitory control deficits may contribute to loss-of-control (LOC) eating. Autonomic indices, including heart rate (HR) and heart rate variability (HRV), may reflect stress and capacity for inhibitory control in response to stress. METHOD: We examined associations between pre-meal HR/HRV and LOC eating in adolescents in the natural environment. Adolescents with BMI %ile ≥70th and recurrent LOC-eating wore biosensors to monitor HR, HRV, and physical activity (PA) for 1 week. After eating, adolescents rated LOC from 0 to 100. Linear Mixed Models (LMM) included time of day, PA, and either HR or HRV. To parse between- and within-subjects’ effects, follow-up LMM included each subject’s average HR/HRV and momentary deviation from person-average. RESULTS: 25 adolescents (68% female; age 15.7±1.7 years) rated LOC 2.5±1.1 times/day for 6.7±0.8 days. Average LOC was 26.6±25.3 across 238 episodes. Controlling for time of day and PA, higher HR predicted LOC (p<0.01). Between- (p=0.05) and within-subjects’ (p=0.04) effects were significant. Controlling for the same covariates, lower HRV on two measures of HRV (RMSSD and pNN50) predicted LOC (p’s=0.02-0.04). Within-subjects’ effects were significant or marginally so (p’s=0.02-0.06). Magnitude of effects was small (i.e., a 10-beat increase in HR predicted a 5-point increase in LOC). CONCLUSION: Higher HR and reduced HRV may reflect a state of stress or reduced inhibitory control that may promote LOC eating. 

Examining Reward Valuation Differences In Anorexia Nervosa Binge-Purge Subtype And Bulimia Nervosa
Sophie R. Abber1,2, Austin Starkey3, Chloe Halfhide3, Jonathan Appelbaum4, Diana L. Williams4, Pamela K. Keel3
1Department of Psychology, Drexel University, Philadelphia, PA, United States, 2WELL Center, Drexel University, Philadelphia, PA, United States, 3Department of Psychology, Florida State University, Tallahassee, FL, United States, 4Department of Clinical Sciences, Florida State University, Tallahassee, FL, United States

Introduction: Anorexia nervosa, binge-purge subtype (ANbp) and bulimia nervosa (BN) are characterized by similar symptoms, but are distinguished on the basis of weight. Research supports altered reward responsiveness in both disorders, but it is unknown whether reward valuation differs between ANbp and BN.    Methods: Healthy controls (HC; n=37), individuals with ANbp (n=9), and individuals with BN (n=87) were recruited as part of a larger study. At separate study visits, participants completed progressive ratio tasks to earn: 1) M&Ms; 2) time playing Angry Birds in a fasted state; 3) time playing Angry Birds in a fed state.    Results: There were significant differences in breakpoint to earn M&Ms (F(2,129)=3.58, p=0.03), earn Angry Birds in a fasted state (F(2,130)=3.68, p=0.03), and earn Angry Birds in a fed state (F(2,130)=3.42, p=0.04). Participants with BN had a higher breakpoint than HC (p=0.04) and a marginally higher breakpoint than ANbp (p=0.05) when working for M&Ms. In a fasted state, BN had a higher breakpoint earning Angry Birds than HC (p<0.05) and ANbp (p=0.04). BN also had a higher breakpoint than ANbp (p<0.05) and a marginally higher breakpoint than HC (p=0.05) earning Angry Birds when fed.  
Conclusions: Preliminary finding suggest higher valuation for non-food rewards in BN versus ANbp that cannot be attributed to fears associated with food. Future research should examine other aspects of reward responsiveness in larger samples of ANbp and BN.

Sunday, September 19, 2021

9:00 - 10:30 AMRoom 1
Poster Session 2

Repressing Self-Needs: Eating Disorder Symptoms, Selflessness And Concern For Appropriateness
Rachel Bachner-Melman1,2, Lilac Lev-Ari2, Ada H. Zohar2, Yonatan Watermann2
1School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel, 2Clinical Psychology Graduate School, Emek Hefer, Israel

Introduction: Selflessness and concern for appropriateness involve repression of self-needs and have both been found to be associated with eating disorder (ED) symptoms in women. This study examines these associations for men as well as women, and their specificity to symptoms of ED rather than other psychopathologies - depression, anxiety, and somatization. Methods 236 volunteers (92 men) aged 18-76 (M=29.11, SD=10.10) completed measures of ED symptoms (EDEQ), concern for appropriateness (CFA), selflessness (SS), and symptoms of depression (PHQ-9), anxiety and somatization (BSI-18) online. Results: Women had significantly higher EDEQ, PHQ-9 and SS scores than men. SS and CFA scores were significantly and positively associated with all other study variables for women only, with correlations ranging between .16 (SS – CAS) and .47 (PHQ-9 – CAS). For women, the association between EDEQ and CFA scores was fully mediated, and the association between EDEQ and SS scores was partially mediated, by PHQ-9 and BSI-18 scores. The only significant correlation observed for men was between CFA and EDEQ (r=.22, *p<0.05). Conclusions: Repression of self-needs seems related to disordered eating for women but not men. While for women, concern for appropriateness seems associated with general symptoms of psychopathology, selflessness appears to be related more specifically to ED symptoms. The denial of self rather than the need to blend in socially may explain women’s disordered eating.

Protection Or Risk? : Self-Judgement Explains Eating Disorder Behaviors Over And Above Self-Compassion
Ege Bicaker, Sarah Racine
McGill University, Montreal, QC, Canada

Introduction: Research demonstrates the protective role of self-compassion for eating disorder symptoms. However, studies investigating self-compassion often rely on the Self-Compassion Scale, which has been criticized for aggregating the distinct but related constructs of self-compassion and self-judgement. Self-compassion refers to an understanding attitude towards oneself and involves a mindful awareness of difficult emotions. Conversely, self-judgement refers to a self-critical attitude and involves overidentification with distress. This study examined differential associations of self-compassion and self-judgement with a diverse range of eating disorder behaviors (i.e., binge eating, purging, restriction, and excessive exercise).
Methods: Participants were 324 female undergraduate students (M (SD) age = 20.29 (1.35) years) who completed measures of self-compassion, self-judgement, and eating disorder behaviors. Results: Self-compassion and self-judgement were moderately correlated (r = -.41). Self-judgement predicted all eating disorder behaviors controlling for self-compassion, whereas self-compassion did not predict any eating disorder behaviors uniquely. Conclusions: Results are consistent with studies showing that the presence of risk factors might outweigh the absence of protective factors in predicting psychopathology. Findings highlight the importance of primarily targeting negative self-relating in eating disorder interventions.

Binge Eating Triggered By Racism Not Race: Preliminary Findings From An Ecological Momentary Assessment Study With Young Black Women
Kristal L Brown1, 2, Andrea K Graham3, Jessica G LaRose1
1Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States, 2Department of Medicine, Johns Hopkins University, School of Medicine, Division of General Internal Medicine, Baltimore, MD, United States, 3Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Introduction: Racial discrimination (RD) is a stressor for Black women that has been linked to poor health outcomes including insufficient obesity treatment response. It is imperative that researchers use ecologically valid approaches to examine RD among young Black women. This study explored experiences of RD in the daily lives of young Black women and the proximal emotional/behavioral reactions following these experiences. Methods: Black women with overweight or obesity (N=22; 21.8+2.4 years; BMI=34.1+4.8 kg/m2) participated in a 14-day ecological monetary assessment (EMA) protocol with 3 daily prompts. Exposure variable was RD (yes/no). Following each exposure, participants were queried about negative affect (abbreviated PANAS), coping strategies and eating behaviors (loss of control, overeating, binge eating; assessed using questions from previous EMA studies). Preliminary analyses included frequencies and chi square tests. Results: The most frequent exposure to RD was via social media/television. Feeling upset (89.1%) was the most common affective response, and participants reported most commonly coping by "kept myself busy" (62.7%). Overeating, loss of control and binge eating all increased after reporting RD (3.7% vs 18.3%; 3.4% vs 12.9%; 3.1% vs 10.8%, respectively). Conclusion: Young Black women might use eating to cope with exposure to RD; interventions for binge eating among young Black women may benefit from assessing RD and addressing coping strategies. 

Race, Loss-Of-Control (Loc) Eating, And Body Weight In Relation To Negative Affect Among Non-Hispanic Black (Nhb) And White (Nhw) Youth
Meghan E. Byrne1,2, M. K. Higgins Neyland1,3,4, Natasha L. Burke5, Taylor N. Swanson2,4, Eliana Ramirez2, Esther A. Kwarteng2, Loie M. Faulkner2, Kweku G. Djan2, Megan N. Parker1,2, Lisa M. Shank1,2,3,4, Natasha A. Schvey1, Lauren B. Shomaker6, Sheila M. Brady2, Tracy Sbrocco1, Marian Tanofsky-Kraff1,2,3
1Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 2Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States, 3Military Outcomes Cardiovascular Research, Bethesda, MD, United States, 4Metis Foundation, San Antonio, TX, United States, 5Fordham University, Bronx, NY, United States, 6Colorado State University, Fort Collins, CO, United States

Introduction: NHB and NHW children and adolescents do not differ in physiology. Yet, race is a construct that consistently predicts psychosocial and health outcomes. LOC-eating and negative affect (NA) are common in youth with high weight. However, social inequity and related stressors may render NHB youth even more vulnerable to NA. Yet, how race, weight, and LOC interact in relation to NA is unclear. Methods: 530 youth (13.4±2.6y; 41% NHB; 1.1±1.1 BMIz; 36% with LOC) self-reported trait anxiety and depression. LOC was assessed by interview and adiposity was measured objectively. Analytic models predicted anxiety and depression from the main, 2-way, and 3-way interactional effects of LOC, race (NHB, NHW) and BMIz or adiposity, adjusting for socioeconomic status, age, and sex. Results: The 2-way interactions of race by BMIz and race by adiposity were significant for anxiety, with stronger positive relationships between BMIz/adiposity and anxiety among NHB youth (ps=.02). Race by adiposity was similar for depression (p=.02), but not race by BMIz (p=.20). No main or interactional effect was significant for LOC (ps>.19). Conclusions: Higher adiposity, but not LOC, was related to anxiety/depression in NHB but not NHW youth. Mechanisms to explain these relationships, such as stress from perceived discrimination and stress-related inflammation, should be explored. These data lend support to the importance of studying impacts of social inequities on psychosocial and health outcomes.

Affective Antecedents And Consequences Of Unhealthy Exercise In Eating Disorders:  Combining Actigraphy & Ecological Momentary Assessment
Danielle A. N. Chapa1, Kelsie T. Forbush1, Kylie Christian1, Ross D. Crosby2, Christopher C. Cushing1, Kandace K. Fleming1, Rebecca E. Swinburne Romine1
1University of Kansas, Lawrence, KS, United States, 2Sanford Research, Fargo, ND, United States

1. When present, unhealthy exercise is associated with more severe eating-disorder (ED) psychopathology, slower rates-of-recovery, and faster rates-of-relapse. The identification of antecedents and consequences associated with unhealthy exercise among persons with EDs is the first step towards developing personalized, mHealth interventions that can be sent to individuals with EDs.  2. The objective of this study was to identify the function of unhealthy exercise relative to temporal changes in affect through a 7-day ecological momentary assessment study of women with EDs who engaged in frequent unhealthy exercise (N=84) using the CentrePoint Insight medical-grade actigraph wrist watch.  3. Positive affect (PA) significantly increased in the hours prior to exercise and decreased after exercise. Negative affect (NA) significantly decreased in the hours prior to exercise and increased after exercise.  4. The current study offers preliminary longitudinal evidence that exercise may have a negative impact on mood for a subset of individuals with an ED. Results of this study have important implications for unhealthy exercise conceptualization and treatment. For example, in the moments when individuals are planning or preparing to engage in exercise (i.e., when PA increases), they could be prompted with alternative coping strategies or tips for how to exercise in a more healthful way.     

Symptom Presentation In Cisgender And Gender Minority Children And Youth With Eating Disorders
Jennifer S Coelho1,2, Janet Suen1, Alex Burns1, Pei-Yoong Lam1,3, Sheila Marshall3,4, Josie Geller2,5
1Eating Disorders Program, BC Children's Hospital, Vancouver, BC, Canada, 2Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, 3Division of Adolescent Medicine, 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

Purpose. To address gaps in knowledge about eating disorder symptoms across the gender spectrum, a prospective study was conducted to assess symptoms in cisgender and transgender youth with eating disorders. Methods. All cisgender male youth and gender minority youth who were admitted to one of two specialized eating disorders programs were invited to participate. Cisgender female youth were matched to cisgender male youth based on age, symptom presentation, and treatment type. Participants completed measures that captured a range of eating disorder symptoms, including muscularity concerns. Results. Participants included 27 cisgender male, 28 cisgender female, and 6 gender minority youth. Kruskal-Wallis tests were conducted. No differences emerged between cisgender male and female youth on eating disorder symptoms, including muscularity concerns. Gender minority youth reported higher scores on the EDE-Q and subscales of the Male Body Attitudes Scale than cisgender youth. No differences emerged between samples for muscularity or overexercise concerns. Conclusions. Similar levels of muscularity concerns were reported in cisgender and gender minority youth, whereas gender minority youth reported significantly higher eating disorder symptoms in other domains.  This study provides insight into symptom presentation on measures that were developed to address concerns about the female-centric nature of questionnaires in the field. Research on treatment outcomes in this sample is ongoing.

Grazing'S Frequency And Associations With Loss Of Control Eating, Psychopathology, And Weight Related Variables In Clinical And Community Contexts: A Systematic Review.
Eva Conceição1, Marília Marília2, Lourdes Marta1, Jéssika Alves2, Carmen Neufeld2
1University of Minho, Braga, Portugal, 2University of São Paulo, São Paulo, Brazil

Grazing is described as the repetitive and nonplanned consumption of small amounts of food, not in response to hunger/satiety sensations. This study identifies and reviews studies examining the frequency of grazing in clinical and community samples, and investigates its relationship with loss of control (LOC) eating, psychopathology, and weight-related variables.  This systematic review followed the PRISMA guidelines. Only 18 of a total of 138 articles meet the inclusion criteria and were considered for analysis. Grazing is present in clinical (11.9% – 46.6%) and community samples (14.1% – 85.9%). Current literature presents inconsistency in the definitions of grazing – particularly regarding its association with LOC – resulting in mixed results about its association with the different variables of interest. When studies distinguish between grazing with/without LOC, there is increasing evidence to support associations between compulsive-grazing (with LOC) with increased eating-related psychopathology, psychological distress, health-related quality of life, and weight-related variables. This literature review supports the need to considered grazing as a well-established concept that should be addressed in a continuum spectrum of LOC and eating-disorder psychopathology. Given its associations with psychopathology and weight-related variables, it's crucial to include grazing in the assessments of obesity, bariatric, and eating-disorders patients. 

Validation Of The Eating Disorder Examination Questionnaire (Ede-Q) For Portuguese Bariatric Population
Eva Conceição, Ana Rita Vaz, Maria Inês Correia, Sofia Ramalho, Marta de Lourdes, Paulo PP Machado
University of Minho, Braga, Portugal

This study sought to analyze and compare the psychometric properties of different EDE-Q forms (7-, 8-, 18-, and 28-items) in bariatric surgery patients. Participants were 262 bariatric surgery patients assessed cross-sectionally in different moments (pre-surgery, 12- and 24-months follow-up). Participants completed the EDE-Q and self-report measures assessing disordered eating, grazing, psychological distress, and negative urgency. All EDE-Q forms showed good global internal consistency (α> .71). All EDE-Q forms showed good convergent validity in all assessment moments, nevertheless the EDE-Q28 and the EDE-Q8 presented the highest number of strong correlations (rsp≥0.4) with the assessed variables. Only the EDE-Q28 and EDE-Q8 allowed differentiating groups of patients reporting/non-reporting problematic eating behaviors which suggest good discriminant validity. Confirmatory factor analysis supports the proposed factor structure for all the EDE-Q forms, except for the EDE-Q8. EDE-Q8 followed by EDE-Q28, EDE-Q7, and EDE-Q18, respectively, revealed great sensitivity to change from pre- to 12-months follow-up (F(3,783)=37.68,p<.001).  In general, the EDE-Q28 presented good psychometric properties for bariatric surgery patients (before and after surgery). However, EDE-Q8 also seems to be a valid short-measure as, although it not be recommended for the study of subscales, it allows a discriminant screening between patients with and without clinically significant eating behaviors for bariatric samples.  

A Mixed Methods Exploratory Evaluation Of Burnout In Front-Line Staff Implementing Dialectical Behavior Therapy On A Pediatric Eating Disorders Unit
Jennifer Couturier, Zechen Ma, Liah Rahman, Cheryl Webb
McMaster University, Hamilton, ON, Canada

Introduction: Eating disorders are life-threatening illnesses that commonly affect adolescents. The treatment of individuals with eating disorders can involve slow treatment progression and addressing comorbidities which can contribute to staff burnout. Dialectical behavior therapy (DBT) has emerged as a viable treatment option and has reduced staff burnout in several other settings. Our aim was to describe frontline staff burnout using mixed methodology on a DBT-trained combined inpatient/day hospital unit for pediatric eating disorders. 
Methods: Frontline staff were trained to provide DBT skills for adolescents with eating disorders.  Twelve months following the training and implementation, they completed the Copenhagen Burnout Inventory (CBI) and a qualitative interview.  Directed and summative content analyses were used. Results: Eleven frontline staff including nurses, child life specialists and child and youth workers participated.  The CBI revealed that only one staff member experienced high personal burnout, while another experienced high client-related burnout. Qualitative data indicated that all frontline staff felt DBT had the potential to reduce burnout.   Conclusions: Qualitative data indicate that staff believe that DBT may hold promise in reducing burnout for pediatric frontline staff who treat children and adolescents with eating disorders. Further study is needed.

Associations Between Shame, Eating Disorder Symptoms, And Depression In A Preliminary Sample Of Women With Food Insecurity
Heather A Davis, Meredith Kells, Sophia Todorov, Jackie Kosmas, Jennifer E Wildes
University of Chicago Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, United States

1.     Introduction. Research indicates that individuals experiencing food insecurity (the state of being without reliable access to enough food or types of food needed to live a healthy life) report pervasive feelings of shame, a maladaptive, self-conscious emotion associated with various forms of psychopathology. Food insecurity also correlates with experiences of disordered eating, anxiety, and depression. Previous research has not yet examined associations between shame, disordered eating, depression, and anxiety symptoms among women experiencing food insecurity. 2.     Methods. Self-report data from community women currently experiencing food insecurity [n = 26; mean (SD) age = 41.58 (14.32) years; 57.7% Caucasian, 27% Black, 11.5% Biracial, 3.8% Asian-American] were used to examine cross-sectional associations between shame, eating disorder, anxiety and depressive symptoms. Analyses included linear regressions predicting shame from various facets of disordered eating psychopathology, anxiety, and depression. 3.     Results. Shame was uniquely associated with elevated body dissatisfaction, binge eating, dietary restriction, and depression, but not anxiety, among women with food insecurity.  4.     Conclusions. Shame in the context of food insecurity is associated with disordered eating psychopathology and depression, similar to known associations among food-secure samples. Participant recruitment is ongoing (expected n = 100); results from the full sample of participants are forthcoming. 

Media Pressure, Body Image And Self-Esteem: Investigating The Protective Role Of Parent-Child Relationships  
Jolien De Coen, Sandra Verbeken, Lien Goossens
Ghent University, Ghent, Belgium

Research has shown that media contributes to the emergence of children’s body dissatisfaction. However, little is known about protective factors that may moderate this relationship. A secure parent-child relationship may help to attenuate negative emotions caused by media. Therefore, this study investigates the relationship between media pressure and children’s body image on the one hand and with self-esteem on the other, and the protective role of the parent-child relationship herein. A total sample of n=194 participants (60 % girls, aged 7-10) was questioned. Children filled out self-report questionnaires on body dissatisfaction, self-esteem, media pressure and attachment towards their parents. Media pressure was associated with more body dissatisfaction and less self-esteem. Higher scores on attachment towards their mother and father were associated with lower scores on body dissatisfaction and higher scores on self-esteem. However, attachment did not moderate the association between media pressure and body dissatisfaction or self-esteem. Follow-up of this sample is needed to further unravel how sociocultural and interpersonal variables interact to explain the course of body image problems. Currently, the majority of prevention and intervention programs for body image problems work at the level of the individual, however, more attention needs to be paid to the family environment.

Prediction Of Non-Suicidal Self-Injury Among Women With Bulimia Nervosa
Dorian R. Dodd, Ross D. Crosby, Li Cao, Kathryn H. Gordon, Stephen A. Wonderlich
Sanford Center for Biobehavioral Research, Fargo, ND, United States

Introduction: Nonsuicidal self-injury (NSSI) frequently co-occurs with eating disorders, especially bulimia nervosa (BN). Theoretical models and empirical evidence show many overlapping risk factors for the onset and maintenance of NSSI and BN. However, it remains unclear what distinguishes BN individuals who do engage in NSSI from those who do not. Methods: Using structural equation modeling we tested a parallel mediation model to predict NSSI among women with BN (N = 130). Childhood trauma (measured via a retrospective self-report questionnaire) was the independent variable. The four parallel mediators (measured at baseline via the Diagnostic Interview for Borderlines, Revised) were lifetime history of affect disturbances, impulsive actions, atypical cognitions (e.g., odd thinking, unusual perceptual experiences, quasi-psychotic and psychotic thinking), and interpersonal problems. The dependent variable was NSSI during a subsequent 2-week ecological momentary assessment protocol. Results: Childhood trauma was significantly associated with all four mediators (all p <.001), but only atypical cognitions predicted NSSI (p = .01). The indirect path from childhood trauma to NSSI, through atypical cognitions was also significant (path coefficient = .001, SE <.001, p = .02). Conclusions: Among women with BN, childhood trauma was associated with atypical cognition, which in turn predicted NSSI. Atypical cognition may be a risk factor or marker for NSSI in this population. 

Waiting Longer, Feeling Fatter: Effects Of Response Delay On Tactile Distance Estimation And Confidence In Females With Anorexia Nervosa
Manja Engel1, Stephen Gadsby2, Andrew W Corcoran2, Anouk Keizer1, Chris H Dijkerman1, Jacob Hohwy2
1Utrecht University, Utrecht, Netherlands, 2Monash University, Clayton, Australia

Research shows that anorexia nervosa (AN) patients overestimate their own body size. However, researchers are divided on whether this overestimation stems from perceptual or attitudinal differences. In this study, we investigated whether overestimation of tactile distances in AN results from perceptual or attitudinal influence, by measuring the role of allowed response time in an adapted version of the Tactile Distance Estimation task. We further investigated the relationship between allowed response time and participants’ confidence in their tactile judgments. Our sample consisted of females: AN (N = 30), recovered AN (REC) (N = 29) and HC (N=31). Participants were asked to estimate tactile distances presented on the skin of either a salient (abdomen) or non-salient (arm) body part, either directly after stimulus presentation (direct condition) or after a 5 second delay (delayed condition). Confidence of estimation accuracy was measured after each response. Results showed that allowing AN and REC more time to respond caused them to estimate tactile distances as larger than in the direct condition. Additionally, AN became less confident when given more time to respond. These results suggest that attitudinal influences cause AN to increase their estimates of tactile distances and become less certain of these estimates. Based on these results, we suggest that previous findings—where AN estimate tactile distances as larger than HC—may be due to attitudinal, rather than perceptual, differences.

Loss-Of-Control Eating, Negative Affect, And Within-Person Loc Variability Among Adults Undergoing Bariatric Surgery: Evaluation Via Ecological Momentary Assessment And Mixed Effects Location Scale Modeling
Hallie M. Espel-Huynh1,2,3, Dale S. Bond1,2,3, Andrea B. Goldschmidt1,2,3, Kathryn E. Smith4, J. Graham Thomas1,2,3
1Weight Control and Diabetes Research Center, Providence, RI, United States, 2The Miriam Hospital, Providence, RI, United States, 3Alpert Medical School of Brown University, Providence, RI, United States, 4Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States

PURPOSE: Loss-of-control eating (LOC) affects 17-64% of bariatric patients and relates to suboptimal postoperative outcomes. Little is known about factors contributing to LOC among bariatric patients. This study used ecological momentary assessment (EMA) to evaluate momentary associations between LOC and negative affect (NA) preoperatively. METHODS: Adult bariatric patients with LOC (N=45; 50% of sample) completed EMA of post-meal LOC and NA for 9.7±2.5 days. Mixed-effects location scale models examined whether: LOC associated with NA overall; NA associated with between- and within-person variability in LOC; and within-person LOC variability contributed to average LOC. RESULTS: In post-meal ratings, LOC positively associated with NA overall (p<.001). Between- (p<.001) and within-subjects (p<.001) effects of NA indicated that between- and within-person LOC variability increased with increasing NA; thus the experience of LOC was more inconsistent from person to person and within-persons when NA was higher. A random scale effect (p<.001) indicated that greater within-person LOC variability predicted higher average LOC across the EMA period. CONCLUSIONS: Consistent with results in eating disorders, NA was related to LOC in bariatric patients. Patients who varied more widely in their experiences of LOC tended to have higher overall LOC, and NA worsened LOC variability. Future research should examine contextual factors contributing to LOC variability and treatment implications.

The Association Between Disordered Eating And Musculoskeletal Injury Among Military Officers
Shannon L. Exley1, Natasha A. Schvey1, Emily Ricker2,3, Amelia S. Barrett2,3, Sarah J. de la Motte2
1Department of Medical and Clinical Psychology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 2Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 3Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States

Purpose Associations between disordered eating (DE) and musculoskeletal injuries (MSK-I), particularly among female athletes, have been documented. However, these associations have not been elucidated in military service members (SMs) who may be at high risk for both DE and MSK-I due to weight and fitness requirements. Method SMs (n=1,405; 24.8±2.9y; 11.5% female; 26.6% racial/ethnic minority) beginning a secondary officer training course completed the EDE-QS and reported the presence of an MSK-I in the preceding six months. A logistic regression, estimated with a generalized linear model, was used to assess the relationship between clinically elevated DE (EDE-QS ≥15) and recent MSK-I, adjusting for age, race, and sex. Results Seven percent were classified as having elevated DE (10.5% of females, 6.8% of males) and 18.2% reported a recent MSK-I. Adjusting for covariates, those with elevated DE were more likely to report a recent MSK-I (p=.005). Sex moderated this relationship (p=.02); among females, elevated DE was associated with four times greater odds of reporting a recent MSK-I (p=.009), whereas among males there was no significant association between elevated DE and MSK-I (p>.05). Conclusions Among female military officers, elevated DE was associated with greater odds of a recent MSK-I, which may pose a threat to military fitness and readiness. Future research should examine the female athlete triad (disordered eating, amenorrhea, osteoporosis) in female SMs.  

Body Dissatisfaction Prospectively Predicts Engagement In Purging Behavior In Bulimia Nervosa
Stephanie C. Fan, Adrienne Juarascio , Stephanie M. Manasse, Paakhi Srivastava
The Drexel University Center for Weight, Eating and Lifestyle Science (WELL Center), Philadelphia , PA, United States

Introduction Purging, a key symptom of bulimia nervosa (BN) is associated with serious medical complications. While most purging occurs in reaction to binge episodes, purging can occur outside of binge eating (BE), and maintain BN pathology. Thus, there is crucial need to identify additional maintenance factors of purging. One underexplored maintenance factor is body dissatisfaction (BD). The current study tests the hypothesis that 1) momentary increases in state BD will prospectively predict engagement in purging, and 2) engagement in purging will prospectively predict decreases in state BD. Methods Generalized estimating equations of 20 adults with BN spectrum disorder who completed an ecological momentary assessment assessing state BD, negative affect (NA), occurrence of BE, and purging (i.e., self-induced vomiting, laxative and diuretic misuse) over 2-weeks were conducted. Results Momentary increases in state BD at a timepoint significantly prospectively predicted engagement in purging behavior at the next timepoint when controlling for between-subject BD, BE and NA at a prior timepoint (ß=.63, p <.001, OR= 1.77). Engagement in purging behavior at a timepoint did not significantly prospectively predict decrease in state BD at the next timepoint after controlling for NA, BE and BD at a prior timepoint (ß= -.07, p=.22, d = .07). Conclusion If replicated, these findings suggest that worse state BD may be a risk-factor for purging and thus, may be targeted in treatment.

A Qualitative Analysis Of The Path To Practicing Self-Compassion
Avarna Fernandes1, Josie Geller1,2, Suja Srikameswaran1,2, Rachelle Pullmer1, Sheila Marshall3
1St. Paul's Hospital Eating Disorders Program, VANCOUVER, BC, Canada, 2University of British Columbia, Department of Psychiatry, VANCOUVER, BC, Canada, 3University of British Columbia, Department of Adolescent Health and Medicine, VANCOUVER, BC, Canada

Although self-compassion has been shown to facilitate eating disorder (ED) remission, significant barriers have been identified. As a result, the journey to practicing self-compassion remains elusive. While self-compassion focused interventions are available, no research has examined how patients experience the process of learning self-compassion. In order to learn how to best support individuals with EDs overcome barriers to self-compassion, patient perspectives were captured using qualitative methods. Methods: Eighteen individuals with a lengthy ED history (7 fully recovered, 11 in recovery-focused residential treatment) participated in audio recorded interviews. Participants described their understanding, experiences with, and barriers to self-compassion, and used a visual timeline to outline their recovery journey. Results: Three processes were identified, reflecting different levels of readiness. Challenging my beliefs involved overcoming cognitive barriers to the concept of self-compassion (i.e., coming to see self-compassion as helpful), and set the stage for dealing with the world around me and rolling up my sleeves, which reflected preparatory (i.e., freeing oneself from difficult life circumstances) and active (i.e., having the courage to do the work) change efforts, respectively. Conclusions: These findings may help clinicians and patients envision a roadmap of supportive processes that address different levels of readiness for self-compassion.

Perceived Changes In Orthorexia Symptoms During The Covid-19 Pandemic
Debra L Franko1, Rachel F Rodgers1, Laura E Fischer1, Matthew Fuller-Tyszkiewicz2
1Northeastern University, Boston, MA, United States, 2Deakin University, Melbourne, Australia

Introduction. Clinicians have raised concerns that the COVID-19 pandemic and related restrictions may exacerbate eating disorder risk in the general population due to increased negative affect and health concerns. The aim of this study was to explore perceived changes in orthorexia symptoms. Orthorexia nervosa is a new pattern of disordered eating behaviors characterized by preoccupations related to diet quality and health concerns, rather than by weight and shape concerns. Methods. A sample of N = 593 English speaking women, mean (SD) age = 29.66 (10.70) completed an online survey between April and August 2020, assessing current orthorexia symptoms, perceived previous levels of these symptoms, and current shape concerns and anxiety. Results. Findings revealed that participants reported experiencing significant higher levels of orthorexia symptoms (such as reporting a detrimental impact of rigid healthy eating patterns on functioning and relationships) during the pandemic compared to previously (p <.001). Body shape concerns, but not anxiety, was a significant predictor of current levels of orthorexia (p = . 012), controlling for reported previous levels. Conclusions. Findings provide support for increases in levels of disordered eating behaviors during the period of the pandemic. Furthermore, although orthorexia symptoms are conceptualized as being driven by concerns separate from appearance, investigation into the ways in which body image may be implicated in orthorexia symptoms is warranted.

The Power Of Feeling Seen: Perspectives On Validation From Individuals With Eating Disorders
Josie Geller1,2, Avarna Fernandes1, Suja Srikameswaran1,2, Rachelle Pullmer1, Sheila Marshall3
1St. Paul's Hospital Eating Disorders Program, VANCOUVER, BC, Canada, 2University of British Columbia, Department of Psychiatry, VANCOUVER, BC, Canada, 3University of British Columbia, Department of Adolescent Health and Medicine, VANCOUVER, BC, Canada

While improvements in self-compassion are associated with more favourable treatment outcomes in the eating disorders (ED), barriers are common. Validation may be central to overcoming these barriers. This research conducted an exploration of validation from patients’ perspectives to inform care provider actions that reduce barriers to self-compassion. Method: Semi-structured interviews were conducted with individuals with EDs (7 recovered, 11 in treatment). Participants identified barriers and facilitators to self-compassion and the importance of validation was highlighted. Thematic analysis focused on the meaning and impact of validation to participants. Results: Five themes were identified: i) made time and space for me, ii) offered a compassionate perspective, iii) understood and recognized my treatment needs, iv) showed me I can do this, and v) walked the runway. These themes were associated with four key participant experiences (feeling trust, cared for, empowered, and inspired), that facilitated participants’ development of self-compassion over time. Conclusions: This research provides insight into patient perspectives of validation and how care providers’ use of validation helped overcome barriers to self-compassion. Recommendations are offered that describe strategies care providers can use (e.g., compassionate reframing of difficult life experiences, matching intervention to readiness, modeling vulnerability) to facilitate the recovery journey.

Body Functional Questionnaire For Patients With Eating Disorders: Development, Validation And Psychometrics Properties  
Juanita Gempeler1,2, Maritza Rodriguez1,2, Sergio Castro1,2
1Equilibrio, Bogota, Columbia, 2Javeriana University, Bogota, Columbia

Body Image distortion is a core symptom in Eating Disorders (ED),usually resistant to treatment. We change the emphasis to the use of the body in a functional way beyond dissatisfaction or distortion measured with this new instrument.Objective: To develop, validate and define the psychometric properties of the Functional Body Questionnaire (FBQ).Methods: We evaluated Face Validity, Internal Consistency, Content validity. FBQ was applied to 120 patients with active ED and a control group. The internal consistency between items was calculated with the Cronbach’s Alpha, content validity was explored using a factorial analysis.Results: Cronbach's alpha was 0.88. KMO test was 0.84, and Barlett´s Test of Sphericity p<0.01. Factor analysis revealed three factors: Self-efficacy, distress tolerance and use of the body in context. Concurrent validity was confirmed analyzing the correlation coefficients between 8 items of the Body Satisfaction Questionnaire (BSQ) and the FBQ and were significant.Conclusion: The FBQ is an instrument of easy application that measure the ability of patients with ED to use their body in daily lifein a functional way. It eases the assessment of new learning and its cognitive reassessment through the application of techniques based on inhibitory learning.

Differential Associations Of Contamination Disgust And Eating Concerns Among Levels Of Fear Of Fat
William Grunewald , Shruti S. Kinkel-Ram, April R. Smith
Miami University, Oxford, OH, United States

1. Introduction.
Both contamination disgust, which refers to beliefs around being contaminated by certain objects/behaviors, and anti-fat attitudes, specifically fear of fat, are correlates of eating concerns (EC). However, research has yet to investigate these factors jointly with EC. Given associations between anti-fat attitudes and disgust sensitivity, as well as associations between these constructs and EC, it may be that individuals who evidence both contamination disgust and anti-fat fear have the highest EC. We tested this in the current study. 2. Methods. 173 college women (majority White/Non-Hispanic) completed study questionnaires in the lab. Analyses tested associations between contamination disgust, anti-fat attitudes and EC, as well as whether fear of fat moderated the association between contamination disgust and EC. Simple slopes were tested at ±1 SD of fear of fat.
3. Results.
At low fear of fat, contamination disgust was not significantly associated with EC. At high fear of fat, contamination disgust was significantly positively associated with EC.
4. Conclusions.
Both fear of fat and contamination disgust represent potential risk factors for EC when considered jointly. Given that negative attitudes towards higher body weight individuals are highly prevalent and rising, results suggest that contamination disgust may be more likely to lead to EC over time. Clinicians should intervene on these anti-fat attitudes to disrupt the pathway discovered in this study. 

Differences In Food-Based Decision Making In Individuals With And Without Binge Eating
Kelsey E Hagan1,2, E. Caitlin Lloyd1,2, Alice M. Xue3,4, Karin E. Foerde1,2, Joanna E. Steinglass1,2, B. Timothy Walsh1,2
1Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States, 2New York State Psychiatric Institute, New York, NY, United States, 3Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, United States, 4Department of Psychology, Columbia University, New York, NY, United States

Purpose: Binge eating is a common disordered eating behavior. We tested whether persons with and without binge eating differed in how they made decisions about what to eat using an experimental paradigm. Methods: Participants were United States-residing adults recruited via MTurk (= 1,054) who completed the EAT-26, TFEQ-18, and an online Food Choice Task. During the task, participants rated 46 food images on various attributes, including tastiness and healthiness. Participants then completed 45 consecutive binary food-choice trials, in which they choose a food they preferred to eat "right now" between a neutrally rated food and each of the other 45 foods. Tastiness and healthiness ratings and food choice were examined as a function of self-reported EAT-26 binge eating. Results: Participants with (= 359) and without (= 695) binge eating did not differ on tastiness and healthiness ratings. Participants with binge eating choose foods they rated as less healthy and less tasty, and exerted greater self-control over food choice (i.e., choosing a healthier food over a tastier food), even when controlling for cognitive restraint. Proportion of high- and low-fat foods selected did not differ as a function of binge eating. Conclusions: In persons with self-reported binge eating, the food choice task appears to capture undervaluation of food tastiness and healthiness when making decisions about what to eat in general, but may not capture specific characteristics of binge eating.

Burnout Among Staff On Eating Disorder Units  
Trine W Hage 1, Karin I Rø 3, Øyvind Rø1,2
1Oslo University Hospital , Oslo , Norway, 2Faculty of medicine , Oslo , Norway, 3Institute for Studies of the Medical Profession, Oslo , Norway

: Burnout is commonly associated with low workplace wellbeing. Patients with eating disorders are frequently referred to as a particularly challenging group to treat, and it is therefore important to study healthcare providers´ workplace wellbeing in settings which treat eating disorders. The aims of the current study were to a) measure burnout among healthcare providers working on specialized eating disorder units in Norway, and b) explore factors predicting burnout. Methods: 186 participants from 11 specialized eating disorder units in Norway completed an online survey including the Mashlach Burnout Inventory, and eating disorder-specific factors related to burnout, job satisfaction, work environment, emotional dissonance and stress. Multiple regression analysis was used to identify predictors of burnout. Results: Overall, low levels of burnout were found among the participants. Eating disorder-specific factors and emotional dissonance predicted the three central aspects of  burnout, namely, emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Conclusion: Findings suggest a relatively low level of burnout across age, gender, and professional categories working at specialized ED units, contrary to commonly-held assumptions pertaining to the challenges involved in treating individuals with EDs.

Associations Between Deployment And Disordered Eating In Transgender And Gender Diverse (Tgd) Military Personnel  
Nia Johnson1,2, Arielle T. Pearlman1, David A. Klein3,4, David S. Riggs1, Natasha A. Schvey1
1Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, United States, 2Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, United States, 3Department of Pediatrics, USU, Bethesda, MD, United States, 4Department of Family Medicine, Bethesda, MD, United States

: Disordered eating (DE) is prevalent in military service members (SMs) and may be exacerbated by deployment, specifically with combat-exposure. Persons identifying as transgender and gender diverse (TGD) are also at high-risk for DE, thus risk for TGD SMs may be multi-fold. We therefore assessed associations between prior deployment and DE in TGD active duty SMs. Method: In an online survey, SMs identifying as TGD completed the Eating Disorder Examination Questionnaire (EDE-Q) and a questionnaire about deployment history. A series of linear regressions, adjusting for age, gender identity, and race/ethnicity, were conducted to assess associations between prior deployments and DE attitudes and behaviors. Results: Of the 110 participants (Mage = 28.9y, 43.6% transfeminine, 20.8% racial/ethnic minority), 26% of the sample reported binge-eating and 34% reported compulsive exercise; the mean EDE-Q global score was 1.57. Few (2.2%) reported laxative misuse or purging. The majority (68%) reported one or more prior deployments; 50% reported at least one prior deployment to a combat zone. Adjusting for covariates, neither total deployments nor combat deployments were associated with DE attitudes or behaviors (ps≥.05). Conclusions: Findings did not support a link between prior deployments and DE among TGD SMs. Given that TGD SMs may be at elevated risk for DE, future research assessing DE attitudes and behaviors during, and immediately after, periods of deployment is warranted.

Compulsivity And Socio-Affective Features Of Compulsive Exercise In Anorexia Nervosa
David R Kolar1, Aleksandra Kaurin2, Adrian Meule1,3, Nina Dittmer3, Sandra Schlegl1,3, Ulrich Voderholzer1,3,4
1Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany, 2Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Witten, Germany, 3Schön-Klinik Roseneck, Prien am Chiemsee, Germany, 4Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany

Introduction: The present study investigates the role of compulsivity in a socio-affective maintenance model of compulsive exercise in Anorexia Nervosa (AN). To this end, we empirically test whether compulsivity increases the likelihood of compulsive exercise via socio-affective pathways in an inpatient sample of adolescents and adults with an (atypical) AN diagnosis. Methods: N = 207 female adolescent and adult patients diagnosed with AN were included. All patients underwent inpatient treatment and completed five assessments (= 1035 datapoints). We tested whether treatment phase within-person links between affect-regulatory difficulties and compulsive exercise were enhanced by dispositional compulsivity. We used multilevel structural equation modeling to test the hypothesis that compulsivity would predict a stronger dynamic link between difficulties in emotion regulation (DERS) or interpersonal sensitivity (IS) with compulsive exercise. Results: Overall, patients who generally experienced more DERS or stronger IS also tended to engage in more compulsive exercise. At the within-person level, the treatment phase coupling of DERS and IS with compulsive exercise was not stronger among those high in compulsivity. Conclusion: Compulsivity did not moderate temporal links of DERS or IS with compulsive exercise at the within-person level. Future studies might assess temporal links of compulsivity with compulsive exercise in daily-life using ecological momentary assessment.

Momentary Changes In Fear Of Weight Gain Are Associated With Maladaptive Exercise And Dietary Restriction Among Individuals With Binge-Spectrum Eating Disorders
Elizabeth W. Lampe1,2, Adrienne S. Juarascio1,2, Stephanie M. Manasse1
1WELL Center, Drexel University, Philadelphia, PA, United States, 2Department of Psychology, Drexel University, Philadelphia, PA, United States

Introduction. Binge-spectrum eating disorders (EDs) are thought to be maintained by increased fear of weight gain (FOWG) which can encourage use of ED behaviors through negative reinforcement. ED behaviors have also been theorized to maintain FOWG. However, no studies to date have examined prospective associations between FOWG and ED behaviors at a momentary level. Methods. The current study recruited 58 treatment-seeking adults with EDs to complete a 7–14-day ecological momentary assessment protocol assessing FOWG and ED behaviors. Generalized estimating equations examined associations between FOWG at time1 and ED behaviors at time2 and diagnosis was examined as a moderator. Results. Increases in FOWG also predicted dietary restriction, both by avoiding eating (β=.475, p=.04, OR=1.61) and limiting the amount eaten (β=.405, p=.001, OR=1.50). No significant associations were observed between FOWG and purging. Diagnosis moderated the association between FOWG and maladaptive exercise (β=.856, p=.01, OR=2.35) such that for each 1-point increase in FOWG, individuals with bulimia nervosa were more than twice as likely to engage in maladaptive exercise. Conclusions. Taken together, the above results indicate that FOWG is implicated in the maintenance of both maladaptive exercise and restriction, but not purging. Future interventions for EDs may be able to use these patterns to predict, and intervene on, ED behaviors in order to improve outcomes.

Aging With Appreciation: Towards Identifying Protective Factors For Disordered Eating Among Older Women
Katherine Laveway1, Rachel Berry1, Rachel F Rodgers1, 2
1APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, United States, 2Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France

Although disordered eating behaviors place increased health risks on older women, to date research on factors associated with these concerns is scarce in this age group, and the little existing work has mainly focused on risk rather than resilience factors.  This study aimed to examine the relations among positive body image and eating constructs on the one hand, and disordered eating on the other, within this age group as a preliminary step to identifying potential protective factors.  A sample of n = 241 women between the ages of 60-75, mean (SD) = 64.99 (4.2) years, were recruited via social media to complete an online survey about body image. Participants reported on body appreciation, intuitive eating, cognitive reappraisal of aging, body image related quality of life, and disordered eating. Higher levels of body appreciation (r = -.40), intuitive eating (r = -.41), cognitive reappraisal of aging (r = -.29), and body image quality of life (r = -.26) were significantly associated with lower levels of disordered eating. Pending replication in longitudinal data, these findings suggest that these positive aspects of body image and adaptive eating patterns may constitute protective factors for disordered eating in older women. Future research should aim to confirm these dimensions as potential targets for intervention among this age group.

Temporal Dynamics Of Impulsivity And Craving Before And After A Binge Eating Episode: Results From An Ongoing Experience Sampling Study
Nicolas Leenaerts1, Jenny Ceccarini2,3, Stefan Sunaert4, Elske Vrieze1
1Mind-body Research, Biomedical Sciences Group, KU Leuven, Leuven, Belgium, 2Department of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium, 3Leuven Brain Institute (LBI), KU Leuven, BelgiumLeuven Brain Institute (LBI), KU Leuven, Leuven, Belgium, 4Department of Radiology, University Hospitals Leuven & Department of Imaging and Pathology, KU Leuven, Leuven, Belgium

Introduction   Previous studies using the experience sampling method (ESM) have shown that negative affect increases before a binge eating (BE) episode and decreases afterwards. However, the temporal dynamics of impulsivity and craving in relation to a BE episode have not yet been investigated.   Methods   Female patients with bulimia nervosa (BN) were included in an ongoing ESM study. On specific days over a 1-year period, patients were asked questions about impulsive behaviors, craving for a BE episode as well as eating behaviors. A mixed-effects polynomial regression model with linear, quadratic and cubic functions was used to model the separate pre- and post-binge trajectories of the within-person effects of impulsivity and craving. Only the ratings from 4 hours before and after a BE episode were considered in the analyses.   Results   In total, 46 patients with BN (mean age = 22.4 ± 4.3, mean BMI = 25.2 ± 5.7) reported 338 BE episodes with 421 antecedent and 354 consequent ratings. Both impulsivity and craving increased before a BE episode. Impulsivity increased curvilinearly with a significant cubic effect (p = 0.108) while craving increased linearly with a significant linear effect (p = 0.009). Afterwards, both impulsivity and craving did not differ significantly from zero and remained constant.   Conclusion   These results point to an increase in impulsivity and craving before a BE episode while after a BE episode, impulsivity and craving return to baseline and remain constant. 

Within-Subjects Negative Affect And Eating Expectancies Predicting Binge Eating: Weight-Related Factors As Modertors
Tyler B Mason1, Wei-Lin Wang1, Kathryn E Smith2, Ross D Crosby3, Scott G Engel3, Stephen A Wonderlich3
1Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States, 2Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, United States, 3Sanford Health, Fargo, ND, United States

Aligned with state-based affect regulation models, within-subject elevations in negative affect (NA) and eating expectancies that eating will improve mood (EE) are predictive of binge eating. Yet, individual difference factors that may moderate these associations have yet to be identified. Given variations in weight and related factors (i.e., body mass index [BMI] and weight suppression) in women with eating disorder symptoms, this study explored interactions among individual differences in weight-related factors and within-subject deviations in NA and EE in predicting binge eating using ecological momentary assessment (EMA). Methods: Thirty women with binge-eating episodes completed anthropometric assessments, self-report questionnaires, and a 14-day EMA protocol. Results: There was an interaction involving within-subjects NA and weight suppression predicting binge eating (p<.001), and there was an interaction involving within-subjects NA and EE and BMI predicting binge eating (p=.01). Higher weight suppression and lower BMI strengthened the association between NA and EE in predicting binge eating. Conclusions: Findings support weight-related factors as modulating variables in within-subjects predictive models of binge eating. Women with a lower BMI and higher suppression may be more likely to engage in binge eating for affect regulation.

The Impact Of The Covid-19 Pandemic On Individuals With Pre-Existing Eating Disorders
Alexia E. Miller, Adrienne Mehak, Vittoria Trolio, Sarah E. Racine
McGill University, Montreal, QC, Canada

Introduction: The COVID-19 pandemic has been challenging for people with pre-existing mental health conditions, including those with eating disorders (EDs). This study explored whether (1) individuals with self-reported EDs experienced a worsening of symptoms during the pandemic, (2) certain COVID-19-related situational factors (i.e., level of social support, days of social distancing, information consumption) related to a greater impact of the pandemic on ED symptoms. Methods: Participants were 88 adults who reported a diagnosis of, or symptoms consistent with, an ED within the last year (i.e., 48 with anorexia nervosa (AN), 15 with bulimia nervosa (BN), 33 with binge eating disorder (BED), 6 with another type of ED). Participants completed an online questionnaire battery within the first 3 months of the pandemic. Results: A large proportion of the sample reported at least moderate symptoms of depression (72.5%), anxiety (48.7%), and stress (58%). Individuals with AN (M (SD)= 4.46 (1.81)), BN (M (SD)= 5.20 (1.93)), BED (M (SD)= 4.63 (1.76)), or another type of ED (M (SD)= 5.67 (1.63)) all reported a moderate impact of the pandemic on their ED symptoms (scale: 1 = not at all to 7 = very much). Of the COVID-19-related situational factors, a greater number of days of social distancing related to a greater impact of the pandemic on BN symptoms. Conclusions: As the pandemic continues, an increase in access to care and psychological support for individuals with EDs is critical.      

Validation Study Of An Emotion Regulation Task For Adolescent Female Patients With Eating Disorders – Value
Laura Mokros
LWL Clinic Hamm / Ruhr University Bochum, Hamm, Germany

Introduction. Deficits in emotional regulation (ER) seem to be a crucial factor in eating disorders (EDs) in adolescence. To get more insight about ER in juvenile EDs, a new task is validated, which uses films to induce emotions. This method has been shown to be valid to induce emotions in adults. Hypotheses: 1) The chosen filmclips induce the supposed emotions. 2) Instructions to reduce emotions result in a lower difference score (pre-post watching) on self-reports (VAS) and a physiological measure (EMG), compared to a "just watch" condition. Method. There are 2 randomized conditions (watch vs. regulate). Filmclips to induce anger, fear, sadness and happiness are presented. Subjects are either instructed to regulate their emotions or to simply watch the filmclips. VAS and EMG are recorded. Correlations and ANOVAs are used to measure reactions on the stimuli and compare both conditions and subjective/objective emotional experience. Results. It is an ongoing study. Data of 8 female, adolescent in-/outpatients with AN/BN have been collected, data analyses have not been executed yet. Conclusions. Feasibility of the task in youth with ED will be discussed.

Investigating An Interpersonal Model Of Eating Disorder Symptoms Using Structural Equation Modelling
Elizabeth Rieger, Katelin Bullman, Richard Burns
Australian National University, Canberra, Australia

Purpose: An eating disorder-specific model of interpersonal psychotherapy (IPT-ED) has been developed to identify the relevant interpersonal factors that drive eating disorder symptoms and hence should be targeted in treatment. The present study sought to provide a comprehensive evaluation of the validity of the IPT-ED model as well as testing possible refinements of the model. Methods: Females between the ages of 18 to 30 years
(N = 321) completed online self-report questionnaires examining the key constructs of the IPT-ED model, including negative social evaluation (both general and specific to body shape/weight), low self-esteem, negative affect, outcome expectancies regarding eating, and eating disorder symptoms. Results: Structural equation modelling indicated that the relationship between negative social evaluation and eating disorder symptoms was fully mediated by low self-esteem and negative affect. In addition, the relationship between negative affect and eating disorder symptoms was moderated by outcome expectancies regarding eating. Finally, eating disorder symptoms in turn predicted negative social evaluation. Conclusions: Results were generally supportive of the validity of the IPT-ED model, but also suggested that some refinements may be needed to more accurately inform interventions aimed at preventing and treating eating disorders.

Greater Appearance Overvaluation And Lower Body Satisfaction Are Reciprocally Related: Evidence From An Ecologically Momentary Assessment Study
Nassim Tabri1,2, Sarah Enouy1, Gail McMillan1
1Carleton University, Ottawa, ON, Canada, 2Mental Health and Well-being Research and Training Hub, Ottawa, ON, Canada

Appearance overvaluation and low body satisfaction are two distinct core psychopathologies of eating disorders. Although appearance overvaluation and low body satisfaction have been shown to be moderately and negatively correlated in cross-sectional research involving community and clinical samples, less is known about the temporal direction of their relationship, which we examined herein. Method: 20 undergraduate women—a vulnerable population to eating disorders—completed an ecological momentary assessment study in which they reported on their momentary levels of appearance overvaluation and body satisfaction at three random points between 9am and 9pm over seven days (N = 420 responses). An autoregressive cross-lagged dynamic structural equation model with Bayesian estimation was used to analyze the data. Noninformative priors were also used. Results: Participants who reported greater appearance overvaluation on assessment t – 1 reported lower body satisfaction on assessment t controlling for level of body satisfaction at assessment t – 1, β = -.13, 95% credible interval (CI) = [-.22. -.04]. Also, participants who reported greater body satisfaction on assessment t – 1 reported lower appearance overvaluation on assessment t controlling for level of appearance overvaluation at assessment t – 1, β = -.09, 95% CI = [-.16. -.02]. Conclusion: Greater appearance overvaluation and lower body satisfaction were reciprocally related and thus may intensify each other over time.  

The Preliminary Predictive Power Of Momentary Changes In Overvaluation And Fear Of Weight Gain On Purging In Bulimia Nervosa.
Lauren C. Taylor1, Elizabeth W. Lampe1,2, Evan M. Forman1,2, Stephanie M. Manasse1
1Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States, 2Department of Psychology, Drexel University, Philadelphia, PA, United States

Introduction. Purging (e.g., self-induced vomiting, laxative use, diuretic use), one of the most destructive behaviors in bulimia nervosa (BN), is thought to be maintained through overvaluation of body shape and weight (OSW) and a closely related construct, fear of weight gain (FOWG). However, it is unclear whether each, or both, play a momentary role in purging.   Methods. The current study recruited 24 adults (Mage =41.2, SD=16.3) with BN to complete a 7-14-day ecological momentary assessment protocol which asked about OSW, FOWG, and purging six times per day. A model using generalized estimating equations examined predictive associations of both OSW and FOWG with purging.   Results. We found that momentary increases in OSW (β=.46, SE=.41, p=.27, OR=1.58) and FOWG (β=.15, SE=.29, p=.59, OR=1.17) at time1 did not significantly predict purging at time2. Despite neither association reaching statistical significance, odds ratios suggest that momentary increases in OSW were a stronger predictor of purging than FOWG. Conclusions. Increases in OSW at time1 were associated with a greater likelihood of purging at time2 while increases in FOWG were less associated with an increased chance of purging. This suggests that addressing momentary increases in OSW may be more central to treating symptoms of BN than momentary increases in FOWG. Future research should replicate and extend these findings in a larger sample.

Gender Differences In Levels Of Disordered Eating Symptoms And Relationships With Eating Disorder-Related Clinical Impairment
Vittoria Trolio, Sarah E. Racine
McGill University, Montreal, QC, Canada

Introduction: Eating disorders (EDs) are marked by eating and body image disturbances resulting in clinically significant distress and/or impairment. In men versus women, body image disturbance is more likely defined by the desire to muscular versus the desire to be thin. Differences in body image foci may lead to different ED symptom presentations and associated levels of clinical impairment in men versus women. We compared ED symptom endorsement in men versus women and examined gender differences in relationships between ED symptoms and ED-related clinical impairment. Methods: Participants were 953 college students (54% female) who completed a battery of questionnaires. Results: Men reported greater excessive exercise and muscle building than women, and women reported greater body dissatisfaction and purging than men. No gender differences were found for binge eating and restriction. Body dissatisfaction and purging contributed to greater ED-related impairment in both men and women, while muscle building and binge eating uniquely predicted greater impairment in men and women, respectively. Excessive exercise was related to less ED-related impairment in men. Conclusions: Men and women not only report differences in types of ED symptoms, but different symptoms relate to more (or less) ED-related impairment in men versus women. ED interventions in college students should consider gender differences in the expression and consequences of ED symptoms.

Emotion Regulation And Psychological Distress As Mediators Of De Relationship Between Severity Of Eating Disorders And Impairment In A Clinical Sample Of Patients With Anorexia Nervosa
Ana R. Vaz1, Rita Ramos1, Adriana Fernandes1, António Neves2, Isabel Brandão3, Paulo PP Machado1
1School of Psychology, University of Minho, Braga, Portugal, 2Hospital de Santa Maria, Lisbon, Portugal, 3Faculty of Medicine, University of Porto, Polrto, Portugal

Introduction: The present study sought to identify variables that mediated the strength of the association between eating disorders (ED) severity and impairment in Anorexia Nervosa (AN).  This study aimed to test emotion regulation difficulties and psychological distress as mediators in the relationship between ED severity and clinical impairment. Also, we aim to find moderators of this association, namely duration of illness and body mass index.
Method: One hundred and ten individuals diagnosed with AN were recruited from two specialized units in Portugal. Participants were interviewed using the EDE interview and a clinical interview and answered Clinical Impairment Assessment, Eating disorders Evaluation Questionnaire, Outcome-45 Questionnaire, and Difficulties in Emotion Regulation Scale at intake assessment.  The macro PROCESS for SPSS was used to test the mediation and moderation models.  Results: Difficulties in emotion regulation and psychological distress were significant mediators of the relationship between ED severity and impairment. Additionally, BMI was found as a significant moderator of this relationship. No moderation effect was found for the duration of illness. Conclusion: This study highlights the link between ED severity, emotion regulation, and psychological distress and impairment and the need for addressing emotion regulation difficulties and psychological distress in treatment as possible targets for impairment secondary to ED severity. 

Gender Differences In Broadband Personality Among Community-Recruited Adults With And Without Disorders Characterized By Binge Eating 
Kristin M. von Ranson, Cynthia T. Gan, Stephanie E. Cassin, Sarah A. Hines, Chantelle A. Magel, Philip C. Masson, Amy E. Wojtowicz
University of Calgary, Calgary, AB, Canada

Personality has implications for treatment and prevention of eating disorders (ED) yet is understudied in men with ED. We compared personality traits associated with binge eating (BE) in women and men. Community women (BEW; n=128) and men (BEM; n=21) with BE (i.e., a BED or BN diagnosis) and healthy women (HW; n=106) and men (HM; n=32) completed the Structured Clinical Interview for DSM and the Multidimensional Personality Questionnaire (MPQ), a self-report with 3 higher-order scales (Positive Emotionality (PE), Negative Emotionality (NE), and Constraint (CON)) and 11 primary scales. Analyses of variance and planned comparisons revealed higher NE and PE in BEW and BEM than same-gender controls, but no differences between BEW and BEM. Both BEW and HM reported lower CON than HW. Effects were medium to large (ηp=.08-.22). A MANOVA showed large differences (ηp=.24) between BE participants and control groups in 3 (BEM) to 6 (BEW) MPQ primary scales, most notably Stress Reaction and Well-Being (p <.001). Finally, we observed differences between HW and HM on Aggression and Harm Avoidance (p <.006) but no BEW-BEM differences in any primary scales. In sum, community women and men with clinical levels of BE reported similar personality patterns, including proneness to sensitivity, nervousness, guilt, and low joy, which tended to differ from same-gender control participants. Thus, men and women with recurrent BE may not require different personality-oriented ED interventions.

College Students’ Perceptions Of Orthorexia Nervosa  And Popular Dieting Trends
Maddie W Weinstock, Suzanne Mazzeo
Virginia Commonwealth University, Richmond, VA, United States

Introduction: Research suggests that how a person eats may impact how they are perceived. For example, those who eat low-fat diets are viewed more positively than those who eat high-fat diets; and individuals with eating disorders are viewed more negatively than those without eating disorders. However, few studies have investigated how adherence to a popularized diet may impact how a person is perceived. This study investigated how perceptions of others are influenced by dietary behavior. Method: A sample of 463 students in a southeastern university were asked to read a vignette with a character who adhered to a specific pattern of eating (Keto, Intermittent Fasting, clean eating, Orthorexia Nervosa (ON), and no diet). Participants reported their perceptions of the character using an attitude scale. Correlates of ON were also studied. Results: The character following a clean eating diet was viewed most positively, followed by the characters on the Keto diet and no diet, then followed by characters on Intermittent Fasting and those with Orthorexia Nervosa. ON pathology was positively correlated with health consciousness, weight bias internalization, and impairment. Conclusion: These findings suggest that the diet a person follows may impact how others view them. This study also identified correlates of ON pathology. Future research may investigate the extent to which a motivation to portray a favorable image of oneself to others may contribute to the decision to follow a diet.

The Relationship Between Social Exclusion, The Urge To Eat And Shame In Obesity: A Experiment Using The Cyberball Paradigm
Robyn Yellowlees1,2, Janet Treasure1, Valeria Mondelli2,3, Valentina Cardi1
1Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom, 2National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, United Kingdom, 3 King’s College London, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom

Individuals with obesity experience weight bias on a daily basis. One facet of this discrimination is the perception of social exclusion and shame. It is possible that these adverse experiences affect eating-related attitudes. The aim of this study was to use an experimental paradigm to investigate how social exclusion influences shame perception and urge to eat in people with obesity. Seventy-nine individuals with obesity (BMI >= 28.5) and 58 normal weight controls (BMI <=25) played three phases of a virtual ball tossing game, the Cyberball task. The phases were inclusion, exclusion and re-inclusion. Before and after exclusion they completed assessments of emotional reactivity (anger, sadness and shame) and urge to eat on a 10-point Likert scale. One-way ANCOVAs showed there was not a significant difference in the observed increase in negative emotional reactivity between groups, including shame. However, there was a significant difference in the urge to eat (F (1, 122) = 8.51, p < .01, n² = .07) in the obese group following social exclusion compared to the normal weight controls. In the face of social exclusion, individuals with obesity show greater urge to eat compared to normal weight individuals. These findings indicate that perceived social rejection might play a maintaining role for extreme eating behaviours.

The Relationship Between Loneliness, Social Media Use, Appearance Comparisons, And Body Dissatisfaction
Haya Zaid-Alkailani, Shannon Zaitsoff, Deepika Bajaj
Simon Fraser University, Burnaby, BC, Canada

Introduction. Although research has demonstrated that social media use has a robust effect on body dissatisfaction through appearance comparisons, the role of loneliness with respect to these variables is unclear. Loneliness is linked with many negative outcomes and may have increased in vulnerable individuals as a result of the COVID-19 pandemic. This study examines loneliness in the context of social media use, appearance comparisons, and body dissatisfaction in young adults. Methods. To begin, participants completed questionnaires on social media use, body dissatisfaction, appearance comparisons, and loneliness. Next, participants uploaded screenshots of their iPhone activity usage data, allowing for an unbiased collection of average time spent on their top 15 applications over the last 10 days. Results. Data collection has concluded but results have not yet been analyzed. The final sample consists of 200 participants, allowing for a power of .98 with an R2 of .39. First, correlations between the four main variables will be examined. Then, a moderated mediation model will be employed to test whether the relationship between social media use, appearance comparisons, and body dissatisfaction is moderated by level of loneliness. Conclusions. The results of this study will further our understanding of the vulnerability of some individuals to the maladaptive uses of social media. Findings may also inform the development of therapeutic interventions for eating disorders.

Acceptability And Feasibility Of A Brief Parent-Training Intervention For Childhood Avoidant-Restrictive Food Intake Disorder
Courtney E Breiner1, McKenzie L Miller1, C Alix Timko2, Julia M Hormes1
1University at Albany, State University of New York, Albany, NY, United States, 2Children's Hospital of Philadelphia, Philadelphia, PA, United States

Avoidant-restrictive food intake disorder (ARFID) is characterized by restriction of volume or variety of food intake and can lead to significant medical and psychological sequelae. Although initial treatment studies have found a variety of approaches to be acceptable and feasible, these protocols may not be accessible to diverse populations due to time and financial constraints. ARFID Parent Training Program (ARFID-PTP) is a two-session, virtual, parent-training program for ARFID that maintains the key therapeutic mechanisms of evidence-based treatment (i.e., mealtime hygiene, differential attention, daily food exposures, and reward systems) but in a brief format delivered remotely. Our study aims to establish the acceptability and feasibility of ARFID-PTP. Participants are children ages 5-12 who meet criteria for ARFID and their parent(s)/guardian(s). Acceptability will be assessed via the Credibility and Expectancy Questionnaire, a 9-point Likert scale, and single-item satisfaction questions. Feasibility will be assessed via retention and recruitment rates. To date, treatment completers (n=3) have rated credibility of the treatment as high (MCEQ=7.9). All completers "strongly agree" with items assessing satisfaction and preparation to implement treatment. We expect to have n=20 treatment completers by presentation of results, which will focus on treatment rationale and components, as well as further preliminary acceptability and feasibility data.

Mdma-Assisted Psychotherapy Significantly Reduces Eating Disorder Symptoms In A Randomized Placebo-Controlled Trial Of Adults With Severe Ptsd
Timothy D. Brewerton1, Julie Wang2, Adele Lafrance2, Michael Mithoefer2, Berra Yazar-Kolinski2, Amy Emerson2, Rick Doblin2
1Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States, 2MAPS Public Benefit Corporation, San Jose, CA, United States

Introduction: Eating disorders (EDs) and PTSD are highly comorbid, yet there are no proven integrative treatment modalities for ED-PTSD. MDMA-assisted psychotherapy (MDMA-AP) shows marked success in the treatment of severe PTSD and holds promise for EDs. Methods: 89 patients with severe DSM-5 PTSD took part in a double-blind, placebo-controlled trial of MDMA-AP. In addition to primary and secondary outcome measures (Clinician-Administered PTSD Scale, Sheehan Disability Scale), the Eating Attitudes Test 26 (EAT-26) was administered at baseline (BL) and at study termination. Total EAT-26 change scores by group were compared after adjustment for BL scores (ANCOVA). Results: 15% of patients with PTSD had total EAT-26 scores in the clinical range (>20), and 31.5% had total EAT-26 scores in the high-risk range (>11) despite no overt ED at BL. There was a significant reduction in total EAT-26 scores in the total group of PTSD patients following MDMA-AP v. placebo (ANCOVA, p=.034). There was also a significant reduction in total EAT-26 scores in women with high EAT-26 scores (>11) following MDMA-AP v. placebo (ANCOVA, p=.0012). Significantly fewer patients had high EAT-26 scores (>20) following MDMA-AP v. placebo (
c2=4.256, p=.039). Conclusions: ED psychopathology is common in patients with PTSD even in the absence of overt EDs. MDMA-AP significantly reduced ED symptoms compared to placebo-assisted psychotherapy in severe PTSD. MDMA-AP for ED-PTSD may be promising and requires study. 

Positive Embodiment, Social Media Use, And Body Image Concerns
Jenna Campagna1, Niva Piran2, Christie Rizzo1, Rachel Rodgers1,3
1Northeastern University, Boston, MA, United States, 2University of Toronto, Toronto, Canada, 3Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital CHRU, Montpellier, France

Photo based social media is associated with body dissatisfaction and negative mood. Emerging evidence suggests that positive body image may offer protection against media exposure more broadly, however, little is known about how this might translate to social media. The aim of this study was to explore the association between positive embodiment and indices of photo based social media use, and its capacity to moderate the relationships among photo based social media use and body image concerns.   A sample of 1,227 women (mean age 22.46±3.5), 69.5% White, 14.3% Asian reported on positive embodiment, body dissatisfaction and aspects of photo-based social media use and appearance comparisons via an online survey.   Women with high positive embodiment reported lower scores on drive for thinness, body dissatisfaction, frequency and impact of social media appearance comparison, and investment and manipulation of social media photos. In addition, positive embodiment emerged as a significant moderator of the relationship between frequency of social media appearance comparisons (p = .009), and photo manipulation (p = .031) and body dissatisfaction.   Findings suggest that among young women with high levels of positive embodiment social media photo-based activities are more weakly associated with body image concerns suggesting that positive embodiment may have the capacity to buffer against the detrimental effects of social media exposure.

Consequences Of Covid-19 Pandemic On Patients With Eating Disorders In Italy: A Longitudinal Observation Of Pre Vs Post Pandemic Psychopathology.
Giovanni Castellini1, Emanuele Cassioli1, Eleonora Rossi1, Alessio Maria Monteleone2, Valdo Ricca1
1Department of Health Sciences. University of Florence, Florence, Italy, 2Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy

Purpose of the study: the aim of this longitudinal study was to evaluate the impact of COVID-19 epidemic on Eating Disorders (EDs) patients, considering the role of environmental and pre-existing vulnerabilities. Methods: 85 patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) and 111 healthy controls were evaluated before the lockdown (T1), during the lockdown (T2), and three months after the lockdown (T3). Patients were also evaluated at the beginning of treatment (T0). Questionnaires were collected to assess psychopathology, childhood trauma, attachment style, COVID-19-related post-traumatic symptoms, as well as those variables which could moderate the psychopathological outcomes. Results: Pathological eating behaviours, such as binge eating, vomiting and compensatory exercise, were found to be increased during the lockdown, especially in patients with BN, reporting PTSD symptoms. Lockdown interfered with treatment outcomes: the descending trend of ED-specific psychopathology was interrupted during the epidemic in BN patients, and it showed a slight amelioration at the last follow up. Several environmental factors, and childhood trauma predicted increased symptoms during the lockdown. Conclusions: COVID-19 epidemic significantly impacted on EDs, both in terms of post-traumatic symptomatology and interference with the recovery process. Individuals with early trauma or insecure attachment were particularly vulnerable. Importance and issues of telemedicine strategies will be discussed.

Mediators Of Enhanced Cognitive Behavioral Therapy In Anorexia And Bulimia Nervosa: The Role Of Embodiment
Giovanni Castellini1, Eleonora Rossi1, Emanuele Cassioli1, Giovanni Stanghellini2, Valdo Ricca1
1Department of Health Sciences. University of Florence, Florence, Italy, 2Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University, Chieti, Chieti, Italy

Purpose: The aim of this study was to evaluate the role of embodiment as a potential mediator of the efficacy of enhanced cognitive behavioural therapy (CBT-E). Methods: 85 patients with anorexia nervosa and 74 with bulimia nervosa were treated with a multidisciplinary approach including CBT-E. Psychometric questionnaires were administered at baseline (T0) and after one (T1) and 2 years (T2) to evaluate general and ED-specific psychopathology, body uneasiness and the embodiment disorder. Outcome measures included partial and full recover, relapses diagnostic crossover, and recovery of regular menses. Results: Remission rate at T2 was 52.2%, and diagnostic crossover occurred in 18.0% of the patients. Reduction of EDs psychopathology and in particular of body uneasiness appeared to be mediated by improvement of embodiment (indirect effect: 0.44 [0.28-0.58]). Improvement of embodiment was also associated in survival function with recovery of regular menses, and reduced relapses rate. Severity of emotion dysregulation was a risk factor associated with crossover.  Conclusion: For the first time, these findings highlighted the role of the embodiment disorder as a maintaining factor of ED symptomatology, supporting the importance of integrating CBT-E with new modules of intervention focused on specific new targets of treatments.

Development Of Melanocortin-3 Receptor Agonists For The Treatment Of Eating Disorders
Roger D Cone1, Luis D Gimenez1, Savannah Y Williams1, Satarupa Mullick Bagchi1, Tomi Sawyer2
1Life Sciences Institute, University of Michigan, Ann Arbor, MI, United States, 2Courage Therapeutics, Inc, Newton, MA, United States

AgRP neurons of the hypothalamus are critical for stimulation of food intake. However, they also project to brain to centers affecting motivation and reward such as the striatum and insula, implicated in patients with anorexia nervosa. Optogenetic or chemogenetic activation of these neurons produces hyperphagia and weight gain, even in fully sated animals.  Further, the central melanocortin system is known to increase food efficiency, and may potentially be used to improve weight regain in eating disorder patients.  Moreover, activation of AgRP neurons in mice suppresses other motivational states, including anxiety and fear.  MC3R receptors act presynaptically on AgRP neurons to induce the release of their synaptic content on downstream effector sites, and our data show that MC3R agonist peptide tool compounds potently induce food intake and weight gain.  Melanocortin peptide analogues acting in the CNS at the MC4R are clinically validated safe and effective therapeutics that improve libido (Vyleesi) or inhibit feeding behavior and induce weight loss (Setmelanotide) following peripheral  administration. Similarly, the GLP-1 therapeutics liraglutide and semaglutide demonstrate that peptide drugs are effective in CNS modulation of feeding and weight loss with wide acceptance in clinical settings. Using melanocortin peptide templates, we describe here potent (<5nM EC50), receptor-subtype specific (1000x MC3R/MC4R), and stable (t1/2> 120min) MC3R agonists for pre-clinical testing in models of anorexia.

Motivation To Change In The Course Of A Step-Down Treatment Approach Of Inpatient And Anorexia Nervosa-Specific Home Treatment For Adolescents 
Brigitte Dahmen1, Astrid Dempfle2, Sophie Altdorf1, Beate Herpertz-Dahlmann1, Kathrin Heider1
1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen University, Aachen, Germany, 2Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany

1. Introduction. Motivation to change is an important predictor for treatment outcome in adolescent Anorexia nervosa (AN), even though its development over the therapeutic process, with transitions between treatment settings, has not yet been studied intensively. In this pilot study, the course of motivation to change and its associations with outcome were investigated over the course of a step-down treatment approach.
2. Methods. 21 adolescent inpatients suffering from AN received multidisciplinary home treatment (HoT) with several weekly visits after short inpatient stabilization. Illness severity (EDI-2 subscales) and motivation to change (ANSOCQ) were assessed at the time of admission, discharge from hospital, at the end of HoT, and at a 12-month follow-up. Changes in motivation over time and its relationship with treatment outcome were investigated. 3. Results. Mean motivation to change improved significantly over the course of treatment from admission till the end of HoT and remained stable during the follow-up period. At each assessment, higher motivation to change was significantly correlated with lower illness severity. 4. Conclusions. Motivation to change is an important aspect of treatment success in adolescent AN. In particular, home treatment contributed significantly to a higher motivation. Targeted therapeutic strategies and interventions that reliably enhance the motivation to change seem promising for adolescent patients with AN.  

Integration Of Neuroscience Into Family Based Treatment For Anorexia Nervosa: Weight Outcomes And Structural Changes
Nandini Datta1, Noam Weinbach2, James D Lock1, Cara Bohon1
1Stanford University School of Medicine , Stanford, CA, United States, 2University of Haifa, Haifa, Israel

: Family-based treatment (FBT) is an evidence-based treatment for adolescents with anorexia nervosa (AN). Yet, there is no integrative data on the neural impacts of weight gain in FBT. Malnutrition has negative impacts on brain volume and cortical thickness (CT). Thus, it is important to understand whether weight gain during FBT is associated with neural change to better understand treatment response. Further, weight gain by session 4 in FBT is predictive of outcome, potentially as a function of brain change associated with weight gain making treatment more accessible, though no data has confirmed this. Methods: Girls with AN (= 16, ages 12-18) completed structural, diffusion weighted, and functional scans at three timepoints: pre-treatment, after session 4, and at end of treatment (EOT). Brain volume, surface area, and CT will be calculated with Freesurfer and assessed globally at each timepoint.  We will explore associations among weight change, brain volume, surface area, and CT. Results: Analyses will be completed when data collection ends next month. We hypothesize that increases in brain volumes, surface area, and CT will positively correlate with weight gain during treatment. Conclusions: Findings will shed light on neural changes in adolescents with AN over the course of FBT and the feasibility of incorporating neuroimaging into a clinical trial.  Such data may help motivate treatment engagement and improve our understanding of treatment response. 

Iterative Development Of A Chatbot To Promote Mental Health Services Use In Individuals With Eating Disorders
Ellen E. Fitzsimmons-Craft1, Bianca DePietro1, Marie-Laure Firebaugh1, Olivia Laing1, Jillian Shah1, Lauren Fowler1, Anneliese Haas1, Lauren Smolar2, Shiri Sadeh-Sharvit3, C. Barr Taylor4, Denise E. Wilfley1
1Washington University School of Medicine, St. Louis, MO, United States, 2National Eating Disorders Association, New York, NY, United States, 3Palo Alto University, Palo Alto, CA, United States, 4Stanford University, Stanford, CA, United States

 The treatment gap for eating disorders (EDs) is wide, with <20% of those with EDs receiving treatment. A novel solution is needed to encourage services use and address treatment barriers. This study aimed to develop a text-based chatbot to increase motivation for seeking care and service use in individuals with EDs not in treatment. Methods. The initial chatbot was developed by multidisciplinary stakeholders and iterated over 4 cycles of usability testing with target users. Content included EDs psychoeducation, motivational interviewing, tailored services recommendation, and follow-up reminders. Cycles 1 (n=5) and 2 (n=5) were in-person and moderated. Cycles 3 (n=5) and 4 (n=6) were remote and unmoderated. All participants completed a post-study semi-structured interview and survey, including the System Usability Scale (SUS). Following each cycle, chatbot refinements were made based on feedback. Results. Average SUS score for Cycles 1-3 was 78.3 (considered "good"). Cycle 4 yielded a score of 85.8 ("excellent"). In addition, in Cycles 3-4, 8 of 11 participants reported using at least one of the mental health resources the chatbot recommended and 2 additional users reported intending to use a resource. Qualitative feedback will also be presented. Conclusion. The chatbot developed through iterative testing and refinement showed excellent usability in the target audience. Next step is to conduct a randomized optimization trial to determine essential components. 

Role Models In Partial Hospitalization Programs For Eating Disorders: Preliminary Results From A Pilot Study
K. Jean Forney1, Sarah A. Horvath1, Jason McCray2
1Ohio University, Athens, OH, United States, 2Columbus Behavioral Health, Columbus, OH, United States

Little objective data exist documenting the influence of peers in group treatment settings for eating disorders. The current pilot study examined 1) if individuals identify role models in treatment and 2) if symptoms are related to being identified as a role model. METHODS: Patients in a partial hospitalization program were invited to complete weekly assessments of symptoms and to identify which peers they viewed as role models for recovery. Three consecutive weeks with the highest census and participation (n=7) were analyzed using social network analysis. RESULTS: Across weeks, 57%-71% of patients identified at least one role model (modal nominations = 0 -3) and 57% of patients (modal nominations = 0 -1) were identified as a role model. Effect sizes suggest that longer duration of treatment in the program (r = .45 - .77), but not eating pathology (r = -.16 – 0.39) was associated with being viewed as a role model. Nominating others as a role model was less consistently associated with duration of treatment (r = -.04 - .64) or eating pathology (r = -.39 – 50). CONCLUSIONS: Patients in partial hospitalization programs identify recovery role models and those who have been in treatment the longest may be most likely to be identified as a role model. Estimated effects varied meaningfully from week to week, suggesting that peer dynamics and influences vary by the make-up of the group. Future work should examine the longitudinal influence of role models in treatment. 

With More Complication Comes More Accuracy?: Comparison Of Traditional Regression And Machine-Learning Models For Predicting Outcomes In A Controlled Treatment Study For Binge-Eating Disorder
Lauren N. Forrest, Valentina Ivezaj, Carlos M. Grilo
Yale School of Medicine, New Haven, CT, United States

 Prediction of treatment outcomes for binge-eating disorder (BED) has proven difficult and few reliable predictors have been identified. Machine learning is a promising method for improving accuracy. We compared accuracy between traditional and machine-learning models for predicting BED treatment outcomes. Methods. 191 adults with BED in a randomized controlled trial testing behavioral and stepped-care treatments were independently assessed. Primary outcomes were binge eating (% reduction, abstinence), eating-disorder psychopathology, and weight loss (% loss, ≥5%). Predictors were treatment condition, demographic variables, and baseline clinical characteristics. Logistic/linear regressions, elastic net regressions, and random forests were used. Predictive accuracy was indicated by area under receiver operator characteristic curve (AUC), root mean square error (RMSE), and R2. Confidence intervals were used to compare accuracy across models. Results. AUCs ranged very poor to fair (.49–.73) for logistic regressions, elastic nets, and random forests, with no differences across model type. RMSEs were lower for elastic nets and random forests versus linear regressions but R2values were low (.01–.23).  Conclusions. Machine learning models provided minimal advantage over traditional models in predictive accuracy for BED treatment outcomes. Although different analytic models revealed some predictors of outcomes, they converged little, and overall their accuracy was modest.

How Effective Is Dialectical Behavioral Therapy In The Treatment Of Eating Disorders? – A Meta-Analysis
Melanie N French, Eunice Y Chen
TEDp, Psychology, Temple University, Philadelphia, PA, United States

Introduction: Given their potential chronicity and severity, multiple alternative interventions are needed for individuals with eating disorders (EDs). Dialectical Behavioral Therapy (DBT) is one promising option. Given recent trials, an updated meta-analysis of DBT in the treatment of EDs is needed. Methods: We conducted a meta-analysis identifying DBT treatment studies using ED samples and comparison groups. Pubmed and PyscINFO searches resulted in 10 included studies (N=674). Outcome measures from pre- and post-treatment data were analyzed in 4 domains: 1) ED pathology, 2) ED behaviors, 3) body mass index (BMI), and 4) emotion regulation skills. Moderator analyses were conducted to compare active treatment vs. waitlist (comparison group type). Results: DBT had a 1) medium effect size (ES) for reducing ED psychopathology (d=-0.66, p=0.002), 2) small ES for reducing ED behaviors (d=-0.35, p=0.011), 3) a non-significant ES for increasing emotion regulation skills (d=-0.70, p= 0.290), and 4) non-significant ES for BMI (d=-0.11, p=0.454). Moderators for comparison group type were significant for ED pathology (p=0.001) and ED behaviors (p=0.005). DBT had a medium to large ES at reducing ED pathology (d=-0.92, p<0.001) and ED behaviors (d=-0.70, p<0.001) compared to waitlist groups, but was not significantly different from active control groups (p’s>0.1). Conclusions: DBT significantly reduces ED behaviors and psychopathology, particularly relative to waitlist groups.

What Is Needed For Eating Disorders Prevention For Transgender And Gender Diverse Youth? 
Allegra R. Gordon1,2,3, Scout Silverstein4,8, Ethan Lopez4, Savannah Roberts5, Allyson Cogan1, Jerel P. Calzo6,7
1Boston University School of Public Health, Boston, MA, United States, 2Boston Children's Hospital, Boston, MA, United States, 3Harvard Medical School, Boston, MA, United States, 4Fighting Eating Disorders in Underrepresented Populations: A Trans+ & Intersex Collective, New York City, NY, United States, 5University of Delaware, Newark, DE, United States, 6San Diego State University, San Diego, CA, United States, 7Institute for Behavioral & Community Health, San Diego, CA, United States, 8CUNY Graduate School of Public Health & Health Policy, New York City, NY, United States

Introduction. Transgender and gender diverse (TGD) young people face elevated risk of eating disorders (ED). This study sought to identify needs and strategies for ED primary preventive interventions in a US sample of TGD young adults.
Methods. We held 8 online focus groups with geographically and racially/ethnically diverse TGD young adults (ages 18-30; N=66). Thematic analysis examined ED prevention needs, advice for intervention developers, and characteristics of support spaces. Results. Themes included recommendations for (1) Intervention Content; (2) Intervention Delivery; and (3) Cultivating Affirming Spaces. Theme 1 subthemes included: (1.1) Representation and intersectionality (e.g., "[We need] more body images of those of us that are disabled, POC [people of color], overweight"); (1.2) Addressing racism, weight stigma, and the gender binary (e.g., "The narrative around eating concerns is that it is a ‘white’ issue and these problems don’t impact POC"). Theme 2 subthemes included: (2.1) Group composition (e.g., "I need people who look like me and who reflect my experiences"); (2.2) Modality (e.g., preference for online interventions). In Theme 3, participants stressed the importance of creating an environment that affirms TGD youth and centers lived experience. Conclusions. TGD young adults described needs and desires for ED prevention content and delivery. Intervention development must also prioritize partnerships with marginalized TGD young people and communities.

Comparing Outcomes Of Published, Randomized Controlled Trials Delivering Family Based Or Inpatient Treatment In Youth With Anorexia Nervosa
Verena K Haas1, Janine Nadler1, Ross D Crosby2, Sloane Madden3, Michael R Kohn4, Daniel Le Grange5,6, Ana Sofia Oliveira Goncalves7, Johannes Hebebrand8, Christoph U Correll1,9
1Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany, 2Sanford Center for Biobehavioral Research and University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States, 3University of Sydney, Sydney, Australia, 4Department of Adolescent and Young Adult Medicine, Centre for Research into Adolescent’S Health, Sydney, Australia, 5Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States, 6Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL, United States, 7Institute of Public Health, Charité-Universitätsmediin, Berlin, Germany, 8Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, 9Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, NY, United States

Purpose Various approaches exist to treat youth with anorexia nervosa (AN), resulting in different duration of hospitalization. Family Based Treatment (FBT), an approach that keeps hospitalization brief, has never been tested against inpatient treatment (IPT) for weight recovery. This focused review aimed to compare published data on long-term body weight trajectories, change in eating disorder psychopathology, days in hospital and treatment costs in RCTs delivering FBT or IPT.
Methods. Review of  meta-analyses published between 2010 and 2020 to identify RCTs in youth with AN, delivering interventions of ≥3 months and reporting body weight at baseline and at least one follow-up ≥ 6-months post-baseline. Results. 4 RCTs delivering FBT (USA n=2; Australia n=2), and 2 RCTs delivering IPT (France n=1; Germany n=1) were identified. The comparison of weight outcome was limited by differences in key patient baseline characteristics (e.g. higher baseline weight in FBT trials) and use of different weight metrics (e.g. body mass index percentiles vs expected body weight). Changes in ED psychopathology, the duration of hospitalization and treatment costs could not readily be compared between studies. Conclusions. FBT needs to be tested against IPT in a multicenter RCT. Minimal outcome reporting standards for body weight metrics and nature of interventions allowing international comparison are needed and suggestions for steps in further developing these standards are presented.

Neuroimaging And The Microbiome In The Ongoing Era-Net Migban-Study In Adolescent Patients With Anorexia Nervosa
Lara Keller1, Jochen Seitz1, Brigitte Dahmen1, Samira Schreiber1, Florian Fischmeister2, Beate Herpertz-Dahlmann1
1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany, 2Institute of Psychology, University of Graz, Graz, Austria

Introduction Growing knowledge of gut-brain interaction in anorexia nervosa (AN) offers a unique opportunity to improve patient care by developing innovative therapies, however, neural mechanisms have not yet been analyzed. The MiGBAN study brings together a multicenter European ERA-NET NEURON consortium. In Aachen we are investigating the impact of polyunsaturated fatty acid administration on the gut microbiome (MI) in adolescents with AN, including neuroimaging techniques. Methods Longitudinal (f)MRI (at admission and after 6 and 12 months) is used to investigate neurobiological mechanisms in patients with AN (e.g. neuroplastic changes) and their interaction with the MI and the intervention. MRI, resting state fMRI, task-based fMRI (probabilistic reversal learning task), and diffusion tensor imaging will be performed. Nutritional intake, weight change, hormonal changes and clinical characteristics of our patients will be used to discern interactions by means of a multivariate statistical framework. Prognostic power of MI and neurobiological markers will be explored. Results In addition to finding the known (pseudo-) atrophy of the brain in AN, we expect the MI to interact with cognitive flexibility (as assessed by the learning task) and hypothesize effects of our intervention on decision making networks and functional connectivity. Conclusions This translational research could provide deeper insights into the underlying neural mechanisms of gut-brain interaction in AN.

Perceptions Of People With Eating Disorder Symptoms Who Have Not Engaged In Treatment 
Livia L Liu, Phillipa Hay, Janet Conti
Western Sydney University, Sydney, Australia

Aim: This study explores barriers to eating disorder (ED) treatment engagement from the perspectives of a community sample who identified as having ED symptoms though have not sought a formal diagnosis or treatment, as well as some who did not follow through with specialist ED treatments after receiving a medical diagnosis. Method: 56 respondents of the Eating Disorders Treatment Experience Survey indicated that they had never undergone ED treatment and were asked to share the reasons for this. Qualitative analysis of responses generated overarching themes to encapsulate the diverse participant accounts. Results: Thematic analysis generated two main themes, each with two subthemes. The first theme was the negotiation of the need for treatment within oneself (intrapersonal factors). This involved the subthemes of self-perceptions and the egosyntonicity of ED symptoms. The second theme focused on the negotiation of the need for treatment with others (interpersonal factors) which included the subthemes of stigma and perceptions of mental health professionals and treatment. Additionally, the two cross-cutting subthemes of fear and health literacy were generated. Conclusion: The process by which individuals decide whether or not to engage with ED treatment services is complex, with varied and intertwined factors influencing the outcome. Additionally, such factors are not static and those that hold significance for patients may shift with the progression of the ED.  

Elucidating Rapid Response To Treatment: The Importance Of Cbt Skills Use During Negative Affective States
Danielle MacDonald1,2, Kathryn Trottier1,2, Li Cao3, Ross Crosby3, Stephen Wonderlich3, Scott Engel3, Marion Olmsted1,2
1University Health Network, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3Sanford Health, Fargo, ND, United States

Early substantial changes to eating disorder behaviors predict better end of treatment outcomes. To date, research has not elucidated treatment-related processes that contribute to rapid response. This study examined whether rapid and nonrapid responders have different patterns of skills use in response to negative emotions early in CBT-based day treatment (DT). Methods: Participants with bulimia nervosa or purging disorder (N=58) completed ecological momentary assessments (EMA) several times per day for the first 28 days of DT. Consistent with prior research, rapid response to treatment was defined as complete abstinence from binge eating/purging in this period. Mixed linear modeling with normal distribution was used to test the relationship between rapid response, negative mood states, and the moderating effect of baseline difficulties with emotion regulation. Results: In individuals with high baseline difficulties with emotion regulation, rapid responders used more CBT skills in response to negative affective states during the first 4 weeks of DT.  A similar but less pronounced pattern was observed for those with low baseline difficulties with emotion regulation. Conclusions: This is the first known study to use EMA to prospectively examine therapy processes that may contribute to a rapid response to treatment.  Supporting early skill use, particularly during times of high negative affect, may enable more individuals to experience positive treatment outcomes.

Group Schema Therapy For Eating Disorders: Results Of A Pilot Study
Suzanne HW Mares, Maartje S Vroling, Leonie Muller
Amarum, GGNet, Zutphen, Netherlands

1. Introduction. Many patients with an eating disorder do not benefit from current treatments of choice, such as CBT-E. Comorbid personality disorder (PD) or rigid personality pathology is a major interfering factor for treatment success in eating disorders. In the current study, the effectiveness of the innovative group schema therapy for eating disorders was examined. 2. Methods. Patients (n = 19) that failed to benefit from guideline treatment due to underlying personality pathology were included in group schema therapy for eating disorders. Questionnaires concerning eating disorder pathology, early maladaptive schemas and schema modes were administered at the start, halfway, and at the end of treatment. 3. Results. Results showed that patients that were included in the group schema therapy for eating disorders showed a significant reduction in eating disorder pathology, early maladaptive schemas, and most maladaptive schema modes, and a significant increase in adaptive schema modes, all with large effect sizes. Almost half of the patients fell within the healthy range on the EDE-Q at the end of treatment. 4. Conclusions. For patients that fail to benefit from guideline treatment due to underlying personality pathology, group schema therapy seams to be a promising treatment option. 

Positive And Negative Treatment Experiences Reported By People With Eating Disorders
Rahul Mital, Phillipa Hay, Janet Conti, Haider Mannan
Western Sydney University, Sydney , Australia

Introduction: Despite eating disorders resulting in significant impairment to the individual, many people disengage from treatment. There is a paucity of literature that focuses on both positive and negative aspects of people’s treatment experiences. This study is aimed to identify the associations between features of therapy with perceived treatment helpfulness and unhelpfulness. Methods: An online cross-sectional survey was developed and disseminated, with the data of 235 participants being utilised for multiple linear regression analyses. Results: As predicted, factors in the therapeutic relationship such as the therapist’s ability to instil hope, provide freedom of choice and understand the patient and address concerns had high, statistically significant predictive value in treatment helpfulness. Contrary to our original hypothesis, change being retrospectively identified as important or possible by the participant did not. Conclusions: These outcomes highlight the significance of the therapeutic relationship in governing positive treatment responses. The results also challenge the traditional conception and potential overvaluation of motivation to change as a key predictor for treatment helpfulness and suggests further exploration to replicate findings. 

Mental Healthcare Use Among Male And Female Veterans With Eating Disorders
Karen S. Mitchell1,2, Megan Sienkiewicz1, Dawne Vogt1,2, Brian Smith1,2, Shannon Kehle-Forbes3, 4, Zafra Kehle-Forbes5
1National Center for PTSD at VA Boston Healthcare System, Boston, MA, United States, 2Boston University School of Medicine, Boston, MA, United States, 3Minneapolis VA Healthcare System, Minneapolis, MN, United States, 4University of Minnesota, Minneapolis, MN, United States, 5Yale University School of Medicine, New Haven, CT, United States

Introduction. Eating disorders (EDs) are associated with high levels of impairment and healthcare costs.  High rates of healthcare use are possibly due to medical and psychological comorbidities of EDs.  Few studies have examined healthcare use among both male and female veterans, a population which may have an increased prevalence of EDs.  We examined associations between probable ED diagnoses and mental healthcare use within a diverse sample of post-9/11 U.S. military veterans.  Methods. Participants (N = 1494) completed the Eating Disorder Diagnostic Scale-5 (EDDS-5) as well as healthcare use items adapted from the National Survey of Veterans.  We estimated multinomial logistic regression models with sample weights applied to enhance the accuracy of standard errors.  Results. Results revealed that only 8.7% of veterans with EDs had received ED-specific services. However, both male and female veterans with EDs received outpatient mental healthcare for a higher number of conditions compared to veterans without EDs (ORs=2.26-3.75).  Male veterans, but not female veterans, received medication services for a higher number of mental health conditions compared to veterans without EDs (OR=4.00).  Conclusions. Findings underscore the importance of bolstering screening and treatment for EDs among both male and female veterans.

Examining The Feasibility Of Virtual Parent-Led Support Groups For Parents Of Children With Eating Disorders: Preliminary Findings
Maria Nicula1, Laura Grennan1, Techiya Loewen2, Erica Crews2, Kelly Giuliani2, Cheryl Webb3, Maria Rosa Gouveia2, Jennifer Couturier1,3
1McMaster University, Hamilton, ON, Canada, 2Reach Out Centre for Kids, Halton, ON, Canada, 3McMaster Children's Hospital, Hamilton, ON, Canada

Purpose: Parents of children with eating disorders (EDs) have voiced a need for support from other parents with lived experience. Many benefits are associated with parent-led support groups; however, their effects are mainly understood in the context of other populations. Currently, no reports exist of parent-led support groups for parents of children with EDs. Methods: To fill this gap in service, our explanatory sequential mixed methods study explores the feasibility, acceptability, and cost of running 4 virtual parent-led support groups in Ontario. Parents are completing measures related to their wellbeing before, during, and after engaging in 12 sessions over 6 months, then partaking in a qualitative interview about their experience. Results: Over a six-month period, 62% (38/61) of interested parents have enrolled; of these, five parents have since withdrawn. Non-recruited parents were either ineligible, lacked time for sessions, or lost interest before consent. Challenges arose when recruiting parents from Northern Ontario. Eligible parents heard about the study through their child’s ED program, online, or by word of mouth, and reached out to receive support from other parents and to give back to the community. Conclusion: The initial strong interest and recruitment rate indicate that support groups for parents of children with EDs are needed. Results from this study have the potential to support the scaling up of parent-led support groups across Ontario and Canada.

An Online Guided Self-Help Cognitive Behavioral Therapy For Bulimia Nervosa And Binge Eating Disorder In Japanese Clinical Settings (Breese Study): Protocol For A Randamized Controlled Trial
Noriaki Ohsako1,2, Hiroshi Kimura1,2, Tony Lam3, Aiko Sato1,2, Yutaka Hosoda1, Tasuku Hashimoto1,2, Masaomi Iyo2, Michiko Nakazato1,2
1 Department of Psychiatry, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan, 2Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan, 3Net Union, Lausanne, Switzerland

1. Introduction. The purpose of this study is to evaluate the effectiveness of an internet-based Guided self-help CBT (iGSH-CBT) for bulimia nervosa (BN) and binge eating disorder (BED) in Japanese clinical settings. 2. Methods. This study is an open parallel-group randomized controlled trial (RCT) comparing the iGSH-CBT to the treatment as usual. The inclusion criteria are as follows: 1) BN / BED (DSM-5), 2) 16-40 year-old, 3) 18 ≤ BMI (kg/m2) ≤ 30. After baseline assessment, 16-week iGSH-CBT followed using SALUT-BN program. Weekly e-mail guides are provided during the intervention. Evaluations are taken at baseline, after 8-week, the end of 16-week intervention and 6-month after the treatment. The primary outcome is the changes in the frequencies of weekly objective binging. Secondary outcomes are the changes in the frequencies of weekly objective purge episode and monthly objective binging, the dropout rates, the self-report questionnaires of the psychopathology characteristics of eating disorders: BITE, EDE-Q, EDI-2, HADS, and EQ-5D, and so on. 3. Results. The study period is from after the approval of ethics review to June 30, 2023, and the case registration is ongoing. The target number of participants is 82. 4. Conclusions. This is the first RCT of the iGSH-CBT for BN / BED in Japan. It has the potential to provide treatment for more BN / BED patients and improve their quality of life and health. Trial registration: UMIN, UMIN000040916. Registered 20 Jul 2020.

Clinical Characteristics And Predictors Of Non-Response To Residential Eating Disorder Treatment
Shelby N Ortiz1, James F Boswell2, Gayle E Brooks3, Taylor E Gardner3, Heather Thompson-Brenner3
1Miami University, Oxford, OH, United States, 2University at Albany, Albany, NY, United States, 3The Renfrew Center, Coconut Creek, FL, United States

1. Patients with eating disorders (EDs) have high levels of treatment non-response. Understanding the heterogenous clinical characteristics of non-responders (N-Rs) is necessary to improve treatment. 2. Participants were residential treatment patients with clinically low weight (BMI<18.5; n=1164) or elevated Eating Disorder Examination-Questionnaire Global scores (EDE-Q>4.0; n=2036). Those whose change in BMI (n=335) or EDE-Q scores (n=519) was less than the sample mean by at least 1 SD were defined as N-Rs. Groups were compared on demographic, clinical, and treatment variables. 3. BMI N-Rs reported significantly shorter length of stay/lesser progression through treatment stages and higher age, duration of illness, rates of co-occurring diagnoses, and urges to engage in ED behaviors. In multivariate analyses, only number of co-occurring diagnoses, urges to engage in ED behaviors, and shorter length of stay were significant predictors of BMI N-R. In contrast, EDE N-Rs reported significantly longer length of stay and lower age, duration of illness, motivation, treatment alliance, rates of co-occurring diagnoses, and change in multiple clinical variables. In multivariate analyses, higher baseline EDE-Q global score and change in depression, as well as lesser change in emotional avoidance were predictors of EDE-Q N-R. 4. Findings highlight heterogenous characteristics of N-R which may inform clinical care. Targeting these predictors may improve treatment for these patients.

A Lower Carbohydrate Enteral Feed Compared With A Standard Feed Results In Less Hypophosphatemia In Adolescent And Young Adults Hospitalised With Anorexia Nervosa: A Randomised Controlled Trial
Elizabeth K Parker1,2, Victoria Flood2,3, Mark Halaki2, Christine Wearne4, Gail Anderson5, Linette Gomes5, Simon Clarke5,6,7, Frances Wilson8, Janice Russell7,9, Elizabeth Frig10, Michael Kohn5,6,7
1Department of Dietetics & Nutrition, Westmead Hospital, Westmead, Australia, 2Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 3Western Sydney Local Health District, Westmead, Australia, 4Department of Medical Psychology, Westmead Hospital, Westmead, Australia, 5Department of Adolescent & Young Adult Medicine, Westmead Hospital, Westmead, Australia, 6Centre for Research into AdolescentS’ Health (CRASH), Westmead Hospital, Westmead, Australia, 7Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 8Department of Psychiatry, Westmead Hospital, Westmead, Australia, 9NSW Statewide Eating Disorder Service, Peter Beumont Unit, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, Australia, 10Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, Australia

Aims: Providing adequate nutrition to patients with anorexia nervosa must be balanced against concerns of developing refeeding complications, particularly with the reintroduction of carbohydrate. This study compared the efficacy and safety of an iso-caloric lower carbohydrate enteral formula (28% carbohydrate) against a standard enteral formula (54% carbohydrate). Methods: Patients (aged 15-25) hospitalised with anorexia nervosa were recruited into this double blinded randomised controlled trial. At a midpoint interim 24 participants, mean age 17.5 years (± 1.1), had been randomly allocated to lower carbohydrate (n=14) or standard (n=10) feeds. Results: At baseline, there was no significant difference in degree of malnutrition, medical instability, history of purging or serum phosphate levels between the two treatment arms. A significantly lower rate of hypophosphatemia developed in patients who received the lower carbohydrate formula compared to standard formula (35.7% vs 90.0%, p=0.013). During treatment there was no significant difference in weight gain, number of days to reach medical stability, hypoglycaemia, or hospital length of stay. Conclusion: The results of this study suggest both feeds were equally tolerated and that weight gain was proportional to caloric prescription and not macronutrient content. Patients experienced improved metabolic health, as indicated by less hypophosphatemia, on the lower carbohydrate feed in comparison to the standard feed.

Adapting And Adopting Highly Specialized Pediatric Eating Disorder Treatment To Virtual Care: Implementation Research For The Covid-19 Context And Beyond
Danielle Pellegrini1, Laura Grennan 1, Catherine Miller2, Paul Agar3, Cheryl Webb1, 3, Kristen Anderson4, Melanie Barwick5, 6, Gina Dimitropoulos7, Sheri Findlay1, 3, Melissa Kimber 1, Gail McVey5, 8, James Lock 9, Jennifer Couturier1, 3
1McMaster University, Hamilton, ON, Canada, 2Guelph Community Health Centre, Guelph, ON, Canada, 3McMaster Children's Hospital, Hamilton, ON, Canada, 4Chicago Center for Evidence-Based Treatment, Chicago, IL, United States, 5University of Toronto, Toronto, ON, Canada, 6Research Institute, The Hospital for Sick Children, Toronto, ON, Canada, 7University of Calgary, Calgary, AB, Canada, 8Research Institute, University Health Network, Toronto, ON, Canada, 9Stanford University, Stanford, CA, United States

Introduction: During the COVID-19 pandemic, evidence-based eating disorder (ED) care, including family-based treatment (FBT), rapidly changed to virtual delivery, but its implementation in ED programs should be studied to protect patient outcomes.  Methods: Using a multi-site mixed method pre/post design, we are investigating the impact of our implementation approach in 4 pediatric ED programs in Ontario, Canada. We developed implementation teams at each site, provided remote training on virtual FBT (vFBT), and are offering clinical consultation for therapists. Therapists are submitting videorecordings of their first 4 vFBT sessions. To study our implementation approach, we are examining whether key components of standard FBT are maintained in virtual delivery, fidelity to our vFBT model, team/family experiences with vFBT, and patient outcomes (weight and binge/purge frequency). Results: Implementation teams at the 4 sites have been established (n=7 therapists, n= 4 medical practitioners, n=6 administrators), and 3 families have been recruited. Challenges to date include confirming site participation, obtaining ethics approval at each site, and family recruitment. High staff turnover and caseload are delaying family recruitment.  Conclusions: Our research informs the delivery of vFBT during COVID-19 but has implications for delivery in a post-pandemic era where virtual services may be preferable to those living in remote locations, with limited access to specialized services.

Latent Trajectories Of Symptom Change During Cbt For Bulimia-Spectrum Eating Disorders Predict Relapse At Three-Month Follow-Up
Emily K. Presseller1,2, Stephanie C. Fan2, Adrienne S. Juarascio1,2
1Drexel University Department of Psychology, Philadelphia, PA, United States, 2Drexel University Center for Weight, Eating, and Lifestyle Science, Philadelphia, PA, United States

Introduction: Up to 44% of individuals with remitted bulimia nervosa (BN) experience relapse after receiving cognitive behavioral therapy (CBT). Identifying risk for relapse using latent trajectories of change in ED symptoms during treatment could allow for personalization of treatment to improve long-term outcomes. Methods: Participants (N=55) with BN-spectrum EDs received 16 sessions of CBT and reported eating episodes and ED behaviors on ecological momentary assessment (EMA) surveys. The Eating Disorder Examination was used to measured ED symptoms at post-treatment and three-month follow-up. Growth mixture modeling of EMA data identified latent growth classes. Kruskal-Wallis H tests examined effect of growth class on post-treatment to follow-up change in ED symptoms. Results: Multi-class models of change in binge eating, compensatory behaviors, and regular eating improved fit over one-class models. Individuals with high binge eating severity and moderate treatment response (H(1)=4.94, p=.03, η2= .10)
and high compensatory behavior severity and rapid response (H(2)=6.43, p=.04, η2= .11) had increased risk of relapse in compensatory behaviors. Individuals with static change in regular eating exhibited greater relapse in binge eating than individuals with moderate response (H(1)=9.06, p=.003, η2= .20). Conclusions: Trajectories of change in ED symptoms predict post-treatment relapse. Personalized treatment approaches should be evaluated among individuals at risk of relapse.

Evaluating The Efficacy Of An Online Training Webinar For Eating Disorder Screening And Referral In U.S. Pediatric Primary Care: A Pilot Study
Amanda Raffoul1, Julia Vitagliano1, Vishnudas Sarda1, Charmaine Chan2, Cindy Chwa2, Katelyn B. Ferreira1, Holly C. Gooding1,3, Sara Forman1,4, S. Bryn Austin1,2,4
1Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States, 2Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States, 3School of Medicine, Emory University, Atlanta, GA, United States, 4Department of Pediatrics, Harvard Medical School, Boston, MA, United States

Introduction: Most U.S.-based pediatric primary care providers (PCPs) lack training in eating disorders (ED) screening and referral. We developed and pilot-tested the efficacy of an online webinar in improving comfort, knowledge, and behaviors related to screening for EDs and referral to services. Methods: We recruited PCPs (e.g., physicians, nurses) who work with adolescents and young adults using professional organization email lists. Participants (N=65) completed a pre-webinar survey (baseline) regarding their comfort in screening or referrals, knowledge about EDs, and ED screening and referral behaviors in the past 2 months before watching a pre-recorded webinar. Participants completed a post-webinar survey 2 months later (follow up). We used McNemar’s tests of association and paired t-tests to assess differences from baseline to follow up. Results: Compared to baseline, at follow up PCPs were more comfortable with screening and providing referrals for a range of EDs (p<0.0001). They were also more knowledgeable about purging in patients with BN (p=0.01) and elevated ED risks among young men of color (p<0.0001). PCPs were more likely to ask patients about body image (p<0.05) and use screening tools during well visits (p<0.05) in the 2 months after the training than in the 2 months before. Conclusion: Findings suggest that the delivery of a brief webinar can improve PCP’s comfort, knowledge, and behavior in screening and referral for EDs among pediatric populations.

Targeting Social Difficulties In Adolescents With Eating Disorders Using Online Cognitive Bias Modification Training
Katie P Rowlands1, Ben Grafton2, Mima Simic3, Colette Hirsch1, Janet Treasure1, Valentina Cardi4
1Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 2Centre for the Advancement of Research on Emotion, University of Western Australia, Australia, Australia, 3Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom, 4Department of General Psychology, University of Padova, Padova, Italy

Introduction. This study examines the feasibility, acceptability and clinical effects of adding an online, multi-session cognitive training intervention (targeting cognitive biases towards negative social information) to eating disorder treatment in adolescents with anorexia nervosa. Methods. Adolescents with anorexia nervosa receiving treatment in the UK were randomly allocated to receive an online cognitive bias modification (CBM) intervention in addition to treatment as usual (n = 38), or treatment as usual only (n = 32). The 4-week intervention consisted of nine sessions of attention bias training towards positive / neutral social stimuli (facial expressions) and interpretation bias training towards benign resolutions of ambiguous social scenarios. Patients were assessed at baseline, end of intervention (4-weeks) and follow-up (12 weeks). Outcome measures included recruitment and retention rates, qualitative participant feedback, near-transfer outcomes (attention and interpretation biases towards social stimuli) and far-transfer outcomes (self-reported clinical symptoms, and sensitivity to criticism from actors). Results. Data analysis is in progress. Conclusions. The findings of this study will indicate whether online, multi-session cognitive bias training is a feasible, acceptable and effective intervention that could be added to eating disorder treatment to target social difficulties in adolescents with anorexia nervosa.

Eating Disorders App Use As A Mediator Of Treatment Effect On Clinical Improvement 
Shiri Sadeh-Sharvit1, Jane Paik Kim2, Hannah Welch2, Eric Neri2, Jenna Tregarthen3, James Lock2
1Palo Alto University, Palo Alto, CA, United States, 2Stanford University, Palo Alto, CA, United States, 3Recovery Record, San Francisco, CA, United States

Eating disorders (EDs) contribute considerably to the global burden of disease and have significant repercussions on the psychological, physical, and social functioning of affected individuals. Despite this, most individuals with EDs do not receive treatment. There is some evidence that mobile health apps may increase access to mental healthcare services for individuals with EDs. However, little is known about the relationship between frequency and duration of app utilization and clinical improvement outcomes. This study examined whether the degree of usage of a tailored, automated self-help app for EDs mediated the effects of the app on the clinical response to the intervention. Methods. App usage measures included the total number of meal logs, total number of days spent using the app, and the last day the app was used during the study period. Mediation analysis was performed using the MacArthur framework. Results. All usage variables met the analytic requirements for testing mediation. Regression coefficients indicated mediation effects, suggesting that increased engagement (as measured by logs and time spent on the app) was related to an increased likelihood of achieving a significant clinical change by the end of the trial. Conclusions. Increased utilization of mental health apps may be related to improved clinical outcomes for individuals with EDs. App use should be further tested as a specific early target in treatment. 

Exposure And Response Prevention Is Associated With Reductions In Physiological And Self-Report Anxiety In Hospitalized Underweight Patients With Anorexia Nervosa
Colleen C. Schreyer, Marita Cooper, Angela S. Guarda
Johns Hopkins University School of Medicine, Baltimore, MD, United States

: Patients with anorexia nervosa (AN) report food-related anxiety, avoid eating high-energy density (HED) foods, and use safety behaviors. Exposure and response prevention (EXRP) shows promise in reducing these symptoms, but has not been studied in underweight inpatients with AN. We examined change in food-related anxiety for inpatients randomized to meal-based EXRP or Motivational Interviewing (MI) as adjunct interventions to treatment. Methods: Participants had AN (n=11) and mean age of 27.53 (SD=12.68). Change in food-related anxiety was assessed pre-treatment, and at BMI of 19 kg/m2 via physiological (skin conductance level [SCL]) and self-report anxiety (rated 1-4) to imagined consumption of HED and low energy density (LED) foods elicited by a visual food cue task. Maximum SCL was assessed as peak SCL during 10-sec image exposure minus mean SCL in the washout period prior to image. Results: Three-way interaction effects (intervention x time x stimulus type) were observed for change in maximum SCL and self-reported anxiety, ps<.01. Maximum SCL decreased for HED foods in both groups, but decreased for LED foods too only in EXRP (p<.05). Self-reported anxiety decreased for LED foods pre- to post-treatment for both groups but decreased significantly for HED foods only in EXRP (p<.05). Conclusion: This study provides preliminary evidence that EXRP is associated with reductions in both physiological and self-report food-related anxiety in underweight inpatients with AN.

Reconnecting To Internal Sensations And Experiences (Rise): An Online Intervention To Improve Interoception And Reduce Eating Disorder Pathology  
April R Smith1, Shruti Kinkel-Ram2, Christina Ralph Nearman3, Claire Cusack3, Cheri Levinson3
1Auburn University, Auburn, AL, United States, 2Miami University, Oxford, OH, United States, 3University of Louisville, Louisville, KY, United States

Purpose: This four study investigation tests whether an intervention designed to improve interoception reduces eating disorder (ED)-related outcomes. Method & Results: Studies 1 and 2 tested elements of the intervention (progressive muscle relaxation [PMR] and body functionality exercises). These studies demonstrated that relative to control conditions, participating in a progressive muscle relaxation exercise (Study 1) and a body functionality exercise (Study 2) was associated with greater interoceptive awareness. Study 3 was a small (n = 22 clinical participants) pre-post pilot of the 4-session online intervention designed to improve interoception. The intervention was associated with improvements in interoception and reductions in suicidal ideation, general psychological symptoms, and ED symptoms. Study 4 is a small, randomized controlled trial in individuals with EDs (current n = 23 , anticipated n = 50). Conclusions: Overall, these findings indicate that our online interoceptive awareness training is acceptable and may be associated with improvements in clinical outcomes, including ED symptoms. Given that interoceptive impairment may contribute to a wide range of psychopathology, an advantage of the intervention may be its transdiagnostic applicability, which is notable given the high rates of comorbidity in EDs. The intervention is brief, free, and can be widely disseminated due to the online delivery.

Who Gets The Most Out Of Cognitive Behavioral Therapy For Bulimia Nervosa? The Role Of Emotion Regulation Ability In Improving Therapeutic Skills Use And Binge Eating
Paakhi Srivastava1, Adrienne Juarascio1,2
1Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, United States, 2Department of Psychology, Philadelphia, PA, United States

The ability to effectively manage cognitive/affective challenges that arise when using therapeutic skills learned in cognitive-behavioral therapy (CBT) may impact improvements in binge eating. Research has yet to examine the impact of baseline emotion regulation ability on skills use during treatment and whether baseline emotion regulation impacts reductions in binge eating at post-treatment via CBT skills use. Participants (N=56) with bulimia nervosa received 16 weekly individual sessions of the focused version of CBT-E. After each session, clinicians rated participants’ use of CBT skills over the past week including regular eating, managing urges to binge and managing negative emotions. Compared to those with high baseline emotion regulation, participants having low baseline emotion regulation demonstrated poor average use of skills related to regular eating (b=-1.12, p=0.02), mood management (b=-0.34, p=0.04), and urge management (b=-0.49, p=0.04) during CBT-E. Low baseline emotion regulation, compared to high baseline emotion regulation predicted lower reductions in binge eating at post-treatment through poor average use of skills related to regular eating (b=0.18, p=0.005), mood management (b=0.80, p=0.04), and urge management (b=0.40, p=0.04) during CBT-E. If replicated, our findings suggest that individuals with low emotion regulation, may benefit from learning emotion regulation skills to improve their ability to successfully utilize CBT skills to reduce binge eating.

Sequencing Of Symptom Emergence In Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, And Purging Disorder And Relation Of Prodromal Sympotms To Future Onset Of These Eating Disorders  
Eric Stice1, Chris Desjardins2, Paul Rohde3, Heather Shaw1
1Stanford University, Palo Alto, CA, United States, 2St. Michaels College, Colchester, VT, United States, 3Oregon Research Institute, Eugene, OR, United States

1. Introduction.
 The objective of this report was to characterize the temporal sequencing of symptom emergence for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) and test whether prodromal symptoms increase risk for future onset of each eating disorder type.  2. Methods. Data from 4 prevention trials that targeted high-risk young women with body image concerns (N=1,952; Mage 19.7, SD 5.7) and collected annual diagnostic interview data over 3-year follow-up were combined to address these aims.   3. Results. Regarding behavioral symptoms, compensatory weight control behaviors typically emerged first for AN, BN, and PD, whereas binge eating typically emerged first for BED. Regarding cognitive symptoms, for AN weight/shape overvaluation typically emerged first, whereas for BN, BED, and PD overvaluation typically emerged simultaneously with feeling fat and fear of weight gain. Binge eating, compensatory behaviors, weight/shape overvaluation, fear of weight gain, and feeling fat predicted BN, BED, and PD onset, whereas weight/shape overvaluation, fear of weight gain, and lower than expected BMI predicted AN onset.  4. Conclusions. Results suggest that compensatory weight control behaviors and cognitive symptoms are likely to emerge before binge eating in the various eating disorders, and that offering indicated prevention programs to youth with prodromal symptoms may be an effective way to prevent eating disorders.

Effectiveness Of The Body Project For Different Racial And Ethnic Groups And An Evaluation Of The Potential Benefits Of Ethnic Matching 
Eric M. Stice1, Z.Ayotola Onipede1, Heather E. Shaw1, Paul Rohde2, Jeff M. Gau2
1Stanford University, Palo Alto, CA, United States, 2Oregon Research Institute, Eugene, OR, United States

1. Introduction.
 Goals were to test whether the dissonance-based Body Project eating disorder prevention program is similarly effective for different racial/ethnic groups and evaluate whether improved racial/ethnic matching of minority participants improves effects.  2. Methods. Examined pre-post Body Project data from 335 women at 3 universities (Study 1) and 1099 women and men at 61 universities (Study 2).  3. Results. In Study 1, reduction differences in thin-ideal internalization, body dissatisfaction, dieting, negative affect, and eating disorder symptoms between Asian, Black, Hispanic, Native American, and White participants were nonsignificant, though power was limited. In Study 2, there was only one instance where effects were weaker for a minority group relative to Whites (Black vs. White participants showed smaller reductions in thin-ideal internalization), but there were several instances in which effects were larger for Hispanic vs. White and Black participants, and for Asian vs. Hispanic and Black participants; differences were partially driven by different pretest risk levels across groups. Ethnic/racial matching for minority groups was not associated with larger effects.  4. Conclusions. The Body Project produced relatively similar effects for racial/ethnic minority groups relative to Whites, though some effects were larger for Asian and Hispanic participants; recruiting Black participants at higher risk may contribute to larger effects for this racial group. 

An Examination Of Mechanisms Of Change In Attachment-Based Family Therapy For Adolescent Binge Spectrum Eating Disorders: Findings From An Initial Case Series
Claire Trainor1,2, Jody Russon3, Suzanne Levy4, Sophie Abber1,2, Ashley King3, Elizabeth W Lampe1,2, Guy Diamond5, Stephanie M Manasse2
1Department of Psychology, Drexel University, Philadelphia, PA, United States, 2Weight, Eating, and Lifestyle Center at Drexel University, Philadelphia, PA, United States, 3Department of Human Development and Family Science, College of Liberal Arts and Human Sciences, Virginia Tech, Blacksburg & Falls Church, VA, United States, 4Drexel University College of Nursing and Health Professions, Philadelphia, PA, United States, 5Couple and Family Therapy, Drexel University, PhiladelphiaPhiladelphia, PA, United States

  Introduction: While family-based treatment (FBT) is effective at treating adolescent (AD) bulimia nervosa (BN), research shows that 1) families high in conflict and expressed emotion (EE; parental criticism and overinvolvement) benefit less from FBT and 2) families of adolescents with BN have higher EE. Attachment based family therapy (ABFT)—an evidence-based approach emphasizing relational skill building in order to reduce conflict and EE—may be an effective adjunct or precursor to FBT for BN. However, this intervention has yet to be tested.   Method: We piloted a 16-week, small case series (N=6, projected N=10) to test ABFT for adolescent BN.   Results: AD reported a mean of 17 binge episodes (BE) at baseline, 2 BE at eight weeks, and 0 BE at post-treatment. Support was mixed in terms of whether treatment: was effective at reducing BN symptoms (AD: M=4.00, SD=1.00, caregivers (CG): CG; M=4.00, SD=1.73), improved family communication (AD: M=4.00, SD=1.00, CG: M=4.00, SD=1.73), decreased family conflict (AD: M=3.67, SD=1.53, CG: M=4.00, SD=1.00), and improved the quality of their relationship (AD: M=4.00, SD=1.00, CG: M=4.00, SD=1.00).   Discussion: Initial findings show that ABFT may be an acceptable and effective treatment for adolescent BN. We will discuss revisions made to ABFT for BN (i.e., integration of behavioral strategies to reduce ED symptoms), impacts of ABFT on mechanistic targets (i.e., family conflict and EE) and ED symptom outcomes, and future research directions.

The Effect Of Integrated Cbt Versus Cbt For Eating Disorders Only For Co-Occurring Eating Disorders And Posttraumatic Stress Disorder On Transdiagnostic Outcomes
Kathryn Trottier1,2, Candice Monson3, Danielle MacDonald1,2, Ross Crosby4, Stephen Wonderlich4
1University Health Network, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3Ryerson University, Toronto, ON, Canada, 4Sanford Health, Fargo, ND, United States

Introduction: Difficulties with emotion regulation, shame, and maladaptive cognitive schemas are associated with both eating disorders (EDs) and posttraumatic stress disorder (PTSD), which frequently co-occur (ED-PTSD). Each has been hypothesized to contribute to the development and maintenance of both disorders, and may be mechanisms of comorbidity. Few studies have examined the impact of treatments for ED or PTSD on emotion regulation, shame, and/or maladaptive schemas. Methods: We conducted secondary analyses of transdiagnostic outcomes (Difficulties with Emotion Regulation Scale, Experience of Shame Scale, Young Schema Questionnaire) from a randomized controlled trial comparing the efficacy of Integrated CBT for ED-PTSD to CBT for ED (N=42). Primary analyses previously showed that both treatments led to improvements in PTSD, anxiety, and depression, with Integrated CBT leading to lower PTSD symptoms at post-treatment and follow-up, as well as lower anxiety at follow-up. Results: Both treatments led to improvements in emotion regulation, shame, and maladaptive schemas, Fs>3.51, ps<.05. However, there was a significant time x condition interaction for shame, F(3,60)=3.08, p=.03. Whereas Integrated CBT led to significant improvements in shame at 3- and 6-month follow-up, improvements made with CBT for ED on shame were lost over follow-up. Conclusions: Although CBT for ED is efficacious for individuals with ED-PTSD, Integrated CBT may enable a more fulsome recovery for individuals with ED-PTSD. 

Comparing Online Exposure Body Image Interventions For Adult Women: A FEasibility And Pilot Trial
Fidan Turk, Stephen Kellett, Glenn Waller
University of Sheffield, Sheffield, United Kingdom

Objective. The aim of the current study was to assess the feasibility and effectiveness of delivering two differing online interventions for body image problems in women to inform the design of a future trial. Methods. Participants were randomized to either online body-exposure or self-compassion interventions.  The primary feasibility outcomes were recruitment, measure completion rates, dropout rates, internet connection failure rates and intervention adherence rates.  The secondary pilot outcomes being change analyses on clinical measures and state subjective units of distress during the interventions. Five validated outcome measures (body shape, satisfaction, appreciation, eating disorder and anxiety) were taken at three time points; pre and post intervention and at 2-week follow-up.   State body shame was scored during the interventions every 5-minutes on a 0-100 scale.  Results. The target of recruiting 30 participants in 60 days was successfully achieved. The measure completion rate was high and the dropout analysis showed the moderate-to-high acceptability of interventions. The subjective units of distress outcome measure showed that the self-compassion intervention significantly reduced state body shame throughout the intervention. There was no significant improvement or difference between interventions in trait outcome measures. Conclusions. Findings suggest that full powered trial is possible and sample size calculation and some methodological suggestions are therefore provided.  

Brief Cognitive-Behavioural Therapy For Binge-Eating Disorder: Clinical Effectiveness In A Routine Clinical Setting
Glenn Waller1, Elana Moore2, Michelle Hinde2
1University of Sheffield, Sheffield, United Kingdom, 2South Yorkshire Eating Disorders Association, Sheffield, United Kingdom

Purpose: Brief cognitive-behavioral therapy (CBT) is effective in working with non-underweight eating disorder patients across transdiagnostic groups. However, is it as effective in the treatment of binge-eating disorder, where emotional eating is likely to play a larger role than starvation-driven eating. Methods: This case series tested whether brief, 10-session CBT (CBT-T) would be effective, in a case series of 53 patients with binge-eating disorder. Attrition rates were comparable to previous research. Eating attitudes, binge frequency, anxiety and depression were measured. Remission was measured comparing different categorical methods: ‘cut off’; Reliable Change Index; and Clinically Significant Change. Results: CBT-T was effective for binge-eating disorder patients, at comparable levels to other non-underweight patients. All measures of pathology were significantly reduced, with large to moderate effect sizes. When categorical changes were used to indicate remission, Reliable Change Index and Clinically Significant Change levels were more appropriate than existing cut-off methods, potentially because of the lower levels of initial restrained eating in this clinical group. Conclusions: CBT-T’s effectiveness in transdiagnostic groups is replicated in binge-eating disorder patients, despite their greater level of emotionally-driven eating. More stringent definitions of remission (Clinically Significant Change; Reliable Change Index) should be used, to ensure realistic estimates.

An Eight Session Mindful Self-Compassion Workshop Improves Self-Compassion And Eating Disorder Symptoms Among Individuals With Eating Disorders
Brenna M Williams, Cheri A Levinson
University of Louisville, Louisville, KY, United States

The Mindful Self-Compassion (MSC) workshop is an eight-week program designed to promote self-compassion and mindfulness delivered in a group setting. MSC has not yet been tested in individuals with EDs. The current study aimed to investigate the feasibility and initial clinical outcomes of MSC among individuals with an ED.
  Participants with a current ED (N=10) attended a weekly MSC workshop and completed measures at pre- and post-workshop and one-month follow-up.   Overall, 60% (n=6) completed at least half of the sessions. Large effect sizes were found for overall self-compassion (η2=.66), self-kindness (η2=.93), self-judgment (η2=.71), common humanity (η2=.40), isolation (η2=.16), mindfulness (η2=.19), and overidentification (η2=.85). Regarding ED symptoms, a medium effect size was found for eating concerns (η2=.11), and small effect sizes were found for overall ED symptoms (η2=.02), restraint (η2=.01), weight concerns (η2=.01), and no effect was found for shape concerns.   These findings suggest that MSC improves aspects of self-compassion with large effect sizes and ED symptoms, with the exception of shape concerns, with medium to small effect sizes. Thus, MSC may be an efficacious program to target self-compassion and ED symptoms among individuals with an ED. Future research is needed with larger sample sizes to continue to understand the impact of self-compassion on ED pathology. 

Feasibility Of A Virtually-Delivered Eating Disorder Prevention Program For Young Females With Type 1 Diabetes
Line Wisting1,2, Severina Haugvik3,4, Anne L Wennersberg1, Trine W Hage1, Eric Stice5, Marion P Olmsted6, Ata Ghaderi7, Cathrine Brunborg8, Torild Skrivarhaug2,3,4,9, Knut Dahl-Jørgensen2,3,4,9, Øyvind Rø1,10
1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway, 2Oslo Diabetes Research Centre, Oslo, Norway, 3Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 4The Norwegian Diabetes Centre, Oslo, Norway, 5Department of Psychiatry and Behavioral Science, Stanford University, Stanford, CA, United States, 6Department of Psychiatry, University of Toronto, Toronto, ON, Canada, 7Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, 8Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway, 9Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway, 10Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Oslo, Norway

Introduction: This study aimed to develop a virtual diabetes-specific version of the eating disorder (ED) prevention program the Body Project (Diabetes Body Project), and to assess feasibility and preliminary efficacy of this program for young females with type 1 diabetes (T1D). Methods: Young females with T1D aged 16-35 years were invited to participate in the study. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over six weeks). Primary measures included ED risk factors and symptoms, and secondary outcomes included T1D-specific constructs previously found to be associated with ED pathology (diabetes distress and illness perceptions). Results: The ease of recruitment, timely conduct of five groups, moderate drop-out rate and appreciation of the intervention by participants indicated that the Diabetes Body Project is feasible. Meaningful reductions, with medium to large effect sizes, occurred on the primary outcomes (i.e. ED pathology, body dissatisfaction, and thin ideal internalization) and on internalization of appearance ideals and appearance pressures (Cohen’s d ranging from .63 to .83) at posttest. Small to medium effect sizes were found for diabetes illness perceptions and distress (.41 and .48, respectively). Conclusions: The virtual Diabetes Body Project is a promising intervention, worthy of more rigorous evaluation. A randomized controlled trial is warranted to determine its efficacy compared to a control condition. 

10:45 - 12:15 PMRoom 1
Target Engagement (Part 1): Leveraging Multi-Modal Exploration of Eating Pathology to Delineate Potential Mechanistic Intervention Targets

Chair(s): Sasha Gorrell
Finding Treatments For Eating Disorders (Fed): A Study Examining The Use Of Repetitive Transcranial Magnetic Stimulation (Rtms) In Adolescents With Anorexia Nervosa
Gina Dimitropoulos
University of Calgary

From Desire To Dread - A Neurocircuitry Based Model For Food Avoidance In Anorexia Nervosa
Guido Frank
University of California, San Diego

Neural Correlates Of Reinforcement Learning Specific To Hyperactivity In Adolescent Anorexia Nervosa
Sasha Gorrell
University of California, San Francisco

Ovarian Hormone Programming Of Neural Reward Systems During Puberty And Their Mechanistic Links To Binge Eating
Kelly Klump
Michigan State University, East Lansing, MI, United States

1:15 - 2:45 PMRoom 2
Target Engagement (Part 2): Transdiagnostic Application in Practice

Chair(s): Maurizio Fava
Target Engagement In Psychiatric Disorders
Joan Camprodon
Massachusetts General Hospital

Cognitive Remediation Therapy As An Adjunct To Family-Based Treatment For Adolescent Anorexia Nervosa
Alix Timko
University of Pennsylvania

Theta Burst Stimulation Studies In An
Lucy Gallop
King's College London

Augmenting Cognitive Behavioral Therapy For Binge Spectrum Eating Disorders With Inhibitory Control Training: Target Engagement And Initial Efficacy
Stephanie Manasse
Drexel University

Maurizio Fava
Massachusetts General Hospital

2:50 - 4:30 PMRoom 1
Top Abstracts Session / Business Meeting

Chair(s): Kamryn Eddy
"Best Student Abstract Award Winner/Top Abstract" One Year Of Covid-19: How Has This Affected Individuals With An Eating Disorder?
Jet D. Termorshuizen1,2, Emma Forsén Mantilla1, Christine M. Peat3, Casey M. MacDermod3, Lauren E. Harper3, Hunna J. Watson3,4,5, Rachael E. Flatt3, Eline van Bree2, Rachel W. Goode3, Afrouz Abbaspour1, David Clinton1, Laura M. Thornton3, Andreas Birgegård1, Eric F. van Furth2,6, Cynthia M. Bulik1,3,7
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 2Rivierduinen Eating Disorders Ursula, Leiden, Netherlands, 3Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 4School of Psychiatry, Perth, Australia, 5School of Paediatrics, Division of Medicine, The University of Western Australia, Perth, Australia, 6Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands, 7Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

Introduction: We assessed eating disorder (ED) symptomatology, well-being, and care access in the first year of the COVID-19 pandemic among individuals with a current or past ED in the Netherlands (NL), the United States (US), and Sweden (SE).
Methods: Participants completed monthly (US, NL) and half-yearly (SE) online surveys between mid-May 2020 and one year later. At one-year follow-up, questions related to socioeconomic status, COVID-19 vaccination, and COVID-19 long-term symptoms were added. We will present baseline, six-month, and one-year follow-up data (one-year data collection will be complete in June 2021 in all three countries). Results: Participants (US n=511; NL n=510; SE n= 982) were mostly young (>50% age <30), female, and self-reported anorexia nervosa (>60% in all three countries). At baseline, we observed an increase in ED symptoms, with >50% of participants reporting concerns about a lack of structure. Also, 40-50% was not in treatment, and >60% self-reported more anxiety since the start of the pandemic. Nearly half of all participants experienced positive life changes. Analysis of SE data indicated shifts in illness status, e.g., some symptom-free at baseline reported re-emergence of symptoms at six-month follow-up. Conclusion: The COVID-19 pandemic has widespread short- and potential long-term effects on individuals with a current or past ED. Clinicians should be attentive to these while recognizing that every individual is affected differently. 

"Early Career Investigator Award Winner" Socioeconomic Status And Eating Disorder Risk: At The Intersections Of Gender Identity, Sexual Orientation, And Race/Ethnicity
Natasha L. Burke1, Vivienne M. Hazzard2, Lauren M. Schaefer2,3, Melissa Simone4,5, Jennifer O'Flynn6, Rachel F. Rodgers6,7
1Department of Psychology, Fordham University, Bronx, NY, United States, 2Sanford Center for Bio-behavioral Research, Fargo, ND, United States, 3Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States, 4Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, United States, 5Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States, 6Department of Applied Psychology, Northeastern University, Boston, MA, United States, 7Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France

Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) have eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research on those of lower SES, this study examined 1) the association between SES and ED risk and 2) ED risk across 4 social identities (SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk.
120,891 college students (18yrs+) from the Healthy Minds Study self-reported family SES with a single-item question, ED risk with the SCOFF, gender identity, sexual orientation, and race/ethnicity. Those of lower SES had 1.27 (95% CI: 1.25–1.30) times greater prevalence of a positive SCOFF than those of higher SES. Substantial heterogeneity was observed across the 4 social identities beyond the association with SES. For example, positive SCOFF screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. Although overall elevated ED risk is more common among those of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating the multi-layered constructs of identity when identifying groups at disproportionate risk.

Biobehavioral Prediction Of Illness Trajectory In Bulimic Syndromes
Pamela K. Keel, Austin Starkey, Chloe Halfhide, Jonathan Appelbaum, Diana L. Williams
Florida State University, Tallahassee, FL, United States

We recently proposed a model to account for the impact of weight suppression (WS) on maintenance of bulimia nervosa (BN) and related syndromes (BN-S) via biobehavioral alterations in reward valuation and reward satiation. Methods: Women with BN-S (n=79) and non-eating disorder controls (n=25) completed structured interviews, progressive ratio tasks of food and nonfood reward value, fixed meal assessment of satiation signals, and ad lib meal assessment of satiation at baseline and 6-month follow-up. Results: Consistent with our model, WS was associated with lower leptin and blunted postprandial glucagon-like peptide 1 (GLP-1) response. Lower leptin prospectively predicted reward satiation at follow-up, controlling for baseline reward satiation, WS, %body fat, and GLP-1 response; reward satiation prospectively predicted binge size in multivariable models. Blunted GLP-1 response prospectively predicted loss of control (LOC) frequency at follow-up, controlling for baseline LOC frequency, WS, %body fat, and leptin. Inconsistent with our model, WS was not associated with food or nonfood reward value. Instead, higher leptin was associated with greater food reward value which was associated with greater binge size. Conclusions: Results support changing our model to reflect direct associations between WS and alterations in leptin and GLP-1 response that demonstrate unique prospective associations with the two defining features of binge episodes in BN-S.

A Double-Blinded, Randomized, Sham-Controlled Trial On The Effects Of Repetitive Transcranial Magnetic Stimulation In People With Binge Eating Disorder And Obesity
Mara F Maranhão1, Nara M Stella1, Maria Elisa G Cury1, Iain Campbell2, Ulrike Schmidt2, Angélica M Claudino1
1Universidade Federal de São Paulo, SAO PAULO, Brazil, 2King’s College London, LONDON, United Kingdom

: Brain mechanisms underlying drug and food cravings are suggested to be similar and evidence suggest that brain stimulation may have a role in eating disorders treatment. The main aims of this study were to investigate the effects of rTMS on binge eating and food craving in people with binge eating disorder (BED) and obesity. Methods: We conducted a double-blind, sham-controlled, randomized trial in adult women with BED (DSM-5 criteria) and BMI> 35Kg/m2. Participants underwent treatment with 20 sessions of neuronavigated rTMS to the left dorsolateral prefrontal cortex. Primary outcomes were binge eating frequency (BEE) and "urge to eat" (craving). Secondary aims included the effects of rTMS on body mass index (BMI), eating and general psychopathology, evaluated at end of treatment and 8-week follow-up. Data was analyzed using linear mixed models. Results: Sixty participants were randomized. Findings did not indicate effects of real rTMS on primary or secondary outcomes considering ITT analysis adjusted for multiple comparisons (BEE: adjusted p=0.254; unadjusted p=0.01 favoring real TMS; group x time interaction). Conclusion: This rTMS protocol could not evidence effects of treatment in women with BED. Future studies should investigate optimal stimulation protocols and brain targets.

Cytokine Concentrations In Adolescent Anorexia Nervosa – A Longitudinal Study
Jochen Seitz1, Hannah Specht1, Stephanie Trinh2, Lara Keller1, Brigitte Dahmen1, Beate Herpertz-Dahlmann1
1Clinic for Child and Adolescent Psychiatry, RWTH University Hospitaly, Aachen, Germany, 2Institute for Neuroanatomy, RWTH University Hospital, Aachen, Germany

Introduction: Cytokines are signalling molecules, important for the functioning of the immune system and brain development and subsequent behavior alike. They play a role in appetite regulation, body weight and psychological health like mood regulation or anxiety. Recent meta-analyses show a low-grade inflammation with increased pro-inflammatory cytokines IL-6, IL-1beta and TNFalpha in adult patients with AN. However, longitudinal results on their course after weight restoration are sparse and results in adolescents are almost completely lacking. Methods: We analyzed serum of 61 adolescent patients at admission and 41 HC and followed them up at discharge and 1 year after admission or respective timepoints. Results: Analysis of the first 20 patients at admission and discharge and comparison to 20 HC confirmed increased TNF-alpha at admission, similar to adults. However, IL-6 and IL-1beta were significantly reduced in our adolescent sample at both admission and discharge, differently than in adults. At the conference we will additionally present the analysis of the remaining sample including the 1 year follow-up. Conclusions: If confirmed in the larger sample, findings of partly increased but also partly reduced pro-inflammatory cytokines in adolescents might point to a differential role of inflammation in adolescents with AN. This could be linked to shorter duration of illness and have implications on understanding pathophysiology early on in the course of AN.

Evidence That A Novel Transdiagnostic Eating Disorder Treatment Reduces Reward Region Response To The Thin Beauty Ideal
Eric Stice1, Sonja Yokum2, Paul Rohde2, Jeff Gau2, Heather Shaw1
1Stanford University, Palo Alto, CA, United States, 2Oregon Research Institute, Eugene, OR, United States

1. Introduction.
 The present report tested whether a transdiagnostic eating disorder treatment reduces responsivity of brain valuation regions to thin models and high-calorie binge foods, the intervention targets, and produced favorable outcomes.  2. Methods. Women with DSM–5 eating disorders (N=138) were randomized to the dissonance-based Body Project Treatment (BPT) or a waitlist control condition and completed fMRI scans assessing neural response to images of thin models and high-calorie foods pretest and posttest.   3. Results. BPT versus control participants showed greater reductions in responsivity of regions implicated in reward valuation (caudate) and attentional motivation (precuneus) to thin versus average weight models, greater reductions in responsivity of regions implicated in reward valuation (ventrolateral prefrontal cortex) and food craving (hippocampus) to high-calorie binge foods versus low-calorie foods, as well as greater reductions in eating disorder symptoms, abstinence from binge eating and purging behaviors, palatability ratings for high calorie foods, monetary value for high-calorie binge foods, and greater increases in attractiveness ratings of average weigh models.  4. Conclusions. Results provide evidence that BPT reduces valuation of the thin ideal and high-calorie binge foods, the intervention targets, per objective brain imaging data, and produces clinically meaningful reductions in eating disorder symptoms.  

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