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Carl Bartl1, Ricarda Schmidt1, Cord Benecke2, Bernhard Strauss3, Elmar Brähler4, Anja Hilbert1
1Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany, 2Department of Psychology, Clinical Psychology and Psychotherapy, Human Sciences, Kassel, Germany, 3Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany, 4Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany

Introduction. Self-regulation including attention control and emotion regulation is known to play a central role in the development and maintenance of eating disorders (ED). Previous research subtyped individuals with EDs based on self-regulation and weight status and found distinctive profiles with relevance to ED etiology, prognosis, and treatment. However, to date nothing is known about the presence of these patterns among the population. This study sought to replicate self-regulation profiles and their ability to discriminate ED psychopathology in the general population. Methods. Within a German representative sample, N = 2395 adults (18-92 years) were examined using established self-report questionnaires on general and emotion regulation, ED and general psychopathology, and personality. Latent profile analysis (LPA) was performed to identify subtypes based on self-regulation and body mass index (BMI). Results. LPA clearly identified seven profiles with specific levels of self-regulation and BMI. Subtypes were associated with significantly different levels of ED and general psychopathology, and personality. The indicators explained 65% of the variance of the sample. Conclusions. This study uniquely revealed that low self-regulation was an indicator for ED and general psychopathology, and personality dysfunction in the adult population. Based on the identified profiles, it might be possible to detect individuals at risk for developing an ED in non-clinical settings.
Session: On-Demand Poster Session
Courtney E. Breiner1,2, Pooja Shah2, Natalia C. Orloff2, Rebecka Peebles2,3, C. Alix Timko2,3
1University at Albany, SUNY, Albany, NY, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA, 3University of Pennsylvania, Philadelphia, PA, USA

Introduction. Initial research on avoidant-restrictive food intake disorder (ARFID) indicates that there are three distinct subtypes: fear of aversive consequences, sensory sensitivity, and lack of interest. Two studies examined clinical differences between these groups, both of which had small sample sizes (n<85) and limited generalizability. In order to understand differences between subtypes, larger and more diverse samples are needed. Method. A retrospective chart review was completed for patients with ARFID aged 5-20 years (n=154,Mage=12.7,50% male) who presented to an outpatient eating disorder program over an 8-year period. Subtypes were compared on demographics, anthropometrics, and clinical characteristics. Results. Youth with a general lack of interest were older than those with sensory sensitivity F(2,154)=4.93,p<.01). Those with fear of aversive consequences had a shorter length of illness (F(2,126)=12.35,p<.01), were more likely to need medical stabilization (Χ2(2,N=149)=10.32,p<.01), consumed less calories in the past 24 hours(F(2,63)=3.22,p<.05), were more likely to need an NG while in hospital (Χ2(2,N=85)=10.36,p<.01), were more malnourished (Χ2(6,N=74)=12.65,p<.05), and were more likely to be female (Χ2(2,N=154)=12.98,p<.01). Conclusions. There are clear differences between the fear of aversive consequences subtype and the other subtypes. Future research should examine follow-up data on recovery markers between subtypes to understand clinical course.
Session: On-Demand Poster Session
Validity evidence of the Negative Urgency subscale of the Urgency, Premeditation, Perseverance, and Sensation Seeking scales (UPPS) in different populations with disordered eating.
Eva M. Conceição1, Jorge Sinval2,3,4, Marta de Lourdes1, Sílvia Félix1, Paulo Machado1, Ana R. Vaz1
1University Of Minho, Braga, Portugal, 2William James Center for Research, ISPA – Instituto Universitário, Lisbon, Portugal, 3Business Research Unit (BRU-IUL), Instituto Universitário de Lisboa (ISCTE-IUL) , Lisbon, Portugal, 4Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

This study investigates the validity evidence of the negative urgency scale of the UPPS (UPPS-NU) in different samples: Community (n = 341), adolescents with obesity (n = 210); bariatric surgery (BS) (n = 291), and eating disorders (ED) patients (n = 143). Participants responded to a set of self-report measures in the context of other parent studies including the UPPS-NU and measures assessing grazing (Rep(eat)-Q), disordered eating (TFEQ-21), depression (DASS), emotion regulation (DERS), loss of control eating (LOCES) and ED psychopathology (ED-15). The community sample showed the lowest mean scores (M = 2.253; SD = 0.585), followed by BS patients, adolescents with obesity, and ED sample (M = 2.841; SD = 0.647). The original dimensionality of the instrument was not confirmed: item 11 presented low factor loading (λitem 11 = .154), and items 2 and 5 were had several high values modification indices. A correlation path between the residuals of items 3 and 4 was added (r = .563; p <.001). As such, we propose a reduced version with 9 items: acceptable fit (χ2(26) = 340.102; p <.001, n = 1,025; CFI = .991; NFI = .990; TLI = .988; SRMR = .065; RMSEA = .109; P(rmsea) ≤ .05) <.001; 90% CI [.098; .119]; good Average Variance Extracted (= .571); good reliability (α = .918, ω = .884); good convergent validity (e.g., rRep(eat)-Q = .405, p <.05; rDERS-impulsive = .567, p <.05). The UPPS showed promising validity evidence across different samples with disordered eating behaviors.
Session: On-Demand Poster Session
Validation of the Norwegian version of the Eating Disorder Assessment for DSM-5 (EDA-5): Final results
Camilla L Dahlgren1,2, B Timothy Walsh3, Karianne Vrabel4, Cecilie Siegwarth1, Øyvind Rø1,5
1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway, 2Department of Psychology, Bjørknes University College, Oslo, Norway, 3Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York State Psychiatric Institute, New York , NY, USA, 4Research Institute of Modum Bad, Vikersund, Norway, 55Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Objective: The Eating Disorder Assessment for DSM-5 (EDA-5) is an electronic, semi-structured interview developed to assess feeding and eating disorders following DSM-5 criteria. The original English version has strong psychometric properties, and previous research has shown high rates of agreement between diagnoses generated by the Eating Disorder Examination (EDE) interview and the EDA-5. The current study aimed to validate the Norwegian version of the EDA-5 and is the first international validation of this diagnostic tool. Method: A total of 91 (87 females and 4 males) adult in- and out-patients were recruited from two of the largest eating disorder clinics in Norway. Diagnoses assigned using the EDA-5 were compared to diagnoses from the EDE interview (v. 17.0D).

Results showed that diagnoses assigned using EDE and EDA-5 were identical for 75 (82.4%) of the 91 cases. Among individual diagnostic categories, kappas ranged from moderate (.49) to perfect (1.00) agreement. Most discrepant cases occurred between full- and sub-threshold AN and BN. The EDA-5 was significantly quicker to administer compared to the EDE (22 vs. 54 min).

The Norwegian EDA-5 can quickly and efficiently generate DSM-5 diagnoses without compromising diagnostic accuracy. It is a promising alternative to existing diagnostic tools and may help streamline the identification of feeding and eating disorders in clinical settings and in research.
Session: On-Demand Poster Session
Factor Structure of a Modified Pregnancy Version of the Eating Disorder Examination (EDE-PV)
Rebecca Emery1, Rachel Conlon2, Michele Levine2
1University of Minnesota, Minneapolis, MN, USA, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Introduction: Given the relationship between pregnancy and changes in eating, shape, and weight, there is a need for psychometrically sound measures of disordered eating attitudes and behaviors among pregnant women. The present study examined the factor structure of a modified pregnancy version of the Eating Disorder Examination (EDE-PV) in a community sample of pregnant women with overweight/obesity.

The EDE-PV was administered to 257 pregnant women between 12-20 weeks gestation. An exploratory factor analysis (EFA) with oblique promax rotation was conducted using robust maximum likelihood estimation. Internal consistency coefficients were calculated for the resulting factors.

EDE-PV items endorsed by fewer than 10% of the sample were excluded from analysis (n=10). An EFA of the remaining 12 items indicated that a 3-factor solution produced the best model fit (root mean square error of approximation=0.05, 90% CI [0.02, 0.07]; root mean square residual=0.04). The items comprising the EDE-PV subscales did not replicate those in the original EDE. The EDE-PV subscales were interpreted as Weight Loss Motivation (α=0.66), Overvaluation of Weight and Shape (α=0.84), and Body Dissatisfaction (α=0.80).

Pregnancy-specific factors associated with disordered eating attitudes and behaviors can be identified among pregnant women with overweight/obesity using the EDE-PV and differ from those in the original EDE.
Session: On-Demand Poster Session
COVID Isolation Eating Scale (CIES): Analysis of the Impact of Confinement in Eating Disorders and Obesity
Mikel Etxandi1, Lucero Munguía1,2, Gemma Mestre-Bach1,4, Isabel Baenas1,3, Roser Granero3,5, Isabel Sánchez1,3, Jessica Sánchez-González1, Fernando Fernández-Aranda1,2,3
1Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), Spain, 2Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain, 3CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain, 4Universidad Internacional de La Rioja, La Rioja, Spain, 5Department of Psychobiology and Methodology, School of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain

Confinement during the COVID-19 pandemic is expected to have a serious impact on the mental health of patients both with eating disorders (ED) and with obesity. The present study has the following aims: to analyze the psychometric properties of the COVID Isolation Eating Scale (CIES), to explore changes that occurred due to confinement in eating symptomatology and to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 with ED and 34 with obesity) that voluntarily completed the questionnaire. Patients were recruited from six different centers. Adequate goodness-of-fit was obtained for the confirmatory factor analysis that tested the rational-theoretical structure of the CIES. Regarding the effects of confinement, different results were observed depending on the ED subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype.
Session: On-Demand Poster Session
Fernando Fernandez-Aranda1,2, Xandra Romero1, Zaida Agüera1,2, Roser Granero2, Isabel Sanchez1,2, Ashley N Gearhardt3, Carlos Dieguez2, Isabel Baenas1,2, Susana Jimenez-Murcia1,2
1Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain, 2CIBERobn, Barcelona, Spain, 3Department of Psychology, University of Michigan, Ann Arbor, MI, USA

Objectives: The study aimed to examine whether food addiction (FA) was associated with greater severity in both binge eating disorders (BED) and bulimia nervosa and, therefore, to determine if FA was predictive of treatment outcome. Method: Seventy-one adult patients with bulimia nervosa and BED (42 and 29, respectively) participated in the study. FA was assessed by means of the Yale Food Addiction Scale.

Results: The results confirmed a high prevalence of FA in patients with binge disorders (around 87%) and also its association with a greater severity of the disorder (i.e., related to an increased eating psychopathology and greater frequency of binge eating episodes). Although FA did not appear as a predictor of treatment outcome in general terms, when the diagnostic subtypes were considered separately, FA was associated with poor prognosis in the BED group. In this vein, FA appeared as a mediator in the relationship between ED severity and treatment outcome.

Conclusions: Our findings suggest that FA may act as an indicator of ED severity, and it would be a predictor of treatment outcome in BED but not in BN. Funding: We thank CERCA Programme/ Generalitat de Catalunya for institutional support. FIS: PI17/01167 and SLT006/17/00246
Session: On-Demand Poster Session
Susana Jimenez-Murcia1,2, Zaida Agüera1,2, Lucero Munguia1, Roser Granero2, Jessica Sanchez1, Ashley N Gerhardt3, Carlos Dieguez2, Isabel Baenas1,2, Fernando Fernandez-Aranda1,2
1Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain, 2CIBERobn, Barcelona, Spain, 3Department of Psychology, University of Michigan, Ann Arbor, MI, USA

Goal: Food addiction (FA) has been associated with greater psychopathology in individuals with eating disorders (ED) and obesity (OBE). The current study aims to provide a better phenotypic characterization of the FA construct by conducting a clustering analysis of FA in both conditions (ED and OBE). Method: The total sample was comprised of 234 participants that scored positive on the Yale Food Addiction Scale 2.0. (YFAS-2) [119 bulimia nervosa (BN), 50 binge eating disorder (BED), 49 other specified feeding or eating disorder (OSFED) and 16 OBE]. All participants completed a comprehensive battery of questionnaires.

Three clusters of FA participants were identified. Cluster 1 (dysfunctional) was characterized by the highest prevalence of OSFED and BN, the highest ED severity and psychopathology, and more dysfunctional personality traits.Cluster 2 (moderate) showed a high prevalence of BN and BED and moderate levels of ED psychopathology. Finally, the cluster 3 (adaptive) was characterized by a high prevalence of OBE and BED, low levels of ED psychopathology, and more functional personality traits. Conclusion: this study identified three distinct clusters of ED-OBE patients with FA and provides some insight into a better phenotypic characterization of the FA construct when considering psychopathology, personality and ED pathology. Future studies should address whether these three food addiction categories are indicative of therapy outcome.
Session: On-Demand Poster Session
Isabel Krug1, An Binh Dang1, Roser Granero2, Zaida Agüera3, Isabel Sánchez3, Nadine Riesco3, Susana Jimenez Murcia3, Jose Menchón3, Fernando Fernandez-Aranda3
1The University of Melbourne, Melbourne, Australia, 2Universitat Autònoma de Barcelona , Barcelona, Spain, 3University Hospital of Bellvitge-IDIBELL, Barceona, Spain

Objective: To assess an alternative transdiagnostic indicator for severity based on drive for thinness (DT) for Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), and Other Specified Feeding or Eating Disorder (OSFED), and to compare this new approach to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) severity categories for EDs. Method:2811 ED [428 AN-Restrictive (AN-R), 313 AN-Binge Purging (AN-BP), 1340 BN, 329 BED, 154 OSFED/Atypical AN (AT), and 223 OSFED/Purging Disorder (PD)] patientswere classified using: a.) the DSM-5 severity categories and b.) a DT categorisation. These severity classifications were then compared based on ED symptoms, general psychopathology, personality, and impulsive behaviours.

For the DSM-5 categories, most ED patients fell into the "mild" to "moderate" categories. Using the DT categories, AN patients were mainly represented in the "low" DT category, and BN, OSFED/AT, and PD in the "high" DT category. The clinically significant findings were stronger for the DT than the DSM-5 severity approach (medium-to-large effect sizes). AN-BP and AN-R provided the most pronounced effects. Conclusion:Our findings question the clinical value of the DSM-5 severity categorisation, and provide initial support for an alternative DT severity approach for AN.
Session: Paper Session 4: Clinical/Psychopathology
Lucero Munguía1,2, Susana Jiménez-Murcia1,2,3, Gemma Mestre-Bach1,4, Trevor Steward5, Mikel Etxandi1, Isabel Baenas1,3, Roser Granero3,6, Isabel Sánchez1,3, Jessica Sanchez-Gonzalez1, Fernando Fernández-Aranda1,2,3
1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 2Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain, 3CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain, 4International University of La Rioja, La Rioja, Spain, 5Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia, 6Department of psychobiology and methodology of health sciences, Autonomous University of Barcelona, Barcelona, Spain

1. Introduction Due to confinement of COVID 19 disease, telemedicine was used in order to continue healthcare services. However, there is a lack of studies looking at the effectiveness and acceptability of telematics interventions by users. The aim of the present study is to explore the acceptability of remote interventions by patients with eating disorders (ED) and obesity during COVID 19 confinement. 2. Methods The sample consisted of 121 female and male participants, 87 ED patients (55 AN, 18 BN, 14 OSFED) and 34 patients with obesity, with an average age of 33 years old (SD=15.8), who were involved in treatment before confinement, recruited from public and private units in Barcelona (Spain). The IV subscale of the COVID Isolation Eating Scale (CIES), Evaluation of remote interventions, was used. The CIES is a self-report questionnaire that assess the impact of confinement in patients with ED and/or obesity. 3. Results A tendency to positive valuations of remote interventions, as well as a general satisfaction with them, was found. The lowest mean was registered for the AN patients, and the highest by the obese and OSFED patients. Therefore, AN patients had the most difficulty in adapting to the telemedicine approach used during confinement. 4. Conclusions The CIES is an instrument that may help to assess remote interventions. To have feedback of the use of telemedicine will help to optimize these modalities of treatment, preventing future confinement scenarios.
Session: On-Demand Poster Session
TITLE:  MEASURING EXERCISE BEHAVIOUR IN PEOPLE WITH EATING DISORDERS. Psychometric evaluation of the Dutch version of the Obligatory Exercise Questionnaire (OEQ), the Exercise Dependence Questionnaire (EDQ) and the Reasons for Exercise Inventory (REI). Research proposal
Aurélie Michelle Nieuwenhuijse1,2, Mia Scheffers1, Marlies Rekkers1,2, Janet Moeijes1, Jooske van Busschbach1, 3, Annemarie van Elburg2
1Windesheim University applied research, Zwolle, Netherlands, 2Utrecht University, Utrecht, Netherlands, 3University of Groningen, Groningen, Netherlands

Introduction In eating disorders (ED) exercise behaviour is often distorted and can be harmful. Assessment of excessive exercise is necessary for diagnosing its behavioural and psychological components and measuring the effect of interventions. The aim of this study is to evaluate the psychometric properties of the Dutch versions of the OEQ, the EDQ and the REI in a clinical sample of adult patients with ED (n = 400) and a representative non clinical adult sample (n = 700). Methods Exploratory factor analysis followed by confirmatory factor analysis will be used to investigate the dimensionality of the scales. For all three questionnaires internal consistency will be calculated in both samples. Test-retest reliability will be evaluated in the non-clinical group. To establish construct validity, correlations between the OEQ, the EDQ and the REI will be examined. Furthermore, the association between excessive exercise and body satisfaction, functional body appreciation and distorted eating will be explored. Results Results from non-clinical data will be presented, clinical data are at the moment being collected. Conclusions With this study we wish to provide adequate instruments to measure excessive exercise in ED to be used in clinical practice. This will help both clinicians and patients to gain more insight and control over seemingly healthy though harmful behaviour.
Session: On-Demand Poster Session
Natalia C Orloff, Connor Mears, Anushua Bhattacharya, Kerri Heckert, Rebecka Peebles, C. Alix Timko
Children's Hospital of Philadelphia, Philadelphia, PA, USA

Introduction. In Family-Based Treatment (FBT), parents take charge of renourishing their child, including making decisions regarding the variety and quantity of food until their child is weight restored. Following is a gradual return of autonomy of eating responsibilities. Increasing adolescents’ flexibility regarding variety and quantity of food, without the aid of parents, is a goal of treatment. Limited data exists regarding adolescents’ progress in this area. The current study examined adolescent eating behavior in the context of a Buffet Challenge, allowing for observation of meal choice, caloric intake, and eating disorder behaviors over the course of treatment. Methods. Adolescents serve themselves a meal from a buffet prior to starting FBT (T1), during Phase 2 (T2), and end of treatment (T3). Results. To date, 24 adolescents (age: 15.13±1.68) with AN (BMIz: -.57±.89) completed T1. All approached the Buffet (calories served= 805.35±709.64); 79.2% consumed food (calories consumed= 601.67±567.00). The most frequent eating disorder behaviors observed were "staring" (n=22, 91.7%), "hand fidgeting" (n=19, 79.2%), "nibbling" and "label checking" (n=10, 41.7%). Descriptive data from 9 adolescents who completed Buffet at T2 will be presented. Conclusions. Results allow for examination of whether or not increases in independently-chosen food type and amounts are associated with specific phases of treatment and if remission or relapse can be predicted by eating behavior.
Session: On-Demand Poster Session
Christina Ralph-Nearman1, Armen C. Arevian2, Megan Sinik1,3, Rajay Kumar4, Scott E. Moseman5, Jamie D. Feusner2, Sahib S. Khalsa1,3
1Laureate Institute for Brain Research, Tulsa, OK, USA, 2Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA, 3University of Tulsa, Tulsa, OK, USA, 4International Technology Consulting, LLC, Los Angeles, CA, USA, 5Laureate Eating Disorders Program, Tulsa, OK, USA

Introduction: Body image disturbance is a core feature of eating disorders with few reliable objective perceptual markers. This study examined the test-retest reliability of Somatomap, a mobile tool for visually mapping body image disturbance.

59 AN inpatients manipulated the size/shape of 23 unique body parts on a 3-dimensional (3D) avatar to reflect their perceived current body on two occasions within the same visit. Actual measurements of corresponding body parts were obtained for discrepancy score calculation. Test-retest reliability was assessed by Intraclass Correlation Coefficient (ICC) with 95% confidence intervals (CI; absolute-agreement 2-way mixed-effect model) for separate body parts and aggregated lengths, girths, and all body parts.

Current body discrepancy ICCs ranged from .43 (ankle girth) to .93 (thigh girth). Common AN concerns (thigh, hip, bust, waist) had the highest reliability (all ICCs≥.79). Aggregate measures had some of the highest ICCs: length .74 (95%CI .56-.84), girth .92 (95%CI .82-.96), all body parts 0.88 (95%CI .79-.93), all ps<.001.

Body image disturbance assessed using Somatomap 3D shows fair to excellent test-retest reliability in AN, with common concern areas and combined measures showing the highest reliability. Somatomap 3D may provide a reliable, objective perceptual marker of visual body image disturbance in AN, suggesting potential utility in longitudinal assessments.
Session: On-Demand Poster Session
Measuring body satisfaction in women with eating disorders and healthy women: Appearance-related and functional components in the Body Cathexis Scale (Dutch version)
Marlies Rekkers1,2, Mia Scheffers1, Jooske van Busschbach1,3, Annemarie van Elburg2
1Windesheim University applied research, Zwolle, Netherlands, 2Utrecht University, Utrecht, Netherlands, 3University of Groningen, Groningen, Netherlands

Introduction Body dissatisfaction may be crucial in the development, persistence and relapse of eating disorders. Refining and differentiating the concept of body satisfaction, especially the functional component, is important in both clinical and research context. The aim of the present study is to report on psychometric properties of the Dutch version of the Body Cathexis Scale (BCS), using data from 238 women with eating disorders and 1060 women from two non-clinical samples. In addition, differences in body satisfaction between clinical and non-clinical respondents are explored. Methods Factor analysis was used to investigate whether functional body satisfaction can be distinguished as a separate factor in both samples. Univariate tests were used to identify differences in scores between the clinical and the non-clinical data. Results Confirmatory Analysis (CFA) offered the best fit for a three-factor model, where Functionality, Non-weight, and Weight were identified as separate factors in both populations. Internal consistency was good and correlations between factors were low. Women in the non-clinical sample scored significantly higher on the BCS than women with eating disorders on all three subscales, with high effect sizes. Conclusions This psychometric evaluation of the Dutch version of the BCS is relevant for both research and clinical practice in the field of eating disorders, showing different components of body satisfaction, including body functionality.
Session: On-Demand Poster Session
Eduardo Serrano-Troncoso1, Laura Cañas1,2, Carol Palma2, Ana Molano1, Lola Domene1, Marta Carulla1, Raquel Cecilia1, Montserrat Dolz1
1Mental Health Department. Sant Joan de Déu Hospital, Barcelona, Spain, 2Faculty of Psychology. Ramon Llull University, Barcelona, Spain

Introduction: Avoidant/restrictive food intake disorder (ARFID) categorizes patients with selective and/or restrictive eating patterns in the absence of distorted cognition concerning weight, food and body image. Objective: To examine the sociodemographic and clinical profile of patients with ARFID in comparison to those with anorexia nervosa (AN) and to a non-clinical group (NCG). Method: A descriptive, observational, comparative study made up of three groups (ARFID, AN and NCG). Ninety-nine children and adolescents were analyzed by means of a semi-structured diagnostic interview and questionnaires on depression, anxiety, clinical fears, and general psychopathology.

Results: The ARFID group was significantly younger (10.8 vs. 14.1 years old), with a greater proportion of males (60.6% vs. 6.1%), an earlier onset of illness (6.2 vs. 13.4 years old), and a longer period of evolution of the illness (61.2 vs. 8.4 months) compared to the AN group. Clinically, the ARFID patients showed greater medical (42.4% vs. 12.1%) and psychiatric (81.8% vs. 33.3%) comorbidity, greater clinical fear (p<.005), more attention problems (p<.005), and fewer symptoms of anxiety and depression (p<.005).

Conclusions: ARFID is a serious disorder with a significant impact on the physical and mental health of the pediatric population. Attention problems and clinical fears in ARFID, and the greater presence of internalized symptoms in AN, were the main differences found in the psychopathological profiles.
Session: On-Demand Poster Session
Elena Tenconi1,2, Meneguzzo Paolo1, Collantoni Enrico1, Zanetti Tatiana1, Favaro Angela1,2
1Department of Neuroscience, University of Padova, Padova, Italy, 2Padova Neuroscience Center, Padova, Italy

INTRODUCTION. Anorexia nervosa (AN) is characterized by some specific neuropsychological alterations possibly linked to autistic and anxiety traits, such as a central coherence weakness, poor set-shifting, and reduced social cognition, high social anxiety and anhedonia. The purpose of our study is to examine the specific impact of autistic traits on clinical, psychopathological and both neuropsychological and emotional aspects in light of both body weight and illness state. METHODS. A total sample of 712 individuals (421 AN and 291 unaffected women) underwent a widespread clinical and neuropsychological assessment. The Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA) was used to assess the presence of autistic traits. Participants were also grouped with regard to BMI and (for patients only) illness state (i.e., acute, partial and fully remitted). RESULTS. In general, patients showed significantly poorer central coherence, visual memory, and emphatic abilities than controls. Weight gain improves empathy, while illness remission improves both empathy and central coherence. Higher autistic traits correlated significantly with obsessive-compulsive aspects, anxiety and depression. The SWEAA Italian adaptation showed very good reliability (𝛼 Cronbach > 0.88) in all subscales. CONCLUSIONS. Future therapeutic approaches for AN should will focus additionally on autistic-like aspects to be more helpful to patients resistant to conventional therapies.
Session: Paper Session 3: Neurocognition
Jennifer J. Thomas1,2, Kamryn T. Eddy1,2, Nadia Micali3,4, Megan Kuhnle1,5, Melissa Dreier1, Elizabeth Lawson2,5, Lucy Cooke6, Rachel Bryant-Waugh7
1Massachusetts General Hospital Eating Disorders Clinical & Research Program, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA, 3Département Universitaire de Psychiatrie, University of Geneva, Geneva, Switzerland, 4Service de Psychiatrie de l’enfant et de l’adolescent, Département de l’enfant et de l’adolescent, Geneva University Hospital, Geneva, Switzerland, 5Massachusetts General Hospital Neuroendocrine Unite, Boston, MA, USA, 6Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom, 7Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom

Introduction: The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a widely used diagnostic interview for the psychopathology of avoidant/restrictive food intake disorder (ARFID). The purpose of the present study was to evaluate the construct validity of a questionnaire version (PARDI-AR-Q), which has the potential to provide similar information with less participant burden.

Children and adults (ages 10-68 years) with ARFID (n=16, 44% female) and healthy controls (HC, n=47, 38% female) completed the PARDI-AR-Q. A subset of the ARFID group also completed the full PARDI.

The ARFID group scored significantly higher than HC on PARDI-AR-Q severity (t=5.00, p<.001), sensory sensitivity (t=4.93, p=<.001), fear of aversive consequences (t=3.56, p=.002), and lack of interest (t=2.97, p=.008). Individuals with ARFID (81%) were significantly more likely than HC (13%) to screen positive for ARFID on the PARDI-AR-Q (X2= 23.43, p<.001). Supporting concurrent validity, in the subset who also completed the PARDI interview, ratings on the questionnaire showed large and significant correlations with the interview on sensory sensitivity (r=.86 p=.002) and fear of aversive consequences (r=.85, p=.004).

Though replication in larger samples is needed, findings provide early support for the validity of the PARDI-AR-Q as a self-report screen for possible ARFID in clinical or research settings, though the measure may require refinement to enhance sensitivity.
Session: On-Demand Poster Session
B. Timothy Walsh1,2, Tianchen Xu3, Yuanjia Wang3, Evelyn Attia1,2, Allan S. Kaplan4
1Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA, 2New York State Psychiatric Institute, New York, NY, USA, 3Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA, 4Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Introduction There is long-standing interest in whether stages of illness can be defined for Anorexia Nervosa (AN). In a paper on stages of major depression, Frank et al (1991) proposed that stages be defined using measures of severity of illness and duration. They conceived of remission as a "brief…period during which…the individual is asymptomatic" and suggested that an empirical method of determining the duration criterion for when recovery was achieved would be to identify a "point of rarity, a period after which very few patients experience a return of the syndrome." We examined data from a previously published study (Walsh et al., 2006) to determine whether a point of rarity could be identified. Methods 93 weight-restored women with AN were randomized to fluoxetine or placebo and followed for up to a year or until they relapsed. Fluoxetine treatment had no significant effect on relapse. For each day, we calculated the risk of relapse over the following 60 days. Results The risk of relapse rose immediately after entry into the study, reached a peak after approximately 50 days, and then gradually fell. There was no indication of an inflection point at which the risk of relapse fell precipitously. Conclusions These results do not follow the model suggested by Frank et al (1991). Therefore, over the year following discharge from acute treatment, it is not possible to empirically identify a duration of remission at which recovery can be declared.
Session: On-Demand Poster Session
Biological/Risk Factors

Sophie R. Abber1,2, Stephanie M. Manasse2, Christina E. Wierenga3, Evan M. Forman1,2
1Department of Psychology, Drexel University, Philadelphia, PA, USA, 2WELL Center, Drexel University, Philadelphia, PA, USA, 3Department of Psychiatry, University of California, San Diego, San Diego, CA, USA

Introduction: Research examining deficits in cognitive flexibility (CF; the ability to alter behavior in response to the environment) among individuals with eating disorders (ED) has produced mixed results. One explanation for this is that CF deficits are confined to disorder-specific stimuli (e.g., food). However, food-specific deficits would not be captured in general CF paradigms. Thus, the present study aimed to develop a food-specific CF task.

We adapted the cued color-shape switching task (CCSST) into a food-specific task (FCCSST) and examined its validity. Undergraduate participants (n=48) completed the CCSST, FCCSST, measures of distinct constructs (Sternberg Memory Task and Iowa Gambling Task), and the EDE-Q to determine whether ED pathology moderated task performance.

The FCCSST showed strong convergent (r=0.76, p=0.00) and discriminant (rSMT = -0.12, p=0.40; rIGT=0.08, p=0.61) validity. A GLM with a median split of the sample by ED pathology revealed no main effect of task type (ηp2=0.01,p=0.42), but revealed an interaction of ED pathology by task type on performance (ηp2=0.04, p=0.18). However, we are underpowered to detect an effect.

These findings suggest that the FCCSST is a valid measure of food-specific CF. Furthermore, food-specific CF deficits may be more pronounced in those with high ED pathology. Future research should test the effect of ED pathology in a powered sample, and explore food-specific CF in clinical samples.
Session: On-Demand Poster Session
Laura A. Berner1, Alan N. Simmons2,3, Xinze Yu2, Erin E. Reilly4, Joanna Chen5, Angeline Krueger2, Mary Ellen Trunko2, Walter H. Kaye2
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2University of California, San Diego, San Diego, CA, USA, 3VA San Diego Healthcare System, San Diego, CA, USA, 4Hofstra University, Hempstead, NY, USA, 5Drexel University, Philadelphia, PA, USA

Introduction: Difficulty regulating intense, volatile emotion has been implicated in the development and maintenance of binge eating and purging. In addition, severe emotion dysregulation predicts poorer treatment outcome in bulimic-spectrum disorders. However, the interactions within and between emotion regulation (REG) and reactivity (REA) neural networks that may be critical to these emotion-symptom dynamics remain uncharacterized. Method: With a new graph theoretical approach, we tested whether intra- and inter-network influences of REG and REA circuits predict treatment response in 19 women with bulimic-spectrum disorders. Patients in an intensive dialectical behavior therapy program completed a resting-state fMRI scan and subsequent biweekly surveys.

Weaker relative influence of the REG network on the REA network predicted smaller decreases in purging frequency and smaller increases in skills use over treatment (pFDR<.05). Weaker influences of lateral prefrontal REG nodes on the REA network predicted smaller decreases in binge eating and in impulsive action in the context of negative emotion (p<.05). Within the REA network, stronger amygdala influence predicted smaller increases in skills use (p<.05).

Quantifying the impact of REG circuits on REA circuits may help identify those least and most likely to benefit from treatment for bulimic-spectrum disorders. This inter-network influence could also serve as a mechanistic target for new interventions.
Session: On-Demand Poster Session
Cara Bohon, Hannah Welch
Stanford University School of Medicine, Stanford, CA, USA

1. This study investigated the relationship between BMI, depression, and brain structure in children using baseline data from the ABCD study. We hypothesized that there would be a quadratic relationship between BMI and depression and BMI and brain structure, and that these effects would be present in the brain as a whole in addition to key cortical and subcortical regions. 2. 11,875 children were enrolled in the ABCD study. Depressive symptoms were measured using the Child Behavior Checklist – withdrawn-depressed subscale and brain volume was collecting using structural MRI scans. Data were analyzed using linear and quadratic mixed models. 3. Nearly all of the models in the analysis were significant. The quadratic models with depression as an independent variable accounted for approximately 20% of the variance in total brain volume, 10% of the variance in the left lateral orbitofrontal cortex and right hemisphere hippocampus, and 12% of the variance in the right hemisphere putamen. 4. This is the first study to examine and provide evidence for the quadratic relationship between BMI and depressive symptoms and BMI and brain volumes. These results are consistent with findings from separate studies looking at these variables in obesity and anorexia nervosa, and they contribute to our understanding of the relationship between brain structure and depression, including the role of over and underweight.
Session: On-Demand Poster Session
Bianca Borsarini1, Edoardo Pappaianni1, Gaelle Doucet2,3, Sophia Frangou3, Nadia Micali1,4,5
1Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland, 2Boys Town National Research Hospital (BTNRH), Omaha, NE, USA, 3Icahn School of Medicine at Mount Sinai, New York, NY, USA, 4Division of Child and Adolescent Psychiatry, Geneva University Hospital, Geneva, Switzerland, 5Great Ormond Street Institute of Child Health, University College London, London, United Kingdom

Myelin is a lipid-containing substance that coats axons enabling fast electrical impulse propagation. Cognitive functions rely on adequate axonal myelination. Few studies have investigated myelin abnormalities in patients with Anorexia nervosa (AN) using standard 3T MR scanners. In this preliminary study we aimed to examine intracortical myelin in AN using a 7T ultra-high field scanner. We hypothesized that AN patients would show myelin abnormalities compared to controls. T1-weighted images were acquired from 7 adult females with AN (age range: 18-33) and 11 healthy female controls (age range: 23-32) using ultra-high resolution (7T scanner). T1 values (inverse index of myelin concentration) were extracted for 10 layers. These levels were then clustered into an inner (1-5) and an outer cluster (6-10). We compared global, inner and outer layers-cluster myelin concentration (T1 mean values), between AN and controls using ANOVA. Individuals with AN exhibited overall decreased myelin concentrations (higher T1 values, p=0.03). Age-adjusted differences between AN and controls were minimal in the inner layer (p= 0.05), but stronger in the outer layer (p= 0.01). This preliminary study is the first to study myelin abnormalities at high resolution in AN. The lower myelin levels in AN individuals were both global and particularly evident in the outer layers. Such abnormalities may result from undernutrition/starvation and in turn may contribute to neurobiological deficits seen in AN.
Session: On-Demand Poster Session
Lauren Breithaupt1,2, Laura M. Holsen2,3, Danielle L. Kahn1, Jennifer J. Thomas1,2, Randy Gollub1,2, Kyle A. Williams1,2, Steven E. Arnold 1,2, Elizabeth A. Lawson1,2, Madhusmita Misra 1,2, Kamryn T. Eddy1,2
1Massachusetts General Hospital, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA, 33Brigham and Women’s Hospital , Boston, MA, USA

INTRODUCTION.We explored differences between AN and atypical-AN(at-AN, restrictive eating, BMI>18.5) and healthy controls(HC) across 92 inflammation markers in plasma. METHODS.Plasma samples from 101 female adolescents(61 AN/at-AN, 40 HC) were analyzed to quantify levels of 92 inflammatory proteins. We applied a machine-learning reduction algorithm (LASSO) to determine the optimal proteins distinguishing AN/at-AN from HC. Among significant proteins, we assessed protein function using the STRING database. RESULTS.20 inflammation markers differed between AN/at-AN and HC, predicting AN/at-AN with 72% accuracy. Individuals with AN/at-AN showed lower levels of protein expression in tumor necrosis factor(TNF) signaling and cytokine-cytokine interactions signaling. Higher levels of protein expression in AN/at-AN were evident across interleukin-4 and interleukin-13 signaling as well as cytokine-cytokine interactions compared to HC. DISCUSSION.Immune dysregulation in AN/at-AN is characterized by alterations in both pro- and anti-inflammatory cytokines, suggesting extensive alterations in immune functioning. IL-4 signaling has been shown to induce weight loss. We report disruptions in this pathway that may reflect the low weight status in AN/-at-AN. This represents the first report of their association with adolescents with AN/at-AN. Our findings suggest that immune dysregulation is present in AN/at-AN as either a consequence of or potentially pathogenic contributor to the disease.
Session: On-Demand Poster Session
Leigh C Brosof, Cheri A Levinson
University of Louisville, Louisville, KY, USA

Purpose: Perfectionism is a transdiagnostic factor that predicts a range of psychopathology, including eating disorders (EDs). One dimension of perfectionism particularly related to EDs is concern over mistakes (CM), or the excessive worry over making errors. Elucidating the causal nature of CM on cognitive, behavioral, and affective outcomes will aid in creating precision interventions.

Methods: In the current study (N=196 women), we experimentally manipulated CM (High[n=61]), Low[n=70], and Control [n=65) to examine the impact of perfectionism on cognitive control, anxiety, and food intake. After random assignment, participants completed a computerized cognitive control task (Attentional Network Task) and then were left in a room for 10 minutes to eat M&Ms, potato chips, popcorn, and apple slices. We tested the effect of the High CM condition, as well as trait-by-CM condition interaction, on cognitive control, anxiety, and food intake.

Results: A one-way ANOVA revealed a significant difference between conditions on change of CM due to the manipulation, F(2, 156)=10.82, p<.001, partial h2=.12, We found a main effect of High CM on food intake (b*=-.39, p=.026, partial r=-.17), but not cognitive control or anxiety (ps>.05). We also found a trait-by-High CM interaction on anxiety (b*=-.11, p=.016, partial r=-.18).

Conclusions: CM predicted increases in anxiety and decreases in food intake. Targeting CM in perfectionism interventions for EDs may help improve treatment outcomes.
Session: On-Demand Poster Session
Joanna Y. Chen1, Fengqing Zhang1, Danielle E. Apple1,2, Olivia Wojtkielewicz1, Michael R. Lowe1
1Drexel University, Department of Psychology, Philadelphia, PA, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA

Introduction Research suggests that sweetness preference may be related to loss-of-control (LOC) eating. Propensity for high-fat/high-sugar foods has also been related to weight gain, but the relationship between sweetness preference and body mass is less clear. Thus, the current study examined the relationships between body weight, LOC eating, and sweetness preference. Methods The pilot sample (N=31) included individuals varying in BMI (M=25.29±5.27) and self-reported past-month LOC frequency (M=3.13±5.27 episodes). Participants tasted six samples of 2% milk with 0%, 8%, 16%, 24%, 32%, and 40% sucrose added, presented in random order. After tasting and spitting each sample, they rated how much they liked the sample. Results Mixed model analyses on liking showed significant two-way interactions between sucrose level, BMI, and LOC frequency, such that the linear effect of sucrose level on liking was moderated by BMI (p=.04) and by LOC frequency (p=.006). The moderating effect of LOC frequency on the relationship between sucrose level and liking was further moderated by BMI in a three-way interaction (p=.04). Conclusions There appears to be a complex relation between LOC eating, BMI and sweetness liking: sweetness preference may depend on levels of LOC eating, BMI, and their interaction. Further data collection will allow us to examine if these relationships are robust and help us understand sweetness preference as it relates to eating and weight regulation.
Session: On-Demand Poster Session
Christine E Cooper-Vince1, Megan Kuhnle2, Jenny Jo2, Kristine Hauser2, Kamryn T Eddy2, Madhusmita Misra2, Jennifer J Thomas2, Elizabeth A Lawson2, Nadia Micali1
1University of Geneva, Geneva, Switzerland, 2Massachusetts General Hospital, Boston, MA, USA

The three major Avoidant/Restrictive Food Intake Disorder (ARFID) symptom dimensions (i.e., low interest/appetite, sensory sensitivity, and fear of aversive consequence of eating) are thought to be rooted in dimension-specific biological vulnerabilities. Specifically, we hypothesize that fear of aversive consequences symptoms may stem from anxious hyperarousal, whilst sensory sensitivity symptoms and low interest symptoms are instead rooted in differences in sensory perception and the brain’s appetite regulating centers, respectively. However, anxiety may also be implicated in the development of the sensory sensitivity symptoms in childhood. We used logistic regression to evaluate the contribution of self-reported anxiety (STAI), and the moderating effect of participant age on symptoms within the three major ARFID symptom dimensions (Pica ARFID and Rumination Disorder Interview) in a sample of adolescents 9-23 years old with and without ARFID symptoms (N=107). We found that having sensory sensitivity symptoms was associated with higher trait anxiety (OR=1.05, 95% CI 1.02-1.09). Having fear of aversive consequences symptoms was also associated with higher trait anxiety (OR= 1.08, 95% CI 1.04-1.13). Additionally, low interest/appetite symptoms were associated with higher anxiety (OR= 1.08, 95% CI 1.04-1.12). Age did not moderate these effects. These findings suggest that trait anxiety may confer risk for all ARFID symptom dimensions across adolescence/young adulthood.
Session: On-Demand Poster Session
Inflammatory and oxidative stress markers in eating disorders and their role in emotional reactivity

Patricia Diaz-Carracedo1, Andres Pemau1, Alejandro de la Torre-Luque1,2, Marta Soto3, Aida Navalon3, Jose Luis Carrasco2,3, Marina Diaz-Marsa2,3
1Universidad Complutense de Madrid, Madrid, Spain, 2Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain, 3San Carlos Clinic Hospital, Madrid, Spain

Aims: a) To investigate potential dysregulation in inflammatory and antioxidant response systems of eating disorder (ED) patients; a) To analyse the role of inflammatory and oxidative stress markers in emotional reactivity in response to affective images. Method: The sample comprised 68 women with an ED (72.73% with anorexia nervosa; m = 22.01 years, sd = 9.15) and 35 healthy controls (m = 18.54 years, sd = 4.21). Participants were assessed for ED symptoms, depression and impulsivity. A plasma sample was drawn from each participant. Pro-inflammatory markers (IL-1b,TNF-a, PGE2) and expression levels of inflammatory and oxidative parameters (iNOS, COX-2, ratio MAPK p38 and ratio ERK) were analysed. Moreover, participants rated emotional pictures from the International Affective Picture System (IAPS) by using the self-assessment manikin (SAM) system.

After controlling for age, depression and body mass index, significant between-group differences were revealed for most of markers (TNF-a, PGE2, COX-2, ratio MAPK p38 and ratio ERK), pointing to higher levels of inflammation/oxidative factors and expression parameters. Principal components derived from these markers predicted the valence ratings of ED patients to both positive and negative pictures (p <.05).

Alterations in the inflammatory and antioxidant response systems of ED patients are evident with a subsequent influence on emotion system.
Session: On-Demand Poster Session
The role of Oxytocin as a moderating factor of Theory of Mind performance in impulsivity-related disorders
Marina Diaz-Marsa1,2,3, Patricia Diaz-Carracedo1, Andres Pemau1, Jose Manuel Lopez-Villatoro3, Jose Luis Carrasco1,2,3, Alejandro de la Torre-Luque1,2
1Universidad Complutense de Madrid, Madrid, Spain, 2Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain, 3San Carlos Clinic Hospital, Madrid, Spain

Theory of Mind (ToM) refers to the ability of understanding mental states of others and oneself. Patients with impulsive symptoms may show limitations in interpersonal relationships and impaired empathy. Objective: To study the relationship between ToM and blood oxytocin in impulsivity disorders (borderline personality disorder [BPD] and eating disorders [ED]). Method: The sample comprised 123 participants (BPD, n = 34; ED n = 64; and 25 control participants). They completed self-reported questionnaires on impulsivity, depressive symptoms and traumatic experiences. The MASC test was administered to assess ToM. Analysis of covariance was performed considering the study group as an independent factor and oxytocin and impulsivity as covariates.

A significant main effect of group was not revealed. However, an oxytocin effect was found (p <.05, Hidden formatting deleted. Delete this text! Symbol">h2parcial = 0.05), as well as a group * impulsive interaction effect (p <.05, Hidden formatting deleted. Delete this text! Symbol">h2parcial = 0.11) and group * oxytocin effect (p <.01, h2parcial = 0.06). The BPD participants showed fewer correct responses in MASC with higher levels of circulating oxytocin, while the ED participants showed fewer correct responses with lower levels of impulsivity.

Distinct neuroendocrine underpinnings seem to be involved in socioemotional responses across impulsivity-related disorders, providing some insight into new potential treatment targets.
Session: On-Demand Poster Session
Analysis of the clinical features associated with the purgative phenotype in eating disorders
Marina Diaz-Marsa1,2,3, Andres Pemau1, Patricia Diaz-Carracedo1, Jose Luis Carrasco1,2,3, Alejandro de la Torre-Luque1,3
1Universidad Complutense de Madrid, Madrid, Spain, 2San Carlos Clinic Hospital, Madrid, Spain, 3Centre for Biomedical Research in Mental Health, Madrid, Spain

The ambiguous diagnostic borders and overlap between different Eating disorders (ED) may lead to difficulties in bringing tailored interventions. Studying ED from the perspective of the predominant behavioral regulation of the patient (purging or restriction) rather than using rigid diagnosis-based conceptualizations, can improve our understanding of this group of disorders. Objective: To study the clinical phenotype of purgative and restrictive ED patients to identify clinical markers of each regulation pattern. Method: 69 women (m = 21.77 years, dt = 9.26) diagnosed with ED participated in the study (43 restrictive and 26 purgative). All of them were evaluated in a series of clinical variables, including: depressive symptoms (MADRS), anxiety (HAS), ED symptoms (EDI 2, BITE), opinion on body image (BSQ) and impulsivity (BIS-11). Student's t tests for independent samples were performed in order to compare the scores in these scales between groups.

Significant differences were observed between both groups of patients in the BITE as well as in the EDI (total score and various subscales) and the BSQ (p <.01). Also, they differed in the MADRS and the BIS (p <.05). In all cases, purgative patients presented higher scores (indicative of greater presence of symptoms).

Predominantly purgative patients may present higher levels of ED symptoms, impulsivity and depression, which could indicate greater severity or at least different treatment needs.
Session: On-Demand Poster Session
Angela Favaro1,2, Enrico Collantoni1, Paolo Meneguzzo1, Elena Tenconi1,2
1Department Neuroscience, Padova, Italy, 2Padova Neuroscience Center (PNC), Padova, Italy

Although many neuropsychological weaknesses have been associated to anorexia nervosa (AN), we still do not know the impact of early-onset AN on the full maturation of cognitive functioning. Our study aims at comparing the developmental trajectories of neuropsychological tasks in patients with an early-onset AN, AN patients with later onset and healthy women. The study sample consisted of 364 female patients (age 13-30) diagnosed with lifetime AN, according to DSM-5 criteria, recruited from the ED Unit of the Hospital of Padova, Italy, and 259 healthy women (age 13-30). Patients were grouped into an early-onset group (n=146; onset 14 years) and normal onset (n=218; onset 18 years). A broad neuropsychological and clinical test battery was employed to assess executive functions, visuospatial abilities, emotional processing and psychopathology. For most cognitive tasks, the developmental trajectory in healthy women significantly fitted a linear or a quadratic curve, whereas abnormal trajectories were present in AN patient. The early onset group showed particularly aberrant trajectories in set-shifting, visuospatial and decision-making abilities. Trajectories tend to partially normalize after weight recovery. Cognitive performance and trajectories were very similar among groups during adolescence. In conclusion, AN is associated with aberrant developmental trajectories of cognitive performance, especially in patients with an early onset of the disorder.
Session: Paper Session 3: Neurocognition
K. Jean Forney, Sarah A. Horvath, Gabriella Pucci, Emma R. Harris
Ohio University, Athens, OH, USA

PURPOSE: Gastrointestinal symptoms are common among those with eating disorders and may act as a risk factor for eating pathology under certain circumstances. The current study tested the hypothesis that meal-related gastrointestinal symptoms are linked to compensatory behaviors only in the presence of high body dissatisfaction. METHODS: 281 undergraduate students (70.1% female) completed assessments of excessive fullness/early satiety, bloating/distension, and eating pathology. RESULTS: Excessive fullness/early satiety (Beta=.15, p<.01) and bloating/distension (Beta =.15, p<.01) interacted with body dissatisfaction to explain significant variance in purging behaviors. Both sets of symptoms were more strongly linked to purging in the presence of high body dissatisfaction (p’s>.44). Neither excessive fullness/early satiety (Beta=-.04, p=.80) nor bloating/distension (Beta=-.08, p=.64) interacted with body dissatisfaction to explain variance in restrictive eating behaviors. CONCLUSIONS: Bothersome meal-related gastrointestinal symptoms may play a role in the development of purging as individuals attempt to alleviate physical discomfort. These symptoms appear to only be salient in the presence of body dissatisfaction and may reflect maladaptive interpretations about what these symptoms indicate (e.g., weight gain). Future research should employ longitudinal designs to understand if gastrointestinal symptoms function as a risk or maintenance factor for purging behaviors.
Session: On-Demand Poster Session
Guido K.W. Frank
University of California San Diego, San Diego, CA, USA

Purpose: To test whether prediction error brain response (PE) is inversely related to consummatory behavior in EDs and whether behavior is associated with brain response across diagnoses.

Methods: We recruited ED patients (ages 16–35 years) across all diagnoses (NIMH Research Domain Criteria). During brain imaging, violations of learned associations between conditioned visual and unconditioned taste stimuli evoked the dopamine-related PE.

Results: We recruited AN restrictor (n=68), AN binge eating-purging (n=18), OSFED AN (n=18), OSFED purging (n=7), BN (n=47), BED (n=12), and control individuals (n=116). ED subtype (low to high food intake) correlated negatively with PE in nucleus accumbens (L rho=-0.262, p<0.001; R rho=-0.225, p=0.003) and orbitofrontal cortex (L rho=-0.190, p=0.012; R rho=-0.272, p<0.001). BMI correlated negatively with PE in nucleus accumbens (L rho=-0.274, p<0.001; R rho=-0.245, p0.002) and orbitofrontal cortex (L rho=-0.220, p<0.003; R rho=-0.287, p<0.001). Bulimia score correlated negatively (cingulate L rho=-0.259, p<0.001; orbitofrontal cortex L rho=-0.283, p<0.001, and persistence positively (cingulate L rho=0.181, p=0.010, orbitofrontal cortex L rho=0.146, p=0.038) with PE.

Conclusions: PE is inversely correlated with consummatory behavior and bulimia score. The positive correlation between persistence and PE raises the possibility that changes in PE are associated with exaggerations in temperament as described in the ill state in EDs.
Session: On-Demand Poster Session
Leora L. Haller1, Simar Singh2, Fengqing Zhang2, Michael R. Lowe2
1Montclair State University, Montclair, NJ, USA, 2Drexel University, Philadelphia, PA, USA

Weight history variables such as weight suppression (WS), highest past weight, current body mass index (BMI) and weight rebound (WR) have been studied relative to eating disorder (ED) symptomatology and future weight changes. However, these variables have not been used to predict post-treatment weight changes. Additionally, due to the highly colinear nature of weight history indices, they often are not tested together. This study evaluated 4 weight history indices (WS, admission BMI, highest premorbid BMI, and WR) at treatment admission to predict weight change at 6-month treatment follow-ups in Anorexia Nervosa (AN, n = 300 ) and Bulimia Nervosa (BN, n = 146). Independent variance associated with these variables was calculated by residualizing colinear terms. Prior literature suggests that weight history variables calculated relative to age (i.e. developmental weight history) may be more sensitive than traditional calculations. Thus, this study also included a developmental model for both AN and BN groups. In AN, higher admission BMI, lower WR, and lower developmental WR all predicted post-treatment weight gain, while BN models were not significant. Inconsistent with prior studies, WS did not predict weight gain. Findings indicate that WR may be influential in the post-treatment weight trajectory of AN patients. These findings add to emerging data suggesting that the existing weight suppression framework should be expanded into a more comprehensive weight history framework.
Session: On-Demand Poster Session
Stephanie G Harshman1,2, Megan Kuhnle1,2, Kristine Hauser1,2, Lauren Briethaupt1,2, Murat Sentibas3, Ruslan Sadreyev3, Kamryn T Eddy1, Madhusmita Misra1,2, Nadia Micali4,5, Susan E Erdman6, Jennifer J Thomas1, Elizabeth A Lawson1,2
1Eating Disorder Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA, 2Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA, 3Genomics and Cell Biology Core, Nutrition Obesity Research Center at Harvard, Boston, MA, USA, 4Department of Psychiatry, University of Geneva, Geneva, Switzerland, 5Great Ormond Street Institute of Child Health, University College London, London, United Kingdom, 6Massachusetts Institute of Technology, Cambridge, MA, USA

Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictive eating defined by consuming an inadequate volume or variety of food. Selective dietary patterns have many consequences including altering the gut microbiome. No studies have examined the host microbiome in ARFID. We hypothesized that individuals with ARFID have reduced microbial diversity compared to healthy controls. 18 female participants (ages 11-23y) were included in this preliminary cross-sectional study: full/subthreshold ARFID (n = 10), healthy controls (n = 8). We extracted DNA from stool samples for 16S rRNA gene analysis. Methods of analysis included the Faith Index of Phylogenetic Diversity (α diversity), UniFrac analysis (β diversity), and taxa identification (linear models), correcting for multiple comparisons. Individuals with ARFID had a lower α diversity compared to healthy controls (p=.09). The pattern of β diversity was significantly different from healthy controls (p=.05), such that the microbial profile in ARFID was dominated by a greater proportion of the genera lactobacillus. We hypothesize the reduced bacterial diversity, and prominence of lactobacillus are likely reflective of the different dietary patterns observed in ARFID, more specifically greater intake of dairy which is supported by our prior work characterizing dietary intake in ARFID. This study provides further evidence of the widespread consequences of selective eating in ARFID.
Session: On-Demand Poster Session
Ann F. Haynos1, Samantha V. Abram2, Angus W. MacDonald, 3rd3, A. David Redish4, Scott J. Crow1,5
1Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA, 2San Francisco VA Medical Center, and the University of California, San Francisco, CA, USA, 3Department of Psychology, University of Minnesota, Minneapolis, MN, USA, 4Department of Neuroscience , Minneapolis, MN, USA, 5The Emily Program, Minneapolis, MN, USA

Introduction. Computational neuroscience can provide critical insight into mechanisms of anorexia nervosa (AN) by probing neurally-distinct decisional dysfunctions leading to restriction. In two studies, we used a translational neuroeconomic paradigm to identify AN decision-making anomalies. Methods. In Studies 1 (AN: n=29; healthy control [HC]: n=26) and 2 (weight-restored AN [AN-WR]: n=22; HC: n=14), participants completed a computer task adapted from a rodent foraging paradigm parsing decision systems. Subjects "surf" for videos in a limited time economy, choosing to stay/watch or skip videos based on category and random time delay. Value is the mean threshold of 50% stay probability minus delay. Results. In both studies, all groups made slower choices for "hard" decisions close to stay threshold (ps<.001), indicating non-habitual decision-making. In Study 1, AN choice time x value curves were narrower due to rapid choices for low- and high-value offers (p=.001); HCs deliberated longer on low-value offers, consistent with past human/rodent samples. In study 2, choice time x value narrowing differentiated AN-WR subjects who restricted at a test meal from HC and non-restricting AN-WR (p=.03). Conclusions. AN is associated with a decision pattern distinct from reward or habit aberrations. This pattern may reflect the novel mechanism of rule-based decision-making, whereby choice rules (though sensitive to value) are quickly, rigidly followed, promoting AN symptom persistence.
Session: On-Demand Poster Session
Christopher Huebel1,8, Moritz Herle1, Diana L Santos Ferreira2, Rachel Bryant-Waugh3, Bianca L De Stavola4, Mohamed Abdulkadir5, Ruth J F Loos6, Deborah A Lawlor2, Cynthia M Bulik7,8, Nadia Micali5
1King's College London, London, United Kingdom, 2University of Bristol, Bristol, United Kingdom, 3Maudsley Hospital, London, United Kingdom, 4University College London, London, United Kingdom, 5University of Geneva, Geneva, Switzerland, 6Mount Sinai, New York, NY, USA, 7University of North Carolina, Chapel Hill, NC, USA, 8Karolinska Institutet, Stockholm, Sweden

Introduction. Childhood eating behavior can lead to overweight and negative health consequences. Metabolic markers are intermediate phenotypes that might mediate the relationship between eating behavior and negative health outcomes. Methods. To better understand the effects of overeating, undereating, and fussy eating during the first ten years of life on metabolism in adolescence, we associate longitudinal trajectories of these eating behaviors with metabolic markers measured by a high-throughput (1H) NMR metabolomics platform at age 16 years in 3,104 adolescents in the Avon Longitudinal Study of Parents and Children (ALSPAC). Results. Children who are reported to increasingly overeat have a negative cardiovascular lipid profile in adolescence with higher low-density lipoproteins (LDL), very low-density lipoproteins (VLDL), remnant cholesterol, and polyunsaturated fatty acids, and higher glycoprotein acetyls than controls. Children with persistent fussy eating have lower valine concentrations–an essential amino acid. Some associations between eating behavior in childhood and metabolic profile are mediated through BMI at age 12. Conclusions. Overeating and fussy eating in childhood have long-term effects on the metabolic profile at 16 years independent of a child’s BMI at age 12. Metabolic alterations in children who overeat suggest a chronic inflammatory state at 16 years and may predispose children to negative health conditions, including heart attack, stroke, and diabetes.
Session: On-Demand Poster Session
Lisa-Katrin Kaufmann1,2, Jürgen Hänggi2, Lutz Jäncke2,3,4, Volker Baur1, Marco Piccirelli5, Spyros Kollias5, Ulrich Schnyder6, Chantal Martin-Soelch7, Gabriella Milos1
1Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland, 2Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland, 3International Normal Aging and Plasticity Imaging Center (INAPIC), University of Zurich, Zurich, Switzerland, 4University Research Priority Program (URPP) , Zurich, Switzerland, 5Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland, 6University of Zurich, Zurich, Zurich, Switzerland, 7Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland

Brain connectivity of patients with anorexia nervosa (AN) has previously been reported to be altered by a number of cross-sectional studies during the acute phase of the disorder. It is not yet known, however, how therapeutic interventions influence these aberrant functional circuits. In this longitudinal study, we examined changes in functional networks over the course of an eating-disorder specific treatment in patients with AN. At three distinct stages of treatment, we examined resting-state functional connectivity in 27 women with severe AN and 40 closely matched healthy controls. Using network-based statistics, we identified longitudinal changes in sub-networks differing between AN patients and controls. At the start of treatment, patients with AN showed reduced functional connectivity compared to healthy controls in a sub-network comprising fronto-subcortical and occipito-subcortical connections. During the first phase of treatment, this sub-network markedly recovered, while only minimal changes occurred in the second phase of treatment. Alterations of functional brain connectivity of patients with severe AN in a network related to reward, emotion, and sensorimotor integration normalizes during an eating-disorder specific treatment. These findings support the reversibility of disrupted functional networks during therapy and highlight the importance of the first phase of treatment.
Session: On-Demand Poster Session
Isabel Krug1, Jake Linardon2, Christopher Greenwood2, George Youssef2, Janet Treasure3, Fernando Fernandez-Aranda4, Andreas Karwautz5, Gudrun Wagner5, David Collier3, Marija Anderluh6, Kate Tchanturia3, Valdo Ricca7, Sandro Sorbi7, Benedetta Nacmias8, Laura Bellodi8, Matthew Fuller-Tyszkiewicz2
1The University of Melbourne, Melbourne, Australia, 2Deakin University, Melbourne, Australia, 3Kin's College London, London, United Kingdom, 4Bellvitge University Hospital IDIBELL and CIBEROBN,, Barcelona, Spain, 5Medical University of Vienna, Vienna, Austria, 6University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia, 7The University of Florence, Florence, Italy, 8Fondazione Centro S. Raffaele del Monte Tabor, Milan, Italy

Objectives:Overlapping and distinct risk factors have been revealed for Anorexia Nervosa (AN) and Bulimia Nervosa (BN). However, to date the strongest predictors for these Eating Disorders (EDs) have not been established, nor do we know how these risk factors interact to predict distinct ED classifications. Using various machine learning-based classifications, we examined the prediction of (1) EDs versus non-ED and (2) AN versus BN. Method:Data were part of a larger European Project and comprised 626 (333 AN, 255 BN, 38 other ED) ED patients and 776 controls. Participants completed the Cross-Cultural Risk Factor Questionnaire, which assesses a range of risk factors.

LASSO and decision tree classification analyses were used. The predictors overall had 89% accuracy for predicting ED status, and 68% accuracy for predicting AN vs BN cases. Knowing someone with an ED was the strongest predictor for the ED versus non-ED model, followed by relationship with friends and family, body dissatisfaction and teasing about eating. For the AN vs BN model, the best predictors were body dissatisfaction and teasing about weight and shape for BN. Skipping breakfast was equally predictive for AN and BN. A range of interaction effects amongst these risk factors were also observed.

Our findings provide important insights into aetiological ED models using novel statistical tools with the aim of improving prevention and early intervention for EDs.
Session: On-Demand Poster Session
E. Caitlin Lloyd1,2, Karin Foerde1,2, Jonathan Posner1,2, Joanna Steinglass1,2
1New York State Psychiatric Institute , New York, NY, USA, 2Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA

Introduction: This large-scale prospective study of adolescents with anorexia nervosa (AN) and healthy control (HC) teens uses a food choice task with multimodal MRI to examine developmental trajectories of neural systems related to illness persistence and remission.

Methods: To date, 60 AN and 29 HC completed a food choice task, rating foods on healthiness and tastiness, prior to making selections in a binary choice phase, as well as a laboratory-based multi-item meal (MIM), and the Self-Report Habit Index. Mixed-effects logistic regression assessed whether food choices differed between groups. Linear regression analyses estimated associations between task and other variables.

Results: Relative to HC, adolescents with AN were more likely to: limit selection of high-fat foods, make choices that were influenced by healthiness; and rate healthier items as tastier (ps <0.01). Selection of high-fat items predicted actual intake (p <0.01). Among individuals with AN, strength of restrictive eating habits was associated with healthiness influencing both tastiness and food choices (ps <0.05).

Conclusions: Adolescents with AN show patterns of food choice that are similar to adults with AN, and habits may play a role in maintaining maladaptive eating behavior. This longitudinal neuroimaging study holds promise to examine these mechanisms of illness.
Session: On-Demand Poster Session
Megan E. Mikhail1, Sarah L. Carroll1, D. Angus Clark2, Shannon O'Conner3, S. Alexandra Burt1, Kelly L. Klump1
1Michigan State University, East Lansing, MI, USA, 2University of Michigan, Ann Arbor, MI, USA, 3University of Chicago, Chicago, IL, USA

Emerging evidence suggests food insecurity and other correlates of low socioeconomic status (SES) may increase disordered eating; however, few population-based studies have been conducted, and none have looked at the impact of SES on etiology. We hypothesized that stressors associated with socioeconomic disadvantage may potentiate latent genetic risk in vulnerable individuals and lead to more disordered eating. To investigate this possibility, we examined family SES as a moderator of the etiology of disordered eating in 10,788 male and female twins ages 8-18 from the Michigan State University Twin Registry. Parents rated the twins on nine items assessing core disordered eating symptoms (e.g., weight preoccupation, binge eating). Family SES was computed from family income and mother and father’s education level. At the phenotypic level, lower family SES was associated with more disordered eating symptoms in both boys and girls even after controlling for potential confounds (e.g., race, pubertal status). GxE twin models controlling for age, BMI percentile, and pubertal status suggested that lower family SES was associated with increased genetic influences on disordered eating in girls and increased environmental influences on disordered eating in boys. Contrary to stereotypes of eating disorders as illnesses of privilege, this study is the first to demonstrate the etiologic pathways through which socioeconomic disadvantage may potentiate risk for disordered eating in youth.
Session: Paper Session 2: Biological/Risk Factors
Alessio Maria Monteleone1, Valeria Ruzzi1, Giammarco Cascino2, Marco Carfagno1, Eugenia Barone1, Palmiero Monteleone2
1Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy, 2Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy

Introduction We aimed to assess biological, emotional, and cognitive responses to a psychosocial stressor, in order to provide a multilevel investigation of the RDoC social process system in Eating Disorders (EDs). Methods Cortisol response to Trier Social Stress Test (TSST) was measured in 105 subjects: 35 women with anorexia nervosa (AN), 32 with bulimia nervosa (BN) and 38 healthy women. In a subgroup of them (23 AN, 21 BN, and 25 control women) anxiety, hunger, and desire to eat throughout the TSST were also rated. Results Compared to healthy women, AN and BN women showed reduced cortisol reactivity that disappeared after controlling for trait anxiety and ineffectiveness. They also displayed increased anxiety response, while only people with AN reported greater decrease in hunger and desire to eat. Baseline ineffectiveness predicted post-stress body dissatisfaction through the mediation of post-stress anxiety while no significant correlations were found between cortisol and anxiety, hunger, or desire to eat responses. Conclusions People with EDs are characterized by blunted cortisol reactivity and greater anxiety, hunger, and desire to eat responses to a psychosocial stressor. We show a relationship between socio-emotional distress and ED-related attitudes without an association between biological and emotional or cognitive changes. This study provides the first empirical and multilevel support to a deranged functioning of the RDoC "system for social process" in EDs.
Session: On-Demand Poster Session
The Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Food Choice in Anorexia Nervosa: A Pilot Study
Alexandra F. Muratore1,2, Mariya Bershad1,2, Karin Foerde1,2, Joanna E. Steinglass1,2, Evelyn Attia1,2, Allegra Broft1,2
1Columbia University Irving Medical Center, New York, NY, USA, 2New York State Psychiatric Institute, New York, NY, USA

Introduction. Individuals with Anorexia Nervosa (AN) exhibit greater functional connectivity between the dorsal striatum and dorsolateral prefrontal cortex (DLPFC) when making choices about what to eat. The current pilot study probed this mechanism of maladaptive dietary restriction using repetitive transcranial magnetic stimulation (rTMS). Methods. In a within-subject, double-blinded randomized study, hospitalized patients with AN received high-frequency rTMS (HF-rTMS) versus sham-TMS in two separate sessions while completing a Food Choice Task. Neuronavigation guided HF-rTMS targeted the DLPFC. Results. Data collection is ongoing. Results from the first 7 participants indicate that HF-rTMS, as compared with sham, was associated with a slight increase in Healthiness ratings of food such that low-fat and high fat ratings increased (Cohen’s d = 0.4) with no measurable effect on Tastiness ratings. The proportion of high-fat foods selected over the neutral-rated reference foods increased from 29% (SD = 0.20) with sham TMS to 38% (SD = 0.12) with HF-rTMS (Cohen’s d = 0.7). When the Choice trial item presented a conflict between healthiness and tastiness ratings, proportion of trials indicating engagement of self-control decreased from 49% (SD = 0.41) to 37% (SD = 0.25; Cohen’s d = 0.5). Conclusions. These data suggest that rTMS may be a promising tool for probing neural mechanisms underlying maladaptive food restriction in AN.
Session: On-Demand Poster Session
Anna Marie L Ortiz, Gregory T Smith
University of Kentucky, Lexington, KY, USA

Affective distress may influence eating disorder behaviors in multiple ways. Affective lability refers to the tendency to experience frequent and striking fluctuations in mood. There is considerable evidence that it predicts eating disorder symptoms. Further, alexithymia is characterized by difficulties identifying and describing feelings and an externally oriented thinking style. Alexithymia has also been implicated in the development and maintenance of eating disorders. To date, these risk factors have been studied separately. However, the possibility of a joint effect of affective lability and alexithymia merits investigation. In the current study, we tested whether such a joint effect predicts the frequency of purging cross-sectionally. Using the EDE-Q, the Affective Dysregulation scale, and the Toronto Alexithymia Scale, we assessed affective lability, alexithymia, and purging in 589 college students. We then tested whether the interaction of affective lability and alexithymia predicted the frequency of purging above and beyond gender, BMI, and the main effects of each predictor. A significant interaction indicated that the influence of affective lability on the frequency of purging was stronger at higher levels of alexithymia. Perhaps if one has difficulty identifying one’s emotions, rapid mood shifts are particularly problematic. Transactions among affect-based risk factors may confer eating disorder risk. This research was supported by NIAAA.
Session: On-Demand Poster Session
Edoardo Pappaianni1, Manuela Barona2, Gaelle Doucet3, Sophia Frangou4, Christopher Clark2, Nadia Micali1,2,5
1Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland, 2UCL Great Ormond Street Institute of Child Health, London, United Kingdom, 3Boys Town National Research Hospital (BTNRH), Omaha, NE, USA, 4Icahn School of Medicine at Mount Sinai, New York, NY, USA, 5Depatment of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland

There is good evidence that differences in executive function are present in individuals with eating disorders (ED). However, we still do not know whether these differences are a consequence or precede ED. This is the first study to use the high-risk methodology in ED to investigate neuropsychology and neural networks. Sixteen (16) female children of mothers with ED (anorexia nervosa and bulimia nervosa) (aged 9-15) were compared to 18 healthy females children of mothers with no psychiatric disorders (aged 8-15). Groups were matched for age and pubertal stage. Executive function was assessed using the Attention Switching Task (AST) and Spatial Working Memory Task (SWM). Neuroimaging data were acquired to investigate resting-state networks, obtained via Independent Component Analysis. Data analyses compared groups on executive function and functional connectivity (FC) adjusting for age and IQ. ED offspring showed worse performance in attention switching measured by AST (b= 76.55, p = 0.02) and working memory. They showed reduced FC in the default-mode, sensorimotor and dorsal attentional networks, but increased FC in the medial visual network (all p <0.05 FDR-corrected). Although preliminary this is the first study to investigate neurobiological biomarkers of high-risk status in ED. Differences in executive function (across brain and behavior) were identified as potential markers of ED vulnerability. A larger study aimed at confirming and extending these findings is underway.
Session: Paper Session 2: Biological/Risk Factors
Katarina Prnjak1, Phillipa J. Hay1, Scott Griffiths2, Deborah Mitchison1,3
1Western Sydney University, Sydney, Australia, 2University of Melbourne, Melbourne, Australia, 3Macquarie University, Sydney, Australia

The internalisation and pursual of specific body ideals may lead to eating disorder (ED) pathology. Previous research has shown that drive for leanness is common in both men and women with EDs. Within studies using a network approach, drive for muscularity and leanness have been shown to be highly connected to ED symptoms in men, but these associations are less clear in women. No such research has been conducted in adolescents. We examined the empirical network structure of drive for muscularity, drive for leanness, and central aspects of ED-related body image disturbance (weight/shape dissatisfaction, overvaluation, and fear of weight gain) by estimating mixed graphical models in 4457 adolescents (54% females; 11-19 years old) from a population-based cohort of Australian secondary school students. BMI was most highly associated with fear of weight gain, especially in males. Relative to other components of drive for muscularity and leanness, hating one’s own body and the belief that one would feel better if they had a lean bodywere more strongly associated with central ED-related body image disturbance, weight/shape dissatisfaction in particular. However, some items were negatively linked to ED-related body image disturbance, such as lifting weights and using protein. Some components of the drive for muscularity and leanness are more strongly associated with ED-related body image disturbance, and thus could be targeted in body image prevention that focuses on drive for muscularity and leanness.
Session: On-Demand Poster Session
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, USA, 3Douglas Mental Health University Institute, Montreal, QC, Canada

Effort valuation/willingness to work (i.e., tendency to overcome response costs to obtain a reinforcer) is a positive valence construct in the RDoC matrix. The Effort Expenditure for Rewards Task (EEfRT) is a behavioral measure of willingness to work; participants choose between low-cost/low-reward (LC/LR) and high-cost/high-reward (HC/HR) options on trials associated with different probabilities of winning and monetary reward values. A modified version that assesses effort valuation for food (F-EEfRT) was developed in an undergraduate sample and performed similarly to the original task. Undergraduate females with higher BMIs made more HC/HR choices, and those with greater binge eating made more HC/HR choices when reward magnitude was high. The current study is the first to use the F-EEfRT in individuals with clinical binge eating. Participants were 70 women with sub-threshold and full-threshold binge eating disorders. As expected, the probability of winning and the HC/HR reward magnitude predicted the likelihood of choosing the HC/HR task. Participants with a greater BMI made more HC/HR task choices across the experiment, and there was a significant interaction between probability, reward magnitude, and binge eating severity in predicting HC/HR choices. Future research should examine whether other eating disorder symptoms (e.g., restrictive eating) and state-related variables (e.g., negative affect) modify the relationship between F-EEfRT performance and binge eating.
Session: On-Demand Poster Session
Neurobiological underpinning of eating disorder behaviours and diagnoses: Integrative biopsychosocial longitudinal analyses in adolescents and emerging adults from both population-based and clinical cohort studies. 
Lauren Robinson, Marina Bobou, Zuo Zhang , Sylvane Desrivières , Ulrike Schmidt
Kings College London, London, United Kingdom

Introduction: Our longitudinal, population-based cohort (the IMAGEN study), and clinical cohort of EDs (the ESTRA study) aim to investigate the predictors of development, maintenance and recovery from ED behaviours and diagnoses in adolescence and emerging adulthood.

Methods: This study investigates brain structural correlates, personality factors, life events and co-morbid psychiatric conditions as predictors for the development of ED behaviours and diagnoses across two large cohort studies (N=1350 and N=399). Longitudinal regression models were constructed to investigate current and future ED behaviours and diagnoses by combining a wide range of data from the IMAGEN and ESTRA cohort studies.

Results: Personality characteristics, including neuroticism, contentiousness and agreeableness, negative life events and depression, anxiety and OCD-traits at 14 years predicted the development of ED behaviours in later adolescence within the IMAGEN sample. Clinical EDs had high rates of psychiatric comorbidities, with 36% of BN reporting alcohol misuse and 76% of AN reporting depression Childhood trauma, but not negative life events, significantly distinguished those with ED diagnoses from HCs within the ESTRA cohort.

Conclusions: By identifying the vulnerability factors underlying individual differences in adolescents and emerging adults reporting ED behaviours and diagnoses, these models shed light on the aetiology of ED behaviours and suggest targets for prevention and treatment.
Session: Paper Session 2: Biological/Risk Factors
Sarah A. Rösch1,2,3, Ricarda Schmidt1, Ann-Christine Ehlis4, Swen Hesse5, Michael Lührs6,7, Anja Hilbert1
1Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany, 2International Max Planck Research School NeuroCom, Leipzig, Germany, 3Adaptive Memory Research Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany, 4Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany, 5Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany, 6Brain Innovation B.V., Maastricht, Netherlands, 7Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht,

Purpose: Obesity (OB) and associated binge-eating disorder (BED) are marked by impulsivity and emotional dysregulation. We used functional near-infrared spectroscopy (fNIRS) to examine food-specific brain activity, its association with impulsivity and emotional dysregulation, and temporal variability in individuals with OB and OB+BED compared to an age- and sex-stratified normal weight (NW) group. Methods: Prefrontal cortex (PFC) brain activity was recorded in individuals with OB (n=15), OB+BED (n=13), and NW (n=12) in a passive viewing and a response inhibition task. Impulsivity and emotional dysregulation were self-reported; anthropometrics were objectively measured. To assess brain activity variability, the OB and NW groups were measured twice 7 days apart. Results: Relative to NW, the OB and OB+BED groups showed PFC hypoactivity in both tasks, whereas the OB and OB+BED groups showed few significant differences in brain activity. In OB+BED, impulsivity and emotional dysregulation were significantly negatively associated with PFC activity. Temporal differences in brain activity were found during the response inhibition task in the OB, but not in the NW group. None of the groups showed significant differences in the passive viewing task. Conclusions: This study demonstrated fNIRS-based PFC hypoactivity in OB groups relative to a NW group. The link between impulsivity, emotional dysregulation, and PFC hypoactivity in OB+BED supports views of BED as a specific OB phenotype.
Session: On-Demand Poster Session
Lauren M. Schaefer1, Kathryn E. Smith2, Robert Dvorak3, Ross D. Crosby1,4, Stephen A. Wonderlich1,4
1Sanford Research, Fargo, ND, USA, 2University of Southern California, Los Angeles, CA, USA, 3University of Central Florida, Orlando, FL, USA, 4University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA

Purpose: Theory suggests that improvement in affect following binge-eating (BE) episodes contributes to increased eating expectancies, which then promote BE maintenance.

The current pilot study utilized ecological momentary assessment to examine the prospective independent and interactive effects of eating reinforcement experiences operationalized as reductions in negative affect (NA) following BE episodes and eating expectancies on subsequent BE behavior among 40 women with recurrent BE.

Greater reductions in momentary NA following a BE episode (i.e., greater reinforcement) predicted higher levels of eating expectancies on the following day. Further, eating expectancies interacted with reinforcement history to predict future BE episodes. Participants were most likely to report BE episodes on days that were characterized by higher eating expectancies, and preceded by days during which they experienced greater reinforcement from BE. Conclusion: These preliminary results are consistent with affect regulation and expectancy-based models of BE, suggesting a dynamic and potentially modifiable process of reward-based learning associated with BE behavior.
Session: On-Demand Poster Session
Jochen Seitz1, Meriem Belheouane2, Nina Schulz1, Astrid Dempfle3, John Baines2, Beate Herpertz-Dahlmann1
1Clinic of Child and Adolescent Psychiatry, RWTH University Hospital Aachen, Aachen, Germany, 2Max Planck Institute for Evolutionary Biology, Plön, Germany, 3Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany

Introduction: Gut microbiota are linked to metabolic function, body weight regulation and brain and behavioral changes. Alteration of gut microbiota is repeatedly demonstrated in adults with anorexia nervosa (AN) and transplantation of stool from adult patients with AN reduces weight gain, food consumption and food efficiency in germ-free mice. No similar data are available for adolescents, who might differ from adults due to their shorter duration of illness.

19 female adolescent patients with AN at admission and discharge were included in a longitudinal study and compared to 20 healthy controls (HC). DNA was extracted from stool samples and subjected to 16S rRNA gene sequencing and analysis.

Alpha diversity is increased in AN after short-term weight recovery, while beta diversity shows clear group differences with HC before and after weight gain. A reduction in Romboutsia and taxa belonging to Enterobacteriaceae at both timepoints and an increase in taxa belonging to Lachnospiraceae at discharge are most indicative of patients. Lachnospiraceae abundance at admission helped to predict shorter therapy duration. Conclusion: This study provides evidence of gut microbiota alterations in adolescent patients with AN that do not normalize with weight gain. The predictive power of taxa belonging to Lachnospiraceae for clinical outcome could complement known predictors at admission, inform clinicians and serve as a target for nutritional interventions.
Session: Paper Session 2: Biological/Risk Factors
Kristin Stedal1, Catherine Broomfield2, Ronny Scherer3, Phillipa Hay4, Stephen Touyz2
1Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway, 2School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia, 3Centre for Educational Measurement (CEMO), University of Oslo, Oslo, Norway, 4Translational Health Research Institute, Western Sydney University, Sydney, Australia

INTRODUCTION: The classification, diagnosis, and treatment of anorexia nervosa (AN) have traditionally focused on the behaviors and cognitions of patients. In recent years, several studies have conceptualized some of the defining cognitions and behaviors seen in AN as a reflection of neuropsychological (NP) dysfunction. However, there is a lack of studies quantitatively synthesizing these findings. The aim of the current review was to examine the differences in NP test performance between individuals with AN and healthy controls, and to quantify and explain between-study variation in these differences. METHODS: We performed a random-effects meta-analysis and reviewed primary studies in accordance with PRISMA guidelines, focusing on studies comparing patients with AN to a healthy control group on NP tests. The literature search was performed in July 2019 and updated in May 2020, and included the databases MEDLINE, PsycINFO, ISI Web of Science and Epistemonikos. RESULTS: Fifty studies, that comprised a total of 186 NP test results, fulfilled the inclusion criteria. Findings of the random-effects meta-analyses and moderator analyses will be presented at the conference. CONCLUSION: By quantitatively synthesizing previously published data, the findings from the current study has the potential to aid clinicians and researchers in comparing results across studies, and to provide guidelines for NP test selection for this patient group.
Session: On-Demand Poster Session
C. Alix Timko1, 2, John D. Herrington1, 2
1Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2University of Pennsylvania, Philadelphia, PA, USA

Early weight gain is the most robust predictor of remission in adolescents with anorexia (AN). Determining neural correlates of this marker is key to helping us understand remission. With this as a goal, we began a research program to deepen our understanding of the neurobiology of AN with a focus on reward (RN) and frontal parietal networks (FPN) early in treatment. Method: Adolescents with AN aged 12-18 were recruited for a pilot study designed to establish protocols for recruitment and retention and to generate preliminary data. They completed a baseline scan (T1) consisting of rsfMRI, structural MRI, and diffusion weighted imaging (DWI) and had the option to complete scans at 4 weeks (T2) and 6 months (T3). Results. 25 completed a scan at T1, 18 at T2, and 7 at T3. After applying motion and artifact removal criteria the sample was 19, 14, and 6, respectively. Mean BMIz at baseline was -.49±1.14, -.11±.83at T2, and .41±.56 by T3 (p=.06). EDE global significantly reduced by T2 and T3 (p=.03). Connectivity strength significantly increased within the FPN for rsfMRI (d=1.17) and DWI (d=.54) by T2. Increased network segregation was slower to emerge in the RN, but large by T3 (d=0.71 and 1.12 for rsfMRI and DWI). Conclusions. Changes in network connectivity seen after 4 weeks of renourishment are related to changes in weight and eating disorder symptoms; further changes are seen by 6 months. Implications for our understanding of network changes during treatment are discussed.
Session: On-Demand Poster Session
Stefanie Trinh1, Constanze Schwenzer1, Clara Voelz1, Anna Schlösser1, Vanessa Kogel1, Cordian Beyer1, Beate Herpertz-Dahlmann2, Jochen Seitz2
1RWTH Aachen University, Institute of Neuroanatomy, Aachen, Germany, 2RWTH Aachen University, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Aachen, Germany

Introduction: Anxiety disorders are a major risk factor for a subsequent diagnosis of anorexia nervosa (AN) and are the most frequent comorbidity. Here, the influence of pre-existing anxiety levels on the susceptibility to lose weight in an AN animal model was tested. Furthermore, the interaction of starvation and hyperactivity with anxiety was analyzed.

A chronic activity-based anorexia (ABA) model was applied to mimic characteristics of AN. During the acute starvation period food intake was reduced by 60 % so the rats lost 25 % of their body weight. To imitate chronic starvation the body weight was then kept stable for two weeks. Anxiety-like behavior was quantified using the Elevated Plus Maze.

Rats showing anxiety-like behavior before starvation showed higher running-wheel activity during starvation and lost body weight significantly faster. Additionally, all food-restricted animals showed less anxiety-like behavior after starvation suggesting an anxiolytic effect of food reduction. Conclusion: Anxiety makes rats more prone to body weight loss in the ABA paradigm, potentially mediated by increased (perhaps anxiolytic) exercise. These results support a role for anxiety in the etiology and pathophysiology of AN and help explain clinical findings. Clinicians should take into account possibly rewarding processes caused by a reduction of anxiety following food restriction and hyperactivity in AN therapy.
Session: On-Demand Poster Session
Blair Uniacke, Karin Foerde, Jonathan Posner, Joanna Steinglass
Columbia University, Department of Psychiatry, New York State Psychiatric Institute , New York, NY, USA

Introduction: Abnormalities in reward-based learning have been proposed as a potential mechanism underlying persistent maladaptive dietary restriction in anorexia nervosa (AN). This study used a probabilistic reversal learning task to examine learning from positive and negative feedback in adolescents with AN relative to adolescent healthy controls (HC). We hypothesized that relative to HC, AN would show increased sensitivity to negative feedback, with increased lose-shift behavior and an increased learning rate following loss.

Female adolescents between 12-18 years old with AN (n=48) and HC (n=20) completed the task. The task includes two blocks of 100 trials. Each block involves two pairs of stimuli (AB/CD) and feedback is probabilistic: choice of stimulus A or C is associated with positive feedback on 80% and 70% of trials respectively, and stimulus B or D with positive feedback on 20% and 30% of trials. Participants are instructed to earn as many points as possible.

Mean duration of illness among AN was 10 months ± 12 mo. AN and HC did not differ on overall accuracy (F(1,66)=0.22, p=0.64), in win-stay/lose-shift behavior (F(1,66)=0.07, p=0.79), or in positive or negative learning rates (F(1.66)=.0.002, p=0.97).

We found no evidence of differences in feedback learning between adolescents with AN and HC. Previously observed deficits in feedback learning in AN may reflect neurocognitive changes which emerge following a longer course of illness.
Session: On-Demand Poster Session

Eating behaviors of Women with an Eating Disorder and Autistic Spectrum Disorder
Unna N. Danner1,2, Sabrina S. Schröder1,2, Annelies A. Spek3, Annemarie A. van Elburg1,2
1Altrecht Eating Disorders Rintveld, Zeist, Netherlands, 2Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands, 3Autism Expertise Center, Eemnes, Netherlands

Introduction. A large body of literature has focused on the role and clinical implications of autism spectrum disorder (ASD) traits that have been repeatedly found in eating disorder (ED) 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 60 participants: 20 with ED and ASD, 20 with ED and 20 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.
Session: On-Demand Poster Session
Laxative misuse is associated with suicide attempts in patients with eating disorders independently of the eating disorder type, comorbid psychiatric conditions, sociodemographic and clinical characteristics
Sebastien Guillaume1,2, Aiste Lengvenyte1,3, Robertas Strumila1,3, Philippe Courtet1,2
1CHU Montpellier, Montpellier, France, 2Inserm U1061, Montpellier, France, 3Vilnius University, Vilnius, Lithuania

Objective: Eating disorders (ED) are associated with higher risk of suicidal behaviors. Gut microbiota, inflammation, and 5-HT functioning have been implicated in suicidality and also ED. As laxatives might perturb these systems, the aim of this study was to determine whether laxative misuse (LM) for weight control is independently associated with suicidal attempt (SA) history in patients with ED. Methods: 353 participants with ED were consecutively recruited. Univariate analysis of variance, χ2 and t-test were used to detect associations between LM and the other collected variables, with Bonferroni correction when required. A multiple regression model was used to assess the independence of the relationship between laxative abuse and SA history.

Among the 353 included patients, 73 (21.2%) reported lifetime LM, with no difference among ED types. Patients with LM were more likely to have history of SA compared with non-misusers (43.83% vs 19.9%, p <.001, odds ratio [OR] 3.15, 95% CI 1.82 – 5.46). LM was also associated with higher SA number in suicide attempters (4.35 ± 5.68 vs 2.08 ± 2.39, p = .041). In the multivariate model, adjusted for significant confounders (ED diagnosis and severity, comorbidity, and other purging behaviors), LM remained associated with SA history (OR 2.34, 95% CI 1.19 – 4.62, p = .014). Conclusion: LM is independently associated with SA history in patients with ED. Replication studies should focus on understanding the underlying mechanisms
Session: On-Demand Poster Session
Rowan A. Hunt, Cheri A. Levinson
University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA

Introduction: Eating disorders (EDs) are highly lethal disorders, in part due to high rates of suicide in this population. Mixed findings examining differences in suicidality across ED diagnoses suggest a need to delineate the associations between specific ED behaviors (i.e., binge eating, purging, fasting, and excessive exercise) and multiple aspects of suicidality (i.e., overall suicide risk, suicidal ideation, and suicide behaviors/attempts).

In a sample of individuals (N =181) with an ED: anorexia nervosa (AN; n = 128); bulimia nervosa (BN; n = 53), we tested whether those with AN and BN differed in the aforementioned aspects of suicidality. We also tested transdiagnostic (i.e., across the entire sample) cross-sectional regression models examining how different ED behaviors (i.e., binge eating, purging, fasting, and excessive exercise) contributed to each of the aforementioned aspects of suicidality.

We found that the AN and BN groups did not differ on any aspects of suicidality (ps = .238-.815). In the transdiagnostic regression models, fasting was uniquely associated with all suicide measures (ps = .003-.045), above and beyond all other ED behaviors (i.e., binge eating, purging, excessive exercise; ps = .299- .978).

These findings support and extend upon previous research by demonstrating the unique importance of fasting in the relationship between EDs and suicidal ideation and suicidal behaviors, independently.
Session: On-Demand Poster Session
Jess Kerr-Gaffney1, Luke Mason2, Emily Jones2, Hannah Hayward3, Amy Harrison4,5, Declan Murphy3, Kate Tchanturia1,5,6
1King's College London, Department of Psychological Medicine, London, United Kingdom, 2Birckbeck, University of London, Centre for Brain and Cognitive Development, London, United Kingdom, 3King's College London, Department of Forensic and Neurodevelopmental Sciences, London, United Kingdom, 4University College London, Department of Psychology and Human Development, London, United Kingdom, 5South London and Maudsley NHS trust, National Eating Disorders Service, London, United Kingdom, 6Ilia State University, Department of Psychology, Tbilisi, Georgia

Introduction: Anorexia nervosa (AN) is associated with difficulties in social functioning, including difficulties in understanding nonverbal communication. Attending to others’ eye gaze, facial expressions, and other nonverbal cues is a necessary precursor to effective social interaction and understanding, therefore it is possible that differences in social attention may contribute to the interpersonal difficulties associated with AN. At the same time, a significant proportion of individuals with AN show high autistic traits, a factor which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls (HCs), as well as associations with comorbid psychopathology.

Methods: One hundred and forty-eight participants’ eye movements were tracked while watching a naturalistic social scene, and levels of anxiety, depression, alexithymia, and autistic traits were assessed.

Results: Participants with AN spent significantly less time looking at faces compared to REC and HCs, however patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.

Conclusions: Reduced attention to faces in AN appears to be explained by high levels of autistic symptoms in this group. Those with AN and high autistic traits may require treatment adaptations to accommodate differences in social cognition and attention.
Session: On-Demand Poster Session
A Network Analysis of Intrusive Thoughts, Eating Disorder and Obsessive-Compulsive Disorder Symptoms
Shruti S Kinkel-Ram1, Brenna Williams2, Shelby N Ortiz1, Lauren Forrest1, Joshua Magee1, Cheri A Levinson2, April R Smith1
1Miami University, Oxford, OH, USA, 2University of Louisville, Louisville, KY, USA

Intrusive thoughts are one potential mechanism proposed to maintain the high comorbidity between eating disorders (EDs) and obsessive-compulsive disorder (OCD). The study employed network analysis to identify central ED-related intrusive thoughts and test which intrusive thoughts connect ED and OCD symptoms. A cross-sectional graphical LASSO network was computed using a sample of 353 sub-clinical participants. We identified core and bridge symptoms using strength centrality. Two illness pathways emerged connecting intrusive thoughts, ED symptoms, and OCD symptoms. Desiring weight loss bridged to intrusive urges to exercise and weigh oneself, and resisting and experiencing distress from compulsions. Intrusive thoughts about hoarding food bridged eating in secret and functionally interfering obsessions. Our findings suggest that ED-relevant intrusive thoughts were illness pathways between EDs and OCD, indicating that intrusive thoughts may contribute towards ED and OCD cognitions and behaviors. In general, prevention efforts targeting intrusive thoughts may attenuate ED and OCD symptoms. Specifically, efforts targeting ED-related intrusive thoughts and thin ideal internalization may prevent the development of compensatory behaviors, such as over-exercise. Additionally, targeting intrusive thoughts related to the need to gather and store items may aid in treatment and prevention efforts for both hoarding symptoms in OCD and binge eating symptoms in EDs.
Session: On-Demand Poster Session
Alessio Maria Monteleone1, Giammarco Cascino2, Alberta Mereu3, Palmiero Monteleone2, Stefano Vicari3, Valeria Zanna3
1Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy, 2dDepartment of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy, 3Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy

Introduction. Network analysis provides a new method to conceptualize psychopathology and psychiatric comorbidity. We employed this approach to investigate the relationships between eating-related and general psychopathology in adolescents with anorexia nervosa. Methods. Four-hundred-five adolescents with anorexia nervosa and illness duration less than 3 years were recruited. A network analysis was conducted, including eating-related psychopathology measures, anxiety and depressive symptoms and obsessive-compulsive and post-traumatic stress problems. We applied the bridge function to identify symptom clusters. Results. Depression symptoms and personal alienation showed the highest centrality in the network, followed by ascetism, post-traumatic stress problems, drive to thinness and low self-esteem. We identified three symptom clusters: one relative to eating disorder psychopathology, one to self-esteem problems and one to internalizing difficulties. Depression symptoms, personal alienation, low self-esteem and interoceptive deficits were the nodes with the highest bridge centrality. Conclusions. Besides eating disorder core symptoms, negative affect and internalizing symptoms contribute to anorexia nervosa psychopathology. These findings confirm that anorexia nervosa is characterized by a broad psychopathological spectrum. We suggest the need to re-conceptualize psychiatric comorbidity in this disorder with intriguing diagnostic and therapeutic implications.
Session: On-Demand Poster Session
Alexandra C. Rich1, Ann F. Haynos1, Jazmin Camchong1, Leah M. Jappe Hall3, Carol B. Peterson1,4, Scott J. Crow1,4, Bonnie Klimes-Dougan2, Kathryn R. Cullen1, Kelvin O. Lim1
1Psychiatry at University of Minnesota, Minneapolis, MN, USA, 2Psychology at University of Minnesota, Minneapolis, MN, USA, 3Eastern Oklahoma VA Medical Center, Tulsa, OK, USA, 4Emily Program, Minneapolis, MN, USA

Introduction: Anorexia Nervosa (AN) shares etiological and phenotypic overlap with anxiety disorders. Little is known about neural processes linking these disorders. Aberrant activity of the amygdala, a region involved in threat responding, has been found in AN. Prior studies have probed reactions to eating disorder cues (e.g., body images), precluding the ability to evaluate global functional threat system disruptions. Resting-state functional connectivity (RSFC) permits examination of amygdala function divorced from cue elicitation.

Seed-based RSFC from the amygdala was compared between AN (n=19) and healthy control (HC; n=19) groups (cluster threshold: p<.01). Regressions examined relations between RSFC z-scores and clinical symptoms (anxiety, behavioral inhibition, eating disorder symptoms).

The AN group had lower RSFC between the amygdala and frontal (e.g., orbitofrontal cortex), temporal, parietal, and posterior (e.g., precuenus) regions compared to HCs (ps<.001). In the AN group, lower RSFC between the amygdala and parietal regions (r=-.57, p=.02), cingulate gyrus (r=-.50, p=.04), precuneus (r=-.52, p=.03) associated with more anxiety, but not behavioral inhibition or eating disorder symptoms.

Synchrony between the amygdala and brain regions subserving emotional and sensory regulation is impaired in AN and predicts anxiety. These results parallel those established in anxiety disorders, suggesting a transdiagnostic mechanistic bridge.
Session: On-Demand Poster Session
Melissa Simone, Emily Pisetsky
University of Minnesota, Minneapolis, MN, USA

Introduction This study examined the prevalence of suicide attempts in sexual and gender minority (SGM) young adults and the association between eating disorder (ED) symptoms and suicide attempts in this population. Methods Participants were 232 SGM young adults with current ED symptoms (36.2% cisgender women). Chi-square tests examined gender and sexual orientation differences in suicide attempts. Regressions examined associations between ED symptoms and suicide attempts. Results Approximately 13% of the sample reported a past year suicide attempt and 42% reported a lifetime suicide attempt. Past year suicide attempts were highest among bisexuals (20%) and lifetime suicide attempts were highest among pansexuals (62%). Transgender women (100%) and transgender men (67%) reported the highest prevalence of lifetime suicide attempts. Results revealed a significant, positive association between eating concerns and past year suicide attempts (OR=1.65). Participants with a lifetime suicide attempt reported higher restraint, eating concern, shape concern, and weight concern than those without a lifetime suicide attempt (p<.01). Conclusion High eating concern was associated with higher odds of a past year suicide attempt. In contrast, lifetime suicide attempts were associated with higher ED symptoms across all dimensions. The association between suicide attempts and EDs in SGM young adults is likely bidirectional and eating concern may be the ED symptom most proximal to suicide risk.
Session: On-Demand Poster Session
Brenna M Williams, Cheri A Levinson
University of Louisville, Louisville, KY, USA

Eating disorders (EDs) are highly comorbid with obsessive-compulsive disorder (OCD). In order to develop treatments to address this common comorbidity, it is important to identify shared mechanisms. Two potential shared mechanisms of EDs and OCD are maladaptive perfectionism (MP; i.e., critical self-evaluation, high standards, and concern over mistakes) and intolerance of uncertainty (IU; i.e., negative perceptions and reactions to ambiguity). Research suggests that MP and IU are maintenance factors for EDs and OCD separately. However, research has yet to examine how these two mechanisms contribute to ED-OCD comorbidity in one comprehensive model. In the current study (N=168 individuals with EDs), we assessed how MP and IU contribute to the maintenance of ED and OCD symptoms. Variables were assessed at two timepoints approximately six months apart. Cross-sectional and prospective path models were conducted in Mplus. We found that MP and IU were shared correlates of ED (ps≤.039), and only IU was significantly related to OCD (p<.001). Additionally, MP and IU prospectively predicted OCD (ps.044), but not ED (ps>.05). Our findings suggest that MP and IU may promote the development of OCD symptoms among individuals with EDs, rather than maintenance of an ED. Intervening on MP and IU in individuals with an ED may prevent the onset or minimize the co-occurrence of OCD symptoms. Current MP treatments for EDs may also benefit from adding interventions targeting IU.
Session: On-Demand Poster Session

Jojanneke M. Bijsterbosch1, Anouk Keizer2, Paul A. Boelen3, Hendrik C. Dijkerman4, Unna N. Danner5, Lot C. Sternheim6
11, Utrecht, Netherlands, 22, Utrecht, Netherlands, 33, Utrecht, Netherlands, 44, Utrecht, Netherlands, 55, Zeist, Netherlands, 66, Utrecht, Netherlands

Introduction. Inherent to anorexia nervosa (AN) are repetitive and intrusive thoughts about weight and shape. Growing research suggests the relevance of worry and intolerance of uncertainty (IU) in maintaining these repetitive and inflexible thinking styles. The relation between these cognitive processes and weight and shape concerns in adolescents remains understudied. This study aims to investigate associations between IU, worry and weight and shape concerns in adolescents with AN. Methods. 65 adolescent girls with AN completed 3 questionnaires, measuring weight and shape concerns (EDE-Q), worry (PSWQ) and IU (IUS-12). A mediation model with worry as a mediator between IU and weight and shape concerns was tested. Results. A direct effect of IU on weight and shape concerns was found. Although higher IU was associated with more worry, worry did not mediate the relation between IU and weight and shape concerns. Conclusions. These results confirm the importance of cognitive processes such as IU and worry in adolescents with AN. This group might potentially benefit from additional intervention strategies related to IU and worry. Furthermore, these results could indicate that whilst weight and shape concerns are important for adolescents with AN, they may not yet be an integrative part of the repetitive thinking styles as observed in adult populations. Further research should investigate these relations over longer periods of time.
Session: On-Demand Poster Session
Lien Goossens1, Eva Van Malderen1, Sandra Verbeken1, Laurence Claes2
1Ghent University, Ghent, Belgium, 2Leuven University, Leuven, Belgium

Introduction: Loss of control eating (LOC) in adolescents increases the risk for eating disorders and other psychopathology. Interpersonal models propose that LOC can be explained by insecure attachment relationships and problems with emotion regulation (ER). Attachment insecurity towards mother appears to be a risk factor for LOC in adolescents; yet the role of attachment towards father and peers is less studied. The current study examined whether attachment towards mother, father and peers explain LOC and whether interactions with maladaptive ER strategies could be found.

Participants were 496 early adolescents (10 – 15 years; 51.9% girls) who self-reported on LOC (ChEDE-Q), attachment towards parents and peers (IPPA) and maladaptive ER strategies (FEEL-KJ).

Insecure attachment towards mother, father and peers significantly increased the odds of LOC. More trust towards mother, father and peers, as well as more communication with mothers and fathers (but not peers) decreased the odds of LOC. Only peer alienation significantly interacted with maladaptive ER strategies to explain LOC.

Results demonstrate that insecure attachment towards both parents and peers may put youth at risk for LOC. Results also show that adaptive interpersonal functioning may protect youth from experiencing LOC offering opportunities for clinical practice. Future research should prospectively investigate the moderating role of more specific ER strategies or emotions.
Session: On-Demand Poster Session
Ashley A King1, Jody M Russon1, Janell L Mensinger2
1Virginia Tech, Blacksburg, VA, USA, 2Villanova University, Villanova, PA, USA

Introduction: The quality of familial relationships is a critical factor in the etiology and maintenance of disordered eating (DE). Previous research has established that parental psychological control (PPC) is a risk factor for DE in adolescents. Despite associations between attachment insecurity and DE, few studies explore if attachment interacts with family factors to impact DE. This study examined if attachment insecurity strengthens the positive association between PPC and DE in young adults. We hypothesized that a) PPC would predict DE, and b) attachment insecurity (avoidant and anxious types) would moderate the relationship of PPC on DE. Method: We applied secondary analysis on a sample of college women (N=82). Self-reported measurements included the Eating Attitudes Test to assess DE, the Psychological Control Scale-Youth to assess PPC, and the Experiences in Close Relationships-Relationships Structure Questionnaire to assess attachment anxiety and avoidance. We fit separate moderated regressions for maternal and paternal PC using Hayes’ Process Macro and the Jersey-Neyman method for probing the interactions. Results: There were no main effects in either model; however, paternal PC moderated anxious and avoidant attachment (combined R2 change=.062, p =.036). Maternal PC did not moderate either form of attachment insecurity.

The findings point to the saliency of fathers in predicting DE among young adults. Implications for treatment are discussed.
Session: On-Demand Poster Session
Rachel Potterton1, Karina Allen1,2, Tirril Harris3, Ulrike Schmidt1,2
1Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 2The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom, 3Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom

Background: Emerging adulthood (EA; ~18-25 years) is a high risk period for the onset of eating disorders (EDs) It is associated with intense psychosocial development and related life-events (e.g. starting university; residence changes). Sparse research has investigated interactions between such developmental factors and clinical outcomes. This study examines associations between intercurrent (i.e. during treatment) positive and negative life-events, treatment outcomes and recovery in EAs who have received specialised ED treatment. Method /

61 EA patients (mean age 20.83 years (SD 3.18); 41% anorexia nervosa; 59% other EDs) accessing their first ED treatment through FREED, an early intervention service, were recruited. Clinical outcomes were assessed at baseline, 3, 6 and 12 months after starting treatment. The Life Events and Difficulties Schedule was completed at 12 months, covering the previous year. Events were rated contextually for "threat", whether they provided a "fresh start" and/or "anchored" the individual’s self-definition. Participants were classified as "recovered" or "non-recovered" based on ED symptoms and BMI. Statistical analysis (in progress) compares odds of exposure to different types of intercurrent life-events in recovered (70%) and non-recovered (30%) participants. Conclusion: This is the first study of its kind. Findings will have important implications for understanding recovery trajectories and developmentally-informed ED care.
Session: Paper Session 4: Clinical/Psychopathology
Leni Raemen1, Koen Luyckx1,2, Adelene Grobler2, Laurence Claes1,3
1KU Leuven, Leuven, Belgium, 2University of the Free State, Bloemfontein, South Africa, 3University of Antwerp, Antwerp, Belgium

INTRODUCTION: Traumatic experiences have been commonly associated with self-harming behaviors in adolescents. However, research about this association in less developed countries is limited. This study investigated the link between trauma and self-harming behaviors in South-African high school students, and examined the mediating role of identity formation. METHODS: A total of 552 high school students (60.4% girls) were included. Students filled out self-report questionnaires, including measures of traumatic experiences, identity formation, eating behaviors and suicidal thoughts and behaviors. RESULTS: Structural equation modelling indicated that the link from traumatic experiences to self-harming behaviors was partially mediated by identity formation. Trauma was associated with higher levels of identity diffusion, bulimia, and suicidal thoughts and behaviors. Identity diffusion, in turn, was associated with more drive for thinness, bulimia, body dissatisfaction, and suicidal thoughts and behaviors. Identity consolidation was positively associated with drive for thinness and negatively with body dissatisfaction and suicidal thoughts and behaviors. No moderation by gender or age was found for these paths. CONCLUSIONS: Identity formation partially mediated the link between traumatic experiences and self-harming behaviors in South-African high school students. These findings suggest the importance of focusing on identity formation in prevention and intervention programs.
Session: On-Demand Poster Session
Megan M. Shope1, Felipe D. Diaz1, Kristen M. Culbert2
1University of Nevada, Las Vegas, Las Vegas, NV, USA, 2Wayne State University School of Medicine, Detroit, MI, USA

Later pubertal timing increases risk for drive for muscularity (DM), even after the completion of puberty. It has been posited that these effects may arise because later maturing boys experience physical changes (e.g., body hair, deepening voice, increased muscle mass) later than their peers, and thus, they may be at greater risk for DM because their physical development remains most discrepant from socially idealized attributes of masculinity/attractiveness, including the muscular body ideal. We tested this sociocultural theory by exploring whether heightened levels of internalization of the muscular ideal mediate pubertal timing effects on DM. Participants were 255 young adult men. Age at onset of secondary sex characteristics (hair growth, voice drop) were used as indicators of pubertal timing. The SATAQ-4R assessed internalization of the muscular ideal, and a latent factor of DM was created from well-validated measures. Consistent with sociocultural theory, later pubertal timing predicted higher levels of DM in men and this association was fully mediated by heightened internalization of the muscular ideal. Since males who mature later are at heightened risk for DM and behavioral attempts to achieve muscularity appear to be largely due to internalizing societal standards regarding masculinity/attractiveness, these findings highlight the critical need to screen later maturing boys and use targeted prevention efforts to reduce muscular ideal internalization and DM behavior.
Session: On-Demand Poster Session
Alyssa J. Smith, Emilie Lacroix, Kristin M. von Ranson
University of Calgary, Calgary, AB, Canada

Introduction. Longitudinal research on body image across the lifespan is characterized by variability in populations studied, body image constructs assessed, and measures used, and has yielded conflicting evidence regarding the question of what constitutes normative body image development. In this study, we synthesized existing longitudinal studies to investigate normative changes in body image across the lifespan. Methods. We conducted a systematic review following PRISMA guidelines. We searched 4 databases and consulted reference lists of key articles to identify studies that assessed body image at 2+ time points over 6+ months. We aggregated effect sizes from samples reporting mean-level changes in body image. Random effects meta-analytic regression models were used to assess age-related changes and gender differences in body image constructs (e.g., body esteem, satisfaction, and dissatisfaction, and shape and weight concern). We also assessed the impact of potential moderators, including attrition rates and publication bias.

We identified >165 longitudinal studies that reported on body image development. Results will describe normative trends in body image constructs across developmental periods, as well as the influence of attrition rates and publication bias on estimates of mean-level change over time.

We will discuss the implications of our findings for prevention efforts and theories of body image development.
Session: On-Demand Poster Session
Nora Trompeter1, Kay Bussey1, Miriam K Forbes1, Deborah Mitchison1,2
1Centre for Emotional Health, Macquarie University, Sydney, Australia, 2Translational Health Research Institute School of Medicine, Western Sydney University, Sydney, Australia

Introduction: Emotion dysregulation is associated with eating disorder (ED) symptoms among adolescents, but is also linked to a wide range of other psychopathology. Using a dimensional approach, emotion dysregulation may be associated with ED behaviours, specifically when combined with ED-specific risk factors (e.g., weight/shape concerns). The current study examined the association between emotion dysregulation and ED behaviours and whether this association was moderated by weight/shape concerns.

Methods: As part of a larger study, 2245 adolescents completed a questionnaire on ED behaviours, weight/shape concerns and emotion dysregulation.

Results: When controlling for age, sex, BMI percentile, and weight/shape concerns, emotion dysregulation was positively associated with most ED behaviours (binge eating, fasting, and purging (all p <.01)), but not driven exercise. Moreover, the relationships for emotion dysregulation with both fasting and purging were moderated by weight/shape concerns, whereby associations were stronger at higher levels of weight/shape concerns (all p <.01).

Conclusions: Emotion dysregulation is a unique correlate of binge eating, representing a modifiable potential treatment target. Furthermore, the co-occurrence of emotion dysregulation with weight/shape concerns amplified the association with extreme weight control behaviours. Taken together, these findings have implications for how ED risk factors are conceptualised in a transdiagnostic model.
Session: On-Demand Poster Session
Two to tango: The interplay of maternal authority, feeding practices and child’s problem eating in six-year-old children
Ada H Zohar1,2, Lilac Lev-Ari1,2, Rachel Bachner-Melman1,3
1Ruppin Academic Center, Emek Hefer, Israel, 2Lior Zfaty Center for Suicide and Mental Pain Research, Emek Hefer, Israel, 3Hebrew University Jerusalem, Jerusalem, Israel

The purpose of this study was to elucidate the relationship between maternal feeding practices and children’s eating problems. Mothers of 280 children aged 5.9+1.1, 50% boys, reported online on parental authority [PAQ], overt and covert control of the child’s food choices [OC], child feeding practices [CFQ], and their child’s eating behaviour [CEBQ]. Structural equation modelling using AMOS yielded a model with excellent indices of fit (=50.72, p=.56; normed fit index NFI= .94; root mean square error of approximation RMSEA=.001; standardized root means square residual RMR=.04). The model showed that authoritarian maternal authority style was associated with overt control, which was associated with maternal tendency to pressure the child to eat and maternal restriction of highly processed or calorie- rich snack foods. These in turn were positively associated with the child’s satiety response, food fussiness, and slow eating, and negatively with the child’s enjoyment of food. In contrast, maternal permissive authority style was associated with covert control of the child’s eating, concern over the child being overweight, and restriction of highly processed and calorie-rich snack foods, which were in turn positively associated with the child’s emotional overeating and the child’s food responsiveness. The model thus describes two distinct patterns of mother-child feeding and eating dynamics, apparently related to children with opposing appetitive tendencies.
Session: On-Demand Poster Session

The prevalence of Avoidant/Restrictive Food Intake Disorder (ARFID) in 4- to 7-year-old children: results from the Japan Environment and Children’s Study
Lisa Dinkler1,2, Kahoko Yasumitsu-Lovell1,2, Masamitsu Eitoku2, Mikiya Fujieda3, Narufumi Suganuma2, Yuhei Hatakenaka1, Nouchine Hadjikhani1,4, Rachel Bryant-Waugh5, Maria Råstam1,6, Christopher Gillberg1,2
1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden, 2Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan, 3Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan, 4Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA, 5Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom, 6Department of Clinical Sciences Lund, Lund University, Lund, Sweden

Introduction: The prevalence of Avoidant/Restrictive Food Intake Disorder (ARFID) in children of the general population is still largely unknown and there is a lack of screening tools for ARFID. The aim of this study was to investigate the prevalence of ARFID in a large cohort of Japanese children using a new parent-reported screening tool for ARFID developed by our group. Methods: We conducted a cross-sectional survey in a sub-sample of the Japan Environment and Children's Study (JECS), an ongoing nationwide birth cohort study. Participants were the parents of children born in Kochi prefecture between July 2011 and December 2014. The newly developed screening tool was sent out to all 6,533 parents in the Kochi cohort in December 2018 (response rate 57.3%). Results: In 3,746 children aged 4 to 7 years (49.1% female), the point prevalence of ARFID according to the DSM-5 criteria was 0.7%. Using the ICD-11 criteria increased the point prevalence of ARFID to 1.3%. The male-female ratio among children with ARFID was 1:1. Sensory sensitivity was the most common driver of food avoidance/restriction (59.8%) and having more than one driver was common (36.1%). Conclusions: This is the largest study on ARFID prevalence to date in children up to 7 years. The prevalence estimates should be considered preliminary, until future studies demonstrate diagnostic validity of the applied screening tool. Further studies on the prevalence of ARFID in the general population are needed.
Session: On-Demand Poster Session
Alexis E. Duncan1, Holly E. Smith1, Yahui Fan1, Sarah C. Van Alsten2
1The Brown School at Washington University in St. Louis, Saint Louis, MO, USA, 2Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

Introduction: The link between depression and BMI and is well studied; however, evidence regarding the association of depression with weight perception, both alone and in the context of BMI, is sparse.

Methods: Data from 11,100 adults aged 20-59 from the 2011 to 2016 National Health and Nutrition Examination Survey were analyzed using logistic regression stratified by sex. Current depression, measured with the PHQ-9, served as the dependent variable. Weight perception, and BMI category were included as independent variables in separate models and together in the same model, adjusting for demographic covariates.

Results: In models including both BMI and weight perception, self-perception of overweight was associated with greater odds of depression in both women (OR = 2.13; 95% CI: 1.14-3.99) and men (OR = 2.06; 95% CI: 1.18-3.62) relative to those with a perception of "about the right weight", but underweight self-perception increased the odds of depression only in men (OR = 2.05; 95% CI: 1.40-3.10). In women, obesity, but not over- or underweight, was positively associated with depression (OR = 1.83; 95% CI: 1.27-2.63). In contrast, both obesity (OR = 0.47; 95% CI: 0.26-0.83) and overweight (OR = 0.57; 95%: 0.35-1.64) were associated with lower odds of depression among men. Conclusion: Weight perception is associated with depression independent of associations between depression and BMI. The nature of associations of depression with weight perception and BMI may differ by sex.
Session: On-Demand Poster Session
Anne Claire Grammer1, Melissa M. Vazquez1, Ellen E. Fitzsimmons-Craft1, Lauren A. Fowler1, Natasha A. Schvey2, Sarah K. Lipson3, Michelle G. Newman4, Daniel Eisenberg 5, C. Barr Taylor 6,7, Denise E. Wilfley1
1Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA, 2Department of Medical and Clinical Psychology, Uniformed Services University , Bethesda, MD, USA, 3Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA, 4Department of Psychology, Penn State University, University Park, PA, USA, 5Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA, 6Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, 7Center for m2Health, Palo Alto University, Palo Alto, CA, USA

Introduction: Sexual and gender minority (SGM) college students report higher rates of mental health concerns, yet few studies have characterized the clinical profiles of students at-risk for EDs by SGM status. We examined ED risk/diagnostic status and chronicity by sexual orientation and gender identity in a national sample of U.S. students.

Students completed online screener for DSM-5 clinical or subclinical ED diagnoses and chronicity of ED symptoms. Sexual orientation (heterosexual, lesbian, gay, bisexual, queer, questioning, 2 or more sexual orientations, Other orientation) and gender identity (cisgender male, cisgender female, transgender/gender-queer) were also collected. A series of chi-square, Kruskal-Wallis 1-way ANOVA, and ANCOVA with Bonferroni correction tests were conducted, adjusting for age, race, and ethnicity.

8,510 students (23.7% SM; 2.9% GM) were studied. Significantly fewer students who identified as bisexual were at low risk for an ED compared to students who identified as heterosexual or gay (p<.001). Students who identified as bisexual or Other SM had more chronic symptoms compared to heterosexual students (ps<.02). Significantly fewer cisgender males were at high risk for an ED and endorsed less chronic symptoms compared to cisgender females and GM students (ps<.001).

Some SGM students may be at heightened risk for EDs, highlighting the need to identify mechanisms that contribute to disparities in SGM populations.
Session: On-Demand Poster Session
Phillipa J Hay1, W. Kathy Tannous1, Frederick Gorosi1, Andreea Heriseanu2, Moin Uddin Ahmed1, Stephen Touyz2
1Western Sydney University, Sydney, Australia, 2University of Sydney, Sydney, Australia

Purpose: Whilst it is well-known that quality of life impacts are high for eating disorders (EDs), research regarding fiscal and related costs is severely limited. The aim of this study was to better understand economic and other costs of EDs at the community level. Method: Data were derived from a 2017 household community representative structured interview of 2977 people aged > 15 years. ED diagnoses, health systems, productivity, transaction, out-of-pocket costs and burden of disease were used to estimate economic burden of disease.

Results: The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This comprised of $81 billion from burden of disease from years of life lost due to disability (YLD) ($A62 billion) and years of life lost (YLL) ($A19 billion). The health system costs, productivity and tax revenue loss were estimated at $A1 billion, $A1.6 billion and $A0.6 billion respectively.

Conclusions: The YLD average cost in 2018 in South Australia was $A296,649 per person. This is two thirds of the costs borne by individuals and wider economy. Prevention and management initiatives need to note these costs when assessing their potential benefits. Early identification and timely effective treatment are imperative to reduce the impact of these disorders both for the individual and the community.
Session: On-Demand Poster Session
Development of transdiagnostic clinical risk prediction models for 12-month onset and course of eating disorders among adolescents in the community: A pilot study
Deborah Mitchison1, Shirley Wang2, Tracey Wade3, Ann Haynos4, Phillipa Hay1
1Western Sydney University, Sydney, Australia, 2Harvard University, Cambridge, MA, USA, 3Flinders University, Adelaide, Australia, 4University of Minnesota, Minneapolis, MA, USA

Introduction: Clinical risk prediction models are used to determine individualized risk for outcomes and facilitate shared-decision making about if, when, and how to commence treatment. This study aimed to develop and internally validate the first multivariable risk prediction models for eating disorder (ED) (1) onset and (2) untreated course in the community. Methods: 1,999 adolescents completed an online survey in class and again after one year as part of the EveryBODY Study, a cohort study of Australian school students. The outcomes included (1) onset of an ED among adolescents without an ED at baseline, and (2) persistence of an ED among adolescents with an ED at baseline. Risk factors included in the models were pre-selected based on known prognostic value: sex, BMI percentile, weight loss dieting, bullying, distress, weight/shape concerns, purging and social functioning. Results: We will use 10-fold internal cross-validation to evaluate the ability of elastic net, a supervised machine learning model, to predict the outcomes. Models will be evaluated using several classification metrics, including AUC, AUPRC, PPV, Brier score, and model calibration. Conclusions: Validated models for ED outcomes have the potential to be used to develop risk calculators for implementation in routine clinical and screening settings to improve decision-making about if and how to commence ED treatment, improving the efficiency and effectiveness of ED treatment.
Session: Paper Session 4: Clinical/Psychopathology
Laura Mokros1, Anne-Kathrin Radix1, Anca Sfärlea2, Mike Rinck3, Eni S Becker3, Gerd Schulte-Körne2, Tanja Legenbauer1
1LWL University Hospital Hamm of the Ruhr-University Bochum for Child and Adolescent Psychiatry , Hamm, Germany, 2Klinik und Poliklinik für Kinder- und Jugendpsychiatrie der Ludwig-Maximilians-Universität München, München, Germany, 3Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands

Introduction. Anxiety is one of the vulnerability factors discussed as contributing to the development and maintenance of AN. Additionally, anxiety has been shown as important for ABs towards negative or threatening stimuli. In AN, ABs concerning body related stimuli have been proven. Hypotheses: 1) Induced anxiety enhances ABs in patients with AN or depression, compared to a healthy control group. 2) The relationship between trait-anxiety and AN symptoms, both measured with questionnaires, is mediated by body-related ABs. Method. A manipulation to induce anxiety was performed, followed by a semantic Stroop task, consisting of neutral, negative, positive and body related words, to measure the strength of potential ABs. Results. Manipulation induced anxiety in all participants, but had no influence on the ABs. A stimuli by group interaction emerged. Post-hoc analyses showed a higher body-related AB in the AN group compared to the depressive and control group. Mediation effects of ABs on the relation between trait anxiety and AN symptoms were not found, but trait anxiety affected AN symptoms directly. Conclusions. Neither ABs did mediate the relation between trait anxiety and AN symptoms; nor induced anxiety enhanced ABs. However, AN patients showed significantly higher ABs to body related stimuli. Interestingly, all three groups showed increased ABs towards body related stimuli, insisting the importance of body image in youth generally.
Session: On-Demand Poster Session
Kathrin Schag, Marisa Schurr, Stephan Zipfel, Florian Junne, Katrin Giel
Medical University Hospital Tübingen, Tübingen, Germany

Introduction. COVID-19-Pandemic currently leads to major constraints in public and private life and this is associated with increased psychosocial burden. Pandemic-related life circumstances might affect individuals with previous or current mental disorders in an even stronger way. Individuals with an eating disorder might suffer from amplification or re-occurrence of eating disorder symptoms. In individuals with binge eating disorder (BED), psychosocial burden might lead to difficulties in emotion regulation which in turn might result in more frequent binge eating. Methods. We are currently investigating eating behavior, eating disorder and general psychopathology during the COVID-19-Pandemia in N = 80 patients with BED who have previously participated in the randomized-controlled IMPULS trial (Schag et al., 2019). In order to compare current symptoms with the trajectories of BED symptoms across the initial IMPULS assessment period, we are using the same assessment instruments and outcomes. We assess number of binge eating episodes in the past 4 weeks and further ED symptoms according to EDE and general psychopathology using the SCID interview. Eating behavior, impulsivity, and depression are assessed via validated self-report instruments. Additionally, we assess current health services use and psychosocial burden associated with COVID-19-Pandemic. Results. Results will be presented at the conference. Conclusions. Conclusions will be presented at the conference.
Session: Paper Session 4: Clinical/Psychopathology

Katherine E Schaumberg1, Zeynep Yilmaz2, Cynthia M Bulik2,3, Nadia Micali4
1University of Wisconsin, Madison, WI, USA, 2University of North Carolina, Chapel Hill, NC, USA, 3Karolinska Institutet, Stockholm, Sweden, 4Geneva University Hospital, Geneva, Switzerland

Multiple metabolic, anthropometric, and psychiatric traits share genetic risk with anorexia nervosa (AN). Anxiety disorders also show significant genetic overlap with psychiatric traits, but less so with metabolic and anthropometric traits, suggesting both shared and divergent genetic factors underlying anxiety and AN.The current study examined the genomic factor structure of anxiety-related and anthropometric phenotypes. We hypothesized that AN would uniquely demonstrate cross-loading to anxiety-related and anthropometric genomic factors. We utilized summary statistics from published genome-wide association studies of anthropometric (BMI, body fat percentage, fat-free mass, physical activity [vigorous and overall]) and anxiety-related (obsessive-compulsive disorder [OCD], posttraumatic stress disorder [PTSD], anxiety disorders, worry, neuroticism) phenotypes, along with AN. A genomic structural equation modeling approach characterized the genetic architecture of these 11 traits. Results supported a two-factor model (CFI = 0.95). AN demonstrated a similar loading on both factors (standardized anxiety-related factor loading = 0.32; anthropometric = -0.34). OCD and PTSD also showed cross-loading onto the anthropometric factor (OCD = -0.32; PTSD = 0.37). Findings suggest that anxiety-related and anthropometric genomic factors associate independently with AN. This cross-loading may not be specific to AN, as OCD and PTSD also showed genetic loading with an anthropometric factor.
Session: Paper Session 2: Biological/Risk Factors
Medical Factors

Isabel Baenas1,2, Elena Caravaca-Sanz1, Roser Granero2,3, Isabel Sánchez1,2, Nadine Riesco1,2, Giulia Testa1,2, Cristina Vintró-Alcaraz1,2, Janet Treasure4, Susana Jiménez-Murcia1,2,5, Fernando Fernández-Aranda1,2,5
1Department of Psychiatry. Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 2Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain, 3Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain, 4King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom, 5Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain

Objectives: To assess the level of symptomatological aggravation of ED patients during confinement due to COVID19, and to explore associated factors (coping strategies, anxiety-depressive symptomatology and personality traits).

A total of 74 EDs patients who were following treatment before COVID19 break out were considered in this study. Baseline pre-treatment evaluation included the SCL-90R, TCI-R, EDI-2 and Y-FAS 2.0 questionnaires for general psychopathology, personality and EDs severity indexes. The EDs symptoms coping strategies, socio-demographic data and COVID19 concerns were qualitatively collected by clinicians through a semi-structured telephone survey during lockdown.

Aggravation of ED symptoms and general psychopathology, namely anxiety and depression, were predicted by specific personality traits, namely low self-directedness, during lockdown. Higher ED symptomatology during confinement was associated with less-adaptative coping strategies to deal with lockdown situation and with consequent BMI increase.

These results suggest the relevance of identifying specific vulnerability factors in EDs patients within a confinement situation in future research, in order to design personalized preventive and therapeutic approaches.
Session: On-Demand Poster Session
Barbara Mangweth-Matzek1, Sophia Vedova1, Vanessa Dunst1, Philine Hennecke1, Georg Kemmler1, Martin Daniaux2, Claudia Rupp3
1University Hospital of Psychiatry II, Department of Psychiatrie, Psychotherapy and Psychosomatics, Innsbruck, Austria, 2Breast Diagnostic Unit, Department of Radiology, Innsbruck, Austria, 3University Hospital of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck, Austria

Introduction: Previously we described the menopausal transition as a "window of vulnerability for eating disorders." The present study aimed to assess eating behavior from two perspectives 1) the menopausal status and 2) by a new approach using menopausal symptomatology in order to compare low versus high symptomatology.

Methods: We included 336 women aged 40 - 60 years, recruited at the breast diagnostic unit of the Medical University Hospital in Innsbruck. An anonymous questionnaire assessed demographic characteristics, menopausal status and symptomatology, weight history, physical and mental health, eating behavior including eating disorder symptomatology and body image. We did two parallel analyses adjusted for age and BMI on women a) of different menopausal stages and b) with low versus high menopausal symptomatology.

Results: While women in different menopausal stages did not differ statistically from each other regarding eating behavior, disordered eating, and body image, women reporting high menopausal symptomatology showed significantly more eating pathology and body dissatisfaction as compared to those with low symptomatology. Conclusion: Our findings suggest that the vulnerability for disordered eating is not associated with a specific menopausal stage but with the menopausal transition as a process determined by menopausal symptomatology. Whatever factor of the hormonal transition causes or mediates the pathological eating is unclear.
Session: On-Demand Poster Session
Experimental therapy with recombinant human leptin in two patients with anorexia nervosa – preliminary results
Gabriella Milos1, Jochen Antel 2, Lisa-Katrin Kaufmann1, Nikolaus Barth2, Antonia Koller1, Susanne Tan3, Urban Wiesing4, Anke Hinney2, Lars Libuda2, Martin Wabitsch5, Roland von Känel1, Johannes Hebebrand2
1Eating Disorders Unit, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland, 2Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen (LVR-Klinikum), Essen, Germany, 3Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany, 4Institute for Ethics and History of Medicine, University of Tübingen, Tübingen, Germany, 5Center for Rare Endocrine Diseases, Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm, Germany

To test the hypothesis that normalization of low circulating leptin levels via application of recombinant human leptin ameliorates clinical symptoms in patients with AN, two patients were treated off-label with metreleptin*. Two patients (26 and 19 years; BMI 13.6 and 12.2 kg/m2) with restricting AN, as well as major depressive disorder, and clinically relevant hyperactivity were treated with subcutaneously administered metreleptin (dosages 3 - 10 mg/day, duration 9-14 days); patients gave written informed consent for the off-label use. Visual analogue scale for the assessment of key cognitions, emotions, and safety/physiological items was completed daily. Self-rating scales included Eating Disorders Inventory-2, Eating Disorders Examination Questionnaire (base on the last seven days) and Beck Depression Inventory-II. Patients were clinically monitored during treatment several times a day. No clinically relevant adverse events were observed. Depression, weight phobia, inner restlessness, rigidity and hyperactivity decreased quickly in the 26-year-old patient; she reported also a more "realistic" assessment of her body shape, and a major boost in her motivation to overcome the AN. In the 19-year-old patient, the improvement of the AN symptoms and depression was more modest, but clearly observable. Clinical trials are required to confirm the observed beneficial effects and to assess the safety of metreleptin treatment of AN. *Milos et al. Translational Psychiatry, accepted
Session: Paper Session 1: Treatment/Prevention
RETROSPECTIVE ANALYSIS OF HYPOPHOSPHATEMIA RATES AND OTHER CLINICAL PARAMETERS IN PATIENTS WITH EATING DISORDERS  Candice Richardson1, Paulina Huniewicz1, Georgios Paslakis1,2 1 Toronto General Hospital, University Health Network, Toronto, Ontario, M5G 2C4, Canada 2 Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada 
Georgios Paslakis1,2, Candice Richardson1, Paulina Huniewicz1
1Toronto General Hospital, University Health Network, Toronto, ON, Canada, 2Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Objective: To retrospectively assess medical services of a specialist inpatient eating disorders (EDs) unit. Method: We retrospectively evaluated clinical parameters of 288 inpatients classified as "moderately" or "significantly" medically compromised between January 1, 2016 and June 30, 2019.

We analyzed 288 patients (mean age 32.5 (SD = 11.4) years, 96% women, 76% with anorexia nervosa). Average length of stay was 38.4 (SD = 28.4) days. Average admission BMI was 14.8 (SD = 1.8) kg/m2, and 16.1 (SD = 1.9) kg/m2 at four weeks. At admission, 82% of patients were considered significantly medically compromised, while 6% were deemed moderately compromised. Only 5% of patients required transfer to ICU. Prevalence of hypophosphatemia was 17.7%; rates did not increase significantly between years despite more assertive re-feeding processes. There was no association between risk classification at admission and change in BMI at four weeks (F(2,166) = 0.588, p = 0.557). BMI at admission was found to be significantly associated with clinical outcome (β = 0.92, p <0.001). Discussion: Hypophosphatemia rates did not increase despite more assertive re-feeding over 3 years. Our results provide support for a model of treatment that simultaneously addresses the medical and psychiatric sequelae of patients with severe EDs.
Session: On-Demand Poster Session
Executive dysfunction in patients with eating disorders: A shared marker between heterogeneous clinical profiles?
Andres Pemau1, Patricia Diaz-Carracedo1, Alejandro de la Torre-Luque1,2, Aida Navalon3, Marta Soto3, Jose Luis Carrasco2,3, Marina Diaz-Marsa2,3
1Universidad Complutense de Madrid, Madrid, Spain, 2Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain, 3San Carlos Clinic Hospital, Madrid, Spain

Aims: a) To gain insight into the characterization of Executive Function (EF) in eating disorder patients (ED) by means of measuring a wide variety of skills; b) To study the relationship between clinical profile (restrictive vs. purgative) and EF deficits in ED patients. Method: The sample consisted of 75 women with a diagnosis of eating disorder (62.3% restrictive; m = 22.01 years, sd = 9.15) and 37 healthy controls (m = 18.54 years, sd = 4.21). All the participants filled in some psychopathological tests on anxiety, depression, trauma, ED symptoms, impulsivity and attachment. Neuropsychological performance was measured by a battery of tests on verbal fluency, set shifting ability, attention span, selective and divided attention, working memory, inhibitory control, and processing speed.

After controlling for body mass index and age, differences were found between patients and controls in set shifting (TMT B, p <.001), inhibitory control (Stroop task, p <.01) and processing speed (TMT A and SDMT, p <.001). ED patients performed worse in all four tests. No differences were found according to clinical profile.

Deficits in EF skills may be related to lack of impulse control and emotional regulation problems observed among ED patients. Although no differences related to clinical profile emerged, it is necessary to continue investigating symptom-specific profiles to disentangle potential intervention pathways.
Session: On-Demand Poster Session
A Prospective Longitudinal Assessment of Linear Growth and Final Height in Female Adolescents hospitalized because of Anorexia Nervosa
Daniel Stein1,3, Orit Pinhas Hamiel2,3, Yael Levy-Shraga 2,3, Brigitte Kochavi1, Sharon Iron-Segev 4,5, Adi Enoch-Levy1, Anat Toledano1, Dalit Modan-Moses 2,3
1Pediatric Psychosomatic Department, Safra Children's Hopsital, Sheba Medical Center, Tel Hashomer, Israel, 2Pediatric Endocrinology and Diabetes Unit ,Safra Children's Hopsital, Sheba Medical Center, Tel Hashomer, Israel, 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 4Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel, 5School of Nutrition, Peres Academic Center , Rehovot, Israel

Purpose: Our objective was to assess linear growth and final height in female adolescents with anorexia nervosa (AN). Methods: All 255 female adolescent AN patients hospitalized in our center between 1/1/2000- 31/5/2015 were included in the study. Height and weight were assessed at admission and during hospitalization. Patients were subsequently invited for measurement of final height. Additional data included pre-morbid height, menstrual history, skeletal age, pertinent laboratory studies and parental heights. Results: Pre-morbid height standard deviation scores (SDS) were not significantly different from those expected in normal adolescents (0.005±0.96). However, height-SDS at admission (-0.36±0.99), discharge (-0.34±0.96), and at final height (-0.29± 0.95), were significantly (p<0.001) lower than expected. Furthermore, final height was significantly (p=0.006) shorter compared to the mid-parental target height. Stepwise forward linear regression analysis identified age and bone age on admission, growth during hospitalization, and change in luteinizing hormone during hospitalization as significant independent predictors of improvement in height SDS from admission to final height. Conclusions: Whereas the premorbid height of female adolescents with AN is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.
Session: Paper Session 1: Treatment/Prevention

Metacognition, personality traits and impulsivity associated with Binge Eating Disorder psychopathology: a network analysis
M Aloi, M Rania, M Caroleo, R. de Filippis, G. Calabrò, EA. Carbone, A. Falvo, F. Staltari, C. Segura-García
University Magna Graecia, Catanzaro, Italy

Introduction. Binge eating disorder (BED) despite being the most frequent, is the least studied eating disorder. Dysfunctional personality traits, low self-monitoring and high impulsivity traits are recognized as non-specific risk factors for BED, but the mechanisms explaining this association have been insufficiently investigated. Our purpose is to assess the relationship between metacognition, personality traits, impulsivity and eating psychopathology by means of the network analysis approach in a sample of BED obese patients. Methods. 144 patients with BED completed the EDE-Q, MSAS, BIS-11 and TCI-R. All these variables were included in a network analysis. Results. Network analysis showed that the most central nodes in the network were related to self-monitoring, cooperativeness and dysfunctional mastery strategies. The highly interconnected nodes were self-directedness and attentional impulsivity. Nodes belonging to the same construct were spatially contiguous and highly interconnected. Moreover, eating psychopathology variables were less interconnected than those belonging to other constructs, such as impulsivity, metacognition and personality. Conclusions. The results support the key role of metacognition, in particular self-monitoring and mastery strategies, and cooperativeness in BED and suggest the importance of taking into consideration metacognitive and personological variables as possible targets for psychotherapeutic interventions among BED patients.
Session: On-Demand Poster Session
Body satisfaction and gender congruence in non-binary transgender people: A case control study
Jon Arcelus1,2, Beth Jones3, Walter Bouman2, Emma Haycraft4
1University of Nottingham , Nottingham , United Kingdom, 2Nottingham centre for transgender health, Nottingham , United Kingdom, 3Trent university , Nottingham , United Kingdom, 4Loughborough university, Loughborough, United Kingdom

Background: Despite the increase in nonbinary transgender people, this population are less likely to access transgender health services compared to binary transgender people. Objective: The aim of this study was to compare levels of gender congruence and body satisfaction in nonbinary transgender people to controls [binary transgender people and cisgender (nontrans) people]. Method: In total, 526 people from a community sample in the UK took part in the study (97 nonbinary, 91 binary, and 338 cisgender identifying people). Participants were asked to complete an online survey about gender congruence and body satisfaction.

Results: There were differences in gender congruence and body satisfaction between nonbinary and binary transgender people. On sex-specific parts of the body nonbinary transgender people reported significantly higher levels of gender and body satisfaction compared to binary transgender people. However, there was no difference in congruence between the two transgender groups (nonbinary and binary). Cisgender people reported significantly higher levels of gender congruence and body satisfaction compared to transgender people (nonbinary and binary).

Conclusions: Nonbinary individuals may be less likely to access transgender health services due to experiencing less gender incongruence and more body satisfaction compared to binary transgender people.
Session: On-Demand Poster Session
Evelyn Attia1,2, Deborah Glasofer1, Nikki Pagano1
1Columbia University Medical Center, New York, NY, USA, 2Weill Cornell Medical College, New York, NY, USA

PURPOSE: Education and training about eating disorders for health professionals is limited, with many physicians reporting that they received little or no training about eating disorders during medical school. The purpose of this project was to develop online education about eating disorders for medical and other health professional students. METHODS: The authors developed distinct training modules for medical students and other health professional students, available as online courses. Topics relevant to eating disorders include: Diagnosis, Assessment, Risk Factors, Medical Complications, Treatment, and Obesity. RESULTS: A total of 120 minutes of training on topics relevant to eating disorders (assembled into 6 modules) were developed for health professional students, and made available online at no cost. A guide for educators and other tools for students are included as downloadable documents; Modules include built-in knowledge checks to assess learning. Authors will present outline of course objectives, associated materials and information about no-cost access. Additionally, authors will discuss opportunities for future research that could assess the utility of this program. CONCLUSIONS: Accessible high-quality training for future clinicians about eating disorders is needed. This project has produced an accessible online English-language course that colleagues may wish to introduce to their medical schools.
Session: On-Demand Poster Session
Victoria Burmester, Alexis Buckle, Ana Pascual-Sanchez, Dasha Nicholls
1, London, United Kingdom

Introduction: COVID-19 prompted quarantine measures limiting social contact and exercise for young people (YP), prompting emotions that predispose to emotional eating (EE) such as anxiety, irritability and boredom.

Cross-sectional survey of parents of children 4-17 years. Parent report included Family Eating and Activity Habits Questionnaire, a section of the Child Eating Behaviour Questionnaire, and Strengths and Difficulties Questionnaire. YP self-report (age 11-17) included the revised Three-Factor Eating Questionnaire and questions on eating and exercise related social media. Results: 118 completed > 45% of the survey; 57 YP completed self-report. Mean lockdown time was 12.7 weeks. YP were 48% males and 52% females; age adjusted BMI was normally distributed. Concordance between parent and YP report of change in eating behaviour was high (r = .60), 13% eating less, 35% eating more and 53% no change. Mean parent (9.7 hrs/wk) and YP (12.6) activity hours correlated (r= 0.68). YP spent 21.6 hrs on screens (excluding schoolwork) and 12.6 being active. Commonest eating behaviour change was eating when bored. There was no significant correlation between snacks consumed and restraint, or between snacks purchased and eaten. Females had significantly lower restraint (p = .029) when adjusted for no. of snacks consumed. Conclusions: Studies of the impact of COVID 19 should consider EE in YP. Equipping parents and schools in managing EE in YP is a public health priority.
Session: On-Demand Poster Session
Trine W Hage1, Øyvind Rø1,2
1Regional Department for Eating Disorders , Oslo, Norway, 2University of Oslo, Faculty of Medicine,, Oslo, Norway

Introduction Working with patients with eating disorders (ED) is frequently described as challenging. Contributing aspects to both negative as well as positive aspects regarding working on specialized eating disorder units (EDU) is to a little extent explored empirically. Aims with this study were to investigate overall job satisfaction on specialized eating disorder units in Norway and possible differences between professional groups. Methods Clinical staff working on specialized EDUs was invited. Data was gathered using an online questionnaire. Measures included Job Satisfaction Sale (JSS), consisting of 10 items, scored on a seven-point Likert scale from 1 (very dissatisfied) to 7 (very satisfied). In addition, socio-demographic data was gathered. Results The total sample consisted of 186 participants from 11 specialized EDUs. Job satisfaction was 5,10 (0,97), indicating high job satisfaction. Daytime workers had significant higher score on mean JSS (p <.01) and on 8 of 10 items (p <.01 and (p <.001) compared to shift workers. Medical doctors/psychologists scored significantly higher on mean JSS (p <.001) and on 5 of 10 items (p <.01- .001) compared to nurses and others professions. Conclusions Findings from the current study indicate high overall job satisfaction, and significant differences between professional groups. empirically. Findings from this study indicate high overall job satisfaction, and significant differences between professional groups.
Session: On-Demand Poster Session
Erin N. Harrop1,2, Janell L. Mensinger3
1University of Washington, Seattle, WA, USA, 2University of Denver, Denver, CO, USA, 3Villanova University, Villanova, PA, USA

INTRODUCTION: Patient experiences of atypical anorexia (AAN) are understudied. We aimed to 1) describe weight suppression, treatment delay (TxD), eating disorder (ED) severity, clinical impairment, and internalized weight bias (IWB), and 2) test if there were associations between weight-related variables and TxD in a sample of AAN patients. METHODS: 39 diverse AAN individuals (3 fully recovered, 11 partially recovered) were administered structured interviews and self-report measures. RESULTS: Percent body weight lost ranged from 10.0 to 50.2% (mean=26.4, SD=10.7). Adult lifetime maximum BMI mean=42.0, SD=11.3; adult lifetime minimum BMI mean=22.3, SD=4.8. TxD averaged 11.7 years (SD=11.1) with 28% of the sample untreated. Eating Disorder Examination Questionnaire mean=2.9, SD=1.3; Clinical Impairment Assessment mean=20.9, SD=10.8; Weight Bias Internalization Scale mean=5.1, SD=1.4. Highest level of care was inversely correlated with maximum BMI (r=-.35, p=.03). Minimum BMI (b=.76, SE=.31, p=.02) predicted treatment delay after controlling for age (b=.46, SE=.13, p=.001); there was no relationship between maximum BMI and TxD. CONCLUSION: AAN patients have levels of IWB that double community norms and ED severity commensurate with other EDs. Findings suggest higher weight AAN patients receive lower levels of care compared to thinner peers. Attaining lower BMI may be a possible "key" to unlocking treatment in AAN. Screening for ED behaviors across the weight spectrum is needed.
Session: On-Demand Poster Session
Sandra Schlegl1, Julia Maier1, Adrian Meule1,2, Ulrich Voderholzer1,2,3
1University Hospital, Department of Psychiatry and Psychotherapy, Munich, Germany, 2Schoen Clinic Roseneck, Prien, Germany, 3University Hospital, Department of Psychiatry and Psychotherapy, Freiburg, Germany

Introduction. The COVID-19 pandemic poses a psychological burden for humans worldwide. These effects may be particularly detrimental in individuals with mental disorders. Therefore, the current study explored effects of the COVID-19 pandemic on former inpatients with EDs. Methods. Two hundred and fourteen patients with EDs (n=159 anorexia nervosa, AN; n=55 bulimia nervosa, BN) - discharged in 2019 - completed an online survey on contact history with COVID-19, changes in ED symptoms and other psychological aspects, health care utilization during the pandemic, and different coping strategies. Results. 49.1% of patients with BN and 41.5% patients with AN reported a worsening of their ED symptomatology, 25.5% and 33.4% respectively an improvement. More than 70% of participants reported that eating, shape and weight concerns, drive for activity, depressive symptoms, restlessness, and a general feeling of loss of control increased. Access to face-to-face psychotherapies decreased, but videoconference therapy was used by less than 25%. Routines, day planning and enjoyable activities were rated as most helpful. Conclusions. The COVID-19 pandemic poses great challenges to patients with EDs. ED-related thoughts and behaviors may be used as a dysfunctional coping mechanism to regain control over the current circumstances. E-mental health interventions—especially those focusing on mindfulness and emotion regulation strategies—might help to support ED patients during these times.
Session: On-Demand Poster Session

Zaida Aguera1,2,3, Nadine Riesco1,2, Eduardo Valenciano-Mendoza2, Roser Granero1,4, Isabel Sánchez1,2, Alba Andreu5, Susana Jiménez-Murcia1,2,6, Fernando Fernández-Aranda1,2,6
1CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain, 2Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Hospitalet de Llobregat, Spain, 3Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain, 4Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain, 5Department of Endocrinology and Diabetes, Obesity Unit, Hospital Clinic de Barcelona, Barcelona, Spain, 6Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

Introduction: The role of illness perception in the clinical course of the disease has been well described, both for some physical conditions and mental disorders. However, little is known about this clinical construct in eating disorders (ED). Therefore, this study aimed to extend our understanding of illness perceptions in different ED types, and to explore its association with clinical, psychopathological, motivational, personality and food addiction (FA) features. Methods: The sample consisted of 104 patients with ED (23 AN, 39 BN, 19 BED, and 23 OSFED). Among other clinical indexes, assessment included eating symptoms (EDI-2), general psychopathology (SCL-90R), personality traits (TCI-R) and food addiction (YFAS 2.0) measures. Illness perception was assessed by means of the Revised-Illness Perception Questionnaire (IPQ-R). Results: Patients with BN and BED showed greater illness perception than those with AN or OSFED. Overall, an improved illness perception was better explained by a longer duration of the disorder and FA-related symptoms. Other clinical features, such as low self-directedness and high ED severity and general psychopathology may play an indirect role in this relationship.

Our findings suggest that longer duration of the disorder and FA symptoms may act as the best indicators of improved illness perception. This may explain the low levels of initial motivation in these patients and their high drop-out rates in the early stages of treatment.
Session: On-Demand Poster Session
‘I feel lonelier than ever’ - Understanding the impact of the COVID-19 pandemic on people with current or life-time eating disorders: A qualitative study
Amelia Austin1, Catherine McCombie2, Bethan Dalton1, Vanessa Lawrence2, Ulrike Schmidt1,3
1Eating Disorders Section, Department of Psychological Medicine, King's College London, London, United Kingdom, 2Department of Health Services and Population Research, King's College London, London, United Kingdom, 3South London and Maudsley NHS Foundation Trust, London, United Kingdom

Background: The COVID-19 pandemic has had a profound impact on all aspects of life, including mental health. We wanted to know how people with current or past eating disorders (EDs) are impacted.

Methods: Participants with life-time EDs were recruited through social media from April to June 2020, i.e. during a period of strict infection control measures (‘lockdown’, ‘social distancing’).They completed open-ended questions online, on how the pandemic had affected their ED and lives. Responses were analysed using thematic analysis.

Results: Preliminary analysis (n=from 36) shows that most people felt their ED symptoms had worsened or re-surfaced. Loneliness, boredom, low mood, anxiety, lack of structure, and disruption to routines, seemed to contribute, as well as a range of practical issues (e.g. constraints on availability of usual foods and exercise, shopping restrictions, media/social media experienced as ‘triggering’ symptoms). Limited or remote access to treatment was also a concern, as it allowed the person to hide aspects of their ED (e.g. falsifying weight). Nonetheless, some participants reported ‘silver linings’ of the pandemic.

Conclusions: In this self-selected sample, deterioration or recurrence of ED were the norm. This has implications for the provision of treatment and care for people with EDs currently and also in future waves of the pandemic. ED services need to prepare for a significant surge of new and re-referrals.
Session: On-Demand Poster Session
Cristina Berchio1,2, Freda Ménétre1, Ynès Bouamoud1, Christoph Michel2,3, Nadia Micali1,4,5
1Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland, 2Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland, 3Biomedical Imaging Center (CIBM) Lausanne, Geneva, Switzerland, 4Division of Child and Adolescent Psychiatry, Department of Child and Adolescent Health, Geneva University Hospital, Geneva, Switzerland, 5Great Ormond Street Institute of Child Health, University College London, London, United Kingdom

1.Introduction. Impaired cognitive flexibility (CF) is a key feature of anorexia nervosa (AN) that contributes to symptoms persistence. Despite its clinical relevance, the brain mechanisms underlying poor CF in AN are not well understood. 2.Methods. The objective of this study is to investigate brain activity in adolescents with AN, while they perform a Dimensional Change Card Sorting (DCCS) task, assessing flexible switching between rules. To describe brain activity with high temporal resolution, the DCCS was performed during a high-density electroencephalography (EEG) recording, with the application of neuroimaging methods. We present preliminary data collected in 10 AN adolescents (aged 12-20 years) and 10 age and gender-matched controls. 3.Results. AN patients show significantly slower reaction times as compared to controls, especially when switching tasks (ps<.05). During rule-processing, AN patients exhibit preparatory slow-waves poorly modulated by task-switching (quantified via global randomization tests). Source-imaging analyses indicates that in controls, rule-switching induces stronger temporal-parietal and amygdala activations at 420-470ms, and prefrontal inhibition at 1650-1900ms. These networks are not significantly modulated by rule-switching in AN patients. 4.Conclusions. To our knowledge, this is the first high-density EEG study assessing CF in AN. These data suggest temporal dysfunction of large-scale-networks as a functional correlate of impaired CF in AN.
Session: On-Demand Poster Session
Ege Bicaker, Sarah Racine
McGill University Psychology Department, Montreal, QC, Canada

Introduction: Individuals with emotional eating report elevated eating disorder symptoms. However, it is not clear whether such symptoms are explained by co-occuring binge eating episodes, given the strong relationship between emotional eating and binge eating. This study compared eating disorder symptoms among women with objective binge eating (OBE), with emotional eating only (EE only), and with no disinhibited eating (no DE).

Data were drawn from a larger study of university students who completed online questionnaires. Females in the OBE group (n = 104) endorsed objective binge eating episodes in the past month. Females in the EE only (n = 84) and no DE (n = 126) groups endorsed absence of binge eating episodes and scored in the top and the bottom quartile of the DEBQ emotional eating scale, respectively.

Women with EE only or OBEs had significantly higher levels of body dissatisfaction, restrained eating, purging behaviors, and clinical impairment than the no DE group. No significant differences emerged between EE only and OBE groups on outcome variables except clinical impairment.

Results suggest that individuals with emotional eating are at higher risk of experiencing elevated eating disorder symptoms. These findings point to the importance of addressing eating disorder symptomatology in emotional eating interventions.
Session: On-Demand Poster Session
The link between emotion regulation (ER) and emotional processing in adolescents with obesity  
Elisa Boelens, Taaike Debeuf , Sandra Verbeken , Lien Goossens , Caroline Braet
Ghent University , Ghent , Belgium

The aim of this study is to investigate how emotional processing affects adolescents’ memory for negative experiences. More specific, children develop emotion regulation (ER) at a young age and this study will investigate both the role of their trait adaptive versus maladaptive emotion regulation strategies and the role of other ER components e.g. emotional awareness. Data is being collected from an RCT study (N=93) in a group of adolescents with obesity at risk for emotional problems between 10 and 14 years, enrolled in an inpatient treatment program. Several ER questionnaires were included to measure ER (FEEL-KJ, DERS, PANAS, EMO-Check). Memory processing is studied by inducing a sad mood through a movie clip and adolescents filling out a memory questionnaire afterwards (5 peripheral and 5 central questions). Based on previous research, it is expected that adolescents who use more adaptive ER strategies, will be less biased for negative emotional stimuli and will remember more peripheral information (details not directly related to the main emotional event) when filling out the memory questionnaire. Preliminary results show that adaptive ER mediates the relationship between emotional awareness and peripheral memory.
Session: On-Demand Poster Session
Emily K Burr1, Brittany L Stevenson1, Lauren M Schaefer2, Robert D Dvorak1
1University of Central Florida, Orlando, FL, USA, 2Sanford Health, Sioux Falls, SD, USA

Introduction: A key feature of objective or subjective binge eating episodes is loss of control eating (LOCE); a perception one is unable to resist or stop intake. LOCE is associated with psychopathology (e.g. depression, anxiety), poor health outcomes (e.g. obesity), and eating disorder symptoms (e.g. purging, body dissatisfaction). LOCE may also be associated with other vulnerabilities (e.g. higher affect lability, emotion dysregulation, distress intolerance), but more investigation could elucidate how they relate to LOCE.

Methods: Community and university adults (n =3401; Mage =20.09(4.46)) completed assessments of LOCE (Loss of Control Over Eating Scale; LOCES), affect lability (Affect Lability Scale; ALS), distress tolerance (Distress Tolerance Difficulties; DTS), and emotion regulation (Difficulties with Emotion Regulation Scale; DERS). A path model tested a relationship between DERS and LOCES by ALS, accounting for the influence of DTS.

Results: The model showed DERS was associated with LOCES by ALS and this relationship was moderated by DTS. For high DTS scores, the relationship between DERS and LOCES was reduced, resulting in an indirect association between DERS and LOCES. However, for low DTS scores the DERS - LOCES relationship was strengthened, resulting in a stronger indirect relationship between DERS and LOCES.

Conclusions: Low distress tolerance moderates the indirect relationship between emotion dysregulation and LOCE eating by way of affect lability.
Session: On-Demand Poster Session
Rayane Chami1, Valentina Cardi1,2, Natalia Lawrence3, Pamela MacDonald1, Katie Rowlands1, John Hodsoll4, Janet Treasure1
1Section of Eating Disorders, King's College London, London, United Kingdom, 2Department of General Psychology, University of Padova, Padova, Italy, 3School of Psychology, University of Exeter, Exeter, United Kingdom, 4Biostatistics and Health Informatics, King's College London, London, United Kingdom

Objective. This trial examined the feasibility, acceptability, and clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. Methods. Seventy-eight participants with bulimia nervosa or binge eating disorder were allocated to receive food-specific or general ICT and if-then planning for 4 weeks. Results. Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the cut-offs. The cut-off adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks; moderate to large effect sizes), and there were greater reductions (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation, food approach, anxiety, and depression. Participants indicated that both interventions were acceptable. Conclusion. The study reveals that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology, and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.
Session: On-Demand Poster Session
Sophie Clohessy1, Lukasz Walasek2, Caroline Meyer1,3,4,5
1WMG, Applied Psychology, International Digital Laboratory, University of Warwick, Coventry, United Kingdom, 2Department of Psychology, University of Warwick, Coventry, United Kingdom, 3Warwick Medical School, University of Warwick, Coventry, United Kingdom, 4University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom, 5Coventry and Warwickshire Partnership NHS Trust, Coventry, United Kingdom

Purpose:Literature commonly asserts that individuals use social comparisons in order to make a judgement about their appearance/body weight. Alternatively, perceived rank in a given sample may play a critical role in these judgements, although there has been no direct examination of this. This study examined whether individuals’ perceived relative rank position of their body weight is related to their eating, shape and weight concerns (measured by the Eating Disorders Examination Questionnaire, EDE-Q). The study also examined whether relative rank of body weight with four different reference groups (friends, people living in the same neighbourhood, colleagues,UK population) is linked to levels of psychopathology.

A non-clinical group of men and women (n=352) were asked to rank their weight in relation to four reference groups (e.g. friends,UK population). Participants completed measures of the EDE-Q and self-reported weight and height.

Rank of weight relative to others predicted EDE-Q weight and shape concerns and levels of restraint, this is true over and above BMI. Interestingly, this was specific to participant’s rank of weight with the UK population.

Relative judgement and rank are the key principle supported here. Demonstrating how rank of weight predicts measures of eating, shape and weight concern. Future research should investigate the composition of reference groups when making body weight judgements.
Session: On-Demand Poster Session
An B Dang1, Sarah Giles 1, Fernando Fernandez-Aranda 2, Litza Kiropoulos1, Matthew Fuller-Tyszkiewicz 3,4, Isabel Krug 1
1Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia, 2University Hospital of Bellvitge- IDIBELL, Barcelona, Spain, 3School of Psychology, Deakin University, Geelong, VIC, Australia, 4Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia

Introduction. We aimed to systematically review and synthesis the frequency of the DSM-5 severity categories (mild, moderate, severe and extreme) for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorders (BED), and to examine whether these severity ratings had any clinical utility across all of the eating disorder (ED) subtypes. Methods. A systematic review was conducted in accordance with PRISMA Guidelines. Five databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO, and ProQuest) were searched for academic and grey literature published from 2013 until July 8, 2020. Twenty-five studies, meeting inclusion and exclusion criteria, were retrieved for the systematic review and six studies were eligible for meta-analysis. Results. We found limited support for the current DSM-5 severity ratings for all ED indices, as the majority of ED severity groups were not significantly distinguishable in overall ED psychopathology (mean effect size ranged from .02 to .5). Moreover, only 16% to 40% of individuals with AN, BN, and BED were categorised into serve and extreme groups. However, there were instances where heterogeneity of effects was significant (p<.001), indicating that there were variabilities across the studies. Conclusions. These findings provide limited support for the DSM-5 severity ratings for the different EDs and support the exploration of alternative severity classification approach.
Session: On-Demand Poster Session
Unna N. Danner1,2, Lot C. Sternheim2, Boris van Passel3, Alexandra E. Dingemans4, Danielle C. Cath5,6
1Altrecht Eating Disorders Rintveld, Zeist, Netherlands, 2Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands, 3Overwaal Center for Anxiety Disorders, OCD, and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, Netherlands, 4Rivierduinen Eating Disorders Ursula, Leiden, Netherlands, 5Altrecht Academic Anxiety Center, Utrecht, Netherlands, 6GGz Drenthe, Department of Specialist Training, Rijksuniversiteit Groningen and University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands

Introduction. People with anorexia nervosa (AN) and obsessive compulsive disorder (OCD) share phenomenological overlap characterized by lack of flexibility in behavior and thinking. Few studies have investigated this potential shared neuropsychological mechanisms that might contribute to these inflexible behaviors in both disorders. Methods. In total, 61 patients with AN, 72 patients with OCD and 67 age-matched control participants were asked to do several neuropsychological tasks to measure set shifting ability (TMT, ID/EDS, CWIT-rigidity) and fill in a questionnaire to assess experienced inflexibility (DFLEX). Results. In the analyses we controlled for age. Similar degree of set shifting impairments were found for patients with AN and OCD on the TMT, but no differences were found with the ID/EDS and the CWIT-rigidity. Patients with AN and OCD both reported strong levels of experienced inflexibility in comparison to the HC group, which showed strong correlations with clinical outcomes. Experienced inflexibility in the AN group was related to the TMT outcomes. Conclusions. This was one of the first studies to compare flexibility outcomes in people with AN and OCD. Set shifting impairments were only found on one of the tasks in both groups. Patients reported high levels of experienced inflexibility which in turn was related to higher levels of comorbid symptoms. Further research is needed to understand specific flexibility profiles in these disorders.
Session: Paper Session 3: Neurocognition
Media influence as a predictor of children’s body image and eating problems: A longitudinal study in 8-11 -year old boys and girls
Jolien De Coen1, Lien Goossens 1, Sandra Verbeken1
1Ghent University, Ghent, Belgium, 2Ghent University, Ghent, Belgium, 3Ghent University, Ghent, Belgium

Purpose: Body image problems are reported during middle childhood and associated with exposure to appearance-focused media. Most studies in children are cross-sectional and do not determine possible moderators. The present study aimed to investigate whether awareness, internalization and pressure of media ideals predict body image and eating problems in children and whether sex moderates this effect.

We investigated a total sample of n=601 participants (52 % boys, aged 8-11). Self-report questionnaires were administered on media influence and body image and eating problems at T1 and T2 (1 year later). Results: After controlling for age, adjusted body mass index and baseline levels of body image and eating problems, results show that media influence significantly predicted restraint and concerns about eating, weight and shape one year later. For both awareness and internalization, sex did not moderate the effect on body image and eating problems. In contrast, significant interactions were found between sex and pressure in predicting eating concerns. Conclusion: Awareness and internalization of media ideals plays a role in the development of body image and eating problems in both boys and girls. Perceived pressure of media ideals, however, only predicts increases in body image and eating problems in girls. This indicates that media influence affect girls and boys differently. Future research is necessary to unravel these sex specific vulnerabilities.
Session: On-Demand Poster Session
Fasting occurs transdiagnostically in individuals with feeding and eating disorders and is associated with clinical impairment  
Melissa J. Dreier1, Kendra R. Becker1, Debra L. Franko2, Helen B. Murray1, Lazaro Zayas1, Lauren Breithaupt1, Shirley B. Wang3, Kamryn T. Eddy1, Jennifer J. Thomas1
1Massachusetts General Hospital, Boston, MA, USA, 2Northeastern University, Boston, MA, USA, 3Harvard University, Cambridge, MA, USA

Introduction: Irregular eating patterns, such as fasting, are characteristic of eating disorders, including avoidant/restrictive food intake disorder (ARFID), and eating disorders characterized by shape/weight concerns (SW-EDs), such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Yet, little is known about the adverse psychological effects of fasting in these populations. Method: Five hundred eighty individuals (M age=26.80, SD=13.27) with eating disorders––AN, BN, ARFID, BED, and other specified feeding and eating disorder––completed the Eating Disorder Examination-Questionnaire, Clinical Impairment Assessment, and Food Neophobia Scale. We examined frequencies of fasting and relationships between fasting and clinical impairment (CI).

Fasting was more frequent in those with BN (p<.001) and AN binge/purge type (p=.004) than in those with ARFID. Frequencies did not differ between other diagnoses. In the SW-ED sample (n=455), frequency of fasting was significantly associated with CI (p=.004). In those with ARFID (n=125), frequency of fasting was significantly associated with CI (p=.004), accounting for more variance than food neophobia. Conclusions: Fasting is inversely associated with psychological wellbeing for individuals with a variety of feeding and eating disorders. Findings suggest that promoting regular eating early in treatment may promote reduction in clinical impairment, although further longitudinal is necessary.
Session: On-Demand Poster Session
Manja M Engel, Anouk Keizer
Utrecht University, Utrecht, Netherlands

Body image disturbances (BID) are a key feature of eating disorders (ED). Clinical experience shows that BID exists in patients who Completed their Eating Disorder Treatment (CEDT), however studies concerning BID in CEDT patients are often limited to cognition and affect, measured by interviews and questionnaires. The current study is the first systematic study investigating the full scope of the mental body representation, including bodily attitudes, visual perception of body size, tactile perception, and affordance perception in CEDT patients. ED patients (N = 22), CEDT patients (N = 39) and healthy controls (HC; N = 30) were compared on BID tasks including the Body Attitude Test (BAT), Visual Size Estimation (VSE), Tactile Estimation Task (TET), and Hoop Task (HT). Results on the BAT show higher scores for ED patients compared to CEDT patients and HC but no difference between CEDT patients and HC. Both ED and CEDT patients show larger overestimations on the VSE and HT compared to HC, where ED patients show the largest overestimations. No group differences were found on the TET. The results indicate the existence of disturbances in visual perception and affordance perception in CEDT patients. Research focusing on more effective treatments for ED addressing multiple (sensory) modalities is advised.
Session: On-Demand Poster Session
Natasha Fowler1, Pamela K Keel2, Debra K Katzman3, Cheryl L Sisk1, Michael C Neale4, S. Alexandra Burt1, Kelly L Klump1
1Michigan State University, East Lansing, MI, USA, 2Florida State University, Tallahassee, FL, USA, 3University of Toronto, Toronto, ON, Canada, 4Michigan State University, East Lansing, MI, USA, 5Virginia Commonwealth University, Richmond, VA, USA, 6Michigan State University, East Lansing, MI, USA, 7Michigan State University, East Lansing , MI, USA

Introduction: Women who engage in emotional eating (EE) tend to have experienced more stressful events and perceive events as more stressful than women who do not engage in EE. Because major life stress (e.g., parental divorce) increases susceptibility to stress-related behaviors (e.g., EE), it is possible that women with higher levels of major life stress will engage in more EE following daily stressors than women with lower levels of major life stress. Our study examined this possibility in 225 women (aged 15-30 years) from the Michigan State University Twin Registry.

Ratings of daily EE (assessed via the Dutch Eating Behavior Questionnaire), daily minor stress (e.g., traffic) frequency and impact (assessed via the Daily Stress Inventory) were collected for 49 consecutive days and averaged for the current analyses. Major life stressors were also measured via the Social Readjustment Rating Scale. Mixed linear models examined major stress as a moderator of daily stress-EE associations.

As expected, a higher frequency and greater impact of daily stressors significantly predicted increased levels of EE. However, major life stress was not a significant moderator of these associations. Conclusion: Daily minor stress is associated with EE across all levels of major life stress. Future studies should examine other moderators and mechanisms (e.g., hypothalamic-pituitary-adrenal [HPA] axis alterations) through which daily stress influences EE in women.
Session: On-Demand Poster Session
Sarah E Giles1, Elizabeth K Hughes1,2,3, Isabel Krug1
1The University of Melbourne, Melbourne, Australia, 2Department of Paediatrics, The University of Melbourne, Melbourne, Australia, 3Murdoch Children’s Research Institute, Melbourne, Australia

1. Introduction. Cognitive rigidity and high levels of attention to detail are neuropsychological features frequently associated with eating disorders (ED). However, agreement as to the best way to assess these constructs remains equivocal. We investigated the differences between performance-based tasks and a self-report measure of set-shifting and attention to detail and examined the relationship of each to ED symptoms. 2. Methods. Participants were 68 adult females from the community (n=44) and ED services (n=24; 75% Anorexia Nervosa). All participants were administered the Wisconsin Card Sorting Test (WCST) and Group Embedded Figures Task (GEFT). They also completed the Detail and Flexibility Questionnaire (DFlex) and Eating Disorder Examination Questionnaire (EDE-Q). 3. Results. Self-reported attention to detail and cognitive rigidity on the DFlex were significantly positively correlated with all EDE-Q subscales and global score (Global score: r=.32 and r=.50 respectively). However, the performance-based measures (WSCT and GEFT) were not correlated with the EDE-Q scores, nor were they correlated with the DFlex. 4. Conclusions. Greater cognitive rigidity and attention to detail were associated with greater ED symptoms, but only when neuropsychological features were self-reported rather than assessed using performance-based measures. The lack of significant correlations between self-report and performance-based measures may suggest these measures assess distinct constructs.
Session: On-Demand Poster Session
Keisha C. Gobin, Sarah E. McComb, Jennifer S. Mills
York University, Toronto, ON, Canada

Introduction: Using social media applications can lead to increased body dissatisfaction and lower mood among women. This study examined whether a brief writing-based self-compassion intervention could mitigate increases in body dissatisfaction and negative mood.

In an online study, 178 women, aged 18 to 55 (M=28.31, SD=10.81), completed baseline measures of mood, body image, and trait appearance comparison tendencies. Next, they compared themselves to pre-selected thin ideal images on an Instagram profile and completed the same measures of state mood and body image. Then, participants were randomly assigned to either a brief-self compassion writing task or to a simple sorting task. Immediately after completion of their assigned tasks all participants completed the same measures of state mood and body image for the third time.

The results demonstrated that the self-compassion intervention improved feelings of happiness, F(1,91)=11.18, p>.01, partial η2=.06, and confidence, F(1,93)=5.17, p>.01, partial η2=.29, over and above the control condition. Moderation analyses showed that the self-compassion intervention was most effective for women who have a low tendency to compare themselves to others in terms of body dissatisfaction. Discussion: These findings suggest that a brief self-compassion intervention may help mitigate the negative mood and, for some populations, the body dissatisfaction associated with social media use.
Session: On-Demand Poster Session
Gemma Gordon1, Timo Brockmeyer2, Iain Campbell3, Ulrike Schmidt4
1Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 2Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Göttingen, Göttingen, Germany, 3Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 4Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom

Introduction: Automatic cognitive processes contribute to food cravings and binge eating. Both transcranial Direct Current Stimulation (tDCS) and Approach Bias Modification (ABM) training target these processes and are thought to act synergistically. The present study assessed feasibility, clinical and neurocognitive outcomes of combining ABM with tDCS.

Methods: 65 people with binge eating disorder (BED) and a BMI of ≥25 kg/m2 were randomly allocated to: real tDCS + ABM (n=21), sham tDCS + ABM (n=22) or waiting-list (n=22). Both intervention groups had 6 sessions of real/sham tDCS + ABM over 3 weeks, engaging in the ABM task during bilateral tDCS to the dorsolateral prefrontal cortex. Assessments were conducted at 3 timepoints.

Results: Study completion was 89%, with high treatment tolerance and acceptability. While not significant, findings indicate a treatment effect of both real and sham tDCS + ABM interventions separately. Between-group effect sizes of change scores (baseline to follow-up) comparing the combined intervention groups with the control group were small to medium for eating disorder symptoms (d=-0.43, 95% CI −0.01 to 0.74) and objective binge eating episodes (d=-0.33, 95% CI −1.41 to 6.40), and medium to large for food addiction scores (d=-0.6, 95% CI 0.39 to 3.59), all favouring the active interventions. Full findings will be presented.

Conclusions: Findings support the feasibility and efficacy of multi-session tDCS combined with ABM for BED.
Session: On-Demand Poster Session
Constricted affect during an eating task is moderated by surprise in adolescent females with low weight eating disorders
Trevor C Griffen1, Stephanie E Millot1, Robyn Sysko1, Kurt Schulz1, Daniela Schiller1,2, Tom Hildebrandt1
1Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA

1. Introduction. Individuals with anorexia nervosa manifest alexithymia and reduced expressed emotion (EE) during affective tasks. These deficits include reduced expression of positive and negative emotion in response to valenced stimuli and of positive emotion to food stimuli. Emotion recognition software was used to identify expressed emotion in adolescent females (age 12-18) with low-weight eating disorders (LW-ED) and healthy controls (HC) while eating. 2. Methods. 63 LW-ED and 22 HC participated. Subjects were recorded watching a neutral-valence video and consuming a meal (yogurt shake). Videos were analyzed for EE (Neutral, Happy, Sad, Angry, Surprised, Scared, Disgusted) using FaceReader. Subjects were excluded if a satisfactory video with > 50% analyzable frames was not obtained. Emotional intensity/time of eating was compared between groups using a general linear model. 3. Results. 36 LW-ED and 15 HC videos were available for analysis. The % analyzed frames and total video length did not differ between LW-ED and HC (p > 0.05). LW-ED had less emotional intensity/time of Surprised (0.07 vs. 0.17, p <0.01) and more Neutral (0.59 vs. 0.50, p <0.05) compared to HC. No differences were observed in other emotions. 4. Conclusions. LW-ED demonstrated constricted affect during an eating task with reduced expression of surprise. To our knowledge, this is the first report of an EE deficit in LW-ED during eating and the first reported deficit in expression of surprise in LW-ED.
Session: Paper Session 3: Neurocognition
Kelsey E. Hagan1,2, Maya N. Dalack1,2, Chanel G. Powell1,2, Isabel Ghisolfi1,2, Jonathan E. Posner1,2, Joanna E. Steinglass1,2
1Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA, 2New York State Psychiatric Institute, New York, NY, USA

Purpose: In an effort to slow the spread of the novel coronavirus pandemic (COVID-19), public health officials have provided guidance to socially distance. This guidance has resulted in rapid, unprecedent changes and disruptions in schooling, social activities, and employment with yet unknown impacts. Here, we present initial findings on pandemic-related stressors and resilience behaviors in teens who are participating in our ongoing longitudinal, multi-modal neuroimaging study of adolescent anorexia nervosa (AN).

Adolescents enrolled in our longitudinal study complete monthly follow-ups and, beginning March 27, 2020, were asked to complete a COVID-19 Stress Response Scale, which assesses stressors related to COVID-19 (e.g., financial strain, isolation) and resilience behaviors (e.g., seeking social support, helping others) during monthly follow-ups. Data collection commenced when COVID-19 cases were peaking in the New York City metropolitan area and is ongoing.

Out of 60 teens surveyed, 33 responded (55%). 77.79% of teens reported COVID-19 related major stressors and 93.93% of teens indicated that COVID-19 had at least some overall impact on them and their family. Each teen reported engaging in at least one resilience behavior; all teens reported seeking social support.

Although adolescents reported major stressors related to COVID-19, all reported some resilience behaviors. Social support may help to buffer the overall impact of COVID-19.
Session: On-Demand Poster Session
Kayla B. Hollett, MSc, Jacqueline C. Carter, DPhil
Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada

Objective: Vignette research on the social stigma of BED is limited and lacking methodological rigor. First, these studies lack effective control vignettes. Second, characters in BED vignettes are nearly always described as obese, introducing the confound of weight stigma. The current study examined the social stigma of BED compared to two control vignettes while controlling the effect of body size. Method: Participants (N = 421) were randomly assigned to read one of six vignettes describing a woman with either BED or no BED, as well as either no mention of weight, a recommended weight, or an obese weight. Four questionnaires examined stigma as personality stereotypes, emotional reactions, desire for social distance, and blame attributions.

The character with BED was ascribed more negative personality characteristics and faced less positive emotional reactions than the character without BED, regardless of weight status. Desire for social distance did not depend on BED status, and the presence of BED reduced blame attributions when the character was obese. Evidence for weight stigma was limited and contingent on the presence of BED. Discussion: BED is a highly stigmatized eating disorder and should be examined within the context of weight stigma. Members of the public and healthcare professionals should challenge personal biases related to eating behaviour and body size in an effort to improve help-seeking and treatment opportunities for individuals with BED.
Session: On-Demand Poster Session
Longitudinal course and outcome of adolescent eating disorders over 18 months: diagnostic crossover, illness chronicity, and weight recovery
Danielle L. Kahn1,2 , Lauren Breithaupt1,2,3, Meghan Slattery1, Franziska Plessow1,3, Christopher Mancuso1,2, Alyssa Izquierdo1, Melissa J. Dreier2, Kendra Becker2,3, Jennifer J. Thomas2,3, Elizabeth A. Lawson*1,3, Madhusmita Misra*1,3,4, Kamryn T. Eddy*2,3
1Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital , Boston, MA, USA, 2Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA, 3Harvard Medical School, Boston, Boston, MA, USA, 4Division of Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, MA, USA

Introduction. Approximately half of adults with anorexia nervosa (AN) experience diagnostic crossover, while chronic illness is reported in about 20% of individuals with low weight eating disorders (LWED). We examined occurrence of crossover versus persistence of baseline diagnosis, and progression to weight recovery in adolescents with LWED followed for 18 months. Method. Eighty-two females (ages 10-22) with AN (n=40), Atypical AN (atAN; n=26), and Avoidant Restrictive Food Intake Disorder (ARFID; n=16) were evaluated at baseline, 9m (76% retention), and 18m (70% retention). Crossover (meeting criteria for a different eating disorder at 9m or 18m vs. maintaining BL diagnosis) and weight recovery (BMI percentile ≥20 [adolescents] or BMI ≥19.5 [adults]) were assessed. Result. Forty-eight % of the sample (55% with AN, 67% with atAN) experienced crossover. No one with a baseline diagnosis of ARFID experienced longitudinal crossover. Weight restoration over 18m was most common in those with atAN (78%), compared to AN (49%) or ARFID (25%). Conclusion. Over 18m of follow-up, more than half of our adolescent sample with traditional LWED experienced crossover. None of those with ARFID experienced crossover, and the other eating disorders did not crossover to ARFID, supporting its distinction from other LWED. Our results affirm that LWED and illness courses are malleable in adolescents, even in a relatively brief follow-up period, and support the diagnostic distinctiveness of ARFID.
Session: On-Demand Poster Session
Aleece Katan, Allison C. Kelly
University of Waterloo, Waterloo, ON, Canada

Introduction: Symptoms of bulimia nervosa (BN) are purported to be largely affected by an individual’s daily experiences. Yet, little is known about factors that can lessen bulimic symptoms day-to-day within affected individuals. Days of increased self-compassion, defined as the ability to respond to personal distress with care, have been linked to less eating and weight/shape concerns in women with anorexia nervosa (Kelly et al., 2019). It is unknown whether these findings extend to BN, and whether higher daily self-compassion levels may be associated with fewer behavioural symptoms of eating disorders. Thus, the present study examined whether daily fluctuations in self-compassion contribute to eating disorder symptoms in individuals with BN.

For two weeks, 124 women who met the DSM-5 criteria for BN completed nightly measures of their daily eating disorder symptoms and self-compassion.

Intraclass correlations showed that self-compassion levels varied almost as much within a person from day-to-day as from one person to the next. Multilevel modelling revealed that on days that participants were more self-compassionate than usual, they reported less negative affect, dietary restraint, body shame and clinical impairment, as well as lower probabilities of binge eating and purging.

Responding to daily distress with more self-compassion than usual may be associated with fewer psychosocial and behavioural symptoms of BN.
Session: On-Demand Poster Session
Kelly L. Klump1, Megan Mikhail1, Natasha Fowler1, S. Alexandra Burt1, Michael C. Neale2, Pamela K. Keel3, Jason Moser1, Ashley N. Gearhardt4, Debra K. Katzman5, Cheryl L. Sisk1
1Michigan State University, East Lansing, MI, USA, 2Virginia Commonwealth University, Richmond, VA, USA, 3Florida State University, Tallahassee, FL, USA, 4University of Michigan, Ann Arbor, MI, USA, 5University of Toronto, Toronto, ON, Canada

Introduction: Longitudinal data are needed to examine effects of the COVID-19 pandemic on risk for eating and other forms of psychopathology. We capitalized on the existence of an ongoing, longitudinal study collecting daily data to examine changes in symptoms in women across 49 days that spanned the time before and during the COVID-19 outbreak in the USA.

Women (M age = 21.81) from the MSU Twin Registry completed daily questionnaires and were categorized into three groups: 1) 335 women who completed the study prior to the US COVID-19 outbreak; 2) 34 women whose 49-day study period spanned days before and during the outbreak; and 3) 33 women who completed all questionnaires during the outbreak. We examined between-subject (i.e., differences in groups assessed before vs during the COVID-19 outbreak) and within-subject (i.e., within-subject changes across days before vs during the outbreak) effects on symptoms.

Significantly increased levels of binge-related pathology and mood symptoms were observed in women who completed assessments during, vs before, the COVID-19 outbreak. Minimal group differences were observed for body dissatisfaction/shape concerns, substance use, or other variables. Findings were largely replicated in within-subject analyses, where binge-related symptoms changed significantly from the days before vs during the outbreak.

Findings suggest a specific effect of the COVID-19 pandemic on risk for binge-related phenotypes in women.
Session: Paper Session 4: Clinical/Psychopathology
David R. Kolar1, Florian Hammerle1, Tanja Legenbauer2, Inken Kirschbaum-Lesch2, Martin Holtmann2, Karin Perthes1
1Department of Child and Adolescent Psychiatry, University Medicine Mainz, Mainz, Germany, 2Department for Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany

Introduction: Adolescents with eating disorders often exhibit emotion regulation difficulties. Most studies assessed these difficulties across different emotions and did not differentiate between adaptive and maladaptive strategies. Hence, we investigate whether adolescents with anorexia (AN) or bulimia nervosa (BN) differ from healthy adolescents (HC) in their (mal-)adaptive regulation strategies regarding anger, fear and sadness.

Methods: 118 adolescents with AN, 32 with BN and 47 HC filled in a questionnaire to assess emotion regulation strategies for fear, anger and sadness (FEEL-KJ; Grob & Smolenski, 2005). Two rmANOVAs for adaptive and maladaptive strategies with factors emotion and group were calculated.

Results: Significant main effects of emotion (p ≤ .001) and group (p ≤ .001) emerged, but no significant interaction effects of emotion × group (p ≥ .09). Post-hoc comparisons revealed the use of more adaptive and less maladaptive strategies for fear compared to anger and sadness (p ≤ .002). Furthermore, adolescents with AN and BN reported less adaptive (p ≤ .001) and more maladaptive strategies than HC (p ≤ .001). Adolescents with BN showed more maladaptive strategies than AN (p = .009).

Conclusions: Differentiating between deficits in adaptive and excesses in maladaptive emotion regulation strategies between AN and BN may be warranted. Future studies might investigate whether adolescents with AN and BN differ in their emotion regulation of guilt and shame.
Session: On-Demand Poster Session
Megan C Kuhnle1,2, Kendra R Becker1,3, Helen Burton Murray1,3, Jenny H Jo1,2, Stephanie G Harshman1,2, Kristine S Hauser1,2, Madhusmita S Misra2,3, Nadia Micali4,5, Elizabeth A Lawson2,3, Kamryn T Eddy1,3, Jennifer J Thomas1,3
1Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA, 2Massachusetts General Hospital Neuroendocrine Unit, Boston, MA, USA, 3Harvard Medical School, Boston, MA, USA, 4Great Ormond Street Institute of Child Health, University College , London, United Kingdom, 5Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland

Avoidant/restrictive food intake disorder (ARFID) is characterized by sensory sensitivity, fear of aversive consequences, and/or lack of interest in eating/food, and often presents with psychological comorbidities. Eighty-four (52% male) participants were diagnosed with full or subthreshold ARFID via the Pica, ARFID and Rumination Disorder Interview (PARDI; Mage=15.2±3.6; MBMI percentile=37.2±35.1). We hypothesized that greater lack of interest on the PARDI would account for variance on the Beck Depression Inventory (BDI), Child Depression Inventory (CDI), and State-Trait Anxiety Inventory (STAI) as well as on BMI percentile, amount eaten over a 24-hour food recall, visual analogue scale (VAS) of hunger prior to a standardized meal, and post-meal VAS of amount able to eat. Consistent with hypotheses, lack of interest accounted for additional variance in BDI/CDI (β=.374, p=.001) and STAI t-scores (β=.26, p=.025) above and beyond the other ARFID presentations. Lack of interest also accounted for variance in BMI percentile (β=-.256, p=.034), amount eaten (β=-.254, p=.044), pre-meal hunger (β=-.381, p=.002), and post-meal estimate of amount able to eat (β=-.346, p=.005) above and beyond the other presentations. Findings suggest that poor appetite, low mood, and higher anxiety may contribute to the maintenance of lack of interest and relate to the persistence of the disorder.
Session: On-Demand Poster Session
Childhood Maltreatment in Patients with Binge Eating Disorder with and without Night Eating Syndrome vs. Control
Yael Latzer1,2, Michal Rozenstain-Hason1, Orna Kabakov2, Miri Givon2, Shiran Mizrachi1, Sigal Alon2, Orna Tzischinsky3
1University of Haifa, Faculty of Social Welfair Welfare and Health Sciences, Haifa, Israel, 2Eating Disorders Institution, Psychiatric Division, Rambam, Health, Care, Campus, Haifa, Israel, 3Behavioral Science, Emek-Yezreel College, Emek Yezreel, Israel

Objective: This study compared women with Eating Disorders (ED) binge ED (BED) or bulimia nervosa (BN) with and without night eating syndrome (NES) regarding varied forms of childhood maltreatment (CM) and psychopathology relative to healthy controls (HC). Design: The study included 426 women (18–60) divided into two groups: ED (n = 158) and HC (n = 268). The ED was divided into three diagnostic subgroups: BN, BED, NES-BE. Participants completed self-report questionnaires: childhood traumatic questionnaire (CTQ), ED, self-esteem, psychopathology, and depression. HC completed all questionnaires and ED evaluation.

No significant differences were found for most research variables in ED subgroups. Significant differences were found for all research variables between ED and HC. Significant correlations were found between CTQ subscales, psychopathology, emotional abuse, and self-esteem only in ED. Regression showed that emotional abuse was a significant predictor of self-esteem only in ED and group was a significant moderator of the effect of emotional abuse on psychopathology.

The results emphasize that women with NES-BE may be a variant of groups with BED or BN and not a separate diagnostic entity. Result highlights the importance of early assessment of CM in patients with NES, in particular, the role of emotional abuse in level of distress and psychopathology.
Session: On-Demand Poster Session
Yael Latzer2,3, Eynat Zubery1, Rinat Grundman Shem-Tov1,2, Noa Loevy Hecht1
1Eating Disorders Treatment and Research Unit, Shalvata Mental Health Center , Hod haSharon, Israel, 2Faculty of Social Welfare and Health Sciences, University of Haifa,, Haifa, Israel, 3Eating Disorders Institution, Psychiatric Division, Rambam Medical Center, Haifa, Israel

Objective: in recent decades there has been a significant increase in the prevalence of eating disorders among non-western populations. This article will address unique socio-cultural issues regarding the process of referral, diagnosis, and treatment of eating disorders among young Ethiopian women in Israel.

cultural aspects relating to the perception of the disease and the circumstantial contexts relating to this population will be presented, such as the process of immigration, integration into Israeli society, and issues related to identity and trauma.

a culturally sensitive diagnostic-therapeutic model is proposed, and will be illustrated by case studies. Discussion: the proposed culturally sensitive diagnostic-therapeutic model will be discussed in light of observations of clinical cases from different cultural backgrounds. It was noted, that this therapeutic and diagnostic model cannot be achieved solely through a western diagnostic prism. In addition, the integrative diagnostic phase is presented, including western-oriented diagnosis, an interview based on a cultural formulation as well as clarification of complex post-traumatic disorder.
Session: On-Demand Poster Session
Tanja Legenbauer1, Miriam Davids1, Carina Huhn1, David Laux1, Martin Holtmann1, Marlies Pinnow2, Natalie Deux1
1LWL University Hospital Hamm for Child and Adolescent Psychiatry Ruhr University Bochum, Hamm, Germany, 2Institute of Cognitive Neuroscience, Biopsychology Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany

Obese children show more loss of control eating and higher impulsiveness compared to normal weight controls. Also, in children with high impulsivity (e.g. ADHD) overweight is common. This might be due to low inhibitory control (IC) towards food related stimuli and the disability to postpone food related rewards. Up to now, no study compared these groups on different measures of impulsivity comprising both food + generic stimuli. The present study therefore applies 3 tasks to capture different facets of impulsivity towards both neutral + food related stimuli among three groups (overweight/obese; OWG; normal weight, NWG; children with externalizing disorders; EXD): marshmallow task (MAT), door opening task (DOT), go/nogo task (GNG). In addition, trait impulsiveness (BIS/BAS) and eating disturbances (DEBQ) were assessed. In total, N=92 children took part (Mage = 8.24, SD = 1.42), MBMIperc. = 57.99, SD = 32.83). A positive association between emotional and restraint eating styles and weight emerged, whereas no differences in BIS/BAS could be found. Experimentally IC deficits (GNG) showed differences between the groups: NWG + EXD showed more omission errors in relation to food related stimuli compared to generic ones. Among OWG, no differences in omission errors occurred dependent of stimuli category. In the DOT, OWG responded stronger to neutral stimuli. The MAT showed no group differences. Results imply a more general IC deficit and generic reward sensitivity among OWG.
Session: On-Demand Poster Session
María Lozano-Madrid1,2,3, Danielle Clark Bryan4, Roser Granero3,5, Isabel Sánchez1,2,3, Nadine Riesco1,2,3, Nuria Mallorquí-Bagué3,6, Susana Jiménez-Murcia1,2,3,7, Janet Treasure4 , Fernando Fernández-Aranda1,2,3,7
1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 2Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain, 3Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain, 4Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 5Departament de Psicobiologia i Metodologia. Universitat Autònoma de Barcelona, Barcelona, Spain, 6Addictive Behavior Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain, 7Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

Background: Empirical data suggests a high comorbid occurrence of eating disorders (EDs) and substance use disorders (SUDs), as well as neurological and psychological shared characteristics. However, no prior study has identified the neuropsychological features of this subgroup. This study examines the prevalence of alcohol and/or drug abuse (A/DA) symptoms in ED patients. It also compares the clinical features and neuropsychological performance of ED patients with and without A/DA symptoms.

Methods: 145 participants (74.5% females) with various forms of diagnosed EDs underwent a comprehensive clinical (TCI-R, SCL-90 and EDI-2) and neuropsychological assessment (Stroop, WCST and IGT).

Results: Approximately 19% of ED patients (across ED subtypes) had A/DA symptoms. Those with A/DA symptoms showed more impulsive behaviours and higher levels of interoceptive awareness (EDI-2), somatisation (SCL-90R) and novelty seeking (TCI-R). This group also had a lower score in the Stroop-words measure, made more perseverative errors in the WCST and showed a weaker learning trajectory in the IGT.

Conclusions: ED patients with A/DA symptoms display a specific phenotype characterised by greater impulsive personality, emotional dysregulation and problems with executive control. Patients with these temperamental traits may might benefit from augmented treatment that targets these deficits, which may prevent the later evolution into a SUD.
Session: Paper Session 3: Neurocognition
Paulo PP Machado1, Rita Ramos 1, Ana Pinto-Bastos1, Isabel Brandão2, Elsa Louro1, Ana Vaz1
1University of Minho, Braga, Portugal, 2University of Porto, Porto, Portugal

Introduction: Lockdown implemented to prevent the COVID-19 spread resulted in marked changes in daily routines. The objective of the current study was to assess the impact of lockdown measures on a cohort of eating disorder (ED) patients being followed as part of an ongoing naturalistic treatment study.

Fifty-nine patients were interviewed by phone, and 42 agreed to respond to a set of self-report measures of ED symptoms, emotion regulation, clinical impairment, negative urgency and Covid19 impact, during the week after the end of the lockdown period.

Data showed that of the patients currently in treatment: 8 remained unchanged (27.5%), 5 deteriorated (17.2%), 12 reliably improved (41.3%); and 4 recovered (13.7%). Of the 13 participants that were considered previously recovered:5 relapsed (38.4%), and 8 remained recovered (61.5%) after the lockdown period. The COVID Impact Scale, showed that most patients considered their routines moderately or extremely impacted, experienced stress related to coronavirus, and showed difficulty in maintaining physical exercise and feeding routines. Increased impairment after lockdown was associated with previous levels of eating concern (r=.490, p=.004), shape concern (r=.406, p=.019) and difficulties in impulse control (r=.376, p=.029).

Findings suggest that ED patients may be particularly affected by lockdown measures, and highlights the need for intervention strategies to mitigate its negative impact.
Session: On-Demand Poster Session
Suzanne H.W. Mares1, Julian Burger2, Lotte H.J.M. Lemmens3, Annemarie A. van Elburg1, 4, Maartje S. Vroling1
1GGNet, Warnsveld, Netherlands, 2University Medical Center Groningen, Groningen, Netherlands, 3Maastricht University, Maastricht, Netherlands, 4Utrecht University, Utrecht, Netherlands

1. Introduction. One of the prevailing theories of eating disorders (ED) is the transdiagnostic cognitive behavioural theory of eating disorders, which suggests that certain ED symptoms, such as over-evaluation of eating, shape, and weight, may be more central than others. In the present study, network analyses were used to validate these assumptions in a patient sample. 2. Methods. Participants were 336 individuals receiving treatment at an expert center for ED in the Netherlands. Participants completed the EDE-Q before treatment and at the end of treatment as part of routine outcome assessment. ED networks were estimated using the bootnet package in R. 3. Results. Inspection of separate networks for patients with bulimia nervosa and binge eating disorder showed that over-evaluation of shape, weight, and eating were the most central symptoms in the network. A transdiagnostic network of ED symptoms and a separate network for patients with anorexia nervosa showed that strict dieting was an additional central ED symptom. 4. Conclusions. In conclusion, the current study confirmed that over-evaluation of shape, weight, and eating are central symptoms across ED’s, in agreement with the transdiagnostic cognitive behavioural model of eating disorders. Further, results showed that, given the centrality of strict dieting in especially the AN, but also BN subsamples in previous studies, the emphasis on the normalization of eating behaviour in many ED treatments seems justified.
Session: On-Demand Poster Session
Brittany Matheson, Hannah Welch, Cara Bohon
Stanford University School of Medicine, Stanford, CA, USA

Introduction: Limited research has investigated the context surrounding binge episodes. This study seeks to understand clinical correlates of binge characteristics to guide treatment selection and clinical targets in adolescents and young adults. Method: Participants were 44 females (14-35 years old; M ± SD: 21.39 ± 6.33 y; BMI: 27.34 ± 8.35 kg/m2) who reported at least one binge episode in the past 3 months. Participants completed a qualitative interview detailing the context surrounding two unique binge episodes. Participants also completed the Eating Disorder Examination (EDE), Beck Depression Inventory (BDI-I), Beck Anxiety Inventory (BAI), Dutch Eating Behavior Questionnaire (DEBQ), and Difficulties in Emotion Regulation Scale (DERS).

Results: Pre-binge negative mood was associated with DEBQ Emotional Eating scores (r=.34) and DERS Nonacceptance, Impulse, Strategies, and Total scores (r’s=.31-.43). Positive mood was correlated with DERS Goals, Impulse, Strategies, and Total scores (r’s=-.41- -.50). Stress surrounding the binge episode was correlated with DEBQ Emotional Eating scores (r=.45). Cue-driven binge eating variables showed small effect sizes with related clinical measures. Conclusion: Affective measures, including emotion regulation and emotional eating, were more strongly correlated than hunger or cue-driven measures with qualitative binge episode features in this study. Affective components of binge episodes may be important targets for intervention.
Session: On-Demand Poster Session
Sarah E. McComb, Keisha C. Gobin, Jennifer S. Mills
York University, Toronto, ON, Canada

Introduction: COVID-19 is a global pandemic that is having negative impacts on mental health worldwide. The purpose of the current study was to examine what effect the COVID-19 quarantine in Canada was having on the eating, exercise, and social media habits of individuals who displayed disordered eating habits, relative to their healthy counterparts.

Methods: Participants were 143 women, aged 17-73 years (M = 25.85, SD = 8.12) recruited during COVID-19 quarantine. Participants completed the Eating Disorders Examination Questionnaire (EDE-Q) and self-report questionnaires on their eating, exercise, and social media habits during COVID-19.

Results: Results revealed that those who reported high levels of disordered eating reported greater restriction, food consumption, thoughts about food, laxative use, perceived pressure to start a diet and lose weight, actual weight loss and weight gain, perceived pressure from social media specifically to diet, lose weight, and exercise, and increased Tiktok and Facebook use during quarantine, relative to their healthy counterparts.

Conclusions: Findings suggest that those with existing disordered eating problems are experiencing an exacerbation of symptomology during COVID-19, and that social media may be a contributing factor. Findings may inform mental health initiatives and provide insights for clinical practice for those with disordered eating during COVID-19.
Session: On-Demand Poster Session
Feeling Fat’ Uniquely Influences Eating Pathology Beyond Body Dissatisfaction in Undergraduate Women
Adrienne Mehak, Sarah E. Racine
McGill University, Montréal, QC, Canada

‘Feeling fat,’ the somatic experience of excess weight not entirely explained by objective body mass, correlates with eating disorder (ED) symptoms in individuals with and without eating disorders. Feeling fat and body dissatisfaction are clinically recognized maintenance factors in EDs. It is unclear if feeling fat uniquely influences eating pathology or if it is merely an element of body dissatisfaction. Undergraduate women (N = 184) with a range of ED symptoms completed online questionnaires. Hierarchical multiple regression analyses showed that feeling fat accounted for significant unique variance in global Eating Disorders Examination-Questionnaire scores, dietary restriction, and purging when controlling for BMI and body dissatisfaction. Feeling fat did not account for unique variance in binge eating or muscle building behavior. While feeling fat relates to body dissatisfaction, it is a separate construct with relation to ED symptoms. Feeling fat has a specific relationship with symptoms that reduce caloric intake. Body dissatisfaction influences binge eating more than feeling fat, perhaps because feeling fat inspires attempts to reduce one’s shape. An athletic ideal is growing increasingly popular yet feeling fat did not influence women’s muscle building behaviors beyond body dissatisfaction. Feeling fat’s relationship with muscle building behavior requires further investigation in men: feeling fat may reflect the desire to lose weight to accentuate muscularity in men.
Session: On-Demand Poster Session
Romina Miranda-Olivos1, 2, Trevor Steward3, Ignacio Martinez-Zalacain1, Gemma Mestre-Bach1, Asier Juaneda-Seguí1, 4, Carles Soriano-Mas1, 4, 5, Fernando Fernandez-Aranda1, 2, 6
1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 2Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain, 3Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia, 4Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III, Madrid, Spain, 5Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Barcelona, Spain, 6Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain

Purpose of study. Delay discounting is relevant to the impulsivity-related processes in obesity and binge eating disorder (BED). Although BED and obesity frequently co-occur, the neural mechanisms underlying delay discounting in each condition remain poorly understood. Methods. In this study, we investigated monetary delay discounting using a functional magnetic resonance imaging (fMRI) task in women with obesity (n=25), women with obesity and BED (n=10), and healthy controls (n=31). We compared brain activity between groups during smaller, immediate reward choices (NOW) vs. greater, delayed reward choices (LATER). Results. We also sought to examine associations between neural response during delay discounting and individual impulsivity traits. fMRI analyses revealed decreased activity in the left anterior insula during NOW>LATER in all participants with obesity compared to controls (pFWE<0.05). Comparisons between obesity groups identified decreased activity in the dmPFC during NOW>LATER in participants with BED compared to those without BED. Furthermore, dmPFC response during delay discounting was negatively correlated to lack of perseverance (p=0.021) and positive urgency (p=0.048) in the BED group. Conclusions. Our findings suggest dysfunctional activity in the anterior insula may underlie impulsive decision making in obesity, with alterations in dmPFC response specifically contributing to the devaluing of prospective rewards in BED.
Session: On-Demand Poster Session
Alexandra Muir1, Teena Moody2,3, Courtney Sheen2,3, Michael Strober2,3, Jamie Feusner2,3
1Department of Psychology, Brigham Young University, Provo, UT, USA, 2Department of Psychiatry and Biobehavioral Sciences, The University of California Los Angeles, Los Angeles, CA, USA, 3Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA

Purpose: Individuals with anorexia nervosa (AN) have disturbances in the experience of their body weight and shape. Adults with AN also rate appearances of others’ bodies and faces more negatively compared with controls. Less is known about whether similar phenomena occur for adolescents. Methods: AN and control participants (nAN=23, nCON=18; age 12-19) rated pictures of others’ bodies and faces on: attractiveness, aversiveness, triggering thoughts of own appearance, and (bodies) how over/underweight. Linear mixed models were utilized to parse group differences and interaction effects with stimulus type and level of detail (spatial frequency). Six-month follow-up data was available for 16 AN participants. Results: Those with AN rated others’ bodies as less attractive (p<.01), more overweight (p=.04), more aversive (p=.03), and more triggering of thoughts of own appearance compared to controls (p=.05). AN rated normal detail images as more attractive (p<.01) compared with high/low detail images, but only at time 1. All other results remained consistent at follow-up. Conclusions: Similar to adults with AN, adolescents with AN display negative evaluations of others’ bodies. Unlike adults, however, negative evaluations and triggered thoughts of own appearance were not present for faces. This raises a possibility that generalized negative perceptions of others may develop as AN progresses into adulthood. Results have implications for treatment of body image disturbances.
Session: On-Demand Poster Session
Nina Palmeroni1, Laurence Claes1,2, Margaux Verschueren1, Koen Luyckx1,3
1Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium, 22Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium, 3University of the Free State, Bloemfontein, South Africa

Introduction. Eating disorder symptomatology generally develops during adolescence and emerging adulthood. Previous research has focused on the predictive role of both identity and body dissatisfaction in eating disorder symptomatology, but integrative work is lacking. The present cross-sectional study examined the mediating role of body dissatisfaction between identity and eating disorder symptomatology in adolescents and emerging adults. Methods. The sample comprised 659 adolescents and emerging adults (68.9% females; Mage=19.44; SDage=3.99; range 15-30) who completed self-report measures on identity, body dissatisfaction, and eating disorder symptomatology. Latent variable modeling from a structural equation modeling approach was used. Results. First, identity significantly predicted eating disorder symptomatology. Additionally, indirect effects were found linking identity to eating disorder symptomatology through the mechanism of body dissatisfaction. No significant differences between males and females or between adolescents and emerging adults on direct or indirect effects were found. Conclusion. The present study indicates that body dissatisfaction mediates the relationship between identity and eating disorder symptomatology during mid-to-late adolescence and emerging adulthood in both men and women.
Session: On-Demand Poster Session
Arielle T. Pearlman1,2, David A. Klein3,4, David S. Riggs1, Natasha A. Schvey1
1Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sicences, Bethesda, MD, USA, 2The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA, 3Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, 4Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, 5Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD, USA

Both military personnel and transgender/gender diverse (TGD) individuals are at increased risk for eating pathology; thus the risk for TGD persons serving on active duty may be multifold. Further, deployment is a time of considerable stress, which may adversely impact eating- and weight-related pathology. Social support during deployments may attenuate this risk, though no studies to date have examined these relationships among TGD military personnel. Therefore, we assessed associations between social support during deployments and eating pathology among TGD service members. Self-identified TGD service members completed an anonymous online survey, including the Eating Disorder Examination Questionnaire and a measure of social support during their most recent deployment. Scores were log-transformed to improve normality. Linear regressions adjusting for gender, age, race/ethnicity, and military rank were conducted. One hundred ten TGD service members participated (Mage: 29.4y, 48.2% transmale, 43.6% transfemale, 8.2% non-binary, 79.2% non-Hispanic white; 82.6% enlisted). Adjusting for covariates, both unit and family support were inversely associated with global eating pathology (βs = -.28 and -.33, respectively, ps <.028). Among TGD service members, unit and family support during periods of deployment may be protective against eating pathology. Prospective research is needed to elucidate possible mechanisms in these relationships.
Session: On-Demand Poster Session
Gabriella Pucci, Emma Harris, Sarah Horvath, K. Jean Forney
Ohio University, Athens, OH, USA

PURPOSE: Negative affect (NA) is thought to increase body dissatisfaction; however, the role of positive affect (PA) is unknown. PA may result in selective attention to liked body features and protect against body dissatisfaction. As such, the present study tested the hypothesis that positive affect is negatively associated with body dissatisfaction above and beyond NA. We tested this hypothesis in four samples varying in age and assessment measures. METHODS: Four unique samples completed questionnaire assessments of body dissatisfaction, positive and negative affect, and demographic information. Sample 1 comes from an online undergraduate sample (N=309; 74% women). In Sample 2, adults from the community (N=112; 78% women) completed online questionnaires. Sample 3 comes from an online study of undergraduate nutrition students (N=89, 93% women), and Sample 4 comes from an in-person undergraduate sample (N=48; 63% women). RESULTS: In Sample 1, higher PA was associated with lower body dissatisfaction (β= -.15, p = .001), after adjusting for BMI, gender, and NA. After adjusting for covariates, effect sizes in the replication samples were similar, showing a negative relationship in Samples 2 (β= -.12), 3 (β= -.24), and 4 (β= -.14). CONCLUSION: Results support a unique protective role for PA in the development and/or maintenance of body dissatisfaction. PA may serve as a novel intervention target for preventing or treating body dissatisfaction.
Session: On-Demand Poster Session
Sofia M. Ramalho, Ana Trovisqueira, Sónia Gonçalves, Ana R. Vaz, Paulo P. P. Machado, Eva Conceição
School of Psychology, University of Minho, Braga, Portugal

Introduction:The COVID-19 pandemic was a trigger for generalized disorganized eating patterns. This study aimed to explore associations and compare individuals who experienced high vs low psychosocial impact of COVID-19 pandemic on sociodemographic, psychological and eating behavior variables.

This is a community-based cross-sectional study assessing 263 Portuguese adults after the COVID-19 lockdown (82.1% women; 35.90 ±11.72 years). An online survey was conducted to evaluate psychological distress, self-compassion, psychological reactance, disordered eating, and psychosocial impact of COVID-19 pandemic.

Lack of access to mental health care, the experience of stress and family discord during the COVID-19 lockdown were positively associated with uncontrolled/emotional eating (p<.05). The high psychosocial impact group reported significantly lower levels of self-compassion, higher psychological reactance, anxiety, stress, depression, uncontrolled/emotional eating (p<.01). Structural equation modeling revealed that the psychosocial impact of COVID-19 was related to disordered eating behaviors (uncontrolled/emotional eating), being this relation fully mediated by psychological distress (anxiety, depression, stress) (CMIN/DF=1.499; CFI=.994, TLI=.987, RMSEA=.045).

The identified factors linked to a higher psychological COVID-19 impact can be used to inform interventions to enhance mental health and manage disordered eating after the COVID-19 lockdown.
Session: On-Demand Poster Session
Identifying the Contingencies of Self-Worth Associated with Eating Disorder Symptoms: The Use of Choice-Based Conjoint Analysis
Elizabeth Rieger, Kevin Prasetya, Bruce Christensen
Australian National University, Canberra, Australia

Shape/weight-based self-worth is a diagnostic criterion and key maintaining factor for eating disorders. Yet there has been minimal attention to other contingencies of self-worth that may be relevant for eating disorder symptoms. Moreover, research has relied on self-report questionnaires, which are subject to distortion through socially desirable responding. The present study investigated a broad range of contingencies of self-worth in relation to eating disorder pathology, and employed a novel approach for assessing these contingencies (choice-based conjoint [CBC] analysis) that is less susceptible to social desirability. A total of 428 young adults completed the Contingencies of Self-Worth Scale (CSWS) and a CBC task to assess the domains in which self-worth is invested, and the Eating Disorder Examination Questionnaire (EDE-Q). After controlling for the effects of the shape/weight domains, EDE-Q scores were positively predicted by God’s Love, and negatively predicted by Family Support, Quality Relationships, and Creativity. Moreover, the CBC method was generally unrelated to socially desirable responding in contrast to the self-report method of the CSWS. The findings suggest that a broader range of contingencies of self-worth than shape/weight are relevant to eating disorder pathology and should be considered as potential treatment targets. In addition, this first use of the CBC method in eating disorder research supports its validity and utility in this context.
Session: On-Demand Poster Session
Tania F. Rodrigues1, Ana Vaz1, Isabel Brandão2, Fernando Fernandez-Aranda3, Paulo PP Machado1
1University of Minho, Braga, Portugal, 2University of Porto, Porto, Portugal, 3University of Barcelona, Barcelona, Spain

Introduction. Difficulties in emotion regulation are conceptualized as transdiagnostic factor on the maintenance of eating disorders (ED)(1,2). In a meta-analysis(3) the role of self-compassion as an adaptive emotion regulation strategy in ED was highlighted. The present study explores the role of self-compassion on the relationship between pathogenic eating-related attitudes/behaviours and emotion dysregulation. Methods. A clinical ED (N=111) and a college student (N=223) samples were combined (Mage=24.2, SD=8.10; MBMI=21.9, SD=4.70). PROCESS macro for SPSS was used to test the moderation role of self-compassion (5,000 bias-corrected resamples, 90% CI). Results. A series of moderation models revealed that self-compassion is a significant moderator on the relationship between emotion regulation difficulties and 1) overall eating psychopathology (F(3,321)=91.84, p<.001, R2=.46), 2) weight and shape concerns (F(3, 323)=91.89, p<.001, R2=.46), 3) objective binge-eating episodes (F(3,312)=11.31, p<.001, R2=.10) and 4) self-induced vomiting episodes (F(3,318)=9.23, p<.001, R2=.08). Johnson-Neyman plots evidence a pattern in which higher levels of emotion regulation difficulties result in higher levels of eating psychopathology, a tendency significantly buffered as levels of self-compassion increase. Conclusions. This study offers novel insights on the buffering effect of self-compassion as an adaptive emotion regulation strategy. Clinical implications are discussed.
Session: On-Demand Poster Session
A mixed-methods study investigating interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders and healthy peers
Katie P Rowlands1, Silvia Cerea2, Emma Wilson3, Ben Grafton4, Mima Simic5, Robyn Yellowlees1, Amy Harrison6, Colette Hirsch7, Janet Treasure1, Valentina Cardi2
1Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 2Department of General Psychology, University of Padova, Padova, Italy, 3Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom, 4Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia, 5Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom, 6Department of Psychology and Human Development, University College London, Institute of Education, 25 Woburn Square, London, United Kingdom, 7Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom

The main aims of this project were to assess interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders (n=80) compared to healthy controls (n=78) and to develop materials for a cognitive bias modification training for adolescents with eating disorders. Participants completed computerised assessments of interpersonal functioning, cognitive biases towards social stimuli, and eating disorder symptoms. Focus groups were held with patients, carers and professionals focused on the topic of social rejection. Scenarios (n=339) covering these themes were developed and piloted in a sample of adolescents with eating disorders (n=27). Participants with eating disorders reported greater interpersonal sensitivity, poorer quality relationships and lower self-esteem following virtual ostracism and displayed a negative interpretation bias compared to controls. In the eating disorder sample, a negative interpretation bias was associated with greater interpersonal sensitivity, greater reactivity to virtual ostracism, poorer quality of relationships and greater eating disorder symptoms. The final set of scenarios rated as highly age-appropriate and emotionally salient (n=301) were translated into an interpretation bias modification module. Interventions to reduce a negative interpretation bias and increase resilience to social rejection might improve interpersonal functioning and eating disorder symptoms in adolescents with eating disorders.
Session: Paper Session 3: Neurocognition
Lindsay Samson4, Josie Geller1,2, Allison C. Kelly3, Megumi M. Iyar5, Suja Srikameswaran1,2
1Eating Disorders Program, Department of Psychiatry, St. Paul's Hospital, Vancouver, BC, Canada, 2Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, 3Department of Psychology, University of Waterloo, Waterloo, ON, Canada, 4Department of Psychology, York University, Toronto, ON, Canada, 5Department of Psychology, University of British Columbia Okanagan Campus, Kelowna, BC, Canada

1. Introduction. There is growing support for the role of self-compassion in eating disorder (ED) recovery. Using the Fears of Compassion for Self-scale (Gilbert, 2011), two barriers to self-compassion have been identified in individuals with EDs: (a) fears that self-compassion will result in a failure to meet personal and interpersonal standards (Meeting Standards); and (b) fears that self-compassion will give rise to difficult emotions such as grief and unworthiness (Emotional Vulnerability). This research examined the relative contribution of these subscales to the clinical characteristics of individuals with EDs. 2. Methods. Participants (N = 349) completed the Fears of Compassion for Self-scale, measures of self-compassion, ED and psychiatric symptom severity, interpersonal and affective functioning, quality of life and readiness for ED change. 3. Results. Together, the two subscale types accounted for significant variance in all study variables. Meeting Standards was associated with lower readiness to change and greater over-control. In contrast, Emotional Vulnerability was associated with lower self-compassion, readiness, and quality of life, poorer interpersonal and affective functioning, and greater ED and psychiatric severity. 4. Conclusion. While both barriers to self-compassion were related to functioning in individuals with EDs, the emotional vulnerability barrier accounted for more variance in pathology and thus may be most beneficial to target in treatment.
Session: On-Demand Poster Session
Isabel Sánchez1,2, Jessica Sánchez 1, Susana Jiménez-Murcia 1,2,3, Mónica Giménez1, Roser Granero2,4, Carlos Dieguez5, Ashley N Gearhardt 6, Fernando Fernández-Aranda1,2,3
1Bellvitge University Hospital, Barcelona, Spain, 2CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain, 3Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain, 4Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain, 5Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain, 6Department of Psychology, University of Michigan, Michigan, MI, USA

Objective. 1) To explore the Food Addiction (FA) construct in a sample of patients with Anorexia nervosa (AN) and among differences ED subtypes (ANR and ANBP) and 2) to analyze the psychopathological and personality traits associated factors. Method. A sample of 116 patients with AN were included (72 restrictive [AN-R] and 44 binge-purge AN [AN-BP]), according to DSM-5 diagnostic criteria. Eating-related, personality and psychopathological variables were collected. Stepwise regression and a path analysis were used to evaluate the associations of different measures with the presence of FA and the underlying mechanisms between them. Results. Most participants were women (92.2%), mean age 27.1 years-old (SD=10.5). Total number of substance-related and addictive disorders (SRAD) criteria for FA was directly associated with AN-BP diagnosis (75% of cases) and it was also associated with higher eating and general psychopathology and more dysfunctional personality traits, namely lower scores in self-directedness. The subgroup of ANR with FA (54.2 % of cases) was found as intermediate group, when considering psychopathological and clinical symptoms, between ANR (without FA) and ANBP. Conclusions. AN-BP patients had a higher level of FA compared to AN-R patients. Presence of FA was associated with higher psychopathology and more dysfunctional personality traits. The relevance of the ANR group with positive FA will be discussed.
Session: On-Demand Poster Session
Emotion processing deficits in Anorexia Nervosa  
Emma, E. E. Saure1, Marja Laasonen1, 2, Tuulia Lepisto-Paisley3, Anu Raevuori4, 5
1Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland, 2Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland, 3Department of Child Neurology, Helsinki University Hospital, Helsinki, Finland, 4Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland, 5Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland

Introduction: Individuals with anorexia nervosa (AN) have suggested to have difficulties in emotion recognition and regulation, empathizing, and identification as well as in the expression of one's emotions (alexithymia), but the evidence is still inconsistent. These challenges in emotional processing are also suggested to predispose to AN and contribute to the prolongation of the illness. Aims of this study were to examine 1) whether individuals with AN differ from healthy control individuals (HCs) in emotional processing, and 2) whether broad, and potentially milder, form of AN differed from narrow AN in these deficits.

Recognition of emotions was studied using face pictures and short film clips. Emotion regulation, alexithymia, and empathy were assessed by self-reported questionnaires. HCs (n = 38) and individuals with AN (n = 24 narrow AN, n = 12 broad AN) participated in the study.

Those with AN had significantly more challenges in emotion regulation, performed poorer in emotion recognition from video clips and reported more alexithymic traits than HCs. Those with narrow AN performed worse than HCs in emotion recognition from face pictures and exhibited lower empathizing whereas those with broad AN did not differ from HCs.

Individuals with AN have emotion processing deficits. Those with narrow AN appear to have more widespread problems in emotion processing that individuals with broad AN.
Session: On-Demand Poster Session
Sarah E. Schell, Iulia Banica, Anna Weinberg, Sarah E. Racine
McGill University, Montreal, QC, Canada

Interpersonal stress contributes to eating disorder (ED) symptoms, and individuals with EDs exhibit maladaptive interpersonal styles (e.g., hypersensitivity and overreaction to social threat) that may perpetuate interpersonal problems. Further, there are differences across diagnostic features that may influence how individuals respond to social threat. Binge eating (BE) has been associated with a hostile/confrontational style, whereas dietary restriction (DR) is often associated with avoidance of conflict. The current study examined relations between responses to social threat and core ED symptoms (BE and DR) using a novel experimental paradigm. Undergraduate women (N = 127) played an online Survivor-type game in which they voted to keep or reject computerized "coplayers" across six rounds until six winners remained. After entering their votes each round, participants were shown how coplayers voted for them. We hypothesized that BE would be related to greater retaliation against coplayers who previously voted to reject them, whereas DR would be related to lower retaliation. While neither ED symptom was related to retaliation against coplayers, DR was associated with more overall rejection (i.e., a tendency to reject others regardless of how the co-player voted towards them). This finding suggests that individuals with DR may rely on a maladaptive defensive interpersonal strategy in which they reject others before others have a chance to reject them.
Session: On-Demand Poster Session
Emotion Processing under Conditions of Uncertainty in Adult Women with and without Anorexia Nervosa
Lot C Sternheim1, Mirjam CM Wever2, Amy K Harrison3, Unna N Danner1,5
1Dep of Clinical Psychology, Utrecht University, Utrecht, Netherlands, 2Clinical Psychology, Leiden University, Leiden, Netherlands, 3epartment of Psychology and Human Development, UCL, London, Netherlands, 4Altrecht Eating Disorders Rintveld, Zeist, Netherlands

Introduction. Research suggests emotion processing deficits in individuals with Anorexia Nervosa (AN). Uncertainty is inherent to emotion processing, yet there are no studies into the role of uncertainty in AN in relation to emotion processing. This experimental study set out to investigate emotion processing under conditions of uncertainty. Methods. Forty-one AN and 43 non-ED participants were asked to complete an affective appraisal task (Wall of Faces) whereby participants view 96 trials of 36 faces, either happy or sad, male or female, with differing conditions of uncertainty (ratio). Response latencies were recorded. Results. A significant three-way interaction between trial type, ratio and group was found. For the non-ED group, but not for the AN group, a difference between affective trials and gender trials was found. The level of uncertainty contributed to response latencies across the groups. Whilst the AN participants had lower response latencies, the non-ED participants had higher latencies for the uncertain compared to the non-uncertain conditions. Conclusions. Results highlight the importance of uncertainty in the appraisal of emotions in AN. Future studies should investigate to what extend uncertainty, and the intolerance for uncertainty affect other emotion regulation processes in AN. Moreover, individuals with AN may benefit from interventions strategies targeting both emotion processing and increasing tolerance for uncertainty.
Session: On-Demand Poster Session
Kimberly S Stevens1, Andrew Freeman1, Kristen M Culbert2
1University of Nevada, Las Vegas, Las Vegas, NV, USA, 2Wayne State University School of Medicine, Detroit, MI, USA

Introduction: Loneliness is linked with negative mental health outcomes (e.g., depression) and may be associated with pathological eating behavior (e.g., binge eating), yet few studies have explored this possibility. The COVID-19 pandemic provides a unique opportunity to examine the impact of loneliness on binge eating (BE) symptoms since social distancing policies (i.e., keeping physical distance; limited close contact with others) could result in isolation and feelings of loneliness. Thus, this study examined the association between loneliness and BE symptoms during the COVID-19 pandemic and tested whether social distancing policies exacerbated feelings of loneliness and BE symptoms. Methods: 298 women (age 18-45) living in the United States completed an online survey in May 2020 that assessed their adherence to social distancing restrictions, feelings of loneliness, and BE symptoms as well as their perceptions of changes in loneliness and BE since social distancing began. Results: Loneliness was positively associated with BE symptoms. Additionally, women who endorsed increased feelings of loneliness since social distancing began (56%) reported significantly higher levels of BE symptoms than women who reported no change or reductions in loneliness (d=.34-.36).

Results indicate that COVID-19 social distancing is related to increases in loneliness and BE and suggest that loneliness is an important factor to consider in the development and maintenance of BE.
Session: On-Demand Poster Session
Does ADHD Symptomatology Influence Treatment Outcome and Dropout Risk in Eating Disorders? A longitudinal Study
Giulia Testa1,2, Isabel Baenas1, Cristina Vintró-Alcaraz1,2, Roser Granero3, Susana Jiménez-Murcia1,4, Fernando Fernández Aranda1,2,4
1Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain, 2Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain, 3Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain, 4Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona,

Introduction: Attention-Deficit/Hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs), and are associated with increased psychopathology and more dysfunctional personality traits. The study aimed to assess if the presence of ADHD symptoms in patients with EDs affects their short and long-term therapy outcome.

A total of 136 consecutively treated ED patients were considered in this study. Baseline pre-treatment evaluation included the ASRS questionnaire for ADHD symptoms and EDs severity indexes. The clinical symptoms of EDs were evaluated after a CBT-based treatment and after a follow-up of 8 years on average.

Results showed that the baseline symptoms of ADHD did not directly affect the ED outcome after treatment or follow-up. However, the role of baseline ADHD symptoms on therapy result was indirect by acting as a mediator of eating symptomatology.

These results suggest the relevance of identifying specific mediators of therapy outcome in future research in order to design and conduct more personalized approaches.
Session: Paper Session 1: Treatment/Prevention
Vittoria Trolio, Adrienne Mehak, Sarah E. Schell, Sarah E. Racine
McGill University, Montreal, QC, Canada

The interpersonal psychotherapy model of eating disorders (IPT-ED) argues that interpersonal problems result in negative affect, and an inability to cope with this negative affect triggers ED symptoms. Relatedly, it is theorized that ‘feeling fat’ (the somatic experience of being overweight not entirely explained by one’s body mass) results from shifting negative affect onto one’s body which can then be controlled via ED symptoms. Research has yet to identify why negative affect caused by interpersonal problems may trigger ED symptoms as opposed to other maladaptive behaviours. Integrating ‘feeling fat’ into the IPT-ED may help to explain this relationship. This study examined whether interpersonal problems positively relate to ED symptoms via negative affect and ‘feeling fat’ in 179 undergraduate women. We tested the indirect effects of ostracism and peer victimization on binge eating and restricting via negative affect and ‘feeling fat’ using serial indirect effects analyses. Significant indirect effects of both ostracism and peer victimization on binge eating, and of ostracism on restricting, via negative affect and ‘feeling fat’ in a serial manner were observed. Individuals may displace negative feelings that result from interpersonal problems onto their body, triggering ‘feelings of fatness’ and prompting ED symptoms. Future research should investigate whether addressing ‘feeling fat’ in interpersonal psychotherapy can help alleviate ED symptoms.
Session: On-Demand Poster Session
Is self-compassion relevant to the pathology and treatment of eating and body image concerns? A systematic review and meta-analysis
Fidan Turk, Glenn Waller
University of Sheffield, sheffield, United Kingdom

Eating disorders are severe mental health conditions, with substantial consequences for health and quality of life. Such disorders are strongly associated with body image concerns. It is important to consider treatments that might enhance our ability to treat such cases. Recently, there has been a growing body of research on self-compassion in relation to such problems. However, we are not yet clear about the extent of such effects, given the range of studies and methodologies used. Therefore, a systematic literature review was carried out using four key databases. Meta-analysis was used to reach conclusions about the size of the effects and moderators. Random-effects meta-analyses were conducted with 59 studies. Higher self-compassion was associated with lower eating pathology, reduced body image concerns, and greater positive body image, with medium to strong effect sizes (respectively, r = -0.34, r = -0.45, r = 0.52). Furthermore, self-compassion interventions for eating pathology and body image were effective, and superior to control groups (respectively, g = 0.58, g = 0.39). These findings support the role of self-compassion in understanding and addressing eating and body image concerns. Self-compassion appears to be an adaptive emotion regulation strategy in eating disorders and body image.
Session: On-Demand Poster Session
Determining the potential links of self-compassion with eating pathology and body image: a mixed cross-sectional and longitudinal mediational study
Fidan Turk, Glenn Waller
University of Sheffield, sheffield, United Kingdom

These two studies explore what factors mediate the previously established link between self-compassion and eating/body image concerns.Both cross-sectional and longitudinal designs will be used.The cross-sectional study used a community sample of 369 women and 201 men, who completed a set of questionnaires online. These included measures of self-compassion, eating attitudes, body image and potential mediators (rumination, shame, self-criticism, perfectionism).The female sample were asked to complete measures again three and six months later.Final data collection will be completed during August 2020. Hidden formatting deleted.In the cross-sectional study, shame was the most consistent mediator, acting as a partial mediator of the self-compassion-eating/body image relationships among women, and as a perfect mediator among men. In each case, lower self-compassion was associated with higher levels of shame, which were linked to higher levels of eating and body image concerns.The longitudinal analyses to be reported will determine whether this pattern is replicated among women, when using a more conclusive design. Hidden formatting deleted.These results confirm that self-compassion is relevant to eating and body image disturbance. However, they also demonstrate that shame is an important mechanism in that relationship. This pattern suggests that interventions that reduce shame should be considered when addressing issues relating to self-compassion and its links to eating disorders.
Session: On-Demand Poster Session
Eva Van Malderen1, Eva Kemps2, Sandra Verbeken1, Lien Goossens1
1Ghent University, Ghent, Belgium, 2Flinders University, Adelaide, Australia

1. Purpose: Loss of control over eating (LOC) is common among adolescents. Poor inhibitory control is increasingly emphasized as an underlying factor in LOC, but the specific context in which these capacities fail, remains unclear. The affect regulation model proposes that state negative affect may trigger LOC, but research has mostly measured trait negative affect using questionnaires. Therefore, this study examined the interaction between poor inhibitory control and state negative affect in LOC among adolescents using an experimental mood-induction design 2.

Participants were 50 adolescents (10-18 years) from the general community. Participants self-reported on their inhibitory control capacities. They were randomly assigned to a sad or a neutral mood-induction (via a movie fragment), followed by a multi-item food buffet from which they could eat as much as they liked. Finally, participants self-reported on their experience of loss of control while eating. 3. Results: Inhibitory control interacted with the mood-induction in predicting LOC. Adolescents with poor inhibitory control experienced significantly more LOC, but only in the sad mood condition 4. Conclusions: The experience of negative affect appears to be an important trigger for LOC in adolescents with poor inhibitory control. For prevention and early intervention of LOC, inhibitory control training may be most effective in contexts where adolescents experience high levels of negative affect.
Session: On-Demand Poster Session
Ana Vaz1, Eva Conceição1, Tania Roderigues1, Isabel Brandão2, Antonio Neves3, Paulo PP Machado1
1University of Minho, Braga, Portugal, 2University of Porto, Porto, Portugal, 3Santa Maria Hospital, Lisbon, Portugal

Introduction: Individuals with anorexia nervosa (AN) may use restraint behavior to cope with negative emotions. The aim of this study was to explore the relation between emotion regulation difficulties (ERDs) and restraint as well as the role of possible mediators, like depressive mood and shape and weight concern. Method: One hundred and twenty-five participants with AN participated in this study and were recruited in two eating disorders specialized treatment units. Self-report measures were used to assess eating disorders behaviors and attitudes, emotion regulation difficulties and depressive symptoms. Mediation analysis with two possible pathways was conducted to evaluate indirect effects, using the PROCESS macro for SPSS by Hayes. Results: Mediation analysis showed that both depressive symptoms and shape and weight concern significantly mediated the effects of difficulties in emotion regulation on restraint behavior (β = .04, 95% CI [.02, .57]). This model accounted for 30% of the total variance of restraint (F (1, 107) =43,9, p<.001). Conclusions: This study highlights the importance of ERDs in restraint behavior, and possible paths in explaining this relation. ERDs increase depressive symptoms that increase restrain behavior. Also, ERDs increase core ED psychopathology (weight and shape concern) that in turn have an effect in increasing restraint behavior. Results can have impact on treatment formulation and intervention strategies in AN.
Session: On-Demand Poster Session
Melissa M. Vazquez1, Ellen E. Fitzsimmons-Craft1, Lauren A. Fowler1, Jilian Shah1, Andrea K. Graham2, Shiri Sadeh-Sharvit3, 4, 5, Katherine N. Balantekin6, Grace E. Monterubio1, Marie-Laure Firebaugh1, Mickey T. Trockel3, C. Barr Taylor3, 4, Denise E. Wilfley1
1Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 2Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA, 3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, 4Center for m2Health, Palo Alto University, Palo Alto, CA, USA, 5Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel, 6Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA

Introduction: The degree of racial diversity on university campuses may impact eating disorder (ED) risk and socio-environmental factors associated with EDs (i.e., thin-ideal internalization (TII), social comparison (SC), and peer body talk (PBT)) in different racial groups.

4,276 female students across 27 U.S. universities were screened via the Healthy Body Image study for EDs and ED correlates (TII, ED-related SC, PBT). Differences in levels of these constructs across racial groups were examined via ANCOVA and chi-square tests. Multiple regression was used to determine whether the degree of racial diversity at schools moderated the relations between race and ED related variables.

ED correlates were significantly lower in black students compared to white when controlling for age and body mass index (ps<0.001). A higher percentage of black students at a university was significantly associated with lower scores on ED correlates for black students except for TII and eating and exercise SC subscales (ps<0.05) when including relevant school-level covariates in the models (acceptance rate, school size, etc.).

Racial composition of U.S. colleges relates to black female students’ ED risk profiles. Further research is needed to better understand this relationship. Exploring ED prevalence and correlates at the school-level allows for a more nuanced understanding of the sociocultural model of EDs and holds potential to inform policy and treatment.
Session: Paper Session 4: Clinical/Psychopathology
Ulrich Voderholzer1,2,3, Adrian Meule1,2, Sandra Schlegl2
1Schoen Clinic Roseneck, Prien, Germany, 2University Hospital, Department of Psychiatry and Psychotherapy, Munich, Germany, 3University Hospital, Department of Psychiatry and Psychotherapy, Freiburg, Germany

Introduction. Patients with restrictive type anorexia nervosa (AN) have been found to have a lower body weight in the winter than in the summer. Increased compulsive exercise (CE) in the colder months might be a mediating mechanism of this effect, but studies on this are rare. Therefore, the current study investigated seasonal effects on CE in a large sample of patients with AN. Methods. Inpatients with AN (n=991 adults, n=821 adolescents) completed the Compulsive Exercise Test, Commitment to Exercise Scale, Eating Disorder Examination-Questionnaire, and Beck Depression Inventory-II at admission to a multimodal treatment program based on cognitive-behavioral therapy. Results. CE was highest in autumn (autumn>spring>winter>summer) with a significant difference to summer. Age showed no significant interaction effect. Differences regarding the other instruments as well as between AN subtypes will be presented at the conference. Conclusions. Increased CE in autumn may be a possible mechanism that leads to lower body weight in winter in persons with AN. A replication of this effect, also in other cultures or latitudes is warranted.
Session: On-Demand Poster Session
Sydney V. Waring, Allison C. Kelly
University of Waterloo, Waterloo, ON, Canada

Introduction: Although social factors influence body image, it remains unknown whether a given individual’s body image varies from one specific relationship to another. The present study examined this novel concept of relational body image by investigating the extent to which individuals’ body image differs across their relationships with specific others. These differences were expected to arise in part due to differences in how an individual perceives others’ personal body preoccupation, others’ acceptance of her body, and others’ body size relative to her own. Methods: Eighty-seven female undergraduates completed an in-lab egocentric network survey. Participants reported on their typical levels of body appreciation, appearance orientation, and intuitive eating with 10 people in their lives, and reported on the characteristics of these others. Results: Intraclass correlations revealed that participants’ body image and eating varied across their different relationships. Furthermore, participants perceived differences in others’ acceptance of the participant’s body, body preoccupation, and body size. Multilevel modelling showed that participants reported more adaptive body image and eating patterns in relationships with others whom they perceived to be relatively more accepting of their body, less body preoccupied, and more similar in size to them. Conclusions: Findings provide initial support for the concept of relational body image.
Session: On-Demand Poster Session
Alexithymia and anorexia nervosa: The relation between underweight, physiological sensitivity to emotional stimuli, alexithymia and emotion regulation.
Elke Wezenberg1, Simon Peters1, Ger Keijsers2, Maartje Vroling1, 2
1GGNet Amarum, Zutphen, Netherlands, 2Radboud University Nijmegen, Nijmegen, Netherlands

Introduction: The last decade there is extensive scientific evidence that patients with Anorexia Nervosa (AN) experience difficulties with emotion regulation. People with AN are often described as having lack of emotions, called alexithymia. Many therapies rely on the ability to recognize emotions, alexithymia appears to have negative consequences for treatment outcome. There is emerging evidence for this claim. However, we still don’t know what constitutes this alexithymia in AN: Does alexithymia mean that these patients don’t have as much feeling as other people. Does underweight lead to reduced physiological sensitivity? Or does it mean that they are only limited in their ability to verbalize their internal experiences?

40 AN patients and 40 healthy controls will participate. Behavioural and physiological responses (HR, SCR) to emotional stimuli will be assessed. BMI, EDE-Q, TAS-20 & DERS scores will be obtained. Data will be analysed for group differences. The predictive value of BMI, behavioural and physiological responses to emotional stimuli on alexithymia and emotion regulation will be analysed by multiple regression analysis.

Data collection is still ongoing: 75% complete.

The results from this study will shed light on how alexithymia works in AN patients and how strong underweight, behavioural and physiological sensitivity to emotional stimuli predicts alexithymia and emotion regulation.
Session: On-Demand Poster Session
Samantha Wilson, Adrienne Mehak, Sarah E. Racine
McGill University, Montreal, QC, Canada

‘Feeling fat’ refers to the somatic experience of being overweight. Despite its inclusion in the clinical conceptualization and treatment of eating disorders, little empirical research has investigated ‘feeling fat’. Further, ‘feeling fat’ is almost exclusively assessed as a trait, despite the notion that ‘feeling fat’ fluctuates independent of body weight. Examining state ‘feeling fat’ in response to external stimuli can inform us of the nature of this construct. A community sample of women (N = 290) viewed affective images and images of women at different body weights. Standard Self-Assessment Manikin (SAM) valence and arousal rating scales as well as a novel SAM ‘feeling fat’ scale were administered after each image. Theoretically related constructs (trait ‘feeling fat’, thin-ideal internalization, body dissatisfaction, eating pathology) were measured via self-report. Exposure to body images elicited greater state ‘feeling fat’ than affective images, with images of obese bodies producing higher state ‘feeling fat’ than images of thin bodies. Positive correlations were observed between state ‘feeling fat’ in response to images of thin bodies and all variables of interest, whereas associations between state ‘feeling fat’ in response to obese bodies were limited to body dissatisfaction and eating pathology. The development of a state measure of ‘feeling fat’ allows for the investigation of triggers of this bodily experience and will facilitate future research in this area.
Session: On-Demand Poster Session

Skylar L. Borg1, Lauren M. Schaefer1, Vivienne M. Hazzard1, Nicola Herting1,2, Carol B. Peterson3, Ross D. Crosby1,4, Scott J. Crow3,5, Scott G. Engel1,4, Stephen A. Wonderlich1,4
1Sanford Research, Fargo, ND, USA, 2Red River Advocacy Center, Fargo, ND, USA, 3University of Minnesota, Minneapolis, MN, USA, 4University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA, 5The Emily Program, St. Paul, MN, USA

Childhood maltreatment is considered a risk factor for eating disorders (EDs). The current study sought to examine potential moderating factors (i.e., self-discrepancy and negative self-directed style), which may increase or decrease the impact of maltreatment (i.e., emotional abuse, physical abuse, sexual abuse) on later ED symptoms. One hundred twelve men and women diagnosed with DSM-5 binge-eating disorder (BED) completed semi-structured interviews and questionnaires assessing childhood maltreatment, self-discrepancy, negative self-directed style, and ED pathology. Linear regression was used to examine the interaction between each type of maltreatment and each proposed moderator (i.e., self-discrepancy and negative self-directed style) in predicting level of ED severity. Actual:ought self-discrepancy interacted with emotional abuse (β = .26, p = .007) and physical abuse (β = .23, p = .02) to predict ED pathology. The results from the current study suggest that the relationship between childhood abuse (i.e., emotional abuse, physical abuse) and ED pathology may be stronger for those with higher levels of actual:ought self-discrepancy. Further clarification of the relationships between actual:ought self-discrepancy and distinct forms of childhood abuse is needed, as well as intervention studies examining whether targeting actual:ought self-discrepancy provides additional benefit for individuals with BED who experienced emotional or physical abuse.
Session: On-Demand Poster Session
Timothy D. Brewerton1, 2, 3, Ismael Gavidia3, Giulia Suro3, Molly M. Perlman3, 4
1Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA, 2Timothy D. Brewerton, MD, LLC, Mt. Pleasant, SC, USA, 3Monte Nido and Affiliates, Miami, FL, USA, 4Department of Psychiatry & Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA

Introduction:Trauma histories and resultant posttraumatic stress disorder (PTSD) and its symptoms are strongly associated with eating disorders (EDs), which are known to occur across all sexual orientations and gender identities. Prior traumas and PTSD have also been reported to occur significantly more frequently in individuals identifying as lesbian, gay, bisexual, transgender, queer or questioning, non-binary, or other (LGBTQ+). Although higher rates of traumatic events and PTSD have been reported to occur in individuals presenting to higher levels of ED care, little is known about rates of PTSD in LGBTQ+ individuals with EDs.

Methods: We studied a sample of 570 adults with DSM-5 EDs admitted to residential treatment (RT). We examined the rates of current presumptive PTSD and no PTSD by LGBTQ+ status as determined by responses on the Life Events Checklist (LEC-5) and the PTSD Symptom Checklist for DSM-5 (PCL-5).

Results: Nearly 25% of admitting individuals self-reported as LGBTQ+. The LEC-5 total score was significantly higher in the LGBTQ+ group (6.9±5.2) than the non-LGBTQ+ group (5.8±4.4, F=5.2, p≤.03). Rates of presumptive PTSD were also higher in the LGBTQ+ group (.63±.48) compared to the non-LGBTQ+ group (.45±.5, F=12.4, p≤.001).

Conclusions: Individuals with EDs admitted to RT who identify as LGBTQ+ had significantly higher rates of lifetime traumas and presumptive PTSD diagnosis than cisgender heterosexual individuals. Clinical implications are discussed.
Session: On-Demand Poster Session
Vivienne M. Hazzard1, Ross D. Crosby1, Scott J. Crow2,3, Scott G. Engel1, Lauren M. Schaefer1, Timothy D. Brewerton4, Giovanni Castellini5, Kathryn Trottier6, Carol B. Peterson2, Stephen A. Wonderlich1
1Sanford Center for Biobehavioral Research, Fargo, ND, USA, 2Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA, 3The Emily Program, St. Paul, MN, USA, 4Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA, 5Department of Health Sciences, University of Florence, Florence, Italy, 6Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Introduction: Childhood abuse (CA) history is common in patients with binge-eating disorder (BED) and may negatively influence treatment (Tx) outcomes. However, the traumatic impact of CA (e.g., posttraumatic stress disorder; PTSD) may be more influential than CA exposure itself. This study examined CA and PTSD as predictors and moderators of BED Tx outcomes in a randomized controlled trial comparing Integrative Cognitive-Affective Therapy with cognitive-behavioral guided self-help.

In 112 adults with BED, CA was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM-IV, and outcomes were assessed via the Eating Disorder Examination (EDE), Edition 16.0D. Regression models predicting binge-eating episode frequency (BE) and EDE global scores at end of Tx and 6-month follow-up adjusted for baseline level of Tx outcome, demographics, study site, and Tx group.

PTSD predicted greater BE at end of Tx (B=1.32, p=.009) and CA predicted greater BE at follow-up (B=1.00, p=.001). PTSD moderated the association between CA and BE at follow-up (B=2.98, p=.009), such that CA predicted greater BE among participants with PTSD (B=3.30, p=.001) but not among those without PTSD (B=0.31, p=.42). No interactions with Tx group were observed.

Results suggest that a trauma history may hinder Tx success and that traumatic impact may be more influential than CA itself.
Session: On-Demand Poster Session
Renee D. Rienecke1,2, Dan V. Blalock3,4, Daniel Le Grange5, Craig Johnson1, Alan Duffy1, Jamie Manwaring1, Philip S. Mehler1,6,7, Susan F. McClanahan1,2,8
1Eating Recover Center and Insight Behavioral Health Centers, Chicago, IL, USA, 2Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA, 3Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA, 4Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA, 5Department of Psychiatry, University of California, San Francisco, CA, USA, 6ACUTE, at Denver Health, Denver, CO, USA, 7Department of Medicine, University of Colorado, Denver, CO, USA, 8Rush University Medical Center, Chicago, IL, USA

Introduction: Individuals with eating disorders (EDs) report high rates of traumatic events. Trauma-related symptoms can impair ED recovery, but integrating evidence-based trauma treatments into higher-level-of-care (HLOC) settings is difficult. Trauma-informed care (emphasizing safety, collaboration, patient empowerment, and recognizing the role trauma plays in patients’ lives) has been increasingly recommended in HLOC. Method: The PTSD Checklist for DSM-V (PCL-5) was administered at admission and discharge to 622 consented patients with EDs at two HLOC facilities. ED treatment was trauma-informed. Treatment consisted of 2 3-hour evidence-based skills groups (e.g., dialectical behavior therapy), 3 supervised meals and 2-3 snacks per day. Patients received two individual therapy sessions and one family therapy session per week. Clinicians were trained in delivering trauma-informed care.

At admission, 53.7% (n=334) met PCL-5 threshold criteria associated with PTSD symptoms severe enough to meet a PTSD diagnosis. At discharge, only 33.1% (n=206) met the same PCL-5 criteria. Cluster D (negative alterations in cognition and mood) and E (hyperarousal) symptoms showed the greatest decreases (Cohen’s d=.72 and .65, respectively). Cluster B (intrusions) and C (avoidance) showed weaker but still meaningful decreases (Cohen’s d=.35 and .31, respectively).

Trauma-informed care in HLOC ED treatment may be associated with reductions in ED patients’ PTSD symptoms.
Session: On-Demand Poster Session

Brittany K Bohrer1, Kara A Christensen2, Marianna L Thomeczek2, Natalie A Babich2, Sara R Gould3, Kelsie T Forbush2
1UC San Diego Health Eating Disorders Center for Treatment and Research, San Diego, CA, USA, 2University of Kansas, Lawrence, KS, USA, 3Children's Mercy Hospital Eating Disorders Center, Kansas City, MO, USA

Purpose: Eating disorders (EDs) are prevalent among college students, yet fewer than 20% of college students with EDs receive treatment. Given the lack of specialized ED treatments on campuses, mobile adaptations of evidence-based treatments may be innovative methods of disseminating treatment. The purpose of this study was to administer a mobile, self-guided cognitive-behavioral therapy (CBT-gsh) for EDs in college students.

A multiple-baseline design was used to examine intervention effects on ED psychopathology and clinical impairment. Data were examined using visual analysis and Tau-U effect-size calculations.

Participants (N=3 [recommended N for multiple-baseline design]; data collection is ongoing and larger N will be presented) demonstrated significant decreases in Eating Pathology Clinical Outcomes Tracking (EPCOT) Total Score and Binge Eating. Clinical impairment decreased. Results were mixed for EPCOT Restricting, Excessive Exercise, and Body Dissatisfaction.

This study was one of the first to examine mobile CBT-gsh for ED treatment in college students and one of few applications of a multiple-baseline design in the ED field. The current findings give preliminary evidence that mobile CBT-gsh is an effective treatment for reducing binge eating, overall ED pathology, and clinical impairment. Mobile CBT-gsh is an innovative tool that could be scaled to reach more persons with EDs, especially those who are under-served.
Session: On-Demand Poster Session
Linda Booij1,2,3,4, Jeanne Sansfaçon5, Lise Gauvin4,6, Émilie Fletcher5, Farah Islam7, Mimi Israël3,5,8, Howard Steiger3,5,8
1Concordia University , Montreal, QC, Canada, 2Centre de Recherche de l’Hôpital Sainte-Justine, Montreal, QC, Canada, 3McGill University, Montreal, QC, Canada, 4Université de Montreal, Montreal, QC, Canada, 5Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada, 6Centre de Recherche du Centre Hospitalier, Montreal, QC, Canada, 7KU Leuven, Leuven, Belgium, 8Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada

Purpose: Identifying modifiable predictors of outcomes in the treatment of eating disorders (EDs) may help to tailor interventions to patients’ individual needs and improve treatment efficacy. The aim of this meta-analysis was to quantify the association between pre-treatment motivation and post-treatment changes in ED symptoms.

We reviewed 196 studies reporting on change on indices of ED symptomatology. Studies were meta-analyzed using both combined-probability and effect-size approaches; and were reviewed qualitatively when the number of studies or reported data were insufficient.

Forty-two articles were included in the meta-analyses, comprising over 4400 patients. Despite substantial heterogeneity as to study methodologies, our meta-analyses showed consistent positive effects of motivation on global ED symptomatology (r=.17, CI: 0.09-0.24). There were no associations with depression/anxiety (r=.00, CI: -0.19-0.19). Additionally, while we confirmed findings of qualitative reviews showing associations between pre-treatment motivation and post-treatment weight gain (r=.14, CI: 0.02-0.26) and reductions in binge-eating (r=.48, CI: 0.38-0.58), effect sizes of the preceding associations were inflated by publication bias and small sample sizes. Conclusion: Our meta-analysis underscores the importance of incorporating treatment engagement approaches in the treatment of EDs, regardless of patient’s demographic or specific clinical features and treatment modality.
Session: On-Demand Poster Session
Kayla Costello1, Tom Hildebrandt1, Daniel Herron1, Andreas Michaelides2, Robyn Sysko1
1Mount Sinai School of Medicine, New York, NY, USA, 2Noom Inc., New York, NY, USA

Introduction: Rigorous research on smartphone apps for individuals pursuing bariatric surgery is limited. Noom Bariatric Health is a recently developed platform using standard behavioral weight loss programs with specific modifications for bariatric surgery. The current study evaluated efficacy of this app for improving diet, exercise, and psychosocial health over 8-weeks prior to surgery. Method: Fifty patients were randomized to receive either Noom Bariatric Health or treatment as usual at Mount Sinai prior to a surgical procedure. Measures of depressive symptoms, quality of life, physical activity, and diet were administered at baseline and at 8-week follow-up.

Results of random effects models controlling for baseline severity, indicated that the Noom group had significant improvements on all subscales of the DASS, the social functioning, physical, and pain subscales of the SF-36, increased physical activity, and decreased total calories consumed. Younger Noom Bariatric Health users faired better on most measures than older men and women seeking surgery

The Noom Bariatric Health platform application appears to significantly improve several measures of physical activity, nutrition, and social and emotional functioning in candidates for bariatric surgery, which could augment surgical outcomes. These results may be particularly relevant for younger users.
Session: On-Demand Poster Session
Jennifer Couturier1, Melissa Kimber1, Melanie Barwick2, Gail McVey2, Sheri Findlay1, Cheryl Webb1, Alison Niccols1, James Lock3
1McMaster University, Hamilton, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3Stanford University, Stanford, CA, USA

Introduction: We examined fidelity to Family-Based Treatment (FBT) measured by several different raters including an expert, a peer, therapists themselves, and parents.

Methods: Each therapist audio-recorded at least one FBT case and submitted recordings from session 1, 2, and 3 from phase 1, plus one additional session from phase 1, two sessions from phase 2, and one session from phase 3. These sessions were rated by an expert and a peer rater using a validated FBT fidelity measure. Therapists and parents rated fidelity immediately following each session. Inter-observer reliability was calculated using the intraclass correlation coefficient (ICC), comparing the expert ratings on each item to ratings from each of the other raters. In addition, mean scale scores were compared using repeated measures ANOVA.

Results: Agreement was the best between expert and peer, with excellent, good, or fair agreement in 7 of 13 items from session 1, 2 and 3. Scale level analysis indicated that expert fidelity ratings for phase 1 treatment sessions scores were significantly higher than the peer ratings and, that parent fidelity ratings tended to be significantly higher than the other raters across all three treatment phases. There were no significant differences between expert and therapist mean scores.

Conclusions: Peer rating or therapist self-rating may be considered pragmatic, efficient, and reliable approaches to fidelity assessment for real-world clinical settings.
Session: On-Demand Poster Session
Primary care-takers as co-therapists during home treatment of adolescent AN
Brigitte Dahmen1, Sophie Altdorf1, Kathrin Heider1, Jochen Seitz1, Astrid Dempfle2, Beate Herpertz-Dahlmann1
1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany, 2Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany

Purpose of the study: Anorexia nervosa (AN) frequently begins in late childhood or adolescence. The psychosocial burden on the primary care-takers of adolescents with AN is high and affects treatment (Salerno et al., 2016; Rhind et al., 2016). The aim of this study was to investigate the psychosocial stress and coping abilities of the primary care-takers during home treatment, a novel therapeutic concept for adolescent AN patients and their families in Germany.

22 adolescents admitted for inpatient treatment with AN received treatment after a short inpatient stabilization at home involving the family for 3-4 months. The program consists of several weekly visits at home (individual and family meetings) by a multi-professional team (Herpertz-Dahlmann et al., accepted). The burden and skills of the primary care-takers (all parents) were identified with standardized questionnaires (AESED, CASK, EDSIS) at the time of admission, at the end of home treatment and after a 1-year follow-up after admission.

The parents` burden was significantly reduced during treatment. Parents' ability to deal with the condition also improved over the course of home Treatment.

Home treatment of adolescents with AN by a multidisciplinary team instead of a longer inpatient stay did not seem to be related to high parental stress. On the contrary, primary care-takers as co-therapists seemed to benefit significantly from this new treatment method.
Session: On-Demand Poster Session
Bethan Dalton1, Yael D. Lewis1,2,3, Savani Bartholdy1, Maria Kekic1, Jessica McClelland1, Iain C. Campbell1, Ulrike Schmidt1,4
1Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom, 2Hadarim Eating Disorder Unit, Shalvata Mental Health Centre, Hod Hasharon, Israel, 3Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, 4South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom

Introduction: This study assessed longer-term outcomes from a randomised controlled feasibility trial of 20 sessions of real versus sham high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex in patients with severe enduring anorexia nervosa (SE-AN).

Thirty participants who completed the original study protocol were invited to take part in an open follow-up (18-months post randomisation), assessing body mass index (BMI), eating disorder (ED) and other psychopathology.

Twenty-four participants (12 each originally allocated to real/sham) completed the 18-month follow-up. Ten of 12 participants who originally received sham treatment had real rTMS at some stage during the follow-up. A medium between-group effect size was seen for BMI change from baseline to 18-months favouring those originally allocated to real rTMS. In this group at 18-months, five participants were weight recovered (BMI >18.5 kg/m2), compared with one in the original sham group. Both groups showed further improvement in ED symptoms during the follow-up. Effects on mood were largely maintained at follow-up, with catch-up effects in the original sham group.

Findings suggest that rTMS treatment effects on mood are durable and that BMI and ED symptom improvements need time to emerge. Large-scale trials are needed.
Session: On-Demand Poster Session
Marit Danielsen1,2, Sigrid Bjørnelv1,2, Siri Weider1,3, Tor Å Myklebust4, Henrik Lundh1, Øyvind Rø5,6
1Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, Levanger, Norway, 2Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway, 3Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway, 4Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway, 5Regional Eating Disorder Service, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway, 6Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Introduction: Treatment outcome after inpatient treatment is reported as poorer than outcome after outpatient treatment. Research to date has not provided consistent results for predictors of treatment outcome. The aims of the study were to investigate outcome at follow-up after inpatient treatment and predictors of treatment outcome. Methods: The sample consisted of 150 female adult former patients (66% AN, 21% BN and 13% OSFED). Mean age at admission was 21.7 years. Data collection was performed at admission, discharge and follow-up (mean 2.7 years). Definition of remission was based on EDE-Q Global score (≤ 2.5), body mass index (BMI ≥ 18.5) and no binge/purge behavior during the last four weeks. Results: At follow-up, 35.2% of the participants were classified as being in remission. Significant symptom reduction (in all patients) (Cohen’s d = 0.46–0.92) and significant increase in BMI (AN participants) (Cohen’s d = 1.76) was found. Increased BMI (p <0.05), admission level of core ED symptoms (p <0.05) and reduced core ED symptoms (p <0.01) during inpatient treatment were found as significant predictors of outcome.

About 1/3 of the participants were classified as being in remission at follow-up. However, the majority of participants experienced significant symptom improvement. The study results confirmed the importance of achieving healthy weight and reduced core ED symptoms during inpatient treatment to enhance the rate of remission among ED patients.
Session: On-Demand Poster Session
Nandini Datta1, Brittany Matheson1, Daniel Le Grange2, Harry Brandt3, Blake Woodside4, Katherine Halmi 5, Denise Wilfley 6, James Lock 1
1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, 2Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA, 3St. Joseph Medical Center, University of Maryland, Townson, MD, USA, 4Program for Eating Disorders, Toronto General Hospital, Toronto, ON, Canada, 5Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA, 6Washington, Department of Psychiatry, University in St. Louis, St Louis, MO, USA

Background: This study explores the role of weight gain during medical stabilization hospitalization on weight outcomes between three outpatient treatments for adolescent anorexia nervosa (AN): Adolescent Focused Therapy (AFT), Systemic Family Therapy (SFT), and Family Based Treatment (FBT). Methods: A secondary analysis of weight gain data (N= 213) of adolescents (12-18 years) meeting DSM-IV criteria for AN (exclusive of amenorrhea criteria) who participated in two randomized clinical trials (RCTs) was conducted. Main outcomes examined were changes in weight restoration (>94% EBW), differences in weight change attributable to hospital weight gain, and amount of weight gain per day of hospitalization (efficiency) by treatment type. Results: Weight gain resulting from hospitalizations did not substantially change weight restoration rates. Hospital weight gain contributed most to overall weight gain in AFT compared to FBT and SyFT. Efficiency of hospital weight gain (in kilograms) was greater in AFT relative to SyFT but not FBT. Conclusion: Brief medical stabilization weight gain does not contribute substantially to weight recovery in adolescents with AN who participated in RCTs. Those treated in AFT gained more weight overall and more quickly as result of hospitalization, while those treated with SyFT gained the least weight per day of hospitalization, perhaps speaking to the varying processes involved in the treatment.
Session: On-Demand Poster Session
Kamryn T. Eddy1,2, Kendra R. Becker1,2, Lauren Breithaupt1,2, Helen B. Murray1,2, Jenny H. Jo1, Megan C. Kuhnle1, Melissa J. Dreier1, Kristine Hauser1, Madhusmita M. Misra1,2, Elizabeth A. Lawson1,2, Jennifer J. Thomas1,2
1Massachusetts General Hospital, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA

Introduction: There are no evidence-based treatments for avoidant/restrictive food intake disorder (ARFID) in adults. Method: This study evaluated the acceptability, feasibility, and proof-of-concept of cognitive-behavioral therapy for ARFID (CBT-AR) in an uncontrolled trial. Males and females (18-55 years) were offered 20-30 outpatient sessions of CBT-AR.

Of 18 eligible adults offered CBT-AR, 15 took up the treatment. Eight have completed treatment and seven will complete by October 2020. To date, none have dropped out. All patients endorsed high ratings of treatment credibility and expected improvement at session 1. Based on preliminary analyses of the 8 completers, therapists rated the majority (88%) of completers as “much improved” or “very much improved,” and 88% of completers reported high treatment satisfaction. ARFID severity on the Pica, ARFID, and Rumination Disorder Interview (PARDI) decreased from pre- to post-treatment, d=1.28, p=.003; and patients incorporated a mean of 20.13 novel foods. The underweight subgroup (n=3) showed an upward trend in weight gain of 13.37 lbs, d=2.25, p=.096. At post-treatment, 38% of patients no longer met criteria for ARFID. Conclusion: To our knowledge, this is the first prospective treatment study of ARFID in adults. Findings provide preliminary evidence of the feasibility, acceptability, and proof-of-concept of CBT-AR for heterogeneous ARFID presentations in older patients. Randomized controlled trials are needed.
Session: Paper Session 1: Treatment/Prevention
Gamification of a daily, neurocognitive training program enhances weight loss for men but not for women
Drexel University, PHILADELPHIA, PA, USA

A major contributor to the obesity epidemic is the overconsumption of high-calorie foods, which is partly governed by inhibitory control, the ability to override pre-prepotent impulses and drives. Computerized inhibitory control trainings (ICTs) have demonstrated success at impacting real-world health behaviors, and at improving weight loss. Real-world impact depends on compliance with ICTs that are repeated frequently over an extended duration. Gamification (e.g., incorporating a storyline, sounds, graphics) might enhance compliance with such regimens. Previous findings from a mostly-female sample did support this hypothesis. However, men may be more motivated by gaming elements, and thus the present study investigated whether gender moderated the effect of a gamified ICT on weight loss. 76 overweight individuals received a no-sugar-added dietary prescription and were randomized to 42 daily and 2 weekly ICTs focused on sweet foods that were either gamified or non-gamified. Results supported the hypothesis that gamification elements had a positive effect on weight loss for men and not women (p = .03). However, mechanistic hypotheses for the moderating effect were generally not supported. These results suggest that gamification of ICTs may boost weight loss outcomes for men and not women, but further research is needed to determine the specific mechanisms driving this effect and to arrive at gamification elements that enhance effects for both men and women.
Session: On-Demand Poster Session
A new instrument to evaluate the body experience in ED patients: development and validation of the Functional Body Questionaire in a Colombian population.
Juanita Gempeler1,2, Maritza Rodriguez1,2, Sergio Castro1,2, Carolina Villanueva1,2, Maria Mercedes Ospina1,2
1Equilibrio, Bogota, Columbia, 2Javeriana University, Bogotá, Columbia

Introduction: Functional Body refers to cognitive, motor and autonomic responses in relation to one’s own body independent of body disatisfaction or distortion. We developed a questionnaire to assess body experience in ED patients: the Functional Body Questionnaire (FBQ). Aim: To continue the development and validation of the FBQ and compare the scores of FBQ in a sample of ED patients with a control sample.

Methods: We applied the FBQ and EAT-26 to a sample of 51 school students (age 12-17) and compared the results with a sample of 51 ED patients. We did a descriptive analysis of the population and performed a Wilcoxon rank-sum test to evaluate the median difference. We computed the rho coefficient (Spearman) between the EAT-26 and FBQ . We also obtained odds ratio between the score of FBQ and a set of confirmation questions to assess body experiences.

Results: In the control sample we did´nt find a correlation between EAT-26 and FBQ scores (-0,089), ruling out ED symptoms. FBQ scores differ between cases and controls :controls presented higher scores of FBQ (p =0.003). Subscales showed statistically significant differences (p = 0.012 and p <0,001). A significant correlation between FBQ scores and the confirmation questions in ED cases was found .

Conclusions: FBQ seems to be a valid way to discriminate between normal people and ED patients in their body experience. Further research will aim to find optimal cut-off points. Psychometric properties will be reported.
Session: On-Demand Poster Session
Moria Golan1,2
1Tel Hai Academic College, Tel Hai, Israel, 2Shahaf, Private Eating Disorder Centre, Tel Hai, Israel

Introduction: Targeted therapeutic strategies to improve eating disorder treatments and outcomes are crucial. Objectives: To address the gap between theory of self-regulation & mentalization in the management of eating disorders by suggesting a newly developed axis, ECOSA, to better conceptualize the complex interaction between eating style and control conditions.

A randomized blinded study using the Eating Attitudes Test 26, the Difficulties in emotion regulation scale and the Reflective Functioning Questionnaire, as the main outcomes, was used to assess the impact of integrating the suggested tool in mentalization based treatment. Eight experienced therapists, and their consecutively 9 admitted clients with ED, were randomly allocated to the intervention group that received mentalization-based psychotherapy with ECOSA, and to the control group with treatment as usual (interpersonal psychotherapy-resolving problems & symptomatic recovery). Results: A statistically significant improvement was revealed in both groups in respect to ED symptoms, DERS, and mentalization score. Superiority of the mentalization-based treatment was statistically significant in regard to some subscales of DERS and to the reflective functioning score, with large effect size.

The results of this pilot study are promising, and warrant consideration of more rigorous study designs to explore the potential usage of clinical tools to enhance mentalization among people with ED.
Session: On-Demand Poster Session
Eva-Maria Gröbner1, Florian Fischmeister2, Kathrin Kollndorfer1, Michael Zeiler1, Beate Herpertz-Dahlmann3, Andreas Karwautz1
1EDU at C&A Psych Med Univ Vienna, Vienna, Austria, 2Univ Graz, Graz, Austria, 3C&A Psych at RWTH Aachen, Aachen, Germany

INTRODUCTION: Mechanisms of alterations of gut microbiota and action of probiotics are under investigation in healthy adults & several clinical groups including anorexia nervosa (AN). The gut microbiota in AN exhibits profound perturbations which improve with weight gain in richness, but short chain fatty acid profiles & gastrointestinal symptoms do not. Thus, weight gain alone does not change the microbiota sufficiently, pointing to the putative need of adding probiotics to refeeding diet. METHODS: It is therefore crucial, to study the clinical efficacy of probiotics administration in hospitalized adolescents with 60 AN compared with placebo and 30 healthy controls during a 6 months double-blind RCT plus 6-months follow-up. All behavioral measures are linked to changes in neural measures using fMRI including neuropsychology. This combination of methods is crucial and promising. RESULTS: After treatment with probiotics, we expect alterations in gut microbiota approaching a composition of healthy weight individuals, improvement of gastrointestinal complaints and of psychopathology, a reduction of inflammatory processes and improved weight gain after treatment and at follow-up. Outcomes are BMI, gastrointestinal complaints, eating disorder symptoms, anxiety and mood, serum inflammatory markers, gut permeability and immunological parameters. CONCLUSIONS: Oral administration of multi-strain probiotics could add to a multidimensional treatment approach of AN.
Session: On-Demand Poster Session
Natalie Gukasyan, Angela S. Guarda, Colleen C. Schreyer, Mary P. Cosimano, Roland R. Griffiths
Johns Hopkins University School of Medicine, Baltimore, MD, USA

Introduction: Clinical trials of psychedelic-assisted psychotherapy suggest possible efficacy for several mental health conditions. Little is known about the acceptability of this treatment approach in anorexia nervosa (AN), or the typical profile of individuals who would seek such treatment. Methods: Individuals who were interested in participating in a pilot study on the safety and efficacy of psilocybin-assisted psychotherapy for AN responded to social media advertising and community referrals. Respondents completed a 30-minute online screening survey that included information on eating disorder diagnoses, treatment history, and mental and physical health comorbidity. Results: 285 respondents were screened. Mean age was 31.1 ± 0.7 years, 90.2% were female, 78.3% had a lifetime diagnosis of AN (23.9% of bulimia nervosa, 8.1% binge eating disorder, 11.2% ARFID, 7.4% other). Mean number of years since diagnosis of AN was 12.2 ± 0.7 years. 83.2% had prior eating disorder treatment (68.1% outpatient, 50.9% inpatient or residential). 79.8% reported other mental health diagnosis, and 56.5% reported concurrent treatment with prescription psychotropics. 38.6% reported having used a psychedelic in the past. Conclusions: Individuals with AN demonstrated interest in participating in a study of psilocybin-assisted psychotherapy. Respondents had higher rates of both past treatment and prior psychedelic use than expected from epidemiological data on this population.
Session: On-Demand Poster Session
Kelsey E. Hagan1,2, Nandini Datta3, Alexa M. L'Insalata3, Brittany E. Matheson3, Ayotola Onipede3, Sangeeta Mondal3, Sasha Gorrell4, Cara M. Bohon3, Daniel LeGrange4, James D. Lock3
1Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA, 2New York State Psychiatric Institute, New York, NY, USA, 3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA, 4Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA

Purpose: Family-based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa (AN). However, remission is not achieved for about half of adolescents with AN treated with FBT. Understanding predictors of response to FBT, such as eating disorder psychopathology and parental self-efficacy, may inform treatment development and improve outcomes.

Network analysis was used to identify central symptoms of adolescent AN in youths who completed the EDE interview prior to receiving FBT (N=405). Additionally, bridge symptoms among adolescent AN and parental self-efficacy in re-feeding their child were identified in a subset of participants (N=125). Central and bridge symptoms were tested as predictors of early response (≥ 2.4 kg weight gain by FBT session four) and end-of-treatment (EOT) remission (≥ 94% expected body weight and EDE global score within 1 SD of norms).

Central symptoms of adolescent AN were desire to lose weight and feeling fat. These symptoms predicted EOT remission but not early response. Bridge symptoms were parental beliefs about being "tough" on AN and adolescent dietary restraint. Bridge symptoms did not predict early response nor EOT remission.

Findings highlight the prognostic utility of core symptoms of AN. Parent beliefs about being "tough" on AN may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT to improve outcomes.
Session: Paper Session 1: Treatment/Prevention
Johannes Hebebrand1, Gabriella Milos2, Nikolaus Barth1, Susanne Tan3, Christine Ludwig1, Lars Libuda1, Judith Bühlmeier1, Martin Wabitsch4, Jochen Antel1
1Department of Child and Adolescent Psychiatry, University Hospital Essen, University Duisburg-Essen, Essen, Germany, 2Eating Disorders Unit, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland, 3Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany, 4Center for Rare Endocrine Diseases, Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm, Germany

Introduction: The underlying hypothesis is that metreleptin improves hyperactivity and depression in patients with anorexia nervosa (Hebebrand et al. 2019; Frontiers in Psychology).

Methods: Two adolescent patients aged 17 (AB; female; Milos et al., Translational Psychiatry, accepted) and 15 years (CD, male, unpublished data) with severe anorexia nervosa (AN) were treated with subcutaneously applied human recombinant leptin for seven and 17 (treatment currently ongoing) days with dosages of 3 to 10 mg per day. Patients and their parents gave written informed consent for the off-label use of metreleptin (licensed by both FDA and EMA for treatment of lipodystrophy). Visual analog scales, Eating Disorders Inventory-2, Beck Depression Inventory-II, Childhood Depression Rating Scale (CD) and an accelerometer (CD) were used to assess psychopathology and safety parameters; blood sampling was repeatedly performed.

Results: Within 1-5 days metreleptin had strong and beneficial effects on hyperactivity, depression, rigidity, social interaction, fear of weight gain, and cognition. The strong clinical effects were readily apparent to staff members and parents.

Conclusions: A double blind randomized controlled trial is urgently required to exclude expectation effects. No adverse effects were observed. Weight gain proved difficult in both patients, possibly due to a history of obesity in AB and of a childhood onset body image disturbance in CD.
Session: On-Demand Poster Session
A software-assisted qualitative study on the use of music in people with anorexia nervosa
Hubertus Himmerich1,2, Briana Applewhite1, Aishwarya Krishna Priya1, Valentina Cardi1
1Department of Psychological Medicine, King's College London, London, United Kingdom, 2South London and Maudsley NHS Foundation Trust, London, United Kingdom

Anorexia nervosa (AN) is an eating disorder associated with a high mortality and an often chronic and disabling course. Thus, novel treatment options should be explored. We performed two focus groups with a total of six people with AN on their use of music and their thoughts about music as an additional therapeutic option. Interviews were transcribed and analyzed in-depth using the NVivo 12 software package. The most prevalent theme throughout the focus groups involved positive expressions, emotions and memories related to music. This theme occurred in ~25% of the data. The importance of music was the second most common theme. Negative feelings and memories associated with music accounted for only ~10% of all references. All six patients expressed that they see benefit in using music therapy as an adjunct to their current treatment. Our analysis shows that people with AN connect music mainly with positive emotions and memories. Therapists might think about applying music more frequently during their sessions with AN patients and consider adding music therapy to their overall treatment concept. However, the results also suggest that music can influence mood not only positively but negatively as well. Quantitative research in bigger patient samples and randomized clinical trials will be necessary to verify these results.
Session: On-Demand Poster Session
Integration of Movement and Sports into the Therapy of Anorexia Nervosa:
An explorative study about the integration of a guided functional exercise program as a supplement to standard therapy

Michael Hollauf, MSc
Lading 61, St.Michael im Lavanttal, Austria

Background: Due to the high prevalence and potentially adverse effect of unhealthy, sportive activity linked to dysfunctional, compulsive attitudes there often is a prohibition of movement in the therapy of anorexia nervosa. The aim of this explorative pilot study is to test the effects of a guided and functional exercise program as a supplement to the standard therapy treatment of anorectic patients. Question: The study should determine which outcomes an additional functional exercise program yields with patients with anorexia nervosa within the setting of a standard therapy treatment.

Methods: Weight, BMI, athletic endurance tests and the questionnaires Reasons for exercise inventory and Commitment to exercise scale were used for evaluation at the beginning and the end of the intervention.

Results: All four participants achieved a significant increase in BMI from average 16.4 to 18.4. In the athletic endurance tests an increase in coordination and power as well as in the total score was achieved. Health become an increasingly important reason to everyone for the practice of sport. At the end of the intervention the patients had less strict routines. Discussion: The implementation of the functional exercise program had no negative effect on the weight gain. The intervention has led to an improvement in the motor function and a reduction of dysfunctional attitudes.Thus, a prohibition of physical activity during therapy does not seem sensible.
Session: On-Demand Poster Session
Lara Keller, Jochen Seitz, Samira Schreiber, Brigitte Dahmen, Beate Herpertz-Dahlmann
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany

Introduction Growing evidence on the gut-brain axis offers the chance to develop innovative therapies for patients with psychiatric diseases. Patients with AN show profound alterations of the gut microbiome that do not fully recover with weight gain. Previous studies have shown effects of PUFA that might be beneficial in the treatment of AN, affecting e.g. the microbiome, body weight and executive functions. Methods The Microbiome Gut-Brain interaction in Anorexia Nervosa (MiGBAN) study is a multi-center European ERA-NET NEURON consortium including preclinical and clinical studies. Here we present a longitudinal, double-blind, randomized, placebo-controlled trial examining the effects of PUFA administration on the gut microbiome currently conducted at the University Hospital Aachen. Within two years, 60 patients aged 13-19 years with AN will receive PUFA or placebo for 6 months. After one year, the stability of effects will be tested. Results Patient recruitment started in January 2020. PUFA effects on the gut microbiota, body weight, eating disorder psychopathology, comorbidities and gastrointestinal symptoms are being tested. Additionally, neuropsychological tests and fMRI measurements assess executive functions. Anti-inflammatory effects of PUFA in AN are tested via serum inflammation and gut permeability markers. Conclusions PUFA supplementation could contribute to microbiome modification and would be a readily applicable additional component of multimodal AN treatment.
Session: On-Demand Poster Session
Innovative Moments and the process of change in the treatment of adults with Bulimia Nervosa
Iakovina Koutoufa1, Eva M. Conceição2, Miguel Gonçalves2, Ross Crosby3, Stephen Wonderlich3, Inês Mendes1
1Department of Psychology, Royal Holloway University of London, London, United Kingdom, 2School of Psychology, University of Minho, Braga, Portugal, 3Sanford Center for Bio-Behavioral Research Sanford Research, Fargo, ND, USA

Psychotherapy researchers have been increasingly interested in identifying processes of change to improve treatment outcomes. Innovative Moments (IMs) are markers in the patient narrative that oppose the assumptions of the problem. This exploratory study aims to investigate the development of IMs throughout treatment of bulimia nervosa (BN) and examine their associations with bingeing and purging frequency change. IMs were coded in 60 sessions across ten participants (five good and five poor outcome cases) in different stages of the treatment by two independent raters. Bingeing and purging frequency were also monitored in the sessions examined. Generalized Estimation Equations (GEE) investigated trajectories of IMs for good and poor outcomes cases and tested whether IM predicted symptoms change. The proportion of IMs in this sample was low in comparison to previous studies. Multi-level analyses indicated that most IMs changed significantly over time. Results also showed that only Protest subtype II, describing a position of assertiveness and empowerment, in one session predicted symptom changes in the following session. Models where bingeing and purging frequency predicted IMs showed a better fit than vice versa. Preliminary findings suggest that Protest II IMs play a role in the process of change in BN. This study provides a novel clinical understanding of important processes in psychotherapy for BN and their association with treatment outcome.
Session: On-Demand Poster Session
Isabel Krug1, Olivia McConchie 1, Stephanie Fung1, Sarah Giles1, Chia Huang2, Kim Felmingham1, Matthew Fuller-Tyszkiewicz3
1The University of Melbourne, Melbourne, Australia, 2The Melbourne Clinic, Melbourne, Australia, 3Deakin University, Melbourne, Australia

Objectives:Oxytocin has been shown to improve emotion recognition and trust in the general population and in eating disorder (EDs) patients, however this has not been examined in an at-risk population for EDs. The current study aimed to investigate the impact of oxytocin on emotion recognition and trusting behaviours. Method: Female university students (n=149), of whom n=52(34.9%) where at risk for an ED,were randomly allocated to receive in a double-blind nature, a single dose of oxytocin intranasal spray (n=76) or a placebo (saline) intranasal spray (n=73). Sociodemographic and ED symptomatology data was collected at baseline. Forty-five minutes after receiving an intranasal spray, participants completed an experimental measure of emotion recognition and an investor trust task. State anxiety, mood and body satisfaction were also assessed before and after participants received the intranasal spray.

The oxytocin group exhibited greater positive affect, trusting behaviours, recognition of overall and positive emotions scores than the control group post-manipulation. These effects were not moderated by ED symptom severity, nor were effects found for negative affect, anxiety, negative emotion recognition or for body image states.

Oxytocin was effective in improving trust, positive emotions and recognising emotions overall. These findings were independent of ED status and therefore suggest that the general population could benefit from oxytocin.
Session: On-Demand Poster Session
Preoperative inhibitory control predicts weight loss 1 year after bariatric surgery
Camilla Lindvall Dahlgren1,2, Ingela Lundin Kvalem 3, Jon Kristinsson4, Inger Eribe4, Øyvind Rø1,5, Cathrine Brunborg6, Gro Walø-Syversen 1
1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway, 2Department of Psychology, Bjørknes University College, Oslo, Norway, 3Department of Psychology, University of Oslo, Oslo, Norway, 4Centre for Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway, 5Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway, 6Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway

Background: Executive function (EF), in particular inhibitory control, has been associated with weight loss (WL) in behavioral WL treatment for obesity. However, few studies have focused on the relationship between preoperative inhibitory control and postoperative WL following bariatric surgery, and the potential mediating role of maladaptive eating behaviors. Objectives: The aim of this study was to investigate preoperative EF as a predictor of WL one year following surgery, and to explore the role of postoperative grazing on inhibitory control and WL.

Participants (80 % female, mean age = 41 years) completed neuropsychological testing before, and one year following bariatric surgery (N = 61/80; 76% follow-up). Regression analyses were used to examine the relationship between preoperative EF and percentage total weight loss (%TWL), and structural equation modeling was used to examine compulsive grazing as a mediator.

Preoperative inhibitory control explained 8 % of the variance in %TWL (p≤ .05). Preoperative working memory was not significantly associated with %TWL. Postoperative compulsive grazing was significantly associated with %TWL (p≤ .05), but did not mediate the association between preoperative inhibitory control and %TWL. Conclusion: Preoperative inhibitory control is a relevant predictor of postoperative WL, and compulsive grazing is an eating behavior warranting clinical attention after surgery.
Session: On-Demand Poster Session
Caitlin M McMaster1, Tracey Wade2, Janet Franklin3, Susan Hart1,4
1Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia, 2Blackbird Initiative, Órama Institute, Flinders University, Adelaide, Australia, 3Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney, Australia, 4Nutrition & Dietetics, St Vincent's Hospital, Sydney, Australia

Introduction: Amongst current research regarding dietetic intervention for eating disorders (EDs), few studies have included the input of ED consumers and none have considered the degree to which consumers and carers agree with the view of ED specialists in relation to dietetic treatment.

The ED specialist panel from a previously conducted Delphi study which aimed to develop consensus-based guidelines for dietetic treatment for EDs was re-coded into two new panels - ED specialist dietitians and ED specialist clinicians. Chi-squared tests were performed to identify statistically significant differences in responses from dietitians (n=31), other clinicians (n=48) and consumers and carers (n=55).

Twelve per cent of statements showed statistically significant differences (p<0.05) in the level of agreement between panels and although not statistically significant, a further 16% of statements had a difference of at least 20% in the level of agreement between panels. Discrepancies were primarily observed in relation to dietetic management of children and adolescents and inclusion of behavioural tasks such as exposure to feared foods and self-monitoring.

This study highlights discrepancies amongst ED specialists and consumers regarding what dietetic treatment for this population should encompass. Additionally, it indicates the need for further research into optimising dietetic treatment for EDs which is conducted in collaboration with individuals with lived experience.
Session: On-Demand Poster Session
Janell L. Mensinger1, Dana Sturtevant2, Hilary Kinavey2
1Villanova University, Villanova, PA, USA, 2Be Nourished, Portland, OR, USA

Introduction: In a time of exceptional uncertainty, especially acute for individuals from underserved communities with limited access to care, it is more important than ever to evaluate scalable virtual programs that will support the needs of those exposed to traumatic distress who are struggling with eating and body-related concerns. This study aimed to evaluate the effectiveness of Body Trust®, a new scientifically grounded trauma-informed online program guided by Piran’s developmental theory of embodiment and Brown’s framework of shame resilience for improving disordered eating and traumatic distress.

Using quality outcomes data, we examined 70 mostly white (87%) women with mild to moderate trauma symptoms enrolled in a 6-module online Body Trust® program (Mage=46, SD=11; MBMI=34, SD=8). Half of the sample had a current or past eating disorder diagnosis, primarily binge eating disorder (47%). Outcomes included traumatic distress, objective binge episodes, eating concern, and body shame. Generalized estimating equations were applied to determine pre-to-post outcomes.

Significant improvements with medium to very large effect sizes were detected for all outcomes (p’s <.002). Findings held after adjusting for BMI, age, anxiety, and depressive symptoms.

Body Trust® shows early promise as an evidence-based online program for alleviating symptoms of trauma, body shame, and disordered eating in middle-aged women with co-occurring traumatic distress.
Session: On-Demand Poster Session
Stephanie Millot, Colleen Cook Flannery, Tom Hildebrandt
Mount Sinai School of Medicine, New York, NY, USA

Introduction: Family-based therapies (FBTs) are the treatment of choice for adolescents with anorexia nervosa (AN). The effects of these interventions are well documented for weight outcomes but not body image (BI), which is not explicitly targeted. Thus, we conducted a meta-analysis of FBTs’ effects on BI.

Methods: We searched PsychInfo and PubMed with key terms (family based treatment, eating disorder, anorexia nervosa, bulimia nervosa, body image, shape, weight) for clinical trials of FBT v. comparator treatments using PRISMA guidelines. English studies with baseline and end of treatment (EOT) BI measures were included, except for those with n <2. Our primary outcome was the standard effect size of the change in BI.

Results: We found 6 RCTs from 501 studies screened. Using a random effects model, we found no significant treatment effect of FBT on BI outcomes at EOT [g = -0.10, 95% CI (-0.48; 0.28), p = 0.52]. Heterogeneity was moderate [I^2 = 58%, 95% CI (0.0%; 83%), p = 0.04]. Independently, neither AN [g = -0.04, 95% CI (-0.82; 0.74) nor bulimia nervosa (BN) [g = -0.15, 95% CI (-1.32; 1.03), p = 0.64] yielded significant difference.

Conclusions: Pooled effects of FBTs for AN show no significant effect over controls. This finding is not surprising, as FBTs do not explicitly target these symptoms. The effect of FBT for BI concern in BN was more robust but also not significant. Findings suggest that FBTs may benefit from explicit targeting of BI symptoms.
Session: On-Demand Poster Session
Karen S. Mitchell1,2, Simar Singh3, Heather Thompson-Brenner4
1VA Boston Healthcare System, Boston, MA, USA, 2Boston University School of Medicine, Boston, MA, USA, 3Drexel University, Philadelphia, PA, USA, 4Private Practice, Boston, MA, USA

Purpose. Many women with eating disorders (EDs) have comorbid posttraumatic stress disorder (PTSD). Recently, PTSD diagnosis was associated with drop-out from a day hospital program for EDs. However, there have been few studies of how comorbid PTSD impacts ED treatment outcomes. Methods. Participants were 2765 patients from residential ED treatment facilities. We investigated whether PTSD diagnosis at admission was associated with changes in Eating Disorder Examination (EDE) scores across three time points, as well as treatment drop-out. Results. Using latent growth models, with time modeled as a second-order polynomial, we found that EDE scores decreased from admission to discharge but then increased at the six-month follow-up. PTSD diagnosis was associated with the intercept only for EDE global scores as well as the shape, weight, and restraint subscales. PTSD diagnosis was not associated with treatment dropout. Conclusions. PTSD was associated with ED severity at admission, such that patients with comorbid PTSD had higher baseline EDE scores. PTSD was not associated with ED symptom trajectories during and post-treatment, or with dropout, suggesting treatment was similarly effective for patients with and without PTSD. Future studies should investigate the impact of ED treatment on PTSD symptoms in order to determine the need for integrated treatments for these comorbid conditions.
Session: On-Demand Poster Session
Development of an online Guided Self-Help Cognitive Behavioral Therapy for Bulimia Nervosa in Japanese clinical settings: a feasibility study.
Noriaki Ohsako1,2, Hiroshi Kimura1,2, Tony Lam3, Tasuku Hashimoto1,2, Yutaka Hosoda1, Yosuke Inaba4, Masaomi Iyo2, Michiko Nakazato1,2
1Department of Psychiatry, International University of Health and Welfare (IUHW), Narita, Japan, 2Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan, 3NetUnion, Lausanne, Switzerland, 4Clinical Research Center, Chiba University, Chiba, Japan

Introduction; The purpose of this study was to develop an internet-based Guided self-help CBT (iGSH-CBT) for Bulimia Nervosa (BN) / Binge Eating Disorder (BED) and to test the feasibility of iGSH-CBT in Japanese clinical settings. Methods; A single-arm feasibility study. After baseline assessment, the 16-week iGSH-CBT followed using SALUT-BN program. During the treatment period, weekly e-mail guides within the program were provided. Evaluations were taken at baseline, after 8-week, at the end of 16-week intervention and 2-month after treatment. The primary outcome measure was the changes in the frequencies of weekly objective binging. Secondary outcomes were the changes in the frequencies of weekly objective purge episodes, self-report questionnaires of the frequencies of binging and purging, the psychopathology characteristics of eating disorders, such as BITE, EDE-Q, EDI-2, HADS, EQ-5D, the measurements of motivation and the completion rates of intervention. Results; The participants were 9 female outpatients with BN (n=5) / BED (n=4). Mean age was 28 years (SD=7.9). 88.9% of the participants attended the assessment at the end of 16-week intervention. The average reduction rate of the frequencies of weekly objective binging was 25% and at the end of 16-week intervention, 25% of the participants achieved symptom abstinence. Conclusions; iGSH-CBT might decrease the frequencies of binging and be confirmed to be feasible in Japanese clinical settings.
Session: On-Demand Poster Session
Rebecca J Park, Jessica Scaife, Tipu Aziz
University of Oxford, Oxford, United Kingdom

Purpose: To investigate if Deep Brain Stimulation (DBS) to the Nucleus Accumbens benefits SE-AN. Background: Research suggests AN pathology is a consequence of aberrant reward circuitry, leading to compulsivity. Reward and compulsivity involve cortico-striatal circuits, centrally the Nucleus Accumbens. DBS to Nucleus Accumbens improves OCD, and in rats increases food intake.

7 patients with SE-AN (4 with comorbid OCD , 3 without comorbid OCD) completed our published DBS study protocol and ethical gold standard : NCT01924598, ethical/ HRA approval: Project ID 128658. Neural processes were tracked using MEG, neuropsychological, psychiatric and behavioural measures monthly over 15 months.

In 3 patients with comorbid OCD, DBS was associated with marked (50-75%) reductions in OCD, Depression and AN pathology, with temporary relapse in the double blind DBS 'off' phase: Patients reported DBS as ‘life changing’ and ‘liberating’. In the 4th with comorbid OCD, functional outcome improved despite lesser symptomatic relief. The 3 patients without OCD showed little change. There were no serious adverse events or side effects and all chose to continue DBS longterm. Qualitative reports suggest mechanisms of change.

DBS to the Nucleus Accumbens appears feasible and of benefit in SE-AN with comorbid OCD but of little benefit in SE-AN without comorbid OCD. Larger studies are needed and a guiding neuro-ethical gold standard is crucial.
Session: On-Demand Poster Session
Enhancing Eating Disorder Recovery: Weight Control Beliefs Predict Body Dissatisfaction in Group Cognitive Behavioural Therapy for Body Image
Rachelle Pullmer1,2, Sarah Potter2,3, Michele Laliberte2,3
1St. Paul's Hospital, Vancouver, Canada, 2St. Joseph's Healthcare Hamilton, Hamilton, Canada, 3McMaster University, Hamilton, Canada

Introduction: Body dissatisfaction is an important determinant of wellbeing and is one of the strongest predictors of eating disorder relapse. Yet, a dearth of research exists on factors that facilitate change in body dissatisfaction following treatment focused on symptom interruption. Recent research points to the role of weight control beliefs in predicting outcomes in patients with eating disorders. The primary objective of this research was therefore twofold: 1) To investigate the impact of group cognitive behavioural therapy (GCBT) on weight control beliefs and body dissatisfaction and 2) to examine the influence of weight control beliefs on body dissatisfaction over time.

Participants were 50 adults with a recent eating disorder diagnosis who completed 10 sessions of GCBT for body image following GCBT for eating disorders. All participants completed the Eating Disorder Inventory and Weight Control Beliefs Questionnaire at baseline and post-treatment.

Body dissatisfaction and weight control beliefs improved from pre- to post-treatment (all ps <.01). Hierarchical linear regression analyses revealed that increases in lifestyle control beliefs, a subtype of weight control beliefs, predicted decreases in body dissatisfaction (∆R2 = .12, F(5,44) = 19.01, p = .001).

Results underscore the utility of fostering healthy weight control beliefs to cultivate a positive body image in patients navigating the eating disorder recovery process.
Session: On-Demand Poster Session
Renee D. Rienecke1,2, Daniel Le Grange3, Craig Johnson1, Alan Duffy1, Jamie Manwaring1, Casey N. Tallent1, Karen Schneller1, Ashley M. Solomon1, Philip S. Mehler1,4,5, Susan F. McClanahan1,2,6, Dan V. Blalock7,8
1Eating Recovery Center/Insight Behavioral Health Centers, Chicago, IL, USA, 2Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA, 3Department of Psychiatry, University of California, San Francisco, CA, USA, 4ACUTE, at Denver Health, Denver, CO, USA, 5Department of Medicine, University of Colorado, Denver, CO, USA, 6Rush University Medical Center, Chicago, IL, USA, 7Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA, 8Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

Introduction: Access to evidence-based treatment for eating disorders is limited by patient barriers and available clinician training. While clinical parameters often point to the need for a high level of care, patients may resist pursuing higher levels of care due to these barriers. One option that might mitigate such obstacles is the provision of a higher level of care via internet-based treatment for eating disorders, which may be particularly relevant given the current COVID-19 pandemic.

We sought to determine the feasibility, acceptability, and preliminary clinical outcomes associated with treatment of eating disorders through virtual intensive outpatient programming (VIOP). Fifty-seven patients meeting DSM-5 criteria for an eating disorder participated in VIOP.

Of the 57 patients in VIOP treatment, 3 did not complete voluntary measures at admission or discharge, and 9 additional patients did not complete voluntary measures at discharge. Overall, 45 VIOP patients completed admission and discharge assessments. Recruitment, treatment adherence, and completion of assessments in VIOP were feasible and acceptable. VIOP patients showed significant and clinically meaningful improvements in all outcomes measured, including self-reported eating disorder symptoms, depression, self-esteem, quality of life, and overall satisfaction.

VIOP appears feasible, acceptable, and evidences clinically meaningful changes in eating and mood disorder symptoms.
Session: Paper Session 1: Treatment/Prevention
How Motivation to Change among Adolescent and Adult Residential Patients with an Eating Disorder Predicts Eating Disorder and other Psychosocial Variables
Renee D. Rienecke1,7, Dan V. Blalock2,3, Daniel Le Grange4,5, Alan Duffy1, Susan F. McClanahan1,6,7, Craig Johnson1, Philip S. Mehler1,8,9, Millie Plotkin1, Jamie Manwaring1
1Eating Recovery Center and Insight Behavioral Health Centers, Chicago, IL, USA, 2Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA, 3Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA, 4Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA, 5Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA, 6Rush University Medical Center, Chicago, IL, USA, 7Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA, 8ACUTE, at Denver Health, Denver, CO, USA, 9Department of Medicine, University of Colorado, Denver, CO, USA

Introduction: Increased motivation to recover from an eating disorder (ED) has been found to impact outcome positively in both adolescents and adults.

This study examined how motivation to recover may differ between adolescents and adults in residential treatment for an ED; how differences in motivation between these samples may impact treatment outcome; and how motivation to recover may impact other psychosocial factors. The aims of the current study were to separately examine in adults and adolescents how scores on the Decisional Balance Scale (DBS) at baseline predict ED and comorbid symptoms, and weight recovery at end of treatment.

Adolescent and adult patients completed the DBS and psychosocial measures at admission to discharge; 220 adolescents and 456 adults completed all but the DBS at discharge. The DBS Avoidance Coping and Burdens subscales at admission were significantly lower for adolescents than adults (p<.001), whereas the DBS Benefits subscale at admission did not significantly differ between samples (p=.33). The DBS Burdens subscale did not significantly predict outcome in either sample (p>.10). Motivation to recover was a more reliable predictor of outcomes in both ED and comorbid psychopathology in adults (significant predictor in 10 out of 24 analyses) than adolescents (significant predictor in 1 out of 24 analyses).

Motivation to recover may be more important in predicting outcome in adults as compared to adolescents.
Session: On-Demand Poster Session
Sarah Smith1, Blake Woodside1,2
1University of Toronto, Toronto, ON, Canada, 2University Health Network, Toronto, ON, Canada

Introduction: Prior research has shown that many adult eating disorder patients require repeat admissions to inpatient care after an initial admission, but little is known about what patient characteristics are associated with repeat admissions. This study was designed to quantify differences between patients who require repeat admissions and those who do not at the time of an initial admission Methods: Participants were 432 patients admitted voluntarily to a specialist inpatient eating disorder program in Canada over a 15year period. At admission, all patients completed measures of demographic characteristics, eating disorder symptoms, eating disorder cognitions and depressive symptoms. Body weight was measured weekly.

26% of patients had repeat admissions over the study period. Analyses showed associations between repeat admissions and patient body mass index (BMI), eating disorder cognitions and depressive symptoms at initial admission. In multivariable analyses, only measures of eating disorder symptom severity (BMI and eating disorder cognitions) remained significant.

Eating disorder patients who go on to have repeat admissions differ from those who do not at initial admission. Potential clinical implications of these findings will be discussed.
Session: On-Demand Poster Session
Lea Thaler1,2, Chloé Paquin-Hodge1,2, Anne-Gaëlle Leloup1, Aimée Wallace3, Stephanie Oliverio1, Shiri Freiwald1, Mimi Israel1,2, Howard Steiger1,2,3
1Douglas University Institute, Montreal, QC, Canada, 2Department of Psychiatry, McGill University, Montreal, QC, Canada, 3Department of Psychology, McGill University, Montreal, QC, Canada

People with Eating Disorders (EDs) are too often unable to access informed treatment, or wait for access for unacceptably long periods of time. Training of non-specialized clinicians by experienced professionals through knowledge transfer (KT) programs has been shown to be an effective way to enhance access to evidence-based treatments for EDs. The goal of the present study was to conduct a qualitative analysis of factors that facilitated or impeded the uptake of an eating disorder-focused knowledge transfer program. Semi-structured interviews were conducted with therapists at 10 front-line community sites who received a specialized training in ED treatment as well as 11 managers from sites where the project either succeeded or did not take hold. Data were analysed using thematic analysis methods. The most frequently noted facilitators by both therapists and managers were management support for the program, and building professional competence through training and ongoing supervision of clinicians. The barriers most frequently cited by therapists and managers were lack of management support for the program and limited access to clients with EDs. Unique barriers noted by managers from sites where the project did not succeed was change-over of therapists, as well as perceived complexity in treating individuals with EDs. These results provide insights into the practical imperatives involved in implementing a KT initiative for ED treatment.
Session: On-Demand Poster Session
Lea Thaler1,2, Samantha Kenny2, Mimi Israel1,2, Howard Steiger1,2
1Douglas University Institute, Montreal, QC, Canada, 2McGill University, Montreal, QC, Canada

This study examined factors associated with early termination of treatment in a day treatment program in a multi-diagnostic sample of adults with eating disorders (EDs). Non-completion was defined not completing the contracted 12 or 16 weeks of treatment. A total of 207 patients participated in the study. Reasons for non-completion included being discharged due to not making weight gain targets, having too many absences, or patient choosing to end treatment early. Logistic regression analyses showed that initial BMI was a significant predictor of non-completion, with patients beginning treatment with a lower BMI being more likely to not complete their treatment (B = -.878, Exp (B) = .416, p=.000). In addition, higher autonomous motivation at the start of treatment predicted better chances of completing day treatment (B = -.446, Exp (B) = .640, p=.039). EDE-Q and personality measures were not significant predictors of non-completion. Individuals with Anorexia Nervosa-Restrictive and Binge/Purge type were more likely to not complete treatment as compared to individuals with Bulimia Nervosa χ2 (11) = 36.88, p=.000. Results highlight the importance of taking into account diagnosis, weight and motivation when engaging individuals in day treatment.
Session: On-Demand Poster Session
Heather Thompson-Brenner1, Simar Singh2, Taylor Gardner1, Gayle E. Brooks1, James F. Boswell2
1The Renfrew Center, Philadelphia, PA, USA, 2Drexel University, Philadelphia, PA, USA, 3State University of New York at Albany, Albany, NY, USA

INTRODUCTION Few large-scale studies have investigated evidence-based treatment (EBT) in residential eating disorder (ED) programs. METHODS This study examines 5 years of data following implementation of an EBT for emotional disorders (Unified Protocol [UP]; Barlow et al, 2016) in residential ED programs (Thompson-Brenner et al, 2018). N=176 pre-UP and N=2094 post-UP patients completed the Eating Disorder Examination-Questionnaire (EDEQ); Center for Epidemiologic Studies Depression Scale (CESD); Brief Experiential Avoidance Questionnaire (BEAQ); and Anxiety Sensitivity Index (ASI) at admission (AD), discharge (DC), and 6-mo follow-up (6MFU). Growth curve analyses examined changes in outcome over time and the moderating effect of UP status, controlling for diagnosis, age, site, and length of stay. Post-hoc tests explored covariate and UP status interactions. RESULTS EDEQ scores showed significantly different quadratic trajectories pre- vs. post-UP. Pre-UP EDEQ scores showed steep declines from AD to DC, followed by substantial relapse by 6MFU. Post-UP EDEQ scores showed slower rates of improvement by DC, followed by less relapse at 6MFU. Baseline BEAQ moderated UP response: participants with higher scores showed greater declines in EDEQ post-UP. Changes on the BEAQ and ASI, but not CESD, were significantly larger post-UP. CONCLUSIONS Individuals with EDs and experiential avoidance may show specific beneficial response to emotion-focused EBT.
Session: On-Demand Poster Session
C. Alix Timko1, 2, Kathleen Kara Fitzpatrick3, Daniel Rodriguez4, Natalia C. Orloff1, Rebecka Peebles 1, 2
1Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2University of Pennsylvania, Philadelphia, PA, USA, 3Private Practice, Palo Alto, CA, USA, 4LaSalle University, Philadlephia, PA, USA

Introduction: Cognitive Remediation Therapy (CRT) is an adjunctive treatment for anorexia nervosa. Data from adults have consistently shown increases in flexibility at treatment end; data have been less clear for adolescents, whose set-shifting and inhibitory skills are still developing. A dearth of randomized controlled trials (RCTs) prohibits us from determining whether CRT truly increases flexibility above and beyond renourishment that occurs within family-based treatment (FBT).

Preliminary data from an ongoing RCT (current N=18, 12-18y) comparing FBT to FBT+CRT. Inhibition and cognitive flexibility are assessed at four time points over a 15-session protocol using the Delis Kaplan and BRIEF. Results. Adolescents receiving CRT had a greater increase in inhibition (controlling for baseline BMIz and IQ; [F(1,10)] = 5.15, p = .047, partial η2 = .340]) after 8 sessions. Data indicate a trend for increases in flexibility by session 12. Conclusion. Using a developmentally sensitive model of executive functioning as a foundation, these early trial results may inform a reformulation of how CRT facilitates outcome. Early improvements in inhibition lead to later increases in flexibility. Future analyses will explore whether these increases facilitate approach-based motivation and decrease avoidance. A postulated end result is greater flexibility in eating, a faster rate of weight gain, and more rapid reduction in eating disorder behaviors and cognitions.
Session: On-Demand Poster Session
Irina A Vanzhula, Cheri A Levinson
University of Louisville, Louisville, KY, USA

Mindfulness-based interventions (MBIs) are gaining popularity in the treatment of eating disorders (EDs), but it's unclear which specific mindfulness practices may be the most beneficial. The current experimental study compared the effects of general mindfulness meditation (e.g., mindful breathing), eating-focused practices (e.g., mindful eating), and a combination of the two on ED symptoms. Participants (152 undergraduate students) were randomly assigned to participate in one of four brief audio-practices: Mindful breathing, mindful eating, mixed mindfulness (a combination of the two), and control (a neutral recording about produce transportation). Participants completed a measure of ED symptoms at baseline and a survey of state ED cognitions and urges before and after the manipulation. We found that all four conditions resulted in a moderate reduction of state ED symptoms (p <.001), with no time-by-condition interaction (p = .949). Baseline ED severity moderated the effect of condition on state ED symptom reduction (p = .008), such as that individuals with higher baseline ED symptoms, on average, experienced greater reductions in state ED symptoms than those with lower baseline ED symptoms in the mixed mindfulness condition, but not in all other conditions. Our results support the inclusion of both practices into MBIs for ED symptoms. Pending replication in clinical samples, these findings have implications for improving ED treatments.
Session: On-Demand Poster Session
Ulrich Voderholzer1,2,3, Sandra Schlegl1, Adrian Meule1,2
1Schoen Clinic Roseneck, Prien, Germany, 2University Hospital, Department of Psychiatry and Psychotherapy, Munich, Germany, 3University Hospital, Department of Psychiatry and Psychotherapy, Freiburg, Germany

Introduction. Inpatient treatment is highly effective in the short term. However, there is a high risk of relapse within the first year after discharge, which calls for investigating long-term treatment success and its moderators. Methods. Female adolescent inpatients with anorexia nervosa (N = 142) were tested, of which 85% participated at one-year follow up. Dependent variables were body mass index percentiles, eating disorder (ED) symptoms, depressive symptoms, compulsive exercise, and life satisfaction. We tested age, duration of illness, previous inpatient treatments, length of stay, and readmission after discharge as potential moderators of treatment outcomes. Results. Body weight increased and ED symptoms as well as depressive symptoms decreased from admission to discharge and remained stable at follow up. Compulsive exercise decreased and life satisfaction increased from admission to discharge and even improved further at follow up. Age, duration of illness, previous inpatient treatments, length of stay, and readmission after discharge moderated changes in body weight and other outcome variables. Conclusions. Several moderators of these changes indicated individual differences in treatment response. These subgroups of patients (e.g., those with an older age, longer duration of illness, and previous inpatient treatments) require special attention during inpatient treatment and aftercare to prevent relapse.
Session: On-Demand Poster Session
Kristin M. von Ranson, Leah N. Tobin, Christopher R. Sears
Department of Psychology, University of Calgary, Calgary, AB, Canada

Introduction: Body dissatisfaction (BD) is linked to maladaptive attentional biases that are theorized to contribute to the development of eating disorders (ED). The Body Project, a cognitive dissonance-based ED preventive intervention, reduces self-reported BD and other ED risk factors. It is unknown whether Body Project participation reduces attentional biases associated with BD.

We evaluated the efficacy of Body Project group participation in reducing attentional biases and self-reported BD in a cluster randomized controlled trial. 168 university women with BD were randomized to a Body Project, a Media Psychoeducation (active control), or a Waitlist control condition. Data were collected at baseline and post-intervention. We assessed attention via eye-gaze tracking and other outcomes via questionnaires.

In addition to replicating previously documented improvements in self-reported outcomes, Body Project participation reduced attention to “thin” model images, but not to weight-related words, compared to Waitlist. The Media Psychoeducation condition also changed some attentional bias outcomes, suggesting media literacy programs may be a viable alternative for reducing maladaptive attentional biases.

This is the first study to find two preventive interventions effectively reduce an objective outcome measure--attentional bias to “thin” model images--in women with BD. Attentional bias merits further study as an objective measure of BD.
Session: On-Demand Poster Session
Reduction of high expressed emotions and treatment outcome in anorexia nervosa – parents’ and adolescents’ perspective
Gudrun Wagner1, Julia Philipp1, Stefanie Truttmann1, Michael Zeiler1, Hartmut Imgart2, Janet Treasure3
1Eating Disorders Unit Dep. of Child and Adolescent Psychiatry, Medical Universtiy, Vienna, Austria, 2ParklandClinic, Clinic for Psychosomatic Medicine and Psychotherapie, Bad Wildungen, Germany, 3Dep. of Psychological Medicine, Section of Eating Disorders, King's College, London, United Kingdom

High expressed emotions (EEs) are common in parents of patients with anorexia nervosa (AN), associated with poorer outcome and can be decreased by interventions. The patients’ view and whether reducing EEs predicts improvements in patients’ outcome are rarely investigated. This study analysed factors associated with EEs, whether EEs is reduced by SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders in Austria) and whether a reduction predicts patients’ outcome. Parents of adolescents with AN were randomly allocated to the SUCCEAT intervention (workshops or online) and compared to a comparison group. EEs and patients’ outcome (Eating Disorder Inventory-2, Eating Disorder Examination, BMI) were assessed at baseline, post-intervention and 12-month follow-up. Up to half of parents showed high EEs. Correlations between patients’ and caregivers’ perspectives of EEs were low. High EEs were associated with lower caregiver skills, higher symptom impact, more depression, higher motivation to change in parents and outpatient treatment settings. EEs were reduced in all groups according to the parents’, but not patients’ perspective. The level of reduction (parents’ and patients’ view) could partially predict improvements in subjective and clinically assessed AN symptoms and BMI. Implementing interventions for parents addressing EEs in the treatment of adolescents with AN is recommended.
Session: On-Demand Poster Session