XXIVth Annual Meeting of the Eating Disorders Research Society

Printable Program

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

Friday, September 6, 2019

9:00 - 12:00 PMMississippi
Computational Modeling for Use in Understanding Behavioral Data

Chair(s): David Redish
9:00 - 10:30 AMOhio
Early Career Workshop I

The Art Of Grant Writing: Beyond The Science
Andrea Kass Graham, Neil Jordan
Northwestern University

10:45 - 12:15 PMOhio
Early Career Workshop II

The Art Of Scientific Reviewing: How To Boost Your Research Career From The Other Side Of The Table
Ruth Striegel Weissman1, Debra Franko2, Phillipa Hay3
1Montana State University, 2Northeastern University, 3Western Sydney University

1:00 - 1:15 PMChicago 9/10

Chair(s): Jennifer Wildes
1:15 - 2:15 PMChicago 9/10

Chair(s): Ross Crosby
The Adaptive Measurement Of Eating Disorders
Robert Gibbons
University of Chicago

2:15 - 3:15 PMChicago 9/10
Jim Mitchell Lecture

Chair(s): Kamryn Eddy
Integrating Eating Disorders Within Novel Hierarchical-Dimensional Models Of Psychopathology
Kelsie Forbush
University of Kansas

3:15 - 3:45 PMChicago Ballroom Foyer
Coffee Break

3:45 - 5:15 PMChicago 9/10
ICD-11 Feeding and Eating Disorders: A Global Classification System for Global Disorders

Chair(s): Kathleen Pike
Overview Of The Development Of The Icd-11: Empirical Support For The New Guidelines
Kathleen Pike
Columbia University

How Do Patient Descriptions Of Loss Of Control Interact With Episode Size To Influence Icd-11 Diagnosis?
Laura Berner
University of California, San Diego

Impacts Of Diagnostic Specifiers On Epidemiological And Clinical Bed Diagnostic Assessments
Phillipa Hay
Western Sydney University

Symptom Presentations Of Avoidant/Restrictive Food Intake Disorder In Adults: Mechanisms Of Severity And Symptom Overlap
Hana Zickgraf
University of Chicago Pritzker School of Medicine

Dsm-5 And Icd-11 Diagnostic Categories For Eating Disorders: State Of The Field And Future Directions
Robyn Sysko
Icahn School of Medicine at Mount Sinai

5:15 - 6:45 PMChicago 8
Poster Session I / Welcome Reception

Measuring Remission And Recovery From Dsm-5 Eating Disorders: The Eating Disorders Recovery Questionnaire
Rachel Bachner-Melman1, 2, Ada H. Zohar2, Lilac Lev-Ari2, Michal Linetzky2
1School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel, 2Clinical Psychology Graduate Program, Emek Hefer, Israel

There is no standardized definition or tool to assess remission and recovery from eating disorders (ED). In addition, the advantages and disadvantages of a transdiagnostic approach versus an approach tailored to specific diagnoses are unclear. We propose the Eating Disorders Recovery Questionnaire (EDRQ) as a comprehensive measure of recovery across ED diagnoses. Participants were 839 women, 218 with a current ED (105 AN, 55 BN, 68 BED), 156 with a past ED (92 AN, 43 BN, 21 BED) and 465 controls. They completed the EDRQ, a 28-item self-report scale assessing ED recovery and measures of ED symptom severity (SS), positive body image (PBI), depression (D), positive and negative affect (PA, NA), satisfaction with life (SWL) and positive eating (PE). The EDRQ showed good reliability (Cronbach’s α=.91) and factor structure derived via exploratory factor analysis (FA) and confirmed via confirmatory FA. Its subscales,
Lack of Symptomatic Behavior, Acceptance of Self and Body, Social and Emotional Connection and Physical Health, correlated moderately to strongly with most other variables. SS, D, and NA scores were highest for currently ill women and lowest for controls; scores of women with a past ED fell between the two groups. EDRQ, PA, SWL and PA scores showed the opposite pattern. Correlational patterns and questionnaire scores were similar across diagnoses. Results supported the EDRQ as a valid, psychometrically sound tool for assessing ED recovery status across ED diagnoses.    

Evaluation Of The Diagnostic Frequency Criterion For Bulimia Nervosa
Brittany K Bohrer, Victoria L Perko, Danielle A Chapa, Alexis C Exum, Brianne N Richson, Kelsie T Forbush
University of Kansas, Lawrence, KS, United States

The diagnostic criteria for bulimia nervosa (BN) require both objective binge-eating (OBEs) and inappropriate compensatory behaviors (ICBs) to occur, on average, at least once per week for three-months. Persons who meet the frequency threshold for either OBEs or ICBs are diagnosed with subthreshold BN, an other specified feeding or eating disorder (OSFED). This study tested whether adults who engaged in either weekly OBEs or ICBs (n=69) were distinct from those with full-threshold BN (
n=103). We used MANOVA to compare ED behaviors, age-of-onset, BMI, illness chronicity, lifetime/current mood or anxiety disorder, substance use, and clinical impairment between groups. We computed the minimal clinically important difference to test clinical significance. With the exception of OBE frequency, body dissatisfaction, and clinical impairment, groups were equivalent on outcome variables. Participants with BN had clinically and statistically significantly greater clinical impairment and EPSI Binge Eating scores. Persons who experienced weekly OBEs or ICBs were more similar than different to their BN counterparts. Clinical impairment was high in both groups, with the endorsement of one more item on a 16-item measure representing the difference between groups. Our findings suggested that relaxing the diagnostic criteria to include persons who engage in either weekly OBEs or ICBs would result in significant reductions to the OSFED category without altering the clinical presentation of BN.

Associations Between Anxiety Sensitivity, Visceral Sensitivity, And Eating Disorder Symptoms In A Clinical Sample
Tiffany A. Brown, Erin E. Reilly, Christina E. Wierenga, Walter H. Kaye
University of California, San Diego, Department of Psychiatry, San Diego, CA, United States

Individuals with eating disorders (EDs) often have difficulty tolerating uncomfortable body sensations. As such, anxiety sensitivity and visceral sensitivity (a variant of anxiety sensitivity specific to gastric sensations) have relevance for EDs; however, few studies have examined these constructs in EDs. This study examined differences in anxiety and visceral sensitivity across ED diagnoses and associations of these constructs with ED symptoms. Methods: Adolescents and adults in an ED partial hospital program (n=111) completed self-report surveys within 14 days of admission. Results: Analyses of variance revealed avoidant restrictive food intake disorder (ARFID) patients reported lower anxiety sensitivity compared to other specified ED patients (p=.02) and lower visceral sensitivity compared to anorexia nervosa patients (p<.04). All ED diagnoses, except for ARFID, reported anxiety sensitivity scores comparable to anxiety disorder samples and visceral sensitivity scores comparable to those with IBS. Hierarchical regression models revealed that higher visceral sensitivity, but not anxiety sensitivity, predicted cognitive restraint (p=.003), body dissatisfaction (p=.009), purging (p=.049), and exercise (p=.003) beyond age, body mass index, and trait anxiety. Conclusions: Results support the initial relevance of examining gastric-specific anxiety sensitivity in EDs and suggest a potential greater role of visceral sensitivity versus broad anxiety sensitivity. 

The Loss Of Control Over Eating Scale: Psychometric Properties For The Portuguese Sample
Eva M Conceição1, Ana R Vaz1, Célia S Moreira2, Paulo PP Machado1, Marta de Lourdes1
1University of Minho, Braga, Portugal, 2University of Porto, Porto, Portugal

This study aims to evaluate the psychometric properties of Loss of Control Over Eating Scale (LOCES) " a self-report measure that assesses the multiple dimensions of loss of control (LOC) over eating " and its brief version (LOCES_B) in a Portuguese community sample.  Methods: A total of341 participants aged between 18 and 59 years (M = 23.21, S.D. = 6.02), were recruited from a university campus and completed the LOCES and a set of self-report measures assessing weight suppression, disordered eating, depression, negative urgency, emotional regulation difficulties, and auto-criticism.  Confirmatory factor analyses tested the factor structure; internal consistency construct, convergent and discriminant validity were also tested. Results: Results revealed that the three subscales model proposed had a good fit to the data (CMIN/df = 2.05; p = 0.000; HOELTER.05 = 221; RMSEA = 0.056; PCLOSE = 0.251; CFI = 0.966; NFI = 0.937; TLI = 0.954; AIC = 210.697). LOCES subscales and its brief version showed good internal consistency (range 0.71 to 0.93). Disordered eating and negative urgency showed moderate to strong correlations with LOCES total score and LOCES-B (rsp ≥ 0.436 to0.518), indicating good convergent validity. t-test showed invariance across genders and participants scoring within the clinical range of disordered eating presented higher scores. Conclusion:TheLOCES showed to be a useful, reliable and robust measure to assess LOC eating in this population. 

Eating Disorder Diagnostics In The Digital Era: Validation Of The Norwegian Version Of The Eating Disorder Assessment For Dsm-5 (Eda-5)
Camilla L. Dahlgren1, Karianne Vrabel2, Cecilie Siegwarth1, Timothy B. Walsh3, Øyvind Rø1,4
1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo, Norway, 2Research Institute of Modum Bad, Vikersund, Norway, 3Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York State Psychiatric Institute, New York, NY, United States, 4Institute of Clinical Medicine, University of Oslo, Oslo, Norway

The Eating Disorder Assessment for DSM-5 (EDA-5) is a web-based, semi-structured interview assessing DSM-5 feeding and eating disorders. It was developed to reduce participant and staff burden, and is currently the only existing interview assessing all DSM-5 feeding and eating disorders. High rates of agreement have previously been reported between the EDA-5 and clinical interviews. The aim of the current study was to compare the diagnostic validity of the Norwegian version of the EDA-5 to the “gold standard” clinical interview; the Eating Disorder Examination (EDE) Interview v. 17.0D. Methods. A sample of 71 adults (3 males and 68 females) between 18 and 56 years (M = 31.3, SD = 9.2) were recruited from two tertiary care clinics in Norway. Participants were interviewed using the EDA-5 and the EDE within 24 h, on average. Results. The EDA-5 and EDE assigned identical diagnoses in 84.5% of the cases. Agreements for individual diagnostic categories were: moderate agreement (κ = .58) for OSFED-AN, good agreement for AN-R (κ = .74) and AN-BP (κ = .79), very good agreement for BN (κ = .81) and UFED (κ = .91), and excellent agreement (κ = 1.00) for BED, OSFED-BN and no ED. Results also showed a significant difference (p <.01) in EDA-5 (M = 23 minutes, SD = 9.2)  and EDE (M = 56 minutes, SD = 27.0) administration time.  Conclusions. Our results support the validity of the Norwegian version of the EDA-5 to efficiently generate DSM-5 eating disorder diagnoses.

When Does Anorexia Nervosa Start? Using An Age Of Onset Questionnaire To Measure Duration Of Eating Behaviors.
Lauren E. Davis1,2, Lisa M. Ranzenhofer1,2, Jonathan E. Posner1,2, Joanna E. Steinglass1,2
1Columbia University Irving Medical Center, New York, NY, United States, 2New York State Psychiatric Institute, New York, NY, United States

Introduction Anorexia Nervosa (AN) is often diagnosed in mid- to late-adolescence, yet little is known about when maladaptive behaviors begin. The aim of this study was to assess the onset of a range of eating disorder (ED) related behaviors and the time between onset, impairment and diagnosis of AN. Methods Participants were 35 female adolescents with AN (n = 29) or Atypical AN (n = 6) and their parents. They were separately administered a standardized Age of Onset interview that assessed dieting, food restriction, binge eating, and compensatory behaviors. Patients completed the Eating Disorder Examination Questionnaire and Eating Pathology Symptom Inventory. Results Overall concordance between parent and child reports were high (77-97% agreement) across behaviors. The most prevalent behavior was food restriction, reported by 97% of participants. Mean age of onset of food restriction was 14.2 ± 1.8 yrs per patient report and 14.1 ± 2.6 yrs, per parent report. Mean time between onset of food restriction and impairment was 0.3 ± 0.8 yrs and to diagnosis was 0.9 ± 1.1 yrs. Mean duration of illness was 1.3 ± 1.53 yrs. Controlling for duration of illness, linear regressions showed associations between time to diagnosis and measures of ED severity. Conclusion In this cohort, behaviors began in early adolescence and there was approximately 1 year until diagnosis. The relationship between time to diagnosis and severity underscores the need for early detection and intervention.

Association Of Measures Of Uncontrolled Eating In Children And Parents 
Dawn M Eichen, David R Strong, Kyung E Rhee, Kerri N Boutelle
UC San Diego, La Jolla, CA, United States

1. Introduction. Uncontrolled eating (UE) includes loss of control eating (LOC), eating in the absence of hunger (EAH), and power of food (POF), and is a significant risk factor for eating disorders and obesity. This study assessed the extent to which measures of UE were associated in school age children and their parents. 2. Methods. 140 overeating treatment-seeking children, ages 8-13 years, with BMI 85-99.9% and their parents were assessed. Children completed the child eating disorder examination (ChEDE) and parents completed the EDEQ to assess LOC. Both completed the EAH and POF questionnaires. Logistic and linear regressions controlling for BMIz, BMI, age and sex evaluated the associations of these three UE measures. 3. Results. 29% of parents and 39% of children endorsed LOC. Parent LOC was associated with POF (p<02; OR=2.18, 1.19-4.18) and EAH (p<.03; OR=2.59, 1.13-6.26) with no significant covariates. Child LOC was associated POF (p<.05; OR=1.73, 1.02-3.07) and BMIz (p<.02; OR=4.06, 1.36-13.44). EAH and POF were associated in parents (B=.29, SE=.06; p<.001) and children (B=.42, SE=.05; p<.001) 4. Conclusions. In parents, POF and EAH were both related to LOC; however, in children when analyzed concurrently, only POF was related. These differences may be due to children having difficulty with self-report measurements. EAH and POF were related in both children and parents. These disinhibited eating constructs represent potential targets to help reduce LOC eating.

What Can We Learn About Early Treatment Response From “Unpredictable” Patients? Empirical Analysis Of Patients Whose Treatment Outcome Was Misclassified Via Machine Learning Prediction
Hallie M. Espel-Huynh1, Fengqing Zhang2, Michael R. Lowe2, J. Graham Thomas1
1Brown University & The Miriam Hospital, Providence, RI, United States, 2Drexel University, Philadelphia, PA, United States

Background: Personalized prediction of treatment response may facilitate individualized care and improve outcome for patients with eating disorders (EDs). Latent trajectory modeling has identified 3 treatment response trajectories among patients in residential ED treatment (Rapid Response, RR; Gradual Response, GR; Static Response, SR). Machine learning achieved 84.1% accuracy in predicting RR/GR/SR outcome at end of treatment (EOT), using only early treatment data (training set n=280; test set n=63). While promising, this model could misdirect treatment efforts for the 15.9% whose response was incorrectly predicted. This study explored causes of misclassification. Method: Standardized scores on weekly symptom measures were extracted for each misclassified case; relative position to group averages for correctly predicted RR/GR/SR cases were examined during early treatment and at EOT. Result: Misclassified RR patients (50%) had gradual early change but improved markedly later; thus, early change resembled the GR group but ultimately became RR by EOT. Misclassified GR patients (20%) improved markedly early in treatment (resembling RR) but rebounded later, becoming GR. Misclassified SR patients (30%) improved modestly early on (resembling GR) but fully rebounded by EOT. Conclusion: Patients whose symptoms fluctuate early may have the most difficult outcome to predict. Models could be improved by identifying predictors that differentiate early fluctuation in symptoms from trends.

Development And Validation Of The Eating Disorders Screen For Athletes (Edsa): A Brief Screening Tool For Male And Female Athletes
Vivienne M. Hazzard1,2, Lauren M. Schaefer2, Allison Mankowski3, Traci L. Carson1, Sarah Lipson4, Claire Fendrick1, Kendrin R. Sonneville1
1University of Michigan School of Public Health, Ann Arbor, MI, United States, 2Sanford Research, Fargo, ND, United States, 3Eastern Michigan University Athletics, Ypsilanti, MI, United States, 4Harvard University, Boston, MA, United States

Introduction: Athletes face a unique set of eating disorder (ED) risk factors related to sport participation. However, existing ED risk measures for this population are limited in their use as screening tools by their length and focus on a single gender. Therefore, the purpose of this study was to develop and validate the Eating Disorders Screen for Athletes (EDSA), a brief screening tool for both male and female athletes. Methods: Data from Division I athletes at a Midwestern university (N=434) were used to conduct exploratory factor analysis (EFA) by gender. Data from college athletes competing at various levels across the United States (N=482) were used to conduct confirmatory factor analysis (CFA) and receiver operator characteristic (ROC) curve analysis by gender. Athletes from a range of lean and non-lean sports were included. Gender-specific empirically derived cut-offs on the Eating Disorder Examination-Questionnaire were used to identify ED cases and non-cases for the ROC curve analysis. Results: A 5-item, 1-factor structure for the EDSA was supported by EFA and CFA in both males and females. ROC curve analyses indicated that the EDSA was highly accurate in distinguishing between cases and non-cases and identified a score of 3.6 as the optimal cut-off for both males (sensitivity=.96, specificity=.86) and females (sensitivity=.91, specificity=.67). Conclusions: The EDSA shows promise as a brief screening tool to identify male and female athletes at risk for EDs.

Avoidant/Restrictive Food Intake Disorder Is Impairing Even Without Low Weight, Nutritional Deficiencies, Or Dependence On Supplemental Feedings
Jenny H. Jo1, Ani C. Keshishian1, Kendra R. Becker1,2, Olivia B. Wons1, Lauren Breithaupt1,2, Kristine Hauser1, Madeline Rogers1, Madhusmita Misra1,2, Kamryn T. Eddy1,2, Elizabeth A. Lawson1,2, Nadia Micali3,4, Jennifer J. Thomas1,2
1Massachusetts General Hospital, Boston, MA, United States, 2Harvard Medical School, Boston, MA, United States, 3Département universitaire de psychiatrie, Université de Genève, Genève, Switzerland, 4Service de psychiatrie de l'enfant et de l'adolescent, Département de l'enfant et de l'adolescent, Genève, Switzerland

Introduction:DSM-5 criteria for avoidant/restrictive food intake disorder (ARFID) have been recently updated to allow for diagnosis based on psychosocial impairment even in the absence of physical markers of malnutrition. We aimed to explore if those who met criteria for ARFID by psychosocial impairment alone (AP) differed from those with ARFID met by low weight/faltering growth, nutritional deficiency, and/or dependence on supplemental feeding (with or without impairment, ARFID-malnourished: AM) and healthy controls (HC). Methods:Males and females ages 10-22 years (AP=12; AM=45; HC=21) were recruited as part of an ongoing study, and completed the Food Neophobia Scale (FNS), Clinical Impairment Assessment (CIA), State-Trait Anxiety Inventory (STAI), and Pica, Avoidant/Restrictive Food Intake Disorder, Rumination Disorder Interview (PARDI). Results:HC were older than AM (p=.001) so all analyses controlled for age. Both ARFID groups scored significantly higher than HC on FNS (ps<.001), CIA (ps<.002), STAI (ps<.04), and PARDI (ps<.001) but did not differ from each other. AP had higher FNS scores compared to AM (p=.03). Conclusions:Individuals who meet criteria for ARFID based on psychosocial impairment alone endorse even less willingness to try unfamiliar foods than those who fulfill the other three criteria. ARFID groups endorse similar levels of clinical impairment, anxiety and PARDI severity. These findings support the diagnosis of ARFID in the absence of criteria A1-3.

Confirmatory Factor Analysis And Evidence Of Convergent And Discriminant Validity For The Approach/Avoidance Of Weighing Questionnaire (Aawq)
Paraskevi E Kambanis, Angeline R Bottera, Kyle P De Young
University of Wyoming, Laramie, WY, United States

Individuals with eating disorders often engage in frequent self-weighing as a means of assessing their shape and weight, while others go to great lengths to avoid knowledge of their weights. Although thoroughly characterized as clinically-relevant behaviors, there are limited means by which to measure these differing weighing tendencies. This study reports on the development of a self-report measure " The Approach/Avoidance of Weighing Questionnaire (AAWQ) - that measures how individuals respond to opportunities to learn their weights to clarify their approach/avoidance tendencies toward weight. Initially, an exploratory factor analysis using 10 items identified 2 factors and indicated all should be retained. A confirmatory factor analysis tested the fit of this 2-factor solution in a second sample, indicating that a revised 6-item version fit reasonably well. This study reports on a second confirmatory factor analysis in a new sample that tested the fit of the 2-factor solution in the 6-item measure (Χ2:df= 4.79; RMSEA=.11; CFI=0.96; TLI=0.92; SRMR=0.05). The factors indicate the tendency to approach weighing (α = .89) and to avoid weighing (α = .79). Additional evidence of convergent and discriminant validity will be presented, covering a number of eating behaviors. The AAWQ may be a useful tool to examine the potential function of weight-checking/avoidance and may aid in cognitive-behavioral clinical case formulation for individuals with eating disorders.

From Little Albert To Eating Disorders: A Test Of Fear Generalization In Anorexia Nervosa
Lisa M. Anderson1, Samuel E. Cooper1, Ann F. Haynos1, Carol B. Peterson1, 2, Scott J. Crow1, 2, Shmuel Lissek1, Kelly C. Berg1
1University of Minnesota, Minneapolis, MN, United States, 2The Emily Program, St. Paul, MN, United States

Introduction: Etiological models of anorexia nervosa (AN) have posited that learned fears contribute to core AN symptoms (e.g., food avoidance, restriction). Fear generalization, or the process by which individuals develop fear responses to safe stimuli that share characteristics with threat stimuli, is one mechanism that may contribute to pathological fear and avoidance behavior in AN. However, fear generalization has not been examined in individuals with AN, to date. Methods: Using a startle eye-blink fear generalization paradigm, the current study aims to compare patterns in fear generalization from stimuli conditioned to elicit fear through electrical shock to perceptually similar safe stimuli between adults with AN and healthy controls (anticipated N = 20 AN, 20 HC). Results: Preliminary findings (current N = 9 AN, 8 HC) indicate that individuals with AN have elevated threat responses to both safety and conditioned danger-cues, and elevated startle response during inter-trial intervals in which no stimulus is presented, compared to HC (p’s<.05). Conclusions: Individuals with AN appear to demonstrate altered threat responding characterized by elevated sensitivity versus over-generalization to threat. Fear generalization patterns will be modeled using data from the final sample. Further evidence of altered fear learning processes, such as fear generalization, may inform and ultimately optimize targeted treatment efforts for AN (e.g., exposure-based interventions).

Rehospitalization Risk Score In Individuals With An: Why Is It Important And How Do We Get There?
Lauren E Blake1, Jessica H Baker2, Rachel Guerra2, Laura Thornton2, Cynthia Bulik2,3
1Department of Human Genetics, University of Chicago, Chicago, IL, United States, 2Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, United States, 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

Maintenance and recovery after hospitalization for anorexia nervosa (AN) is challenging, and up to 45% of patients are rehospitalized. Better predictions of outcome post-discharge-- specifically negative outcomes, which are less studied than who does well-- could enable earlier and more personalized interventions. Before making predictions of outcome, we need to more rigorously define it. We obtained clinical, demographic, and biological information from 29 females with AN over 15 years-old at admission, discharge, and 3 timepoints post-discharge from the UNC Eating Disorder Unit. Consistent with previous findings, BMI at discharge is well correlated with BMI post-discharge (Pearson’s r = 0.60, 0.53, 0.41 for 3-, 7- and 12-months post-discharge, respectively, P <0.01 for each). Surprisingly, we found that BMI at discharge is lowly correlated with rate of BMI change (r = 0.19, 0.10, -0.05, respectively, P >0.29 for each), which replicated in an independent cohort. These results suggest that we can not use discharge BMI alone to predict whether patients will increase or decrease in BMI post discharge. To connect this rate of BMI change with a measurable, interpretable, and actionable outcome, we empirically derived risk of rehospitalization. We are now developing a risk score for rehospitalization within 1 year, akin to a score for 10-year risk of heart attack. We strive to make this risk score straightforward and cost effective enough for use in clinical practice.

The Influence Of Ghrelin On White Matter Microstructure In Anorexia Nervosa In Adolescents And Young Adults
Lauren Breithaupt1, 2, Natalia Chunga-Iturry2, 3, 4, Suheyla Cetin-Karayumak2, 4, Benjamin Reid2, 4, Kendra R. Becker1, 2, Jennifer J. Thomas 1, 2, Nikos Makris4, 5, Franziska Plessow6, 7, Amanda E. Lyall2, 4, 11, Ofer Pasternak2, 4, 8, Laura M. Holsen2, 9, 10 , Marek Kubicki4,2,11, Madhusmita Misra6, 7, Elizabeth A. Lawson6, 7, Kamryn T. Eddy 1, 2
1Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States, 2Department of Psychiatry, Harvard Medical School, Boston, MA, United States, 3Resident in Neurology, University of Rochester School of Medicine, Rochester, NY, United States, 4Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, United States, 5Departments of Psychiatry, Neurology and Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Center for Morphometric Analysis, Center for Neural Systems Investigations, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States, 6Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States, 7Department of Medicine, Harvard Medical School, Boston, MA, United States, 8Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston , MA, United States, 9Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States, 10Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States, 11Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States

White matter (WM) microstructure modulates functional connections in reward regions. Inflammation may play a causal role in anorexia nervosa(AN), and can affect WM micsrostructure. The orexigenic neuropeptide ghrelin is elevated in AN and has anti-inflammatory effects on WM in other conditions; its influence on WM in AN, particularly in adolescence during key neurodevelopmental growth, is unknown. Method:We evaluated ghrelin and WM microstructure (measured by free-water corrected fractional anisotropy (FA)) in adult (18"22y) and adolescent (11"17y) females with AN (n=36) and healthy controls (HC; n=20). Results:FA did not differ between AN and HC. In AN, but not HC, ghrelin was negatively associated with FA in forceps major (r=-0.38, P=0.04), which links the occipital lobes through the corpus callosum, and fornix (r=-0.65, P<0.001), involved in energy balance and reward. In AN, ghrelin was higher in adults than adolescents (P<.05); in HC ghrelin did not differ by age. In AN, age moderated these relationships (both Ps<0.001): higher ghrelin was associated with decreased FA in the fornix and forceps major in adult AN, but with higher FA in adolescents. Conclusions:Ghrelin affects WM microstructure in key energy balance and reward structures in an age-dependent manner in AN. Positive associations of ghrelin with WM FA in adolescents may reflect an adaptive mechanism, whereas negative associations in adults may indicate acquired resistance to such effects.

Inflammation In Relation To Symptom Severity In Anorexia Nervosa
Brooks B Brodrick1,2, Jayme M Palka1, Carrie J McAdams1
1University of Texas Southwestern Medical Center, Dallas, TX, United States, 2Parkland Health and Hospital System , Dallas, TX, United States

Identification of biomarkers in Anorexia Nervosa (AN) is important for developing personalized treatments. Since inflammation impacts treatment response in depression, we hypothesized inflammation may be related to symptom severity in AN. Serum samples from 63 women who had previously participated in research studies at our institution were utilized. Based on clinical symptoms subjects were classified into 3 groups: currently ill (AN-C), weight recovered (AN-W), and healthy controls (HC). Cytokines were quantified using Luminex Human Cytokine Magnetic 12 Plex Panel (GM-CSF, IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17A, TNF-α, and MCP-1). Bayesian t-test analysis determined if there were differences in cytokines across the groups. Significance was defined as less than 5% overlap between the ROPE and 95% HDI for each comparison. IL-17A and MCP-1 were significantly higher in AN-C than HC. AN-W exhibited increased levels of IL-8, IL-17A, and MCP-1 compared to AN-C. Additionally, IL-8 was elevated in AN-W compared to HC. Our findings support a link between immune dysregulation and AN. Although inflammatory markers were elevated in AN compared to HC, there was no correlation with symptom severity in our cohort. IL-17A has been implicated in the pathogenesis of depression and autoimmune diseases, and a higher prevalence of autoimmune diseases has been observed in AN. Accordingly, IL-17A pathway may be an important new therapeutic target in AN.

Evaluating The Role Of The Bed Nucleus Of The Stria Terminalis (Bnst) In The Neurocircuitry Of Anxiety In Patients With Anorexia Nervosa Restricting Type
Scott C Bunce, Fauzia Mahr, Christopher Freet, Lauren Spreen, Jeff Vesek, Xiaoyu Wang, Lidija Petrovic-Dovat, Jianli Wang
Penn State College of Medicine, Hershey, PA, United States

Introduction: Growing evidence implicates neurocircuitry regulating anxiety and appetite in the etiology of anorexia nervosa (AN). The sexually dimorphic BNST modulates anxiogenic responses as well as feeding behaviors, and mediates anxious temperament. No studies on BNST structure or function have been reported in AN. We used a novel fMRI technique to image predicted morphological and functional differences of BNST in adolescent females with AN. Method: An experimental design previously demonstrated to elicit BNST activation by manipulating anxiety was modified to include threat due to swallowing milkshake. BNST morphology and functional responses were assessed with fMRI while AN (n=11), generalized anxiety disorder (GAD; n=5), and controls (HC; n=4) anticipated “threats” (i.e., aversive images; swallowing milkshake). Taste thresholds for salty and sweet tastes were evaluated, and subjective anxiety levels were recorded during stimulation. Results: AN reported higher trait anxiety than HC, and reduced sensitivity to salty and sweet taste (p=0.02; 0.10). The milkshake condition elicited higher anxiety in AN than HC.  The milkshake condition also elicited BNST activation in AN (p<0.001), but not in HC or GAD. GAD had smaller BNST than AN (p<0.05).  Conclusions: These results suggest altered sensation and BNST activation in AN related to food perception.  These findings open a new line of inquiry into the neuropathophysiology of AN, identifying new targets of treatment.

Disordered Eating Behaviors In Pregnancy And The Relationship With Expected Vs. Unexpectated Pregnancy
Fary M Cachelin1, Brooke Palmer2
1Open University, Milton Keynes, United Kingdom, 2UNC Charlotte, Charlotte, NC, United States

Stressors accompanying pregnancy can lead to the development of disordered eating. No studies have investigated the link between pregnancy intentionality and disordered eating in nonclinical pregnant women. Methods: Pregnant women (N = 206) in their third trimester of first pregnancy and with no history of eating disorder completed an online survey on eating behaviors, body image and weight gain. Women self-reported pregnancy intentionality and weight gain, and completed the Eating Disorders Examination and Body Attitudes questionnaires. Results: Participants reported frequent binge eating episodes in the past month (M = 4.2, SD = 6.4) and an average of 27.4 pounds of weight gain (SD = 14.3).  Based on t-tests, women who did not intend to become pregnant (41% of sample) were significantly heavier at pre-pregnancy (BMI 30.2 vs. 26.9, p = .002) and reported significantly more episodes of objective overeating (7.8 in last month vs. 5.5, p = .003), as well as trends toward more frequent objective binge episodes (5.2 vs. 3.6, p = .06) and greater increase in body image disturbance (p = .05). Conclusions: Results are clinically significant given that women without an eating disorder history may be less likely to be screened by providers and therefore not receive appropriate referrals or intervention for disordered eating. Findings suggest women would benefit from routine screening of eating behaviors throughout pregnancy, especially if pregnancy was not intended.

Elevated Within-Subject Variability In Weight: Another Sign Of Weight Dysregulation In Bulimia Nervosa
Joanna Y. Chen1, Leora Benson1, Nicole E. Virzi1, Laurel S. Mayer2, Michael R. Lowe1
1Drexel University, Department of Psychology, Philadelphia, PA, United States, 2Columbia University, Department of Psychiatry, New York, NY, United States

Introduction Recent research has found weight variability to be associated with hyperactivation of reward brain regions in response to palatable food, as well as a predictor of long-term weight gain and poorer weight loss outcomes. However, no study has examined weight variability in eating disorder samples relative to non-eating-disordered samples. Methods Women with bulimia nervosa (BN;n=84) were weighed four times over an average of 42.32 days. Root mean square error (RMSE) of variation around the regression slope of weight change for each individual was calculated, accounting for between- and within-subject trends in weight over time. The mean RMSE value of this BN sample was compared with four non-BN samples. Results Independent samples t-tests showed that women with BN had a significantly higher RMSE (M=1.67) relative to healthy-weight adolescents (M=0.55), healthy-weight college women (M=0.70), and overweight women in two weight-loss samples (Ms=1.04 and 0.42), all ps <.001. Conclusions These results show for the first time that past indicators of weight dysregulation (high premorbid BMIs and high weight suppression) extends to current, shorter-term variability in weight. The highly dysregulated and chaotic eating patterns in BN apparently extends to their body weights. Such weight instability may be highly distressing and intensify ED symptoms. Future research should examine the relationships between weight variability and eating disorder symptomology and course.

Loss Of Control Over Eating Predicts Gestational Weight Gain Among Women With Overweight/Obesity
Rachel P.K. Conlon1, Bang Wang2, Marsha D. Marcus1, Yu Cheng2, Michele D. Levine1
1Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States, 2Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States

Introduction: Excessive gestational weight gain (GWG) robustly predicts negative pregnancy outcomes and postpartum health concerns. Women who begin pregnancy with overweight/obesity (OV/OB) are more likely to gain weight excessively during pregnancy. One mechanism that may explain GWG is loss of control over eating (LOC). Given that LOC is prevalent among women with OV/OB, related to weight gain, and modifiable, we examined the contribution of LOC to GWG. Methods: We recruited women (N=247; 50% non-White) between 12-20 weeks gestation with a pre-pregnancy body mass index (BMI [kg/m2])≥25. Rates of LOC before and during pregnancy were documented using the Eating Disorder Examination-Pregnancy Version interview. Women reported demographic factors, and weight and height were obtained via calibrated scale and stadiometer. We conducted regression analyses, adjusting for age, gestational age, race, education, income, pre-pregnancy weight, parity, and smoking status. Results: Women who experienced LOC in pregnancy (n=62, 25%) gained 6.8lbs. more than women who did not experience LOC (n=151, 61%; p=.04). Women with LOC pre-pregnancy only (n=3, <1%) or with LOC pre- and during pregnancy (n=31, 13%) did not have significantly different GWG than women without LOC (ps>.36). Conclusions: LOC during but not before pregnancy was associated with higher GWG in women with OV/OB. Understanding the relationship between LOC and GWG may lead to improved interventions to prevent excessive GWG.

A Preliminary Test Of Mood And Circadian Rhythm Mechanisms Driving Binge Eating
Kyle P De Young, Angeline R Bottera, P Evelyna Kambanis
University of Wyoming, Laramie, WY, United States

Mood and circadian rhythm disruptions are associated with binge eating (BE). Negative mood states often precede BE episodes, and the daily rhythms of food intake and mood fluctuations are implicated in the occurrence of BE; thus, understanding the role of daily negative mood changes is a critical area for research on BE. The most potent synchronizer of circadian rhythms is light, and evidence indicates that negative mood and BE are reduced by exposure to bright light. However, it is unknown whether light reduces BE through overall reductions in negative mood or through the regularizing of circadian rhythms, such as the timing of sleep, eating, and activity, that may themselves be associated with mood improvement. This knowledge can inform the development of treatment adjuncts that target biobehavioral mechanisms that maintain BE. A total of 18 women with at least twice/week BE for 3 months will be complete (7 are complete to date). Participants are exposed to 10 consecutive days of bright light (~10k lux) and 10 consecutive days of normal light (~500 lux) for 30 minutes in the morning in random order while they provide multiple ecological momentary assessment reports/day. Generalized estimating equations will test a model wherein aggregated daily negative mood and an index of regular sleep, eating, and activity are used to account for the occurrence of BE to provide a preliminary test of the viability of these two hypotheses in this ongoing trial. 

Associations Between Positive Affect And Dysregulated Eating In Youth With Overweight/Obesity: An Ecological Momentary Assessment Study
Amy H. Egbert1, Alissa Haedt-Matt2, Kathryn E. Smith3, Kristen M. Culbert4, Scott Engel5, Andrea B. Goldschmidt6
1Loyola University Chicago, Department of Psychology, Chicago, IL, United States, 2Illinois Institute of Technology, Department of Psychology, Chicago, IL, United States, 3Sanford Research/University of North Dakota School of Medicine, Fargo, ND, United States, 4University of Nevada - Las Vegas, Department of Psychology, Las Vegas, NV, United States, 5Neuropsychiatric Research Institute, Fargo, ND, United States, 6Brown Medical School/The Miriam Hospital, Providence, RI, United States

Most research characterizing associations between emotion regulation and dysregulated eating has focused on negative affect, largely neglecting the role of positive affect (PA), especially in youth. Further, studies have not considered the influence of puberty, a time of rapid biological and emotional change. We examined independent and interactive effects of PA dimensions (intensity and instability) and puberty stage on loss of control eating (LOCE) and overeating (OE) severity in 40 youth (Mage=11.16±1.94 years) with overweight/obesity who participated in an ecological momentary assessment protocol. PA instability was calculated as percent acute change (PAC) and mean squared successive difference (MSSD). Pubertal status was calculated using the Tanner. There were no main effects of PA intensity on LOCE or OE.  Across pubertal stages, youth with greater overall stability in PA (i.e., lower MSSD relative to the sample mean) reported greater OE severity (p=.005), as did youth with fewer extreme increases in PA (i.e., lower PAC; p=.001). However, moderation analyses revealed the opposite finding among youth in later puberty stages, where more extreme increases in PA (i.e., higher PAC) were related to greater OE (p=.001) and LOCE severity (p=.043). Taken together, PA and its momentary fluctuations should be considered when evaluating emotion regulation in youth with LOCE/OE, and pubertal status may be important to consider when designing emotion-focused treatments for youth.

Brain Response To Reward-Based Decision-Making In Bulimia Nervosa: A Pilot Study
Alice V. Ely1, Amanda Bischoff-Grethe2, Kanchana Jagannathan3, Christina E. Wierenga2, Walter Kaye2
1Christiana Care Health System, Newark, DE, United States, 2University of California, San Diego, San Diego, CA, United States, 3University of Pennsylvania, Philadelphia, PA, United States

: Bulimia nervosa (BN) is marked by impulsivity, seen both in eating pathology and in other risk-taking behavior. Delay discounting (DD), or the extent to which smaller immediate rewards are valued over larger later ones, may underlie altered reward processing in BN. In this pilot study, we used fMRI to investigate brain response to reward-based decision-making in BN, and if this response is related to delay discounting. Methods: Ten women ill with BN and 15 control women (CW) completed a monetary DD task during an fMRI scan while fasted. Brain response was measured during immediate reward trials and decision-making overall. K was calculated to reflect DD, where higher k values indicate greater preference for immediate reward. Results: Behaviorally, BN and CW did not differ on k. Regions-of-interest analysis revealed brain response did not differ between groups. While CW showed no relationship between k and brain response, greater DD significantly correlated with lower activation in the anterior insula during decision-making in the BN group. Conclusions: Findings show underresponse in the insula in BN during reward-based decision-making may be linked to choosing immediate over delayed reward. Prior research is consistent, suggesting broader failure to recruit the insula during reward processing in BN. The insula plays an important role integrating bodily sensation with motivation; elucidating the pathophysiology of impulsivity in BN may lead to better treatment.

Increased Risk-Taking Behavior Following A Loss By Women With Obesity Is Associated With Ventromedial Prefrontal Cortex And Insula Alterations
Fernando Fernandez-Aranda1,2,4, Trevor Steward1,2,8, Asier Juaneda-Seguí1,2,4, Gemma Mestre-Bach1,2, Ignacio Martínez-Zalacaín1,4, Nuria Vilarrasa5,6, José M Menchón1,3,4, Carles Soriano-Mas1,3,7
1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 2Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Madrid, Spain, 3Ciber Salud Mental (CIBERSAM),, Madrid, Spain, 4Department of Clinical Sciences, School of Medicine, Barcelona, Spain, 5Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain, 6CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain, 7Departament de Psicobiologia i Metodologia de les Ciències de la Salut. Universitat Autònoma de Barcelona, Barcelona, Spain, 8Department of Psychological Sciences, University of Melbourne, Melbourne, Australia

Introduction: Obesity is linked with increased risk-taking behavior regarding food choices. We aimed to define the brain regions purportedly underpinning risk-taking behavior in obesity using the Risky Gains Task.  
Methods: 23 adult women with obesity (OB) and 23 healthy weight (HC) controls completed the Risky Gains Task during a fMRI scan. The Risky Gains Task consists of participants choosing between a safe option for a small, guaranteed monetary reward and risky options with larger rewards but a higher chance of loss. Neural response during winning vs. losing trials and during risk vs. safe decisions were compared.
Results: The OB group showed decreased activity in the anterior insula during losing trials in comparison to HC (p<0.05, AlphaSim), suggesting that the insula gives more weight to positive response to reward over the impact of a loss. In addition, insula activation during losses was negatively correlated with UPPS-P sensation-seeking scores (p=0.30, r=-0.320). During safe trials following a loss, the OB group presented decreased activation in the ventromedial prefrontal cortex (vmPFC) (p<0.05, AlphaSim). vmPFC response during post-loss trials was positively correlated with safer choices (p=0.14, r=-0.371), coinciding with previous evidence of the vmPFC supporting the assessment of risk. 
Conclusions: The brains of individuals with obesity may be hyposensitive to interoceptive cues stemming from losses, thereby leading to increased risk-taking behaviors. 

Can Neural Response To Reversal Learning Distinguish Adults With Binge Eating And Purging?
Erika E. Forbes1, Neil P. Jones1, Tori Blazinski1, Ekaterina Sheftel1, Megan Martinho2, Morgan Lindenmuth1, Jennifer E. Wildes3
1University of Pittsburgh, Pittsburgh, PA, United States, 2University of California, San Diego, San Diego, CA, United States, 3University of Chicago, Chicago, IL, United States

Introduction. Conceptual models have postulated that altered cognitive flexibility is a hallmark of eating disorders (ED), but rarely have considered how components of flexibility could differentially contribute to ED presentations. Reversal learning reflects inhibitory control in the context of changing reward contingencies and could be particularly disrupted in binge eating and purging behaviors given their reinforcement functions. We examined whether neural response to reversal learning distinguished adults with binge eating and purging from adults without these symptoms. Methods. Participants were 102 medically stable adults (age M=26.1; 92% female, 73% European American) who met SCID-5 and Eating Disorder Examination criteria for Anorexia Nervosa-Binge Eating/Purging Subtype (AN-BP; n=23), Anorexia Nervosa-Restricting Subtype (n=23), Bulimia Nervosa (BN; n=29), or no psychiatric disorder (n=27). Participants completed a probabilistic reversal learning functional magnetic resonance imaging task in a 3T Siemens Trio scanner. SPM12 analyses focused on the final reversal error before shifting to the newly rewarded stimulus (vs. correct response). Results. Compared to adults without binge eating and purging, those with AN-BP and BN exhibited greater VLPFC response to reversal learning. Conclusions. Discrete, transdiagnostic facets of cognitive flexibility can help to elucidate neural mechanisms of ED and promote understanding of their etiology, pathophysiology, and course.

Examining The Relationship Between Weight Suppression And Naturalistic Long-Term Outcome In Women With Purging Syndromes
K. Jean Forney1, Lindsay P. Bodell2, Pamela K. Keel3
1Ohio University, Athens, OH, United States, 2Western University, London, ON, Canada, 3Florida State University, Tallahassee, FL, United States

Introduction: Weight suppression (WS), the difference between a person’s current and lifetime highest weight, has been associated with the onset and maintenance of eating disorders (ED). Yet, little is known about whether lower levels of WS are necessary for improved outcomes. The current study examined cross-sectional and longitudinal associations between WS and eating pathology in a sample of women who participated in a naturalistic, long-term follow-up of purging syndromes.  Methods: 141 women who previously met criteria for purging disorder or bulimia nervosa completed the Eating Disorder Examination (EDE) at a mean(SD) 10.60(3.74) year follow-up. Results: Adjusting for BMI at follow-up, higher WS at follow-up was associated with higher EDE global scores (B=.21, p=02) and a greater likelihood of meeting criteria for an ED (OR=1.50, p=.03). Follow-up WS and BMI did not interact to predict EDE global scores (B=-.41, p=.54) or ED status (OR=.99, p=.64). Baseline WS data were only available for a subset of women (n=45). Neither baseline WS nor its interaction with baseline BMI longitudinally predicted EDE global scores (B=.05, p=.75; B=.92, p =.68) or ED status (OR =.98, p=.67; OR=.99, p=.78). Conclusions: Although cross-sectional findings are consistent with prior work supporting a relationship between WS and illness maintenance, longitudinal findings do not support this relationship. This may reflect differences in exclusion criteria among parent studies at baseline. 

Inflammatory Cytokines And Anorexia Nervosa : A Longitudinal Study
Sebastien Guillaume1,2, Benedicte Nobile1,2, Laurent Maimoun1, Isabelle Jaussent1, Anne marie Dupuy1,2, Jean paul Cristol1, Maude Seneque1, Nicolas Ramoz3, Philippe Courtet1,2
1CHU Montpellier, Montpellier, France, 2INSERM U1061, Montpellier, France, 3INSERM UMR894, Paris, France

Purpose : Anorexia nervosa (AN)  seems associated with increased inflammatory cytokines. Nevetheless, there are few studies and it is unclear if this reflects AN or undernutrition. Methods : 69 women suffering from AN at their baseline assessment (T1) were compared to 29 healthy women (HC).  Participants with AN were reassessed  12 months later (T2), and split in two subgroups according to their evolution: a group who restored a normal weight (NW) (n=37) and a group presenting still a low weight (LW) (n=32). Inteleukine 1β (IL1 β), Interleukine 6 (IL6), TNFα and CRP were dosed. Results : At baseline, we found higher levels of IL1β and IL6  in AN versus HC (p= 0.007 and 0.03 respectively). There was a trend for a difference on TNFα between (p= 0.07).  IL1β levels seem to be associated with lower BMI (p-value = 0.02) while IL6 levels seem to be associated with AN duration (p= 0.03). Baseline IL1β and IL6 levels were higher in patient who will not recover a normal weight 12 months later (p= 0.0007 and 0.002 respectively). At T2 (12 month later) AN patient NW where similar to HC for  IL1β whereas AN LW had higher level (p= 0.03). By contrast, IL6 level where similar in AN independently of the weight restoration and higher than HC. Conclusion : Those results confirm low-grade inflammation in AN. This inflammation might be prognosis marker of poor evolution. IL1β could be a malnutrition marker while IL6 could be a marker of the disease itself

Cortical Thickness And Brain Volume In Adolescent Girls And Women With Binge Eating
Kelsey E Hagan, Cara Bohon
Stanford University, Palo Alto, CA, United States

Purpose: Reductions in cortical thickness (CT) and brain volume have been observed in individuals with binge eating; however, few studies exist and replication is warranted. Further, none have included both adolescents and adults in a single study, which allows for investigation of age effects. Methods: Adolescent girls and women with recurrent binge eating (n=55; ages 15-35) and healthy controls (n=23) completed structural magnetic resonance imaging scans, a diagnostic interview, and measures of height and weight. Recruitment is ongoing with 5 additional participants anticipated. CT and volume (grey and white matter) will be calculated with Freesurfer and compared between groups. Comparisons will include global brain measures and a priori selected regions of interest (frontoparietal, temporal). We will explore associations among binge eating frequency, age, and CT and volume within the binge-eating group. Results: We hypothesize that CT and volume will be reduced in the binge-eating vs. control group and inversely correlate with binge frequency. We expect that CT and volume reductions will be even greater in older participants with binge eating. Conclusions: Findings will further characterize structural abnormalities underlying binge eating and provide insight into whether abnormalities become more pronounced with age in this population. Given that structural abnormalities may, in part, contribute to binge eating, identification of abnormalities may inform novel treatments. 

Premenstrual Symptoms As A Marker Of Ovarian Hormone Sensitivity In Eating Disorders
Sabrina L. Hardin, Laura M. Thornton, Melissa A. Munn-Chernoff, Jessica H Baker
University of North Carolina, Chapel Hill, NC, United States

Eating disorder (ED) symptoms fluctuate predictably across the menstrual cycle as ovarian hormones change. This suggests women with an ED may be sensitive to normally fluctuating ovarian hormones. Premenstrual symptoms (PMS), which occur the week prior to menses, are caused by normal change in ovarian hormones; thus, may indicate ovarian hormone sensitivity. We test this by examining the association between 11 domains of PMS (e.g., depressed mood, appetite change) and 4 ED symptoms: binge eating (BE), body dissatisfaction (BD), restriction (RES), and purging (PUR). Subjects were 455 young adult women (M=19 years;SD=1.4) who completed an online survey. There were significant correlations between a majority of ED symptoms and PMS (r’s=.09-.37;p<.05). Stepwise regression, including relevant covariates (e.g., BMI), revealed significant (p<.05) PMS predictors for each symptom; BE (R2=.18): BMI, decreased interest in usual activities, concentration problems, appetite change; BD (R2=.22): BMI, depressed mood, appetite change; RES (R2=.15): depressed mood, feel overwhelmed; PUR (R2=.07): BMI, feel overwhelmed. Exploratorily, we repeated regressions excluding PMS appetite change. For BD, affective lability entered the model; for BE, affective lability replaced decreased interest. PUR and RES were unchanged. As hypothesized, PMS may be a marker of ovarian hormone sensitivity in women with an ED. Future studies should address mechanisms underlying this sensitivity. 

Stability Of Binge Eating Prone Phenotypes With Adult Ovariectomy In Female Rats
Kelly L. Klump1, Jessica Van Huysse2, Deborah Kashy1, Megan E. Mikhail1, Kristen M. Culbert3, Alexander Johnson1, Cheryl L. Sisk1
1Michigan State University, East Lansing, MI, United States, 2University of Michigan, Comprehensive Eating Disorders Program, Ann Arbor, MI, United States, 3University of Nevada, Las Vegas, Las Vegas, NV, United States

Introduction: Pre-pubertal ovariectomy (OVX) markedly increases rates (2-5x higher) of binge eating prone (BEP) rats in adulthood. One interpretation is that pubertal estrogen has protective organizational effects, and its absence results in permanent changes in brain structure/function that increase risk for binge eating (BE) in adulthood. However, in order to confirm the protective role of pubertal hormones, removal of ovarian hormones in adulthood only should not significantly alter the proportion of BEP phenotypes. Removal of estrogen in adulthood might increase palatable food (PF) intake in all rats (consistent with hormone activational effects), but the proportion of rats defined as particularly prone to consistently high levels of BE should remain unchanged. This study examined these predictions. Methods: Two independent samples of female rats were intermittently presented with PF before and after OVX in adulthood and phenotyped using the binge eating resistant (BER)/BEP model.  Results: Findings were consistent across samples. PF intake increased significantly following OVX in both BER and BEP rats. However, the proportion of BEP rats (~30%) remained unchanged across OVX, and ~70% of BEP rats categorized as BEP before OVX remained BEP after OVX. Conclusions: Findings confirm that adult OVX has minimal effects on extreme binge eating proneness. Although additional studies are needed, risk for binge eating in adulthood may be organized by pubertal hormones in females.

Elevated Postprandial Insulin Responses In Women With Purging Disorder 
Calyn B. Maske, Diana L. Williams, Pamela K. Keel
Department of Psychology, Florida State University, Tallahassee, FL, United States

Introduction: Purging disorder (PD) is characterized by excessive nausea, urge to vomit, and purging behavior following consumption of a normal-sized meal. However, the underlying biological mechanisms are not yet well-understood. In this preliminary study, we examined whether women with PD demonstrate elevated postprandial insulin release, and whether insulin responses are associated with excessive nausea and urge to vomit after a meal. M
ethods: Women with PD (n=16), bulimia nervosa (BN; n=16), and controls (n=18) underwent structured clinical interviews and assessments of gut hormone and subjective responses to a fixed test meal. Results: Insulin levels significantly increased following the test meal. Women with PD showed greater insulin release compared to participants with BN, but not controls. Multilevel model analyses support significant groupXinsulin interactions predicting subjective ratings of nausea and urge to vomit, with a strong association between higher insulin responses and higher nausea and urge to vomit in women with PD and BN. Conclusion: Elevated insulin response may be a physiological mechanism underlying purging behavior in the absence of binge eating. Increased sensitivity to the effects of insulin on nausea and urge to vomit may be linked to purging in both PD and BN.

Psychopathological And Psychosocial Features In Patients With Obesity: A Network Analysis
Riccardo Dalle Grave, Simona Calugi
Villa Garda Hospital, Garda (VRI, Italy

Background. The aim of this study was to assess the relationship among variables measuring eating disorder and general psychopathology, quality of life, body mass index (BMI), weight loss expectations and internalized weight-stigma in individuals with obesity, using a network analysis. Methods. Treatment seeking patients with obesity were consecutively recruited in a rehabilitative residential treatment program for severe obesity. Each patient completed the following questionnaires: EDE-Q, SCL-90), ORWELL 97) and WBIS. Moreover, current BMI was measured, and maximum acceptable and dream BMI were assessed. Results. The sample included 996 patients with obesity (age 52.3 (SD=16.0) years; BMI 41.8 (SD=7.8) kg/m2; 65.7% females; 52.2%). The network analysis showed that interpersonal sensitivity and shape concern, but also quality of life and internalized weight-stigma were the most central and highly interconnected nodes in the network. On the contrary, objective binge-eating episodes and dietary restraint were the most peripheral and least connected nodes. Eating disorder and general psychopathology formed two clearly separated clusters. No difference in the network structure was found between men and women. Conclusions. The pattern of network node connections supports the design and evaluation of personalized interventions addressing interpersonal sensitivity, shape concern and internalized weight-stigma.

The Temporal Relationship Of Restriction, Alcohol Consumption, And Binge Eating
Sarah Fischer1, Joseph Wonderlich1, Li Cao2, Lauren Breithaupt3
1George Mason University, Fairfax, VA, United States, 2Sandford Center for Biobehavioral Research, Fargo, ND, United States, 3Massachusetts General Hospital

Purpose: Alcohol use disorders often co-occur with disordered eating. A pattern of behavior popularly labeled “drunkorexia” is characterized by restricting food due to concerns about calories from alcohol, leading to increased negative outcomes from use. Studies of this phenomenon have used cross-sectional self-report data or qualitative data. We examined the temporal relationship between restriction, alcohol consumption, and binges on a daily basis. Methods: 135 undergraduates completed 2 weeks of ecological momentary assessment (EMA). Participants responded to 6 prompts per day regarding disordered eating, alcohol use, mood, and motives for eating behaviors and drinking, and completed end of day ratings. Generalized estimating equations were used to estimate the probability of alcohol use following restriction for any reason, restriction for the purpose of later drinking, drinking after binge eating, and binge eating after drinking. Results: Aggregate restriction throughout the day was not associated with later drinking (b=-.79, p<.15). Restriction endorsed for the purpose of drinking was associated with later use (b=.47, p<.046). Binge eating was not associated with later same day drinking. However, drinking predicted binge eating that occurred later in the day (b=2.64, p<.001). Conclusions: Data suggests that restriction with the intent of consumption predicts drinking. Drinking may then increase the likelihood of later binges, consistent with qualitative data.

Vulnerability To Stress-Related Sleep Disturbances Is Associated With Anxiety And Dietary Restriction 
Alissa A. Haedt-Matt, Elizabeth N. Dougherty , Nicole Johnson , Krystal Badillo
Illinois Institute of Technology , Chicago, IL, United States

Anxiety and eating disorders are highly comorbid, suggesting that they may have shared etiological underpinnings. Sleep reactivity (the tendency to experience sleep disturbance in response to stress) is associated with elevated symptoms of anxiety, but no research has investigated this in relation to disordered eating despite findings that stress predicts both disordered eating and sleep disturbances in those with eating disorders. The purpose of this study was to investigate whether sleep reactivity is associated with anxiety and disordered eating. College students (N=160; 50% female) completed self-report measures of anxiety (social anxiety and panic subscales of IDAS), disordered eating (binge eating, purging, dietary restriction subscales of EPSI), and sleep reactivity (Ford Insomnia Response to Stress Test). Partial correlations indicated that greater sleep reactivity was associated with increased dietary restriction (p=.04), but not binge eating (p=.67) or purging (p=.06), controlling for anxiety. Greater sleep reactivity was also associated with elevated symptoms of panic (p<.001) and social anxiety (p<.001), controlling for dietary restriction. Thus, sleep reactivity appears to be a transdiagnostic feature of disordered eating and anxiety symptoms that may partially explain high rates of comorbidity. Findings suggest that having a sleep system that is more sensitive to the effects of stress may enhance vulnerability for anxiety and restrictive-type eating disorders. 

Do Depression, Anxiety And Intolerance Of Uncertainty Contribute To Social Peoblem Solving In Adults With Eating Disorders?
Amy Harrison1, Lot Sternheim2, Unna Danner3, Anne-Marie van Elburg4
1University College London, London, United Kingdom, 2Universiteit Utrecht , Utrecht, Netherlands, 3Universiteit Utrecht and Altrecht Eating Disorders Rintveld, Utrecht, Netherlands, 4Universiteit Utrecht, Utrecht, Netherlands

Purpose: Inefficient social problem solving may underlie the interpersonal factors maintaining anorexia nervosa (AN). However, depression, anxiety and intolerance of uncertainty (IU), known to contribute to social problem-solving, were not controlled for in previous work. Methods: This study explored whether 30 adults with AN would show differences in social problem-solving on the Means-End Problem Solving task (MEPS) and report differences in their attitudes (positive, negative) towards social problem-solving and their use of social problem-solving styles (rational, impulsive-careless, avoidant) on the Social Problem-Solving Inventory Revised (SPSRI) compared to 44 non-AN controls. Results: Those with AN generated significantly less effective solutions on the MEPS (d=1.96) and reported poorer social problem-solving on the SPSRI (d=0.58), with more negative and less positive attitudes towards social problem-solving and less impulsive and more avoidant social problem-solving styles. Once depression (Beck Depression Inventory), state anxiety (State Trait Anxiety Inventory) and IU (Intolerance of Uncertainty Scale-12) were included as covariates, these differences were no longer significant, suggesting that social problem-solving difficulties can be explained by comorbid depression, anxiety and IU. Conclusions: Treating depression, anxiety and IU might improve social problem-solving and enable people with AN to be able to better access social support to aid their recovery.

Eating Disorder Symptoms And E-Cigarette Use Motives In Collegiate E-Cigarette Users
Kathrin M. Hennigan, Jessica H. Baker, Melissa A. Munn-Chernoff
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

Introduction: Women with eating disorders (ED) have a higher prevalence of traditional cigarette use (i.e., smoking) than healthy controls. Enhancement and coping are common motives for smoking and using e-cigarettes (i.e., vaping). In the United States, smoking has decreased and vaping has increased notably in younger ages (e.g., college students), but limited data exists on vaping and vaping motives related to ED symptoms. Methods: Participants were 716 college students (Mage=19.23, SD=1.65; 61% women) answering the Eating Pathology Symptoms Inventory, a vaping questionnaire, and the Drinking Motives Questionnaire-Revised modified for vaping via an online survey. We used t-tests to examine ED symptoms in lifetime (and past-month) e-cigarette users vs. non-users, Pearson correlations to examine associations between ED symptoms and vaping motives, and linear regressions to explore if sex impacts significant findings. Results: Nearly 23% of students reported lifetime vaping; 9.5% reported past-month vaping. After multiple testing correction, lifetime e-cigarette users reported higher muscle building; findings were no longer significant after adjusting for sex (β=.25, SE=.30, t=.85, FDR p=.6390). Purging was significantly related to coping motives for vaping after adjusting for sex (β=1.09, SE=.40, t=2.76, FDR p=.0412). Conclusions: The relation between purging and coping motives for vaping could suggest a need for alternate coping strategies in those with this comorbidity.

Comborid Depression And Substance Use Prospectively Predict Eating Disorder Persistence Among People With Anorexia And Bulimia, Respectively
Ani C. Keshishian1, Nassim Tabri2, Kendra R. Becker1,3, Jennifer J. Thomas1,3, Debra L. Franko1,4, Kamryn T. Eddy1,3
1Massachusetts General Hospital, Boston, MA, United States, 2Carleton University, Ottowa, ON, Canada, 3Harvard Medical School, Boston, MA, United States, 4Northeastern University, Boston, MA, United States

Introduction: The temporal relations between eating disorders (EDs) and comorbid psychopathology are poorly understood. To explore these links, we examined two common comorbidities, major depressive disorder (MDD) and substance use disorder (SUD), in adult women with intake diagnoses of anorexia nervosa (AN) and bulimia nervosa (BN) who participated in a 22-year longitudinal study. Method: To test the longitudinal reciprocal relations among ED (yes/no), MDD (yes/no), and SUD (yes/no) diagnoses in participants diagnosed with AN and BN at study intake, we conducted a multi-group autoregressive cross-lagged path analysis. In the model, ED, MDD, and SUD in a given three-month period (t-1) each predicted ED, MDD, and SUD during the subsequent three-month period (t) across 5 years. Moderation analyses tested whether the magnitude of the path coefficients varied as a function of intake diagnosis (AN vs. BN). Results: Among AN (but not BN) participants, having MDD at t-1 predicted having an ED at time t, OR=1.97, B=.68, z=2.49, p=.01. Among BN (but not AN) participants, having a SUD at t-1 predicted having an ED at time t, OR=5.16, B=1.64, z=2.34, p=.01. In contrast, having an ED at t-1 did not predict MDD or SUD at time t for AN or BN participants. Conclusion: The results suggest that MDD and SUD may be maintaining factors of EDs among individuals with AN and BN, respectively. Addressing how to treat MDD and SUD in the context of EDs may be important for improving ED outcomes. 

Effect Of Family-Based Treatment For Adolescent Anorexia Nervosa On Psychiatric Comorbidity      
Daniel Le Grange1,2, Claire Trainor1, Sasha Gorrell1, Elizabeth K Hughes3,4, Claire Burton4, Susan M Sawyer3,4,5
1University of California, San Francisco, San Francisco, CA, United States, 2The University of Chicago (Emeritus), Chicago, IL, United States, 3University of Melbourne, Melbourne, Australia, 4Murdoch Children's Research Institute, Melbourne, Australia, 5Royal Children's Hospital, Melbourne, Australia

Purpose: Rates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa (AN), but less is known about rates of psychiatric comorbid diagnoses after eating disorder (ED) treatment.  Methods: Within a randomized clinical trial testing two forms of family-based treatment for AN within a specialist ED service,85 adolescents completed the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline and end-of-treatment. Analyses explored whether having a baseline comorbid diagnosis predicted the presence of a diagnosis at end-of-treatment, and if ED psychopathology impacted this association.  Results:Findings from logistic regressions showed that the presence of a baseline diagnosis predicted the absence of a comorbid diagnosis at end-of-treatment (b= -1.76, p<.01). Further, regression analyses revealed that a diagnosis of major depressive disorder (b= -1.77, p<.01), generalized anxiety disorder (b= -1.46, p= .03), or panic disorder (b= -2.82, p<.01) at baseline predicted the absence of the corresponding diagnoses at end-of-treatment. Greater baseline ED psychopathology predicted having a comorbid psychiatric condition at end-of-treatment (b= .46, p<.01).  Conclusions: Family-based treatment for adolescent AN may be effective at also alleviating co-occurring psychiatric conditions. Further research is needed to understand the factors that may influence comorbid symptom improvement during treatment.   

The Role Of Eating Disorder Pathology In The Maintenance Of Problematic Substance Use In Women And Men During Adulthood
Margaret C. Walsh, Elizabeth H. Fitzgerald, Madeline R. Wick, Pamela K. Keel
Florida State University, Tallahassee, FL, United States

Substance use generally peaks in late adolescence and young adulthood, and declines as individuals assume more responsibilities and become more concerned with personal health. Disordered eating behaviors in adolescence have been linked to onset of problematic substance use in later adolescence/young adulthood. However, the role of disordered eating in maintenance of substance use problems during adulthood has not been fully explored. The present study examined whether disordered eating was a prospective risk factor for maintenance of substance use problems (frequency of intoxication, interference with work, and worry over use of drugs or alcohol) as women and men (N=645; 71% female) transitioned from their 30’s to their 40’s.
  For men, increased Drive for Thinness (DT) prospectively predicted greater maintenance of problematic substance use at 10-year follow-up; however, Bulimia scores were not predictive. For women, neither DT nor Bulimia predicted changes in substance use problems over time. Finally, neither the use of inappropriate compensatory behaviors nor the presence of binge eating at baseline prospectively predicted problematic substance use at 10-year follow-up in either gender. Future research should investigate why DT puts men at greater risk for continued problematic substance use. 

Can Insecure Attachment Disentangle The Association Between Thin Ideal Internalisation And Eating Related Concerns In Girls?
Lien Goossens1, Kim Van Durme1, Hanne Naeye2, Sandra Verbeken1, Guy Bosmans3
1Department of Developmental, Personality and Social Psychology, Ghent University, Gent, Belgium, 2Vrij CLB Ieper, Ieper, Belgium, 3Clinical Psychology Research Unit, KULeuven, Leuven, Belgium

Objective: The present study aims to cross-sectionally investigate whether insecure attachment dimensions towards mother and father moderate the association between internalization of the thin ideal and eating related concerns in adolescent girls. Method: Self-report questionnaires on attachment anxiety and attachment avoidance towards both mother and father, thin ideal internalization, and eating related concerns were administered to a community-based sample of 167 adolescent girls (11-18 years). Results: After controlling for participants’ age and adjusted body mass index, significant interactions were found between attachment anxiety towards mother and thin ideal internalization for explaining girls’ eating related concerns. Also, a significant interaction between attachment avoidance towards mother, as well as between attachment avoidance towards father and thin ideal internalization was found for explaining girls’ eating related concerns. Conclusion: Both attachment anxiety (towards mother) as well as attachment avoidance (towards both parents) play a moderating role in explaining the relationship between internalization of the thin ideal and pathological eating attitudes in female adolescents. Longitudinal and experimental studies are needed to further unravel the role of insecure attachment as a vulnerability for eating pathology in youth. Clinically, insecurely attached girls may be a target for prevention and early intervention.

I'M Not A Teenager, I'M 22. Why Am I Not Able To Snap Out Of It?Emerging Adults' Experiences Of Seeking Help For A First-Episode Eating Disorder
Rachel Potterton1, Karina Allen1,2,3, Vanessa Lawrence4, Ulrike Schmidt1,2
1Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom, 2The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom, 3School of Psychological Science, The University of Western Australia, Perth, Australia, 4Department of Health Services & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom

Emerging adulthood (~18-25 years) is a developmental phase with unique challenges. Whilst there are overlaps with adolescence in relation to development of identity and risk-taking, emerging adults typically are afforded much greater independence, in practical, economic, socio-cultural and legal terms. First-episode eating disorders (ED) commonly present during this phase. Data suggest that emerging adults present for ED treatment with delays. This qualitative study explores emerging adults’ experiences of seeking help for a first-episode ED. Methods: Participants (N=20; M age= 21) were purposively sampled emerging adults receiving specialist outpatient or day-care treatment for a first-episode ED. Semi-structured interviews relating to participants’ experiences of help-seeking were conducted, and data were analysed thematically. Results: Three themes were identified: i) social norms; ii) identity; iii) flux and change. Peer normalisation of disordered eating acted as a barrier to help-seeking, as did experiencing ED as a valued identity or as incongruent with other identities (e.g. gender, age, ethnicity). Frequent environmental upheaval presented both difficulties and opportunities for help-seeking. Conclusions: Emerging adulthood’s unique psychosocial characteristics are associated with distinctive challenges and opportunities for ED-related help-seeking. Efforts to encourage and support early help-seeking should be tailored to this developmental stage. 

Desired Weight Change And Bullying As Correlates Of Tobacco Use Among Heterosexual And Sexual Minority Adolescent Females
Jerel P. Calzo1, 2, Blair C. Turner3, Rachel Marro4, Saanjh Boyani1, Cameron Wadstrom1, Ethan Lopez1, Gregory L. Phillips4
1San Diego State University, San Diego, CA, United States, 2Institute for Behavioral and Community Health, San Diego, CA, United States, 3Chicago Department of Public Health, Chicago, IL, United States, 4Northwestern University

Lesbian and bisexual (LB) female youth report higher prevalence of tobacco use and disordered eating behaviors (DEB) than heterosexual youth. Risk factors for these potentially co-occurring behaviors are less well understood. Common motivators can include weight suppression and stress relief. Using pooled 2009-2017 US Youth Risk Behavior Surveillance surveys (n=200,928; ages 12-24 years; 12% LB), logistic regression models estimated associations between: desired weight change (lose weight: 59.3%; gain weight: 8%; stay the same: 16.7%; do nothing [ref]: 16.1%); any DEB (e.g., diet pills, purging: 20.4%); and the outcomes of ever smoke (22.8%); current smoking (in past month, 8.1%); and ever vape (41.8%). Adjusting for bullying (a stress indicator, 21.6%) and age, race, and BMI, LB females had 2.9 times the odds of heterosexual females of ever smoking, 3.3-3.9 times the odds of being a current smoker, and 80%-90% greater odds of ever vaping. Desire to lose weight was associated with 10% greater odds of ever smoking; desire to gain weight was associated with 50% greater odds of ever smoking and 40% greater odds current smoking. Reporting DEB more than doubled the odds of ever smoking and being a current smoker. Sexual orientation did not modify associations between the tobacco use outcomes and desired weight change and DEB. Thus, desired weight change, DEB, and bullying may all be associated with greater odds of tobacco use among adolescent girls of all sexual orientations.

Parental Perception Of Child’S Current And Ideal Body Size Longitudinally Predicts Child’S Perception Of Their Current And Ideal Body Size
Samantha L. Hahn, Mikayla R. Barry, Kendrin R. Sonneville
Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States

Introduction: Weight perception and idealization of thin bodies during pre-adolescence is associated with numerous physical and mental health effects. However, little is known about parental factors that predict these constructs. Methods: Study participants came from the ABC cohort, a longitudinal study of children and their parents recruited during early childhood (4-6 years old) from Head Start programs in Southeastern, MI. At the time of enrollment, parents were shown silhouettes of different body sizes and were asked to assess the child’s current body size and their ideal body size. Children were asked to assess their own body size and ideal body size during pre-adolescence (10-12 years old, n=136). Multivariable logistic regression models adjusted for age, sex, race/ethnicity, and BMI z-score were used to examine whether parental perception of current and ideal body size longitudinally predicted the same variables for children. Results: Parental perception of child’s body size at age 4-6 was positively associated with child’s perception of current body size (b=.235, p=.07) and ideal body size (b=.302, p=.01) in pre-adolescence. Parental rating of ideal body size for their child at age 4-6 was positively associated with the child’s rating of ideal body size during pre-adolescence (b=.274, p=.05). Conclusion: Parents perceiving and accepting a larger body for their children during early childhood may protect their children from idealizing a thin body later in life.

The Influence Of Peer-Based Poly-Victimization On Disordered Eating Behaviour In A Representative Sample Of Adolescents: Evidence From The 2014 Ontario Child Health Study 
Melissa Kimber, Masako Tanaka, Andrea Gonzalez, Jennifer Couturier, Harriet MacMillan
McMaster University, Hamilton, ON, Canada

Purpose: Emerging literature details the cumulative impacts of exposure to multiple forms of violence, that is 'polyvictimization,' on well-being. However, there is a dearth of studies examining the independent and intersecting impacts of exposure to various forms of violence on disordered eating behaviour (DEB) among youth. This study examines the relationship between peer-based polyvictimization and DEB among a representative sample of youth living in Canada. Methods: Data come from the 2014 Ontario Child Health Study, a provincially representative survey of families with children in Ontario. Youth aged 14 to 17 years (n = 2,396) completed a self-administered questionnaire to assess experiences of peer-based bullying (PBB), teen dating violence (TDV), DEB, and associated correlates, including child maltreatment. Linear regression with bootstrapped standard errors was used to address our research objectives. Results: Exposure to PBB and TDV were significantly associated with DEB; their interaction was non-significant. Only the main effect for PBB remained significant after accounting for child maltreatment exposure. Compared to males, female youth reported significantly greater DEB, irrespective of violence exposure. Youth self-esteem partially mediated the association between PBB and DEB. Conclusions: PBB represents a particularly salient risk factor for DEB. Interventions which improve youth self-esteem have the potential to reduce DEB severity among polyvictimized youth.

Exploratory Analysis Of The Association Between Gene Expression Networks And Clinical Indices Of Anorexia Nervosa    
1University of North Carolina, Chapel Hill, NC, United States, 2University of Chicago, Chicago, IL, United States

Genetic factors play a substantial role in anorexia nervosa (AN). However, less is known about how genomic factors change with weight restoration and the association between these changes and clinical indices. Weighted gene co-expression network analysis (WGCNA) was applied to genes previously identified to significantly differ in expression levels (551 genes; FDR=5%) before (T1) and after (T2) weight restoration treatment for AN (N=55; age M=25 [7.6] years). WGCNA reduces the change in gene expression levels into networks. Three networks were identified, and gene ontology showed enriched pathways associated with [1] immunodeficiency disorders, [2] membrane component consisting of gene products and protein complexes, [3] thiol compound-dependent ubiquitin protein-specific protease activity, respectively. Pearson correlations identified associations between networks and clinical factors at 3-months post-discharge (T3). T1 weight was significantly correlated with all networks (r=-.50-.30;p<.05). Notable correlations also emerged at T3: network 1 with self-reported persistence (r=.37;p<.05) and sensation seeking (r=-.34; p=.06); network 2 with weight change from T1 to T3 (r=.40;p<.05) and self-reported perceived stress (r=-0.70;p=.05); network 3 with the eating concerns subscale of the EDEQ (r=.36;p<.05). Results are exploratory so should be interpreted accordingly. Future studies with larger samples are needed to confirm and address the clinical utility of the findings.

Antimicrobial Peptides In Anorexia Nervosa
Marie-Christin Bendix1, Michael Stephan1, Wally Wünsch-Leiteritz2, Hagen Schmidt2, Jürgen Hader3, Martina de Zwaan1
1Hannover Medical School, Hannover, Germany, 2Klinik Lüneburger Heide, Bad Bevensen, Germany, 3University Hospital Schleswig-Holstein, Kiel, Germany

Introduction: Patients with anorexia nervosa (AN) are reported to be remarkably free of clinical infections, despite significant nutritional deprivation. In Drosophila, starvation resulted in increased expression of antimicrobial peptides (AMP). As part of the innate immune system, AMPs protect from pathogenic microorganisms. We thus hypothesized that starvation in AN might be associated with elevated levels of AMPs compared to healthy controls (HC) and that concentrations of AMPs might decrease with weight gain. Methods: Shortly after admission and after some weight regain, 33 patients with AN were investigated and compared to age-matched HCs. Participants were female, with a BMI <15 kg/m2, older than 16 years, non-smoker, and skin-healthy. Using a standardized rinsing method to absorb the AMPs on the forehead, quantitative determination of psoriasin, the dominating AMP of human skin, was carried out by ELISA. Results: We did not find significant differences in psoriasin concentrations between patients with AN and HC. BMI had increased from 12.6 kg/m2 to 14.5 kg/m2 at the time of the second measurement. Psoriasin increased significantly during weight gain (p=0.011) which was mainly due to strong increases in patients with bulimic subtype AN. Effect sizes were medium to high. Conclusions: As opposed to our hypothesis we did not find differences in AMP levels between patients with low-weight AN and HC. Also, AMP concentrations significantly increased with weight gain.

Impact Of Intersectional Identities On Body Image And Related Shared Decision Making For Sexual Minority Latina Women
Seeba Anam1, Jessica Mora2, Katherine Ordonez2, Monica Vela2, Jennifer E. Wildes1, Julie Grutzmacher2, Arshiya Baig2
1University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, United States, 2University of Chicago, Department of Medicine, Chicago, IL, United States

Purpose:  This mixed methods study examined the impact of intersectional identities on body image concerns and related shared decision making (SDM) between Latina women and their healthcare providers. Methods: We conducted semi-structured interviews with lesbian (n=14) and bisexual, pansexual, or queer (n=6) cis-gender Latina women (M[SD] age = 33[11] years) in English (n=15) or Spanish (n=5).  Participants were asked how their identities affected their eating patterns, exercise habits, and body image, and to describe SDM with their providers. Transcripts were double coded using an iteratively developed codebook. Themes were analyzed using NVIVO and modified Grounded Theory. Results: Stigma about body image in Latina and queer spaces contributed to body dissatisfaction. Differential social norms, acceptance, and regulation of diverse body types, and the conflict related to attaining competing body ideals emerged as major themes. Most participants had not engaged in SDM about body image or related eating patterns with a provider due to provider stigma, lack of awareness of the impact of body image on health decisions, and limited acceptability of provider recommendations. Conclusions: Intersectional cultural factors play a role in conceptualizing body ideal for Latina sexual minority patients and inform SDM with providers. Findings highlight the importance of implementing individualized, patient centered approaches to SDM for patients with intersectional identities. 

Assessment Of Food Choices In Adolescents With Anorexia Nervosa
Unna N. Danner1, Karin E. Foerde2, Stephanie van Leeuwen1, Annemarie A. van Elburg1, Joanna E. Steinglass3
1Altrecht Eating Disorders Rintveld, Zeist, Netherlands, 2Columbia University Department of Psychology/New York State Psychiatric Institute, NY, NY, United States, 3Columbia University Irving Medical Center/New York State Psychiatric Institute, NY, NY, United States

Introduction: Restrictive food intake is one of the most striking features of anorexia nervosa (AN). With time this maladaptive behavior shows habitual characteristics as food choices, in particular the limited section of high-fat foods, are no longer based on tastiness ratings. Most studies were done in adults with AN and less is known about adolescents with AN, who have a shorter illness duration and therefore habit formation may be less prominent. Methods: A group of 40 adolescents with and without AN were asked to perform the Food Choice Task to learn about their food choices in the context of tastiness and healthiness ratings. The adolescents were also asked to fill in the Self-Reported Habit Index regarding a range of eating routines, Food Frequency Questionnaire and a food-related Implicit Association Task. Results and conclusions: Adolescents with AN showed the characteristic decrease in preference for high-fat foods as adults with AN do. However, ratings of tastiness and healthiness of the food items showed differences from adults, with less conflation of the two values. Further analyses are currently conducted to learn about the association of food preferences and value ratings with 1) the strength of several eating habits, 2) the implicit evaluations of high- and low caloric food items. These data provide in-depth assessment of food-based decision making in adolescents with AN, thereby enriching understanding of mechanisms of maladaptive restriction in AN.

Relationship Between Eating Disorder Pathology And Physical Activity In Pregnant Women With Overweight And Obesity
Shannon D. Donofry1, Lisa J. Germeroth1, Rachel P. K. Conlon1, Elizabeth M. Venditti1,2, Michele D. Levine1,3,4
1University of Pittsburgh Department of Psychiatry, Pittsburgh, PA, United States, 2University of Pittsburgh Department of Epidemiology, Pittsburgh, PA, United States, 3University of Pittsburgh Department of Psychology, Pittsburgh, PA, United States, 4University of Pittsburgh Department of Obstetrics, Gynecology, and Reproductive Science, Pittsburgh, PA, United States

Introduction: Overweight and obesity during pregnancy increase risk for adverse maternal outcomes. Pregnancy is a period in which women experience changes in eating, physical activity (PA), and weight. However, few studies have documented the relationship between eating disorder (ED) pathology and PA among pregnant women with overweight/obesity.   Methods: Women with body mass index (BMI) ≥25 (N=264; Mage=28.46, SDage=5.43; MBMI=34.00, SDBMI=7.09) between 12-20 weeks gestation (M=15.69, SD=2.45) were recruited for an observational study of perinatal weight and eating patterns. Participants underwent diagnostic interviewing using the Structured Clinical Interview for DSM-IV and Eating Disorders Examination-Pregnancy Version. PA was assessed via interview using the Paffenbarger Physical Activity Survey. Weeks gestation was included as a covariate.   Results: Lifetime history of ED diagnosis, weight concerns, and shape concerns were not associated with energy expenditure. However, higher global ED pathology scores were related to fewer blocks walked (β=-0.14, p=0.03) and higher eating concerns were related to lower energy expenditure (β=-0.18, p<0.01).   Discussion: ED pathology was related to lower levels of PA in pregnant women with overweight/obesity. Future research is needed to determine whether the relationship between ED pathology and PA early in pregnancy persists and whether it predicts maternal outcomes later in the perinatal period.

Help-Seeking Intentions And Behaviors Of Individuals Completing A Widely Available Online Screen For Eating Disorders In The U.S. 
Ellen E. Fitzsimmons-Craft1, Katherine N. Balantekin2, Andrea K. Graham3, Lauren Smolar4, Dan Park4, Claire Mysko4, Burkhardt Funk5, C. Barr Taylor6,7, Denise E. Wilfley1
1Washington University School of Medicine, St. Louis, MO, United States, 2University at Buffalo, Buffalo, NY, United States, 3Northwestern University , Chicago, IL, United States, 4National Eating Disorders Association, New York, NY, United States, 5Leuphana University, Luneburg, Germany, 6Stanford University, Stanford, CA, United States, 7Palo Alto University, Palo Alto, CA, United States

Introduction: Scaling an online screen that provides feedback and referrals may be a key first step in closing the treatment gap between those who need and receive care for eating disorders (EDs). Yet we need to understand respondents’ help-seeking intentions and behaviors. Methods: Participants completed a validated ED screen on the National EDs Association website over 11 months (2/25/18-1/26/19). Upon completion, participants screening positive or at high risk for an ED were presented with optional questions about help-seeking intentions and a request to complete a 2-month follow-up about help-seeking behaviors. Results: Of 226,058 respondents (of whom 87.7% screened positive for an ED and 9.2% as high risk), 5.9% of eligible participants (n=13,176) completed the end-of-survey questions. When asked about intentions to seek help, only 33.4% reported they definitely or probably would. Only 0.6% (n=1,455) of eligible respondents opted in to the 2-month follow-up, with 25.4% (n=370) completing. The majority (69.2%) remembered receiving a referral for treatment. 61.4% reported wanting help for an eating problem over the past 2 months, with 11.9% actually receiving treatment. Conclusions: Among the small minority who provided data on help-seeking, only about a third expressed help-seeking intentions and only 12% actually received treatment. Mass online screening should consider ways to increase user motivation for care and follow-through with treatment recommendations.

Associations Between Daily Stress, Major Life Stressors, And Emotional Eating In Women
Natasha L Fowler1, Pamela K Keel2, Debra K Katzman3, Cheryl L Sisk4, Michael C Neale5, S. Alexandra Burt1, Kelly L Klump1
1Michigan State University, East Lansing, MI, United States, 2Florida State University, Tallahassee, FL, United States, 3University of Toronto, Toronto, ON, Canada, 4Michigan State University, East Lansing, MI, United States, 5Virginia Commonwealth University, Richmond, VA, United States

Studies report associations between stress exposure, psychological and physiological responses to stress and emotional eating (EE). However, it is uncertain how daily minor stressors and major life stressors differentially influence EE. This study examined associations between daily minor and major life stress and EE in 103 female twins (aged 16-25 years) from the Michigan State University Twin Registry. Methods: Daily ratings of EE (assessed via the Dutch Eating Behavior Questionnaire), number of minor life events (e.g., car trouble), average impact rating (ranging from ‘not stressful’ to ‘caused me to panic’; assessed via the Daily Stress Inventory), and major life stressors (e.g., parental divorce; assessed via the Social Readjustment Rating Scale) were collected for 49 consecutive days. Mixed linear models assessed effects of stress impact and major and minor stressors on EE. Results: After controlling for BMI and negative affect, number of daily stressors more strongly predicted EE than stress impact and major life stress. Conclusion: Exposure to daily minor stress may be the most important type of stress for EE in women. Additional studies of major life stress assessed over longer time periods (e.g., lifetime versus just the last 49 days) are needed to test if major life stress predict predicts EE.

Restrictive Eating Disorders In Higher Weight Persons: A Systematic Review Of Atypical Anorexia Literature
Erin N. Harrop1, Janell L. Mensinger2
1University of Washington, Seattle Childrens, Seattle, WA, United States, 2Drexel University, Philadelphia, PA, United States

Atypical Anorexia (AAN) denotes individuals with anorexia nervosa (AN) whose body mass index (BMI) is over 18.5. Little is known about rates of AAN, levels of impairment, and how AAN compares to AN. This systematic review of AAN literature from 2007 to 2017 investigates: 1) how often AAN cases are identified in community and clinical samples compared to AN, 2) to what degree AAN patients are weight suppressed compared to AN, and 3) what medical complications AAN patients face compared to AN. METHOD: Systematic review was conducted in three databases according to current PRISMA guidelines. The search yielded 67 articles that were coded for 50 variables. Quality was assessed via the Quality Assessment Scale. RESULTS: Studies often lacked rigor and used small samples of mostly white, young, female patients. In community-based designs, AAN was at least as common or more than AN; AAN was less represented in clinical samples. AAN had greater percentage weight lost and higher lifetime nadir BMI, lifetime maximum BMI, and BMIs at amenorrhea and admission. AAN experienced medical complications at levels commensurate to AN, yet waited longer for care. CONCLUSIONS: Disparate findings in community and clinically based studies suggest that while AAN may be more common in the population, fewer patients receive care. Treatment delay could explain findings of higher weight suppression in AAN. These findings are concerning given the frequency of medical complications in AAN.

Core Eating Disorder Psychopathology Among Males And Females
Kirstie M Herb, Karen K Saules
Eastern Michigan University, Ypsilanti, MI, United States

Network analysis (NA) has previously been applied to better understand eating disorder (ED) nosology. However, the samples used to model these networks have primarily been comprised of treatment seeking females, making it unknown if these results generalize to males and non-clinical populations. The present study aimed to fill this gap in the literature. 2. Students from a Midwestern university (N = 990) completed measures designed to assess ED psychopathology, including the Eating Disorder Questionnaire (EDE-Q). NA was used to identify core ED symptoms. Symptom networks were also modeled for both males (n = 331) and females (n = 659), separately. Networks contained all items of the EDE-Q excluding behavioral frequency items. 3. In the overall network model, desire to lose weight, overvaluation of weight, and shape dissatisfaction were the most central symptoms (strength [S] = 1.71, 1.40, and 1.28 respectively). Similarly, desire to lose weight and overvaluation of weight emerged as core symptoms within the female network (S = 1.53 and 1.30). Shape and weight preoccupation also emerged as highly central (S = 1.24). Within males, fear of weight gain, shape dissatisfaction and discomfort seeing body were most central (S = 2.14, 1.92 and 1.13). 4. In all networks, indicators of shape and weight overvaluation had the highest centrality. Results converge with past NA studies and cognitive behavioral models and suggest similar core ED symptoms in non-clinical males and females. 

Workforce Diversity In The Field Of Eating Disorders Among An International Sample: A Mixed Methods Study
Karen M Jennings1, Carolina Anaya2, Betty Rambur1, Lindsay P Bodell3, Andrea K Graham4, K. Jean Forney5, Seeba Anam2, Jennifer E. Wildes2
1University of Rhode Island, Providence, RI, United States, 2University of Chicago, Chicago, IL, United States, 3Western University, London, ON, Canada, 4Northwestern University, Chicago, IL, United States, 5Ohio University, Athens, OH, United States

Introduction: Though diversity initiatives have increased worldwide, more information is needed about what diversity looks like in the current eating disorders (ED) workforce. This mixed-methods study examined diversity across demographic and professional variables inclusive of different identities and backgrounds, and inquired about perceived barriers to increasing diversity. Method: Participants (N=512) were recruited from ED and discipline-specific professional organizations and by snowball sampling and completed an online survey. Results: Among survey respondents, 292 (57.0%) answered the open-ended question “What are some of the barriers to increasing diversity in the field of ED?” Most of these respondents identified as women (n=258; 88.4%), heterosexual/straight (n=236; 80.8%), and White/Caucasian (n=216; 74%); mean age was 41.2 (SD=12.5) years. “Stigma, Bias, Stereotypes, Myths” emerged as the overarching qualitative theme for a direct barrier to increasing diversity in the ED field and directly impacted other emerging themes: field of ED pipeline and homogeneity of the existing ED field. Conclusion: Results inform a theoretical model, which serves as a step towards addressing perceived barriers to increasing diversity within the ED field. Increasing workforce diversity on a global scale continues to be necessary to prepare a culturally-appropriate ED workforce and yield new perspectives that enhance scientific knowledge. 

Addicted To Food? Food Characteristics And Perceived Addiction To Food And Eating
Kristin M. von Ranson, Hilary Herman
Department of Psychology, University of Calgary, Calgary, AB, Canada

Per food addiction (FA) theory, substance-based addiction to “certain” foods may help explain rising obesity rates. A cornerstone of FA theory is that foods do not possess equal addiction potential: people tend to become addicted to foods that are highly processed, i.e., contain refined carbohydrates and/or fat. Eating addiction (EA), however, involves a behavioral addiction not driven by specific food components. Little is known about foods associated with FA or EA. In this online study, we examined how well foods to which people reported feeling addicted fit the FA model. 600 psychology students (84% female; M 21.7 yrs; 59% Cauc.) responded to: “Have you felt addicted to food or eating in the past 12 months?” which yielded Food, Eating, Both, or Neither categories; then the Yale Food Addiction Scale (YFAS). 44.1% of participants reported perceived FA and/or EA, and 35.7% listed at least 1 food they felt addicted to. We compared self-generated foods to YFAS forced-choice options. Participants generated 1.6 foods on average, vs 4.6 endorsed on YFAS. Contrary to our hypothesis that those with perceived FA would report addiction to processed, high-fat, and high-sugar (but not unprocessed) foods, chi-square results indicated no patterns of group differences in these food characteristics, p>.05. Findings suggest processed, high-fat, high-sugar foods are problematic for many individuals, including those perceived EA and neither FA or EA, not just those with FA.

Idealization Of The Eurocentric Ideal In Asian American Women: Psychometric Properties Of The Eurocentric Ideal Internalization And Pressure Scale (Edips)
Liya M. Akoury, Cortney S. Warren, Kristen M. Culbert
University of Nevada, Las Vegas, Las Vegas, NV, United States

In addition to being young and thin, beauty ideals in mainstream Western media are Eurocentric. These Eurocentric appearance ideals are particularly unattainable for women of color and may heighten risk for Eurocentric body dysmorphic concerns (i.e., dissatisfaction with racially salient features). Asian American women may be particularly vulnerable, as they have among the highest rates of body dysmorphic concerns of any ethnic group. There is an absence of research exploring these effects and no known measures of the idealization of Eurocentric ideals. Accordingly, this study developed EDIPS to test internalization and pressures for Eurocentric ideal in 430 Asian American women. Methods. Factor structure and psychometric properties of the EDIPS were explored. Results. EDIPS demonstrated good psychometric properties for a 4-factor structure, interpreted as: Eye-Skin-Hair Ideal Internalization; Nose-Ideal Internalization; Family/Peer Pressure for Eurocentric Appearance; and Media Pressure for Eurocentric Appearance. Factors showed medium positive associations with pressures for thinness and thin-ideal internalization, suggesting that thin and Eurocentric beauty ideals are related, yet distinct constructs. EDIPS significantly positively predicted Eurocentric body dysmorphic concerns. Conclusions. EDIPS may be a useful measure of idealization of Eurocentric beauty ideals in Asian American women. Future study is needed to examine EDIPS in other women of color.

Modeling The Interplay Of Anxiety And Food Restriction In Anorexia Nervosa Using Cellular And Circuit-Level Studies In Mice
Mark L Andermann, Hakan Kucukdereli, Andrew Lutas, Kayla Fernando, Trent Pottala, Yoav Livneh
Divison of Endocrinology, Beth Israel Deaconess Medical Center, Boston, MA, United States

Restrictive-type anorexia nervosa causes anguish in patients and families, and can often be fatal. Treatments remain inadequate, in part because we lack a good understanding of the underlying neural circuits and their pathology. Several important brain areas involved in stress and learning of cues may be drive altered reactions to food cues and aversive cues in patients with anorexia nervosa. We are developing novel mouse models for understanding the basic circuits that underlie anorexia nervosa. 
We are using cutting-edge neuroscience imaging techniques to test the hypothesis that natural and artificial hunger (i.e. direct optogenetic and chemogenetic stimulation of hypothalamic agouti-related peptide neurons) may suppress aversive cue responses in neural circuits involved in stress and anxiety, including the basolateral amygdala. In a second related series of experiments, we are developing a novel mouse model of anorexia nervosa, and are testing the hypothesis that mice in high-anxiety contexts will learn to voluntarily seek direct optogenetic stimulation of hunger-promoting hypothalamic neurons, while healthy mice will actively avoid such stimulation. We have established all experimental methods required for testing these hypotheses. Together, these experiments will provide novel approaches to understanding the neural circuits underlying learned behaviors that promote sustained food restriction in anorexia nervosa.

Changing Preferences For Food In Anorexia Nervosa
Akram Bakkour1, Karin Foerde2, Eileen Hartnett1, Tom Schonberg3, B. Timothy Walsh2, Joanna Steinglass2, Daphna Shohamy1,4
1Department of Psychology, Columbia University, New York, NY, United States, 2New York State Psychiatric Institute Eating Disorders Research Unit, Columbia University, New York, NY, United States, 3Department of Neurobiology, University of Tel Aviv, Tel Aviv, Israel, 4Zuckerman Mind, Brain, Behavior Institute and Kavli Institute for Brain Science, Columbia University, New York, NY, United States

Anorexia Nervosa (AN) is characterized, in part, by maladaptive food choices. Even when treatment is successful in weight restoration and psychological improvement, rigid and restrictive food choices are difficult to change. Our goal was to leverage known behavioral paradigms that nudge preferences in healthy controls (HC) to examine whether food decisions can be altered in AN.   Methods: The cue-approach task, shown to shift food preferences among HC, was administered to female patients with AN (n=25) and to age- and education-matched HC (n=25). The paradigm pairs a subset of foods with an auditory cue that signals a button press. Later, choices between foods of equal initial preference but different cue status were recorded while eye movements were measured.   Results: We replicated a shift in preferences in HC (cued foods chosen on 59% of trials, p=0.01). Patients with AN showed a similar shift (57%, p=0.04), suggesting that both groups’ food preferences are malleable. This shift was accompanied by a viewing bias toward previously cued foods in HC, but not in AN (DeltaBias=45.7ms, p=0.04). The difference in viewing time is indicative of differing mechanisms governing changes in food choice between groups.   Conclusions: Simple behavioral training can induce changes in food preference in AN. Behavioral markers of preferences reveal different underlying cognitive mechanisms in AN and HC, offering insight into the link between cognition and choice in this illness.

Disordered Eating Attitudes And Behaviors Among Female  Undergraduates Who Are Varsity Athletes, Intramural Athletes, Or Not Involved In Organized Sports 
Anna M. Bardone-Cone, Alexandra J. Miller, Emily C. Walsh, Katherine A. Thompson
University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

Introduction Research on college athletes and eating pathology is mixed and generally limited to a focus on varsity levels. We compared disordered eating attitudes and behaviors in college females identifying as varsity athletes, intramural athletes, or not involved in organized sports. Methods Female undergraduates (23 varsity athletes, 70 intramural athletes, 311 not in organized sports) completed a survey assessing a variety of constructs including disordered eating attitudes (weight/shape concern, eating concern, body shame, thinness and restricting expectancies) and behaviors (broad eating pathology, dietary restraint, objective binge eating, and skipping meals). Results For all attitudes except body shame (p=.475), groups differed: weight/shape concern (F(2,400)=3.70, p=.026), eating concern (F(2,400)=3.74, p=.025), and thinness and restricting expectancies (F(2,368)=5.45, p=.005); in all cases, intramural athletes reported significantly greater disordered eating attitudes than varsity athletes. Groups did not differ on disordered eating behaviors (ps≥.259), although there was a trend toward varsity athletes being less likely to skip breakfast than those not in organized sports (F(2,401)=2.76, p=.064). Conclusions Intramural female athletes had elevated disordered eating attitudes compared to varsity athletes (but did not differ in disordered eating behaviors) and may warrant attention for prevention and intervention programs.

Body Dissatisfaction And Bulimic Symptoms: Unique Role Of Self-Compassion As A Buffer
Ege Bicaker1, Ayse Altan-Atalay2
1McGill University, Montreal, QC, Canada, 2Koc University, Istanbul, Turkey

Early studies suggest that emotion regulation (ER) difficulties strengthen the relationship between body dissatisfaction and bulimic symptoms. While self-compassion is conceptualized as an effective ER strategy, research has not examined self-compassion’s moderating role in the link between body dissatisfaction and bulimic symptoms or the unique contribution of self-compassion to bulimic symptoms that is independent from its overlap with other ER strategies. The current study investigated the unique moderator roles of self-compassion and ER deficits in the relationship between body dissatisfaction and bulimic symptoms. Methods Participants were 154 females (M (SD) age= 23.89 (4.66) years) who completed questionnaires assessing body dissatisfaction, self-compassion, ER difficulties, and bulimic symptoms. Results Analyses showed that self-compassion was a unique buffer against the negative consequences of body dissatisfaction even when controlling for ER, while ER did not have a moderating effect when self-compassion was accounted for. Body dissatisfaction was significantly associated with bulimic symptoms in low and middle levels of self-compassion, but not in high levels of self-compassion. Conclusions Overall, results suggest that self-compassion buffers the negative impact of body dissatisfaction through mechanisms that are distinct from those of ER. These findings highlight the importance of focusing on self-compassion in eating disorders interventions.

Dynamic Associations Between Interpersonal Needs And Suicidal Ideation In Women With Eating Disorders
Lindsay P. Bodell1, April R. Smith2, Tracy K. Witte3
1University of Western Ontario, London, ON, Canada, 2Miami University, Oxford, OH, United States, 3Auburn University, Auburn, AL, United States

Introduction. Over half of individuals with eating disorders experience suicidal ideation at some point in their lives. Although previous research has identified trait-level factors that inform who is most at risk for suicide, nothing is known about factors that fluctuate within an individual, which is critical for determining when a specific individual is most likely to engage in suicidal behaviors. Methods. Longitudinal multilevel models were conducted to examine within-person predictors of suicidal ideation across 12 weeks of treatment. Women (N=93) receiving treatment for their eating disorder completed weekly questionnaires assessing suicidal ideation and interpersonal constructs (i.e., perceived burdensomeness, thwarted belongingness) theorized to be proximal predictors of suicidal desire. Results. Significant within-person effects for burdensomeness (est=.07; p<.001) and thwarted belongingness (est=.03; p<.001) indicate that when an individual has greater feelings of loneliness or burdensomeness compared to their own average, they also experience increases in suicidal ideation. Conclusions. This study is the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results are consistent with the Interpersonal Theory of Suicide and suggest that identifying and targeting more short-lived changes in belongingness and burdensomeness may prevent escalation of suicidal behavior in this population.  

A Two-Hour Emotion Regulation Workshop In Early Adolescents With Obesity: A Feasibility Study
Elisa Boelens, Taaike Debeuf, Brenda Volkaert, Sandra Verbeken, Caroline Braet
Department of Developmental, Personality and Social psychology, Ghent, Belgium

Emotional eating is defined as eating in response to a range of negative emotions and correlates positive with Body Mass Index. Therefore, this study aims to investigate the feasibility of training adequate emotion regulation strategies (ER) in adolescents with obesity during an inpatient obesity treatment program. Adolescents were randomly assigned to one out of three conditions and learned one ER strategy (distraction, cognitive reappraisal or acceptance). After the training, participants were presented a sad mood induction and had to use the learned ER strategy to reduce negative affect. Feasibility was evaluated based on different informants. Results show, for all three conditions, a significant increase in negative affect after the sad mood induction and a significant decrease in negative affect after using the learned strategy. Furthermore 75% of the educators reported the training to be an added value to care as usual and 73% of the adolescents responded positive to the workshop. Only 54% started their homework. Results of this study show that early adolescents are capable of learning ER, but homework compliance is an intervention barrier. Furthermore, emotional awareness is an important (first) step in adopting ER but needs more attention. The findings of this study were used to establish a randomized controlled trial in which the effect of a 12-session ER training is being investigated.

Exploring The Interplay Between Disordered Eating And Emotional Regulation To Understand Loss Of Control Eating.
Eva M. Conceição1, Ana R Vaz1, Célia S Moreira2, Marta de Lourdes1, Paulo PP Machado1
1University of Minho, Braga, Portugal, 2University of Porto, Porto, Portugal

Introduction:Loss of Control (LOC) eating has been directly related to the core aspects of eating disorder psychopathology and to different dimensions of emotion regulation. This study explores the interplay between disordered eating psychopathology and aspects related to emotional regulation to understand LOC eating. Methods:A total of 341 participants recruited in a college campus, mean age23.21, S.D. = 6.02, completeda set of self-report measures assessing LOC, weight suppression, disordered eating, depression, negative urgency, emotional regulation difficulties, and auto-criticism. A path analysis tested a model with 3 different paths for LOC: disordered eating; ii) emotion regulation; iii) interplay between these paths.  Results:There was a good fit of the model (χ2= 23.98, df = 14, CFI = .99, TLI = .97, RMSEA = .046, SRMR = .042) suggesting that: i) participants with higher weight suppression showed higher degrees of disordered eating which was linked to higher levels of LOC; ii) more emotional dysregulation was associated with greater auto-criticism and depressive symptoms, which increase the level of LOC eating via greater negative urgency; iii) difficulties in emotion regulation and auto-criticism were positively associated with greater disorder eating which was significantly associated with LOC eating via more negative urgency.  Conclusion:These results highlight the interplay between disordered eating psychopathology and emotion regulation to explain LOC eating. 

Positive Body Image In Women: Protective Factors Against Disordered Eating
Alexandria E Davies, C. Blair Burnette, Suzanne E Mazzeo
Virginia Commonwealth University, Richmond, VA, United States

Emerging adulthood is a critical time period for disordered eating due to the developmental changes in body satisfaction and eating pathology. Abundant research suggests body surveillance is a mechanism that influences the development of disordered eating. The current study investigated the moderating role of two facets of positive body image, broad conceptualization of beauty (BCB) and body appreciation, on body surveillance and disordered eating in emerging adult women. Undergraduate women (N = 768, M = 19.00 years) completed measures of body image and eating behaviors. The sample was racially/ethnically diverse (40.2% White, 22.8% Black, 7.2% Latina, 17.0% Asian, 6.9% Pacific Islander, 5.2% Multiracial). Consistent with objectification theory, the current study found that body surveillance was associated with global eating pathology (r = .53, p <.01). In this sample, body appreciation was a significant moderator, with high levels of body appreciation weakening the positive association between body surveillance and disordered eating (p = .003). Contrary to our hypothesis, BCB did not significantly moderate the link between body surveillance and disordered eating (p = .37). Results suggest that fostering body appreciation among emerging adult women could be an important target of eating disorder prevention programs. Future work should investigate mechanisms that foster the development of positive body image longitudinally.

Do Bulimic Behaviors Increase Shame? Toward An Understanding Of Transdiagnostic Risk
Heather A Davis1, Pamela K Keel2, June P Tangney3, Gregory T Smith1
1University of Kentucky, Lexington, KY, United States, 2Florida State University, Tallahassee, FL, United States, 3George Mason University, Fairfax, VA, United States

Binge eating is a harmful behavior associated with comorbid psychopathology. Theory posits that increases in maladaptive, transdiagnostic emotions following binge eating in individuals with BN may predict the experience of comorbid symptoms. The current study served as a laboratory test of the first part of this theory: whether state increases in maladaptive emotions occur following engagement in binge eating behavior in women with BN compared with healthy controls. Women (n = 51) were recruited from the community if they met DSM-5 criteria for BN or OSFED BN (n = 21) or were free of lifetime disordered eating and current psychopathology (n = 30). Participants completed questionnaires assessing eating disorder symptoms (preoccupation with weight and shape, urge to vomit), state shame, and state negative affect before and after consuming a test meal in which they were instructed to binge. Women with BN endorsed significantly greater preoccupation with weight and shape and urge to vomit following test meal consumption compared with controls. Women with BN reported significant increases in state shame, but not state negative affect, following test meal consumption, compared with controls. Results are consistent with a model indicating binge eating precipitates increases in state shame among women with BN. Given shame’s status as a transdiagnostic risk factor, future work should clarify whether state shame following binge eating predicts increases in comorbid symptoms.

Stress And (Un)Healthy Food Behavior: The Moderating Role Of Emotional Eating And Emotion Regulation; A Daily Diary Study
Taaike Debeuf1, Sandra Verbeken1, Marie-Lotte Van Beveren1, Nathalie Michels2, Caroline Braet1
1Ghent University, Department of Developmental, Social and Personality psychology, Ghent, Belgium, 2Ghent University, Department of Public Health, Ghent, Belgium

Purpose of Study
: An important mechanism in the vicious cycle of obesity is emotional eating (EE), which is assumed to act as a maladaptive way of regulating daily stress and emotions. However, ecologically momentary analyses like the daily variations between stress and eating is far less studied. Herein, the specific role of (mal)adaptive emotion regulation (ER) strategies should be studied as it might be crucial for prevention and treatment. The present study aims to investigate the momentary relationship between stress and unhealthy eating behavior as well as the moderating role of ER and EE. Method: The present study recruited 109 average weighted youngsters (aged 10-16 years). The youngsters fill out trait-questionnaires on ER and EE before starting the study, and answer an online diary after school, during seven days. The online diary contains questions on the daily stress amount, hunger eating - and desire to eat motives and snacking. Results: Results revealed that daily stress is significantly associated with trajectories of desire to eat and hunger eating motives throughout the week, but not for snacking. A marginally significant effect was found for EE in the trajectories of desire to eat motives and snacking.  Conclusions: These results stress the importance of looking into the daily relationship between stress and eating behavior parameters, as both are related with change over and within days

Face Yourself(Ie): Investigating Selfie-Behavior In Females With Severe Eating Disorder Symptoms
Alexandra Dingemans1, Robyn Yellowlees1, Jolanda Veldhuis2, Nadia Bij de Vaate2
1Rivierduinen Eating Disorders Ursula, Leiden, Netherlands, 2Vrije Universtiteit, Amsterdam, Netherlands

Introduction: With the rise of camera phones, selfie-taking has become a normative part of our modern culture. However, little is known about how this behavior may relate to eating disorder (ED) characteristics, particularly in those who already have eating disorder of clinical severity. The current study investigated how selfie-posting and selfies taking with no intention of posting online (offline selfies) were related to ED symptoms.
Method: A total of 152 females (average age 22.44 years) with ED symptoms of clinical severity completed self-report questionnaires measuring selfie-frequency (online and offline), frequency of non-selfie photo posting, social networking site use, body dissatisfaction, body checking, ED symptom severity, self-esteem and body avoidance. Responses were collected via an ED social community. Results: No direct relationship, or indirect association via body dissatisfaction, was found between selfie behavior and ED symptom severity. However, the more offline selfies an individual took, the more frequently they body checked, and this, in turn, was related to greater ED symptom severity. Conclusions: These results suggest that offline selfies may be a modern form of body checking. Our findings are the first to imply that offline selfie-taking may be a problematic behavior and a maintenance factor for individuals with severe ED symptoms.  

Attentional Biases Towards Food And Body Stimuli Among Individuals With Disordered Eating Versus Food Allergies
Melissa Dreier, Shirley B. Wang, Matthew K. Nock, Jill M. Hooley
Harvard University, Cambridge, MA, United States

Individuals with disordered eating display heightened attentional biases towards food and body stimuli. However, it is unknown whether these biases reflect eating pathology or are simply a function of frequent food-related thoughts. This study investigated this question, through the inclusion of a group with peanut allergies, which has not been studied in this context to date. Methods: We recruited healthy controls (N=122), participants with disordered eating (N=139), and participants with peanut allergies (N=60) and examined performance on a Stroop task containing food and body words. We also examined how attentional biases interacted with emotion regulation strategies, as Stroop performance was assessed before and after a negative mood induction. Results: There was a significant main effect of group on Stroop task performance. Individuals with disordered eating and individuals with peanut allergies had significantly slower reaction times for food and body words than did healthy controls (p = .05 and .003, respectively). This was not the case for other types of words (e.g., positive or negative). Participants with disordered eating also showed more mood deterioration following the negative mood induction, though mood changes did not affect Stroop performance for any group. Conclusions: Although preliminary, findings shed light on differences between adaptive and maladaptive ways of thinking about food and how this affects biases towards food and body stimuli. 

Force Of Habit: The Role Of Habit In Disordered Eating And Self-Injurious Behavior
Jesse WP Dzombak, Christine A Conelea, Ann F Haynos
University of Minnesota - Twin Cities, Minneapolis, MN, United States

Introduction: Habit is theorized to play a role in recalcitrant patterns of disordered eating and other repetitive behavior, and is especially emphasized in models of restrictive eating (RE) and body-focused repetitive behaviors (BFRBs); yet little attention has been given to the potential role for habit in other commonly comorbid 
behaviors (e.g., binge eating/purging [BP], nonsuicidal self-injury [NSSI]). Methods: The Self-Report Habit Index (SRHI) was administered online to 210 transdiagnostic participants to probe aspects of habit in reference to their self-identified most problematic behavior in the past month. Participants were grouped according to primary behavior endorsed on the SRHI (RE [n=36], BP [n=33], BFRBs [n=72], and NSSI [n=69]); ANOVA was used to compare SRHI scores across groups. Results: SRHI scores differed across groups, F(3, 206)=33.86, p<.001 (RE=BFRB>BP>NSSI), identifying greatest habit strength for RE and BFRBs. SRHI scores positively correlated with symptom severity of NSSI (r=.46, p=.001), binge eating (r=.52,  p=.004), purging (r=.37, p=.046) and RE (r=.39, p=.02), but not BFRBs (r=.04, p=.778). Conclusions: Habit may be particularly relevant to the clinical presentation of RE and BFRBs; however, across behaviors, more severe psychopathology is generally associated with habit strength. Once more precisely defined and assessed, habit mechanisms may be important treatment targets for heterogeneous clinical presentations.

Stability Of Parental Feeding Practices And Bi-Directional Relations With Weight Status In Pre-School Children
Janina Eichler1, Ricarda Schmidt1, Andreas Hiemisch2,3, Tanja Poulain2, Wieland Kiess2,3, Anja Hilbert1
1Leipzig University Medical Center, Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig, Germany, 2LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany, 3Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research (CPL), University of Leipzig, Leipzig, Germany

Background. Parental feeding practices are known to be associated with child weight status, but there is little evidence on their stability and the direction of their association with weight status in pre-school children. Methods. Within a population-based longitudinal sample of 362 children (2 - 5 years), parental feeding practices were assessed via the Child Feeding Questionnaire twice with a time lag of 1 year. Children’s standardized body mass index (BMI SDS, kg/m²) was derived from objective measures. Pearson correlations were used to examine the stability of feeding practices over time. The bi-directional associations between parental and child weight were analyzed via regression analyses while controlling for child age. Results. Correlation coefficients (r = .336 - .705) demonstrated moderate stability for monitoring and high stability of restriction and pressure to eat. Regression analyses indicated bi-directional effects between all parental feeding practices and children’s BMI SDS with all ps <.05. Conclusions. The results suggest that parental feeding is stable at pre-school age and that parents both respond to and influence child weight via their feeding practices. Intervention programs on childhood obesity should pay attention to this bi-directional association.

Clinical And Neurophysiological Correlates Of Emotion And Food Craving Regulation In Patients With Anorexia Nervosa
Fernando Fernández-Aranda 1,2,3, Nuria Mallorquí-Bagué1,2, Maria Lozano-Madrid 1,2, Giulia Testa1,2, Cristina Vintró-Alcaraz 1,2, Isabel Sánchez1,2, Nadine Riesco1,2, Roser Granero2,4, Susana Jiménez-Murcia1,2,3
1Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain, 2Ciber Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III , Madrid, Spain, 3Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain, 4Departament de Psicobiologia i Metodologia de les Ciències de la Salut, , Barcelona , Spain

Introduction: Dysregulation of emotion and food craving are contributing factors to the maintenance of eating disorders. However, little is known about neurocognitive correlates of these processes in anorexia nervosa (AN). The study aimed to assess emotion and food craving regulation by means of behavioral measures and event-related potentials (ERPs). Methods: ERPs were recorded in 20 AN and 20 healthy controls (HC), during the execution of emotion and food craving regulation tasks. As self-report measures the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaires (ERQ), and the Food Addiction Scale (YFAS) were adopted. Results: AN showed higher score in DERS, lower ERQ-reappraisal, higher ERQ-suppression, and higher YFAS compared to HC. ERPs results showed in both AN and HC higher P300 and LPP amplitudes in response to emotional or food images compared to neutrals images, and lower LPP during down-regulation of food craving. Between groups differences at neurophysiological level were present, as suggested by smaller P300 amplitudes in AN compared to HC, regardless of experimental condition. Conclusions: Patients with AN reported difficulties in emotion regulation, the tendency to use maladaptative techniques to manage emotions, and food addiction symptoms. At neurophysiological level, reduced P300 was present in AN compared to HC, whch may index neurocogntive alterations as a secondary effect of malnutrition. 

Psychometric Properties Of The Idealization Of Thinness Scale Among Young Adult Women
Rachael E. Flatt1, Anna M. Karam2, Ellen E. Fitzsimmons-Craft2, Shiri Sadeh-Sharvit3,4, Katherine N. Balantekin5, Andrea K. Graham6, Grace E. Monterubio2, Denise E. Wilfley2, C. Barr Taylor3,7, Mickey Trockel7
1Department of Psychology and Neurosciences, University of North Carolina at Chapel Hill , Chapel Hill, NC, United States, 2Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States, 3Center for m2Health, Palo Alto University, Palo Alto, CA, United States, 4Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel, 5Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, United States, 6Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States, 7Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States

: Thin ideal internalization (TII) is a well-established risk factor for developing an eating disorder (ED). Currently used measures only assess how TII affects pressure or desire to look thin and behaviors to change one’s body. The Idealization of Thinness Scale (ITS) was developed to assess perceived generalized effects of thinness in an individual’s life (e.g., how being thin relates to professional success, overall happiness). Methods: The current study describes the 12-item ITS and examines its psychometric properties. Two studies of young adult women (ages 18-25), recruited on Amazon Mechanical Turk, evaluated the concurrent validity (study 1, N=78) and test-retest reliability (study 2, N=77) of the ITS. Results: The ITS had significant correlations with 7 established measures/subscales of TII and related ED psychopathology (rs=.54-.68, ps<.001), and a smaller significant correlation (r=.36, p<.01) with a measure of general Western female beauty ideal. The ITS had good 2-week test-retest reliability (r=.84, p<.001). Conclusions: The ITS showed high concurrent validity and test-retest reliability and some support for discriminant validity, overall demonstrating strong psychometric support. The ITS provides a unique insight into TII as it more broadly measures perceptions of how thinness relates to improving other aspects of one’s life.

Deficient Goal-Directed Control In A Population Characterized By Extreme Goal Pursuit
Karin Foerde1,2, Nathaniel Daw3,4, Daphna Shohamy5,6, Teresa Rufin1, B. Timothy Walsh1,2, Joanna Steinglass1,2
1Dept. of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States, 2Dept. of Psychiatry, New York State Psychiatric Institute, New York, NY, United States, 3Princeton Neuroscience Institute, Princeton University, Princeton, NJ, United States, 4Dept. of Psychology, Princeton University, Princeton, NJ, United States, 5Dept. of Psychology, Columbia University, New York, NY, United States, 6Zuckerman Mind Brain Behavior Institute and Kavli Institute for Brain Science, Columbia University

Although Anorexia Nervosa (AN) appears to be characterized by extreme goal-directedness, the goal-directed vs. habitual nature of maladaptive behavior in AN remains unclear. Computational approaches provide tools to distinguish between these possibilities.   Methods: We tested individuals with AN (n=41) and healthy comparison (HC, n=53) participants on a Two-Step decision task designed to measure the contribution of model-based and model-free learning, which are thought to underlie goal-directed vs. habitual behavior, respectively. Because food is at the core of AN psychopathology, we administered separate tasks with monetary or food outcomes. Further, we tested individuals with AN while acutely ill and again after weight restoration, and HC at two time points.   Results: AN and HC did not differ significantly in their model-free learning (Estimate:  0.09, SE = 0.06, z = 1.36, p = 0.17). In contrast, model-based learning was significantly worse in AN relative to HC (Estimate:  0.15, SE = 0.06, z = 2.27, p = 0.023). This pattern was invariant to whether food or monetary outcomes were used (Estimate: -0.08, SE = 0.07, z = -1.11, p = 0.27) and to whether AN were acutely ill or weight restored (Estimate: 0.02, SE = 0.08, z = 0.27, p = 0.79).   Conclusions: AN show a deficit in goal-directed learning across domains and illness state. This persistent deficit may contribute to difficulty changing behavior in response to treatment and to poor long-term prognoses.

Using Network Analysis To Identify Central Eating Disorder Symptoms Among Men
Lauren N Forrest1, Natalie M Perkins1, Jason M Lavender2, April R Smith1
1Miami University, Oxford, OH, United States, 2University of California San Diego, San Diego, CA, United States

1. The network theory of psychopathology has been described as an “innovative framework”that may “transform” clinical psychological science. While several eating disorder (ED) network studies have been conducted, they have been comprised primarily of women. We estimated the first ED symptom networks among men with and without core ED symptoms.  2. Participants were recruited from universities and Amazon’s Mechanical Turk. Participants completed the Eating Disorder Examination-Questionnaire (EDE-Q), Male Body Attitudes Scale, and Drive for Muscularity Scale. ED symptom networks were jointly estimated among men with (n=248) and without (n=620) core ED symptoms. Core ED symptoms were defined by scoring above a suggested male EDE-Q clinical cutoff (Global score ≥1.68) and reporting symptoms consistent with probable ED diagnoses. Expected influence was calculated for each node to indicate centrality.  3. Believing that one’s body has too much fat, desiring weight loss, feeling guilty for missing weight training, using supplements, and fear of losing control over eating had the greatest expected influence.  4. The centricity of several body dissatisfaction items supports some components of cognitive behavioral theories of EDs. However, findings also suggest the importance of muscularity- and leanness concerns. These concerns have been traditionally neglected from leading ED theories, which tend to focus on thinness pursuits as a main driver of body dissatisfaction.

Predicting Outcome From Eating Disorders Treatment: Barriers To Self-Compassion
Josie Geller1,2, Lindsay Samson1, Megumi M. Iyar1,3, Allison C. Kelly4, Suja Srikameswaran1
1St. Paul's Hospital Eating Disorders Program, Vancouver, BC, Canada, 2Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, 3Department of Psychology, University of British Columbia , Kelowna, BC, Canada, 4Department of Psychology, University of Waterloo, Waterloo, ON, Canada

Introduction: Self-compassion is associated with physical and emotional well-being including decreased eating disorder (ED) symptoms and shape and weight concerns. Unfortunately, barriers to self-compassion are common, and two types of barriers have been identified in individuals with EDs: Meeting Standards, or concern that having self-compassion would result in showing flaws, and/or lead to loss of achievements or relationships, and Emotional Vulnerability, or concerns regarding experiencing difficult emotions such as grief, hurt or anger. This research examined the relation between self-compassion and the two types of barriers to self-compassion and ED treatment outcome. Methods: Eighty-eight individuals admitted to EDs treatment completed measures of self-compassion, barriers to self-compassion, ED and psychiatric symptom severity, interpersonal functioning, affect regulation, and quality of life at baseline and following completion of a 12 to 15 week residential treatment. Results: Higher baseline self-compassion scores were only related to improvements in quality of life at post. Conversely, greater baseline barriers to self-compassion were associated with less improvement in ED symptoms, interpersonal functioning, affect regulation and quality of life, and were uniquely accounted for by Emotional Vulnerability. Conclusions: Pre-treatment barriers to self-compassion may play a more central role than self-compassion in predicting symptom change in individuals with EDs. 

Angry Rumination And Emotional Eating
Anna K Gernand1, Cara M Luchtefeld2, Ari M Feinstein3
1Indiana State University, Terre Haute, IN, United States, 2Indiana State University, Terre Haute, IN, United States, 3Indiana State University, Terre Haute, IN, United States

Negative interpersonal experiences can influence maladaptive eating behaviors. Hostility, and related constructs such as aggression and anger, likely play a role in the relationship between these negative interpersonal experiences and disordered eating. There have been inconsistent findings, however, and this may be due to the fact that hostility and related constructs have been defined in different ways. Anger has often been examined in disinhibited individuals, but a recent development in the literature is a construct called displaced aggression that focuses on behaviorally inhibited experiences of anger, and how it may function as a relevant mediator. The current study examined the three components of displaced aggression - angry rumination, revenge planning, and behaviorally displaced aggression - and their mediating function in predicting emotional eating. One hundred and twenty-seven healthy participants (Mage = 19.3; 64.5% female) completed self-report questionnaires to assess the components of displaced aggression, emotional eating, and exposure to negative interpersonal experiences. The PROCESS macro for SPSS was utilized to assess whether the components of displaced aggression mediate the relationship between negative interpersonal experiences and emotional eating. Only angry rumination functioned as a mediator. Results are discussed in terms of the interpersonal perspective of clinical, social, and personality psychology and its application to eating disorders.

Understanding How Target Users Select & Implement Behavioral Strategies To Inform The Design Of A Mobile Intervention For Binge Eating & Obesity
Andrea K. Graham1, Sarah W. Neubert1, Sean A. Munson2, Madhu Reddy1, David C. Mohr1, Jennifer E. Wildes3
1Northwestern University, Chicago, IL, United States, 2University of Washington, Seattle, WA, United States, 3University of Chicago, Chicago, IL, United States

Introduction: Applying human-centered design approaches to design a mobile app for binge eating and obesity, we qualitatively assessed target users’ experiences managing binge eating and weight in a remotely-administered digital video diary study. This project examines how target users select and implement behavioral strategies when offered multiple options. Methods: Adults (N=22; 64% non-white, 36% male) with self-reported obesity and recurrent binge eating (>=12 episodes in 3 mo) were chosen from 885 people who answered a screen in just 28 hours. During the 4-week study, participants completed a 1-week self-experiment. We analyzed their process of selecting a strategy to implement from a list of 20, and change in outcomes. Results: Participants either selected 1 strategy without debate, debated the strategy to select, or selected multiple strategies (max=3). They picked strategies perceived as attainable, new, or most helpful, and avoided strategies perceived as unachievable or irrelevant. Strategies were chosen most commonly to manage binge eating or weight, or to address triggers or improve a related area. Many set a plan and/or identified benefits of maintaining a plan. Subsequent 1-week average changes in weight (-2.2 lbs) and binge eating (-1.6 episodes) indicated clinical improvement. Conclusions: A digital platform enabled rapidly capturing in-depth perspectives of target users, including how behavioral strategies are selected and implemented, to inform app design.

Relation Among Socioeconomic Status, Eating Pathology, And Percent Overweight In Children 
Anne Claire Grammer 1, Genevieve M. Davison1, Lauren A. Fowler1, Mary Katherine Ray1, Richard I. Stein1, Rachel P.K. Conlon2, Katherine N. Balantekin3, Brian E. Saelens4, R. Robinson Welch1, Michael G. Perri5, Leonard H. Epstein3, Denise E. Wilfley1
1Washington University in St. Louis, St. Louis, MO, United States, 2University of Pittsburgh, 3University at Buffalo (SUNY Buffalo), 4Seattle Children's Hospital, 5University of Florida

Introduction: Socioeconomic disparities in childhood obesity rates are well documented, yet few studies have examined if eating pathology contributes to the relation between socioeconomic status (SES) and excess weight. We examined whether various facets of eating pathology mediated the relation between SES and percent overweight (%OW) in children seeking family-based behavioral treatment (FBT). Methods: Children with overweight/obesity (OW/OB) completed baseline questionnaires of loss of control eating, emotional eating, global eating disorder (ED) pathology, and SES (parent report). Child %OW was assessed prior to initiation of FBT. Cross-sectional mediation models with bias-corrected bootstrap confidence intervals (CI) were conducted adjusting for child age, sex, and race/ethnicity. Results: 172 youth (age 9.4±1.3 years; 61.6% female; z-BMI 2.19±0.38) were studied. There was a significant direct (c’=-.58; SE=.18; 95% CI=-.94 to -.22) path between SES and child %OW and a significant indirect path between SES and child %OW through global ED pathology (ab=-.10; SE=.05; 95% CI=-.22 to -.02). Global ED pathology accounted for 14.4% of the total effect (PM=.144). No other significant indirect paths were observed. Conclusions: In this treatment-seeking sample, the relation between SES and child %OW appears to be explained in part by global ED pathology. Further research should identify driving factors (e.g., food insecurity) of the relation between SES and eating pathology.

Time-Limited Versus Open-Ended Treatment For Anorexia Nervosa: Study Protocol Of A Health-Economic Evaluation Alongside Two Paired Prospective Cohorts.
Alberte Jansingh1, Unna Danner1,2, Alexandra Dingemans3, Eric van Furth3, Hans W. Hoek4,6,7, Filip Smit5, Ben Wijnen5, Annemarie van Elburg1,2
1Altrecht Eating Disorders Rintveld, Zeist, Netherlands, 2Utrecht University, Department of Social Sciences, Utrecht, Netherlands, 3Rivierduinen Eating Disorders Ursula, Leiden, Netherlands, 4Parnassia Bavo Psychiatric Institute, The Hague, Netherlands, 5Trimbos Institute, Utrecht, Netherlands, 6Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands, 7Department of Epidemiology, Mailman School of Public Health, Columbia University New York, New York, NY, United States

Introduction: Three time-limited treatments are now recommended by the NICE- and Dutch guidelines for anorexia nervosa following several RCTs (Byrne, 2017, Schmidt et al.,2016): MANTRA, CBT-E and SSCM. Study outcomes do not provide indication criteria and as yet the cost-effectiveness of these treatments has not been studied. By introducing Shared Decision Making (SDM) as a way to help patients make a choice to which treatment suites them best, we hope to enhance autonomous motivation for treatment. This study aims to test the cost-effectiveness of implementing MANTRA, CBT-E and SSCM in clinical practice using SDM. Methods: 166 adult patients with AN will be recruited to conduct a health-economic evaluation alongside two paired prospective cohorts. According to treatment setting patients will receive one of the three therapies (MANTRA, CBT-E and SSCM) combined with SDM, or open-ended top-clinical care for AN. Weight, eating pathology, quality of life and health care costs will be assessed at clinical assessment and then in cycles of 3 months, up till two years after inclusion. Results: The health-economic evaluation will be conducted as a cost-minimisation, cost-effectiveness, cost-utility and budget impact analysis. Conclusions: Prior research provided evidence for the effectiveness of MANTRA, CBT-E and SSCM in AN. The present study will elaborate on these findings by examining the cost-effectiveness of these three treatments applied by SDM.

An Investigation Of Interpersonal Profiles Of Eating Disorder Characteristics Using The Interpersonal Circumplex
Kevin Jordan1, Gabrielle Pointon2
1Indiana State University, Terre Haute, IN, United States, 2University of Notre Dame, Notre Dame, IN, United States

The interpersonal tradition in personality, clinical, and social psychology that began with Harry Stack Sullivan posits that interpersonal processes play a key role in influencing health and well-being. Using circumplex-based assessments, one can determine the interpersonal style, problems, and goals associated with a particular individual difference variable, and based on the principle of complementarity, there are expected recurring patterns of interpersonal experiences that can have salubrious or deleterious consequences. The present study (141 participants, Mage = 19.2) involved two assessments separated by two weeks, and it sought to clarify and extend past research by examining the interpersonal style associated with eating disorder characteristics in a college student sample. Restrictive eating tendencies as well as body dissatisfaction had the expected correlation with the submissive dimension of the Interpersonal Circumplex while other eating disorder characteristics did not display a distinct interpersonal style, but rather, demonstrated more broad-based interpersonal difficulties. Based on the principle of complementarity and recurring interpersonal patterns, it was hypothesized that eating disorder characteristics would predict the frequency of negative social exchanges at a two week follow up assessment. This prediction was largely confirmed. Results are discussed as supporting an interpersonal conceptualization of eating disorder characteristics.

Level Of Dietary Restraint Does Not Distinguish Eating Disorder Symptomatology Among Individuals With Bed
Therese E. Kenny1,2, Jacqueline C. Carter1
1Memorial University of Newfoundland, St. John's, NL, Canada, 2University of Guelph, Guelph, ON, Canada

Introduction: Research suggests that individuals with binge eating disorder (BED) who report higher overvaluation of weight/shape experience more severe symptoms. Other features may also be associated with increased symptom severity in BED as different underlying mechanisms may be involved in perpetuating binge eating among different subgroups. To this end, eating disorder (ED) symptom severity was compared across individuals with BED who were high and low on dietary restraint (DR). Method: Data were collected from 71 individuals meeting DSM-5 criteria for BED. High DR was defined as reporting a DR subscale score of 4 of higher on the EDE-Q. Results: Individuals reporting low and high DR did not differ in terms of body dissatisfaction, d = -0.09, 95% CI = [-0.56, 0.38], overvaluation of weight/shape, d = 0.00, 95% CI = [-0.47, 0.47], or body mass index, d = 0.00, 95% CI = [-0.46, 0.47]. Participants with high DR reported more binge episodes, d = 0.31, 95% CI = [-0.16, 0.78], and greater difficulties in emotion regulation, d =0.26, 95% CI = [-0.22, 0.73]. Conclusions: Though individuals with high DR reported more binge episodes, CIs were wide and spanned zero. Overall, our findings suggest that DR is not associated with more severe ED symptoms among individuals with BED. Consistent with evidence that DR is not elevated among individuals with BED compared to the general population, this may suggest a lesser role of DR in the development and maintenance of BED.

Comparisons In Eating Disorder Psychopathology, Depression, And Trait Anxiety In Individuals With Anorexia Nervosa Who Do And Do Not Engage In Elevated Levels Of Exercise
Megan C Kuhnle1, Kamryn T Eddy1,2, Jennifer J Thomas1,2, Reitumetse L Pulumo1, Karen K Miller1, Anne Klibanski1, Elizabeth A Lawson1, Kendra R Becker1,2
1Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States, 2Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

. Exercise, anxiety, and depression are common in anorexia nervosa (AN). While some research suggests that exercise alleviates symptoms of depression and anxiety in healthy individuals, the relationship between exercise and mood is unclear in AN. Methods. In secondary analysis, 102 adult females with DSM-5 AN and atypical AN completed the Eating Disorders Examination-Questionnaire (EDE-Q). Of these, 80 completed the State-Trait Anxiety Inventory (STAI-Trait) and 76 completed the Beck Depression Inventory (BDI). Number of hours exercised per week was assessed via clinical interview. 61 of 102 participants reported exercising ≥5 hours/week and were identified as engaging in elevated levels of exercise in the context of energy deficit. Results. Results from ANCOVAs adjusted for age and body mass index showed no significant difference in EDE-Q (F=.002, p=.959) or STAI (F=2.93, p=.091) but individuals who exercised >5 hours/week had significantly lower BDI scores (F=4.25, p=.043). Among those who exercised ≥5 hours/week, STAI scores were positively correlated with weekly hours of exercise (R=0.341, p=.026). Conclusions. ≥5 hours of exercise each week is associated with lower levels of depression in AN, but anxiety levels increase with the number of hours of exercise per week. Understanding the complex relationship between exercise, anxiety and depression may help inform treatment decisions.

The Influence Of Cognitive Defusion Strategies On Body Size Perception 
Jennifer S. Mills, Mariam Khalid, Keisha Gobin
York University, Toronto, ON, Canada

Body image distortion (i.e., overestimation) is common among individuals with eating disorders. Rather than being a perceptual deficit, studies suggest that negative body-related thoughts bias self-referent information to distort body image. The present study examined whether practicing cognitive defusion (CD) with negative body-related thoughts would reduce body image distortion in a sample of 100 female dieters who endorsed high levels of weight concern. The differential efficacy of two CD strategies was also compared. Participants were randomly assigned to one of four conditions: 1) singing negative body-related thoughts, 2) verbally repeating negative body-related thoughts, 3) singing neutral thoughts, or 4) verbally repeating neutral thoughts. Body size estimates were measured using a digital image-distorting technique. A photo of the participant was manipulated to create four degrees of realistic distortion. Contrary to predictions, body size estimates did not differ as a function of practicing CD with negative body-related thoughts when compared to neutral thoughts. However, participants who verbally repeated negative body-related thoughts were more likely to overestimate their size than participants who sang negative body-related thoughts. Singing body-related thoughts to the tune of a benign song may be easier and less threatening than verbally repeating unwanted thoughts. Findings suggest the utility of singing as a self-help defusion strategy to improve body image.

A Web-Based Intervention For Adolescents With Overweight/Obesity Seeking Treatment: An Effectiveness Study 
Sofia Ramalho1, Sílvia Felix1, Diana Silva2, Helena Mansilha3, Pedro Saint-Maurice4, Eva Conceicao1
1School of Psychology, University of Minho, Braga, Portugal, 2School of Psychology, University of Minho, Braga, Portugal, 3Centro Hospitalar de São João, Porto, Portugal, 4Centro Hospitalar e Universitário do Porto , Porto, Portugal, 5National Institutes of Health, National Cancer Institute, Rockville, MD, United States, 6School of Psychology, University of Minho, Braga, Portugal

Introduction: The APOLO-Teens 6-month web-based intervention was designed to enhance treatment as usual outcomes for adolescents with overweight/obesity seeking treatment at public health care centers. It combines a manualized intervention delivered by Facebook, chat sessions and a self-monitoring web-application with personalized feedback. Methods: This Randomized Clinical Trial included 77 adolescents (per completed protocol analysis) distributed into control (n=39) and intervention group (n= 38) (67.5% girls; mean age of 14.92 (SD=1.62) years). To test within/between differences into group conditions between baseline and end of intervention two-way mixed ANOVAs were conducted. 
Results: At the end of intervention, the intervention group depicted a greatest increase on fruit consumption, when compared with the control group, who decreased on fruit consumption. Additionally, the APOLO-Teens high adherence group presented a significant and positive change on weekly intake of fruit, vegetables on the plate, fear of getting fat, grazing behaviors and depressive symptomatology (p<0.05). Conclusions: APOLO-Teens web-based intervention was effective, as an affordable complementary intervention to the treatment as usual, in increasing fruit intake on adolescents with overweight/obesity. This intervention can lead to significant clinical changes with potential to reduce the gap in specialized treatment access between adolescents from high vs low socioeconomic status.

The Impact Of Early Symptom Changes And Therapeutic Alliance On Treatment Outcome In A Treatment Seeking Eating Disorders Sample
Ana R Vaz1, Elsa Louro1, Tãnia Rodrigues1, Eva M Conceição1, Isabel Brandão2, Paulo PP Machado1
1University of Minho, Braga, Portugal, 2São João Hospital, Porto, Portugal

Introduction: This study aims to clarify the role of the therapeutic alliance in therapeutic outcomes and explore possible predictors of therapeutic alliance in a treatment seeking eating disorders sample
Method: Fifty-one patients with Eating Disorders (mean age=24.75; SD=8.38) were assessed at baseline, 4thtreatment session, and after 6 months from baseline using a set of self-report measures, (Eating Disorder Questionnaire, Outcome 45 questionnaire, Beck Depression Inventory, Clinical Impairment Assessment, Difficulties in emotion Regulation Scale, and Working Alliance Inventory at 4thsession). Participants were monitored at every session using Eating Disorders -15 measure. Generalized estimated equations were conducted.  Results: Preliminary analysis show a significant effect of the time on the eating disorders pathology (Wald Chi-square = 8.95; ρ= .01). Also, change in eating pathology occurs mainly between baseline and 4thsession (ρ=.02). The therapeutic alliance was indicated as a significant predictor of later change in the frequency of binge eating episodes (ρ<.001), restraint symptoms (ρ<.001), and self-induced vomiting (ρ= .006). Several mediators will be tested regarding the relation of Eating disorders symptoms and attitudes and associated psychopathology with working alliance using structural equations modeling.  Conclusion: Results are important in enhance treatment outcomes and will be presented with a larger sample that is still being recruited. 

Assessment And Treatment Results Using An Integrated Approach With Cognitive Processing Therapy For Eating Disorders And Ptsd In A Residential Treatment Center 
Timothy D. Brewerton1,2,3, Molly McShane3, Jessica Genet3, Ismael Gavidia3, Giulia Suro3, Melissa Coffin3, Doug Bunnell3,4
1Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States, 2Timothy D. Brewerton, MD, LLC, Mt. Pleasant, SC, United States, 3Monte Nido & Affiliates, Miami, FL, United States, 4Private Practice, Westport, CT, United States

Introduction: Trauma histories, PTSD, and related comorbidities are common in ED patients, but little is known about best approaches for those admitted to residential care (RC). Staff were trained in Cognitive Processing Therapy (CPT), which was integrated into a comprehensive ED-PTSD approach. Methods: Adult women entering RC (n=80) agreed to complete a series of validated assessments for symptoms of ED, PTSD, major depression, and state-trait anxiety upon admission and discharge. DSM-5 PTSD diagnoses were made via Life Events Checklist-5 (LEC-5) for criterion A and PTSD Symptom Checklist for DSM-5 (PCL-5) for criteria B-E. Results: Forty-nine percent of ED patients met criteria for current PTSD (PTSD+). PTSD+ patients had significantly higher scores than PTSD- patients on several measures, including: total # of traumas on LEC-5 (p<.001), EDE-Q global and all subscale scores (p<.001), PHQ-9 depression scores (p<.001), and Spielberg's State-Trait Anxiety Inventory scores (p<.001). Eating Disorder Quality of Life (EDQOL) was worse in PTSD+ patients (p<.001). Following implementation of CPT, change in EDE-Q scores was significantly correlated with change in PCL-5 scores from admission to discharge (p<.003). Conclusions: Results indicate that ED-PTSD patients have significantly more severe symptoms and EDQOL, but that they can be successfully treated using an integrated treatment approach with CPT that results in significant improvement in ED, PTSD and comorbid symptoms.

Olanzapine Vs Placebo For Outpatient Adults With Anorexia Nervosa: Results From Secondary Analyses
Evelyn Attia1,2, Joanna E Steinglass1, B Timothy Walsh1, Angela S Guarda3, Allan S Kaplan4, Marsha D Marcus5
1Columbia University Medical Center, New York, NY, United States, 2Weill Cornell Medicine, New York, NY, United States, 3Johns Hopkins Medicine, Baltimore, MD, United States, 4University of Toronto, Toronto, ON, Canada, 5University of Pittsburgh, Pittsburgh, PA, United States

PURPOSE: To examine analyses relevant to exploratory aims of a large double-blind placebo-controlled RCT comparing olanzapine to placebo in adult outpatients with anorexia nervosa (AN).  METHODS: 152 participants with AN were randomly assigned 1:1 to receive olanzapine or placebo for 16 weeks. BMI, YBOCS and other measures were collected at baseline, 16 and 24 weeks post-randomization. RESULTS:  Previously published results demonstrated a significant treatment-by-time interaction, indicating that an increase in BMI was greater for the olanzapine group.  Secondary analyses performed more recently include that in a multilevel-model longitudinal analysis using all data available until week 24, olanzapine was associated with a trend difference of rate of BMI change (0.230 per month) compared with placebo (0.122 per month) (p = 0.10). Additionally, in a responder analysis examining all subjects assigned to the olanzapine group whose BMI change exceeded the predicted rate of change in the placebo group (i.e., olanzapine response defined as BMI change > 0.095/month), there was an interaction between YBOCS obsessionality and olanzapine response, with higher obsessionality predicting response (p=0.036).  CONCLUSION: Secondary analyses from a large RCT of olanzapine vs placebo for adults with AN find a marginal difference in BMI change over time associated with olanzapine  at 24 weeks following randomization. Also, higher YBOCS obsessionality was associated with olanzapine weight response. 

Evaluating The Role Of Digital Intervention Design In Treatment Outcomes And Adherence To Etherapy Programs For Eating Disorders: A Systematic Review And Meta-Analysis
Sarah Barakat1, Sarah Maguire2, Kathryn E. Smith3,4, Tyler B. Mason5, Ross D. Crosby3,4, Stephen Touyz1
1School of Psychology, University of Sydney, Sydney, Australia, 2InsideOut Institute for Eating Disorders, Boden Institute, University of Sydney, Sydney, Australia, 3Center for Bio-behavioral Research, Sanford Research, Fargo, ND, United States, 4Department of Psychiatry and Behavioural Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States, 5Department of Preventative Medicine, University of Southern California, Los Angeles, CA, United States

Despite the existence of numerous reviews which document the effectiveness of online, self-help therapies, there is little consensus regarding the exact components responsible for online treatment delivery. The current systematic review and meta-analysis aimed to determine which characteristics of web-based interventions are associated with better user engagement and improved therapeutic outcome in the treatment of eating disorders.  Electronic databases were searched for published studies of eTherapies for eating disorders. A final 23 papers were included in the review. Each intervention was coded across four dimensions including multimedia channels employed (e.g. text, audio, videos), user interactivity (e.g. online self-monitoring), automated feedback (e.g. reminders, personalised feedback) and technological device through which the program was accessible (e.g. smartphone, computer). The findings indicate that interventions which employed a more diverse range of multimedia channels were associated with greater symptom improvement, however no other intervention characteristics were not associated with treatment outcome or dropout. The findings will be discussed in terms of future considerations for digital intervention design, with an emphasis upon the ways in which digital features can be used to imitate aspects of direct clinical contact (e.g. personalised support) and to allow for targeted treatment delivery specific to the user’s own beliefs and behaviours.

The Integration Of Exposure Sessions Into Family-Based Treatment For Anorexia Nervosa: Treatment Development And A Pilot Study  
Catherine E. Byrne1, Daniel Le Grange2, Joanna Marino1, K. Naomi Pak1, Sarah F. Fischer1
1George Mason University , Fairfax, VA, United States, 2University of California San Francisco, San Francisco, CA, United States

Introduction: Family-Based Treatment (FBT) is an efficacious intervention for medically stable youth with anorexia nervosa (AN). Although FBT helps adolescents restore weight, weight and shape concerns often remain at end-of-treatment (EOT). While exposure is fundamental for targeting core fears in anxiety disorders, and has been studied with adult AN, it has not been utilized with adolescent AN. This study examines the efficacy of adding exposure sessions to FBT to target weight and shape concerns in AN youth. Methods: Exposure sessions were delivered to 8 participants; enrollment is ongoing. Participants completed baseline assessment prior to starting FBT, prior to Phase II of FBT, at the end of Phase II of FBT, at EOT, and at follow-up. During Phase II of FBT, participants receive 8 individual exposure sessions that target fear of fatness. Results: Enrolled patients are aged 10 to 16 (M = 12.8), with a baseline percentage of mean percent expected body weight of 89.7, and a mean Eating Disorder Examination Global score of 4.2. Six participants have completed exposure sessions. As this study is ongoing, session content is being refined via feedback from participants. Results from session evaluation forms indicate that participants and families find the exposure sessions feasible and beneficial. Conclusions: In this pilot case series, targeting weight and shape concerns in youth with AN using exposure sessions concurrently with FBT appears to be feasible and acceptable. 

Exploration Of Mechanism Of Interpersonal Psychotherapy (Ipt) For Preventing Excess Weight Gain In Adolescent Girls With Loss Of Control (Loc) Eating
Meghan E. Byrne1,2, Lauren B. Shomaker3, Ross D. Crosby4, Sheila M. Brady2, Merel Kozlosky2, Jami F. Young5, Denise E. Wilfley6, Jack A. Yanovski2, Marian Tanofsky-Kraff1,2
1Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 2Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States, 3Colorado State University, Fort Collins, CO, United States, 4Sanford Research Center for Biobehavioral Research, , Fargo, ND, United States, 5Children’s Hospital of Philadelphia, Philadelphia, PA, United States, 6Washington University in St. Louis, St. Louis, MO, United States

Introduction: IPT has been suggested to improve weight gain trajectories over time among adolescent girls with a combination of LOC eating and elevated anxiety (JCCP, 2017, 85:218-27). As the mechanisms underlying this finding are unclear, we conducted an exploratory analysis of the original trial’s data. Methods: We studied 108 girls (14.5±1.7y; 24% non-Hispanic Black), all 75th-97th BMI %ile (BMIz=1.5±0.3) and with >1 LOC episode/past mo, who participated in a 12wk RCT of IPT vs. health education (HE). At 4 intervals over 3y, girls self-reported anxiety and consumed lunch from a LOC-test meal. Adiposity was measured via DEXA. ANCOVAs were used to predict (i) snack intake (kcal) from the main/interactional effects of change in anxiety (∆Anx) and group assignment, adjusting for height, lean mass, and % adiposity, and (ii) adiposity from the main/interactional effects of snack intake and group, adjusting for baseline anxiety and intake. Separate analyses of groups predicted adiposity with the same covariates. Results: There was a significant ∆Anx by group interaction such that only among girls in IPT, ∆Anx from baseline to 6mo follow-up predicted lower snack intake at 1y (p=.02). In turn, only in IPT (p=.01), but not HE (p=.92), lower snack intake at 1y predicted lower adiposity at 3y follow-up. Conclusions: IPT may exert its effects on preventing excess adiposity gain by improving anxiety which reduces snack intake. Further testing of this hypothesis is required.

Pre- And Post-Operative Psychosocial Interventions For Bariatric Surgery Patients: A Systematic Review
Stephanie E. Cassin1,2,3, Lauren A. David1, Iris Sijercic1
1Ryerson University, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3University Health Network, Toronto, ON, Canada

Introduction: Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize weight loss and psychosocial adjustment.  The current systematic review examined the impact of pre-operative and post-operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning.  Methods: A PsycINFO and Medline search of publications was conducted in March 2019.  Two authors rated the quality of included studies using a validated checklist. Results: 44 articles (representing 36 studies) met the study inclusion criteria.  Overall, the current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (e.g., binge eating, emotional eating) and psychological functioning (e.g., quality of life, depression, anxiety).  In contrast, the evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (e.g., dietary intake), and lifestyle behaviours (e.g., physical activity) is relatively weak and mixed.  Conclusion: Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post-operative period, before significant problematic eating behaviours and weight regain occur.

Working On Working Out: A Longitudinal Investigation Of How Excessive Exercise Behaviors Change In Treatment
Danielle A. N. Chapa1, Benjamin A. Kite1, Kelsie T. Forbush1, Jenna P. Tregarthen2, Stuart Argue2
1University of Kansas, Lawrence, KS, United States, 2Recovery Record Inc., San Francisco, CA, United States

Approximately 50% of persons with eating disorders (EDs) engage in excessive exercise (EE) to influence their body weight or shape and/or to compensate for self-perceived binge eating. In the general population, EE is associated with a higher risk of all-cause mortality and poor mental health. When present among persons with EDs, EE is associated with a lower quality-of-life, longer hospital stays, and faster rates-of-relapse. Despite the seriousness of EE, most treatments for EDs do not target EE directly. Given the large proportion of ED patients who engage in EE and its effect on treatment outcomes, it is critical to understand what predicts change in EE and if changes in EE can lead to reductions in other ED symptoms. The purpose of this study was to test whether changes in other ED symptoms predicted later change in EE and vice versa. Participants were treatment-seeking, Recovery Record users (N= 5,685; 87.2% female) who completed the Eating Pathology Symptoms Inventory (EPSI) once per month for three months. Bivariate latent change score analyses indicated that EE and other ED symptoms changed simultaneously and mutually predicted change in one another. Moreover, reductions in EE predicted later large reductions in cognitive restraint and purging. Results from this study highlight that reductions in EE can lead to later reductions in other ED behaviors and cognitions providing initial support for treatments that directly target EE.

Inclusive Body Image Programs, Inclusive Outcomes? The Impact Of The Everybody Project On College Students With Marginalized Identities
Anna C Ciao, Kendall Lawley
Western Washington University, Bellingham, WA, United States

This study explored differential outcomes following the EVERYbody Project, an inclusive dissonance body image program for college students. Intervention data from two randomized trials were pooled to increase statistical power (N=113); control participants were excluded. Exploratory GLM compared changes over time (pre, post, 1-month follow-up) in students with marginalized gender, sexuality, or racial identities versus those in majority groups more traditionally represented in body image conversations (cisgender, straight, white students). Participants (Mage=19.75 years) self-identified gender (77% cisgender female, 16% cisgender male, 6% gender diverse), sexual identity (66% straight, 44% LGBQ), and race (78% white, 20% students of color). There was improvement over time for all outcomes (eating disorder symptoms, sociocultural appearance pressure, body satisfaction, negative affect) across all participants (ps<.001), with no difference in outcomes according to gender or racial identities (ps>.350). However, LGBQ students experienced greater reductions in eating disorder symptoms compared to straight participants both pre-post and pre-follow-up (ps<.017), and more improvement in body satisfaction pre-follow-up (p=.019), but not pre-post (p=.416). This suggests that students with marginalized identities may benefit from inclusive body image programs, although more research is needed to understand how diversity-focused body image conversations can be done most effectively.

Homework Compliance And Treatment Outcomes In Cognitive-Behavioral Treatments For Bulimia Nervosa
Kelsey E. Clark, Megan N. Parker, Adrienne S. Juarascio
Drexel University, Philadelphia, PA, United States

Although homework (HW) compliance is associated with enhanced outcomes from cognitive-behavioral therapies (CBTs) for anxiety and depression, HW compliance has been underexplored as a mechanism or predictor of outcomes in CBTs for eating disorders. In the current study, clinicians rated compliance with HW as part of a randomized controlled trial of two CBTs for bulimia nervosa (BN, N=44). Clinicians rated 1) self-monitoring of food intake and eating disorder symptoms, 2) written HW (i.e., filling out an assigned worksheet), and 3) behavioral HW (i.e., completing an assigned task such as at-home food exposures) on a 1-3 Likert scale based on degree and quality of completion after each treatment session. Average compliance was high for self-monitoring (M=2.7,SD=.62) and moderate for written (M=2.1, SD=.78) and behavioral (M=1.98,SD=.72) HW. Results revealed small-to-moderate negative correlations between HW compliance ratings and end-of-treatment Eating Disorder Examination (EDE) global scores, controlling for pre-treatment EDE scores (self-monitoring: r=-.03; written: r=-.18; behavioral: r=-.26). Contrary to hypotheses, self-monitoring compliance was not associated with improved treatment outcomes. Written and behavioral assignments showed small correlations in the expected direction. Behavioral HW compliance was most associated with outcomes and the effect size was comparable to results from meta-analyses of HW compliance in CBTs for anxiety and depression.

Atypical Anorexia Nervosa: Symptom Severity And Hospital Course 
Marita Cooper, Colleen Schreyer, Angela Guarda
Johns Hopkins University, Eating Disorder Program, Baltimore, MD, United States

Introduction: The amount or speed of weight loss required for the diagnosis of atypical anorexia nervosa (AAN) remains poorly defined, as do differences in behavioral and psychological symptom severity and hospital course between AAN and anorexia nervosa (AN). We compared individuals with AN and AAN on admission symptomatology and examined weight stability in AAN during hospitalization on a 2000cal/day weight maintenance (WM) diet. Methods: Participants were individuals with AN(n=299) and AAN(n=44) admitted to an integrated inpatient-partial hospitalization eating disorder program. Among patients with OSFED, we classified individuals with fear of fatness who were >10% below highest lifetime weight and had no history of BMI<18.5kg/m2 as AAN. Thirty-five patients with AAN were treated on a WM protocol, while nine were underweight (BMI<20.0kg/m2) and placed on a weight gain protocol to target BMI of 20.   Results: AN and AAN did not differ on examined variables of age, family history or length of illness. The AAN group on WM gained an average of 4.84 lbs/week over a 15 day length of stay. Compared to AN, the AAN group reported more frequent purging (vomiting and laxatives) and higher drive for thinness and body dissatisfaction. Conclusions: Although patients presenting at higher weights with AAN (BMI >18.5 kg/m2) may be less likely to be referred to inpatient care, these findings reinforce the elevated symptom severity reported by early studies of hospitalized patients with AAN.

Developing Canadian Practice Guidelines For The Treatment Of Eating Disorders In Children And Adolescents
Jennifer Couturier1, Leanna Isserlin2, Mark Norris2, Wendy Spettigue2, Melissa Brouwers2, Melissa Kimber1, Gail McVey3, Cheryl Webb1, Sheri Findlay1, Neera Bhatnagar1, Natasha Snelgrove1, Amanda Ritsma1, Wendy Preskow4, Catherine Miller5, Jennifer Coelho6, Ahmed Boachie3
1McMaster University, Hamilton, ON, Canada, 2University of Ottawa , Ottawa, ON, Canada, 3University of Toronto, Toronto, ON, Canada, 4National Initiative for Eating Disorders, Toronto, ON, Canada, 5Canadian Mental Health Association Waterloo Wellington, Kitchener, ON, Canada, 6University of British Columbia, Vancouver, BC, Canada

Introduction:  Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist.  Methods:  Systematic review methodology was used with the following inclusion criteria:  1) meta-analyses, systematic reviews, randomized controlled trials, open trials, case series, and case reports; 2) involving children and adolescents (under age 18 years) with eating disorders; 3) focusing on psychotropic medications and psychotherapeutic treatments; and 4) reporting on patient outcomes (weight, binge/purge frequency, psychological symptoms).  Two reviewers agreed upon each article for inclusion, with a third resolving disputes. Forward citation chaining of all included articles was conducted to November 15, 2018.  Included articles were then graded in terms of quality of evidence and presented to a panel of stakeholders, followed by a modified Delphi procedure in order to arrive at consensus.  Results:  Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intrusive treatment.  Weak recommendations in favour of Multi-Family Therapy, adjunctive Yoga, Cognitive Behavioural Therapy and atypical antipsychotics were confirmed.  Conclusions:  Several gaps for future work were identified including enhanced research efforts on new adjunctive treatments in order to address complex co-morbidities. 

Dual Treatment Pathways For Patients With Morbid Obesity And Binge Eating Disorder
Trine T Eik-Nes1,2, Kjersti H Berg2, Åsne A Hyldmo3, Olga Vea 3, Bård E Kulseng4
1NTNU. Department of Neuromedicine and Movement Science, Trondheim, Norway, 2Stjørdal Community Mental Health Centre Nord-Trøndelag Hospital Trust, Stjørdal, Norway, 3Centre for Obesity. St. Olavs Hospital, Trondheim, Norway, 4NTNU. Department of Cancer Research and Molecular Medicine, Trondheim, Norway

: Individuals with binge eating disorder (BED) often present with greater degree of morbidity compared to those without BED. However, health services fail to address BED in patients seeking weight treatment. The aim of this project is to investigate pathways in health services and develop new integrated pathways for patients with morbid obesity and BED. Methods: A project group collected information from eating disorders units and providers of treatment of morbid obesity in Mid-Norway to assess the provision of BED treatment. A BED team was established at a mental health outpatient clinic. Together with health care professionals from an obesity clinic, regular meetings and workshops were organized to share knowledge and develop coordinated care and new interventions for patients presenting with binge eating symptoms in obesity clinics. Results: Several fragmented efforts in the care pathway for patients with morbid obesity and BED were discovered. Identification of BED, eating disorder pathology, psychiatric comorbidity, body image, obesity risk factors was assessed in 16 patients with morbid obesity. A 10-week group based psychoeducational intervention was developed. Preliminary results from the project and the BED intervention will be presented. CONCLUSIONS: Health care professionals reported complex dealings with health care services regarding patients with morbid obesity and BED. Coordination of care is possible through shared knowledge of BED and obesity.

Outpatient Treatment For Adults With Complex Eating Disorders And Comorbid Disorders: A Decision Making Model And Case Example
Sarah Fischer1, Alexandra Gasbarro2, Joanna Marino2, Rebecca Hardin2
1George Mason University, Fairfax, VA, United States, 2Potomac Behavioral Solutions, Arlington, VA, United States

. Cognitive Behavioral Therapy (CBT-E) has the most empirical support for outpatient treatment of adult eating disorders. These studies often do not include data on frequently co-occurring symptoms of suicide attempts, non-suicidal self-injury, and symptoms of Borderline Personality Disorder (BPD). Clinicians attempting to use empirically supported treatments to serve complex adult ED clients may ask: Who is likely to come in for treatment? How do I decide which treatment to use? What are the outcomes for complex clients in this decision making process? Methods. Using data collected from a group practice, we provide descriptive data regarding clients who present to non-academic setting for treatment of complex EDs, describe a DBT based and research informed conceptual model for treatment decision making for an outpatient  setting, and present a case example of a client with BPD, complex trauma, and BN using this decision making model. Results. 228 clients presented for treatment for EDs over 4 years. Clients had a mean length of illness of 9.5 years, and 57.5% had previous treatment for an eating disorder.  24% had AN, 14% had BN, 7% had BED, and 55% had OSFED. 78 clients were referred for C-DBT. A case is presented with course of treatment and outcome data provided. Conclusions. This clinical data suggests symptoms are more effectively managed when this decision making model is used. This decision making model should be tested in a randomized controlled trial.

Investigating Symptom Development And Pre-Treatment Illness Trajectories In First-Episode Eating Disorders: A Comprehensive Semi-Structured Interview Approach
Michaela Flynn1, Amelia Austin1, Karina Allen2, Nina Grant2, Victoria Mountford2, Danielle Glennon2, Amy Brown2, Mary Franklin-Smith3, Monique Schelhase3, Rhys W Jones3, Lucy Serpell4,6, Kate Mahoney4, Gabrielle Brady5, Nicole Nunes5, Frances Connan5, Schmidt Ulrike1,2
1King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom, 2South London and Maudsley NHS Foundation Trust, London, United Kingdom, 3Leeds and Yorkshire NHS Foundation Trust, Leeds, United Kingdom, 4North East London NHS Foundation Trust, London, United Kingdom, 5Central and North West London NHS Foundation Trust, London, United Kingdom, 6University College London, London, United States

Introduction: Studies describing eating disorder (ED) symptom development, illness onset and trajectories prior to the start of first evidence-based treatment are relatively scant.  We wanted to assess pre-treatment illness course in first episode EDs, to improve understanding of early stage EDs. 
Methods: Patients, aged 16-25 years, presenting in the early stages (i.e. illness duration <3 years) of first episode ED were recruited. ED onset, symptom development, illness trajectory, diagnostic transitions and peak severity prior to start of treatment were assessed retrospectively and longitudinally using a semi-structured interview which combined the assessment of ED variables with a life chart approach. Sociodemographic and clinical information were also obtained. Results: 270 patients were interviewed. 40% had anorexia nervosa. Mean duration of untreated ED (DUED) across diagnoses was 16 months, with shorter DUED in AN (M=16.60 months, SD=10.77) than in other EDs (M=19.37 months, SD=10.27). No significant relationship between DUED and ED severity or related psychopathology at clinical assessment was observed. Data relating to illness trajectory, diagnostic transitions and peak severity prior to treatment will also be presented. Conclusion: The semi-structured interview tool provides a comprehensive assessment of the DUED period in first episode EDs and may be of benefit in future research. The implications for improving understanding of early stage EDs will be discussed.

What Do Women In A Guided Self-Help Program For Disordered Eating Write To Their Coaches? A Qualitative Analysis Of Text Messages
Lauren A Fowler1, Shiri Sadeh-Sharvit2,3, Orly Idan3, Ellen E Fitzsimmons-Craft1, Arielle Smith1, Neha J Goel3, Rachael E Flatt3, Katherine N Balantekin4, Grace E Monterubio1, Marie-Laure Firebaugh1, Anna M Karam1, Andrea K Graham5, Burkhardt Funk6, C Barr Taylor2,7, Denise E Wilfley1
1Washington University in Saint Louis, St Louis, MO, United States, 2Palo Alto University, Palo Alto, CA, United States, 3School of Psychology, Interdisciplinary Center, Herzliya, Israel, 4University at Buffalo, Buffalo, NY, United States, 5Northwestern University, Chicago, IL, United States, 6Leuphana University of Lueneburg, Lueneburg, Germany, 7Stanford University, Stanford, CA, United States

Digital guided self-help is effective and accepted by clients with eating disorders (EDs). However, understanding the experiences of users of these programs is essential to optimize user needs, expectations, preferences, and outcomes. Methods. This study analyzed text messages provided by users of the Healthy Body Image (HBI) Program, a guided self-help mobile intervention to treat EDs among college-aged women. Participants were female students (n=385) from 36 universities who screened positive for a subclinical/clinical ED. The intervention was a structured, cognitive-behavioral program with 40 core sessions; each participant was paired with a coach with whom they could freely correspond throughout the intervention. Results. HBI users (mean age=22.1 years old [SD=4.8]) sent 4646 text messages to their coaches during the intervention. After removing messages that were detailing technical, non-intervention related issues (n=986), 3660 texts remained for analysis. We will present the results of a thematic analysis of these texts, using a systematic coding process to illuminate the experiences of HBI participants. Preliminary themes include ED symptoms, coping strategies, and stress/stressors. Conclusion. Content analysis of user-initiated text messages sent to HBI coaches may offer insight into the experiences of women completing guided self-help ED programs and may provide direction for future optimization of the development and tailoring of online interventions.

The Functional Body Questionnaire For Eating Disorders: Development And Initial Validation
Juanita Gempeler, Martiza Rodriguez
Equilibrio ltda, Bogota, Columbia

Abstract: ‘Functional body’, is the ability to use one’s body independently of body image dissatisfaction or distortion, coping with everyday situations as other people do, with a coherent pattern of cognitive, motor and affective responses. Method: A working panel of experts develop the instrument. Content analysis of two previous qualitative studies, informed the first draft. Eight categories were identified, 16 Items were defined .The draft was submitted to the panel to obtain feedback about the instrument items for its face validity. An exploratory factor analysis to evaluate the initial validity of the tool was conducted. The KMO Test was used to check sample adequacy. 42 patients answered the questionnaire. Results: The instrument contains 16 items with a Likert response scale and 5 remaining questions that don´t sum to the final score. The higher the score, the higher the functional use the patient gives to his/her body. The exploratory factor analysis showed 3 Factors with an eigenvalues greater than 1.0: body used in context, body distress tolerance and self-efficacy, that show a strong correlation between items which suggest a robust relationship between items and the functional body concept (construct validity). Factorial analysis did not remove any item from the initial scale (variance <.30).Currently, the analysis of concurrent validity and other psychometric properties of the instrument is being carried out.

Research Trial Versus Usual Clinical Care: Outcomes For Adolescents With Anorexia Nervosa Treated In A Publicly Funded Specialist Service
Sasha Gorrell1, Elizabeth K. Hughes2,3, Erin C. Accurso1, Susan M. Sawyer2,3,4, Michele Yeo2, Martin Pradel2, Daniel Le Grange1,5
1University of California, San Francisco, San Francisco, CA, United States, 2Department of Paediatrics, The University of Melbourne , Melbourne, Australia, 3Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Australia, 4Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, Melbourne, Australia, 5The University of Chicago (Emeritus), Chicago, IL, United States

Introduction:Evidence-based treatment for adolescents with eating disorders may result in different outcomes in usual clinical care than in research trials due to strict trial eligibility criteria, differences in families who agree to participate in trials, or differences in intensity of treatment. Identifying differences between these settings could inform future clinical and research efforts.  Methods:This study examined weight outcomes for 110 adolescents with anorexia nervosa who received family-based treatment (FBT) through an RCT (n= 54) or usual clinical care (Clinic, n= 56) at the same publicly-funded pediatric eating disorder service. Weight was recorded during outpatient treatment (18 sessions over 6 months), and at follow-up (6 and 12 months). Survival curves were used to examine time to weight restoration (greater than 95% median Body Mass Index [mBMI]) as predicted by type of care (RCT vs. Clinic), baseline clinical and demographic characteristics, treatment intensity, and their potential interactions.  Results:There was no significant main effect for type of care, but there was a significant effect for baseline %EBW (p= .03), such that weight restoration was achieved sooner across both treatment types for those with a higher initial %mBMI.  Conclusions:Findings indicate that weight restoration achieved from FBT within usual clinical care in this specialist publicly-funded service was comparable to that achieved within a research trial.

Physical Coercion During Inpatient Treatemnt Of Adolescent Anorexia Nervosa: Frequency, Clinical Correlates And Association With Outcome At Five-Year Follow-Up.
Øyvind Rø1,3, Inger Halvorsen1, Thomas Blikshavn2
1Regional Department for Eating Disorders. Oslo University Hospital, Oslo, Norway, 2Department of Child and Adolescent Mental Health, Akerhus University Hospital, Oslo, Norway, 3Insitute of Clinical Medicine, University of Oslo, Oslo, Norway

Purpose of study: Reports on the use of physical coercion in the treatment of eating disorders (EDs) are lacking, and the clinical significance of a coercion history is unclear. The current study was undertaken to describe frequency of physical coercion in a tertiary family-based inpatient treatment program for adolescents with anorexia nervosa, and to examine the relationship between meal-related coercion and outcome at follow-up. Methods: Participants were 38 patients out of 58 invited who took part in a follow-up examination at 5 years post-discharge. Average age at admission was 15.9 years (SD = 1.9). Patient data, including coercive episodes, were obtained from the patient records. Results: A total of 201 physical coercive events were recorded during a total of 5513 days of inpatient treatment. The most common justifications were administration of nutritional treatment (meal-related, n = 109) and self-harm (n = 56). Four patients together accounted for 91% of all physical coercive events. Eight had experienced meal-related coercion. Meal-related physical coercion was not significantly associated with EDE-Q total score or BMI at follow-up. However, meal-related coercion was associated with higher rates of ED diagnoses at follow-up. Conclusions: Physical coercive events are infrequent, and affect only a small number of patients. It is probably associated with poorer outcome. More studies on the use and effects of physical coercive events in larger samples are needed.

Parent-Based Prevention Following Parental Weight Loss Surgery
Shiri Sadeh-Sharvit1, 2, Cristin D. Runfola1, Hannah A. Welch1, Elise L. Gibbs1, Caroline E. Dickens1, James Lock1, Debra L. Safer1
1Stanford University, Stanford, CA, United States, 2Interdisciplinary Center, Herzliya, Israel

Introduction: Overeating and obesity are elevated in children of parents who have undergone weight loss surgery (PWLS). PWLS often report their personal history of obesity interferes with their knowledge, skills, and self-efficacy in developing their children’s healthy habits, thus reducing the likelihood of addressing obesogenic environmental factors. Methods: This study examines whether a six-session Parent-Based Prevention (PBP) program adapted for PWLS and delivered online is feasible and acceptable for parents. The program's signal of efficacy is also explored by examining short-term impact on targeted parental cognitions, feeding practices, and child behaviors. Results: 10 families enrolled and 7 completed the study. Parents found the intervention relevant and suitable for addressing their parenting concerns. Parental feeding behaviors, such as restriction and pressure to eat, reduced from 3.66 (SD=.63) to 3.14 (SD=.75) and 2.06 (SD=1.00) to 1.65 (SD=.86), respectively. Tracking of sweets and high-fat snacks increased, from 3.56 (SD=1.26) to 4.17 (SD=1.05). Children reduced both emotional overeating (2.14 [SD=1.21] vs. 1.60 [SD=.85]) and undereating (2.73 [SD=.74] vs. 1.90 [SD=.58]). Daily hours of screen time reduced from 3.89 (SD=3.69) to 2.09 (SD=1.97), and outdoor play hours increased, from 1.61(SD=2.52) to 2.36 (SD=2.34). Conclusions: PBP aimed at helping PWLS engineer healthier family lifestyles is feasible, acceptable, and associated with reduced risk factors.

Using Network Analysis To Compare Disorder- And Age-Specific Symptom Networks In Eating Disorders Before And After Treatment
Sandra Schlegl1, Kathryn Smith2,3, Ross D. Crosby2,3, Markus Moessner4, Christina Neumayr5, Silke Naab5, Ulrich Voderholzer1,5
1Department of Psychiatry and Psychotherapy, University Hospital Munich (LMU), Munich, Germany, 2Sanford Center for Bio-behavioral Research, Fargo, ND, United States, 3Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States, 4Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany, 5Schoen Clinic Roseneck, Prien, Germany

Purpose: Network analysis (NA) studies in eating disorders (EDs) mostly have examined transdiagnostic and/or mixed age samples, and only two studies have analyzed data before and after treatment. The aim of our study was to evaluate if adolescents and adults with anorexia nervosa (AN) or bulimia nervosa (BN) differ in networks at baseline as well as in change from admission to discharge of inpatient treatment. Methods: Participants were 2704 patients (n= 1067 AN adults, n=862 AN adolescents, n=520 BN adults, n=255 BN adolescents) who completed the Eating Disorder Examination-Questionnaire and Eating Disorder Inventory-2; 2038 patients had data at admission and discharge. Networks were estimated using regularized Graphical Gaussian Models. Network comparison tests and bootstrapped difference tests assessed group differences. Results: We found no differences in networks at admission between adolescents and adults for either AN or BN. Admission networks differed in structure between AN and BN. Network structure also changed between admission and discharge in each group. Differences will be presented in detail. Conclusions: NAs hold promise in identifying core symptoms that should be addressed in therapy. Results offer insights into the core symptoms of EDs and how the nature of symptom relationships change during treatment. Our findings might have implications on how to treat adolescents and adults differently and to what extent transdiagnostic thinking holds.

Clinician-Led,Peer-Led, And Internet-Delivered Dissonance-Based Eating Disorder Prevention Programs: Long-Term Effectiveness Of These Delivery Modalities
Eric Stice, Paul Rohde, Heather Shaw, Jeff Gau
Oregon Research Institute, Eugene, OR, United States

Intro. We tested whether delivery of the Body Project eating disorder prevention program can be task-shifted from clinicians to undergraduate peer educators or to internet-delivery. Methods. 680 young women recruited at colleges were randomized to clinician-led Body Project groups, peer-led Body Project groups, the internet-based eBody Project or an educational video control condition. Results. Participants in all three variants of the Body Project showed greater reductions in risk factors and eating disorder symptoms than educational video controls, though effects tapered off by 4-yr follow-up. Peer-led, but not clinician-led groups produced larger reductions in outcomes than the eBody Project. Peer-led Body Project group participants showed greater reductions in future eating disorder onset through 4-yr follow-up than clinician-led Body Project and educational video control participants, and marginally greater reductions than eBody Project participants (a 57%, 57%, & 51% reduction, respectively). Conclusions. Results suggest that the Body Project can be effectively implemented by peer educators and via the Internet, as well as by clinicians, though reductions in risk factors and symptoms taper off by 4-yr follow-up. Most excitingly, results provide the first evidence that peer-led Body Project groups can prevent onset of future eating disorders relative to credible alternative interventions, suggesting task-shifting implementation to peer-leaders can be highly effective.

Saturday, September 7, 2019

7:30 - 8:15 AMChicago 9/10

Open Science is a global movement to increase the accessibility to scientific research in order to foster collaboration and innovation, increase scientific rigor and reproducibility, encourage data integration, and accelerate the translation of basic research into clinical practice. Increasingly, funders demand Open Science practices, and scientific journals are following suit. These requirements pose logistical burdens and raise ethical or intellectual property concerns. EDRS members should shape the future of Open Science in our field. Two brief talks will set the stage to engage EDRS attendees in a discussion of the Open Science framework and offer practical strategies for increasing transparency and reproducibility in eating disorder research. Weissman will introduce the Open Science framework, provide examples of specific rigor and reproducibility criteria, and summarize findings of a study of open science practices as reflected in manuscripts published in three eating disorder journals. An important component of Open Science is data sharing. Crosby, based on extensive collaborative experience across the globe, will share practical guidelines and tips regarding sharing data. The presenters then will facilitate audience discussion of how our field should address the opportunities and challenges arising from the Open Science movement and of possible guidelines for protecting investigators and participants from misuse or unintended consequences of open science practices.

Practical Guidelines For Data Sharing In The Era Of Open Science
Ross D Crosby
Sanford Research, Fargo, ND, United States

Introduction. Open Science is a global movement to increase the accessibility to scientific research in order to foster collaboration and innovation, increase scientific rigor and reproducibility, encourage data integration, and accelerate the translation of basic research into clinical practice. An important component of Open Science is data sharing. This paper, the third in a trilogy of Open Science papers, will provide practical guidelines for sharing data. Methods. Concerns about data sharing will be addressed. Data sharing topics will include the range of materials to be shared, formats for data sharing, what information should be included (and not included), and where these materials can be shared. Practical and ethical considerations in data sharing will also be addressed. Results. Study materials that should be shared include a detailed study protocol, a data code book (including variable names and descriptions, value labels, and missing data codes), data file(s), and analysis syntax for primary analyses. Materials should be shared in standard formats, such as pdf or rtf formats for text files, and csv or common statistical formats (e.g., SAS/SPSS) for data files. Data file(s) should include both items and summary scores. No personal identifying information (e.g., birthdates) should be included. Discussion. Promoting data sharing practices in eating disorder research will serve to increase the scientific rigor and reproducibility within our field.

Pressures And Practices Of Implementing Open Science For Eating Disorder Researchers
Tom Hildebrandt
Icahn School of Medicine at Mount Sinai, New York, NY, United States

Introduction. The Open Science movement promises increased transparency, reduction in methodological biases/errors, and the promotion of quality science. As the practice of open science matures, publishers, funding agencies, and authors are experiencing significant pressure to conform to evolving guidelines and best practices. Methods. A critical review of nine specific rigor and reproducibility criteria and their frequency in published literature will be reviewed. The relative ‘cost’ of these practices for investigators, funding agencies, and publishers will be discussed and practical advice provided for inclusion of these open science elements in provided through a worked clinical trial example.  Results. Open Science and associated rigor and reproducibility practice introduces the promise of higher impact findings from well-funded and resourced designs and may inadvertently diminish exploratory and secondary data analytic approaches.  Simple sums of these nine criteria or “badge” based incentives provide some objective measure of open science practices, but their impact on common metrics of scientific impact remains uncertain. Discussion.  Stakeholder ‘buy-in’ from promotion committees, funding agencies, publishers, and peer-reviewers will be essential for open science's success. Developing guidelines for protecting investigators and participants from misuse or unintended consequences of open science may help incentivize adoption of open science practices

Open Science Practices In Eating Disorder Research: Introduction And Status Report
Ruth S. Weissman
Wesleyan University, Middletown, CT, United States

Increasingly, funders demand Open Science practices, and scientific journals are following suit. These requirements pose burdens and raise ethical or intellectual property concerns. EDRS members should shape the future of Open Science in our field. Our three linked presentations will engage attendees in a discussion of the Open Science framework and offer practical strategies for increasing transparency and reproducibility. Paper 1 introduces the Open Science Framework and illustrate the status of three Open Science practices in ED: study preregistration, data sharing, and material sharing. Method A systematic review of treatment (or ancillary) studies published from 2016-4/15/2019 in EEDR, JED, IJED examined Open Science practice indicators in 65 papers. Results Trial preregistration was most commonly reported, yet only in a minority of papers. A few studies made materials available online, while online data sharing was not found. No article featured an Open Science badge. Locating Open Science related information was time-consuming due to inconsistency in reporting practices. Discussion Findings will be discussed in light of barriers to open science practices. The discussion will set the stage for Papers 2 & 3 which will offer concrete advice on improving transparency in ways that are mindful of the myriad of pressures experienced by researchers. Our paper trilogy will facilitate a dialogue of how our field should meet the challenges of Open Science practices.  

8:30 - 10:00 AMChicago 9/10
New Directions in Eating Disorders Treatment Research

Chair(s): Jennifer Wildes
Short-Term Outcomes Of A Multi-Center Randomized Controlled Trial Of Refeeding In Anorexia Nervosa: The Study Of Refeeding To Optimize Inpatient Gains (Strong)
Andrea Garber
UCSF Benioff Children's Hospital, University of California

Using Just-In-Time Adaptive Interventions To Enhance Cognitive Behavioral Treatment For Bulimia Nervosa
Adrienne Juarascio
Drexel University

Cognitive Bias Modification Training (Cbm) And Transcranial Direct Current Stimulation (Tdcs) To Treat Eating Disorders With Binge Eating
Gemma Gordon
Kings College London

Harnessing Technology For Screening And Intervention With Eating Disorders On College Campuses: Long-Term Outcomes From A Cluster Randomized Trial And Future Directions
Ellen Fitzsimmons-Craft
Washington University School of Medicine

10:00 - 10:30 AMChicago Ballroom Foyer
Coffee Break

10:30 - 12:00 PMChicago 9/10
What We’re Missing in Eating Disorders Research (and Prevention, Treatment and Advocacy): The Epidemiologist’s Perspective

Chair(s): Alexis Duncan
Many People With Eating Disorders Don’T Receive Treatment (And People With Eds Who Receive Treatment Are Different From Those Who Do Not).
Ruth Weissman
Wesleyan University

Most People With Eating Disorders Are Not Underweight, Nor Are They Adolescent Girls
Alexis Duncan
The Brown School, Washington University in St. Louis

The Vast Majority Of People With Eating Disorders Have Other Psychiatric Disorders
Kristin von Ranson
University of Calgary

It Is Unlikely That The Ed Diagnostic Criteria Represent “The Truth”
Alison Field
Brown University School of Public Health

The Prevalence Of Eating Disorders And Disordered Eating Is Much Higher Than We Think
Katie Loth
University of Minnesota

Sub-Diagnostic Disordered Eating Matters
Dianne Neumark-Sztainer
University of Minnesota

You Don’T Have To Be A (Mental) Healthcare Provider To Do Something About Eds
S. Bryn Austin
Harvard T.H. Chan School of Public Health

Carly Pacanowski
University of Delaware

Kendrin Sonneville
University of Michigan, School of Public Health

12:00 - 1:00 PMChicago 9/10

Chair(s): Scott Crow
The New Paradigm Of Computational Psychiatry
David Redish
University of Minnesota

1:00 - 2:15 PMChicago Ballroom Foyer
Lunch (on your own)

2:15 - 3:30 PMChicago 9
Parallel Paper Session II: Dietary Intake and Biology of Restrictive Eating Disorders

Chair(s): Kathleen Pike
Fat Preference And Fat Intake In Individuals With And Without Anorexia Nervosa
Janet E. Schebendach, Blair Uniacke, B. Timothy Walsh, Laurel E.S. Mayer, Evelyn Attia, Joanna Steinglass
NYS Psychiatric Institute, Columbia University Medical Center, NY, NY, United States

Purpose: Fat restriction is a characteristic eating behavior among individuals with anorexia nervosa (AN),and laboratory meal studies demonstrate restricted fat intake among low-weight patients. The Geiselman Food Preference Questionnaire-I© is a validated self-report measure that yields a fat preference score (FPS). Prior research reported that AN patients had a significantly lower FPS than did healthy controls (HC). The goal of the current study was to compare the FPS to fat intake at a multi-meal (MIM) study. Specific aims were to 1)determine if the FPS differed between ANs and HCs; 2)determine if fat and kcal intakes differed between ANs and HCs; and 3)determine if the FPS was associated with fat and kcal intakes in ANs and HCs. Methods: 44 ANs and 48 HCs completed the FPQ and a MIM study. Results: Compared to HCs, ANs consumed less energy (469.1 + 397.7 vs. 856.4 + 346.8 kcal, p<0.001), less fat (16.4 + 20.4 vs. 36.7 + 18.9 g, p<0.001), and a lower % fat kcal (22.9 + 13.8 vs. 36.6 + 8.0%, p<0.001)at the MIM. Compared to HCs, ANs also had a lower FPS (79.7 + 27.4 vs. 102.3 + 18.9, p<0.001). The FPS was significantly and positively correlated with kcal (r=0.481, p<0.01), fat (r=0.453, p<0.01), and % fat kcal (r=0.37, p<0.05) in ANs as well as in HCs (kcal: r=0.583, p<0.001; fat: r=0.621, p<0.001; % fat kcal: r=0.601, p<0.001). Conclusion: The FPS is related to objective measures of energy and fat intake in patients with AN as well as in healthy individuals.

A Diet High In Processed Foods, Total And Added Sugars, And Low In Protein Is Characteristic Of Youth With Avoidant/Restrictive Food Intake Disorder
Stephanie G Harshman1,2, Olivia Wons1,2, Madeline S Rogers1,2, Alyssa M Izquierdo1,2, Tara M Holmes3, Reitumetse L Pulumo1,2, Elisa Asanza1,2, Kamryn Eddy1,2,4, Madhusmita Misra1, Nadia Micali5,6,7,8, Elizabeth A Lawson1, Jennifer J Thomas2,4
1Neuroendocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, United States, 2Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States, 3Translational Clinical Research Center, Massachusetts General Hospital, Boston, MA, United States, 4Department of Psychiatry, Harvard Medical School, Boston, MA, United States, 5Département universitaire de psychiatrie, Université de Genève, Geneva, Switzerland, 6Great Ormond Street Institute of Child Health, University College London, London, United Kingdom, 7Service de psychiatrie de l'enfant et de l'adolescent, Geneva, Switzerland, 8Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland

Introduction: Avoidant/restrictive food intake disorder (ARFID) is characterized in part by limited dietary variety, but dietary characteristics of this disorder have not yet been systematically studied. Methods: We analyzed 24-hour dietary recall data for 46 males and females with full or subthreshold ARFID, and 43 healthy controls (HC), ages 10-22 years. We examined frequency of commonly reported foods by chi-square, and intake of food groups, calories, macro- and micronutrients between groups by ANOVA. We adjusted for multiple comparison with Holm-Bonferroni. Results: The most common foods reported in ARFID were in the ‘cakes/cookies/pastries’ and the ‘chips’ subgroups, with 63% and 56% of ARFID participants reporting consumption compared to 35% and 21% of HC, respectively (all p’s<0.001). Vegetable intake was significantly lower in ARFID compared to HC (p=0.001). Percent calories from protein was significantly lower in ARFID compared to HC, with no significant differences in percent calories from carbohydrates or fats. Intake of dairy, added sugars, and total sugars was higher in ARFID compared to HC (all p’s<0.001). Individuals with ARFID had lower intake of vitamin K, consistent with low vegetable intake, and higher intake of calcium consistent with higher dairy intake, compared to HC. Conclusions: Our results support the need for diet diversification as part of therapeutic interventions reducing risk for nutrient insufficiencies and related complications.

The Role Of Frontostriatal Circuits In Restrictive Food Choice Across The Spectrum From Illness To Health
Joanna E Steinglass1,2, Karin Foerde1,2, Janet Schebendach1,2, B. Timothy Walsh1,2, Daphna Shohamy3
1Columbia University Irving Medical Center, New York, NY, United States, 2New York State Psychiatric Institute, New York, NY, United States, 3Columbia University, New York, NY, United States

Hidden formatting deleted. Delete this text! normal;background:white">Introduction:
An emerging focus on maladaptive restrictive intake in Anorexia Nervosa (AN) has led to a habit-centered mechanistic model and an initial fMRI study found that the dorsal striatum and dorsal frontostriatal circuits guide food decisions among individuals with AN, but not healthy comparison women (HC). To replicate and extend these findings, we tested whether dorsal frontostriatal circuits are specific to the illness of AN, or play a role in restrictive eating more broadly. Methods: We administered the Food Choice Task with functional MRI to women with acute AN (n=38), healthy comparison (HC; n=36) women, and two additional groups exhibiting restrictive eating, but with a weight in the healthy range: sub-threshold/atypical AN (sAN; n=19) and HC who demonstrated weight loss on a diet (HC-D; n=20). AN and HC were tested twice. Results: AN chose fewer high-fat foods than HC (p <0.0001), HC-D did not differ from HC (p=0.55), and sAN did not differ from AN (p=0.52). Neuroimaging replicated the finding that AN engaged dorsal striatum more than HC (p <0.005, uncorrected), whereas both the sAN and HC-D group showed activation similar to HC (ps > 0.53). Acute weight restoration did not change food choices (p=0.30) or neural substrates (p,0.05, uncorrected). Conclusion: Engagement of the dorsal striatum during food choice was specific to individuals with AN, regardless of weight status.

Reduced Plasma Orexin-A Concentrations Are Associated With Cognitive Deficits In Anorexia Nervosa
Fernando Fernández-Aranda1,2,3, Trevor Steward1,2, Gemma Mestre-Bach1,2, Susana Jiménez-Murcia1,2,3, Roser Granero2,4, Isabel Sánchez1,2, Nadine Riesco1,2, Cristina Vintró-Alcaraz1,2, Zaida Agüera1,2, José M. Menchón5
1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 2Ciber Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III , Madrid, Spain, 3Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain, 4Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona , Barcelona, Spain, 5CIBER Salud Mental, Instituto Salud Carlos III, Madrid, Spain

: Orexins/hypocretins are neuropeptides implicated in numerous processes, including food intake and cognition. Little is known regarding the role of these peptides in anorexia nervosa (AN). The study aimed to evaluate the associations between plasma orexin-A concentrations and neuropsychological functioning in an adult sample with AN. Methods: Fasting plasma orexin-A concentrations were taken in 51 females with AN and in 51 matched healthy controls. Set shifting was assessed using the computerized Wisconsin Card Sorting Test (WCST) whereas decision making was measured using the Iowa Gambling Task (IGT). Body composition was measured via bioelectrical impedance. Results: The AN group obtained lower plasma orexina-A levels than the HC group. Lower means were obtained on all the IGT measures (except for block 1) in AN patients. WCST perseverative errors were significantly higher in the AN group compared to HC. In the AN group, orexin-A levels were negatively correlated with IGT block 1 performance and WCST non-perseverative errors. In the HC group, orexin-A levels were also negatively correlated with WCST non-perseverative errors. Conclusions: Reduced plasma orexin-A concentrations were found to be associated with set-shifting impairments in AN. Taking into consideration the function of orexins in promoting arousal and cognitive flexibility, future studies should explore orexin whether partly underpins the cognitive impairments found in AN.

Altered Micronutrient Levels In Anorexia Nervosa: A Preliminary Study On The Possible Mediating Role Of Dna Methylation
Linda Booij1,2,3, Jessica Burdo3,4, Esther Kahan4, Luis B Agellon3, Lea Thaler3,4, Kevin McGregor3, Aurelie Labbe5, Mimi Israël3,4, Linda Wykes3, Howard Steiger 3,4
1Concordia University, Montreal, QC, Canada, 2CHU Sainte-Justine Hospital, Montreal, QC, Canada, 3McGill University, Montreal, QC, Canada, 4Eating Disorders Program, Douglas Univer­sity Institute, Montreal, QC, Canada, 5HEC Montreal, Montreal, QC, Canada

PURPOSE: Various studies have shown altered DNA methylation in Anorexia Nervosa (AN) at genes that influence many physiological and brain functions. As methylation is responsive to nutritional factors, it may be an etiological factor in AN. Our ongoing study compares associations between DNA methylation and plasma levels of micronutrients (folate, B12, betaine, choline, methionine). METHODS: Genome-wide DNA methylation from leukocytes and plasma nutrient levels have been analyzed so far in 34 women with active AN, 34 in whom AN was in remission and in 39 age-matched, normal-eater women. RESULTS: Women with active AN had higher levels of betaine (d=0.54) and B12 (d=0.68) than normal eaters (p<.01). After controlling for medication, smoking, cell-type composition and False Discovery Rate, general linear models showed that betaine and B12 were differentially associated with methylation in women with active AN compared to normal eaters and women with remitted AN (135 probes). Results include differential associations between the nutrients and methylation of genes involved in cell growth in response to nutrients (RPTOR), insulin regulation (IGF1R, IGF2R), bone health (SERPINB13), estrogen (GREB1) and glutamate (GRM5GRIN3B) [all Q<.01]. CONCLUSION: Epigenetic processes may mediate influences of nutritional factors in AN. In addition to increasing sample size, longitudinal analyses will provide insight into the clinical relevance of the associations as marker for illness stage.

2:15 - 3:30 PMChicago 10
Parallel Paper Session I: Binge Eating and Obesity

Chair(s): Debra Franko
Psychopathological Networks In Cognitive-Behavioral Treatments For Binge-Eating Disorder
Anja Hilbert1, Andreas Mayr2, Stephan Herpertz3, Stephan Zipfel4, Brunna Tuschen-Caffier5, Hans-Christoph Friederich6, Martina de Zwaan7
1University of Leipzig, Leipzig, Germany, 2University of Bonn, Bonn, Germany, 3University of Bochum, Bochum, Germany, 4University of Tuebingen, Tuebingen, Germany, 5University of Freiburg, Freiburg, Germany, 6University of Duesseldorf, Duesseldorf, Germany, 7Hanover Medical School, Hanover, Germany

In network approaches to psychopathology, network connectivity was assumed to negatively predict treatment response. This study uniquely sought to elucidate network structure, its change, and predictive value in cognitive-behavioral therapy (CBT) for binge-eating disorder (BED). In a multicenter randomized trial of face-to-face and Internet-based guided self-help CBT (N=178), eating disorder and general psychopathology, and body mass index (BMI) were subjected to Gaussian Graphical Network and Exploratory Graph Analyses at pre- and posttreatment and 6-month follow-up. At pretreatment, three network communities of eating disorder psychopathology, general psychopathology, and restraint and BMI were identified, with the latter community included in the first thereafter. Eating disorder impairment and self-esteem had the highest, and BMI and binge eating had the lowest pretreatment node strength. Network connectivity significantly increased from pre- to posttreatment, with the greatest increases in node strength of binge eating and shape concern, but it did not predict binge-eating remission. With decreasing symptom severity, CBT resulted in a greater integration and connectivity of the psychopathology network in BED, suggesting an increased patient understanding of relations between binge eating and other symptoms. Network connectivity was not a negative prognostic indicator of treatment outcome, supporting a refinement of network theory in the explanation of therapeutic change.

The Interactive Effects Of Low Testosterone And Prolonged Stress On Binge Eating Symptoms In Men
Kristen M. Culbert, Megan M. Shope, Kimberly S. Stevens
Department of Psychology, University of Nevada - Las Vegas, Las Vegas, NV, United States

Introduction: Animal and human data suggest that testosterone levels contribute to individual variability in risk for binge eating. For example, low testosterone increases sweet-taste preference in post-pubertal male rodents and is predictive of heightened levels of binge eating symptoms in boys and men. Nonetheless, additional etiologic factors may intersect with low testosterone and further enhance vulnerability to binge eating. Prolonged stress is a promising biopsychosocial candidate as it can over-activate glucocorticoid production, blunt testosterone, and enhance cravings for highly palatable (high-fat/high-sugar) food. Given that there are natural between-person differences in testosterone concentrations, it may be that the risk effects of low testosterone on binge eating are greatest in men who also have heightened levels of prolonged stress. The current study examined this possibility. Methods: Male college students (N = 70) completed self-report questionnaires of binge eating symptoms and stress over the past month. Afternoon saliva samples were assayed for testosterone. Results: A significant interaction between prolonged stress and testosterone emerged. Men suffering from low testosterone and heightened stress reported substantially higher binge eating symptoms than other men. Conclusions: Results indicate that the consideration of prolonged stress is important for understanding why some men with low testosterone may be particularly vulnerable to binge eating.

Difficulty Putting On The Breaks: Neural Activation Differs By Binge Eating Status In Individuals With Obesity When Attempting To Inhibit Responses To Food 
Megan N. Parker1, Helen B. Murray1, Stephanie M. Manasse3, Amani Piers1, Alexandra F. Muratore1, Michael R. Lowe1, Hasan Ayaz2, Adrienne S. Juarascio1,3
1Department of Clinical Psychology Drexel University, Philadelphia, PA, United States, 2School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States, 3Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States

Previous studies show that obese individuals with binge eating disorder (BED) are poorer at inhibiting responses to food compared to obese individuals without BED (noBED). However, brain activation underlying differences in food related inhibition in these groups remain untested. As such, this study examined neural correlates of food-related inhibition in obese individuals with and without BED. A wearable neuroimaging tool, functional Near Infrared Spectroscopy, measured activity in the prefrontal cortex during a “cognitive reappraisal” task. The task elicits brain areas active in inhibition processes by having individuals watch videos of food and attempt to “resist” the food (ie. consider the negative consequences of eating the food). Participants were adults with an obese body mass index (BMI); 20 with BED (70.0% female; BMI M=38.56, SD=6.58) and 16 with noBED (62.5% female; BMI M=38.36, SD=6.58).  Mixed models showed that compared to noBED, the BED group exhibited a poorer ability to recruit areas related to inhibition (eg. right ventromedial (F=7.58, p=.02), bilateral dorsomedial (F=5.71-12.41, p<.01-.05), and bilateral superior frontal gyrus (F=6.99-9.18, p=.01-.03 )). Our study extends research on inhibition in BED by identifying neural correlates of food-related inhibition that underlie BED in obese individuals. In the future, portable and less expensive neuroimaging devices could be used to identify deficits and inform treatment matching for this population.

Dialectical Behavior Therapy (Dbt) Guided Self-Help For Binge-Eating Disorder (Bed): A Randomized Controlled Trial
Jacqueline C. Carter1, Therese E. Kenny1,2, Christopher W. Singleton1, Megan Van Wijk1, Olga Heath1
1Memorial University of Newfoundland, St. John's, NL, Canada, 2University of Guelph, Guelph, ON, Canada

Objective: The aim of this RCT was to compare the effectiveness of DBT guided self-help (DBT-GSH) and DBT unguided self-help (DBT-USH) with an active unguided self-help control condition (SE-USH) for BED. Method: Seventy-one people with DSM-5 BED recruited from the community took part. GSH was administered via video-conferencing. Participants were assessed prior to randomization, 12, and 24 weeks later. The primary outcome variable was binge eating (BE) frequency over the previous 28 days. Multiple imputation was used to estimate missing data due to attrition and intention-to-treat analyses were performed. Results: Retention was 65% at post-treatment and 63% at follow-up. Drop-out was highest and treatment expectations were lowest in the active control condition. There was a significant decrease in BE at post-treatment that did not differ across conditions and was maintained at follow-up. Effect sizes from baseline to post-treatment in all three groups were large. A similar pattern emerged for secondary outcome variables. The mean percentage reductions in BE from baseline to post-treatment were: 74% DBT-GSH, 44% DBT-USH, and 59% SE-USH. From baseline to follow-up rates of decrease were: 62% DBT-GSH, 63% DBT-USH, and 59% SE-USH. Conclusions: The two DBT conditions produced similar results. Like previous RCTs on BED including an active control condition, there was little evidence for the superiority of the DBT conditions over the control condition.

Exploring The Effectiveness Of A Self-Control Training On Top Of Inpatient Treatment, For Improving Weight Loss And Eating Behavior In Obese Youngsters
Tiffany Naets1, Leentje Vervoort1, Eline Vermeiren2, Annelies Van Eyck2, Ann Tanghe3, Caroline Braet1
1Ghent University - Developmental, Personality and Social Psychology, Ghent, Belgium, 2Antwerp University - Pediatrics, Antwerp, Belgium, 3Zeepreventorium vzw, De Haan, Belgium

PURPOSE: Long-term effects of childhood multidisciplinary obesity treatment (MOT) can still be improved by tackling underlying mechanisms for sustainable weight control. Evidence stresses the role of dual self-control processes, stating that individuals with obesity have strong bottom-up reactivity towards unhealthy food (attention bias), that cannot be properly regulated because of weak top-down executive functioning (i.c. inhibitory control). Substantial proof of concept underlines the importance of training this attention and inhibition towards better self-control. METHOD: This RCT, conducted in both an inpatient and two outpatient treatment settings, supplemented existing MOT with an online self-control training. Effects on various parameters were compared in an experimental versus an active control group of youngsters with obesity (originally n=187, 63% girls, 8-18y), at both post-treatment and 6-month follow-up. RESULTS: Follow-up data are still being collected, but pre-post changes were already explored. In comparison to the active control group, better progress is expected in the experimental condition on weight, eating behavior, internalizing symptoms, and self-esteem. Preliminary pre-post analysis show changes in both self-control abilities and maladaptive eating behavior. CONCLUSION: It is stated that this self-control training is important in facilitating long-term effectivity of childhood obesity treatment.

3:30 - 4:00 PMChicago Ballroom Foyer
Coffee Break

4:00 - 5:15 PMChicago 9
Parallel Paper Session IV: Epidemiology, Course, and Outcome

Chair(s): Anja Hilbert
Attachment And Mentalization As Predictors Of Outcome In Family Therapy For Adolescent Anorexia Nervosa.
Tom Jewell1,2, Lucy Serpell3,4, Sarah Liston5, Kirsty Tahta-Wraith4, Alison Eivors5, Mima Simic2, Peter Fonagy3, Ivan Eisler2
1King's College London, London, United Kingdom, 2South London and Maudsley NHS Foundation Trust, London, United Kingdom, 3University College London, London, United Kingdom, 4North East London NHS Foundation Trust, London, United Kingdom, 5Leicestershire Partnership NHS Trust, Leicester,

Purpose of study: Family therapy is the first-line treatment for adolescent anorexia nervosa (AN). Whilst it is successful in the majority of cases, there remains a sub-group for whom outcomes are poor. Furthermore, the predictors of poor treatment response are not well-understood, thereby hampering efforts to modify or personalize treatment. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome at nine months, using the Morgan-Russell outcome categories. Method: This prospective observational study recruited a sample of 193 adolescents with AN and their parents/carers as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization and emotion regulation were completed at the start of treatment by adolescent patients, and also at four further time-points ending at nine months. Results: The preliminary analysis suggests that baseline adolescent emotion regulation, as measured by the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), predicts both treatment outcome and weight gain at nine months, whereas adolescent attachment and mentalization predict neither outcome. Conclusions: Emotion regulation may be a worthwhile treatment target in adolescent AN. Future studies should investigate emotion regulation as a moderator and mediator of treatment response in adolescent AN.

Self-Assessment Of Eating Disorder Recovery: Absence Of Eating Disorder Psychopathology Is Not Essential
Margarita C. Slof-Op 't Landt1, Alexandra E. Dingemans1, Jésus de la Torre Y Rivas2, Eric F. van Furth1,3
1Rivierduinen Eating Disorders Ursula, Leiden, Netherlands, 2Weet, Patient and Family Organization for Eating Disorders, IJsselstein, Netherlands, 3Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands

Objective: The definition of recovery in eating disorders (EDs) according to researchers is not necessarily similar to the patient definition. This study aimed to explore the concept of recovery as assessed by those affected by an ED themselves. Method: Participants from the Netherlands Eating disorder Registry (NER) who reported an (former) ED diagnosis (n=814) assessed their own recovery level: current ED, partial or full recovery. Furthermore, research-based criteria (Bardone-Cone et al., 2010) were applied to define recovery. Within the self-assessed full recovery group (n=179), participants who also fulfilled the research-based criteria were compared to those who were only recovered based on self-assessment in the following domains: ED psychopathology, psychiatric comorbidity, quality of life, and social and societal participation. Results: Ninety-six of the participants (54%) who considered themselves recovered did not fulfill the research-based definition. The two recovery groups did not significantly differ in psychiatric comorbidity, quality of life, and social and societal participation. Discussion: Absence of ED characteristics was not essential for individuals to consider themselves recovered. Although the self-assessed recovery status may be subjective, it does advocate the use of additional health indicators besides ED psychopathology when defining recovery.

Temperament In Pre-Adolescence Is Associated With Weight And Eating Pathology In Young Adulthood
Annelies E. van Eeden1, Hans W. Hoek1,2,3, Daphne van Hoeken1, Mathijs Deen1, Albertine J. Oldehinkel2
1Parnassia Psychiatric Institute, The Hague, Netherlands, 2Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 3Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States

1. Introduction. There are few longitudinal studies that investigate the role of temperament traits on weight and eating problems. The present study investigates whether temperament in pre-adolescence influences body weight and the development of eating pathology in adolescence and young adulthood. 2. Methods. This study uses data from TRAILS (Tracking Adolescents’ Individual Lives Survey), a Dutch community cohort study (N=2230) from pre-adolescence into adulthood. At age 11, the temperament dimensions Negative Affectivity and Effortful Control were measured with the Early Adolescent Temperament Questionnaire - Revised. Body mass index (BMI) was measured at all assessment waves. At age 19, the prevalence of eating disorders was estimated by two-stage screening. At age 22 and 26, the Eating Disorder Diagnostic Scale was administered to assess the level of eating pathology. 3. Results. High negative affectivity in pre-adolescence was associated with high BMI and eating pathology in young adulthood. Low effortful control in pre-adolescence was found to be a risk factor for the development of obesity in young adulthood. 4. Conclusions. Both negative affectivity and effortful control play a role in the development of weight or eating problems during adolescence. This knowledge is useful in the development of more focused prevention programs for obesity and eating pathology.

Mortality And Longer-Term Outcome Of Anorexia And Bulimia Nervosa In Males As Compared To Females - Work In Progress
Manfred M. Fichter1,2, Norbert Quadflieg2
1Schoen Klinik Roseneck, Prien, Germany, 2Psychiatrische Klinik der Universität München (LMU), München, Germany

Aim: To explore if the longer-term outcome and mortality is different in males and females treated for anorexia nervosa (AN) or bulimia nervosa (BN). Methods: Using the questionnaires SIAB-S, EDI, BSI 119 males and 119 matched females with AN, and 60 males and 60 matched females with BN were assessed at follow-up 6 to 8 years later. Crude mortality rates (CMR) and standardized mortality ratios (SMR) were computed for 147 (AN) and 81 (BN) males. Preliminary results: AN: 22% of the males and 31% of the females still had AN at FU (n.s.). 3% of the AN males and 8% of the AN females crossed over to BN (n.s.), and 34 % of the AN males and 19 % of the AN females had EDNOS (χ2 (1)=6.6; p<.01). Remission rate for AN was 40 % for males and 41 % for females (n.s.). BN: 17 % of the BN males and 22 % of the BN females still had BN at follow-up. 3% of the BN males and 2 % of the BN females crossed to AN and 34 % of the BN males and 27 % of the BN females had EDNOS. Remission rate for BN was 44 % in males and 50 % in females (n.s.). In the EDI and BSI subscales males tended to have lower scores than females. SMR was 4.93 (95% CI 2.36-9.07) for AN males and 5.29 (4.32-6.40) for AN females; it was 1.42 (0.39-3.63) for BN males and 1.57 (1.15-2.09) for BN females. Conclusions: Although at follow-up, males and females differed in some subscales of the EDI and BSI longer-term outcome for AN and BN males and females is surprisingly similar with slight tendencies for better outcome in males.

Home Treatment:A New Method Of Relapse Prevention In Adolescent Anorexia Nervosa (An)
Beate M. Herpertz-Dahlmann1, Astrid Dempfle 2, Brigitte Dahmen1
1Department of Child & Adolescent Psychiatry RWTH University, Aachen, Germany, 2Institute for Medical Statistics and Informatics Christian-Albrechts-University, Kiel , Germany

Objectives: In our previous clinical trial inpatient (IP) was compared to day-patient treatment (DP) (Lancet 2014). However, relapse rates in DP over a 2.5-year period were still high (approx. 30%). We will now aim to evaluate home treatment (HoT): 1) HoT involves caregivers more strongly than any other setting. 2) HoT might help patients to overcome eating disorder (ED) habits in their familiar environment. Methods: Subjects: Adolescent patients fulfilling DSM-5 criteria for AN after short IP treatment. HoT commenced with a frequency of 3-4 visits/week for the 1st and 2nd month after discharge and then declined in frequency. The visits were performed by a multidisciplinary team (clinical therapist, nurse, nutritional therapist, etc.) experienced in treatment of AN and supervised by a senior child & adolescent psychiatrist including a conjoint session with the patient and her family. Outcome was assessed by change in BMI, ED symptoms (EDI-II) as well as by carers` skills (CASK) and burden (EDSIS). The treatment is financed by the German health care system and similarly expensive as DP. Results: The outcome of AN at discharge and 1-year follow-up in the first 20 patients including its effect on carers will be reported. First results show a higher BMI and a lower rate of relapses than in DP-treatment. Conclusion: We hypothesise that HoT facilitates the transition from hospital to home and leads to a significant reduction of relapses in adolescent AN patients.

4:00 - 5:15 PMChicago 10
Parallel Paper Session III: Interventions

Chair(s): Fernando Fernandez-Aranda
Project Recover: Results Of A First Randomized Controlled Trial Of Integrated Cognitive-Behavioral Therapy For Co-Occurring Eating Disorders And Posttraumatic Stress Disorder
Kathryn Trottier1, 2, Candice Monson3, Stephen A. Wonderlich4, Li Cao4, Ross D. Crosby4
1University Health Network, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3Ryerson University, Toronto, ON, Canada, 4Sanford Health, Fargo, ND, United States

INTRODUCTION: Eating disorders (ED) and posttraumatic stress disorder (PTSD) frequently co-occur and are thought to share a bidirectional and functional relationship. Project Recover aims to enable recovery from ED-PTSD through integrated treatment. Results of an uncontrolled trial were promising. The primary aim of this initial randomized controlled trial (RCT) was to determine whether integrated CBT for ED-PTSD was superior to CBT for ED only in improving PTSD symptoms. METHOD:
Following a course of intensive treatment focused on ED symptom interruption, 43 individuals with ED-PTSD were randomly assigned to integrated CBT for ED-PTSD or CBT for ED. Time in therapy was controlled, and assessors were blind to condition. PTSD symptoms were measured via the Clinician-Administered PTSD Scale. ED psychopathology was measured via the Eating Disorder Examination (EDE). RESULTS: Intent-to-treat analyses revealed that integrated CBT resulted in significantly lower PTSD symptoms at post-treatment compared with CBT for ED only. Although those who received CBT for ED experienced an improvement in PTSD symptoms, 94% continued to meet diagnostic criteria for PTSD; in contrast to only 44% of those who received integrated PTSD treatment. There were no differences in EDE global scores between therapy conditions at post-treatment. CONCLUSIONS: Integrating PTSD treatment into CBT for ED is efficacious. Next steps include examining whether integrated CBT improves long-term outcomes for ED-PTSD.

Improving Psychological Outcomes For Carers Of Adults With Anorexia Nervosa Via A Web-Based Skills Package: A Randomised Controlled Trial
Lucy E Spencer1, Juliane Schmidt-Hantke2, Karina Allen1, 5, Peter Musiat1, Rachel Potterton1, Gemma Gordon1, Franziska Hager2, Beintner Ina2, Bianka Vollert2, Barbara Nacke2, Dennis Görlich3, Jennifer Beecham4, Eva-Maria Bonin4, Corinna Jacobi2, Ulrike Schmidt1, 5
1King's College London, London, United Kingdom, 2Technische Universität Dresden, Dresden, Germany, 3Wilhelms-Universität Münster, Münster, Germany, 4London School of Economics and Political Science, London, United Kingdom, 5The Eating Disorders Service, Maudsley Hospital, London, United Kingdom

Introduction: Carers potentially have an important role in aiding the recovery of people with anorexia nervosa (AN), provided they are given appropriate information and skills to support their loved one. Our study sought to assess the impact of delivering ‘We Can’, a web-based systemic cognitive-behavioural carers’ skills training intervention with different levels of support on a range of carer outcomes. Methods: The study consisted of a multi-site, two-country, pragmatic randomised controlled trial. Carers of individuals (aged 14+) with AN were recruited from centres in the UK and Germany, and randomly assigned to one of three study conditions: We Can (a) with clinician messaging support, (b) with moderated live chatroom support, and (c) with online forum alone. A range of carer outcomes, including symptoms of depression and anxiety as the primary outcomes (measured using the PHQ-9 and GAD-7), were assessed at baseline, 1, 3, 6 and 12 months. Results: 280 carers of individuals with AN were included. Clinical outcomes and intervention utilisation up to 6 months will be presented. Semi-structured interviews conducted with 12 participants found the intervention was perceived as helpful and accessible. Conclusions: The implications of outcome differences between carers assigned to the We Can intervention with different levels of support will be discussed. Qualitative data suggests that web-based interventions are acceptable to carers of individuals with AN.

Cognitive Behaviour Therapy Versus Compassion Focused Therapy For Patients With Eating Disorder With And Without Childhood Trauma: A Randomized Controlled Trial
KariAnne Vrabel1, Bruce Wampold1, Glenn Waller2, Ken Goss3, Asle Hoffart1,4
1Research Institute of Modum Bad, Vikersund, Norway, 2University of Sheffield, Sheffield, United Kingdom, 3Coventry Eating Disorder Service, Birmingham, United Kingdom, 4University of Oslo, Oslo, Norway

.  In the current study we compared Cognitive behaviour therapy (CBT) and Compassion focused therapy (CFT) for ED in a residential setting. Approximately half of the patients had a history of childhood trauma. Methods. A total of 137 patients with a primary diagnosis of ED were randomized to either CBT or CFT. Patients were assessed at pre-treatment, post-treatment and one-year follow-up. Primary outcome measures were global score from Eating Disorder Examination (EDE) interview, which was administered blind to treatment condition at each time point. Results. Preliminary results show an overall drop-out rate of 13%. There were significant difference in the level of EDE global score for both groups as a whole and for trauma and non-trauma patients in each group at post-treatment and one-year follow-up. There were no significant difference between the two groups neither at post-treatment nor one-year follow-up both. However, the effect sizes favouring CBT (d=1.1) versus CFT (d=0.5) at post-treatment, this holds for both trauma (CBT, d=1.1; CFT, d=0.7) and non-trauma (CBT, d=0.8; CFT, d=0.4) patients. These differences decreases at one-year follow-up for the groups as a whole (CBT, d=0.6; CFT, d=0.4) and for trauma (CBT, d=0.7; CFT, d=0.5) and non-trauma (CBT, d=0.8; CFT, d=0.5) patients.  Conclusions. Both treatments were efficacious; however, CBT seems to have a more rapid effect on ED symptoms both for trauma and non-trauma patients.

Online Imaginal Exposure Therapy For Eating Disorders Decreases Eating Disorder Symptoms, Fear Of Food, And Core Eating Disorder Fears
Cheri A Levinson, Caroline Christian, Shruti Shankar-Ram, Irina A Vanzhula, Leigh C Brosof, Lisa Michelson, Brebba Williams
University of Louisville, Louisville, KY, United States

Introduction: Exposure therapy is the ‘gold’ standard for the treatment of anxiety disorders and works by targeting inhibitory learning systems in the brain. One type of exposure therapy is imaginal exposure therapy (IE) (i.e., imagining the core fear that maintains anxiety). IE has not yet been tested as a treatment for eating disorders (EDs). Methods: The current study tested a trial of online IE for EDs in 229 participants with EDs (primary dx: OSFED;37.1%) from all over the world. Participants completed diagnostic interviews, four sessions of online IE, in which they wrote about and imagined a core ED fear (identified with a therapist), and completed measures of ED symptoms and fears (i.e., fear of weight gain, food) at pre, post, and 6-month-follow-up. Results: All primary outcomes (ED symptoms, ED fears) significantly decreased at study completion and at 6-month follow-up with medium-to large effect sizes (η2≥.16, ps<.031). State anxiety across the four sessions of exposure did not significantly decrease (p=.785). Conclusions: Online IE significantly decreases ED symptoms and fears; these decreases are maintained or strengthened 6 months after treatment. State anxiety did not decrease across the four exposure sessions, supporting the inhibitory learning theory of exposure. Despite steady levels of anxiety during treatment, ED participants’ learning during IE likely led to decreases in ED symptoms/fears across time. A future randomized control trial is needed.

Enhanced Cognitive Behavioral Therapy For Adolescents With Anorexia Nervosa: Outcome And Predictors Of Change
Riccardo Dalle Grave, Massimiliano Sartirana, Simona Calugi
Villa Garda Hospital, Garda (VR), Italy

Objective. The study aimed to establish the outcome and the predictors of change in a cohort of patients with marked anorexia nervosa treated with enhanced cognitive behavioural therapy (CBT-E). 
Methods. Forty-nine adolescent patients with anorexia nervosa were recruited from consecutive referrals to a clinical eating disorder service offering outpatient CBT-E. Centiles of body mass index (BMI), and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI) and Clinical Impairment Assessment (CIA) scores were recorded at admission, at the end of treatment, and at six-month follow-up.  Results. Thirty-five patients (71.4%) completed the treatment. The patients displayed a large increase in weight together with a marked decrease in eating-disorder and general psychopathology and clinical impairment. The changes were maintained at six-month follow-up. No baseline predictors of drop-out and treatment outcome were found.  Conclusions. These findings suggest that CBT-E is a promising treatment for adolescents with anorexia nervosa.

5:15 - 6:45 PMChicago 8
Poster Session II

Predicting Eating Behaviors From Internet Data 
Ellen E. Fitzsimmons-Craft1, Elad Yom-Tov2, Shiri Sadeh-Sharvit3.4, C. Barr Taylor4
1Washington University in St. Louis, St. Louis, MO, United States, 2Microsoft Research, Herzliya, Israel, 3Interdisciplinary Center, Herzliya, Israel, 4Palo Alto University, Palo Alto, CA, United States

: Early identification of eating disorders is a public health challenge. However, it may take individuals affected with the illness up to several years to acknowledge their condition and seek help. Internet data collected passively could illustrate online interests and behaviors associated with detrimental health outcomes and inform timely interventions. Methods: To determine feasibility of the approach, we administered a clinically validated online survey that identifies individuals at risk for or with eating disorders and asked research participants to contribute their Internet browsing history, if they consented to do so. Results: 787 participants (54% female) enrolled in the study with an average BMI of 23.1 (SD=4.4), of whom 473 met criteria for no eating disorder, high risk for or an eating disorder. 107 participants consented to contribute their browsing history. Early models, even with this small sample, found an overall classification accuracy of 47% (compared to approximately 33% for random). The results of our final models using larger samples will be reported. Conclusions: Tailored intervention efforts timed to when target online behaviors occur have the potential to improve the wellbeing of many cases who may otherwise remain undetected and to prevent future cases. Findings will suggest whether patterns of Internet activity should be implemented in eating disorder research. 

Eating Disorder-15 (Ed-15): Factor Structure, Psychometric Properties, And Clinical Validation
Paulo PP Machado, Tãnia Rodrigues, Ana R Vaz, Eva Conceição
University of Minho, Braga, Portugal

Objective: The purpose of the current study was to explore the factor structure and psychometric properties of the Portuguese version of the ED-15, as well as to establish cut-off scores and normative data for the Portuguese version. Methods: Participants from a non-clinical sample (N=860) and an eating disorders clinical sample (N=260) were invited to complete a set of questionnaires, including the Portuguese version of the ED-15. Results: The first-order two-factor structure originally proposed by the ED-15 authors was endorsed through a Confirmatory Factor Analysis (c
2/df=2.610; SRMR=0.0325; RMSEA=0.079; TLI/GFI/IFI>0.95). Items revealed adequate construct validity (λ=0.54-0.90; R2=0.29-0.81). The ED-15 revealed excellent internal consistency (a=.91) and temporal stability (ICC=.92; 95% CI .84 - .95). Normative data for the ED-15 were provided. The ED-15 demonstrated acceptable concurrent and convergent validity. Receiver Operating Characteristic analysis revealed that the ED-15 Total score accurately discriminates between participants with and without an Eating Disorder (AUC=.80; SE=.017; p≤.001; 95% CI .766-.834). A cut-off score for Clinical significance and a Reliable change index were computed. Conclusions: ThePortuguese version of the ED-15 is a reliable and valid measure of eating psychopathology and symptoms, whenever a brief measure is needed, as in session-by-session assessment of therapy progress and outcome. 

Eating Disorder Questionaires Short Forms: A Comparison
Paulo PP Machado1, Carlos Grilo2, Ross D Crosby3,4
1University of Minho, Braga, Portugal, 2Yale School of Medicine, New Haven, CT, United States, 3Sanford Research, Fargo, ND, United States, 4University of North Dakota, Fargo, ND, United States

Objective Psychometric investigations of the Eating Disorder Examination-Questionnaire have not supported the original four-scale structure. Recently, several alternative short forms were proposed (e.g., Grilo, et al., 2013). The purpose of the current study was to compare several short versions of the EDE-Q and the ED-15, explore their psychometric properties, as well as their relative sensitivity and specificity. Methods Participants from an eating disorders clinical sample (N=186) completed a set of questionnaires, including both the Portuguese version of the EDE-Q and ED-15, and set of other clinical measures. Participants from a non-clinical group (N=5000) completed either the EDE-Q or the ED-15 Results Both the short version of the EDE-Q and the ED-15 demonstrated good psychometric properties, and its usefulness in discriminating cases from non-cases in independent samples. The current study compared the ED-15 and the available short EDE-Q versions in their power to discriminate clinical cases and compare their sensitivity and specificity. In addition will compare their concurrent validity with other measures (BDI, CIA) in an attempt to determine the best measure for treatment outcome monitoring. Preliminary analyses suggested some convergences across measures including ways to enhance factor structure and clinical utility of the measures Discussion Implications for clinical practice across settings and for future research to improve measurement tools will be offered.

Diagnostic Utility Of Bulimia Nervosa And Binge Eating Disorder Symptoms In Men And Women 
Karen S. Mitchell1,2, Katherine M. Iverson1,2
1VA Boston Healthcare System, Boston, MA, United States, 2Boston University School of Medicine, Boston, MA, United States

Eating disorder (ED) criteria were written based on symptom presentations in women, and most ED assessment instruments were developed and validated in female samples.  Thus, it is unclear how well current ED criteria capture male symptom presentations.  We examined the diagnostic utility of individual criteria for bulimia nervosa (BN) and binge eating disorder (BED) in men and women. Method: This study utilized data from nationally representative samples of male (N = 642) and female (N = 266) veterans.  Participants responded to an e-mail invitation and completed surveys online, including the Eating Disorder Diagnostic Scale, which was used for these analyses. Results: Substantial numbers of men and women endorsed ED criteria.  Across diagnoses and samples, quality of sensitivity and negative predictive value were high, while quality of specificity and positive predictive power were low.  Among women, the BN criteria with the strongest diagnostic utility were binge eating plus loss of control and compensatory behavior frequency, and the strongest BED criteria were binge eating plus loss of control and binge characteristics.  BN and BED criteria generally performed less well in men.  Conclusions: Our results indicate that most ED criteria may not be used as reliable indicators of a diagnosis, especially among men.  There is a need for ED assessments with greater diagnostic utility and applicability to a range of symptoms presentations for use with women and men. 

Using Exploratory Data Mining To Identify Diagnostic Severity Presentations For Other Specified Feeding Or Eating Disorder (Osfed)
Shelby N. Ortiz, Lauren N. Forrest, April R. Smith
Miami University, Oxford, OH, United States

Unlike other eating disorders (EDs), no severity specifiers are noted for other specified feeding or eating disorder (OSFED). However, shape/weight overvaluation has been proposed as a transdiagnostic ED severity specifier. We used structural equation modeling trees, an exploratory data mining approach, to identify OSFED severity “splits” based on shape/weight overvaluation. 2: Participants were 595 females with OSFED in residential ED treatment. Using the semtree R package, clinically-relevant variables (all Eating Disorder Examination-Questionnaire [EDE-Q] subscales, body mass index, ED onset) determined meaningful severity splits indexed by shape/weight overvaluation, which was assessed with two EDE-Q items. After identifying splits, analysis of variance tests compared severity categories on demographic and comorbid characteristics. 3: Severity splits occurred at shape/weight overvaluation scores <1.75 (n=47), 1.75-4.75 (n=109), 4.75-5.75 (n=119), and >5.75 (n=320). Individuals within categories significantly differed on severity of depressive and anxiety symptoms, trauma history, and length of stay but not on ED duration. Nearly all symptoms increased with each severity category. 4: Shape/weight overvaluation can meaningfully differentiate OSFED presentations. Validated and meaningful OSFED severity specifiers may inform treatment planning regarding level of care and core treatment targets.

Identifying Research Priorities For The Study Of Atypical Anorexia Nervosa: A Delphi Study 
Christine M. Peat1, Mattias Strand2, Christopher Hübel2,3, Johan K. Zvrskovec 2, Cynthia M. Bulik 1,2
1University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 2Karolinska Institutet, Stockholm, Sweden, 3King's College London, London , United Kingdom

Debate is ongoing regarding whether anorexia nervosa (AN) is distinct from atypical anorexia nervosa (AAN), in which all criteria for AN are met with the exception of underweight status. Research comparing AN and AAN has yielded inconsistent findings, which influences clinical decision-making and research designs. Thus, the current study explores the questions necessary to determine whether AN and AAN are distinct diagnostic entities. We will employ the Delphi method, a well-established process to achieve consensus. Participants (N=60-80) will include individuals with a demonstrated interest and expertise in AN, AAN, or psychiatric nosology. Participants are invited via email to participate in a three-round Delphi survey. The first round asks participants an open-ended question regarding which research questions need to be answered in order to determine whether AN and AAN are the same or different conditions. A qualitative content analysis will identify themes from the first round of responses, and subsequent rounds will ask participants to rate statements derived from these themes on a 5-point Likert-type scale indicating level of agreement ranging from “strongly agree” to “strongly disagree.” Consensus will be achieved when at least 85% of participants indicate the same level of agreement. We hypothesize that the Delphi survey will yield informative data to guide prioritization of research questions to advance our understanding of the relation between AN and AAN. 

Visual Mapping Of Body Image Disturbance In Anorexia Nervosa
Christina Ralph-Nearman1, Armen C. Arevian2, Maria Puhl1, Alexandra Weindel1,3, Scott E. Moseman4, Jamie D. Feusner2, Sahib S. Khalsa1,3
1Laureate Institute for Brain Research, Tulsa, OK, United States, 2Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States, 3University of Tulsa, Tulsa, OK, United States, 4Laureate Eating Disorders Program, Tulsa, OK, United States

Body image is a subjective construct usually assessed via questionnaire and currently lacking objective behavioral markers. We created Somatomap 2D, a novel assessment using a visual mapping interface to capture body image concerns. This study examined the feasibility of Somatomap 2D to measure body image disturbance in anorexia nervosa (AN).   Methods: AN inpatients (n=25) and non-clinical comparisons (NC; n=25) sequentially outlined individual body concerns on an avatar and rated the associated concern intensity and affective valence. Regional differences in body image disturbance were evaluated via statistical body maps using proportional z-scores.    Results: A higher proportion in the AN group had concerns about the chest, lower abdomen, and legs (p<.05). AN exhibited greater body concerns, higher concern intensities, and more negative emotional valence compared to NC (p<.001). The number of body concerns explained a large proportion of the variability in eating disorder severity (EDE-Q), controlling for age and BMI (R2=.30, p=.009, 95% CI [0.07, 0.43]).    Conclusions: Somatomap 2D demonstrated feasibility in identifying body image disturbances in inpatients with AN, showing regional differences in body concerns. Moreover, the number of concerns predicted eating disorder severity, suggesting that it might serve as an objective behavioral marker for AN. We are currently examining the utility of this measure in longitudinally tracking recovery following treatment.

Interview-Based Assessment Of Avoidant/Restrictive Food Intake Disorder (Arfid) In A Clinical And Non-Clinical Sample: Evaluation Of The Arfid-Module 2.0 For The Eating Disorder Examination
Ricarda Schmidt1, Franziska Schlensog-Schuster2, Andreas Hiemisch3,4, Wieland Kiess3,4, Anja Hilbert1
1Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany, 2Department of Paediatric Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Medical Center, Leipzig, Germany, 3Leipzig University, LIFE Leipzig Research Center for Civilization Diseases, Leipzig, Germany, 4Leipzig University Medical Center, Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany

1. An initial evaluation showed reliability and validity of a newly developed module of the Eating Disorder Examination (EDE) to diagnose avoidant/restrictive food intake disorder (ARFID) in a non-clinical sample. This study presents a refined version of the child, parent, and adult version of the EDE ARFID module 2.0 and its psychometric properties in a larger clinical sample. 2. The sample (0-17y) was recruited from a university hosptial feeding and eating disorder unit and from the population. Children (≥8y) and parents were assessed with the (Ch)EDE and respective version of the ARFID module 2.0, measures on general and eating disorder psychopathology, child development, and food diaries. Anthropometric data were objectively measured. 3. N=97 children (8.2±5.8y, 64% girls, 44% treatment-seeking) are currently included, with ongoing recruitment. The module showed high interrater reliability and convergent, divergent, and discriminant validity. Current and lifetime ARFID diagnosis was made in n=13 and n=11 children, while current and lifetime anorexia nervosa was diagnosed in n=4 and n=7 children, respectively. ARFID diagnosis was related to younger age, lower weight status, treatment-seeking status, and birth-related complications, but not to child sex.  4. First evidence supports the ARFID module 2.0 to be a psychometrically sound measure for diagnosing ARFID and discriminating it from other restrictive eating disorders in a clinical setting.

Developing An Illness-Staging Framework For Anorexia Nervosa Via Expert Consensus
Joanna E Steinglass1,2, Deborah R Glasofer1,2
1Columbia University Irving Medical Center, New York, NY, United States, 2New York State Psychiatric Institute, New York, NY, United States

Introduction: Ideally, stages of illness would emerge empirically, through understanding of pathophysiology. Yet, most of the pathophysiology of anorexia nervosa (AN) remains unknown. Broadly speaking, clinical staging frameworks presume that there is predictable path of illness. As the disease progresses from subsyndromal and through to full disorder, dissociable phases are distinguished by differences in treatment recommendations or prognosis. We aimed to develop expert consensus on behavioral, biological, and cognitive factors that identify hinge points between stages of illness in AN. Method: Using the Delphi method, we solicited participation from experts in the field of AN. Expertise was defined by years of experience and membership in professional organization. The process consists of three rounds of surveys, aiming for consensus on each stage (consensus is defined as >=85% agreement). Results: Thirty-one individuals from different geographic regions and a range of clinical disciplines participated as panel members. Responses to Round 1 have been collated into statements to distribute in Round 2, which will be rated for agreement and disagreement. Final results will be available for presentation. Conclusions: Identifying stages of illness in AN will improve reproducibility of research, in accordance with NIH initiatives, and will allow for pooling across studies as science continues to demand larger sample sizes that are difficult to achieve in AN.

High Parent-Child Concordance In The Assessment Of Avoidant/Restrictive Food Intake Disorder: Inter-Rater Reliability Of The Pica, Arfid, And Rumination Disorder Interview
Olivia B Wons1, Ani Keshishian 1, Jenny Jo1, Kendra Becker1, Lucy Cooke2, Madhusmita Misra1, Elizabeth Lawson1, Rachel Bryant-Waugh2, Kamryn Eddy1, Jennifer Thomas1, Nadia Micali3
1Massachusetts General Hospital, Boston, MA, United States, 2University College London, London, United Kingdom, 3Geneva University Hospital, Geneva, Switzerland

The Pica, ARFID, and Rumination Disorder Interview (PARDI) is currently the only parent-child clinical interview that assesses ARFID. Little is known about the concordance between parent-child PARDI responses. Method: As part of an ongoing treatment study for children and adolescents with ARFID, 21 patients (10-22 years), completed the child or young person/adult PARDI, and one or both of their parents completed the parent PARDI, as part of pre-treatment assessment. Results: In 81% of cases, the patient met full criteria for ARFID on both the child and parent PARDI. To assess inter-rater agreement, we calculated intraclass correlations (ICC) for severity and subscale scores. The severity score, lack of interest subscale, and fear of aversive consequences subscale showed good agreement respectively [ICC=.895, .851, .801]. The sensory sensitivity subscale showed moderate agreement [ICC=.582]. In paired t-tests evaluating absolute differences in scores, parents rated their children significantly higher on severity (p<.001), sensory sensitivity (p=.004), lack of interest (p=.029), and fear of aversive consequences (p=.014). Conclusion: Results suggest high concordance between parent-child PARDI responses. Higher parent-rated scores are common across other parent restrictive eating disorder measures and may reflect minimization of symptoms in children with ARFID and/or relatively higher levels of distress around child eating difficulties in parents versus children.

The Contribution Of Reward And Punishment Sensitivity In Childhood And Adolescence To The Onset Of Eating Disorders In Later Adolescence
Amy Harrison1, Marta Francesconi2, Eirini Flouri3
1University College London, London , United Kingdom, 2University College London, London, United Kingdom, 3University College London, London, United Kingdom

Purpose: People with acute eating disorders (EDs) and those in recovery show differences in responses to reward and punishing stimuli; e.g. under conditions of risk, they may be driven by a desire to avoid harm/failure and show differences in reward sensitivity relative to unaffected peers. However, conclusions regarding the putative role of reward and punishment sensitivity in ED aetiology are limited by cross-sectional designs. Methods: In this longitudinal, prospective cohort study, responses on the Cambridge Gambling Task (CGT) from 13,493 participants from the Millennium Cohort Study (MCS) measured at age 11 were investigated using logistic regression to understand their role in the emergence of ED symptomatology at age 14. Results: Data analysis for this first longitudinal study in our the field investigating reward and punishment sensitivity is underway and findings will be discussed in terms of odds ratios, that is the relative odds of developing ED symptoms given a particular profile on the CGT(e.g high punishment and low reward sensitivity). Conclusions: As the next wave of MCS data (age 18) becomes available, this project will examine whether reward and punishment sensitivity measured at ages 11 and 14 can help to explain the emergence of ED psychopathology at age 18. This knowledge can be used to further prevention programmes.

Is Volume Of The Pontocerebellum A Predictor For Weight Restoration In Anorexia Nervosa?
Gabriella Franca Milos1, Juergen Haenggi 2, Volker Baur1, Lutz Jaencke2, Marco Piccirelli 3, Spyros Kollias3, Roland von Kaenel1, Chantal Martin-Soelch4, Lisa-Katrin Kaufmann1
1University Hospital, Dep. Consultation-Liaison Psychiarty and Psychosomatic Medicine,, Zurich, Switzerland, 2University Zurich, Dep. Psychology, Div. Neuropsychology , Zurich, Switzerland, 3University Hospital, Dep. Neuroradiology, Zurich, Switzerland, 4University Fribourg, Dep. Psychology, Fribourg, Switzerland

Course of Anorexia nervosa (AN) is often chronic. The identification of brain regions with a predictive value for the outcome by neuroimaging is expected to have potential in guiding understanding and therapy of the illness. Adult patients with severe AN participated in an inpatient weight gain therapy. Based on weight status at the end of therapy, patients could be assigned post-hoc to either of two groups: weight-restored patients (ANwr) having reached a BMI > 17.5, and non-weight-restored patients (ANnwr) not having gained weight at a clinically relevant magnitude. High-resolution T1-weighted magnetic resonance images at baseline (begin of therapy) were analysed using voxel-based morphometry. In an exploratory whole-brain approach, data of 25 ANwr were contrasted with data of 25 ANnwr in order to obtain regional volumes associated with later weight status. ANwr and ANnwr did not differ in any of the demographic, psychopathological and psychometric variables. Voxel-based morphometry yielded a significant cluster (corrected for multiple comparisons) in the right pontocerebellum with reduced grey matter in ANnwr as compared to ANwr. The right pontocerebellum might be involved in functions that ultimately lead to a favourable outcome of weight gain therapy in AN. This is in line with recent studies which also identified cerebellar subregions as being associated with outcome. Based on the present results, future studies should elucidate the exact functional mechanisms.

Heart Rate Variability And Sympathovagal Balance ​As A Metric Of Hedonic Hunger
Alexandra F Muratore1,2, Nicole Virzi1, Michael R Lowe1
1Drexel University, Philadelphia, PA, United States, 2Columbia University, New York, NY, United States

Introduction. Hedonic hunger represents motivation for food in the absence of homeostatic need and places individuals at increased susceptibility to environmental food cues. The physiological basis of hedonic hunger is not fully understood and requires additional investigation. The current study sought to determine the relationship between hedonic hunger and HRV in fasted and fed states. Methods. Healthy adults (N = 67) had HRV data collected in fasted and fed states. Hedonic hunger was measured using the Power of Food Scale (PFS). A 2 (PFS Group: High vs. Low) x 2 (Metabolic State: Fasted vs. Fed) ANOVA was conducted to examine effects of hedonic hunger and metabolic state on indices of HRV. Results. When comparing HRV between fasted and fed states, there was a significant interaction between PFS Group and Condition (p = .03, η2 = .08), such that when fasted, the Low PFS Group had higher  LF/HF HRV than the High PFS Group. Analyses with HF and LF HRV found a significant main effect of Condition, indicating that both indices of HRV were elevated in fed, compared to fasted, states. Conclusions. Results of the present analysis suggest hedonic hunger is associated with decreased sympathovagal balance when fasted in a non-clinical sample. These findings suggest certain forms of HRV may serve as physiological metrics of hedonic hunger and that decreased LF/HF HRV in fasted states could have implications for differential food responsivity and change following food intake.

Is Fear Of Physical Pain Associated With Lifetime Suicide Attempts In Individuals With Eating Disorders?
Vi T. Nguyen, Lisa M. Anderson, Scott J. Crow, Carol B. Peterson, Emily M. Pisetsky
University of Minnesota, Minneapolis, MN, United States

Introduction: Individuals with eating disorders (ED) have elevated rates of mortality and death by suicide. Joiner’s Interpersonal Theory of Suicide (IPTS) posits that one must have acquired capability for suicide, which includes both increased pain tolerance and decreased fear of death, in order to make a suicide attempt (SA). The role of fear of pain in lifetime SA has not been assessed among individuals with ED. Hypothesis: As increased pain tolerance is associated with suicide, we hypothesize that a lower fear of pain will be associated with greater prevalence of a lifetime SA. Methods: Participants were patients in an ED treatment facility (N = 91) who completed the Fear of Pain (FOP) questionnaire as well as measures related to ED symptoms and other facets of the IPTS including lifetime SA. Results: FOP was not significantly correlated with fearlessness about death or painful and provocative events (all p’s > 0.05). FOP was positively associated with lifetime SA when controlling for current ED symptoms (B=0.03, S.E.=0.02, p=0.03). Conclusion: Contrary to our hypothesis, individuals with a lifetime SA endorsed elevated fear of pain. One possible explanation could be that FOP might increase following a past failed SA and that FOP might be predictive of suicide risk among individuals who have never made a SA. Interestingly, FOP was not significantly associated with other constructs of the IPTS in this study, indicating that FOP may not fit within the IPTS framework.

Immune Regulation Of Food Consumption And Hyperactivity In The Activity-Based-Anorexia Paradigm
Noga Or-Geva, Lawrence Steinman
Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States

Introduction Anorexia Nervosa (AN) is a debilitating eating disorder of unknown etiology. Evidence exists to implicate the immune system in AN, including autoimmune factors, such as elevated autoantibodies against neuropeptides, increased expression of autoimmune-related genes and high rates of autoimmune comorbidities in AN patients. Conversely, reduced immune reactivity has been described at the peak of disease. Studies have consistently generated contradictory results, thus the role of the immune system in AN pathophysiology remains unsolved. We hypothesize that the immune system plays a key regulatory role in the onset and progression of AN and aim to discover targets for intervention. Methods To control disease onset and manipulate immune variables (unfeasible in humans) we used the Activity-based-anorexia(ABA) paradigm, which recapitulates two common AN symptoms; restrictive eating and hyperactivity. We compared ABA symptoms in immune-deficient vs. competent mice and measured both anxiety (elevated O-maze) and learning ability (fear-conditioning). Results Immune-deficient mice were significantly more susceptible to ABA weight loss, due to decreased food intake and increased running, while minor differences were noted for behavioral tests. Conclusions Our preliminary findings suggest a role for the immune system in mitigating ABA.  Investigation of the mechanisms involved is underway with the goal of finding therapeutic targets, that can be validated in AN patients.

Affective Lability And Negative Urgency Predicting Binge Eating
Anna Marie L. Ortiz, Heather A. Davis, Gregory T. Smith
University of Kentucky, Lexington, KY, United States

Affective distress may influence binge eating in multiple ways. Affective lability refers to the tendency to experience striking fluctuations in mood often. There is considerable evidence that it predicts eating disorder symptoms. Negative urgency is the tendency to act rashly when distressed to distract from, or alleviate, the distress. Prospectively, it predicts the onset of, and increases in, binge eating. To date, these risk factors have been studied separately. However, the possibility that there is a joint effect of affective lability and negative urgency merits investigation. In the current study, we tested whether such a joint effect predicts binge eating prospectively. We assessed affective lability, negative urgency, and binge eating in 358 college students at three time points across the first year of college. From wave 1 to wave 3, we tested whether the interaction of affective lability and negative urgency predicted binge eating beyond prior binge eating and the main effects of each predictor. It did. The interaction did not, however, predict binge eating from wave 1 to wave 2. From wave 2 to wave 3, the interaction predicted binge eating beyond prior binge eating. In each interaction, the influence of negative urgency on binge eating was stronger at higher levels of affective lability. Findings support the hypothesis that emotion-based risk factors may transact to further elevate risk for binge eating. This research was supported by the Lipman Foundation.

Implicit And Explicit Motivational Responses To High- And Low-Calorie Food In Relation To Binge Eating And Restrictive Eating
Sarah E. Racine1, Léah Suissa-Rocheleau1, Shelby J. Martin2, Stephen D. Benning3
1McGill University, Montreal, QC, Canada, 2Ohio University, Athens, OH, United States, 3University of Nevada Las Vegas, Las Vegas, NV, United States

Eating disorders are associated with altered implicit and explicit motivational responding to food, although the exact nature of this altered responding is unclear. Distinct symptoms of eating disorders (i.e., binge eating, restrictive eating) may differentially relate to motivational responses to food. We examined implicit (i.e., startle blink and postauricular reflex reactivity) and explicit (i.e., valence, arousal, and craving ratings) motivational responses to high- and low-calorie foods in 80 women with and without binge eating and restrictive eating. Participants viewed high-calorie (i.e., sweet and savoury food), low-calorie (i.e., fruits, vegetables), and emotional images while startle blink (indexes defensive motivation) and postauricular (indexes appetitive motivation) reflexes were measured. Zero-inflated negative binomial regressions revealed that lower postauricular reflex reactivity to high-calorie foods predicted a greater number of restrictive eating episodes among women who endorsed restrictive eating. Rating low-calorie foods as lower on valence and arousal was also associated with more restrictive eating episodes, whereas rating low-calorie foods as lower on craving predicted the endorsement of any restrictive eating. Decreased implicit and explicit appetitive motivation to high- and low-calorie food related to the presence and frequency of restrictive eating, while no significant associations were detected with binge eating in this sample.    

Sexual Orientation Correlates With Baseline Characteristics But Did Not Moderate Effects Of Dissonance-Based Eating Disorder Prevention Programs For Women
Paul Rohde, Heather Shaw, Christopher Desjardins, Eric Stice
Oregon Research Institute, Eugene, OR, United States

1. Introduction. Using data from an RCT evaluating 3 methods of delivering the dissonance-based Body Project eating disorder prevention program (clinician-led groups; peer-led groups; an Internet-based version) relative to educational video control, this study tested whether sexual orientation (heterosexual vs. non-heterosexual) was associated with baseline eating disorder risk factors and symptoms or moderated intervention effects or the relation of baseline risk factors to change in eating disorder symptoms.   2. Methods. 680 women with body image concerns (60% Caucasian; 22% non-heterosexual) were randomized to clinician-led or peer-led Body Project groups, the Internet-delivered eBody Project, or educational video control. Participants were assessed on risk factors and symptoms at pretest, posttest, 6-,12-,24-, & 36-month follow-up. 3. Results. Non-heterosexual women had significantly higher negative affect and impaired psychosocial functioning at baseline (d=.40 and .34), but did not differ on thin-ideal internalization, body dissatisfaction, or eating disorder symptoms. Sexual orientation did not moderate the effects of these prevention programs on risk factor or symptom change over follow-up or the relation of baseline risk factors to future change in eating disorder symptoms. 4. Conclusions. Non-heterosexual and heterosexual women may differ on two baseline eating disorder risk factors but appear to respond similarly to different versions of the Body Project.

Bmi- And Not Bmi-Associated Longitudinal Gut- Microbiome Alterations In Adolescent Patients With Anorexia Nervosa (An)
Jochen Seitz1, Schulz Nina1, Belhouane Meriem2, Baines John2,3, Dahmen Brigitte1, Herpertz-Dahlmann Beate1
1Child and Adolescent Psychiatry, RWTH University Hospital Aachen, Aachen, Germany, 2Max Planck Institute for Evolutionary Biology, Plön, Germany, 3Institute for Experimental Medicine, Christian-Albrechts-University Kiel, Kiel, Germany

Introduction: The gut microbiome has been shown to play a causal role in obesity, malnourishment, depression and anxiety. In patients with (AN) it appears to be altered and associated with depressive and eating disorder symptoms, however its longitudinal course, influencing factors and predictive power remain unclear. Methods: We analyzed longitudinal 16s rRNA microbiome changes in 22 adolescent AN and 21 healthy controls at hospital admission and after weight restoration. Their associations with prior weight loss, weight gain during therapy, eating disorder symptoms (EDI-2), depressive symptoms (BDI-2) and their power to predict duration of therapy were explored. Results: Phylum-level abundance of Bacteroidetes was inversely associated with prior weight loss and increased again after weight restoration, acting as potential state marker. Contrary, significantly increased Firmicutes was positively correlated with prior weight loss; however, it further increased during weight gain. Genus level Clostridium XVIII and Fusicatenibacter were associated with BDI-2 and Parasuterella with EDI-2. Faecalibacteria predicted duration of therapy independent of BMI-SDS or illness duration. Conclusions: The gut microbiome in adolescent AN is altered, partly BMI-dependent, but does not completely normalize upon weight restoration. It is associated with symptom severity and Faecalibacteria, known to have anti-inflammatory properties, could potentially help predict the course of therapy.

Caregiver Deployment, Parental Distress And Measures Of Glycemic Homeostasis In Adolescent Military Dependents At High-Risk For Eating Disorders And Adult Obesity
Lisa M. Shank1,2, M K. Higgins Neyland1,3, David A. Klein1,3, Sarah Jorgensen1,3, Tracy Sbrocco1,3, William Leu Dakota Gillmore1,3, Mary Quattlebaum Abigail Pine1,3, Arielle Pearlman1,3, Natasha A. Schvey1,3, Cara H. Olsen1,3, Mark Stephens3,4, Denise E. Wilfley3,5, Mark C. Haigney1,2, Jack A. Yanovski3,6, Jeffrey Quinlan1,3, Marian Tanofsky-Kraff1,2,3
1Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 2Military Cardiovascular Outcomes Research Program, Bethesda, MD, United States, 3Preventing Obesity in Military Communities-Adolescents , Bethesda, MD, United States, 4College of Medicine, Pennsylvania State University, Hershey, PA, United States, 5Washington University in St. Louis, St. Louis, MO, United States, 6Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States

Introduction: Caregiver deployment is a stressor unique to the military family. Stress potentially promotes insulin resistance (IR) and type 2 diabetes. We examined caregiver deployment and parental distress in relation to glycemic homeostasis in adolescent military dependents. Method: 117 dependents (57% female; 20% non-Hispanic Black; 14.6±1.6y; BMIz:1.9±0.4) with BMI%ile≥85th and self-reported elevated anxiety and/or loss of control (LOC) eating completed the study (anxiety only=51; LOC only=7; both=59). A parent reported their current distress and any caregiver deployment (ever vs. never). Youth BMIz, HbA1c and fasting serum insulin and glucose were measured. IR was estimated using Homeostatic Model Assessment. Regressions examined if parent distress moderated the relationship between caregiver deployment and glycemic homeostasis measures. Covariates included age, sex, race, depression/anxiety, LOC eating and BMIz. Results: There were no interaction effects of parent distress and deployment on glucose, insulin or IR (ps>.05). However, for HbA1c, parent distress and deployment significantly interacted (p<.01): for families who experienced deployment, parent distress was positively associated with youth HbA1c. For no deployment, there was no relationship. Findings replicated for combat deployment. Conclusion: Deployment and parental distress may interact to impact glycemic homeostasis in military dependents. Prospective studies are needed to better elucidate these links.

Early Pubertal Timing And Risk For Disordered Eating In Young Adult Women: Testing The Role Of The Leading Theorized Factors
Megan M. Shope, Kristen M. Culbert
University of Nevada, Las Vegas, Las Vegas, NV, United States

Early pubertal timing is implicated in risk for disordered eating (DE) and effects persist even after the completion of puberty. Nonetheless, the mechanisms underlying these associations remain unclear. Pubertal increases in adiposity and psychosocial risk (e.g., pressures for thinness, thin-ideal internalization, weight-based teasing) have largely been theorized to account for early pubertal timing effects on DE, yet no studies have tested this possibility. The current study addressed this gap by examining whether higher body mass index (BMI), perceived pressures for thinness, thin-ideal internalization, and history of weight-based teasing mediate the predictive effects of early pubertal timing on DE symptoms.
Participants were 358 young adult women. Age at onset of menses was used as the indicator of pubertal timing, and well-validated measures were used to assess DE symptoms and psychosocial variables. Early pubertal timing predicted higher levels of body dissatisfaction and binge eating symptoms. The effect of early pubertal timing on body dissatisfaction was completely accounted for by BMI; conversely, none of the hypothesized factors significantly mediated early pubertal timing effects on binge eating. These data suggest that BMI is important for understanding the long-term effect of early pubertal timing on body dissatisfaction, whereas other unexplored factors (e.g., biological influences) may contribute to early pubertal timing effects on binge eating.

Psychological Correlates Of Weight Variability In A Sample Of Women With Bulimia Nervosa
Simar Singh, Joanna Y. Chen, Michael Lowe
Drexel University, Philadelphia, PA, United States

Introduction: Weight variability (WV) reflects individual differences in degree of weekly weight fluctuations.  WV in non-ED individuals has found that WV predicts future weight gain and food-related brain activation in reward and inhibitory regions. We previously showed high levels of WV in bulimia nervosa (BN) - but its source in BN is unknown. Methods: WV was calculated as the root mean square error of variation around each participant’s weight regression line (N=84). ED symptomatology was measured via the Eating Disorder Examination (EDE). Linear regressions examined the relation between EDE scores and WV.
Results: WV was correlated with EDE global scores (r=.23,  p<.05), EDE weight concerns (r=.26,  p<.05), EDE shape concerns (r=.27,  p<.05), and BMI (r=.22,  p<.05). WV was not related to EDE eating concern or restraint subscales, or binge eating (all p’s>.05). However, when controlling for BMI, WV was no longer associated with any EDE subscale or full score. Conclusions: The foregoing analyses followed up on the finding of elevated WV within BN, to understand WV’s possible relation to BN psychopathology. WV’s lack of significant associations with ED pathology, when controlling for BMI, parallels WV findings in non-clinical samples: WV is not related to any of several psychological dimensions of eating behavior. Both sets of findings - clinical and nonclinical - suggest that WV may have biological, rather than psychological, roots.

Differentiating "Anxiety About Eating" And "Wanting To Eat" High Versus Low Energy Dense Foods In Anorexia Nervosa
Kimberly R. Smith, Afroditi Papantoni, Lori Laddaran, Timothy H. Moran, Susan Carnell, Kellie Tamashiro, Angela Guarda
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States

Mixed findings in fMRI food cue tasks in AN are likely due to methodological issues including inadequate attention to contextualizing food cues. As part of a study investigating whether the orexigenic hormone agouti-related peptide (AgRP) is dysregulated in adult women with AN, we developed a fMRI visual food cue task to distinguish neural activation to food images under the condition “want to eat” versus “anxiety about eating”. To date, 8 female inpatients with AN and 5 healthy restrained eaters underwent a 7T fMRI and blood draw for AgRP. Participants completed the food cue task in the scanner and rated both desire to eat and how anxious they would feel consuming a range of high and low calorie density foods (N=45 food images/category). The AN group had lower ‘Wanting’ and higher ‘Anxiety’ scores for both high and low calorie foods relative to dieters. Both groups endorsed higher ‘Anxiety’ scores in response to high versus low calorie food images.  Neither group had different ‘Wanting’ scores for high versus low calorie foods. Blood and fMRI data collection is ongoing. Data support the sensitivity of this food cue paradigm in detecting differences in desire for, and anxiety provoked by, imagined consumption of foods of varying energy density. Preliminary results suggest that dietary restraint results in greater anxiety to consume high versus low calorie foods, with this effect being more pronounced in AN than in normal weight restrained eaters.

Accuracy Of Empirically Established Risk Factors For Predicting Future Eating Disorder Onset.
Eric Stice, Chris Desjardins
Oregon Research Institute, Eugene, OR, United States

Intro. We evaluated the accuracy of a set of empirically established risk factors to predict future onset of each eating disorder or any eating disorder to advance etiologic knowledge and the ability of interventionists to deliver effective prevention programs to youth at greatest risk. Methods. We examined data from 1952 female adolescents at high-risk for eating disorders due to body image concerns who completed six diagnostic interviews over 3 yr f-up. Risk factors included pursuit of thin beauty ideal, body dissatisfaction, dieting, negative affect, psychosocial impairment, BMI, overeating, fasting, and excessive exercise. Results. This set of risk factors showed good accuracy in predicting future onset of any eating disorder (67%), anorexia nervosa (73%), bulimia nervosa (61%), binge eating disorder (71%), and purging disorder (70%), with acceptable sensitivity (range 63% to 84%) and specificity (range 59% to 73%). Conclusions. Established risk factors were able to accurately identify youth with a high probability of showing future onset of eating disorders, suggesting that etiologic models should include these risk factors, but that it will be important to search for additional risk factors that account for the unexplained variance in eating disorder onset. Data also imply that a brief questionnaire should allow clinicians to deliver prevention programs that have produced 60%-73% reductions in future eating disorder onset over 2-3 yr f-ups to youth at greatest risk.

Gut- Microbiome-Brain Alterations In The Translational Aba Anorexia Animal Model
Stefanie Trinh1, Anna Schloesser1, Constanze Schwenzer1, Clara Voelz1, Vanessa Kogel1, Cordian Beyer1, Beate Herpertz-Dahlmann2, Jochen Seitz2
1Institute of Neuroanatomy, Aachen, Germany, 2Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Aachen, Germany

Introduction: Variations of the gut bacterial composition (microbiome) have been causally implicated in weight regulation in obesity and malnourishment and via the gut-brain axis in depression and anxiety. Current research finds changes also in the gut microbiome of patients with anorexia nervosa (AN), however the underlying pathophysiology remains unclear. Using the translational activity-based anorexia model (ABA) we previously showed brain volume reduction similar to patients and associated loss of astrocytes. Here we analyze gut microbiome changes and their relation to brain changes using the ABA model.
  Methods: A total of 48 Wistar rats was distributed to ABA or control animals. Fecal samples from these animals were analyzed using 16s rRNA gene amplicon sequencing and brain sections were examined.   Results: ABA rats, like patients with AN, display an altered microbiota composition compared to controls. We found increased alpha-diversity, increased abundance of Akkermansia, Lactobacillus, Bifidobacteria, Roseburia and Ruminococcus genera and reduced abundance of Prevotella genus. Initial analysis revealed an inverse association of Akkermansia and Roseburia with hippocampus volumes. Further analyses of associations with white and grey matter volume, neuronal and astrocytic cell count and mRNA analysis will be presented.   Conclusions: ABA appears to be an interesting translational model to study the microbiome gut brain axis.

Approach And Avoidance Learning In Anorexia Nervosa
Blair Uniacke1, Karin Foerde1, Zarrar Shehzad2, Nathaniel Daw3, Daphna Shohamy2, Joanna Steinglass1
1Columbia University/New York State Psychiatric Institute, New York, NY, United States, 2Columbia University, New York, NY, United States, 3Princeton University, Princeton, NJ, United States

Background: Maladaptive dietary restriction is a core feature of Anorexia Nervosa (AN) yet existing research has yet to probe whether this behavior is guided by approach (i.e., reward-seeking) or avoidance mechanisms. This ongoing study used an instrumental learning task to examine approach and avoidance learning in AN relative to healthy volunteers (HC). One possibility is that AN have an exaggerated tendency to reframe successful avoidance as a reward. Methods:  The Gains and Losses Task uses a Learning Phase to train participants to pair cues with reward (vs nothing) or loss (vs nothing). In each pair, one cue has a higher probability of a beneficial outcome. The Post-Test assesses how the individual has assigned value, and whether successful avoidance of loss has been reframed as reward. Results: Learning rates for both conditions were similar between groups (17 AN and 19 HC to date, data collection is ongoing). The post-test probe indicates that AN, more than HC, reframed cues associated with a low probability of loss as rewarding and cues with a low probability of gain as punishing ((F
2,34)=6.99, p=0.012). Conclusions: Preliminary results indicate greater reframing of value among AN, consistent with the hypothesis that AN are abnormally prone to perceive avoidance of loss as rewarding. This tendency to reframe successful avoidance as rewarding in individuals with AN may relate to the neural mechanisms driving avoidance of high fat foods.  

Puberty Moderates The Relationships Between Impulsivity, Anxiety, Depressive Symptoms, And Binge Eating
Phuong T. Vo1, Natasha Fowler1, Sarah R. Racine2, S. Alexandra Burt1, Kelly L. Klump1
1Michigan State University, East Lansing, MI, United States, 2McGill University, Montreal, QC, Canada

Impulsivity, anxiety, and depressive symptoms are known risk factors for binge eating (BE) that tend to increase during puberty in girls. These increases could be one (of many) reasons why we also see significantly higher rates of binge eating during/after puberty in girls.  The present study tested this possibility by examining potential differences in risk factor-BE associations across the key pubertal transition period. Methods: Participants included 981 female twins (aged 8-16 years) from the Michigan State University Twin Registry. Impulsivity, anxiety, depressive symptoms, pubertal status, and BE were assessed with well-validated self-report questionnaires. Results: Controlling for the effects of age and body mass index, multilevel models showed that pubertal status moderated the risk factor-BE associations, such that there were stronger associations between these risk factors and BE in girls with more advanced pubertal status (b’s = .07-.28, p <.05). Moderating effects of pubertal status were particularly consistent in the associations between depressive symptoms and BE. Conclusions: Findings suggest that pubertal development might amplify relationships between impulsivity, anxiety, and depressive symptoms and BE. Future studies are needed to identify the mechanisms underlying these enhanced effects.

Dopamine Binding Potential In Adult Women With Binge Eating Behaviors: An Exploratory Study Using Pet Imaging 
Hannah A Welch, Cara Bohon
Stanford University, Stanford, CA, United States

INTRODUCTION: Binge eating (BE) is associated with psychosocial impairment and increased risk of suicide. Understanding neurochemical correlates may help identify treatment targets. Research implicates reward dysfunction in BE, with a particular focus on dopamine function. The current study aimed to explore nondisplaceable D2/D3 binding potential (BPnd) in women with BE using positron emission tomography (PET). METHODS: Ten adult women with a range of BE frequency (0-4 episodes/week) underwent PET imaging using 11C
-Raclopride, which binds to D2/D3 receptors in striatal regions. BPnd was measured using the simplified reference tissue model in PMOD software with the cerebellum as reference tissue. RESULTS: There was no correlation between BE frequency and D2/D3 BPnd in the nucleus accumbens, caudate, putamen, or pallidum. In addition, there was no correlation between body mass index (BMI) and BPnd in these regions. Exploratory analyses revealed moderate, but not significant negative correlations between depression and anxiety and BPnd in the putamen (r = -.418, r = -.552) and between sensitivity to reward and BPnd in the thalamus and caudate (r= -.471, r= -.390). CONCLUSIONS: Results from this small study focusing on BE behavior, rather than diagnosis, are in line with inconsistent findings in obesity and eating disorder literatures. Future research should examine the relationship between anxiety, depression, and reward sensitivity and D2/D3 BPnd in reward brain regions.

How Changing Life Roles Predict Eating Disorder Pathology Over 30-Year Follow-Up
Madeline R Wick1, Tiffany A Brown2, Margaret C Walsh1, Elizabeth H Fitzgerald1, Pamela K Keel1
1Florida State University, Tallahassee, FL, United States, 2University of California San Diego, San Diego, CA, United States

Individuals in midlife may be at greater risk for eating disorders than previously thought, supporting the need to identify factors that contribute to risk beyond young adulthood. Previous studies have supported the relevance of changing life roles (e.g., educational attainment, occupational status, marital status, parental status) for disordered eating (DE) in midlife. The present study uses multilevel model analyses to examine the impact of shifting life roles on DE (Drive for Thinness and Bulimia) in a cohort of men and women (N=900, 69% women) assessed when they were in college and again at 10-, 20-, and 30-year follow-up. Obtaining a higher degree was concurrently associated with higher Drive for Thinness and greater maintenance of Drive for Thinness over time. This effect was moderated by gender, with significant associations observed in women but not men. In time-lagged models, obtaining a higher degree was prospectively associated with increases in Drive for Thinness. Becoming a parent was concurrently associated with lower Drive for Thinness and Bulimia scores but did not predict DE in time-lagged models, and higher educational attainment was concurrently associated with lower Bulimia scores. Neither marital/partner status nor occupational status contributed to prediction of DE in any models. Future research should examine what aspects of graduate training may increase internalization of the thin ideal, particularly for women.  

Dorsomedial Prefrontal Cortex Repetitive Transcranial Magnetic Stimulation In Anorexia Nervosa: Fmri Correlates Of Response: A Pilot Trial
Blake Woodside, Eileen Lam, Jonathan Downar
University Health Network, Toronto, ON, Canada

This study examines brain circuitry correlates of a trial of dorsomedial prefrontal cortex(dmPFC) repetitive transcranial magnetic stimulation(rTMS) in Anorexia Nervosa(AN). Data was extracted from a pilot study of rTMS in eating disorders. 19 subjects received 20-30 sessions of neuronavigated rTMS at 20 Hz for indications other than AN. Clinical and psychometric data were collected at the initiation and completion of treatment.   Patients initiated treatment and an average BMI of 16.4 and exited treatment at an average BMI of 16.3. Improvements were seen on subscales of the Eating Disorders Examination(EDE), including shape concerns(p=0.042), weight concerns(p=0.024) and global EDE score(p=0.01). There was a trend for improvements on the eating concerns subscale(p=0.054).   Baseline whole-brain dmPFC resting-state functional connectivity revealed two significant clusters that negatively correlated with percent global EDE score improvement. Lower pre-treatment resting-state functional connectivity from the dmPFC to the right frontal pole and left superior/lateral occipital cortex significantly correlated with symptomatic improvement Mean parameter estimates extracted from each cluster also significantly correlated with this improvement (p=0.009 and  =0.008 respectively).   These results show improvements in clinical symptoms correlated to circuits possibly relevant to AN, including circuits in involved in decision making and body image/self-perception. Further study may allow for

Avoidant/Restrictive Food Intake Disorder Caused By Selective/Neophobic (“Picky”) Eating: Disgust Sensitivity, Sensory Processing, And Impaired Set-Shifting As Possible Target Mechanisms
Hana Zickgraf1, Gregory Wallace2, Terrence Dovey3
1University of Chicago Pritzker School of Medicine, Chicago, IL, United States, 2George Washington University, Washington, DC, United States, 3Brunel University, London, United Kingdom

Introduction. Severe picky eating (PE) causes symptoms of avoidant/restrictive food intake disorder (ARFID), but the mechanisms through which PE leads to ARFID are not well-understood. Candidate mechanisms include disgust sensitivity (DS), sensory over-responsivity (SOR), and impaired set-shifting (SS). Methods. Participants will be recruited on Amazon’s Mechanical Turk (MTurk) through ads targeting self-identified picky eaters (N=450). Computerized tasks measuring food-specific DS (implicit apperceptions test) and SS (modified dimensional change card sort) will be collected using stimuli derived from a standardized set of food images. Self-report data on SOR will be collected using an existing measure and a novel measure with ratings of anticipated intensity of taste, oral texture, and smell of the food images used in the disgust and set-shifting tasks. Results. Data collection is not complete. Pilot self-report data on the mechanisms of interest were collected from MTurk picky eaters and an undergraduate subject pool. In the MTurk sample, DS (β=.24) but not SS (β=.07) predicted PE; each independently predicted ARFID symptoms (DS Exp(B)=1.66, SS Exp(B)=1.20). In the undergraduate data, SOR (β=.26) and SS (β=.19) were independent predictors of PE. Conclusions. DS, SOR, and SS are likely contributors to PE/ARFID. The current study extends these results by 1) using task-based measures rather than self-report and 2) using food-specific measures of the three mechanisms.

Network Analysis Of Borderline Personality Disorder And Eating Disorder Symptoms
Sarah Fischer, Jillian Nelson, James Thompson
George Mason University, Fairfax, VA, United States

Purpose: Borderline personality disorder (BPD) and bulimia nervosa (BN) often co-occur.  Network analysis is a statistical tool that shows how symptoms may relate to each other and thus influence comorbidity. We used network analysis to examine relationships between BPD and BN symptoms in a community and an undergraduate sample. Methods: Sample 1: 54 community women with BN completed the Eating Disorder Examination (EDE) and Structured Clinical Interview for DSM-IV (SCID-IV). Sample 2: 871 undergraduates completed the EDE-Q and Personality Assessment Inventory-Borderline Scale. The R package, ‘qgraph’, was used to create correlational networks with items from the EDE (or EDE-Q) and SCID-IV (or PAI-BOR). Results: The Sample 1 network consisted of 4 communities. BPD suicide/self-harm was in a community with shape/weight dissatisfaction, feeling fat and body/exposure discomfort. All other BPD items were in a community with fasting, avoidance of eating and reaction to weighing. Shape/weight importance, dissatisfaction, and preoccupation were most central to the network. Analysis in Sample 2 showed 3 network communities. Objective binges were associated with BPD symptoms in one community. As in the clinical sample, importance of and dissatisfaction with shape/weight are central to the network. Conclusions: The finding that suicidal behaviors in the clinical sample are related to feeling fat and reaction to weighing should be replicated in a larger clinical sample.

Being Afraid Of Gaining Weight - The Path From Anxiety To Anorexia Nervosa Through Biased Attention
Tanja Legenbauer1, Anne Radix1, Mike Rink2, Anca Sfaerla3, Belinda Platt3, Gerd Schulte-Körne3, Eni Becker2
1LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-Uni Bochum, Hamm, Germany, 2Clinical Psychology and Behavioural Science Institute, Radboud University, Nijmwegen, Netherlands, 3University Hospital for Child and Adolescent Psychiatry, Ludwig Maximilian University Munich, Munich, Germany

Permanent elevated levels of anxiety bias the initial processing of information towards a disproportionate likelihood of detecting threat (attentional bias, AB). In particular under stressful situations, such biases have been found. This study strived to assess whether high levels of anxiety elicit a 
specific body-related AB in patients with Anorexia nervosa (AN) compared to a depressed and a normal control group and tests whether this mediates the pathway from anxiety to AN. 34 clinically diagnosed female patients with a AN (n=34), a normal control group (NCG, n = 30) and a depressed clinical control group (DCG, n=31) were recruited. All participants completed a range of questionnaires and took part in 2 experimental sessions (Stroop task, dot probe task, free viewing task) following an anxiety induction (version A) or a neutral performance task (version B).  The anxiety induction worked very well. All three groups showed a significant increase in experienced anxiety and stress levels following the manipulation. First results based on our dot probe data reveal a significant attentional bias for underweight body stimuli only in the AN group. However, no significant 3way ‘Group x StimuliType x Manipulation’ interaction was found.  The lack of a 3way interaction indicates that the manipulation did not amplify the attentional bias following the anxiety induction; however, this might be a ceiling effect. Subsequent analyses will focus on mediating effects. 

Eating Disorders And The Nine Symptoms Of Borderline Personality Disorder:  A Systematic Review And Meta-Analysis
Alexia E Miller, Vittoria Trolio, Amane Halicki-Asakawa, Sarah E Racine
McGill University, Montreal, QC, Canada

Eating disorders (EDs) and borderline personality disorder (BPD) have high rates of comorbidity
. Further, having both an ED and BPD is associated with higher levels of distress, psychological disturbance, and suicidal/parasuicidal behavior than having only one of these disorders, making this a critical clinical subgroup. Notably, BPD is a multidimensional disorder characterized by the presence of at least five of nine distinct symptoms: abandonment avoidance, unstable interpersonal relationships, identity disturbance, impulsive behavior, suicidal behavior, affective instability, emptiness, inappropriate anger, and dissociation/paranoia.  Due to the number and variety of BPD symptoms, it may be that some BPD symptoms play a particularly important role in the comorbidity with EDs, whereas others do not. We will provide a systematic review of the literature on the link between each individual BPD symptom and EDs, focusing on articles that include individuals with EDs compared to healthy controls. PsycINFO, PubMed, and Scopus will be used to conduct ten literature searches, one for each BPD symptom and a broad search on BPD and EDs. From the selected articles, meta-analyses will be conducted comparing the levels of each BPD symptom in those with EDs versus healthy controls. Knowing which BPD symptoms have the strongest association with EDs, and which BPD symptoms are unstudied/understudied in relation to EDs, will allow for a better understanding of ED-BPD comorbidity. 

Comorbidity Of Eating Disorder Pathology And Alcohol Use: A Network Analysis Approach
Melissa A. Munn-Chernoff1, Leigh C. Brosof2, Laura M. Thornton1, Jessica H. Baker1
1Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 2Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States

Introduction: Eating disorders (EDs) are comorbid with problem alcohol use: binge eating and purging are hypothesized to influence this association. We evaluated which symptoms contribute to the comorbidity of ED pathology and alcohol use using network analysis. Methods: A college sample (N=531; 60% female; mean age=19.36, SD=1.79) completed the Eating Pathology Symptoms Inventory (EPSI) and Alcohol Use Disorder Identification Test (AUDIT) online. Stability, centrality, and bridge symptoms of three item-level networks (i.e., EPSI, AUDIT, and EPSI-AUDIT) were examined. Results: All networks yielded adequate stability (>.50). The most central symptoms of the EPSI network were not liking how one’s body looked (S=2.58) and planning one’s days around exercise (S=1.35). The most central symptom of the AUDIT network was having 6+ drinks on one occasion (S=2.00). The most central symptoms of the EPSI-AUDIT network also emerged as bridge symptoms between ED-alcohol use: not liking how one’s body looked (S=2.02) and having 6+ drinks on one occasion (S=2.64). In this network, variance in each item accounted for by all other items in the network (R2s) ranged from 0.44-0.51. Conclusions: Body dissatisfaction, rather than binge eating or purging, and binge drinking bridged ED pathology and alcohol symptoms. Findings provide insight regarding how comorbid EDs and problem alcohol use may develop.

Eating Disorders And Diabetes Risk In A Sample Of Individuals With Food Insecurity
Maribel Plasencia1, Francesca Gomez2, Keesha Middlemass3, Carolyn Black Becker2
1Rutgers University, Piscataway, NJ, United States, 2Trinity University, San Antonio, TX, United States, 3Howard University, Washington, DC, United States

Introduction: Food Insecurity (FI) may confer risk for eating disorder (ED) pathology such as binge-eating and purging (Becker et al., 2017; in press). We sought to understand the prevalence of pre-diabetes risk in a sample of individuals with varying levels of FI in addition to evaluating the relationship between pre-diabetes risk and EDs (e.g., Raevuori et al, 2015). Method: We recruited a total of 891 clients seeking services at a local food bank. Clients filled out various questionnaires including a screener for pre-diabetes risk (i.e., CDC Pre-Diabetes Screening Test; CDC-PDST), and the Eating Disorder Diagnostic Scale (EDDS). Results: Clients self-reported a mean BMI of 30.73 (SD = 7.71). Results demonstrated that 60.1 percent of the sample either had a diabetes diagnosis (24%) and/or had scores indicating high risk for pre-diabetes on the CDC PDST (54.1%). Frequency of binge eating did not predict pre-diabetes risk but did predict self-reported BMI, F(1,815) = 14.60, p <.01, r2 = .02. Clinical severity on the EDDS predicted low versus high pre-diabetes risk (beta = .56, p <.05, OR = 1.72).  However, this became non-significant when controlling for BMI, which is a construct accounted for by the CDC PDST. Conclusion: BMI may be a better indicator of pre-diabetes risk than binge eating or clinically significant EDs. However, research is needed to determine the reliability of self-reported of BMI and binge-eating frequency in populations with FI. 

Eating Disorders And Posttraumatic Stress Disorder: A Systematic Review
Cleo Rijkers1, Maartje Schoorl1,2, Daphne van Hoeken1, Hans W. Hoek1,3,4
1Parnassia Psychiatric Institute, The Hague, Netherlands, 2Department of Clinical Psychology, Leiden University, Leiden, Netherlands, 3Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 4Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States

In eating disorders (ED) a history of sexual abuse and other adverse experiences are common risk factors for the development of ED. Previous research has mainly focused on childhood trauma in ED. It has been suggested that posttraumatic stress disorder (PTSD) is even more closely associated with ED. The aim of this systematic review was to provide an overview of the recent literature on comorbid PTSD in ED, with a specific focus on prevalence, operating mechanisms and treatment.  Methods We systematically searched the databases PsychInfo, Medline and EMBASE for studies published from January 2013 to April 2019 with the search terms [Eating Disorder OR anorexia nervosa OR bulimia nervosa OR binge eating disorder] and [Trauma OR posttraumatic stress disorder]. The following criteria were used to include studies for full-text evaluation: 1. a peer-reviewed study, 2. including a patient population, 3. application of measurement instruments to identify ED and PTSD. Preliminary results Out of 167 papers, 16 studies were included. Several studies showed that the comorbidity of PTSD in ED is associated with more severe ED symptoms. There is some evidence for the mechanism of emotion regulation difficulties. Only two studies investigated treatment of this specific comorbidity and demonstrated preliminary evidence that concurrent CBT may be effective.  Conclusions We will present the results of the systematic review on prevalence, operating mechanisms and treatment. 

Using Network Analysis To Identify Bridge Symptoms Between Eating Disorders And Suicidality
April Smith1, Lauren Forrest1, Mary Duffy2, Emily Pisetsky3, Jones Payton4
1Miami Univesity, Oxford, OH, United States, 2Florida State University, Tallahassee, FL, United States, 3University of Minnesota , Minneapolis, MN, United States, 4Harvard, Boston, MA, United States

1. Those with eating disorders (EDs) are at elevated risk for suicidality (ideation, attempt, death). However, the mechanisms linking the conditions are unclear. This study tested whether ED and suicidality symptoms bridge ED and suicidality networks. Further, networks were constructed and compared for individuals with and without EDs and suicide attempts. 2. Participants were recruited from outpatient and ED clinics in the U.S. to construct three groups: Outpatient (n = 538 [reported no attempts and no current ED]); Attempt (n = 166 [reported attempt]), and ED (n = 238 [current ED, regardless of attempt status]). Participants completed measures assessing ED symptoms, burdensomeness, belongingness, suicidal ideation, fearlessness about death, and pain tolerance. ED and suicidality networks were jointly estimated across groups. Expected influence values indicated centrality, and bridge expected influence values signified bridge symptoms. 3. Suicidal ideation and feeling inadequate were central symptoms across groups. Drive for thinness was central in the Outpatient and ED groups, and interoceptive deficits was central in the Attempt group. Symptoms bridging ED and suicidality symptoms varied by group: inadequate (Outpatient), interoceptive deficits (Attempt), pain tolerance (ED). 4. Although bridge symptoms varied by group, overall they appear to represent body disconnect or disregard. Thus, poor body regard may be a mechanism linking EDs and suicidality.

The Longitudinal Pattern Of Comorbidity In Eating Disorders: An Approach Using Sequence Analysis
Sarah C. Van Alsten, Alexis E. Duncan
Washington University, St. Louis, Saint Louis, MO, United States

Most individuals with eating disorders (EDs) have additional lifetime psychiatric diagnoses. This study characterized longitudinal profiles of comorbid disorders in adults with EDs. We applied sequence analysis and hierarchical clustering to ages of onset and recency for eating, substance, mood and anxiety disorders from 479 participants in the Collaborative Psychiatric Epidemiology Surveys with lifetime DSM-IV EDs. Of the 63% of participants who met criteria for ≥ 1 additional diagnosis, 27% reported an ED onset first. In the largest of the five classes identified (Class 1, 46% of sample; median age ED onset 18), 76% had a comorbid diagnosis and 28% still met criteria for at least one diagnosis at time of interview. In Class 2 (20% of sample; median age ED onset 19), 52% had comorbid diagnoses and 3% met criteria for a psychiatric disorder at time of interview. Half (46%) of those in Class 3 (15% of sample; median age ED onset 34.5) had comorbid diagnoses, and 68% no longer met criteria at the time of interview. In Class 4 (14% of sample; median age ED onset 16), 40% had comorbid diagnoses. At the time of interview 36% still met criteria for a psychiatric disorder. All persons in Class 5 (5% of sample; median age ED onset 27) had history of a major depressive episode. ED onset occurred first in only 2% of cluster members and 86% still met criteria for at least one disorder at the time of the interview. This study underscores the need to consider diagnoses temporally. 

Similar Functions, Different Behaviors: New Insights Into The Co-Occurrence Of Eating Disorders And Nonsuicidal Self-Injury
Shirley B Wang1, Kathryn R Fox1, Ann F Haynos2, Matthew K Nock1
1Harvard University, Cambridge, MA, United States, 2University of Minnesota, Minneapolis, MN, United States

Eating disorder (ED) behaviors frequently co-occur with nonsuicidal self-injury (NSSI). Theoretical accounts suggest this co-occurrence may be driven by shared underlying functions, such that individuals engage in multiple maladaptive behaviors to serve the same function. We provide the first empirical examination of the within-person organization of ED and NSSI functions. Participants were 524 adolescents endorsing 2+ of the following behaviors: restrictive eating, binge eating, purging, and NSSI. For each behavior endorsed, participants completed the Functional Assessment of Maladaptive Behaviors (Wedig & Nock, 2010). Exploratory factor analyses indicated a four-factor model (automatic negative, automatic positive, social negative, and social positive reinforcement) was a good fit for each behavior. Hierarchical clustering analyses revealed social positive functions and social negative functions of each behavior clustered together. Automatic negative and automatic positive functions of restrictive eating and purging also clustered together. Results indicate that individuals who engage in one ED or NSSI behavior for social reinforcement purposes (e.g., to avoid social interactions, to communicate distress) are likely to engage in other behaviors for the same reason. Future research replicating these results could have meaningful clinical implications, such that targeting social reinforcement processes may simultaneously reduce engagement in multiple maladaptive behaviors.

Comorbid Type 1 Diabetes And Disturbed Eating Behaviors: Prevalence And Association With Metabolic Control
Line Wisting1,2, Torild Skrivarhaug2,3,4,5, Knut Dahl-Jørgensen2,3,4,5, Øyvind Rø1,6
1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway, 2Oslo Diabetes Research Centre, Oslo, Norway, 3Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway, 5The Norwegian Diabetic Centre, Oslo, Norway, 6Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Oslo, Norway

The increased prevalence of disturbed eating behaviors (DEB), depression, and anxiety in type 1 diabetes (T1D) is generally well established; however the majority of existing research has focused on female adolescents and young adults. Data on males and older females is scarce. The aim of this study was to assess prevalence of DEB, depression, and anxiety among adult males and females with T1D, associations with metabolic control, and patterns of eating pathology by age and weight. Methods: 282 adults with T1D aged 18-79 years completed the Diabetes Eating Problem Survey-Revised and the Hospital Anxiety and Depression Scale. Additionally, clinical data was retrieved from the Norwegian Quality Improvement of Laboratory Examinations system. Results: 20.3% of the whole sample (13.3% among males and 24.8% among females) scored above the cut-off score for DEB. As for depression and anxiety, the prevalence in the whole sample was 6.2% and 19.0%, respectively. Prevalence was generally higher in females than males across psychopathology. HbA1c was significantly associated with eating disorder psychopathology among females, but not with depression and anxiety. Eating disorder psychopathology decreased with increasing age. Conclusions: There is a need for increased awareness of psychological comorbidity among adults with T1D, in particular young adult females. Screening is recommended to secure early detection and subsequent intervention for these individuals.

Is There A Relationship Between Mothers' Emotion Socialization And Daughters' Eating Disorder Psychopathology? A Mediation Study Based On Mothers' Reports. 
Karolina A. Rozworska1, Richard A. Young1, Daniel W. Cox1, Jennifer S. Coelho2,1
1University of British Columbia, Vancouver, BC, Canada, 2British Columbia Children's Hospital, Provincial Specialized Eating Disorders Program for Children and Adolescents, Vancouver, BC, Canada

Introduction Parental emotion coaching has been proposed as an intervention to improve emotion regulation (ER) in youth with eating disorders (EDs) but there have been no studies to determine if emotion coaching relates to ED psychopathology as suggested by theory. Research in developmental psychology indicates that mothers’ emotion coaching and other emotion socialization behaviors predict better emotion regulation (ER) in youth and, indirectly, less psychopathology. The purpose of this study was to examine if there are mediated relationships between mothers’ emotion coaching, ER, and expressed emotion, and daughters’ ED psychopathology through daughters’ ER. Method 135 mothers completed questionnaires assessing their emotion socialization as well as their daughters’ observed ER and behaviors linked to ED psychopathology. Daughters were 12 to 24 years old and 60 had a confirmed diagnosis of an ED. Results Mediated relationships were found. Mothers’ emotion coaching was linked to daughters’ lower emotion dysregulation, which was linked to lower ED psychopathology. Mothers’ ER difficulties and critical comments were related to higher daughters’ emotion dysregulation, which was related to higher ED psychopathology. Conclusions This study is the first to empirically link emotion coaching to lower ED psychopathology through a mediator. The results suggest that mothers’ emotion socialization can be relevant for ED psychopathology and warrants further research.

Eating Disorder Disparities Among Sexual And Gender Minority Youth: Findings From The Adolescent Brain Cognitive Development (Abcd) Study 
Natasha A. Schvey, Arielle T. Pearlman, Mikela Murphy, Joshua C. Gray
Uniformed Services University, Bethesda, MD, United States

Background: Sexual and gender minority (SGM) youth may be at increased risk for eating disorders (ED) compared to non-SGM youth. Though many identify as gay or gender non-conforming in childhood, most prior studies have assessed older adolescents. The current study, therefore, utilized data from the ABCD study to compare the prevalence of EDs among 9-10 year old SGM and non-SGM youth.  Methods: Children underwent an assessment, including measured height and weight. SGM status was self-reported and ED diagnoses were determined by parent-report on the KSADS for DSM-5. Logistic regressions, adjusting for age, race, family income, sex-assigned at birth, and BMI-z, were conducted to compare current ED prevalence by SGM status. Analyses were repeated by sex-assigned at birth.  Results: The study comprised 4,516 participants (M age: 10.0y; 52.5% assigned male at birth; 58% non-Hispanic white), of whom 59 (1.3%) were SGM. The prevalence of BED and OSFED among SGM youth was 1.7% and 10.3%, respectively. Among non-SGM youth the prevalence was .5% and 9.8%, respectively. No cases of AN nor BN were reported. Adjusting for covariates, rates of EDs did not differ by SGM status among the entire sample nor among females. However, SGM males were over 6 times more likely to have OSFED compared to non-SGM males (OR: 6.04, p= .002).  Conclusions: Prevalence of EDs was comparable between SGM and non-SGM youth. However, SGM males were significantly more likely to have OSFED compared to non-SGM males. 

Developing Mouse Models To Identify Novel Therapeutic Targets For Anorexia Nervosa
Lori M. Zeltser
Columbia University, New York, NY, United States

There is an urgent need to develop new strategies to treat anorexia nervosa, because there are no medications that reverse the life-threatening restrictive feeding behaviors that cause severe weight loss. A major obstacle to achieving this goal is the lack of animal models that recapitulate the pattern of disease onset typically observed in human populations. We developed a novel translational mouse model to study interactions between genetic, psychosocial and biological risk factors that promote anorexic behavior.  This model incorporates several factors that are consistently associated with increased risk of anorexia " adolescent females, genetic predisposition to anxiety imposed by the Brain-derived growth factor (BDNF)-Val66Met gene variant, social stress and caloric restriction.  Approximately 40% of the mice with all of these risk factors will exhibit severe self-imposed dietary restriction, sometimes to the point of death. We are using this paradigm to identify
signaling pathways in the brain that drive anorexic behavior in our model, with the ultimate goal of identifying novel therapeutic targets for anorexia. This research was supported by the Klarman Family Foundation for Eating Disorders Research

Emotional Overeating Across The Childhood Years
Pauline Jansen1,2, Ivonne Derks1,2, Robin Thomas1,3, Vincent Jaddoe4, Manon Hillegers1, Henning Tiemeier5
1Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, Netherlands, 2Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands, 3Department of Public Health, University of Torino, Torino, Italy, 4Generation R Study Group, Rotterdam, Netherlands, 5Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States

Introduction. Although emotional eating is a quite common behaviour and a potential precursor of binge eating, only little is known about its developmental course and correlates in childhood. This abstract gives an overview of our work on emotional eating in a population-based sample.   Methods. Within a Dutch cohort (Generation R, n=3514), emotional eating was assessed with the Child Eating Behaviour Questionnaire at ages 4 and 10 years. Correlates were assessed with questionnaires and hands-on measurements (body mass index, BMI).   Results. Mean emotional eating scores were higher at age 10 (mean item score=1.49, SD=0.66) than at 4 years (1.44, SD=0.60, p-value<0.001). About 36% of children were on a trajectory of increasing emotional overeating, with the remaining sample staying at the same level. Children with an increasing trajectory were more likely to be girls, to have emotional/behavioural problems, to have experienced life events and to be soothed with food by their parents in infancy. For BMI, a bi-directional association was found: emotional eating prospectively predicted a high BMI, while overweight also predicted emotional eating.   Conclusions. Tendencies towards emotional eating seem to be expressed with increasing age, suggesting that childhood provides a window of opportunity to target emotional eating habits and its predictors. Ultimately, this may impede the development of overweight and binge eating. 

The Differential And Cumulative Impacts Of Five Forms Of Child Maltreatment On Disordered Eating Behaviour Among A Representative Sample Of Canadian Youth
Melissa Kimber1, Masako Tanaka1, Andrea Gonzalez1, Jennifer Couturier1, Tracie Afifi2, Harriet MacMillan1
1McMaster University, Hamilton, ON, Canada, 2University of Manitoba, Winnipeg, MB, Canada

Purpose: There is no investigation of the joint or cumulative effects of all forms of maltreatment on disordered eating behaviour (DEB) in youth. The present study determines the prevalence and associations between child exposure to intimate partner violence (CEIPV), child sexual (CSA), physical (CPA), and emotional abuse (CEA), as well as child physical neglect (CPN) and disordered eating behaviour (DEB) among a representative sample of youth. Methods: Data come from the 2014 Ontario Child Health Study, a provincially representative survey of families with children in Ontario. Youth aged 14 to 17 years (n = 2,396) completed a self-administered questionnaire to assess experiences of DEB, CEIPV, CSA, CPA, CEA, CPN, and associated correlates. Linear regression with bootstrapped standard errors was used to address our research objectives. Results: In models that considered exposure to all forms of maltreatment, only CSA, CEA, and CPN remained significantly associated with DEB; the impact of CEA on DEB was significant for females only.  A significant dose-response relationship between maltreatment exposure and DEB was identified. Exposure to more forms of child maltreatment was associated with greater DEB; this finding was amplified for females and attenuated for migrant youth. Conclusions: Exposure to CSA, CEA, CEIPV, CPA and CPN has differential and cumulative impacts on DEB among Canadian youth. Developing in a migrant family could be protective from DEB experiences. 

Health Disparities In Eating Disorder Prevalence And Impairment By Gender And Sexual Identities And Their Intersection
Melissa Simone, Autumn Askew, Katherine Lust, Marla Eisenberg, Emily Pisetsky
University of Minnesota, Minneapolis, MN, United States

Introduction: The study examines disparities across eating disorder (ED) diagnoses and ED-specific academic impairment by gender identity, sexual orientation, and their intersection. Methods: Participants were college students (n = 16,215; 56% cisgender women; 86% heterosexual; 31% Non-White). Chi-square tests examined differences in self-reported anorexia nervosa (AN) and bulimia nervosa (BN) prevalence and impairment by: (1) three gender identities; (2) six sexual orientations; and (3) across sexual orientations within gender identity. Results: There were higher rates of AN and impairment in cisgender women and transgender students as compared to cisgender men (ps<.05). Rates of BN were higher in cisgender women compared to cisgender males (p<.05). AN, BN, and impairment were more prevalent in sexual minorities compared to heterosexuals (
ps<.05). Within-gender chi-square tests revealed higher AN, BN, and impairment in sexual minority cisgender women and sexual minority cisgender men compared to their heterosexual cisgender counterparts (ps<.05). No differences in ED prevalence or impairment were observed across orientation in transgender students (ps≥ .05). Conclusions: Sexual minority status is associated with higher rates of EDs and impairment in cisgender men and women. ED prevalence and impairment was similar across sexual orientation among transgender people. Thus, significant ED disparities exist in transgender college students, regardless of sexual orientation. 

Antecedents And Correlates Of Nasogastric (Ng) Tube Feeding During Medical Hospitalization For Adolescents/Young Adults With Anorexia Nervosa
Meredith R. Kells1,2, Susan Kelly-Weeder2, Andrea K. Garber3, Barbara E. Wolfe4
1Boston Children's Hospital, Boston, MA, United States, 2Boston College, Boston, MA, United States, 3University of California, San Francisco, San Francisco, CA, United States, 4University of Rhode Island, Kingston, RI, United States

Introduction: The use of NG feeds for caloric replacement in meal-based refeeding is the predominant approach in the U.S.; however, use varies across sites, antecedents and outcomes are unclear. Methods: A total of 300 charts were reviewed.  The sample was 88.3% female, mean age 15.5 years.  Nutritional protocol started between 1250-2500 kcal daily, increasing by 250 kcal daily until goal.  Formula was first offered orally for refusal to complete meals/snacks, or failure to meet weight gain goals.  NG feeding was used when oral intake was refused or incomplete.  Binomial logistic regression was used to identify factors associated with NG feeding. Results: NG feeding used in 44 individuals (14.7%).  Higher kcal on admission (p=.023) and psychiatric distress score (p<.001) were significantly associated with NG feeding, and psychiatric score significantly contributed to the model.  For each 1-unit decrease in psychiatric score, odds of NG feeding increase by a factor of 1.1 (b=-.053, p<.001).  Pre-morbid weight, prior weight loss, age, sex, weight, BMI, %mBMI, and AN subtype were not significantly associated with NG feeds.  Those who required NG feeding received more kcal in formula than those who did not (p<.001) and had 3x higher odds of nadir phosphorus level <3.0 mg/dL (p=.049) during admission. Conclusions: Higher prescribed kcal and psychiatric distress are predictors of NG feeding during hospitalization, and the intervention itself is a predictor of low serum phosphorus. 

Medical Outcomes Among Inpatients Treated For Anorexia Nervosa After Bariatric Surgery
Wynne Lundblad2, Rachel P Kolko Conlon1, Alexis M Fertig2, Michele D Levine1, Marsha D Marcus1
1University of Pittsburgh Medical Center, Pittsburgh, PA, United States, 2Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Purpose:Anorexia nervosa (AN) has been reported after bariatric surgery, but this population has been poorly characterized. Given that AN and Roux-en-Y gastric bypass (RYGB) surgery each confer risk for malnutrition, we examined whether patients with both would have poorer medical outcomes. Methods: We identified patients admitted to an eating disorder unit between 2010-2014 with a diagnosis of AN and a history of RYGB (n=9), all of whom were women. We compared this group to female inpatients with AN who did not have a history of RYGB (n=9) and separately to female patients with a history of RYGB admitted for other psychiatric conditions (n=13). We present Chi-square analyses, t-tests, standardized mean differences, and phi coefficients. Results: Preliminary findings suggest higher rates of hypoalbuminemia, anemia, Wernicke Encephalopathy, medical hospitalization, and mortality in AN patients with a history of RYGB compared with either of the other groups.  Conclusions: Patients with AN who have undergone RYGB appear to be more likely to suffer from malnutrition-related medical outcomes than patients with AN alone or patients with a history of RYGB with other psychiatric conditions. Research is needed to characterize risk factors and prevention strategies for AN in this population. 

Recovery In Context: How Do Present Models Of Recovery Fit With The Experience Of Those With Lived Experience?
Therese E. Kenny, Stephen P. Lewis
University of Guelph, Guelph, ON, Canada

Purpose: As part of a larger and unfolding program of research examining eating disorder (ED) recovery, we have found that individuals writing about recovery in blogs do not experience recovery in isolation. Here we provide a commentary, integrating these findings within current models of recovery. Method: Thematic analysis was used to assess 168 blogs posted to ED sites. A literature review was conducted to situate resultant themes in present conceptualizations of recovery. Results: Existing models of recovery typically focus on the assessment of ED symptoms at a single time point, often the end of treatment. Bloggers, however, noted that recovery reflects a change in identity, connection, vibrancy, acceptance, and control over time. Moreover, individuals noted that there are unique challenges maintaining recovery in the “real” world as compared to treatment. Bloggers also noted frustration with ableism, fatphobia, and lack of diversity in recovery spaces. Conclusions: Present models of recovery do not capture the experience of recovery in broader context. Our findings suggest that: (1) the use of a single assessment to determine recovery status does not reflect the experience of change during recovery; (2) assessing functioning during treatment does not capture the unique challenges of recovery in the real world; (3) social justice issues are prevalent and may cause distress in the recovery experience. Conceptual, empirical, and practical implications will be discussed.

'Feeling Fat' Predicts Specific Eating Disorder Symptom Dimensions In Young Men And Women
Adrienne Mehak, Sarah E. Racine
McGill University, Department of Psychology, Montreal, QC, Canada

‘Feeling fat’ is the somatic experience of having excess body weight that is not fully explained by one’s true adiposity. It is associated with overall eating pathology in individuals with and without clinical eating disorders. It is unclear whether feeling fat is more strongly related to specific eating disorder symptom dimensions, such as those that comprise anorexia nervosa (i.e., dietary restraint and restriction) versus bulimia nervosa (i.e., dietary restraint, binge eating, and compensatory behaviours). This study examined feeling fat in relation to specific eating disorder symptoms: cognitive restraint, dietary restriction, binge eating, and purging. Questionnaires were completed by 989 undergraduates (54.3% female). Path analyses controlling for BMI indicated significant paths between feeling fat and all four eating disorder symptom dimensions. No paths were moderated by gender. Chi-square difference tests indicated that the model including paths from feeling fat to all four eating disorder symptom dimensions had better fit than models restricted to certain symptom dimensions, suggesting that feeling fat was not more relevant for certain eating disorder symptoms in the current sample. In sum, feeling fat related to symptoms of both anorexia nervosa and bulimia nervosa in a non-clinical population. This finding was similar in both men and women. Future research should compare the influence of feeling fat on specific eating disorder symptoms in clinical samples.

Implicit Regulation In Eating Disorders: A Review
Georgios Paslakis1,2, Anne Deborah Scholz-Hehn3, Laura Marie Sommer4, Simone Kühn3
1Toronto General Hospital, University Health Network, Toronto, ON, Canada, 2Department of Psychiatry, University of Toronto, Toronto, ON, Canada, 3University Medical Center, Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany, 4Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Erlangen, Germany

Background: The regulation of food-intake in eating disorders may underlie explicit processes that require cognitive insight and conscious control or be steered by implicit mechanisms that are mostly automatic, rapid, and associated with affective -rather than cognitive- processing. So-called indirect experimental tasks can assess implicit responses underlying a specific behavior by-passing the participant’s consciousness. Methods: We performed a systematic review (PRISMA guidelines) and present the current evidence regarding studies on implicit responses towards food and body image cues in patients with eating disorders. We included studies performed in clinical cohorts and controls and using at least one indirect assessment method of interest. Results: Out of 104 screened investigations, we identified 26 studies fulfilling the eligibility criteria, and present a synthesis of the essential findings and future directions. Discussion: In this emerging field of research, the present work provides cornerstones of evidence highlighting aspects of implicit regulation in eating disorders. Applying both direct (e.g., self-reports) and indirect measures for the assessment of both explicit and implicit responses is necessary for a comprehensive investigation of the interplay between these different regulatory mechanisms and eating behavior. Targeted training of implicit reactions might be a useful future tool as an add-on to standard psychotherapeutic treatments.

Application Of Network Analysis To Investigate Sex Differences In Interactive Systems Of Eating Disorder Psychopathology
Victoria L. Perko1, Kelsie T. Forbush1, Cynthia S. Q. Siew2, Jenna P. Tregarthen3
1University of Kansas, Lawrence, KS, United States, 2University of Warwick, Coventry, United Kingdom, 3Recovery Record Inc., Palo Alto, CA, United States

The purpose of this study was to compare the interconnectivity among ED symptoms in men vs women using network analysis. Consistent with cognitive-behavioral theories of EDs, we hypothesized that symptoms related to overvaluation of weight/shape would emerge as the most important (central) symptoms in networks for both men and women. Participants (n=1348) were users of Recovery Record, a smartphone app that allows individuals to monitor their ED symptoms. Participants were matched on age and duration of illness. Seperate networks were created for both sexes and strength centrality indices, network stability, and centrality difference tests were calculated. The Network Comparison Test (NCT) was used to identify differences in network structures and the cumulative strength of the connections within networks. For both sexes, items related to food restriction and binge eating emerged as most central. The NCT found differences in global strength (p=.03), but not network invariance (p=.10) suggesting that the structure of the networks was not statistically different but the strength of the connections within the network was greater for women. Results show that EDs are maintained through similar processes in both sexes; lower global strength in networks of men suggests that there was a wider variety of symptom presentations in men with EDs. Our findings have important clinical implications by supporting the theoretical underpinnings of cognitive-behavioral models of EDs across sex.  

Clinicians As A Crtical Link: Understanding Clinician Attitudes And Illness Perceptions
Deborah L Reas1,2, Rasmus Isomaa3, Kjersti Solhaug Gulliksen4, Johanna Levallius5
1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo , Oslo, Norway, 2Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway, 3Department of Social Services and Health Care, Jakobstad, Finland, 4Journal for the Norwegian Psychological Association, Oslo, Norway, 5Karolinska Institutet, Stockholm, Sweden

Introduction: This study investigated clinician attitudes toward perceived illness chronicity, symptom controllability, treatment effectiveness, and level of functional impairment attributed to main diagnostic groups (AN, BN, BED). Methods: A total of 188 healthcare professionals (32% psychologists, 18% nurses, 14% medical doctors, 11% nutritionists, 10% social workers)completed a modified ED-version of the Illness Perception Questionnaire (Currin, Wallin, & Schmidt, 2009). Items were rated using a five-point Likert scale (“strongly disagree” to “strongly agree”). Results: Results showed that clinicians viewed BED as less impairing than AN or BN, and BED symptoms more attributable to personal responsibility. Clinicians also rated significantly less personal enjoyment working with BED than AN or BN. Treatment for BN was viewed as more highly effective than either AN or BED, with a less chronic course and greater symptom controllability. AN was viewed as severe and enduring, with symptoms unlikely to resolve without specific treatment. Conclusions: Data revealed significant differences in clinician attitudes toward perceived illness course, chronicity, and symptom controllability attributable to different diagnostic groups. Understanding the perspectives of health professionals is an understudied, yet integral component in translational research and implementation science, and may help bridge bench-to-bedside gaps in treatment decisions and delivery.

Eating Disorder Patient Presentations And Outcomes In Repeat Inpatient Hospital Admissions
Sarah Smith1, Blake Woodside1,2
1University of Toronto, Toronto, ON, Canada, 2University Health Network, Toronto, ON, Canada

Introduction: Inpatient eating treatment has high rates of relapse and readmission.  Prior research has reported rates of readmission ranging from 22 to 45% with many patients requiring multiple readmissions.  Yet, whether patients’ clinical presentations change with multiple admissions is unknown.  This study explored this question.  
Methods:  Existing data from a specialist inpatient eating disorder program collected from 2000 to 2016 was analyzed and 37 patients with three admissions were identified.  Data on eating disorder symptoms, depressive symptoms and treatment outcomes was compared across repeat admissions.  Analyses included descriptive analyses, repeated measure ANOVAs and Chi-square tests.   Results:  Treatment outcomes improved with repeat inpatient admissions with more patients completing treatment.  Patients’ eating disorder and depressive symptoms at admission did not differ significantly at admission save an increase in the frequency of laxative use.   A trend towards increased frequency of purging was also observed.    Conclusions:  Eating disorder patients’ clinical presentations do not change with multiple admissions save laxative use and purging behaviour which may be markers of disease progression.  Despite this, with repeat admissions patient outcomes improved.  This supports the utility of repeat inpatient admissions in eating disorder treatment.  

Body Image And Eating Pathology In Fashion Industry Students And Professionals
Kristin M. von Ranson, Hilary Herman, Emilie Lacroix
Department of Psychology, University of Calgary, Calgary, AB, Canada

Although previous studies have not found elevated eating pathology (EP) or body dissatisfaction (BD) among fashion models, other fashion industry professionals’ bodies may be less likely to meet the industry’s thin ideal and may consequently be at higher risk for EP and BD. This group has yet to be studied. The present study assessed levels of EP, BD, appearance schematicity (AS), physical appearance comparisons (PAC), and weight bias internalization (WBI) in female fashion students and professionals. We hypothesized that scores on these outcome variables would be higher among fashion students and professionals than published norms, and that weekly hours spent consuming fashion media would predict scores on these outcomes. Preliminary results examined 95 fashion students and professionals, who had lower scores than comparison samples on measures of EP and BD (t[708] = 7.33-19.01, p <.0001) and comparable scores on measures of AS and PAC (ps > .05). Fashion students and professionals had higher scores on WBI than comparison samples (t[448] = 2.31, p = .022), but when p values were adjusted for multiple comparisons, this difference was no longer statistically significant. Media consumption hours did not predict any outcome. The present study extended examinations of EP and BD in the fashion industry beyond traditional model-only samples, providing further evidence that contradicts presumed positive associations between industry involvement and risk of BD and EP.

Open Science Practices In Treatment Studies Published In Eating Disorder Journals Between 2016 And April 2019: An Examination Of Three Journals 
Wesleyan University, Middletown, CT, United States

Purpose Increasingly, funders demand Open Science practices such as preregistration of study protocols (to improve transparency, reduce “p-hacking” or post-hoc theorizing) or data- or material sharing (to facilitate verification or replication), and scientific journals are following suit. This study examined the status of three Open Science practices in three ED journals: study preregistration, data sharing, and material sharing. Because trail registration is the most commonly required Open Science practice by funders, the study focused on treatment trials and studies ancillary to such trials. Method A systematic review of treatment (or ancillary) studies published from 2016 to 4/15/2019 in the EEDR, JED, or IJED examined Open Science practice indicators. Search terms for article retrieval included “treatment trial” OR clinical trial,” Or “random” OR “randomized.” Upon inspection, 65  of 95 papers were retained. Open Science practices will be coded by two independent raters; discrepancies are resolved by discussion/agreement. Rater 1 has completed coding, results from rater 2 are pending. Results The poster will report a complete listing of findings by study, thus complementing an oral presentation focused on discussing the practical issues arising from Open Science framework for our field. Discussion Future studies should expand the focus to non-intervention studies. We welcome a dialogue of how our field should meet the challenges of Open Science practices.

The Role Of Depressive Symptoms In Decision Making Across Patients With Anorexia Nervosa, Somatic Symptom Disorder, Unipolar And Bipolar Depressive Disorder
Unna N. Danner1, Sabrina S. Schröder1, Annemarie A. van Elburg1, Eline J. Regeer2, Pieter Dingemanse3, Saskia A.M. van Broeckhuysen4
1Altrecht Eating Disorders Rintveld, Zeist, Netherlands, 2Altrecht Bipolar, Utrecht, Netherlands, 3Altrecht Mood Disorders, Utrecht, Netherlands, 4Altrecht Psychosomatic Medicine Eikenboom, Zeist, Netherlands

Introduction: Impaired decision making is thought to be a transdiagnostic problem across psychiatric disorders. In uncertain circumstances, decision making seems based on the short-term consequences irrespective of the longer-term outcomes. Problematic emotional functioning and specifically depressive symptoms may be an underlying factor. It is important to test this further as many people suffer from (comorbid) depressive symptoms. The present study aims to compare the relationship between decision making, emotion regulation and depressive symptoms in patients diagnosed with different disorders: anorexia nervosa (AN), somatic symptom disorder (SSD), unipolar and bipolar depressive disorder. Methods:  In total, 80 patients (20 patients per group) and 40 control participants performed one of the most widely used decision making tasks, the Iowa Gambling Task (IGT), and filled in the IDS-SR (depressive symptoms), ERQ (emotion regulation), UPPS (emotion-driven impulsivity) and the BSI (psychopathology symptoms). Comorbidity was determined using either the MINI or the SCID. Results and conclusions:  Analyses are currently being done and will be presented at the conference. This study will enhance our understanding of the role of depressive symptoms in decision making as measured with the IGT. Furthermore, the outcomes will provide a first comparison of people with AN and SSD regarding their emotional functioning. 

Gender-Related Patterns Of Emotion Regulation Among Patients With Eating Disorders
Susana Jiménez- Murcia1,2,3, Zaida Agüera1,2,4, Georgios Paslakis2, Lucero Munguía3, Isabel Sánchez2, Roser Granero1,5, Jéssica Sánchez-González2, Trevor Steward1,2, Fernando Fernández-Aranda1,2,3
1CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain, 2Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain, 3Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain, 4Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain, 5Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain

Introduction: Difficulties in emotion regulation (ER) are common in females with eating disorders (ED). However, no study to date has analyzed ER in males with ED. In the study at hand, we assessed ER in males with ED and compared results to both females with ED and healthy controls (HC). We also examined associations between ER difficulties, personality and psychopathology. Methods: A total of 62 males with ED were compared with 656 females with ED, as well as 78 male and 286 female HC. ER was assessed by means of the Difficulties in Emotion Regulation Scale (DERS). Results: We found that males and females with ED showed greater ER difficulties compared to HC. Pronounced general psychopathology was a shared factor associated with higher ER difficulties in both males and females with ED. However, whereas higher novelty seeking, higher cooperativeness, lower reward dependence, and lower self-directedness were related to higher ER difficulties in females with ED, lower persistence was associated with ER difficulties in males with ED. Conclusions: males and females with ED show similar ER difficulties, yet they are distinct in how ER deficits relate to specific personality traits. Research on strategies promoting ER in the treatment of males with ED is warranted.

Validation Of The Eating Disorders After Bariatric Surgery Questionnaire (Eadbs-Q) From The Eating Disorders Examination Bariatric Surgery Version (Ede-Bsv)
Yael Latzer1, Inbal Globus2, James E. Mitchell3, Jeon D. Hamm4, Rafah T. Chaudhry4, Musya Herzog4, Harry R. Kissileff4
1Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel, 2Faculty of Public health, Haifa University, Haifa, Israel, 3Neuropsychiatric Research Institute, Fargo, ND, United States, 4Obesity Nutrition Research Center Columbia University Medical Center, New York, NY, United States

Introduction: Current eating disorders questionnaires do not accurately detect eating pathology (EP) in bariatric surgery patients (BSP). This study adapted and validated an existing EDE-BSV interview to a new questionnaire. Methods: At least 1 y after bariatric surgery, 30 BSP (sex: 25 F, mean age: 45.7 ± 8.5 y SD, mean pre-surgical BMI: 40.5 ± 4.8 kg/m2 SD, BMI at interview: 28.1 ± 5.2 kg/m2 SD) were interviewed, with an adapted EDE-BSV (EDABS-I) and completed the EDABS-Q. The EDABS-Q included an expanded subscale for nibbling & grazing with loss of control (NGLC). The EDABS-Q differentiated behaviors that resemble EP but were done to relieve physical discomfort (PD). To assess validity, EDABS-Q scores were regressed from EDABS-I. Results: All EDABS-Q subscales correlated positively with EDABS-I, except purging related to EP (PUREP): restraint EP (b = .97, r2 = .64, p <.0001); restraint PD (b = 1.0, r2 = .51,p <.0001); eating concern (b = .77, r2 = .46,p <.0001), weight concern (b = .74, r2 = .65,p <.0001), shape concern (b = .89, r2 = .80,p <.0001), NGLC (b = .70, r2 = .65,p <.0001), Total EDABS (all foregoing EP subscales, b = .73, r2 = .69,p <.0001),Total EDE-Q (weight, shape & eating concerns & restraint EP,b = .97, r2 = .84,p <.0001); PUREP (b = .05, r2 = .001,p = .82); and purging PD (b = .37, r2 = .38,p <.0003). Conclusions: The EDABS-Q is an innovative self-report tool that can be useful for clinical evaluation and treatment of EP after bariatric surgery.

Negative Urgency Mediates The Relationship Between Negative Emotionality And Eating Disorder Psychopathology In Women Who Binge Eat
Chantelle A Magel, Kristin M von Ranson
University of Calgary, Calgary, AB, Canada

Negative emotionality (NE) is a risk factor for anorexia and bulimia nervosa (BN), and negative urgency (NU) is a risk factor for subthreshold disordered eating behaviors. It is unknown how these traits may interact to increase risk for eating disorders (EDs) characterized by binge eating. In this cross-sectional study, we examined a model of associations among levels of NE, NU, and ED psychopathology (i.e., eating, shape, and weight concerns, and restraint) in a community sample of 69 women with binge eating disorder or BN and 72 control women with no history of ED. Participants completed semi-structured diagnostic interviews to evaluate DSM-5 ED diagnoses and a series of self-report questionnaires. After controlling for symptoms of anxiety and depression, analyses revealed a significant moderated mediation model: NU mediated the relationship between NE and ED psychopathology, and this relationship was moderated by diagnostic group membership (i.e., the relationship was stronger for women who binge ate), β=-.004, SE=.003, 95% CI [-.012, -.001], p

Low Emotion Differentiation: An Affective Risk Factor For Binge Eating?
Megan E. Mikhail1, Pamela K. Keel2, S. Alexandra Burt1, Michael Neale3, Steven Boker4, Kelly L. Klump1
1Michigan State University, East Lansing, MI, United States, 2Florida State University, Tallahassee, FL, United States, 3Virginia Commonwealth University, Richmond, VA, United States, 4University of Virginia, Charlottesville, VA, United States

Emotion differentiation, a person’s tendency to experience discrete emotions (e.g., feeling angry) as opposed to vague affective states (e.g., feeling “bad”), is theorized to help people respond adaptively to emotion-eliciting experiences. While affect has been shown to play a role in binge eating, the association between emotion differentiation and binge eating phenotypes has yet to be investigated. We therefore examined whether women low in emotion differentiation are more prone to binge eating and emotional eating after controlling for overall affect. Methods: Female twins (n = 475) from the Michigan State University Twin Registry rated their experience of 10 negative and 10 positive emotions and emotional eating (EE) daily for 45 days. Measures of trait negative and positive emotion differentiation (NED and PED) were created by calculating the variance of a participant’s ratings of distinct negative emotions (e.g., irritable, scared, etc.) on a given day, then averaging these daily values across the study. Lifetime history of objective binge eating (OBE) was assessed using the SCID-5. Results: After controlling for negative affect, positive affect, and BMI, both NED (β = -.23, p = .006) and PED (β = -.09, p = .043) were independently associated with lower EE. NED was also associated with a reduced likelihood of lifetime OBE (OR = .38, p = .049). Conclusions: Low emotion differentiation may be a risk factor for binge eating phenotypes.

Understanding The Experiences And Triggers Of Binge Eating And Obesity To Inform The Design Of A Mobile Intervention
Sarah W. Neubert1, Jennifer E. Wildes 2, Sean A. Munson 3, Madhu Reddy 1, David C. Mohr 1, Andrea K. Graham 1
1Northwestern University, Chicago , IL, United States, 2University of Chicago, Chicago , IL, United States, 3University of Washington, Seattle , WA, United States

Introduction: To design a mobile app for binge eating and obesity, we qualitatively assessed how target users experience these conditions. Methods: Adults (N=22) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) completed a 4-week digital diary study of their experiences with binge eating and obesity. Results: Two themes emerged: 1) triggers for binge/excess eating, and 2) experiences and impacts of binge eating and obesity. Internal triggers included various emotions, excessive thoughts of food or hunger, anticipating a binge, difficulty with motivation/goals, and a perceived need to consume available food. External triggers were situational (e.g., eating alone, unstructured eating pattern, eating outside the home, eating-related activities, access to certain foods, inactivity/boredom, late night eating, interpersonal problems) and physical (i.e., lack of sleep, health problems). Experiences and impacts had 4 sub-themes: experiences during a binge (i.e., distracted eating, rapid intake), socialized experiences/environmental impacts (e.g., negative body image, negative food judgments, feeling excluded, perception that home hinders healthy behavior, health responsibility for others, financial burden), mental health impacts (i.e., guilt, failure, low self-esteem, low mood), and physical health impacts (e.g., fatigue, pain). Conclusion: Understanding how target app users experience binge eating and excess weight helps inform intervention targets.

Sexual And Gender Minority Status And Academic Distress Associated With Suicide Attempts In Students With Eating Disorders
Emily M Pisetsky, Melissa Simone, Katherine Lust
University of Minnesota, Minneapolis, MN, United States

Introduction: The current study examined prevalence and correlates of individuals with an eating disorder (ED) who endorsed a suicide attempt (SA) in the past year. Methods: Participants were college students who self-reported having an ED (n = 560). Chi-square tests examined differences in demographics and recent stressful life events between those with and without a past year SA. Logistic regression analyses examined whether discrimination and resilience were associated with a past year SA. Results: Three percent of college students with an ED reported a past year SA (n = 17). Those with a past year SA had a higher prevalence of identifying as transgender (11.8% vs 2.6%, p <.05), gay or lesbian (17.6% vs 4.4%, p <.05), and experiencing issues related to their sexual orientation (41.2% vs 9.8%, p <.05) than those without an SA. Higher discrimination (OR = 3.20, p <.001) and lower resilience (OR = 0.41, p = 0.013) were associated with a past year SA. Additionally, there was a higher prevalence of academic stress including failing a class, being on academic probation, and roommate conflict in those with a recent SA (ps <.05). Conclusions: Sexual and gender minority status, experiences of discrimination, and academic issues were associated with higher prevalence of a recent suicide attempt in individuals with an eating disorder. Findings can be used to identify those at highest risk for a suicide attempt and to develop targeted prevention and intervention efforts.

Negative Effects Of Tretament Among Patients With Eating Disorders- A Descriptive Study
Øyvind Rø1,2, Tonje Granne Kvale2, Elisabeth Veseth Kristoffersen2
1Department for Eating Disorders, Oslo University Hospital, Oslo, Norway, 2Insitute of Clinical Medicine, University of Oslo, Oslo, Norway

Purpose of study: Potentially negative effects of treatment have not been given much attention. The purpose of this study is to explore the negative effects caused by treatment among patients with eating disorders, its associations with treatment satisfaction, and if there is any difference between treatments received at an outpatient or inpatient unit. Methods: 220 participants aged 30.2 years (SD=10.6) with former or current eating disorders were recruited from social network platforms. The Negative Effects Questionnaire and PASopp10 (treatment satisfaction questionnaire) were used in the study. Correlations between negative effects and treatment satisfaction and eating disorder diagnosis, were investigated. Results: 72.6% (outpatient) and 85.8% (inpatient) of the participants reported having experienced at least one negative effect caused by the given treatment. The results showed a significant association between experienced negative effects and treatment satisfaction. Patients with anorexia nervosa were least satisfied with their treatment. Conclusions: Most patients with eating disorders experience negative effects as part of their psychotherapeutic treatment. Whether negative effects intervene with the treatment outcome is unclear. It is also important to further study the difference between negative effects of treatment and the natural treatment process.

Experiences Of Fear Of Fat And Desire For Thinness In Young Women With Body Image Concerns: A Qualitative Analysis 
Rachel F Rodgers1,2, Laura E Fischer1, Katherine Laveway1, Kristen Laws1, Joyce Chen1, Eric TH Bui3,4
1APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, United States, 2Department of Psychiatric Emergency & Acute Care, CHRU Montpellier, Montpellier, France, 3Massachusetts General Hospital , Boston, MA, United States, 4Harvard Medical School, Boston, MA, United States

Introduction: Research has suggested that fear of fat and drive for thinness play different roles in eating disorder symptomatology. This study qualitatively examined individual accounts of experiences of fear of fat and drive for thinness among young women with body dissatisfaction. Methods: To date, n = 15 female students, mean age = 20.25 years have been recruited. As part of a study examining psychophysiological correlates of eating disorder-related emotions, participants were interviewed to generate scripts of distinct experiences of fear of fat and desire for thinness. Scripts were transcribed and themes extracted. Results: For fear of fat, themes emerged around precipitating events, including trying on clothing, peer appearance comparisons, and situations when the body is on display. Furthermore, self-conscious emotions such as embarrassment or shame, and cognitions regarding the controllability of weight through diet and exercise were present. For desire for thinness, themes included positive expectations related to thinness and media exposure and peer appearance comparisons as precipitating factors. For both emotions, participants described the roles of sociocultural and individual factors recognized to contribute to eating disorders.
Conclusions: Young women describe separate experiences of fear of fat versus desire for thinness, supporting them as distinct. Individual variability in the experience of these emotions may have implications for intervention.

Associations Between Weight-Based Teasing And Disordered Eating Behaviors Among Youth
Sarah G. Rubin1, Natasha A. Schvey2, Lisa M. Shank1,2, Manuela Jaramillo1,2, Deborah R. Altman1,2, Sophie Ramirez1, Elisabeth K. Davis1, Sarah LeMay-Russell1,2, Meghan E. Byrne1,2, Sheila M. Brady1, Miranda M. Broadney1, Nichole R. Kelly3, Marian Tanofsky-Kraff1,2, Jack A. Yanovski1
1Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States, 2Uniformed Services University of the Health Sciences, Bethesda, MD, United States, 3University of Oregon, Eugene, OR, United States

Purpose: Weight-based teasing (WBT) is commonly reported among youth and is predictive of excess weight gain, a relationship that may be partially explained by disordered eating. Specifically, youth who experience WBT may engage in unhealthy weight control behaviors or use food to cope with negative affect. Therefore, we examined associations between WBT and disordered eating among youth. Methods: A convenience sample of non-treatment-seeking youth (8-17y) completed The Perception of Teasing Scale and questionnaires to assess emotional eating and eating in the absence of hunger. Loss of control (LOC) eating and disordered eating attitudes and behaviors were assessed via the Eating Disorder Examination (EDE) interview. Linear and logistic regressions were conducted adjusting for sex, race, age, height, and fat mass. Results: Two hundred and three youths (13.1 ± 2.8 y; 54% female; 29% non-Hispanic Black; 33% with overweight/obesity) participated. WBT was associated with eating concern, shape concern, and global eating pathology, as well as emotional eating and eating in the absence of hunger (ps <.03). WBT was not significantly associated with odds of reporting a LOC episode in the past three months (p= .59). Conclusions: WBT was associated with disordered eating attitudes and behaviors among youth across weight strata. Longitudinal studies could help determine directionality of these associations, which should be assessed among larger samples of youth experiencing WBT.

Body Satisfaction Predicts Positive And Negative Affect: An Ecological Momentary Assessment Study.     
Margarita Sala1, Jennifer A. Linde2, Ross D. Crosby3, Carly R. Pacanowski4
1Connecticut VA - West Haven, West Haven, CT, United States, 2University of Minnesota, Minneapolis, MN, United States, 3Neuropsychiatric Research Institute, Fargo, ND, United States, 4University of Delaware, Newark, DE, United States

Body dissatisfaction (i.e., displeasure with some aspects of one’s appearance, such as weight and shape) is ubiquitous in our society, particularly in individuals with eating disorders. Body dissatisfaction is theorized to lead to worsening affect, followed by eating disorder behaviors to escape negative mood. Cross-sectional research suggests that higher body dissatisfaction is associated with lower negative affect. However, no study has assessed how momentary body satisfaction may subsequently impact affect and vice-versa. In the current study, we examined the relationship between body satisfaction and affect and vice-versa, using data collected in real time. Method: Female college students (N = 67) completed measures of affect and body satisfaction five times daily across fourteen days using ecological momentary assessment. We used within subject cross-lag panel analyses. Results: Higher body satisfaction significantly predicted higher subsequent positive affect  (b = .19, SE = .04, p <.001) and lower subsequent negative affect (b = -.12, SE = .04, p <.001). Negative (b = .00, SE = .02, p = .96) and positive affect (b = -.01, SE = .01, p = .27) did not predict subsequent body satisfaction. Conclusion: Short-term negative effects of body dissatisfaction on affective response were apparent. Targeting body dissatisfaction may be important for improving affect and ultimately alleviating eating disorder symptoms.

The Role Of Affect In The Maintenance Of Binge-Eating Disorder With And Without Heightened Overvaluation Of Weight And Shape: Evidence From An Ecological Momentary Assessment Study
Lauren M. Schaefer1, Kathryn E. Smith1,2, Lisa M. Anderson3, Li Cao1, Ross D. Crosby1,2, Scott G. Engel1, Scott J. Crow3,4, Carol B. Peterson3,4, Stephen A. Wonderlich3,4
1Sanford Research, Fargo, ND, United States, 2University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States, 3University of Minnesota, Minneapolis, MN, United States, 4The Emily Program, St. Paul, MN, United States

Introduction: According to DSM-5 criteria, binge-eating disorder (BED) is characterized by negative affect (e.g., feeling depressed, guilty) following binge episodes. However, affect regulation models of eating pathology predict improvement in affect following binge eating. Method: Ecological momentary assessment data from 112 men and women enrolled in a large RCT for BED were used to examine the trajectories of positive affect (PA), negative affect (NA), guilt, fear, hostility, sadness, and stress relative to binge eating episodes. Overvaluation of weight and shape, a hypothesized indicator of disorder severity, was examined as a moderator of these trajectories. Results: Prior to binge eating episodes, PA significantly decreased, while NA, guilt, and sadness significantly increased. Following binge episodes, levels of NA, stress, and guilt significantly decreased. Affect trajectories demonstrated minimal differences between weight and shape overvaluation groups (high versus low), however, individuals with higher weight and shape overvaluation reported higher levels of guilt at the time of binge episodes. Conclusions: Contrary to current DSM-5 criteria, results suggest binge eating may function to alleviate unpleasant emotional experiences among individuals with BED. Findings also highlight the relative importance of understanding the relationship between guilt and binge eating behavior, particularly among individuals with heightened overvaluation of weight and shape.

Intolerance Of Uncertainty And Compulsive Exercise: Evidence For The Importance Of A Transdiagnostic Mechanism In Relation To Problematic Exercise Behaviors
Christina Scharmer1, Erin E Reilly2, Sasha Gorrell3, Courtney Breiner1, Drew A Anderson1
1University at Albany, SUNY, Albany, NY, United States, 2University of California, San Diego, San Diego, CA, United States, 3University of California, San Francisco, San Francisco, CA, United States

Introduction. Compulsive exercise (CE) behaviors are common in eating disorder (ED) populations and lead to worse outcomes. Identifying transdiagnostic mechanisms associated with CE will aid in the development of effective, targeted interventions. Recent work suggests that CE may also be related to OCD symptoms; accordingly, intolerance of uncertainty (IU), which is elevated in OCD and in EDs, may be important in understanding the function of CE. However, no studies to date have explored the link between IU and CE. The current study examined associations between CE and IU. Method. Undergraduate participants (N = 130; 63% female) completed the Trait form of the State-Trait Anxiety Inventory (STAI), Intolerance of Uncertainty Scale (IUS), and Compulsive Exercise Test (CET). Hierarchical multiple linear regression analyses, controlling for STAI, examined relations between IU and total CET scores. Results. IUS was a significant predictor of CE, accounting for significantly more variance in CET scores ("R2=.10, p<.01), than STAI alone. Conclusions. Findings indicate that IU is associated with CE, above and beyond trait anxiety, supporting the hypothesis that IU could drive engagement in CE. Future research should explore this hypothesis in clinical populations and test the possibility that interventions targeting IU may be effective in reducing CE.

Delay Discounting In Anorexia Nervosa: Trait Anxiety Is Associated With Preference For Larger Later Caloric Restriction Rewards
Colleen C Schreyer1, Meredith S Berry2, Jennifer L Hansen1, Angela S Guarda1
1Johns Hopkins University School of Medicine, Baltimore, MD, United States, 2University of Florida, Gainesville, FL, United States

Delay discounting (DD) studies have demonstrated that drugs of abuse are discounted more than money. Eating restraint in anorexia nervosa (AN) is a highly salient reward pursued despite significant adverse consequences. Compared to controls, patients with AN prefer larger later (LL) monetary rewards to smaller sooner (SS) rewards, and trait anxiety, often elevated in AN, is associated with preference for LL rewards. This study examined whether patients with AN would discount future caloric restriction rewards more than money, and the role of trait anxiety in DD. Methods: Inpatients (n=39) with AN completed caloric restriction and individualized monetary DD tasks, and the STAI, a measure of anxiety. The maximum caloric restriction reward was 1000 calories. Response to the statement: “Receiving $____ right now would be just as attractive as skipping 1000 calories” was used to compare monetary and caloric restriction DD rates, with the individualized value as the maximum reward in the individualized monetary task. Area under the curve scores were calculated. Results: Participants discounted caloric restriction rewards more than monetary rewards (p<.05). Trait anxiety was positively correlated with preference for LL caloric restriction rewards (p<.05). Conclusion: Findings suggest that, consistent with the addiction literature, caloric restriction is treated like a drug reward and is discounted more than money in AN, and trait anxiety moderates this effect.

Determinants Of Food Choice In A Large Typical Sample
Zarrar Shehzad1, Karin Foerde2,3, Akram Bakkour4, Alice M Xue4, Naomi Assaf2, B Timothy Walsh2,3, Daphna Shohamy1,4, Joanna E Steinglass2,3
1Zuckerman Institute, Columbia University, New York, NY, United States, 2Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States, 3Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States, 4Department of Psychology, Columbia University, New York, NY, United States

Introduction. Food-based tasks are commonly used to study mechanisms of eating disorders. To better understand the determinants of food choice, we studied how a wide range of individuals characterize foods and make food-based decisions. Methods. In this large, online study of the general population (N = 429, 70% female), participants were shown images of food (45 per participant, 138 total). Each food was rated on 17 different attributes (health, taste, etc). Participants then completed a food choice task. Results. BMI ranged from 17.7-80.8 kg/m2 and age ranged from 18-75 years. A factor analysis identified 3 components among the ratings: sensory experience (taste, texture, etc), nutritional content (health, vitamins, etc), and sugar/protein levels. Using each factor score to predict choice, we found that foods rated as tasty (p <0.001) and protein-rich/not-sugary (p <0.05) were more likely to be chosen while health-related ratings did not influence choices (p = 0.83). Foods rated as healthy were less likely to be chosen by men (p <0.01) and individuals with higher BMI (p <0.05). In contrast, foods rated as healthy were more likely to be chosen by older adults (p <0.001) and such healthy foods were more likely to be rated as tasty by older adults (p <0.05). Conclusions. This study characterizes attributes and decision making across food images representative of a normal diet, in a large group of individuals, providing broader context to food choices in eating disorders.

Associations Between Eating Disorder Symptoms, Employment Status, And Occupational Functioning Among Female Veterans
Megan E Sienkiewicz1,2, Katherine M Iverson1,2,3, Karen S Mitchell1,2,3
1National Center for PTSD, Boston, MA, United States, 2VA Boston Healthcare System, Boston, MA, United States, 3Boston University School of Medicine, Boston, MA, United States

Introduction: Eating disorders (EDs) have been shown to negatively impact occupational functioning and may be associated with employment status. Findings have been inconsistent, and depression may mediate this relation. Further, prior research focuses mainly on binge eating disorder’s impact on occupational functioning. We assessed the impact of transdiagnostic ED symptoms on occupational functioning and employment status among female veterans, who tend to have high rates of unemployment and EDs but who remain understudied. Method: Participants were 198 female veterans (Mage=54.09) in the New England region who participated in a larger study. They completed a mailed survey including the Eating Disorder Diagnostic Scale, Center for Epidemiologic Studies-Depression scale, employment status (employed vs. unemployed and out of the workforce), and the Inventory of Psychosocial Functioning to assess occupational functioning. Results: ED symptoms were not related to employment status (p=.93) but were negatively associated with occupational functioning when controlling for body mass index (β=-.24, p = .04). Depression symptoms mediated this association (B=-.26, 95% CI: -.55, -.08). Conclusion: Higher levels of ED symptoms were associated with worse occupational functioning in a female veteran sample. Depressive symptoms mediated this association, suggesting that comorbid depressive symptoms are an important treatment target when addressing occupational health in women with EDs.

Types Of Social Comparison And Male Body Attitudes Among Men With And Without A History Of An Eating Disorder
Katherine A Thompson, TJ Raney, Anna M. Bardone-Cone
University of North Carolina, Chapel Hill, NC, United States

Introduction: Little is known about how different types of social comparison relate to body image concerns of men. Methods: This study examined three types of comparison (body, eating, exercise) in relation to negative body attitudes among a pilot sample of men with and without a history of an eating disorder (n = 36 and n = 27, respectively). Participants completed online questionnaires assessing types of comparison and male body attitudes (total score and subscale scores for muscularity and body fat). Results: Controlling for the other types of comparison, only body comparison was significantly positively associated with the total negative body attitudes score among men with an eating disorder history (p = .001) and controls (p = .011). Regarding muscularity and body fat subscales, no type of comparison explained unique variance among controls (ps > .066). However, among men with a history of an eating disorder, body comparison explained significantly more variance in body fat attitudes (p = .001), and body (p = .003), eating (p = .012), and exercise comparison (p = .037) each explained a significant amount of unique variance in dissatisfaction with muscularity. Conclusions: Body, eating and exercise comparisons appear to be important factors related to muscularity among men with a history of an eating disorder, while body comparison is the most important type of comparison when assessing negative body attitudes among all men. 

Multi-Method Evidence For A Dual-Pathway Perspective On Loss Of Control Over Eating Among Adolescents
Eva Van Malderen1, Lien Goossens1, Sandra Verbeken1, Eva Kemps2
1Ghent University, Ghent, Belgium, 2Flinders University, Adelaide, Australia

Loss of control over eating (LOC) is common among adolescents and is associated with negative developmental outcomes. Dual-pathway models propose that LOC is the result of an imbalance between immature regulatory processes (e.g., inhibitory control) and strong reactive processes (e.g., attentional bias, reward responsivity); but most studies have been conducted in adult samples. The aim of the current study was to investigate the dual-pathway perspective in the context of LOC in adolescents. Methods: A community sample of 295 adolescents (10-17 years; 64.1% girls; Mean Age = 14 years; SD = 1.99) was subdivided into a LOC-Group (n = 93) and a No-LOC-Group (n = 202) based on a self-report questionnaire. Both regulatory and reactive processes were measured with behavioral tasks and self-report questionnaires. Results: Significant interaction effects were found. More specifically, the combination of impaired inhibitory control and strong reward sensitivity and the combination of impaired inhibitory control and strong attentional bias increased the risk of experiencing LOC, both with the use of behavioral tasks as well as with self-report questionnaires. Conclusions: Our results provide multi-method evidence for the dual-pathway perspective in which impaired regulatory processes and strong reactive processes interact in explaining LOC in adolescents. Theoretical and practical implications are discussed.

Evidence For The Replicability Of Eating Disorder Psychological Networks In Five Samples: Conceptual And Methodological Considerations
Irina A Vanzhula1, Caroline Christian1, Payton Jones2, Leigh C Brosof1, Kelsey Forbush3, Kathryn Smith4, Jenna Tregarthen5, Cheri A Levinson1
1University of Louisville, Louisville, KY, United States, 2Harvard University, Cambridge, MA, United States, 3The University of Kansas, Lawrence, KS, United States, 4Sanford Research, Fargo, ND, United States, 5Recovery Record, Palo Alto, CA, United States

Introduction: Network analysis is a statistical technique in psychopathology research that quantifies unique associations between symptoms. However, the replicability of psychological networks has been a topic of recent debate. Methods: We examined (a) the replicability of eating disorder (ED) networks across five different samples (four clinical [N=363-13,819] and one non-clinical [N=708]) and between two widely used measures (Eating Disorder Examination Questionnaire [EDEQ] and Eating Pathology Symptom Inventory [EPSI]); (b) how different methodological approaches (i.e., network estimation and node selection procedures) affect replicability. We estimated both GLASSO and association networks. The Network Comparison Test and correlations of edges and node centralities were used to assess replicability. Results: Overall, networks had moderate to good replicability, with the EDEQ having higher replicability than the EPSI. The degree of similarity across networks was dependent on the methodology used to estimate the network and its parameters (i.e., centrality indices), showing the importance of considering methodological factors when computing networks. Items related to overvaluation of weight and shape and overall dissatisfaction with one’s body were the most central across networks, supporting prior ED network analyses. Conclusions. We discuss implications of these results for the conceptualization of EDs and future research in the field of network science.

Weight Concern As A Mediator Of Early Change In Guided Self-Help For Bulimic Disorders
Ana R Vaz1, Eva Conceição1, Célia Moreira2, António Neves3, Jennifer Santos3, Paulo PP Machado1
1University of Minho, Braga, Portugal, 2University of Porto, Porto, Portugal, 3Santa Maria Hospital, Lisbon, Portugal

Introduction: Early change in bulimic symptoms has been consistently indicatedas a robust predictor of good outcome in bulimic disorders. Less research as focused on baseline predictors of early change.  Method: Fifty-seven patients entered a guided self-help treatment for bulimic disorders and were classifiedas having an early change in bulimic symptoms by the 3rdsession in treatment. Participants were assessedat baseline regarding eating disorders symptoms and psychopathology (Eating Disorders Examination questionnaire), Psychological distress (Outcome Questionnaire " 45), depressive symptoms (Beck depression inventory). Structural Equation Modeling analyses were performed to test the 
Pathdiagram model for the early change, regarding Weight suppression, restraint and symptoms distress.  Results:All (standardized) path coefficients were significance (p <.001). The model showed good fit to the data with the following fit values: chi-square = 3.141, df = 3, RMSEA = 0.029, CFI = 0.997, TLI = 0.994, GFI = 0.995, AGFI = 0.976, and SRMR = 0.038. A mediator effect was found for weight concern. Conclusion: Weight concern is an important variable related to achieving early change and should be assessedand addressed in a very early stage of guided self-help treatment, namely providing education about weight trajectories during treatment. Results have implications in the delivery of treatment components. 

Implicit Body Dissatisfaction Predicts Disordered Eating Behaviors
Elizabeth A Velkoff, April R Smith
Miami University, Oxford, OH, United States

Introduction: Implicit measures of cognition sometimes predict behavior better than self-report. We developed a personalized implicit measure of body dissatisfaction (BD) to determine if it predicted disordered eating (DE) over and above self-reported BD. Method: Participants were female undergraduates (n=145) age 18 to 22 (M=18.83, SD=0.95). BD was measured with the Eating Disorder Inventory BD subscale (EDI-BD) and DE by the Eating Disorder Examination-Questionnaire (EDEQ). The BD-IAT required participants to sort words related to “satisfaction” to one side of the computer screen and to sort words related to “dissatisfaction” to the other side of the screen. Participants categorized pictures of themselves to the side of the screen with the word “Me,” which sometimes appeared with the “satisfied” category and other times appeared with the “dissatisfied” category. Based on response latency, the BD-IAT provided a measure of the strength which with a participant associated images of her own body with dissatisfaction. Results: BD-IAT correlated positively with EDI-BD (r=0.21, p<0.05), supporting its convergent validity. Controlling for self-reported BD and baseline DE, BD-IAT predicted EDEQ one week later, and BD-IAT uniquely accounted for 4.7% of the variance in DE at one-week follow-up. Conclusions: The BD-IAT is a valid implicit measure of BD and predicts future DE above and beyond explicit measures of BD.

Feasibility And Effectiveness Of Adding A Cognitive Bias Modification Training To A Residential Childhood Obesity Treatment " Pilot Studies.
Sandra Verbeken1, Caroline Braet1, Lien Goossens1, Katrijn Houben2, Julie Latomme3, Tom Loeys4, Ellen Moens1, Tiffany Naets1, Wouter Boendermaker5
1Department of Developmental, Personality and Social Psychology, Ghent University, Gent, Belgium, 2Maastricht University, Maastricht, Netherlands, 3Department of Movement and Sports Sciences, Ghent University, Gent, Belgium, 4Department of Data Analysis, Ghetn University, Gent, Belgium, 5Utrecht University, Utrecht, Netherlands

Childhood obesity is not a transient developmental phenomenon, therefore tackling weight problems in childhood is important for both children’s and adult’s health. However, weight loss treatments have only limited success at long-term. One explanation for the modest results of treatments is the decreased self-regulatory capacities of obese individuals (e.g. attentional bias, automatic approach tendency towards food and difficulties inhibiting impulses). Therefore, the current studies aim to evaluate the feasibility and initial effectiveness of a cognitive-bias modification training for weight maintenance in obese youngsters. Subjects were youngsters (study 1: N= 36, 9-5 years; study 2: N=41, 10-15 years) from an inpatient obesity treatment program, randomized over a training- and a control group. The training consisted of 6 (study 1) or 10 sessions (study 2). Treatment outcomes were performances on tasks of approach avoidance, attentional bias and inhibition, ratings on craving symptoms and weight loss maintenance after leaving the clinic (12 week follow up). The training program was feasible and acceptable for participants and clinicians. Changes over time were not significantly different between conditions for the measures of automatic processes, craving and weight loss maintenance. Lessons for future research and possible accounts for the null findings are discussed.

Anorexia Nervosa: Does Low Weight Help To Suffer Less From Ones Trauma?
Maartje S. Vroling1, 2, Suzanne H. W. Mares1, Ger P. J. Keijsers2
1GGNet Amarum, Zutphen & Nijmegen, Netherlands, 2Radboud University Nijmegen, Nijmegen, Netherlands

INTRODUCTION The initial focus of treatment for Anorexia Nervosa (AN) is weight gain and re-establishing a healthy diet. This oftentimes does not meet the wishes of patients suffering from AN and Post-Traumatic Stress Disorder (PTSD). They say that when they gain weight, their PTSD symptoms increase. Indeed, qualitative studies show that patients often report that being underweight stifles their emotions, and that not-eating serves as a way of coping with emotions. This is in line with clinical impressions. Quantitative studies on the experiencing of emotions in relation to underweight are limited, and no studies have yet been conducted that investigate the relationship between trauma-related symptoms and underweight. In the present study we tested whether there is a correlation between BMI and PTSD symptom severity, and whether PTSD symptom severity increases with an increase in BMI. METHOD 51 Participants with anorexia nervosa and a history of trauma were included in the study. All participants were admitted to our in-patient ward. BMI, PTSD symptom severity and intensity of emotions were measured every second week during a period of 12 weeks. RESULTS AND CONCLUSION Parallel Processes Growth Model and Cross-Lagged Path Model were fitted to the data. No meaningful relationships of PTSD symptom severity with BMI or BMI growth were found. These findings are contradictory to clinical impressions, and is also not in line with some of the leading models for anorexia nervosa.

Perceived Social Support In Stages Of Eating Disorder Recovery
Emily C. Walsh, Anna M. Bardone-Cone
University of North Carolina, Chapel Hill, Chapel Hill, NC, United States

Introduction: Emotional support is an essential component of recovering from an eating disorder (ED). We examined perceived social support overall and in the domains of friends, family, and significant others in relation to ED status. Methods: Women diagnosed with an ED (n=18) and those in partial (physical and behavioral) ED recovery (n=11) and full (physical, behavioral, and cognitive) ED recovery (n=28) were compared to non-ED female controls (n=31). Participants completed the Multidimensional Scale of Perceived Social Support (PSS; friend, family, and significant other items). Results: ANOVA revealed a significant effect of ED recovery status on overall PSS, F=2.86, p=.042; Tukey’s tests found that controls and the fully recovered group reported more social support at a trend-level (p<.10) compared to those with an ED. A MANOVA of the PSS subscales was significant, F=2.69, Wilks’ lamda=.76, p=.006. Follow-up ANOVAs indicated that PSS from friends was driving the group differences (F= 6.65, p<.001), rather than support from family (F=2.22, p=.092) or significant others (F=.08, p=.973). Tukey’s tests indicated that the fully recovered group and controls perceived greater social support from friends than the partial recovery and ED groups. Conclusions: Those fully or partially recovered from an ED did not differ from controls on overall PSS. The role of PSS from friends may distinguish those in full recovery from those with an ED or in partial recovery.

Parental Functioning And Child Feeding Practices Among Mothers With Eating And Weight Disorder Histories 
Hannah A Welch1, Shiri Sadeh-Sharvit2, Cristin D Runfola3, Elise L Gibbs3, Caroline E Dickens1, James D Lock3, Debra L Safer3
1PGSP-Stanford Psy.D. Consortium, Palo Alto, CA, United States, 2Baruch Ivcher School of Psychology, Herzliya, Israel, 3Stanford University Dept of Psychiatry & Behavioral Sciences, Stanford, CA, United States

INTRODUCTION: Parents who have struggled with eating disorders and/or obesity often report a history of difficulties with food, eating, and body image, and associated concerns about instilling healthy eating habits in their children. This study explores differences among mothers with eating disorders, mothers who recently underwent weight loss surgery, and healthy controls regarding related concerns and behaviors . METHODS: The Brief Symptom Inventory (BSI), Parenting Stress Inventory (PSI), and Child Feeding Questionnaire (CFQ) were compared across groups using a one-way ANOVA. RESULTS: Significant group differences were found on the BSI [F (2, 48) = 8.721, p = .001], the PSI [F(2, 49) = 16.578, p <.001], and the concern subscale of the CFQ [F(2, 50) = 11.483, p <.001]. CONCLUSIONS: The data suggest that these three groups of parents differ on key measures related to psychosocial functioning, parenting, and child feeding. Mothers with a history of disordered eating behaviors - either an eating disorder or obesity - report greater stress and concerns associated with child rearing and feeding. Findings could inform interventions designed to support parents who are vulnerable in terms of both their own psychosocial functioning and in the realm of parenting.

Affective Dynamics In The Eating Disorders
Gail A. Williams-Kerver1, Stephen A. Wonderlich1,2, Ross D. Crosby1,2, Li Cao1, Kathryn E. Smith1, Scott G. Engel1, Scott J. Crow3, Carol B. Peterson3, James E. Mitchell1,2, Daniel Le Grange4
1Sanford Research, Fargo, ND, United States, 2University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States, 3Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States, 4Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States

Introduction and Purpose: While theories suggest that affect intensity plays a crucial role in the development and maintenance of eating disorders (EDs), there is little research on other aspects of emotional experience. Indeed, several affective dynamics (including lability, differentiation, and inertia) are relatively novel to the ED literature. As such, this study is the first to use ecological momentary assessment (EMA) to examine diagnostic differences in daily negative affect (NA) dynamics among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Method: EMA data were combined across three large studies (AN, n = 118; BN, n = 133; BED, n = 116). Diagnoses were confirmed using structured clinical interviews. Participants then completed an EMA protocol where they rated seven NA items throughout the day for up to two weeks. Ratings were then used to calculate indices of daily NA intensity, lability, differentiation, and inertia. Results: A series of linear mixed models showed that the AN and BN groups experienced significantly greater NA intensity and better differentiation than the BED group. The BN group demonstrated significantly greater lability than the AN, but not BED, group. No group differences were found for inertia. Conclusions: Results suggest that daily affective experiences differ between EDs and have implications towards distinct conceptualizations and treatments. Limitations/future directions will be discussed.

Body Dissatisfaction And Food Addiction Among College Students: Mediating Role Of Eating Expectancies
Ya-Ke Wu1,2, Catherine Zimmer3, Melissa A. Munn-Chernoff2, Jessica H. Baker2
1The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, United States, 2The University of North Carolina at Chapel Hill Department of Psychiatry & UNC Center of Excellence for Eating Disorders, Chapel Hill, NC, United States, 3The University of North Carolina at Chapel Hill Department of Sociology & The Odum Institute , Chapel Hill, NC, United States

There is a positive association between body dissatisfaction and food addiction (i.e., an addiction to compulsively overeat highly palatable foods). However, little is known about the underpinning mechanism of this association. Eating expectancies, one’s learning history regarding the association between eating and its consequences, may provide potential pathways linking body dissatisfaction and food addiction. In the current study, five eating expectancies (e.g., eating helps manage negative affect) were evaluated as potential mediators between body dissatisfaction and food addiction in 659 college students (mean age=19.23±.07,61.3% female). Students completed the Eating Pathology Symptoms Inventory, Yale Food Addiction Scale, and Eating Expectancy Inventory. Adjusting for sex, age, race, and body mass index, structural equation modeling was used to examine the mediation effects of the eating expectancies between body dissatisfaction and food addiction. Results show that body dissatisfaction was positively associated with food addiction (β=.31, 95% CI=.17-.46), and the relationship was partially mediated by the eating expectancy that eating leads to feeling out of control (β=.41, 95% CI=.30-.52). No other eating expectancies significantly mediated this association. Findings suggest the need to address the influence of the expectancy that eating leads to feeling out of control in interventions for body dissatisfaction-food addiction psychopathology among college students.

Deserving Of Love And Passion
Ada H Zohar1,2
1Ruppin Academic Center, Emek Hefer, Israel, 2Lior Zfaty Center for the Prevention of Suicide and Mental Pain, Emek Hefer, Israel

This study examined to what extent individuals feel worthy of being loved, and whether romantic partner-entitlement (RPE) would be protective against exposure to the thin-ideal.  Participants were 570 community volunteers 18-63 years old. Most were college educated and were in a relationship. BMI ranged from 12 -70. Participants self-reported on positive eating, body experiences, self-esteem, social support, well-being, and mood. In addition, they were asked four questions about feeling RPE. They were then randomly allocated to one of two conditions: exposure to pictures of gender-matched models, or neutral pictures. Participants then completed the second part of the mood questionnaire. The outcome measures were RPE, and the protective role of RPE on mood on thin-ideal exposure. Participants in a relationship had higher values of RPE. Hierarchical linear regression for RPE resulted in R2=40.1% with no contribution from BMI or age, and contributions for body narcissism, sexual fulfilment, vitality, subjective health, social support, positive eating, life satisfaction, and self-directedness. Mood change after exposure to the thin ideal was not predicted by BMI, gender or age; there was an intervention effect  and no additional explained variance by RPE. Conclusions: Partner-entitlement is an interesting psychological indicator of physical and mental well-being, not dependent on BMI or on gender. It does not however protect against the ill-effect of thin-ideal exposure.

Gender And Sexual Minority Individuals Enter Higher Levels Of Eating Disorder Specialty Care With More Severe Eating Disorder Symptoms And Greater Frequencies Of Trauma-Related Risk Factors
Janell L. Mensinger1, Janeway L. Granche1, Shelbi Cox2, Jennifer Henretty2
1Drexel University, Dornsife School of Public Health, Philadelphia, PA, United States, 2Center for Discovery, Discovery Behavioral Health, Los Alamitos, CA, United States

Significant health disparities exist for individuals identifying as gender and/or sexual minorities (GSM). Eating disorders (EDs) occur at higher rates in this population. To date, we know little about the risk factor profiles of GSMs who have entered higher levels of ED specialty care. The aims of our study are to 1) compare risk factor profiles of GSM to non-GSM individuals when entering higher levels of care, and 2) determine if GSMs present to treatment with more severe ED symptoms than their cisgender heterosexual peers. We conducted secondary analysis of a de-identified database of 2896 individuals with an ED, 488 (17%) of whom identified as GSM. Aim 1 was tested with chi-squares; Aim 2 used random coefficients models with EDEQ scores measured over time. GSM individuals were more likely to have a history of substance abuse (25.9% vs. 14.3%, p<.001), suicide attempts (30.2% vs. 11.9%, p<.001), sexual abuse (24.9% vs. 13.6%, p<.001), bullying (21.6% vs. 12.3%, p<.001), and physical/emotional abuse (21.9% vs. 12%, p<.001). Random coefficients models showed that at treatment initiation, GSMs had higher EDEQ scores (b=.41, SE=.08, p<.001). These data suggest disparities in ED prevalence among GSMs may be due to their elevated risk factor profiles. Moreover, although it is well-established that GSMs have higher rates of EDs than the general population, they are initiating higher levels of care with more severe symptoms, suggesting potential barriers to treatment.

Using An Empirically Derived Classification Of Child Abuse To Examine Prospective Associations Of Abuse With Eating Disorders Developing In Young Adulthood 
Hannah N. Ziobrowski1, Stephen L. Buka1, Adam J. Sullivan2, S. Bryn Austin3,4, Nicholas J. Horton5, Alison E. Field1,6
1Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States, 2Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States, 3Department of Social and Behavioral Sciences, Harvard University T.H. Chan School of Public Health, Boston, MA, United States, 4Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States, 5Department of Mathematics and Statistics, Amherst College, Amherst, MA, United States, 6Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States

Previous studies examining associations of child abuse with eating disorders (EDs) have not accounted for the timing and co-occurrence of abuse types in their classifications of abuse. 
Data came from 5,932 women followed from 1996-2013 in the Growing Up Today Study (11 waves). Latent class analysis identified classes based on self-report of physical, sexual, and emotional abuse occurring in childhood (before age 11) and adolescence (ages 11-18). Associations of classes with symptoms of bulimia nervosa, binge eating disorder, and other specified eating or feeding disorder developing in young adulthood were examined with generalized estimating equations. Six classes of abuse were identified: 1) None; 2) Child physical; 3) Adolescent emotional; 4) Child and adolescent sexual; 5) Child and adolescent physical and emotional; 6) Child and adolescent physical, sexual, and emotional. Compared to women in the no abuse class, those in each abuse class were more likely to develop ED symptoms (ORs ranged from 1.25 to 2.45). Regardless of class membership, most women who developed ED symptoms reported them on only one survey. However, women in abuse classes were more likely to receive ED treatment than those in the no abuse class (OR: 2.23; 95%CI: 1.10-4.51). Women with abuse were more likely to develop ED symptoms. Those who reported abuse in both childhood and adolescence had the greatest odds. Women with a history of abuse should have disordered eating assessed as part of treatment.

Predictors And Moderators Of Treatment Outcome In A Randomized Clinical Trial For Adults With Binge-Eating Disorder
Lisa M. Anderson1, Kathryn M. Smith2, Lauren M. Schaefer2, Ross D. Crosby2, 3, Li Cao2, Scott G. Engel2, 3, Scott J. Crow1, 4, Stephen A. Wonderlich2, 3, Carol B. Peterson1, 4
1University of Minnesota, Minneapolis, MN, United States, 2Sanford Center for Biobehavioral Research, Fargo, ND, United States, 3University of North Dakota, Fargo, ND, United States, 4The Emily Program, Minneapolis, MN, United States

The current study examined predictors and moderators of two interventions for binge eating disorder (BED). Methods: Participants were 112 adults with BED (Mage = 39.7+13.4 years; MBMI = 35.1 +13.4 kg/m2; 82% female; 91% Caucasian) recruited from the midwestern region of the United States and randomly assigned to Integrative Cognitive-Affective Therapy for BED (ICAT-BED) or guided self-help cognitive-behavioral therapy (CBTgsh). Generalized linear models tested predictors and moderators of treatment outcomes (binge episode frequency, global eating pathology) at end-of-treatment (EOT) and 6-month follow-up (FU). Results: Greater pretreatment levels of dietary restraint predicted worse binge eating and global eating pathology outcomes at EOT and FU. Individuals with greater actual-ideal self-discrepancy had greater reductions in binge frequency at EOT and FU in ICAT-BED, compared to CBTgsh. Individuals with greater baseline levels of emotion dysregulation, and negative self-directed style (self-blame, self-control) had greater reductions in binge frequency at EOT in ICAT-BED than in CBTgsh. Further, individuals with higher pretreatment self-blame at baseline had greater reductions in global eating disorder psychopathology at EOT and FU in ICAT-BED, than in CBTgsh. Conclusions: Findings suggest that ICAT-BED may confer specific benefit for individuals with emotion regulation difficulties, negative self-directed styles, and greater actual-ideal self-discrepancy.

Family-Based Treatment For Children And Adolescents With Eating Disorders: A Mixed Methods Evaluation Of A Blended Evidence-Based Implementation Approach
Jennifer Couturier1, Melissa Kimber1, Melanie Barwick2, Tracy Woodford1, 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, United States

Introduction: This study evaluated a blended implementation approach with teams providing Family-Based Treatment (FBT) to adolescents with eating disorders. Methods: Four sites participated in a sequential mixed method pre-post study to evaluate the implementation of FBT in their clinical settings.  The implementation approach included: 1) preparatory site visits; 2) the establishment of implementation teams; 3) a training workshop; 4) monthly clinical consultation; 5) monthly implementation consultation; and, 6) fidelity assessment.  Quantitative measures examining attitudes toward evidence-based practice, organizational learning environment, organizational readiness for change, and individual readiness for change were delivered pre and post implementation.  Qualitative interviews were performed at the conclusion of the study.  Results:  Seventeen individuals participated (nine therapists, four medical practitioners, and four administrators).  The threshold of 80% fidelity on every FBT session was achieved by only one therapist.  None of our baseline variables were associated with implementation success or changed significantly from pre- to post implementation.  Qualitative data indicated that all participants found the implementation intervention helpful.  Conclusions: Our blended implementation approach was well received by participants.  A larger trial is needed to determine which factors predict FBT fidelity.

Identifying Trajectories Of Change In Eating Disorder Psychopathology And Mental Health During Outpatient Treatment
J.A. de Vos1,2, M. Radstaak2, E.T. Bohlmeijer2, G.J. Westerhof2
1Stichting Human Concern, centrum voor eetstoornissen, Amsterdam, Netherlands, 2Twente University, department of Psychology, Health & Technology, Enschede, Netherlands

Introduction In this study we sought to identify distinct interindividual trajectories of change (latent recovery groups) in symptom remission and mental health during ED outpatient treatment. Method A latent growth mixture model (LGMM) was applied on a dataset of 442 ED patients who had received five measurements (every three months) during a year of outpatient treatment. The global score of the Eating Disorder Examination Questionnaire was used for the measurement of symptom remission and the Mental Health Continuum Short Form for the measurement of mental health. Results The most parsimonious model showed three classes (recovery groups) of patients with distinct recovery trajectories for eating disorder psychopathology. A first group (55%) had a high symptom level at baseline and a very slow trajectory of improvement. A second group (20%) had a high symptom level at baseline and a steep trajectory of improvement and a last group (25%) had an intermediate level of symptoms at baseline and no significant trajectory of improvement. For mental health, also three groups were found. Several background characteristics were found to be associated with class membership. Discussion Further research should focus on examining which patient background characteristics may be associated with class membership in order to predict treatment response as early in treatment as possible.

  The Development Of A Chatbot For The Prevention Of Eating Disorders
Ellen E Fitzsimmons-Craft1, Naira W Topooco2,3, William Chan3,4, Marie-Laure Firebaugh1, Arielle Smith1, Burkhardt Funk5, Nicholas C Jacobson6, Shiri Sadeh-Sharvit7, Denise E Wilfey1, C Barr Taylor3,4
1Washington University in St. Louis, Department of Psychiatry, St. Louis, MO, United States, 2Department of Behavioral Sciences and Learning, Linkoping, Sweden, 3Palo Alto University, Center for m2Health, Palo Alto, CA, United States, 4Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States, 5Leuphana University of Lüneburg, Lüneburg, Germany, 6Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States, 7Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel

Introduction: Eating disorders (EDs) are common and disabling problems. Fortunately, risk factors for EDs have been identified and interventions have been developed to reduce these risk factors. StudentBodies is one such approach, but is most effective when moderated (ES >0.40 when targeted for women at risk of ED in coached format). However, human guided coaching is expensive, unstandardized and not available in many parts of the U.S. or abroad.  Methods: This study describes the design process of the first chatbot to deliver a targeted EDs prevention program, aiming to keep intervention effective while scalable and low-cost. The original StudentBodies© was reworked into1) brief, 5-10 minute interactive psychoeducational conversations; and 2) brief, interactive follow-up skills training conversationsto further learning of key tenets of the StudentBodies© program. The content was implemented into the chatbot TessaTM, provided by a chatbot company X2AI. Results:StudentBodies is being evaluated on a national level with women 18-30 years at high risk for the onset of ED, with recruitment via Facebook and intervention conducted using SMS text messaging or Facebook messenger. Preliminary results will be presented.   Conclusion:If effective, the program could provide an inexpensive prevention program to any female at high risk for the onset of an ED, anywhere, anytime. 

Does Experiencing Care As Collaborative Enhance Inpatient Eating Disorders Treatment Outcome?  
Josie Geller1,2, Lindsay Samson1, Nadia Maiolino1, Suja Srikameswaran1
1St. Paul's Hospital Eating Disorders Program, Vancouver, BC, Canada, 2Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

Introduction: Inpatient eating disorders treatment is costly and resource intensive. Evidence suggests that collaborative care produces higher levels of patient motivation to change, a predictor of better outcome. Unfortunately, given that mandatory treatment components are central to effective inpatient care, fostering a collaborative environment can be challenging. This study examined whether experience of care as collaborative contributed directly to better outcome and explored whether collaborative care was associated with the manner in which mandatory treatment components (e.g., weight gain, abstinence from use of compensatory strategies) were delivered. Methods: Inpatients (N = 146) completed measures of readiness for change, eating disorder and psychiatric symptoms, and quality of life, pre and post-treatment. At post, they also completed measures of collaborative care and the extent to which mandatory treatment components were implemented with a sound rationale, consistency, advance warning, and the provision of choices. Results: Experiencing care as collaborative was associated with improvements in nearly all symptom domains. Collaboration ratings were also associated with the manner in which mandatory treatment components were implemented. Conclusions: Findings add to the growing literature that enhancing patient collaboration and autonomy on inpatient units is associated with best outcomes, and may be fostered by the delivery of mandatory treatment components. 

Increased Mindfulness Predicts Improvements In Hedonic Eating And Glucose Metabolism Following A Mindfulness-Based Intervention (Mbi) In Adolescent Girls At Risk For Type 2 Diabetes (T2D)
Lauren D Gulley1, Lauren B Shomaker1,2,3, Shelly K Annameier1, Jordan Quaglia4, Kirk Warren Brown5, Patricia Broderick6, Christopher Bell7
1Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States, 2Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, United States, 3Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States, 4Department of Contemplative Psychology, Naropa University, Boulder, CO, United States, 5Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States, 6Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, PA, United States, 7Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States

Purpose: T2D is on the rise in adolescents. Increases in depression may worsen glucose metabolism and increase T2D risk via hedonic eating. Increasing mindfulness through MBI may decrease hedonic eating and T2D risk. Methods: Secondary analyses were performed on a pilot RCT comparing 6-session MBI v cognitive-behavioral therapy (CBT) in 33 15+/-2y girls with overweight, depression, and T2D family history. At pre, post, and 1-year, mindfulness, adiposity, insulin, glucose, and hedonic eating, including food reward responsiveness and eating in the absence of hunger (EAH), were assessed. ANCOVA tested condition main effects on outcomes accounting for initial outcome level. Moderation analyses tested if changes in mindfulness differentially predicted changes in eating or glucose metabolism by condition. Results: MBI v CBT showed greater decreases in food reward (p<.01) and EAH (p<.05) at 1-year follow-up. Increased mindfulness during the intervention predicted decreases in food reward (p<.01) and EAH (p<.05) at 1-year follow-up only in MBI, but not CBT. Increased mindfulness predicted subsequent decreases in 1-year fasting glucose in MBI (p<.01), but not CBT. There were no main or interaction effects for insulin or insulin resistance. Conclusions: MBI may be a promising psychosocial intervention to address hedonic eating patterns that contribute to elevated T2D risk in adolescents. Increasing mindfulness may be a mechanism by which MBI improves hedonic eating and glucose.

The Effect Of Using Imagery Rescripting Of Autobiographical Memories Versus Imagery Rescripting Of Intrusive Images In Core Beliefs And Eating Disorder Symptoms
Fortesa Kadriu1, 2, Laurence Claes1, Cilia Witteman2, Julie Krans2
1KU Leuven, Leuven, Belgium, 2Radboud University, Nijmegen, Netherlands

Research indicates that intrusive images are a prominent feature in eating disorders (ED) and may be a core maintaining mechanism. They may represent self-images associated with previous negative experiences.The objective of the research project is to investigate the effect of imagery rescripting (ImRs) of intrusive image and early autobiographical memories on core beliefs and eating disordered behaviors. Participants were randomly allocated to one of three conditions: ImRs of intrusive images, ImRs of negative autobiographical memories and a non-imagery manipulation (a no task control). Participants in the first two conditions identified either an intrusive image or a negative memory associated with their disordered eating and described the meaning they associate with the image or the memory. Then, they received a 9-minute ImRs intervention (a self-guided ImRs protocol via PC) in the lab and for the next 6 days online. All participants completed questionnaires on eating disorder symptoms and core beliefs, and attended a follow-up testing after one week. During this talk I will present the preliminary data of the study. It is expected that both ImRs manipulations will result in greater reductions in all outcome measures (i.e., intrusive image/autobiographical memory characteristics, core beliefs and ED symptoms) compared to control group, because ImRs should change the meaning of the image to a more positive one whereas the control group should not change the image content.  

Predictors Of Early Improvements In Access To Emotion Regulation Strategies During Intensive Treatment
Danielle E. MacDonald1,2, Kathryn Trottier1,2
1Centre for Mental Health, University Health Network, Toronto, ON, Canada, 2Department of Psychiatry, University of Toronto, Toronto, ON, Canada

INTRODUCTION: Rapid and substantial behavior change (RSBC) is the most robust predictor of good outcomes from CBT-based eating disorder treatments. Recently, we demonstrated that early improvements in access to emotion regulation strategies predicted intensive treatment outcomes, over and above RSBC, both at end-of-treatment and at 6-month follow-up (MacDonald et al., 2017; under review). To date, no consistent pre-treatment patient characteristics have been found to predict RSBC. This secondary analysis investigated predictors of early improvements in emotion regulation.
METHODS: Participants had bulimia nervosa or purging disorder and completed ≥6 weeks of CBT-based intensive treatment. Several baseline variables were examined as potential predictors of changes in emotion regulation between baseline and week 4.
RESULTS: Individuals with more pathological defectiveness/shame schemas made greater early improvements in overall emotion regulation difficulties. Those with more pathological defectiveness/shame schemas and more severe depression symptoms made greater improvements in access to emotion regulation strategies specifically.
CONCLUSIONS: It is encouraging that those with more severe depressive schemas and symptoms made the greatest improvements in emotion regulation, which were associated with better treatment outcomes in our previous paper. This may be due, in part, to them having higher baseline emotion regulation difficulties.

Investigating Early Response To Treatment In A Multi-Site Study For Adolescent Bulimia Nervosa 
Brittany Matheson1, Sasha Gorrell2, Cara Bohon1, W. Stewart Agras1, Daniel Le Grange2, 3, James Lock1
1Stanford University School of Medicine, Stanford, CA, United States, 2University of California, San Francisco School of Medicine, San Francisco, CA, United States, 3The University of Chicago (Emeritus), Chicago, IL, United States

Introduction: This secondary data analysis seeks to replicate and extend findings that early response to treatment in adolescent bulimia nervosa (BN) predicts outcome, resulting in earlier identification of patients who need a different treatment approach. Methods: Participants were 130 adolescents (M ± SD: 15.69 ± 1.49 y; 92% female; 75% Caucasian) with a DSM-IV diagnosis of BN or partial BN enrolled in a two-site treatment study (see Le Grange et al., 2015). Participants were randomized to cognitive behavioral therapy for adolescents, family-based treatment, or supportive psychotherapy. The Eating Disorder Examination was administered at baseline, end of treatment (EOT), 6-month and 1-year follow-up. Binge and purge symptoms were reported at each session. Outcome was defined as no binging or purging in the 28 days prior to assessment. Receiver operating characteristic (ROC) analyses will be utilized to assess the viability of predicting treatment outcomes based on reduction of symptoms early in treatment. Results: Preliminary analyses on a subset of the sample suggest symptom reduction in purging at session 3 and binging at session 4 indicate treatment response at EOT. We plan to conduct full sample analyses across time points as well as evaluate differences in early response based on treatment type. Conclusions: This study seeks to better understand early markers of progress in adolescent BN treatment in order to inform clinical care.

Changing Self-Perceptions In Eating Disorders
Carrie J McAdams1,2, Susan Mericle1, Bethany Hunt1, Jessica A Harper1, Whitney Smith Hagan1
1UT Southwestern Medical School, Dallas, TX, United States, 2Children's Medical Center, Dallas, TX, United States

Introduction. Eating disorders (ED) include altered perceptions about oneself. Neural activations during social perspective-taking and cognitive differences in an interpersonal attribution bias, the externalizing bias, vary with recovery state in anorexia nervosa. The externalizing bias measures one’s tendency to attribute positive versus negative scenarios to oneself. Evidence-based treatments for EDs focus on cognitions and behaviors related to eating and body-image, not social perspective-taking or self-attributions.
Methods. We piloted an outpatient treatment targeting these constructs: the Self-Blame and Perspective-Taking Intervention (SBPI). The SBPI consisted of art-therapy experientials and psychoeducation about social attributions, delivered through four two-hour groups over one month. Discussion about either ED cognitions or behaviors was not permitted in groups. Sixteen participants with EDs provided pre (month before) and post (month after) data assessing interpersonal attributions, self-esteem, and psychiatric symptoms with a MANOVA. Results. We observed significant improvements in the externalizing bias (p = 0.004) and state self-esteem (p = 0.012) as well as reductions in eating disorder symptoms (p = 0.002). Conclusion. A brief intervention for outpatients can alter constructs related to self-perceptions as well as ED symptoms. More research is needed to understand how interpersonal attributions relate to illness expression in EDs.

Motivation Versus Psychoeducation-Infused Day Hospital Treatment For Eating Disorders
Jennifer S. Mills1, Gillian Kirsh2, Jacqueline Hogue1
1York University, Toronto, ON, Canada, 2North York General Hospital, Toronto, ON, Canada

Maximizing patients’ motivation to recover from an eating disorder (ED) is a major challenge. There is little evidence that motivational approaches work on their own, but motivationally focused pre-treatments appear somewhat helpful for treatment retention. This is an ongoing feasibility study examining motivational-interviewing-infused treatment throughout multifaceted hospital-based day treatment for an ED. We compared 35 transdiagnostic (mostly BN) adult patients across two psychosocial adjunctive treatments: Motivation-oriented (emphasizing patient-centered decision making) versus Psychoeducation-oriented (emphasizing the causes and negative consequences of an ED). Adjunctive treatment consisted of individual therapist contact and a self-help manual. In a randomized controlled trial design, we assessed participants at entry, 6 weeks, and 10-12 weeks into the program. Outcomes include treatment completion, symptom change, and treatment satisfaction. Results suggest that participants in the Motivation group were more likely to complete treatment than those in the Psychoeducation group and were more satisfied with their treatment. Participants in the Motivation group also felt more confident that they could fully recover. Self-help manual use was generally low, but patients reported liking them. We conclude that there is no apparent elevated risk of early drop-out of hospital day treatment for an ED when patient-centered decision-making is emphasized.

Comparison Of Two Maintenance Treatments For Anorexia Nervosa 12 Months Following Intensive Treatment
Marion P Olmsted1,2, Danielle E MacDonald1,2
1University Health Network, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada

There are few investigations related to the effectiveness of maintenance therapies (MT) focused on relapse prevention. This study compared the effectiveness of a group-based maintenance treatment (GMT) to individual CBT for AN. Participants were 44 patients diagnosed with AN prior to intensive inpatient or day treatment (IT), who made significant improvements during IT, completed at least 4 weeks of MT and attended 6 and 12 month follow-up assessments. This was a sequential cohort design with only one of the treatments available at any time. GMT consisted of 2-5 group sessions per week for up to 20 weeks and CBT consisted of 16 individual sessions over 14 weeks. Patients were assessed before and after IT, after MT and at 6 and 12 months. Linear and logistic regression models were used to examine whether MT type predicted BMI and relapse status at 6- and 12-months. Although treatment type did not predict relapse or BMI at 6-months, at 12-months individual CBT had a lower BMI than GMT (p<.05). At the 12-month assessment, 42.1% of GMT and 62.5% of CBT had a BMI less than 18.5 and/or 4 or more episodes of bingeing/ vomiting/ laxative use in the past month. The increased support provided in GMT (6-15 hours weekly vs 1-2 hours weekly for CBT) appeared to be more effective in helping AN patients maintain their weight in the months after MT ended. However, relapse rates were high in both conditions, underscoring the challenges in providing effective treatment for this illness.

Preliminary Efficacy Of Peer Mentorship In Outpatients With Anorexia Nervosa, Bulimia Nervosa, Or Binge Eating Disorder
Lisa Ranzenhofer, Kaitlin Sanzone, Annabella Hochschild, Elisabeth Larson, B.Timothy Walsh, Evelyn Attia
Columbia University Medical Center, New York, NY, United States

Peer mentorship has proliferated in the ED field, but no study has systematically evaluated its efficacy. A parallel, 3-arm RCT was designed to test the efficacy of peer mentorship in outpatients with AN, BN, or BED. Subjects were randomized to peer mentorship (PEER) or an active (“social support”, SS) or inactive (“wait list”, WL) control condition for 6 months. ED symptoms and general psychopathology were assessed at baseline (BL), mid-intervention (M3) and post-intervention (M6) using the Eating Pathology Symptoms Inventory (EPSI) Body Dissatisfaction, Cognitive Restraint and Restriction subscales and the ED Quality of Life scale (ED-QOL), and standardized measures of depression and anxiety. Intent-to-treat analyses of group differences in symptom trajectories from BL to M3 were performed using LMM. M6 outcomes will be available at time of presentation. Sixty subjects (28.5±7.0y) were randomized: 20 to PEER, 18 to SS, and 22 to WL. One third participated in-person and 2/3 participated “online” via videochat. Discontinuation of mentorship was more common in SS (28%) compared to PEER (0%). Subjects randomized to PEER, but not SS, exhibited greater reductions in EPSI-Body dissatisfaction (p = 0.01) and anxiety (p =0.03) and marginally greater improvement in ED-QOL (p = 0.09), compared to WL. There were no group differences for EPSI-Cognitive Restraint or Restriction subscales or depression. Peer mentorship shows promise as an adjunct intervention for ED patients.

Randomized-Controlled Trials On The Effects Of Music In People With Or At Risk For Eating Disorders
Francesca Testa1,2, Sarah Arunachalam2, Annette Heiderscheit,3, Hubertus Himmerich1,4
1Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom, 2Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom, 3Department of Music Therapy, Augsburg University, Minneapolis, MN, United States, 4South London and Maudsley NHS Foundation Trust, London, United Kingdom

Introduction: The prevalence of the three main eating disorders (EDs) anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) is increasing. A growing number of patients with EDs is seeking professional help, and the mortality of people with EDs is high. Thus, there is a need for additional treatment strategies in EDs.
  Methods: Following the PRISMA guidelines, we performed a systematic literature review on the therapeutic use of music in EDs using PubMed as a database and including “music”, “music therapy”, “eating disorders”, “anorexia nervosa”, “bulimia nervosa” and “binge eating disorder” as search terms.   Results: Five out of 17 identified and screened articles qualified as scientific studies. They reported on the use of music or music therapy in AN and BN, but not BED. In inpatients with AN, listening to classical music was beneficial to food consumption. Singing in a group reduced post-prandial anxiety in AN patients. Vodcasts which also included positive visual or autobiographical stimuli helped BN patients with anxiety and body image perception. Watching music videos, however, reinforced body dissatisfaction and the drive for thinness in teenage girls.   Conclusions: These findings suggest that the therapeutic application of music may be beneficial in patients with AN and BN under certain circumstances. However, the availability of studies with a rigorous randomized controlled trial (RCT) design is scarce.

Patient And Therapist Perceptions Of Autonomy Support: Relationships To Client Motivation And Eating Disorder Treatment Outcome
Lea Thaler1,2, Chloé Paquin-Hodge1,2, Audrey Mariamo1, Maria Tuntisi3, Annie St-Hilaire1,2, Esther Kahan1, Mimi Israel1,2, Howard Steiger1,2,3
1Eating Disorders Continuum, Douglas University Institute, Montreal, QC, Canada, 2Department of Psychiatry, McGill University, Montreal, QC, Canada, 3Department of Psychology, McGill University, Montreal, QC, Canada

otivation to engage in therapy is an important factor that predicts treatment outcome in eating disorders (EDs). Self-Determination Theory posits that autonomy supportive actions by therapists can enhance autonomous motivation in patients which in turn can enhance ED outcomes. The current study examined both patient and therapist perceptions of therapist autonomy support and its relationship to motivation and treatment outcomes in patients with EDs. Methods: The current sample includes 30 adult outpatients undergoing treatment for an ED (AN, BN, OSFED or ARFID diagnoses) and 11 therapists providing treatment. By the time of presentation we hope to have a sample of 45 patients. Measures included patients’ self-report of eating symptoms and motivation at the start, mid-point and end of a 4-month treatment, as well as patient and therapist ratings, every month, of perceptions of therapist autonomy support after sessions. Results: Hierarchical Linear modelling will be used to examine concordance between patient and therapist ratings of autonomy support and whether perceived support predicts higher levels of autonomous motivation and ED symptom improvement. Conclusions: Preliminary results show a positive correlation between therapist perceived autonomy support and patient autonomous motivation and a negative correlation between therapist support and patient ED symptoms. Results can help identify therapeutic processes that could enhance treatment outcome for patients with EDs.

Inpatient Treatment For Adolescents With Severe Bulimia Nervosa: Clinical Significance And Predictors Of Treatment Outcome
Ulrich Voderholzer1,2, Silke Naab1, Markus Fumi1, Sandra Schlegl2
1Schoen Clinic Roseneck, Prien, Germany, 2University Hospital, Department of Psychiatry and Psychotherapy, Munich, Germany

Purpose: Inpatient treatment for patients with bulimia nervosa (BN) may be considered (i) if they are severely disturbed regarding eating and compensatory behavior; (ii) if they are non-responding to previous outpatient treatment; (iii) if they are suffering from severe comorbid conditions; and (iv) if they live in a treatment-impeding environment. There are few studies evaluating the effectiveness of inpatient treatment for adults with BN. The aim of this study was to evaluate treatment outcomes of adolescents with BN and to explore predictors of clinically significant changes in eating disorder (ED) symptoms. Methods: A total of 275 female inpatients were assessed at admission and at discharge on the following measures: body-mass-index (BMI), eating disorder symptoms (Eating Disorder Inventory-2, EDI-2), general psychopathology and depression. Results: 30.6% of patients showed a reliable change in EDI-2 Global score and 35.4% showed clinically significant changes between admission and discharge. 34% of patients remained unchanged; no one deteriorated. Predictors of clinically significant changes will be presented. Conclusions: Intensive psychotherapeutic inpatient treatment is highly effective in two thirds of severely affected adolescents with BN. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients. Furthermore, follow-up studies are indicated to investigate long-term effectiveness.

Transdiagnostic Cognitive Remediation Therapy For Patients With Eating Disorders: A Protocol For A Randomized Controlled Trial
Siri Weider1,2, Tora Thorsrud1,2, Camilla L. Dahlgren3
1Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway, 2Specialised Unit for Eating Disorder Patients, Department of Psychiatry, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway, 3Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway

Introduction. Cognitive difficulties are common in patients with eating disorders (EDs). This randomized controlled trial (RCT) aims to investigate the effect of cognitive remediation therapy (CRT) in a transdiagnostic sample of patients with EDs and concomitant cognitive difficulties. Methods. In this assessor-blind parallel study, patients meeting the criteria for an ED and exhibiting cognitive difficulties will be randomized either to receive 9 hours of individually tailored CRT (n=50) or to a control group (n=50). The patients will be assessed with a battery of neuro­psychological tests and self-report questionnaires prior to the intervention, immediately afterward, and 6 months after the end of the intervention. Results.The primary outcome of the study is performance on neuropsychological tests of executive function, self-reported executive function, and self-reported ED symptoms at the 6-month follow-up. Secondary outcome measures include general psychopathology, quality of life, a broader battery of neuro­psychological tests, and objective measures of sleep and activity. Conclusions. This project proposes a unique contribution through a transdiagnostic approach that embraces patients with a variety of ED diagnoses, including understudied diagnoses such as Binge Eating Disorder and the “atypical” EDs. A lack of evidence-based treatment for EDs represents an obstacle to recovery, so the current project may contribute to increased rates of recovery across ED diagnoses

Sunday, September 8, 2019

9:00 - 10:30 AMChicago 9/10
Top Abstracts & Awards

Chair(s): Jennifer Wildes
A Randomized Comparison Of Icat-Bed And Cbt-Gsh To Treat Binge Eating Disorder Using Standard And Naturalistic Momentary Outcome Measures
Carol Peterson1, Scott Engel2, Ross Crosby2, Scott Crow1, Tracey Smith3, Marjorie Klein4, James Mitchell2, Timothy Strauman5, Li Cao2, Ann Erickson2, Kayla Bjorlie6, Stephen Wonderlich2
1Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States, 2Sanford Research, Fargo, ND, United States, 3Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, Houston, TX, United States, 4Department of Psychiatry, University of Wisconsin Medical School, Madison, WI, United States, 5Department of Psychology and Neuroscience, Duke University , Durham, NC, United States, 6Department of Psychology, University of Kansas, Lawrence, KS, United States

Purpose: To compare Integrative Cognitive-Affective Therapy (ICAT-BED), a psychotherapy targeting momentary behavioral and emotional precipitants of binge eating (BE), with cognitive-behavioral therapy, guided self-help (CBTgsh) for binge eating disorder (BED). In addition to standard outcome measures, ecological momentary assessment (EMA) using technology-based naturalistic behavior sampling was used to measure BE. Methods: 112 adults with BED were randomized to 21 sessions of ICAT-BED or 10 sessions of CBTgsh over 17 weeks. BE frequency was assessed using the EDE and EMA at end of treatment (EOT) and 6-month follow-up (6MF). Results: Significant reductions in BE were observed at EOT and 6MF with no significant differences between groups. EDE BE abstinence rates at EOT (ICAT-BED: 57.1%; CBTgsh: 42.9%) and 6MF (ICAT-BED: 46.4%; CBTgsh: 42.9%) were not significantly different. Secondary measures including hypothesized maintenance mechanisms also showed improvement with no treatment differences. Treatment retention was higher for ICAT-BED (87.5%) than CBTgsh (71.4%). Conclusions: These findings suggest that ICAT-BED and CBTgsh were associated with similar reductions in BE as measured by the EDE as well as EMA, and that these improvements were generally sustained at 6MF. Although no differences between treatments were observed, ICAT-BED was associated with higher levels of treatment retention than CBTgsh and may be more acceptable to some adults with BED.

Shortening Duration Of Untreated Illness Through Implementation Of An Early Intervention Service: A Quasi-Experimental Study
Ulrike H Schmidt1,2, Michaela Flynn1, Amelia Austin1, Karina Allen1,2, Nina Grant2, Victoria Mountford2, Danielle Glennon2, Amy Brown2, Mary Franklin-Smith3, Monique Schelhase3, Rhys William Jones3, Lucy Serpell4, Kate Mahony4, Gaby Brady5, Nicole Nunes5, Frances Connan5
1King's College London, London, United Kingdom, 2South London and Maudsley NHS Foundation Trust, London, United Kingdom, 3Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom, 4North East London NHS Foundation Trust, London, United Kingdom, 5Central and North West London NHS Foundation Trust, London, United Kingdom

Introduction: Duration of untreated illness is a key outcome in early intervention across diverse disorders. Internationally, duration of untreated eating disorder (DUED) is 2.5-6 years. To shorten DUED, we developed FREED (First Episode Early Intervention for Eating Disorders), an early intervention care pathway for emerging adults with eating disorders (Eds). Here we assess the effects of implementing FREED in a multi-centre study, including impact on DUED.  Methods: We used a pre-post design to assess DUED in patients receiving FREED or those receiving treatment as usual (TAU). Patients from 4 centres were included if they were: aged 16-25, had a first episode ED (<3 years duration) and presented during the study period. Baseline sociodemographic and clinical information was obtained. Illness onset and trajectory to first treatment were assessed with a semi-structured interview. ED outcomes and service utilisation for FREED patients were assessed at 0, 3, 6, and 12 months and for TAU patients obtained from their case notes at similar timepoints. Results: 278 FREED and 222 TAU patients were included. Mean age was 20.2 years. 46% of patients had anorexia nervosa. DUED was 15.2 months for FREED versus 20.7 months for TAU (p <0.001). Clinical outcomes and service utilisation up to 6 months will be presented. Conclusions: Data show FREED is effective at improving outcomes and is scalable. This has important implications for service delivery in early stage EDs. 

Differences In Genetic And Environmental Influences On Body Dissatisfaction And Weight Preoccupation Across Pubertal Development In Females
Shannon M. O'Connor1, Kristen M. Culbert2, Laura A. Mayhall3, S. Alexandra Burt3, Kelly L. Klump3
1University of Chicago, Chicago, IL, United States, 2University of Nevada-Las Vegas, Las Vegas, NV, United States, 3Michigan State University, East Lansing, MI, United States

The heritability of disordered eating increases during puberty; however, prior studies have largely examined a composite score of disordered eating rather than specific symptoms. Cognitive symptoms of eating pathology cut across all eating disorder diagnoses and are some of the strongest prospective risk factors for the development of eating disorders. Yet, little is known about potential developmental increases/decreases in genetic and environmental influences for these key symptoms. This study examined differences in genetic and environmental effects on a range of body weight and shape concerns during puberty and compared results to findings for overall levels of disordered eating. Participants were 926 same-sex female twins. Well-validated questionnaires were used to examine disordered eating and pubertal maturation. Findings for overall levels of disordered eating were very similar to those obtained in previous work, with significantly increased genetic effects in girls at more advanced pubertal development. Importantly, these same pubertal increases in genetic influences were observed for body dissatisfaction, shape concerns, and weight concerns. However, no pubertal moderation of genetic effects was observed for weight preoccupation; instead, pubertal moderation of nonshared and shared environmental effects was observed. Our findings point to differences in the extent to which genetic and environmental factors contribute to body weight and shape concerns during puberty.

Treating Binge Eating Disorder: Dialectical Behaviour Therapy Compared To Cognitive Behaviour Therapy In A Controlled Trial.
Mirjam Lammers1,2, Maartje Vroling1,2, Ross Crosby3, Van Strien Tatjana2,4
1GGNet Amarum, Zutphen, Netherlands, 2Radboud University, Nijmegen, Netherlands, 3Sanford Center for Bio-Behavioral Research, Fargo, ND, United States, 4Free University Amsterdam, Amsterdam, Netherlands

Purpose: Cognitive behavioural therapy (CBT), the treatment of choice for binge eating disorder (BED),
primarily links dieting and binge eating. CBT is effective, yet a substantial amount of people do not reach abstinence of binges. This shows the need for improvement. Dialectical Behaviour Therapy (DBT) for BED links difficulties in emotion regulation and binge eating. We tested if DBT-BED (Safer, Telch & Chen, 2009), so far only scarcely tested in BED, is a viable alternative to CBT. Methods: We compared DBT-BED to an intensive outpatient CBT program, based on the manual developed by Fairburn, Marcus and Wilson (1993) in a  controlled trial (N = 74). We assessed eating disorder pathology, emotion regulation and general psychopathology at the start and at the end of treatment as well as half a year after treatment. Results: Preliminary data of the controlled trial suggest that both treatments are effective on all measures both at end of treatment and at short term follow-up. However, CBT seems to outperform DBT on binge frequency, eating disorder psychopathology and some measures related to emotion regulation. We are currently running the final analyses. (Earlier preliminary results were presented at EDRS 2017.) Conclusions: Although DBT leads to a substantial decrease in many symptoms, CBT seems to have better results on primary outcome measures. The results of the final analyses will be discussed also in light of the theoretical basis of both therapies.

Prediction Of Binge Eating And Purging Symptoms Using Machine Learning 
Leigh C Brosof, Christopher Trombley, Cheri A Levinson
University of Louisville, Louisville, KY, United States

Relapse in eating disorders (EDs) is common. Advanced statistical techniques, such as machine learning, can be used to help predict disordered eating behaviors, such as binge eating and purging, which may inform precision treatment efforts of EDs and prevent future relapse. In the current study, we created two machine learning models to predict later binge eating and purge behaviors. Methods:Fifty-nine individuals with EDs completed ecological momentary assessment surveys four times per day for 18 days that assessed binge eating and purging (i.e., vomiting) frequency, as well as other ED symptoms and correlates. Two deep learning artificial neural networks were computed using Python to predict binge eating and purging behaviors, respectively, at the next time point. Binge eating and purging were dichotomized as present (1) or absent (0) at each time point. Results: The binge eating neural network resulted in a model that predicted binge eating at the next time point with 92.69% accuracy. The purging neural network resulted in a model that predicted purging at the next time point with 90.22% accuracy. Conclusions: These findings show the feasibility of implementing machine learning models that are extremely accurate at predicting binge eating and purging behaviors. Such models could be adopted into clinical practice to aid in the development of precision interventions to disrupt binge eating and purging and ultimately prevent relapse.

Can Eating Disorders Be Conceptualized Etiologically As The Extreme Manifestation Of Continuous Traits? Evidence From A Swedish Twin Sample
Lisa Dinkler1, Mark Taylor2, Maria Råstam1,3, Nouchine Hadjikhani1,4, Cynthia M Bulik2,5,6, Paul Lichtenstein2, Christopher Gillberg1, Sebastian Lundström1,7
1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden, 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 3Department of Clinical Sciences Lund, Lund University, Lund, Sweden, 4Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States, 5Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 6Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 7Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

Introduction: Accumulating evidence suggests that many psychiatric disorders represent the extreme end of dimensionally distributed traits rather than etiologically distinct entities. The extent to which this applies to eating disorders (EDs) is unknown. This study investigates the association of genetic risk factors between the continuous distribution of ED traits and the extremes/ED diagnoses in a large twin sample. Methods: 6680 twin pairs from the Child and Adolescent Twin Study in Sweden reported continuous ED traits on the Eating Disorders Inventory-2 at ages 15 and/or 18. ED diagnoses are identified through the National Patient Register, parent-reported ED treatment and/or frequent purging behavior. We use DeFries-Fulker extremes analysis and liability threshold models to investigate whether there is similar etiology of ED traits in the whole distribution and in percentile-based extreme groups. Using a joint categorical/continuous twin model we estimate genetic correlations between continuous ED traits and ED diagnoses. Conclusions: Consistent heritability of ED traits over different extreme groups and substantial genetic correlation between continuous ED traits and ED diagnoses would suggest that EDs can be conceptualized etiologically as the extreme manifestation of continuous traits. It would also justify studying continuous ED traits in the general population in genome-wide association studies, which could help accelerate genetic findings for EDs significantly.  

10:30 - 11:00 AMChicago Ballroom Foyer
Coffee Break

11:00 - 12:30 PMChicago 9/10
Collaborating with Computers: The Promise of Machine Learning to Advance Eating Disorders Research

Chair(s): Ann Haynos
Machine Learning To Predict Longitudinal Illness Course Of Eating Disorders
Shirley Wang
Harvard University

Developing Coaching Tools Using Machine Learning Methods For Pattern Recognition In Two Guided Self-Help Samples
Tom Hildebrandt
Mount Sinai

Using Machine Learning Algorithms And Passive Sensing Technology To Predict And Detect Disordered Eating Behaviors
Stephanie Manasse
Drexel University

Discussion: Emerging Data-Driven Mathematical Methods: Paradigm Shift Or Latest Statistical Fad?
Ross Crosby
Sanford Research

12:30 - 1:00 PMChicago 9/10
Business Meeting