Elizabeth K. Hughes

Objective: This study aimed to assess the structural validity and readability of a brief 7‐item version of the Eating Disorder Examination Questionnaire (the EDE‐Q7) among adolescents. Method: Latent variable analysis was used in a sample of 263 adolescents (age range = 13–17.99y) diagnosed with an eating disorder and recruited from treatment centres in the United States of America and Australia. Several indices were used to provide different estimates of overall model fit. Results: The EDE‐Q7 showed good fit to the data, although absolute fit indices suggested some evidence of imperfect fit. Several other models (both brief and full‐item versions) failed to meet most criteria indicating good fit. The subscales of the EDE‐Q7 showed significant correlations with several disordered eating behaviors, suggesting convergent validity. Review of the EDE‐Q7 suggests ease of readability for adolescents from at least 11 years of age. Discussion: This is one of the first clinical studies to support the EDE‐Q7 as a brief, valid assessment of eating psychopathology that can be used with adolescents as well as adults. The results indicate that the EDE‐Q7 might be appropriate for assessing eating pathology among adolescents from the age of 13 years.

Background: Population–based cohort studies are increasingly expected to demonstrate benefits for public health and wider society. However, there is limited systematic evidence on what such impact entails or how it is generated and sustained. To address this gap, we examined researcher perspectives on the impact of cohort studies. Methods: We conducted, to our knowledge, the first quantitative study of researcher views on cohort impact, recruiting active cohort researchers through national and international networks between August and December 2025. The anonymous cross–sectional survey captured researcher characteristics, perceived contributions, impact processes, challenges, and open–ended reflections. Results: A total of 163 cohort researchers participated, primarily from Australia (42%) and the UK (23%). Participants perceived their work as informing a wide range of societal issues and reported investing an average of 24% of their work time in impact–related activities. While most respondents (73%) believed their research leads to tangible policy or practice change, two–thirds indicated that impact is rarely or never demonstrable shortly after study completion (67%) and seldom attributable to a single study (67%). Key concerns included pressure to overstate contributions (80%), perceived disadvantages for cohort studies in impact assessments (78%), and inadequate skills or resources to achieve impact (65%). Conclusions: Cohort researchers perceive their work as generating broad societal contributions and invest substantial effort in supporting impact. However, they face systemic challenges in both achieving and demonstrating impact. These findings highlight the need for impact frameworks that better capture complexity, long–term influence, and cumulative contributions, while mitigating unintended consequences. Key Messages: Researchers perceive population–based cohort studies as generating broad societal value and contributing evidence relevant to complex societal challenges. Cohort impact is described as unfolding over long timescales and rarely attributable to single studies; features that sit uneasily within short–term, attribution–focused impact models. Current impact frameworks appear poorly aligned with long–term research investments and may create unintended pressures to overstate research contributions.

Key Features: Generation Victoria (GenV) is a whole-of-state research platform established to improve child and adult health, development and wellbeing through discovery and interventional research. It comprises participant-provided and service-collected data and biosamples, with planned 5-6 yearly child and parent phenotypic waves. All children living in Victoria, Australia, born between 4 October 2021 and 3 October 2023 and their parents/guardians are eligible for GenV’s ‘ Cohort 2020s’ . Recruitment remains open. We describe the GenV Cohort ‘Foundation Set’ recruited to 1 May 2025. Of eligible children, 29.7% had joined Cohort 2020s (43 945 children; 64 106 parents/guardians). Together with an ‘ Advance Cohort ’ (born December 2020-October 2021), we recruited 49 783 children and 74 270 parents/guardians (48 213 birth parent/mothers; 25 428 fathers; 314 other parents/guardians); 761 (0.6%) had withdrawn. Cohort 2020s birth mothers/parents were aged 15-54 years, 23% lived in regional/rural areas, and 25% spoke non-English languages. Data and biosample collection includes baseline surveys, biosamples (e.g., saliva 81%, stool 16%, breastmilk 16%); optional inter-wave surveys (up to 33%); residual antenatal (up to 28%) and birth biosamples (up to 97%), and extensive linkage to services, administrative and geospatial data (up to 98%). Numerous collaborative research projects are under way; end-user applications will commence 2026.

Objective: To compare all other specified feeding or eating disorders (OSFED) groups (atypical anorexia nervosa [AN], purging disorder [PD], night eating syndrome [NES], subthreshold bulimia nervosa [sub‐BN], and subthreshold binge‐eating disorder [sub‐BED]) to threshold eating disorders (EDs [AN, BN, and BED]) and control groups (CGs) on measures of eating and general psychopathology.Method: We conducted a comprehensive search in PsycINFO, Medline, Embase, and CINAHL on all published studies from January 2013 to February 2024 using DSM‐5 diagnostic criteria via clinical interviews or well‐established diagnostic tools. We also undertook a quality appraisal using an adapted version of the Downs and Black criteria and registered the review with PROSPERO (ID: CRD42022314495).Results: Overall, our meta‐analyses (n = 33 eligible studies) indicated that the combined OSFED and several specific OSFED subtypes displayed comparable levels of eating psychopathology to full‐threshold EDs. Our systematic review (n = 33 eligible studies) found individuals with OSFED to have comparable levels of eating and general psychopathology to full‐threshold EDs, but higher levels of eating and general psychopathology than CGs. These findings were specifically attributed to atypical AN and NES. There was a lack of evidence available for sub‐BN and sub‐BED. Studies mainly met the quality appraisal criteria. The main limitations identified in the included studies were insufficient reporting of their statistical power (78%) and no adjusting for potential confounding factors (67%).Discussion: Findings support the conceptualization of atypical AN, and NES as clinically significant EDs with similar severity to full‐threshold EDs.

Objective: The definition and assessment of remission in anorexia nervosa (AN) needs greater consensus. Particularly in adolescents, the use of patient‐reported composite indices (such as the Eating Disorder Examination [EDE] Global Score) as the sole measure of psychological remission has the potential to obscure patients' true clinical status, given developmental factors and the propensity towards symptom minimization in AN.Method: End of treatment (EOT) data from a randomized controlled trial comparing two formats of manualized family‐based treatment for adolescents with AN (N = 106) were analyzed. Participants completed the EDE, and their parents completed a parent‐as‐informant version of the EDE (Parent Eating Disorder Examination; PEDE). Rates of remission were compared across indices (i.e., EDE Global Score vs. diagnostic item analysis) and informant (i.e., adolescent vs. parent), both independently and in combination with the achievement of a percent median body mass index (% mBMI) greater than or equal to 95%.Results: For both adolescent and parent reports, there were higher rates of remission when defined by Global Score than when defined by EDE or PEDE diagnostic items. There were no significant differences in remission rates based on informant.Discussion: In the assessment of remission in AN, the EDE Global Score may not detect some adolescents who continue to exhibit clinically significant psychological symptoms. This study supports a detailed, multidimensional approach to assessing remission in adolescent AN to optimize sensitivity to patients' diagnostic profile. Future research should explore whether parent–child concordance on measures of ED psychopathology varies over the course of treatment.

Background: Patient and public involvement and engagement (PPIE) have long been considered important to good research practice. There is growing, yet diverse, evidence in support of PPIE with children and young people (CYP). We must now understand the various approaches to involvement of CYP in research.Aims: This rapid umbrella review aimed to provide an overview of when, how and to what extent CYP are involved in the conduct of health research, as well as the reported benefits, challenges, and facilitators of involvement.Methods: We searched OVID Medline, Embase and PubMed. Published reviews were included if they reported meaningful involvement of CYP in the conduct of health research. Extracted data were synthesised using thematic analysis.Results: The 26 reviews included were predominately systematic and scoping reviews, published within the last decade, and originating from North America and the United Kingdom. CYPs were involved in all stages of research across the literature, most commonly during research design and data collection, and rarely during research funding or data sharing and access. Researchers mostly engaged CYP using focus groups, interviews, advisory panels, questionnaires, and to a lesser extent arts‐based approaches such as photovoice and drawing. Visual and active creative methods were more commonly used with children ≤12 years. The evidence showed a shared understanding of the benefits, challenges, and facilitators for involvement of CYP, such as time and resource commitment and building partnership.Conclusion: Overall, the review identified consistency in the range of methods and approaches used, and stages of research with which CYP are commonly involved. There is a need for more consistent reporting of PPIE in the literature, both in terminology and detail used. Furthermore, the impact of approaches to CYP involvement on research and community outcomes must be better evaluated.Patient/Public Contribution: This review forms part of broader research initiatives being led by the authors. Together, these projects aim to support embedding of child voices in research practice and to explore the desirability and suitability of Young Persons Advisory Groups within birth cohort studies. The findings from this review, alongside public and stakeholder consultation, will inform development of resources such as practice recommendations to guide future involvement of CYP in health research undertaken at the author's respective institutions.

Objectives: Obsessive‐compulsive personality disorder (OCDP) traits are commonly associated with eating disorders (EDs), with evidence demonstrating that these traits predispose and exacerbate the ED illness course. However, limited research has examined the symptomatic interplay between ED and OCDP traits. We used network analysis to (1) identify the most central symptoms in a network comprised of OCPD traits retrospectively assessed in childhood and ED symptoms and (2) to identify symptoms which bridged OCPD traits and ED symptoms.Methods: Participants were 320 females with an ED (anorexia nervosa n = 227, bulimia nervosa n = 93), who completed the semi‐structured EATATE interview and the Eating Disorder Inventory‐2. Expected influence (EI) was computed to determine each symptom's influence in the network. Bridge symptoms were identified by computing bridge EI.Results: A regularised partial correlation network showed that ascetism, social insecurity, ineffectiveness, and impulsivity had the highest EI in the OCPD and ED network. With respect to bridging symptoms, interpersonal distrust emerged as a possible bridging node between the OCPD and ED trait/symptom clusters.Discussion: These findings highlight the centrality of non‐specific ED symptoms in the ED symptom network and suggest that interpersonal distrust may play a functional role through which childhood OCPD traits and ED symptoms are connected.

Objective: Stepped‐care models of treatment are underexplored in eating disorders. To enhance treatment outcomes, and informed by literature about adaptations to family‐based treatment (FBT), we developed an FBT‐based stepped‐care model for adolescents with anorexia nervosa (AN) that was consistent with family preference (i.e., tailored) and responsive to adolescent needs (i.e., intensity). The aim of this study was to evaluate the effectiveness of this model in terms of remission at end‐of‐treatment.Method: Adolescents (N = 82), aged 12–18 years (M = 15.1, SD = 1.8) and meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for AN, were assessed at baseline, Weeks 24 and 48. FBT was tailored to family preference and clinical need, with 16–18 sessions by Week 24. This was followed by three FBT booster sessions or an extension of FBT plus booster sessions (Week 48). The primary outcome was defined as weight > 95% of %median body mass index plus within 1 SD of the Eating Disorder Examination (EDE) global score community norms.Results: Remission rates were 45.1% and 52.4% at Weeks 24 and 48, respectively. Commensurable improvements were evident across secondary outcomes (e.g., EDE subscale scores). As a reference point, remission rates compared positively with results from a recent randomized clinical trial from the same center and at the same time points (Week 24:45.1% vs. 32.1% and Week 48:52.4% vs. 30.2%). Controlling for propensity score, no statistically significant differences were observed.Discussion: This stepped‐care model, designed to be responsive to the individual needs of adolescents and their families, achieved encouraging rates of remission. This study provides an important signal that supports future clinical trials of stepped‐care models for adolescents with AN.

Purpose Autism spectrum disorder traits have been implicated in the psychopathology of eating disorders and may also be relevant for the development of orthorexia symptoms. Further, intolerance of uncertainty (IUS) may indirectly contribute to the development of disordered eating, as the displacement of anxiety onto food may help achieve a sense of control and maximise certainty. We examined a new cognitive model of eating pathology which assessed the role of IU and orthorexia symptoms as potential mediators of the relationship between autistic traits and disordered eating in a community sample. Methods Three-hundred-and-ninety-six female participants (M = 20.07, SD = 4.52 years old) completed an online self-report questionnaire which assessed the variables of interest. Results Despite finding significant bivariate correlations, our model results showed that autistic traits did not directly predict disordered eating or orthorexia symptoms. Significant indirect relationships were found between autistic traits and eating disorder symptoms through both IU and orthorexia symptoms. Conclusion The findings provide partial support for our proposed model suggesting that autistic traits may increase the vulnerability for disordered eating, not directly, but through their associations with mechanisms such as IU and the development of problematic eating behaviours typical of orthorexia. Future research should focus on whether targeting IU may assist in preventing the development of disordered eating. Level of evidence Level V, cross-sectional descriptive study.