Karina Allen

Background: Early intervention increases the likelihood of eating disorder recovery but many young people delay help-seeking. We developed a smartphone-friendly, online decision-making tool to address this gap (FREED-Mobile (FREED-M)). Aims: To conduct a randomised controlled feasibility trial of the FREED-M decision-making tool with 16- to 25-year-olds with a suspected eating disorder and no previous treatment for this. Method: Participants were randomly allocated to FREED-M or an active control in a parallel group, two-arm trial. Outcomes were measured at weeks 0 (baseline), 4 (post-intervention) and 12 (follow-up). The primary feasibility outcome was attrition at follow-up. Other outcomes included motivational, clinical and economic measures. Results: We over-recruited with 204 randomised participants (including 20 fraudulent participants). Main analyses were conducted with 184 genuine responders (FREED-M: n = 91, control: n = 93). At baseline, participants’ mean age was 21.0 (s.d. 2.0) years, 89% identified as female and 64% as White. Mean body mass index was 23.1 kg/m ² (6.3). N = 83 participants had an anorexia nervosa-like disorder, 101 had another eating disorder or high eating disorder risk. Attrition at week 12 was n = 112 (61%). Of the n = 42 FREED-M participants who provided acceptability ratings, 79% liked the intervention and 66% found it useful. Between-group effect sizes for motivation and readiness to change were small to medium at 4 weeks ( d = 0.27 and d = 0.15, respectively) favouring FREED-M, but differences were not sustained at follow-up ( d = −0.02 and d = −0.12, respectively). Discussions: Although the attrition rate was high, recruitment exceeded expectations. Acceptability of FREED-M was high among participants who provided acceptability ratings. Motivation/readiness to change and help-seeking are candidates for primary outcomes in a future randomised controlled trial.

Background: Autistic traits are overrepresented among individuals with anorexia nervosa (AN) and are associated with greater eating disorder (ED) psychopathology, psychological distress, and work and social functioning difficulties in this population. However, less is known about the prevalence and clinical associations of autistic traits in other ED presentations, such as bulimia nervosa (BN). This study examined the prevalence of autistic traits and their associations with ED psychopathology, psychological distress, and work and social functioning difficulties in a transdiagnostic ED sample. Methods: A retrospective cross-sectional analysis was conducted using routinely collected clinical data of adults attending a specialist ED service with restrictive AN (AN-R), binge–purge AN (AN-BP), BN, binge eating disorder (BED), atypical AN (A-AN), or avoidant/restrictive food-intake disorder (ARFID). Prevalence rates of elevated autistic traits (AQ-10 ≥6) were described across diagnoses. Multiple linear-regression analyses examined associations between autistic traits and measures of eating disorder psychopathology, psychological distress, and work and social functioning difficulties. Results: Elevated autistic traits were reported by 40.0% of patients with ARFID, 34.2% with AN-BP, 31.9% with AN-R, 27.0% with BN, 26.4% with A-AN, and 16.7% with BED. Higher AQ-10 scores were significantly associated with greater ED psychopathology, psychological distress, and work and social functioning difficulties across the AN-R, BN, and full samples. In the AN-R and full samples, the associations remained significant across all models after controlling for age, gender, and ED duration. In the BN sample, all associations remained significant following adjustment except for ED psychopathology, which was no longer significant after controlling for ED duration. Conclusions: Autistic traits are elevated across multiple ED diagnoses and are associated with greater clinical severity. The findings support the clinical relevance of autistic traits across ED presentations and support the need for further investigation of autism-informed approaches across transdiagnostic ED services.

Background: There has been growing interest in developing a clinical staging model for eating disorders (EDs). The aim of this scoping review is to investigate the extent, range, and nature of research that can inform clinical staging approaches for EDs. Methods: This review was conducted following the Joanna Briggs Institute methodology for scoping reviews and the PRISMA extension for Scoping Reviews. A search of PubMed, PsycINFO, MEDLINE and Web of Science databases was conducted. Sixty studies were included for review, and data were extracted according to revised pre-published criteria. Studies were summarized using narrative synthesis. Results: Thirty-six of the included manuscripts were quantitative, 18 were qualitative, and six were conceptual/review papers. The included studies primarily focused on anorexia nervosa in white, female samples and compared only two stages of illness, equating to “early” and “longstanding” or “severe and enduring” EDs. “Middle” stages or transitions between stages were not well-defined. Stages have mostly been conceptualized using duration of illness or other behavioral or clinical parameters, with few (neuro) biological studies identified. Factors that may modify illness stage have not yet been integrated into ED staging literature. Conclusions: There is growing consensus that early- and later-stage EDs have distinct characteristics and treatment requirements; however, these distinctions require clearer definition. Recommendations for future research are outlined, emphasizing integration of psychosocial and biological research, focused investigation of illness phases outside of early and longstanding phases, and evaluation of personalized, stage-based treatments. A tentative staging model for EDs is proposed.

Objective: To explore barriers and facilitators to help‐seeking by people from under‐served groups in eating disorders (EDs). Methods: Seventeen participants with lived experience of an ED, identifying as members of groups traditionally under‐served in ED research (ethnic minority, sexual or gender minority, or men), took part in semi‐structured interviews. Data were analysed using reflexive thematic analysis, with inductive coding, interpretive theme development, and deductive mapping onto a micro‐, meso‐, and macro‐level intersectional framework. Results: Participants identified factors consistent with existing research on barriers and facilitators to help‐seeking alongside factors unique to under‐served groups. These included internalised stigma, stereotypes about EDs, lack of inclusive environments and poor representation in ED resources. Systemic factors comprised barriers to accessibility or strict inclusion criteria for specialist treatment. Facilitators to help‐seeking included inclusive care, and the utility of information seeking online. Conclusion: Findings extend existing evidence on ED help‐seeking and offer novel insights into experiences of under‐served groups in ED. To improve help‐seeking among under‐served groups, recommendations include interventions to address stigma, challenging stereotypes about EDs, and ensuring inclusive representation in psychoeducation and service provision. At a systemic level, reforms to service commissioning and inclusion criteria are necessary to create equitable access to care.

Aim: To broaden treatment options for emerging adults with anorexia nervosa we explored the applicability of an adapted Family Therapy for Anorexia Nervosa (FT‐AN‐EA) in a routinely collected outpatient case series. Method: Thirty emerging adults (aged 18–25) diagnosed with anorexia nervosa or atypical anorexia nervosa were recruited and agreed to participate in FT‐AN‐EA. Participant demographics, treatment characteristics (treatment duration, number of sessions, treatment non‐completion, need for inpatient care) and body mass index (BMI) at assessment and discharge were collected. Results: The series comprised of 21 new referrals to the adult eating disorder service and 9 age‐related transitions from child and adolescent services (CAEDS). Two patients were classified as early non‐completers (attending four sessions or less of FT‐AN‐EA). In the treatment‐completers group ( n = 28), mean duration of treatment was 10 months (22 sessions). 20 completers (71.4%) restored weight to BMI > 18.5 kg/m ² at discharge. 24 completers (85.7%) were discharged to no further care (general practitioner [GP] only), two (7.1%) were referred onto other interventions and two (7.1%) were admitted to inpatient care. Conclusion: This case series provides preliminary evidence for the applicability of adapted FT‐AN for emerging adults with anorexia nervosa. Further studies, under more controlled conditions, are needed to establish its efficacy and identify optimal treatment adaptations for this population.

Introduction: First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention service model for young people with recent‐onset eating disorders. This manuscript describes the development and pilot testing of an implementation fidelity tool for FREED or similar early intervention models, exploring feasibility of the tool and changes in fidelity over time. Methods: An iterative consultation process within the FREED national team reviewed the core aims, functions, principles, and key components of FREED services. A set of items and a scoring rubric were drafted and pilot‐tested via two assessments in a London‐based FREED service with routine data and interviews with team members. Items were scored independently by two raters. Inter‐rater reliability was assessed. Results: The fidelity tool comprised 35 items across two components: (1) rapid access to the service and (2) adherence to the FREED care package (e.g., family involvement, attention to transitions). Overall fidelity scores were 63% at time 1% and 60% at time 2, indicating ‘lower’ fidelity. Component scores ranged from ‘not satisfactory’ for rapid access, to ‘medium fidelity’ for care package components. Weighted Cohen's kappa indicated almost perfect agreement across assessments. Conclusion: This is the first fidelity measurement tool for early intervention eating disorders services. It demonstrated feasibility, simple administration, and time efficiency. Pilot testing suggested fidelity to some aspects of FREED, but further support is required to improve fidelity. Future work should focus on refining the tool (e.g., further psychometric evaluation) and testing it in more services to investigate whether ongoing assessments support fidelity.

Objective: This scoping review seeks to evaluate the efficacy of teacher‐led interventions in mitigating risk factors related to eating disorders, considering the necessity for universal prevention programmes that can be effectively administered by educators. Methods: A literature search was conducted via ERIC, PubMed, and Scopus, following PRISMA guidelines. This search focused on peer‐reviewed studies that evaluated teacher‐led programmes among adolescents aged 11–16. Data was extracted on study design, sample characteristics, intervention content, and outcomes. Quality appraisal was conducted using CASP and CONSORT to enable evaluation. Results were synthesised and guided by PRISMA. Results: From 16 studies, this review identified that teacher‐led programmes could effectively reduce risk factors, including thin‐ideal internalisation and body dissatisfaction. However, effectiveness requires an emphasis on teachers following program manuals, as deviations from the program often weaken outcomes, underscoring the need for comprehensive teacher training and support. The review also highlighted gender‐specific challenges, with some programmes being less effective for boys. Conclusions: Teacher‐led interventions are important for scalable and sustainable eating disorder prevention in schools; however, success depends on rigorous adherence to intervention protocols and ongoing support for educators. Future research should focus on long‐term efficacy, gender‐specific adaptations, and the comparative cost‐effectiveness of teacher‐led versus clinician‐led programmes.

BackgroundSome people experience mood changes when hungry. However, the relevance of this phenomenon to clinical conditions, such as depression and eating disorders, is understudied. Therefore, we devised a questionnaire to measure hunger-related mood dysregulation.MethodsWe developed and validated the Mood, Emotions and Appetite List (MEAL) using exploratory and confirmatory factor analysis in adults and adolescents in the community, and adults with a history of mental health disorder (N = 1,119). We examined the association of MEAL scores with happiness, frustration and boredom during the frustration-inducing mood drift task, in which participants wait for six minutes and rate their mood every 30 seconds.ResultsThe MEAL showed good psychometric properties, capturing three factors for hunger-related ‘irritability’, ‘low mood’ and ‘somatic feelings’ (RMSEA = 0.03 in community adults, 0.05 in community adolescents, 0.08 in adults with mental health disorder history). Quantitative and qualitative responses evidenced that hunger-related mood dysregulation impacts relationships, work and other activities. MEAL scores were associated with irritability, depression, anxiety and menstrual symptoms. In the mood drift task, the irritability subscale (MEAL-i) demonstrated a significant interaction with time, such that individuals with higher MEAL-i scores reported steeper decreases in happiness (B = -0.11; 95% CI: -0.16–-0.06) and steeper increases in boredom (B = 0.06; 95% CI: 0.00–0.12) and frustration (B = 0.12; 95% CI: 0.05–0.19).ConclusionsThe MEAL measures individual differences in hunger-related mood dysregulation, is associated with mental health, self-reported functioning, and predicts faster worsening of mood during experimentally induced frustration.