Mie Sedoc Jørgensen

Background: Executive functions (EFs), particularly cognitive flexibility, are affected in eating disorders (EDs), and similar impairments have been shown in familial high-risk (FHR) children. However, the field lacks intergenerational assessments of EF allowing evaluation and comparison of these parent-child patterns of impairment in EDs. This preliminary study used comparable EF tasks in mothers with a history of EDs and FHR daughters to estimate mother-daughter associations, explore associations with maternal illness characteristics, and identify candidate EF domains for future research. Method: Thirty-five mothers with a lifetime history of anorexia nervosa ( n = 11), bulimia nervosa ( n = 12), or binge eating disorder ( n = 12) and their FHR daughters (median age = 10, range = 7) completed three EF tasks. Exploratory correlation and regression analyses examined mother-daughter EF associations, and associations between maternal illness characteristics and daughters’ EF scores. Results: Mother-daughter correlations were observed in cognitive flexibility ( r _s =0.39) and response inhibition ( r _s =0.41) tasks but did not survive multiple-comparison correction. Unadjusted analyses found that maternal cognitive flexibility significantly predicted daughter’s cognitive flexibility ( β = 0.36, p =.036, 95% CI [0.06, 1.57]). Maternal response inhibition significantly predicted daughter’s response inhibition ( β = 0.46, p =.002, 95% CI [0.28, 1.17]), and maternal ED recovery status predicted daughter response inhibition ( B = -8.02, p =.01, 95% CI [-13.97, -2.07]). Conclusions: Our exploratory findings show patterns of mother-daughter EF congruence, as well as associations between maternal ED recovery status and daughter EF. These findings serve to generate hypotheses and guide larger longitudinal studies evaluating EF as a potential intergenerational trait marker associated with ED risk, highlighting cognitive flexibility and response inhibition as candidates for future research.

Objective: Research on mentalization‐based treatment (MBT) for adolescents with borderline personality disorder (BPD) has yielded mixed results. This qualitative study aimed to explore the experiences of adolescents who participated in a group‐based MBT (MBT‐G) programme 5 years earlier, to uncover the pitfalls, potentials and long‐term effects of MBT within this population. Methods: Eleven participants were included in the study. They were interviewed 5 years after completing a 1‐year MBT‐G programme designed for adolescents with BPD or subthreshold BPD. At the time of the interviews, participants were between 19 and 23 years old. Data were analysed using Interpretative Phenomenological Analysis (IPA). Findings: The study revealed weak working alliances, as many participants reported feeling uncertain about the goals of treatment and expressed a desire for more concrete therapeutic ‘tools’ and opportunities to address past trauma in individual sessions. Additionally, most participants described a lack of group cohesion, with group participation often experienced as burdensome and anxiety‐provoking. Some participants perceived therapists as distant and lacking empathy, which negatively affected their engagement. In contrast, positive treatment experiences were associated with a clear understanding of the treatment rationale, strong group cohesion and therapists who actively and supportively facilitated the group. Research Implications: The findings suggest that establishing effective MBT groups for adolescents with BPD can be challenging and working specifically on establishing group cohesion and uncovering the rationale for the treatment are pivotal. Further quantitative and qualitative studies are recommended to investigate MBT programmes that integrate both individual and group therapy for this population.

Objective: The International Classification of Diseases (ICD) was recently updated to an 11th edition, introducing significant changes to the diagnostic criteria for Anorexia Nervosa (AN). Little is known about how these updated criteria impact diagnostic classification in previously diagnosed populations. This study aims to examine how a Danish youth sample previously diagnosed with ICD-10 AN or Atypical AN (atypAN) would classify under ICD-11 criteria, including the application of the new subtype specifier. Furthermore, it investigates how ICD-11 diagnoses and subtypes relate to ED symptom severity compared to ICD-10 diagnoses. Methods: a prior ICD-10 AN and atypAN sample (N = 895) was reclassified under ICD-11 criteria, categorising those not meeting AN criteria as OSFED. AN cases were subtyped into Restrictive (AN-R) or Binge-Purge (AN-BP). Multiple linear models examined associations between 1) ICD-10 diagnoses; 2) ICD-11 diagnoses; and 3) AN subtypes, and EDE scores, while controlling for age and sex. Results: ICD-11 reclassification led to all ICD-10 AN and 127 atypAN cases meeting AN criteria. Only ICD-11 diagnosis was significantly associated with ED symptom severity, with AN showing greater severity than OSFED. AN-BP exhibited greater severity than AN-R. Discussion: ICD-11 increased number of full-threshold diagnoses and may thus aid in providing adequate treatment, and findings supported the subtyping introduced in ICD-11. However, a substantial amount of prior atypAN cases were not captured in ICD-11 diagnostic criteria.

Objective: Inpatient treatment aimed at weight restoration and psychiatric stabilization is often required for individuals with anorexia nervosa (AN). This study aimed to identify distinct trajectories of change in body mass index (BMI) and depressive symptoms during inpatient treatment, examine clinical predictors and outcomes, and test reciprocal associations between BMI and depressive symptom changes. Method: Weekly BMI and depressive symptom data were collected from 156 inpatients with AN (mean treatment duration = 11.6 weeks). Growth mixture modeling identified trajectory classes. Baseline clinical variables were examined as predictors, and discharge outcomes were compared across classes. A joint Bayesian growth model was used to examine longitudinal associations between BMI and depressive symptoms. Results: Three BMI trajectories were identified: steady increase (58.3%; higher baseline BMI with consistent gains), gradual weight gain (28.9%; low baseline BMI with steady gains), and rapid response (12.8%; low baseline BMI with early rapid gain followed by slowing or decline). Two depressive symptom trajectories emerged: severe‐stable and moderate‐improving. The severe‐stable group was predicted by higher trauma‐related comorbidity (OR 11.11, p = 0.009) and eating psychopathology (OR 3.23, p < 0.001). Depressive symptom class was associated with initial BMI but not BMI change, while BMI classes predicted the curvature of depressive symptom trajectories. No credible week‐to‐week associations emerged between BMI and depressive symptom changes. Discussion: Findings highlight substantial heterogeneity in treatment response. Rapid early weight gain in patients with extremely low BMI and high severity may not indicate sustained improvement. Persistent depressive symptoms, especially in those with trauma histories, underscore the need for trauma‐informed care alongside weight restoration.

Children of parents with eating disorders (EDs) are at greater risk of developing an ED, likely due to an interplay of genetic and environmental factors. The familial high-risk (FHR) study design offers a valuable framework for studying development of EDs in individuals at increased risk over time. The study aimed to (1) to explore mothers’ with EDs perspectives on the intergenerational transmission of EDs and (2) to explore mothers’ with EDs perspective on FHR research related to EDs. Three focus group interviews were conducted in October and November 2023 with a total of eight mothers with a current ED, comprising groups of two, three, and three participants, respectively. All participants had a child of at least five years. Data were analyzed using thematic framework analysis. The first theme focused on navigating motherhood with an ED including experiences and reflections on how having an ED can impact children and had the subtheme: Communicating with children about EDs. The second theme was advancing prevention and early detection of EDs incorporating the promising impact of research on early detection of EDs and targeted preventive interventions and had two subthemes: Protecting children’s emotional well-being and willingness to participate in research. Overall, mothers with EDs were deeply concerned about intergenerational transmission and the implications of disclosing their ED to their children, yet they remained highly motivated to participate in prevention research, offering valuable insights into how to engage families more effectively in ED research.

Introduction The aetiology of eating disorders (EDs) is complex, involving an interplay of genetic and environmental factors. Children at familial high risk (FHR) for EDs demonstrate increased risk of developing EDs themselves compared with children born to parents without EDs, though the majority remain unaffected. The BLOOM study is an FHR study that aims to identify biological, neurocognitive and psychosocial risk and protective pathways to EDs. Results of this study will help identify trait markers of EDs, inform targeted preventive intervention strategies and clarify how to mitigate genetic risk of EDs. Methods and analysis This prospective cohort study will enrol 510 children aged 8–10 years, including 360 at FHR for developing EDs (comprising 120 children each from mothers with anorexia nervosa, bulimia nervosa and binge ED) and 150 children not at FHR. Participants will be recruited over 2 years and followed up every 2 years. Data collection will include dual X-ray absorptiometry scans to evaluate body composition, saliva samples for genotyping, neurocognitive testing, self and parent-reported questionnaires and semistructured diagnostic interviews of psychopathology and well-being. Optional data collection will include fasting blood samples, stool samples and brain MRI scans. Mothers and secondary caregivers will complete questionnaires regarding family functioning and their mental health. Ethics and dissemination The study has been approved by the Danish Data Protection Agency (p-2023-14826) and the Regional Ethics Committee of Health Research of the Capital Region of Denmark (H-23043100). Written consent will be obtained from all participants. Results will be disseminated at scientific conferences, in peer-reviewed publications, PhD dissertations and to relevant stakeholders.

This commentary, written for Journal of Clinical Psychology: In Session , synthesizes five case‐based contributions on psychotherapy for adolescents with personality disorders (PDs). Although PDs often emerge in adolescence, age‐adapted treatments remain scarce. Randomized clinical trials are still limited, making carefully constructed case studies important for identifying promising treatments. Three of the featured cases draw on mentalization‐based therapy for adolescents, implemented in combined group–individual formats, adapted toward dimensional models of PD, or extended socioecologically to involve wider social networks, such as family, peers, and school systems. The remaining two derive from metacognitive approaches: one applying Metacognitive Interpersonal Group Therapy (MIT) for Adolescents in a case of dependent and borderline PD, and the other applying MIT for Eating Disorders with an adolescent with binge eating disorder and comorbid avoidant and obsessive–compulsive PD. Across studies, four shared priorities emerge. First, the capacity to think, reason, and regulate mental states, defined as mentalizing or metacognition, serves as a central mechanism of change. Second, impairments in self and interpersonal functioning are treated as the core pathology in PDs. Third, therapeutic progress depends on actively engaging the adolescent's broader social context rather than working solely within the therapist–patient dyad. Fourth, comorbidity, whether trauma‐related disorders, substance use, eating disorders, or others, should be treated integratively to ensure targeted, personalized treatment. These cases demonstrate that innovation in adolescent PD treatment often begins with single cases. The task ahead is to translate these clinical examples into rigorously tested, developmentally sensitive, and ecologically grounded intervention models that can be applied in early intervention programs.

Introduction: Adolescence is a crucial period for the onset of both borderline personality disorder (BPD) and first‐episode psychosis. Although transient stress‐related paranoid ideation and dissociative symptoms are one of the diagnostic criteria for BPD, determining when these psychotic features progress to early‐stage schizophrenia remains unclear. Methods: Two case studies aimed to explore the challenges in assessing and following up on psychotic features in BPD over time. Two adolescent girls aged 14 and 15 were initially diagnosed with BPD using semi‐structured clinical interviews for DSM‐IV personality disorder. Five years later, symptom development was explored using comprehensive diagnostic interviews. Results: Both cases exhibited lapses in reality testing at baseline, interpreted as transient and stress‐related symptoms. The first case illustrated the difficulties in distinguishing normative magical and imaginative thinking in youth from odd beliefs or bizarre fantasies and preoccupations, emphasizing the need for age‐adapted and elaborate, detailed phenomenological assessment of the content, duration and frequency of these experiences and their impact on functioning. The second case demonstrated the progression of psychotic features from adolescence into early adulthood and the challenge of judging whether these features crossed the threshold to psychosis. Conclusion: Both cases underscore the need for clinical training regarding differential diagnostics and management of psychotic features when present in early manifestations of BPD. This gap in care presents a missed opportunity for inclusion of patients in targeted early intervention programs for first‐episode psychosis. We propose the implementation of a continuous monitoring strategy in BPD with psychotic features.

In a 5‐year longitudinal follow‐up study of adolescents ( N = 97) treated for borderline personality disorder (BPD), we examined the characteristics of the persistent BPD group ( N = 23), the stability of BPD criteria from baseline to 5 years, and the predictors of remission ( N = 74). Significantly more participants in the persistent BPD group, compared to the remitted group, had depression, bipolar disorder, schizophrenia, or another personality disorder, received psychotropic medication, and were less likely to be in a relationship or in education. All nine diagnostic criteria of BPD exhibited extremely low stability over time across groups. Prior sexual abuse, conduct disorder, and high levels of general BPD psychopathology at baseline predicted persistent BPD at the 5‐year follow‐up. These findings suggest that while the status from late adolescence to young adulthood on each diagnostic criterion for BPD is highly variable over time, clinicians need to be aware that adolescents with high overall levels of BPD symptoms, a record of sexual abuse, and co‐occurring externalizing behaviors are at increased risk of a poor prognosis.