Erica Cini

Background: A proportion of patients with anorexia nervosa require compulsory admission due to treatment refusal in the context of high medical or psychiatric risk. Aims: The clinical characteristics and treatment outcomes of patients with anorexia nervosa compulsorily admitted for in-patient care (current and previous) were compared with those of patients admitted voluntarily. The characteristics of their caregivers were also evaluated. Method: This is a secondary analysis of the Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise trial. We included 274 patient–caregiver dyads: 62 on compulsory admission (‘current compulsory’), 48 on voluntary admission with a history of compulsory treatment (‘previous compulsory’) and 164 on voluntary admission without a history of compulsory treatment (‘voluntary’). Baseline demographic and clinical characteristics, and longitudinal clinical outcomes at 3–6 and 9–12 months, were compared across groups. Results: Patients in the current compulsory group had an earlier age of onset, a higher proportion of obsessive–compulsive disorder comorbidity and less motivation and confidence to change compared with the voluntary group. The previous compulsory group showed a longer illness duration, older age and lower body mass index (BMI) compared with the other groups. All groups showed improvement, with similar outcomes at the end of the study except for depression symptoms and BMI. Caregivers had varying levels of distress and caregiving skills at baseline, which had improved by the end of the study. Conclusions: People receiving current or previous compulsory treatment presented with diverse clinical presentations. Further studies are needed to determine whether more individualised approaches improve outcomes in these subgroups. Trial registration number: Trial registration number and data-set information: ISRCTN14644379.

Background: Despite young British Bangladeshis experiencing a higher prevalence of mental health problems than the White British population, they are comparatively underrepresented in mental health research and fewer access services. Aims: This study aimed to identify priorities and preferences for mental health support among young British Bangladeshis, as well as strategies to enhance the cultural appropriateness and accessibility of services. Method: A qualitative study was conducted in London and Leicester, with participants recruited through voluntary and community organisations. In-depth interviews were held with young people with lived experience of mental health problems ( n = 12), their family members ( n = 7) and Bangladeshi community workers from voluntary sector organisations ( n = 7). Data were analysed using thematic framework analysis. Results: Participants’ priorities for mental health support included reducing stigma, raising awareness, and addressing intergenerational and identity-related stressors. Preferences centred on culturally and linguistically appropriate care delivered by therapists familiar with Bangladeshi values in trusted community settings. Suggested strategies for improving existing services included enhancing access by providing support in trusted community spaces, building trust through the involvement of culturally aware professionals, and involving families and community leaders to reduce stigma and promote open discussion around youth mental health. Conclusions: This study identifies a need for culturally tailored, linguistically accessible and community-rooted mental health support for British Bangladeshi youth. Representatives from these communities should be actively involved in the development of future programmes and policies, ensuring that support is both relevant and sustainable.

Background: Adolescence is period of social change during which peer relationships are prioritised. The desire for social approval, which heavily influences behaviour, is often linked to an increased risk of developing an eating disorder (ED). Social cognition is impaired in ED and both autism and social anxiety frequently co‐occur. It is difficult to disentangle the contributing factors of cognitive and interpersonal difficulties in adolescents who present at children's ED services, and whether these relate to treatment response. We investigated whether baseline social measures predicted early treatment response after the initial 6‐month period. Methods: Adolescents aged 12–16 years ( N = 983) treated by children's community ED services in England, UK, between 2017 and 2023, completed the Revised Child Anxiety and Depression Scales (RCADS) and/or the Strengths and Difficulties Questionnaire (SDQ) at assessment. Early weight restoration, defined as reaching at least 85% median‐BMI adjusted for age and sex, at 6 months, was the primary outcome. A multiple linear regression was conducted using three measures: RCADS' Social Phobia, SDQ's Peer Problems and SDQ's Prosocial Behaviour to predict the degree of early weight restoration (85%medBMI), which was the primary outcome. Results: The combined baseline social predictors: social phobia (standardised β = −0.382), peer problems (standardised β = −0.118) and prosocial behaviour (standardised β = −0.105) explained 20% of variance in weight restoration at 6‐months post assessment ( p < 0.001). Individual predictors regressed to %mBMI, were not moderated by age, with peer problems negatively predicting weight at 6 months and prosociality scores demonstrating significant skew because self‐rated scores were high. Exploratory analyses showed that social anxiety was greater in those who did not reach early weight recovery at 6‐months post assessment. Conclusions: Assessing and addressing difficulties in social/peer group functioning might be a central consideration in treatment for AN in adolescents. Further research is needed to better understand the role of social functioning in recovery from AN.

Objective: Despite the UK national guidance for Managing Emergencies in Eating Disorders (MEED) being widely used, little is known about how the guidance has been embedded into clinical practice or implemented across services. Methods: Clinicians (n = 13) working in community child and adolescent eating disorder services and medical wards were interviewed about their experience of using the MEED guidance in their clinical practice. Open-ended questions were used. Reflexive thematic analysis was used to analyse interview data. Results: Reflexive thematic analysis of responses identified three main themes. These were the following: (1) a common language, (2) looking beneath the surface, and (3) refeeding syndrome—a rare event in youth. These themes evidenced the important role of the MEED guidance in child and adolescent eating disorders and highlighted both the benefits and limitations of the current guidance. Conclusions: This study demonstrated that MEED was most helpful as a tool to clearly communicate acuity of medical risks between services, aiding multi-agency working required to manage both physical and mental health risks of young people with AN. The absence of parameter risk stratification and the lack of consistency on refeeding guidance across adolescent and adult guidance were highlighted as areas that future research should focus on.

Background: Research suggests that those caring for a loved one with an eating disorder in the UK report unmet needs and highlight areas for improvement. More research is needed to understand these experiences on a wider, national scale. Aims: To disseminate a national survey for adults who had experience caring for a loved one with an eating disorder in the UK, informed by the findings of a smaller scale, qualitative study with parents, siblings and partners in the UK. Method: A cross-sectional web-based survey was disseminated to adults who had experience caring for a loved one with an eating disorder in the UK. Results: A total of 360 participants completed the survey. Participants described experiences of care received in both children and young people's, and adult services. Those receiving care from children and young people's services generally reported more timely care, greater involvement in care and more confidence managing their loved one's symptoms post-discharge. In both settings, participants identified a number of areas for improvement, including more timely access to care, improved transition processes and discharge planning, and increased involvement in their loved one's care. Conclusions: This survey captures the experiences of individuals caring for a loved one with an eating disorder in the UK. There are identified discrepancies between experiences of care in children and young people services compared with adult services. Clinical implications and recommendations for improvement are discussed, including improved transition and discharge processes, increased involvement of and/or support for carers themselves, and more timely access to support services for the unwell individual.

Consultant eating disorder (ED) psychiatrists play a lead role among the multidisciplinary team within ED services, as their skill set equips them to manage these complex disorders effectively using a multidimensional approach. The aim of this audit was to determine the degree of alignment of consultant ED psychiatrist roles with the 2014 Royal College of Psychiatrists guidelines (1), focusing on clinical work, leadership and educational responsibilities. Fifteen consultant ED psychiatrists were interviewed and their self-reported roles were compared to the guideline set by the Royal College. The data showed that clinical responsibilities were the most consistently performed (100%), while educational roles, specifically external education, were least represented (13.3%). Leadership responsibilities, mainly service development, were also prominent (80.0%) but some psychiatrists reported insufficient time for other responsibilities, such as therapeutic work and training. No psychiatrist was able to fulfil all of the roles described in the 2014 guidelines. This audit highlights the differences between Royal College expectations and current practice, emphasising the importance of further investment in consultant ED psychiatry to enhance service delivery.

Eating disorders have historically been considered "culture-bound" phenomena, confined to Western societies and specifically, young White females with, predominantly, anorexia nervosa. Eating disorder research tended to align with these perceptions and, until relatively recently, few studies had been conducted to establish the prevalence of eating disorders in non-Western countries. Evidence from epidemiological surveys, undertaken largely in the last three decades, have shown that eating disorders are present in African, Asian, Middle-Eastern and South American societies and in many cases the prevalence estimates are comparable to those in the West. However, there is evidence to suggest that precipitating factors, presentations and cultural perceptions of eating disorders differ between sociocultural contexts. This may result in underdiagnosis of eating disorders in non-white individuals and may be a barrier to successful management. These considerations are exemplified by studies in the South Asian population in the UK which have shown a different symptom profile than white individuals. Clinicians who are not attuned to these cultural differences, may fail to recognise an eating disorder diagnosis. South Asian populations may present with somatic concerns and the absence of "fat phobia". Culture-specific familial expectations, religious observances and issues of self-identity may have a greater role in the development and maintenance of eating pathologies in this, and other, minority ethnic groups. Greater awareness of these factors among clinicians would increase the prospects for recognition, diagnosis and successful outcomes.