Sarrah I. Ali

Introduction: Although individuals with bulimia nervosa (BN) demonstrate elevated reward sensitivity and reward valuation‐effort (RV‐e) compared to controls, whether BN differs from its other specified feeding or eating disorder variant (OSFED‐BN), remains unclear. Further, whether differences best reflect categorical distinctions or correlations with symptom severity is unknown. This study examined whether trait and behavioural reward indicators differentiate BN, OSFED‐BN, and controls, predict diagnostic status, and correlate with bulimic symptom severity. Methods: Participants were 349 women (153 BN, 118 OSFED‐BN, 78 controls). Group comparisons, multinomial logistic regression, and correlational analyses were conducted on the Sensitivity to Punishment/Sensitivity to Reward‐Reward subscale (SPSRQ‐Reward), Behavioural Activation System‐Drive (BAS‐Drive) scale, and progressive ratio tasks assessing RV‐e for food and game rewards. Results: BN and OSFED‐BN demonstrated higher SPSRQ‐Reward scores than controls but did not differ from each other. OSFED‐BN, but not BN, showed higher food and game RV‐e compared to controls. SPSRQ‐Reward predicted higher odds of BN or OSFED‐BN versus controls, whereas BAS‐Drive predicted lower odds. SPSRQ‐Reward was positively associated with bulimic symptom frequencies. Food RV‐e was inversely associated with purging frequency. Discussion: Findings supported the role of reward‐related processes in contributing to both dimensional and categorical differences between BN, OSFED‐BN, and controls.

Objective: This study aimed to evaluate the feasibility of implementing 10‐session group cognitive behavioural therapy (CBT‐Tg) in routine outpatient eating disorder care and to descriptively examine outcomes of CBT‐Tg and individual CBT‐T (CBT‐Ti). Method: Using a naturalistic, non‐randomised, mixed‐methods design, this implementation study was conducted in a publicly funded outpatient eating disorder service. Adults eligible for outpatient eating disorder services selected CBT‐Tg or CBT‐Ti following intake. Feasibility outcomes included acceptability (treatment satisfaction, qualitative interviews, dropout), demand (uptake over time) and practicality (estimated clinician time). Effectiveness outcomes included eating‐disorder psychopathology, measured by the eating disorder examination questionnaire (EDE‐Q), and secondary outcomes assessing eating disorder symptoms, impairment and mood/anxiety during treatment and follow‐up. Results: Of 157 referred patients, 116 consented and initiated treatment. Satisfaction was high in both formats. Premature termination from CBT‐Tg was 44.7%. Demand supported offering CBT‐Tg in 8 of 9 three‐month intervals. Estimated clinician time per enrolled patient was 4.3–5.7 h for CBT‐Tg versus 8.0 h for CBT‐Ti. EDE‐Q global scores improved with very large within‐group effects at end of therapy and were maintained through 6‐month follow‐up in both formats (CBT‐Tg: g = −1.57 at end of therapy; g = −1.63 at follow‐up; CBT‐Ti: g = −1.97; g = −2.14). Discussion: CBT‐Tg appears feasible and acceptable in real‐world outpatient care, with large and sustained improvements in eating disorder psychopathology and potential efficiency advantages relative to individual delivery. Findings support further evaluation in comparative and cost‐effectiveness studies.

Societal and cultural shifts can influence psychological well-being and development in adulthood. Maturity fears, an individual's desire to retreat to the security of childhood, have been found to be increasing in younger generations. The present study explored how maturity fears change over adult development in three cohorts of university students assessed in 1982, 1992, and 2002 and followed over time. The study employed a sequential design in which university students (N = 2,482, 69.8% female) completed self-report surveys in college and at 10-year and 20-year follow-up. At baseline, female in the 2002 cohort showed the highest maturity fears, followed by 1992 and then 1982, with all cohorts having decreases in maturity fears over time. There was a significant Cohort × Time interaction, such that compared to the 1982 cohort, both the 1992 and 2002 cohorts demonstrated significantly greater declines in maturity fears over time. Males in the 1992 and 2002 cohorts showed greater maturity fears than those in the 1982 cohort. As with the females, for males there was a significant Cohort × Time interaction. Compared to the 1982 cohort, both the 1992 and 2002 cohorts demonstrated significantly greater declines in maturity fears over time. Overall, the pattern of findings indicates higher levels of maturity fears during college in more recent cohorts, a decrease in maturity fears during adult development, and greater declines in more recent generations. Additional research is needed to not only replicate these findings but also explore potential mechanisms underlying cohort differences. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The Eating Disorder Inventory (EDI) is one of the oldest and most widely used surveys of eating disorder thoughts and behaviors. Its recent and frequent use to study differences in eating pathology across ethnoracial groups underscores importance of establishing its measurement invariance across groups. However, mixed evidence has emerged, and studies have focused on Black, mixed-race Hispanic/Latino, and White women. The present study aimed to establish the measurement invariance of the EDI Drive for Thinness, Bulimia, Perfectionism, Maturity Fears, and Interpersonal Distrust subscales across four ethnoracial groups in a sample of women and men. Participants (N = 2,931) were Hispanic White (7%), non-Hispanic Asian (18%), non-Hispanic Black or African American (7%), and non-Hispanic White (68%) college students (67% female) recruited in a cohort-based epidemiological, longitudinal study of health and eating patterns. First, multigroup confirmatory factor analysis examined whether the EDI performed comparably across ethnoracial groups in the full sample. Next, the same approach was followed in sensitivity analyses within each sex. Evaluation of changes in comparative fit index indicated that full metric invariance, scalar invariance, and uniqueness were supported across ethnoracial groups in the full sample and in women (change in comparative fit index ≤ .01). Only partial measurement invariance was supported in analyses of non-Hispanic Asian and non-Hispanic White men. Analyses support use of the EDI in ethnoracially diverse samples including women and men or only women. Limited score variance in men suggests the need for tests of measurement invariance in larger samples. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Limited prospective research examines how ethnicity and race impact changes in eating pathology over time. To date, most research has focused on the adolescent developmental period and has not accounted for body mass index (BMI), an established risk factor for eating pathology that differs by ethnicity and race. The current study aimed to close this gap by examining ethnoracial status and its intersection with gender as a predictor of levels and changes in BMI, Eating Disorder Inventory (EDI) bulimia scores, and EDI drive for thinness (DT) scores over a 20-year period from early to middle adulthood. Two cohorts of university students established in 1982 and 1992 provided survey responses at baseline (n = 1,415; 71% female) and were sought for 10- and 20-year follow-up. Multilevel models indicated Hispanic White and non-Hispanic Black/African American ethnoracial groups demonstrated greater increases in BMI over time compared to non-Hispanic Asian and non-Hispanic White ethnoracial groups. EDI bulimia and DT scores were comparable across ethnoracial groups in college. Trajectories for DT were also comparable across ethnoracial groups. Conversely, ethnoracial status was a predictor of differing trajectories of EDI bulimia among women, such that non-Hispanic Black/African American women's bulimia scores demonstrated significantly less decline over time compared to non-Hispanic Asian and non-Hispanic White women's scores. While eating pathology is stereotypically linked to young, White women, results suggest sustained propensity for binge eating among Black/African American women into midlife. Future research should examine factors such as exposure to weight stigma and internalized weight bias that may contribute to this effect. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Cognitive Behavioral Therapy‐Ten (CBT‐T) is a 10‐session manualized eating disorder (ED) treatment protocol for nonunderweight EDs. CBT‐T was developed to increase access to treatment and reduce wait times, as it can be delivered in half the time as existing CBT approaches for EDs. To improve access to treatment, the Nova Scotia Eating Disorder Provincial Service trained 36 clinicians through a 10‐month CBT‐T training program and offered CBT‐T provincially. This study examines changes in ED psychopathology, binge eating, compensatory behaviors, anxiety, and depression in a transdiagnostic cohort of adult patients treated with CBT‐T. Further, an exploratory analysis of predictors of treatment outcome was conducted.Methods: A retrospective chart review was conducted on adults who began CBT‐T between July 2022 and March 2024. Participants completed routine outcome measures per the CBT‐T manual. Mixed‐effects models examined symptom changes over time, along with predictors of treatment outcome, dropout, and extension.Results: A total of 267 patients started CBT‐T. Significant reductions in ED psychopathology, binge eating, and compensatory behaviors, anxiety, and depression were observed throughout treatment. Effect sizes were large to very large at the end of treatment for primary and secondary outcomes. Early change in ED psychopathology predicted better outcomes, whereas diagnoses of anorexia nervosa and atypical anorexia nervosa were associated with higher dropout rates.Discussion: Findings support that CBT‐T may be an effective, scalable treatment associated with significant symptom reductions corresponding to large effect sizes. Future research should explore adaptations to improve retention, especially for those with anorexia nervosa and atypical anorexia nervosa.

Binge Focused Therapy (BFT) is a 3-session, group-based, guided self-help treatment for binge-eating disorder (BED). In this parallel-group randomized controlled trial (RCT), adults with BED were randomized to virtual BFT or a traditional unguided self-help approach (Overcoming Binge Eating; Fairburn, 2013). Self-report measures were collected at baseline, week 6, week 10 (posttreatment), 6- and 12-month follow-up. We hypothesized BFT (n = 82) would lead to better BED outcomes and lower dropout than unguided self-help (n = 82). Our intention-to-treat analysis demonstrated a significant effect of treatment group on BED symptomatology (primary outcome; β= - 5.04, p < .001, 95% CI [ - 7.57, - 2.52]), binge frequency (β= - 3.24, p = .001, 95% CI [ - 5.22, - 1.26]), general ED symptomatology (β= - 0.91, p < .001, 95% CI [ - 1.17, - 0.65]), clinical impairment (β= - 6.27, p < .001, 95% CI [ - 8.78, - 3.77]), confidence to change binge eating (β = 1.22, p < .001, 95% CI [0.56, 1.89]), BED remission (OR = 4.98, p = .003, 95% CI [1.72, 14.40]), and treatment attrition (β = 0.456, p < .001), with the BFT group reporting greater improvements and lower dropout. We did not find evidence of a significant effect of group on binge-eating abstinence (OR = 2.01, p = .103, 95% CI [0.87, 4.64]). BFT may be an effective BED treatment that could overcome common barriers to treatment implementation and accessibility.

Background: Bulimia nervosa and related syndromes (BN-S) characterized by binge eating vary considerably in illness severity and course. Using the Research Domain Criteria framework of the National Institute of Mental Health, we developed a model positing that the same set of physiological consequences of weight suppression (WS; defined as the difference between the highest and current adult body weight) contribute to binge-eating severity and maintenance by (1) increasing the drive or motivation to consume food (reward valuation effort [RVE]) and (2) decreasing the ability for food consumption to lead to a state of satiation or satisfaction (reward satiation). Objective: Our funded project aimed to test concurrent associations among WS, physiological factors (leptin concentrations and postprandial glucagon-like peptide 1 [GLP-1] response), behavioral indicators of RVE (breakpoint on progressive ratio tasks) and reward satiation (ad-lib test meal intake), self-report of these core constructs, and binge-eating severity in BN-S (aim 1); test prospective associations to determine whether WS predicts BN-S maintenance in longitudinal models and whether posited mediators also predict BN-S maintenance (aim 2); and determine whether associations between WS and BN-S severity and maintenance are mediated by alterations in leptin levels, GLP-1 response, RVE, and reward satiation (aim 3). Methods: We aimed to recruit a sample of 320 women with BN-S or noneating disorder controls, with BMI from 16 kg/m2 to 35 kg/m2, for our study. The study included diagnostic interviews; questionnaires; height, weight, and percentage of body fat measurements; weight history; fasting leptin level; postprandial GLP-1 and insulin responses to a fixed meal; and ad-lib meal and progressive ratio tasks to behaviorally measure reward satiation and RVE, respectively, at baseline, with at least 78.1% (250/320) of the participants providing data at 6- and 12-month follow-up visits. Data will be analyzed using structural equation models to test posited pathways. Results: Data collection began in November 2016 and ended in April 2023, pausing in-person data collection from March 2020 to February 2021 due to the COVID-19 pandemic. Of 399 eligible women enrolled, 290 (72.7%) provided clinical, behavioral, and biological data at baseline, and 249 (62.4%) provided follow-up data. Measures demonstrated strong psychometric properties. Conclusions: We seek to identify biobehavioral predictors to inform treatments that target key factors influencing the severity and course of binge eating. These data, supported solely through federal funding, can inform questions emerging from recent interest and controversy surrounding the use of GLP-1 agonists for binge eating. International Registered Report Identifier (IRRID): RR1-10.2196/66554

BACKGROUND Bulimia nervosa and related syndromes (BN-S) characterized by binge eating vary considerably in illness severity and course. Using the Research Domain Criteria framework of the National Institute of Mental Health, we developed a model positing that the same set of physiological consequences of weight suppression (WS; defined as the difference between the highest and current adult body weight) contribute to binge-eating severity and maintenance by (1) increasing the drive or motivation to consume food (reward valuation effort [RVE]) and (2) decreasing the ability for food consumption to lead to a state of satiation or satisfaction (reward satiation). OBJECTIVE Our funded project aimed to test concurrent associations among WS, physiological factors (leptin concentrations and postprandial glucagon-like peptide 1 [GLP-1] response), behavioral indicators of RVE (breakpoint on progressive ratio tasks) and reward satiation (ad-lib test meal intake), self-report of these core constructs, and binge-eating severity in BN-S (aim 1); test prospective associations to determine whether WS predicts BN-S maintenance in longitudinal models and whether posited mediators also predict BN-S maintenance (aim 2); and determine whether associations between WS and BN-S severity and maintenance are mediated by alterations in leptin levels, GLP-1 response, RVE, and reward satiation (aim 3). METHODS We aimed to recruit a sample of 320 women with BN-S or noneating disorder controls, with BMI from 16 kg/m2 to 35 kg/m2, for our study. The study included diagnostic interviews; questionnaires; height, weight, and percentage of body fat measurements; weight history; fasting leptin level; postprandial GLP-1 and insulin responses to a fixed meal; and ad-lib meal and progressive ratio tasks to behaviorally measure reward satiation and RVE, respectively, at baseline, with at least 78.1% (250/320) of the participants providing data at 6- and 12-month follow-up visits. Data will be analyzed using structural equation models to test posited pathways. RESULTS Data collection began in November 2016 and ended in April 2023, pausing in-person data collection from March 2020 to February 2021 due to the COVID-19 pandemic. Of 399 eligible women enrolled, 290 (72.7%) provided clinical, behavioral, and biological data at baseline, and 249 (62.4%) provided follow-up data. Measures demonstrated strong psychometric properties. CONCLUSIONS We seek to identify biobehavioral predictors to inform treatments that target key factors influencing the severity and course of binge eating. These data, supported solely through federal funding, can inform questions emerging from recent interest and controversy surrounding the use of GLP-1 agonists for binge eating. INTERNATIONAL REGISTERED REPORT RR1-10.2196/66554