Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

Sixty referrals to a Pediatric Eating Disorder clinic were compared on a number of demographic, clinical, and psychological variables. Twelve patients met definite diagnostic criteria for anorexia nervosa and 14 met criteria for a diagnosis of bulimia nervosa. Twenty‐one patients had a subclinical form of anorexia nervosa and eight had subclinical bulimia nervosa. Five patients could not be classified. The subclinical and definite diagnostic groups were compared across a number of demographic, eating pathology, and general psychological variables. The results revealed a clear pattern of difference between the two bulimia nervosa groups on variables related to the regulation of affects and impulses. There was no clear pattern of difference between the definite and subclinical anorexia nervosa groups. The results suggest that the DSM‐III‐R criteria for anorexia nervosa may substantially underestimate the number of individuals with a psychologically distressing eating disorder, but provide tentative support for the maintenance of strict diagnostic criteria for bulimia nervosa.

Objective: Traumatic events, posttraumatic stress disorder (PTSD) and related symptoms are commonly associated with eating disorders (ED). Several clinical features indicative of a more severe and complex course have been associated with traumatized ED patients, especially those with PTSD, who may be more likely admitted to residential treatment (RT). Research in this population is sparse but of increasing interest. Method: Adult participants (96.7% female) with EDs entering RT (n = 642) at seven sites in the U.S. completed validated self-report assessments of ED, PTSD, major depression, state-trait anxiety, and quality of life. Presumptive diagnoses of DSM-5 PTSD (PTSD+) were made via the Life Events Checklist-5 and the PTSD Symptom Checklist for DSM-5. Results: PTSD+ occurred in 49.3% of patients. PTSD+ patients had significantly higher scores on all assessment measures (p ≤ .001), including measures of ED psychopathology, depression, state-trait anxiety, and quality of life. Those with PTSD+ had significantly higher numbers of lifetime traumatic event types, higher rates of almost all lifetime traumatic events, and a greater propensity toward binge-type EDs. Discussion: Results confirm that ED-PTSD+ patients in RT are more symptomatic and have worse quality of life than ED patients without PTSD+. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed.

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Objective-There is a growing consensus that there is a need to test the real-world effectiveness of eating disorder therapies that show promise in efficacy research. The current paper provides a narrative account of an NIMH-funded study that attempted to apply efficacy findings from CBT research to an Intensive Outpatient Program (IOP) at the largest community-based eating disorder program in the United States.Method-We describe the study as originally envisioned as well as the various challenges that the researchers and the IOP staff encountered in implementing this study.Results-The different training, assumptions, and "ways of knowing" of the research team and the treatment staff in regard to the nature of eating disorders and their treatment created multiple challenges for both groups during the study period. We describe valuable lessons learned about how to -and how not to -implement effectiveness designs in clinical settings that are relatively unfamiliar with empirically-based research findings.Discussion-It is hoped that our experience in attempting to apply efficacy-based research findings on eating disorders treatment in a community-based clinical setting will prove helpful to other researchers and service providers engaging in such translational research.The vast majority of controlled psychotherapy outcome studies for eating disorders have used efficacy designs, leaving open the question of the real-world applicability of their findings. Efficacy studies have found cognitive-behavior therapy (CBT) to be the treatment of choice for bulimia nervosa (BN). It may hold promise for anorexia nervosa (AN) as well1 , 2 , 3. The present paper describes our attempt to translate CBT findings from efficacy studies on bulimia nervosa to a community-based intensive outpatient program. This study was supported by a NIMH R34 grant that was designed to promote such translational studies. The reason that we wrote this narrative account is that the attempt to apply findings from well-controlled efficacy studies to a clinical setting using an effectiveness design creates a number of novel challenges that must be identified and overcome to facilitate this kind of translational research in the future.Two goals of the R34 grant that funded this research were to "encourage research on 1) the development and/or pilot testing of new or adapted interventions, [and] 2) pilot testing interventions with demonstrated efficacy in broader scale effectiveness trials…"4. This

Objective Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents. Methods Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self‐report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM‐5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM‐5. Results PTSD+ occurred in 35.4% of participants, and those with ED‐PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type. Conclusions Results confirm that adolescent patients in residential treatment with ED‐PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED‐PTSD+ are greatly needed in ED programs that treat adolescents.

The Body Shape Questionnaire (BSQ) is a 34‐item self‐report questionnaire that measures the degree of body shape dissatisfaction. To date, the BSQ has not been used with adolescents. The present study compared the BSQ scores of five adolescent subject samples: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Subclinical Bulimia Nervosa (SB), Subdinical Anorexia Nervosa (SA), and non‐eating‐disordered adolescent females (Q. Results show that patients with BN have the highest levels of body dissatisfaction. All clinical groups had higher BSQ scores than subjects in the comparison sample but only the BN patients had significantly higher scores. The mean BSQ score for the Comparison group was higher than published means for non‐eating‐disordered adult samples. The two major findings of the study are that significant body shape concerns are particular features of patients with bulimia nervosa but that some body shape concerns are common among non‐eating‐disordered adolescent females.

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