No abstract

Purpose Research demonstrates that anorexia nervosa (AN) takes a significant toll on affected families, yet the well-being of siblings has been largely overlooked. This study examines mental health symptoms in siblings of adolescents with AN and seeks to identify modifiable factors associated with well-being. Method Participants included 34 siblings (aged 11-19) of adolescents with AN and 47 age and sex matched controls. Participants and their caregivers completed assessments of anxiety, depression, internalizing and externalizing problems, and parentification. Siblings of adolescents with AN also completed the Sibling Perception Questionnaire, an assessment of perceptions and attitudes about AN. Results Analyses indicated that siblings of adolescents with AN reported greater anxiety and parentification than controls. On caregiver reports of participants' internalizing and externalizing symptoms, no significant differences were found across groups. In siblings of adolescents with AN, females were more vulnerable to anxiety, depression, and negative attitudes and perceptions about AN than males. Perceived negative interpersonal interactions, specific to having a brother or sister with AN, were associated with greater anxiety and depression among AN siblings. Conclusion Findings from this pilot study suggest that siblings of adolescents with AN are vulnerable to anxiety and parentification behaviors. Negative interpersonal interactions specific to having a brother or sister with AN may perpetuate risk for poorer well-being. Caregivers may not be attuned to these struggles, highlighting the importance of provider and family education about sibling vulnerabilities. Therapeutic interventions that target siblings of adolescents with AN are also indicated. Level of evidence Level III, case-control analytic study.

Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictive eating in the absence of body image disturbance or drive for thinness, resulting in the persistent failure to meet appropriate nutritional and/or energy needs and/or psychosocial impairment. ARFID is a heterogeneous diagnosis with diverse etiologies. Thus, identification of best practice guidelines and evidence-based treatments for ARFID is challenging and, to our knowledge, randomized treatment studies have not been published. Existing literature promotes a multidisciplinary care approach that integrates behavioral, cognitive behavioral, and family-based interventions. In this report, we present the case of an 8-year-old female with ARFID who began restricting her food and fluid intake following a viral illness. The patient also choked on a lozenge at school and peers laughed in response, resulting in heightened fears of eating, subsequent dehydration, and admission to a gastroenterology unit at a pediatric hospital. While hospitalized, she was diagnosed with ARFID, a nasogastric tube (NGT) was placed, and was referred to outpatient eating disorder specialists. Despite participating in 16-outpatient therapy sessions, progress was limited and the patient was medically admitted to safely remove the NGT in the context of behavioral interventions targeting food refusal. This case report describes the successful use of an intensive inpatient behavioral intervention used for the patient, which resulted in the rapid resumption of food and fluid intake, by mouth. This case study supports the use of such intervention for ARFID when sufficient progress is not achieved in outpatient care.

Objective The COVID‐19 pandemic hastened a transition to treatment delivery via telehealth. While barriers still exist, the increased uptake of telehealth has the potential to increase access to mental health treatment for all diagnoses, including eating disorders. Delivery of evidence‐based treatment as well as adjunctive treatments, including those that are hard to find in‐person, have been modified to virtual format to increase accessibility and allow for continuity of care for adolescents with anorexia nervosa. Method We describe how to modify and deliver Cognitive Remediation Therapy for youth with anorexia nervosa (CRT‐AN) via a telehealth platform. Preliminary and practical guidance for best practice for both group and individual delivery is established. Results With minimal modifications, CRT‐AN can be delivered via telehealth for both individual and group delivery. More disengagement in group delivery was noted; however, overall application of the treatment via a remote platform was observed. Discussion As more treatment moves to a telehealth format, highlighting how an adjunctive treatment like CRT‐AN can combined with other treatments in a telehealth format has the potential to increase research in its implementation and furthermore increase its dissemination. Public Significance Cognitive Remediation Therapy for Anorexia Nervosa (CRT‐AN) requires significant manipulation of materials and supplementary human guidance. Suggestions for how to modify CRT‐AN for remote delivery via telehealth are provided. Modifications grew out of immediate changes made during the beginning of the COVID‐19 pandemic and can be used to inform changes therapists and programs can make to continue to or begin to use CRT‐AN in a remote fashion.

Compared to cisgender peers, transgender and gender diverse (TGD) youth and adults report elevated eating disorder (ED) symptoms likely related to gender dysphoria and attempts to modify their bodies accordingly. Less is known about the impact on gender-affirming care and ED symptoms. This study aimed to expand on extant research and describe ED symptoms in TGD youth seeking gender-affirming care while exploring potential associations between gender-affirming hormone use and ED symptoms. A total of 251 TGD youth completed the Eating Disorders Examination-Questionnaire (EDE-Q) as part of routine clinical care. ANCOVAs and negative binomial regressions examined differences in ED symptoms among transgender females (identifying as female but assigned male at birth) and transgender males (identifying as male but assigned female at birth). ED severity was not significantly different among transgender females versus transgender males, ( p = .09), or associated with gender-affirming hormone use ( p = .07). Transgender females receiving gender-affirming hormones reported a greater proportion of objective binge eating episodes compared to those who were not ( p = .03). Over a quarter of TGD youth reported engagement in ED behaviors suggesting assessment and intervention related to ED behaviors among TGD youth is imperative since adolescence is a particularly vulnerable period for adolescents and engagement in ED behaviors could lead to full ED development and medical risk.