There is a dearth of research assessing the prevalence of eating disorders in publicly insured populations. While evidence shows that eating disorders affect people of all racial, ethnic, and socioeconomic backgrounds, research has neglected to focus on the rate at which they occur among those who have public health insurance. The present study indexes the prevalence of clinically significant disordered eating in a case series of 165 adults in a publicly insured sample at an outpatient general psychiatry clinic in Los Angeles, California. Results illustrate that 46 (27.8%) participants screened positive for clinically significant disordered eating with no significant differences relating to age or gender in those who screened positive versus those who did not (p > .05). This markedly elevated frequency of disordered eating presentations underscores the need for improved clinician training and education around disordered eating and eating disorder assessment as a whole. In addition, there is a critical need to study publicly insured populations so as to mitigate stereotypes about who has eating disorders and improve the likelihood of diagnosis and care.

The impact of psychiatric comorbidities in the diagnosis and treatment of feeding and eating disorders (FEDs) represents an emerging research topic. The current literature, nonetheless, lacks studies investigating the developmental paths of individuals with FEDs and comorbid neurodevelopmental disorders (NDDs). Here, we report 11 cases of children and adolescents with comorbid FEDs and NDDs, as assessed along the neuropsychological, psychopathological, and nutritional developmental pathways. The onset of FED-related psychopathology was preceded, sometimes undiagnosed, by altered neurodevelopmental features leading to specific NDD diagnoses (autism spectrum disorder-ASD; attention-deficit/hyperactivity disorder-ADHD; specific learning disorder-SLD). NDDs appeared to influence the diagnoses and treatments of FEDs, frequently with an impact on socio-relational and emotional premorbid features, and on the possibility to receive and attend FED-targeted treatments. Further studies should longitudinally contribute to assessing the experiences of care and neurodevelopmental pathways of children with FEDs and specific NDD comorbidities.

Eating disorders (EDs) are increasingly emerging as a health risk in men, yet men remain underrepresented in ED research, including interventional trials. This underrepresentation of men may have facilitated the development of women-centered ED treatments that result in suboptimal outcomes for men. The present study retrospectively compared pre- vs. post-treatment outcomes between age-, diagnosis-, and length-of-treatment-matched samples of n = 200 men and n = 200 women with Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), or Eating Disorder Not Otherwise Specified (EDNOS), treated in the same setting during the same period, and using the same measurements. Compared to women, men with AN showed marked improvements in weight gains during treatment as well as in ED-specific cognitions and general psychopathology. Likewise, men with BED showed marked weight loss during treatment compared to women with BED; ED-specific cognitions and general psychopathology outcomes were comparable in this case. For BN and EDNOS, weight, ED-specific cognitions, and general psychopathology outcomes remained largely comparable between men and women. Implications for treatments are discussed.

Introduction: Binge eating disorder (BED) is the most common eating disorder, affecting a large population worldwide. It is characterized by recurrent episodes of binge eating, with no compensatory behaviors. BED is often associated with psychiatric comorbidities, and still represents a challenge in terms of treatment strategies. In the last years, neuromodulation has represented a promising approach in the treatment of BED. We report the cases of two women, affected by Bipolar Disorder Type II (BD-II) and comorbid BED, whose BED symptoms improved after a course of accelerated intermittent Theta Burst Stimulation (iTBS). Methods: We carried out a clinical study, involving neurostimulation on six patients with a treatment-resistant depressive episode. The trial consisted of a 3-week accelerated iTBS treatment, delivered to the left dorsolateral pre-frontal cortex. Clinical evaluation scales (Hamilton Rating Scale for Depression, Montgomery-Åsberg Depression Rating Scale, and Young Mania Rating Scale) were administered at baseline, after 2 weeks, and at the end of the stimulation cycle. Pharmacotherapy was maintained unchanged during iTBS treatment. Patients gave their informed consent both for the protocol and for the publication. Results: The treatment was well-tolerated. Depressive symptoms only slightly improved; however, patients\' binge episodes remitted completely, which was a serendipitous finding. BED symptomatology complete remission lasted up to 12 weeks follow-up. Discussion: This is the first study regarding iTBS use in BED in comorbidity with BD-II. Further research is still needed to assess the efficacy of this technique in BED treatment.

BACKGROUND: Obsessive-compulsive and related disorders (OCRDs) are a group of intractable and chronic mental disorders. Trichotillomania (TTM) is a common type of OCRDs characterized by repetitive hair pulling, driven by escalating tension before the action and during the attempts to resist it. Binge eating disorder (BED) is a common type of eating disorder characterized by recurrent compulsive episodes of binge eating. Both have common psychological processes (tension or impulsion) and pathological manifestations (out of control), but the pathological mechanisms are still unclear and the current clinical treatments are often unsatisfactory for these two disorders.
METHODS: A 25-year-old woman with TTM comorbid BED came to our hospital for treatment. She had accepted systematic cognitive behavioral therapy (CBT) and also monotherapy or multidrug therapy with sertraline, fluvoxamine, bupropion, risperidone in full dosage and duration for 2 years, but all of them did not work. We treated this case with N-acetylcysteine (NAC) as a synergist on the basis of recent treatment (fluvoxamine 150 mg/day and bupropion 300 mg/day). The pathological hair plucking behavior and binge eating symptoms were both significantly and rapidly improved, and the follow-up in next 14 weeks showed that the effect was still maintained.
CONCLUSIONS: To our knowledge, this may be the first case report of using NAC as a synergist to treat TTM comorbid BED successfully, which suggest that these two disorders may have a common pathophysiological mechanism. Moreover, NAC can be one choice as a synergistic treatment for OCRDs.

BACKGROUND: The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder.
OBJECTIVE: We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores.
METHODS: We conducted a case-control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge - assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test.
RESULTS: The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered.
CONCLUSIONS: We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image.
METHODS: Level II: controlled trial without randomization.

BACKGROUND: There is a high prevalence of overweight or obesity in people with eating disorders. However, therapies for eating disorders, namely binge eating disorder and bulimia nervosa, do not address weight management. Conversely, weight loss treatments for people with overweight or obesity do not address psychological aspects related to eating disorders. Thus we developed a new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa, entitled HAPIFED (a Healthy APproach to weIght management and Food in Eating Disorders). This paper describes HAPIFED and reports a case series examining its feasibility and acceptability.
METHODS: Eleven participants with overweight or obesity and binge eating disorder or bulimia nervosa were treated with HAPIFED in two separate groups (with once or twice weekly meetings). Weight, body mass index (BMI) and eating disorder symptoms, as well as depression, anxiety and stress, were assessed at baseline and at the end of the 20-session HAPIFED intervention.
RESULTS: Eight of the 11 participants completed the intervention, with diverse results. Six of the 8 participants who completed HAPIFED reduced their weight between baseline and the end of the intervention. Median scores on the Eating Disorder Examination Questionnaire for binge eating, restraint, and concerns about eating or weight and shape, were reduced in the group overall between baseline and the end of the intervention. One participant, who at baseline was inducing vomiting and misusing laxatives in an attempt to lose weight, reduced these behaviors by the end of the intervention. Three participants at baseline were undertaking episodes of compulsive exercise, and they reduced or stopped this behavior, but one participant commenced episodes of compulsive exercise by the end of the intervention. All participants who completed the intervention rated the suitability and success of HAPIFED as 7 or more out of 10 (0 = not at all suitable/successful; 10 = extremely suitable/successful).
CONCLUSIONS: This case series supports the feasibility and acceptability of HAPIFED as a potential new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa. Clinical trials are necessary to examine the efficacy and effectiveness of HAPIFED.
BACKGROUND: Australian and New Zealand Clinical Trials Registry (Universal Trial Number): U1111-1149-7766. Date of registration: 4th November 2013.

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