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Purpose Childhood maltreatment (CM) experiences are associated with heightened risk of Eating disorders (EDs). The psychopathological pathways promoting this association in people with Bulimia nervosa (BN) and in those with Binge eating disorder (BED) are under-investigated. Methods One hundred and eighty-one people with BN and 144 with BED filled in the Eating Disorder Inventory-2, to measure ED psychopathology, and the Childhood Trauma Questionnaire, to assess their early traumatic experiences. Network analysis was conducted to investigate the interplay between those variables. The shortest pathways function was employed to investigate the shortest out of all routes conveying the association between CM and ED-specific symptoms. Results In both people with BN and with BED, all CM types were connected to the ED psychopathology through the emotional abuse node. The association between emotional abuse and ED-specific symptoms (bulimia and body dissatisfaction) differed in the two groups: in people with BN, it included ineffectiveness, while in people with BED, it involved impulsivity. Interoceptive awareness, an indirect measure of emotion regulation, was included in these pathways in both groups. Conclusion In the light of literature showing that emotional abuse has a connecting role between CM and ED psychopathology also in anorexia nervosa, the present findings support the idea that emotional abuse conveys such association in all the main ED diagnoses. Ineffectiveness and impulsivity may represent the specific psychopathological dimensions connected to emotional abuse and promoting the maintenance of ED-specific symptoms in BN and in BED, respectively. These findings are worth of attention by clinicians. Level of evidence Level III: evidence obtained from well-designed cohort or case–control analytic studies

Background: In recent years, there has been a shift in the clinical presentation and, hence, diagnostic definitions of eating disorders (EDs), reflected in a dramatic change in the diagnostic criteria of EDs in the DSM-5. The Eating Attitudes Test-26 (EAT-26) is currently considered an accepted instrument for community studies of EDs, although it features an inconsistent factorial structure in different cultures. Therefore, it is essential to investigate whether the EAT-26 can still be considered an adequate instrument for identifying the risk of developing EDs in different cultures. The aim of the present study was to examine the construct validity and internal consistency of the EAT-26. Method: The study used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among different cultural populations in Israel. Results: Findings indicated different factors in different ethnic groups, most of which do not correspond with the original EAT-26 three-factor structure. Results: The analysis yielded two main factors among Israeli Jews, four main factors among Israeli Muslim Arabs, and three main factors among Israeli Christian Arabs. Conclusion: These findings shed light on cultural factors affecting perceptions of the EAT-26 items. This calls for a reconsideration of the generalization of the original three-factor structure of the questionnaire in different cultures.

Eating disorders (EDs) are considered a major disease in the modern world, being one of the most prevailing public health problems among female adolescents and young adults in recent decades, and reaching epidemic proportions in many Western countries. The last two decades have envisioned an abundance of research in many aspects related to EDs. Nevertheless, EDs are still highly misunderstood disorders that often raise a host of negative emotions such as bewilderment, mistrust and fear. This book reviews research on the diagnosis and classification of EDs, as well as the historical and socio-cultural aspects and the genetics, biology and psychological considerations involved.

Objective The Eating Attitudes Test-26 (EAT-26) is considered the screening instrument of choice to identify eating disorders (ED) symptoms in clinical and community populations, showing a classical three-factor structure. This study assessed whether the factor structure of the EAT-26 in patients with ED was stable at admission and discharge from inpatient treatment. Methods We administered the EAT-26 to 207 female adolescents with ED at both admission and discharge. Results Factor structure of the EAT-26 at admission comprised of four factors and at discharge three factors and 15-item version of the EAT, producing two factors, was considerably more stable at both admission and discharge. Cutoff score of 23 in the EAT-15 better defined patients as improved at discharge than the cutoff score of 20 in the EAT-26. Conclusion Different factor structures of the EAT are found in the same population of young females with ED during the acute stage of illness vs. symptomatic improvement. In addition, shorter versions of the EAT with higher cutoff scores may better differentiate between improved and not improved patients at discharge. Findings suggest that using the EAT-15 is more effective for evaluating a population with clinical characteristics of ED. Plain English summary This study investigates the factor structure of the Eating Attitudes Test (EAT-26) in female adolescents with eating disorders (ED) at admission and discharge from an inpatient treatment facility. We aim to understand how the EAT-26, a widely used screening tool for ED, performs in different stages of the illness. By comparing the factor structure at admission and discharge, we hope to identify a more stable and accurate version of the test that can better differentiate between symptomatic and non-symptomatic patients. Our findings suggest that a shorter version of the EAT-26, consisting of 15 items, may provide a more reliable measure for assessing eating disorder symptoms and guiding treatment decisions. This research contributes to improving the tools used for diagnosing and treating eating disorders, ultimately enhancing patient care.

Objectives: Night eating syndrome (NES) is classified as a delay of food intake, reflected by consuming large amounts after the evening meal or ingesting food after sleep onset (DSM-5). This article aims to describe NES experience, awareness, narratives, and behavior from the perspectives of patients with NES in light of their history of traumatic life events. Method: Semi-structured interviews based on the phenomenological approach were conducted with 18 women (aged 19–60) diagnosed with NES. Results: The analysis raised two themes: 1. References to NES as an experience that represents the darker sides of patients’ behaviors and involves helplessness, contempt, self-loathing, and a loss of control. Patients also related to difficult memories concerning sexual, physical, and emotional abuse. 2. References to the comforting side of NES patients’ behaviors that involves soothing, regulating, emotional disconnecting, and a sense of calm, control, and the ability to function. Conclusion: Findings present the relationship between traumatic life events, dissociation, and EDs. Clinically, they highlight the importance of an early assessment and a traumatic life history and suggest giving special treatment attention to the role of dissociation and night eating as regulatory mechanisms in the therapeutic process and alliance.

Background Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI). Methods A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter 2 ). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies. Results About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings. Conclusions Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.

Objective This study aimed to compare dietary patterns (timing and frequency of binge episodes, caloric intake and macronutrient composition) of patients with binge eating disorders (BE) with and without night eating syndrome (NES). Design The study includes 59 women (18–60) who sought treatment for Eating Disorders (EDs) and were diagnosed with BED or BN (BE) with or without NES. They were divided into two groups: NES–BE and BE-only. The participants kept 7-day, 24-h food diaries and completed demographic and depression questionnaires. Results NES–BE reported significantly a higher frequency of binge days and binge episodes during the week, and more energy and fat consumption than BE-only. Conclusions Individuals with NES–BE exhibit higher levels of eating pathology than individuals with BE-only. Thus, NES–BE may not be simply a variant of BED or BN but rather a separate entity that may lead to a more severe disorder and require early assessment and more intensive and suitable treatment. Level of evidence Level V, cross-sectional descriptive study.

Background During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020–21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions. Methods Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap ® ) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls. Results Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience. Conclusions Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients. Plain English summary The recent COVID-19 pandemic has been associated with increased rates of eating disorders in many countries around the globe, including Israel. Our study evaluated whether Israeli patients with anorexia nervosa would fare worse than a control group during the COVID-19 pandemic, and whether adults and adolescents with anorexia nervosa would differ. For this purpose, we administered questionnaires to 71 females with anorexia nervosa—36 adolescents and 35 adults—and to a control group of 25 adolescent and young adult women. We found that females with anorexia nervosa showed not only more eating-disordered and psychiatrically-related symptoms, but also more pandemic-related disturbances than the control group. Among the patients with anorexia nervosa, adults fared worse than adolescents. Fifty-one percent of adolescents and 58% of adults with anorexia nervosa received treatment via telemedicine, although all were offered this treatment. Adults treated with telemedicine showed fewer positive attitudes toward it than adolescents. Last, more disordered eating and other psychiatric symptoms were associated with more COVID-19-specific disturbances. Our findings suggest that the emotional-behavioral state of female Israeli patients with anorexia nervosa is worse than that of control females during the COVID-19 pandemic, especially in adults.

In recent years, the diagnostic definitions of eating disorders (EDs) have undergone dramatic changes. The Eating Attitudes Test-26 (EAT-26), which is considered an accepted instrument for community ED studies, has shown in its factorial structure to be inconsistent in different cultures and populations. The aim of the present study was to compare the factor structure of the EAT-26 among clinical and non-clinical populations. The clinical group included 207 female adolescents who were hospitalized with an ED (mean age 16.1). The non-clinical group included 155 female adolescents (mean age 16.1). Both groups completed the EAT-26. A series of factorial invariance models was conducted on the EAT-26. The results indicate that significant differences were found between the two groups regarding the original EAT-26 dimensions: dieting, bulimia and food preoccupation, and oral control. Additionally, the factorial structure of the EAT-26 was found to be significantly different in both groups compared to the original version. In the clinical group, the factorial structure of the EAT-26 consisted of four factors, whereas in the non-clinical sample, five factors were identified. Additionally, a 19-item version of the EAT-26 was found to be considerably more stable and well suited to capture ED symptoms in both groups, and a cutoff point of 22 (not 20) better differentiated clinical samples from non-clinical samples. The proposed shortening of the EAT from 40 to 26 and now to 19 items should be examined in future studies. That said, the shortened scale seems more suited for use among both clinical and non-clinical populations. These results reflect changes that have taken place in ED psychopathology over recent decades.