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Background Stigma significantly hinders treatment seeking, adherence to treatment, referrals, and can prolong recovery, while increasing the risk of relapse due to social exclusion and stress. Stigmatizing attitudes towards anorexia nervosa are widespread, and not only held by the general public, but also by professionals. Objective As stigmatizing attitudes towards mental disorders often develop early during education and training, the study’s objective was to investigate stigmatizing attitudes towards anorexia nervosa among Dutch psychiatry residents, as well as their mental health literacy. Methods In this pilot study, Dutch psychiatry residents ( N  = 61) were surveyed, with a 49% response rate, using a comprehensive questionnaire that included nine parts, covering multiple stigma domains, disease prestige, knowledge, and professional training. Results Anorexia nervosa was ranked 18th in disease prestige with a mean score of 6.23. Although most stigmatizing attitudes were not widely endorsed by psychiatry residents, there were a few notable exceptions, especially attitudes related to blame, fragility and social distance. They characterized patients as insecure, controlling, sad, and defensive, and reported feeling worried, incompetent, pessimistic and anxious when dealing with patients with anorexia nervosa. Only 37% felt confident in diagnosing anorexia nervosa. Conclusion There is a critical need for further research on the social value ranking of psychiatric disorders and the development of a comprehensive stigma scale, as well as targeted educational interventions. Addressing stigma through focused training programs could lead to better patient outcomes, improved treatment satisfaction, and reduced barriers to care for individuals with anorexia nervosa. Plain English summary Stigmatizing attitudes towards anorexia nervosa are not only held by the general public, but also by professionals and often develop early during education and training, likely due to insufficient knowledge. Stigmatization can hinder treatment participation and adherence, potentially worsening illness duration and severity, delaying recovery, and increasing relapse risk. The current pilot study examined several stigma domains as well as knowledge about anorexia nervosa. Furthermore, satisfaction with psychiatry residents’ training was investigated. Results revealed that most stigmatizing attitudes towards anorexia nervosa were not widely endorsed by many psychiatry residents. However, several stigmatizing attitudes in the blame, fragility and social distance stigma categories were prominent. More research is needed regarding the social value ranking of psychiatric disorders and the development of a comprehensive stigma scale, as well as educational interventions.

Background Severe and Enduring Eating Disorders (SEED), in particular SEED-Anorexia Nervosa (SE-AN), may represent the most difficult disorder to treat in psychiatry. Furthermore, the lack of empirical research in this patient group, and, consequently the lack of guidelines, call for an urgent increase in research and discussion within this field. Meanwhile experts concur that effective care should be structured in a collaborative manner. Objective To identify the challenges in providing care to patients with SE-AN in the Dutch healthcare context, and propose a collaborative care treatment model to address these issues. Methods A pragmatic mixed-method approach was used, structured as follows: (1) Identifying perceived barriers and treatment needs from the viewpoint of both patients and eating disorder healthcare professionals through an evaluation questionnaire; (2) Investigating current treatment practices for SEED/SE-AN via benchmarking; (3) Gaining insight into the optimal structure and content of care by interviewing network partners and experts-by-experience. Based on these findings, and drawing from literature on severe and enduring disorders, a treatment model for SE-AN was proposed and implemented. Results The key challenges identified included a lack of knowledge about eating disorders among network partners, treatment ambivalence among patients and poor collaboration between professionals. The proposed model enhances self-management and collaborative relationships with healthcare providers, offers user-friendly and practical guidance, and aims at stabilization, reducing relapses, deterioration, and readmissions, thereby being cost-effective. Importantly, the model operates across levels of care (primary, secondary, tertiary). Conclusion This study, describing a collaborative care program for SE-AN, developed and implemented in a highly specialized treatment center for eating disorders, sets the stage for further explanatory/efficacy research to build on the findings in this study, with the following aims: addressing the critical gap in care for SEED/SE-AN, improving better healthcare organization, reducing relapse rates, and lowering costs for this often overlooked patient group. Plain English summary Severe and Enduring Eating Disorders (SEED), and particularly Severe and Enduring Anorexia Nervosa (SE-AN), present significant challenges in psychiatric treatment. This study aimed to understand the obstacles in caring for patients with SEED/SE-AN in the Dutch healthcare system and proposed a collaborative care model to address the issues. Through surveys, interviews, and benchmarking, key challenges were identified, including limited knowledge about eating disorders, patient ambivalence, and poor professional collaboration. The collaborative care model for SE-AN that was proposed in this study emphasizes structured care coordination, education for network partners, and support for eating disorder professionals, combining clinical management and psychotherapy. The study aims to bridge the gap in care for SE-AN and improve healthcare organization for this overlooked patient group.

Background Dissonance-based eating disorder programs have successfully targeted body dissatisfaction by challenging the thin beauty ideal in the preventive context and in groups of patients with a subthreshold and full threshold DSM-5 eating disorder. As there is a need for interventions specifically targeting thin-ideal internalization in (highly) specialized treatment centres, the present study adapted Stice’s et al.’s Body Project for its use as an add-on treatment for severe eating disorders with the aims to identify whether it was feasible and acceptable in this treatment context, to determine any necessary modifications with regard to the treatment and study procedures, and to test preliminary effectiveness. Methods The study was a randomized controlled pilot/feasibility trial. Thirty patients started in the Body Project group and 25 in the Psycho-education group. Measurements took place pre- and post-intervention, and at three and six months follow-up. Patients and staff evaluated treatment and study procedures, and patients completed questionnaires on thin-ideal internalization, body dissatisfaction, self-objectification, negative affect and eating disorder pathology. Results The Body Project group and Psycho-education group both proved highly feasible and acceptable, as well as preliminarily effective, based on quantitative scores and qualitative feedback. Preliminary analyses showed that treatment effects did not differ between treatment groups. As both groups were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. Qualitative feedback for the Body Project group included several recommendations for future implementation: increasing the number of treatment sessions, creating homogeneous therapy groups, and optimizing timing of the treatment. Conclusions Future research should examine further modifications to the Body Project group for severe eating disorders, as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group. Plain English summary We tested the feasibility and acceptability of a group intervention targeting the thin beauty ideal (Body Project group) in patients with severe eating disorders and compared this intervention to a group intervention focusing on psycho-education about eating disorders (Psycho-education group). Both interventions were added to standard treatment. We adapted the protocol for patients with severe eating disorders. Both the Body Project group and the Psycho-education group were evaluated by patients as well as staff as highly feasible and acceptable, and effects were positive. Treatment effects did not differ between treatment groups. As both treatments were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. The study suggested further modifications to the Body Project group. Future research should examine these modifications as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group.

The true risk of COVID‐19 infection in anorexia nervosa (AN) including the duration of viral RNA shedding and infectivity is still unclear. We report on a case of a patient with severe AN with a mild course of COVID‐19 and prolonged viral RNA shedding for at least 39 days after symptom onset. A careful evaluation of long‐term infectivity must include viral load, live virus isolation, and viral genome sequencing. We report on a case of a patient with severe anorexia nervosa (AN) with unusually prolonged viral clearance, despite a mild course of COVID‐19. Careful evaluation and preventive actions should be tailored to each patient with AN requiring hospitalization considering the potential for disease transmission and viral mutation.

Since COVID-19 is a global health emergency, there is an urgent need to share experiences on decision-making with regard to safety recommendations and for hypotheses that can inform a more focused prevention and treatment. Moreover, combining research into eating disorders and obesity with research into COVID-19 may provide a unique opportunity to shed light on the susceptibility to COVID-19.

The present study investigated implicit approach-avoidance action tendencies towards snack foods (pictorial Approach-Avoidance Task), implicit approach-avoidance associations (verbal approach-avoidance Single-Target IAT) and affective associations (verbal positive-negative Single-Target IAT) with snack foods in a group of unselected student participants (N = 83). Participants with higher BMI scores had more difficulty to avoid sweet, but not salty snack foods on the Approach-Avoidance Task. Furthermore, as shown by both Single-Target IATs, there were no significant associations between BMI on the one hand and approach-avoidance associations and positive-negative affective associations on the other hand. BMI did show a positive correlation with errors made on all tasks. The results found on the Approach-Avoidance Task suggest that not increased approach, but impaired avoidance of sweet snacks, might be related to increased BMI. However, more research is needed to further disentangle these findings.

People with trichotillomania often have persistent negative beliefs about giving into one’s habit. Central in the present study was the hypothesis that the follow-up effects of cognitive therapy (CT), in which these negative beliefs are directly addressed, are better compared to the follow-up effects of behaviour therapy (BT). Fifty-six trichotillomania patients were randomly assigned to either six sessions CT or BT. Forty-eight completed their treatment. Follow-up measurements took place after a 3 months treatment-free period, and at 12 and 24 months. CT and BT both resulted in clear reductions of trichotillomania symptoms (severity, urge, inability to resist, and negative beliefs) immediately after treatment. There were no differences between the groups. Following the treatment-free period, there was a reoccurrence of symptoms. In contrast to our expectation, we failed to show that CT compared to BT resulted in lower relapse rates after the treatment-free period.

This study investigated implicit self-control dispositions—implicit approach tendencies towards low-caloric food rather than towards high-caloric food—in dieters. Action tendencies were assessed and trained using the Approach-Avoidance Task (AAT). Additionally, positive/negative affective associations [Brief Implicit Association Test (BIAT)], approach/avoidance associations (BIAT), and attentional biases [Dot Probe Task (DPT)] were assessed before and after training. Before training, dieters showed a more negative affective association with high-caloric food than non-dieters (positive/negative BIAT), consistent with the presence of self-control dispositions. On the AAT, all participants, not just dieters, showed more approach of low-caloric food than of high-caloric food. Results of neither the approach/avoidance BIAT nor the DPT showed any indication of implicit self-control dispositions. This study also investigated whether implicit self-control dispositions interfered with AAT training effects. This did not seem to be the case, as action tendencies could be strengthened even further. Moreover, training effects generalized to the DPT.

This ex post facto study examined the effect of secrecy on well-being in a sample of 287 HIV-positive individuals, using both self-report data and objective immune parameters. The effects on well-being of three components of secrecy were studied; self-concealment, possession of a secret, and cognitive preoccupation. Confirming our hypotheses, we found a positive effect of possession of a secret on quality of life, depression and anxiety, but only after controlling for both self-concealment and cognitive preoccupation. The effects of self-concealment and cognitive preoccupation on wellbeing were negative. Since cognitive preoccupation partly mediated the effect of selfconcealment on well-being, we concluded that cognitive preoccupation is a toxic element of secrecy. Our results imply that HIV-positive individuals that keep their serostatus secret are not per se at risk to directly experience negative effects of concealing their serostatus, as long as they do not have a disposition to conceal personal information and do not ruminate about their secret(s). [PUBLICATION ABSTRACT]

Background Tobacco smoking is a well-known modifiable risk factor for many chronic diseases, including cardiovascular disease (CVD). One of the proposed underlying mechanism linking smoking to disease is via epigenetic modifications, which could affect the expression of disease-associated genes. Here, we conducted a three-way association study to identify the relationship between smoking-related changes in DNA methylation and gene expression and their associations with cardio-metabolic traits. Results We selected 2549 CpG sites and 443 gene expression probes associated with current versus never smokers, from the largest epigenome-wide association study and transcriptome-wide association study to date. We examined three-way associations, including CpG versus gene expression, cardio-metabolic trait versus CpG, and cardio-metabolic trait versus gene expression, in the Rotterdam study. Subsequently, we replicated our findings in The Cooperative Health Research in the Region of Augsburg (KORA) study. After correction for multiple testing, we identified both cis - and trans -expression quantitative trait methylation (eQTM) associations in blood. Specifically, we found 1224 smoking-related CpGs associated with at least one of the 443 gene expression probes, and 200 smoking-related gene expression probes to be associated with at least one of the 2549 CpGs. Out of these, 109 CpGs and 27 genes were associated with at least one cardio-metabolic trait in the Rotterdam Study. We were able to replicate the associations with cardio-metabolic traits of 26 CpGs and 19 genes in the KORA study. Furthermore, we identified a three-way association of triglycerides with two CpGs and two genes ( GZMA ; CLDND1 ), and BMI with six CpGs and two genes ( PID1 ; LRRN3 ). Finally, our results revealed the mediation effect of cg03636183 ( F2RL3 ), cg06096336 ( PSMD1 ), cg13708645 ( KDM2B ), and cg17287155 ( AHRR ) within the association between smoking and LRRN3 expression. Conclusions Our study indicates that smoking-related changes in DNA methylation and gene expression are associated with cardio-metabolic risk factors. These findings may provide additional insights into the molecular mechanisms linking smoking to the development of CVD.