Pre-diagnostic stages of psychotic illnesses, including ‘clinical high risk’ (CHR), are marked by sleep disturbances. These sleep disturbances appear to represent a key aspect in the etiology and maintenance of psychotic disorders. We aimed to examine the relationship between self-reported sleep dysfunction and attenuated psychotic symptoms (APS) on a day-to-day basis.

Seventy-six CHR young people completed the Experience Sampling Methodology (ESM) component of the European Union Gene-Environment Interaction Study, collected through PsyMate® devices, prompting sleep and symptom questionnaires 10 times daily for 6 days. Bayesian multilevel mixed linear regression analyses were performed on time-variant ESM data using the brms package in R. We investigated the day-to-day associations between sleep and psychotic experiences bidirectionally on an item level. Sleep items included sleep onset latency, fragmentation, and quality. Psychosis items assessed a range of perceptual, cognitive, and bizarre thought content common in the CHR population.

Two of the seven psychosis variables were unidirectionally predicted by previous night's number of awakenings: every unit increase in number of nightly awakenings predicted a 0.27 and 0.28 unit increase in feeling unreal or paranoid the next day, respectively. No other sleep variables credibly predicted next-day psychotic symptoms or vice-versa.

In this study, the relationship between sleep disturbance and APS appears specific to the item in question. However, some APS, including perceptual disturbances, had low levels of endorsement amongst this sample. Nonetheless, these results provide evidence for a unidirectional relationship between sleep and some APS in this population.

Despite a wide range of proposed risk factors and theoretical models, prediction of eating disorder (ED) onset remains poor. This study undertook the first comparison of two machine learning (ML) approaches [penalised logistic regression (LASSO), and prediction rule ensembles (PREs)] to conventional logistic regression (LR) models to enhance prediction of ED onset and differential ED diagnoses from a range of putative risk factors.

Data were part of a European Project and comprised 1402 participants, 642 ED patients [52% with anorexia nervosa (AN) and 40% with bulimia nervosa (BN)] and 760 controls. The Cross-Cultural Risk Factor Questionnaire, which assesses retrospectively a range of sociocultural and psychological ED risk factors occurring before the age of 12 years (46 predictors in total), was used.

All three statistical approaches had satisfactory model accuracy, with an average area under the curve (AUC) of 86% for predicting ED onset and 70% for predicting AN v. BN. Predictive performance was greatest for the two regression methods (LR and LASSO), although the PRE technique relied on fewer predictors with comparable accuracy. The individual risk factors differed depending on the outcome classification (EDs v. non-EDs and AN v. BN).

Even though the conventional LR performed comparably to the ML approaches in terms of predictive accuracy, the ML methods produced more parsimonious predictive models. ML approaches offer a viable way to modify screening practices for ED risk that balance accuracy against participant burden.

Studies have suggested that stress predicts both body dissatisfaction (BD) and disordered eating (DE) patterns. However, the mechanisms of this process are not entirely clear and could be elucidated through further exploration in daily life.

The purpose of this study was to 1) explore the concurrent and lagged relationship between stress and BD in the daily life of individuals with differing levels of trait eating pathology (EP) and 2) to investigate whether maladaptive coping moderated these relationships.

107 female participants (mean age = 26.92) completed an online survey about stress, coping strategies and trait EP. Participants used a smartphone app to report on state stress, BD and DE six times a day for seven days

Individuals with elevated trait EP experienced a significantly higher frequency of stress events (b = 0.04). Participants’ use of maladaptive coping significantly increased state stress (b = 0.41), but was not moderated by EP. Participants’ state stress and BD measured at the same time point (concurrent assessment) were significantly related (b = 0.13). Either stress or BD at the previous time point did not significantly predict changes in the other (lagged assessment, b = 0.02, b = -0.09, respectively). The aforementioned state-based associations were not moderated by trait EP

Women with more severe EP were found to experience stress more frequently. Maladaptive coping strategies were related to stress, but not moderated by EP. The association between stress and BD from concurrent but not lagged assessment highlights the importance of assessing and targeting momentary stress levels.

No significant relationships.

Objectification theory argues that self-objectification confers risk for disordered eating (DE) both directly, and indirectly through a cascade of negative psychological consequences (e.g. low mood and self-conscious body monitoring). Robust cross-sectional evidence supports these relationships. However, these cross-sectional studies do not provide evidence for the complex intraindividual psychological processes outlined in objectification theory which purportedly contribute to DE.

Using an ecological momentary assessment design, the current study investigated the direct within-person effect between state self-objectification and DE and examined the indirect within-person effect of negative mood and body comparisons, on the relationship between state self-objectification and DE.

Two-hundred female participants (M=20.43 years, SD=4.60) downloaded a smartphone app which assessed momentary experiences of self-objectification, mood, body comparisons, and DE six times per day at random intervals for seven days.

Indicated that self-objectification significantly predicted DE behaviours [95% CI 0.01, 0.03] and body comparisons [95% CI 0.32, 0.41]. However, the indirect effect of body comparisons on the relationship between state self-objectification and DE was not significant [95% CI -0.01, 0.00]. In the second mediation model, self-objectification significantly predicted DE behaviours [95% CI 0.01, 0.03], but did not significantly predict mood [95% CI -0.06, 0.03]. Similarly, the indirect effect of mood on the relationship between state self-objectification and DE was not significant [95% CI -0.00, 0.00].

These results enhance our understanding of objectification theory and suggest that self-objectification confers risk to DE directly. However, our findings do not support the indirect effect of self-objectification on DE through low mood or body comparisons.

No significant relationships.

The DSM-5 introduced severity indicies for the first time.

We conducted a systematic review and synthesis the frequency of each DSM-5 severity categories (i.e., mild, moderate, severe and extreme severe) for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorders (BED), and to evaluate studies that assess the clinical utility of these severity specifiers for all eating disorders (ED) subtypes.

Five databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO, and ProQuest) were used to identify for both academic and grey literature published from 2013 until July 8, 2020. Twenty-five studies were retrieved for the systematic review based on the inclusion and exclusion criteria, and up to six studies were qualified for meta-analysis

We found limited support for the current DSM-5 severity ratings for all ED indices, as the majority of ED severity groups were not significantly distinguishable in overall ED psychopathology (mean effect size ranged from .02 to .5). The value of the DSM-5 severity ratings was further devalued as 56.91% to 80.52% of individuals with AN, BN, and BED were categorized into mild and moderate groups. However, there was significant heterogeneity between the studies (p< .001), and some of these heterogeneities were explained by differences in study settings and measurement of eating disorder psychopathology.

Overall, the current study provided little support for the DSM-5 severity ratings for EDs, thus it is suggested that further exploration in alternative severity classification approach is needed.

No significant relationships.

To examine the impact of appearance comparison behaviours, trait body dissatisfaction and eating pathology on women's state body dissatisfaction and engagement in disordered eating behaviours in daily life.

Using ecological sampling method (ESM), 116 women residing in Australia, completed a baseline questionnaire containing the trait-based measures, before being signalled by an iPhone app six times daily, for seven days, to self-report on their recent appearance comparison behaviours, current state body dissatisfaction and recent disordered eating behaviours.

Multi-level modelling revealed that upward comparisons (comparisons against more attractive individuals) elicited increases in state body dissatisfaction (β = 0.89, P < .001) and disordered eating behaviours (β = 0.29, P = .002). Contrastingly, downward comparisons (comparisons against less attractive individuals) elicited decreases in state body dissatisfaction (β = –0.31, P = .048) and, unexpectedly, increases in disordered eating behaviours (β = 0.46, P < .01). The frequency of appearance comparison engagement, regardless of whether it was upward or downward comparisons, was also predictive of increased disordered eating behaviours (β = 0.12, P < .001). In addition, eating pathology and trait body dissatisfaction were directly associated with higher state body dissatisfaction, and increased in disordered eating behaviours (all P < .001).

These findings highlight the general negative impact that appearance comparisons have on fluctuating states of body dissatisfaction and eating pathology, as well as illustrating how trait characteristics partially account for this volatility. These findings provide further information that may be used to inform eating disorder prevention and intervention efforts.

The authors have not supplied their declaration of competing interest.

Gene × environment (G × E) interactions in eating pathology have been increasingly investigated, however studies have been limited by sample size due to the difficulty of obtaining genetic data.

To synthesize existing G × E research in the eating disorders (ED) field and provide a clear picture of the current state of knowledge with analyses of larger samples.

Complete data from seven studies investigating community (n = 1750, 64.5% female) and clinical (n = 426, 100% female) populations, identified via systematic review, were included. Data were combined to perform five analyses: 5-HTTLPR × Traumatic Life Events (0–17 events) to predict ED status (n = 909), 5-HTTLPR × Sexual and Physical Abuse (n = 1097) to predict bulimic symptoms, 5-HTLPR × Depression to predict bulimic symptoms (n = 1256), and 5-HTTLPR × Impulsivity to predict disordered eating (n = 1149).

The low function (s) allele of 5-HTTLPR interacted with number of traumatic life events (P < .01) and sexual and physical abuse (P < .05) to predict increased likelihood of an ED in females but not males (Fig. 1). No other G × E interactions were significant, possibly due to the medium to low compatibility between datasets (Fig. 1).

Early promising results suggest that increased knowledge of G × E interactions could be achieved if studies increased uniformity of measuring ED and environmental variables, allowing for continued collaboration to overcome the restrictions of obtaining genetic samples.

The authors have not supplied their declaration of competing interest.

Although the influence of trait internalization and state body satisfaction on appearance comparisons has been well documented, their interactive influence on comparison behaviours is unknown. Therefore, the present study thus tested a person X situation model in which both mood state and trait internalization interacted to predict engagement in upward comparisons.

One hundred and forty-eight women aged 18 to 40 completed baseline measures of trait internalization, and then completed via iPhone app an experience sampling phase in which they reported momentary experiences of mood and comparison behaviours at up to 6 random times daily for 7 days.

Multilevel analyses revealed that although upward comparisons were more likely for individuals who internalized the thin ideal (t = 3.27, P < .001), this effect was minimized in instances when a participant was satisfied with her appearance (t = –1.90, P = .031). Further exploratory analyses showed that state body satisfaction was a stronger predictor than trait internalization of comparison behaviours (R2 = .14 vs. R2 = .11) when the time lag between state body satisfaction and comparison event was less than 2 hours, but this pattern reversed as the time lag between state level predictor and outcome increased beyond 2 hours (R2 = .09 vs. R2 = .12).

Present findings suggest that bolstering one's body satisfaction in the moment may be as clinically important as reducing a client's interest in the thin ideal for alleviating occurrence of unhealthy body comparisons.

The authors have not supplied their declaration of competing interest.

Despite the considerable number of studies that have assessed evidence for a longitudinal relationship between eating pathology and depression, there is no clear consensus regarding whether they are uni- or bi-directionally related.

To undertake a meta-analysis to provide a quantitative synthesis of longitudinal studies that assessed the direction of effects between eating pathology and depression. A second aim was to use meta-regression to account for heterogeneity in terms of study-level effect modifiers.

Meta-analysis results on 30 eligible studies showed that eating pathology was a risk factor for depression (rm = 0.13, 95% CI: 0.09 to 0.17, P < 0.001), and that depression was a risk factor for eating pathology (rm = 0.16, 95% CI: 0.10 to 0.22, P < 0.001). Meta-regression analyses showed that these effects were significantly stronger for studies that operationalized eating pathology as an eating disorder diagnosis versus eating pathology symptoms (P < 0.05), and for studies that operationalized the respective outcome measure as a categorical variable (e.g., a diagnosis of a disorder or where symptoms were “present”/“absent”) versus a continuous measure (P < 0.01). Results also showed that in relation to eating pathology type, the effect of an eating disorder diagnosis (b = −0.06, t = −7.304, P ≤ 0.001) and bulimic symptoms (b = −0.006, t = −2.388, P < 0.05) on depression was significantly stronger for younger participants.

Eating pathology and depression are concurrent risk factors for each other, suggesting that future research would benefit from identifying factors that are etiological to the development of both constructs.

The authors have not supplied their declaration of competing interest.