Education, dissemination, and the science of eating disorders: Reflections on the 2019 International Conference on Eating Disorders

Abstract

Objective:

This virtual issue of the International Journal of Eating Disorders highlights recently published research that aligns with the broad themes of the 2019 International Conference on Eating Disorders (ICED), held in New York, NY, USA.

Methods and results:

We selected articles that were published between 2017 and 2019 that complement the content of the keynote and plenary sessions. We also curated additional articles from early career scholars, given that an important component of the annual ICED is to foster the development and training of the next generation of eating-disorder clinicians and researchers.

Discussion:

We hope that this virtual issue will spark more in-depth discussion and reflection on the topics, questions, and critical advances in the field of eating disorders that were presented at the 2019 ICED.

1 |. THE NEED FOR GREATER EDUCATION, DISSEMINATION, AND IMPROVED FOCUS ON THE SCIENCE OF EATING DISORDERS

Community-based studies show that eating disorders (EDs) have a prevalence of 13–18% in young adults (Allen, Byrne, Oddy, & Crosby, 2013; Stice, Marti, & Rohde, 2013), which is similar to the prevalence of anxiety or depressive disorders. Despite the fact that EDs are relatively common mental disorders, there are few opportunities for specialty training and education in EDs. The annual International Conference on Eating Disorders (ICED) represents the largest academic conference devoted to EDs and brings together a diverse group of scholars, clinicians, social justice advocates, patients, and careers toward a common goal—improving education, dissemination, and using rigorous scientific investigation to better understand and treat EDs. In this editorial, we highlight some of the critical themes and issues raised at the 2019 ICED with the goal of spurring additional research and clinical work to address the main topics from the conference. We curated articles published in the International Journal of Eating Disorders (IJED) between 2017 and 2019 that addressed topics brought up in the keynote address, plenary sessions, and recent work by early career scholars in the field of EDs. Our emphasis on early career scholars compliments the Academy for Eating Disorder’s longstanding commitment to supporting the professional development of early career scholars—ensuring ongoing progress in scientific discovery.

2 |. UNDERSTANDING AND PREVENTING DEATH BY SUICIDE (KEYNOTE)

Recent studies highlight the importance of better assessing and treating suicidal ideation among persons with EDs. For example, data from the Danish National Register Study suggested that people with an ED were significantly more likely to attempt and complete suicide than persons without an ED (Zerwas et al., 2015; Fichter & Quadflieg, 2016; Fichter, Quadflieg, Crosby, & Koch, 2017). Other work suggests that family members of individuals with an ED are also at higher risk for suicidal behavior (Pisetsky, Crow, & Peterson, 2017). In light of recent findings regarding high rates of suicidal thoughts and behavior in persons with EDs, the 2019 ICED keynote speaker, Dr. Thomas Joiner, Jr., will discuss his Interpersonal Theory of Suicide (IPTS) and the implications of his theory for assessment, treatment, and prevention of suicidal behavior in persons with an ED. For readers who are interested in understanding the applications of the IPTS for EDs, we included an article by Pisetsky et al. (2017), which found partial support for key aspects of the IPTS in a heterogeneous sample of 114 persons with an ED. Additional articles provide new insights into ways in which a client’s self-image can be used to predict their risk for suicide (Andersén & Birgegård, 2017), and correlates of suicidal ideation in college women with an ED (Goel et al., 2018).

3 |. TREATMENT QUICKER AND BETTER: EVIDENCE FOR SHORT-TERM TREATMENT IN EATING DISORDERS (PLENARY 1)

Several studies find that the best predictor of end-of-treatment outcomes is rapid, early response to behavioral or family based therapy in the first 4 weeks of treatment (Grilo & Masheb, 2007; Le Grange, Accurso, Lock, Agras, & Bryson, 2014; Thompson-Brenner, Shingleton, Sauer-Zavala, Richards, & Pratt, 2015; Linardon, Brennan, & de la Piedad Garcia, 2016). The literature on rapid response led to intriguing questions about the optimal “dose” and duration of therapy for EDs. Indeed, if early reductions in symptoms do not occur, continuation of the same treatment may offer little benefit. The treatment plenary will ask whether short-term treatments in EDs lead to enduring benefits. One of the articles we selected comes from plenary speaker, Dr. Glenn Waller, who completed an innovative study testing a case series of nonunderweight adult patients with an ED using a brief, 10-session cognitive–behavioral therapy approach (Waller et al., 2018). We chose an additional article, co-written by another plenary speaker, Dr. Ivan Eisler, about the acceptability, feasibility, and 3-month outcomes of a 5-day multifamily treatment for adults with anorexia nervosa (Simic et al., 2018).

4 |. EATING DISORDERS IN THE LGBTQ+COMMUNITY (PLENARY 2)

Clinicians and researchers must cultivate their own cultural humility to best help people with an ED feel supported throughout treatment and, ultimately, recover. Thus, it is timely to consider both trends and disparities in disordered eating across the sexuality spectrum, which is the topic of our second plenary session. We selected an article by Watson et al. (2017), which provides results from a large longitudinal dataset of over 25,000 youth to identify trends in disordered eating behavior in heterosexual and sexual minority youth (Watson, Adjei, Saewyc, Homma, & Goodenow, 2017). Their large dataset provides an overview of time trends in disordered eating among heterosexual and sexual minority youth, and highlights disparities experienced by sexual minorities that need to be addressed through future research and advocacy efforts. Another emergent issue is how to provide optimal care to persons who identify as gender nonconforming. The article by Donaldson et al. (2018) will pick up on important plenary themes related to understanding the complex psychiatric and medical needs of persons with EDs who are experiencing gender dysphoria (Donaldson et al., 2018). To facilitate this discussion, this article provides a case series of gender nonconforming clients, with recommendations for interdisciplinary treatment for nonconforming teenagers who have comorbid disordered eating and gender dysphoria.

5 |. ISSUES, CHALLENGES, AND IMPLICATIONS OF COMPULSORY EATING DISORDERS TREATMENT (PLENARY 3)

Balancing respect for a client’s wishes to refuse treatment with preventing premature mortality is an issue that the ED field has been grappling with for decades. In the third ICED plenary, speakers address the topic of compulsory (or involuntary) treatment. To complement this discussion, we selected an article by Clausen, Larsen, Bulik, and Petersen (2018), in which the authors use data from over 4,000 patients with a diagnosis of anorexia nervosa from two national Danish registries (Clausen et al., 2018). The authors provide an analysis of factors associated with involuntary treatment and therapeutic considerations when determining how and when to provide compulsory treatment.

6 |. HITTING THE BULLSEYE: THE ROLE OF EXPERIMENTAL THERAPEUTICS IN TARGETED EATING-DISORDER TREATMENTS (PLENARY 4)

The final plenary session for the 2019 ICED will address the issue of using new, targeted biologically based therapeutics to provide more effective treatments for people with EDs. The first article, written by Smith, Mason, Johnson, Lavender, and Wonderlich (2018), provides a helpful overview of past literature on neurocognitive dysfunction in people with EDs, as well as novel directions for future research and treatment (Smith et al., 2018). In the second article, Guillaume et al. (2018) presents findings from a study that used 2 weeks of high frequency repeated transcranial magnetic stimulation of the dorsolateral prefrontal cortex in women with bulimia nervosa to see if this treatment would lead to changes in a specific neurocognitive biomarker for bulimia nervosa (Guillaume et al., 2018). Finally, we selected an article by Feusner, Deshpande, and Strober (2017), which proposes a new explanation for why people with anorexia nervosa have difficulty perceiving their body size accurately, as well as suggestions for future brain-based research designed to normalize body-size misperception (Feusner et al., 2017).

7 |. EARLY CAREER SCHOLARS

Individuals early in their careers constitute an important group contributing to the advancement of science both through ICED and IJED. Yet, it has been noted that early career ED researchers often face significant challenges in having their work acknowledged through publication, presentation, and funding opportunities (Keel & Smith, 2017) and, thereby, lose experiences that can allow them to develop as researchers. Over time, this may perpetuate the issues of the EDs field being both underfunded (Murray, Pila, Griffiths, & Le Grange, 2017) and under-published within broader mental health domains (Strand & Bulik, 2018). Therefore, it is important to the mission of IJED to highlight the promising work from the emerging researchers who will become the next generation of eating-disorder scientists and clinicians. Encouragingly, nearly half of the individuals chairing plenaries at ICED 2019 are within 10 years of their terminal degree, and still more individuals early in their careers are first authors of conference paper presentations.

In this editorial, we opted to select recent high-quality articles by early career scholars on topics that are not otherwise highlighted in the ICED program. For instance, the article by Murray, Thomas, Hinz, Munsch, and Hilbert (2018) focuses on understudied forms of disordered eating, such as pica and rumination behavior, and work by Goodman et al. (2018) investigates disordered eating patterns in women over 50 years (Goodman et al., 2018; Murray et al., 2018). Not only are both of these populations underrepresented at ICED 2019, but also they represent understudied populations within the larger landscape of ED research. Finally, Chapa et al. (2018) focuses on measure development; the authors composed and validated an assessment that enhances the ability to detect ED symptoms in athletes (Chapa et al., 2018). Of note, each of these articles resulted from cross-institutional collaborations, and two involved international collaborations (Goodman et al., 2018; Murray et al., 2018), thus corresponding with the theme of the ICED 2019 Early Career SIG panel discussion on building and capitalizing on collaborations across career development.

8 |. CONCLUDING COMMENTS

The Strategic Goals of the Academy of Eating Disorders, the sponsoring organization for ICED, include the following:

• To generate knowledge and integrate collective expertise about EDs.

• To provide platforms for the promotion of understanding, sharing of knowledge, and research-practice integration in the field of EDs.

• To build capacity in the next generation of ED professionals.

• To foster innovation and best practice by recognizing excellence in the field of EDs.

The 2019 ICED, as well as this virtual issue of the IJED, were planned and designed to meet these strategic goals. Our keynote speaker, Dr. Thomas Joiner, Jr., is one of the leading experts on suicide. He will discuss how his Interpersonal Theory of Suicide can inform best practices for the assessment, treatment, and prevention of suicidal behavior in persons with an ED. Each of the four plenaries provides a platform for sharing state-of-the-art information on important, sometimes controversial topics for the field of EDs. The vast amount of information available to conference attendees in the form of workshops, papers, posters, and special interest groups, provides rich sources of information to all those involved in the EDs field. Finally, this virtual issue is designed to highlight and promote recent, innovative empirical work by early career researchers that touch on each of these important issues. We hope that these papers will stimulate new and innovative research within the field.