Peterson, Carol B.

AbstractBackgroundIntegrative Cognitive Affective Therapy (ICAT) is an empirically supported treatment for bulimia nervosa (BN) in adults. However, it is unclear whether a modified version, Integrative Cognitive Affective Therapy–Adolescent (ICAT‐A) is feasible and beneficial for adolescents. This study evaluated the feasibility of ICAT‐A for adolescents with BN or subthreshold BN.MethodsEight adolescents with BN or subthreshold BN (mean age = 16.1) were enroled in the study. At baseline and end of treatment, adolescents who participated in ICAT‐A completed the Eating Disorder Examination (EDE) and self‐report measures of eating disorder symptoms, depression, anxiety, self‐esteem and functional impairment.ResultsRetention for the intervention (75%) suggests that the majority of participants found the intervention acceptable. Although all treatment completers participated in the clinician‐administered assessment (EDE), compliance with end of treatment self‐report questionnaires was compromised by the COVID‐19 pandemic, which occurred during the treatment course of the majority of the sample. At the end of treatment, all 6 adolescents who completed the ICAT‐A intervention were in full eating disorder remission based on EDE scores, with large effect sizes identified for reductions in EDE global scores (d = 2.71), objective binge episodes (d = 0.91), subjective binge episodes (d = 1.06) and compensatory behaviours (d = 1.72).ConclusionResults suggest that ICAT‐A is a feasible treatment that has promise for the treatment of adolescents with BN. Future studies are necessary to establish the efficacy of ICAT‐A for adolescent BN.

AbstractDifferential susceptibility, a reconceptualization of the diathesis‐stress model of psychopathology, describes gene–environment interactions that reflect individual differences in responsiveness to environmental influences, both detrimental and beneficial. This model has been described metaphorically by the classification of orchids, which thrive under optimal care but wither under adverse conditions, and dandelions, which weather broad environmental circumstances but are less responsive to careful cultivation. Etiological research in the field of eating disorders has largely focused on the identification of specific behavioral phenotypes, temperamental traits, genotypes and neurobiological processes that confer risk. In this article, we propose that these putative vulnerability factors represent phenotypes and endophenotypes of a genetic predisposition towards environmental sensitivity. We assert that this sensitivity not only transmits eating disorder risk but also confers resilience, depending on the circumstances. In particular, we propose that differential susceptibility can be used as a framework to organize disparate temperamental and neurobiological findings and their complex interplay with various developmental, environmental and sociocultural influences to increase eating disorder risk and treatment responsiveness. Finally, we assert that viewed through the lens of differential susceptibility, sensitivity can be leveraged to refine our interventions and develop novel treatment and prevention strategies to support favorable outcomes for individuals with eating disorders.