Art and Science of Eating Disorders: A Global Vision to Help Patients and Carers Royal College of Faculty of Eating Disorders Psychiatry & European Chapter of Academy for Eating Disorders Meeting

4th & 5th December 2019 Royal College of Psychiatrists

Conference Information

Certificates of attendance Certificates of attendance will be emailed to delegates within one week of the conference. This conference is eligible for 6 CPD hours, subject to peer group approval.

Registration The registration desk will open at 08:40 on both days of the conference. Registration will be attended by staff throughout the conference where they will be able to provide information and assist you with any queries about the event.

Speaker presentations Presentations will be available online after the close of the conference. All delegates will be sent details of this after the conference. Please be aware that these presentations are kindly provided by the speakers but on some occasions it is not possible to make these publicly available.

Security For security reasons we ask that you wear your identity badge at all times to gain access to the conference and facilities. Please do not leave your valuables unattended.

Poster Presentations We invite you to view the poster exhibition and meet the authors during the breaks

Cloakroom The cloakroom can be found on the first floor, on the left next to the entrance of Room 1.1.

Multi faith room This is located on the lower ground floor. Please ask a member of staff for access.

Fire exit No fire drills scheduled for today, so if alarm sounds it is a real fire. Please take the stairs to reception and out through the front doors (where you came in this morning). Then turn left and the assembly point is on the corner of Prescot Street and Chamber Street. There’s an alternative exit at the back of the building. Diagrams can be seen on the fire route plans around the room.

Wi-Fi There is free Wi-Fi available through-out the building. The network name is RCPSYCH-WiFi and the password is RCP19@w1f1

Mobile phones For the benefit of other delegates and speakers please switch your phone on to silent mode during the conference.

Toilets 1st floor - out of the double doors and follow the railings around to the right and then through the white door. There are also toilets available on the ground floor in the same position.

Twitter We would like to encourage all delegates to get involved in discussions @RCPsych and #EDconf19.

Exhibition We are pleased to welcome Ellern Mede, Elysium Healthcare & Orri to the conference as exhibitors.

Programme

Wednesday 4th December

08:40 - 09:15 Registration, Refreshments and Poster Viewing

09:20 – 11:00 Plenary Session 1: Welcome and Introduction Rm 1.7 Chair: Dr Agnes Ayton Chair, Faculty of Eating Disorders, Royal College of Psychiatrists, London & Consultant Psychiatrist and Honorary Senior Lecturer, University of Oxford, Cotswold House, Oxford

09:20-09:30 Inauguration of the Conference Professor Wendy Burn President of the Royal College of Psychiatrists

09:30 – 10:10 Keynote: What is New in Our Understanding of Risks and Treatment for Eating Disorders? Professor Janet Treasure Director of the Eating Disorder Unit and Professor of Psychiatry at the Institute of Psychiatry, King's College, London

10:10– 10:50 Obesity Policy from an Eating Disorders Perspective Dr Dasha Nicholls Reader in Child Psychiatry, Imperial College London Honorary Consultant Child and Adolescent Psychiatrist

10:50-11:00 Questions

11:00 – 11:25 Refreshments and Poster Viewing G1-4 11:30 - 12:20 Plenary Session- 2 Rm 1.7 Chair: Dr Agnes Ayton Consultant Psychiatrist, Cotswold House, Oxford, Chair, Faculty of Eating Disorders, Royal College of Psychiatrists

11:30 – 11:45 Early Warning Signs of Eating Disorders: Evidence from Large-Scale Data Study Dr Jacinta Tan Consultant Child and Adolescent Psychiatrist, Aneurin Bevan University Health Board and Medical Ethicist

11:45 - 12:00 Neurocognitive Decline in Eating Disorder Patients: Evidence for Clinical Interventions Dr Ashish Kumar President, European Chapter of the Academy for Eating Disorders, Vice Chair, Faculty of Eating Disorders, Royal College of Psychiatrists, London & Deputy Associate Medical Director & Clinical Lead for Eating Disorder Services for Children and Young People, North West Boroughs NHS Foundation Trust

12:00 - 12:15 Experiences Among Non -affected Adult Siblings of People with Eating Disorders and those of People With Diabetes Dr Maria Tsiaka PhD King’s College , Founder and Director of Hellenic Center For Eating Disorders , Athens

12:15-12:20 Questions

12:20 - 13:10 Lunch, Poster and exhibition viewing – Prizes and Certificates for top 3 G1-4 winning posters, the best Poster will get £250 Award and Certificate.

12:45 - 13:10 Faculty of Eating Disorders Business Meeting (Open to all Faculty Rm 1.7 Members) Chair: Dr Agnes Ayton

13:15 - 15:00 Plenary 3 Chair: Professor Janet Treasure Director of the Eating Disorder Unit and Professor of Psychiatry at the Institute of Psychiatry, King's College, London

13:15-14:00 Neurobiology Meets Family Systems: Integrating Findings from Neurobiological Research in to the Practice of Maudsley for Professor Ivan Eisler, OBE, PhD Emeritus Professor King’s College London Joint Head, Maudsley Centre for Child & Adolescent Eating Disorders South London and Maudsley NHS Foundation Trust

14:05-14:55 Treatment of Suicidality and Self- harm in Eating Disorders Dr Mima Simic Joint Head of the National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Consultant Psychiatrist, Dialectical Behaviour Therapy Service for Young People with Emerging Borderline

14:55-15:00 Questions

15:00 - 15:25 Refreshments and Posters and exhibition viewing G1-4 15:30 - 15:50 Plenary Session 4 Rm 1.7 Chair: Dr Ruth Marshall Consultant Psychiatrist, Galaxy House Eating Disorder Service, Manchester

Service Development without the Science: Caring for Eating Disorder Patients Dr Sandeep Ranote Medical Director, Northwest Boroughs Health Care NHS Foundation Trust, Consultant Child and Adolescent Psychiatrist, Honorary Professor, University of Chester & University of Salford

15:55 - 16:50 5 Parallel workshops

Workshop 1 Chair - Dr Andrea Brown Rm 1.1 Finance Officer, Faculty of Eating Disorders, The RCPsych Consultant Psychiatrist, Schoen Clinic, London

CBT-T: The Nuts and Bolts of a Brief Cognitive-Behavioural Therapy for Non-underweight Eating Disorders Dr Hannah Turner C Psychol, PhD Consultant Lead Clinical , Eating Disorders Service, Southern Health NHS Foundation Trust

Workshop 2 Chair: Dr Kiran Chitale Rm 1.2-3 Consultant Child and Adolescent Psychiatrist, Ellern Mede Eating Disorders Outpatient Service, London ’s Campaign for Greater Family Empowerment: using research, innovation and carer experiences to achieve best practice Mr Andrew Radford Chief Executive, Beat Emily Rothwell Beat

Workshop 3 Chair: Dr Jane Whittaker Rm 1.6 Consultant Child and Adolescent Psychiatrist, Cheshire and Merseyside Eating Disorder Service, Chester What Does Your Lawyer Needs From You?: Things You Need to Know to be on the Right Side of Law and Ethical Management of Patients with Eating Disorders Clementine Robertshaw Solicitor (Expert in Law) Hempsons Solicitors, London

Workshop 4 Chair: Dr Jacinta Tan Rm 1.4 Consultant Child and Adolescent Psychiatrist, Aneurin Bevan University Health Board and Medical Ethicist

What to Do When the Media Comes Calling? Useful Tips for Psychiatrists Dr Louise Theodosiou Consultant Child and Adolescent Psychiatrist, Manchester University NHS Foundation Trust Mr Nick Hodgson Media Manager, Royal College of Psychiatrists Mr Jeremy Gale Senior Communications Officer, Royal College of Psychiatrists

Workshop 5 Chair: Dr John Roche 15:50 – 16:20 Consultant Psychiatrist, Priory Eating Disorder Service, Manchester Rm 1.7 Exercise and Eating Disorders - Friend or Foe? Dr Matthew Cahill Consultant Psychiatrist in Eating Disorders Cheshire and Wirral Partnership NHS Foundation Trust Ms Renee McGregor BSc(hons)PGDIP(Diet)PGCERT(SportsNutr)RD Sports and Eating Disorder Specialist Dietitian Author of Orthorexia, Training Food and Fast Fuel books Dr Caz Nahman Consultant Child and Adolescent Psychiatrist Nottinghamshire Healthcare NHS Trust

16:20 – 16:50 Career in Eating Disorder Psychiatry: Thrill and Challenges. Chair: Dr Sandeep Ranote Medical Director, Northwest Boroughs Health Care NHS Foundation Trust, Honorary Professor, University of Chester & University of Salford

Dr Erica Cini Clinical Team Lead, Consultant Child and Adolescent Psychiatrist, East London Community Eating Disorder Service for Children & Young People, East London Foundation Trust, Honorary Associate Professor, University College London Dr Stephen Anderson Chair, FED, Scotland, The RCPsych, Consultant Psychiatrist at the NHS Forth Valley Eating Disorder Service, Scotland Dr John Carroll Psychiatry CT2 Trainee, CAMHS Eating Disorder Service in London

16:50 - 17:00 Faculty of Eating Disorders Psychiatry Award Ceremony for Winners Rm 1.7 of Poster Presentation, Bursary Winners, Essay Prize Winners and Research Grant Winners Dr Agnes Ayton, Chair, Faculty of Eating Disorders, Dr Ashish Kumar, Vice Chair, Faculty of Eating Disorders, Dr Matthew Cahill, Academic Secretary of the Faculty of Eating Disorders

17:00 Close Thursday 5th December Faculty of Eating Disorders of the Royal College of Psychiatrists & European Chapter of Academy for Eating Disorders Meeting

08:40 - 09:05 Registration, Refreshments and Poster Viewing

09:10 - 11:00 Plenary Session 1 Rm 1.7 09:10 - 09:15 Welcome and Introduction Chair: Dr Ashish Kumar President, European Chapter of the Academy for Eating Disorders Vice Chair, Faculty of Eating Disorders, Royal College of Psychiatrists, London & Deputy Associate Medical Director & Clinical Lead for Eating Disorder Services for Children and Young People, North West Boroughs Health Care NHS Foundation Trust

09:15-09:20 Inauguration of the European Chapter of the Academy for Eating Disorders and Faculty of Eating Disorders Joint Conference Professor Wendy Burn President of the Royal College of Psychiatrists

09:20 - 09:25 Introductory Notes about AED Elissa Myers Chief Executive, The Academy for Eating Disorders

09:25 – 10:00 Keynote: Accelerating Progress in Prevention of Eating Disorders: A Call for Policy Translation Research & Training Professor S. Bryn Austin President, Academy for Eating Disorders, Professor, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Director of Research Training, Adolescent and Young Adult at Boston Children’s Hospital, Boston, USA

10:00 - 10:10 Questions

10:15 – 10:50 Childhood Trauma Exposure and the Endogenous Stress Response System in Patients With Eating Disorders: Implications for Pathophysiology and Treatment Professor Palmiero Monteleone President of the Italian Society of Food Psychopathology (SIPA), Professor, University of Salerno and Director of the Psychiatric Operations Unit, University of Salerno, Italy

10:50-11:00 Questions

11:00 – 11:25 Refreshments and Poster Viewing G1-4

11:30 - 12:30 Plenary Session 2: New Research in Eating Disorders Rm 1.7 Chair: Professor Umberto Nizzoli Vice President of European Chapter of Academy of Eating Disorders President, SISDCA (Italian Society for Food Behavior Disorders)

11:30 – 11:50 Interpersonal Synchrony in Vocally Encoded Emotional Arousal Predicts Treatment Outcome in Outpatient For Anorexia Nervosa Professor Timo Brockmeyer Department of and Psychotherapy University of Goettingen, Goettingen, Germany

11:50 - 12:10 Prevalence, Comorbidity and Mortality of Eating Disorders – A Danish Register-Based Study Dr Gry Kjaersdam Telléus Senior Researcher, Unit for Psychiatric Research, Aalborg University Hospital & Assistant Professor, Department of Clinical Medicine, Aalborg University Dr Loa Clausen Associate professor, Department of Psychology and Behavioural Sciences, University of Aarhus, Denmark

12:00 - 12:20 Implementation of Inpatient CBT-E in an Adult Specialist Unit: Challenges and Solutions Dr Agnes Ayton Consultant Psychiatrist, Cotswold House, Oxford, Chair, Faculty of Eating Disorders, Royal College of Psychiatrists 12:20 - 12:30 Questions

12:30 - 13:20 Lunch, Poster and Exhibition viewing, Prizes and Certificates for top G1-4 3 winning posters

12:55 - 13:20 European Chapter of Academy for Eating Disorders Business Meeting Rm 1.7 Chair: Dr Ashish Kumar

13:25 - 14:50 Plenary Session 3 Co-Chairs: Professor S. Bryn Austin President, Academy for Eating Disorders Dr Ashish Kumar, President European Chapter of Eating Disorders

13:25 – 14:00 The Reward System in Eating Disorders – An update on the Neurobiology Dr Ursula Bailer President of the Austrian Society for Eating Disorders; President-Elect of the Academy for Eating Disorders (AED); Associate Professor and Head of the Specialized Outpatient Clinic for Eating Disorders at the Department of Psychiatry and Psychotherapy, Medical University of Vienna; Assistant Adjunct Professor, Department of Psychiatry, University of California, San Diego

14:05 – 14:40 MARSIPAN and Management of Physical Health Complexities in Eating Disorder Patients: Making it Easy for Clinicians Dr Simon Chapman Consultant Paediatric/Adolescent Medicine King's College Hospital NHS Foundation Trust & Maudsley Hospital NHS Foundation Trust Dr Alastair McKinlay Consultant Gastroenterologist, Aberdeen Royal Infirmary, Aberdeen Dr William Rhys Jones Consultant Psychiatrist & Clinical Lead CONNECT: The West Yorkshire and Harrogate Adult Eating Disorders Service

14:40 - 14:50 Questions

14:50 - 15:10 Refreshments and exhibition viewing G1-4 15:15 - 15:35 Plenary 4 Chair: Dr Dasha Nicholls Reader in Child Psychiatry, Imperial College London Honorary Consultant Child and Adolescent Psychiatrist

Emotions in Play: Young People’s Experience of Thinking About Emotions Group in an Inpatient Eating Disorder Programme Dr Lucia Giombini (CPsychol) Rhodes Wood Hospital, Elysium Healthcare, London (UK) Sophie Nesbitt (CPsychol) PO59 King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine

15:40 - 15:45 Questions

15:50 - 16:45 5 Parallel Sessions

Parallel session 1

15:50 - 16:45 Evidence Based Therapy For Eating Disorder Patients Rm 1.6 Chair: Dr Matthew Cahill Academic Secretary, Faculty of Eating Disorders, The RCPsych

15:50 - 16:10 Exercise is Medicine: Approaching Dysfunctional Exercise and Including Healthy Exercise in The Treatment of Eating Disorders Professor Jorunn Sundgot-Borgen Department of Sports Medicine at the Norwegian School of Sport Sciences, Norway Dr Therese Fostervold Mathisen Faculty of Health and Welfare, Østfold University College, Norway

16:10- 16:30 New Medical Treatments for Altered Eating Behaviours in Binge Eating Disorders Dr Cristina Segura Associate Professor, Center for Clinical Research and Treatment of Eating Disorders, University Hospital “Mater Domini” Catanzaro, Italy

16:25 - 16:45 Integrating Trauma Therapy in The Multidisciplinary Treatment For Feeding And Eating Disorders: Preliminary Results of a Multi-Centric European Study Dr R Schumann Outpatient Treatment Centre for Eating Disorders - Centro Gruber – Bologna, Italy Dr P Todisco Unit For Eating Disorders - Casa Di Cura Villa Margherita, Arcugnano, Italy

15:50 - 16:45 Parallel session 2

15:50 - 16:20 Reframing Rigidity: The Art and Science of Addressing the Rm 1.7 Intersection of Autism Spectrum Disorder and Anorexia Nervosa. Chair: Dr Andrea Brown Finance Officer, Faculty of Eating Disorders, The RCpsych Dr Melissa Nishawala, MD Speakers: Lauren Donnelly, PhD, Michelle Miller, PsyD, Bridget Murphy, MS, RDN, CDE, CDN, Melissa Nishawala, MD, Andrea Vazzana, PhD

16:20 - 16:45 Chair: Dr Paul Robinson Consultant Psychiatrist and Senior Clinical Lecturer at University College London

Parental Carer Burden:Caring for a Child With an Eating Disorder Overview of carer burden in ED, with reference to findings from STEDI: A Study of ED in Ireland Prof Fiona McNicholas Consultant, Child and Adolescent Psychiatrist OLCHC, Crumlin, CAMHS Lucena Clinic, Rathgar & University College Dublin and Dr Kristen Maunder, Registrar, St Patrick’s University Hospital, Dublin Ms Harriet Parsons MA, MSc, Reg Prac APPI, MICP, training and development manager, Bodywhys, The Eating Disorders Association of Ireland Dr Sara McDevitt Consultant, Child and Adolescent Psychiatrist , Clinical lead ED program HSE Dr. Hakan Öğütlü Consultant, Child and Adolescent Psychiatrist at Ankara City Hospital, Ankara, Turkey

Parallel session 3

15:50-16:45 Culture and Eating Disorders Rm 1.1 Chair: Dr Gry Kjaersdam Telléus Assistant Professor, Department of Clinical Medicine, Psychologist at Aalborg University Hospital, Denmark

Treating Ultra-Orthodox Young Women with Eating Disorders in 15:50- 16:10 Israel: Culturally-Sensitive Interventions, Difficulties, and Dilemmas Professor Yael Latzer, Faculty of Social welfare and Health Science, Haifa University, Haifa, Eating Disorders Institute, Rambam Medical Centre, Haifa, Israel

16:10- 16:30 Is the Problem “The Family Don’t Get It” or Is It That We (The Professionals) “Don’t Get Them”? The Challenge of Developing More Culturally Sensitive CYP-ED Services Elizabeth Dodge Family Therapist, Dr Catherine Stewart, Clinical Psychologist Clinical Psychologist South London and Maudsley NHS Foundation Trust

16:30- 16:45 Eating Disorder Behaviors in Transgender and Gender Non- Conforming Individuals: Findings from Project AFFIRM (USA). Evelyn Attia, MD

Parallel session 4

15:50 - 16:45 Nutrition and Dietetics and Eating Disorders Rm 1.4 Chair: Dr Ursula Bailer President of the Austrian Society for Eating Disorders Head of the Specialized Outpatient Department for Eating Disorders at the Department of Psychiatry and Psychotherapy, Med University Vienna/Vienna General Hospital, Associate Professor, University of California, San Diego

15:45 - 16:05 Orthorexia Nervosa: Challenges with Diagnosis and Clinical Management Professor Lorenzo Donini Professor of Nutrition, Department of Experimental Medicine, Sapienza University of Rome.

16:05 - 16:30 A Combination of CBT-E and Nutritional Counseling in ED Psychotherapy in the Russian Population Dr Svetlana Bronnikova, PhD Center for Intuitive Eating and Eating Disorders Treatment “IntuEat”, Moscow, Russia

16:30 - 16:45 Dietician Led Patient and Carer Group: Evidence of Improvement and Scope of Learning from the Evidence Rachel Doust (Specialist Dietician) Clare Gregson (Occupational Therapist), Natalie Denny (Team Manager) , Dr Ashish Kumar (Consultant Psychiatrist and Clinical Lead) Mid Mersey Eating Disorder Service, North West Boroughs Health Care NHS Foundation Trust

Parallel session 5

15:50 - 16:45 Interventions and Ethics in Eating Disorders Rm 1.2-3 Chair: Dr Stephen Anderson Chair, FED, Scotland, The RCPsych, Consultant Psychiatrist at the NHS Forth Valley Eating Disorder Service, Scotland

15:45 - 16:15 Neuroethically Informed Study of Deep-Brain Stimulation In Severe Enduring Anorexia Nervosa (Se-An): Which Patients Might Benefit And How? Dr Rebecca J Park Consultant Psychiatrist University of Oxford Dr Jacinta Tan Consultant Child and Adolescent Psychiatrist, Aneurin Bevan University Health Board and Medical Ethicist

16:15 - 16:45 Emerging best practice for Naso-gastric Tube feeding under Restraint? Are We doing this Intervention too much or too little? Ms Sarah Fuller Advanced Specialist Eating Disorders Dietitian, East London NHS Foundation Trust Dr Jacinta Tan Consultant Child and Adolescent Psychiatrist, Aneurin Bevan University Health Board and Medical Ethicist Dr Dan Shears MD Huntercombe Maidenhead

16:50 - 17:00 Award Ceremony for Winners of Poster Presentation and Thank you!

Rm 1.7 Professor Bryn Austin President, Academy for Eating Disorders, Elissa Myers CEO, AED, Dr Agnes Ayton, Chair, Faculty of Eating Disorders, Dr Ashish Kumar, Vice Chair, Faculty of Eating Disorders, Dr Matthew Cahill, Academic Secretary of the Faculty of Eating Disorders

17:00 Close

Speaker Abstracts and Biographies

Professor Bryn Austin

Dr. S. Bryn Austin is an award-winning researcher, teacher, and mentor. She is Professor in Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health, Professor of Pediatrics at Harvard , and Director of Fellowship Research Training in the Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital. She directs the Strategic Training Initiative for the Prevention of Eating Disorders: A Public Health Incubator (https://www.hsph.harvard.edu/striped/), based at the Harvard Chan School and Boston Children’s Hospital. Dr. Austin is the President of the board of directors of the Academy for Eating Disorders, Immediate Past President of the board of directors of the Eating Disorders Coalition, and she serves on the editorial boards of the International Journal of Eating Disorders and Eating Disorders: The Journal of Treatment and Prevention. She is a social epidemiologist and behavioral scientist with a research focus on health inequities, especially those affecting socially marginalized adolescents, and she has received numerous grants funded by the U.S. National Institutes of Health and foundations to support her research. She leads two primary research programs: One focuses on environmental influences on eating disorders risk and public health approaches to primary and secondary prevention of eating disorders with an emphasis on policy translation research and advocacy. The second focuses on determinants of sexual orientation and gender identity disparities in a range of health domains, including disordered weight-related behaviors, substance use, bullying victimization, and other health risk indicators. A unifying goal of her academic career has been to advance innovations in transdisciplinary science applied to eating disorders prevention and the study of health inequities adversely affecting sexual minority and transgender youth. Across her research and teaching initiatives, her aim is to offer the kinds of mentorship and opportunities that will help the next generation of talented junior scientists excel in their pursuit of health equity for all.

Professor Timo Brockmeyer

Abstract:

Objective: Psychotherapy outcomes in adults with anorexia nervosa (AN) are relatively poor. So far, process outcome research has contributed little to the advancement of psychotherapy for AN. One key change process in psychotherapy is therapeutic empathy. Recent research has shown that empathy is associated with high levels of interpersonal synchrony in vocally encoded emotional arousal between patient and therapist.

Method: Audio recordings from therapy sessions in a randomized controlled trial on the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) were used for analyzing fundamental frequency (f0) in the voices of patients and therapists, a robust indicator of vocally encoded emotional arousal. Levels of f0 synchrony between patients and therapists were calculated and used as a predictor of treatment outcome. Results: Interpersonal f0 synchrony between patients and therapists in mid-treatment was at a level clearly above chance (r=.11) and predicted treatment outcome. Higher levels of synchrony were associated with higher body mass index (BMI) at 12 months post- randomization.

Conclusions: Findings suggest that dyadic synchrony in vocally encoded emotional arousal between patients with AN and their therapists contributes to favorable longer-term treatment outcomes. High levels of interpersonal f0 synchrony may reflect high levels of empathic processes between patient and therapist.

Professor Wendy Burn

Biography:

Wendy was elected President of the College in 2017. She holds this role until 2020 and leads the RCPsych on behalf of its members and associates. Professor Wendy Burn became a consultant old age psychiatrist in Leeds in 1990 and now works part time in a community post. Her main clinical interest is .

She has held a regional leadership role in this area from 2011 and was co-clinical Lead for dementia for Yorkshire and the Humber Strategic Clinical Network between 2013 and 2016. She also sits on national groups for the planning of dementia care.

Wendy has been heavily involved in postgraduate training since starting as a consultant and has held many roles in education, including setting up the Yorkshire School of Psychiatry and becoming the first Head of School.

She was a senior organiser of clinical examinations at the College, deputy convenor, regional co-ordinator for continuing professional development and the deputy lead for national recruitment.

She co-chairs the Gatsby Wellcome Neuroscience Project, aimed at reworking the core training curriculum for psychiatry trainees. From 2011 to 2016 Wendy was College Dean.

Abstract:

I am looking forward to welcoming delegates to the conference and discussing the importance of Eating Disorders and how the College is bringing together psychiatrists working in this area to exchange information, set standards, influence training and improve services to patients.

Dr Lauren Donnelley

Abstract:

Autism Spectrum Disorder (ASD) and Anorexia Nervosa (AN) have similar neuropsychological dysfunction, most evident in problems related to set shifting, central coherence, social cognition, interpersonal deficits, rigidity, and increased attention to detail. Other qualities that overlap include a strong desire to control one’s environment, inflexible and concrete thinking, limited social spontaneity, and overly restrained emotional expression. Despite this diagnostic overlap, there are few clinicians who specialize in both ASD and AN. This session is designed for clinicians from all disciplines who work with individuals with autism and eating disorders. The focus will be on anorexia nervosa, though the strategies are also useful for atypical eating disorders and avoidant restrictive food intake disorder (ARFID). Our team, which includes experts in autism, eating disorders, and both, will illustrate practical and effective use of evidence-based strategies such as positive behavioral supports, visual supports, parent management training, and social narratives to support food exposures, food flexibility, and adequate nutrition.

Dr Lucia Giombini & Dr Sophie Nesbitt

Biography:

Dr Lucia Giombini and Dr Sophie Nesbitt are both Clinical working at Rhodes Wood Hospital, Inpatient Service for Children and Adolescent with Eating Disorders, Elysium Healthcare.

They have worked extensively with young people with eating disorders using various different treatment approaches such as cognitive behaviour therapy and motivational enhancement therapy.

Most recently they have introduced the delivery of individual cognitive remediation therapy (CRT), and emotions skills training (CREST) in a group format in the service. Both therapies focus on the process of thoughts and emotions rather than the content of eating disorder symptoms.

They are currently working in collaboration with Professor Kate Tchanturia and Kings College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN) on the development of the evidence supporting the effectiveness of these approaches.

Abstract:

Emotional difficulties in young people (YP) with anorexia nervosa (AN) are well recognised. Improved strategies are needed to support inpatients to tolerate group therapy and to better identify and manage their emotions. Cognitive Remediation and Emotion Skills Training (CREST) for AN adults, aimed at improving emotional processing skills, has been found beneficial in adult AN groups. Two case series of CREST was conducted in an inpatient ward for YP (CREST-YP) to evaluate its suitability for a younger population.

Although quantitative results showed no statistically significant changes in emotional functioning, qualitative results showed that YP found it helpful to learn about emotion processes, acknowledging their need to be supported to express them and understand the link with eating disorder symptoms.

Pilot findings suggest that CREST-YP is an acceptable intervention for YP with AN. Further studies are needed to clarify if CREST can produce more beneficial treatment results than treatment as usual.

Dr Ashish Kumar

Biography: Dr Ashish Kumar is a Consultant Psychiatrist and Deputy Associate Medical Director at North West Boroughs Health Care NHS Trust. He is also serving the Faculty of Eating Disorders of the Royal College of Psychiatrists as its Vice Chair and the European Chapter of the Academy for Eating Disorders as its President. In these roles he has contributed to national and international policy revisions and reviews on Eating Disorders and development of curriculum for medical students and psychiatrists. Dr Kumar is passionate about creating systems, knowledge and undertaking research in Eating Disorders and mental health. He has presented on important topics related to Eating Disorders and leadership. As a clinical lead he helped establish one of the first Children’s Eating Disorder Service in the country in Liverpool, under new NHS-E initiative. He continues to lead Children’s Eating Disorder Service to deliver high quality of care and also he is National Coordinating Investigator for UK for Votioxetine (Kite) Study in Children.

Professor Yael Latzer

Abstract:

Young ultra-Orthodox women in Israel have been faced in recent years with a greater risk of developing disordered eating and eating disorders (EDs), as they are more exposed to Westernized norms of the thin body ideal, self-realization, and personal choice. Most are treated by mainstream Israeli psychotherapists who likely have different value systems, perspectives on the nature of illness, aims of treatment and recovery. Ultra-Orthodox psychotherapists may well experience a conflict between a need to be loyal to their patients and a concomitant need to honor the values of patients’ families and the community from which they come.

The current article presents a theoretical background and case study highlighting the complexities and controversies inherent in the treatment of these women.

Both ultra-Orthodox and mainstream secular psychotherapists treating young Jewish Ultraorthodox women with EDs must be knowledgeable in both Judaism and psychology. They must also be flexible, creative, and emphatic to both the patient and her family and community, to arrive at a compromised definition of recovery that can be accepted by all parties concerned.

Dr Therese Fostervold Mathisen

Abstract:

Physical inactivity is the 4th leading cause of mortality worldwide, causing high prevalence of non-communicable diseases (NCD) in most part of the population. Specifically, people with severe mental illnesses have a shorter expected lifespan of 15-20 years, mainly due to a high prevalence of NCD. Physical activity (PA) is widely documented as effective in prevention and treatment of NCD, and in improving mental health, wellbeing and quality of life. PA is acknowledged as a component in treatment of mental health challenges such as depression, anxiety and substance use, and is associated with improved self-esteem, self-efficiency, body image, coping skills, and quality of life. In EDs, the excessiveness and compulsiveness of PA is defined as a core symptom, and this type of dysfunctional exercise complicates and challenges the use of PA as part of ED treatment. In this symposium, we will present suggestions of new understanding of dysfunctional PA, and how the complexity of such dysfunction can be identified and managed during treatment for different groups of patients with ED. Furthermore, we will discuss the evidence-base for the integration of PA as part of ED treatment, and provide clinical experiences of the implementation of health-related, progressive and guided PA in treatment of anorexia, bulimia, binge eating disorders, and among athletes.

Dr Alastair McKinlay

Abstract:

HELP! I think my patient is really ill – When to admit a patient with Anorexia nervosa to a Medical Unit?

Patient’s with anorexia nervosa are exposed to a variety of risks including psychological, physical and social factors.

There are no absolute criteria regarding physical risks, but as the severity of malnutrition increases the chance of a serious complication also tends to rise. In general patient’s with a BMI less than 14kgs per m2 are less resilient.

Those with a BMI of less than 12kgs per m2 are very vulnerable. Failure of homeostasis should always be taken seriously which includes brady or tachycardia, hypothermia or fever and evidence of muscle weakness for example the sit up, squat, stand (SUSS) test.

The risk of cardio myopathy is well recognised. Patients also lose muscle from the GI tract and there is therefore more risk of perforation and other forms of gastrointestinal dysfunction.

Severely malnourished patients may be functionally immuno deficient and more at risk of infection. The presence of co-morbid disease, super imposed infection and evidence of any organ failure should always be discussed with a medical unit, preferably one that is experience in refeeding and managing anorexic behaviour. Any condition that requires close monitoring either by chemical, hematological or physical is best undertaken in a hospital with immediate access to laboratories and high dependency care.

Elissa Myers

Biography:

The Academy for Eating Disorders is an international medical society whose members are , psychiatrists, psychologists, academic researchers, and others who work to understand the very serious mental illnesses classified as eating disorders and to alleviate the suffering of those who struggle with this illness through evidence-based treatment and prevention. AED has members in more than 70 countries, and Chapters in Latin America, the Middle East, and Europe, and is proud of the participation of our European Chapter of AED in developing this special portion of the Royal College Conference. Elissa Myers serves as Executive Director of the Society.

Dr Hakan Öğütlü

Abstract: Turkey is one of the most youthful countries, and all eating disorders (ED) are increasing in Turkey. School counselors should be knowledgeable and aware of ED. It is of great importance for children and adolescents to have early diagnosis, support, and treatment and not to be stigmatized by the community. According to the results of our study, although counselors can diagnose cases of ED at a high rate, their level of knowledge needs to be increased. Anorexia nervosa is an ED that they are most familiar with but have the lowest level of knowledge. In the treatment of ED, the importance of collaboration with the family is not adequately understood. The fact that teachers do not regard anorexia nervosa as a severe biological disease contributes reduce the stigma. It is essential to support the students by increasing their role in the diagnosis, follow-up, and treatment of ED.

Biography:

Hakan Öğütlü is a Consultant Child and Adolescent Psychiatrist at Ankara City Hospital, Ankara, Turkey. He mainly works on eating disorders and applies Family Based Therapy (FBT) and Cognitive Behavioral Therapy-Enhanced (CBT-E). He is also an International Diplomate and Certified Cognitive Behavioral Therapist of the Academy of . His research interests include eating disorders, autism, attention deficit hyperactivity disorder, and intellectual disabilities. Besides, he is a member of The Grand National Assembly of Turkey Parliamentary Research Committee of Down Syndrome, autism and other developmental disorders.

Rebecca Park

Biography:

Rebecca trained in medicine with and intercalated BSC in neuroanatomy in Bristol UK and in psychiatry in Edinburgh, London and Cambridge where she did a PhD . She moved to Oxford in 2002 as the first NHS consultant in Eating Disorders psychiatry to their new Inpatient service. She was subsequently awarded a HEFCE Clinical Senior Lecturer award, allowing her to also develop a research team. In collaboration with neuroscientists, neurosurgeons and ethicists her research focuses on defining the psychological and neural processes underpinning eating disorders and using this deeper understanding to develop new forms of treatment particularly for Anorexia Nervosa, because more effective forms of treatment are urgently needed. Her team use cutting edge forms of brain imaging in addition to psychological experiments to define neural targets for adjunctive interventions. Rebecca currently leads the sole UK trial of Deep Brain Stimulation for severe enduring Anorexia Nervosa and is lead author of the only published ethical gold standard and protocol such studies.

Dr Jacinta Tan

Biography:

Dr Jacinta Tan is a Consultant Child and Adolescent Psychiatrist who is also a researcher and medical ethicist. Jacinta spent many years researching mental capacity in anorexia nervosa at the University of Oxford. Jacinta is particularly proud to have just completed the Welsh Eating Disorder Service Review for the Welsh Government. She is the Welsh Representative to the Eating Disorder Faculty in the Royal College of Psychiatrists and is also a member of the Professional Practice and Ethics Committee. She is a Senior Editor for the Biomed Central journal Child and Adolescent Psychiatry and Mental Health.

Jacinta vision as a research-active child psychiatrist in Wales is to co-produce interdisciplinary research embedded in CAMHS together with patients, families, other clinicians and academic partners, which examines issues at the coalface of treatment and directly improves healthcare for mental disorders in children and young people and people with eating disorders across the lifespan in Wales.

Abstract:

Diagnosing eating disorders can be difficult and few people with the disorder receive specialist services despite the associated high morbidity and mortality. We used linked electronic health records from general practitioner and hospital admissions in Wales, UK within the Secure Anonymised Information Linkage (SAIL) databank to investigate the incidence of new eating disorder diagnoses over a long period of time, 1990-2017. We examined the frequency of comorbid diagnoses and prescribed medications in cases and controls in the 2 years before and 3 years after diagnosis and performed a survival analysis. A total of 15 558 people were diagnosed with eating disorders between 1990 and 2017 by Welsh GPs. I will talk about the strengths and limitations of routine clinical database research, our findings and its implications for earlier detection especially amongst GPs.

Professor Janet Treasure

Biography:

Janet completed her medical degree and a PhD in Physiology at St. Thomas’ Medical School. She then did her clinical training, as a and a psychiatrist.

For much of her career, Janet has specialised in the treatment of eating disorders at the Maudsley Hospital and in King’s College London. She has carried out extensive research - often collaboratively with patients and carers- that has led to greater understanding of, and better treatments for eating disorders.

She has trained over 40 PhD students who have implemented various aspects of translational psychiatry as part of their research training. Many of these have progressed to hold important academic and clinical positions in eating disorders. She has worked collaboratively with other international centres. In total, she has authored over 600 scientific articles.

As well as writing professional texts, Janet has co-produced self-care interventions (in books and e-health formats), for people affected by eating disorders and their carers. She has received many awards for her research. In 2012 she was awarded an OBE for her work with people with eating disorders.

Abstract:

The cognitive interpersonal model conceptualising anorexia nervosa has been used to frame research and development at the Maudsley adult eating disorder unit following MRC guidelines. The initial focus was on valued and visible maintaining factors (Schmidt et al 2006). Later the model was updated to include a summary of the underpinning cognitive and emotional traits (Treasure Schmidt 2013). In this presentation I summarise the social, and stress related consequences that accumulate in the severe enduing stage of the illness. The precision of the model has improved through an iterative process of development with feedback from patients and carers and research findings. Novel treatment targets that maintain the disorder have been exposed. Isolation and ruptured interpersonal relationships have been targeted with interventions that share understanding and skills with close others. These reduce the need for high intensity care (in or day patient) and improve carer and patient well-being. Training approaches that target risk traits or habitual eating disorder behaviours have been developed and show promise. Finally approaches used for treatment resistance in other branches of psychiatry are being applied in order to ameliorate the chronic stress response from starvation and social pain present in severe endurin neuro and addiction models.. What do you think? A title and abstract neuro and addiction models. What do you think? A title and abstract g anorexia nervosa.

Dr Hannah Turner

Biography:

Hannah Turner is a Consultant Clinical Psychologist and Clinical Lead of the Southern Health NHS Foundation Trust Eating Disorders Service. She has worked in the eating disorders field for twenty years and is a BABCP accredited therapist and supervisor. She has an interest in the delivery of evidence-based treatments in routine clinical settings, and more recently has been involved in the development and evaluation of brief interventions for non-underweight eating disorders, including CBT-T.

Abstract:

For adults, cognitive-behaviour therapy (CBT-ED) is the treatment that is recommended for non-underweight eating disorders under the recent National Institute for Health and Care Excellence guidelines (NICE, 2017). However, compared to CBT for other disorders, it is relatively long and expensive to deliver. Therefore, a new, brief form of CBT has been developed for non-underweight patients, lasting 10 sessions rather than 20, and focusing on early change – CBT-T. This workshop will focus on the key principles and phases of treatment, as well as the core skills needed to deliver CBT-T. Effective supervision and progress monitoring will also be discussed, and data related to clinical outcomes presented.

Poster Abstracts

Abstract Number: 1

Incidence of Anorexia Nervosa and the Use of Psychotropic Medications in This Cohort From UK Primary Care, 1996–2016: A Retrospective Database Study

Maedeh Y Beykloo, Dasha Nicholls, Ian CK Wong, Mima Simic, Elizabeth Mills, and Ruth Brauer

Aims and hypothesis: This study aimed to comprehensively assess trends in the incidence of anorexia nervosa (AN) in order to provide up-to-date results and to measure the use of psychotropic medications in individuals with AN over two decades. Background: There’s a call for greater understanding of psychotropic prescribing in individuals AN within the United Kingdom (UK) in order to deliver empirical evidence and provide guidance for their use in clinical practice. Methods: A retrospective database study was conducted using The Health Improvement Network (THIN) database which consists of anonymised medical records from general practices throughout the UK. Individuals aged 12-50 years and with recorded AN diagnosis were identified between 1996 and 2016. The incidence of AN were calculated annually and Kaplan Meier analyses were used to measure the prescribing duration and cessation of psychotropic medications in this cohort. The results were stratified by gender and age groups in accordance with UK clinical care guidelines. Results: A total of 17,597 individuals were identified from 1996-2016, of which 80.28% were females. The incidence of AN remained fairly constant for females and males from an overall incidence of 15.21/100,000 person years in 1996, to 21.84/100,000 person years in 2006, followed by a decrease in 2016 to 18.25/100,000 person years. Almost half of individuals with AN (47.44%) received a prescription for psychotropic medication in the study period, with the most common antidepressant prescribed being fluoxetine (59.73%) and the most common antipsychotic being olanzapine (8.90%). Under half of individuals (46%) initiated on a psychotropic medication continued with a psychotropic prescription after 6 months. Conclusions: Our findings in this study highlight the use of psychotropic medications for the treatment of AN despite lack of sufficient evidence. Our study calls for greater investigations into the benefits and harms associated with psychotropic medications in this population.

Abstract Number: 2

The Association between Sexual Orientation and Eating Disorders Symptoms in Adolescents: A systematic review and meta-analysis

Zhangqi Cao, Erica Cini, Dario Pellegrini, Kostantinos C. Fragkos

Aims and Hypothesis: This poster aims to systematically review and analyse the existing literature on the association between sexual orientation and eating disorder (ED) symptoms in the adolescent age-group. Background: Eating disorders’ peak onset occurs during adolescence, which coincides with the time when adolescents also develop their sexual identity. Methods: The review was performed in accordance to the PRISMA guidelines. Relevant studies published between January 1990 and August 2019 were searched by 2 of the co-authors (ZC, DP) in 4 electronic databases (Web of Science, PsycInfo, Medline by Ovid version, and PubMed). These articles were assessed for their quality of evidence and the risk of bias using GRADE’s approach, the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Furthermore, a meta-analysis of the proportion of sexual orientation and the adjusted odds ratio (OR) with 95% confident interval of ED symptoms was conducted using RevMan. Results: 10 studies fulfilled the inclusion criteria and were included in this review. The results demonstrated homosexual/bisexual identity was associated with a greater likelihood of ED symptoms amongst adolescents and were more likely to exhibit ED symptoms: purging (OR: M=4.60 [4.18, 5.07]; F=2.13 [1.99, 2.29]), binge eating (OR: M=3.66 [2.90, 4.60]; F=2.15 [1.73, 2.67]), dieting (OR: M=2.52 [2.30, 2.77]; F=1.67 [1.58,1.78]), and using diet pills (OR: M=3.16 [2.82, 3.54]; F=2.06 [1.89, 2.24]). Besides, those identifying as homosexuals were more likely to engage in purging and dieting behaviours than those identifying as bisexuals. Conclusions: Individuals who identify as homosexual or bisexual were associated with higher odds of reported ED symptoms than adolescents identifying as heterosexual. The association between homosexuality and ED symptoms was stronger than that between bisexuality and ED symptoms. This association was noted across both genders, though it was stronger in adolescent males than females.

Abstract Number: 3

Ethnic variation in diagnoses and symptom profiles of adolescents presenting to the East London Community Eating Disorder Service for Children and Young People (EL-CEDS- CYP)

Cini, E., Hodes, M.

Aims and hypothesis: Gaining an understanding of the community that a service covers is key in ensuring that the population needs are met. This service evaluation calculated the rates and explored the presenting eating disorder (ED) symptomatology by examining initial assessment data to help clinicians gain an understanding of EDs that presented to this clinic. It was hypothesised that the ED diagnosis and symptomatology were different across ethnicities. Background: EL-CEDS-CYP covers the East London boroughs of Newham, Tower Hamlets (TH) and City and Hackney (C&H). Methods: 215 patients’ data were retrospectively collated and analysed using EXCEL. The time period examined was January 2017 to January 2019. Results: The overall eating disorder rate following initial assessment was 69% [95% CI: 62.8% to 75.2%] to include 44% (95% CI: 37.4% to 50.6%) for Anorexia Nervosa (AN), 12% (95% CI: 7.7% to 16.3%) for sub-threshold EDs and 10% (95% CI: 6.0% to 14.0%) for Bulimia Nervosa (BN) across the 2-year period. A difference in presentation rates was observed across the 3 boroughs, with the lowest ED rates being in Newham [19% Newham:23% C&H:27% TH]. The main ethnicities presenting to the service were White (of who 25% were White British), Asian (of who 26% were Bangladeshi) and Black (of who 2.79% were Other). The rate of AN was higher in White and Asian populations [46% vs 48%] and lower in Black populations [17%]. The reverse was noted for BN [10% White:7% Asian:42% Black]. Symptom profiling analysis showed that vomiting [25% Black:9% White:14% Asian] and body avoidance [20% Black:13% White:11% Asian] were more prominent in the Black followed by the Asian population, whilst body weighing [0% Black:10% White:11% Asian] and weighing/measuring food [0% Black: 6% White: 6% Asian] were completely absent in the Black population. Conclusions: ED diagnosis and symptom profiling varied across ethnicities.

Abstract Number: 4 How does social media impact on young adults in treatment for severe & enduring eating disorders?

Charlotte Cliffe Hubertus Himmerich Rina Dutta

Aims: An explorative study of the impact of social media on young adults in treatment for severe and enduring eating disorders. Background: Increasing evidence has suggested that social media maybe associated with abnormal eating patterns and contribute to negative self-body image. In particular, studies have suggested abnormal eating patterns and the rise of the term ‘orthorexia’ is associated with increased Instagram use, related to posts of extreme ‘healthy eating’ and intensive exercise programmes. Methods: A qualitative explorative study. A focus group of five young adults, over 18 years, attending an intensive day care service at the Bethlem Royal Hospital (BRH), which uses a client-centred approach to support individuals with EDs to work towards recovery, was recorded. The session was held with both a consultant specialist in eating disorders and trainee psychiatrist. Results: The participants reported using Instagram the most frequently. Positive themes elicited were (1) entertainment and ‘passing time’ whilst in treatment (2) a platform of support from other service users (3) contact with friends and family. Negative themes elicited were (1) competitive nature of some posts amplifying the competitiveness of the illness (2) false recovery profiles (3) negative impact on self-esteem and body confidence by quantifying how many ‘likes’ a post may receive (4) obsessional use and impact on mental state (5) having no control over content and seeing triggering posts containing ‘thinspiration’ messages (6) the negative impact of stigma posts. Conclusions: Although there are some positive impacts of social media on individual recovery in ED, there are Further research into the impact of social media is needed with a focus on these distinct themes.

Abstract Number: 5

Assessment & Management of reduced Bone Mineral Density (BMD) in adolescent males with Anorexia Nervosa (AN) – A narrative synthesis of the literature

Dr Emma Davies (trainee) Dr Jessica Buckle (trainee) Dr Craig McEwan (trainee) Dr Paula Jenkins (Consultant)

Aims and hypothesis Identify existing literature to address: 1. Do adolescent males with AN have reduced BMD? 2. Are there any factors which would indicate higher risk of reduced BMD? We hypothesise that reduced BMD is a consequence of AN in adolescent males, although evidence to support this is likely to be scarce. Background Reduced BMD is a well-recognised complication of AN in females, with clear guidance for assessment and management. However this does not exist for males with AN. Methods A systematic search of Psychinfo and Pubmed identified papers against inclusion criteria. Two researchers independently screened all titles to identify and appraise papers. Data were collated using narrative approach. Results 12 papers were identified which met the inclusion criteria: 1 case control study, 1 cross sectional study, 1 prospective cohort study, 5 retrospective cohort studies, 4 case reports. All studies were small in size, largest sample population: 53. 8 studies identified reduced BMD in adolescent male AN. One cohort study identified a greater reduction in BMD in males compared to their female counterparts. 4 papers identified indicators for lower BMD, including illness duration, BMI and hormone levels, but these were conflicting between papers. Biomarkers; testosterone and oestradiol were studied in 2 papers, identifying possible further areas of research. Conclusion There is significant paucity of evidence regarding the identification and management of BMD in AN male adolescents. There is universal agreement from these papers that male adolescents have reduced BMD secondary to AN, similar to their female counterparts. However, males have long been neglected in this field and there is no guiding evidence for helping clinicians identify, investigate or manage these patients. We would urge any clinicians in the field to strongly consider studying this further to prevent the ongoing neglect of physical health in male anorexic adolescents.

Abstract Number: 6

Improving Knowledge and Confidence in the Acute Management of Eating Disorders and Resulting Complications

Dr Sarah Fynes-Clinton, CT3 Psychiatry, CWPT Dr Maisha Shahjahan, FY1, CWPT Dr Brendan McKeown, Speciality Grade Doctor, CWPT Dr Clare Price, Consultant Psychiatrist, CWPT Dr Louisa Beckford, Consultant Psychiatrist, CWPT

Aims and Hypothesis To improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call. Background Patients with Eating Disorders have complex physical and mental health needs, however a recent survey found 1% of doctors have the opportunity for clinical experience in eating disorders. Several doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts. Methods A survey was sent to 97 doctors working in a Mental Health Trust to ascertain levels of confidence when managing patients with eating disorders, as well as to collect suggestions for improvements. Three suggestions were implemented to improve identified areas of concern: 1. Direct lectures. A multiple choice questionnaire (MCQ) was given out before and after the lecture to assess its impact. 2. An educational poster highlighting pertinent information. This was displayed in key clinical areas. 3. An information booklet covering key clinical information. This was made available to all on call doctors. Results The response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Re-feeding syndrome was identified as a particular area of concern, both due to its clinical significance, and low level of confidence reported. The MCQ scores were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%. Conclusions Multiple methods were implemented to improve the knowledge and confidence of doctors when treating eating disorders whilst on call. Lectures were shown to improve overall knowledge in the short term. Easy access to important information in the form of visual posters and printed booklets aims to support this improvement long term.

Abstract Number: 7

Improving the care given to perinatal patients with eating disorders – a quality improvement project

Dr Aurielle Goddard, CT2 Psychiatry Trainee, Avon and Wiltshire NHS Trust

Aims This quality improvement project aimed to improve the care given to perinatal patients with eating disorders by tackling the following four drivers: Reducing delays in assessment from the point of referral, improving team member’s clinical knowledge and confidence in supporting perinatal patients, improving the liaison between the eating disorders and the perinatal team, improving new mothers’ access to treatment. Background Pregnancy and the postnatal period pose new challenges in providing care for women with eating disorders. For some, pregnancy can be a protective factor against their eating disorder. For many, the period is associated with increased stress, as they have to deal with rapid changes in their body. For professionals there is the added concern of keeping the developing baby healthy. New mothers face challenges attending therapy appointments and risk relapse. This project adopted a multipronged approach to develop some guidance and training for team members caring for perinatal patients. Methods The project involved an audit of perinatal patients on the caseload to determine the length of and reason for delays in assessment. A new referral pathway was developed in an effort to minimise delays. Interviews and meetings with eating disorders and perinatal team members were held in order to develop a guidance document and facilitate joint working. An audit into treatment and outcomes of perinatal patients was conducted. The literature was reviewed and recommendations were made to support new mothers’ access to treatment. Results The new referral pathway produced a modest reduction in delays to assessment. The guidance document and training was well received by team members and improved confidence. Conclusions Care of patient groups with complex needs who are looked after by multiple services can be improved by a multifaceted approach.

Abstract Number: 8

Fear conditioning in women with current anorexia nervosa and healthy controls.

Ellen R. Lambert, Kirstin L. Purves, Janet Treasure, Thomas McGregor, Valentina Cardi - Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Aims and hypothesis: To test the processes of fear acquisition, extinction, generalisation and renewal in patients with anorexia nervosa. Background: Anorexia Nervosa (AN) is characterised by an intense fear of weight gain. In line with an anxiety-based model, it has been hypothesised that abnormal eating behaviours might develop from an increased tendency to learn fear associations and to overgeneralise these associations to “neutral” stimuli, such as food. There is scarce experimental research investigating these learning mechanisms in AN. Methods: Participants (n=30 AN; n=44 healthy controls) underwent a fear conditioning experiment. A loud female scream served as the unconditional stimulus (US) and was paired with 75% of one out of two circles serving as the conditioned stimulus (CS+). The other circle was never paired with the scream (CS-). For each trial, participants recorded how much they expected the stimulus to be followed by a scream (expectancy ratings) and how it made them feel (negative affective ratings). T-tests were used to assess group differences in outcomes. Results: No significant differences in expectancy ratings emerged between the clinical group and healthy controls during any experimental phase (p>0.05). However, negative affect ratings for the CS+ were significantly higher in the clinical group than the control group after extinction (t(76)=-2.15, p<0.01) and renewal (t(76)=-2.22, p<0.05). Correlation analyses showed that ED psychopathology (r=0.31, p<0.01; r=0.25, p<0.05) and trait anxiety (r=0.27, p<0.05; r=0.24, p<0.05) were significantly associated with negative affect scores for the CS+ after extinction and renewal. Fear of food (r=0.26, p<0.05) was significantly associated with negative affect scores for the CS+ after extinction only. Conclusions: People with AN did not show a higher expectation of threat but did show greater emotional reactivity to the conditioned stimulus. This emotional reaction might contribute to patients’ resistance to extinguish aversive responses to illness-related stimuli (i.e. food, weight gain). Acknowledgments: V. Cardi, E. R. Lambert & J. Treasure acknowledge funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. K.L. Purves acknowledges funding from the Alexander von Humboldt Foundation and is part supported by the UK Medical Research Council (MR/M021475/1).

Abstract Number: 9

The Influence of Oxytocin on the Neural Processing of Palatable Taste in Women With and Without Bulimia Nervosa or

Leslie, Monica Leppanen, Jenni Treasure, Janet Paloyelis, Yannis

Aims and hypothesis: This study aimed to investigate the influence of oxytocin on the neural processing of palatable food cues in women with and without bulimia nervosa (BN) or binge eating disorder (BED). We hypothesized that women with BN and BED would exhibit heightened neural activation in the orbitofrontal cortex (OFC) and striatal regions in response to the image of chocolate milk, versus water, and lower neural activation in response to the receipt of chocolate taste, versus water taste. We further hypothesized that oxytocin would suppress neural activation in the OFC, hypothalamus, and striatal regions in response to images of chocolate milk. Background: Preliminary evidence has suggested that intranasal oxytocin administration can reduce food consumption in women with BN, but the mechanism of this effect is unclear. Methods: We recruited 25 women with BN or BED and 27 healthy comparison women. Each participant received 40IU intranasal oxytocin prior to an fMRI scan during one experimental session, and an equal volume of placebo nasal spray during the opposite session in a double-blind design. During the fMRI scan, participants viewed a series of images of a glass of water or a glass of chocolate milk and received the corresponding flavour, water or chocolate milk, on a random set of trials. Results: We did not observe significant differences in neural activation between women with BN or BED, versus healthy comparison women, in response to the anticipation or receipt of chocolate, versus water. Oxytocin did not affect neural activation in response to anticipation or receipt of chocolate, versus water. Conclusions: The current findings contradict previous evidence finding differences in the neural processing of palatable food cues between women with a history of BN and healthy comparison women and do not support a role for oxytocin in moderating the neural processing of palatable food cues.

Abstract Number: 10

Co-producing school-based body image interventions to prevent the onset of eating disorders: a pilot study

Hannah Lewis

Aim: To co-produce and pilot a school-based intervention with young Experts-by-Experience (ExE) who have lived experience of body image disturbances and eating disorders, in order to potentially prevent future cohorts from developing similar issues. Background: Rethink Mental Illness (RMI) was delivered the ‘Step-Up: Transitions’ project, which seeks to raise mental health awareness and equip young people with self-help tools based on a Cognitive Behavioural Therapy (CBT) techniques. The intervention used a co-production model where young ExE who have lived experience of mental health problems to co-design and co-deliver the workshops. After two years of delivery, the need for a body-image and eating disorder specific workshop was raised by both students, champions and staff. A small pilot study was thus conducted from January to March 2018. Method: An exploratory focus group took place, where the latest research from the field was presented to the ExE (n=10, 100% female, 50% identified as Caucasian and 50% identified as BAME). Alongside a discussion of their own experiences, the ExE – who identified as ‘Young Champions’ – identified with approaches from the research and adapted these into interactive resources to be shared in the intervention. The co-designed intervention was then co-delivered in two sessions, to 40 participants of diverse genders and ethnicity, aged between 14 and 19 years old, from inner London schools. Results: Using a Generalised Self-Efficacy (GSE) scale (with adapted language to be body image specific), positive data from the post-intervention ranged from 70% to 98%, with 97.5% of participants reporting a better understanding of the ways that body image can affect their mental health and wellbeing. Conclusions: This small-scale pilot study clearly demonstrated that post-intervention, participants better understood the impact of body image on their mental health and felt better equipped to manage body image problems using the techniques learned in session. N.B The Step-Up: Transitions project was funded by the Big Lottery Fund 2015-2018.

Abstract Number: 11

Eating disorders (ED) mothers and their children: a systematic review of the literature

Maria Giulia Martini1,2, MD, MSc; Manuela Barona-Martinez1; Nadia Micali1,3,4, MD, PhD, MRCPsych, FAED 1. Institute of Child Health, University College London, London, UK 2. South London and Maudsley, NHS Foundation Trust, London UK 3. Dept. of Psych

Aim: To provide an overview of the impact of maternal ED on child development in a number of domains including feeding and eating behaviour, neuropsychological profile, cognitive development, psychopathology and temperament. We hypothesised that children of parents with eating disorders exhibit compromised development. Background: Risk for developmental problems in children of women with psychiatric disorder has been well documented in the literature and several aspects of children's development can be affected, including their physical, cognitive, social, emotional, and behavioural development. Fewer studies are available regarding the impact of ED on child development. However, available literature suggests children of mothers with ED are at risk for adverse developmental outcomes during childhood and are also vulnerable to the developing disordered eating themselves. Methods: PubMed, Embase, and PsychInfo were searched for studies exploring the impact of maternal ED on children between January 1980 and September 2018. Results: Initial search yielded 569 studies. After exclusion, 32 studies were reviewed. Overall, available evidence shows that children of mothers with ED are at increased risk of disturbances in several domains. They exhibit more difficulties in feeding and eating behaviours, display more psychopathological and socio-emotional difficulties, they are more likely to be described as having a difficult temperament. Conclusion: Maternal ED have an impact on child psychological, cognitive and eating behaviours, and might affect the development of ED in the offspring. Future research should focus on resilience and on which protective factors might lead to positive outcomes. These factors can be then used as therapeutic and preventative targets.

Abstract Number: 12

The Treatment of Anorexia Nervosa in adolescents: A Metasynthesis of parents’ perspectives.

Dr Ngozi Oketah Dr Peter Frost

Background: Anorexia nervosa (AN) is a severe eating disorder with onset typically in adolescence characterised by a distorted body image major and an intense fear of weight gain. It greatly impact on the adolescent growth, puberty and psychological development with a high risk of death and can be challenging to treat. Studies have established the central role of the family in recognition, treatment and recovery of anorexia. Aim: We sought to perform systematic review of qualitative studies to synthesize the views of parents on the treatment and recovery process of anorexia nervosa in their adolescent. Methods: A systematic search of six databases - Medline, PsychINFO, CINHAL, EMBASE, Cochrane library and SSCI was conducted for qualitative studies regarding parents’ views about the treatment of anorexia nervosa in adolescents. Quality of articles was assessed using the critical appraisal skills program (CASP). Thematic synthesis was used to summarise topics found in the articles and develop central themes. Results: 14 studies from six countries met my inclusion criteria reporting the views of 202 parents. Four themes were inductively developed from the analysis: Understanding the child and the disease, experience of services and treatment modalities, the role of professionals and the concept of recovery. Conclusion: This metasynthesis highlights the importance of taking into account parents views in the treatment of adolescent anorexia. While parents report relief in finding help at a very difficult time in their life, they continue to struggle with delays in finding help, negative attitudes of professionals and uncertainty about the future. Clinicians recognition the challenges faced by parents and families will help to provide the much needed support, a focus on a holistic approach for better outcomes and prevention of chronicity of adolescent anorexia into adulthood.

Abstract Number: 13

Management of eating disorders in the postpartum period: A case report and review of current literature

Aims and Hypothesis To understand the challenges faced by women suffering from eating disorders (EDs) during pregnancy, and to evaluate the effectiveness of ED management, in particular during the postpartum period. It was anticipated that a literature review would show inadequate research into the management of EDs during the postpartum period and, consequently, there is a lack of evidence-based clinical guidance. Background Pregnancy is an especially challenging time for women with EDs, which can have adverse outcomes for the baby, such as growth restriction. It has been found that 4-7.5% of pregnant women have EDs, many presenting to ED services for the first time. Although there is some guidance on the management of EDs perinatally, there is little covering the postpartum period. Methods A review of the literature on eating disorders in pregnancy was undertaken through PubMed. Search terms included “Eating disorders”, “Pregnancy”, “Perinatal” and “Postpartum”. Additionally, a patient who had bulimia nervosa (BN) during pregnancy was interviewed and her clinical notes used. Results Women with EDs face new difficulties such as bodily changes outside their control and anxiety over their babies’ wellbeing. During pregnancy, women often surrender their ‘ED identity’ and take on the ‘pregnancy identity’, a protective factor against EDs. The loss of the ‘pregnancy identity’ in the postpartum period contributes significantly to the high incidence of ED relapse. Research shows 70% of women with BN suffered a relapse within 36 months postpartum. Challenges during the postpartum period include; breastfeeding, the desire to lose weight and attending ED appointments. Crucially, there is a decrease in care provided during this time. Conclusions There is a lack of evidence- based clinical guidance on the management of EDs during pregnancy. Further research into ED management and greater support during the postpartum period is needed to help prevent relapse of EDs.

Abstract Number: 14

Mind the Gap! Indications of the true economic burden of eating disorders to the NHS

Jacinta Tan Ioan Humphreys Joanne Demmler

Background: It is known that owing to high levels of morbidity and need for longer durations of treatment, eating disorders have a high economic cost, to the healthcare system, to patients and their families, and to society as a whole. Aims: To quantify health economic costs of eating disorders using two discrete items within a population clinical database – General Practitioner contacts, and inpatient admissions. Method: We used linked electronic health records from GP and hospital admissions in Wales, within the Secure Anonymised Information Linkage (SAIL) databank which covers 77% of the Welsh population, to investigate the GP contacts and inpatient admissions (for any reason). We analysed a cohort diagnosed by their GPs with eating disorders; a control cohort of 4 controls per subject matched to the GP-diagnosed cohort by gender and age at time of diagnosis; and an un- matched cohort of patients treated by specialist adult eating disorder services. The health economic costs were calculated using standard tables. Results: The combined cost of the Length of Stay and GP Events is £680,305,745 or £25,196,509 per year (over 27 years from 1990 to 2017) for the GP-diagnosed cohort in Wales. This equates to £405 per person per year for inpatient admissions and £1,072 per person per year for the GP-diagnosed eating disorder cohort. The control cohort incurred costs of £78 per person per year for GP contacts and £640 per person per year for inpatient admissions. The specialist eating disorder patient cohort incurred costs of £401 per person per year for GP contacts and £1,397 per person per year for inpatient admissions. Conclusions: These results suggest a high overall cost to the NHS of patients with eating disorders, whether or not they are known to specialist eating disorder services.

Abstract Number: 15

Mind the Gap! An examination of the interface between primary and secondary healthcare for eating disorders

Gemma Johns Bridget Taylor Jacinta Tan

Eating disorders have the highest mortality of all mental disorders, and greatly affect health. Evidence shows that prompt diagnosis and early intervention can help recovery. Yet, there are many difficulties across eating disorder services, which are producing significant gaps, thus standing in the way of providing a good and effective service. Aims: The aim of this research is to examine the primary and secondary care interface for the treatment of eating disorders in Wales to provide policy and practice recommendations for improvement of existing services. Methods: A mixed methods approach was taken to explore the interface. This includes focus group discussions with people with eating disorders, families and healthcare professionals; and an analysis of routine clinical care records (SAIL Database). In addition, this evidence will be combined with data gathered in a recent Eating Disorder Service Review 2018. Results: In Wales, eating disorder services are faced with many gaps spanning across the entire healthcare interface. These include: poor resources and communication links, lack of support; and different cultures and definitions of ‘need’ across services. For example, specialist services are reserved for the ‘very severe’, thus filtering ‘others’ down to a very low level of expertise. Conclusions: Eating disorder services are very varied across Wales. There is an urgent need for a reform of services for eating disorders that is better resourced, better managed, and is offered as a high level of expertise to anyone that needs them.

Abstract Number: 16

Evaluation of an online intervention for anorexia nervosa patients and carers in a multi- centre study

Valentina Cardi, Suman Ambwani, Pamela MacDonald, Daniel Willmott, Katie Rowlands, Gillian Todd, Ulrike Schmidt, Sabine Landau, Jonathan Arcelus, Eva Bonin & Janet Treasure.

TRIANGLE is a multi-centre, randomized controlled trial (RCT) collecting long-term outcome data on the wellbeing of anorexia nervosa (AN) patients who are admitted to inpatient or intensive day care services, as well as their carers. TRIANGLE is testing whether delivering the hybrid patient/carer intervention ECHOMANTRA online can improve outcomes for patients and carers. ECHOMANTRA is a guided self-help intervention based on the cognitive interpersonal model of AN and is delivered through a platform containing workbooks, videos, separate online groups for patients and carers, and joint multi-family online groups. People receiving intensive hospital treatment (N = 380) are being recruited from NHS trusts, private hospitals and the community and randomised to treatment as usual (TAU) or TAU plus ECHOMANTRA. The poster will report interim engagement data; we will present quantitative and qualitative feedback (including a thematic analyses of a focus group) on the acceptability and credibility of the intervention.

Acknowledgements

This abstract describes independent research commissioned by the NIHR under HTA. This trial is funded by the NIHR ‐ HTA program (project reference number 14/68/09). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR.

We are grateful to the local investigators and clinical study officers at the following participating centres:

South London & Maudsley NHS Foundation Trust; Cheshire & Wirral Partnership NHS Foundation Trust; Midlands NHS Foundation Trust; Avon & Wiltshire NHS Foundation Trust; Dorset Healthcare University NHS Foundation Trust; Central & North West London NHS Foundation Trust; Barnet, Enfield & Haringey Mental Health NHS Trust; Leicestershire Partnership Trust; Northumberland, Tyne & Wear NHS Foundation Trust; NHS Grampian; NHS Lothian; South West London & St Georges NHS Foundation Trust; North Essex NHS Foundation Trust; 2Gether NHS Foundation Trust; Berkshire Healthcare NHS Foundation Trust; Oxford Health NHS Foundation Trust; Ellern Mede Centre for Eating Disorders; The Priory Roehampton; The Priory Southampton; The Priory Altrincham; The Priory Cheadle Royal; Surrey and Borders NHS Foundation Trust; Devon Partnership NHS Foundation Trust; Ellern Mede Barnet; The Priory Hayes Grove; Tees, Esk and Wear Valleys NHS Foundation Trust; Cambridgeshire & Peterborough NHS Foundation Trust; New Market House and The Cardinal Clinic.

We are grateful to the Beating Eating Disorders (BEAT) charity for their support to the project.

Abstract Number: 17

A questionnaire exploring the extent of social media use and its impact upon patients in an eating disorders service

Dr Nicholas Wolstenholme, Consultant Psychiatrist, TEWV, UK Dr Oladipupo Omolabi, Speciality Doctor, NTW, UK Victoria Frater, Specialist Eating Disorder Nurse, NTW, UK

Aims and Hypothesis To understand the extent and impact of social media use on body image concerns and eating habits in patients within an eating disorders service. Background: Since its rise in the mid-2000s, social media has revolutionised the way society shares information. However, there are concerns around the relationship between social media and mental health. Little research has been carried out specifically looking at how social media impacts service users with an eating disorder. Methods: A questionnaire was developed exploring what social media platforms patients used, how frequently, and to what extent they felt it impacted on concerns around body image and eating habits. They were distributed to inpatient and day service users at the Richardson Eating Disorders Service in Newcastle in July 2019. Responses were input onto an excel spreadsheet and data was analysed quantitatively. Concerns around the impact of social media was also analysed qualitatively, Results: The response rate was 94% (n=15). All but one service user reported using at least one social media platform. The average time spent was around an hour and a half each day. Whatsapp was the most frequently used social media platform, used by approximately 80% of service users. Instagram was the most common daily used platform (47%) and was also used for the longest period each day (on average for 60.7 minutes). In terms of concerns around body image and eating habits, most service users reported Instagram impacted them the most with 62.5% stating it did so to a “reasonable” or “significant” extent. Conclusions: Social media use appears to be widespread amongst service users and can significantly impact on core eating disorders symptomatology. Further research needs to take place into its impact with a view to identifying how best to help service users navigate the potentially negative aspects of social media.

Abstract Number: 18

Main focus on weight or on motivation and psychological evolution? Evaluation of two different treatment approaches of adolescents with Anorexia Nervosa.

K. BAEKELANDT DR. K. MAES PROF. DR. DR. I. GLAZEMAKERS

In February 2018 a change was made in the inpatient treatment approach of the Eating Disorders Department of the University Centre of Child and Adolescent Psychiatry Antwerp, Belgium. The shift was from an approach previously focused on weight gain to the current treatment approach centered on motivation, a deeper understanding of the illness, and psychological evolution. The results of a study on outcome and effectiveness of both treatment approaches will be presented by comparing underweight percentages of patients at admission and discharge, as well as admission duration, of 67 adolescents with Anorexia Nervosa admitted to the Department since September 2016. In addition, the Patient Reported Experience Measures (PREM) of a qualitative study based on a questionnaire regarding the perception of both patients and their parents, who received treatment under both approaches, will be presented. To conclude, the results of a survey questionnaire investigating the perception of the multidisciplinary team working under both approaches will also be discussed.

Abstract Number: 19

The role of the Middle East Eating Disorder Association in tackling eating disorders and obesity in the region

Rayane Chami, MSc Dr Carine el Khazen, PhD Dr Jeremy Alford, PhD

As the growing literature on eating disorders in the Middle East suggests, eating disorders can no longer be considered problems of the West. While the prevalence of eating disorders and obesity in the Middle East seems to exceed that of the Western world, there remains low awareness, low specialization among healthcare professionals, and inadequate care offered to patients. The Middle East Eating Disorders Association (MEEDA) is a non-profit organization that focuses on raising awareness, providing free support and treatment to sufferers, offering trainings on eating disorders and obesity to healthcare professionals, and conducting research within universities in the Middle East. Despite this, MEEDA requires international support to achieve cultural and clinical impact. The poster presented will introduce eating disorder and obesity research findings obtained from Middle Eastern samples, describe MEEDA’s aims and present accomplishments, and outline ways in which international support can be provided.

Abstract Number: 20

An investigation of the affective experience of females at high risk for eating disorders in general and pathology-specific contexts

Rhonda M. Merwin, Drew Anderson & Maria Karekla

Aims and Hypothesis: The aim of the current study was to examine: i) physiological reactivity and subjective report of emotional experiences in response to unpleasant affect, induced via affective film clips with general and Eating Disorders (EDs) – specific content, and ii) the impact of film on body size estimation in females at high vs. low risk for EDs. It was expected that: i) high ED risk participants would present greater reactivity to the affective film clips, and ii) unpleasant affect would have a greater negative impact on body size estimations in the ED high risk group compared to the low risk group. Background: Difficulties with emotional experiences have long been implicated in the development of EDs. However, the vast majority of this work is theoretical or self-report, with few studies examining the somatic-affective experience of individuals at high ED risk, who do not yet present with clinical symptoms nor do they suffer from the physical consequences of the illness, under experimental conditions. Methods: Females aged 14 to 24 years old of either high (N=42) or low (N=43) risk for EDs viewed pathology-specific and general affective film clips and provided their affective ratings and body size estimations post film clips. Heart Rate and Skin Conductance Levels were recorded during each clip. Results: High-risk participants evidenced greater physiological arousal across conditions and in both general and pathology-specific affective contexts. Negative affect induced via the ED-pathology specific film clip had a greater impact on the high risk group’s body size estimations. Conclusions: Individuals at risk for EDs seem to experience greater physiological arousal and this may influence the experience of their bodies, or direct attention to their body as a way to attenuate unwanted emotion or due to somatic feedback.

Abstract Number: 21

Innovative Moments and the process of change in the treatment of Bulimia Nervosa: a case study

Iakovina Koutoufa, Inês Mendes, Eva Conceição, Ross Crosby & Steve Wonderlich

Aims and hypothesis: This is the first study to report an intensive analysis of a good-outcome case of a female with bulimia nervosa using the Innovative Moments Coding System (IMCS). We aimed to examine the process of client change in psychotherapy for bulimia nervosa. We hypothesize that increased presence of Innovative Moments (IMs) will be associated with an improvement in bulimic symptoms for this patient. Background: The IMCS, inspired by the narrative approach, establishes patient change as a result of narrative novelties (IMs) that oppose the patient’s core problem. It highlights different types of narrative novelties, such as action, protest, reflection, and reconceptualization. Past process-outcome research found IMs to predict symptom reduction in different therapeutic approaches (e.g. Cognitive Behavioural Therapy; Emotion-Focused Therapy) in depression. Methods: “Kate” attended 21 sessions of Integrative Cognitive Affective Therapy (ICAT) and the sessions were coded for IMs by two independent raters using the IMCS. The trajectories of emergence of the various IMs are explored and correlated with her eating disorder symptoms as measured by the Eating Disorder Examination (EDE) and weekly recall of bingeing and purging. Results: Preliminary analyses indicate that there was an overall increase in the presence of IMs mid-therapy. Action and reflection IMs linked to an emerging insight to the problem as well as finding solutions against the problem were more prevalent at the start of therapy, whereas reflection and protest IMs related to the process of change emerged more frequently and in higher proportion during mid- to late-treatment. Conclusions: This is the first study to examine a psychotherapy case of bulimia nervosa using the IMCS. Results indicate a distinct developmental trend of IMs in this case of bulimia nervosa. This can have important implications on the treatment of bulimia nervosa.

Abstract Number: 22

The role of different compensatory behaviours in body composition, medical complications, functional and psychological status in Eating Disorders

Cecilia Mancini, Patrizia Todisco, Lorenzo M Donini

AIM OF THE STUDY. The aim of the study was to investigate differences in body composition, biochemical, functional and psychological patterns related to different compensatory behaviours (CB) in patients with Eating Disorder (ED). BACKGROUND. A broad spectrum of complications due to malnutrition, binging/purging behaviours, and excessive exercise is frequently associated to all ED categories. METHODS. 135 inpatients (female, aged 18-59) with ED [Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Other Specified Feeding or Eating Disorder (OSFED) based on DSM-5 classification] were enrolled. For each diagnostic category, 4 subtypes were identified based on CB: vomiting, excessive exercise, combination of different CB and no CB. All patients underwent anthropometry (height, weight, circumferences, plicometry), bioimpedance analysis, hand grip strength (HGS), biochemical investigations, electrocardiogram, blood pressure measurement, psychometric tests (SCL-90R, CIA, EDE-Q, BDI, STAXI-2); 39 patients underwent dual-energy-X-ray absorptiometry (DXA). RESULTS. Among diagnostic categories of ED we detected significant differences in body composition and body hydration; for each category these differences were not consistent with CB. Impairment of HGS had no differences among groups. On the other hand, in each diagnostic category, different CB impacted differently on the incidence of gastrointestinal, endocrine- metabolic and cardiac complications. BN patients with different CB presented different score in some dimensions of SCL-90R and CIA tests. CONCLUSIONS. Loss of fat and fat free mass, impairment of body hydration and body function can be detected in each category of ED and doesn’t seem to depend on CB but just on diagnostic category. On the other hand, different CB seem to have different impact on medical complications and psychological status in AN, BN and OSFED patients. Wider and longitudinal studies are needed to better understand how CB impact on patients’ global health. Authors declare no conflict of interest

Abstract Number: 23

A proposal for a Staging System for Eating-Disorders (ED-SS): preliminary data

Cecilia Mancini, Patrizia Todisco, Samira Terlizzi, Lorenzo M Donini

AIM OF THE STUDY. Clinical application of a Staging System for Eating Disorders (ED-SS). BACKGROUND. Eating Disorders (ED) impair organic, social and psychological functions and the severity of illness is not necessarily consistent with diagnostic category (DSM-5); therefore, a transdiagnostic approach might be more useful. In recent years, there has been a growing interest in developing a staging system for ED, that should be useful for risk stratification and to guide treatment decisions. METHOD. We propose an ED-SS based on a bio-psycho-social assessment, exploring psychological, clinical and functional status and quality of life. For each domain an assessment tool has been selected with a four-level staging (mild, moderate, significant, severe) and the final stage was determined by the most impaired domain. We applied this system on a 42 inpatients female sample with a diagnosis of Anorexia Nervosa (AN), Bulimia Nervosa (BN) or Other Specified Feeding or Eating Disorder (OSFED). RESULTS. AN patients had moderate, significant or severe as final stage, none had mild stage; final stage of BN and OSFED patients was significant or severe, none of them had mild or moderate stage. Higher final stage was associated with a shorter illness duration and greater use of drugs; patients with final, psychological and functional stage classified as significant or severe needed more extra therapy, medical interventions and specialist assessment during recovery; none of these findings was statistically significant. CONCLUSIONS. The severity of illness is not consistent with diagnostic category, as OSFED may present with a high level of global impairment, confirming the importance of a transdiagnostic approach. Using our ED-SS we detected differences between different stages of severity, as higher final stage is associated with worst clinical course. Due to small sample size differences were not statistically significant, so a wider sample and longer follow-up are needed to assess sensibility, specificity, reliability and utility of this staging system. Authors declare no conflict of interest

Abstract Number: 24

Physical exercise and dietary therapy (PED-t) as treatment of BN and BED – a farfetched idea or exciting news?

Mathisen, Therese Fostervold (PhD); Rosenvinge, Jan H (PhD); Friborg, Oddgeir (PhD); Vrabel, Karianne (PhD); Bratland-Sanda, Sofrid (PhD); Pettersen, Gunn (PhD); Sundgot-Borgen, Jorunn (PhD).

Aims: To explore a new therapy for bulimia nervosa (BN) and binge eating disorder (BED) combining physical exercise and dietary therapy (PED-t), and to compare its efficiency to cognitive behavior therapy (CBT). Hypothesis: The PED-t is an equally effective therapy for BN and BED to the currently preferred CBT. Background: There is a need to explore evidence-based therapies for eating disorders (EDs), due to long waitlists for therapy and current inadequate treatment outcome. Physical exercise is effective in prevention and treatment of several mental illnesses, but controlled studies on ED patients are limited, mainly out of fear of exacerbating the compulsive and excessive nature of exercise in patients. Methods: We recruited 164 women (18-40 yrs; BMI 17.5-35) to a 16 weeks outpatient, randomized group treatment. Pre-post measures (T1-T2), and measures at 6 (T3), 12 (T4) and 24 months (T5), were EDE-q, clinical impairment assessment (CIA), Beck Depression Inventory (BDI), satisfaction with life scale (SWLS), and remission rates. The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (ID:2013/1871). Results: At T2 EDE-q and CIA improved more in PED-t than in CBT (g=0.52, p <0.003, and g=0.49, p=0.005, respectively). Concurrently, the BDI improved in PED-t only (g=0.89, p<0.001), still with no between-group difference. Both therapies were equally effective in providing improvement in SWLS (g>0.6, p<0.004). During T2-T5 improvements from both therapies sustained, with no further between group differences. Numbers in full- or partial remission were comparable in PED-t (29% and 20%) and CBT (12% and 17%) with sustained effect during T2-T5. Conclusions: PED-t adds to the pool of evidence-based successful therapies for EDs, and the high availability of professionals in exercise medicine and dietetics may effectively deal with the waitlists challenges. Financial resources: The PhD position was funded by the Norwegian Women’s Public Health Association. Operating funds were supported partly by the Norwegian School of Sport Sciences, the UiT – The Arctic University of Norway, and by an assigned fund from the Research Council of Norway. Dairy sports recovery products were supported for the PED-t intervention by Tine Dairy Producer (Norway) as part of their charity funding activity.

Abstract Number: 25

EARLY MALADAPTIVE SCHEMAS IN SOCIAL EXCLUSION AND INCLUSION IN ANOREXIA NERVOSA

Paolo Meneguzzo1, Enrico Collantoni1, Elena Tenconi1,2, Angela Favaro1,2 1: Department of Neurosciences, University of Padova, via Giustiniani 2, 35128 Padova (Italy) 2: Padova Neuroscience Center, University of Padova

AIM The aim of the present study is to employ the Cyberball Paradigm to explore the relation between Early Maladaptive Schemas, social exclusion/overinclusion and a sample of AN patients’ emotions, cognition and psychopathology. BACKGROUND Patients with Anorexia Nervosa (AN) show an impairment in the recognition and expression of emotions, as well as an increased sensitivity to being socially excluded, and rigid maladaptive schemas. The Cyberball paradigm is a virtual ball-toss game that can simulate social exclusion and inclusion. Our aim is to evaluate how cognitive schemas can influence the perception and the evaluation of the experiences of social inclusion/exclusion. METHODS 32 AN patients and 34 healthy controls completed a psychological evaluation and were randomly assigned to exclusion or overinclusion paradigm of the Cyberball task. RESULTS Patients with AN showed a significantly higher level of maladaptive schemas as well as higher sensitivity to being ostracized by peers in comparison with healthy subjects. Regression analyses identified specific significant relation between being ostracized and punitiveness, emotional inhibition and entitlement/grandiosity. CONCLUSIONS Our findings provide evidence that patients with AN may be ineffective in expressing their mood in exclusive and overinclusive social situations. Specific cognitive/temperamental schemas might play a role in thee way people communicate their feelings and they could be considered targets for psychotherapy interventions to improve social interpretation and emotional recognition/communication.

Abstract Number: 26

ASSESSING THE INFLUENCE OF BODY-RELATED ATTENTIONAL BIAS IN THE RELATIONSHIP BETWEEN GENDER AND BODY DISSATISFACTION. A Virtual Reality and Eye-Tracking study

Bruno PORRAS-GARCIA, Agata OLSZEWSKA, Aïna MANZANO-TORRA, Nahum MONTAGUD, Adrià VALVERDE, Alexandra GHITA, Marta FERRER-GARCÍA, Eduardo SERRANO- TRONCOSO, Antoni TALARN-CAPARROS, Joseba ACHOTEGUI-LOZATE and José GUTIÉRREZ- MALDONADO

Aims and hypothesis: A combination of a Virtual Reality-based embodiment technique and eye-tracking Attentional Bias (AB) assessment was used to assess the relationship between gender, body-related attention and body dissatisfaction (BD). Background : Previous studies reported that women and men evaluate their appearance in different ways, for example by showing a different AB toward their respective body parts. However, little information is available about the impact of gender on BD when the influence of body-related attention is controlled. Method: Eighty-two participants (43 women and 39 men) were embodied in a virtual body (VB) with their real silhouette (real-size VB), while their real-time attention patterns were measured. To analyze the gaze data, weight- and non-weight-related body areas were defined. Complete fixation time on each body area was recorded while participants owned their real-size VB. Additionally, BD levels after owning a real-size VB were measured using a figural drawing scale questionnaire. Results: A simple moderation analysis was performed, with complete fixation time as a quantitative moderator. BD was significantly predicted by gender and by the interaction between gender and AB toward weight-related body parts (p.05) in women and men who showed a preference to attend to non-weight- related body areas. However, gender differences were significantly related to BD (p>.05) in participants who showed a preference to attend to weight-related body parts; specifically, women reported significantly higher BD levels than men (p Abstract Number: 27

ASSESSING BODY-RELATED ATTENTIONAL BIAS AMONG WOMEN WITH HIGH AND LOW DRIVE FOR THINNESS. A Virtual Reality and Eye-Tracking study

Oscar CASTILLERO-MIMEMZA, Bruno PORRAS-GARCIA*, Marta FERRER-GARCIA, Erik EXPOSITO-SANZ, Lena Yilmaza Yiğit ONUR-ŞEN, Antoni TALARN-CAPARROS, Joseba ACHOTEGUI-LOZATE and José GUTIÉRREZ-MALDONADO

Aims and hypothesis: This study aims to assess whether women with high and low Drive for Thinness (DT) display different body-related attention towards specific body parts when owning a virtual avatar with different body mass index (BMI). Background: DT is considered a core factor among Eating Disorders (ED) and may influence body-related attention, for instance by selectively diverting attention to unattractive body parts in preference to other body parts. This study combines Virtual Reality (VR) and Eye Tracking (ET) technologies and uses a VR-based embodiment technique while measuring real-time attention patterns. Method: Forty-four women were exposed to an immersive virtual environment in which they were embodied in three avatars: the first with the same BMI as the participant; the second with an increased BMI; and finally, one with a decreased BMI. To analyze the gaze data Weight-related Areas of Interest (W-AOIs) and Non-Weight-related Areas of Interest (NW- AOIs) were defined. Number of fixations and complete fixation time on each AOI were recorded at the different assessment times. Results: Mixed between (Group)-within (Time) analyses of variance showed a statistically significant interaction between group and time (p<0.5) in number of fixations and a marginally significant interaction in complete fixation times (p=.08). Post-hoc analyses did not reveal any significant group differences in the first (real BMI) and the second condition (increased BMI). While statistically significant differences were found in the third condition (decreased BMI), in which women with low DT showed an attentional bias toward W-AOIs, while women with high DT paid more attention to NW-AOIs. Conclusion: This study provides new information about the influence of DT on body-related attention in healthy women owning a virtual avatar with different BMI values. Future psychological ED assessments and treatments could take advantage of the possibilities of VR during objective measurement of real-time visual attention.

Abstract Number: 28

Defining the Role of the Intestinal Microbiota in Anorexia Nervosa

Samuel Stone Susan Byrne

Aims and Hypotheses This pilot study represented a first step toward helping us to understand the precise mechanism(s) by which intestinal bacteria (the microbiome) contribute to the dysregulation of adiposity, body mass index, anxiety, depression and stress in patients with anorexia nervosa (AN). We hypothesized that i) individuals with AN would have a less diverse microbiome community compared to healthy people, ii) eating disorder psychopathology would be negatively correlated with microbiota diversity, and iii) that a less diverse microbiome community would be associated with higher levels of depression, anxiety, and stress. Background Emerging research suggests that the microbiome plays a key role in the regulation of weight, providing a strong rationale for exploring the role of the ‘gut’ in the emergence and maintenance of, and recovery from, AN. Previous research has demonstrated an intestinal dysbiosis in patients with AN, and an association between the intestinal microbiota and depression and anxiety in individuals with AN, providing evidence for the intestinal microbe-gut-brain axis communication in these individuals. Methods Intestinal microbiota (extracted from faecal samples) and measures of psychopathology of a sample of people with AN (N = 5) were compared with a healthy control group (N = 5). The composition and diversity of the intestinal microbiota were characterized via high-throughput sequencing of the bacterial 16S rRNA gene and the fungal 18s rRNA gene. We then assessed associations with adiposity and psychopathology Results The findings failed to support all hypotheses; however, observation of single cases in the AN group suggest a potential relationship between binge eating and purging behaviours and the intestinal microbiota. Conclusions Our results provided evidence for the feasibility of using cutting-edge technology to investigate the role of the intestinal microbiota in AN and will inform future research aimed at enhancing current approaches to weight restoration and improve treatment outcome in AN.

Abstract Number: 29

‘I’m eating through you lol’: a netnographic analysis of mukbang and disordered eating

Mattias Strand, M.D. Sanna Aila Gustafsson, Ph.D.

Aims and hypothesis: The aim of this study was to explore how viewers of online mukbang videos relate their audience experiences to self-perceived symptoms of disordered eating. Background: A ‘mukbang’ (Korean abbreviation for ‘eating show’) is a video recording of a host eating large amounts of food, usually while leisurely chatting with the audience, that is streamed or posted on an online video platform. Anecdotal reports have described how watching mukbang videos can trigger and reinforce disordered eating behaviors such as binge eating or purging behaviors, but that it may actually also help some individuals to restrain from binge eating or encourage overly restrictive eaters to grow an appetite. Methods: A large-scale assessment of YouTube comments of 15 popular mukbang videos and of Reddit posts on the topic of mukbang and disordered eating was performed, employing a qualitative netnographic approach recommended for studies on sensitive topics where it may be difficult to negotiate access for a more traditional qualitative design. Results: Two overarching themes were identified: a viewer perspective, by which users discuss mukbang without describing any personal involvement, and a participant perspective, by which users describe their own experiences of affect and behavior in response to watching mukbang videos. Several topical categories and subcategories were identified, describing how watching mukbang can both limit and increase eating, reduce loneliness and guilt, and become obsessive and self-destructive. Not least, there is often a striking ambivalence in how users are influenced by and make sense of mukbang. Conclusions: The mukbang phenomenon can be described as a ‘double-edged sword’. For some, mukbang appears to be a constructive tool in increasing food intake, preventing binge eating, or reducing loneliness; for others, it is clearly a destructive force that may motivate restrictive eating or trigger a relapse into loss-of-control eating.

Abstract Number: 30

Reach, Adoption, Implementation and Maintenance of Internet-based prevention for eating disorders in adolescents: A systematic review Karin Waldherr, FernFH Distance Learning University of Applied Sciences, Austria; Michael Zeiler, Medical University of Vienna, Department for Child and Adolescent Psychiatry, Eating Disorder Unit, Austria; Stefanie Kuso, FernFH Distance Learning Unive

Aims and hypothesis: The aim of this systematic review was to apply the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) framework to evaluate external validity and potential of large-scale dissemination of universal and targeted Internet- based prevention for eating disorders (IPEDs) in adolescents. We anticipated that the results of this study will provide insights relevant to the large-scale dissemination of such programmes as well as identify research gaps. Background: There is a growing number of studies suggesting that IPEDs in adolescents are effective. However, knowledge on their potential of large-scale dissemination and their population impact (PI) is lacking. Evaluation of the PI of such interventions and of external validity indicators would support future efforts for their wider dissemination. Methods: We conducted a literature search on PubMed, Web of Science and PsycINFO. Furthermore, we searched the reference lists of existing reviews. Twenty-two studies published between January 2000 and April 2019 met our inclusion criteria. We extracted data on 43 indicators within RE-AIM dimensions for each article. Results: The best described RE-AIM dimensions were Reach (mean reporting rate of indicators: 55.0%) and Implementation (54.0%), followed by Effectiveness (46.8%), Adoption (34.7%) and Maintenance (18.2%). Internal validity indicators (e.g. sample size, effects, intervention intensity) were frequently reported, whereas external validity indicators (e.g. representativeness of participants and adopting organisations, implementation costs and programme sustainability) were not reported in most of the studies. Conclusions: Evidence indicates that IPEDs can reach a large number of adolescents, especially when implemented in school settings. However, some key elements for assessing the transferability to different settings and geographical regions of such programmes as well as PI and dissemination potential are rarely included in the current literature. Therefore, the reporting of RE-AIM indicators should be improved in future studies. Funding: This study has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634757.

Abstract Number: 31

Value of Inpatient Treatment for Eating Disorders

Dr. P Amin, Dr. D Nicholls

Objective: This study aimed to examine expert opinion on the role of Inpatient (IP) treatment for Eating disorders (ED) so that we can best utilise limited available resources. Methods: Quantitative online survey of Royal College of Psychiatrists (RCPsych), ED’ faculty members and qualitative interviews of select experts in the field of ED. Analysis done via SPSS for quantitative data, and qualitative data was analysed using NVIVO software using thematic analysis. Results: Majority (78%, p < 0.001) of the participants believed that inpatient treatment for eating disorders are not being utilised effectively. Majority (58%) of adult psychiatrists felt patients were being admitted for appropriate reasons compared to a minority (30%) of child psychiatrists. Qualitative analysis identified eight major themes of which most significant was difference in treatment ethos for Child and adolescent mental health (CAMHS) patients and Adult patients –whereby we found out that while children can be treated in paediatric, general psychiatric (CAMHS) or specialist eating disorder unit (SEDU) setting, adult patients are best treated at a SEDU setting. We also found that lack of community resources and incomplete pathways often prolong admissions. Conclusion: Inpatient treatment for eating disorders are not being utilised effectively and as per NICE guidelines due to lack of step down pathways and eating disorder specialist staff. There is role for technological innovation to carry out family therapy and there is a need for early prioritisation and prevention to improve long term outcomes. Lastly adult general physicians and psychiatrists need better training in management of eating disorders, as do general adult nursing staff.