Tom B Hildebrandt

Icahn School of Medicine at Mount Sinai | MSSM · Department of Psychiatry

Background Rigorous research on smartphone apps for individuals pursuing bariatric surgery is limited. A digital health intervention was recently developed using standard behavioral weight loss programs with specific modifications for bariatric surgery. The current study evaluated this intervention for improving diet, exercise, and psychosocial hea...

OBJECTIVE Despite the emotional challenges of parental adjustment to a child’s type 1 diabetes diagnosis and the unique complexities of early childhood, there are few programs designed to meet the needs of parents of young children at new onset. This study evaluated First STEPS (Study of Type 1 in Early childhood and Parenting Support), a stepped-c...

Background: Overweight and obesity are serious public health concerns. As the prevalence of excess weight among individuals continues to increase, there is a parallel need for inexpensive, highly accessible, and evidence-based weight loss programs. Objective: This weight loss trial will aim to examine the efficacy of the Noom weight loss program...

This narrative review aims to pinpoint mental and behavioral effects of starvation, which may be triggered by hypoleptinemia and as such may be amenable to treatment with leptin receptor agonists. The reduced leptin secretion results from the continuous loss of fat mass, thus initiating a graded triggering of diverse starvation related adaptive fun...

Objective: Incorporating open science practices has become a priority for submission criteria in the International Journal of Eating Disorders (IJED). In this systematic review, we used the rigor and reproducibility framework developed by Hildebrandt and Prenoveau (2020) to examine the implementation of statistically sound open science principles...

Objective: To examine psychosocial, sociodemographic, medical, and coronavirus disease 2019 (COVID-19) experiences as correlates of COVID-19 vaccination intentions among parents of children with type 1 diabetes (T1D). Methods: 121 parents of children with T1D (Mchild age = 7.78 ± 1.70; MA1c = 8.3% ± 1.5%) in the mid-Atlantic and Southwest region...

Previous research has uncovered medical and psychological effects of anabolic–androgenic steroid (AAS) use, but the specific relationship between AAS use and risk-taking behaviors as well as between AAS use and psychopathic tendencies remains understudied. To explore these potential relationships, we anonymously recruited 492 biologically male, sel...

Objective: Despite the known challenges of parental adjustment to new-onset type 1 diabetes (T1D) in young children, little is known about parental sleep soon after diagnosis. Methods: Parents (n=157) of young children (4.5±1.6 years) with new-onset T1D (29±15 days) self-reported their sleep (Pittsburgh Sleep Quality Index, PSQI) at the baseline...

Binge-eating disorder (BED) is the most common eating disorder yet its genetic architecture remains largely unknown. Studying BED is challenging because it is often comorbid with obesity, a common and highly polygenic trait, and it is underdiagnosed in biobank datasets. To address this limitation, we apply a supervised machine learning approach to...

Objective: The evaluation and use of treatment fidelity procedures are rare in the development and implementation of psychological interventions. This article aims to review the construct of treatment fidelity, highlight limitations to currently available measures, and introduce a conceptual framework for studying and adapting fidelity measures in...

Background Anorexia nervosa (AN) usually develops in early adolescence and is characterized by high rates of morbidity and mortality. Family-based therapy (FBT) is the leading evidence-based treatment for adolescents with AN, but not all patients experience sufficient improvement. The purpose of this manuscript is to describe the development and su...

This editorial seeks to encourage the increased application of three open science practices in eating disorders research: Preregistration, Registered Reports, and the sharing of materials, data, and code. For each of these practices, we introduce updated International Journal of Eating Disorders author and reviewer guidance. Updates include the int...

Objective Cognitive behavioral therapies such as Prolonged Exposure (PE) are considered first line treatments for posttraumatic stress disorder (PTSD). Nonetheless, many continue to experience significant symptoms following treatment and there is interest in enhancing treatment effectiveness. Glucocorticoid alterations in PTSD are well documented,...

Objective: Relapse after weight restoration in anorexia nervosa (AN) is a critical problem. Higher body fat percentage after weight gain has been shown to predict better weight maintenance outcome. Leptin, a fat-derived hormone, has been associated with progress during weight gain, but its association with weight maintenance is unknown. This study...

Objective: Relapse after weight restoration in anorexia nervosa (AN) is a critical problem. Higher body fat percentage after weight gain has been shown to predict better weight maintenance outcome. Leptin, a fat-derived hormone, has been associated with progress during weight gain, but its association with weight maintenance is unknown. This study...

Body checking is a repeated behavior conducted in an attempt to gain information about one’s shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less...

Objective: Anorexia nervosa (AN) typically begins in early adolescence and other than weight status has few reliable biomarkers. Early diagnosis is a critical prognostic factor, but this can be clinically challenging. Heart rate variability (HRV), the beat-by-beat variance in heart rate (HR), may provide a unique assessment for the presence of AN...

Significance Obesity is a major public health problem in a growing proportion of children and adults in the developed world. Estrogen influences body weight and behavioral responses to appetitive stimuli. Estrogen biosynthesis is catalyzed by the enzyme aromatase in all organs measured, including the brain. Using the aromatase radiotracer [ ¹¹ C]vo...

Objective The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence‐based interventions. This article draws together clinician ex...

The rigor and reproducibility of science methods depends heavily on the appropriate use of statistical methods to answer research questions and make meaningful and accurate inferences based on data. The increasing analytic complexity and valuation of novel statistical and methodological approaches to data place greater emphasis on statistical revie...

Objective: In a randomized trial for women with alcohol use disorders (AUD), the efficacy of Female-Specific Cognitive Behavioral Therapy (FS-CBT) was compared with Gender-Neutral CBT (GN-CBT; Epstein et al., 2018). The current study examined whether putative mechanisms of change differed between treatment conditions, using a novel statistical app...

Objective: Cognitive-behavioral therapy (CBT) has shown efficacy in the treatment of eating disorders. The authors conducted a randomized controlled telemedicine trial of CBT-guided self-help (CBT-GSH) assisted with a smartphone app, Noom Monitor, for binge eating with or without purging. They hypothesized that coach-delivered CBT-GSH telemedicine...

Women with anorexia nervosa (AN) develop visceral adiposity associated with insulin resistance after partial weight restoration, but little is known about the glucose homeostasis after full weight restoration. In this investigation, we studied glucose homeostasis in twenty-four women with AN before (AN) and after weight restoration (WR) at a single...

Objective: This pilot study aimed to refine and test an adaption of family-based treatment (FBT) for eating disorders that addressed the distinct clinical needs of adolescents with overweight or obesity in the absence of eating disorder pathology. Our hypothesis was that FBT for paediatric obesity (FBT-PO) would be feasible to implement and superi...

Objective: To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors. Method: This study was a community participatory three-site, two-arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a be...

Avoidant/restrictive food intake disorder (ARFID), which was introduced in DSM-5, may be one of the most functionally impairing eating disorders, yet little is known regarding risk factors, prevalence, or efficacious treatment models for the disorder. With no empirically supported treatment for ARFID, it is important to investigate the clinical uti...

Objective The current case report details the treatment of a 16‐year‐old adolescent with anorexia nervosa utilizing a novel adjunct, acceptance‐based interoceptive exposure, prior to family‐based treatment (FBT) for eating disorders. Method The exposure‐based module focused particularly on the tolerance of disgust. For six sessions, the clinician...

Introduction Bariatric surgery outcomes are variable, often with suboptimal weight loss and/or weight relapse. Smartphone coaching applications offer a potential window of affecting behavioral change to improve outcomes in a widespread and cost-effective way, but clinical efficacy is unknown. In phase I of this pilot study, we investigated effects...

Muscle dysmorphia (MD) is a condition that is characterized by body image disturbance, a drive for muscularity and excessive exercising. It leads to considerable functional impairment. Most previous studies focused on male samples. The study aimed to validate a German version of the Muscle Dysmorphic Disorder Inventory (MDDI) in order to make the i...

The explosion of new methods in science has put additional pressure on authors, readers, and peer reviewers to evaluate the rigor and reproducibility of these new approaches. This issue brings together a collection of articles aimed to stimulate our thinking about how to evaluate the quality of these new methodologies, in the form of several expert...

Food avoidance in anorexia nervosa (AN) has been hypothesized to occur as a result of deficits in reversal learning and altered neuronal processing of food-cue relationships. Extant findings suggest that those with AN may rely on heightened recruitment of prefrontal regions during initial formation of food-cue learning and difficulty extinguishing...

Objective Individuals with eating disorders are theorized to have basic impairments in affective appraisal and social–emotional processing that contribute to pathogenesis of the disease. We aimed to determine if facial electromyography could be used to discriminate between happy and disgust emotions during simultaneous acquisition of an fMRI BOLD s...

Mirror exposure therapy is a clinical trial validated treatment component that improves body image and body satisfaction. Mirror exposure therapy has been shown to benefit individuals with high body dissatisfaction and patients with eating disorders (ED) in clinical trials. Mirror exposure is an optional component of cognitive behavioral therapy (C...

Synthetic androgens (i. e., anabolic-androgenic steroids) are the primary component to the majority of problematic appearance and performance enhancing drug (APED) use. Despite evidence that these substances are associated with increased risk for aggression, violence, body image disturbances, and polypharmacy and can develop a pattern of chronic us...

Objective: Theoretically, legal supplement use precedes and increases the risk for illicit appearance and performance enhancing drug (APED) use-also referred to as the gateway hypothesis. Little is known about associations between the speed of progression, or gap time, from legal to illicit APED use, and psychological risk factors, such as sociocu...

Objectives To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and...

Alle Entwicklungen rund ums Auto und das vieldiskutierte vollautomatisierte Fahren sind sehr sehr spannend. Hier können Sie die neuesten Entwicklungen nachlesen. Inhalt (Auszüge) HAF und VAF: Anforderungen, Realisierungen und Ausblicke Artifical Intelligence in the Driver’s Seat / AI – enabling autonomous driving and transportation . . . . . . . ....

This study compared Female-Specific Cognitive Behavioral Therapy (FS-CBT) to evidence-based, gender-neutral CBT (GN-CBT; Epstein & McCrady, 2009) for women with alcohol use disorder (AUD). Women (N = 99) with AUD, mean age 48, were randomly assigned to 12 outpatient manual-guided sessions of FS-CBT (n = 44) or GN-CBT (n = 55). Women were assessed a...

Objective: Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application d...

Background Eating Disorders (EDs) are serious psychiatric illnesses marked by psychiatric comorbidity, medical complications, and functional impairment. Research indicates that female athletes are often at greater risk for developing ED pathology versus non-athlete females. The Female Athlete Body (FAB) study is a three-site, randomized controlled...

Intolerance of uncertainty is an empirically supported transdiagnostic construct that may have relevance in understanding eating disorders. We conducted a meta-analysis and systematic review of intolerance of uncertainty in eating disorders using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We calculated r...

Background: The type A/B classification model for alcohol use disorders (AUDs) has received considerable empirical support. However, few studies examine the underlying latent structure of this subtyping model, which has been challenged as a dichotomization of a single drinking severity dimension. Type B, relative to type A, alcoholics represent th...

Many patients with bulimia nervosa (BN) also meet criteria for a lifetime alcohol use disorder (AUD). In order to understand possible mechanisms contributing to the co-occurrence and perpetuation of these disorders, this study investigated the importance of impulsivity and test meal intake among patients with BN by comparing women with BN only (n =...

As adherence to weight loss interventions has been shown in prior research to be crucial in achieving weight reduction, we were interested in examining whether this held true for individuals attempting to lose weight using smartphone applications. Archived data from an international community sample of 7633 overweight men and women using Noom, a sm...

Research has increasingly noted that gay male adults are more at risk for developing body image dissatisfaction than other male populations. Body image issues warrant attention, particularly since they have been connected to the development of disordered eating patterns. Studies have often traced gay male body dissatisfaction to various sociocultur...

Eating disorders, including anorexia nervosa and bulimia nervosa, have long been recognized in psychiatry and other medical disciplines for their primary dysregulation in the basic ability to eat and inability to maintain weight without significant distress or dysregulation. Although the diagnostic criteria of these disorders have been debated over...

Anabolic-androgen steroids (AASs) are the primary drug class in a larger pattern of drug use designed to improve one’s appearance or alter their ability to perform in athletic or other competitive environments. The use of these substances has evolved tremendously in the last century. The evolution of this form of drug use has been aided by the adva...

Research indicates that negative mood effects associated with anabolic-androgenic steroids (referred to as “steroids” here) are likely idiosyncratic, however, little is known about what factors might lead to higher risk for these effects. Research is lacking on the possible contribution of thermogenic/ergogenic drugs to this risk. As thermogenic/er...

Objective This study examined the prevalence and correlates of suicidal ideation and behaviour (SI/B) among adolescents receiving bariatric surgery.Method Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the programme n = 31, 15%) were case matched on g...

Objective: Behavioral disinhibition in the context of negative emotion (e.g., disgust, fear, etc.) may promote the core psychopathology of anorexia nervosa (AN). Affective models of AN position a number of clinical behaviors as functioning to reduce negative affect. Gonadal hormone dysregulation, in particular testosterone, likely plays some role...

Objective Impediments limit dissemination and implementation of evidence-based interventions (EBIs), including lack of sufficient training. One strategy to increase implementation of EBIs is the train-the-trainer (TTT) model. The Body Project is a peer-led body image program that reduces eating disorder (ED) risk factors. This study examined the ef...

Building upon previous research on the stigmatization of individuals with eating disorders (EDs), the present study sought to evaluate healthcare providers' attitudes toward male anabolic androgenic steroid (AAS) users. Healthcare providers (N=148) were first randomly assigned to read one of four vignettes describing a male AAS user, ED patient, co...

Anorexia nervosa is characterized by chronic food avoidance that is resistant to change. Disgust conditioning offers one potential unexplored mechanism for explaining this behavioral disturbance because of its specific role in facilitating food avoidance in adaptive situations. A food based reversal learning paradigm was used to study response flex...

Analysis of short- and long-term effects of rapid response across 3 different treatments for binge eating disorder (BED). In a randomized clinical study comparing interpersonal psychotherapy (IPT), cognitive-behavioral therapy guided self-help (CBTgsh), and behavioral weight loss (BWL) treatment in 205 adults meeting Diagnostic and Statistical Manu...

Existing measures for DSM-IV eating disorder diagnoses have notable limitations, and there are important differences between DSM-IV and DSM-5 feeding and eating disorders. This study developed and validated a new semistructured interview, the Eating Disorders Assessment for DSM-5 (EDA-5). Two studies evaluated the utility of the EDA-5. Study 1 comp...

Recent advances in psychological intervention research have led to an increase in evidence-based interventions (EBIs), yet there remains a lag in dissemination and implementation of EBIs. Task-shifting and the train-the-trainer (TTT) model offer two potential strategies for enhancing reach of EBIs. The Body Project, an EBI found to prevent onset of...

Background: Adherence behaviors have not been examined among adolescents undergoing laparoscopic adjustable gastric banding (LAGB). In addition, studies of youth receiving bariatric surgery have not considered the influence of psychopathology on postoperative adherence. The purpose of this study was to evaluate predictors and correlates of adheren...

Objective Change in binge eating is typically a primary outcome for interventions targeting individuals with eating pathology. A range of statistical models exist to handle these types of frequency distributions, but little empirical evidence exists to guide the appropriate choice of statistical model.Method Monte Carlo simulations were used to inv...

A growing translational literature suggests that adolescent exposure to anabolic-androgenic steroids (AASs) leads to increased aggression and impulsivity. However, little is known about the cognitive effects of AASs among AAS users or the differences between adolescent- and adult-onset users. This study provides a test of the effects of acute natur...

The overlap between anorexia nervosa (AN) and anxiety disorders has led to the development of anxiety-based etiological models of AN and anxiety-based interventions for AN, including exposure treatment. Family-based treatment (FBT) is an efficacious intervention for adolescents with AN; however, it has recently been proposed that FBT accomplishes p...

Anabolic-androgen steroids (AASs) are the primary drug class in a larger pattern of drug use designed to improve one’s appearance or alter their ability to perform in athletic or other competitive environments. The use of these substances has evolved tremendously in the last century. The evolution of this form of drug use has been aided by the adva...

Eating disorders, including anorexia nervosa and bulimia nervosa, have long been recognized in psychiatry and other medical disciplines for their primary dysregulation in the basic ability to eat and inability to maintain weight without significant distress or dysregulation. Although the diagnostic criteria of these disorders have been debated over...

Cognitive behavior therapy has received empirical support for the treatment of eating disorders, alcohol use disorders, and substance use disorders; however, there is no empirical research on the use of cognitive behavior therapy specifically for comorbid eating disorders and substance use disorders. Common cognitive behavioral treatments of alcoho...

Appetitive behaviors such as substance use and eating are under significant regulatory control by the hypothalamic-pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes. Recent research has begun to examine how these systems interact to cause and maintain poor regulation of these appetitive behaviors. A range of potential molecular,...

There is a need for treatment interventions to address the high prevalence of disordered eating throughout adolescence and early adulthood. We developed an adolescent-specific manualized CBT protocol to treat female adolescents with recurrent binge eating and tested its efficacy in a small, pilot randomized controlled trial. We present lessons lear...

Proposed DSM-5 severity dimensions reveal ambiguity regarding the extent to which certain features define boundaries between similar diagnoses or represent underlying dimensions within a broader category of bulimic syndromes. The current study utilized a novel mixed modeling approach that can simultaneously model latent dimensions and latent catego...

Elevated rates of psychopathology are noted among severely obese youth presenting for weight loss surgery. The role of mental health providers in this population is not well defined, and the selection of candidates is often the result of clinical judgment alone. The purpose of this study was to comprehensively evaluate psychiatric symptoms among a...

Approximately 3.0% of young Americans have used anabolic-androgenic steroids (AAS). A traditional model of adolescent substance use, the gateway hypothesis, suggests that drug use follows a chronological, causal sequence, whereby initial use of a specific drug leads to an increased likelihood of future drug use. Therefore, the use of illicit appear...

The purpose of this study was to examine gay men's perceived attractiveness of male figures based on short-term and long-term partner contexts. A sample of 190 gay adult men rated the attractiveness of line-drawings depicting male figures varying systematically in muscularity and body fat percentage in both short-term and long-term dating contexts....

Anorexia nervosa (AN) is characterized by its similarity to anxiety disorders, especially obsessive-compulsive disorder (OCD). Family-based treatment (FBT) has shown promising initial results for treatment of AN in adolescents, yet the precise mechanisms of action are unknown. We present a theoretical argument and model, suggesting that FBT may wor...

The primary aim was to examine the utility of DSM-IV criteria in predicting treatment outcome in a sample of adolescents with eating disorders. We (a) descriptively compared the baseline rates of anorexia nervosa (AN) and bulimia nervosa (BN) across multiple reference points for diagnostic criteria, (b) using ROC curve analyses, assessed the sensit...

Most obese youth screened for diabetes have normal fasting glucose levels. Identification of youth with increased risk for type 2 diabetes (T2D) is needed within this large population to guide further management. Retrospective chart review was performed for obese youth, 8-20 yr old, who met American Diabetes Association criteria for screening (OB)...

Anabolic-androgenic steroids (AASs) are synthetic hormones used by individuals who want to look better or perform better in athletics and at the gym. Their use raises an interesting paradox in which drug use is associated with a number of health benefits, but also the possibility of negative health consequences. Existing models of AAS addiction fol...

Appearance-and-performance enhancing drug (APED) use is a form of drug use that includes use of a wide range of substances such as anabolic-androgenic steroids (AASs) and associated behaviors including intense exercise and dietary control. To date, there are no reliable or valid measures of the core features of APED use. The present study describes...

Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anab...

This article reviews relevant research on male homosexual attraction. Utilizing masculinity as its theoretical frame, the authors use childhood experiences with both fathers and peers, the gay community's inculcation of heteronormative ideologies, and the gay media's adherence to masculine prototypes, to provide causal explanations for the appeal o...

Body checking includes any behavior aimed at global or specific evaluations of appearance characteristics. Men and women are believed to express these behaviors differently, possibly reflecting different socialization. However, there has been no empirical test of the impact of gender on body checking. A total of 1024 male and female college student...

To present a case report detailing the use of an enhanced form of cognitive behaviour therapy (CBT). The treatment was provided to an adolescent with an eating disorder not otherwise specified (EDNOS) diagnosis, and included a focus on the additional maintaining mechanisms of mood intolerance and interpersonal problems. This case began as an unsucc...