Anxiety and Interoception Risk for Eating Disorders in Childhood

项目概要/摘要 每10万名儿童和青少年中，120人将患有唐氏综合症，56人将死于 婴儿猝死综合症，15人将被诊断为癌症，12人将发展为II型 糖尿病，2,900人患有饮食失调症（艾德）。虽然ED的发病年龄是 传统上在青春期观察到，发病发生在年轻时， 在12岁时发展为ED。估计将有190万新的青年ED病例 到2024年尽管ED的患病率、成本、损害和死亡率很高， 对儿童易患ED的原因知之甚少。重要的是，早期发现和 干预是至关重要的：有问题的饮食行为会损害发育中的大脑和身体， 并且未经治疗的ED具有成为终身慢性健康状况的显著风险， 与高死亡率、社会和个人负担相关。我们的科学前提， 从我们过去的工作，是焦虑和内感受性缺陷（不准确识别）， 身体感觉，对这些感觉的敏感性增强或减弱），以及 恐惧学习潜在的焦虑和内感受性缺陷，将预测常见的，有问题的， 进食行为和认知（例如，限制，身体不满，认知约束），作为 以及临床ED。我们的研究目标是（1）测试儿童焦虑和内感受性缺陷是否 是有问题的饮食行为和认知和ED的危险因素，（2）测试是否存在缺陷， 恐惧学习是焦虑和内感受性缺陷导致风险的一种机制。 这些目标将最终导致（a）能够更好地检测儿童ED风险因素的工具 和（B）直接针对预测艾德发作的机制的预防努力。拟议 研究采用创新的家长报告的瞬间评估结合完善的 诊断、行为、观察和生理评估。我们将招募一批 两个年龄组（6-8岁; 10-12岁）的400名女孩因内感受性缺陷而得到强化， 焦虑和ED; 75%（n=300）将根据母亲的ED或焦虑史招募， 对照组25%（n=100）。这项研究将首次使我们能够 开始量化艾德的早期症状如何发展。具体目标是测试（1）多- 焦虑的模态方面和（2）可能前瞻性的内感受性缺陷的特征 预测有问题的饮食行为和认知以及ED，以及（3）预测机制 焦虑和内感受性缺陷之间的关系。这项拟议的研究具有临床影响：最终， 这项研究将导致早期发现和预防儿童期及以后的ED， 与儿童期发作和慢性ED相关的巨大个人和社会成本。

PROJECT SUMMARY/ABSTRACT Out of 100,000 children and adolescents, 120 will have Down Syndrome, 56 will die from sudden infant death syndrome, 15 will be diagnosed with cancer, 12 will develop Type II diabetes, and 2,900 will have an eating disorder (ED). Although the age of onset for EDs was traditionally observed in adolescence, onset is occurring younger, with many children developing EDs by age 12. Estimates suggest there will be 1.9 million new cases of youth EDs by 2024. Despite the high prevalence, costs, impairment, and deaths from EDs, there is very little knowledge on what predisposes children to develop EDs. Importantly, early detection and intervention is crucial: problematic eating behaviors can damage developing brains and bodies, and untreated EDs carry significant risk for becoming lifelong chronic health conditions, associated with high mortality rates, societal and personal burden. Our scientific premise, developed from our past work, is that anxiety and interoceptive deficits (inaccuracy identifying bodily sensations, heightened or blunted sensitivity to these sensations), as well as deficits in fear learning underlying anxiety and interoceptive deficits, will predict common, problematic eating behaviors and cognitions (e.g., restriction, body dissatisfaction, cognitive restraint), as well as clinical EDs. Our study goals are to (1) test if childhood anxiety and interoceptive deficits are risk factors for problematic eating behaviors and cognitions and EDs and (2) test if deficits in fear learning are a mechanism by which anxiety and interoceptive deficits contribute to risk. These goals will ultimately lead to (a) tools that can better detect childhood risk factors for EDs and (b) prevention efforts directly targeting mechanisms predictive of ED onset. The proposed research uses innovative parent-report momentary assessment combined with well-established diagnostic, behavioral, observational, and physiological assessment. We will recruit a sample of 400 girls across two age cohorts (6-8; 10-12 years old) enriched for interoceptive deficits, anxiety, and EDs; 75% (n=300) will be recruited based on maternal history of EDs or anxiety, and 25% (n=100) will make up the control group. This study will, for the first time, allow us to begin to quantify how early symptoms of ED develop. The specific aims are to test (1) multi- modal aspects of anxiety and (2) characteristics of interoceptive deficits that may prospectively predict problematic eating behaviors and cognitions and EDs, and (3) mechanisms of prediction among anxiety and interoceptive deficits. The proposed research has clinical impact: ultimately, this study will lead to early detection and prevention of EDs in childhood and beyond, averting the large personal and societal costs associated with both childhood onset and chronic EDs.