Subtyping binge eating disorder.

Cluster-analytic studies of bulimia nervosa and binge eating disorder (BED) have yielded 2 subtypes (pure dietary and mixed dietary-negative affect). The authors aimed to (a) replicate the subtyping with BED, (b) consider alternative approaches to subtyping, and (c) test the stability in individual differences in the subtyping. Cluster analyses of 101 patients revealed a dietary-negative affect subtype (33%) and a pure dietary subtype (67%). The dietary negative affect subtype was characterized by greater eating related psychopathology and psychological disturbance. Cluster analysis produced different results from alternative subtyping approaches (by major depression or by binge eating frequency). Cluster-analytic subtyping of data at 2 time points 4 weeks apart for a subset of 73 patients demonstrated significant consistency (κ=.55). Findings suggest that moderate dieting is characteristic of BED and that affective disturbances occur in a subset of cases that represent a more disturbed variant. The subtypes may represent reasonably stable individual differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rapid response to treatment for binge eating disorder.

The authors examined rapid response among 108 patients with binge eating disorder (BED) who were randomly assigned to 1 of 4 16-week treatments: fluoxetine, placebo, cognitive-behavioral therapy (CBT) plus fluoxetine, or CBT plus placebo. Rapid response, defined as 65% or greater reduction in binge eating by the 4th treatment week, was determined by receiver operating characteristic curves. Rapid response characterized 44% of participants and was unrelated to participants' demographic or baseline characteristics. Participants with rapid response were more likely to achieve binge-eating remission, had greater improvements in eating-disorder psychopathology, and had greater weight loss than participants without rapid response. Rapid response had different prognostic significance and distinct time courses for CBT versus pharmacotherapy-only treatments. Rapid response has utility for predicting outcomes and provides evidence for specificity of treatment effects with BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rapid response predicts treatment outcomes in binge eating disorder: Implications for stepped care.

The authors examined rapid response in 75 overweight patients with binge eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments (cognitive-behavioral therapy [CBTgsh] and behavioral weight loss [BWLgsh]). Rapid response, defined as a 65% or greater reduction in binge eating by the 4th treatment week, occurred in 62% of CBTgsh and 47% of BWLgsh participants. Rapid response was unrelated to most patient characteristics except for eating psychopathology and depressive symptoms. Participants with rapid response were more likely to achieve binge remission and had greater improvements in overall eating pathology and depressive symptomatology than participants without rapid response. Rapid response had different prognostic significance for the 2 treatments. In terms of binge eating, participants receiving CBTgsh, but not BWLgsh, did equally well regardless of whether they experienced rapid response. In terms of increasing restraint and weight loss, participants with rapid response receiving BWLgsh had greater restraint and weight loss than participants receiving CBTgsh. Rapid response has utility for predicting outcomes, provides evidence for specificity of treatment effects, and has implications for stepped care treatment models of BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling.

Objective: At present, the most frequently investigated psychosocial intervention for borderline personality disorder (BPD) is dialectical behavior therapy (DBT). We conducted a meta-analysis to examine the efficacy and long-term effectiveness of DBT. Method: Systematic bibliographic research was undertaken to find relevant literature from online databases (PubMed, PsycINFO, PsychSpider, Medline). We excluded studies in which patients with diagnoses other than BPD were treated, the treatment did not comprise all components specified in the DBT manual or in the suggestions for inpatient DBT programs, patients failed to be diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, and the intervention group comprised fewer than 10 patients. Using a mixed-effect hierarchical modeling approach, we calculated global effect sizes and effect sizes for suicidal and self-injurious behaviors. Results: Calculations of postintervention global effect sizes were based on 16 studies. Of these, 8 were randomized controlled trials (RCTs), and 8 were neither randomized nor controlled (nRCT). The dropout rate was 27.3% pre- to posttreatment. A moderate global effect and a moderate effect size for suicidal and self-injurious behaviors were found, when including a moderator for RCTs with borderline-specific treatments. There was no evidence for the influence of other moderators (e.g., quality of studies, setting, duration of intervention). A small impairment was shown from posttreatment to follow-up, including 5 RCTs only. Conclusions: Future research should compare DBT with other active borderline-specific treatments that have also demonstrated their efficacy using several long-term follow-up assessment points. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overvaluation of shape and weight in binge eating disorder.

The excessive influence of shape or weight on self-evaluation--referred to as overvaluation--is considered by some a central feature across eating disorders but is not a diagnostic requirement for binge eating disorder (BED). This study examined shape/weight overvaluation in 399 consecutive patients with BED. Participants completed semistructured interviews, including the Eating Disorder Examination (EDE; C. G. Fairburn & Z. Cooper, 1993) and several self-report measures. Shape/weight overvaluation was unrelated to body mass index (BMI) but was strongly associated with measures of eating-related psychopathology and psychological status (i.e., higher depression and lower self-esteem). Participants were categorized via EDE guidelines into 1 of 2 groups: clinical overvaluation (58%) or subclinical overvaluation (42%). The 2 groups did not differ significantly in BMI or binge eating frequency, but the clinical overvaluation group had significantly greater eating-related psychopathology and poorer psychological status than the subclinical overvaluation group. Findings suggest that overvaluation does not simply reflect concern commensurate with being overweight but is strongly associated with eating-related psychopathology and psychological functioning and warrants consideration as a diagnostic feature for BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive behavioral guided self-help for the treatment of recurrent binge eating.

Objective: Despite proven efficacy of cognitive behavioral therapy (CBT) for treating eating disorders with binge eating as the core symptom, few patients receive CBT in clinical practice. Our blended efficacy–effectiveness study sought to evaluate whether a manual-based guided self-help form of CBT (CBT-GSH), delivered in 8 sessions in a health maintenance organization setting over a 12-week period by master's-level interventionists, is more effective than treatment as usual (TAU). Method: In all, 123 individuals (mean age = 37.2; 91.9% female, 96.7% non-Hispanic White) were randomized, including 10.6% with bulimia nervosa (BN), 48% with binge eating disorder (BED), and 41.4% with recurrent binge eating in the absence of BN or BED. Baseline, posttreatment, and 6- and 12-month follow-up data were used in intent-to-treat analyses. Results: At 12-month follow-up, CBT-GSH resulted in greater abstinence from binge eating (64.2%) than TAU (44.6%; number needed to treat = 5), as measured by the Eating Disorder Examination (EDE). Secondary outcomes reflected greater improvements in the CBT-GSH group in dietary restraint (d = 0.30); eating, shape, and weight concern (ds = 0.54, 1.01, 0.49, respectively; measured by the EDE Questionnaire); depression (d = 0.56; Beck Depression Inventory); and social adjustment (d = 0.58; Work and Social Adjustment Scale), but not weight change. Conclusions: CBT-GSH is a viable first-line treatment option for the majority of patients with recurrent binge eating who do not meet diagnostic criteria for BN or anorexia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness of guided self-help treatment for recurrent binge eating.

Objective: Adoption of effective treatments for recurrent binge-eating disorders depends on the balance of costs and benefits. Using data from a recent randomized controlled trial, we conducted an incremental cost-effectiveness analysis (CEA) of a cognitive–behavioral therapy guided self-help intervention (CBT–GSH) to treat recurrent binge eating compared to treatment as usual (TAU). Method: Participants were 123 adult members of an HMO (mean age = 37.2 years, 91.9% female, 96.7% non-Hispanic White) who met criteria for eating disorders involving binge eating as measured by the Eating Disorder Examination (C. G. Fairburn & Z. Cooper, 1993). Participants were randomized either to treatment as usual (TAU) or to TAU plus CBT–GSH. The clinical outcomes were binge-free days and quality-adjusted life years (QALYs); total societal cost was estimated using costs to patients and the health plan and related costs. Results: Compared to those receiving TAU only, those who received TAU plus CBT–GSH experienced 25.2 more binge-free days and had lower total societal costs of $427 over 12 months following the intervention (incremental CEA ratio of ?$20.23 per binge-free day or ?$26,847 per QALY). Lower costs in the TAU plus CBT–GSH group were due to reduced use of TAU services in that group, resulting in lower net costs for the TAU plus CBT group despite the additional cost of CBT–GSH. Conclusions: Findings support CBT–GSH dissemination for recurrent binge-eating treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment.

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = –0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder.

The authors compared 3 methods for assessing the features of eating disorders in patients with binge eating disorder (BED). Participants were administered the Eating Disorder Examination (EDE) interview and completed the EDE Questionnaire (EDE-Q) at baseline. Participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. The EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating) and on the Dietary Restraint, Eating Concern, Weight Concern, and Shape Concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes were not significant, but scores on the 4 subscales differed significantly, with the EDE-Q yielding higher scores. At 4 weeks, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes, and the mean difference between methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. Thus, in patients with BED, the 3 assessment methods showed some acceptable convergence, most notably for objective bulimic episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heterogeneity moderates treatment response among patients with binge eating disorder.

Objective: The purpose of the study was to explore heterogeneity and differential treatment outcome among a sample of patients with binge eating disorder (BED). Method: A latent class analysis was conducted with 205 treatment-seeking, overweight or obese individuals with BED randomized to interpersonal psychotherapy (IPT), behavioral weight loss (BWL), or guided self-help based on cognitive behavioral therapy (CBTgsh). A latent transition analysis tested the predictive validity of the latent class analysis model. Results: A 4-class model yielded the best overall fit to the data. Class 1 was characterized by a lower mean body mass index (BMI) and increased physical activity. Individuals in Class 2 reported the most binge eating, shape and weight concerns, compensatory behaviors, and negative affect. Class 3 patients reported similar binge eating frequencies to Class 2, with lower levels of exercise or compensation. Class 4 was characterized by the highest average BMI, the most overeating episodes, fewer binge episodes, and an absence of compensatory behaviors. Classes 1 and 3 had the highest and lowest percentage of individuals with a past eating disorder diagnosis, respectively. The latent transition analysis found a higher probability of remission from binge eating among those receiving IPT in Class 2 and CBTgsh in Class 3. Conclusions: The latent class analysis identified 4 distinct classes using baseline measures of eating disorder and depressive symptoms, body weight, and physical activity. Implications of the observed differential treatment response are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in attachment anxiety is associated with improved depression among women with binge eating disorder.

The study examined if the relationship between change in attachment insecurity and target symptom outcomes was moderated by treatment type. Women (N = 66) with binge eating disorder (BED) were randomly assigned to two treatment types: group cognitive-behavioral therapy (GCBT) or group psychodynamic-interpersonal psychotherapy (GPIP). Results indicated significant positive pre- to posttreatment changes in all attachment insecurity scales, but no difference between GCBT and GPIP on these changes. Change in attachment anxiety was related to improved depression for women completing GPIP, but not for women completing GCBT. This indicated a moderating effect of treatment type in explaining the relationship between change in attachment anxiety and improved depression. Changes in attachment anxiety may be important for symptom outcomes related to psychodynamic-interpersonal therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dialectical behavior therapy for women victims of domestic abuse: A pilot study.

This article describes a brief, 12-week dialectical behavior therapy program modified for female victims of domestic abuse and provides a preliminary examination of this intervention. Dialectical behavior therapy is a comprehensive cognitive–behavioral treatment, which was originally developed to treat multiproblem clients with severe and chronic emotion dysregulation, and was adapted for this study to treat female victims of domestic abuse. From pretreatment to posttreatment, participants (N = 31) showed significant reductions in depressive symptoms, hopelessness, and general psychiatric distress as well as increased social adjustment. Additionally, participants reported high levels of consumer satisfaction with the treatment. Findings support the possible utility of dialectical behavior therapy for enhancing psychological and social well-being in female victims of domestic abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overvaluation of shape and weight in binge eating disorder and overweight controls: Refinement of a diagnostic construct.

Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n = 92), BED participants with subclinical levels of overvaluation (n = 73), and participants in an overweight comparison group without BED (n = 45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The perfectionism model of binge eating: Tests of an integrative model.

This study proposes, tests, and supports the perfectionism model of binge eating (PMOBE), a model aimed at explaining why perfectionism is related to binge eating. According to this model, socially prescribed perfectionism (SPP) confers risk for binge eating by generating exposure to 4 triggers of binge episodes: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. In testing the PMOBE, a daily diary was completed by 566 women for 7 days. Predictions derived from the PMOBE were supported, with tests of mediation suggesting that the indirect effect of SPP on binge eating through triggers of binge episodes was significant. Reciprocal relations were also observed, with certain triggers of binge episodes predicting binge eating (and vice versa). Results supported the incremental validity of the PMOBE over and above self-oriented perfectionism and neuroticism and the generalizability of this model across Asian and European Canadian participants. The PMOBE offers a novel view of individuals with high levels of SPP as active agents who raise their risk of binge eating by generating conditions in their daily lives that are conducive to binge episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled evaluation of the distress criterion for binge eating disorder.

Objective: Research has examined various aspects of the validity of the research criteria for binge eating disorder (BED) but has yet to evaluate the utility of Criterion C, “marked distress about binge eating.” This study examined the significance of the marked distress criterion for BED using 2 complementary comparison groups. Method: A total of 1,075 community volunteers completed a battery of self-report instruments as part of an Internet study. Analyses compared body mass index (BMI), eating-disorder psychopathology, and depressive levels in 4 groups: 97 participants with BED except for the distress criterion (BED–ND), 221 participants with BED including the distress criterion (BED), 79 participants with bulimia nervosa (BN), and 489 obese participants without binge eating or purging (NBPO). Parallel analyses compared these study groups using the broadened frequency criterion (i.e., once weekly for binge/purge behaviors) proposed for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) and the 4th edition (DSM–IV) twice-weekly frequency criterion. Results: The BED group had significantly greater eating-disorder psychopathology and depressive levels than the BED–ND group. The BED group, but not the BED–ND group, had significantly greater eating-disorder psychopathology than the NBPO comparison group. The BN group had significantly greater eating-disorder psychopathology and depressive levels than all 3 other groups. The group differences in eating-disorder psychopathology existed even after controlling for depression levels, BMI, and demographic variables, although some differences between the BN and BED groups were attenuated when controlling for depression levels. Conclusions: These findings provide support for the validity of the “marked distress” criterion for the diagnosis of BED. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Motivational enhancement therapy and self-help treatment for binge eaters.

The aims of this study were to evaluate whether a single session of motivational enhancement therapy (MET) would increase participant readiness to change, improve the efficacy of self-help treatment for binge eaters, and improve participant compliance with the self-help manual. Method: Participants with bulimia nervosa or binge eating disorder were randomly assigned either to attend a 1-hr MET session prior to receiving the self-help manual (n = 45) or to receive the self-help manual only (n = 45). Participants were followed for 4 months for assessment of self-reported eating disorder outcome and compliance. Results: The MET intervention resulted in increased readiness to change for binge eating compared with the self-help-only (SH) condition. Few differences were found between the MET condition and the SH condition for changes in eating attitudes and frequency of binge eating and compensatory behaviors. No significant effects were found for compliance. Discussion: This research adds to the literature regarding the use of brief motivational interventions to enhance readiness for change in populations with eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dietary restraint moderates genetic risk for binge eating.

Dietary restraint is a prospective risk factor for the development of binge eating and bulimia nervosa. Although many women engage in dietary restraint, relatively few develop binge eating. Dietary restraint may increase susceptibility for binge eating only in individuals who are at genetic risk. Specifically, dietary restraint may be a behavioral exposure factor that activates genetic predispositions for binge eating. We investigated this possibility in 1,678 young adolescent and adult same-sex female twins from the Minnesota Twin Family Study and the Michigan State University Twin Registry. Twin moderation models were used to examine whether levels of dietary restraint moderate genetic and environmental influences on binge eating. Results indicated that genetic and nonshared environmental factors for binge eating increased at higher levels of dietary restraint. These effects were present after controlling for age, body mass index, and genetic and environmental overlap among dietary restraint and binge eating. Results suggest that dietary restraint may be most important for individuals at genetic risk for binge eating and that the combination of these factors could enhance individual differences in risk for binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adapted motivational interviewing for women with binge eating disorder: A randomized controlled trial.

In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multisite investigation of binge eating behaviors in children and adolescents.

The phenomenology of childhood and adolescent loss of control (LOC) eating is unknown. The authors interviewed 445 youths to assess aspects of aberrant eating. LOC was associated with eating forbidden food before the episode; eating when not hungry; eating alone; and experiencing secrecy, negative emotions, and a sense of "numbing" while eating (ps     

Reformulating and testing the perfectionism model of binge eating among undergraduate women: A short-term, three-wave longitudinal study.

The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking, supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating. (PsycINFO Database Record (c) 2011 APA, all rights reserved)