Onset of binge eating and dieting in overweight women: implications for etiology, associated features and treatment

This study investigated differences between overweight binge eating women who reported the onset of binge eating prior to or following the onset of dieting (binged first [BF], or dieted first [DF]). Of overweight binge eating subjects enrolled in a treatment study, 38.7% indicated binge eating first, and 48.1% dieting first. The mean age of onset of binge eating differed significantly between the two groups (11.8 years vs. 25.7 years). More of the BF group (82.5%) satisfied proposed binge eating disorder (BED) criteria than did the DF group (52.0%), although short of significantly. The results suggest that: (a) the leading hypothesis concerning dieting as a cause of binge eating does not apply to a substantial number of individuals who binge eat; (b) there may be an early pattern and a late pattern in the development of binge eating among overweight individuals; and (c) the early or binge first pattern may be more likely to result in BED.     

Binge antecedents in obese women with and without binge eating disorder.

In this study, women with binge eating disorder (BED; n?=?41) and weight- and age-matched comparison women without BED (NBED; n?=?38) monitored their eating for 6 days, using handheld computers to measure mood, appetite, and setting at all eating episodes and comparison noneating episodes. Poor mood, low alertness, feelings of poor eating control, and craving sweets all preceded binge episodes for the BED group. An unanticipated finding was the frequent report of binge episodes in the comparison group; only feelings of poor eating control and craving sweets predicted binge episodes in this group. Binge eating NBED women tended to experience worse mood, less control, and more craving than other NBED women, contributing to evidence of the close relationship of binge eating and decrements in emotional and appetitive functioning. (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)     

Dialectical behavior therapy for binge eating disorder.

This study evaluated the use of dialectical behavior therapy (DBT) adapted for binge eating disorder (BED). Women with BED (N=44) were randomly assigned to group DBT or to a wait-list control condition and were administered the Eating Disorder Examination in addition to measures of weight, mood, and affect regulation at baseline and posttreatment. Treated women evidenced significant improvement on measures of binge eating and eating pathology compared with controls, and 89% of the women receiving DBT had stopped binge eating by the end of treatment. Abstinence rates were reduced to 56% at the 6-month follow-up. Overall, the findings on the measures of weight, mood, and affect regulation were not significant. These results support further research into DBT as a treatment for BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Binge Eating Disorder and Night Eating Syndrome: A Comparative Study of Disordered Eating.

The authors compared eating patterns, disordered eating, features of eating disorders, and depressive symptoms in persons with binge eating disorder (BED; n = 177), with night eating syndrome (NES; n = 68), and in an overweight comparison group without BED or NES (comparison; n = 45). Participants completed semistructured interviews and several established measures. Depressive symptoms were greater in the BED and NES groups than in the comparison group. NES participants ate fewer meals during the day and more during the night than BED and comparison participants, whereas BED participants ate more during the day than the comparison participants. BED participants reported more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger than NES and comparison participants, whereas NES participants reported more eating pathology than comparison participants. This evaluation provides strong evidence for the distinctiveness of the BED and NES constructs and highlights their clinical significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One-year follow-up of cognitive-behavioral therapy for obese individuals with binge eating disorder.

The results of a 1-year posttreatment follow-up of 93 obese women diagnosed as having binge eating disorder (BED) and treated with group cognitive–behavior therapy (CBT) followed by weight loss treatment are described. The group as a whole maintained both reductions in binge eating and abstinence rates fairly well. However, they regained the weight lost during treatment. Those who stopped binge eating during CBT maintained a weight lost of 4.0 kg over the follow-up period. In contrast, those who continued to binge gained 3.6 kg. Twenty-six percent of those abstinent after CBT met criteria for BED at follow-up and had gained weight, whereas the remaining 74% had lost weight. Stopping binge eating appears critical to sustained weight loss. (PsycINFO Database Record (c) 2010 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)     

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)     

Psychiatric comorbidity in women with binge eating disorder: Prevalence rates from a non-treatment-seeking sample.

This study provides estimates of comorbid psychiatric disorders in women with binge eating disorder (BED). Sixty-one BED and 60 control participants, who were recruited from the community, completed the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) Axis I and Axis II disorders and self-report measures of eating and general psychiatric symptomatology. Regarding psychiatric diagnoses, women with BED had higher lifetime prevalence rates for major depression. any Axis I disorder, and any Axis II disorder relative to controls. BED women also evidenced greater eating and psychiatric symptomatology than did controls. Results suggest that the prevalence of comorbid psychiatric disorders in BED may be lower than previously indicated by clinical studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pretreatment and process predictors of outcome in interpersonal and cognitive behavioral psychotherapy for binge eating disorder.

The present study examined pretreatment and process predictors of individual nonresponse to psychological group treatment of binge eating disorder (BED). In a randomized trial, 162 overweight patients with BED were treated with either group cognitive-behavioral therapy or group interpersonal psychotherapy. Treatment nonresponse, which was defined as nonabstinence from binge eating, was assessed at posttreatment and at 1 year following treatment completion. Using 4 signal detection analyses, greater extent of interpersonal problems prior to treatment or at midtreatment were identified as predictors of nonresponse, both at posttreatment and at 1-year follow-up. Greater pretreatment and midtreatment concerns about shape and weight, among those patients with low interpersonal problems, were predictive of posttreatment nonresponse. Lower group cohesion during the early treatment phase predicted nonresponse at 1-year follow-up. Attention to specific pre- or intreatment predictors could allow for targeted selection into differential or augmented care and could thus improve response to group psychotherapy for 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)     

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)     

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)     

Cognitive–behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: A randomized controlled trial.

Objective: Cognitive–behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL). Method: 125 obese patients with BED were randomly assigned to 1 of the 3 manualized treatments delivered in groups. Independent assessments were performed posttreatment and at 6- and 12-month follow-ups. Results: At 12-month follow-up, intent-to-treat binge-eating remission rates were 51% (CBT), 36% (BWL), and 40% (CBT + BWL), and mean percent BMI losses were ?0.9, ?2.1, and 1.5, respectively. Mixed-models analyses revealed that CBT produced significantly greater reductions in binge eating than BWL through 12-month follow-up and that BWL produced significantly greater percent BMI loss during treatment. The overall significant percent BMI loss in CBT + BWL was attributable to the significant effects during the BWL component. Binge-eating remission at major assessment points was associated significantly with greater percent BMI loss cross-sectionally and prospectively (i.e., at subsequent follow-ups). Conclusions: CBT was superior to BWL for producing reductions in binge eating through 12-month follow-up, while BWL produced statistically greater, albeit modest, weight losses during treatment. Results do not support the utility of the sequential approach of providing BWL following CBT. Remission from binge eating was associated with significantly greater percent BMI loss. Findings support BWL as an alternative treatment option to CBT for BED. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Binge eating onset in obese patients with binge eating disorder

In this study we examined whether obese women with binge eating disorder (BED) reporting earlier onset binge eating differed from those with later onset binge eating on salient clinical parameters. Subjects were 112 women who sought treatment for BED. Subjects with early (< or = age 18) and later onset (> age 18) did not differ in age, weight, body mass index, or severity of binge eating. Participants were interviewed using the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM-III-R, and completed a weight and diet history questionnaire. Early-onset binge eaters were more likely than those with later-onset to binge-eat before dieting, to have early onset of obesity and dieting, to have longer binge-free periods, and more paternal obesity and binge eating. Early-onset binge eaters also reported more eating-disorders psychopathology, and they were more likely to report a lifetime history of bulimia nervosa and DSM-III-R mood disorder. These data suggest that there are marked differences among BED patients presenting for treatment. Further research is needed to determine whether these differences reflect a different etiology or have implications for treatment.     

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)     

Prevalence of serologic markers of hepatitis B and D viruses in children of the Caiabi and Txucarram?e tribes from the Indian Reservation of Xingu, central Brazil

Obese individuals with binge eating disorder (BED) differ from obese non-binge eating (NBE) individuals in a number of clinically relevant ways. This study examined attitudinal responses to various measures of body image in women seeking obesity treatment, by comparing NBE participants (n = 80) to those with BED (n = 48). It was hypothesized that women with BED would demonstrate greater attitudinal disturbance of body image compared to NBE individuals. It was further hypothesized that significant differences between groups would remain after statistically controlling for degree of depression. Consistent with the primary hypothesis, BED participants reported significantly increased attitudinal disturbance in body dissatisfaction and size perception compared to NBE participants. Although shared variance was observed between measures of depression and body image on some items, several aspects of increased body image disturbance remained after statistically controlling for depression. Treatment implications and recommendations for future research are discussed.     

Bulimia and binge eating in college women: A comparison of personality and behavioral characteristics.

Assessed 9 behavioral and personality characteristics—restraint, binge eating, high self-expectations, demand for approval, body attitude, assertion, dating, self-esteem, and depression—that have been implicated in studying the onset of bulimia. Ss were 30 women who fulfilled an operationalized definition of the DSM-III criteria for bulimia (bulimics), 22 women who reported binge eating 8 or more times per month but did not fulfill the criteria for bulimia (binge eaters), and 28 women who did not binge eat (controls). Ss completed measures that included the Beck Depression Inventory, a self-esteem index, and the short form of the Personality Attributes Questionnaire. In comparison to controls, bulimics were more depressed and had lower self-esteem, poorer body image, higher self-expectations, higher need for approval, greater restraint, and higher binge-eating scores. Binge eaters exhibited higher restraint and binge-eating scores than controls. Bulimics and binge eaters differed significantly on all but a few variables. Results suggest that treatment for bulimics should extend beyond the disturbed eating pattern and that the distinction between binge eating and bulimia is an important one. Some empirical support for the DSM-III definition of bulimia was found. (31 ref) (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)     

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)