Combined dieting and stress evoke exaggerated responses to opioids in binge-eating rats.

The authors developed an animal model of binge eating where history of caloric restriction with footshock stress (R + S) causes rats to consume twice the normal amount of palatable food. The authors tested the hypothesis that binge eating is mediated by changes in opioid control of feeding by comparing rats' anorectic and orexigenic responses to naloxone and butorphanol, respectively, and by testing the ability of butorphanol to elicit binge eating of chow when palatable food was absent. Mu/kappa opioid-receptor blockade and activation had exaggerated responses in the R + S rats with naloxone suppressing binge eating to control levels, and although butorphanol did not trigger chow binge eating, it enhanced binge eating of palatable food. These responses in sated normal-weight rats strengthen evidence that reward, over metabolic need, drives binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brain activation in restrained and unrestrained eaters: An fMRI study.

Restraint theory has been used to model the process that produces binge eating. However, there is no satisfactory explanation for the tendency of restrained eaters (REs) to engage in counterregulatory eating, an ostensible analogue of binge eating. Using functional magnetic resonance imaging (fMRI), the authors investigated brain activation of normal weight REs (N = 9) and unrestrained eaters (UREs; N = 10) when fasted and fed and viewing pictures of highly and moderately palatable foods and neutral objects. When fasted and viewing highly palatable foods, UREs showed widespread bilateral activation in areas associated with hunger and motivation, whereas REs showed activation only in the cerebellum, an area previously implicated in low-level processing of appetitive stimuli. When fed and viewing high palatability foods, UREs showed activation in areas related to satiation and memory, whereas REs showed activation in areas implicated in desire, expectation of reward, and goal-defined behavior. These findings parallel those from behavioral research. The authors propose that the counterintuitive findings from preload studies and the present study are due to the fact that REs are less hungry than UREs when fasted and find palatable food more appealing than UREs when fed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight suppression is a robust predictor of outcome in the cognitive-behavioral treatment of bulimia nervosa.

This study examined weight suppression (difference between highest premorbid weight and pretreatment weight) as a predictor of outcome in 188 outpatients with bulimia nervosa enrolled in a cognitive- behavioral therapy intervention. Participants who dropped out of treatment had significantly higher levels of weight suppression than treatment completers. Of participants who completed treatment, those who continued to engage in binge eating or purging had significantly higher levels of weight suppression than those who were abstinent from bingeing and purging. Results did not change when body mass index, dietary restraint, weight and shape concerns, or other relevant variables were controlled. Relinquishing bulimic behaviors and adopting normal eating patterns may be most feasible for patients who are closest to their highest premorbid weights. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prefrontal and striatal dopamine metabolism during enhanced rebound hyperphagia induced by space restriction--a rat model of binge eating

BACKGROUND: Several lines of evidence indicate that abnormalities in brain dopamine and serotonin metabolism may play an important role in bulimia nervosa. However, the regional neurochemical mechanism of the binge eating is poorly understood. Our purpose was to elucidate brain neurochemical mechanisms of binge eating using a rat model. METHODS: The dopamine release and metabolism in the prefrontal cortex (PFC) and in the ventrolateral striatum (VLS) of rats were studied using microdialysis during enhanced rebound hyperphagia induced by space restriction (an animal model of binge eating). RESULTS: The rats showed rebound hyperphagic state when they were released from scheduled feeding (2 hours/day feeding for 7 days). The hyperphagia was further enhanced when they were put in a space-restricted cage where their mobility was restricted. Dopamine release and metabolism were increased both in the PFC and in the VLS during the enhanced rebound hyperphagia. CONCLUSIONS: These results tentatively suggest that increased dopamine release and metabolism in the PFC and in the VLS may be related to space restriction and to activation of motor function involved in feeding behavior, respectively. The enhanced rebound hyperphagia induced by space restriction may be useful as an animal model of binge eating.     

Coping With Distress by Eating or Drinking: Role of Trait Urgency and Expectancies.

The authors propose that trait urgency (the tendency to act rashly when distressed) is a risk factor for both alcohol abuse and bulimic symptoms, that disorder-specific expectancies influence whether one engages in one behavior or the other, and that expectancies moderate urgency's influence on those behaviors. Cross-sectional findings were consistent with the model. Problems from alcohol use were comorbid with binge eating and purging. Trait urgency was associated with both behaviors. Alcohol expectancies were associated with drinking levels and with problem drinking, but not with eating. Eating expectancies were associated with binge eating, but not with alcohol use or problems. Urgency's effect on binge eating was moderated by expectancies, but its effect on alcohol use and problem drinking was not. (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)     

Prevalence of gastrointestinal symptoms in obese and normal weight binge eaters

OBJECTIVES: Disturbances in gastrointestinal function may result from disordered eating and may lead to increases in gastrointestinal (GI) symptoms. We compared GI symptoms in obese and non-obese binge eaters and non-binge eaters. METHODS: One hundred nineteen obese and 77 normal-weight females completed a questionnaire on bowel symptoms and binge eating behaviors for the previous 3 months. Based on binge behaviors and body mass index (> 30 kg/m2), individuals were grouped as obese binge eaters (n = 73), obese non-binge eaters (n = 43), non-obese binge eaters (n = 14), and normal-weight controls (n = 61). RESULTS: Obese binge eaters reported more upper GI symptoms than normal controls or obese non-binge eaters (p < 0.001). Compared with normal controls, nausea, vomiting, and bloating was 2-4 times more prevalent in both binge eating groups. Indigestion was more prevalent in both obese groups. Obese binge eaters reported more lower GI symptoms than normal-weight controls (p < 0.05). Binge eating in both weight groups was associated with more frequent abdominal pain and dyschezia. Obesity was associated with more frequent constipation, diarrhea, straining, and flatus, whether or not subjects reported binge eating. Chi-square showed a significant association between obesity, binge eating, and symptoms of irritable bowel syndrome, using the Manning criteria. CONCLUSIONS: Specific GI symptoms were associated with binge eating and obesity. Overall, symptoms were more prevalent and more severe in obese binge eaters. The high prevalence of GI symptoms in obese patients who indulge in binge eating should be considered in their evaluation and treatment.     

In situ morphology of fetal aortic isthmus following ductal constriction in rats

Obese female subjects with binge eating disorder BED; (N = 107) completed the Beck Depression Inventory, Symptom Checklist-90, Inventory of Interpersonal Problems, and Rosenberg Self-Esteem Scale. Subjects were divided into moderate or severe binger on the basis of scores on the Binge Eating Scale, and grouped into moderately or severely obese by performing a median split on their weights. Spearman correlational analyses were performed to determine the relationship between psychopathology and obesity and psychopathology and binge eating. Analyses of variance (ANOVAs) were then performed using scores on the psychological measures with subjects grouped both by severity of obesity and severity of binge eating. The results indicated that in our sample, obesity and scores on the measures of psychiatric symptomatology were unrelated. However, a significant positive relationship was found between binge eating severity and degree of psychiatric symptomatology. We suggest that binge eating may account for the observed relationship between obesity and psychopathology reported in previous studies. We discuss the importance of assessing BED when conducting research with obese individuals.     

Binge eating proneness emerges during puberty in female rats: A longitudinal study.

Puberty is a critical risk period for binge eating and eating disorders characterized by binge eating. Previous research focused almost entirely on psychosocial risk factors during puberty to the relative exclusion of biological influences. The current study addressed this gap by examining the emergence of binge eating during puberty in a rat model. We predicted that there would be minimal differences in binge eating proneness during pre-early puberty, but significant differences would emerge during puberty. Two independent samples of female Sprague–Dawley rats (n = 30 and n = 36) were followed longitudinally across pre-early puberty, mid-late puberty, and adulthood. Binge eating proneness was defined using the binge eating resistant (BER)/binge eating prone (BEP) model of binge eating that identifies BER and BEP rats in adulthood. Across two samples of rats, binge eating proneness emerged during puberty. Mixed linear models showed little difference in palatable food intake between BER and BEP rats during pre-early puberty, but significant group differences emerged during mid-late puberty and adulthood. Group differences could not be accounted for by changes in nonpalatable food intake or body weight. Similar to patterns in humans, individual differences in binge eating emerge during puberty in female rats. These findings provide strong confirming evidence for the importance of biological risk factors in developmental trajectories of binge eating risk across adolescence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological and Behavioral Risk Factors for Obesity Onset in Adolescent Girls: A Prospective Study.

Because little is known about risk factors for obesity, the authors tested whether certain psychological and behavioral variables predicted future onset of obesity. The authors used data from a prospective study of 496 adolescent girls who completed a baseline assessment at age 11-15 years and 4 annual follow-ups. Self-reported dietary restraint, radical weight-control behaviors, depressive symptoms, and perceived parental obesity--but not high-fat food consumption, binge eating, or exercise frequency-predicted obesity onset. Results provide support for certain etiologic theories of obesity, including the affect regulation model. The fact that self-reported, weight-control behaviors identified girls at risk for obesity implies that high-risk youths are not engaging in effective weight-control methods and suggests the need to promote more effective strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social contagion of binge eating.

A social psychological account of the acquisition of binge eating, analogous to the classic social psychological work, "Social Pressures in Informal Groups" (Festinger, Schachter, & Back, 1950), is suggested and tested in 2 college sororities. In these sororities, clear evidence of group norms about appropriate binge-eating behavior was found; in 1 sorority, the more one binged, the more popular one was. In the other, popularity was associated with bingeing the right amount: Those who binged too much or too little were less popular than those who binged at the mean. Evidence of social pressures to binge eat were found as well. By the end of the academic year, a sorority member's binge eating could be predicted from the binge-eating level of her friends. As friendship groups grew more cohesive, a sorority member's binge eating grew more and more like that of her friends. The parsimony of a social psychological account of the acquisition of binge eating behavior is shown. I argue that there is no great mystery to how bulimia has become such a serious problem for today's women. (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)     

Eating behavior of bulimics, self-identified binge eaters, and non-eating-disordered individuals: what differentiates these populations?

This article reviews and critiques the eating behavior literature comparing the binge and non-binge-eating episodes of three populations of normal-weight women: bulimics, self-identified binge eaters, and non-eating-disordered women. The specific behaviors evaluated are number of calories consumed during different types of eating episodes, frequency of binge eating, number of eating episodes, rate of food consumption, the macronutrient composition of the food ingested, and context and duration of eating. Differences in these populations' eating behavior are analyzed in terms of their theoretical contribution. It is concluded that differences in the observed behavior of these groups are consistent with restraint theory, purge opportunity, and the forbidden foods hypothesis. Conversely, results do not support carbohydrate craving theory or a deficit in the satiety mechanisms of bulimics. Suggestions for future research are presented.     

Tetralogy of Fallot with flap valve ventricular septal defect producing suprasystemic right ventricular pressure: echocardiographic observations

The study objectives were to gain insight into how the terms "dieting" and "binge eating" are understood and used by adolescents and to assess whether interpretations of these terms are consistent across age and gender. Twenty-five focus groups were conducted with 203 adolescents (138 girls and 65 boys) in urban public junior and senior high schools. Respondents were asked questions about dieting and binge eating behaviors. In the majority of groups (n=19), healthful eating behaviors, such as eating less fat or more fruits and vegetables, were mentioned in reference to dieting. However, in many of the groups (n=13) unhealthful eating behaviors, such as skipping meals or "starvation," were also described. Dieting was frequently described as an umbrella term for different behaviors aimed at weight control (ie, physical activity) or in nonbehavioral terms (ie, as a desire or plan for weight loss). Although binge eating was described as overeating by many participants, often it was not clear if youth were referring to uncontrolled overeating. In nearly half of the groups, participants indicated unfamiliarity with the term "binge eating." There was some confusion between binge eating and other forms of disordered eating. The findings suggest that prevalence rates of self-reported dieting and binge eating behaviors should be interpreted with caution and it should not be assumed that the majority of adolescents who self-report dieting are engaging in unhealthful behaviors. In providing nutrition counseling to youth, and in assessing dieting and binge eating behaviors in clinical settings and in research studies, specific behaviors should be defined.     

On the relation of dieting and bingeing in bulimia nervosa.

The continuum model of bulimia nervosa suggests that dieting plays a major role in the etiology and maintenance of bulimia. However, a previous study (M. R. Lowe et al., 1996) recently found no relationship between dieting intensity and binge eating problems in nonclinical participants differing widely in eating and weight concerns. The present study extended these findings by examining the relationship between dieting and bingeing among individuals with bulimia. Three samples of individuals diagnosed with bulimia were divided into frequent and infrequent weight-loss dieters and were compared on multiple measures of binge eating. No diet-binge relationship was found in 1 sample, whereas in the other 2 samples frequent dieters binged less than infrequent dieters. These results raise new questions about the continuum model of bulimia and suggest that weight-loss dieting may not play as prominent a role in the maintenance of bulimia as it does in its initiation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and treatment of bulimia nervosa

Bulimia nervosa is characterized by binge eating and inappropriate compensatory behaviors, such as vomiting, fasting, excessive exercise and the misuse of diuretics, laxatives or enemas. Although the etiology of this disorder is unknown, genetic and neurochemical factors have been implicated. Bulimia nervosa is 10 times more common in females than in males and affects up to 3 percent of young women. The condition usually becomes symptomatic between the ages of 13 and 20 years, and it has a chronic, sometimes episodic course. The long-term outcome has not been clarified. Other psychiatric conditions, including substance abuse, are frequently associated with bulimia nervosa and may compromise its diagnosis and treatment. Serious medical complications of bulimia nervosa are uncommon, but patients may suffer from dental erosion, swollen salivary glands, oral and hand trauma, gastrointestinal irritation and electrolyte imbalances (especially of potassium, calcium, sodium and hydrogen chloride). Treatment strategies are based on medication, psychotherapy or a combination of these modalities.     

Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation.

Because little is known about the predictors of binge eating (a risk factor for obesity), a set of putative risk factors for binge eating was investigated in a longitudinal study of adolescent girls. Results verified that binge eating predicted obesity onset. Elevated dieting, pressure to be thin, modeling of eating disturbances, appearance overvaluation, body dissatisfaction, depressive symptoms, emotional eating, body mass, and low self-esteem and social support predicted binge eating onset with 92% accuracy, Classification tree analysis revealed an interaction between appearance overvaluation, body mass, dieting, and depressive symptoms, suggesting qualitatively different pathways to binge eating and identifying subgroups at extreme risk for this outcome. Results support the assertion that these psychosocial and biological factors increase risk for binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of behavioral and cognitive-behavioral interventions for bulimia nervosa.

Examined the relative efficacy of cognitive-behavioral and behavioral treatment approaches for bulimia nervosa. Female bulimic Ss were randomly assigned to cognitive-behavioral, behavioral, or attention placebo conditions. At posttreatment, 92% of the cognitive-behavioral group, 100% of the behavioral group, and 69% of the nonspecific self-monitoring group were abstinent from binge eating–purging. At 6-mo follow-up, 69% of the cognitive-behavioral group, 38% of the behavioral group, and 15% of the nonspecific self-monitoring group were abstinent from binge eating and purging. The results support the conceptualization of bulimia nervosa as a multifaceted disorder best treated with an approach that directly addresses maladaptive cognitions, problematic behaviors, and the development of more adaptive coping skills. (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)     

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.