Weight suppression predicts weight gain over treatment but not treatment completion or outcome in bulimia nervosa.

The authors attempted to replicate previous findings that weight suppression is a significant predictor of treatment completion and treatment outcome (M. L. Butryn, M. R. Lowe, D. L. Safer, & W. S. Agras, 2006) and weight gain over treatment (M. R. Lowe, W. Davis, D. Lucks, R. A. Annunziato, & M. L. Butryn, 2006) among women with bulimic disorders. The authors also examined 2 alternative measures of weight variability. Participants were 132 women with bulimia nervosa treated with cognitive-behavioral therapy. Participants who dropped out of treatment did not have significantly higher levels of weight suppression than did treatment completers. Among those who completed treatment, weight suppression did not significantly predict binge eating and purging at post-treatment. Weight suppression did significantly predict weight change and, in particular, weight gain (≥5 kg) over treatment. Alternative measures of weight variability did not significantly predict treatment completion or treatment outcome, but 1 measure significantly predicted weight gain over treatment. In conclusion, the authors failed to replicate the previous finding that weight suppression predicts treatment compliance and treatment outcome, but they did replicate the finding that weight suppression predicts weight gain over treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session and intersession experience related to treatment outcome in bulimia nervosa.

Treatment in bulimia nervosa is challenging, with rates of successful treatments for only about 50% of all patients. This study aimed to identify predictors of outcome through secondary analysis of data from a randomized clinical trial that compared inpatient and day hospital treatment for bulimia. Process measures included assessments of patients' in-session experiences, therapeutic alliance, and therapy-related intersession experiences (ISE). ISE measures were better predictors of outcome than pretreatment variables (e.g., social adjustment) or global therapeutic alliance. Outcome at 3 month follow-up was strongly related to the ISE dimension Recreating Therapeutic Dialogue with Negative Emotions, indicating a heightened risk of failure. Prediction of outcome by these variables showed a sensitivity of 0.86 and a specificity of 0.78, and 83% of patients could be correctly classified. These results show that certain aspects of ISE may serve as early and reliable indicators of long term treatment failure, prompting alternate treatment approaches and opening new directions of research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivations for dieting: Drive for thinness is different from drive for objective thinness.

Drive for thinness is a cardinal feature of bulimia nervosa. However, the widely used Drive for Thinness (DFT) subscale of the Eating Disorder Inventory (Garner, 2004; Garner, Olmstead, & Polivy, 1983) appears to measure a desire to be thinner, not a desire to be objectively thin. We developed the Drive for Objective Thinness (DFOT) Scale and compared unrestrained and restrained eaters and those with bulimia nervosa on the DFT subscale, Goldfarb's Fear of Fat Scale (GFFS; Goldfarb, Dykens, & Gerrard, 1983), and the DFOT Scale. Restrained eaters had higher scores than unrestrained eaters on the DFT subscale and the GFFS, but both groups had low scores on the DFOT Scale. Only the group with bulimia nervosa showed elevated scores on the DFOT Scale. We conclude that restrained eaters diet mostly to avoid weight gain, that individuals with bulimia nervosa diet to achieve thinness and avoid fatness, and that the drive for objective thinness is a unique feature of bulimia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtyping women with bulimia nervosa along dietary and negative affect dimensions: Further evidence of reliability and validity.

Studies have found that individuals with bulimia nervosa can be classified into dietary and dietary-negative affect subtypes and that the latter exhibit greater eating pathology, psychiatric comorbidity, and functional impairment; a more protracted clinical course; and a worse treatment response. In this report, the authors describe 2 prospective studies that found that young women with threshold (n = 48) and subthreshold (n = 83) bulimic pathology can be classified into dietary and dietary-negative affect subtypes; that two subtyping approaches produced similar results (mean κ = .94); that the subtyping distinction showed 4-week test-retest reliability (κ = .61); and that the dietary-negative affect subtype showed greater eating pathology, emotional distress, functional impairment, treatment seeking, and lower likelihood of recovery over 6-month and 3-year follow-ups than the dietary subtype. The dieting-negative affect subtyping distinction evidenced greater test-retest reliability and concurrent and predictive validity than did the purging-nonpurging subtyping distinction. The additional evidence for the reliability and validity of this subtyping scheme, particularly the prognostic utility, suggests it is worth additional inquiry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for bulimia nervosa: Time course and mechanisms of change.

Cognitive-behavioral therapy (CBT) is an effective treatment of bulimia nervosa, but its mechanisms of action have not been established. In this study the authors analyzed the results of a randomized control trial comparing CBT with Interpersonal Psychotherapy (IPT) to identify possible mediators of change of CBT for BN and its time course of action. Reduction in dietary restraint as early as Week 4 mediated posttreatment improvement in both binge eating and vomiting. Measures of self-efficacy concerning eating behavior, negative affect, and body shape and weight at midtreatment were also significantly associated with posttreatment outcome at 20 wks. No evidence was found that the therapeutic alliance mediated treatment outcome. CBT had a significantly more rapid treatment effect than IPT, with 62% of posttreatment improvement evident by Week 6. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of treatment for eating disorders.

Reviews the book, Handbook of treatment for eating disorders (2nd ed.) edited by David M. Garner and Paul E. Garfinkel (see record 1997-08478-000). In this book, the editors state that their primary goal is to present treatment approaches in sufficient detail that clinicians can conduct therapy of these disorders. A strong research base undergirds each chapter, filled with extensive case illustration and practical approaches, directed toward the practicing clinician. With new as well as revised chapters, this book consists of five major sections. The first, "The Context for Treatment," describes the history of eating disorders, focusing on Anorexia Nervosa and Bulimia Nervosa. The second, and most coherent, section focuses on cognitive-behavioral and educational approaches. A conglomeration of approaches based on other theoretical perspectives appears in the third section, entitled "Psychodynamic, Feminist, and Family Approaches." In the fourth section, issues around inpatient, partial hospitalization, and drug therapies are reviewed. A final, catch-all section covers special topics, including comorbid histories and conditions (sexual abuse, substance abuse, and medical issues), diagnostic concerns (personality disorders), alternative treatments (group, self-help), treatment dilemmas (treatment refusal in anorexia nervosa), age considerations (prepubertal eating disorders), and binge-eating disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding persistence in bulimia nervosa: A 5-year naturalistic study.

Bulimia nervosa shows a marked tendency to persist, suggesting that powerful maintaining mechanisms operate. Using data from a prospective, 5-year, study of the natural course of 102 people with bulimia nervosa, the authors sought to identify predictors of persistence and to test specific hypotheses derived from the cognitive-behavioral theory of the persistence of bulimia nervosa. The results of both sets of analyses were consistent with the theory, with the degree of overevaluation of shape and weight and a history of childhood obesity predicting a persistent course. There was also support for the central prediction of the cognitive-behavioral theory. These findings suggest that the mechanisms specified by the theory influence its longer term natural course. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affect regulation and food intake in bulimia nervosa: Emotional responding to food cues after deprivation and subsequent eating.

Emotional responding to salient food cues and effects of food deprivation and consumption were investigated in 32 women with bulimia and 32 control women. One half of each group was food deprived before viewing unpleasant, neutral, pleasant, and food-related pictures. Then participants could eat from a buffet before viewing a parallel picture set. Women with bulimia showed a substantial potentiation of startle responses during viewing of food cues relative to control women. This startle potentiation was attenuated by food deprivation and augmented by increased food consumption. These data support the affective regulation model suggesting that food cues prompt negative affective states in women with bulimia, who are overwhelmed by fasting. The resulting deprivation increases the incentive value of food cues and may thus trigger binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight suppression predicts maintenance and onset of bulimic syndromes at 10-year follow-up.

Conflicting results have emerged regarding the prognostic significance of weight suppression for maintenance of bulimic symptoms. This study examined whether the magnitude of weight suppression would predict bulimic syndrome maintenance and onset in college-based samples of men (n = 369) and women (n = 968) at 10-year follow-up. Data come from a longitudinal study of body weight and disordered eating with high retention (80%). Among those with a bulimic syndrome at baseline, greater weight suppression significantly predicted maintenance of the syndrome and, among those without a bulimic syndrome at baseline, greater weight suppression predicted onset of a bulimic syndrome at 10-year follow-up in multivariate models that included baseline body mass index, diet frequency, and weight perception. Future research should address mechanisms that could account for the effects of weight suppression over a long duration of follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological correlates of decision making in patients with bulimia nervosa.

In addition to the core psychopathology of bulimia nervosa (BN), patients with BN often show impulsive behavior that has been related to decision making deficits in other patient groups, such as individuals with anorexia nervosa and pathological gamblers. However, it remains unclear whether BN patients also show difficulties in decision making. In this study, 14 patients with BN and 14 healthy comparison subjects, matched for age, gender, education, body mass index, and intelligence, were examined with the Game of Dice Task (M. Brand, E. Fujiwara, et al., 2005), a gambling task that has fixed winning probabilities and explicit rules for gains and losses, as well as with a neuropsychological test battery and personality questionnaires. On the task, the patients with BN chose the disadvantageous alternatives more frequently than did the comparison subjects. Performance on the Game of Dice Task was related to executive functioning but not to other neuropsychological functions, personality, or disease-specific variables in the BN group. Thus, in patients with BN, decision making abnormalities and executive reductions can be demonstrated and might be neuropsychological correlates of the patients' dysfunctional everyday-life decision making behavior. Neurocognitive functions should be considered in the treatment of BN. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a Weight Maintenance Diet on Bulimic Symptoms in Adolescent Girls: An Experimental Test of the Dietary Restraint Theory.

It is widely accepted that dieting increases the risk for bulimia nervosa, but there have been few experimental tests of this theory. The authors conducted a randomized experiment with adolescent girls (N=188) to examine the effects of a weight maintenance diet on bulimic symptoms. A manipulation check verified that the diet intervention resulted in weight maintenance and significantly reduced the risk for obesity onset and weight gain observed in assessment-only controls. As hypothesized, the diet intervention resulted in significantly greater decreases in bulimic symptoms and negative affect than observed in controls. These experimental findings, which converge with those from a weight loss diet experiment, appear antithetical to dietary restraint theory and suggest instead that dietary restriction curbs bulimic symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client experience of psychodynamic psychotherapy for bulimia nervosa: An interview study.

We examined 14 bulimic clients' experiences of individual psychodynamic psychotherapy through semistructured interviews, which were analyzed using qualitative methods. The results showed that the psychodynamic approach was a challenge to most of the clients. Yet, most clients profited from therapy both symptomatically and with regard to interpersonal relations and affect regulation. There were, however, marked differences in the clients' experiences. One subgroup rather quickly felt that the therapy met their needs, another initially felt challenged by the approach and the therapeutic attitude but ultimately succeeded in using this particular kind of therapy. A third group remained predominantly critical of their therapies. The clinical implications and possible explanations of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Experiential therapies for eating disorders.

Reviews the book, Experiential therapies for eating disorders, edited by Lynne M. Hornyak and Ellen K. Baker (see record 1989-97569-000). In this book, Lynne Hornyak and Ellen Baker provide a collection of chapters describing "experiential" therapies for eating disorders. Hornyak and Baker define experiential therapy as '...treatment techniques, based on psychological principles that are developed and used with the specific intention of increasing clients' present awareness of feelings, perceptions, cognitions, and sensations; that is, their in-the-moment experience..." (p.3). The book is divided into two sections: The first part addresses the treatment of bulimia nervosa; the second deals with anorexia nervosa. Each author presents his or her treatment approach in sufficient detail to give the reader a clear picture of how the technique could be implemented in the clinical setting. This book may stimulate practitioners to consider the theoretical rationale of their clinical methods and to consider alternative therapies in their treatment of patients with eating disorders. However, the book fell short of the mark in several respects. First, although the authors of each chapter attempted to emphasize the interrelationship of theory and practice, they often glossed over the fact that there was little or no empirical support for either their conceptualiztion of the disorder or the efficacy of the intervention that they espoused. Second, the editors failed to provide the reader with an integrative summary. There was no attempt to provide the practicing clinician with a guide to decision making in the treatment of eating disorders. The editors did not address key questions such as how one assesses a patient with an eating disorder or how one decides which treatment is best suited for her. A related shortcoming is that the editors do not provide the reader with a summary of the state of the art with regard to the conceptualization and treatment of eating disorders. There is now sufficient empirical literature to support specific models of etiology and the efficacy of particular interventions (cf. Brownell & Foreyt, 1986). Without an overview, the reader is left with the impression that the current understanding and treatment of eating disorders is in a prescientific state and that personal preferences rather than empirical findings dictate which treatments are best suited for particular patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of psychotherapy for anorexia nervosa and bulimia.

Reviews the book, Handbook of psychotherapy for anorexia nervosa and bulimia edited by David M. Garner and Paul E. Garfinkel (1985). In the Introduction, the editors indicate that the text, intended for an audience of practising and academically oriented clinicians, has two major purposes: (1) to delineate the various types of therapy advocated for the treatment of anorexia and bulimia, and (2) to identify the factors that predispose or precipitate these eating disorders. The book is immensely successful in fulfilling the first intent. However, the ability of the various chapter authors to isolate the risk factors for anorexia and bulimia is less satisfying. In fairness, however, this does not represent a shortcoming on the part of the authors but rather provides an accurate reflection of the degree of our current understanding of these eating disorders. Several features of the book make it an invaluable reference text on anorexia and bulimia--a large range of treatment options is presented ranging from feminist psychoanalytic approaches to behavioural management techniques; the authors attempt to articulate the theoretical bases that underlie or justify the particular treatment they advocate; and the inclusion of case studies, sample therapist-patient dialogue, and the overall detailed manner with which the therapies are described provide the reader with a clear flavour of the treatment modality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment.

The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH), and stress (STRS); they also indicated binge or vomit episodes (BN-events) 6 times each day. Mixed models were used to compare mood and STRS between and within days when BN-events occurred. Between-days analyses indicated that binge and vomit days both showed less PA, higher NA, higher AH, and greater STRS than days with no BN-events. Within-day, decreasing PA, and increasing NA and AH, reliably preceded BN-events. Conversely, PA increased, and NA and AH decreased following BN-events. Demonstration of the temporal sequencing of affect, STRS, and BN-events with a large BN sample may help advance theory and clinical practice, and supports the view that binge and purge events hold negatively reinforcing properties for women with BN. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms.

The article describes a 20-year longitudinal study of body weight, dieting, and disordered eating in women and men. Body weight increased significantly over time in both women and men. However, women's weight perception and dieting frequency decreased over time, whereas men's weight perception and dieting frequency increased, and disordered eating declined more in women than in men from late adolescence to midlife. In both women and men, changes in weight perception and dieting frequency were associated with changes in disordered eating. In addition, adult roles such as marriage and parenthood were associated with significant decreases in disordered eating from late adolescence to midlife in women, whereas few associations were observed in men. Despite different developmental trajectories, women demonstrated more weight dissatisfaction, dieting, and disordered eating compared with men across the period of observation. (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)     

Coping Strategies in Bulimia Nervosa Treatment: Impact on Outcome in Group Cognitive-Behavioral Therapy.

This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1- and 6-month follow-up. Frequency of outcome expectancies (OE), stimulus-response prevention (SRP), and social support-seeking (SSS) strategies significantly increased by end of treatment. By 1-month follow-up, use of SSS, not OE or SRP, declined significantly relative to treatment end. Although frequency of coping strategy use at treatment end did not predict 1-month BN symptom remission, SSS use at 1-month follow-up predicted 6-month remission. Findings highlight the importance of social support to maintain treatment gains. (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)     

Need for cognition as a predictor and a moderator of outcome in a tailored letters smoking cessation intervention.

Objective: To analyze whether baseline need for cognition (NFC) was a predictor or a moderator of treatment outcome in a tailored letters intervention for smoking cessation. Design: A total of 1,499 daily smokers were recruited from general medical practices in Germany within a quasi-randomized trial testing the efficacies of two brief interventions for smoking cessation: (a) computer-generated tailored letters and (b) physician-delivered brief counseling versus assessment-only. For this study, we used data from 1,097 daily smokers who were assigned to the tailored letters or the assessment-only condition. Main Outcome Measures: self-reported 6-month prolonged abstinence from tobacco smoking assessed at 12-, 18-, and 24-month follow-ups, and smoking cessation self-efficacy assessed at 6- and 24-month follow-ups. Results: Baseline NFC predicted 6-month prolonged smoking abstinence (p = .01) and smoking cessation self-efficacy (p .05) but on smoking cessation self-efficacy (p = .05). Tailored letters resulted in higher smoking cessation self-efficacy only for persons with higher NFC. Conclusion: Higher levels of NFC are required to increase smoking cessation self-efficacy in computer-tailored interventions for smoking cessation. Considering an individual's NFC might improve the efficacy of written interventions for smoking cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)