Psychosocial and health consequences of adolescent depression in Black and White young adult women.

Depression in adolescent girls may result in negative consequences in young adulthood. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 1,727 Black and White girls ages 16 to 18 years who participated in the National Heart, Lung, and Blood Institute's Growth and Health Study. Three years later, women in the depressed groups were more likely to be current smokers, had attained a lower level of education, and reported lower self-worth relative to the nondepressed group. Body dissatisfaction, eating concerns, and loneliness were greater in the depressed groups. Relative to Black women, White women who were moderately depressed during adolescence reported more health care services utilization in young adulthood. Prevention efforts for depressed adolescents should be broadly focused to improve young adult outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The social self in bulimia nervosa: Public self-consciousness, social anxiety, and perceived fraudulence.

Bulimic women appear preoccupied not only with their physical presentation but also with their "social self," how others perceive them in general. This study examined the relationship of the social self to body esteem and to bulimia nervosa. In Phase 1, in which 222 nonclinical women (aged 16–50 yrs) participated, the social-self measures of Perceived Fraudulence, Social Anxiety, and Public Self-Consciousness were negatively associated with body esteem. In Phase 2, 34 bulimic women were compared with 33 Ss scoring high on the Eating Attitudes Test (EAT) and 67 matched controls. Bulimic Ss, high-EAT Ss, and control Ss all differed on Perceived Fraudulence, and bulimic Ss and high-EAT Ss scored higher than control Ss on Public Self-Consciousness and Social Anxiety. The findings strongly support the hypothesized link of social self concerns to body dissatisfaction and bulimia nervosa. (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)     

Risk factors for eating disorders.

The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances in understanding the etiology of eating disorders require a new generation of studies that integrate these domains. They discuss how more sophisticated and novel conceptualizations of risk and causal processes may inform both nosology and intervention efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Participant reactions to a cognitive-behavioral guided self-help program for binge eating: developing criteria for program evaluation

This article evaluates the effectiveness of a telephone-based guided self-help program for women who binge eat. We report how key program components (e.g., phone sessions, the self-help book) contribute to the four self-help goals identified in the clinical literature: (1) decrease isolation/increase support; (2) increase knowledge of the problem; (3) broaden coping skills; and (4) improve self-esteem. Using the example of our feasibility study, we illustrate that even minimal interventions create a relational context which can promote entry into and engagement with treatment. We conclude that program evaluation should include not only traditional measures of outcome (e.g., reduction in symptomatology), but utilize outcome measures related to the specific goals of minimal interventions (e.g., changes in help-seeking behavior).     

Bias in binge eating disorder: How representative are recruited clinic samples?

The aim of this study was to investigate sampling bias as it affects recruited clinic samples of binge eating disorder (BED). Demographic and clinical characteristics of a recruited clinic sample were compared with a community sample. The 2 groups met the same operational definition of BED and were assessed using the same primarily interview-based methods. Ethnicity, severity of binge eating, and social maladjustment were found to increase treatment seeking among participants with BED rather than levels of psychiatric distress or comorbidity. These findings suggest that previous studies using recruited clinic samples have not biased estimates of psychiatric comorbidity in BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward an understanding of risk factors for bulimia.

Explores why women in general are more prone to develop bulimia than men and which women in particular have a higher risk of becoming bulimic. Risk factors for bulimia are discussed in terms of sociocultural variables, such as the central role of beauty in the female sex-role stereotype; developmental processes; psychological variables; and biological factors, including genetic determinants of weight, the disregulation of body weight and eating through dieting, affective instability, and family variables. The sociocultural and psychological mediators that contribute to the increased risk of bulimia in this era are discussed, including a shift toward an increased emphasis on thinness, the effects of media attention on dieting and bulimia, fitness, and shifting sex roles. Results indicate that female socialization is a major contributing factor in bulimia. Although significantly fewer men than women currently show evidence of bulimia, it is hypothesized that the general pressure on men to become conscious of physical fitness and appearance, together with certain male subcultures that emphasize weight standards, will lead to an increased incidence of bulimia in men. (5? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)