Comparison of binge eating disorder and bulimia nervosa in a community sample

Long-term course of binge eating disorder and bulimia nervosa: relevance for nosology and diagnostic criteria

OBJECTIVE

To present the twelve-year outcome of binge eating disorder (BED) in 68 female inpatients compared to bulimia nervosa, purging type (BN-P; N = 196).

METHOD

Self and expert ratings focused on the beginning of therapy and the 12-year follow-up.

RESULTS

36% of BED and 28.2% of BN-P patients still received an eating disorder diagnosis at follow-up. Differences between groups were small (Eating Disorder Inventory, Structured Inventory for Anorexic and Bulimic Syndromes, Hopkins Symptom Checklist, Beck Depression Inventory). Similar predictors for BED and BN-P were identified. Psychiatric comorbidity was the predominant predictor of poor outcome in both diagnoses. Predictors for BED outcome were body dissatisfaction, sexual abuse, and impulsivity; self-injury predicted BN-P outcome.

CONCLUSION

Course, outcome, and mortality were similar for BED and BN-P. Both disorders had psychiatric comorbidity as the main predictor of outcome, and there was a diagnostic shift between BED and BN-P over time, pointing to their nosological proximity. Data are relevant for the formulation of DSM-V and ICD-11 diagnostic criteria.

Psychological characteristics of morbidly obese candidates for bariatric surgery

BACKGROUND

Morbid obesity has multiple negative consequences for psychological health. These patients are described as depressed, anxious, and impulsive, with low self-esteem and impaired quality of life. The severity of these psychological disorders has been related to the degree of obesity. The aim of this study was to analyze the psychopathological characteristics of obese candidates for bariatric surgery, determining differences and similarities in general and specific psychopathologic symptoms among patients with different degrees of obesity and normal-weight individuals.

METHODS

The study included 50 patients (26 type III obesity, 24 type IV obesity) and 25 normal-weight volunteers. They were all assessed for: stress (CED44-B), anxiety-depression (General Health Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), family function (Apgar Family Function Questionnaire), quality of life (Spanish version of the Quality of Life Index), personality (Eysenck Personality Questionnaire-Revised), food craving (Food Craving Questionnaire-Trait), and eating behavior disorder (EBD) symptomatology (Eating Disorders Examination-Questionnaire Version-4).

RESULTS

The obese patients had higher levels of stress, anxiety, depression, food craving, and EBD symptoms and lower levels of self-esteem and quality of life compared with normal-weight controls. No personality or family function disorders were observed in any of the obese or normal-weight subjects. Patients with type III and type IV obesity differed only in anxiety and personality findings.

CONCLUSIONS

Although the presence of psychological disorders cannot be taken as an absolute criterion for exclusion of candidates for obesity surgery, a better understanding of the relationship of these variables with weight loss and other outcomes of bariatric surgery may improve patient selection and facilitate more appropriate interventions.

A randomized, double-blind trial comparing sertraline and fluoxetine 6-month treatment in obese patients with Binge Eating Disorder

Previous studies support the use of selective serotonin reuptake inhibitors (SSRIs), in overweight patients with Binge Eating Disorder (BED), but results are far from conclusive. Sertraline has been studied less extensively, and there have been a few studies concerning SSRIs that report follow-up data at more than 12 weeks of follow-up. The present study assesses the effectiveness of sertraline and fluoxetine over a period of 24 weeks in obese patients with BED (DSM-IV-TR). Forty-two obese outpatients were randomized and assigned to one of two different drug treatments: 22 were treated with sertraline (dose range: 100-200 mg/day) and 20 with fluoxetine (dose range: 40-80 mg/day). Subjects were assessed at baseline and at 8, 12, and 24 weeks of treatment for binge frequency, weight loss, and severity of psychopathology. No significant differences were found between the two treatments. After 8 weeks of treatment a significant improvement in the Binge Eating Scale score and a significant weight loss emerged. These results were maintained by responders (weigh loss of at least 5% of baseline weight) over 24 weeks. The results suggest that a 6-month treatment with SSRI may be an effective option to treat patients with BED.

Public perceptions of binge eating and its treatment

OBJECTIVE

Attitudes and beliefs concerning a binge eating problem were examined in a community sample of men and women (n = 1031) aged 15 to 94 years.

METHOD

A vignette describing a fictional 32-year-old female obese binge eater was presented, followed by a series of questions concerning the nature and treatment of the problem described.

RESULTS

Most participants believed that binge eating is primarily a problem of low self-esteem or depression. Behavioral weight loss treatment and self-help interventions were the treatments considered most helpful, whereas few participants believed that psychotherapy would be helpful. General practitioners and dieticians were the treatment providers considered most helpful. Most participants were ambivalent about prognosis given treatment and pessimistic about outcome in the absence of treatment.

CONCLUSION

The fact that binge eating is viewed primarily as a problem of negative affect, and that specific psychotherapy is not highly regarded as a treatment, may go some way to explaining why most individuals with binge eating-type disorders do not receive appropriate treatment. The benefits of specific psychotherapy in stabilizing eating behavior and improving quality of life for obese binge eaters need to be communicated to sufferers and to the health professionals they are likely to contact.

The diagnostic validity of the criteria for binge eating disorder

OBJECTIVE

This paper considers whether the criteria currently used to classify the diagnosis of binge eating disorder (BED) are valid and appropriate.

METHOD

We review evidence that reflects on the validity of the current criteria for binge eating episodes and BED, using literature retrieved through major psychology and psychiatry search engines (e.g., PsycInfo, PubMed).

RESULTS

Evidence from experimental research points to the relative importance of episode frequency, the amount of food consumed at episodes, the subjective sense of loss of control over eating, and several additional criteria associated with binge episodes in BED. Evidence on the differences in psychopathology between BED and bulimia nervosa and between BED and obesity without binge eating, as related to diagnostic criteria, is reviewed.

CONCLUSION

Although evidence concerning the diagnostic criteria of BED is mixed, broadening certain diagnostic criteria for binge eating episodes and BED might more accurately reflect the research literature and increase the number of individuals eligible for inclusion in treatment programs.

Classification of eating disorders: toward DSM-V

OBJECTIVE

A goal of the DSM-IV revision is to increase clinical and research utility by improving diagnostic validity through reliance on empirical evidence. Currently defined eating disorder (ED) categories have limited validity and require refinement based on data.

METHOD

The available scientific evidence is considered in evaluating the current ED nosology.

RESULTS

Specific recommendations include modifying ED classification by retaining categories but adding a dimensional component; removing the amenorrhea criterion for anorexia nervosa (AN); removing the subtypes for AN and bulimia nervosa (BN); making binge eating disorder (BED) an official diagnosis; and unifying the frequency and duration cut-points for BN and BED to once per week for 3 months. Priority research areas should include epidemiologic studies of full-range ED symptomatology and should focus on empirical validation for individual criterion.

CONCLUSION

There are significant issues to address in revising ED nosology as we move toward a more valid and useful DSM-V.

Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa

OBJECTIVE

To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN).

METHOD

Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating.

RESULTS

In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress.

CONCLUSION

Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood.

Health service utilization for eating disorders: findings from a community-based study

BACKGROUND

Prior use of health services was examined in a community sample of women with bulimic-type eating disorders.

METHOD

Participants (n = 159) completed a structured interview for the assessment of eating disorder psychopathology as well as questions concerning treatment-seeking and type of treatment received.

RESULTS

Whereas a minority (40.3%) of participants had received treatment for an eating problem, most had received treatment for a general mental health problem (74.2%) and/or weight loss (72.8%), and all had used one or more self-help treatments. Where treatment was received for an eating or general mental health problem, this was from a primary care practitioner in the vast majority of cases. Only half of those participants who reported marked impairment associated with an eating problem had ever received treatment for such a problem and less than one in five had received such treatment from a mental health professional.

CONCLUSION

Women with bulimic-type eating disorders rarely receive treatment for an eating problem, but frequently receive treatment for a general mental health problem and/or for weight loss. The findings underscore the importance of programs designed to improve the detection and management of eating disorders in primary care.

Placebo response in binge eating disorder

OBJECTIVE

Placebo response in studies of binge eating disorder (BED) has raised concern about its diagnostic stability. The aims of this study were (1) to compare placebo responders (PRs) with nonresponders (NRs); (2) to investigate the course of BED following placebo response; and (3) to examine attributions regarding placebo response.

METHOD

The baseline placebo run-in phase (BL) was part of a RCT investigating sibutramine hydrochloride for BED; it included 451 participants, ages 19-63, diagnosed with BED. Follow-up (FU) included 33 PRs.

RESULTS

: In this study, 32.6% of participants responded to placebo (PRs = 147; NRs = 304). PRs exhibited significantly less symptom severity. At FU (n = 33), many PRs reported continued symptoms.

CONCLUSION

PRs exhibited significantly less severe pathology than NRs. Placebo response in BED may transitory or incomplete. The results of this study suggest variable stability in the BED diagnosis.

Self-recognition of disordered eating among women with bulimic-type eating disorders: A community-based study

OBJECTIVE

Self-recognition of eating-disordered behavior was examined in a community sample of young adult women (n = 158) with bulimic eating disorders.

METHOD

A vignette was presented describing a fictional person meeting diagnostic criteria for bulimia nervosa. Participants were asked whether they might currently have a problem such as the one described. Scores on measures of eating disorder psychopathology, functional impairment and general psychological distress were compared between participants who recognized a problem with their eating and those who did not.

RESULTS

Participants who recognized a problem with their eating (n = 86, 51.9%) had higher levels of eating disorder psychopathology and general psychological distress, were more likely to engage in self-induced vomiting, and tended to be heavier, than those who did not (n = 72, 48.1%). In addition, participants who recognized a problem were more likely to have received treatment for an eating or weight problem. In multivariate analysis, the occurrence of self-induced vomiting and higher body weight were the only variables significantly associated with recognition.

CONCLUSION

Poor recognition of eating-disordered behavior may be conducive to low or inappropriate treatment seeking among individuals with bulimic- type eating disorders. The perception that only disorders involving self-induced vomiting are pathological may need to be addressed in prevention programs.

Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder

Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".

Binge eating in overweight treatment-seeking adolescents

OBJECTIVE

To examine the frequency and recency of binge eating in relation to psychopathology in overweight, treatment-seeking adolescents.

METHODS

We investigated psychological correlates of the frequency and recency of reported loss of control (LOC) eating episodes in 160 overweight (body mass index [BMI]: 40.7 +/- 8.8 kg/m(2)) adolescents. On the basis of the responses to the eating disorder examination (EDE), participants were categorized into one of four groups: full-syndrome binge eating disorder (BED); recent but infrequent binge eating (episodes within the 3 months before interview; RECENT-BINGE); remote and infrequent LOC eating (episodes occurring >3 months before assessment; PAST-LOC), or no history of LOC episodes (NE).

RESULTS

The BED group reported higher EDE scores (global, p < .01), and more negative mood and anxiety than all other groups (p's < .01). Compared with NE, RECENT-BINGE also reported more anxiety and higher EDE scores (p's < .01).

CONCLUSIONS

Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.

An update on the definition of "excessive exercise" in eating disorders research

OBJECTIVE

The current study informed the definition of "excessive exercise" by examining relations between exercise behavior, eating-disordered behavior, and quality of life (QOL) in a community sample of women.

METHOD

Self-report measures of frequency of exercise, obligatory exercise and motivation for exercise, and of eating disorder psychopathology and QOL, were completed by 3,472 women aged 18-42 years who engaged in regular exercise.

RESULTS

The extent to which exercise is intended to influence weight or shape and the degree to which guilt is experienced when exercise is postponed were the exercise variables most strongly associated with elevated levels of eating disorder psychopathology and reduced QOL. Subgroups of participants who reported exercising solely for weight and shape reasons (n = 322 [9.3%]), intense guilt after postponement of exercise (n = 136 [3.9%]), or both (n = 116 [3.3%]), had markedly elevated levels of eating disorder psychopathology. There was no association between excessive exercise and reduced QOL after the effects of eating disorder psychopathology were statistically controlled.

CONCLUSION

The findings suggest that exercise is excessive when its postponement is accompanied by intense guilt or when it is undertaken solely to influence weight or shape. Operational definitions of excessive exercise might usefully include reference to these terms. The findings may also be of benefit in informing the content of prevention programs, which address dysfunctional exercise behavior. Excessive exercise is unlikely to be associated with impairment in psychosocial functioning in the absence of eating disorder psychopathology. It may, however, be a useful indicator of such psychopathology.

Correlates of the use of purging and non-purging methods of weight control in a community sample of women

OBJECTIVE

To inform the classification of bulimic-type eating disorders, the correlates of purging and non-purging methods of weight control were examined in a large community sample of young adult women reporting recurrent episodes of binge eating.

METHOD

Scores on self-report measures of eating disorder psychopathology, functional impairment and health-service utilization were compared among individuals who reported (recurrent episodes of binge eating and) the use of either purging (self-induced vomiting, laxative or diuretic misuse; n = 41) or non-purging (extreme dietary restriction, excessive exercise, or use of diet pills; n = 62) methods of weight control. Individuals who reported recurrent binge eating in the absence of extreme weight control behaviours (n = 442) were also included in the analysis.

RESULTS

Non-purgers tended to be younger and heavier and have higher levels of eating disorder psychopathology and functional impairment than purgers and non-compensating binge eaters, however these differences were not statistically significant. Purgers were more likely than non-purgers to have sought treatment specifically for a problem with eating, however this difference was no longer significant after age and body mass index were statistically controlled. In multivariate analysis, frequency of extreme dietary restriction was the best predictor of functional impairment.

CONCLUSIONS

These findings call into question the validity of subtyping of bulimia nervosa into purging and non-purging forms as outlined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Correlates of self-induced vomiting and laxative misuse in a community sample of women

The correlates of self-induced vomiting and laxative misuse were examined in a large community sample of young adult women (N = 5255). Scores on measures of eating disorder psychopathology, general psychological distress, functional impairment, as well as the use of health services for an eating or weight problem were compared among participants who reported regular self-induced vomiting, but not laxative misuse (N = 59), and those who reported regular misuse of laxatives, but not vomiting (N = 39). Individuals who misused laxatives were older, perceived poorer physical health, and were less likely to have sought treatment specifically for a problem with eating than those who engaged in self-induced vomiting. In all other respects, the groups were similar. However, individuals who regularly engaged in both forms of purging (N = 8) had particularly high levels of eating disorder and comorbid psychopathology. The perception among women of normal weight that only syndromes involving the use of self-induced vomiting constitute an eating disorder may need to be addressed in prevention programs. The combination of self-induced vomiting and laxative misuse may indicate a particularly severe psychiatric disturbance.

An empirical comparison of atypical bulimia nervosa and binge eating disorder

The International Classification of Diseases, 10th edition (ICD-10) defines atypical bulimia nervosa (ABN) as an eating disorder that encompasses several different syndromes, including the DSM-IV binge eating disorder (BED). We investigated whether patients with BED can be differentiated clinically from patients with ABN who do not meet criteria for BED. Fifty-three obese patients were examined using the Structured Clinical Interview for DSM-IV and the ICD-10 criteria for eating disorders. All volunteers completed the Binge Eating Scale (BES), the Beck Depression Inventory, and the Symptom Checklist-90 (SCL-90). Individuals fulfilling criteria for both ABN and BED (N = 18), ABN without BED (N = 16), and obese controls (N = 19) were compared and contrasted. Patients with ABN and BED and patients with ABN without BED displayed similar levels of binge eating severity according to the BES (31.05 +/- 7.7 and 30.05 +/- 5.5, respectively), which were significantly higher than those found in the obese controls (18.32 +/- 8.7; P < 0.001 and P < 0.001, respectively). When compared to patients with ABN and BED, patients with ABN without BED showed increased lifetime rates of agoraphobia (P = 0.02) and increased scores in the somatization (1.97 +/- 0.85 vs 1.02 +/- 0.68; P = 0.001), obsessive-compulsive (2.10 +/- 1.03 vs 1.22 +/- 0.88; P = 0.01), anxiety (1.70 +/- 0.82 vs 1.02 +/- 0.72; P = 0.02), anger (1.41 +/- 1.03 vs 0.59 +/- 0.54; P = 0.005) and psychoticism (1.49 +/- 0.93 vs 0.75 +/- 0.55; P = 0.01) dimensions of the SCL-90. The BED construct may represent a subgroup of ABN with less comorbities and associated symptoms.

A comparison of quality of life in obese individuals with and without binge eating disorder

OBJECTIVE

This study investigates whether binge eating disorder (BED) in obese individuals is associated with a greater degree of impairment in quality of life (QOL) than obesity alone.

METHOD

Treatment-seeking obese individuals with and without BED were compared on QOL scores using the Impact of Weight on Quality of Life (IWQOL-Lite) questionnaire.

RESULTS

With the exception of the Physical Function subscale, obese individuals with BED scored significantly higher than non-BED participants on each of the subscales and on the total scale of the IWQOL-Lite. For all participants, body mass index (BMI) was related significantly to scores on the Physical Function and Public Distress subscales of the IWQOL-Lite.

DISCUSSION

Obese individuals with BED have impaired functioning on psychosocial aspects of QOL in addition to poorer physical functioning associated with obesity. These findings underscore the pervasive impact of BED in obese individuals, as BED is associated with more impairment than obesity alone.

Psychological Treatment of Eating Disorders

Manual-based cognitive behavior therapy (CBT) is presently the most effective treatment of bulimia nervosa. Its efficacy is limited, however. Different strategies for improving upon current manual-based CBT are discussed, including combining CBT with antidepressant medication, integrating CBT with alternative psychological therapies, and expanding the scope and flexibility of manual-based CBT. CBT is underutilized in clinical practice. Dissemination of evidence-based treatment is a priority. Research on anorexia nervosa is minimal. Effective treatments have yet to be developed, although the Maudsley method of family therapy has shown the most promise in the treatment of adolescents. The most commonly seen eating disorders in clinical practice are those classified as "eating disorder not otherwise specified." With the exception of binge eating disorder (BED), however, they have been neglected by researchers. Several psychological therapies have been shown to be effective in treating BED. Controversy exists over whether treatment-specific effects have been identified. Whereas treatments have proved effective in eliminating binge eating and associated eating disorder psychopathology, achieving clinically significant weight loss remains a challenge.

Adipositas im Kindes- und Jugendalter:

Zusammenfassung. Adipöse Kinder und Jugendliche gelten als Risikogruppe für die Entwicklung von psychosozialen Belastungen, den Einsatz von gesundheitsschädigenden Gewichtskontrollmaßnahmen sowie auffällige Essverhaltensweisen. Dennoch ist relativ wenig über das Auftreten von Heißhungerattacken (“binging“) und Binge Eating Disorder (BED) bei dieser Gruppe bekannt. Die folgende Studie untersuchte bei 156 adipösen Kindern und Jugendlichen (im Alter zwischen 11 und 18 Jahren) die selbstberichtete Verbreitung von “binging“ und BED. Im zweiten Schritt wurde untersucht, inwieweit sich “Binger“ von “non-Bingern“ in der Störbarkeit ihres Essverhaltens, ihrem Selbstkonzept, dem Erleben von Hänseleien und dem Umgang damit unterscheiden, wobei eine erhöhte Auffälligkeit der Binger vermutet wurde. Die Kinder beantworteten ein Fragebogenpaket mit folgenden Instrumenten: QEWP-A (essgestörtes Verhalten), POTS (Hänseleien), Auslöser für Essverhalten, Fragebogen zur Problembewältigung und FSK-K (Selbstkonzept). Die Auftretenshäufigkeit der BED lag bei 3.8%. Insgesamt berichteten jedoch 12.8% der Kinder und Jugendlichen (sog. Binger) von Heißhungerattacken. Diese Gruppe unterschied sich von den non-Bingern weder im Alter, noch im BMI oder in der Geschlechtsverteilung. Erwartungsgemäß berichteten die Binger über eine höhere Auslösbarkeit von Essverhalten sowie ein häufigeres Auftreten von gewichtsbezogenen Hänseleien, unter denen sie auch angaben, vermehrt zu leiden. Beim Umgang mit solchen Hänseleien benutzten Binger darüber hinaus häufiger vermeidende Strategien. Keine Gruppenunterschiede wurden im Selbstwert, der erlebten Attraktivität und schulischen Kompetenz gefunden. Vermeidender Bewältigungsstil sowie hohe Störbarkeit des Essverhaltens erwiesen sich als bedeutsam zur Vorhersage der Gruppenzugehörigkeit. Die Ergebnisse wurden in Bezug auf die Bedeutung von Hänseleien und deren Bewältigung diskutiert.

The relationship between binge eating disorder and non-purging bulimia nervosa

AIMS

To further investigate the differentiation between non-purging bulimia nervosa (BN-NP) and binge eating disorder (BED), particularly as concerns weight-shape overconcern affecting self-esteem, a core belief to both anorexia and bulimia nervosa.

METHODS

Twenty-five female subjects with BN-NP and 25 female subjects with BED, consecutively referred to the Eating Disorder Unit of the DPPhNB, were administered the BEDCI, the EDI-2 and the BUT.

RESULTS

BED patients had a higher BMI (35.5 vs. 23.8 kg/m2, p<0.0001) and were slightly older than BN-NP ones. Weight-shape concerns as one of the main/the most important things influencing self-esteem were reported by 68% of BN-NP patients and 62.5% of BED ones. Age at onset of binge-eating, weight-cycling, overall impairment due to the eating behavior, sexual harassment, depressive and substance abuse comorbidity were equally represented in the two groups of patients. BN-NP patients scored higher than BED ones as regards EDI drive for thinness (p<0.05) and BUT weight phobia (p<0.05), with these scores significantly related to differences in BMI (p<0.0005 and p=0.012). Weight-shape overconcern influencing self-esteem was predictive of an earlier onset of binge-eating (p<0.05) and higher scores at the BUT weight phobia, and body image concerns (p<0.05).

CONCLUSIONS

Differences between BED and BN-NP seem to be more of degree than type and there seems little value in the separation between BED and BN-NP based on weight-shape concerns that substantially impair self-esteem. This construct seems core to both disorders and plays a substantial role in triggering and maintaining the binge-eating cycle.

Eating disorder or disordered eating? Non-normative eating patterns in obese individuals

Binge eating disorder (BED) and night eating syndrome (NES) are putative eating disorders frequently seen in obese individuals. Data suggest that BED fulfills criteria for a mental disorder. Criteria for NES are evolving but at present do not require distress or functional impairment. It remains unclear whether BED and NES, as they are currently defined, are optimally useful for characterizing distinct patient subgroups. We propose that a distinction be made between "eating disorders" and "non-normative" eating patterns without associated distress or impairment. Although non-normative eating patterns may not be considered mental disorders, they may be very important in terms of their impact on body weight and health. More precise behavioral and metabolic characterization of subgroups with eating disorders and non-normative eating behaviors has important implications for understanding the etiology, pathophysiology, and treatment of obesity. Ultimately, better understanding of the many pathways to increased energy intake may lead to targeted strategies for prevention of overweight and obesity in at-risk individuals and populations.

Binge eating and psychological distress: is the degree of obesity a factor?

The purpose of the present study was to examine whether individuals with Binge Eating Disorder (BED) demonstrate comparable levels of eating pathology and psychological distress independent of weight status. Male and female participants with BED (N = 96) completed the Questionnaire on Eating and Weight Patterns-Revised; Beck Depression Inventory (BDI), Symptom Checklist (SCL)-90-Revised, and Eating Disorder Inventory-2 (EDI-2). Participants were divided into categories of normal/overweight, obese, and severely obese based on their body mass index (BMI). Analysis of variance was performed using scores on the psychological measures with subjects grouped according to weight status. Participants with BED did not differ on any of the measures of psychological or eating symptoms regardless of weight status. These results replicate and extend previous findings, suggesting that binge eating pathology independent of weight status, accounts for psychological distress among binge eaters.

A preliminary analysis of binge episodes: comparison of a treatment-seeking sample of Black and White women

OBJECTIVE

This study sought to examine differences in the nutritional composition of binges, both qualitatively and quantitatively, between participants with binge eating disorder (BED) and bulimia nervosa (BN) taken from a sample of treatment-seeking Black and White women. Overall qualitative and quantitative differences between diagnostic categories, regardless of ethnicity, were also explored.

METHOD

Patients seeking treatment for eating disorders were assessed on binge content. Black (n=26) and White (n=26) participants were matched on age and body mass index (BMI).

RESULTS

The binges of individuals with BN were lower in percent protein, but higher in calories, carbohydrates, and sugar, than those individuals with BED. However, there was little difference as a function of ethnicity between treatment-seeking Black and White women.

DISCUSSION

Preliminary data suggest that health professionals are faced with similar binge eating pathology, regardless of ethnicity, despite, probably, etiologic variation. The importance of the role of ethnicity in the expression of eating disorders is discussed.

The clinical significance of binge eating disorder

OBJECTIVE

Current controversy exists regarding the status of binge eating disorder (BED) as a diagnostic entity. A critique of the literature is provided to address the question of whether BED represents a clinically significant syndrome.

METHOD

The scientific evidence is considered through addressing five questions that are key in evaluating the clinical utility of any mental disorder.

RESULTS

Individuals with BED meaningfully differ from individuals without eating disorders, and share important similarities to, yet are distinct from, individuals with anorexia nervosa (AN) and bulimia nervosa (BN). BED is associated with co-occurring physical and mental illnesses, as well as impaired quality of life and social functioning. Questions about the course of the disorder and the optimal treatment regimen for the syndrome need to be explored further.

DISCUSSION

BED's distinctive combination of core eating disorder psychopathology, and other co-occurring physical and psychiatric conditions, impaired psychosocial functioning, and overweight constitute an eating disorder of clinical severity and a significant public health problem.

Binge eating in children and adolescents

OBJECTIVE

To establish what is known about binge eating in children and adolescents and to identify unresolved questions.

METHOD

We reviewed relevant studies to highlight and synthesize salient research findings.

DISCUSSION

Available research has suggested that loss of control over eating may be more important than consumption of an objectively large amount of food in the assessment of binge eating in children. In addition, dieting may not be associated consistently with binge eating in children. Behavioral correlates of binges may include eating in the absence of hunger, eating in response to strong emotions or external cues, and eating in secret. On the basis of available research, provisional research criteria for binge eating disorder (BED) in children are suggested to stimulate further study of pediatric samples. We emphasize the need for prospective studies on the relationships among aberrant eating, weight and mood, and the inclusion of boys and girls of different ethnicities.

Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder

This study compared patients with bulimia nervosa (BN), obese patients with binge eating disorder (BED), and nonobese patients with BED. One hundred sixty-two adult women consecutively evaluated for outpatient clinical trials who met DSM-IV criteria for BN, purging type (N = 46) or for BED (N = 79 obese and N = 37 nonobese) were compared using the Eating Disorder Inventory (EDI). The three groups differed significantly on two (drive for thinness and body dissatisfaction) of the three eating-related scales and on all five of the general personality scales of the EDI. When age and depression level were controlled, findings for the eating-related scales did not change, whereas four of the five general personality scales were no longer significant. Post hoc analyses revealed that the BN group and the nonobese BED group had significantly higher drive for thinness than the obese BED group. The nonobese and the obese BED groups did not differ from each other in any area (other than drive for thinness), including body dissatisfaction. The nonobese and the obese BED groups had significantly lower maturity features than the BN group. Our findings suggest that when the effects of age and depression levels are controlled, treatment-seeking women with BN and BED are generally similar. Certain differences that do exist between women with BN and BED are associated with obesity status (drive for thinness), whereas others are associated with diagnosis (body dissatisfaction, maturity fears).

Psychiatric comorbidity in a Brazilian sample of patients with binge-eating disorder

We compared sociodemographic characteristics and psychiatric status in obese Brazilian patients who did (n=32) and did not (n=33) meet DSM-IV criteria for binge-eating disorder (BED). The sample's mean age was 35.0 years (+/-10.5), with 92.3% of individuals being female and 41.5% having some higher education. Obese binge eaters (OBE) were significantly more likely than obese non-binge eaters to meet criteria for a current diagnosis of any axis I disorder, any mood disorder and any anxiety disorder. Specifically, OBE patients were characterized by significantly higher rates of current and lifetime histories of major depressive disorder. Similar to patients from developed countries, Brazilian patients with BED display increased rates of psychiatric comorbidity, particularly mood and anxiety disorders.

Aspectos psiquiátricos da obesidade

Pesquisas recentes mostram que a obesidade é, em grande parte, o produto da vulnerabilidade genética mediada por um ambiente promotor da doença, o que sugere que os modelos biológicos podem ser mais úteis que os psicológicos para entender seu início e manutenção. No entanto, entre os pacientes que procuram tratamento, a obesidade tem sido associada a outros transtornos psiquiátricos, especialmente à depressão, o que sugere que a comorbidade psiquiátrica deve ser considerada na avaliação e no manejo clínicos. Além disso, embora a obesidade não seja em si mesma um transtorno alimentar, um subgrupo de indivíduos obesos, incluídos aqueles com o transtorno de compulsão alimentar periódica (TCAP) e com a síndrome do comer noturno - SCN (night eating syndrome - NES) sofrem de transtornos alimentares. Os psiquiatras podem e devem ter um papel ativo no tratamento da comorbidade ou de patologias relacionadas à alimentação e no auxílio aos pacientes obesos para que façam escolhas de estilos de vida saudáveis que levem a um maior bem-estar em termos físicos e psicológicos.

Self-harm and substance use in a community sample of Black and White women with binge eating disorder or bulimia nervosa

OBJECTIVE

This study evaluated rates of self-harm and substance use in women with either bulimia nervosa (BN) or binge eating disorder (BED) and assessed whether differences in self-harm and substance use are related to sexual or physical abuse.

METHOD

Alcohol abuse, self-harm, and use or abuse of various illicit drugs were evaluated in a sample of 53 women with BN and 162 women with BED.

RESULTS

Self-harm and substance use generally did not differentiate BED and BN cases, but rates of self-harm and substance use were elevated among women with a history of sexual or physical abuse relative to women without such a history.

DISCUSSION

Elevated rates of self-harm and substance use may not be related uniquely to BN diagnostic status, but may be related to a characteristic shared by women with BN and BED, such as a history of sexual or physical abuse.

Epidemiologia dos transtornos alimentares: estado atual e desenvolvimentos futuros

Os objetivos do presente trabalho foram: fornecer uma avaliação do progresso da epidemiologia na área de transtornos alimentares, desde estudos sobre incidência e prevalência até os estudos comunitários prospectivos, bem como estudos caso-controle; sintetizar o atual estado da incidência e prevalência dos transtornos alimentares; discutir os estudos epidemiológicos analíticos sobre os transtornos alimentares, enfocando estudos comunitários sobre fatores de risco e nosologia; e apontar as áreas de estudos futuros, especialmente sobre a carga social e econômica e o grau de "conhecimento sobre saúde mental" da população em geral a respeito das pessoas com transtornos alimentares. Apesar dos problemas para identificar e recrutar um número suficiente de pessoas com anorexia nervosa e os métodos variáveis de recrutamento de casos, os estudos sobre incidência e prevalência dos transtornos alimentares atingiram um consenso e em geral não corroboram uma incidência ascendente atual, exceto, possivelmente, por um pequeno aumento na anorexia nervosa em mulheres jovens. A aplicação de métodos epidemiológicos analíticos permitiu uma compreensão melhor dos fatores ambientais e genéticos, em comparação com os sociais e econômicos, quanto ao risco de desenvolvimento de transtornos alimentares, bem como ajudaram no refinamento da nosologia desses transtornos. Futuramente, a epidemiologia analítica terá potencial para responder a questões-chave sobre a natureza e os determinantes dos transtornos alimentares e para ajudar a decidir como auxiliar os que mais necessitem.