The assessment of binge eating severity among obese persons

Bulimia nervosa: group behavior therapy with exposure plus response prevention

Exposure plus response prevention has been demonstrated to be effective in the treatment of bulimia nervosa. However, when done individually, it is labor intensive and cost-ineffective. In the present study exposure plus response prevention was used in the context of a 6-wk., 12-session behavioral group. In addition to the exposure plus response-prevention component, other techniques included self-monitoring, cognitive restructuring, eating-habit stabilization and problem-solving. Eight bulimic women, vomiting a minimum of five times per week for at least a year, participated in the group. At the end of treatment significant reductions in bingeing and vomiting behaviors were reported by all but one subject, substantiated by significantly lower depression scores (Beck Depression Inventory) and binge-eating scores (Binge Eating Scale). At 6 mo. and 1 yr. posttreatment, 6 of 8 subjects reported averaging less than one binge-purge episode per week, one subject continued unchanged, and one subject had relapsed. A group of wait-list control subjects reported essentially no change in binge-purge frequency over the treatment period. Exposure plus response prevention conducted in a behavioral group context appears to be a cost-effective alternative to individual treatment.

The validity of the eating disorder examination and its subscales

The EDE is a semistructured interview which has been developed as a measure of the specific psychopathology of anorexia nervosa and bulimia nervosa. To establish its discriminant validity it was administered to 100 patients with anorexia nervosa or bulimia nervosa and to 42 controls. The two groups differed significantly on all items. Five subscales were derived on rational grounds and evaluated on the two populations. The alpha coefficients for each subscale indicated a satisfactory degree of internal consistency. The EDE provides clinicians and research workers with a detailed and comprehensive profile of the psychopathological features of patients with eating disorders.

Body weight: relationship to conversational distance and self-actualization

Body weight is a major concern for women. This study investigated the relationship between body weight deviation, perceived effect of weight, conversational distance, and self-actualization in healthy caucasian college women (N = 109) between the ages of 18 and 50. The perception of body weight was measured with a structured questionnaire. Conversational distance was measured by having the participant approach the investigator, and self-actualization was determined using the Personal Orientation Inventory (POI). Significant correlations were found between the Time Competence (TC) subscale of the POI and Perceived Effect (PE) and between conversational distance and TC. Further analysis of the data revealed a relationship between body weight deviation, using the actual deviation from the norm, and the combined effect (magnitude and direction) of body weight (r = .54, p less than .001). Path analysis revealed the multidimensional nature of the issue of body weight for women. The usual assumptions about body fat for women are questioned and implications for future research are discussed.

Validity, reliability, and factor structure of the Anorectic Cognitions Questionnaire

Several authors have hypothesized cognitive distortion as central to the psychopathology of anorexia nervosa and bulimia. However, there have been few investigations of these hypotheses. Equally as important, psychometrically sound devices for assessing these cognitions are notably lacking. The purpose of this investigation is to examine the psychometric characteristics of the Anorectic Cognitions Questionnaire (MAC). This study reports on initial item development, initial concurrent validity, factor structure, initial item refinement, and internal consistency. Results indicated that the MAC has good concurrent validity, three theoretically defined factors were empirically supported, and the scale is internally consistent.

Bulimia nervosa and dietary restraint

Patients with bulimia nervosa were compared with non-bulimic restrained and unrestrained eaters on several questionnaire and interview measures related to eating patterns, preoccupation with dieting and food, and general psychopathology. Bulimic subjects did not differ significantly from non-bulimic restrained eaters on measures of fear of weight gain, dietary restraint, and the Eating Disorders Inventory (EDI) subscales of Drive for Thinness and Body Dissatisfaction, although both groups scored significantly higher on these measures than unrestrained eaters. Subjects with bulimia nervosa differed significantly from both restrained and unrestrained eaters on the Eating Habits Checklist, the Beck Depression Inventory, the EDI total score and Interoceptive Awareness, Introversion and Bulimia subscales, the Three Factor Eating Questionnaire (TFEQ), Disinhibition subscale and the Symptom Checklist 90-revised version. These findings show that bulimic patients may be quite similar to their restrained, non-bulimic counterparts on dietary concern and ideals of slenderness and suggest the importance of including a restrained control group in attempts to isolate the variables that differentiate individuals with the clinical eating disorder from their peers who demonstrate normative discontent about body weight and shape.

Assessment of disordered eating in females: instrument validation

The purpose of this study was to validate an instrument capable of assessing 10 dimensions related to disordered eating and weight control behaviors. All subjects were female and ranged in age from 14 to 40. Of these females 68 were bulimics, 12 were compulsive eaters, and 24 eating disorders. The Disordered Eating and Weight Control Instrument (DEWCI) was administered. Differences between the groups were investigated by constructing three dummy variables contrasting the groups, correlating the scales with the dummy variables, and determining which correlations were significant. Eight of the DEWCI scales significantly (p less than .005) differentiated between the three groups. This instrument may therefore have utility for use with female populations.

Self-efficacy, standards, and abstinence violation: a comparison between newly sober and long-term sober alcoholics

Recent theory and empirical data suggest that self-efficacy plays an important role in resistance to relapse for substance abusers. Another key in the relapse process, according to Marlatt and Gordon (1985), is the abstinence violation effect, which comprises self-attribution for failure and affective reaction to violation of self-imposed standards. The combination of unrealistically high standards and low self-efficacy for following those standards may potentiate the risk for relapse. A 25-item questionnaire designed to assess self-efficacy and standards was administered to alcoholics newly admitted to an inpatient treatment program and alcoholics who had been sober for at least 1 year. The groups did not differ with regard to having high standards, but the successfully abstinent alcoholics had significantly higher self-efficacy expectations than the newly sober alcoholics. These results suggest that treatment programs may need to include interventions which decrease unrealistic standards as well as those designed to increase self-efficacy expectations.

Emotional reactivity and eating in binge eating and obesity

The present study investigated daily mood fluctuations and moods during eating in normal and overweight binge and nonbinge eaters (N = 56) and moods during binge and nonbinge episodes of individuals who binge eat (N = 29). For 2 weeks, subjects completed the Multiple Affect Adjective Checklist each morning and continuously recorded the mood during eating and the type and quantity of food eaten during each eating episode. The results indicated that bingers experience greater fluctuations of anxiety and depression than nonbingers and overweight individuals experience greater fluctuations in anxiety, hostility, and depression than normal-weight individuals. In addition, for bingers, negative mood states are experienced during a significantly greater proportion of binge episodes than nonbinge episodes, although the intensity of the negative mood state was not related to the severity of the binge-eating episode. Theoretical and clinical implications of these findings are discussed.

Bulimia: a case illustration of the superiority of behavioral over cognitive treatment

The present study compared the relative efficacy of two major clinical procedures previously used in multicomponent cognitive-behavioral programs for treating bulimia. A single-subject experimental design was used and the results showed that the behavioral procedure of exposure plus response prevention was more effective than the cognitive procedure in reducing binge and vomit episodes as well as the urges to binge-vomit. These results suggest that the exposure plus response prevention component is more relevant for cognitive as well as behavioral changes in treating bulimia.

Alcohol use and depression in women with bulimia

In a preliminary study examining affective and addictive components of the bulimia syndrome, individual tendencies toward alcohol abuse and depression as well as family histories of alcoholism and affective disorder were examined. Twelve women meeting DSM-III criteria for bulimia and 12 matched controls participated in the investigation. Bulimic women were significantly more depressed than controls. Although there were no significant differences in global alcoholism scores, a subgroup of bulimics emerged for whom bulimia was one of multiple and debilitating addictions. In addition, bulimic women evidenced a significantly greater family history of alcoholism than controls. Bulimia is described as a disorder with salient disruptions in eating behavior yet strongly influenced by affective and addictive components.

The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger

This report describes the construction of a questionnaire to measure three dimensions of human eating behavior. The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts. This version was administered to several populations selected to include persons who exhibited the spectrum from extreme dietary restraint to extreme lack of restraint. The resulting responses were factor analyzed and the resulting factor structure was used to revise the questionnaire. This process was then repeated: administration of the revised questionnaire to groups representing extremes of dietary restraint, factor analysis of the results and questionnaire revision. Three stable factors emerged: (1) 'cognitive restraint of eating', (2) 'disinhibition' and (3) 'hunger'. The new 51-item questionnaire measuring these factors is presented.

Binge eating and dietary restraint in obese patients

The present study was conducted to determine the prevalence and severity of binge eating among 432 women seeking behavioral treatment for obesity and to assess the relationship between binge eating and dietary restraint. Subjects completed standardized self-report questionnaires which assessed the severity of binge eating and habitual dietary restraint. Binge eating was extremely prevalent, with 46% of subjects reporting serious problems. Serious binge eating was more common in younger and heavier subjects. Further, binge eating severity was significantly related to overall dietary restraint. The current findings indicate that the treatments of binge eating may need to be considered in planning behavioral programs for the obese.

The topography of binge eating

The present study investigated the topography of binge eating by comparing characteristics of eating episodes recorded by individuals who engage in binge eating (n = 29) with those who do not (n = 27), and characteristics of binge and non-binge episodes recorded by individuals who binge eat. For 2 weeks, subjects continuously recorded the type and quantity of food eaten during each eating episode, time and place of consumption, number of persons present, mood while eating, and whether the food eaten was part of a meal or snack. Results indicated binge eaters experienced negative moods during a significantly greater proportion of their eating episodes than non-binge eaters. Within the group of binge eaters, negative moods were experienced during a significantly greater proportion of binge episodes than non-binge episodes. Furthermore, binge episodes occurred significantly more often than non-binge episodes from 6:00 to 12:00 p.m. and significantly less often at appropriate places. Clinical implications of these findings are discussed.

Personality and eating habit variables as predictors of severity of binge eating and weight

The present study investigated several personality and eating habit variables as predictors of the severity of binge eating and weight deviation. Subjects were 120 normal weight and overweight undergraduate women selected to vary along predetermined dimensions of weight and severity of binge eating. After providing relevant demographic and life history data, they completed a series of self-report questionnaires. Results of a canonical analysis support the independence of binge eating and weight. Two stepwise multiple regressions indicated that anorexic-like eating attitudes, dissatisfaction with body image, and poor self-image were significant predictors of the severity of binge eating while none of the measures was a significant predictor of weight deviation. The amount of stress experienced in the past year was found to be the only significant demographic/historical predictor of binge eating. These findings are discussed with respect to their implications for current understanding of the binge eating phenomenon.