Eating pathology, emotion regulation, and emotional overeating in obese adults with Binge Eating Disorder

Emotion regulation in disordered eating: Psychometric properties of the Difficulties in Emotion Regulation Scale among Spanish adults and its interrelations with personality and clinical severity

Objective: The aims of the study were to (1) validate the Difficulties in Emotion Regulation Scale (DERS) in a sample of Spanish adults with and without eating disorders, and (2) explore the role of emotion regulation difficulties in eating disorders (ED), including its mediating role in the relation between key personality traits and ED severity.

Methods: One hundred and thirty four patients (121 female, mean age = 29 years) with anorexia nervosa (n = 30), bulimia nervosa (n = 54), binge eating (n = 20), or Other Specified Feeding or Eating Disorders (n = 30) and 74 healthy control participants (51 female, mean age = 21 years) reported on general psychopathology, ED severity, personality traits and difficulties in emotion regulation. Exploratory and confirmatory factor analyses were conducted to examine the psychometrics of the DERS in this Spanish sample (Aim 1). Additionally, to examine the role of emotion regulation difficulties in ED (Aim 2), differences in emotion regulation difficulties across eating disorder subgroups were examined and structural equation modeling was used to explore the interrelations among emotion regulation, personality traits, and eating disorder severity.

Results: Results support the validity and reliability of the DERS within this Spanish adult sample and suggest that this measure has a similar factor structure in this sample as in the original sample. Moreover, emotion regulation difficulties were found to differ as a function of eating disorder subtype and to mediate the relation between two specific personality traits (i.e., high harm avoidance and low self-directedness) and ED severity.

Conclusions: Personality traits of high harm avoidance and low self-directedness may increase vulnerability to ED pathology indirectly, through emotion regulation difficulties.

Binge-eating disorder diagnosis and treatment: a recap in front of DSM-5

INTRODUCTION

Binge Eating Disorders is a clinical syndrome recently coded as an autonomous diagnosis in DSM-5. Individuals affected by Binge Eating Disorder (BED) show significantly lower quality of life and perceived health and higher psychological distress compared to the non-BED obese population. BED treatment is complex due to clinical and psychological reasons but also to high drop-out and poor stability of achieved goals. The purpose of this review is to explore the available data on this topic, outlining the state-of-the-art on both diagnostic issues and most effective treatment strategies.

METHODS

We identified studies published in the last 6 years searching the MeSH Term "binge eating disorder", with specific regard to classification, diagnosis and treatment, in major computerized literature databases including: Medline, PubMed, PsychINFO and Science Direct.

RESULTS

A total of 233 studies were found and, among them, 71 were selected and included in the review.

REVIEW

Although Binge Eating Disorder diagnostic criteria showed empirical consistency, core psychopathology traits should be taken into account to address treatment strategies. The available body of evidence shows psychological treatments as first line interventions, even if their efficacy on weight loss needs further exploration. Behavioral and self-help interventions evidenced some efficacy in patients with lower psychopathological features. Pharmacological treatment plays an important role, but data are still limited by small samples and short follow-up times. The role of bariatric surgery, a recommended treatment for obesity that is often required also by patients with Binge Eating Disorder, deserves more specific studies. Combining different interventions at the same time does not add significant advantages, planning sequential treatments, with more specific interventions for non-responders, seems to be a more promising strategy.

CONCLUSIONS

Despite its recent inclusion in DSM-5 as an autonomous disease, BED diagnosis and treatment strategies deserve further deepening. A multidisciplinary and stepped-care treatment appears as a promising management strategy. Longer and more structured follow-up studies are required, in order to enlighten long term outcomes and to overcome the high dropout rates affecting current studies.

Binge eating in bariatric surgery candidates: The role of insecure attachment and emotion regulation

Binge eating has a high prevalence among bariatric patients and is associated with post-surgical weight gain. This study examined the potential mediating role of emotion regulation difficulties in the relation between attachment insecurity and binge eating among this population. Participants were 1388 adult pre-bariatric surgery candidates from an accredited bariatric surgery assessment centre in Toronto, Ontario. Participants completed measures of psychological functioning, including attachment style and emotion regulation. Mediation analyses revealed that difficulties with emotion regulation mediated a positive association between insecure-anxious attachment and binge eating. An insecure-avoidant attachment was found to have a non-significant association with binge eating when examining the total effect. However, when difficulties with emotion regulation were controlled for in the model to examine its role as a mediator, this association became significant, and emotion regulation difficulties also mediated the relationship between attachment avoidance and binge eating. These findings suggest that difficulties in emotion regulation may be an important clinical issue to address in order to reduce binge eating in adult bariatric surgery candidates.

Recognizing disordered eating in primary care patients with obesity

OBJECTIVE

In clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes.

METHODS

We conducted a telephone interview of 337 primary care patients aged 18-65 years with BMI ≥ 35 kg/m(2) in Greater Boston, 2009-2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (scores 0-100) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) (scores 0-100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0-10).

RESULTS

50% of the patients reported high emotional eating (score>50) and 28% reported high uncontrolled eating (score>50). Women were more likely to report emotional [OR=4.14 (2.90, 5.92)] and uncontrolled eating [OR=2.11 (1.44, 3.08)] than men. African-Americans were less likely than Caucasians to report emotional [OR=0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR=0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes.

SUMMARY

Disordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly.

Hoarding and eating pathology: the mediating role of emotion regulation

Hoarding disorder is characterized by persistent difficulty discarding possessions resulting in clutter that precludes one from using living areas for their intended purposes. The limited empirical work available has suggested a strong link between hoarding and various non-psychiatric conditions, including obesity. Despite these associations, no research has examined the link between hoarding and other forms of eating pathology including symptoms associated with binge eating. Moreover, little is known about mechanisms that may account for this relationship. The current study examined the associations between hoarding severity, obesity, and symptoms associated with binge eating in a sample (N=97) of individuals with elevated hoarding symptoms. Results revealed that hoarding severity was associated with increased body mass index (BMI) and symptoms of binge eating. In addition, difficulties regulating emotions mediated the association between hoarding and eating concerns. Considering the lack of information on hoarding behaviors, as well as its classification as a new diagnosis within DSM-5, these findings add considerably to a growing body of literature on hoarding disorder.

Factor structure and clinical utility of the Beck depression inventory in patients with binge eating disorder and obesity

OBJECTIVE

The Beck Depression Inventory (BDI) is often used to assess depression symptoms, but its factor structure and its clinical utility have not been evaluated in patients with binge eating disorder (BED) and obesity.

METHODS

A total of 882 treatment-seeking obese patients with BED were administered structured interviews (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders) and completed self-report questionnaires.

RESULTS

Exploratory and confirmatory factor analyses supported a brief 16-item BDI version with a three-factor structure (affective, attitudinal and somatic). Both 21- and 16-item versions showed excellent internal consistency (both α=0.89) and had significant correlation patterns with different aspects of eating disorder psychopathology; three factors showed significant but variable associations with eating disorder psychopathology. Area under the curves (AUC) for both BDI versions were significant in predicting major depressive disorder (MDD; AUC=0.773 [16-item], 73.5% sensitivity/70.2% specificity, AUC=0.769 [21-item], 79.5% sensitivity/64.1% specificity) and mood disorders (AUC=0.763 [16-item], 67.1% sensitivity/71.5% specificity, AUC=0.769 [21-item], 84.2% sensitivity/55.7% specificity). The 21-item BDI (cutoff score ≥16) showed higher negative predictive values (94.0% vs. 93.0% [MDD]; 92.4% vs. 88.3% [mood disorders]) than the brief 16-item BDI (cutoff score ≥13).

CONCLUSIONS

Both BDI versions demonstrated moderate performance as a screening instrument for MDD/mood disorders in obese patients with BED. Advantages and disadvantages for both versions are discussed. A three-factor structure has potential to inform the conceptualization of depression features.

Examining substance use and affective processes as multivariate risk factors associated with overweight body mass among treatment-seeking smokers

Cigarette smoking and obesity are two major public health problems. However, factors related to the underlying risk for being overweight are not well established. Certain demographic, smoking, and psychological factors have been linked to overweight/obese body mass. The current study examined a multivariate risk model, stratified by gender, in order to better explicate the nature of overweight body mass among daily smokers. In a sample of treatment-seeking smokers (n = 395), among males and females, (1) older age, (2) stronger expectancies about the weight/appetite control effects of smoking, (3) greater smoking-based inflexibility/avoidance due to smoking-related sensations, and (4) less problematic alcohol use, were associated with being overweight. Additionally, among males, having a tobacco-related medical problem and higher tolerance for physical discomfort aided in the discriminant function model for classifying smokers as overweight. Together, numerous cognitive-affective vulnerabilities and smoking processes may be targetable and potentially inform weight-related prevention programs among smokers.

Examination of the difficulties in emotion regulation scale and its relation to disordered eating in a young female sample

OBJECTIVE

Difficulties with emotion regulation is considered an important maintaining factor of disordered eating. One of the most commonly used measures of this construct is the Difficulties in Emotion Regulation Scale (DERS). The aim of this study was to explore the factor structure of this measure in young females and to examine its reliability and validity with respect to disordered eating.

METHOD

Females aged 17-25 years (M age = 19.6 years, N = 486) were examined in the analyses. Confirmatory factor analyses were conducted followed by regression analyses examining the DERS subscales as predictors of eating disorder severity and disordered eating behaviors.

RESULTS

The original 6-factor 36-item model did not fit well and analyses indicated a 6-factor 30-item solution was a more suitable fit for our population. Validity and reliability of the 30-item solution were found to be acceptable. Regression analyses also indicated the 36- and 30-item models were able to adequately predict eating disorder severity and disordered eating behaviors with the "Awareness" and "Goals" subscales being predictors of the former, and the "Impulsivity" subscale being a significant predictor of the latter.

DISCUSSION

The overall findings suggest that an abbreviated version of the DERS might be more appropriate than the original version with young females and that this measure exhibits stronger relationships with eating disorder severity and disordered eating behaviors than the longer version. Further examinations of the psychometric properties of the DERS with clinical populations are indicated.

Acceptance and Commitment Therapy for Individuals With Problematic Emotional Eating

Emotional eating is characterized by eating in response to intense inner emotions, not hunger. This case-series study presents the outcomes from two adults with problematic emotional eating who voluntarily participated in 10 weekly sessions of Acceptance and Commitment Therapy. Emotional eating was self-monitored daily prior to and throughout the course of treatment. The average number of emotional eating episodes reported weekly across participants at pre-treatment was nine, which decreased to one per week at post-treatment, and was two per week at follow-up. Both participants also showed improvements in body image flexibility, a theoretically consistent process of change, and these improvements were maintained at 3-month follow-up. The results are discussed as well as implications for clinical practice and future research.