Assessment of bulimia nervosa: a comparison of interview and self-report questionnaire methods

Loss of Control over Eating, Inhibitory Control, and Reward Sensitivity in Children and Adolescents: A Systematic Review

OVERVIEW

In recent years, there has been increasing clinical and empirical interest in the concept of pediatric loss of control over eating, particularly about its link with the executive functions related to the concept of impulsivity, such as inhibitory control and reward sensitivity. However, there has yet to be a comprehensive literature synthesis about the associations between these variables. A comprehensive literature synthesis would help identify future research directions to advance the field in this area. Therefore, this systematic review aimed to synthesize evidence concerning the associations between loss of control over eating, inhibitory control, and reward sensitivity in children and adolescents.

METHODS

The systematic review was conducted according to the guidelines proposed by PRISMA in Web of Science, Scopus, PubMed, and PsycINFO. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias.

RESULTS

Twelve studies met the selection criteria and were included in the final review. Overall, methodological heterogeneity, variability in assessment methods, and the age of participants make it difficult to draw general conclusions. Nevertheless, most studies with community samples of adolescents indicate that inhibitory control difficulties are linked to the concept of loss of control eating. The presence of obesity seems to be associated with inhibitory control difficulties, regardless of the presence of loss of control eating. Studies on reward sensitivity are scarcer. However, it has been suggested that higher reward sensitivity is related to loss of control eating behaviors in young people, particularly binge eating.

CONCLUSIONS

The literature on the link between loss of control eating and trait-level facets of impulsivity (low inhibitory control and higher reward sensitivity) among young people remains limited, and more studies on children are needed. Findings from this review may make healthcare professionals more aware of the potential clinical importance of targeting the trait-level facets of impulsivity and help to inform existing and future weight-loss/maintenance interventions in childhood and adolescence.

Traditional versus developmental measures of weight suppression: Exploring their relationships with bulimic psychopathology

OBJECTIVE

Weight suppression (WS) is related to a wide variety of eating disorder characteristics. However, individuals with eating disorders usually reach their highest premorbid weight while still developing physically. Therefore, a more sensitive index of individual differences in highest premorbid weight may be one that compares highest premorbid z-BMI to current z-BMI (called developmental weight suppression [DWS] here).

METHOD

In this exploratory study, we compared the relationships between traditional weight suppression (TWS) and DWS and a variety of measures related to bulimic psychopathology in 91 females (M age, 25.2; 60.5% White), with clinical or sub-clinical bulimia nervosa.

RESULTS

TWS and DWS were correlated (r = 0.40, p < 0.001). TWS was only significantly related to a measure of physical activity whereas DWS was related to 14 outcomes. DWS showed consistent positive relations with behavioural outcomes (e.g., binge eating) but consistent negative relations with cognitive/affective outcomes (e.g., weight concerns).

CONCLUSIONS

Findings indicated much more consistent relationships between the novel DWS measure and bulimic characteristics than with the TWS measure. DWS showed both positive and negative relations with bulimic symptoms, though these findings require replication to confirm their validity. Consistent evidence indicated that the two WS measures served as mutual suppressor variables.

Disordered eating and eating disorders among women seeking fertility treatment: A systematic review

The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.

Using shape and weight overvaluation to empirically differentiate severity of other specified feeding or eating disorder

BACKGROUND

Although no severity specifiers are noted in the Diagnostic and Statistical Manual of Mental Disorders - 5 for other specified feeding or eating disorder (OSFED), shape/weight overvaluation is a proposed eating disorder (ED) severity specifier. We used structural equation modeling (SEM) Trees to empirically determine values of shape/weight overvaluation that differentiate OSFED severity. We additionally tested whether the SEM Tree-defined thresholds or a clinical cutoff for shape/weight overvaluation differentiated severity more meaningfully.

METHODS

Participants were 690 females with OSFED presenting to residential ED treatment. SEM Tree analyses specified an outcome model of OSFED severity and then recursively partitioning the outcome model into severity groups. The SEM Tree-defined and clinical cutoff severity groups were compared on clinical characteristics.

RESULTS

SEM Trees identified one split that occurred at value 5.12 on our shape/weight overvaluation items from the Eating Disorder Examination Questionnaire. The subgroup with higher overvaluation had significantly greater intensity of ED and depressive symptoms and longer lengths of stay. The subgroups created from the shape/weight overvaluation clinical-cut off value of 4 differed on the same clinical characteristics as the SEM Tree-derived groups, with the exception of laxative use frequency. Effect sizes were larger for the clinical cutoff as compared to the SEM Tree severity specification scheme.

LIMITATIONS

These cross-sectional data were used from a predominately white and female residential treatment sample; this likely skewed the subgroups and may limit generalizability.

CONCLUSIONS

Shape/weight overvaluation can meaningfully differentiate OSFED severity. The clinical cutoff slightly outperformed the empirically determined thresholds for shape/weight overvaluation.

Implementing evidence-based individual psychotherapies for adults with eating disorders in a real world clinical setting

OBJECTIVE

This study aimed to evaluate the effectiveness of evidenced-based psychological treatments (specifically, Cognitive-Behaviour Therapy for Eating Disorders [CBT-ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology.

METHOD

Three hundred and seventy-nine participants meeting criteria for DSM-5 anorexia nervosa, bulimia nervosa, binge-eating disorder or other specified feeding or eating disorder completed pre- and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging.

RESULTS

Ninety seven percent of participants received treatment in line with evidence-based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m² over treatment, with similar outcomes for MANTRA and CBT-ED.

DISCUSSION

These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence-based psychotherapies to real-world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders.

Heart Rate Variability Reactivity to Food Image Stimuli is Associated with Body Mass Index

Appetitive control is driven by the hedonic response to food and affected by several factors. Heart rate variability (HRV) signals have been used to index autonomic activity and arousal levels towards visual stimuli. The current research aimed to examine the influence of body mass index (BMI), disordered eating behaviors, and sex on the HRV reactivity to food in a nonclinical sample. Thirty-eight healthy male and sixty-one healthy female participants completed questionnaires assessing disordered eating symptoms. HRV was recorded when the participants received visual stimuli of high-calorie food, neutral and negative emotional signals. Generalized estimating equation models were used to investigate the associations between HRV, BMI, disordered eating behaviors, and sex across the three stimulus types. Male participants demonstrated a higher ratio of low-frequency power to high-frequency power (LF/HF) than females across all the stimulus types. An increase in LF/HF reactivity to food signals was observed in all the study subjects. The moderation effect of BMI on LF/HF in response to food signals was also observed. Our study suggests that body weight may play a role in the interaction between sympathetic activity and food stimuli; however, how the interaction between sympathetic activity and food stimuli contributes to diet control warrants further investigation.

Comparison of Interview to Questionnaire for Assessment of Eating Disorders after Bariatric Surgery

The Eating Disorder Examination Interview Bariatric Surgery Version (EDE-BSV) assesses eating pathology after bariatric surgery but requires significant training and time to administer. Consequently, we developed a questionnaire format called the Eating Disorders After Bariatric Surgery Questionnaire (EDABS-Q). This study evaluates the consistency of responsiveness between the two formats. After surgery, 30 patients completed the EDE-BSV and EDABS-Q in a restricted randomized design. Patient reported behavior for each item which was converted to a score following the Eating Disorder Examination-Questionnaire (EDE-Q) scoring scheme. Responses fell into three distributions: (1) dichotomous, (2) ordinal, or (3) unimodal. Distributions of items were not different between the two formats and order did not influence response. Tests of agreement (normal approximation of the binomial test) and association (χ² analyses on binary data and spearman rank order correlations on ordinal items) were performed. Percent concordance was high across items (63-100%). Agreement was significant in 31 of 41 items (Bonferroni-P < 0.001). Association was significant in 10 of 21 in χ²-appropriate items (Bonferroni-P < 0.002), and the ordinal items had highly significant correlations between formats (Bonferroni-P < 0.0125). The EDABS-Q is an adequate substitute for the EDE-BSV and may be useful for research and clinical evaluation of eating pathology after bariatric surgery.

Psychoform and somatoform dissociation among individuals with eating disorders

Objective: This study analyzed the prevalence of psychoform and somatoform dissociation among individuals with the whole spectrum of eating disorder diagnoses and compared it with ratings from a non-clinical group. The relationship between dissociation and severity of eating disturbance was examined as well as differences between the eating disorder diagnosis groups in extent of dissociation. The validity of a new structural dissociation interview suitable for eating disorder patients was analyzed.Method: Sixty individuals with eating disorder completed three self-report questionnaires: Dissociation Questionnaire Sweden, Somatoform Dissociation Questionnaire and Eating Disorder Examination Questionnaire. The ratings were compared with the scores in a female non-clinical group (N = 245). Twenty patients with eating disorder diagnoses were interviewed with the Interview for Dissociative Disorders and Trauma Related Symptoms. The validity of the interview was tested by comparing the ratings on the interview subscales with the scores on the Dissociation questionnaires and the Somatoform Dissociation Questionnaire.Results: Participants with eating disorders reported a higher extent of both psychoform and somatoform dissociation compared with the non-clinical individuals. Analyses also showed a correlation between degree of dissociation and severity of eating disorder symptoms. No differences in dissociation were found between the ED subgroups. Participants reporting more dissociation got higher ratings on the interview, indicating convergent validity.Discussion: Eating disorders seem to be associated with presence and severity of dissociative symptoms. The extent of dissociation needs to be assessed for these individuals as treatment may benefit from a focus on such symptoms in order to increase its effect.

Long-term outcome of inpatients with bulimia nervosa-Results from the Christina Barz Study

OBJECTIVE

To assess the long-term outcome and identify outcome predictors in a very large sample of inpatients treated for bulimia nervosa (BN).

METHOD

Out of a total of 2,033 patients admitted consecutively to specialized treatment, 1,351 patients (mean age at treatment 25.94) were assessed for follow-up on average 11 (SD 6) years after admission. Also a very long-term (21 years) subsample (N = 147; mean age 25.92) was defined. Bivariate and logistic regression analyses identified predictors of poor outcome.

RESULTS

For more than 70% of the patients follow-up information could be gathered. Severity of eating disorder (ED) and other symptoms decreased over time but remained higher than in healthy controls, using published normative data. Remission rate was 38% after 11 years and 42% in the subsample after 21 years. Out of the total sample of N = 2,033 patients, 49 had died (2.4%). Persistent BN was found in 14.2% and the most frequent crossover was to ED not otherwise specified. Predictors of poor outcome were fewer follow-up years, higher drive for thinness, higher age at treatment, and less global functioning.

DISCUSSION

Based on clinical indicators, patients presented with a high level of ED and psychiatric symptomatology. With less than half of the patients remitted after 22 years, efforts are needed to improve treatment outcome.

Symptoms predicting psychosocial impairment in bulimia nervosa

PURPOSE

The current study aimed to determine which particular eating disorder (ED) symptoms and related features, such as BMI and psychological distress, uniquely predict impairment in bulimia nervosa (BN).

METHODS

Two hundred and twenty-two adults with BN completed questionnaires assessing ED symptoms, general psychological distress, and psychosocial impairment. Regression analyses were used to determine predictors which account for variance in impairment.

RESULTS

Four variables emerged as significant predictors of psychosocial impairment: concerns with eating; concerns with weight and shape; dietary restraint; and general psychological distress.

CONCLUSIONS

Findings support previous work highlighting the importance of weight and shape concerns in determining ED-related impairment. Other ED symptoms, notably dietary restraint and concerns with eating, were also significant predictors as was psychological distress. Results suggest that cognitive aspects of EDs, in addition to psychological distress, may be more important determinants of impairment than behavioural symptoms, such as binge eating or purging.

Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard

When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.

Group schema therapy for eating disorders: study protocol

BACKGROUND

The treatment of eating disorders is a difficult endeavor, with only a relatively small proportion of clients responding to and completing standard cognitive behavioural therapy (CBT). Given the prevalence of co-morbidity and complex personality traits in this population, Schema Therapy has been identified as a potentially viable treatment option. A case series of Group Schema Therapy for Eating Disorders (ST-E-g) yielded positive findings and the study protocol outlined in this article aims to extend upon these preliminary findings to evaluate group Schema Therapy for eating disorders in a larger sample (n = 40).

METHODS/DESIGN

Participants undergo a two-hour assessment where they complete a number of standard questionnaires and their diagnostic status is ascertained using the Eating Disorder Examination. Participants then commence treatment, which consists of 25 weekly group sessions lasting for 1.5 h and four individual sessions. Each group consists of five to eight participants and is facilitated by two therapists, at least one of who is a registered psychologist trained on schema therapy. The primary outcome in this study is eating disorder symptom severity. Secondary outcomes include: cognitive schemas, self-objectification, general quality of life, self-compassion, schema mode presentations, and Personality Disorder features. Participants complete psychological measures and questionnaires at pre, post, six-month and 1-year follow-up.

DISCUSSION

This study will expand upon preliminary research into the efficacy of group Schema Therapy for individuals with eating disorders. If group Schema Therapy is shown to reduce eating disorder symptoms, it will hold considerable promise as an intervention option for a group of disorders that is typically difficult to treat.

TRIAL REGISTRATION

ACTRN12615001323516. Registered: 2/12/2015 (retrospectively registered, still recruiting).

Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa

OBJECTIVE

To characterize exercise behaviors among adolescents with anorexia nervosa (AN), atypical AN, or bulimia nervosa (BN), and determine associations between exercise and medical risk.

STUDY DESIGN

Cross-sectional electronic medical records of all patients evaluated by the Eating Disorder Program at Stanford between January 1997 and February 2011 were retrospectively reviewed.

RESULTS

1,083 subjects (961 females, 122 males; mean age 15.6) met eligibility criteria. Most patients (89.7%) reported exercise (mean 7.0 h per week over mean 5.4 days per week) prior to presentation. Running (49.9%), calisthenics (40.7%), walking (23.4%), soccer (20.9%), and swimming (18.2%) were the most common exercises; a majority (60.6%) reported team sport participation. Males were less likely to report team exercise (p = .005). Bradycardia (heart rate <50) at presentation was associated with team sport participation (adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.02-2.72) and hours of exercise per week (AOR 1.05, 95% CI 1.02-1.09), controlling for diagnosis, sex, age, duration of illness, rate of weight loss, and percent median body mass index (%mBMI).

DISCUSSION

Adolescents with AN, atypical AN, and BN reported high levels of exercise. Females reported more team sport participation. Greater exercise frequency and team sport participation were associated with bradycardia. Further studies assessing the relationship between exercise and bradycardia may help inform the medical management of adolescents with these eating disorders who are more physically active.

Global/local processing style: Explaining the relationship between trait anxiety and binge eating

OBJECTIVE

Anxiety is a risk factor for disordered eating, but the mechanisms by which anxiety promotes disordered eating are poorly understood. One possibility is local versus global cognitive processing style, defined as a relative tendency to attend to details at the expense of the "big picture." Anxiety may narrow attention, in turn, enhancing local and/or compromising global processing. We examined relationships between global/local processing style, anxiety, and disordered eating behaviors in a transdiagnostic outpatient clinical sample. We hypothesized that local (vs. global) processing bias would mediate the relationship between anxiety and disordered eating behaviors.

METHOD

Ninety-three participants completed the eating disorder examination-questionnaire (EDE-Q), State-Trait Anxiety Inventory (STAI)-trait subscale, and the Navon task (a test of processing style in which large letters are composed of smaller letters both congruent and incongruent with the large letter). The sample was predominantly female (95%) with a mean age of 27.4 years (SD = 12.1 years).

RESULTS

Binge eating, but not fasting, purging, or excessive exercise, was correlated with lower levels of global processing style. There was a significant indirect effect between anxiety and binge eating via reduced global level global/local processing.

DISCUSSION

In individuals with disordered eating, being more generally anxious may encourage a detailed-oriented bias, preventing individuals from maintaining the bigger picture and making them more likely to engage in maladaptive behaviors (e.g., binge eating).

Just Desserts? Exploring Constructions of Food in Women's Experiences of Bulimia

Bulimia, an eating disorder that affects more women than men, involves binging and compensatory behaviors. Given the importance of food in experiences of these behaviors, in this article, we examine constructions of food in accounts of bulimic behavior: how these constructions relate to cultural discourses, and their implications for subjectivity. Fifteen women who engaged in bulimic behaviors were interviewed. Through a thematic decomposition of their accounts, we identified six discursive constructions of food: "good/healthy" or "bad/unhealthy," "contaminating body and soul," "collapsed into fat," "pleasurable reward," "comfort," and "fuel for the body." Many constructions were consolidated through participants' embodied experiences, but made available through discourses in public health, biomedicine, and femininity, and had implications for subjectivity in terms of morality, spirituality, and self-worth. Thus, despite women deploying these constructions to make sense of their bulimic behaviors, they are culturally normative; this point has implications for therapeutic and preventive strategies for bulimia.

Eating disorder examination questionnaire: Norms and clinical reference data from adolescent boys and girls in Sweden

The study investigated norms and clinical reference values for the 14-day time frame version of the Eating Disorders Examination Questionnaire (EDE-Q) specifically developed to suit adolescent populations. The EDE-Q is a self-report instrument measuring problematic eating behaviors and attitudes. A general population sample (N=487, 239 girls and 248 boys) and a clinical sample (N=1051, 989 girls and 62 boys) aged 12-14 years were analyzed. Descriptive statistics for EDE-Q subscales and Global scale, as well as key behaviors, are presented, along with sex differences and diagnostic differences (clinical sample). General population sample sex differences were consistent and medium to large, with some evidence of floor effects for boys. In the clinical sample there was a main effect of gender, with girls scoring higher overall. The covariate age accounted for more variance in EDE-Q subscale scores than did diagnostic group. Results are discussed in terms of the appropriateness of the EDE-Q for boys, and possible denial of illness among patients.

Development and Psychometric Validation of the EDE-QS, a 12 Item Short Form of the Eating Disorder Examination Questionnaire (EDE-Q)

Objective

The aim of this study was to develop and validate a short form of the Eating Disorder Examination Questionnaire (EDE-Q) for routine, including session by session, outcome assessment.

Method

The current, 28-item version (6.0) of the EDE-Q was completed by 489 individuals aged 18–72 with various eating disorders recruited from three UK specialist eating disorder services. Rasch analysis was carried out on factors identified by means of principal component analysis, which in combination with expert ratings informed the development of an EDE-Q short form. The shortened questionnaire’s reliability, validity and sensitivity was assessed based on online data collected from students of a UK university and volunteers with a history of eating disorders recruited from a national eating disorders charity aged 18–74 (N = 559).

Results

A 12-item short form, the Eating Disorder Examination Questionnaire Short (EDE-QS) was derived. The new measure showed high internal consistency (Cronbach’s α = .913) and temporal stability (ICC = .93; p < .001). It was highly correlated with the original EDE-Q (r = .91 for people without ED; r = .82 for people with ED) and other measures of eating disorder and comorbid psychopathology. It was sufficiently sensitive to distinguish between people with and without eating disorders.

Discussion

The EDE-QS is a brief, reliable and valid measure of eating disorder symptom severity that performs similarly to the EDE-Q and that lends itself for the use of sessional outcome monitoring in treatment and research.

Eating disorder features and quality of life: Does gender matter?

PURPOSE

This study examined whether gender moderates the associations between eating disorder features and quality-of-life impairment and whether eating disorder features can explain gender differences in quality of life in a sample of undergraduate students.

METHODS

The SF-12 Physical and Mental Component Summary Scales were used to measure health-related quality of life (HRQoL), and the Eating Disorders Examination Questionnaire (EDE-Q) was used to quantify eating disorder behaviors and cognitions. These self-report forms were completed by undergraduate men and women (n = 709).

RESULTS

Gender was a significant predictor of mental HRQoL, such that women in this sample reported poorer mental HRQoL than men. Eating disorder cognitions were the strongest predictor of undergraduate students' mental and physical HRQoL, while binge eating negatively predicted their physical HRQoL only. Gender was not found to moderate the associations between eating disorder features and HRQoL, and eating disorder cognitions were found to mediate the association between gender and mental HRQoL such that a proportion of the difference between undergraduate men and women's mental HRQoL was attributable to eating disorder cognitions.

CONCLUSION

This study provided further evidence of the significant impact of eating disorder features, particularly eating disorder cognitions, on HRQoL. The finding that gender did not moderate the relationships between eating disorder features and HRQoL indicates the importance of investigating these features in both men and women in future research.

Psychometric evaluation of self-report measures of binge-eating symptoms and related psychopathology: A systematic review of the literature

OBJECTIVE

Binge eating is a symptom common to bulimia nervosa, anorexia nervosa (binge/purge subtype), and binge eating disorder. There are many self-report measures available to aid the assessment of eating disorders symptoms, but there has not yet been a systematic review of the literature to identify the most valid and reliable measures for use in assessment and treatment of binge eating.

METHOD

A systematic review of the psychometric properties of self-report measures that assess binge eating symptoms and psychopathology was conducted. Two independent raters assessed the psychometric properties of each measure using a standardized quality analysis tool.

RESULTS

Of the 2,927 studies identified, 72 studies met the inclusion criteria and described the psychometric properties of 29 different self-report measures, and nine specific subscales within these. Results from the quality analysis tool utilized in this study indicated that none of the included measures currently meet all nine criteria of adequate psychometric properties.

DISCUSSION

Most of the included measures had evidence for some adequate psychometric properties. Two measures received six out of nine positive ratings for the assessed psychometric properties, the BITE and the BULIT-R, and thus appear to be the measures with the most evidence of their validity and reliability. Overall, our findings implicate a need for further investigation of the psychometric properties of the available self-report questionnaires in this field.

Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology

BACKGROUND

Difficulties with emotion regulation have been established as a core deficit in anorexia nervosa (AN). However, limited research has evaluated whether weight gain is associated with improvements in emotion regulation difficulties in AN and whether improvements in emotion regulation are associated with reductions in eating disorder psychopathology. The aims of this study were threefold: 1) to examine the nature and extent of emotion regulation difficulties in AN; 2) to determine whether these difficulties improved during intensive treatment for the eating disorder; and 3) to study whether improvements in emotion regulation were associated with improvements in eating disorder psychopathology.

METHOD

The participants were 108 patients who met DSM-IV-TR criteria for AN and were admitted to a specialized intensive treatment program. Self-report measures of eating disorder symptoms and difficulties with emotion regulation were administered at admission to and discharge from the program.

RESULTS

Patients with the binge-purge subtype of AN reported greater difficulties with impulse control when upset and more limited access to emotion regulation strategies when experiencing negative emotions than those with the restricting subtype. Among those who completed treatment and became weight restored, improvements in emotion regulation difficulties were observed. Greater pre-to-post treatment improvements in emotional clarity and engagement in goal directed behaviours when upset were associated with greater reductions in eating disorder psychopathology during treatment.

CONCLUSIONS

These findings add to growing evidence suggesting that eating disorder symptoms may be related to emotion regulation difficulties in AN and that integrating strategies to address emotion regulation deficits may be important to improving treatment outcome in AN.

Age differences in prenatal testosterone's protective effects on disordered eating symptoms: developmental windows of expression?

Prenatal testosterone exposure may be protective against disordered eating. However, prior studies have produced mixed results. Developmental differences in prenatal testosterone's protective effects on disordered eating may explain these discrepancies. Indeed, studies have differed in the age of participants assessed, with data supporting prenatal testosterone effects on disordered eating in early adolescent and young adult samples but not in late adolescence. The present studies are the first to investigate age differences in prenatal testosterone's protective effects on disordered eating. Two indirect markers of higher prenatal testosterone were examined: (a) lower finger-length ratios (Study 1: index [2D]/ring [4D] finger [2D:4D]) and (b) lower disordered eating in female s from opposite-sex twin pairs (who are thought to be exposed to higher prenatal testosterone from their male co-twin) relative to female controls (Study 2). Participants were twins from the Michigan State University Twin Registry (Study 1: n = 409; Study 2: n = 1,538) in early adolescence, late adolescence, or young adulthood. Disordered eating was assessed with well-validated questionnaires. Finger-length ratios were measured from hand scans, using electronic computer calipers. Findings were consistent across both studies. Higher prenatal testosterone (lower 2D:4D; females from opposite-sex twin pairs vs. controls) predicted lower disordered eating in early adolescence and young adulthood only. Prenatal testosterone-disordered eating associations were not observed during late adolescence. Results point to the possibility of developmental windows of expression for prenatal testosterone's protective effects on disordered eating and suggest that prior discrepant results may reflect age differences across samples.

The Detection of Eating Disorder Symptoms in Adolescence: A Comparison Between the Children's Eating Disorder Examination and the Children's Eating Disorder Examination Questionnaire

Introduction: Eating disorder symptoms already occur in childhood and adolescence and are predictive of full-blown eating disorders and obesity later in life. To enhance the quality of assessment in youngsters, this study examined the convergence between the clinical interview, the Child Eating Disorder Examination (ChEDE), and the self-report questionnaire, the Child Eating Disorder Examination-Questionnaire (ChEDE-Q). Method: Both instruments were administered in 12- to 16-year-old boys and girls retrieved from the general population (N = 57, Mage = 13.4). Results: The results showed that there was a strong correlation between the interview and the questionnaire and that the subscale scores of the two research instruments did not significantly differ. Discussion: The present study is among the first to confirm the utility of the ChEDE-Q to screen for eating disorder symptoms in adolescents from the general population. Large-scale studies should further determine whether these preliminary findings can be generalised.

Central coherence in adolescents with bulimia nervosa spectrum eating disorders

BACKGROUND

Weak central coherence-a tendency to process details at the expense of the gestalt-has been observed among adults with bulimia nervosa (BN) and is a potential candidate endophenotype for eating disorders (EDs). However, as BN behaviors typically onset during adolescence it is important to assess central coherence in this younger age group to determine whether the findings in adults are likely a result of BN or present earlier in the evolution of the disorder. This study examines whether the detail-oriented and fragmented cognitive inefficiency observed among adults with BN is observable among adolescents with shorter illness duration, relative to healthy controls.

METHOD

The Rey-Osterrieth Complex Figure Test (RCFT) was administered to a total of 47 adolescents with DSM5 BN, 42 with purging disorder (PD), and 25 healthy controls (HC). Performance on this measure was compared across the three groups.

RESULTS

Those with BN and PD demonstrated significantly worse accuracy scores compared to controls in the copy and delayed recall condition with a moderate effect size. These findings were exacerbated when symptoms of BN increased.

DISCUSSION

Poorer accuracy scores reflect a fragmented and piecemeal strategy that interferes with visual-spatial integration in BN spectrum disorders. This cognitive inefficiency likely contributes to broad difficulties in executive functioning in this population especially in the context of worsening bulimic symptoms. The findings of this study support the hypothesis that poor global integration may constitute a cognitive endophenotype for BN.

BodyWise: evaluating a pilot body image group for patients with anorexia nervosa

Body image disturbance can be enduring and distressing to individuals with eating disorders and effective treatments remain limited. This pilot study evaluated a group-based treatment-BodyWise-developed for use in full and partial hospitalization with patients with anorexia nervosa at low weight. A partial crossover waitlist design was used. BodyWise (N = 50) versus treatment as usual (N = 40) were compared on standardized measures of body image disturbance. Results demonstrated significant improvement in the group compared to treatment as usual for the primary outcome measure (Eating Disorder Examination-Questionnaire Shape Concern subscale) and other manifestations of body image disturbance including body checking and body image quality of life. BodyWise appeared acceptable to participants, and was easy to deliver within the pragmatics of a busy eating disorder service. There is potential for its wider dissemination as a precursor to more active body image interventions.

Activity-related parenting practices: development of the Parenting Related to Activity Measure (PRAM) and links with mothers' eating psychopathology and compulsive exercise beliefs

This is a two-study paper that developed a measure to assess parenting practices related to children's physical activity and explored maternal predictors of such parenting practices. Study 1: A self-report measure of parents' activity-related practices (the Parenting Related to Activity Measure) was developed, and a principal component analysis was carried out using data from 233 mothers of 4.5- to 9-year-old children. The results supported a six-factor model and yielded the following subscales: Responsibility/monitoring; Activity regulation; Control of active behaviours; Overweight concern; Rewarding parenting; and Pressure to exercise. Study 2: Mothers (N = 170) completed the Parenting Related to Activity Measure, alongside measures of eating psychopathology and compulsive exercise, to identify predictors of activity-related parenting practices. Mothers' eating psychopathology and exercise beliefs predicted activity parenting practices with their sons and daughters, but different predictors were seen for mothers of daughters versus sons. Mothers' eating and exercise attitudes are important predictors of their activity-related parenting practices, particularly with girls. Identifying early interactions around activity/exercise could be important in preventing the development of problematic beliefs about exercise, which are often a key symptom of eating disorders. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Cognitive Behaviour Therapy for Bulimia Nervosa and Eating Disorders Not Otherwise Specified: Translation from Randomized Controlled Trial to a Clinical Setting

BACKGROUND

Enhanced Cognitive Behaviour Therapy (CBT-E) (Fairburn, Cooper and Shafran, 2003) was developed as a treatment approach for eating disorders focusing on both core psychopathology and additional maintenance mechanisms.

AIMS

To evaluate treatment outcomes associated with CBT-E in a NHS Eating Disorders Service for adults with bulimia and atypical eating disorders and to make comparisons with a previously published randomized controlled trial (Fairburn et al., 2009) and "real world" evaluation (Byrne, Fursland, Allen and Watson, 2011).

METHOD

Participants were referred to the eating disorder service between 2002 and 2011. They were aged between 18-65 years, registered with a General Practitioner within the catchment area, and had experienced symptoms fulfilling criteria for BN or EDNOS for a minimum of 6 months.

RESULTS

CBT-E was commenced by 272 patients, with 135 completing treatment. Overall, treatment was associated with significant improvements in eating disorder and associated psychopathology, for both treatment completers and the intention to treat sample.

CONCLUSIONS

Findings support dissemination of CBT-E in this context, with significant improvements in eating disorder psychopathology. Improvements to global EDE-Q scores were higher for treatment completers and lower for the intention to treat sample, compared to previous studies (Fairburn et al., 2009; Byrne et al., 2011). Level of attrition was found at 40.8% and non-completion of treatment was associated with higher levels of anxiety. Potential explanations for these findings are discussed.

Autonomous and controlled motivation for eating disorders treatment: baseline predictors and relationship to treatment outcome

OBJECTIVE

This study aimed to identify baseline predictors of autonomous and controlled motivation for treatment (ACMT) in a transdiagnostic eating disorder sample, and to examine whether ACMT at baseline predicted change in eating disorder psychopathology during treatment.

METHOD

Participants were 97 individuals who met DSM-IV-TR criteria for an eating disorder and were admitted to a specialized intensive treatment programme. Self-report measures of eating disorder psychopathology, ACMT, and various psychosocial variables were completed at the start of treatment. A subset of these measures was completed again after 3, 6, 9, and 12 weeks of treatment.

RESULTS

Multiple regression analyses showed that baseline autonomous motivation was higher among patients who reported more self-compassion and more received social support, whereas the only baseline predictor of controlled motivation was shame. Multilevel modelling revealed that higher baseline autonomous motivation predicted faster decreases in global eating disorder psychopathology, whereas the level of controlled motivation at baseline did not.

CONCLUSION

The current findings suggest that developing interventions designed to foster autonomous motivation specifically and employing autonomy supportive strategies may be important to improving eating disorders treatment outcome.

PRACTITIONER POINTS

The findings of this study suggest that developing motivational interventions that focus specifically on enhancing autonomous motivation for change may be important for promoting eating disorder recovery. Our results lend support for the use of autonomy supportive strategies to strengthen personally meaningful reasons to achieve freely chosen change goals in order to enhance treatment for eating disorders. One study limitation is that there were no follow-up assessments beyond the 12-week study and we therefore do not know whether the relationships that we observed persisted after treatment. Another limitation is that this was a correlational study and it is therefore important to be cautious about making causal conclusions when interpreting the results.

Disordered eating, menstrual irregularity, and musculoskeletal injury in high school athletes: a comparison of oral contraceptive pill users and nonusers

BACKGROUND

The female athlete triad is the interrelatedness of energy availability, menstrual function, and bone density. Currently, limited information about triad components and their relationship to musculoskeletal injury in the high school population exists. In addition, no study has specifically examined triad components and injury rate in high school oral contraceptive pill (OCP) users.

HYPOTHESIS

To compare the prevalence of disordered eating (DE), menstrual irregularity (MI), and musculoskeletal injury (INJ) among high school female athletes in OCP users and non-OCP users.

STUDY DESIGN

Retrospective cohort study.

LEVEL OF EVIDENCE

Level 2.

METHODS

The subject sample completed the Eating Disorder Examination-Questionnaire (EDE-Q) and Healthy Wisconsin High School Female Athletes Survey (HWHSFAS). Athletes were classified by OCP use and sport type.

RESULTS

Of the participants, 14.8% reported OCP use. There was no difference in MI and INJ among groups. The prevalence of DE was significantly higher among OCP users as compared with non-OCP users; OCP users were twice as likely to meet the criteria for DE (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.20-5.09). OCP users were over 5 times more likely to have a global score that met criteria for DE as compared with non-OCP users (OR, 5.36; 95% CI, 1.92-14.89).

CONCLUSION

Although MI and INJ rates are similar among groups, there is a higher prevalence of DE among high school female athletes using OCPs as compared with non-OCP users.

CLINICAL RELEVANCE

Because OCP users may be menstruating, clinicians may fail to recognize the other triad components. However, DE exists in the menstruating OCP user. As such, clinicians should be vigilant when screening for triad components in high school OCP users, particularly DE.

Body checking and avoidance in low weight and weight restored individuals with anorexia nervosa and non-clinical females

Body dissatisfaction (BD) is central to the development, maintenance and relapse of anorexia nervosa (AN). BD has been conceptualized as a multi-dimensional construct incorporating behaviours, cognitions and affect, yet little is known about the impact of weight and disordered eating on these aspects. 56 'below DSM-IV weight criteria for AN' (<BMI 17.5 kg/m(2)) and 44 'above DSM-IV weight criteria for AN' (>BMI 17.5 kg/m(2)) individuals currently receiving treatment for an eating disorder, and 60 non-eating disordered females completed the Body Checking Scale, Body Image Avoidance Questionnaire and the Body Image Anxiety Questionnaire. As expected, females diagnosed with AN showed significantly more behavioural and affective body dissatisfaction than the control group. Patients at lower weights showed significantly more avoidance behaviours and less body image anxiety than those with anorexia at higher weights. No difference was seen in checking behaviours between these groups. Weight based differences in avoidance behaviours continued to exist even when the effects of anxiety were controlled for. Affective and behavioural aspects of BD should be considered in clinical practice at all stages of treatment.

Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial

BACKGROUND

Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified.

METHODS/DESIGN

This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants' motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on RCTs.

DISCUSSION

This study protocol presents the design of a RCT for evaluating the effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified.

TRIAL REGISTRATION

The protocol for this study is registered with the Netherlands Trial Registry NTR2415.

Calorie estimation accuracy and menu labeling perceptions among individuals with and without binge eating and/or purging disorders

Menu labeling is a public health policy that requires chain restaurants in the USA to post kilocalorie information on their menus to help consumers make informed choices. However, there is concern that such a policy might promote disordered eating. This web-based study compared individuals with self-reported binge eating disorder (N = 52), bulimia nervosa (N = 25), and purging disorder (N = 17) and those without eating disorders (No ED) (N = 277) on restaurant calorie information knowledge and perceptions of menu labeling legislation. On average, people answered 1.46 ± 1.08 questions correctly (out of 6) (25%) on a calorie information quiz and 92% of the sample was in favor of menu labeling. The findings did not differ based on eating disorder, dieting, or weight status, or race/ethnicity. The results indicated that people have difficulty estimating the calories in restaurant meals and individuals with and without eating disorders are largely in favor of menu labeling laws.

Latent profile and latent transition analyses of eating disorder phenotypes in a clinical sample: a 6-year follow-up study

The DSM-IV classification of Eating Disorders (EDs) identifies clinical entities showing considerable overlap and diagnostic instability across time. Latent profile analysis (LPA) allows the identification of underlying groups of individuals according to their patterned responses across a set of features. LPA was applied to data regarding EDs symptoms of a clinical sample of 716 EDs patients, with a current DSM-IV diagnosis of threshold and subthreshold EDs. Latent transition analysis (LTA) was used to examine the longitudinal stability of the obtained profiles. The latent profiles were compared for psychopathological variables and long-term outcomes (recovery, relapse), based on a 6-year follow-up after a cognitive behavioural treatment. Five different phenotypes were identified: "severe binging", "moderate binging", "restricted eating", "binge and moderate purging", and "binge and severe purging". The relevance of this characterization was confirmed by the differences in terms of psychopathological features and outcomes. Over the long term, a three-profile solution was adopted, clustering the subjects into "binge eating", "binge eating and purging", and "restricted eating". Latent profiles showed a moderate stability over the 6-year period, with probability estimates of stability within status over time of 0.57 for "binge eating", 0.40 for "binge eating and purging", and 0.41 for "restricted eating". The implications for DSM 5 were discussed, and the relative high rate of transition within phenotypes confirmed the significant instability of EDs phenomenology.

An intensive DBT program for patients with multidiagnostic eating disorder presentations: a case series analysis

OBJECTIVE

This study presents case-series data on a novel outpatient program that blends dialectical behavior therapy (DBT) with standard eating disorder (ED) interventions (i.e., food exposure, weight monitoring, cognitive modification, ED psychoeducation) for patients with complex and multidiagnostic ED presentations.

METHOD

Quantitative and qualitative data was collected on a sample of seven consecutively admitted women who presented with a severe ED, a history of several failed treatment attempts, pervasive emotion dysregulation, and significant Axis I or II psychiatric comorbidity (e.g., PTSD, borderline personality disorder).

RESULTS

Treatment was associated with reductions in ED symptoms, suicidal and self-injurious behaviors, treatment interfering behaviors, psychiatric and medical hospitalizations, and clinician burnout.

DISCUSSION

Overall, the results suggest that this blended DBT/cognitive behavior therapy for ED treatment model is a promising intervention for this complex and "hard to treat" population.

Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa

This study examined the relationship between therapeutic alliance and primary symptom change (weight gain) during CBT for anorexia nervosa. The aims were threefold: (1) to establish the strength of the therapeutic alliance across the treatment, (2) to determine whether early therapeutic alliance is associated with the completion of CBT for this client group, and (3) to determine the direction of the relationship between therapeutic alliance and weight gain. Adult outpatients (N=65) with a diagnosis of anorexia nervosa (or atypical anorexia nervosa) completed a measure of alliance at session six and at the end of treatment. Weight was recorded at the start of treatment, session six and at the end of treatment. The strength of the alliance was consistently high in the sample. However, early therapeutic alliance was not associated with either the likelihood of completing treatment or subsequent weight gain. In contrast, both early and later weight gain were associated with the strength of subsequent alliance. These findings indicate that it might be advisable to focus on techniques to drive weight gain rather than rely on the therapeutic alliance to bring about therapeutic change.

Validation of Eating Disorder Examination Questionnaire (EDE-Q) –Spanish Version– for Screening Eating Disorders

This research examines the internal consistency, convergent validity, and sensitivity, specificity, and positive and negative predictive value of the Spanish version of the Eating Disorder Examination-Self-Report Questionnaire (S-EDE-Q), as a screening questionnaire for eating disorders (ED) in a community sample. Participants were 1543 male and female Spanish-speaking students (age range: 12-21 years), who volunteered to complete the S-EDE-Q and the EAT-40. The Spanish version of the Eating Disorders Examination (S-EDE) interview, 12th edition, was administered to 602 of the students. Acceptable internal consistency for the four subscales of the S-EDE-Q was obtained (α ≥ .74). Corrected pointbiserial correlation performed with the 22 items included in the S-EDE-Q subscales showed acceptable values for all the items. The EAT-40 Dieting subscale correlated highly and positively with the four S-EDE-Q subscales (r ≥ .70). Acceptable results in sensitivity, specificity, and positive and negative predictive value when compared with the EDE were found. Correlation between S-EDE and S-EDE-Q diagnoses was positive and significant. Overall, results support the psychometric adequacy of the S-EDE-Q as a screening questionnaire for ED in community samples.

Persistence, perseveration and perfectionism in the eating disorders

BACKGROUND

Perseveration, persistence and perfectionism are traits that have been suggested to be relevant to the eating disorders. This study explored the levels and correlates of these three traits in the eating disorders and control groups.

METHOD

A measure of these three elements (the Persistence, Perseveration and Perfectionism Questionnaire - PPPQ-22) was administered to 99 women with eating disorders, 25 women with other psychiatric disorders, and 91 non-clinical women. Differences in PPPQ-22 scores across groups were measured, as were the associations between PPPQ-22 scores and eating attitudes.

RESULTS

The eating disordered groups showed lower levels of persistence (the drive towards goal achievement) than the non-clinical group, but did not show higher levels of perseveration (the following of rules, without considering whether goals are achieved). Both women with eating disorders and non-clinical controls showed correlations between eating disorder symptoms and perseveration.

CONCLUSIONS

The current study, using a relatively new measure, suggests that low levels of persistence, rather than high levels of perseveration, may be implicated in the eating disorders. It was less clear that perfectionism per se was a useful construct in understanding eating pathology. If confirmed by future research, persistence should be considered in treatment of these complex and challenging conditions.

Influence of college peers on disordered eating in women and men at 10-year follow-up

Research supports both concurrent and prospective associations between peer behaviors and disordered eating levels in late adolescent and young adult men and women. However, no study has examined peer influence after a follow-up duration over which peer groups change dramatically. This study examined how college roommates' dieting predicted disordered eating levels in women (n = 566) and men (n = 233) at 10-year follow-up. For women, college roommates' dieting significantly predicted Eating Disorder Inventory Drive for Thinness and Bulimia scores and purging at 10-year follow-up. Findings highlight the potential for school-based, peer-led interventions to have long-term benefits in women.

Eating Disorder Examination Questionnaire (EDE-Q)

Background: Most studies on the Eating Disorder Examination Questionnaire (EDE-Q) focus exclusively on women. Aims: To examine the internal consistency and convergent validity of the EDE-Q in Spanish undergraduate men and to compare the results with those obtained previously in college samples of Spanish women and American men. Methods: 269 college men, aged 18–30 years, answered the EDE-Q, Eating Disorder Inventory (EDI-2), and Body Shape Questionnaire (BSQ). Results: The four subscale scores and the global score of the EDE-Q achieved acceptable internal consistency (α ≥ .65), and evidence on convergent validity with EDI-2 and BSQ was obtained (r ≥ .41). Average scores, standard deviations, and percentile ranks for the raw EDE-Q subscales and data on the occurrence of binge eating and compensatory behaviors are presented. Most values were lower than those found in previous studies with Spanish undergraduate women and American undergraduate men. Discussion: Lower scores in EDE-Q subscales provide country differences between Spain and United States and support the existence of gender differences in eating disorders attitudes. These data should help clinicians and researchers to interpret the EDE-Q scores of college men in Spain.

The impact of age and BMI on Eating Disorder Examination Questionnaire (EDE-Q) scores in a community sample

OBJECTIVES

The primary objectives for this study were to establish normative data for the EDE-Q in a nationally representative sample of women and to investigate the unique and relative effects of age and BMI.

METHODS

A community sample of 3000 women aged 16-50 was randomly selected from the Norwegian National Population Register.

RESULTS

Mean global EDE-Q was 1.27 (SD=1.19). EDE-Q scores decreased significantly with age yet increased with BMI. In the regression model, BMI and age accounted for 19% versus 2%, respectively, of the global EDE-Q. Extreme shape and weight concerns appeared to drive the higher global EDE-Q scores for individuals with overweight or obesity, with 30-40% scoring above the recommended clinical cut-off for Shape and Weight Concern.

CONCLUSIONS

Higher EDE-Q scores, largely driven by elevated shape and weight concerns, appear normative among individuals with obesity in a nationally representative population. BMI should be routinely considered when establishing criteria for defining recovery and determining clinical significance using the EDE-Q.

Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition

Research evidence has been accumulating for the efficacy of dialectical behaviour therapy (DBT) for binge eating. However, support for its effectiveness and transportability beyond efficacy trials is lacking. The current study evaluated the feasibility of group-based DBT for binge eating within the context of an operating community clinic. Women ages 24-49 (M = 39.60, SD = 9.53) with either subthreshold and full-threshold binge eating disorder or bulimia nervosa formed the group and comprised the sample (n = 5 treatment completers). Positive outcomes included significant improvement in both binge eating and secondary outcomes with the Eating Disorder Inventory subscales of Bulimia, Ineffectiveness, Perfectionism and Interpersonal Distrust. Attrition was elevated compared with previous efficacy trials, suggesting the need for increased attention to how to improve retention within routine practice settings. Given our limited sample size, these findings are viewed as promising but preliminary.

Convergence of scores on the interview and questionnaire versions of the Eating Disorder Examination: a meta-analytic review

Significant discrepancies have been found between interview- and questionnaire-based assessments of psychopathology; however, these studies have typically compared instruments with unmatched item content. The Eating Disorder Examination (EDE), a structured interview, and the questionnaire version of the EDE (EDE-Q) are considered the preeminent assessments of eating disorder symptoms and provide a unique opportunity to examine the concordance of interview- and questionnaire-based instruments with matched item content. The convergence of EDE and EDE-Q scores has been examined previously; however, past studies have been limited by small sample sizes and have not compared the convergence of scores across diagnostic groups. A meta-analysis of 16 studies was conducted to compare the convergence of EDE and EDE-Q scores across studies and diagnostic groups. With regard to the EDE and EDE-Q subscale scores, the overall correlation coefficient effect sizes ranged from .68 to .76. The overall Cohen's d effect sizes ranged from .31 to .62, with participants consistently scoring higher on the questionnaire. For the items measuring behavior frequency, the overall correlation coefficient effect sizes ranged from .37 to .55 for binge eating and .90 to .92 for compensatory behaviors. The overall Cohen's d effect sizes ranged from -0.16 to -0.22, with participants reporting more binge eating on the interview than in the questionnaire in 70% of the studies. These results suggest the interview and questionnaire assess similar constructs but should not be used interchangeably. Additional research is needed to examine the inconsistencies between binge frequency scores on the 2 instruments.

Binge eating in surgical weight-loss treatments. Long-term associations with weight loss, health related quality of life (HRQL), and psychopathology

BACKGROUND

Studies that have investigated the relationship between binge eating and the long-term outcome of bariatric surgery have shown mixed results. Does binge eating affect long-term BMI, health-related quality of life (HRQL), or psychopathology after surgery?

METHODS

We assessed 173 bariatric patients before and three years after weight loss surgery with regard to weight, binge eating, HRQL, and psychopathology.

RESULTS

Binge eating before and after weight loss surgery was unrelated to long-term BMI outcome. Binge eating after weight loss surgery was associated with more psychopathology and lower HRQL.

CONCLUSIONS

Binge eating before or after weight loss surgery does not predict long-term BMI outcome. Therefore, exclusions from surgery for this reason alone are difficult to motivate. However, results show that binge eating after weight loss surgery is common and is associated with more psychopathology and lower HRQL, which might increase the vulnerability for future weight regain and complications beyond the follow-up period of the present study. The high rate of binge eating after surgery and its negative association with HRQL and psychopathology suggest that we need to be observant of the occurrence and potential effects of binge eating in the context of bariatric surgery.

Concurrent validity of the Disordered Eating Questionnaire (DEQ) with the Eating Disorder Examination (EDE) clinical interview in clinical and non clinical samples

OBJECTIVES

The aim of the present study was to evaluate the concurrent validity, specificity and sensitivity of the Disordered Eating Questionnaire (DEQ). The DEQ is a brief questionnaire (24 items), that can be used for epidemiological screenings. It addresses face valid questions to evaluate frequency and intensity of disordered eating attitudes and behaviors over a time frame of three months.

DESIGN

The study was conducted using a cross-sectional design.

METHODS

The DEQ was completed by 190 eating disordered patients (73 patients with Anorexia, 48 with Bulimia, 11 with Binge Eating Disorder, 48 with Eating Disorders Not Otherwise Specified, 10 recovered patients) and 88 healthy controls.

RESULTS

In the whole group, DEQ scores were highly correlated with the scores of the Eating Disorder Examination (EDE 12.0D). Sensitivity and specificity were evaluated. In the female subsample, the ROC curves indicate that a cut-off score of 30 allows to obtain a sensitivity of 82% and a specificity of 68%. A formative approach of Structural Equationing Model confirm the construct validity of the instrument.

CONCLUSIONS

The DEQ confirm to be a valid and reliable instrument, whose sensitivity and specificity is comparable to that of the EAT-40 even though it has fewer items.

Perfectionism and its relation to overevaluation of weight and shape and depression in an eating disorder sample

OBJECTIVE

To examine the relative association between psychopathology (depression and overevaluation of weight and shape) and measures of perfectionism and self-criticism in an eating disorder sample.

METHOD

Participants (n = 39) completed measures of independent variables (perfectionism and self-criticism) and dependent variables (depression and overevaluation of weight and shape).

RESULTS

Simultaneous multiple regression analyses suggest that clinical perfectionism has a unique association with depression. Self-criticism and clinical perfectionism had a stronger association with overevaluation of weight and shape than other measures of perfectionism.

DISCUSSION

Clinical perfectionism and self-criticism may be of more relevance than existing measures of multidimensional perfectionism in terms of explaining maintenance of depression and overevaluation of weight and shape.

Associations between body checking and disordered eating behaviors in nonclinical women

OBJECTIVE

Recent research suggests that body checking cognitions and behaviors are differentially associated with pathological eating behaviors in clinical women. However, it is unknown whether similar associations exist in nonclinical populations. The aim of this study is to examine whether body checking (cognitions and behaviors) is associated with pathological eating behaviors in a nonclinical sample of women.

METHOD

Validated measures of pathological eating behaviors, body checking cognitions, and body checking behaviors were completed by 342 nonclinical university women.

RESULTS

Women engaging in binging (objective and subjective), purging, restraint, and excessive exercise reported consistently higher scores across all body checking cognitions and behaviors. All body checking cognitions and behaviors independently contributed to distinguishing those who reported each behavior as opposed to those who did not. The predicted classification was most accurate for the cardinal diagnostic symptoms for bulimia-objective binging and purging.

DISCUSSION

Body checking cognitions are implicated in the development of pathological eating behaviors in nonclinical populations, requiring consideration for planning prevention programs.