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Presseller EK, Velkoff EA, Riddle DR, Liu J, Zhang F, Juarascio AS. Using Continuous Glucose Monitoring to Passively Classify Naturalistic Binge Eating and Vomiting Among Adults With Binge-Spectrum Eating Disorders: A Preliminary Investigation. Int J Eat Disord 2024. [PMID: 39031922 DOI: 10.1002/eat.24266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE Binge eating and self-induced vomiting are common, transdiagnostic eating disorder (ED) symptoms. Efforts to understand these behaviors in research and clinical settings have historically relied on self-report measures, which may be biased and have limited ecological validity. It may be possible to passively detect binge eating and vomiting using data collected by continuous glucose monitors (CGMs; minimally invasive sensors that measure blood glucose levels), as these behaviors yield characteristic glucose responses. METHOD This study developed machine learning classification algorithms to classify binge eating and vomiting among 22 adults with binge-spectrum EDs using CGM data. Participants wore Dexcom G6 CGMs and reported eating episodes and disordered eating symptoms using ecological momentary assessment for 2 weeks. Group-level random forest models were generated to distinguish binge eating from typical eating episodes and to classify instances of vomiting. RESULTS The binge eating model had accuracy of 0.88 (95% CI: 0.83, 0.92), sensitivity of 0.56, and specificity of 0.90. The vomiting model demonstrated accuracy of 0.79 (95% CI: 0.62, 0.91), sensitivity of 0.88, and specificity of 0.71. DISCUSSION Results suggest that CGM may be a promising avenue for passively classifying binge eating and vomiting, with implications for innovative research and clinical applications.
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Affiliation(s)
- Emily K Presseller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Velkoff
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Devyn R Riddle
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jianyi Liu
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
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Wang JN, Wang M, Wu GW, Li WH, Lv ZL, Chen Q, Yang ZH, Li XH, Wang ZC, Li ZJ, Zhang P, Tang LR. Uncovering neural pathways underlying bulimia nervosa: resting-state neural connectivity disruptions correlate with maladaptive eating behaviors. Eat Weight Disord 2023; 28:91. [PMID: 37899387 PMCID: PMC10613592 DOI: 10.1007/s40519-023-01617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE Bulimia nervosa (BN) is characterized by recurrent binge-eating episodes and inappropriate compensatory behaviors. This study investigated alterations in resting-state surface-based neural activity in BN patients and explored correlations between brain activity and eating behavior. METHODS A total of 26 BN patients and 28 healthy controls were enrolled. Indirect measurement of cerebral cortical activity and functional connectivity (FC) analyses were performed in Surfstat. A principal component analysis (PCA) model was used to capture the commonalities within the behavioral questionnaires from the BN group. RESULTS Compared with the healthy control group, the BN group showed decreased surface-based two-dimensional regional homogeneity in the right superior parietal lobule (SPL). Additionally, the BN group showed decreased FC between the right SPL and the bilateral lingual gyrus and increased FC between the right SPL and the left caudate nucleus and right putamen. In the FC-behavior association analysis, the second principal component (PC2) was negatively correlated with FC between the right SPL and the left caudate nucleus. The third principal component (PC3) was negatively correlated with FC between the right SPL and the left lingual gyrus and positively correlated with FC between the right SPL and the right lingual gyrus. CONCLUSION We revealed that the right SPL undergoes reorganization with respect to specific brain regions at the whole-brain level in BN. In addition, our results suggest a correlation between brain reorganization and maladaptive eating behavior. These findings may provide useful information to better understand the neural mechanisms of BN. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Jia-Ni Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, China
| | - Miao Wang
- Chinese Institute for Brain Research, Beijing, China
| | - Guo-Wei Wu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wei-Hua Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, China
| | - Zi-Ling Lv
- Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, No. 5 Ankang Hutong, Xicheng District, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, China
| | - Zheng-Han Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, China
| | - Xiao-Hong Li
- Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, No. 5 Ankang Hutong, Xicheng District, Beijing, China
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, China
| | - Zhan-Jiang Li
- Beijing Anding Hospital, Capital Medical University, Beijing, China.
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, No. 5 Ankang Hutong, Xicheng District, Beijing, China.
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, China.
| | - Li-Rong Tang
- Beijing Anding Hospital, Capital Medical University, Beijing, China.
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, No. 5 Ankang Hutong, Xicheng District, Beijing, China.
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Moraes CEFD, Antunes MML, Mourilhe C, Sichieri R, Hay P, Appolinario JC. Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City. Nutrients 2023; 15:nu15071573. [PMID: 37049413 PMCID: PMC10096673 DOI: 10.3390/nu15071573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/11/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
The prevalence of binge eating spectrum conditions (BESC) are increasing globally. However, there is a lack of data from general population samples in low- and middle-income countries. Thus, this study described the food consumption during objective binge eating episodes (OBE) in people with BESC from a metropolitan city in Brazil. Participants comprised 136 adults (18 years old-60 years old) with Binge Eating Disorder (BED), Bulimia Nervosa (BN), or recurrent binge eating (RBE) from a two-phase epidemiological survey. They were interviewed in their homes by trained lay interviewers using the Questionnaire on Eating and Weight Patterns updated for the DSM-5 to assess BESC diagnosis and food consumption during a typical OBE. Overall, participants consumed a mean of 1067 kcal during the episodes. For the most part, these calories were derived from carbohydrates (58%) and lipids (30%), irrespective of the diagnosis. Regarding food item consumption, individuals with BED and RBE consumed staple foods (mainly rice and beans) more frequently than those with BN. Conversely, participants with BN ingested sugar-sweetened beverages more frequently than the BED group. In conclusion, there were differences in the eating patterns of individuals with BESC in Brazil. BED and RBE participants consumed more typical foods, whereas those with BN preferred foods with a high content of energy during their OBE.
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Affiliation(s)
- Carlos Eduardo Ferreira de Moraes
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2750, Australia
| | - Marina Maria Leite Antunes
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Carla Mourilhe
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Social Medicine Institute (IMS), State University of Rio de Janeiro (UERJ), Rio de Janeiro 28625-570, Brazil
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2750, Australia
- Mental Health Services, South West Sydney Local Health District (SWSLHD), Campbelltown, NSW 2560, Australia
| | - Jose Carlos Appolinario
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
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Hyperpalatable Foods Consumption in a Representative Sample of the General Population in Brazil: Differences of Binge and Non-Binge Eating Meals. Behav Sci (Basel) 2023; 13:bs13020149. [PMID: 36829377 PMCID: PMC9952327 DOI: 10.3390/bs13020149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The availability of hyper-palatable foods (HPF) increased over the past three decades worldwide, a period when eating disorders (ED) and obesity have become global public health concerns. The present study aimed to assess HPF consumption during binge and non-binge meals in a representative sample of adults with and without ED from a metropolitan city in Brazil. A total of 2297 individuals were interviewed in their homes by trained lay interviewers to assess the presence of binge eating disorder (BED), bulimia nervosa (BN), and recurrent binge eating (RBE). Information on their food consumption in objective and subjective binge eating episodes (OBE and SBE, respectively), as well as in the 24 h food recall were obtained. Individuals from the general population consumed 56% of their total calories from HPF. In non-binge meals, people with BN consumed substantially fewer calories from HPF than BED (63% vs. 48%) and RBE (63% vs. 48%) groups. During OBE, participants consumed an average of 70% of the calories from HPF, with no between-group differences. During SBE, subjects with BN consumed substantially fewer calories from HPF than those with BED (76% vs. 50%). In conclusion, HPF were highly consumed by the Brazilian population. However, there was a greater impact on BED and RBE subjects and during binge eating episodes.
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Hower H, LaMarre A, Bachner-Melman R, Harrop EN, McGilley B, Kenny TE. Conceptualizing eating disorder recovery research: Current perspectives and future research directions. J Eat Disord 2022; 10:165. [PMID: 36380392 PMCID: PMC9664434 DOI: 10.1186/s40337-022-00678-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. BODY: This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological "toolkits" could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery. CONCLUSION Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.
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Affiliation(s)
- Heather Hower
- Department of Psychiatry, Eating Disorders Center for Treatment and Research, University of California at San Diego School of Medicine, 4510 Executive Drive, San Diego, CA, 92121, USA. .,Department of Health Services, Policy, and Practice, Hassenfeld Child Innovation Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
| | - Andrea LaMarre
- School of Psychology, Massey University, North Shore, Private Bag 102-904, Auckland, 0632, New Zealand
| | - Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, 4025000, Emek-Hefer, Israel.,School of Social Work, Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel
| | - Erin N Harrop
- Graduate School of Social Work, University of Denver, 2148 S High Street, Denver, CO, 80208, USA
| | - Beth McGilley
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Therese E Kenny
- Department of Psychology, Clinical Child and Adolescent Psychology, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
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Milano W, Ambrosio P, Carizzone F, De Biasio V, Foia MG, Saetta B, Milano MF, Capasso A. Menstrual Disorders Related to Eating Disorders. Endocr Metab Immune Disord Drug Targets 2021; 22:471-480. [PMID: 34182917 DOI: 10.2174/1871530321666210625145345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/27/2021] [Accepted: 04/06/2021] [Indexed: 11/22/2022]
Abstract
Eating disorders (ED) are associated with multiple physical complications that strongly affect the physical health of these young and fragile patients and can also cause significant mortality, the highest among psychiatric pathologies. Among the various organic complications, albeit still little known, the gynecological implications, up to infertility, are very widespread. Among adolescent and adult patients, gynecological symptoms can be very widespread and range from menstrual irregularities to amenorrhea, from vaginitis to ovarian polycystosis, up to complications during the gestational phase and postpartum, in addition to the possible consequences on the unborn child. Among the most frequent and significant gynecological disorders in women with ED, there are menstrual irregularities that may occur with oligomenorrhea or even amenorrhea. , Although no longer part of the DSM-5 diagnostic criteria for defining anorexia nervosa (AN), this symptom must be considered a very relevant event in the overall evaluation of young women and adolescents with eating disorders. Functional hypothalamic amenorrhea in ED patients is related to psychological distress, excessive exercise, disordered eating, or a combination of these factors, which results in suppression of the hypothalamic-pituitary-ovarian axis, and consequently, hypoestrogenism. This paper has the objective to summarize the causes and the mechanism underlying menstrual disorders and provide a better understanding of the correlation between the reproductive system and the mechanisms that regulate food intake and eating habits. In addition, early recognition of risk factors for eating disorders for gynecological implications can help put more accurate assessments of patients to prevent potentially fatal complications. The importance of the involvement of specialist gynecologists in the multidisciplinary team that has to follow patients with eating disorders is also discussed.
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Affiliation(s)
- Walter Milano
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Paola Ambrosio
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Francesca Carizzone
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Valeria De Biasio
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Maria Gabriella Foia
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Biancamaria Saetta
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | | | - Anna Capasso
- Department of Pharmacy , University of Salerno, Fisciano, 84084 Salerno, Italy
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Wiklund CA, Rania M, Kuja-Halkola R, Thornton LM, Bulik CM. Evaluating disorders of gut-brain interaction in eating disorders. Int J Eat Disord 2021; 54:925-935. [PMID: 33955041 PMCID: PMC10751984 DOI: 10.1002/eat.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/18/2021] [Accepted: 04/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders commonly co-occur with gastrointestinal problems. This case-control study aimed to (a) document the prevalence of disorders of gut-brain interaction (DGBI) in eating disorders, (b) examine the specific impact of disordered eating behaviors on the risk of DGBI, and (c) explore the impact of current eating disorder psychopathology on DGBI. METHOD We included 765 cases with eating disorders and 1,240 controls. DGBI were assessed via the ROME III questionnaire. Prevalences of DGBI were calculated across eating disorder diagnoses (anorexia nervosa, bulimia nervosa, and multiple eating disorders) and in controls. The association between disordered eating behaviors and DGBI was examined using logistic regression models. Lastly, we compared the total number of DGBI in individuals with high versus low current eating disorder symptoms. RESULTS A large majority (88.2-95.5%) of individuals with eating disorders reported at least one DGBI and 34.8-48.7% reported three or more DGBI. Of the DGBI categories, functional bowel disorders were the most commonly endorsed category, and of the individual DGBI, irritable bowel syndrome was the most frequently reported (43.9-58.8%). All investigated disordered eating behaviors showed a positive association with most DGBI categories. Finally, individuals reporting high current eating disorder symptoms reported higher mean number of DGBI (3.03-3.34) than those with low current symptoms (1.60-1.84). DISCUSSION The directionality and mechanisms underlying the nature of the relationship between gastrointestinal and eating disorder symptoms is worthy of further study and clinicians should adopt an integrated approach by attending to both gastrointestinal and eating disorder symptoms in their patients.
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Affiliation(s)
- Camilla A Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marianna Rania
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, Mater Domini University Hospital, Catanzaro, Italy
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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8
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Mourilhe C, Moraes CED, Veiga GD, Q da Luz F, Pompeu A, Nazar BP, Coutinho ESF, Hay P, Appolinario JC. An evaluation of binge eating characteristics in individuals with eating disorders: A systematic review and meta-analysis. Appetite 2021; 162:105176. [PMID: 33639247 DOI: 10.1016/j.appet.2021.105176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 12/16/2020] [Accepted: 02/19/2021] [Indexed: 01/29/2023]
Abstract
The objective of this review is to provide an updated synthesis of studies in individuals with eating disorders that examined the following components of binge eating episodes (BEEs): caloric intake, episode duration, and also the association of BEE size with psychopathology. A systematic review and meta-analysis were performed following the PRISMA guidelines. Searches were conducted on PubMed, PsycINFO, Scopus, SciELO, ScienceDirect and ProQuest databases. Meta-analysis was performed using random effects models and meta-regression. Forty-three studies were included. There was a paucity of information regarding BEE in individuals with anorexia nervosa. The pooled caloric intake of participants with bulimia nervosa (BN) during BEE in laboratory studies was significantly greater in comparison to the caloric intake during BEE in clinical studies [(3070 (95%CI 2596, 3544) vs. 1789 (95%CI 1498, 2081)], respectively. In participants with binge eating disorder (BED), the pooled means were 2088 (95%CI 1819, 2358) kcal in laboratory studies and 1903 (95%CI 1622, 2184) kcal in clinical studies, with no statistically significant difference between groups. Overall, BEE had a mean duration of 37.3 min in participants with BN and 41.7 min in those with BED. We found a positive correlation between the average caloric intake and level of depression (β = 55.5; p = 0.019). BEE in individuals with BN or BED were characterized by the consumption of extremely large quantities of calories. This was mainly found in laboratory studies of individuals with BN. BEE had a mean duration of less than 1 h in individuals with BN or BED. BEE size was positively associated with depression severity. Future research should explore the relevance of binge size as a core component of binge eating in clinical samples, in males, and in pediatric populations.
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Affiliation(s)
- Carla Mourilhe
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Institute of Nutrition Josue de Castro, Department of Social and Applied Nutrition - Av. Carlos Chagas Filho, 373 - bloco J, 2° andar - Cidade Universitária, CEP:21941-902, Rio de Janeiro, Brazil.
| | - Carlos EduardoFerreira de Moraes
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
| | - GloriaValeria da Veiga
- Federal University of Rio de Janeiro, Institute of Nutrition Josue de Castro, Department of Social and Applied Nutrition - Av. Carlos Chagas Filho, 373 - bloco J, 2° andar - Cidade Universitária, CEP:21941-902, Rio de Janeiro, Brazil.
| | - Felipe Q da Luz
- University of São Paulo, Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), São Paulo, SP 05403-010, Brazil.
| | - Amanda Pompeu
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
| | - Bruno Palazzo Nazar
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
| | - Evandro Silva Freire Coutinho
- The State University of Rio de Janeiro, Institute of Social Medicine - R. São Francisco Xavier, 524 - Maracanã, CEP:20550-900, Rio de Janeiro, Brazil.
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, School of Medicine - David Pilgrim Avenue, Campbelltown, NSW 2560, Australia.
| | - Jose Carlos Appolinario
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
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Krug I, Giles S, Paganini C. Binge eating in patients with polycystic ovary syndrome: prevalence, causes, and management strategies. Neuropsychiatr Dis Treat 2019; 15:1273-1285. [PMID: 31190833 PMCID: PMC6529622 DOI: 10.2147/ndt.s168944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/18/2019] [Indexed: 12/28/2022] Open
Abstract
Emerging evidence suggests that disordered eating, particularly binge-eating symptomatology, is overrepresented within Polycystic Ovary Syndrome (PCOS) populations. This comorbidity presents a clinical dilemma as current treatment approaches for PCOS emphasize the importance of weight management, diet, exercise, and the potential for harm of such treatment approaches in PCOS patients with comorbid disordered eating. However, limited research has assessed the occurrence of binge eating and disordered eating in PCOS patients. Consequently, little is known about the prevalence of binge eating in PCOS, and the possible etiological processes to explain this comorbidity remain poorly understood. Given the paucity of research on this topic, the aims of this narrative review are fourfold: 1) to outline the main symptoms of PCOS and binge eating; 2) to provide an overview of the prevalence of binge eating in PCOS; 3) to outline possible etiological factors for the comorbidity between PCOS and binge eating; and 4) to provide an overview of management strategies of binge eating in PCOS.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Chiara Paganini
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- Faculty of Health, Federation University, Ballarat, VIC, Australia
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10
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Sucrose and fat content significantly affects palatable food consumption in adolescent male and female rats. Appetite 2017; 118:49-59. [DOI: 10.1016/j.appet.2017.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 12/19/2022]
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Goldschmidt AB. Are loss of control while eating and overeating valid constructs? A critical review of the literature. Obes Rev 2017; 18:412-449. [PMID: 28165655 PMCID: PMC5502406 DOI: 10.1111/obr.12491] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Binge eating is a marker of weight gain and obesity, and a hallmark feature of eating disorders. Yet its component constructs - overeating and loss of control (LOC) while eating - are poorly understood and difficult to measure. OBJECTIVE The objective of this study is to critically review the human literature concerning the validity of LOC and overeating across the age and weight spectrum. DATA SOURCES English-language articles addressing the face, convergent, discriminant and predictive validity of LOC and overeating were included. RESULTS Loss of control and overeating appear to have adequate face validity. Emerging evidence supports the convergent and predictive validity of the LOC construct, given its unique cross-sectional and prospective associations with numerous anthropometric, psychosocial and eating behaviour-related factors. Overeating may be best conceptualized as a marker of excess weight status. LIMITATIONS Binge eating constructs, particularly in the context of subjectively large episodes, are challenging to measure reliably. Few studies addressed overeating in the absence of LOC, thereby limiting conclusions about the validity of the overeating construct independent of LOC. Additional studies addressing the discriminant validity of both constructs are warranted. DISCUSSION Suggestions for future weight-related research and for appropriately defining binge eating in the eating disorders diagnostic scheme are presented.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
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Ålgars M, Huang L, Von Holle AF, Peat CM, Thornton L, Lichtenstein P, Bulik CM. Binge eating and menstrual dysfunction. J Psychosom Res 2014; 76:19-22. [PMID: 24360136 PMCID: PMC3909535 DOI: 10.1016/j.jpsychores.2013.11.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/21/2013] [Accepted: 11/22/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The relation between eating disorders and menstrual function has been widely studied, but it is unknown whether the behavior of binge eating itself is related to menstrual dysfunction. METHODS The 11,503 women included in this study were from the Swedish Twin study of Adults: Genes and Environment. The associations between menstrual dysfunction and binge eating were analyzed using logistic regression or multiple linear regression models with generalized estimation equations. RESULTS Women who reported lifetime binge eating were more likely to report either amenorrhea or oligomenorrhea than women who reported no binge eating. These results persisted when controlling for compensatory behaviors including self-induced vomiting, laxative use, and diuretic use. No differences between women with and without a history of binge eating were observed for age at menarche. CONCLUSION Even when controlling for the effect of compensatory behaviors, the behavior of binge eating is associated with menstrual dysfunction. Metabolic and endocrinological factors could underlie this association. Careful evaluation of menstrual status is warranted for women with all eating disorders, not just anorexia nervosa.
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Affiliation(s)
- Monica Ålgars
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Lu Huang
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Ann F. Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Laura Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill,Department of Nutrition, University of North Carolina at Chapel Hill
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Peat CM, Huang L, Thornton LM, Von Holle AF, Trace SE, Lichtenstein P, Pedersen NL, Overby DW, Bulik CM. Binge eating, body mass index, and gastrointestinal symptoms. J Psychosom Res 2013; 75:456-61. [PMID: 24182635 PMCID: PMC3817501 DOI: 10.1016/j.jpsychores.2013.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/14/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Symptoms of both gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are frequently reported by individuals who binge eat. Higher body mass index (BMI) has also been associated with these disorders and with binge eating (BE). However, it is unknown whether BE influences GERD/IBS and how BMI might affect these associations. Thus, we examined the potential associations among BE, GERD, IBS, and BMI. METHODS Participants were from the Swedish Twin study of Adults: Genes and Environment (STAGE) and provided information on disordered eating behavior, BMI, gastrointestinal (GI) disorders, and commonly comorbid psychiatric and somatic illnesses. Key features of GERD and IBS were identified to create modified definitions of both disorders that were used as primary outcome variables. Logistic regression models were applied to determine the association between BE and each GERD/IBS both independently and in the context of BMI and other commonly comorbid psychiatric and somatic morbidities. RESULTS Prevalence estimates for GERD and IBS were higher among women than men (all p-values<.001). Only the association between BE and IBS was significant in both men and women after adjustment for BMI and the psychiatric/somatic morbidities. CONCLUSION BE appears to be an important consideration in the presence of IBS symptoms in both men and women, even when considering the impact of BMI and other commonly comorbid conditions. This association underscores the importance of routine assessment of BE in patients presenting with IBS to effectively manage the concurrent presentation of these problems.
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Affiliation(s)
- Christine M. Peat
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA,Correspondence to: Cynthia Bulik, PhD, Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA. Voice: (919) 843-1689; Fax: (919) 843-8802;
| | - Lu Huang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ann F. Von Holle
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sara E. Trace
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paul Lichtenstein
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - D. Wayne Overby
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
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Bartholome LT, Peterson RE, Raatz SK, Raymond NC. A comparison of the accuracy of self-reported intake with measured intake of a laboratory overeating episode in overweight and obese women with and without binge eating disorder. Eur J Nutr 2013; 52:193-202. [PMID: 22302613 DOI: 10.1007/s00394-012-0302-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 01/10/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Research has demonstrated significant underreporting of food intake in obese individuals with and without binge eating disorder (BED). An improved understanding of the accuracy of self-reported food intake is central to diagnosis of eating disorders and monitoring response to treatment. The purpose was to: (1) confirm those with BED consume significantly more kilocalories (kcal) than overweight/obese controls when instructed to overeat in the laboratory and (2) compare dietary recall data with measured intake. METHODS Fifteen women fulfilling BED criteria and 17 controls participated in an overeating episode and completed a 24-h dietary recall. RESULTS BED participants consumed significantly more kilocalories according to both methodologies. The BED group self-reported 90% of the measured intake compared to 98% for the control group. Mean differences between the methods indicated that on average both groups underreported intake; however, the mean difference between methods was significantly greater in the BED group. CONCLUSIONS Findings confirm that those with BED consume significantly more than controls during a laboratory binge and controls tended to be more accurate in recalling their intake 24 h later.
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Affiliation(s)
- Lindsay T Bartholome
- Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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Lardeux S, Kim JJ, Nicola SM. Intermittent access to sweet high-fat liquid induces increased palatability and motivation to consume in a rat model of binge consumption. Physiol Behav 2013; 114-115:21-31. [PMID: 23499930 DOI: 10.1016/j.physbeh.2013.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/16/2013] [Accepted: 03/05/2013] [Indexed: 12/16/2022]
Abstract
Binge eating disorders are characterized by discrete episodes of rapid and excessive food consumption. In rats, giving intermittent access to sweet fat food mimics this aspect of binge eating. These models typically employ solid food; however, the total amount consumed depends on motivation, palatability and satiety, which are difficult to dissociate with solid food. In contrast, lick microstructure analysis can be used to dissociate these parameters when the ingestant is a liquid. Therefore, we developed a binge model using a liquid emulsion composed of corn oil, heavy cream and sugar. We show that rats given intermittent access to this high-fat emulsion develop binge-like behavior comparable to that previously observed with solid high-fat food. One feature of this behavior was a gradual escalation in consumption across 2.5 weeks of intermittent access, which was not apparent in rats given lower-fat liquid on the same access schedule. Lick microstructure analysis suggests that this escalation was due at least in part to increases in both motivation to consume and palatability-driven consumption.
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Affiliation(s)
- Sylvie Lardeux
- Department of Psychiatry and Behavioral Science and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Raymond NC, Peterson RE, Bartholome LT, Raatz SK, Jensen MD, Levine JA. Comparisons of energy intake and energy expenditure in overweight and obese women with and without binge eating disorder. Obesity (Silver Spring) 2012; 20:765-72. [PMID: 22016098 PMCID: PMC3882077 DOI: 10.1038/oby.2011.312] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine whether there are differences in energy intake or energy expenditure that distinguish overweight/obese women with and without binge eating disorder (BED). Seventeen overweight/obese women with BED and 17 overweight/obese controls completed random 24-h dietary recall interviews, and had total daily energy expenditure (TDEE) assessed by the doubly labeled water (DLW) technique with concurrent food log data collection. Participants received two baseline dual-energy X-ray absorptiometry (DXA) scans and had basal metabolic rate (BMR) and thermic effect of food (TEF) measured using indirect calorimetry. Results indicated no between group differences in TDEE, BMR, and TEF. As in our previous work, according to dietary recall data, the BED group had significantly higher caloric intake on days when they had binge eating episodes than on days when they did not (3,255 vs. 2,343 kcal). There was no difference between BED nonbinge day intake and control group intake (2,233 vs. 2,140 kcal). Similar results were found for food log data. Dietary recall data indicated a trend toward higher average daily intake in the BED group (2,587 vs. 2,140 kcal). Furthermore, when comparing TDEE to dietary recall and food log data, both groups displayed significant under-reporting of caloric intake of similar magnitudes ranging from 20 to 33%. Predicted energy requirements estimated via the Harris-Benedict equation (HBE) underestimated measured TDEE by 23-24%. Our data suggest that increased energy intake reported by BED individuals is due to increased food consumption and not metabolic or under-reporting differences.
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Affiliation(s)
- Nancy C Raymond
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
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Peterson RE, Latendresse SJ, Bartholome LT, Warren CS, Raymond NC. Binge Eating Disorder Mediates Links between Symptoms of Depression, Anxiety, and Caloric Intake in Overweight and Obese Women. J Obes 2012; 2012:407103. [PMID: 22778917 PMCID: PMC3385667 DOI: 10.1155/2012/407103] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 02/19/2012] [Accepted: 04/14/2012] [Indexed: 11/17/2022] Open
Abstract
Despite considerable comorbidity between mood disorders, binge eating disorder (BED), and obesity, the underlying mechanisms remain unresolved. Therefore, the purpose of this study was to examine models by which internalizing behaviors of depression and anxiety influence food intake in overweight/obese women. Thirty-two women (15 BED, 17 controls) participated in a laboratory eating-episode and completed questionnaires assessing symptoms of anxiety and depression. Path analysis was used to test mediation and moderation models to determine the mechanisms by which internalizing symptoms influenced kilocalorie (kcal) intake. The BED group endorsed significantly more symptoms of depression (10.1 versus 4.8, P = 0.005 ) and anxiety (8.5 versus 2.7, P = 0.003). Linear regression indicated that BED diagnosis and internalizing symptoms accounted for 30% of the variance in kcal intake. Results from path analysis suggested that BED mediates the influence of internalizing symptoms on total kcal intake (empirical P < 0.001 ). The associations between internalizing symptoms and food intake are best described as operating indirectly through a BED diagnosis. This suggests that symptoms of depression and anxiety influence whether one engages in binge eating, which influences kcal intake. Greater understanding of the mechanisms underlying the associations between mood, binge eating, and food intake will facilitate the development of more effective prevention and treatment strategies for both BED and obesity.
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Affiliation(s)
- Roseann E. Peterson
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA 23298, USA
- ,
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Biotechnology I, Richmond, VA 23298, USA
- *Roseann E. Peterson:
| | - Shawn J. Latendresse
- ,
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Biotechnology I, Richmond, VA 23298, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | | - Cortney S. Warren
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
| | - Nancy C. Raymond
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55455, USA
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Wolfe BE, Baker CW, Smith AT, Kelly-Weeder S. Validity and utility of the current definition of binge eating. Int J Eat Disord 2009; 42:674-86. [PMID: 19610126 DOI: 10.1002/eat.20728] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Binge eating, a cardinal symptom of bulimia nervosa (BN) and binge eating disorder (BED), continues to pose challenges in terms of its definition and thus construct validity and clinical utility. This article reviews the available empirical data that support or refute the current DSM-IV-TR defined characteristics of a binge episode. METHOD A systematic literature review was conducted using Medline/PubMed electronic database on DSM-IV-TR defined binge characteristics and associated attributes. RESULTS Data support the current DSM guidelines indicating that binge episodes typically occur in less than 2 h. Size of binge episodes has variability across BN and BED diagnostic groups. Loss of control (LOC) continues to be a core feature of binge eating. Negative affect is the most widely reported antecedent. Strikingly, little is known about binge episodes among individuals with anorexia nervosa-binge/purge subtype. DISCUSSION Available empirical evidence supports the current DSM duration and LOC attributes of a binge episode in BN and BED. However, a more controversial issues is the extent to which size is important in the definition of a binge episode (e.g., subjective vs. objective episodes) across diagnostic categories and the extent to which binge size informs prognosis, treatment, and clinical outcomes. Further study of binge eating attributes in AN is needed.
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Affiliation(s)
- Barbara E Wolfe
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, Massachusetts 02467, USA.
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The efficacy of a short version of a cognitive-behavioral treatment followed by booster sessions for binge eating disorder. Behav Res Ther 2009; 47:628-35. [DOI: 10.1016/j.brat.2009.04.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 03/31/2009] [Accepted: 04/06/2009] [Indexed: 11/17/2022]
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20
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Smyth JM, Wonderlich SA, Sliwinski MJ, Crosby RD, Engel SG, Mitchell JE, Calogero RM. Ecological momentary assessment of affect, stress, and binge-purge behaviors: day of week and time of day effects in the natural environment. Int J Eat Disord 2009; 42:429-36. [PMID: 19115371 PMCID: PMC2996234 DOI: 10.1002/eat.20623] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The present study examined ecological momentary assessments of binge/vomit behavior, mood, and type and severity of stressors in a sample of 133 women with bulimia nervosa. METHOD Participants completed an ecological momentary assessment protocol for a period of 2 weeks. RESULTS Mixed-effects and multilevel logistic models revealed significant variation across time of day and day of the week in the occurrence of binging, vomiting, positive and negative affect, and the severity and types of stressful events. DISCUSSION These findings explicate how momentary and daily experiences vary in the natural environments of women with bulimia nervosa, and document critical time periods for intervention.
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Affiliation(s)
- Joshua M. Smyth
- Department of Psychology, Syracuse University, Syracuse, New York,Correspondence to: Joshua M. Smyth, Department of Psychology, Syracuse University, Syracuse, New York.
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota
| | | | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota
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