Clinical utility of subtyping binge eating disorder by history of anorexia or bulimia nervosa in a treatment sample

Onset patterns and clinical features of binge-eating disorder in a Japanese clinical sample

OBJECTIVE

This study aimed to investigate the clinical presentation of binge-eating disorder (BED) in a Japanese sample and to examine the relationship between subtypes of BED differing in onset patterns and those differing in prior history of another eating disorder (ED).

METHODS

The study participants were 137 adults who met the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for BED. We subtyped participants based on prior history of another ED: 55 (40.1%) participants with a history of another ED (BED ED+) and 82 participants without such a history (BED ED-).

RESULTS

Unlike in some Western studies, approximately three quarters of participants had a body mass index of <25 kg/m2 . None of the participants reported a history of another ED with purging or excessive exercise. All BED ED+ participants transitioned to BED from anorexia nervosa restricting type (AN-R) or from atypical AN-R. BED ED+ participants reported more severe psychopathology than BED ED-participants. Only 20% had a treatment history for BED. Dieting preceded their first binge eating in 55 participants (DIET-first BED), and binge eating preceded their first dieting in 82 participants (BINGE-first BED). Regarding the relationship between the two different subtypes, all DIET-first BED participants were in the BED ED+ group, whereas all BINGE-first BED participants were in the BED ED-group.

DISCUSSION

Present findings revealed the clinical presentation of BED in a Japan-based study and suggested that subtypes of BED differing in the prior history of another ED yielded an accurate prediction of onset patterns (dieting first vs. binge eating first).

PUBLIC SIGNIFICANCE

This study highlights the need for clinicians to consider subtype differences in onset patterns and clinical features of BED to treat and prevent this disorder. This study revealed that, although individuals with BED in Japan have severe symptoms and a long duration of illness, only 20% have received BED treatment. The results indicate a need to disseminate knowledge about BED to the Japanese public and healthcare providers.

Binge-eating disorder with and without lifetime anorexia nervosa: A comparison of sociodemographic and clinical features

OBJECTIVE

To compare individuals who have experienced binge-eating disorder (BED) and anorexia nervosa (AN) (BED AN+) to those who have experienced BED and not AN (BED AN-).

METHOD

Participants (N = 898) met criteria for lifetime BED and reported current binge eating. Approximately 14% had a lifetime diagnosis of AN. Analyses compared BED AN+ and BED AN- on sociodemographic variables and clinical history.

RESULTS

The presence of lifetime AN was associated with more severe eating disorder symptoms, including earlier onset, more frequent, more chronic, and more types of eating disorder behaviors over the lifetime, as well as a higher lifetime prevalence of bulimia nervosa (BN). Participants with lifetime AN reported being more likely to have received treatments for BED or BN, had significantly lower minimum, current, and maximum BMIs, had more severe general anxiety, and were significantly more likely to be younger and female. In the full sample, the lifetime prevalence of unhealthy weight control behaviors was high and treatment utilization was low, despite an average 15-year history since symptom onset. Gastrointestinal disorders and comorbid anxiety, depression, and attention-deficit/hyperactivity disorder symptoms were prevalent.

DISCUSSION

Individuals fared poorly on a wide array of domains, yet those with lifetime AN fared considerably more poorly. All patients with BED should be screened for mental health and gastrointestinal comorbidities and offered referral and treatment options.

PUBLIC SIGNIFICANCE

Individuals experiencing binge-eating disorder have severe symptomology, but those who have experienced binge-eating disorder and anorexia nervosa fare even more poorly. Our study emphasizes that patients with binge-eating disorder would benefit from being screened for mental health and gastrointestinal comorbidities, and clinicians should consider history of unhealthy weight control behaviors to inform treatment and relapse prevention.

A preliminary study of momentary, naturalistic indicators of binge-eating episodes in adults with obesity

OBJECTIVES

Binge eating is common in adults with obesity. The Diagnostic and Statistical Manual for Psychiatric Disorders describes five indicators of binge eating (eating more rapidly than usual; eating until uncomfortably full; eating large amounts of food when not physically hungry; eating alone because of embarrassment over how much one is eating; and feeling disgusted with oneself, depressed, or very guilty after overeating), but their validity is unclear.

METHOD

We examined preliminary associations between the five indicators and binge versus nonbinge episodes among 50 adults with obesity via ecological momentary assessment.

RESULTS

Generalized linear models revealed that, relative to nonbinge episodes, self-reported binge episodes were associated with lower pre-episode hunger (p = .004), higher postepisode fullness (p < .001), a greater likelihood of reporting moderate to extreme shame prior to eating in conjunction with eating alone (p < .001), and a greater likelihood of reporting moderate to extreme disgust, depression, and/or guilt after eating (p < .001), but not with eating more rapidly than usual (p = .85).

DISCUSSION

Results support the validity of most binge-eating indicators, although the utility of the rapid eating criterion is questionable. Future research should examine whether modifying these indicators in binge-eating interventions would reduce the occurrence of loss of control and/or overeating.

Evaluating the Ecological Validity of the Dutch Eating Behavior Questionnaire Among Obese Adults Using Ecological Momentary Assessment

This study evaluated the ecological validity (i.e., accurate measurement of a construct as experienced in naturalistic settings) of the self-report Dutch Eating Behavior Questionnaire (DEBQ). Obese adults (N = 50) completed the DEBQ, followed by a 2-week ecological momentary assessment protocol that included measures of eating episodes and associated intrapersonal contextual factors. Results revealed that DEBQ Emotional Eating was associated with greater negative affect and less positive affect at both pre- and post-eating episode, as well as post-eating ratings of feeling driven to eat. DEBQ External Eating was positively associated with pre-eating expectations about enjoying the taste of food, but was unrelated to actual enjoyment reported post-eating; External Eating was positively associated with the post-eating ratings of feeling driven to eat. DEBQ Dietary Restraint was positively associated with pre-eating intentions to eat less to lose/avoid gaining weight. Overall, results provide some support for the ecological validity of the DEBQ.