Psychological factors in the etiology of binge eating

Adolescents and Eating Disorders:

Little is known about the incidence and prevalence of eating disorders among adolescents of color who are poor or identify themselves as gay or lesbian. Among American women, eating disturbances are equally as common among Native, Asian, or Hispanic Americans as they are among Caucasians. African Americans were at higher risk of developing eating disorders than were Hispanic and Asian Americans. Media and gender-role body stereotype and body dissatisfaction are strongly linked and have been shown to be the strongest predictors of disordered eating. As these youth adopt Western values about beauty, they may be at increased risk for developing eating disorders.

Eating Disorders in the Adolescent Population:

Although eating disorders often begin during adolescence, characteristics of this population can complicate early detection by clinicians. The purpose of this article is to selectively review the literature on the diagnostic criteria for eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder) as described in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and International Classification of Diseases (10th ed.). The prevalence and course of eating disorders, theories regarding their etiology, and issues of comorbidity and differential diagnosis are also discussed.

Gender Role Internalization, Multiple Roles, and Chinese Women's Mental Health

The influence of gender role internalization as a moderator in the relationship between women's multiple roles and psychological distress was investigated. Study 1 identified three components of gender role internalization, which were labeled “Traditional Ideal Person,” “Self-Sacrifice,” and “Competence Without Complaint,” and found that it did not, overlap with existing gender-typed measures among 128 female Chinese university students. The multidimensionality of gender role internalization was confirmed in Study 2 among a sample of 225 women in the paid Hong Kong workforce. As expected, role quality was a better predictor of psychological distress than role quantity. Gender role internalization accounted for significant portions of explained variance even after taking role quality into account. Internalization of Traditional Ideal Person and Competence Without Complaint messages exacerbated distress in certain areas when role quality was low. However, internalization of Self-Sacrifice messages mitigated distress for Chinese women with low work quality.

Smoking in College Women: The Role of Thinness Pressures, Media Exposure, and Critical Consciousness

There are strong social pressures for U.S. females, particularly those of European heritage, to achieve and maintain an extremely low body weight. These pressures are reflected in a variety of media sources, including advertising. We argue that valuing thinness, exposure to thinness-depicting media, and lacking skepticism about tobacco advertisements have adverse effects on young women's decisions about smoking, particularly smoking for weight control. We tested these hypotheses in a study of 188 female undergraduates, both never-smokers and daily smokers. Believing that smoking controls weight, exposure to thinness-depicting media, and low levels of skepticism about tobacco advertising were associated with being a smoker. Among smokers, believing that smoking controls weight, internalizing thinness pressures, and low levels of feminist consciousness were associated with smoking for weight control. Results are discussed with the aim of encouraging public health anti-smoking campaigns targeted at women, and smoking cessation programs that are responsive to the needs of weight-concerned female smokers.

Executive functioning and behavioral impulsivity of young women who binge eat

OBJECTIVE

To examine the link between binge eating, executive functioning, and behavioral impulsivity.

METHOD

Fifty women who reported engaging in weekly binge eating in the absence of regular compensatory behaviors and 66 women with no history of binge eating completed several self-report questionnaires and a brief neuropsychological battery, including the Wisconsin Card Sorting Task and Conner's Continuous Performance Task.

RESULTS

Hierarchical regression analyses revealed that groups did not differ in executive functioning after controlling for depression, anxiety, body mass, general intelligence, and psychotropic medication use. Correlation analyses suggest that individuals who endorse more frequent binge eating might have greater difficulties thinking flexibly or shifting attention. Individuals who binge eats are also more likely to behave impulsively, but only for emotional reasons.

DISCUSSION

Although this study is unable to determine whether these cognitive and behavioral factors precede or follow binge-eating episodes, outcomes have implications for treatment and prevention.

Relationships between psychological stress, coping and disordered eating: A review

Abstract Objective: Psychological stress and inadequate coping skills have been hypothesized to play important roles in the etiology of disordered eating. This paper reviews the empirical evidence which has emerged regarding the proposed relationships among stress. coping skills and various forms of disordered eating.

METHOD

A search of psychological and medical databases was conducted to identify studies examining life events, and other types of psychological stress and coping strategies, in relation to the onset of disordered eating.

RESULTS

Despite methodological limitations such as the use of non-representative samples and retrospective methodologies, evidence of relationships between stress. coping and disordered eating was obtained in the majority of studies reviewed.

DISCUSSION

The implications of these findings am discussed and suggestions for future research, including the utilization of longitudinal. prospective studies, am presented.

Childhood emotional problems and self-perceptions predict weight gain in a longitudinal regression model

BACKGROUND

Obesity and weight gain are correlated with psychological ill health. We predicted that childhood emotional problems and self-perceptions predict weight gain into adulthood.

METHODS

Data on around 6,500 individuals was taken from the 1970 Birth Cohort Study. This sample was a representative sample of individuals born in the UK in one week in 1970. Body mass index was measured by a trained nurse at the age of 10 years, and self-reported at age 30 years. Childhood emotional problems were indexed using the Rutter B scale and self-report. Self-esteem was measured using the LAWSEQ questionnaire, whilst the CARALOC scale was used to measure locus of control.

RESULTS

Controlling for childhood body mass index, parental body mass index, and social class, childhood emotional problems as measured by the Rutter scale predicted weight gain in women only (least squares regression N = 3,359; coefficient 0.004; P = 0.032). Using the same methods, childhood self-esteem predicted weight gain in both men and women (N = 6,526; coefficient 0.023; P < 0.001), although the effect was stronger in women. An external locus of control predicted weight gain in both men and women (N = 6,522; coefficient 0.022; P < 0.001).

CONCLUSION

Emotional problems, low self-esteem and an external locus of control in childhood predict weight gain into adulthood. This has important clinical implications as it highlights a direction for early intervention strategies that may contribute to efforts to combat the current obesity epidemic.

Shared psychopathology in obese subjects with and without binge-eating disorder

OBJECTIVE

To investigate obese people with/without binge-eating Disorder (BED) in terms of shared psychopathological features pertaining to spectrum of eating disorders.

METHOD

One-hundred obese adult patients with a BMI > 30 kg/m(2) referred to an Eating Disorder Unit and/or hospital weight-loss programs were administered the BED Clinical Interview, the Eating Disorder Inventory, and the Structured Clinical Interview for Anorexic-Bulimic Spectrum, Self-Report.

RESULTS

Twenty-seven subjects satisfied DSM-IV research criteria for current BED; compared to nonbingeing obese subjects, BED ones were characterized by greater weight-shape concerns influencing self-esteem (p = .05), overall impairment due to the overweight condition (p < .005), psychological distress leading to professional help (p < .001), dichotomous reasoning (p = .01) and secondary social phobia due to the overweight condition (p < .005). Compared to the other group, BED obese subjects scored higher at the following EDI subscales: bulimia (p < .0001), ineffectiveness (p < .01), interoceptive awareness and social insecurity (p < .05).

CONCLUSION

The results of this study highlight the role of cognitive mechanisms such as dichotomous reasoning and weight-shape concerns unduly influencing self-esteem as a hallmark of BED in obese patients, and the importance of investigating eating disorder psychopathology by adopting a dimensional perspective, rather than strictly focusing on categories when dealing with obese patients.

Structure analysis of the Children's Eating Attitudes Test in overweight and at-risk for overweight children and adolescents

BACKGROUND

In school-based samples of children, the Children's Eating Attitudes Test (ChEAT) has a four-factor structure; however, previous studies have not examined its factor structure in samples restricted to overweight youth.

METHODS

The ChEAT was administered to 220 overweight (BMI>or=95th percentile) and 45 at-risk for overweight (BMI 85th-<95th percentile) children and adolescents. Factors were identified by a principal component analysis with varimax rotation. ChEAT factor scores of children with BMI>or=85th percentile were contrasted with those of 152 non-overweight (BMI 5th to <85th percentile) children and adolescents.

RESULTS

Factor analysis generated four subscales described as 'body/weight concern,' 'food preoccupation,' 'dieting,' and 'eating concern.' ChEAT total score, body/weight concern, and dieting subscale scores were positively related to BMI-Z and body fat mass (p's<.05). Compared to non-overweight children, overweight and at-risk for overweight children had higher ChEAT total (9.9+/-7.4 vs. 6.6+/-7.8, p<.001), body/weight concern (3.2+/-3.1 vs. 1.3+/-3.0, p<.001), and dieting (1.8+/-2.2 vs. .8+/-2.3, p<.001) subscale scores.

CONCLUSIONS

The previously elucidated factor structure of the ChEAT was primarily supported in a sample of overweight children. The emergence of separate body/weight concern and dieting subscales may relate to these children's experiences with attempted weight reduction.

Relationship between spiritual well-being and binge eating in college females

The aim of this study was to examine the relationship of spiritual well-being in college female non-binge, objective binge and binge-trait eaters. Therefore, this study aimed to measure spiritual well-being in non-binge, objective binge and partial/full-syndrome binge eating disorder college females. Survey research was conducted using a randomized sample of 809 female students. The sample was categorized into three binge eating categories: nonbinge, objective binge, and binge eating trait. Chi-Squares and Analysis of Variance determined binge eating group differences on demographics, global spiritual well-being, religious well-being, and existential well-being. Significant differences were found among groups for global spiritual well-being (p< or = 0.000), religious well-being (p< or = 0.000), and existential well-being (p< or = 0.000). Higher levels of binge eating severity were associated with lower global spiritual and existential well-being scores. On measures of religious well-being, significant differences existed between the non-binge and the binge eating trait groups. The results suggest that spiritual well-being and especially existential well-being may be indirectly associated with the severity of binge eating.

Cognitive-behavioral treatment of irritable bowel syndrome

There is increasing evidence that supports the view that irritable bowel disorder (IBS) is a disorder of brain-gut function. Cognitive-behavioral therapy (CBT) has received increased attention in light of this recent shift in the conceptualization of IBS. This review has two main aims. The first is to provide a critical review of controlled trials on CBT for IBS. The second is to discuss ways of further developing CBT interventions that are more clinically relevant and meaningful to health care providers and individuals with a diagnosis of IBS. A theme from a CBT intervention will be presented to illustrate how CBT interventions can be incorporated within a larger social context. A review of CBT for IBS lends some limited support for improvement in some IBS symptoms and associated psychosocial distress. This conclusion needs to be expressed with some caution, however, in light of many methodological shortcomings including small sample sizes, inadequate control conditions and failure to identify primary versus secondary outcome measures. In addition, future studies will need to further develop more relevant CBT protocols that more fully integrate the patient's perspective and challenge social cognitions about this stigmatized disorder.

Parents are key players in the prevention and treatment of weight-related problems

There is growing agreement among experts that an obesogenic environment, which encourage excess food intake and idealizes thinness, plays a crucial role in the epidemic of childhood obesity and eating disorders. Because parents provide a child's contextual environment, they should be considered key players in interventions aimed at preventing or treating weight-related problems. Parenting style and feeding style are crucial factors in fostering healthy lifestyle and awareness of internal hunger and satiety cues and de-emphasizing thinness. Effective interventions for prevention and treatment of weight-related problems should be approached from a health-centered rather than a weight-centered perspective, with the parents as central agents of change. This paper reviews the environmental risk factors and parents' role in the prevention and treatment of children's weight-related problems.

Prevalence and correlates of binge eating in white and African American adolescents

OBJECTIVE

This study examined the prevalence and correlates of binge eating in a biracial sample of adolescent males and females.

METHOD

White and African American students in Grades 6-12 (N=822) completed measures of social economic status (SES), body mass index (BMI), depression, current-ideal body image discrepancy, eating attitudes, dieting frequency, dietary intake, and activity level.

RESULTS

Binge eating prevalence was highest among African American boys relative to the other demographic groups: 26% African American boys, 17% African American girls, 19% white boys, 18% white girls. Binge eating rates increased with age for white participants and decreased with age for African American participants. Depressive symptoms and consumption of high-fat foods predicted binge status among adolescents, whereas SES, BMI, eating attitudes, body image discrepancy, dieting, and low activity level failed to add predictive value.

DISCUSSION

The observation of developmental differences in binging between whites and African Americans corresponds to their physical maturational divergence. These findings underscore the need for population-based surveys that sample binge eating across age, gender, and ethnicity.

Binge eating disorder: a review

Binge eating disorder (BED) is a new proposed eating disorder in the DSM-IV. BED is not a formal diagnosis within the DSM-IV, but in day-to-day clinical practice the diagnosis seems to be generally accepted. People with the BED-syndrome have binge eating episodes as do subjects with bulimia nervosa, but unlike the latter they do not engage in compensatory behaviours. Although the diagnosis BED was created with the obese in mind, obesity is not a criterion. This paper gives an overview of its epidemiology, characteristics, aetiology, criteria, course and treatment. BED seems to be highly prevalent among subjects seeking weight loss treatment (1.3-30.1%). Studies with compared BED, BN and obesity indicated that individuals with BED exhibit levels of psychopathology that fall somewhere between the high levels reported by individuals with BN and the low levels reported by obese individuals. Characteristics of BED seemed to bear a closer resemblance to those of BN than of those of obesity.A review of RCT's showed that presently cognitive behavioural treatment is the treatment of choice but interpersonal psychotherapy, self-help and SSRI's seem effective. The first aim of treatment should be the cessation of binge eating. Treatment of weight loss may be offered to those who are able to abstain from binge eating.

A study of the attribution style, self-efficacy, and dietary restraint in female binge and non-binge eaters

The purpose of this study was to identify the role that attribution style and self-efficacy expectations have in overweight binge and non-binge eaters. The subjects were women (n=210) enrolled for weight control treatment, who completed a questionnaire to assess attribution style and self efficacy expectations. They were categorized into three binge eating disorder (BED) groups: non-BED, borderline BED and BED. The results of the ANOVA analysis indicated that the borderline and BED groups were significantly similar in terms of all measures of attribution and self-efficacy; and logistic regression analysis that the odds of being borderline BED or BED were greater if an individual had internal attributions, and more likely in the presence of diminished self-efficacy expectations. The subjects with low levels of eating self-efficacy and internal, global, and uncontrollable attributions were also more likely to have borderline BED and BED. The implications of the borderline BED category are discussed in relationship to the DSM-IV BED diagnosis.

Disordered eating in college freshman women: a prospective study

The authors assessed eating behaviors and attitudes of 225 college freshman women on the bulimia and restraint scales at the beginning of the year. Seven months later, they reassessed 104 of the original students. Concurrent data regression analyses found that symptoms of eating pathology were associated with figure dissatisfaction, ineffectiveness, public self-consciousness, and vigor on the Profile of Mood States, and for bulimia, self-efficacy to control eating when experiencing negative feelings, and reward conditions. Both bulimia and restraint were highly stable across the 7 months. Prospective analyses, controlling for the initial level of eating pathology in hierarchical regressions, found that figure dissatisfaction, ineffectiveness, and alcohol use/abuse over the past year were significant predictors of worsening symptoms. Beginning levels of bulimia and restraint were the best predictors of eating pathology at the end of the study. The roles that self-image and alcohol use may play as vulnerabilities for eating pathology are also considered.

Binge eating disorder: prevalence and psychopathological features in a clinical sample of obese people in Italy

Binge eating disorder (BED) is a recently conceptualized eating disturbance, and its clinical features and prevalence are still a matter of debate. This study uses interview methodology to estimate the prevalence of BED in Italy in a sample of 66 obese people presenting for treatment, and examines potential related features typical of patients with anorexia and bulimia nervosa. The lifetime and the 6-month prevalences of BED were 18.1 and 12.1%, respectively. Breaking the group down on the basis of the current as well as lifetime presence of BED, we found that the weight and shape primary to self-esteem, and the interpersonal distress related to body image, were associated with lifetime BED (P<0.05). All-or-none thinking about food and dieting was typical of BED patients as a whole, either current (P<0.01) or remitted (P<0.05). We discuss two important findings from our study: (a) the key role of self-esteem depending upon weight and shape in discriminating the eating-disordered obese from non-eating-disordered individuals; and (b) the need to explore the whole lifespan when screening for BED, so pointing to the state-trait issue.