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Goldschmidt AB, Jeong K, Yu L, Egbert AH, Schmidt R, Hilbert A. Executive functioning and treatment outcome among adolescents undergoing cognitive-behavioral therapy for binge-eating disorder. J Child Psychol Psychiatry 2024. [PMID: 38940077 DOI: 10.1111/jcpp.14031] [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] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) is an evidence-supported treatment for adolescents with binge-eating disorder (BED). Executive dysfunctions, which are associated with binge eating and elevated body weight in youth, may undermine CBT outcomes by making it difficult for youth to engage with or adhere to treatment, including recalling and/or implementing intervention strategies in real-world contexts. METHODS We assessed 73 adolescents [82.2% female; Mage = 15.0 ± 2.5 year; M baseline standardized body mass index (zBMI) = 1.9 ± 1.0 kg/m2] with BED at baseline, posttreatment, 6-, 12-, and 24-month follow-up. Linear mixed models examined the effects of baseline executive functioning (EF) on loss of control (LOC) eating and weight change following CBT. Linear and logistic regressions probed associations between EF, attendance, and attrition. RESULTS More impulsive decision-making, as reflected in higher baseline scores on the Iowa Gambling Task, predicted better attendance (β = .07; p = .019) and more frequent LOC eating following treatment (β = .12; p = .017). Lower cognitive flexibility, as reflected in lower baseline T-scores on the Comprehensive Trail Making Test complex sequencing index, predicted higher zBMI following treatment (β = -.03; p = .003). Inhibition, concentration, attention, and parent-reported EF behavior symptoms were not associated with outcome, attendance, or attrition. CONCLUSIONS More impulsive decision-making and lower cognitive flexibility were associated with suboptimal response to CBT for BED, although findings should be interpreted with caution in light of the sample size and waitlist control design. Future research should examine whether strengthening EF could improve eating and weight outcomes among adolescents with BED who have lower pre-treatment EF.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kwonho Jeong
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lan Yu
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amy H Egbert
- Department of Psychological Sciences, University of Connecticut, Storz, CT, USA
| | - Ricarda Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
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2
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Smith KE, Goldschmidt AB. Treatment of Binge-Eating Disorder Across the Lifespan: An Updated Review of the Literature and Considerations for Future Research. Curr Obes Rep 2024; 13:195-202. [PMID: 38363468 PMCID: PMC11150297 DOI: 10.1007/s13679-024-00553-4] [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] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW The present review describes the recent literature on treatment for binge-eating disorder (BED) in adults and youth, with a particular focus on research gaps, emerging treatments, and future research directions. RECENT FINDINGS Evidence supports the efficacy of several treatment modalities in adults, including self-help treatment, clinician-led psychotherapy, and pharmacotherapy; the largest effect sizes have been found for psychotherapies, most of which were cognitive-behavioral in orientation. Adapted psychotherapies for youth also show promise but lack a robust body of evidence. Predictors, moderators, and mediators of treatment outcome remain poorly understood; individuals with BED continue to experience significant barriers to treatment; and research is needed to address suboptimal treatment response. Recent work has highlighted the potential of adaptive interventions and investigation of novel mechanisms to address these gaps. Research on BED treatment continues to grow, though critical questions must be answered to improve treatment efficacy across the lifespan.
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Affiliation(s)
- Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar St #2200, Los Angeles, CA, 90033, USA.
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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3
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Downey AE, Odette M, Sanders AE, Kuykendall M, Saunders E, Nagata JM, Forsberg S, Buckelew SM, Garber AK. What medical providers need to elevate outpatient care for adolescents and young adults with binge-eating disorder: A novel protocol. Int J Eat Disord 2024; 57:294-302. [PMID: 38130097 DOI: 10.1002/eat.24110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Binge-eating disorder (BED) in adolescents and young adults is underrecognized and understudied and no standardized guidelines exist for medical providers caring for this population. To highlight the lack of extant evidence, we examine the demographic characteristics of youth with BED in an academic eating disorders (EDs) program and primary care clinic and describe the needs of their medical care providers. METHOD A retrospective chart review was conducted for patients who met criteria for BED from July 2021 to June 2022. We surveyed their medical providers to understand their needs in caring for this population. A multidisciplinary team with expertise in the care of youth with EDs amalgamated current evidence in caring for youth with BED into a protocolized care schema designed for implementation in the outpatient medical setting. RESULTS Eighteen youth with BED were reviewed, 14 identified as female, 3 as male, and 1 as "Other." Average age was 15.4 (2.7) years old, and mean body mass index was 35.90 (8.25). 33.3% (6) patients identified as White/Caucasian, followed by 22.2% (4) Hispanic/Latinx. Eleven of 18 were privately insured. The most common medical recommendations were for regular meals and snacks and for individual psychotherapy. Medical providers desired more education about identification and management of youth with BED. CONCLUSIONS To address the lack of medical care guidelines for youth with BED, recommendations in this Forum include: increased education for medical providers, standardized medical monitoring, an emphasis on psychotherapy, and a weight-inclusive orientation. PUBLIC SIGNIFICANCE Adolescents and young adults with BED are underrecognized and undertreated. Little is known about the characteristics of these patients and the medical care these patients receive within academic EDs program. For the first time, preliminary recommendations for medical care are provided.
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Affiliation(s)
- Amanda E Downey
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Michelle Odette
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Austin E Sanders
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Mikayla Kuykendall
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth Saunders
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Sara M Buckelew
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Manasse SM, Russon J, Lampe EW, King A, Abber SR, Trainor C, Gillikin LM, Levy S, Diamond G. Attachment-Based Family Therapy to Improve Family Functioning in Adolescent Binge-Spectrum Eating Disorders: An Initial Evaluation Via Case Series Design. Clin Child Psychol Psychiatry 2024; 29:45-62. [PMID: 37384823 DOI: 10.1177/13591045231187433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Binge-spectrum eating disorders (EDs; bulimia nervosa, binge eating disorder) often develop during adolescence and are associated with serious psychological and physical consequences. Current treatments for adolescents are highly behavioral in nature and while efficacious, many patients do not reach remission indicating that current treatments fail to target a key maintenance factor for EDs. One potential maintenance factor is poor family functioning (FF). In particular, high family conflict (e.g., arguing, critical comments) and low family cohesion (e.g., warmth, support) are known to maintain ED behaviors. Poor FF can (1) cause or exacerbate an adolescent's use of ED behaviors to cope with life stress and/or (2) inhibit parents from being a resource to adolescents during ED treatment. Attachment-Based Family Therapy (ABFT) is specifically designed to improve FF, and thus may be a promising adjunct to behavioral ED intervention strategies. ABFT, however, has not been tested in adolescents with binge-spectrum EDs. Thus, the current study is the first to evaluate a 16-week adapted ABFT treatment for adolescents with EDs (N = 8, Mage = 16.00, 71.43% female, 71.43% White) fusing together behavioral treatment for EDs with ABFT for highest possible impact. Eight families were treated in an open pilot trial to examine treatment feasibility, acceptability, and preliminary efficacy on FF and eating pathology. Overall, findings were promising. ABFT + B treatment was feasible and acceptable and showed preliminary evidence that it could improve FF and ED behaviors. Future research will test this intervention in a larger sample and further examine the role of FF in maintaining ED symptoms.
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Affiliation(s)
- Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jody Russon
- Department of Human Development & Family Science, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Elizabeth W Lampe
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Allie King
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Claire Trainor
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Suzanne Levy
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Guy Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
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Forrer F, Rubo M, Meyer AH, Munsch S. Binge-eating adolescent treatment (BEAT) - findings from a pilot study on effects and acceptance of a blended treatment program for youth with loss of control eating. BMC Psychol 2023; 11:415. [PMID: 38012794 PMCID: PMC10683190 DOI: 10.1186/s40359-023-01429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group remains scarce. We assessed for the first time the effects and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT). METHODS Twenty-four youths (mean age 19.1 years) participated in an active treatment of nine-weeks including three face-to-face workshops and six weekly email-guided self-help sessions, followed by four email guided follow-up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design). RESULTS The number of weekly LOC episodes substantially decreased during both the waiting-time (effect size d = 0.45) and the active treatment (d = 1.01) period and remained stable during the subsequent 12-months follow-up (d = 0.20). The proportion of patients with full-threshold binge-eating disorder (BED) diagnoses decreased and transformed into LOC during the study course, while the abstainer rate of LOC increased. Values for depressive symptoms (d = 1.5), eating disorder pathology (d = 1.29) and appearance-based rejection sensitivity (d = 0.68) all improved on average from pretreatment to posttreatment and remained stable or further improved during follow-up (d between 0.11 and 0.85). Body weight in contrast remained constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12-months follow-up. CONCLUSIONS This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish readily accessible interventions targeted more profoundly at age-salient maintaining factors such as appearance-based rejection sensitivity, while at the same time keeping dropout rates at a low level. TRIAL REGISTRATION The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018).
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Affiliation(s)
- Felicitas Forrer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.-A.-de-Faucigny 2, Fribourg, 1700, Switzerland.
| | - Marius Rubo
- Department of Psychology, Cognitive Psychology, Perception and Research Methods, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
| | - Andrea H Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.-A.-de-Faucigny 2, Fribourg, 1700, Switzerland
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Missionsstrasse 62A, Basel, 4055, Switzerland
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.-A.-de-Faucigny 2, Fribourg, 1700, Switzerland
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Baker JH, Temes E, Bohon C, Derenne J, Duvall A, Steinberg D. Enhanced Family-Based Treatment for an Adolescent With Binge-Eating Disorder: A Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2023. [DOI: 10.1016/j.cbpra.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Shank LM, Moursi NA, Tanofsky-Kraff M. Loss-of-Control Eating and Cardiometabolic Health in Relation to Overweight and Obesity. Curr Diab Rep 2022; 22:257-266. [PMID: 35403985 DOI: 10.1007/s11892-022-01466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Loss-of-control (LOC) eating, the subjective feeling of being unable to control what or how much is being consumed, is common. The purpose of this review was to examine the relationships among LOC eating, cardiometabolic health, and weight management intervention outcomes. RECENT FINDINGS In youth and adults, LOC eating is associated with and predictive of psychological symptoms, high weight, and worsened cardiometabolic health. While LOC eating pre-intervention does not appear to impact outcomes, LOC eating during or following is associated with worsened outcomes from behavioral and surgical weight management interventions. When individuals are undergoing weight management interventions, it may be important to regularly assess for LOC eating. There is limited research on the examined relationships in diverse populations (e.g., males, individuals of a lower socio-economic status, racial/ethnic minority groups). Future research should examine these relationships across the lifespan in diverse populations, with a focus on how these relationships can be impacted through targeted interventions.
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Affiliation(s)
- Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Nasreen A Moursi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA.
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Feltner C, Peat C, Reddy S, Riley S, Berkman N, Middleton JC, Balio C, Coker-Schwimmer M, Jonas DE. Screening for Eating Disorders in Adolescents and Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 327:1068-1082. [PMID: 35289875 DOI: 10.1001/jama.2022.1807] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Eating disorders are associated with adverse health and social outcomes. OBJECTIVE To review the evidence on screening for eating disorders in adolescents and adults to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, Cochrane Library, PsycINFO, and trial registries through December 19, 2020; surveillance through January 1, 2022. STUDY SELECTION English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or interventions for eating disorders in populations with screen-detected or previously untreated eating disorders (trials limited to populations who are underweight were ineligible). DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality. Meta-analysis of test accuracy studies and intervention trials. MAIN OUTCOMES AND MEASURES Test accuracy, eating disorder symptom severity, quality of life, depression, and harms. RESULTS Fifty-seven studies were included (N = 10 773); 3 (n = 1073) limited to adolescents (mean or median age, 14-15 years). No study directly evaluated the benefits and harms of screening. Seventeen studies (n = 6804) evaluated screening test accuracy. The SCOFF questionnaire (cut point ≥2) had a pooled sensitivity of 84% (95% CI, 74% to 90%) and pooled specificity of 80% (95% CI, 65% to 89%) in adults (10 studies, n = 3684). Forty RCTs (n = 3969) evaluated interventions for eating disorders; none enrolled a screen-detected population. Lisdexamfetamine for binge eating disorder (4 RCTs; n = 900) was associated with larger reductions in eating disorder symptom severity on the Yale-Brown Obsessive Compulsive Scale modified for binge eating (YBOCS-BE) than placebo (pooled mean difference, -5.75 [95% CI, -8.32 to -3.17]). Two RCTs (n = 465) of topiramate for binge eating disorder found larger reductions in YBOCS-BE scores associated with topiramate than placebo, from -6.40 (95% CI, -8.16 to -4.64) to -2.55 (95% CI, -4.22 to -0.88). Nine pharmacotherapy trials (n = 2006) reported on harms. Compared with placebo, lisdexamfetamine was associated with higher rates of dry mouth, headache, and insomnia, and topiramate was associated with higher rates of paresthesia, taste perversion, confusion, and concentration difficulty. Twenty-four trials (n = 1644) assessed psychological interventions. Guided self-help for binge eating disorder improved eating disorder symptom severity more than control (pooled standardized mean difference, -0.96 [95% CI, -1.26 to -0.67]) (5 studies, n = 391). Evidence on other interventions was limited. CONCLUSIONS AND RELEVANCE No studies directly assessed the benefits and harms of screening. The SCOFF questionnaire had adequate accuracy for detecting eating disorders among adults. No treatment trials enrolled screen-detected populations; guided self-help, lisdexamfetamine, and topiramate were effective for reducing eating disorder symptom severity among referred populations with binge eating disorder, but pharmacotherapies were also associated with harms.
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Affiliation(s)
- Cynthia Feltner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christine Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Shivani Reddy
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
| | - Sean Riley
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Nancy Berkman
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Casey Balio
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
- Center for Rural Health Research, East Tennessee State University, Johnson City
| | - Manny Coker-Schwimmer
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
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Schmidt R, Hilbert A. Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder. Behav Ther 2022; 53:137-149. [PMID: 35027155 DOI: 10.1016/j.beth.2021.08.002] [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: 10/22/2020] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022]
Abstract
Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12-20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.
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Affiliation(s)
- Ricarda Schmidt
- University of Leipzig Medical Center, Behavioral Medicine Research Unit.
| | - Anja Hilbert
- University of Leipzig Medical Center, Behavioral Medicine Research Unit
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10
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Munsch S, Forrer F, Naas A, Mueller V, Rubo M, Hannoun F, Mugellini E. Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial. BMC Psychol 2021; 9:193. [PMID: 34895337 PMCID: PMC8666071 DOI: 10.1186/s40359-021-00690-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce. METHODS The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14-24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists' rating of patients' condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment. DISCUSSION The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT). TRIAL REGISTRATION German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706.
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Affiliation(s)
- Simone Munsch
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Felicitas Forrer
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Adrian Naas
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Verena Mueller
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Marius Rubo
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Fouad Hannoun
- Technology for Human Well-Being Institute (HumanTech), University of Applied Sciences of Western Switzerland, Boulevard de Pérolles 80, Fribourg, Switzerland
| | - Elena Mugellini
- Technology for Human Well-Being Institute (HumanTech), University of Applied Sciences of Western Switzerland, Boulevard de Pérolles 80, Fribourg, Switzerland
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11
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Vogel EN, Singh S, Accurso EC. A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders. J Eat Disord 2021; 9:131. [PMID: 34663452 PMCID: PMC8522082 DOI: 10.1186/s40337-021-00461-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders have serious psychological and physical consequences. Current evidence-based treatments for adolescents with eating disorders have modest effects, underscoring the need to improve current treatment approaches. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have been proposed as alternative treatment options, with burgeoning research in this area. This review aims to summarize and critically analyze the current literature on the feasibility, acceptability, effectiveness, and efficacy of CBT and DBT for adolescent eating disorders, and then proposes areas of future research. METHODS PsycINFO and PubMed were searched using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify studies examining the feasibility, acceptability, effectiveness and/or efficacy of CBT or DBT for adolescent eating disorders. RESULTS Eligible studies (N = 50; CBT: n = 40, DBT: n = 10) indicated that both treatments are reasonably feasible, acceptable, and possibly effective for adolescent eating disorders across diagnoses and levels of care, though efficacy trials are lacking. CONCLUSIONS CBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders. Adequately powered trials to establish the effectiveness and efficacy of CBT and DBT are needed, particularly ones that compare these treatments against other leading approaches. Despite high rates of relapse and likelihood for severe and enduring illness, there is a dearth of evidence-based treatment options for adolescents with eating disorders. Potentially viable but less well-studied treatments for adolescents with eating disorders include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This systematic review of CBT and DBT for adolescent eating disorders focuses on feasibility (i.e., how easy it was to implement the treatment), acceptability (i.e., how well the intervention was received by patients and therapists), effectiveness (i.e., how well the intervention performed under routine, real-world circumstances), and efficacy (i.e., how well the intervention performed in highly-controlled research settings). This review concludes that research supports the feasibility and acceptability of these approaches, as well as preliminary evidence of their effectiveness. However, the field is lacking studies that systematically compare CBT and DBT to other evidence-based approaches. Recommendations to advance research on CBT and DBT for adolescent eating disorders are provided, including a call for efficacy studies that clarify their performance compared to other leading approaches.
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Affiliation(s)
- Emily N Vogel
- PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, USA. .,Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Simar Singh
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA.,Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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12
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Manasse SM, Lampe EW, Abber SR, Butler R, Gillikin L, Trainor C. Exposure-enhanced cognitive behavioral therapy for adolescents with binge eating: An initial case series. Clin Child Psychol Psychiatry 2021; 26:1124-1136. [PMID: 34237236 DOI: 10.1177/13591045211028963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Binge eating (BE) often develops during adolescence and is associated with deleterious psychological and physical consequences. Current treatments for adolescents achieve suboptimal results, likely due to failure to adequately address fear of weight gain (FOWG) which maintains BE. Thus, exposure treatment (the most powerful intervention for fear) may be a promising approach. However, exposure treatment has only minimally tested in adults with BE and never tested in adolescents. Thus, the current study is the first to evaluate a 4-session exposure module within a 12-session standard cognitive behavioral therapy for adolescents with BE. We recruited adolescents with BE (N = 5) and examined treatment feasibility, acceptability, and preliminary effects on FOWG and eating pathology. Overall, the 4-session exposure module was feasible and acceptable and showed preliminary evidence that it could reduce FOWG. However, several participants did not endorse significant fears of weight gain; rather, these participants reported that fears of deprivation or social judgment were more related to their BE. Future research should test higher doses of exposure and further examine the role of fear of deprivation/social judgment. Finally, future iterations of this treatment could include more parent involvement or test exposure in combination with treatments other than cognitive behavioral therapy, such as family-based treatment.
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Affiliation(s)
- Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
| | - Elizabeth W Lampe
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
- Department of Psychology, 6527Drexel University, Philadelphia, PA, USA
| | - Sophie R Abber
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
- Department of Psychology, 6527Drexel University, Philadelphia, PA, USA
| | - Rachel Butler
- Department of Psychology, 6558Temple University, Philadelphia, PA, USA
| | - Lindsay Gillikin
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
| | - Claire Trainor
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
- Department of Psychology, 6527Drexel University, Philadelphia, PA, USA
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13
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Hilbert A, Petroff D, Neuhaus P, Schmidt R. Cognitive-Behavioral Therapy for Adolescents with an Age-Adapted Diagnosis of Binge-Eating Disorder: A Randomized Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:51-53. [PMID: 31533113 DOI: 10.1159/000503116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany, .,Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany,
| | - David Petroff
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Petra Neuhaus
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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Tanofsky-Kraff M, Schvey NA, Grilo CM. A developmental framework of binge-eating disorder based on pediatric loss of control eating. AMERICAN PSYCHOLOGIST 2020; 75:189-203. [PMID: 32052994 PMCID: PMC7027731 DOI: 10.1037/amp0000592] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although binge-eating disorder may manifest in childhood, a significantly larger proportion of youth report episodes involving a loss of control while eating, the hallmark feature of binge eating that predicts excess weight gain and obesity. Adults with binge-eating disorder often report that symptoms emerged during childhood or adolescence, suggesting that a developmental perspective of binge eating may be warranted. Thus, loss of control eating may be a marker of prodromal binge-eating disorder among certain susceptible youth. The present article offers a broad developmental framework of binge-eating disorder and proposes areas of future research to determine which youths with loss of control eating are at risk for persistent and exacerbated behavior that may develop into binge-eating disorder and adult obesity. To this end, this article provides an overview of loss of control eating in childhood and adolescence, including its characterization, etiology, and clinical significance, with a particular focus on associations with metabolic risk, weight gain, and obesity. A conceptual model is proposed to further elucidate the mechanisms that may play a role in determining which youths with loss of control are at greatest risk for binge-eating disorder and obesity. Ways in which treatments for adult binge-eating disorder may inform approaches to reduce loss of control eating and prevent excess weight gain in youth are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
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Omiwole M, Richardson C, Huniewicz P, Dettmer E, Paslakis G. Review of Mindfulness-Related Interventions to Modify Eating Behaviors in Adolescents. Nutrients 2019; 11:nu11122917. [PMID: 31810307 PMCID: PMC6950168 DOI: 10.3390/nu11122917] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/20/2022] Open
Abstract
There are few well-established treatments for adolescent eating disorders, and for those that do exist, remission rates are reported to be between 30 and 40%. There is a need for the development and implementation of novel treatment approaches. Mindfulness approaches have shown improvements in eating disorder-related psychopathology in adults and have been suggested for adolescents. The present review identifies and summarizes studies that have used mindfulness approaches to modify eating behaviors and to treat eating disorders in adolescents. Focused searches were conducted in Embase, Medline, and PsycINFO, and identified articles were checked for relevance. A small number of studies (n = 15) were designated as appropriate for inclusion in the review. These studies were divided into those that focused on the promotion of healthy eating/the prevention of disordered eating (n = 5), those that concentrated on targeted prevention among high risk adolescents (n = 5), and those that focused on clinical eating disordered adolescents (n = 5). Thirteen of the 15 studies reviewed reported at least one positive association between mindfulness treatment techniques and reduced weight/shape concerns, dietary restraint, decreased body mass index (BMI), eating in the absence of hunger (EAH), binge eating, increased willingness to eat novel healthy foods, and reduced eating disorder psychopathology. In summary, incorporating mindfulness to modify eating behaviors in adolescent non-clinical and clinical samples is still in the early stages, with a lack of data showing clear evidence of acceptability and efficacy. Further studies and preferably controlled conditions are warranted.
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Affiliation(s)
- Michael Omiwole
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
| | - Candice Richardson
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
| | - Paulina Huniewicz
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
| | - Elizabeth Dettmer
- Department of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Department of Peadiatrics, University of Toronto, Toronto, ON M5T 1R8, Canada.
| | - Georgios Paslakis
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
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Abstract
Binge eating disorder onset often occurs during adolescence, yet the diagnosis and treatment of the disorder in this age group has been inadequately studied. Criteria and challenges in making the diagnosis in children and adolescents are reviewed, as well as prevalence rates, current treatment options, and complications.
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Affiliation(s)
- Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA.
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Abstract
PURPOSE OF REVIEW This review summarizes findings on pediatric loss-of-control (LOC) eating and obesity published since 2013 in relation to physiological, socioenvironmental, and psychological factors. RECENT FINDINGS LOC eating and obesity are highly comorbid in youth. Genetic and physiological risk factors are associated with the development of LOC eating. Adverse physiological outcomes of LOC eating include increased risk for overweight and obesity and greater dysfunction in components of metabolic syndrome. Socioenvironmental, psychological, and behavioral factors, such as weight-based teasing, dieting, negative affect, emotion dysregulation, and aspects of cognitive functioning, are consistently related to LOC eating in youth, independent of weight. Prospectively, LOC eating may predict the onset of anxiety disorders, depression, and more severe eating psychopathology later in life. Updates on interventions and future directions are discussed. LOC eating may be a key symptom to target adverse physiological and psychological outcomes; however, treatments are limited and require further examination.
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Affiliation(s)
- Meghan E Byrne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD, 20814-4799, USA
| | - Sarah LeMay-Russell
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD, 20814-4799, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD, 20814-4799, USA.
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Rubo M, Forrer F, Munsch S. [E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder]. PRAXIS 2019; 108:911-915. [PMID: 31662114 DOI: 10.1024/1661-8157/a003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder Abstract. Eating disorders can often be treated with psychotherapy, but mostly due to a lack of trained clinicians, the majority of the persons concerned do not receive any treatment. In recent years, internet-based psychotherapy (e-therapy) was proposed and tested in several pilot projects as a novel possibility to offer a larger number of places on a treatment program with a constant number of available clinicians. Recent results are promising, but before an implementation into standard care can take place, more detailed knowledge must be provided as to which patients may be recommended this type of therapy as an equivalent alternative to traditional face-to-face therapy.
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Affiliation(s)
- Marius Rubo
- Klinische Psychologie und Psychotherapie, Universität Fribourg
| | | | - Simone Munsch
- Klinische Psychologie und Psychotherapie, Universität Fribourg
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Linardon J, Messer M, Fuller-Tyszkiewicz M. Meta-analysis of the effects of cognitive-behavioral therapy for binge-eating-type disorders on abstinence rates in nonrandomized effectiveness studies: Comparable outcomes to randomized, controlled trials? Int J Eat Disord 2018; 51:1303-1311. [PMID: 30584663 DOI: 10.1002/eat.22986] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The efficacy of cognitive-behavioral therapy (CBT) for eating disorders is well-established. The extent to which CBT tested in controlled research settings generalizes to real-world circumstances is unknown. We conducted a meta-analysis of nonrandomized studies of CBT for eating disorders, with three aims: (a) to estimate the prevalence of patients who achieve binge-purge abstinence after CBT in routine practice; (b) to compare these estimates with those derived from two recent meta-analyses of randomized controlled trials (RCTs) of CBT for bulimia nervosa (BN) and binge-eating disorder (BED); (c) to examine whether the degree of clinical representativeness of studies was associated with effect sizes. METHOD Twenty-seven studies, mainly involving BN, were included. Pooled event rates were calculated using random effects models. RESULTS The percentage of treatment completers who achieved abstinence at post-treatment was 42.1% (95% CI = 34.7-50.0). The intention-to-treat (ITT) estimate was lower (34.6% [95% CI = 29.3-40.4]). However, abstinence rates varied across diagnoses, such that the completer and ITT analysis abstinence estimates were larger for BED samples (completer = 50.2%, 95% CI = 29.4-70.9; ITT = 47.2%, 95% CI = 29.8-65.2) than for BN (completer = 37.4%, 95% CI = 29.1-46.5; ITT = 29.8%, 95% CI = 24.9-35.3) and atypical eating disorder samples (completer = 37.8%, 95% CI = 20.2-59.3; ITT = 28.8%, 95% CI = 18.2-42.4). No relationship between the degree of clinical representativeness and the effect size was observed, and our estimates were highly comparable to those observed in recent meta-analyses of RCTs. DISCUSSION Findings suggest that CBT for eating disorder can be effectively delivered in real-world settings. This study provides evidence for the generalizability of CBT from controlled research settings to routine clinical services.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
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Linardon J. Meta-analysis of the effects of cognitive-behavioral therapy on the core eating disorder maintaining mechanisms: implications for mechanisms of therapeutic change. Cogn Behav Ther 2018; 47:107-125. [DOI: 10.1080/16506073.2018.1427785] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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Marzilli E, Cerniglia L, Cimino S. A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:17-30. [PMID: 29379325 PMCID: PMC5759856 DOI: 10.2147/ahmt.s148050] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Binge eating disorder (BED) represents one of the most problematic clinical conditions among youths. Research has shown that the developmental stage of adolescence is a critical stage for the onset of eating disorders (EDs), with a peak prevalence of BED at the age of 16–17 years. Several studies among adults with BED have underlined that it is associated with a broad spectrum of negative consequences, including higher concern about shape and weight, difficulties in social functioning, and emotional-behavioral problems. This review aimed to examine studies focused on the prevalence of BED in the adolescent population, its impact in terms of physical, social, and psychological outcomes, and possible strategies of psychological intervention. The review of international literature was made on paper material and electronic databases ProQuest, PsycArticles, and PsycInfo, and the Scopus index were used to verify the scientific relevance of the papers. Epidemiological research that examined the prevalence of BED in adolescent samples in accordance with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition showed a prevalence ranging from 1% to 4%. More recently, only a few studies have investigated the prevalence of BED, in accordance with the Diagnostic and Statistical Manual of Disorders, Fifth Edition criteria, reporting a prevalence of ~1%–5%. Studies that focused on the possible impact that BED may have on physical, psychological, and social functioning showed that adolescents with BED have an increased risk of developing various adverse consequences, including obesity, social problems, substance use, suicidality, and other psychological difficulties, especially in the internalizing area. Despite the evidence, to date, reviews on possible and effective psychological treatment for BED among young population are rare and focused primarily on adolescent females.
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Affiliation(s)
- Eleonora Marzilli
- Department of Dynamic and Clinical Psychology, Psychology and Medicine Faculty, Sapienza - University of Rome
| | - Luca Cerniglia
- Department of Psychology, Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | - Silvia Cimino
- Department of Dynamic and Clinical Psychology, Psychology and Medicine Faculty, Sapienza - University of Rome
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Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behav Res Ther 2017; 88:49-64. [PMID: 28110676 DOI: 10.1016/j.brat.2016.09.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 01/27/2023]
Abstract
Eating disorders are serious mental disorders as reflected in significant impairments in health and psychosocial functioning and excess mortality. Despite the clear evidence of clinical significance and despite availability of evidence-based, effective treatments, research has shown a paradox of elevated health services use and, yet, infrequent treatment specifically targeting the eating disorder (i.e., high unmet treatment need). This review paper summarizes key studies conducted in collaboration with G. Terence Wilson and offers an update of the research literature published since 2011 in three research areas that undergirded our collaborative research project: unmet treatment needs, cost of illness, and cost-effectiveness of treatments. In regards to unmet treatment needs, epidemiological studies find that the number of individuals with an eating disorder who do not receive disorder-specific treatment continues to remain high. Cost-of-illness show that eating disorders are associated with substantial financial burdens for individuals, their family, and society, yet comprehensive examination of costs across public sectors is lacking. Cost measures vary widely, making it difficult to draw firm conclusions. Hospitalization is a major driver of medical costs incurred by individuals with an eating disorder. Only a handful of cost-effectiveness studies have been conducted, leaving policy makers with little information on which to base decisions about allocation of resources to help reduce the burden of suffering attributable to eating disorders.
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Kazdin AE, Fitzsimmons-Craft EE, Wilfley DE. Addressing critical gaps in the treatment of eating disorders. Int J Eat Disord 2017; 50:170-189. [PMID: 28102908 PMCID: PMC6169314 DOI: 10.1002/eat.22670] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 12/11/2022]
Abstract
Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps.
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Affiliation(s)
- Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
PURPOSE OF REVIEW This review provides an update on the new Diagnostic and Statistical Manual (DSM) diagnosis of binge-eating disorder (BED) by presenting diagnostic criteria, associated risk factors and co-morbidities, and tools for assessment. An update on the currently available evidence-based treatments for adolescent BED is provided to help with the coordination of treatment planning for identified patients with this condition. RECENT FINDINGS BED is now officially included in the DSM. Research with youth has begun to show improvement from treatments such as cognitive behavioral therapy, previously shown to be useful in adults. SUMMARY BED is common and often begins during youth. The availability of diagnostic criteria, along with increasing knowledge about the condition and available treatments, is expected to result in improved identification and management in younger patients.
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Abstract
We performed a qualitative review of treatment studies of binge eating disorder (BED), focusing on randomized clinical trials (RCTs). Limited effectiveness has been demonstrated for self-help strategies, and substantial effectiveness has been shown for cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). CBT and IPT may each be more effective than behavior weight loss therapy (BWLT) for reducing binge eating over the long term. The stimulant pro-drug lisdexamfetamine dimesylate (LDX) is the only drug approved by the FDA for the treatment of BED in adults based on 2 pivotal RCTs. Topiramate also decreases binge eating behavior, but its use is limited by its adverse event profile. Antidepressants may be modestly effective over the short term for reducing binge eating behavior and comorbid depressive symptoms, but are not associated with clinically significant weight loss. A RCT presented in abstract form suggests that intranasal naloxone may decrease time spent binge eating. There is no RCT of obesity surgery in BED, but many patients with BED seek and receive such surgery. While some studies suggest patients with BED and obesity do just as well as patients with obesity alone, other studies suggest that patients with BED have more post-operative complications, less weight loss, and more weight regain. This evidence suggests that patients with BED would benefit from receiving highly individualized treatment.
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Schvey NA, Sbrocco T, Stephens M, Bryant EJ, Ress R, Spieker EA, Conforte A, Bakalar JL, Pickworth CK, Barmine M, Klein D, Brady SM, Yanovski JA, Tanofsky-Kraff M. Comparison of overweight and obese military-dependent and civilian adolescent girls with loss-of-control eating. Int J Eat Disord 2015; 48:790-4. [PMID: 25955761 PMCID: PMC4543400 DOI: 10.1002/eat.22424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Limited data suggest that the children of U.S. service members may be at increased risk for disordered-eating. To date, no study has directly compared adolescent military-dependents to their civilian peers along measures of eating pathology and associated correlates. We, therefore, compared overweight and obese adolescent female military-dependents to their civilian counterparts along measures of eating-related pathology and psychosocial functioning. METHOD Adolescent females with a BMI between the 85th and 97th percentiles and who reported loss-of-control eating completed interview and questionnaire assessments of eating-related and general psychopathology. RESULTS Twenty-three military-dependents and 105 civilians participated. Controlling for age, race, and BMI-z, military-dependents reported significantly more binge episodes per month (p < 0.01), as well as greater eating-concern, shape-concern, and weight-concern (p's < 0.01) than civilians. Military-dependents also reported more severe depression (p < 0.05). DISCUSSION Adolescent female military-dependents may be particularly vulnerable to disordered-eating compared with civilian peers. This potential vulnerability should be considered when assessing military-dependents.
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Affiliation(s)
- Natasha A. Schvey
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Tracy Sbrocco
- Uniformed Services University of the Health Sciences (USUHS)
| | - Mark Stephens
- Uniformed Services University of the Health Sciences (USUHS)
| | - Edny J. Bryant
- Uniformed Services University of the Health Sciences (USUHS)
| | - Rachel Ress
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | | | | | | | - Courtney K. Pickworth
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Marissa Barmine
- Uniformed Services University of the Health Sciences (USUHS)
| | | | - Sheila M. Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Jack A. Yanovski
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Marian Tanofsky-Kraff
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
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Hilbert A, Brauhardt A. Childhood loss of control eating over five-year follow-up. Int J Eat Disord 2014; 47:758-61. [PMID: 24899359 DOI: 10.1002/eat.22312] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/20/2014] [Accepted: 05/20/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Emerging prospective evidence from mixed samples, mostly covering short-term follow-up periods, suggests that childhood loss of control (LOC) eating predicts significant impairment in mental and physical health. This study sought to investigate the natural course of childhood LOC eating over the long term and in relation to binge-eating disorder (BED) diagnosis, psychopathology, and body weight trajectory in the community. METHOD A total of 60 children (8-13 years) with LOC eating within the past 3 months and 60 demographically matched children without LOC history were assessed with the Eating Disorder Examination adapted for Children and self-report questionnaires over a 5.5 year follow-up period. Missing data were imputed. RESULTS Over follow-up, 38.3% of children showed persistent LOC eating, and 28.3% revealed an onset of LOC eating. Persistent LOC eating significantly predicted onset of partial-/full-syndrome BED at follow-up. Negative prognostic effects on eating disorder psychopathology, depressive symptoms, and body mass index were nonsignificant. DISCUSSION The results indicate a moderate stability of LOC eating over the long term. LOC eating, especially if stable, was suggested as a variable risk factor of clinically relevant eating disturbances. In contrast, a prognostic value for psychopathology and body mass index was not confirmed.
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Affiliation(s)
- Anja Hilbert
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Integrated Research and Treatment Center Diseases, Leipzig, Germany
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders now recognizes six primary feeding and eating disorders including pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa and binge-eating disorder. Guided by research from the past 3 years, the current review outlines diagnostic criteria for each disorder, their clinical correlates and treatment options. Recent modifications to diagnostic criteria will likely help to improve treatment outcomes and prognosis. Nevertheless, several concerns remain regarding the validity of current diagnostic criteria for youth, including the clinical relevance of the size and frequency of binge eating episodes. Additionally, the lack of randomized controlled trials has led to an overreliance on data from quasi-experimental studies, case series and single case studies that impede development of strong clinical recommendations for treating feeding and eating disorders. Recommendations for future research include identifying empirically supported treatments and prevention programs focused on early markers of pediatric feeding and eating concerns.
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Tetzlaff A, Hilbert A. [The role of the family in childhood and adolescent binge eating - a systematic review]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 42:61-70. [PMID: 24365964 DOI: 10.1024/1422-4917/a000270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE While family factors in childhood and adolescent anorexia nervosa and bulimia nervosa are well documented and have often been reviewed in the past, less is known about these influences on binge eating without compensatory behavior. This systematic review describes family factors in the development and maintenance of binge eating. METHOD A systematic literature search was conducted for studies on associations between binge eating, loss of control eating, and family outcomes. RESULTS Consistent evidence was found for cross-sectional associations between binge eating and insecure attachment of the child, lower family functioning, and lower parental involvement; for parental unemployment and parental depression as retrospective correlates; and for fewer family meals and more critical comments about weight or shape by parents as variable risk factors. In contrast, rather inconsistent findings referred to the influence of family structures, parental eating disorders, dieting, and their knowledge about child's eating behavior. Gender differences were identified in association with family relationships and weight stigmatization. CONCLUSIONS As with other eating disorders in youth, the results suggest the importance of familial factors in binge eating. Consequently, family assessment and family-based interventions might be helpful in the treatment of childhood and adolescent binge eating. More research should clarify inconsistent findings using prospective designs.
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Affiliation(s)
- Anne Tetzlaff
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Universitätsmedizin Leipzig
| | - Anja Hilbert
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Universitätsmedizin Leipzig
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Abstract
PURPOSE OF REVIEW This review summarizes recent evidence on psychological treatments for eating disorders. RECENT FINDINGS Eating disorders are serious psychiatric conditions requiring evidence-based intervention. Treatments have been evaluated within each eating disorder diagnosis and across diagnoses. For adults with anorexia nervosa, no one specialist treatment has been shown to be superior. Cognitive behavioral therapy and interpersonal psychotherapy remain the most established treatments for bulimia nervosa and binge eating disorder, with stepped-care approaches showing promise and new behavioral treatments under study. Enhanced cognitive behavioral therapy has improved symptoms in adults and youth. Maudsley family-based therapy is the most established treatment for youth with anorexia nervosa and may be efficacious for youth with bulimia nervosa. Interpersonal psychotherapy for the prevention of excess weight gain may be efficacious for reducing loss of control eating and weight gain in overweight youth. SUMMARY Significant advances in treatments have been made, including evaluation of long-term outcomes, novel approaches, and tailored extension for specific patient profiles. However, widespread access to effective eating disorder treatments remains limited. Increasing the potency and expanding the implementation of psychological treatments beyond research settings into clinical practice has strong potential to increase access to care, thereby reducing the burden of eating disorders.
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Affiliation(s)
- Andrea E. Kass
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel P. Kolko
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Hilbert A. Cognitive-behavioral therapy for binge eating disorder in adolescents: study protocol for a randomized controlled trial. Trials 2013; 14:312. [PMID: 24066704 PMCID: PMC3850645 DOI: 10.1186/1745-6215-14-312] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/11/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Binge eating disorder is a prevalent adolescent disorder, associated with increased eating disorder and general psychopathology as well as an increased risk for overweight and obesity. As opposed to binge eating disorder in adults, there is a lack of validated psychological treatments for this condition in adolescents. The goal of this research project is therefore to determine the efficacy of age-adapted cognitive-behavioral therapy in adolescents with binge eating disorder - the gold standard treatment for adults with binge eating disorder. METHODS/DESIGN In a single-center efficacy trial, 60 12- to 20-year-old adolescents meeting diagnostic criteria of binge eating disorder (full-syndrome or subthreshold) according to the Diagnostic and Statistical Manual of Mental Disorders 4th or 5th Edition, will be centrally randomized to 4 months of cognitive-behavioral therapy (n = 30) or a waiting-list control condition (n = 30). Using an observer-blind design, patients are assessed at baseline, mid-treatment, post-treatment, and at 6- and 12-month follow-ups after the end of treatment. In 20 individual outpatient sessions, cognitive-behavioral therapy for adolescents focuses on eating behavior, body image, and stress; parents receive psychoeducation on these topics. Primary endpoint is the number of episodes with binge eating over the previous 28 days at post-treatment using a state-of-the art clinical interview. Secondary outcome measures address the specific eating disorder psychopathology, general psychopathology, mental comorbidity, self-esteem, quality of life, and body weight. DISCUSSION This trial will allow us to determine the short- and long-term efficacy of cognitive-behavioral therapy in adolescent binge eating disorder, to determine cost-effectiveness, and to identify predictors of treatment outcome. Evidence will be gathered regarding whether this treatment will help to prevent excessive weight gain. If efficacy can be demonstrated, the results from this trial will enhance availability of evidence-based treatment of adolescent binge eating disorder. TRIAL REGISTRATION German Clinical Trials Register: DRKS00000542.
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Affiliation(s)
- Anja Hilbert
- Department of Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig Medical Center, Philipp-Rosenthal-Strasse 27, Leipzig, 04103 Germany.
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Tailoring Cognitive Behavioral Treatment for Binge Eating in Adolescent Girls. COGNITIVE AND BEHAVIORAL PRACTICE 2013. [DOI: 10.1016/j.cbpra.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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