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Bartholomay J, Schaefer LM, Forester G, Crosby RD, Peterson CB, Crow SJ, Engel SG, Wonderlich SA. Evaluating dietary restriction as a maintaining factor in binge-eating disorder. Int J Eat Disord 2024; 57:1172-1180. [PMID: 37974447 PMCID: PMC11093702 DOI: 10.1002/eat.24094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Prominent theories of binge-eating (BE) maintenance highlight dietary restriction as a key precipitant of BE episodes. Consequently, treatment approaches for eating disorders (including binge-eating disorder; BED) seek to reduce dietary restriction in order to improve BE symptoms. The present study tested the hypothesis that dietary restriction promotes BE among 112 individuals with BED. METHODS Participants completed a 7-day ecological momentary assessment (EMA) protocol before and after completing 17 weeks of either Integrative Cognitive-Affective Therapy or guided self-help cognitive behavioral therapy. Analyses examined whether dietary restriction on 1 day of the baseline EMA protocol predicted risk for BE later that same day, and on the following day. Changes in dietary restriction over the course of treatment were also evaluated as a predictor of change in BE from pre-treatment to post-treatment. Baseline dietary restraint was examined as a moderator of the above associations. RESULTS Dietary restriction did not predict BE later the same day, and changes in restriction were not related to changes in BE across treatment, regardless of baseline dietary restraint levels. Restriction on 1 day did predict increased BE risk on the following day for individuals with higher levels of dietary restraint, but not those with lower levels. DISCUSSION These findings challenge the assumption that dietary restriction maintains BE among all individuals with BED. Rather, results suggest that dietary restriction may be largely unrelated to BE maintenance in this population, and that reducing dietary restriction generally does not have the intended effect on BE frequency.
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Affiliation(s)
- Julia Bartholomay
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
| | - Lauren M Schaefer
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Glen Forester
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Ross D Crosby
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Scott G Engel
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Stephen A Wonderlich
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
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Dance/Movement Therapy for Individuals with Eating Disorders: A Phenomenological Approach. AMERICAN JOURNAL OF DANCE THERAPY 2023. [DOI: 10.1007/s10465-023-09379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Bray B, Sadowski A, Bray C, Bradley R, Zwickey H. Clinical aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts' perspectives. Front Psychiatry 2023; 13:1087165. [PMID: 36864846 PMCID: PMC9971930 DOI: 10.3389/fpsyt.2022.1087165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/22/2022] [Indexed: 02/16/2023] Open
Abstract
Introduction Research on binge eating disorder continues to evolve and advance our understanding of recurrent binge eating. Methods This mixed-methods, cross-sectional survey aimed to collect information from experts in the field about clinical aspects of adult binge eating disorder pathology. Fourteen experts in binge eating disorder research and clinical care were identified based on receipt of relevant federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Anonymously recorded semi-structured interviews were analyzed by ≥2 investigators using reflexive thematic analysis and quantification. Results Identified themes included: (1) obesity (100%); (2) intentional/voluntary or unintentional/involuntary food/eating restriction (100%); (3) negative affect, emotional dysregulation, and negative urgency (100%); (4) diagnostic heterogeneity and validity (71%); (5) paradigm shifts in understanding binge eating disorder (29%); and (6) research gaps/future directives (29%). Discussion Overall, experts call for a better understanding of the relationship between binge eating disorder and obesity, including a need for clarification around the extent to which the two health issues are separate vs. related/overlapping. Experts also commonly endorse food/eating restriction and emotion dysregulation as important components of binge eating disorder pathology, which aligns with two common models of binge eating disorder conceptualization (e.g., dietary restraint theory and emotion/affect regulation theory). A few experts spontaneously identified several paradigm shifts in our understanding of who can have an eating disorder (beyond the anorexi-centric "thin, White, affluent, cis-gendered neurotypical female" stereotype), and the various factors that can drive binge eating. Experts also identified several areas where classification issues may warrant future research. Overall, these results highlight the continual advancement of the field to better understand adult binge eating disorder as an autonomous eating disorder diagnosis.
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Affiliation(s)
- Brenna Bray
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States
| | - Adam Sadowski
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States
| | - Chris Bray
- Wilder Research Division, Amherst H. Wilder Foundation, Saint Paul, MN, United States
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States
| | - Heather Zwickey
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States
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Coffino JA, Udo T, Grilo CM. The Significance of Overvaluation of Shape or Weight in Binge-Eating Disorder: Results from a National Sample of U.S. Adults. Obesity (Silver Spring) 2019; 27:1367-1371. [PMID: 31265763 PMCID: PMC6656600 DOI: 10.1002/oby.22539] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to examine the prevalence of overvaluation of shape or weight in a nationally representative sample of U.S. adults with binge-eating disorder (BED) and to compare functioning correlates using a group of adults with bulimia nervosa (BN). METHODS Participants included 207 respondents from the National Epidemiologic Survey on Alcohol and Related Conditions who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnoses of BED (n = 163) or BN (n = 44). Sociodemographic characteristics and functioning were compared in BED with overvaluation (BED+OV), BED without overvaluation (BED), and BN. RESULTS Approximately 50% of BED respondents reported overvaluation. Mean age was lower in BN than BED. Mean BMI was lower in BED+OV than BED and higher than BN. A greater proportion of BED+OV reported functional impairment than BED. BN was more likely to report "serious problems doing daily tasks" than BED and less likely to report "impairment in normal activities" than BED+OV. BN reported significantly lower mental functioning than BED. CONCLUSIONS Findings based on this nationally representative sample are that overvaluation was associated with greater functional impairment within BED, and BED+OV reported greater impairment than BN in interference with normal activities but less impairment related to mental health. The increased impairment associated with BED+OV provides support for overvaluation as a diagnostic specifier for BED.
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Affiliation(s)
- Jaime A Coffino
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, University at Albany, State University of New York, Albany, New York, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA
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Li N, Mitchison D, Touyz S, Hay P. Cross-sectional comparison of health-related quality of life and other features in people with and without objective and subjective binge eating using a general population sample. BMJ Open 2019; 9:e024227. [PMID: 30787086 PMCID: PMC6398903 DOI: 10.1136/bmjopen-2018-024227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Evidence suggests that while objective binge eating (OBE) and subjective binge eating (SBE) differ in the amount of food consumed, both are associated with impairment in people with eating disorders. However, only OBE is accounted for in the diagnostic criteria of eating disorders. This study compared the sociodemographic profile and burden of OBE versus SBE at a population level. DESIGN Population-based survey. PARTICIPANTS A representative sample of 3028 men and women. Participants were categorised into four groups based on their reporting of binge eating in the past 3 months: non-binge eating group (no OBE or SBE), OBE group, SBE group and OSBE group (both OBE and SBE). OUTCOME MEASURES Demographics (age, genderand body mass index, BMI), binge eating, distress, weight/shape overvaluation and health-related quality of life. Groups were compared on sociodemographic information, overvaluation and health-related quality of life. The OBE and SBE groups were also compared on the distress related to binge eating. RESULTS No differences were found between the SBE group and OBE group in age, gender, BMI, mental health-related quality of life and overvaluation (all p>0.05). However, differences were found in the OSBE participants, namely that they were younger, had a higher mean BMI, lower mental health-related quality of life and higher overvaluation of weight/shape than the non-binge-eating participants (all p<0.001). Proportions of participants who reported distress related to binge eating in the OBE and SBE groups also did not differ (p=0.678). CONCLUSION There is little difference in the demographic profile or burden of people who engage in OBE versus SBE, supporting the proposed inclusion of SBE in the diagnostic criteria for eating disorders in International Classification of Diseases-11. People who experience both OBE and SBE may experience a relatively higher eating disorder severity and impairment.
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Affiliation(s)
- Natalie Li
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Deborah Mitchison
- Psychology Department, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Touyz
- Clinical Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institure, School of Medicine, Western Sydney, Penrith, New South Wales, Australia
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Duarte C, Ferreira C, Pinto-Gouveia J. At the core of eating disorders: Overvaluation, social rank, self-criticism and shame in anorexia, bulimia and binge eating disorder. Compr Psychiatry 2016; 66:123-31. [PMID: 26995245 DOI: 10.1016/j.comppsych.2016.01.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/12/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022] Open
Abstract
This study examined the similarities and differences in eating psychopathology symptoms, overvaluation of body shape, weight and eating, general psychopathology, social comparison, self-criticism and shame, between AN, BN and BED patients. Also, the mediator effect of self-criticism and social comparison on the association between overvaluation and shame, was tested. Participants were 119 patients (34 AN, 34 BN and 51 BED) diagnosed through the Eating Disorder Examination. Results indicated that BED patients are older and present higher BMI. The groups differed regarding eating disorders' symptomatology, but no significant differences were observed in overvaluation, self-criticism, shame and overall psychopathology symptoms. The path model confirmed that overvaluation has a significant indirect association with shame, which is mediated by severe self-criticism and negative social comparisons. The model was fond to be invariant between the clinical groups. These findings contribute for the understanding of the common processes that feed the perpetual cycle of eating psychopathology. Thus, these data have potential implications for transdiagnostic approaches to treatment.
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Affiliation(s)
- Cristiana Duarte
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Portugal.
| | - Cláudia Ferreira
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Portugal
| | - José Pinto-Gouveia
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Portugal
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Duarte C, Pinto-Gouveia J, Ferreira C. Ashamed and Fused with Body Image and Eating: Binge Eating as an Avoidance Strategy. Clin Psychol Psychother 2015; 24:195-202. [DOI: 10.1002/cpp.1996] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Cristiana Duarte
- CINEICC-Cognitive and Behavioural Centre for Research and Intervention; University of Coimbra; Portugal
| | - José Pinto-Gouveia
- CINEICC-Cognitive and Behavioural Centre for Research and Intervention; University of Coimbra; Portugal
| | - Cláudia Ferreira
- CINEICC-Cognitive and Behavioural Centre for Research and Intervention; University of Coimbra; Portugal
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Evaluation of the DSM-5 severity indicator for binge eating disorder in a clinical sample. Behav Res Ther 2015; 71:110-4. [PMID: 26114779 DOI: 10.1016/j.brat.2015.05.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study tested the new DSM-5 severity criterion for binge eating disorder (BED) based on frequency of binge-eating in a clinical sample. This study also tested overvaluation of shape/weight as an alternative severity specifier. METHOD Participants were 834 treatment-seeking adults diagnosed with DSM-5 BED using semi-structured diagnostic and eating-disorder interviews. Participants sub-grouped based on DSM-5 severity levels and on overvaluation of shape/weight were compared on demographic and clinical variables. RESULTS Based on DSM-5 severity definitions, 331 (39.7%) participants were categorized as mild, 395 (47.5%) as moderate, 83 (10.0%) as severe, and 25 (3.0%) as extreme. Analyses comparing three (mild, moderate, and severe/extreme) severity groups revealed no significant differences in demographic variables or body mass index (BMI). Analyses revealed significantly higher eating-disorder psychopathology in the severe/extreme than moderate and mild groups and higher depression in moderate and severe/extreme groups than the mild group; effect sizes were small. Participants characterized with overvaluation (N = 449; 54%) versus without overvaluation (N = 384; 46%) did not differ significantly in age, sex, BMI, or binge-eating frequency, but had significantly greater eating-disorder psychopathology and depression. The robustly greater eating-disorder psychopathology and depression levels (medium-to-large effect sizes) in the overvaluation group was observed without attenuation of effect sizes after adjusting for ethnicity/race and binge-eating severity/frequency. CONCLUSIONS Our findings provide support for overvaluation of shape/weight as a severity specifier for BED as it provides stronger information about the severity of homogeneous groupings of patients than the DSM-5 rating based on binge-eating.
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Grilo CM, Ivezaj V, White MA. Evaluation of the DSM-5 severity indicator for binge eating disorder in a community sample. Behav Res Ther 2015; 66:72-6. [PMID: 25701802 DOI: 10.1016/j.brat.2015.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Abstract
Research has examined various aspects of the diagnostic criteria for binge-eating disorder (BED) but has yet to evaluate the DSM-5 severity criterion. This study examined the DSM-5 severity criterion for BED based on binge-eating frequency and tested an alternative severity specifier based on overvaluation of shape/weight. 338 community volunteers categorized with DSM-5 BED completed a battery of self-report instruments. Participants were categorized first using DSM-5 severity levels and second by shape/weight overvaluation and were compared on clinical variables. 264 (78.1%) participants were categorized as mild, 67 (19.8%) as moderate, 6 (1.8%) as severe, and 1 (0.3%) as extreme. Analyses comparing mild and moderate severity groups revealed no significant differences in demographic variables or BMI; the moderate severity group had greater eating-disorder psychopathology (small effect-sizes) but not depression than the mild group. Participants with overvaluation (N = 196; 60.1%) versus without (N = 130; 39.9%) did not differ significantly in age, sex, BMI, or binge-eating frequency. The overvaluation group had significantly greater eating-disorder psychopathology and depression than the non-overvaluation group. The greater eating-disorder and depression levels (medium-to-large effect-sizes) persisted after adjusting for ethnicity/race and binge-eating severity/frequency, without attenuation of effect-sizes. Findings from this non-clinical community sample provide support for overvaluation of shape/weight as a specifier for BED as it provides stronger information about severity than the DSM-5 rating based on binge-eating. Future research should include treatment-seeking patients with BED to test the utility of DSM-5 severity specifiers and include broader clinical validators.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, United States; Department of Psychology, Yale University, United States.
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, United States
| | - Marney A White
- Department of Psychiatry, Yale School of Medicine, United States; Yale School of Public Health, United States
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Jordan J, McIntosh VVW, Carter JD, Rowe S, Taylor K, Frampton CMA, McKenzie JM, Latner J, Joyce PR. Bulimia nervosa-nonpurging subtype: closer to the bulimia nervosa-purging subtype or to binge eating disorder? Int J Eat Disord 2014; 47:231-8. [PMID: 24282157 DOI: 10.1002/eat.22218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/30/2013] [Accepted: 10/05/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE DSM-5 has dropped subtyping of bulimia nervosa (BN), opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype (BN-NP) within a broad BN category. Some contend however that BN-NP is more like binge eating disorder (BED) than BN-P. This study examines clinical characteristics, eating disorder symptomatology, and Axis I comorbidity in BN-NP, BN-P, and BED groups to establish whether BN-NP more closely resembles BN-P or BED. METHOD Women with BN-P (n = 29), BN-NP (n = 29), and BED (n = 54) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating. Measures included the Structured Clinical Interviews for DSM-IV, Eating Disorder Examination, and Eating Disorder Inventory-2. RESULTS The BN-NP subtype had BMIs between those with BN-P and BED. Both BN subtypes had higher Restraint and Drive for Thinness scores than BED. Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P. Higher Restraint and lower BMI predicted BN-NP relative to BED. BN-NP resembled BED with higher lifetime BMIs; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype. Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype DISCUSSION These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment. These results support retaining the BN-NP group within the BN category. Further research is needed to determine whether there are meaningful differences in outcome over follow-up.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
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Agüera Z, Riesco N, Jiménez-Murcia S, Islam MA, Granero R, Vicente E, Peñas-Lledó E, Arcelus J, Sánchez I, Menchon JM, Fernández-Aranda F. Cognitive behaviour therapy response and dropout rate across purging and nonpurging bulimia nervosa and binge eating disorder: DSM-5 implications. BMC Psychiatry 2013; 13:285. [PMID: 24200085 PMCID: PMC4226246 DOI: 10.1186/1471-244x-13-285] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 06/21/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND With the imminent publication of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a growing interest in the study of the boundaries across the three bulimic spectrum syndromes [bulimia nervosa-purging type (BN-P), bulimia nervosa-non purging type (BN-NP) and binge eating disorder (BED)]. Therefore, the aims of this study were to determine differences in treatment response and dropout rates following Cognitive Behavioural Therapy (CBT) across the three bulimic-spectrum syndromes. METHOD The sample comprised of 454 females (87 BED, 327 BN-P and 40 BN-NP) diagnosed according to DSM-IV-TR criteria who were treated with 22 weekly outpatient sessions of group CBT therapy. Patients were assessed before and after treatment using a food and binging/purging diary and some clinical questionnaires in the field of ED. "Full remission" was defined as total absence of binging and purging (laxatives and/or vomiting) behaviors and psychological improvement for at least 4 (consecutive). RESULTS Full remission rate was found to be significantly higher in BED (69.5%) than in both BN-P (p < 0.005) and BN-NP (p < 0.001), which presented no significant differences between them (30.9% and 35.5%). The rate of dropout from group CBT was also higher in BED (33.7%) than in BN-P (p < 0.001) and BN-NP (p < 0.05), which were similar (15.4% and 12.8%, respectively). CONCLUSIONS Results suggest that purging and non-purging BN have similar treatment response and dropping out rates, whereas BED appears as a separate diagnosis with better outcome for those who complete treatment. The results support the proposed new DSM-5 classification.
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Affiliation(s)
- Zaida Agüera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Mohammed Anisul Islam
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique Vicente
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Eva Peñas-Lledó
- CICAB Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
| | - Jon Arcelus
- Leicester Eating Disorder Service, Brandon Mental Health Unit, Leicester General Hospital, Leicester, UK
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Jose Manuel Menchon
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.
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Grilo CM, White MA, Gueorguieva R, Wilson GT, Masheb RM. Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up. Psychol Med 2013; 43:1335-1344. [PMID: 22967857 PMCID: PMC3666331 DOI: 10.1017/s0033291712002097] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Undue influence of body shape or weight on self-evaluation - referred to as overvaluation - is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This study examined the concurrent and predictive significance of overvaluation of shape/weight in obese patients with BED participating in a randomized clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method A total of 90 participants were randomly assigned to 6-month group treatments of CBT or BWL. Assessments were performed at baseline, throughout- and post-treatment, and at 6- and 12-month follow-ups after completing treatments with reliably administered semi-structured interviews and established measures. RESULTS Participants categorized with overvaluation (n = 52, 58%) versus without overvaluation (n = 38, 42%) did not differ significantly in demographic features (age, gender and ethnicity), psychiatric co-morbidity, body mass index or binge eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology and poorer psychological functioning (higher depression and lower self-esteem) than the non-overvaluation group. Overvaluation of shape/weight significantly predicted non-remission from binge eating and higher frequency of binge eating at the 12-month follow-up, even after adjusting for group differences in depression and self-esteem levels. CONCLUSIONS Our findings suggest that overvaluation does not simply reflect concern commensurate with being obese or more frequent binge eating, but also is strongly associated with heightened eating-related psychopathology and psychological distress, and has negative prognostic significance for longer-term treatment outcomes. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity and treatment outcome.
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Affiliation(s)
- C M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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Peterson CB, Crosby RD, Wonderlich SA, Mitchell JE, Crow SJ, Engel S. Predicting group cognitive-behavioral therapy outcome of binge eating disorder using empirical classification. Behav Res Ther 2013; 51:526-32. [PMID: 23820157 DOI: 10.1016/j.brat.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 04/29/2013] [Accepted: 05/02/2013] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to use empirical classification based on Latent Profile Analysis to identify subgroups of binge eating disorder (BED) and to evaluate the extent to which these subgroups were predictive of treatment outcome in group cognitive-behavioral therapy (CBT). The Eating Disorder Examination (EDE), Structured Clinical Interview for DSM-IV, and Inventory of Depressive Symptomatology-Self-Report were administered to 259 participants at baseline in a 15-session CBT trial (190 of whom received active treatment). The best fitting model included three profiles: dietary restraint only (DRO; n = 96; 51%); low dietary restraint (LDR; n = 52; 27%); and dietary restraint plus psychopathology (DRP; n = 42; 22%). Regression analyses revealed that after controlling for baseline score and treatment condition, EDE Global scores were lower for the DRO compared to the LDR profile at one year follow-up (p = .047). Class assignment was not predictive of EDE binge eating frequency or abstinence at end of treatment or follow-up. These results suggest that meaningful empirical classes based on eating disorder symptoms, psychopathology, dietary restraint, and BMI can be identified in BED and that these classes may be useful in predicting long-term group CBT outcome.
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Affiliation(s)
- Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA.
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14
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Grilo CM. Why no cognitive body image feature such as overvaluation of shape/weight in the binge eating disorder diagnosis? Int J Eat Disord 2013; 46:208-11. [PMID: 23233198 PMCID: PMC3600067 DOI: 10.1002/eat.22082] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Undue influence of body shape or weight on self-evaluation--referred to as overvaluation--is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This article addresses the relevance of a feature reflecting disturbance in body image for the diagnosis of BED. METHOD The distinction between overvaluation of shape/weight and body dissatisfaction is discussed, and empirical research regarding the concurrent and predictive significance of overvaluation of shape/weight for BED is reviewed. RESULTS The literature suggests that overvaluation does not simply reflect concern or distress commensurate with excess weight, is reliably associated with greater severity of eating-related psychopathology and psychological distress, and has reliably shown negative prognostic significance. DISCUSSION Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Psychology, Yale University, New Haven, Connecticut
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15
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Sawaoka T, Barnes RD, Blomquist KK, Masheb RM, Grilo CM. Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology. Compr Psychiatry 2012; 53:740-5. [PMID: 22152497 PMCID: PMC3306525 DOI: 10.1016/j.comppsych.2011.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/19/2011] [Accepted: 10/03/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Research has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with body mass index (BMI) and eating disorder psychopathology in BED. METHODS Participants were 113 overweight or obese treatment-seeking men and women with BED. Participants were administered semistructural diagnostic clinical interviews and completed a battery of self-report measures. RESULTS Social anxiety was positively and significantly correlated with shape and weight concerns and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating, shape, and weight concerns and overall eating disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after covarying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint. DISCUSSION Our findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape and weight concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating disorder psychopathology.
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Affiliation(s)
| | | | | | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine
| | - Carlos M. Grilo
- Department of Psychology, Yale University,Department of Psychiatry, Yale University School of Medicine
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16
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Significance of overvaluation of shape and weight in an ethnically diverse sample of obese patients with binge-eating disorder in primary care settings. Behav Res Ther 2012; 50:298-303. [PMID: 22449893 DOI: 10.1016/j.brat.2012.02.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
Abstract
Undue influence of shape or weight on self-evaluation--referred to as overvaluation--is a core feature across eating disorders, but is not a diagnostic requirement for binge-eating disorder (BED). This study examined overvaluation of shape/weight in ethnically diverse obese patients with BED seeking treatment in primary care. Participants were a consecutive series of 142 (105 female and 37 male) participants with BED; 43% were Caucasian, 37% were African-American, 13% were Hispanic-American, and 7% were of "other" ethnicity. Participants categorized with overvaluation (N=97; 68%) versus without clinical overvaluation (N=45; 32%) did not differ significantly in ethnicity/race, age, gender, body mass index, or binge-eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology, poorer psychological functioning (higher depression, lower self-esteem), and greater anxiety disorder co-morbidity than the group who did not overvalue their shape/weight. The greater eating disorder and psychological disturbance levels in the overvaluation group relative to the non-overvaluation group persisted after controlling for psychiatric co-morbidity. Our findings, based on an ethnically diverse series of patients seeking treatment in general primary care settings, are consistent with findings from specialist clinics and suggest that overvaluation does not simply reflect concerns commensurate with being obese or with frequency of binge-eating, but is strongly associated with heightened eating-related psychopathology and psychological distress. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity.
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17
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Grilo CM, Masheb RM, Crosby RD. Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder. J Consult Clin Psychol 2012; 80:897-906. [PMID: 22289130 DOI: 10.1037/a0027001] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). METHOD 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors, psychiatric and personality disorder comorbidity, eating disorder psychopathology, psychological features, and 2 subtyping methods (negative affect, overvaluation of shape/weight) were tested as predictors and moderators for the primary outcome of remission from binge eating and 4 secondary dimensional outcomes (binge-eating frequency, eating disorder psychopathology, depression, and body mass index). Mixed-effects models analyzed all available data for each outcome variable. In each model, effects for baseline value and treatment were included with tests of both prediction and moderator effects. RESULTS Several demographic and clinical variables significantly predicted and/or moderated outcomes. One demographic variable signaled a statistical advantage for medication only (younger participants had greater binge-eating reductions), whereas several demographic and clinical variables (lower self-esteem, negative affect, and overvaluation of shape/weight) signaled better improvements if receiving CBT. Overvaluation was the most salient predictor/moderator of outcomes. Overvaluation significantly predicted binge-eating remission (29% of participants with vs. 57% of participants without overvaluation remitted). Overvaluation was especially associated with lower remission rates if receiving medication only (10% vs. 42% for participants without overvaluation). Overvaluation moderated dimensional outcomes: Participants with overvaluation had significantly greater reductions in eating disorder psychopathology and depression levels if receiving CBT. Overvaluation predictor/moderator findings persisted after controlling for negative affect. CONCLUSIONS Our findings have clinical utility for prescription of CBT and medication and implications for refinement of the BED diagnosis.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, New Haven, CT 06519, USA.
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18
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Yip SW, White MA, Grilo CM, Potenza MN. An exploratory study of clinical measures associated with subsyndromal pathological gambling in patients with binge eating disorder. J Gambl Stud 2011; 27:257-70. [PMID: 20577790 DOI: 10.1007/s10899-010-9207-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Both binge eating disorder (BED) and pathological gambling (PG) are characterized by impairments in impulse control. Subsyndromal levels of PG have been associated with measures of adverse health. The nature and significance of PG features in individuals with BED is unknown. Ninety-four patients with BED (28 men and 66 women) were classified by gambling group based on inclusionary criteria for Diagnostic and Statistical Manual-IV (DSM-IV) PG and compared on a range of behavioral, psychological and eating disorder (ED) psychopathology variables. One individual (1.1% of the sample) met criteria for PG, although 18.7% of patients with BED displayed one or more DSM-IV criteria for PG, hereafter referred to as problem gambling features. Men were more likely than women to have problem gambling features. BED patients with problem gambling features were distinguished by lower self-esteem and greater substance problem use. After controlling for gender, findings of reduced self-esteem and increased substance problem use among patients with problem gambling features remained significant. In patients with BED, problem gambling features are associated with a number of heightened clinical problems.
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Affiliation(s)
- Sarah W Yip
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, CT, USA.
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19
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Núñez-Navarro A, Jiménez-Murcia S, Alvarez-Moya E, Villarejo C, Díaz IS, Augmantell CM, Granero R, Penelo E, Krug I, Tinahones FJ, Bulik CM, Fernández-Aranda F. Differentiating purging and nonpurging bulimia nervosa and binge eating disorder. Int J Eat Disord 2011; 44:488-96. [PMID: 20872757 DOI: 10.1002/eat.20823] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore similarities and differences in clinical and personality variables across three groups: binge eating disorder (BED), bulimia nervosa-purging type (BN-P), and bulimia nervosa-non purging type (BN-NP). METHOD The participants were 102 female eating disorders patients (34 BED, 34 BN-P, and 34 BN-NP) consecutively admitted to the eating disorders unit, at the University Hospital of Bellvitge, and diagnosed according to DSM-IV criteria. RESULTS BED patients were older, and more likely to have personal and family history of obesity. A gradient in psychopathological scores emerged with BN-P patients having higher pathological scores on the SCL-90-R, followed by BN-NP and BED patients. No statistically significant differences were observed in personality traits. DISCUSSION Our data supported that eating disorders (namely BED, BN-NP, and BN-P) followed a linear trend in general psychopathology. Whereas personality may represent a shared vulnerability factor, differences in clinical severity suggest there to be a continuum with BN-P being the most severe and BED being the least severe.
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Affiliation(s)
- Araceli Núñez-Navarro
- Department of Psychiatry, University Hospital of Bellvitge, Feixa Llarga s/n, PC: 08907 Barcelona, Spain
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20
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Safer DL, Joyce EE. Does rapid response to two group psychotherapies for binge eating disorder predict abstinence? Behav Res Ther 2011; 49:339-45. [PMID: 21459363 DOI: 10.1016/j.brat.2011.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/19/2011] [Accepted: 03/02/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Extend understanding of a rapid response (RR) to treatment by examining its prognostic significance at end-of-treatment (EOT) and 1 year follow-up within two group treatments for binge eating disorder (BED): Dialectical Behavior Therapy for BED (DBT-BED) and an active comparison group therapy (ACGT). METHODS 101 adults with BED randomized to 20-weeks DBT-BED versus ACGT (Safer, Robinson, & Jo, 2010). RR defined as ≥65% reduction in the frequency of days of binge eating by week 4. RR across and within treatment conditions used to predict binge eating abstinence and secondary outcomes (e.g., binge eating pathology, treatment attrition) at EOT and 1 year follow-up. RESULTS (1) Significantly higher binge eating abstinence for rapid responders (RR; n = 41) vs. non-rapid responders (non-RRs; n = 60) at EOT (70.7% vs. 33.3%) and 1 year follow-up (70.7% vs. 40.0%), respectively, as well as improvement on most secondary measures (2) Significantly less attrition among RRs vs. non-RRs (3) Significantly higher binge eating abstinence rates at both time points for DBT-RRs vs. DBT-non-RRs, but not for ACGT-RRs vs. ACGT-non-RRs. CONCLUSIONS Current study extends prognostic significance of RR to 1 year follow-up. RR more prominent for those randomly assigned to DBT-BED than ACGT. Implications discussed.
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Affiliation(s)
- Debra L Safer
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA 94305-5722, United States.
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21
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Dahl JK, Eriksen L, Vedul-Kjelsås E, Strømmen M, Kulseng B, Mårvik R, Holen A. Prevalence of all relevant eating disorders in patients waiting for bariatric surgery: a comparison between patients with and without eating disorders. Eat Weight Disord 2010; 15:e247-55. [PMID: 21406948 DOI: 10.1007/bf03325306] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To study the prevalence of all relevant eating disorders in 157 obese patients waiting for bariatric surgery. Another aim was to explore for possible differences between gender, and those with and without ED. The dependent variables were: socio-demographic characteristics, BMI, obesity onset, and obesity-related somatic diseases. METHODS ED was assessed using the self-report questionnaire, "Eating Disorders in Obesity" (EDO). The patients answered a questionnaire that targeted socio-demographic and health information. RESULTS Subgroups were based on the patients responses to items on the EDO: 1 patient (0.6%) with Bulimia Nervosa (BN), 6 (3.8%) with Eating Disorder Not Otherwise Specified (EDNOS), 21 (13.4%) with Binge Eating Disorder (BED), and 23 (14.6%) with Binge Eating (BE). The patients in the EDNOS group were those who lacked one criterion of the BN diagnosis. The patients in the BE group lacked one criterion of the BED diagnosis. Twenty-eight (17.8%) fulfilled the DSM-IV-TR criteria for ED. When patients with BE were added, 51 patients (32.5%) were identified with ED or sub-threshold ED. In the explorative part of the study, no gender differences in socio-demographic variables, BMI, obesity onset, and obesity-related somatic diseases emerged. With the exception of age, no differences were found in these variables between those with and without ED. CONCLUSION Employing all relevant eating disorders and binge eating symptoms (BE) for this population identified patients with pathological eating behaviors, which are not detected in previous studies measuring only BED and BE.
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Affiliation(s)
- J K Dahl
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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22
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Grilo CM, Masheb RM, White MA. Significance of overvaluation of shape/weight in binge-eating disorder: comparative study with overweight and bulimia nervosa. Obesity (Silver Spring) 2010; 18:499-504. [PMID: 19713949 PMCID: PMC2845446 DOI: 10.1038/oby.2009.280] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increasing empirical evidence supports the validity of binge-eating disorder (BED) and its inclusion as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Contention exists regarding the criteria for BED, including whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape/weight. This study examined the significance of overvaluation for BED using two complementary comparisons groups. Participants were 324 women who completed self-report instruments as part of an Internet study. Analyses compared BMI, eating disorder (ED) features, and depressive levels in four groups: 123 overweight participants without ED, 47 BED participants who do not overvalue shape/weight, 101 BED participants who overvalue shape/weight, and 53 BN participants. Both BED groups had significantly greater ED psychopathology than the overweight group. Within BED, the group with overvaluation had significantly greater ED psychopathology and depressive levels despite no differences in binge eating. BED with overvaluation and BN groups differed little from each other but had significantly higher ED psychopathology and depressive levels than the other groups. Group differences existed despite similar age and BMI across the groups, as well as when controlling for group differences in depressive levels. These findings provide further support for the validity of BED and suggest that overvaluation of shape/weight, which provides important information about BED severity, warrants consideration as either a diagnostic specifier or as a dimensional severity rating. Although inclusion of overvaluation of shape/weight could be considered as a required criterion for BED, this would exclude a substantial proportion of BED patients with clinically significant problems.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
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23
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Goldschmidt AB, Hilbert A, Manwaring JL, Wilfley DE, Pike KM, Fairburn CG, Striegel-Moore RH. The significance of overvaluation of shape and weight in binge eating disorder. Behav Res Ther 2010; 48:187-93. [PMID: 19897174 PMCID: PMC2829349 DOI: 10.1016/j.brat.2009.10.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 10/14/2009] [Accepted: 10/15/2009] [Indexed: 11/27/2022]
Abstract
As publication of DSM-V draws near, research is needed to validate the diagnostic scheme for binge eating disorder (BED). Shape and weight overvaluation has stimulated considerable debate in this regard, given associations with psychosocial impairment and poor treatment outcome in BED. This study sought to further explore the convergent validity and diagnostic specificity of shape and weight overvaluation in BED. A total of 160 women with BED, and 108 women with non-eating disordered psychiatric disorders were recruited from the community. Women with BED were classified as more or less severe based on a global measure of eating-related psychopathology; subsequent receiver operating characteristics analysis determined that a threshold of at least "moderate" overvaluation best predicted membership into a more severe group. BED participants with threshold overvaluation exhibited poorer psychosocial functioning than those with subthreshold overvaluation, as well as participants with other psychiatric disorders. Discriminant function analysis revealed that threshold overvaluation predicted a diagnosis of BED versus other psychiatric disorder with 67.7% accuracy. Results suggest that shape and weight overvaluation is a useful diagnostic specifier in BED. Continued research is warranted to examine its predictive validity in natural course and treatment outcome studies.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychology, Washington University, 660 South
Euclid Avenue, Campus Box 8134, St. Louis, MO, 63110, USA;
(Ms. Goldschmidt);
(Ms. Manwaring)
| | - Anja Hilbert
- Department of Psychology, Philipps University of Marburg,
Gutenbergstrasse 18, Marburg, Germany;
| | - Jamie L. Manwaring
- Department of Psychology, Washington University, 660 South
Euclid Avenue, Campus Box 8134, St. Louis, MO, 63110, USA;
(Ms. Goldschmidt);
(Ms. Manwaring)
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of
Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA;
| | - Kathleen M. Pike
- Department of Psychology, Temple University Japan Campus,
Azabu Hall 6th Floor, Minami-Azabu 2-8-12, Minato-ku, Tokyo, Japan, 106-0047;
| | | | - Ruth H. Striegel-Moore
- Department of Psychology, Wesleyan University, 207 High
Street, Middletown, CT 06459, USA;
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Wonderlich SA, Gordon KH, Mitchell JE, Crosby RD, Engel SG. The validity and clinical utility of binge eating disorder. Int J Eat Disord 2009; 42:687-705. [PMID: 19621466 DOI: 10.1002/eat.20719] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This review attempted to examine the validity and clinical utility of the DSM-IV binge eating disorder (BED) diagnosis across a wide range of validating strategies. METHOD Various electronic databases (Pub Med, Psych Info) were searched for terms relevant to the diagnosis of BED (e.g., binge eating disorder, binge eating) in order to identify papers. Additionally, published papers were reviewed in order to locate additional manuscripts and papers that were presented at meetings. RESULTS The validity and utility of BED varied substantially according to the validator chosen. There is reasonable evidence that BED can be differentiated from other existing eating disorders and is associated with significant impairment and clinical levels of eating disorder psychopathology. The relationship of BED to obesity is complex, and in spite of some positive findings, further research examining the predictive power of BED, beyond the simple presence of obesity and associated psychopathology, in relationship to clinically relevant outcomes is needed. DISCUSSION Binge eating disorder is being considered for inclusion in the DSM-V and various options regarding this decision are reviewed based upon the empirical findings in the paper.
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Affiliation(s)
- Stephen A Wonderlich
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, 120 8th Street South, P.O. Box 1415, Fargo, North Dakota 58107-1415, USA.
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25
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Body-related film clip triggers desire to binge in women with binge eating disorder. Behav Res Ther 2009; 47:790-6. [DOI: 10.1016/j.brat.2009.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 06/10/2009] [Accepted: 06/10/2009] [Indexed: 12/28/2022]
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Grilo CM, Crosby RD, Masheb RM, White MA, Peterson CB, Wonderlich SA, Engel SG, Crow SJ, Mitchell JE. Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa. Behav Res Ther 2009; 47:692-6. [PMID: 19552897 DOI: 10.1016/j.brat.2009.05.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 05/08/2009] [Accepted: 05/11/2009] [Indexed: 12/27/2022]
Abstract
Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, P.O. Box 208098, 301 Cedar Street, 2nd floor, New Haven, CT 06520, United States.
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28
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Grilo CM, Hrabosky JI, White MA, Allison KC, Stunkard AJ, Masheb RM. Overvaluation of shape and weight in binge eating disorder and overweight controls: refinement of a diagnostic construct. JOURNAL OF ABNORMAL PSYCHOLOGY 2008; 117:414-9. [PMID: 18489217 DOI: 10.1037/0021-843x.117.2.414] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n=92), BED participants with subclinical levels of overvaluation (n=73), and participants in an overweight comparison group without BED (n=45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychology, Yale University School of Medicine, New Haven, CT 06520, USA.
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29
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Tanofsky-Kraff M, Goossens L, Eddy KT, Ringham R, Goldschmidt A, Yanovski SZ, Braet C, Marcus MD, Wilfley DE, Olsen C, Yanovski JA. A multisite investigation of binge eating behaviors in children and adolescents. J Consult Clin Psychol 2008; 75:901-13. [PMID: 18085907 DOI: 10.1037/0022-006x.75.6.901] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The phenomenology of childhood and adolescent loss of control (LOC) eating is unknown. The authors interviewed 445 youths to assess aspects of aberrant eating. LOC was associated with eating forbidden food before the episode; eating when not hungry; eating alone; and experiencing secrecy, negative emotions, and a sense of "numbing" while eating (ps<.01). Hierarchical cluster analysis revealed a subgroup, most of whom reported LOC eating. Cluster members reported having a trigger initiate episodes, eating while watching television, and having decreased awareness regarding the amount consumed. The authors conclude that aspects of LOC eating during youth are similar to aspects of adult episodes, but a youth-specific presentation may exist. Findings may provide an intervening point to prevent excessive weight gain and eating disorders.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4712, USA.
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30
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Masheb RM, Grilo CM. Prognostic significance of two sub-categorization methods for the treatment of binge eating disorder: negative affect and overvaluation predict, but do not moderate, specific outcomes. Behav Res Ther 2008; 46:428-37. [PMID: 18328464 DOI: 10.1016/j.brat.2008.01.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 01/08/2008] [Accepted: 01/11/2008] [Indexed: 11/28/2022]
Abstract
Given the absence of known predictors and moderators for binge eating disorder (BED) treatment outcome and recent findings regarding meaningful sub-categorizations of BED patients, we tested the predictive validity of two subtyping methods. Seventy-five overweight patients with BED who participated in a randomized clinical trial of guided self-help treatments (cognitive-behavioral therapy (CBTgsh) and behavioral weight loss (BWLgsh)) were categorized in two ways. First, a cluster analytic approach yielded dietary-negative affect (29%) and pure dietary (71%) subtypes. Second, research conventions for categorizing patients based upon shape or weight self-evaluation yielded clinical overvaluation (51%) and subclinical overvaluation (49%) subtypes. At the end of treatment, participants subtyped as dietary-negative affect reported more frequent binge episodes compared to the pure dietary subtype, and those with clinical overvaluation reported greater eating disorder psychopathology compared to the subclinical overvaluation group. Neither method predicted binge remission, depressive symptoms, or weight loss. Neither sub-categorization moderated the effects of guided self-help CBT and BWL treatments on any BED outcomes, suggesting that these two specific treatments perform comparably across BED subtypes. In conclusion, dietary-negative affect subtyping and overvaluation subtyping each predicted, but did not moderate, specific and important dimensions of BED treatment outcome.
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Affiliation(s)
- R M Masheb
- Department of Psychiatry, Yale Psychiatric Research, Yale University School of Medicine, 301 Cedar Street, PO Box 208098, New Haven, CT 06520, USA.
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31
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Abstract
OBJECTIVE This paper considers whether the criteria currently used to classify the diagnosis of binge eating disorder (BED) are valid and appropriate. METHOD We review evidence that reflects on the validity of the current criteria for binge eating episodes and BED, using literature retrieved through major psychology and psychiatry search engines (e.g., PsycInfo, PubMed). RESULTS Evidence from experimental research points to the relative importance of episode frequency, the amount of food consumed at episodes, the subjective sense of loss of control over eating, and several additional criteria associated with binge episodes in BED. Evidence on the differences in psychopathology between BED and bulimia nervosa and between BED and obesity without binge eating, as related to diagnostic criteria, is reviewed. CONCLUSION Although evidence concerning the diagnostic criteria of BED is mixed, broadening certain diagnostic criteria for binge eating episodes and BED might more accurately reflect the research literature and increase the number of individuals eligible for inclusion in treatment programs.
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Affiliation(s)
- Janet D Latner
- Department of Psychology, University of Hawaii, Honolulu, Hawaii 96822, USA.
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32
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Mond JM, Hay PJ. Functional impairment associated with bulimic behaviors in a community sample of men and women. Int J Eat Disord 2007; 40:391-8. [PMID: 17497705 DOI: 10.1002/eat.20380] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine functional impairment associated with bulimic behaviors in a community sample of men and women. METHOD Binge eating, purging, fasting, extreme weight and shape concerns, and "days-out-of-role" were assessed in a community sample of men (n = 1,290) and women (n = 1,757) aged 15-94 years. RESULTS Participants who reported regular eating disorder behaviors had higher levels of functional impairment than those who did not. This was the case for both men and women and for each of the behaviors assessed, although differences between purgers and nonpurgers were not statistically significant. Also in both men and women, participants who reported eating disorder behaviors and weight or shape concerns had higher levels of impairment than those who reported these behaviors in the absence of weight or shape concerns. In multivariate analysis, binge eating, fasting and weight or shape concerns all contributed to the likelihood of impairment in men, whereas only the presence of weight or shape concerns was significantly associated with impairment in women. CONCLUSION Whereas bulimic behaviors are associated with elevated levels of functional impairment in both men and women, weight or shape concerns may be more central to the experience of this impairment in women.
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Affiliation(s)
- Jonathan M Mond
- School of Psychological Science, La Trobe University, Bundoora VIC 3083, Australia.
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Tanofsky-Kraff M, Wilfley DE, Young JF, Mufson L, Yanovski SZ, Glasofer DR, Salaita CG. Preventing excessive weight gain in adolescents: interpersonal psychotherapy for binge eating. Obesity (Silver Spring) 2007; 15:1345-55. [PMID: 17557971 PMCID: PMC1949388 DOI: 10.1038/oby.2007.162] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The most prevalent disordered eating pattern described in overweight youth is loss of control (LOC) eating, during which individuals experience an inability to control the type or amount of food they consume. LOC eating is associated cross-sectionally with greater adiposity in children and adolescents and seems to predispose youth to gain weight or body fat above that expected during normal growth, thus likely contributing to obesity in susceptible individuals. No prior studies have examined whether LOC eating can be decreased by interventions in children or adolescents without full-syndrome eating disorders or whether programs reducing LOC eating prevent inappropriate weight gain attributable to LOC eating. Interpersonal psychotherapy, a form of therapy that was designed to treat depression and has been adapted for the treatment of eating disorders, has shown efficacy in reducing binge eating episodes and inducing weight stabilization among adults diagnosed with binge eating disorder. In this paper, we propose a theoretical model of excessive weight gain in adolescents at high risk for adult obesity who engage in LOC eating and associated overeating patterns. A rationale is provided for interpersonal psychotherapy as an intervention to slow the trajectory of weight gain in at-risk youth, with the aim of preventing or ameliorating obesity in adulthood.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, NIH, Bethesda, MD, USA.
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34
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Hrabosky JI, Masheb RM, White MA, Grilo CM. Overvaluation of shape and weight in binge eating disorder. J Consult Clin Psychol 2007; 75:175-80. [PMID: 17295577 DOI: 10.1037/0022-006x.75.1.175] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The excessive influence of shape or weight on self-evaluation--referred to as overvaluation--is considered by some a central feature across eating disorders but is not a diagnostic requirement for binge eating disorder (BED). This study examined shape/weight overvaluation in 399 consecutive patients with BED. Participants completed semistructured interviews, including the Eating Disorder Examination (EDE; C. G. Fairburn & Z. Cooper, 1993) and several self-report measures. Shape/weight overvaluation was unrelated to body mass index (BMI) but was strongly associated with measures of eating-related psychopathology and psychological status (i.e., higher depression and lower self-esteem). Participants were categorized via EDE guidelines into 1 of 2 groups: clinical overvaluation (58%) or subclinical overvaluation (42%). The 2 groups did not differ significantly in BMI or binge eating frequency, but the clinical overvaluation group had significantly greater eating-related psychopathology and poorer psychological status than the subclinical overvaluation group. Findings suggest that overvaluation does not simply reflect concern commensurate with being overweight but is strongly associated with eating-related psychopathology and psychological functioning and warrants consideration as a diagnostic feature for BED.
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Affiliation(s)
- Joshua I Hrabosky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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35
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Dunkley DM, Grilo CM. Self-criticism, low self-esteem, depressive symptoms, and over-evaluation of shape and weight in binge eating disorder patients. Behav Res Ther 2007; 45:139-49. [PMID: 16530723 DOI: 10.1016/j.brat.2006.01.017] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 01/25/2006] [Accepted: 01/31/2006] [Indexed: 11/16/2022]
Abstract
Despite the fact that negative self-evaluations are widely considered to be prominent in eating disorders, the role of self-criticism has received little empirical attention. The vast majority of research on the construct of self-criticism has focused on its role as a specific personality vulnerability factor in depression-related phenomena. In this study of 236 patients with binge eating disorder, confirmatory factor analysis supported self-criticism, self-esteem, depressive symptoms, and over-evaluation of shape and weight as distinct, albeit related, constructs. Structural equation modeling demonstrated that the relation between self-criticism and over-evaluation of shape and weight was partly mediated or explained by low self-esteem and depressive symptoms. Continued efforts to understand the role of self-criticism in eating disorders appear warranted.
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Affiliation(s)
- David M Dunkley
- Department of Psychiatry, Institute of Community and Family Psychiatry, S.M.B.D. Jewish General Hospital, 4333 Côte Ste-Catherine Road, Montreal, Que., Canada H3T 1E4.
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36
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Mond JM, Hay PJ, Rodgers B, Owen C. Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder. Behav Res Ther 2006; 45:929-38. [PMID: 17010307 DOI: 10.1016/j.brat.2006.08.011] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 08/10/2006] [Accepted: 08/18/2006] [Indexed: 11/17/2022]
Abstract
Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".
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Affiliation(s)
- Jonathan M Mond
- Discipline of Psychiatry, School of Medicine, James Cook University, Townsville, Qld. 4811, Australia.
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37
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Delinsky SS, Latner JD, Wilson GT. Binge eating and weight loss in a self-help behavior modification program. Obesity (Silver Spring) 2006; 14:1244-9. [PMID: 16899805 DOI: 10.1038/oby.2006.141] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the occurrence of binge eating and its impact on weight loss outcomes among obese participants in the Trevose Behavior Modification Program, a lay-administered, lay-directed self-help weight loss program offering continuing care. RESEARCH METHODS AND PROCEDURES Participants completed questionnaires, and weight loss data were recorded prospectively. RESULTS Although objective bulimic episodes were reported by 41% of the sample, objective bulimic episodes were not associated with worse weight loss outcomes. Mean weight loss after 12 months was 18.2 kg (18.8% of initial body weight) for the treatment completers and 10.3 kg (10.5% of initial body weight) for the full sample (using intent-to-treat analyses, with baseline scores carried forward). DISCUSSION Substantial long-term weight loss, resulting from a continuing care treatment program, occurred in individuals both with and without frequent binge eating.
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Glasofer DR, Tanofsky-Kraff M, Eddy KT, Yanovski SZ, Theim KR, Mirch MC, Ghorbani S, Ranzenhofer LM, Haaga D, Yanovski JA. Binge eating in overweight treatment-seeking adolescents. J Pediatr Psychol 2006; 32:95-105. [PMID: 16801323 PMCID: PMC1862866 DOI: 10.1093/jpepsy/jsl012] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine the frequency and recency of binge eating in relation to psychopathology in overweight, treatment-seeking adolescents. METHODS We investigated psychological correlates of the frequency and recency of reported loss of control (LOC) eating episodes in 160 overweight (body mass index [BMI]: 40.7 +/- 8.8 kg/m(2)) adolescents. On the basis of the responses to the eating disorder examination (EDE), participants were categorized into one of four groups: full-syndrome binge eating disorder (BED); recent but infrequent binge eating (episodes within the 3 months before interview; RECENT-BINGE); remote and infrequent LOC eating (episodes occurring >3 months before assessment; PAST-LOC), or no history of LOC episodes (NE). RESULTS The BED group reported higher EDE scores (global, p < .01), and more negative mood and anxiety than all other groups (p's < .01). Compared with NE, RECENT-BINGE also reported more anxiety and higher EDE scores (p's < .01). CONCLUSIONS Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.
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Affiliation(s)
- Deborah R. Glasofer
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, American University
- Department of Psychology, American University
| | - Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, American University
| | - Kamryn T. Eddy
- Center for Anxiety and Related Disorders, Boston University
- Optimal Weight for Life Clinic, Children’s Hospital
| | | | - Kelly R. Theim
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, American University
| | - Margaret C. Mirch
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, American University
| | - Samareh Ghorbani
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, American University
- Division of Nutrition Research Coordination, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, DHHS
| | - Lisa M. Ranzenhofer
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, American University
- Division of Nutrition Research Coordination, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, DHHS
| | - David Haaga
- Department of Psychology, American University
| | - Jack A. Yanovski
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, American University
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39
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Reas DL, White MA, Grilo CM. Body Checking Questionnaire: psychometric properties and clinical correlates in obese men and women with binge eating disorder. Int J Eat Disord 2006; 39:326-31. [PMID: 16528695 DOI: 10.1002/eat.20236] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Body checking is considered a behavioral manifestation of the overevaluation of shape and weight, which is characteristic of patients with eating disorders. We examined the initial psychometric properties of the Body Checking Questionnaire (BCQ) and the frequency and nature of body checking behaviors in obese men and women with binge eating disorder (BED). METHOD Participants were a consecutive series of 73 (22 men, 51 women) treatment-seeking obese adults who met research criteria for BED as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Participants were administered measures to assess body checking, body image concerns, and the core psychopathology of eating disorders, and general psychological functioning. Semistructured interviews were used to establish the diagnosis of BED. RESULTS Psychometric evidence was found to support the reliability and validity of the BCQ in patients with BED. Women reported significantly greater levels of body checking than men. Participants with greater body dissatisfaction reported more frequent checking than participants with less dissatisfaction. Among women, the frequency of checking was related to younger age, lower body mass index (BMI), body dissatisfaction, overevaluation of body shape and weight, greater depression, and lower self-esteem. CONCLUSION There exist significant gender and age-related differences in both the frequency and correlates of body checking behaviors. Among obese women with BED, body checking is related to the overevaluation of shape as well as with associated psychopathology.
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Affiliation(s)
- Deborah L Reas
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06520-8090, USA
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40
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Allison KC, Grilo CM, Masheb RM, Stunkard AJ. Binge Eating Disorder and Night Eating Syndrome: A Comparative Study of Disordered Eating. J Consult Clin Psychol 2005; 73:1107-15. [PMID: 16392984 DOI: 10.1037/0022-006x.73.6.1107] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors compared eating patterns, disordered eating, features of eating disorders, and depressive symptoms in persons with binge eating disorder (BED; n = 177), with night eating syndrome (NES; n = 68), and in an overweight comparison group without BED or NES (comparison; n = 45). Participants completed semistructured interviews and several established measures. Depressive symptoms were greater in the BED and NES groups than in the comparison group. NES participants ate fewer meals during the day and more during the night than BED and comparison participants, whereas BED participants ate more during the day than the comparison participants. BED participants reported more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger than NES and comparison participants, whereas NES participants reported more eating pathology than comparison participants. This evaluation provides strong evidence for the distinctiveness of the BED and NES constructs and highlights their clinical significance.
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Affiliation(s)
- Kelly C Allison
- Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 19104-3309, USA.
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41
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Grilo CM, Reas DL, Brody ML, Burke-Martindale CH, Rothschild BS, Masheb RM. Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery. Behav Res Ther 2005; 43:629-37. [PMID: 15865917 DOI: 10.1016/j.brat.2004.05.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2004] [Revised: 05/11/2004] [Accepted: 05/12/2004] [Indexed: 11/22/2022]
Abstract
This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale Psychiatric Research, Yale University School of Medicine, P.O. Box 208098, 301 Cedar Street, New Haven, CT 06520, USA.
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42
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Reas DL, Grilo CM, Masheb RM, Wilson GT. Body checking and avoidance in overweight patients with binge eating disorder. Int J Eat Disord 2005; 37:342-6. [PMID: 15856496 DOI: 10.1002/eat.20092] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Repetitive body checking and avoidance are viewed as behavioral manifestations of the core psychopathology of eating disorders (EDs). We examined select body checking and avoidance behaviors in overweight patients with binge eating disorder (BED). METHOD Three hundred seventy-seven overweight (body mass index [BMI] > or = 25) treatment-seeking BED patients (80 men and 297 women) were administered measures to assess body checking and avoidance, other key behavioral features of EDs (binge eating, dietary restraint, and disinhibition), and the core psychopathology of EDs (overevaluation of weight and shape). RESULTS The majority of participants reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations emerged between checking and restraint, and conversely, between avoidance and binge eating. Both checking and avoidance were positively and significantly associated with overevaluation of weight and shape, even after controlling for their unique effects. DISCUSSION These findings offer support to the potential role of checking and avoidance behaviors in the maintenance of BED.
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Affiliation(s)
- Deborah L Reas
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06520-8098, USA
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43
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Tanofsky-Kraff M, Yanovski SZ. Eating disorder or disordered eating? Non-normative eating patterns in obese individuals. ACTA ACUST UNITED AC 2005; 12:1361-6. [PMID: 15483199 DOI: 10.1038/oby.2004.171] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Binge eating disorder (BED) and night eating syndrome (NES) are putative eating disorders frequently seen in obese individuals. Data suggest that BED fulfills criteria for a mental disorder. Criteria for NES are evolving but at present do not require distress or functional impairment. It remains unclear whether BED and NES, as they are currently defined, are optimally useful for characterizing distinct patient subgroups. We propose that a distinction be made between "eating disorders" and "non-normative" eating patterns without associated distress or impairment. Although non-normative eating patterns may not be considered mental disorders, they may be very important in terms of their impact on body weight and health. More precise behavioral and metabolic characterization of subgroups with eating disorders and non-normative eating behaviors has important implications for understanding the etiology, pathophysiology, and treatment of obesity. Ultimately, better understanding of the many pathways to increased energy intake may lead to targeted strategies for prevention of overweight and obesity in at-risk individuals and populations.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, NIH, 10 Center Drive, Building 10, Room 10N262 MSC 1862, Bethesda, MD 20892-1862.
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44
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Dymek-Valentine M, Rienecke-Hoste R, Alverdy J. Assessment of binge eating disorder in morbidly obese patients evaluated for gastric bypass: SCID versus QEWP-R. Eat Weight Disord 2004; 9:211-6. [PMID: 15656016 DOI: 10.1007/bf03325069] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Binge eating disorder (BED) has been hypothesized to be associated with poor outcome in gastric bypass surgery (GBP). However, past studies have yielded inconsistent results regarding BED and surgical outcome, which may be due to the variety of measures used to assess BED. The present study examines the utility of two commonly used BED diagnostic tools: the Structured Clinical Interview (SCID) and the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R). METHOD Subjects were 168 adult patients evaluated for GBP. BED was assessed using the SCID and the RESULTS 27% of the sample received a diagnosis of BED using the QEWP-R, compared with 14% using the SCID. Agreement using Cohen's kappa was 0.37. Compared to sub-non-concordant diagnoses of BED, subjects with concordant diagnoses scored on a measure of self-esteem. DISCUSSION Although both diagnostic tools use the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria, each yielded different results. Further studies are needed to determine the most accurate method of assessing BED in this population.
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Affiliation(s)
- M Dymek-Valentine
- Department of Psychiatry, Center for Advanced Medicine, The University of Chicago, Chicago, IL, USA.
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45
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Abstract
OBJECTIVE To examine Health-Related Quality of Life (HRQL) in patients with binge eating disorder (BED). DESIGN Cross-sectional comparison of HRQL in a BED sample to published normative and clinical samples. Further cross-sectional comparisons within the BED sample comparing obese and non-obese subjects, and depressed and non-depressed subjects. SUBJECTS Ninety-four patients (73 women and 21 men), who met DSM-IV criteria and attended a medical school based program for BED, participated. Mean body mass index (BMI) was 35.2 (SD = 8.1), and mean age was 44.9 (SD = 8.3); 78.7% of participants were Caucasian. MEASUREMENTS Subjects completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36), a self-report measure of HRQL. RESULTS BED patients reported worse functioning in all HRQL domains than US norms, and in some domains of HRQL than obese treatment seekers. Among BED patients, obese BED subjects had significantly worse Physical Component summary scores than non-obese BED subjects, whereas depressed BED subjects had significantly worse Mental Component summary scores than non-depressed BED subjects. CONCLUSION Obesity status and depression appear to be related to HRQL among BED patients with obesity being related to physical HRQL and depression being related to mental HRQL.
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Affiliation(s)
- R M Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520-8098, USA.
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46
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Devlin MJ, Goldfein JA, Dobrow I. What is this thing called BED? Current status of binge eating disorder nosology. Int J Eat Disord 2003; 34 Suppl:S2-18. [PMID: 12900982 DOI: 10.1002/eat.10201] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although binge eating has been recognized as a clinically relevant behavior among the obese for more than four decades, the concept of binge eating disorder (BED) as a distinct psychiatric diagnosis is of much more recent origin. This article presents four ways of conceptualizing BED: a distinct disorder in its own right, as a variant of bulimia nervosa, as a useful behavioral subtype of obesity, and as a behavior that reflects psychopathology among the obese. It also summarizes the evidence supporting and disconfirming each model. METHOD The literature subsequent to the development of DSM-IV regarding the reliability and validity of BED and related conditions was reviewed selectively. RESULTS The preponderance of the evidence suggests that BED differs importantly from purging bulimia nervosa and that BED is not a strikingly useful behavioral subtype of obesity. DISCUSSION Further study is needed to definitively determine the validity of BED as a distinct eating disorder.
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Affiliation(s)
- Michael J Devlin
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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47
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Abstract
OBJECTIVE Current controversy exists regarding the status of binge eating disorder (BED) as a diagnostic entity. A critique of the literature is provided to address the question of whether BED represents a clinically significant syndrome. METHOD The scientific evidence is considered through addressing five questions that are key in evaluating the clinical utility of any mental disorder. RESULTS Individuals with BED meaningfully differ from individuals without eating disorders, and share important similarities to, yet are distinct from, individuals with anorexia nervosa (AN) and bulimia nervosa (BN). BED is associated with co-occurring physical and mental illnesses, as well as impaired quality of life and social functioning. Questions about the course of the disorder and the optimal treatment regimen for the syndrome need to be explored further. DISCUSSION BED's distinctive combination of core eating disorder psychopathology, and other co-occurring physical and psychiatric conditions, impaired psychosocial functioning, and overweight constitute an eating disorder of clinical severity and a significant public health problem.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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48
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Barry DT, Grilo CM, Masheb RM. Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder. J Nerv Ment Dis 2003; 191:589-94. [PMID: 14504568 DOI: 10.1097/01.nmd.0000087185.95446.65] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study compared patients with bulimia nervosa (BN), obese patients with binge eating disorder (BED), and nonobese patients with BED. One hundred sixty-two adult women consecutively evaluated for outpatient clinical trials who met DSM-IV criteria for BN, purging type (N = 46) or for BED (N = 79 obese and N = 37 nonobese) were compared using the Eating Disorder Inventory (EDI). The three groups differed significantly on two (drive for thinness and body dissatisfaction) of the three eating-related scales and on all five of the general personality scales of the EDI. When age and depression level were controlled, findings for the eating-related scales did not change, whereas four of the five general personality scales were no longer significant. Post hoc analyses revealed that the BN group and the nonobese BED group had significantly higher drive for thinness than the obese BED group. The nonobese and the obese BED groups did not differ from each other in any area (other than drive for thinness), including body dissatisfaction. The nonobese and the obese BED groups had significantly lower maturity features than the BN group. Our findings suggest that when the effects of age and depression levels are controlled, treatment-seeking women with BN and BED are generally similar. Certain differences that do exist between women with BN and BED are associated with obesity status (drive for thinness), whereas others are associated with diagnosis (body dissatisfaction, maturity fears).
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale Psyquiatric Research at Congress Place, Yale University School of Medicine, New Haven, CT 06519, USA
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de Zwaan M, Mitchell JE, Howell LM, Monson N, Swan-Kremeier L, Crosby RD, Seim HC. Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry 2003; 44:428-34. [PMID: 14505305 DOI: 10.1016/s0010-440x(03)00092-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The prevalence of binge eating disorder (BED) was assessed in a sample of 110 morbidly obese presurgery patients by means of self-report (Questionnaire on Eating and Weight Patterns [QEWP]). Subsequently, patients with (n = 19, 17.3%) and without BED (n = 91, 82.7%) were compared on several eating-related and general psychopathological instruments, as well as an obesity-specific health-related quality-of-life measure. Patients with BED exhibited higher scores than non-BED patients on most of the subscales of two questionnaires measuring eating behavior and attitudes towards eating, shape, and weight (Three Factor Eating Questionnaire [TFEQ], Eating Disorders Examination-questionnaire version [EDE-Q4]) with the exception of the respective restraint subscales. The two groups also differed significantly on the disease-specific quality-of-life measure (Impact of Quality of Life Questionnaire-Lite [IWQOL-Lite]). No differences were found for measures of severity of depressive symptoms (Inventory of Depressive Symptoms [IDS]) and impairment of self-esteem (Rosenberg Self-Esteem Questionnaire [RSE]). Our findings replicate the results of other studies comparing patients with and without BED in samples with different degrees of obesity and extend the results to an obesity-specific quality-of-life measure. Further research needs to investigate the short- and long-term impact of presurgery BED on surgery outcome, as well as the impact of surgery on binge eating and eating-related psychopathology.
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De Panfilis C, Rabbaglio P, Rossi C, Zita G, Maggini C. Body image disturbance, parental bonding and alexithymia in patients with eating disorders. Psychopathology 2003; 36:239-46. [PMID: 14571053 DOI: 10.1159/000073449] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Accepted: 06/06/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND To evaluate if body image disturbance and alexithymia, two major clinical features of eating disorders (ED), are predicted by an altered parental bonding. SAMPLING AND METHODS 64 female ED outpatients and 68 female healthy controls were assessed by means of the Parental Bonding Instrument (PBI), the Body Uneasiness Test (BUT), and the Toronto Alexithymia Scale (TAS-20). Pearson's correlations and multiple stepwise regression analysis were applied to explore the contribution of PBI factors on BUT and TAS scores. RESULTS BUT weight phobia, body image concerns, avoidance, depersonalization, Global Severity Index and positive symptom total were predicted by low parental care, while compulsive self-monitoring was predicted by parental overprotection. TAS total score and difficulty in describing feelings were predicted by low maternal care. CONCLUSIONS Body image disturbance in ED may be conceptualized as a deficit in self-development, resulting from failures in parent-child interactions which impaired the ability to distinguish bodily needs from emotional experiences.
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Affiliation(s)
- C De Panfilis
- Institute of Psychiatry, University of Parma, Parma, Italy
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