An empirical comparison of atypical bulimia nervosa and binge eating disorder

Many Facets of Eating Disorders: Profiling Key Psychological Features of Anorexia Nervosa and Binge Eating Disorder

Objective. The present study employs a profile analysis to identify and compare psychological features and core eating disorder (ED) symptoms in clinical samples of patients with anorexia nervosa (AN) and binge eating disorder (BED) and the general population (GP). Methods. A sample comprising 421 participants (142 patients with AN; 139 patients with BED; and 140 participants from the GP) was surveyed with the Eating Disorder Inventory-3 (EDI-3). Individuals with AN and BED were recruited and tested during their first week of a multidisciplinary inpatient program for weight loss and rehabilitation at the 'Rete DCA USL Umbria 1' (Eating Disorders Services), Italy. Results. The findings suggest distinct patterns of symptom presentation between the three samples across all the EDI-3 dimensions-with both the AN and BED groups scoring significantly higher than the GP. Patients with AN registered greater scores in all the psychological trait scales and the drive for thinness ED-specific dimension of the EDI-3 compared with their BED counterpart-which, instead, scored higher in the bulimia and body dissatisfaction subscales. These data support the transdiagnostic nature of the main risk factors for the onset and maintenance of EDs-which would vary in severity levels-and the existence of disease-specific pathways giving rise to AN and BED. Conclusion. This study for the first time compares patients with AN and BED with a non-clinical sample on main ED psychological features. This might inform classification approaches and could have important implications for the development of prevention and early intervention programs.

Food Addiction in Eating Disorders and Obesity: Analysis of Clusters and Implications for Treatment

Food addiction (FA) has been associated with greater psychopathology in individuals with eating disorders (ED) and obesity (OBE). The current study aims to provide a better phenotypic characterization of the FA construct by conducting a clustering analysis of FA in both conditions (ED and OBE). The total sample was comprised of 234 participants that scored positive on the Yale Food Addiction Scale 2.0. (YFAS-2) (119 bulimia nervosa (BN), 50 binge eating disorder (BED), 49 other specified feeding or eating disorder (OSFED) and 16 OBE). All participants completed a comprehensive battery of questionnaires. Three clusters of FA participants were identified. Cluster 1 (dysfunctional) was characterized by the highest prevalence of OSFED and BN, the highest ED severity and psychopathology, and more dysfunctional personality traits. Cluster 2 (moderate) showed a high prevalence of BN and BED and moderate levels of ED psychopathology. Finally, cluster 3 (adaptive) was characterized by a high prevalence of OBE and BED, low levels of ED psychopathology, and more functional personality traits. In conclusion, this study identified three distinct clusters of ED-OBE patients with FA and provides some insight into a better phenotypic characterization of the FA construct when considering psychopathology, personality and ED pathology. Future studies should address whether these three food addiction categories are indicative of therapy outcome.

Psychopathological correlates of eating behavior among Portuguese undergraduate students

OBJECTIVES

The aim of this study was to explore the relationships between eating behavior dimensions and psychopathological symptoms among Portuguese undergraduate students.

METHODS

We studied 258 participants (62.4% women) regarding eating behavior dimensions (emotional, external and binge eating, flexible and rigid control of eating behavior, and eating self-efficacy), psychopathological distress (as assessed by the Brief Symptom Inventory), and body mass index. In addition to studying bivariate associations between eating behavior dimensions and psychopathological subscales and indexes, what we believe to be a novel analytical approach, considering simultaneously the effects of the overall level of psychopathological distress and the relevance of specific symptoms on the eating behavior dimensions.

RESULTS

Emotional, external, and binge eating had positive correlations with psychopathological symptomatology, whereas eating self-efficacy was negatively associated.

CONCLUSIONS

Multivariate analysis showed that the overall level of psychopathological distress (combined with body mass index, among women) had a larger effect on eating behavior than the relevance of specific symptoms.

Association of binge eating behavior and psychiatric comorbidity in ELSA-Brasil study: Results from baseline data

OBJECTIVE

To estimate the association of binge eating behavior (BE) with common mental disorders (CMD).

METHOD

Cross sectional investigation of 14,088 adults, aged 35-74years (ELSA-Brasil study). BE was assessed with Structured Clinical Interview for DSM Disorders (SCID - DSM IV) questions, and psychiatric morbidity with CIS-R (CIS R - Clinical Interview Schedule Revised). Poisson regression was used to estimate the association of BE and psychiatric morbidity.

RESULTS

Adjusted prevalence ratios (PR) for CMD and BE were: PR=1.60 (1.34-1.91) for a CIS R score 12-18 (presence of CMD with lower clinical severity); PR=2.40 (2.06-2.80) for a CIS R score≥18 (severe symptom profile likely to require treatment); for psychiatric diagnoses: PR=2.24 (1.84-2.73) for depressive episodes; PR=1.77 (1.53-2.04) for anxiety disorders, and PR=1.42 (1.20-1.67) for mixed depressive-anxiety disorder.

CONCLUSION

BE was associated with higher prevalence of common mental disorders. Our findings highlight the need to investigate mechanisms involved in the relationship of BE, obesity and psychopathology in low/middle income countries.

Cognitive behaviour therapy response and dropout rate across purging and nonpurging bulimia nervosa and binge eating disorder: DSM-5 implications

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.

Automated identification of patients with a diagnosis of binge eating disorder from narrative electronic health records

Binge eating disorder (BED) does not have an International Classification of Diseases, 9th or 10th edition code, but is included under 'eating disorder not otherwise specified' (EDNOS). This historical cohort study identified patients with clinician-diagnosed BED from electronic health records (EHR) in the Department of Veterans Affairs between 2000 and 2011 using natural language processing (NLP) and compared their characteristics to patients identified by EDNOS diagnosis codes. NLP identified 1487 BED patients with classification accuracy of 91.8% and sensitivity of 96.2% compared to human review. After applying study inclusion criteria, 525 patients had NLP-identified BED only, 1354 had EDNOS only, and 68 had both BED and EDNOS. Patient characteristics were similar between the groups. This is the first study to use NLP as a method to identify BED patients from EHR data and will allow further epidemiological study of patients with BED in systems with adequate clinical notes.

A review of Latin American studies on binge eating disorder

OBJECTIVE

To review the state of the art of the scientific literature on binge eating disorder in Latin America.

METHOD

A literature search of studies conducted in Latin American countries using the term "binge eating" was performed in the following electronic databases: PubMed, LILACS, SciELO, and PsycINFO. Selected articles described studies developed with Latin American samples that met partial or complete DSM-IV diagnostic criteria for binge eating disorder.

RESULTS

8,123 articles were screened and 30 studies met the inclusion criteria (18 cross-sectional studies, 5 clinical trials, 4 case reports, 2 validity studies, and 1 cohort study). Most of the studies were conducted in Brazil (27), one in Argentina, one in Colombia, and one in Venezuela. The prevalence of binge eating disorder among obese people attending weight loss programs ranged between 16% and 51.6%. The comparison between obese people with and without binge eating disorder showed a tendency of higher weight, longer history of weight fluctuation, more concern about shape and weight, and association with psychiatric comorbidity in those with binge eating disorder.

CONCLUSION

Binge eating disorder is a detectable phenomenon in Latin America with clinical features similar to those found in the international literature. This review provides support for the consideration of binge eating disorder as a distinct eating disorder in the International Classification of Diseases - 11th edition.

Differentiating purging and nonpurging bulimia nervosa and binge eating disorder

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.

A contribuição dos estudos transculturais dos países latino-americanos e caribenhos para a revisão da CID-10: resultados preliminares

OBJETIVO: Esta revisão visa identificar as evidências dos estudos de países da América Latina e do Caribe para a inclusão das síndromes transculturais na versão da Classificação Internacional de Doenças para sua 11ª Edição. MÉTODO: Os estudos foram identificados nas bases do Medline, LILACS e EMBASE, no período de 1992 a 2008, e classificados segundo o tipo de estudo, tipo de transtorno, país e número de publicações por ano. RESULTADOS: Foram selecionadas e classificadas 163 publicações: 33 no Medline, 90 no EMBASE e 40 no LILACS. A percentagem das síndromes transculturais ("culture bound-syndrome") correspondeu a 9% no Medline, 12% no EMBASE e 2,5% no LILACS. Dos 15 estudos sobre síndromes transculturais, dois eram sobre "nervios e ataque de nervios", dois sobre "susto", quatro sobre a relação entre crenças religiosas, "feitiçaria", transe e apresentação dos transtornos mentais, um sobre proposta de uma nova categoria diagnóstica, três artigos teóricos e três sobre psicopatoplastia dos transtornos mentais. CONCLUSÃO: A escassez de estudos sobre síndromes transculturais pode ter ocorrido pela dificuldade em rastrear os estudos por problema de indexação das publicações, falta de interesse em publicar tais estudos em periódicos indexados e a dificuldade de acesso às publicações. Dentre os estudos identificados, não há uma evidência clara que aponte quais modificações são necessárias nas classificações diagnósticas atuais.

Evaluation of the DSM-IV and ICD-10 criteria for depressive disorders in a community population in Japan using item response theory

The DSM-IV and ICD-10 are both operational diagnostic systems that classify known psychological disorders according to the number of criteria symptoms. Certain discrepancies between the criteria exist and may lead to some inconsistencies in psychiatric research. The purpose of this study was to investigate these differences in the assessment of depression with item response theory (IRT) analyses. The World Mental Health-Japan (WMHJ) Survey is an epidemiological survey of the general population in Japan. We analyzed data from the WMHJ completed by 353 respondents who had either depressive mood or diminished interest. A two-parameter logistic model was used to evaluate the characteristics of the symptoms of the DSM-IV and ICD-10. IRT analyses revealed that the symptoms about psychomotor activity, worthlessness and self-reproach were more informative and suggestive of greater severity, while the symptoms about dietary habits were less informative. IRT analyses also revealed that the ICD-10 seems more sensitive to the mild range of the depression spectrum compared to the DSM-IV. Although there were some variations in severity among respondents, most of the respondents diagnosed with a severe or moderate depressive episode according to the ICD-10 were also diagnosed with a major depressive episode according to the DSM-IV.

Impact of binge eating disorder in the psychopathological profile of obese women

OBJECTIVE

Our objective was to evaluate the psychopathological profile of obese women with binge eating disorder (BED) using the Symptom Checklist-90 (SCL-90).

METHODS

Two hundred twelve obese women who seek for weight loss treatment were sequentially selected to participate in the study. Binge eating disorder was diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Binge eating disorder severity was assessed using Binge Eating Scale. Depressive symptoms were assessed using Beck Depression Inventory. The psychopathological profile was assessed using the SCL-90.

RESULTS

Binge eating disorder was diagnosed in 54 patients (26.6%). Obese patients with BED presented significant higher scores in all domains of SCL-90 (P < .05 for all) in comparison with obese patients without BED. A significant relationship was found among Binge Eating Scale, Beck Depression Inventory, and all domains of the SCL-90 (P < .05 for all). After linear regression, obsessivity-compulsivity (P = .03), interpersonal sensitivity (P = .0064), paranoid ideas (P = .03), and psychoticism (P = .01) were independently related to the severity of BED.

CONCLUSION

Obese women with BED presented a more severe psychopathological profile than obese controls. Among all, obsessivity-compulsivity, interpersonal sensitivity, paranoid ideas, and psychoticism seem to be strongly linked to BED severity.

The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM

Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic AN-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).