Binge-eating Episodes Research Articles

Maladaptive eating behavior assessment among bariatric surgery candidates: Evaluation of the Eating Disorder Diagnostic Scale

BackgroundEating pathology among bariatric surgery candidates is common and associated with adverse outcomes. However, its assessment is complicated by the inconsistent use of standardized measures. We addressed this by examining the use of the Eating Disorder Diagnostic Scale (EDDS) in a large bariatric sample (N = 343). ObjectivesTo evaluate the EDDS among bariatric surgery candidates via examination of: (1) Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) and fifth edition (DSM-5) rates of binge eating disorder, bulimia nervosa, and maladaptive eating behaviors, and (2) the relationship between response biases and self-reported eating disorder symptoms. SettingParticipants were bariatric surgery candidates at a large public hospital in the Midwest. MethodsAs part of a larger preoperative evaluation, 343 patients seeking bariatric surgery completed the EDDS and measures of problematic response bias. ResultsApproximately 16% of the sample met full threshold criteria for binge eating disorder using DSM-5 criteria. Using the DSM-IV-TR, rates were lower but still substantial at 13%. Rates for bulimia nervosa were 8% (DSM-5) and 6% (DSM-IV-TR). The majority (66.1%) of participants reported at least one binge-eating episode per week. The most commonly used compensatory behavior was fasting (20.4%), followed by excessive exercise (11.7%), laxative use (5.6%), and vomiting (1.8%). An inverse relationship between severity of the eating symptomatology and problematic response bias emerged. ConclusionThe EDDS shows promise as a screening tool that uses diagnostic criteria to provide rates of binge eating and eating psychopathology among surgical candidates. Our findings suggest that subsequent validation studies of this measure are needed, should address potential response bias concerns, and should employ clear definitions of binge eating to promote standardization of eating pathology assessment in the bariatric population.

Meta-analysis of the effectiveness of psychological and medical treatments for binge-eating disorder (MetaBED): study protocol

IntroductionBinge-eating disorder (BED) was included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An increasing number of treatment studies...

Validity and utility of the DSM-5 severity specifier for binge-eating disorder.

To test both the concurrent and predictive significance of the new DSM-5 severity specifier for binge-eating disorder (BED) in adult outpatients. Existing data from 195 adults with DSM-5 BED who received evidence-based treatment (manual-based cognitive-behavioral therapy) in an outpatient setting were re-analysed to examine whether these patients sub-grouped according to the DSM-5 severity levels, defined by the frequency of binge-eating (BE) episodes, would show meaningful differences in a range of variables of clinical interest assessed at pre-treatment and end-of treatment abstinence from BE. Participants categorized with mild (33.3% of the sample), moderate (35.4%), severe (15.9%), and extreme (15.4%) severity of BED, based on their pre-treatment clinician-rated frequency of BE episodes, differed significantly from each other in physical characteristics (body mass index) and another sixteen variables of clinical interest assessed at pre-treatment regarding eating disorder psychopathology and putative maintenance factors, lifetime and current psychiatric disorder comorbidity, general psychiatric distress, and psychosocial impairment. The four DSM-5 severity groups were statistically indistinguishable in demographics or age-of-BED onset. However, significant between-group differences were observed in the treatment outcome, i.e., abstinence from BE, achieved by 98.5%, 66.7%, 38.7% and 6.7% of participants categorized with mild, moderate, severe, and extreme severity respectively. The outcome analyses repeated in the completer sample (n = 187) yielded the same pattern of the aforementioned intent-to-treat (N = 195) results. The findings provide support for the severity specifier for BED introduced in the DSM-5 as a means of addressing within-group variability in severity.

Characterization of Binge-Eating Behavior in Individuals With Binge-Eating Disorder in an Adult Population in the United States.

Characterize the frequency, duration, and severity of binge-eating behaviors in adults meeting DSM-5 criteria for binge-eating disorder (BED) in a large US community sample. A representative sample of US adults from the National Health and Wellness Survey was recruited from an online panel and asked to respond to an Internet survey (conducted in October 2013) that included questions designed to assess binge-eating behaviors in relation to DSM-5 BED diagnostic criteria. Of 22,397 respondents, 344 self-reported meeting DSM-5 BED criteria (BED respondents). Most BED respondents reported that binge-eating episodes had occurred for the past 7-12 months (61.0%), and 93.6% reported ≥ 2-3 binge-eating episodes/wk. All BED respondents reported that "extreme" (52.6%) or "great" (47.4%) distress levels were associated with binge-eating episodes. Among BED respondents who agreed to provide detailed binge-eating behavior data after being invited to respond to additional survey questions, 40.6% reported binge eating on average > 1 time/d, and 59.2% reported binge eating 2-3 times/d. For 44.5% of BED respondents, binge-eating duration was 31-60 minutes. BED respondents reported that they "very often" (36.6%) or "often" (34.0%) had urges to binge eat between 7-10 pm. "Feeling disgusted with oneself, depressed, or guilty afterward" was the most bothersome symptom of binge eating for BED respondents (extremely bothersome: 41.9%). Binge-eating frequency among BED respondents averaged once daily. Most BED respondents exhibited binge-eating behavior for 7-12 months, often with severe symptoms. These findings highlight the disease burden of BED and have potential implications for diagnosing and treating BED.

The ABBA study - approach bias modification in bulimia nervosa and binge eating disorder: study protocol for a randomised controlled trial.

BackgroundThe core symptoms of bulimia nervosa (BN) and binge eating disorder (BED) are recurrent episodes of binge eating. Despite negative psychological and physical consequences, BN/BED patients show uncontrollable approach tendencies towards food. This cognitive bias occurs at an early stage of information processing. Cognitive bias modification (CBM) directly targets such biases and has been shown to be effective in treating several mental disorders. In alcohol addiction, automatic action tendencies towards alcohol cues and relapse rates were successfully reduced by a specific form of CBM, termed approach bias modification. Based on these findings and data from a proof-of-concept study in people with high levels of food craving, CBM is considered a promising new treatment approach for BN/BED. Given the similarities between BN/BED and addictive disorders, the rationale for using approach bias modification appears to be particularly strong. The aim of the present study is to examine whether, compared to a sham training, computerised approach bias modification (10 sessions) can reduce binge-eating episodes in BN/BED patients from pre-treatment to follow-up. Additionally, we will investigate whether this CBM programme also reduces global eating disorder psychopathology, trait and cue-elicited food craving, food intake as well as approach and attentional bias towards visual food cues. Treatment acceptance will be determined by attrition rates and responses on a feedback form.MethodsThis is a double-blind, randomised, placebo-controlled, parallel-group superiority trial with two parallel arms. A total of 54 BN/BED patients will be recruited. Approach bias towards food will be retrained by a computer task adopting an implicit learning paradigm. Patients in the control condition (sham) will conduct a similar task but will not be trained to avoid food cues. Methods against bias include public registration, randomisation by a central study office, standardisation of the treatments and blinding of assessors. Furthermore, the session number and duration will be equivalent in the two conditions.DiscussionThis is the first registered randomised controlled trial of approach bias modification in a clinical BN/BED sample. Results from this study will provide an indication of the efficacy of approach bias modification training for BN/BED and the potential mechanisms of action underlying this treatment.Trial registrationDRKS00010231 (retrospectively registered on 24 March 2016; first version)

Annals for Educators - 20 September 2016.

Annals for Educators - 20 September 2016.

Reward-Based Spatial Learning in Teens With Bulimia Nervosa

To assess the functioning of mesolimbic and fronto-striatal areas involved in reward-based spatial learning in teenaged girls with bulimia nervosa (BN) thatmight be involved in the development and maintenance of maladaptive behaviors characteristic of the disorder. We compared functional magnetic resonance imaging blood oxygen level-dependent response in 27 adolescent girls with BN to that of 27 healthy, age-matched control participants during a reward-based learning task that required learning to use extra-maze cues to navigate a virtual 8-arm radial maze to find hidden rewards. We compared groups in their patterns of brain activation associated with reward-based spatial learning versus a control condition in which rewards were unexpected because they were allotted pseudo-randomly to experimentally prevent learning. Both groups learned to navigate the maze to find hidden rewards, but group differences in brain activity associated with maze navigation and reward processing were detected in the fronto-striatal regions and right anterior hippocampus. Unlike healthy adolescents, those with BN did not engage the right inferior frontal gyrus during maze navigation, activated the right anterior hippocampus during the receipt of unexpected rewards (control condition), and deactivated the left superior frontal gyrus and right anterior hippocampus during expected reward receipt (learning condition). These patterns of hippocampal activation in the control condition were significantly associated with the frequency of binge-eating episodes. Adolescents with BN displayed abnormal functioning of the anterior hippocampus and fronto-striatal regions during reward-based spatial learning. These findings suggest that an imbalance in control and reward circuits may arise early in the course of BN. Clinical trial registration information-An fMRI Study of Self-Regulation in Adolescents With Bulimia Nervosa; https://clinicaltrials.gov/; NCT00345943.

Investigating the reinforcing value of binge anticipation.

Binge eating is a hallmark feature of several types of eating disorders, including bulimia nervosa, anorexia nervosa (binge/purge type), and binge-eating disorder, and is associated with numerous harmful consequences. For decades, researchers have sought to understand what maintains and reinforces this behavior in the face of such profound negative consequences. In this context, researchers have focused on the binge-eating behavior itself, and given little consideration to what may be a crucial part of the process: anticipating or planning binge-eating episodes. In this article, we discuss binge anticipation, its potential reinforcing value, and methodologies which would allow researchers to investigate this potentially critical process in individuals who binge eat. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:539-541).

Food Thought Suppression Inventory: Test–retest reliability and relationship to weight loss treatment outcomes

This study examined the test–retest reliability of the Food Thought Suppression Inventory (FTSI) and its relationship with weight loss during weight loss treatment. Participants were 89 adults with and without binge eating disorder (BED) recruited through primary care for weight loss treatment who completed the FTSI twice prior to starting treatment. Intra-class correlations for the FTSI ranged from .74–.93. Participants with BED scored significantly higher on the FTSI than those without BED at baseline only. Percent weight loss from baseline to mid-treatment was significantly negatively correlated with the FTSI at baseline and at post-treatment. Participants reaching 5% loss of original body weight by post-treatment had significantly lower FTSI scores at post assessment when compared to those who did not reach this weight loss goal. While baseline binge-eating episodes were significantly positively correlated with baseline FTSI scores, change in binge-eating episodes during treatment were not significantly related to FTSI scores. The FTSI showed satisfactory one week test–retest reliability. Higher levels of food thought suppression may impair individuals' ability to lose weight while receiving weight loss treatment.

Incremental validity of the episode size criterion in binge-eating definitions: An examination in women with purging syndromes.

Of the two primary features of binge eating, loss of control (LOC) eating is well validated while the role of eating episode size is less clear. Given the ICD-11 proposal to eliminate episode size from the binge-eating definition, the present study examined the incremental validity of the size criterion, controlling for LOC. Interview and questionnaire data come from four studies of 243 women with bulimia nervosa (n = 141) or purging disorder (n = 102). Hierarchical linear regression tested if the largest reported episode size, coded in kilocalories, explained additional variance in eating disorder features, psychopathology, personality traits, and impairment, holding constant LOC eating frequency, age, and body mass index (BMI). Analyses also tested if episode size moderated the association between LOC eating and these variables. Holding LOC constant, episode size explained significant variance in disinhibition, trait anxiety, and eating disorder-related impairment. Episode size moderated the association of LOC eating with purging frequency and depressive symptoms, such that in the presence of larger eating episodes, LOC eating was more closely associated with these features. Neither episode size nor its interaction with LOC explained additional variance in BMI, hunger, restraint, shape concerns, state anxiety, negative urgency, or global functioning. Taken together, results support the incremental validity of the size criterion, in addition to and in combination with LOC eating, for defining binge-eating episodes in purging syndromes. Future research should examine the predictive validity of episode size in both purging and nonpurging eating disorders (e.g., binge eating disorder) to inform nosological schemes. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:651-662).

Associations between negative affect and binge/purge behaviors in women with anorexia nervosa: Considering the role of negative urgency

ObjectiveEvidence implicates negative affect in the occurrence of binge/purge behaviors, although the extent to which theoretically relevant individual difference variables may impact this association remains unclear. Negative urgency, the dispositional tendency to engage in rash action when experiencing negative affect, is a unique facet of impulsivity that may play a key role. Moreover, it was hypothesized that women with anorexia nervosa (AN) who are higher on measures of negative urgency, relative to those lower on negative urgency, would exhibit: 1) greater binge eating and purging frequencies on high negative affect days, and 2) a greater change in negative affect prior to and following binge eating and purging episodes. MethodWomen with AN (n=82) completed a self-report measure of negative urgency and a 2-week ecological momentary assessment protocol in which they recorded binge eating, purging, and negative affect ratings. ResultsWomen with higher levels of negative urgency exhibited a greater frequency of binge eating and purging; however, in comparison to women low on negative urgency, they: 1) were more likely to binge eat on days corresponding with low-to-moderate negative affect (similar rates of binge eating were observed on high negative affect days), and 2) displayed substantially elevated levels of negative affect across time, and thus, smaller degrees of change in negative affect prior to and following binge eating and purging episodes. DiscussionNegative urgency underlies individual differences in the daily experience of negative affect. Women with AN who are high on negative urgency may have an increased propensity for binge eating and purging via a relatively persistent and heightened state of negative emotions.

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n=69) or a wait-list condition (n=70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d=1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82≤d≤1.11). In the treatment group significant improvement was still observed for all measures 1year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.

Therapeutic alliance and binge-eating outcomes in a group therapy context.

The therapeutic alliance in individual and group psychotherapy is associated with treatment outcomes for a variety of disorders. However, debate persists about the centrality of the alliance in determining positive outcomes. We examined the alliance-outcome relationship across 20 sessions of emotionally focused group therapy (EFGT) for binge-eating disorder (BED). We hypothesized that (1) previous session alliance increase will predict lower subsequent session binge eating level while controlling for previous session binge eating level; and (2) previous session binge eating decline will predict higher subsequent session alliance level while controlling previous session alliance level. Participants were 118 individuals with BED who received 20 sessions of EFGT in 8 groups. Levels of binge eating and therapeutic alliance to the therapist were measured weekly. Linear growth in alliance during group therapy was associated with reduced binge eating at 6 months' posttreatment. We also found that the group's and the individual's alliance scores and binge-eating episodes were significantly associated across treatment, suggesting a mutual influence of the group's and individual's experience of the alliance with the therapist. Regarding the first hypothesis, previous session alliance increase was significantly associated with lower subsequent session binge eating. Regarding the second hypothesis, previous session binge-eating decline was not significantly related to higher subsequent session alliance. The findings provide evidence in a group therapy context for a model in which alliance change influences subsequent symptom levels, but not the other way around. (PsycINFO Database Record

Nutritional Rehabilitative Treatment in a Residential Centre for Eating Disorders: A Case Series Report

Purpose: Patients with Eating Disorders (ED) could benefit of temporary leaving from their family and social environment, hosting in specialized residential centers. Methods: Fifty-one female patients (23.5 ± 6.1 years), 22 with Anorexia Nervosa (AN), 14 with Bulimia Nervosa (BN), 9 with Binge Eating Disorders (BED) and 6 with not-otherwise specified eating disorders (EDNOS) were followed in a residential regimen for at least 3 months. Anthropometric, clinical, biochemical and body composition parameters were evaluated at entry, at 1, 3 and 5 months, while residents and 6 months after discharge. A multidisciplinary team, including specialized medical doctors, psychotherapists and dieticians was involved in the treatment. Results: A significant (p<0.001) and progressive weight gain in 22 AN patients, both at the end of the residential period and at 6 month follow-up was observed, with no signs of refeeding syndrome. Resting Energy Expenditure (REE) progressively increased, reaching significance (p<0.02) at 5 month treatment. Menses spontaneously recovered in 12 patients, after 17 (5-48) months amenorrhea. In 14 BN patients, binge eating and purging episodes were eliminated. Nine BED patients gradually lost weight (-14.5 ± 3.2 kg) and in particular Fat Mass (FM), with a significant (p<0.05) improvement in blood lipids and serum transaminases. No significant changes were observed in the 6 EDNOS patients, possibly due to the low number and wide variability of patients gathered in this disease definition. Conclusion: These observations suggest the safety, with the improvement of several clinical and nutritional parameters, of a multi-disciplinary and integrated approach carried out in a residential setting, in particular for AN patients.

Nutritional Rehabilitative Treatment in a Residential Centre for Eating Disorders: A Case Series Report

Purpose: Patients with Eating Disorders (ED) could benefit of temporary leaving from their family and social environment, hosting in specialized residential centers. Methods: Fifty-one female patients (23.5 ± 6.1 years), 22 with Anorexia Nervosa (AN), 14 with Bulimia Nervosa (BN), 9 with Binge Eating Disorders (BED) and 6 with not-otherwise specified eating disorders (EDNOS) were followed in a residential regimen for at least 3 months. Anthropometric, clinical, biochemical and body composition parameters were evaluated at entry, at 1, 3 and 5 months, while residents and 6 months after discharge. A multidisciplinary team, including specialized medical doctors, psychotherapists and dieticians was involved in the treatment. Results: A significant (p<0.001) and progressive weight gain in 22 AN patients, both at the end of the residential period and at 6 month follow-up was observed, with no signs of refeeding syndrome. Resting Energy Expenditure (REE) progressively increased, reaching significance (p<0.02) at 5 month treatment. Menses spontaneously recovered in 12 patients, after 17 (5-48) months amenorrhea. In 14 BN patients, binge eating and purging episodes were eliminated. Nine BED patients gradually lost weight (-14.5 ± 3.2 kg) and in particular Fat Mass (FM), with a significant (p<0.05) improvement in blood lipids and serum transaminases. No significant changes were observed in the 6 EDNOS patients, possibly due to the low number and wide variability of patients gathered in this disease definition. Conclusion: These observations suggest the safety, with the improvement of several clinical and nutritional parameters, of a multi-disciplinary and integrated approach carried out in a residential setting, in particular for AN patients.

A primer on binge eating disorder diagnosis and management.

Binge eating disorder (BED) is the most common eating disorder, with an estimated lifetime prevalence of 2.6% among U.S. adults, yet often goes unrecognized. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BED is defined by recurrent episodes of binge eating (eating in a discrete period of time an amount of food larger than most people would eat in a similar amount of time under similar circumstances and a sense of lack of control over eating during the episode), occurring on average at least once a week for 3 months, and associated with marked distress. It can affect both men and women, regardless if they are at normal weight, overweight, or obese, and regardless of their ethnic or racial group. Psychiatric comorbidities are very common, with 79% of adults with BED also experiencing anxiety disorders, mood disorders, impulse control disorders, or substance use disorders; almost 50% of persons with BED have ≥ 3 psychiatric comorbidities. Multiple neurobiological explanations have been proffered for BED, including dysregulation in reward center and impulse control circuitry, with potentially related disturbances in dopamine neurotransmission and endogenous μ-opioid signaling. Additionally, there is interplay between genetic influences and environmental stressors. Psychological treatments such as cognitive behavioral interventions have been recommended as first line and are supported by meta-analytic reviews. Unfortunately, routine medication treatments for anxiety and depression do not necessarily ameliorate the symptoms of BED; however, at present, there is one approved agent for the treatment of moderate to severe BED-lisdexamfetamine, a stimulant that was originally approved for the treatment of attention deficit hyperactivity disorder.

Impulsivity-focused group intervention to reduce binge eating episodes in patients with binge eating disorder: study protocol of the randomised controlled IMPULS trial

IntroductionThe core symptom of binge eating disorder (BED) is recurrent binge eating that is accompanied by a sense of loss of control. BED is frequently associated with obesity, one of...

DSM 5 through several lenses: how eating disorders can look different

The Eating Disorder Examination (EDE), a structured diagnostic interview, is the ‘gold standard’ for diagnosing eating disorders (EDs). There are well established algorithms for DSM-IV diagnosis but not for DSM-5. The various algorithms proposed for DSM-5 differ in terms of their use of the EDE to operationalise diagnostic criteria such as low weight, episodes of binge eating, and compensatory behaviours to prevent weight gain. We compared four DSM-5 EDE diagnostic algorithms, to evaluate the extent to which the choice of algorithm affects the diagnosis given to a patient. Participants were over 400 patients referred to a specialist West Australian ED outpatient clinic. Clinical psychologists administered the EDE to each patient and these EDE scores were analysed using four different algorithms. We found that, for a significant minority of patients, the diagnosis derived from the EDE changed depending on what diagnostic algorithm was used. The results indicate that competing algorithms for diagnosing DSM-5 EDs using the EDE are not interchangeable, and that the choice of algorithm has a practical impact on which diagnosis is given. The significant implications of these findings for research and clinical practice will be discussed.

Binge eating behavior in college students: What is a binge?

AimThe purpose of this study was to explore binge eating (BE) behavior in male and female college students. BackgroundBE is a disordered eating behavior frequently reported in college students and is of particular concern because of its link to the development of eating disorders and obesity. MethodsAn anonymous online survey was conducted and open-ended responses (n=425) were coded using qualitative methods. Chi-square analyses were used to determine if gender differences existed. ResultsFindings indicate that females were more likely to report emotional concerns such as stress and negative affect prior to BE and poor body image and negative affect following episodes of BE. Meanwhile, males indicated more substance use, exercise, and hunger before a BE episode, with feeling satisfied or full after BE. Males were also more likely to report BE socially on meal type foods, while women were more likely to be at home or alone while BE. ConclusionsSignificant gender differences were noted indicating the need for tailored interventions. Nurses should screen college students for disordered eating behaviors, as well as associated concerns that may precede binge eating episodes including substance use, stress, and negative affect.

Obesity and psychological wellbeing in patients undergoing fertility treatment

Obesity negatively affects reproductive functioning and psychological wellbeing. Distress experienced by infertile women with elevated body mass index (BMI) was investigated. Infertile women (n = 403) were stratified according to World Health Organization (2000) BMI categories (normal, overweight and obese) and infertility category (polycystic ovary syndrome [PCOS] or non-PCOS). Participants anonymously completed a Demographics Questionnaire, International Physical Activity Questionnaire, Depression, Anxiety and Stress Scale, Positive and Negative Affect Schedule, Rosenberg Self Esteem Scale, Fertility Problem Inventory, Clinical Perfectionism Questionnaire and the Eating Disorder Examination Questionnaire. Women in the obese BMI group were no more psychologically vulnerable to general mood (depression, anxiety and stress) or fertility-specific distress than normal or overweight BMI women. Independent of their PCOS status, obese women reported more frequent episodes of binge eating, shape concerns and low self-esteem symptoms associated with disordered eating. Women with PCOS had elevated shape concerns and anxiety independent of their BMI category compared with women who did not have PCOS. Obese infertile women presenting with the characteristics of binge eating, low self-esteem and body shape concerns may represent a vulnerable subgroup that could benefit from accessing targeted psychological interventions as do women with PCOS who have body shape concerns.