Binge Episodes Research Articles

Impact of social stress in early ontogenesis on food addiction and ghrelin levels in the hypothalamus of rats

BACKGROUND: Factors that can trigger episodes of binge (compulsive) eating include psychological and physical stress. Our studies have shown that maternal deprivation in early ontogenesis leads to an increase in elements of gambling addiction in the Iowa Gambling Task test. This raises the question of the role of maternal deprivation in the development of other types of non-chemical addictions, particularly food addiction. AIM: To study the role of ghrelin in the manifestation of food addiction elements in rats subjected to maternal deprivation in early ontogenesis. MATERIALS AND METHODS: Wistar rats were separated from their mothers for 180 minutes daily from day 2 to day 12 after birth. Male rats aged 90–100 days were used in the experiments. To induce compulsive overeating, the animals were given a high-carbohydrate diet (a mixture based on chocolate paste) for 1 hour every third day for 1.5 months. Fifteen minutes before feeding, the chocolate paste was placed within 5 cm of the rat’s reach with visual contact. After compulsive overeating was established, the number and area of ghrelin-producing neuroendocrine cells in the hypothalamus were analyzed using immunohistochemistry in intact rats and animals subjected to maternal deprivation stress. RESULTS: It was shown that intermittent consumption of the chocolate mixture predicted overeating in rats, independent of weight gain or obesity, as a result of compulsive overeating. In studying the effect of maternal deprivation on chocolate consumption, it was found that the average daily consumption in the maternal deprivation group increased (p 0.001) compared to the control group. However, there was no significant difference in standard food consumption between the maternal deprivation and control groups. The number and area of ghrelin-producing neuroendocrine cells in the lateral portion of the medial arcuate nucleus of the hypothalamus were reduced in rats after maternal deprivation. CONCLUSIONS: It was concluded that early psychogenic stress from maternal deprivation causes a dysregulation of the ghrelin system, contributing to elements of food addiction in rats.

Behavioral changes and transcriptional regulation of mesolimbic dopaminergic genes in a mouse model of binge eating disorder by diet intermittent access.

Binge Eating Disorder (BED) is among the most prevalent eating disorders worldwide. It is characterized by recurrent episodes of excessive consumption of palatable foods in short periods, accompanied by a sense of loss of control and distress around the episode, which tends to worsen over time. The mesolimbic dopaminergic system influences on reinforcement and reward-seeking behaviors is implicated in the disorder's pathogenesis. Animal models that replicate the clinical conditions observed in humans, including the disorder progression, are essential for understanding the underlying physiological mechanisms of BED. This study aimed to evaluate binge eating behavior induced by intermittent High Sugar and Butter (HSB) diet access in mice, their phenotypes, transcriptional regulation of mesolimbic dopaminergic system genes, and behavior. Thus, mice were subdivided into three groups: CHOW (maintenance diet only), HSB-i (maintenance diet with thrice-weekly access to HSB), and HSB (continuous access to HSB). Animals were subjected to marble-burying and light-dark box behavioral tests, and transcriptional regulation was evaluated by RT-qPCR. The results indicated that the HSB-i group established a feeding pattern of significantly more kilocalories on days when HSB was available and reduced intake on non-HSB days similar to human binge eating. Over time, binge episodes intensified, potentially indicating a tolerance effect. Additionally, these animals behave differently towards preferring the HSB diet and exhibited altered transcriptional regulation of the Drd1, Slc6a3, and Lrrk2 genes. Our study provides a mouse model that reflects human BED, showing a progression in binge episodes and mesolimbic dopamine pathway involvement, suggesting targets for future therapeutic interventions.

Evaluating the role of binge planning and binge inevitability within affect regulation models of binge eating

Affect regulation models posit that aversive affective states drive binge-eating behavior, which then regulates negative emotions. However, recent findings among individuals with binge-eating disorder (BED) suggest that food-related anticipatory processes may precede and potentially explain the negative affect thought to drive binge eating. Specifically, studies using ecological momentary assessment (EMA) demonstrate that the negative affective state of “Guilt” (from the Positive and Negative Affect Schedule) most strongly predicts later binge eating in the natural environment, and it has been hypothesized that planning a binge or feeling that a binge-eating episode is inventible may account for the increases in Guilt observed prior to binge episodes. In the present study, we tested the hypothesis that binge planning or inevitability may contribute to feelings of shame (a key facet of the broader Guilt construct), which then predict binge-eating episodes, using EMA in 43 individuals with BED. Consistent with hypotheses, feelings of binge inevitability and planning prospectively predicted binge-eating episodes. Further, binge planning predicted subsequent increases in shame. However, shame did not predict subsequent increases in binge planning. Finally, a mediation model revealed that binge planning (Time 1) predicted future binge eating (Time 3) directly and indirectly through increases in shame (Time 2). The results provide novel evidence that individuals with BED anticipate and actively plan for binge-eating episodes, and that binge planning may explain the increased shame/guilt typically observed before binge eating. Overall, accruing evidence suggests that negative affect, although predictive of binge eating, may be better conceptualized as a consequence of the anticipatory processes that lead to binge eating, rather than the starting point, at least among some individuals with BED. Future experimental research is needed to more conclusively test this hypothesis.

Emptiness and negative affect changes related to binge eating and borderline personality traits.

Borderline personality disorder (BPD) is characterized by unstable self-image, conflictual interpersonal relationships, emotional dysregulation, and marked impulsivity. One form of impulsivity commonly seen in BPD is binge eating; however, little is known about this maladaptive behavior in the context of BPD. In the eating disorder (ED) literature, multiple theories suggest binge eating occurs as a result of heightened levels of negative affect. Given that BPD and EDs share emotional dysregulation and impulsivity as maintaining mechanisms of each respective disorder, these theories of binge eating may provide a model for binge eating in BPD. Existing literature suggests feelings of emotional emptiness may precede binge episodes in those with EDs. The current study sought to explore feelings of emptiness as antecedents to binge eating behaviors in those with BPD traits. Using ecological momentary assessment, binge episodes, affect, and feelings of emptiness were tracked throughout the day for 14 days in undergraduate students with BPD traits (n = 55). The current study found momentary feelings of emptiness at the time of the binge eating episode significantly predicted increased odds of a binge episode occurring. Additionally, momentary feelings of emptiness, as well as other negative affects, increase following a binge episode. Results suggest treatment of binge eating within BPD should include elements of acceptance of negative affects including emptiness, such as in dialectical behavior therapy distress tolerance skills training. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sex-dependent effects of ethanol withdrawal from a single- and repeated binge episode exposures on social anxiety-like behavior and neuropeptide gene expression in adolescent rats

Ethanol withdrawal sensitivity is a risk factor for the development of alcohol use disorder. Heavy episodic drinking during adolescence often encompasses repeated periods of withdrawal. Adolescent intermittent ethanol exposure of laboratory rodents produces several neurobiological deficits that differ between sexes, but the sensitivity to withdrawal as a contributor to the observed sex differences is not clear. The current study assessed the impact of acute withdrawal from a single- and repeated binge ethanol episodes during adolescence as well as protracted abstinence from repeated binge episodes on social anxiety-like behavior (indexed via significant decreases of social investigation) as well as oxytocin (OXT) and vasopressin (AVP) system gene expression in the hypothalamus (HYP) and central amygdala (CeA) in male and female Sprague Dawley rats. Females displayed social anxiety-like behavior during withdrawal from a single binge episode, whereas both sexes showed social anxiety-like changes following acute withdrawal from repeated binge episodes. After a period of protracted abstinence, only males still displayed ethanol-associated social alterations. Analysis of gene expression in separate, non-socially tested subjects revealed that withdrawal from repeated binge episodes during adolescence increased AVP gene expression in the HYP of males and decreased it in females. Males also displayed increased AVP and OXTR gene expression during acute withdrawal from repeated binge episodes in the CeA, with these changes persisting into adulthood. Together, these findings suggest that adolescent females are sensitive to withdrawal from both acute and repeated ethanol exposures, whereas males are sensitive to withdrawal from repeated ethanol exposures, with affective and transcriptional changes persisting into adulthood.

Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Bulimia Nervosa (BN): A Review and Insight into Potential Mechanisms of Action.

Bulimia nervosa (BN) is a disorder primarily affecting adolescent females, characterized by episodes of binge eating followed by inappropriate compensatory behaviors aimed at preventing weight gain, including self-induced vomiting and the misuse of diuretics, laxatives, and insulin. The precise etiology of BN remains unknown, with factors such as genetics, biological influences, emotional disturbances, societal pressures, and other challenges contributing to its prevalence. First-line treatment typically includes pharmacotherapy, which has shown moderate effectiveness. Neuroimaging evidence suggests that altered brain activity may contribute to the development of BN, making interventions that directly target the brain extremely valuable. One such intervention is repetitive transcranial magnetic stimulation (rTMS), a non-invasive stimulation technique that has been garnering interest in the medical community for many years. This review explores the use of rTMS in the treatment of BN. Searches were conducted in the PubMed/Medline, ResearchGate, and Cochrane databases. Twelve relevant studies were identified. Analysis of the results from these studies reveals promising findings, particularly regarding key parameters in the pathophysiology of BN. Several studies assessed the impact of rTMS on binge episodes. While some studies did not find significant reductions, most reported decreases in binge eating and purging behaviors, with some cases showing complete remission. Reductions in symptoms of depression and food cravings were also demonstrated. However, results regarding cognitive improvement were mixed. The discussion focused heavily on potential mechanisms of action, including neuromodulation of brain networks, induction of neuroplasticity, impact on serotonergic dysfunction, anti-inflammatory action, and HPA axis modulation. rTMS was found to be a safe intervention with no serious side effects. rTMS in the treatment of BN appears to be a promising intervention that alleviates some symptoms characteristic of the pathophysiology of this disorder. An additional effect is a significant reduction in depressive symptoms. However, despite these findings, further research is required to confirm its effectiveness and elucidate the mechanisms of action. It is also recommended to further investigate the potential mechanisms of action described in this review.

Weight stigma and binge eating related to poorer perceptions of healthcare provider interaction quality in a community-based sample

BackgroundWeight stigma refers to the social rejection, discrimination, and ideological devaluation of individuals because of body size and is a direct result of weight bias and anti-fat attitudes. Individuals with higher weight may be less likely to seek healthcare due to weight stigma, and if or when they do present for care, medical providers with weight bias may fail to provide high quality care. Little, however, is known about the intersectionality of weight stigma and perceptions of healthcare interactions as experienced by individuals who also binge eat.MethodsCommunity-based adults completed online self-report questionnaires regarding generalized weight stigma (Attitudes Towards Obese Persons1), healthcare interaction quality (Patient Perceptions of Healthcare Provider Interaction Quality; PPH), and disordered eating (Eating Disorder Examination-Questionnaire) via Amazon’s Mechanical Turk platform. For this cross-sectional study, participants were categorized by the presence and absence of regular binge episodes. Pearson’s correlations, T-tests, ANOVA/ANCOVA, and a multivariate regression were used to examine relationships among demographic variables, weight stigma, disordered eating, and the PPH.ResultsParticipants (N = 648) primarily identified as female (65.4%) and White, non-Hispanic (72.7%). Participants’ average age and body mass index (BMI) were 37.5 (SD = 12.3) years old and 27.3 (SD = 6.9) kg/m2, respectively. Higher healthcare provider interaction quality ratings (PPH) were significantly related to lower BMI (r(648)=-0.098,p = 0.012), less weight stigma (r(648) = 0.149,p < 0.001), and identifying as a woman (t(514) = 2.09, p = 0.037, Cohen’s d = 0.165) or White, non-Hispanic (t(646)=-2.73, p = 0.007, Cohen’s d=-0.240). Participants reporting regular binge eating endorsed significantly worse perceptions of healthcare provider quality than those who did not, even after accounting for BMI, F(1, 645) = 8.42, p = 0.004, η2 = 0.013. A multivariate linear regression examining the PPH as dependent, and weight stigma and binge eating as independent, variable/s, was significant even after accounting for covariates (sex, race, BMI), F(95, 640) = 7.13,p < 0.001, R2 = 0.053 (small effect).ConclusionsMore negative experiences with healthcare providers was associated with worse weight stigma, higher BMI, regular binge eating and overall disordered eating, and for participants identifying as male or a Person of Color. These data have implications for non-clinical community populations and are particularly important as experiencing poorer quality of interactions with healthcare providers may decrease individuals’ likelihood of seeking needed care for both disordered eating and health-related concerns.Trial RegistrationN/A.

Positive Childhood Experiences are Associated With Alcohol Use in Adolescent and Emerging Adult Females by Adverse Childhood Experiences Dimension

PurposeExperiencing multiple adverse childhood experiences (ACEs) is associated with alcohol use in female adolescents and emerging adults. Protective and compensatory experiences (PACEs) have been theorized to off-set the health and behavioral consequences from the accumulation of ACEs throughout childhood. This study examines the association between protective experiences and subsequent alcohol and binge alcohol use frequency over one month among female adolescent and emerging adults reporting high and low levels of two ACE dimensions (household dysfunction and emotional abuse/neglect). MethodsOne hundred 43 females between the ages of 15–24 who indicated at least one binge episode in the past two weeks completed the six-item ACEs scale, the PACEs scale, and demographics at baseline. Alcohol consumption was measured prospectively over the next month during weekly appointments using the timeline follow back approach. ResultsTwo PACEs factors had significant direct associations, a source of unconditional love was associated with less frequent alcohol use (β = −0.437, 95% confidence interval [CI] -0.744, −0.131, exp(β) = 0.65, p = .005) in the context of high household dysfunction; and having a trusted adult to count on for help and advice (β = −1.373, 95% CI -2.283, −0.464, exp(β) = 0.25, p = .003) predicted fewer binge occasions in the context of high emotional abuse/neglect. Regardless of ACE dimension exposure, nonsport social group membership was associated more frequent alcohol use over the month across all ACE dimensions (β = 0.11-0.74, 95% CI -0.11, 0.74, exp(β) = 1.37 – 1.62, p ≤ .002); and having a trusted adult to count on for help and advice was associated with a 5.7 times more frequent of alcohol use among those with low household dysfunction (β = 1.74, 95% CI 0.83, 2.65, exp(β) = 5.70, p < .001). DiscussionFew PACE items are associated with direct reductions in alcohol outcomes. Indeed, there is consistently heightened risk associated with nonsport group membership for alcohol use frequency, regardless of experiences of childhood adversity. Future research should identify which protective factors have the most potential to off-set alcohol use by ACE dimension.

Suicidal thoughts and attempts in a transdiagnostic eating disorder sample: Do diagnostic severity criteria predict risk?

Eating disorders (EDs) are associated with elevated suicide. Low body mass index (BMI) and frequency of purging and binge eating represent severity criteria for EDs and distinguish full-threshold EDs from other specified feeding and eating disorders (OSFED). However, no work has taken a transdiagnostic approach to studying whether severity of these or other features is associated with suicidal ideation (SI) and attempts. We examined diagnostic status, ED features, and SI and attempts in a large, transdiagnostic, community sample of 257 women with EDs and 45 controls without a current or past ED in the United States using the EDs Examination interview and the Structured Clinical Interview for the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). SI and suicide attempts (SA) were elevated in OSFED compared to controls but did not differ between OSFED and full-threshold EDs. Higher BMI predicted increased SI. Number of purging methods, but not frequency, was related to history of SA. Binge episode frequency and size were not significant predictors. OSFED presents with elevated SI and SA, and ED severity criteria that distinguish OSFED from full-threshold EDs do not predict SI or SA. Suicide risk assessments should be implemented universally across EDs in clinical practice.

COVID-19-Related Increases in Depressive and Anxious Symptoms Are Associated with Maladaptive Eating Among Patients up to 4years Post-bariatric Surgery.

Depressive and anxious symptoms and maladaptive eating behaviors fluctuate with stressful events for patients seeking bariatric surgery. These associations are less clear for patients postoperatively. Using the COVID-19 pandemic as a frame, we examined associations between changes in depressive and anxious symptoms and maladaptive eating behaviors between up to fouryears postoperatively. Participants (N = 703) who underwent surgery between 2018 and 2021 completed web-based questionnaires between 2021 and 2022. Demographic and surgical data were obtained from electronic health records. Participants reported whether depressive and anxious symptoms increased or were stable/decreased during the COVID-19 pandemic, and completed eating behavior measures. Many participants reported increased depressive (27.5%) and anxious (33.7%) symptoms during the COVID-19 pandemic. Compared to those who reported stable or decreased symptoms, these participants were as follows: (1) more likely to endorse presence of binge, loss-of-control, graze, and night eating; (2) reported higher emotional eating in response to anger and frustration, depression, and anxiety; and (3) reported higher driven and compulsive eating behaviors. Frequency of binge, loss-of-control, graze, and night eating episodes did not differ between groups (e.g., increased vs. stable/decreased anxious symptoms) among participants who endorsed any episodes. A large portion of the sample reported increased depressive and anxious symptoms during the COVID-19 pandemic, and these increases were associated with maladaptive eating behaviors. Depressive and anxious symptoms and eating behaviors should be assessed postoperatively as significant stressors may be associated with increased distress and maladaptive eating behaviors that can affect postoperative outcomes. Postoperative interventions may be useful at simultaneously targeting these concerns.

Testing associations between assessments of cognitive flexibility and eating disorder symptoms in adolescent bulimia nervosa.

Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision-making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents. Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self-induced vomiting episodes (SVEs) at baseline and end-of-treatment (EOT). Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (𝛽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11-0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (𝛽 = 0.05, p = 0.005, 95% CI = [0.01-0.08]) positively associated with SVE frequency at EOT. The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes. Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom-level outcomes. However, less flexible thinking at the start of treatment predicted self-induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN.

Anti-obesity Drugs for the Treatment of Binge Eating Disorder: Opportunities and Challenges.

Binge eating disorder (BED) is the most prevalent form of disordered eating, frequently associated with obesity. Both these conditions along with sharing overeating behaviour features can lead to substantial burden of disease and premature mortality. With limited specific evidence available on pharmacotherapy, since lisdexamfetamine is approved only in some countries, new drugs are urgently needed to provide physicians with efficacious prescribing choices when treating BED. Although unique mechanisms underlie psychopathological features of binge eating, including impulsivity, compulsivity, and emotional reactivity, anti-obesity drugs might represent an option for both weight management and symptom reduction in people with BED. The aim of this review is thus to provide a summary of available evidence on the efficacy of anti-obesity drugs for BED. After comprehensively searching for relevant studies in PubMed and the Cochrane Library, as well as for unpublished results in ClinicalTrials.gov, we included 14 clinical trials. Despite the limited sample size and the methodological variability, evidence from available studies suggests that most anti-obesity drugs, namely phentermine/topiramate, naltrexone/bupropion, liraglutide and semaglutide, though not orlistat, might variously achieve improvements for both body weight and severity and frequency of binge episodes. Findings from ongoing clinical trials are likely to provide further insight into the possible role of anti-obesity drugs for treating BED. Since these agents can hold the potential to be misused potentiating dietary restriction and pathological weight loss, it is crucial to promote responsible prescribing practices.

A quantitative feedback intervention to reduce binge drinking in young adults.

Existing binge drinking reduction interventions such as brief intervention and personalized normative feedback have shown modest impact. The purpose of this study was to evaluate the feasibility (recruitment and retention rates), acceptability, and preliminary efficacy testing of a short-term "know your numbers (KYN)" intervention on motivating young adults to reduce their engagement in binge drinking. Young adults (N=94, mean age 21 years) with a history of binge drinking received a 4-week KYN intervention that included information about their U.S. Alcohol Use Disorders Test (USAUDIT) scores and the alcohol biomarker phosphatidylethanol (PEth) level in relationship to different risk levels of alcohol use. At baseline and 4-weeks, measures included USAUDIT scores, PEth levels, motivation (Alcohol Contemplation Ladder) and other drinking measures. Focus groups were conducted at 4-weeks for feedback on the KYN approach. The recruitment rate was 82.26% (retention rate 76.9%). At 4-weeks there was a 62% increase in contemplation scores (indicating higher motivation), a decrease in USADUIT scores with an increase in the percent of participants classified as low-risk drinkers. No differences were found between baseline and 4-week PEth levels or number of binge episodes. Focus group results revealed satisfaction with the KYN approach but the need to understand how PEth levels and USAUDIT scores corresponded to health consequences and alcohol use levels. Results from this pilot study support the acceptability and potential use of a KYN approach in helping young adults understand their drinking levels.

Changes in alcohol consumption and binge drinking during the COVID-19 pandemic among American Indians residing in California and Oklahoma

ABSTRACT Background: This study explored the increased quantity and frequency of alcohol use in the American Indian (AI) population during the COVID-19 pandemic. Objectives: The aims of this study were to explore possible associations between covariables and both binge drinking and alcohol consumption during COVID-19. Methods: This cross-sectional survey study analyzed data from a sample of AI individuals (63% female) residing in California (n = 411) and Oklahoma (n = 657) between October 2020-January 2021. Analysis included summary statistics and multivariable logistic regression, including a variety of socio-economic, COVID-19 concern, and tobacco and marijuana use variables. Results: One or more alcohol binge episodes were reported between October 2020-January 2021 in 19.3% of participants and elevated overall alcohol consumption was reported by 21.6% of participants. Higher odds of elevated alcohol consumption occurred in women and those following more social distancing measures. The odds of binge drinking or elevated alcohol consumption in those using both marijuana and tobacco (aOR/ adjusted odds ratio:18.9, 95% CI = 8.5, 42.2, and aOR:3.9, 95% CI = 1.7, 8.6, respectively) were higher compared to those using neither. Similarly, the odds of binge drinking or elevated alcohol consumption in those using tobacco only (aOR:4.7, 95% CI = 2.9, 7.7 and aOR: 2.0, 95% CI = 1.1, 3.5, respectively) were higher compared to those using neither. Conclusions: This study found high rates of alcohol use and bingeing during the COVID-19 pandemic. Offering collaborative, culturally sensitive, and affordable support services are important components of intervention and preparation for future stressful events on local, as well as global levels.

Eating Disorders and Disordered Eating Behaviors Among Undergraduate Students in Pakistan as Measured by Eating Disorder Examination Questionnaire (EDE-Q).

Objectives Eating disorders (ED) are an emerging public health issue globally, especially in young adults studying at the undergraduate level. This study aims to assess the frequency of eating disorders, their types, and disordered eating behaviors among such students. Moreover, it aims to identify factors like weight concern, shape concern, eating concern, and restraint, along with assessing the shifting trend of BMI impact on eating disorders using a standardized Eating Disorder Examination Questionnaire (EDE-Q). Methods In this cross-sectional study, 400 undergraduate students (aged 18-25) from four public universities participated from July 2022 to November 2023. Data was collected using the Eating Disorder Examination Questionnaire (EDE-Q). The frequency of eating disorders was computed using SPSS version 27. Results Among the participants, 21.75% (n=84) were identified as having a score surpassing the clinical cut-off. This group comprised 5.5% males (n=22) and 16% females (n=64). The highest prevalence among the four subscales was observed in the Shape Concern subscale (10.5%). Objective binge episodes (19.3%) emerged as the most notable disordered eating attitude. Atypical anorexia nervosa accounted for 13.8% of different eating disorders, while disordered eating was noted in 19.5% (n=78) of individuals. Discussion This study offers critical insights into eating disorders among Pakistanundergraduate students, utilizing the EDE-Q 6.0. Disordered eating behaviors, particularly shape concern and objective binge eating, exhibit significant correlations with these disorders. Weight dissatisfaction emerges as a prominent predictor, suggesting societal influence. The study also reveals a moderate correlation between BMI and eating disorders, challenging conventional assumptions. Furthermore, a changing trend in the prevalence of eating disorders is observed among the male population.

Neurocognitive markers during maximum alcohol use in late adolescence as predictors of change in later drinking behaviors

AbstractThe influence of alcohol use on later neurocognitive functioning is well researched, yet few studies have investigated whether neurocognition post‐drinking initiation in adolescence predicts changes in later alcohol use. The objective of this study was to investigate neurocognitive task performance during maximum alcohol use in late adolescence as predictors of drinking behaviors 3–7 years later. Analyses (n = 105) were conducted on a longitudinal data set involving adolescents (12–13 years old) who were followed for 16 years. Time 1 (T1) was defined as the individuals' maximum drinking year within the first 10 study years and Time 2 (T2) was the first available data entry 3–7 years after T1. Four hierarchical linear regression models predicting follow‐up alcohol use were estimated: drinking days, average drinks per drinking day, peak drinks, and binge episodes. All models included inhibition/cognitive flexibility, visuospatial ability, verbal memory, working memory, and their interactions with sex, while covarying for age at T1, follow‐up duration, and controlling for T1 drinking. Better visuospatial ability at T1 predicted decreases in later binge episodes at T2 (β = −0.19, p = 0.048, partial r2 = 0.039). While better inhibition/cognitive flexibility at T1 predicted increases in follow‐up drinks per drinking day at T2 (β = 0.18, p = 0.016, partial r2 = 0.057). Findings suggest specific neurocognitive abilities during maximum drinking in late adolescence are useful as predictors of change in later drinking quantity per occasion and could potentially inform intervention research targeting this age group.

Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial.

Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring-only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350. PRR1-10.2196/55166.

Change in symptoms of depression and eating disorders in adolescents with obesity participating in a clinical trial

Depression and eating disorder (ED) risk are heightened during adolescence(1) and both were exacerbated during COVID-19 lockdowns. This analysis reports changes in self-reported symptoms of depression and eating disorders throughout the Fast Track to Health trial. Fast Track to Health was a 52-week multi-site randomised-controlled trial, conducted 2018-2023, comparing intermittent (IER) and continuous energy restriction (CER) in adolescents with obesity and ≥1 associated comorbidity(2). The Centre for Epidemiologic Studies Depression Scale-revised 10-item version for adolescents (CESDR) was used to assess symptoms of depression (no symptoms, sub-threshold, or possible, probable, major depressive episode). Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED risk; defined as global score ≥2.7, ≥2 episodes of binge eating with/without loss of control, or ≥1 episode of purging within the last 28-days. The Binge Eating Scale (BES) assessed severity of binge eating (no binge eating, mild/moderate, severe). Adolescents were monitored for disordered eating during dietetic consults. Linear mixed models, retaining all data consistent with intention-to-treat analysis, were used to estimate the change in outcomes from baseline to week-52. Descriptive statistics were used to describe the number of participants meeting screening criteria at baseline and week-52. One hundred and forty one adolescents were enrolled and 97 completed the trial, with median (IQR) EDE-Q score 2.28 (1.43 to 3.14), CESDR 9.00 (4.0 to 14.5) and BES 11.0 (5.0 to 17.0) at baseline. EDE-Q (change in estimated marginal means [SE], IER −0.63 [0.18], CER −0.56 [0.17]) and CESDR (IER −2.70 [1.15], CER −3.87 [1.07]) scores reduced between baseline and week-52 in both groups (p&lt;0.05) with no difference between groups. There was a between group difference (p = 0.019) in change in BES. The IER group had a reduction between baseline and week-52 (−3.72 [1.27]) and the CER group had no change. At baseline, 31 (22%) adolescents were classified as having a possible/probable/major depressive episode, 110 (78%) met ≥1 ED criteria and 28 (21%) as mild/moderate or severe binge eating, reducing to 8 (9%), 56 (61%) and 15 (16%) respectively at week-52. A small sub-group of adolescents required additional support for disordered eating. Overall, treatment-seeking adolescents with obesity have symptoms of depression and ED. Although symptoms reduce for most, some required additional support. Screening and monitoring for depression and ED are important to ensure early intervention.

Changing drinking patterns among Italians: 7 out of 10 students experience Binge Drinking

IntroductionThe expression Binge Drinking (BD) refers to dysregulated alcohol consumption, characterized by the intake of large quantities of alcohol, regardless of their nature, consecutively in a limited period of time. BD is a significant public health problem in many European countries, including Italy. According to data from the Istituto Superiore di Sanità, dated 2020, over 4 million Italians exhibit episodic excessive alcohol consumption (compared to 2019 data, there was an increase of approximately 5,3%).ObjectivesThis study aims to examine alcohol consumption habits in the Italian population, evaluating psychopathological correlations that can explain its diffusion.MethodsBetween January and May 2023, an anonymous online questionnaire was randomly sent to the general population. Alongside with tests to evaluate psycho-social features, to estimate the presence of alcohol abuse or dependence the AUDIT scale (Saunders et al. Addict Abingdon Engl. 1993; 88:791–804) was used. It included two specific questions to frame the phenomenon of BD (Cranford et al. Alcohol Clin Exp Res. 2006; 30:1896–905). No other study conducted in Italy has so far used the aforementioned validated questions.ResultsThe sample consists of 308 people (189 F, 119 M), with an average age of 32 years (sd 14). The AUDIT indicates a state of chronic alcohol consumption in 11,7% (95% confidence interval 8,5%-15,7%), of the recruited sample, positively correlating with the element of impulsivity (p&lt;0,005) confirming what has already been reported in literature. BD prevalence reaches 56% (M 57%, F 55%) without any significant correlation with impulsivity, personality disorders, emotional dysregulation, or sensitivity to rejection. Among university students the prevalence of BD exceeds 70% (95% confidence interval 60%-76%), with a number of drinks reported for a single occasion reaching up to 25 units and a reported number of binge episodes, in a two-week span, ranging from 2 to 10.ConclusionsDespite possible biases, this study raises the relevant issue of the extremely high prevalence of BD disorder, which is particularly alarming in light of the numerous issues related to the behavior itself. A direct correlation with reduced school performance, an increase in risky sexual behavior, and an increase in cases of drunk driving have been evaluated. Considering these consequences, it is of primary importance on a medical, but even more social level, to best characterize this phenomenon in such a way as to be able to implement awareness-raising and prevention interventions.Disclosure of InterestNone Declared

THE ROLE of GENERAL PRACTITIONER in PSYCHOTHERAPY of PATIENT BINGE EATING DISORDER

Introduction – Binge Eating Disorder (BED) is a condition in which an individual has repeated episodes of binge eating or episode purging type (inducing vomiting by himself or by using laxatives, diuretics, or enemas). It has happened during at last 3 months. The prevalence of binge eating disorder peaks in female adolescents aged 19-22 years and male adolescents aged 24 years. Treatment that can be given for BED includes psychotherapy, pharmacotherapy, and weight loss therapy. Psychotherapy is the first-line treatment for BED. Types of psychotherapy used in BED are Cognitive behavior therapy (CBT), Interpersonal psychotherapy (IPT), and Dialectical behavior therapy (DBT). Methods – The searching method in this article is based on several journals and textbook reviews including diagnosis of BED, and psychotherapy of BED such as Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Interpersonal Psychotherapy (IPT). Results – A binge eating disorder (BED) is someone who experiences uncontrollable binge eating, and these episodes can be repeated. after that, someone is trying to get his food out or purging (inducing vomiting by himself or by using laxatives, diuretics, or enemas). This is happened during the last 3 months. Psychotherapy is a formal process that involves the interaction between 2 or more people. Several professionals in mental health use psychotherapy. Types of psychotherapy used in BED are CBT, IPT, and DBT. Discuss – The role of GP in CBT is to help patients change their patterns of thinking and what they do. CBT also helps patients develop their skills to identify, and deal with problematic thoughts, and beliefs The role of a GP in IPT is to help people manage negative feelings so they don't vent those feelings by binge eating. IPT enhances the development of healthy interpersonal skills by replacing maladaptive behavior by promoting a positive self-image. DBT is a complete therapy. it consists of many different components, which include behavior therapy such as exposure therapy, skill in taking an action (contingency), stimulus control skills, problem-solving, cognitive restructuring, and other interventions. Conclusion – The three psychotherapies are interrelated with each other, with the combination of the three therapies on BED the results will be better. Keywords: BED, CBT IPT, DBT, general practitioner.