Inappropriate Compensatory Behaviors Research Articles

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.

Exploring the continuum of eating behaviour, from 'normal' to disordered eating.

Eating is a distinct behaviour in humans, in that they must consume food to provide sufficient energy for the body to function and to ensure survival. Behaviours around food consumption can range from 'normal' to disordered, where some people may develop eating patterns that suggest a preoccupation with food or weight. This preoccupation can lead to inappropriate compensatory behaviours, such as purging or excessive exercise, or dysphoric mood following food consumption. This article discusses the continuum between 'normal' eating behaviours and eating disorders, with a focus on binge eating behaviour and binge eating disorder. The author also describes the use of a screening tool for identifying binge eating behaviour and suggests ways in which nurses might support patients in addressing disordered eating behaviours.

Latent Change Trajectories in Mood During Focused CBT Enhanced for Eating Disorders Are Associated With Global Eating Pathology at Posttreatment and Follow-Up Among Individuals With Bulimia Nervosa Spectrum Disorders: A Preliminary Examination

Bulimia nervosa (BN) is characterized by recurrent loss of control over eating (LOC) and inappropriate compensatory behaviors. Although cognitive-behavioral therapy (CBT) is efficacious for BN, many patients continue to experience symptoms at posttreatment. One potential driver of this low treatment response may be low mood, which maintains BN symptoms through negative reinforcement. Thus, it is important to understand how mood changes over enhanced cognitive-behavioral therapy (CBT-E) and whether these changes are associated with improved treatment outcomes. Participants (N = 56) with BN-spectrum eating disorders (EDs) received 16 sessions of the focused version of CBT-E. The Eating Disorder Examination (EDE) was used to measure ED symptoms (global ED pathology, frequency of binge episodes, and compensatory behaviors) at pre- and posttreatment. Latent growth mixture modeling (LGMM) of affective ratings via digital self-monitoring identified latent growth classes. Kruskal–Wallis H tests examined the effect of trajectory of change in mood on pre- to posttreatment symptom change. LGMM yielded a four-class model that best fit the data representing distinct mood trajectories over the course of treatment: (a) highest baseline mood, linear improving; (b) moderate baseline mood, stable; (c) moderate baseline mood, quadratic worsening; and (d) lowest baseline mood, quadratic improving. Participants who demonstrated worsening mood over treatment (i.e., individuals in the “moderate baseline mood, quadratic worsening” class) had significantly higher EDE global scores at posttreatment and follow-up compared to participants with stable mood across treatment. Change in LOC eating frequency and compensatory behaviors across treatment did not significantly differ by mood class. The main effect of mood class or interaction effect between time and mood class on objective binge episodes, subjective binge episodes, and compensatory behaviors was not significant. There were no significant differences in global ED pathology at either posttreatment or follow-up for any other class comparisons. These results suggest that certain trajectories of change in mood during treatment are particularly associated with change in pre- to posttreatment EDE global score. If replicated, our findings could suggest that future iterations of CBT-E should target mood early in treatment in order to maximize reductions in global eating pathology.

Uncovering neural pathways underlying bulimia nervosa: resting-state neural connectivity disruptions correlate with maladaptive eating behaviors

PurposeBulimia nervosa (BN) is characterized by recurrent binge-eating episodes and inappropriate compensatory behaviors. This study investigated alterations in resting-state surface-based neural activity in BN patients and explored correlations between brain activity and eating behavior.MethodsA total of 26 BN patients and 28 healthy controls were enrolled. Indirect measurement of cerebral cortical activity and functional connectivity (FC) analyses were performed in Surfstat. A principal component analysis (PCA) model was used to capture the commonalities within the behavioral questionnaires from the BN group.ResultsCompared with the healthy control group, the BN group showed decreased surface-based two-dimensional regional homogeneity in the right superior parietal lobule (SPL). Additionally, the BN group showed decreased FC between the right SPL and the bilateral lingual gyrus and increased FC between the right SPL and the left caudate nucleus and right putamen. In the FC–behavior association analysis, the second principal component (PC2) was negatively correlated with FC between the right SPL and the left caudate nucleus. The third principal component (PC3) was negatively correlated with FC between the right SPL and the left lingual gyrus and positively correlated with FC between the right SPL and the right lingual gyrus.ConclusionWe revealed that the right SPL undergoes reorganization with respect to specific brain regions at the whole-brain level in BN. In addition, our results suggest a correlation between brain reorganization and maladaptive eating behavior. These findings may provide useful information to better understand the neural mechanisms of BN.Level of evidenceV, descriptive study.

Cyberbullying and eating disorder symptoms in US early adolescents.

The objective of this study was to determine the association between cyberbullying and eating disorder symptoms in a national sample of 10-14-year-old early adolescents. We analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (Year 2, 2018-2020, N = 10,258/11,875, 49% female, 46% non-White). Data were collected using multi-stage probability sampling. Modified Poisson regression analyses examined the association between cyberbullying and self-reported eating disorder symptoms based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5). Cyberbullying victimization was associated with worry about weight gain (prevalence ratio [PR] 2.41, 95% confidence interval [CI] 1.48-3.91), self-worth tied to weight (PR 2.08, 95% CI 1.33-3.26), inappropriate compensatory behavior to prevent weight gain (PR 1.95, 95% CI 1.57-2.42), binge eating (PR 1.95, 95% CI 1.59-2.39), and distress with binge eating (PR 2.64, 95% CI 1.94-3.59), in models adjusting for potential confounders. Cyberbullying perpetration was associated with worry about weight gain (PR 3.52, 95% CI 1.19-10.37), self-worth tied to weight (PR 5.59, 95% CI 2.56-12.20), binge eating (PR 2.36, 95% CI 1.44-3.87), and distress with binge eating (PR 2.84, 95% CI 1.47-5.49). Cyberbullying victimization and perpetration in early adolescence are associated with eating disorder symptoms. Clinicians may consider assessing for cyberbullying and eating disorder symptoms in early adolescence and provide anticipatory guidance. Eating disorders often onset in adolescence and have among the highest mortality rates of any psychiatric disorder. In addition, cyberbullying has increased in prevalence among adolescents and significantly impacts mental health. In a national study of early adolescents, we found that cyberbullying victimization and perpetration are associated with eating disorder symptoms. Screening for and providing anticipatory guidance on cyberbullying and eating disorder symptoms in early adolescents may be warranted.

Eating disorder psychopathology, psychiatric impairment, and symptom frequency of atypical anorexia nervosa versus anorexia nervosa: A systematic review and meta-analysis.

Restrictive eating disorders (EDs) occur across the weight spectrum, but historically more focus has been given to anorexia nervosa (AN) than atypical anorexia nervosa (atypAN). AtypAN's relegation to a diagnosis in the "other specified feeding and eating disorder" (OSFED) category and paucity of research surrounding atypAN invariably implies a less clinically severe ED. However, a growing body of research has begun to question the assumption that atypAN is less severe than AN. The current review and meta-analysis aimed to provide a comprehensive review to compare atypAN and AN on measures of eating disorder psychopathology, impairment, and symptom frequency to test whether atypAN is truly less clinically severe than AN. Twenty articles that reported on atypAN and AN for at least one of the variables of interest were retrieved from PsycInfo, PubMed, and ProQuest. For eating-disorder psychopathology, results indicated that differences were nonsignificant for most indicators; however, atypAN was associated with significantly higher shape concern, weight concern, drive for thinness, body dissatisfaction, and overall eating-disorder psychopathology than AN. Results indicated that atypAN and AN did not significantly differ on clinical impairment or the frequency of inappropriate compensatory behaviors, whereas there was a significantly higher frequency of objective binge episodes in AN (vs. atypAN). Overall, findings indicated that, in contrast to the current classification system, atypAN and AN were not clinically distinct. Results underscore the need for equal access to treatment and equal insurance coverage for restrictive EDs across the weight spectrum. The current meta-analysis found that atypAN was associated with higher drive for thinness, body dissatisfaction, shape concern, weight concern, and overall eating-disorder psychopathology than AN; whereas AN was associated with higher frequency of objective binge eating. Individuals with AN and atypAN did not differ on psychiatric impairment, quality-of-life, or frequency of compensatory behaviors, highlighting the need for equal access to care for restrictive EDs across the weight spectrum.

The mediating role of anxiety and depression between problematic social media use and bulimia nervosa among Lebanese university students

BackgroundBulimia nervosa (BN) is a disorder that is characterized by binge eating and inappropriate compensatory behavior to control weight. The aim of this study was to evaluate the mediating role of anxiety and depression between problematic social media use (PSMU) and BN among a sample of Lebanese university students.MethodsThis cross-sectional study was carried out between July and September 2021; a total of 363 university students was recruited through convenience sampling. The PROCESS SPSS Macro version 3.4, model four was used to test the indirect effect and calculate three pathways. Pathway A determined the regression coefficient for the effect of PSMU on mental health issues (depression/anxiety); Pathway B examined the association between mental health issues on BN, and Pathway C’ estimated the direct effect of PSMU on BN. Pathway AB was used to calculate the indirect effect of PSMU on BN via depression/anxiety.ResultsResults showed that depression and anxiety partially mediated the association between PSMU and BN. Higher levels of PSMU were associated with more depression and anxiety; higher depression and anxiety were associated with more BN. PSMU was directly and significantly associated with more BN. When entering anxiety (M1) then depression (M2) as consecutive mediators in a first model, the results showed that only depression mediated the association between PSMU and bulimia. When taking depression (M1) then anxiety (M2) as consecutive mediators in a second model, the results showed that the mediation PSMU → Depression → Anxiety → Bulimia was significant. Higher PSMU was significantly associated with more depression, which was significantly associated with more anxiety, which was significantly associated with more bulimia. Finally, higher PSMU was directly and significantly associated with more bulimiaConclusionThe current paper highlights the relationship that social media use has on BN and other aspects of mental health such as anxiety and depression in Lebanon. Future studies should replicate the mediation analysis conducted in the current study while taking into account other eating disorders. Additional investigations of BN and its correlates must strive to improve the comprehension of these associations’ pathways through designs that allow to draw temporal frameworks, in order to efficiently treat this eating disorder and prevent its negative outcomes.

Delay Discounting Clinical Implication for BED Treatment

Binge Eating Disorder (BED), a common eating disorder appearing in people in their late 20s, shows a symptom of consuming an unusual amount of food in a short amount of time. BED is usually defined as repeated episodes of binge eating accompanied by feelings of loss of control and distress, but unlike bulimia nervosa (BN), BED does not involve inappropriate compensatory behaviors to maintain weight, such as excessive dieting or exercise. Research has already begun to look at the neural mechanisms of overeating. This paper focuses on the finding of a new treatment for BED patient without the usage of medication. The proposed methods are using stimuli and therapy to regulate the focus of the patients’ eating behavior, self-evaluation, and social behaviors. The results obtained from the research included the effect of delay discounting of each method of treatment on the patient. The findings indicated that reducing delay discounting has clinical implications for the treatment of BED.

"… because I'm so drunk at the time, the last thing I'm going to think about is calories": Strengthening the argument for Drunkorexia as a food and alcohol disturbance, evidence from a qualitative study.

ObjectivesDrunkorexia are inappropriate compensatory behaviours in response to alcohol consumption (restricting food intake, excessive exercise, and purging). Past (predominantly quantitative) research shows that Drunkorexia is prevalent in 18–26‐year‐olds, and has significant negative health‐related consequences. There is a debate whether Drunkorexia constitutes an eating or substance disorder, or a Food and Alcohol Disturbance (FAD). To further explore this, and understand underlying motivators, this study utilized qualitative methods.DesignQualitative interviews with ten participants (aged 18–26).MethodsInterviews were analysed with Thematic Analysis.ResultsThree themes were developed: (1) Appearance concerns as motivators, (2) Drunkorexia behaviours to get value for money, and (3) “It’s just a pattern… something I’ve always done”: Drunkorexia as a routine. Results show that Drunkorexia is driven by appearance‐related concerns, such as, wanting to look better/slimmer, engaged in, in relation to an event, such as going out drinking, and carried out despite negative health‐related consequences. However, disregard for compensatory behaviours once drunk was also described, culminating in the consumption of high‐calorie food. This suggests that Drunkorexia is not a persistent pattern of maladaptive behaviour as found in eating or substance use disorders. Wanting value for money (i.e., feeling the maximum intoxication) was described as another reason for Drunkorexia engagement; thus showing that participants consider compensatory behaviours part of their routine of going out drinking.ConclusionsThese result support the view of Drunkorexia as a FAD, rather than an eating or substance use disorder, and show that 18–26‐year‐olds are an at‐risk group for Drunkorexia and its negative health‐related consequences.

Applying a web-based self-help intervention for bulimia nervosa in routine care: Study protocol for a randomized controlled trial

BackgroundIndividuals with bulimia nervosa (BN) experience persistent episodes of binge eating and inappropriate compensatory behavior associated with impaired physical and mental health. Despite the existence of effective treatments, many individuals with BN remain untreated, leading to a high burden and an increased risk of chronicity. Web-based interventions may help facilitate access to evidence-based treatments for BN by reducing barriers to the health care system. MethodsThe present study will investigate the effectiveness of a web-based self-help intervention for BN in a two-armed randomized controlled trial. Individuals diagnosed with BN (N = 152) will be randomly assigned to either (1) an intervention group receiving a 12-week web-based intervention or (2) a waitlist control group with delayed access to the intervention. Further assessments will be scheduled 6 (mid-treatment) and 12 (post-treatment) weeks after baseline. Changes in the number of binge eating episodes and compensatory behaviors will be examined as primary outcomes. Secondary outcomes include global eating pathology, functional impairments, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. DiscussionAdding web-based interventions into routine care is a promising approach to overcome the existing treatment gap for patients with BN. Therefore, the current study will test the effectiveness of a web-based intervention for BN under standard clinical care settings. Trial registrationClinicalTrials.gov, Identifier: NCT04876196 (registered on May 6th, 2021).

An empirical evaluation of the diagnostic threshold between full-threshold and sub-threshold bulimia nervosa

Previous research has failed to find differences in eating disorder and general psychopathology and impairment between people with sub- and full-threshold bulimia nervosa (BN). The purpose of the current study was to test the validity of the distinction between sub- and full-threshold BN and to determine the frequency of objective binge episodes and inappropriate compensatory behaviors that would best distinguish between sub- and full-BN. Community-recruited adults (83.5% female) with current sub-threshold (n = 105) or full-threshold BN (n = 99) completed assessments of eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse. Receiver operating characteristic curve analysis was used to evaluate whether eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse could empirically discriminate between sub- and full-threshold BN. The frequency of binge episodes and inappropriate compensatory behaviors (AUC = 0.94) was “highly accurate” in discriminating between sub- and full-threshold BN; however, only objective binge episodes was a significant predictor of BN status. Internalizing symptoms (AUC = 0.71) were “moderately accurate” at distinguishing between sub- and full-BN. Neither clinical impairment (AUC = 0.60) nor drug (AUC = 0.56) or alcohol misuse (AUC = 0.52) discriminated between groups. Results suggested that 11 episodes of binge eating and 17 episodes of inappropriate compensatory behaviors optimally distinguished between sub- and full-BN. Overall, results provided mixed support for the distinction between sub- and full-threshold BN. Future research to clarify the most meaningful way to discriminate between sub- and full-threshold is warranted to improve the criterion-related validity of the diagnostic system.

Eating disorders and psychosis: a case report and review of the literature

AimsDespite evidence from case series, the comorbidity of eating disorders (ED) with psychosis is a challenging field to which little attention has been paid. There is no consistent sequence in the co-occurrence of the two conditions-eating disorders sometimes precede, and sometimes follow the onset of psychosis. In this case report, we present a 25-year-old female patient suffering from recurrent episodes of binge eating and inappropriate compensatory purging behaviours with psychotic components to discuss the co-occurrence of these conditions in the light of the literature.MethodOur patient suffered from sleep disturbances, homicidal thoughts, self-induced vomiting worsened in one year. Psychiatric examination revealed psychotic symptoms such as blunted affect, persecutory delusions, and delusions of appeal and justification. In our inpatient psychiatry clinic, she was treated with olanzapine 20 milligrams(mg) and quetiapine 500 mg per day.ResultPsychotic episodes occur in 10–15% of eating disorder patients. The prevalence of primary psychotic diseases like schizophrenia and schizoaffective disorders in eating disorder patients appears to be comparable to that in the general population. An ED can be the early sign of an impending psychosis, or psychotic symptoms can signal the beginning of an ED. The advent of the psychosis, and sometimes the treatment of the psychosis can cure the eating disorder, but it can sometimes aggravate it. The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. To ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.ConclusionThe comorbidity between eating disorders and psychosis is infrequent and raises several conceptual and methodological questions. Epidemiological and family studies show that there is no more significant association between psychosis and ED, although these results are somehow limited by the lack of rigorous data regarding ED.

Visualizing dynamic patterns of binge and purge episodes using passive sensor data

Bulimia nervosa (BN) and binge-eating disorder (BED) are similar in that both are characterized by recurrent episodes of binge-eating, but diverge in that BN but not BED includes recurrent inappropriate compensatory behaviors to limit weight gain or counteract the effects of a binge. Binge (B) and purge (P) “events” are often conceptualized and studied as a series of brief snap shots where changing circumstances increase or decrease the likelihood of these disordered behaviors. We propose that B and P episodes can be better conceptualized as changes in patterns that unfold over time and that shifts between normative and dysfunctional patterns are observable using passive sensing methodologies and may be precluded by physiological or behavioral warning signs. In this paper, we introduce conceptual and theoretical approaches to consider B and P events from this perspective. We then use two illustrative case examples from a larger parent study to demonstrate how recent technologies can be used to collect intensive longitudinal data and how such data can be used to visualize normative and dysfunctional patterns. Finally, we close with discussion of the implications of this conceptualization and the corresponding data collection and visualization methods for basic science and intervention in eating disorders.

Binge Eating Disorder and Related Features in Bariatric Surgery Candidates.

ObjectiveThe present study sought to: 1) assess the prevalence of Binge Eating Disorder (BED) and abnormal eating behaviors in bariatric surgery candidates; 2) compare patients with and without BED as regards to eating disturbances, psychological characteristics, and health status; 3) individuate which factors were significantly related to binge eating severity.MethodsSixty-three preoperative patients (17 males and 46 females) were screened by means of an ad hoc socio-demographic schedule, the Rosenberg Self-Esteem Scale, the Eating Disorders Inventory-3, the Binge Eating Scale, and the General Health Questionnaire-28. BED diagnosis was performed through a clinical interview.ResultsBED and disordered eating, such as episodes of binge eating, sense of lack of control over eating and inappropriate compensatory behaviors, appear common in patients undergoing weight loss surgery. Significant differences between BED and non-BED subjects in relation to eating disturbances and psychological characteristics emerged. Multiple regression analysis revealed that only emotional dys-regulation significantly predicted binge eating vulnerability.ConclusionThe recognition of factors involved in the development and maintenance of disordered eating in bariatric patients may support the choice of particular therapeutic strategies and improve bariatric surgery outcome. Further studies on this issue would be useful.

Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-conforming Adults: Comparative Levels and a Proposed Mediational Model.

In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder (“ED proneness”), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion.

Associations Between Alcohol Involvement and Drive for Thinness and Body Dissatisfaction in Adolescent Twins: A Bivariate Twin Study.

Alcohol involvement has familial associations with bulimic symptoms (i.e., binge eating, inappropriate compensatory behaviors), with several studies indicating a genetic overlap between the two. It is unclear whether overlapping familial risk with alcohol involvement extends to other eating disorder symptoms. Understanding the genetic overlap between alcohol involvement and other eating disorder symptoms may aid in more targeted interventions for comorbid alcohol use-eating disorder symptoms. Thus, we investigated associations between alcohol involvement and 2 core eating disorder symptoms: drive for thinness and body dissatisfaction in adolescent female and male twins. We assessed 3 levels of alcohol involvement: alcohol use in the last month, having ever been intoxicated, and alcohol intoxication frequency via self-report. The Eating Disorder Inventory-II assessed drive for thinness and body dissatisfaction. Sex-specific biometrical twin modeling examined the genetic overlap between alcohol involvement and eating disorder symptoms. Phenotypic associations between alcohol involvement, drive for thinness, and body dissatisfaction were significantly greater in girls compared with boys. A majority of the associations between alcohol involvement, drive for thinness, and body dissatisfaction in girls, but not boys, met our threshold for twin modeling (phenotypic r>0.20). Moderate genetic correlations were observed between the 3 aspects of alcohol involvement and drive for thinness. Moderate genetic correlations were observed between alcohol use and intoxication frequency and body dissatisfaction. Together with the literature on alcohol involvement and bulimic symptoms, these findings suggest a generalized association between alcohol involvement and eating disorder symptoms in girls, whereas this association may be symptom specific in boys. Genetic correlations indicate that the amount and direction of this genetic overlap differs across specific symptoms. When intervening on comorbid alcohol involvement and eating disorder symptoms, it may be important to target-specific eating disorder symptoms.

Is the diagnostic threshold for bulimia nervosa clinically meaningful?

The DSM-5 differentiates full- and sub-threshold bulimia nervosa (BN) according to average weekly frequencies of binge eating and inappropriate compensatory behaviors. This study was the first to evaluate the modified frequency criterion for BN published in the DSM-5. The purpose of this study was to test whether community-recruited adults (N=125; 83.2% women) with current full-threshold (n=77) or sub-threshold BN (n=48) differed in comorbid psychopathology and eating disorder (ED) illness duration, symptom severity, and clinical impairment. Participants completed the Clinical Impairment Assessment and participated in semi-structured clinical interviews of ED- and non-ED psychopathology. Differences between the sub- and full-threshold BN groups were assessed using MANOVA and Chi-square analyses. ED illness duration, age-of-onset, body mass index (BMI), alcohol and drug misuse, and the presence of current and lifetime mood or anxiety disorders did not differ between participants with sub- and full-threshold BN. Participants with full-threshold BN had higher levels of clinical impairment and weight concern than those with sub-threshold BN. However, minimal clinically important difference analyses suggested that statistically significant differences between participants with sub- and full-threshold BN on clinical impairment and weight concern were not clinically significant. In conclusion, sub-threshold BN did not differ from full-threshold BN in clinically meaningful ways. Future studies are needed to identify an improved frequency criterion for BN that better distinguishes individuals in ways that will more validly inform prognosis and effective treatment planning for BN.

Methylphenidate treatment for binge-eating disorder in a 12-year-old boy

Binge-eating disorder (BED) is defined as frequent episodes of binge eating, and the subjective feeling of loss of control over food intake, in the absence of inappropriate compensatory behaviours....

Public and Healthcare Professionals' Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review.

Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs) or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria.

Effects of physical exercise on Body Mass Index in Binge Eating Disorder

Binge Eating Disorder (BED) is characterized by recurrent episodes of eating large quantities of food in a brief period. Bouts of binge are commonly associated with a lack of control on stop eating or on what or how much one is eating. The binge eating is not associated with recurrent use of inappropriate compensatory behavior as bulimia nervosa and occurs, on average, at least once a week for 3 months [1]. BED is also associate with obesity and motor inactivity [2]. Aim of this study was to estimate the effectiveness of a structured physical activity program on the Body Mass Index (BMI) in BED patients. 19 BED women were recruited for this study. The subjects were randomly assigned to two groups: Intervention Group (IG, n=10) and Control Group (CG, n=9). All participants underwent the following measurements: height and weight, to calculate BMI (kg/m²) and participated into the weekly multidisciplinary program, constituted by Cognitive Behavioral Therapy and diet. In addition, the IG carried out a structured physical activity program for 6 months. The exercise session consisted of aerobic, balance and strength activity performed in four weekly sessions of 90 minutes. At baseline and after 6 months BMI was assessed in both groups. Both groups improved their BMI for the influence of diet and changes in body composition but the IG achieved greater results probably for the effects of structured physical activity program. The combination of traditional BED treatment and physical activity seem to improve the quality of life, to increase habitual activity level and to reduce Body Mass Index in BED patients.