1
|
Hsu T, Forestell CA. Mindfulness, depression, and emotional eating: The moderating role of nonjudging of inner experience. Appetite 2020; 160:105089. [PMID: 33373632 DOI: 10.1016/j.appet.2020.105089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/07/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Emotional eating is defined as the tendency to increase food consumption in order to modify negative emotional states. Theories on emotional eating attribute its cause to inadequate emotion regulation, specifically an inability to draw awareness to and accept distress. Mindfulness, or the ability to pay attention to and accept internal and external experiences, is thought to attenuate the association between internalizing distress and emotional eating. Nevertheless, there has been little research examining the moderating role of mindfulness in the relationship between psychological distress and emotional eating. The present study used a cross-sectional design to probe the effects of specific facets of mindfulness, as measured by the Five Factor Mindfulness Questionnaire, on the relationship between internalizing distress (i.e., depression and anxiety) and emotional eating in a diverse community sample (N = 248). Results showed that depression significantly interacted with nonjudging of inner experience to predict emotional eating. Those who were high in nonjudging endorsed less emotional eating than those who were average or low in nonjudging. This was significant only at low levels of depression. These findings delineate the moderating role of specific aspects of trait mindfulness in the association between depression and emotional eating and may inform more targeted intervention and prevention efforts.
Collapse
Affiliation(s)
- Ti Hsu
- Department of Psychological Sciences, William & Mary, P.O. Box 8795, Williamsburg, VA, 23187-8795, USA.
| | - Catherine A Forestell
- Department of Psychological Sciences, William & Mary, P.O. Box 8795, Williamsburg, VA, 23187-8795, USA.
| |
Collapse
|
2
|
Goutaudier N, Ayache R, Aubé H, Chabrol H. Traumatic anticipation of childbirth and disordered eating during pregnancy. J Reprod Infant Psychol 2020; 38:243-258. [PMID: 32189512 DOI: 10.1080/02646838.2020.1741525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND While research on Fear Of Childbirth (FOC) during pregnancy is on the rise, research regarding pretraumatic stress reactions is lacking. Moreover, less is known regarding negative anticipation of childbirth and Eating Disorders (ED). This study aims at identifying typologies of women in the prepartum period based on FOC and pretraumatic stress symptoms and investigating whether or not the identified profiles differ on levels of bulimic symptoms and Drive for Thinness (DT). PARTICIPANTS AND METHODS a sample of 213 pregnant women completed questionnaires assessing FOC, pretraumatic stress, DT and bulimic symptoms. RESULTS four clusters based on pretraumatic stress and FOC symptoms were identified: one characterised by traumatic symptoms, one showing moderated FOC symptoms, one with high symptomatology and one with low symptoms. Higher ED symptoms were found in women with both FOC and pretraumatic stress symptoms, and in the cluster showing elevated pretraumatic stress symptomatology. CONCLUSIONS To our knowledge, this is the first study focusing on anticipated traumatic reactions and ED in pregnant women. While some women evidenced FOC and pretraumatic stress symptoms, two different clusters, one with FOC and one with pretraumatic stress, were found. These findings suggest that, while sharing similarities, these constructs are different.
Collapse
Affiliation(s)
- Nelly Goutaudier
- Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers , Poitiers, France
| | - Raphael Ayache
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
| | - Hélène Aubé
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
| | - Henri Chabrol
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
| |
Collapse
|
3
|
Kenny TE, Singleton C, Carter JC. An examination of emotion-related facets of impulsivity in binge eating disorder. Eat Behav 2019; 32:74-77. [PMID: 30654194 DOI: 10.1016/j.eatbeh.2018.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE While research suggests a positive association between negative urgency (NU) and binge eating, the association between positive urgency (PU) and binge eating has been less well studied. Moreover, few studies have examined NU and PU in binge eating disorder (BED). The present study examined Whiteside and Lynam's (2001) five facets of impulsivity (including NU and PU) in individuals with BED and a control group with no history of an eating disorder (NED). METHOD Community samples of adults with BED (n = 72) and NED (n = 79) completed self-report measures of impulsivity, eating disorder (ED) psychopathology, and symptoms of depression and anxiety. RESULTS The only facet of impulsivity that differed between the groups was NU, with the BED group reporting significantly higher scores on NU than the NED group. Although differences in PU initially emerged, these were no longer significant after controlling for NU. None of the impulsivity subscales predicted binge frequency, but four of the five subscales (NU, perseverance, premeditation, and PU) were significantly related to ED psychopathology. DISCUSSION The present findings suggest that those with BED exhibit greater NU than those without BED and that this may play role in BED symptomatology. Furthermore, the association between various impulsivity factors and ED psychopathology suggests that additional research is needed to understand these relationships in BED.
Collapse
Affiliation(s)
- Therese E Kenny
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9, Canada
| | - Christopher Singleton
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9, Canada
| | - Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9, Canada.
| |
Collapse
|
4
|
Parental Rejection as a Predictor of Emotional Eating After Inpatient Weight Loss Treatment for Youngsters. BEHAVIOUR CHANGE 2018. [DOI: 10.1017/bec.2018.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractObjectiveThe main objective of the study was to examine the relationships between parental rejection, maladaptive emotion regulation strategies, and the emotional eating style of youngsters who finished an inpatient multidisciplinary weight loss treatment program and were back in their home environment.MethodParticipants were 52 youngsters (age 11–17 years) with an average percent over ideal BMI of 186.11% (SD= 27.54) before treatment and 136.37% (SD= 19.65) at a mean follow-up of 4 months. Participants completed questionnaires assessing maternal and paternal rejection, maladaptive emotion regulation strategies, and emotional eating. Data were analysed using bootstrapping procedure.ResultsMediation analyses showed that maladaptive emotion regulation partially mediated the association between maternal rejection and the youngsters’ emotional eating style. Paternal rejection was directly related to emotional eating.ConclusionThe results suggest that the family climate may have an impact on the eating style of the youngsters after weight loss treatment.
Collapse
|
5
|
Examination of the Effectiveness of a Brief, Adapted Dialectical Behavior Therapy-Skills Training Group for Bariatric Surgical Candidates. Obes Surg 2018; 29:252-261. [DOI: 10.1007/s11695-018-3515-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
6
|
Kenny TE, Van Wijk M, Singleton C, Carter JC. An examination of the relationship between binge eating disorder and insomnia symptoms. EUROPEAN EATING DISORDERS REVIEW 2018. [DOI: 10.1002/erv.2587] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Therese E. Kenny
- Department of Psychology; Memorial University of Newfoundland; St. John's Newfoundland and Labrador Canada
| | - Megan Van Wijk
- Department of Psychology; Memorial University of Newfoundland; St. John's Newfoundland and Labrador Canada
| | - Christopher Singleton
- Department of Psychology; Memorial University of Newfoundland; St. John's Newfoundland and Labrador Canada
| | - Jacqueline C. Carter
- Department of Psychology; Memorial University of Newfoundland; St. John's Newfoundland and Labrador Canada
| |
Collapse
|
7
|
Kognitiv-affektive Neuropsychologie der Binge-Eating-Störung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
8
|
Stadler C, Manetsch M, Vriends N. [Dialectical behavior therapy approaches with disruptive behavior disorders]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:443-454. [PMID: 27642799 DOI: 10.1024/1422-4917/a000478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Disruptive behaviour disorders comprise the diagnosis conduct disorder (CD) and in adults the diagnosis antisocial personality disorder (APD). CD is seen as a difficult-to-treat disorder with a high risk for persistent behavioral problems. In addition, CD is seen as the precursor to antisocial personality disorder (Kretschmer et al., 2014). Dialectical behavior therapy (DBT) was originally developed by Marsha Linehan (1991) for the treatment of borderline personality disorder, but because of the core deficits in emotion regulation in disruptive behavior disorders, DBT is also increasingly being recommended for the treatment of CD and APD. This review presents DBT adaptions for the forensic setting and for the treatment of CD/APD. Clinical implications are discussed.
Collapse
Affiliation(s)
- Christina Stadler
- 1 Kinder- und Jugendpsychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel
| | - Madleina Manetsch
- 2 Forensisch-Psychiatrische Klinik, Jugendforensik, Universitäre Psychiatrische Kliniken Basel
| | - Noortje Vriends
- 3 Kinder- und Jugendpsychiatrische Klinik, Entwicklungspsychopathologie, Universitäre Psychiatrische Kliniken Basel
| |
Collapse
|
9
|
Stein RI, Saelens BE, Dounchis JZ, Lewczyk CM, Swenson AK, Wilfley DE. Treatment of Eating Disorders in Women. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000001295004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reviews the most recent treatment literature for anorexia nervosa, bulimia nervosa, and binge eating disorder and serves as a guide for recommended readings and therapist resources. The primary focus is on empirically tested treatment modalities; for each of these approaches reviewed, the theoretical background, nature of the intervention, and existing empirical support are summarized. The article also presents less researched, albeit promising, approaches to eating disorder treatment, describing the rationale and available research. A focus on multicultural issues, including the paucity of eating disorder treatment research among participants of color, and suggestions for building research and enhancing treatment effectiveness with ethnic minority clients, is incorporated throughout. Recommendations concerning pressing research needs are made, and a summary of clinical recommendations for each disorder is formulated.
Collapse
Affiliation(s)
- Richard I. Stein
- San Diego State University and University of California, San Diego,
| | | | - Jennifer Zoler Dounchis
- San Diego State University; University of California, San Diego; and Minneapolis Veterans Affairs Medical Center, Minnesota
| | | | | | | |
Collapse
|
10
|
Anderson LK, Murray SB, Ramirez AL, Rockwell R, Le Grange D, Kaye WH. The Integration of Family-Based Treatment and Dialectical Behavior Therapy for Adolescent Bulimia Nervosa: Philosophical and Practical Considerations. Eat Disord 2015; 23:325-35. [PMID: 26009868 DOI: 10.1080/10640266.2015.1042319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dialectical behavior therapy (DBT) and family-based treatment (FBT) are two evidence-based interventions that have been applied in the treatment of bulimia nervosa (BN) in adolescents. While DBT focuses on providing skills for coping with emotion dysregulation that often co-occurs with BN, FBT targets the normalization of eating patterns. The purpose of the current article is to introduce an integration of both treatments to provide a more comprehensive approach that targets the full scope of the disorder. We provide a review of the conceptual similarities and differences between FBT-BN and DBT along with strategies to guide a blended treatment approach. Given the strengths and limitations of either independent treatment, DBT and FBT-BN complement one another and together can address the range of symptoms and behaviors typically seen in adolescent BN.
Collapse
Affiliation(s)
- Leslie K Anderson
- a Department of Psychiatry , University of California, San Diego , San Diego , California , USA
| | | | | | | | | | | |
Collapse
|
11
|
Svaldi J, Trentowska M, Bender C, Naumann E, Tuschen-Caffier B. Pilotstudie zur Effektivität eines Emotionsregulationstrainings bei Frauen mit Binge-Eating-Störung. ACTA ACUST UNITED AC 2014. [DOI: 10.1024/1661-4747/a000174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Negative Emotionen sind ein häufiger Auslöser von Essanfällen bei Personen mit Binge-Eating-Störung (BES). Erste Untersuchungen haben gezeigt, dass Defizite in der Emotionsregulation (ER) den Zusammenhang von negativen Emotionen und Essanfällen mediieren. Vor diesem Hintergrund erhielten im Rahmen einer Pilotstudie 14 Frauen mit BES ein ER-Training in der Gruppe. Indikatoren für die Effektivität des Trainings waren Anzahl der Episoden und Tage mit objektiven Essanfällen, Körperunzufriedenheit, sowie Depressivität vor Studienbeginn (T0), nach 8 Wochen Wartezeit (T1) und nach dem 8-wöchigen ER-Training (T2). Während es keine Veränderungen von T0 zu T1 gab, zeigte sich eine signifikante Reduktion der Symptomatik in allen erhobenen Variablen von T1 zu T2. Die Ergebnisse der Pilotstudie unterstützen die Relevanz der ER bezüglich der Reduktion von Essanfällen und damit die Notwendigkeit gut implementierter Therapiestudien, die die Effektivität von ER-Trainings in der Veränderung der Psychopathologie der BES untersuchen. Zudem sind weitere Studien, die die Rolle der ER bei der Aufrechterhaltung der BES klären, notwendig.
Collapse
Affiliation(s)
- Jennifer Svaldi
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
| | - Monika Trentowska
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
| | - Caroline Bender
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
| | - Eva Naumann
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
| | | |
Collapse
|
12
|
Hard exercise, affect lability, and personality among individuals with bulimia nervosa. Eat Behav 2013; 14:413-9. [PMID: 24183126 PMCID: PMC3832258 DOI: 10.1016/j.eatbeh.2013.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 06/30/2013] [Accepted: 07/15/2013] [Indexed: 11/24/2022]
Abstract
The current study explores the personality traits of compulsivity (e.g., sense of orderliness and duty to perform tasks completely) and restricted expression (e.g., emotion expression difficulties) as potential moderators of the relation between affect lability and frequency of hard exercise episodes in a sample of individuals with bulimic pathology. Participants were 204 adult females recruited in five Midwestern cities who met criteria for threshold or subthreshold bulimia nervosa (BN). Compulsivity was found to significantly moderate the relation between affect lability and number of hard exercise episodes over the past 28 days, such that among those with high compulsivity, level of affect lability was associated with the number of hard exercise episodes; whereas, among those with low compulsivity, affect lability was not associated with the number of hard exercise episodes. The same pattern of findings emerged for restricted expression; however, this finding approached, but did not reach statistical significance. As such, it appears that affect lability is differentially related to hard exercise among individuals with BN depending upon the level of compulsivity and, to a more limited extent, restricted expression. These results suggest that, for individuals with BN with either compulsivity or restricted expression, focusing treatment on increasing flexibility and/or verbal expression of emotions may help in the context of intense, fluctuating affect.
Collapse
|
13
|
Masuda A, Hill ML. Mindfulness as therapy for disordered eating: a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.36] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
Nowakowski ME, McFarlane T, Cassin S. Alexithymia and eating disorders: a critical review of the literature. J Eat Disord 2013; 1:21. [PMID: 24999402 PMCID: PMC4081716 DOI: 10.1186/2050-2974-1-21] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/25/2013] [Indexed: 02/05/2023] Open
Abstract
Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.
Collapse
Affiliation(s)
- Matilda E Nowakowski
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
| | - Traci McFarlane
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada ; Eating Disorder Program, The Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
| |
Collapse
|
15
|
Barnes RD, Sawaoka T, White MA, Masheb RM, Grilo CM. Factor structure and clinical correlates of the Food Thought Suppression Inventory within treatment seeking obese women with binge eating disorder. Eat Behav 2013; 14:35-9. [PMID: 23265399 PMCID: PMC3670144 DOI: 10.1016/j.eatbeh.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 06/28/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
Prior research on the relations among eating behaviors and thought suppression is limited to a measure of general thought suppression, the White Bear Suppression Inventory. To address this limitation, researchers recently validated the Food Thought Suppression Inventory (FTSI). Analyses using this measure suggest that food thought suppression is distinct from and is more predictive of eating disorder psychopathology than is general thought suppression. The FTSI, however, has not yet been validated in clinical samples. The purpose of the current study is to examine the factor structure and clinical correlates of the FTSI within treatment seeking obese women with binge eating disorder (BED; N=128). Analyses revealed a valid and reliable one-factor measure of food thought suppression that was related to higher levels of eating and general psychopathology. The findings provide evidence for the use of the FTSI with obese women with BED. Future research should examine the psychometric properties of the FTSI within larger and more diverse samples.
Collapse
Affiliation(s)
- Rachel D. Barnes
- Department of Psychiatry, Yale University School of Medicine, USA,Corresponding author at: Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, P.O. Box 208098, New Haven, CT 06520-8098, USA. Tel.:+1 203 785 6395; fax: +1 203 785 7855
| | | | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine, USA,Department of Psychology, Yale University, USA,Department of Chronic Disease Epidemiology, Yale School of Public Health, USA
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, USA,Department of Psychology, Yale University, USA
| |
Collapse
|
16
|
Svaldi J, Griepenstroh J, Tuschen-Caffier B, Ehring T. Emotion regulation deficits in eating disorders: a marker of eating pathology or general psychopathology? Psychiatry Res 2012; 197:103-11. [PMID: 22401969 DOI: 10.1016/j.psychres.2011.11.009] [Citation(s) in RCA: 248] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 11/10/2011] [Accepted: 11/12/2011] [Indexed: 10/28/2022]
Abstract
Preliminary evidence indicates that individuals with eating disorders (ED) show emotion regulation (ER) difficulties. However, it is yet unclear whether different types of ED differ in their ER profile and whether certain ER difficulties are specific for ED or rather a transdiagnostic factor. Twenty women with anorexia nervosa (AN), 18 with bulimia nervosa (BN), 25 with binge eating disorder (BED), 15 with borderline personality disorder (BPD), 16 with major depressive disorder (MDD) and 42 female healthy controls (HC) were administered the Emotion Regulation Questionnaire, the Inventory of Cognitive Affect Regulation Strategies, the Difficulties in Emotion Regulation Scale and the Affect Intensity Measure. The ED groups reported significantly higher levels of emotion intensity, lower acceptance of emotions, less emotional awareness and clarity, more self-reported ER problems as well as decreased use of functional and increased use of dysfunctional emotion regulation strategies when compared to HC. No significant differences between the ED groups emerged for most ER variables. However, there were indications that the BED group may show a slightly more adaptive pattern of ER than the two other ED groups. As a whole, all clinical groups performed very similar on most ER variables and reported more difficulties regulating their emotions than HC. The findings suggest that ER difficulties are not linked to a particular diagnostic category. Instead, ER difficulties appear to be a transdiagnostic risk and/or maintenance factor rather than being disorder-specific.
Collapse
Affiliation(s)
- Jennifer Svaldi
- University of Freiburg, Department of Clinical Psychology and Psychotherapy, Germany.
| | | | | | | |
Collapse
|
17
|
Robinson AH, Safer DL. Moderators of dialectical behavior therapy for binge eating disorder: results from a randomized controlled trial. Int J Eat Disord 2012; 45:597-602. [PMID: 21500238 PMCID: PMC3155005 DOI: 10.1002/eat.20932] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Investigate moderators of a randomized clinical trial of group Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) compared to an active comparison group control (ACGT) on the post-treatment outcome of binge frequency after twenty 2-h weekly sessions. METHOD Moderation analyses. RESULTS Participants were 101 adults with BED [mean (SD) age, 52.2 (10.6) years and BMI, 36.4 (8.6)]. Analyses identified two moderators of post-treatment outcome. Participants with (1) Avoidant Personality Disorder or (2) an earlier onset of overweight and dieting (<15 years old) evidenced significantly worsened outcome when treated with ACGT versus DBT-BED. DISCUSSION Participants with certain indicators of higher baseline pathology respond better to DBT-BED than ACGT at post-treatment.
Collapse
Affiliation(s)
- Athena Hagler Robinson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5722, USA
| | | |
Collapse
|
18
|
Glisenti K, Strodl E. Cognitive Behavior Therapy and Dialectical Behavior Therapy for Treating Obese Emotional Eaters. Clin Case Stud 2012. [DOI: 10.1177/1534650112441701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study describes the treatment of obese individuals who rated high on emotional eating using four case studies that involved 22 sessions of either cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT). Outcomes measures relating to weight, body mass index, emotional eating, depression, anxiety, and stress were all assessed with each participant prior to each baseline (three weekly sessions), during treatment and posttherapy. At the 8-week follow-up, the two cases that had received DBT had lost 10.1% and 7.6% of their initial body weight, whereas the two cases that had received CBT had lost 0.7% and 0.6% of their initial body weight. The two DBT cases also exhibited reductions in emotional distress, frequency of emotional eating or quantity of food eating in response to emotions, whereas the two CBT cases showed no overall reductions in these areas. Important processes from all four cases are described as are the implications to clinicians for developing more effective interventions for obese clients who engage in emotional eating.
Collapse
Affiliation(s)
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
19
|
Klein AS, Skinner JB, Hawley KM. Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e148-53. [PMID: 22367862 DOI: 10.1002/erv.2165] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 01/22/2012] [Accepted: 01/27/2012] [Indexed: 11/10/2022]
Abstract
Research evidence has been accumulating for the efficacy of dialectical behaviour therapy (DBT) for binge eating. However, support for its effectiveness and transportability beyond efficacy trials is lacking. The current study evaluated the feasibility of group-based DBT for binge eating within the context of an operating community clinic. Women ages 24-49 (M = 39.60, SD = 9.53) with either subthreshold and full-threshold binge eating disorder or bulimia nervosa formed the group and comprised the sample (n = 5 treatment completers). Positive outcomes included significant improvement in both binge eating and secondary outcomes with the Eating Disorder Inventory subscales of Bulimia, Ineffectiveness, Perfectionism and Interpersonal Distrust. Attrition was elevated compared with previous efficacy trials, suggesting the need for increased attention to how to improve retention within routine practice settings. Given our limited sample size, these findings are viewed as promising but preliminary.
Collapse
|
20
|
Clyne C, Blampied NM. Training in Emotion Regulation as a Treatment for Binge Eating: A Preliminary Study. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.21.4.269.66105] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBinge eating within Binge Eating Disorder (BED) may represent ineffective management of, and inappropriate escape from, strong, dysphoric emotions, but treatments have been slow to incorporate an emotion regulation focus. Eleven women meeting criteria for BED participated in 11 sessions (2 hours per week) of a psychoeducational group program providing training in emotion recognition and management, problem-solving, assertion training, relaxation and stress management. Outcome was evaluated using a multiple-baseline design replicated across groups. Binges were self-monitored daily, and self-report questionnaires assessed wellbeing and emotion regulation at pretreatment, posttreatment and follow-up. Cognitive changes from pre to posttreatment were evaluated by Articulated Thoughts in Simulated Situations. The program was effective in reducing binge eating, alexithymia, stress and depression, and it improved coping and positive cognitions. No participant met criteria for BED at follow-up. The findings provide support for the inclusion of training in emotion recognition and regulation in treatments for BED and for affect regulation models of binge eating.
Collapse
|
21
|
Barnes RD, Masheb RM, Grilo CM. Food thought suppression: a matched comparison of obese individuals with and without binge eating disorder. Eat Behav 2011; 12:272-6. [PMID: 22051359 PMCID: PMC3208830 DOI: 10.1016/j.eatbeh.2011.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 04/08/2011] [Accepted: 07/19/2011] [Indexed: 11/18/2022]
Abstract
Preliminary studies of non-clinical samples suggest that purposely attempting to avoid thoughts of food, referred to as food thought suppression, is related to a number of unwanted eating- and weight-related consequences, particularly in obese individuals. Despite possible implications for the treatment of obesity and eating disorders, little research has examined food thought suppression in obese individuals with binge eating disorder (BED). This study compared food thought suppression in 60 obese patients with BED to an age-, gender-, and body mass index (BMI)-matched group of 59 obese persons who do not binge eat (NBO). In addition, this study examined the associations between food thought suppression and eating disorder psychopathology within the BED and NBO groups and separately by gender. Participants with BED and women endorsed the highest levels of food thought suppression. Food thought suppression was significantly and positively associated with many features of ED psychopathology in NBO women and with eating concerns in men with BED. Among women with BED, higher levels of food thought suppression were associated with higher frequency of binge eating, whereas among men with BED, higher levels of food thought suppression were associated with lower frequency of binge eating. Our findings suggest gender differences in the potential significance of food thought suppression in obese groups with and without co-existing binge eating problems.
Collapse
Affiliation(s)
- Rachel D Barnes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520-8098, United States.
| | | | | |
Collapse
|
22
|
Safer DL, Chen EY. Anorexia nervosa as a disorder of emotion dysregulation: Theory, evidence, and treatment implications. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1468-2850.2011.01251.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Hill DM, Craighead LW, Safer DL. Appetite-focused dialectical behavior therapy for the treatment of binge eating with purging: a preliminary trial. Int J Eat Disord 2011; 44:249-61. [PMID: 20196109 DOI: 10.1002/eat.20812] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This treatment development study investigated the acceptability and efficacy of a modified version of dialectical behavior therapy (DBT) for bulimia nervosa (BN), entitled appetite focused DBT (DBT-AF). METHOD Thirty-two women with binge/purge episodes at least one time per week were randomly assigned to 12 weekly sessions of DBT-AF (n = 18) or to a 6-week delayed treatment control (n = 14). Participants completed the EDE interview and self-report measures at baseline, 6 weeks, and posttreatment. RESULTS Treatment attrition was low, and DBT-AF was rated highly acceptable. At 6 weeks, participants who were receiving DBT-AF reported significantly fewer BN symptoms than controls. At posttest, 26.9% of the 26 individuals who entered treatment (18 initially assigned and 8 from the delayed treatment control) were abstinent from binge/purge episodes for the past month; 61.5% no longer met full or subthreshold criteria for BN. Participants demonstrated a rapid rate of response to treatment and achieved clinically significant change. DISCUSSION Results suggest that DBT-AF warrants further investigation as an alternative to DBT or cognitive behavior therapy for BN.
Collapse
Affiliation(s)
- Diana M Hill
- Department of Psychology, University of Colorado at Boulder, Boulder, Colorado, USA.
| | | | | |
Collapse
|
24
|
Barnes RD, Tantleff-Dunn S. A preliminary investigation of sex differences and the mediational role of food thought suppression in the relationship between stress and weight cycling. Eat Weight Disord 2010; 15:e265-9. [PMID: 21406950 DOI: 10.1007/bf03325308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Despite improvements in weight loss treatment efficacy, research demonstrates that most people are unable to maintain weight loss over time. Individuals who utilize avoidant coping methods are less successful at maintaining weight loss than those who directly cope with stressors. Thought suppression, or trying to avoid certain thoughts, could be considered cognitive avoidance. Therefore, the current study evaluated the unexplored relationship among stress, food thought suppression, and weight cycling. Overweight and obese community individuals (N=347) completed self-report measures of thought suppression, weight history, and stress. Food thought suppression fully mediated the relationship between stress and weight cycling in women and approached significance for men. Results have implications for improving weight loss maintenance and support further exploration of third wave interventions, such as Acceptance and Commitment Therapy and Mindfulness, in the treatment of obesity.
Collapse
Affiliation(s)
- R D Barnes
- University of Central Florida, Laboratory for the Study of Eating, Appearance, and Health, Department of Psychology, University of Central Florida, Orlando, FL 32816-1390, USA
| | | |
Collapse
|
25
|
Gagnon-Girouard MP, Gagnon C, Bégin C, Provencher V, Tremblay A, Boivin S, Lemieux S. Couple dissatisfaction and eating profile: a mediation effect of coping style. Eat Weight Disord 2010; 15:e240-6. [PMID: 21406947 DOI: 10.1007/bf03325305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Individuals' ways of coping with psychological stress have often been associated with body weight regulation through their impact on eating behaviours. In particular, emotion-oriented and distraction-oriented coping styles have been steadily related to disordered eating. Couple dissatisfaction may be experienced as an important psychological stressor and could therefore affect eating behaviours through the use of inadequate coping strategies. The study proposes 1) to compare women reporting a low vs a high level of couple satisfaction, and 2) to test mediational models including couple satisfaction, coping styles, and eating variables. Analyses were performed among 65 overweight/obese premenopausal women who reported being weight-preoccupied. Women exhibiting couple dissatisfaction (34.8%) showed a higher level of EDE-Q restraint, more intense concerns about eating and shape, a higher level of disinhibition and susceptibility to hunger and endorsed more often a distraction-oriented coping style, independently of their body weight. Furthermore, distraction- oriented coping style seemed to be a valid mediator of the relation between couple dissatisfaction and eating behaviours. Since non-normative eating behaviours, namely disinhibition and susceptibility to hunger, have been particularly linked to a higher body weight status, it is relevant to extend the scope of interest to more distal contributing factors, such as couple dissatisfaction.
Collapse
|
26
|
Clyne C, Latner JD, Gleaves DH, Blampied NM. Treatment of emotional dysregulation in full syndrome and subthreshold binge eating disorder. Eat Disord 2010; 18:408-24. [PMID: 20865594 DOI: 10.1080/10640266.2010.511930] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The link between negative affect and binge eating in those with binge eating disorder (BED) has been well established. The present study examined the efficacy of a treatment for BED designed to increase recognition and regulation of negative emotion, replicating and extending a previous investigation (Clyne, C., & Blampied, N.M. [2004]. Training in emotion regulation as a treatment for binge eating: A preliminary study. Behaviour Change, 21, 269-281) by including a control group, a larger number of participants, and formal diagnoses rather than classifying binge eating symptomatology from self-report questionnaires. Twenty-three women diagnosed with subthreshold or full syndrome BED (using the Eating Disorders Examination) participated in a treatment program that focused on increasing emotional regulation skills. Each participant completed the Eating Disorders Examination Questionnaire, the Binge Eating Scale, the Emotional Eating Scale, and completed self-monitoring records of binge episodes. Binge abstinence rates following treatment (post-treatment and 1 year follow-up were 78% and 87% respectively) were comparable to other empirically supported treatments for BED. Other positive changes in eating and general pathology were observed. These effects were well-maintained up to 1 year later.
Collapse
Affiliation(s)
- Courtney Clyne
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | | | | |
Collapse
|
27
|
Wedig MM, Nock MK. The functional assessment of maladaptive behaviors: a preliminary evaluation of binge eating and purging among women. Psychiatry Res 2010; 178:518-24. [PMID: 20537726 DOI: 10.1016/j.psychres.2009.05.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 11/30/2022]
Abstract
This study applied a functional approach to the study of bingeing and purging behaviors. Based on a four-function theoretical model of bingeing and purging, it was hypothesized that these behaviors are performed because of their intrapersonally reinforcing (e.g., emotion regulation) and/or interpersonally reinforcing (e.g., help-seeking, attention-getting behavior) properties. Participants were 298 adult females who had engaged in bingeing or purging in the last 3 months and who provided data via an online survey of these behaviors. Confirmatory factor analyses revealed support for a four-function model of bingeing and purging in which people use these behaviors for intrapersonal reinforcement functions and also for interpersonal reinforcement. Understanding the functions of binge eating and purging has direct implications for assessment and treatment of these behaviors.
Collapse
Affiliation(s)
- Michelle M Wedig
- Department of Psychology, Harvard University, Cambridge, MA 02138, United States
| | | |
Collapse
|
28
|
Food for thought: examining the relationship between food thought suppression and weight-related outcomes. Eat Behav 2010; 11:175-9. [PMID: 20434065 DOI: 10.1016/j.eatbeh.2010.03.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 02/10/2010] [Accepted: 03/05/2010] [Indexed: 11/22/2022]
Abstract
The current study sought to extend previous eating behaviors and thought suppression literature by assessing the relationship between food thought suppression and weight-related outcomes. Three hundred and twelve overweight/obese community men and women completed self-report measures of thought suppression, weight history, and eating behaviors. Women were more likely than men to endorse food thought suppression, as were individuals who currently were dieting, when compared with those nondieters. Food thought suppression also predicted binge eating, food cravings, and other eating disordered symptoms. Results have implications for obesity and support further exploration of third wave interventions, such as Acceptance and Commitment Therapy and Mindfulness, in the treatment of obesity.
Collapse
|
29
|
Safer DL, Robinson AH, Jo B. Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behav Ther 2010; 41:106-20. [PMID: 20171332 PMCID: PMC3170852 DOI: 10.1016/j.beth.2009.01.006] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 01/14/2009] [Accepted: 01/19/2009] [Indexed: 11/18/2022]
Abstract
Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) aims to reduce binge eating by improving adaptive emotion-regulation skills. Preliminary findings have been promising but have only compared DBT-BED to a wait-list. To control for the hypothesized specific effects of DBT-BED, the present study compared DBT-BED to an active comparison group therapy (ACGT). Men and women (n=101) meeting DSM-IV BED research criteria were randomly assigned to 20 group sessions of DBT-BED (n=50) or ACGT (n=51). DBT-BED had a significantly lower dropout rate (4%) than ACGT (33.3%). Linear Mixed Models revealed that posttreatment binge abstinence and reductions in binge frequency were achieved more quickly for DBT-BED than for ACGT (posttreatment abstinence rate=64% for DBT-BED vs. 36% for ACGT) though differences did not persist over the 3-, 6-, and 12-month follow-up assessments (e.g., 12-month follow-up abstinence rate=64% for DBT-BED vs. 56% for ACGT). Secondary outcome measures revealed no sustained impact on emotion regulation. Although both DBT-BED and ACGT reduced binge eating, DBT-BED showed significantly fewer dropouts and greater initial efficacy (e.g., at posttreatment) than ACGT. The lack of differential findings over follow-up suggests that the hypothesized specific effects of DBT-BED do not show long-term impact beyond those attributable to nonspecific common therapeutic factors.
Collapse
Affiliation(s)
- Debra L Safer
- Stanford University, Dept. of Psychiatry and Behavioral Sciences, 401 Quarry Rd., MC 5722, Stanford, CA 94305, USA. dlsafer@stanford
| | | | | |
Collapse
|
30
|
Svaldi J, Brand M, Tuschen-Caffier B. Decision-making impairments in women with binge eating disorder. Appetite 2009; 54:84-92. [PMID: 19782708 DOI: 10.1016/j.appet.2009.09.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 08/06/2009] [Accepted: 09/18/2009] [Indexed: 11/17/2022]
Abstract
Even though eating is frequently driven by overindulgence and reward rather than by energy balance, few studies so far have analyzed decision-making processes and disturbances in feedback processing in women with binge eating disorder (BED). In an experimental study, 17 women with BED (DSM-IV) and 18 overweight healthy controls (HC) were compared in the game of dice task (GDT). This task assesses decision-making under risk with explicit rules for gains and losses. Additionally, differences in dispositional activation of the behavior inhibition and behavior approach system as well as cognitive flexibility were measured. Main results revealed that women with BED make risky decisions significantly more often than HC. Moreover, they show impaired capacities to advantageously utilize feedback processing. Even though these deficits were not related to disease-specific variables, they may be important for the daily decision-making behavior of women with BED, thus being relevant as a maintenance factor for the disorder.
Collapse
Affiliation(s)
- Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79106 Freiburg, Germany.
| | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE To examine the ability to regulate emotions in children with binge eating. METHOD A community sample of 60 children ages 8-13 with at least one episode of loss of control (LOC) eating during the past 3 months and a matched control group without LOC (n = 60) underwent a clinical interview (Eating Disorder Examination adapted for Children) and completed self-report questionnaires assessing emotion regulation strategies, eating pathology, and depressive symptoms. RESULTS Children with LOC eating made a significantly higher use of dysfunctional emotion regulation strategies (p < .01), especially for the regulation of anxiety (p < .01). Maladaptive strategies were associated with greater depressiveness (p < .001). Use of adaptive emotion regulation strategies did not differ between children with and without LOC eating. DISCUSSION Results document an association between LOC eating and difficulties in regulating negative emotions in children. Interventions targeting LOC eating in children should include training for coping with negative emotions.
Collapse
Affiliation(s)
- Julia Czaja
- Department of Psychology, Philipps University of Marburg, Marburg, Germany.
| | | | | |
Collapse
|
32
|
Finzi-Dottan R, Zubery E. The role of depression and anxiety in impulsive and obsessive-compulsive behaviors among anorexic and bulimic patients. Eat Disord 2009; 17:162-82. [PMID: 19242845 DOI: 10.1080/10640260802714654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Eating disorders are believed to range across a spectrum of varying degrees of obsessive-compulsive and impulsive behavior. Sixty anorexic (mean age = 19.8; sd = 5.9) and 109 bulimic (mean age = 26.9; sd = 11.3) female patients completed self-report questionnaires assessing obsessive-compulsiveness, impulsivity, depression and anxiety, as well as two eating disorder scales. Results yielded significantly higher levels of impulsivity and negative body image in the bulimic compared to the anorexic group. Regression analysis predicting impulsivity showed that bulimia and negative body image were the main contributors. Regression analysis for predicting obsessive-compulsive behavior suggested that depression and anxiety obscure the link between anorexia and obsessive-compulsive behavior, and a high BMI intensifies the association between anxiety and obsessive-compulsive behavior. The high rates of both impulsivity and obsessive-compulsiveness found in both groups, and their association with the severity of the eating disorder, may suggest that impulsivity and obsessive-compulsiveness are not mutually exclusive and can both be found among anorexic and bulimic patients.
Collapse
|
33
|
Krug I, Bulik CM, Vall-Llovera ON, Granero R, Agüera Z, Villarejo C, Jiménez-Murcia S, Fernández-Aranda F. Anger expression in eating disorders: clinical, psychopathological and personality correlates. Psychiatry Res 2008; 161:195-205. [PMID: 18838172 DOI: 10.1016/j.psychres.2007.10.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 07/04/2007] [Accepted: 10/04/2007] [Indexed: 12/01/2022]
Abstract
The goals of the study were to compare anger expressions in individuals with eating disorders and healthy controls, and to explore the relation among eating disorder symptoms, comorbid psychopathology, personality traits, and impulsive behaviours. Participants comprised 135 eating disorder patients consecutively admitted to our unit and 103 healthy controls. Assessment measures included the Eating Disorders Inventory 2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist-Revised (SCL-90-R), Social Avoidance Distress Scale (SAD), Temperament and Character Inventory-Revised (TCI-R), State-Trait Anger Expression Inventory 2 (STAXI-2), and other clinical and psychopathological indices. In the control group also the General Health Questionnaire-28 (GHQ-28) was also used. Women with eating disorders obtained significantly higher mean scores than controls on all STAXI-2 scales except for Anger Control. When various purging methods were assessed independently, the frequency of laxative use was associated with anger suppression. Eating disorder symptoms and specific personality traits were positively associated with different forms of anger expression. Finally, patients with higher scores on anger suppression were more likely to report self-harming behaviors. Eating disorder patients may have inadequate anger expression and deficits in coping with anger and frustration. Furthermore, different purging methods may be related to different facets of anger.
Collapse
Affiliation(s)
- Isabel Krug
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Safer DL, Couturier JL, Lock J. Dialectical Behavior Therapy Modified for Adolescent Binge Eating Disorder: A Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2007. [DOI: 10.1016/j.cbpra.2006.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
van Strien T, Ouwens MA. Effects of distress, alexithymia and impulsivity on eating. Eat Behav 2007; 8:251-7. [PMID: 17336795 DOI: 10.1016/j.eatbeh.2006.06.004] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 06/02/2006] [Accepted: 06/02/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To improve our understanding of possible mechanisms underlying emotional overeating this study examined the effects of a distress manipulation on food intake in relation to alexithymia and impulsivity. METHOD Participants were 86 females who were subjected to a distress manipulation (the anticipation of a public speaking task) prior to an ad lib taste task and filled out questionnaires on impulsivity and the alexithymia constructs difficulty identifying and describing feelings. RESULTS Alexithymia significantly (p<.05) moderated the relationship between food consumption and distress. Instead of eating less in the distress condition, alexithymic females ate the same or even more, this showing a 'biological unnatural' and 'inapt' response. CONCLUSION Findings suggest that for the 'natural' distress response (reduction of food intake) good ability to identify and describe feelings to others is required, and that the presence or absence of these abilities may predict which people respond to distress by undereating or by overeating. The results provide empirical support for Bruch's conceptualisation of poor interoceptive awareness as possible predictive factor for emotional overeating.
Collapse
Affiliation(s)
- Tatjana van Strien
- Behavioral Science Institute, Department of Clinical Psychology, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | | |
Collapse
|
36
|
Gilboa-Schechtman E, Avnon L, Zubery E, Jeczmien P. Emotional processing in eating disorders: specific impairment or general distress related deficiency? Depress Anxiety 2007; 23:331-9. [PMID: 16688732 DOI: 10.1002/da.20163] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The literature on eating disorders emphasizes the relationship between alexithymia and anorexia nervosa on the one hand, and between bulimia nervosa and affect dysregulation on the other. In our study, two questions are addressed: (1) Are there different patterns of emotional processing deficiencies in anorexia and bulimia? and (2) Is there a unique contribution of eating disorders to emotional processing deficiencies? Participants were women with anorexia nervosa (ANs, n=20), bulimia nervosa (BNs, n=20), and normal controls (NCs, n=20). Three hypotheses were examined: (1) Women with eating disorders will exhibit lower emotional awareness and more deficient emotional regulation than will NCs (emotional deficiency); (2) ANs will be less emotionally aware than BNs, whereas BNs will be less capable of effective emotional regulation than ANs (disorder specificity); and (3) emotional distress will mediate the relationships between emotional processing and eating disorders (emotional distress mediation). Results supported the emotional deficiency and distress mediation hypotheses, and partially supported the disorder specificity hypothesis. The need to move beyond alexithymia in understanding the pattern of emotional processing deficiencies in eating disorders is discussed.
Collapse
Affiliation(s)
- Eva Gilboa-Schechtman
- Department of Psychology and the Gonda Brain Research Center, Bar-Ilan University, Israel.
| | | | | | | |
Collapse
|
37
|
Spoor STP, Bekker MHJ, Van Strien T, van Heck GL. Relations between negative affect, coping, and emotional eating. Appetite 2006; 48:368-76. [PMID: 17145096 DOI: 10.1016/j.appet.2006.10.005] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 10/11/2006] [Accepted: 10/13/2006] [Indexed: 11/27/2022]
Abstract
The study was designed to examine the relations between negative affect, coping, and emotional eating. It was tested whether emotion-oriented coping and avoidance distraction, alone or in interaction with negative affect, were related to increased levels of emotional eating. Participants were 125 eating-disordered women and 132 women representing a community population. Measures included the Positive and Negative Affectivity Schedule (PANAS), the Coping Inventory for Stressful Situations (CISS), and the Dutch Eating Behavior Questionnaire (DEBQ). Both emotion-oriented coping and avoidance distraction were related to emotional eating, while controlling for levels of negative affect. Negative affect did not have a unique contribution to emotional eating over and above emotion-oriented coping or avoidance distraction. The findings suggest that emotional eating is related to reliance on emotion-oriented coping and avoidance distraction in eating-disordered women as well as in relatively healthy women.
Collapse
Affiliation(s)
- Sonja T P Spoor
- Department of Psychology, University of Texas at Austin, TX, USA.
| | | | | | | |
Collapse
|
38
|
Tailoring Cognitive Behavioral Therapy for Individuals Diagnosed with Bulimia Nervosa. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2005. [DOI: 10.1007/s10879-005-6695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
39
|
Wisniewski L, Kelly E. The application of dialectical behavior therapy to the treatment of eating disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2003. [DOI: 10.1016/s1077-7229(03)80021-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Abstract
Cognitive-behavioral treatments are the most commonly used approaches for bulimia nervosa. However, these treatments tend to produce only moderate remission rates. Therefore, it is useful to consider how experimental cognitive approaches can help to revise current cognitive-behavioral models of bulimia. Information processing models highlight the role of attentional biases and schema avoidance in the etiology and maintenance of pathology. This review considers how these processes relate to bulimia. In particular, a growing body of evidence suggests that bulimic behaviors may function to "block" aversive self-awareness. Blocking behaviors also feature strongly in other impulsive disorders. This review considers the relationship between bulimia and impulsivity, and discusses whether the functions of the two behaviors are the same. The clinical implications and future research needs that arise from this literature are discussed.
Collapse
|
41
|
le Grange D, Gorin A, Dymek M, Stone A. Does ecological momentary assessment improve cognitive behavioural therapy for binge eating disorder? A pilot study. EUROPEAN EATING DISORDERS REVIEW 2002. [DOI: 10.1002/erv.469] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
42
|
Abstract
OBJECTIVE This case report describes the application of dialectical behavior therapy (DBT) to the treatment of bulimia nervosa in a 20-session manualized therapy. METHOD The treatment, based on an affect regulation model of eating disorders, was developed to teach emotion regulation skills to replace eating-disordered behaviors. The patient, a 36-year-old woman, had a long history of binge eating and purging that had not responded to 2 years of counseling. In the 4 weeks before treatment began, she reported 13 objective binges and 21 purging episodes. RESULTS AND DISCUSSION Upon initiating DBT, her binge eating and purging rapidly declined. She achieved abstinence by the fifth week of treatment and maintained it through treatment. In the 6 months following treatment, she reported a total of two objective binge episodes and two purge episodes.
Collapse
Affiliation(s)
- D L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5722, USA
| | | | | |
Collapse
|
43
|
Abstract
OBJECTIVE Although there are well-established links between bulimic psychopathology and some affective states, the role of anger is not clearly understood. This is likely to be a product of the diverse nature of anger. The present study examines the association of different components of anger with bulimic attitudes and behaviors among a nonclinical group of women. METHODS Eighty-three nonclinical women completed standardized measures of anger and bulimic attitudes/behaviors. RESULTS Bulimic attitudes and behaviors were correlated specifically with state anger and anger suppression, rather than with trait anger. The pattern of results suggests that binging and vomiting behaviors may serve different functions with regard to anger. CONCLUSIONS Bulimic attitudes and behaviors appear to reduce immediate anger states, particularly when the individual has a strong tendency to avoid expressing that emotion. Potential therapeutic implications are considered.
Collapse
Affiliation(s)
- R J Milligan
- Department of Psychology, Royal Holloway, University of London, Southampton, United Kingdom.
| | | |
Collapse
|
44
|
Abstract
The use of different coping strategies, measured by the Ways of Coping Questionnaire was investigated among 1157 women (18 to 30 years), randomly selected from the general population of Sweden as part of a longitudinal study. Subjects were clustered into five groups: subjects with past or current eating disorders (ED), and subjects with no ED but with past, current, or no history of dieting. Subjects with past or current ED reported significantly higher levels of escape avoidance and lower levels of seeking social support and purposeful problem solving compared with subjects with neither ED nor dieting. These group comparisons were then reanalyzed with sum of depressive symptoms as a covariate in covariate analyses. The only significant difference between the groups concerned the use of escape avoidance. The significant differences in the use of escape-avoidance strategies may motivate more extensive training in coping in the context of prevention and treatment of ED and maladaptive dieting.
Collapse
Affiliation(s)
- A Ghaderi
- Department of Psychology, Uppsala University, Sweden
| | | |
Collapse
|
45
|
Arnow BA. Eating disorders. Introduction. J Clin Psychol 1999; 55:669-74. [PMID: 10445858 DOI: 10.1002/(sici)1097-4679(199906)55:6<669::aid-jclp1>3.0.co;2-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- B A Arnow
- Department of Psychiatry & Behavioral Sciences, Stanford University Medical Center, CA 94305-5722, USA
| |
Collapse
|