Recurrent overeating: an empirical comparison of binge eating disorder, bulimia nervosa, and obesity

Microbiota-gut-brain axis drives overeating disorders

Overeating disorders (ODs), usually stemming from dieting history and stress, remain a pervasive issue in contemporary society, with the pathological mechanisms largely unresolved. Here, we show that alterations in intestinal microbiota are responsible for the excessive intake of palatable foods in OD mice and patients with bulimia nervosa (BN). Stress combined with a history of dieting causes significant changes in the microbiota and the intestinal metabolism, which disinhibit the vagus nerve terminals in the gut and thereby lead to a subsequent hyperactivation of the gut-brain axis passing through the vagus, the solitary tract nucleus, and the paraventricular nucleus of the thalamus. The transplantation of a probiotic Faecalibacterium prausnitzii or dietary supplement of key metabolites restores the activity of the gut-to-brain pathway and thereby alleviates the OD symptoms. Thus, our study delineates how the microbiota-gut-brain axis mediates energy balance, unveils the underlying pathogenesis of the OD, and provides potential therapeutic strategies.

Psychometric properties and normative values of the revised demoralization scale (DS-II) in a representative sample of the German general population

BACKGROUND

Demoralization is a clinically relevant syndrome in chronic diseases. The demoralization scale (DS-II) was recently developed as an economic screening tool in clinical populations. Main aim of this study was to provide normative data of DS-II scores in the general population.

METHODS

We developed a new German version, the DS-II Münster, and tested internal consistency as well as the previously proposed two-factor structure with confirmatory factor analyses. The DS-II was applied in a household survey of the general population. Associations between DS-II scores and age, gender and other sociodemographic variables were explored.

RESULTS

The final sample consisted of N = 2471 participants (mean age = 49.8 years, range: 18-96; 50.1% men, 49.8% women). The DS-II Münster showed nearly excellent internal consistency. The model fit indices of the two-factor structure were not superior to those of the one-factor model. Mean scores of the DS-II were as follows. Total score: M = 3.76 (SD = 5.56), Meaning and Purpose subscale: M = 1.65 (SD = 2.77), Distress and Coping Ability subscale: M = 2.11 (SD = 3.02). DS-II scores were increased in women with an effect size of Cohen's d = 0.19. An age-related increase was specifically found for the Meaning and Purpose subscale (d = 0.21).

CONCLUSIONS

The study provides normative values of the DS-II with respect to age and gender in the general population to facilitate interpretation of DS-II scores in clinical samples. A DS-II total score > 5 is suggested as a cut-off value. The findings further our understanding of significant symptom burden that was previously suggested in young patients with cancer.

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

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

The role of body image in obese identity changes post bariatric surgery

PURPOSE

Body image is a multidimensional construct that encompasses perceptions about body size, emotions, and cognition about physical appearance. Obese identity is related to body image in the lifetime, and according to scientific literature body image dissatisfaction among obese patient persist after bariatric surgery. The objective of this review is to examine the body image changes in patients with obesity pre-and post-bariatric surgery.

METHODS

We have carried out a systematic review of literature on PubMed. Initially, 169 publications have been identified, but in total, in compliance with inclusion and exclusion criteria, 15 studies have been analyzed.

RESULTS

According to the examined literature, body image does not change after bariatric surgery. These patients will be difficult to adapt for a new body, because there is a persistent obese view of self. Furthermore, ex-obese patients are dissatisfied with the excessive skin after bariatric surgery. Excessive body weight, and negative self-image are replaced with dissatisfaction with excessive skin, and the factors associated with body image stability are still unknown.

CONCLUSION

Literature examination raises the issue of body image dissatisfaction, but does not explain why it varies so widely across bariatric patients. Obese identity is related to body image across the lifetime and is an important factor of post-surgical outcomes. Longitudinal studies based on ideal body image pre- and post- bariatric surgery and evidence-based controlled studies on psychotherapeutic treatment for body image dissatisfaction are strongly recommended. Psychotherapy could improve body image quality and wellbeing.

LEVEL I

Evidence obtained from: systematic reviews of experimental studies.

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

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

Emotional eating and temperamental traits in Eating Disorders: A dimensional approach

Growing evidence shows that temperamental features and emotional dysregulation are linked to Eating Disorders (EDs). Aim of this study was to explore the possible relationship between temperament and emotional eating (EE) from a dimensional standpoint, and the association of specific temperamental dimensions with overeating triggered by specific emotions. We enrolled 253 women with Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Of those, 189 (74.7%), 73 (28.8%), and 80 (31.6%) reported binge eating, purging, or restrictive behaviors, respectively (the categories are not mutually exclusive). Participants completed the Emotional Eating Scale (EES), the Temperament and Character Inventory, the Eating Disorder Examination Questionnaire (EDE-Q) and the Symptom Checklist 90-Revised (SCL-90-R). Higher Persistence scores were found in the Restriction group, while the Binge group reported lower Persistence and higher Novelty Seeking scores. The Purge group showed lower Reward Dependence, Self Directedness and Cooperativeness scores. Patients with Purge also reported lower BMI and higher scores on EDE-Q restriction and eating concern subscales as well as higher scores for all SCL 90-R subscales. Patterns of association between temperamental traits and specific emotions were found in each group. Therefore, some temperamental features could be considered predictors of specific associations between emotions and the tendency to eat.

The importance of body image concerns in overweight and normal weight individuals with binge eating disorder

Body image concerns in binge eating disorder (BED) have been examined almost exclusively in overweight individuals with BED. The current study extends past research by including overweight and normal weight BED and non-BED groups to assess the multifactorial construct of body image using subscales of the Eating Disorder Examination 16.0 (EDE-16.0) and a Body Comparison Task. Independent of weight status and when controlling for age and race, women with BED are distinguished from those without BED by significantly greater overvaluation of shape and weight on the EDE-16.0 and significantly reduced weight satisfaction after a Body Comparison Task. Both BED diagnosis and weight status were independently associated with Weight Concern and Shape Concern subscales on the EDE-16.0. Taken together, these data provide further support for the consideration of body image concerns in the diagnostic criteria for BED.

Arcuate nucleus homeostatic systems reflect blood leptin concentration but not feeding behaviour during scheduled feeding on a high-fat diet in mice

Hypothalamic homeostatic and forebrain reward-related genes were examined in the context of scheduled meal feeding without caloric restriction in C57BL/6 mice. Mice fed ad libitum but allowed access to a palatable high-fat (HF) diet for 2 hours a day rapidly adapted their feeding behaviour and consumed approximately 80% of their daily caloric intake during this 2-hour scheduled feed. Gene expression levels were examined during either the first or second hour of scheduled feeding vs 24 hours ad libitum feeding on the same HF diet. Gene expression of neuropeptide Y, agouti-related peptide, cocaine- and amphetamine-regulated transcript, pro-opiomelanocortin, long-form leptin receptor and suppressor of cytokine signalling-3 in the hypothalamic arcuate nucleus (ARC), as well as enkephalin, dynorphin, dopamine-2-receptor and dopamine-3-receptor in the nucleus accumbens (NAcc) in the forebrain, were measured by in situ hybridisation. Mice fed ad libitum on a HF diet had the highest total caloric intake, body weight gain, fat mass and serum leptin, whereas schedule-fed mice had a mild obese phenotype with intermediate total caloric intake, body weight gain, fat mass and serum leptin. The effects of feeding regime on ARC gene expression were emphasised by significant positive or negative correlations with body weight gain, fat mass and blood leptin, although they did not appear to be related to feeding behaviour in the schedule-fed groups (ie, the large, binge-type meals) and did not reveal any potential candidates for the regulation of these meals. Mechanisms underlying large meal/binge-type eating may be regulated by nonhomeostatic hedonic processes. However, assessment of opioid and dopamine receptor gene expression in the NAcc did not reveal evidence of involvement of these genes in regulating large meals. This complements our previous characterisation of ARC and NAcc genes in schedule-fed mice and rats, although it still leaves open the fundamental question about the underlying mechanisms of meal feeding.

Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder: a pilot study

BACKGROUND

Although not part of the diagnostic criteria of the DSM-5, body image disturbance seems to be a relevant feature of Binge Eating Disorder (BED) as well as of other eating disorders such as Anorexia Nervosa (AN) or Bulimia Nervosa (BN). Hence, the aim of the present pilot study was to assess the changeability of body image disturbance in a sample of overweight females with BED by a cognitive-behavioral treatment, directly addressing body image disturbance.

METHOD

Overweight females (N = 34) with BED were randomized to a manualized body image therapy or a waiting-list control group. The final sample consisted of n = 15 participants in the intervention group and n = 19 in the control group due to two drop-outs in the control condition. Before and after the intervention or the waiting period, respectively, participants filled out a questionnaire battery assessing several body image and eating disorder related features. To quantify the perceptual component of body image disturbance, a digital photo distortion technique based on a picture of each participant taken in a standardized suit was applied.

RESULTS

In a two-way ANOVA, significant Time × Group interactions were found for eating and shape concerns, drive for thinness, body dissatisfaction, depressiveness and low self-esteem. Follow-up t-tests indicated a significant symptom reduction of a generally high magnitude in the intervention group. No significant changes concerning body checking and the estimations of one's own "real", "felt" and "ideal" body dimensions were found.

CONCLUSION

The strong symptom reduction in the cognitive-affective component of body image disturbance indicates that an exposure-based cognitive-behavioral body image intervention is a promising treatment module for overweight females with BED, but future research with a larger sample size is needed to quantify possible changes in all components of body image.

Psychometric Properties of the Eating Disorders Inventory-2 among Women Seeking Treatment for Binge Eating Disorder

Psychometric properties of the Eating Disorders Inventory-2 (EDI-2) when used for women with Binge Eating Disorder (BED) are assessed. The EDI-2 was administered to 144 outpatients seeking treatment for BED and 152 outpatients seeking treatment for Bulimia Nervosa (BN). Most EDI-2 scales had acceptable internal consistence for both the BED and BN samples. EDI-2 scales demonstrated adequate stability within a subsample of those with BED who were retested. Confirmatory factor analyses revealed a hypothesized second-order two-factor structure for the original EDI scales for the BED group but not for those with BN. When the provisional EDI-2 scales were included, a two-factor structure was not supported for any group. Some scales differentiated the BED from the BN sample, and the second-order factors correlated with measures of similar constructs. The original EDI scales can be used reliably for those with BED.

Body image disturbance in binge eating disorder: a comparison of obese patients with and without binge eating disorder regarding the cognitive, behavioral and perceptual component of body image

Whereas the manifestation of body image disturbance in binge eating disorder (BED) has been intensively investigated concerning the cognitive-affective component, with regard to the behavioral and the perceptual components of body image disturbance in BED, research is limited and results are inconsistent. Therefore, the present study assessed body image disturbance in BED with respect to the different components of body image in a sample of obese females (n = 31) with BED compared to obese females without an eating disorder (n = 28). The Eating Disorder Inventory-2, the Eating Disorder Examination-Questionnaire, the Body Image Avoidance Questionnaire and the Body Checking Questionnaire as well as a Digital Photo Distortion Technique based on a picture of each participant taken under standardized conditions were employed. Using two-sample t tests, we found that the participants with BED displayed significantly greater impairments concerning the cognitive-affective component of body image than the control group. Concerning the behavioral component, participants with BED reported more body checking and avoidance behavior than the controls, but group differences failed to reach significance after the Bonferroni corrections. Regarding the perceptual component, a significant group difference was found for the perceived "ideal" figure, with the individuals suffering from BED displaying a greater wish for a slimmer ideal figure than the control group. These results support the assumption that body image disturbance is a relevant factor in BED, similar to other eating disorders.

Pharmacological approaches to the management of binge eating disorder

In the USA, binge eating disorder (BED) is the most common eating disorder, with a lifetime prevalence of ~3.5 % in adult women, 2.0 % in adult men, and 1.6 % in adolescents. BED is characterized by frequent episodes of binge eating that are accompanied by a sense of loss of control over eating and result in marked psychological distress. BED is highly co-morbid with obesity and with depression and other psychiatric conditions, and it is associated with substantial role impairment. Currently, there are no US FDA-approved pharmacological treatments for BED. Animal and human studies implicate underlying dysregulation in dopamine, opioid, acetylcholine, and serotonin neurocircuitry within brain reward regions in the pathogenesis and maintenance of BED. To date, the efficacy of various agents that target these and other neurotransmitter systems involved in motivated feeding behavior, mood regulation, and impulse control have been investigated in the treatment of BED. Several antidepressant and anticonvulsant agents have demonstrated efficacy in reducing binge eating frequency, but only in limited cases have these effects resulted in patients achieving abstinence, which is the primary goal of treatment; they also range from less (fluvoxamine) to more (topiramate) effective in achieving weight loss that is both clinically meaningful and significantly greater than placebo. Collectively, the literature on pharmacological treatment approaches to BED is limited in that very few agents have been studied in multiple, confirmatory trials with adequate follow up, and almost none have been evaluated in large patient samples that are diverse with respect to age, sex, and ethnicity. In addition, prior trials have not adequately addressed, through study design, the high placebo response commonly observed in this patient population. Several novel agents are in various phases of testing, and recent animal studies focusing on glutamate-signaling circuits linking the amygdala to the lateral hypothalamus offer new avenues for exploration and potential therapeutic development. Studies of newly FDA-approved medications for long-term obesity treatment and further explorations of dietary supplements and neutraceuticals with appetite- and mood-altering properties may also be worthwhile.

Demoralization: a systematic review on its clinical characterization

BACKGROUND

Demoralization has been described as a psychological state characterized by helplessness, hopelessness, a sense of failure and the inability to cope.

METHODS

We conducted a systematic review with qualitative data analysis following PRISMA criteria with the following aims: to review validated assessment instruments of the demoralization syndrome, report main findings regarding demoralization as measured by validated instruments that emerge in the literature, compare and report evidence for the clinical utility of the identified instruments. Utilizing the key word 'demoralization' in PubMed and PsycINFO databases, an electronic search was performed, supplemented by Web of Science and manual searches. Study selection criteria included the assessment of medical patients and use of instruments validated to assess demoralization. Seventy-four studies were selected.

RESULTS

Four instruments emerged in the literature. Main findings concern prevalence rates of demoralization, evidence of discriminant validity from major depression, factors associated with demoralization and evidence of clinical utility. The instruments vary in their definition, the populations they aim to assess, prevalence rates they estimate and their ability to discriminate between different conditions. Nonetheless, demoralization appears to be a distinctive psychological state characterized by helplessness, hopelessness, giving up and subjective incompetence. It is not limited to life-threatening diseases such as cancer, but may occur in any type of clinical situation. It is associated with stress and adverse health outcomes.

CONCLUSIONS

Studies addressing the incremental value of demoralization in psychiatry and psychology are needed. However, demoralization appears to entail specific clinical features and may be a distinct condition from major depression.

Understanding the link between body image and binge eating: a model comparison approach

PURPOSE

The present study tests several competing, explanatory models-dual pathways, escape from awareness, and objectification theory-for the established link between body dissatisfaction and binge eating.

METHODS

408 women aged between 18 and 40 years completed a survey designed to assess contributions of proposed mediators (dietary restraint and negative affect from the dual pathway model, self-distraction from the escape from awareness model, and interoceptive deficits from objectification theory) for the body dissatisfaction-binge eating relationship.

RESULTS

Although mediation analyses supported the dual pathway model and objectification theory when tested separately, the dual pathway model most strongly predicted the body dissatisfaction-binge eating relationship. Both model-implied mediators (dietary restraint and negative affect) made significant unique contributions, accounting for roughly one-quarter of the shared variance between body dissatisfaction and binge eating when tested separately from other mediators. Improvements in variance explained were negligible once other proposed mediators were included in a test of models combined.

CONCLUSIONS

Collectively, these findings suggest the superiority of the dual pathway model over objectification theory and the escape model, but the remaining unaccounted for covariance suggests need to consider alternative mechanisms that may also account for the relationship between body dissatisfaction and binge eating.

Family Environment and Psychiatric History in Women with Binge-eating Disorder and Obese Controls

We examined the prevalence of comorbid psychopathology, family psychiatric history, and perceptions of family environment in 20 women with binge-eating disorder (BED) and 20 non-binge-eating obese controls. Women with BED were significantly more likely to report current or lifetime affective and anxiety disorders as well as family histories of BED. Family histories of substance abuse did not differ across groups. Significantly more women with BED rated their parents' parenting style as consistent with “affectionless control” on the Parental Bonding Instrument, and reported significantly lower cohesion, expressiveness, conflict, independence, intellectual-cultural orientation, and active-recreational orientation on the Family Environment Scale.

Bulimia nervosa-nonpurging subtype: closer to the bulimia nervosa-purging subtype or to binge eating disorder?

OBJECTIVE

DSM-5 has dropped subtyping of bulimia nervosa (BN), opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype (BN-NP) within a broad BN category. Some contend however that BN-NP is more like binge eating disorder (BED) than BN-P. This study examines clinical characteristics, eating disorder symptomatology, and Axis I comorbidity in BN-NP, BN-P, and BED groups to establish whether BN-NP more closely resembles BN-P or BED.

METHOD

Women with BN-P (n = 29), BN-NP (n = 29), and BED (n = 54) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating. Measures included the Structured Clinical Interviews for DSM-IV, Eating Disorder Examination, and Eating Disorder Inventory-2.

RESULTS

The BN-NP subtype had BMIs between those with BN-P and BED. Both BN subtypes had higher Restraint and Drive for Thinness scores than BED. Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P. Higher Restraint and lower BMI predicted BN-NP relative to BED. BN-NP resembled BED with higher lifetime BMIs; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype. Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype

DISCUSSION

These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment. These results support retaining the BN-NP group within the BN category. Further research is needed to determine whether there are meaningful differences in outcome over follow-up.

A phenotypic structure and neural correlates of compulsive behaviors in adolescents

BACKGROUND

A compulsivity spectrum has been hypothesized to exist across Obsessive-Compulsive disorder (OCD), Eating Disorders (ED), substance abuse (SA) and binge-drinking (BD). The objective was to examine the validity of this compulsivity spectrum, and differentiate it from an externalizing behaviors dimension, but also to look at hypothesized personality and neural correlates.

METHOD

A community-sample of adolescents (N=1938; mean age 14.5 years), and their parents were recruited via high-schools in 8 European study sites. Data on adolescents' psychiatric symptoms, DSM diagnoses (DAWBA) and substance use behaviors (AUDIT and ESPAD) were collected through adolescent- and parent-reported questionnaires and interviews. The phenotypic structure of compulsive behaviors was then tested using structural equation modeling. The model was validated using personality variables (NEO-FFI and TCI), and Voxel-Based Morphometry (VBM) analysis.

RESULTS

Compulsivity symptoms best fit a higher-order two factor model, with ED and OCD loading onto a compulsivity factor, and BD and SA loading onto an externalizing factor, composed also of ADHD and conduct disorder symptoms. The compulsivity construct correlated with neuroticism (r=0.638; p ≤ 0.001), conscientiousness (r=0.171; p ≤ 0.001), and brain gray matter volume in left and right orbitofrontal cortex, right ventral striatum and right dorsolateral prefrontal cortex. The externalizing factor correlated with extraversion (r=0.201; p ≤ 0.001), novelty-seeking (r=0.451; p ≤ 0.001), and negatively with gray matter volume in the left inferior and middle frontal gyri.

CONCLUSIONS

Results suggest that a compulsivity spectrum exists in an adolescent, preclinical sample and accounts for variance in both OCD and ED, but not substance-related behaviors, and can be differentiated from an externalizing spectrum.

Loss of control over eating: a description of the eating disorder/obesity spectrum in women

GOALS

This study aimed to analyse the association, commonalities and differences between obesity and eating disorders (ED).

METHOD

A total of 150 female patients [50 obese with bulimia nervosa (OB + BN), 50 obese with binge eating disorders (OB + BED), 50 obese without eating disorders (OB)] and 50 female healthy-eating/weight control (CG) volunteers participated in this study.

ASSESSMENT

All participants were assessed by the Eating Disorders Inventory-2 (EDI-2), the Symptom Checklist-Revised (SCL-90-R) and the Temperament and Character Inventory-Revised.

RESULTS

In general, all the groups differed significantly and showed linear trends (OB + BN > OB + BED > OB > CG) on general and eating psychopathology (SCL-90-R and EDI-2). Regarding personality traits, statistically significant differences across all four groups were found on Harm Avoidance and Self-Directedness. Whereas some symptoms were shared in extreme weight conditions, others were specifically related to ED.

CONCLUSIONS

The presence of binge and purge symptomatology in obese patients is clinically relevant. These findings help to understand the relationship between Obesity and ED.

Differentiating purging and nonpurging bulimia nervosa and binge eating disorder

OBJECTIVE

To explore similarities and differences in clinical and personality variables across three groups: binge eating disorder (BED), bulimia nervosa-purging type (BN-P), and bulimia nervosa-non purging type (BN-NP).

METHOD

The participants were 102 female eating disorders patients (34 BED, 34 BN-P, and 34 BN-NP) consecutively admitted to the eating disorders unit, at the University Hospital of Bellvitge, and diagnosed according to DSM-IV criteria.

RESULTS

BED patients were older, and more likely to have personal and family history of obesity. A gradient in psychopathological scores emerged with BN-P patients having higher pathological scores on the SCL-90-R, followed by BN-NP and BED patients. No statistically significant differences were observed in personality traits.

DISCUSSION

Our data supported that eating disorders (namely BED, BN-NP, and BN-P) followed a linear trend in general psychopathology. Whereas personality may represent a shared vulnerability factor, differences in clinical severity suggest there to be a continuum with BN-P being the most severe and BED being the least severe.

Differences in the nature of body image disturbances between female obese individuals with versus without a comorbid binge eating disorder: an exploratory study including static and dynamic aspects of body image

Various components of body image were measured to assess body image disturbances in patients with obesity. To overcome limitations of previous studies, a photo distortion technique and a biological motion distortion device were included to assess static and dynamic aspects of body image. Questionnaires assessed cognitive-affective aspects, bodily attitudes, and eating behavior. Patients with obesity and a binge eating disorder (OBE, n = 15) were compared with patients with obesity only (ONB; n = 15), to determine the nature of any differences in body image disturbances. Both groups had high levels of body image disturbances with cognitive-affective deficits. Binge eating disorder (BED) participants also had perceptual difficulties (static only). Both groups reported high importance of weight and shape for self-esteem. There were some significant differences between the groups suggesting that a comorbid BED causes further aggravation. Body image interventions in obesity treatment may be warranted.

Validity of self-reported body weight and height among women including patients with eating disorders

The main objective of this study was to evaluate the accuracy of self-reported weight and height among women with eating disorders. The study sample consisted of 271 women aged 18-50 yrs: 73 anorexic patients (AN) with a body mass index (BMI) of <18.50 kg/m2, 54 normal weight bulimic or rehabilitated patients (BU/RE: 18.5<BMI<25), 38 overweight/ obese women (OW/OB: BMI> or =25 kg/m2) and 106 normal weight women without an eating disorder (NW: 18.5<BMI<25). Their self-reported body weight (BW) and height were recorded during an interview, and measured using standard procedures, and their self-reported and measured BMI was calculated (kg/m2). In comparison with the measured data, the AN patients tended to overestimate their body weight by 0.48+/-2.05 kg (p<0.05), whereas the OW/OB and BU/RE patients underestimated it (OW/OB: -1.52+/-3.21 kg, p=0.006; BU/RE: -1.12+/-2.60 kg, p=0.003). All of the groups overestimated height by at least 1 cm, and the OW/OB group overestimated it by 2.31+/-2.94 (p=0.00000). These differences were reflected in the significant underestimate of BMI by all groups except the AN patients. Pearson's correlation coefficients between the self-reported and measured variables ranged from 0.95 to 0.98. The results of a Bland & Altman analysis showed that the underestimates of weight and BMI were related to the magnitude of the values (BW: r=-0.24, p<0.000078; BMI: r=-0.37, p<0.00000), the differences being greater with increasing values of weight and BMI; sensitivity as greater for the AN patients. The self-reported data led to a significant misclassification of body mass categories, especially among the BU/RE and OW/OB subjects. Our results show that the over-reporting of height and under-reporting of body weight led to significant underestimates of BMI. The AN subjects seemed to know their weight quite well, whereas the BU/RE and OW/OB women significantly underestimated it. On the basis of these findings, measured weight and height should always be preferred to self-reported values.

The validity and clinical utility of binge eating disorder

OBJECTIVE

This review attempted to examine the validity and clinical utility of the DSM-IV binge eating disorder (BED) diagnosis across a wide range of validating strategies.

METHOD

Various electronic databases (Pub Med, Psych Info) were searched for terms relevant to the diagnosis of BED (e.g., binge eating disorder, binge eating) in order to identify papers. Additionally, published papers were reviewed in order to locate additional manuscripts and papers that were presented at meetings.

RESULTS

The validity and utility of BED varied substantially according to the validator chosen. There is reasonable evidence that BED can be differentiated from other existing eating disorders and is associated with significant impairment and clinical levels of eating disorder psychopathology. The relationship of BED to obesity is complex, and in spite of some positive findings, further research examining the predictive power of BED, beyond the simple presence of obesity and associated psychopathology, in relationship to clinically relevant outcomes is needed.

DISCUSSION

Binge eating disorder is being considered for inclusion in the DSM-V and various options regarding this decision are reviewed based upon the empirical findings in the paper.

Eating beyond satiety and body mass index

OBJECTIVE

To examine discrete eating behaviours as predictors of body mass and psychological processes through which these behaviours might lead to increased body mass.

METHOD

Three hundred and twenty-nine undergraduate females filled out questionnaires on eating beyond satiety (EBS), snacking, night eating, and hunger as well as the process variables--eating expectancies and self-reported cue reactivity--in an online study. The eating behaviours were regressed on body mass index and mediation analyses were conducted for the process variables.

RESULTS

EBS was the strongest predictor of body mass when the other eating behaviours were controlled. The process variables did not mediate the relationship between EBS and body mass.

DISCUSSION

EBS may be a discrete variable on which to intervene to prevent and treat overweight and obesity. Further research is needed to elucidate the situational and affective antecedents of EBS.

Test meal intake in obese binge eaters in relation to impulsivity and compulsivity

OBJECTIVE

Studies have linked increased impulsivity and compulsivity with bulimia nervosa (BN). Less is known about this relationship in binge eating disorder (BED).

METHOD

Seventy-nine overweight participants (28 male, 65 females) were classified as BED (n = 22), BE (Subthreshold BED, not meeting full criteria for BED) (n = 21), and non-BED (n = 36). Following an 8-hr fast, participants completed psychological scales to assess impulsivity, compulsivity, and depression. They then consumed a liquid test meal until extremely full.

RESULTS

Test meal intake (TMI) was significantly greater for both BED and BE than non-BED participants. Impulsivity and depression scores were significantly higher in BED and BE than in non-BED participants. Men had significantly higher compulsivity scores than women. Impulsivity correlated significantly with TMI, accounting for 16% of the variance.

CONCLUSION

There was greater impulsivity in BED and BE, compared with non-BED. Moreover, impulsivity was the best predictor of TMI, and may play a larger role in BE than previously realized.

Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa

OBJECTIVE

To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN).

METHOD

Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating.

RESULTS

In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress.

CONCLUSION

Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood.

Recurrent binge eating (RBE) and its characteristics in a sample of young women in Germany

OBJECTIVE

To examine the characteristics of recurrent binge eating (RBE) in a non-treatment-seeking sample from the general population. RBE individuals are described in terms of socio-economic status, general psychopathology, and comorbidity rates of mental disorders.

METHOD

Participants were 1877 German females aged 18-24 years from a population-based epidemiological study.

RESULTS/DISCUSSION

The point prevalence of RBE in our sample was 0.9% (N = 17). Compared to healthy women, subjects with RBE suffered more often from comorbid mental disorders and also exhibited more general psychopathology: They were similar to women with other mental disorders and other eating disorders (EDs). RBE seems to be a syndrome of clinical significance itself and might be an important risk factor for the development of further EDs, especially binge eating disorder (BED) and other mental disorders.

An empirical comparison of atypical bulimia nervosa and binge eating disorder

The International Classification of Diseases, 10th edition (ICD-10) defines atypical bulimia nervosa (ABN) as an eating disorder that encompasses several different syndromes, including the DSM-IV binge eating disorder (BED). We investigated whether patients with BED can be differentiated clinically from patients with ABN who do not meet criteria for BED. Fifty-three obese patients were examined using the Structured Clinical Interview for DSM-IV and the ICD-10 criteria for eating disorders. All volunteers completed the Binge Eating Scale (BES), the Beck Depression Inventory, and the Symptom Checklist-90 (SCL-90). Individuals fulfilling criteria for both ABN and BED (N = 18), ABN without BED (N = 16), and obese controls (N = 19) were compared and contrasted. Patients with ABN and BED and patients with ABN without BED displayed similar levels of binge eating severity according to the BES (31.05 +/- 7.7 and 30.05 +/- 5.5, respectively), which were significantly higher than those found in the obese controls (18.32 +/- 8.7; P < 0.001 and P < 0.001, respectively). When compared to patients with ABN and BED, patients with ABN without BED showed increased lifetime rates of agoraphobia (P = 0.02) and increased scores in the somatization (1.97 +/- 0.85 vs 1.02 +/- 0.68; P = 0.001), obsessive-compulsive (2.10 +/- 1.03 vs 1.22 +/- 0.88; P = 0.01), anxiety (1.70 +/- 0.82 vs 1.02 +/- 0.72; P = 0.02), anger (1.41 +/- 1.03 vs 0.59 +/- 0.54; P = 0.005) and psychoticism (1.49 +/- 0.93 vs 0.75 +/- 0.55; P = 0.01) dimensions of the SCL-90. The BED construct may represent a subgroup of ABN with less comorbities and associated symptoms.

Adipositas im Kindes- und Jugendalter:

Zusammenfassung. Adipöse Kinder und Jugendliche gelten als Risikogruppe für die Entwicklung von psychosozialen Belastungen, den Einsatz von gesundheitsschädigenden Gewichtskontrollmaßnahmen sowie auffällige Essverhaltensweisen. Dennoch ist relativ wenig über das Auftreten von Heißhungerattacken (“binging“) und Binge Eating Disorder (BED) bei dieser Gruppe bekannt. Die folgende Studie untersuchte bei 156 adipösen Kindern und Jugendlichen (im Alter zwischen 11 und 18 Jahren) die selbstberichtete Verbreitung von “binging“ und BED. Im zweiten Schritt wurde untersucht, inwieweit sich “Binger“ von “non-Bingern“ in der Störbarkeit ihres Essverhaltens, ihrem Selbstkonzept, dem Erleben von Hänseleien und dem Umgang damit unterscheiden, wobei eine erhöhte Auffälligkeit der Binger vermutet wurde. Die Kinder beantworteten ein Fragebogenpaket mit folgenden Instrumenten: QEWP-A (essgestörtes Verhalten), POTS (Hänseleien), Auslöser für Essverhalten, Fragebogen zur Problembewältigung und FSK-K (Selbstkonzept). Die Auftretenshäufigkeit der BED lag bei 3.8%. Insgesamt berichteten jedoch 12.8% der Kinder und Jugendlichen (sog. Binger) von Heißhungerattacken. Diese Gruppe unterschied sich von den non-Bingern weder im Alter, noch im BMI oder in der Geschlechtsverteilung. Erwartungsgemäß berichteten die Binger über eine höhere Auslösbarkeit von Essverhalten sowie ein häufigeres Auftreten von gewichtsbezogenen Hänseleien, unter denen sie auch angaben, vermehrt zu leiden. Beim Umgang mit solchen Hänseleien benutzten Binger darüber hinaus häufiger vermeidende Strategien. Keine Gruppenunterschiede wurden im Selbstwert, der erlebten Attraktivität und schulischen Kompetenz gefunden. Vermeidender Bewältigungsstil sowie hohe Störbarkeit des Essverhaltens erwiesen sich als bedeutsam zur Vorhersage der Gruppenzugehörigkeit. Die Ergebnisse wurden in Bezug auf die Bedeutung von Hänseleien und deren Bewältigung diskutiert.

Eating Disorder Examination: Deutschsprachige Version des strukturierten Essstörungsinterviews

Zusammenfassung. Das Eating Disorder Examination (EDE) von Fairburn und Cooper (1993) ist ein strukturiertes Essstörungsinterview zur Erfassung der spezifischen Psychopathologie von Essstörungen. In der klinischen Forschung und Praxis gilt es weithin als Methode der Wahl für die Essstörungsdiagnostik. Die in diesem Beitrag vorgestellte deutschsprachige, reübersetzte Version des EDE zeigte in Stichproben von 80 Patientinnen mit Bulimia Nervosa, 144 Patientinnen mit Binge-Eating-Störung und 20 Patientinnen mit Anorexia Nervosa hohe Interrater-Reliabilitäten der Items sowie der Subskalen. Als Indikatoren für die konvergente Validität waren die EDE-Subskalen Shape Concern und Weight Concern mit Selbstbeurteilungsskalen zum Körperbild, z.B. dem Fragebogen zum Figurbewusstsein, hoch korreliert. Die EDE-Subskalen Restraint und Eating Concern zeigten signifikante Zusammenhänge mit dem in Ernährungstagebüchern protokollierten Essverhalten, z.B. Mahlzeiten- oder Essanfallshäufigkeit oder Nährstoffaufnahme. Die Subskalen des EDE unterschieden zwischen Gruppen mit verschiedenen Essstörungsdiagnosen und bildeten Veränderungen durch psychologische Psychotherapie sensitiv ab. Somit steht mit der deutschsprachigen Version des EDE ein dem englischsprachigen Original entsprechendes, geeignetes Instrument für die Erfassung der spezifischen Psychopathologie von Essstörungen zur Verfügung.

What is this thing called BED? Current status of binge eating disorder nosology

OBJECTIVE

Although binge eating has been recognized as a clinically relevant behavior among the obese for more than four decades, the concept of binge eating disorder (BED) as a distinct psychiatric diagnosis is of much more recent origin. This article presents four ways of conceptualizing BED: a distinct disorder in its own right, as a variant of bulimia nervosa, as a useful behavioral subtype of obesity, and as a behavior that reflects psychopathology among the obese. It also summarizes the evidence supporting and disconfirming each model.

METHOD

The literature subsequent to the development of DSM-IV regarding the reliability and validity of BED and related conditions was reviewed selectively.

RESULTS

The preponderance of the evidence suggests that BED differs importantly from purging bulimia nervosa and that BED is not a strikingly useful behavioral subtype of obesity.

DISCUSSION

Further study is needed to definitively determine the validity of BED as a distinct eating disorder.

Binge-eating disorder in Brazilian women on a weight-loss program

OBJECTIVE

To examine binge-eating disorder (BED) and its association with obesity, weight patterns, and psychopathology in a Brazilian sample of female participants of a weight-loss program in São Paulo, Brazil.

RESEARCH METHODS AND PROCEDURES

Two hundred and seventeen overweight (body mass index >/= 25 kg/m(2)) women, ages 15 to 59 years, enrolled in the Weight Watchers Program were recruited for the study at a program branch meeting after completing the Questionnaire on Eating and Weight Patterns-Revised, Beck Depression Inventory, and the Toronto Alexithymia Scale-20. Participants were categorized into four groups: those who met questionnaire criteria for BED, those who met questionnaire criteria for bulimia nervosa (BN), those that reported binge eating but did not meet all the criteria for any eating disorder (BE), and those with no eating disorder symptoms (No ED). Groups were compared on measures of weight, depressive symptoms, and alexithymia.

RESULTS

Binge eating was frequently reported by women in this study (BED, 16.1%; BN, 4.6%; BE, 22.6%). BED women had significantly higher body mass index, greater highest weight ever, and more frequent weight cycling than the No ED group. BED women also reported more depressive symptoms than BE and No ED women, and were more alexithymic than the No ED group. BE women presented more frequent weigh cycling and were also more depressed and alexithymic than the No ED group.

DISCUSSION

BED is not uncommon in overweight Brazilian women, and similar to North American and European samples, it is associated with overweight and higher levels of psychopathology in this population.

Maintenance of weight loss after obesity treatment: is continuous support necessary?

OBJECTIVE

This study examined outcome differences of 109 obese subjects, who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support.

METHODS

Self-rated weight loss, eating behaviors, and general psychopathology were assessed several months before treatment, when subjects were admitted, at discharge, and at the 6-, 12-, and 18-month follow-ups. Structured interviews for mental disorders and eating pathology were conducted additionally.

RESULTS

The mean weight of the sample at baseline was 127 kg. Weight loss of the total sample amounted to 8.0 kg (6.3%) and was completely maintained during the follow-up period. Significant reductions of eating and general psychopathology were observed at the 18-month follow-up. The outcome in the maintenance condition did not significantly differ from the outcome in the control condition.

CONCLUSIONS

Weight regain after obesity treatment is not inevitable, but continuous patient-therapist contacts do not distinctly improve treatment effects.

Medical and psychiatric morbidity in obese women with and without binge eating

OBJECTIVE

To determine the prevalence of obesity and binge eating in a population-based sample of female twins and to examine whether the presence of binge eating was associated with a greater risk for medical and psychiatric disorders in obese women.

METHOD

A population-based study of twins who were born between 1934 and 1971 and both members responded to a mailed questionnaire (individual response rate was conservatively estimated to be 64%). Data for the present study are from the first and third interview waves. In Wave 1 (1987-1989), we assessed 92% of the eligible individuals (N = 2,163), 90% face-to-face and the remainder by telephone. We assessed lifetime history of psychiatric disorders, major medical disorders, health limitations, health satisfaction, and an array of personality and attitudinal measures.

RESULTS

Obese women with binge eating reported greater health dissatisfaction and higher rates of major medical disorders than obese women without binge eating. Binge eating was also associated with higher lifetime prevalence of major depression, panic disorder, phobias, and alcohol dependence. Obese women with binge eating scored higher on neuroticism and symptom scales measuring depression, anxiety/phobia, and neurovegetative symptoms (i.e., insomnia, agitation, retardation, and obsessive-compulsive traits).

DISCUSSION

The presence of binge eating in obese women is a marker for greater medical and psychiatric morbidity.

Effects of prolonged and repeated body image exposure in binge-eating disorder

OBJECTIVE

The purpose of the present study was to investigate psychological mechanisms associated with prolonged and repeated body image exposure.

METHOD

In an experimental design, 30 female volunteers diagnosed with binge-eating disorder (BED) (DSM-IV) and 30 non-eating-disordered controls (NC) were exposed to their physical appearance in a mirror. The confrontation procedure was guided by a standardized interview manual and took place on two separate days. Self-reported mood, appearance self-esteem, and frequency of negative cognitions were assessed repeatedly throughout the experiment.

RESULTS

During body image exposure sessions, binge-eating-disordered individuals showed significantly lower mood than controls while appearance self-esteem was diminished in both groups. During the second body image exposure session, higher levels of mood and appearance self-esteem were observed in both groups, and negative cognitions occurred less frequently.

CONCLUSION

Results are discussed with regard to the therapeutic use of body image exposure.

Binge eating disorder: a review

Binge eating disorder (BED) is a new proposed eating disorder in the DSM-IV. BED is not a formal diagnosis within the DSM-IV, but in day-to-day clinical practice the diagnosis seems to be generally accepted. People with the BED-syndrome have binge eating episodes as do subjects with bulimia nervosa, but unlike the latter they do not engage in compensatory behaviours. Although the diagnosis BED was created with the obese in mind, obesity is not a criterion. This paper gives an overview of its epidemiology, characteristics, aetiology, criteria, course and treatment. BED seems to be highly prevalent among subjects seeking weight loss treatment (1.3-30.1%). Studies with compared BED, BN and obesity indicated that individuals with BED exhibit levels of psychopathology that fall somewhere between the high levels reported by individuals with BN and the low levels reported by obese individuals. Characteristics of BED seemed to bear a closer resemblance to those of BN than of those of obesity.A review of RCT's showed that presently cognitive behavioural treatment is the treatment of choice but interpersonal psychotherapy, self-help and SSRI's seem effective. The first aim of treatment should be the cessation of binge eating. Treatment of weight loss may be offered to those who are able to abstain from binge eating.

Psychopathological and clinical features of outpatients with an eating disorder not otherwise specified

In order to investigate similarities and differences between Eating Disorder Not Otherwise Specified (EDNOS) and Anorexia Nervosa (AN) and Bulimia Nervosa (BN), we studied a consecutive series of 189 female outpatients attending two Eating Disorder Units. The data were collected by means of interviews (Eating Disorder Examination, EDE 12.0D), the Structured Diagnostic Interview for DSM III-R, (SCID), and self-reported questionnaires (Beck Depression Inventory, BDI, and State and Trait Anxiety Inventory, STAI 1-2). The diagnosis of EDNOS was as frequent as that of AN and BN (43.8% versus 43.2%). There were no significant differences between EDNOS and AN/BN patients in terms of their general and specific psychopathological features, but significant differences were observed between bulimic-like and anorectic-like EDNOS patients, as well as between those with AN and BN. In conclusion, in our clinical setting, the patients with EDNOS and those with typical eating disorders have similar psychopathological features, thus suggesting that EDNOS patients should be further divided into two groups, anorectic-like (similar to AN) and bulimic-like (similar to BN) patients.

Subtyping binge eating-disordered women along dieting and negative affect dimensions

OBJECTIVE

Because etiologic and maintenance models of binge eating center around dieting and affect regulation, this study tested whether binge eating-disordered (BED) individuals could be subtyped along dieting and negative affect dimensions and whether subtypes differed in eating pathology, social functioning, psychiatric comorbidity, and response to treatment.

METHOD

Three independent samples of interviewer-diagnosed BED women (N = 218) were subtyped along dieting and negative affect dimensions using cluster analysis and compared on the outcomes of interest.

RESULTS

Cluster analyses replicated across the three independent samples and revealed a dietary subtype (63%) and a dietary-depressive subtype (37%). The latter subtype reported greater eating and weight obsessions, social maladjustment, higher lifetime rates of mood, anxiety, and personality disorders, and poorer response to treatment than did the dietary subtype.

DISCUSSION

Results suggest that moderate dieting is a central feature of BED and that affective disturbances occur in only a subset of cases. However, the confluence of dieting and negative affect signals a more severe variant of the disorder marked by elevated psychopathology, impaired social functioning, and a poorer treatment response.

Perfectionism in women with binge eating disorder

OBJECTIVE

This study examined self-oriented (SOP), socially prescribed (SPP), and other-oriented (OOP) perfectionism in 127 obese women with binge eating disorder (BED).

METHOD

Relationships between eating disorder and general psychopathology variables and SOP, SPP, and OOP were assessed. Levels of SOP, SPP, and OOP in the BED sample were compared with those of 32 normal weight women with bulimia nervosa (BN) and 60 obese non-eating-disordered individuals (NED). Structural equation modeling (SEM) was used to test models of the maintenance of BED.

RESULTS

Only SPP was significantly associated with eating disorder variables related to BED. All three groups demonstrated similar levels of SPP and OOP. BN and BED groups scored significantly higher than the NED group on SOP only. SEM resulted in two models with good fits.

DISCUSSION

Further research is needed on the roles of SPP and SOP in BED and on weight and shape overconcern in BED maintenance models.

Comparison of binge eating disorder and bulimia nervosa in a community sample

OBJECTIVE

This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN).

METHOD

Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14).

RESULTS

The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN.

DISCUSSION

Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN.

Weight loss after dieting with behavioral modification for obesity: the predicting efficiency of some psychometric data

The aim of the study was to identify the predicting efficiency of some psychometric data on weight loss after behavior modification in moderately obese patients. A group of patients on a weight loss program with a moderately hypoenergetic diet plus behavior modification therapy for 24 weeks completed the Eating Inventory (EI), the Eating Disorder Inventory (EDI), the Body Shape Questionnaire (BSQ) and the Body Attitude Questionnaire (BAQ). Correlations between the pre-diet and post-treatment scores were evaluated by stepwise regression analysis. The weight loss percentage was positively correlated with the EDI Bulimia scale and the BAQ Feeling Fat, and negatively with the EDI Body Dissatisfaction and Interpersonal Distrust scores. These findings indicate the true effectiveness of the behavior modification technique employed to extinguish bulimic behaviors. Furthermore, it can be suggested that realistic attitudes towards own fatness with a strong motivation and a good relationship with the therapist guarantee a greater weight loss.

Screening for binge eating disorder in obese outpatients

The prevalence of binge eating disorder (BED) in clinical samples of obese patients is controversial, and sensitive diagnostic protocols for use in routine clinical practice need to be further defined. Three hundred forty-four obese (body mass index [BMI] > or =30 kg/m2) patients were studied with the Structured Clinical Interview for DSM-III-R to investigate the lifetime prevalence of mental disorders. The current prevalence of BED was assessed using DSM-IV criteria. Eating attitudes and behavior were investigated with the Bulimic Investigation Test, Edinburgh (BITE) and the Binge Eating Scale (BES). The Beck Depression Inventory (BDI) and Spielberg's State-Trait Anxiety Inventory (STAI) were also applied. The prevalence of BED was 7.5%. Patients with BED had a higher BMI compared with obese patients without BED. Differences in the lifetime prevalence of mental disorders in patients with and without BED were not statistically significant. Using the BES as a screening instrument for BED with a threshold of 17, the sensitivity was 84.8%, specificity 74.6%, positive predictive value 26.2%, and negative predictive value 97.9%. Using the BITE with a threshold of at least 10, the sensitivity was 91%, specificity 51.4%, positive predictive value 71.8%, and negative predictive value 98.2%. The BITE can be a valid alternative to the BES as a screening method for BED in obese patients.

Perception of parental acceptance in women with binge eating disorder

The authors contribute to the validating literature for binge eating disorder (BED) by examining perceptions of parents and satisfaction with life among obese women with and without BED. Participants were female patients, recruited through a private medical clinic, who were assigned to groups on the basis of body mass index (BMI) and scores on the Questionnaire on Eating and Weight Patterns (QEWP; R. L. Spitzer et al., 1992). Groups consisted of (a) obese women with BED (n = 32), (b) obese women who had no eating disorders (n = 51), and (c) nonobese women with no eating disorders (n = 30). All participants completed the Parental Acceptance/Rejection Questionnaire (PARQ; R. P. Rohner, 1986), the Satisfaction with Life Scale (SWLS; J. Fischer & K. Corcoran, 1994), and the Beck Depression Inventory (BDI; A. T. Beck & R. A. Steer, 1987). Obese women with BED perceived their fathers as more rejecting than did women in the other groups. Moreover, obese women with BED perceived their fathers as significantly more rejecting than their mothers. The BED group indicated lower satisfaction with life and higher levels of depression than the groups without eating disorders. These findings further validate the diagnostic category of BED. Obese women with BED appear to be a distinct subgroup of the obese population. The results indicate a need for further assessment of the father-daughter relationship in connection to BED and other eating disorders.

Differences between binge eating disorder and nonpurging bulimia nervosa

OBJECTIVE

To compare the pathway to binge eating and clinical characteristics of binge eating disorder patients (BED) and nonpurging bulimics.

METHODS

The subjects were 45 nonpurging bulimics and 45 BED patients who consecutively sought treatment in an outpatient eating disorders unit. The subjects underwent a clinical interview and replied to the Eating Disorders Inventory and the Hopkins Symptom Checklist.

RESULTS

In most of the nonpurging bulimics (89%), binge eating is preceded by dieting and weight loss, whereas among BED patients the pathway to binge eating is more variable. Previous episodes of anorexia nervosa are significantly more frequent among nonpurging bulimics than among BED patients. The two groups did not differ in other clinical and psychological characteristics, such as psychiatric symptoms, frequency of binging, and impulsivity traits. However, on many of the variables, the BED group shows a significantly greater variance.

DISCUSSION

Unlike nonpurging bulimics, BED patients appear to form a more heterogeneous group.

Natural course of a community sample of women with binge eating disorder

OBJECTIVE

A community sample of women with binge eating disorder (BED) was followed for a period of 6 months, in order to examine the natural course of the disorder.

METHOD

Baseline, 3-, and 6-month assessments were conducted. The following variables were examined: eating disorder symptomatology, importance of weight or shape, psychopathology, social adjustment, childhood sexual abuse, childhood obesity, parental obesity, and parental psychopathology.

RESULTS

After the 3-month follow-up, 10 of the original sample of 31 participants dropped out of the study; drop-outs were more likely to have reported a history of sexual abuse. Of the 21 remaining participants, 11 continued to suffer from full-syndrome BED at 6-month follow-up, while the remaining 10 appeared to be in partial remission. There were no significant baseline predictors of outcome.

CONCLUSION

It appears that for some women with BED, the eating disorder improves with a decrease in binge eating and importance of weight or shape. For others, the eating disorder symptoms remain constant.