Mindfulness trait, eating behaviours and body uneasiness: a case-control study of binge eating disorder

Redefining diagnostic parameters: the role of overvaluation of shape and weight in binge-eating disorder: a systematic review

INTRODUCTION

Overvaluation of shape and weight is a critical component in understanding and diagnosing eating disorders. While the transdiagnostic model states that overvaluation of shape and weight is the core pathology of all eating disorders, this concept is not a criterion for binge-eating disorder. The lack of recognition of overvaluation of shape and weight may lead to overlooking, and consequently failure to address this construct during treatment. The aim of the present review is to examine whether overvaluation is a critical component in understanding and diagnosing binge-eating disorder and whether it should be addressed during treatment, and therefore be added as a criterion of binge-eating disorder.

METHODS

The present review was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024541433). PsycINFO, Web of Science, PubMed (Medline), and Google Scholar were used in order to systematically search and review literature by using a list of keywords related to overvaluation of shape and weight and binge-eating disorder. All N = 93 peer-reviewed studies were published in English from 1993 onwards.

RESULTS

Overvaluation of shape and weight was more severe among individuals with binge-eating disorder compared to individuals with solely a similar high BMI. In addition, levels of overvaluation in binge-eating disorder were comparable in severity with that of individuals of the other named eating disorder subtypes. Overvaluation was positively associated with other psychiatric symptoms, a risk factor for the onset of binge eating in adolescents and predicted poorer treatment outcomes. It was not clear whether overvaluation predicted dropout from Cognitive Behavior Therapy interventions.

DISCUSSION

It is suggested to consider including overvaluation of shape and weight as a criterion for the diagnosis of binge-eating disorder. Including overvaluation in the DSM and ICD may prevent overlooking this construct, and potentially enhance treatment outcomes. It is suggested that overvaluation of shape and weight is the core pathology of all eating disorders. However, this concept is not a criterion for a binge-eating disorder diagnosis. The lack of recognition of overvaluation of shape and weight may lead to overlooking, and consequently failure to address this construct during treatment. The aim of the present review is to examine whether overvaluation is a critical component in understanding and diagnosing binge-eating disorder and whether it should be addressed during treatment, and therefore be added as a criterion of binge-eating disorder. Consequently, a total of N = 93 peer-reviewed studies were examined. It was found that overvaluation of shape and weight was associated with the severity of eating disorder psychopathology, and was comparable in severity with that of individuals diagnosed with anorexia nervosa and bulimia nervosa. There is enough evidence to include overvaluation in the DSM and ICD as a criterion for binge-eating disorder. Consequently, this may prevent overlooking this construct, and potentially enhance treatment outcomes.

Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT)

Despite evidence linking trait mindfulness and mindfulness training with a broad range of effects, still little is known about its underlying active mechanisms. Mindfulness is commonly defined as (1) the ongoing monitoring of present-moment experience (2) with an orientation of acceptance. Building on conceptual, clinical, and empirical work, we describe a testable theoretical account to help explain mindfulness effects on cognition, affect, stress, and health outcomes. Specifically, Monitor and Acceptance Theory (MAT) posits that (1), by enhancing awareness of one's experiences, the skill of attention monitoring explains how mindfulness improves cognitive functioning outcomes, yet this same skill can increase affective reactivity. Second (2), by modifying one's relation to monitored experience, acceptance is necessary for reducing affective reactivity, such that attention monitoring and acceptance skills together explain how mindfulness improves negative affectivity, stress, and stress-related health outcomes. We discuss how MAT contributes to mindfulness science, suggest plausible alternatives to the account, and offer specific predictions for future research.

Binge-eating disorder diagnosis and treatment: a recap in front of DSM-5

INTRODUCTION

Binge Eating Disorders is a clinical syndrome recently coded as an autonomous diagnosis in DSM-5. Individuals affected by Binge Eating Disorder (BED) show significantly lower quality of life and perceived health and higher psychological distress compared to the non-BED obese population. BED treatment is complex due to clinical and psychological reasons but also to high drop-out and poor stability of achieved goals. The purpose of this review is to explore the available data on this topic, outlining the state-of-the-art on both diagnostic issues and most effective treatment strategies.

METHODS

We identified studies published in the last 6 years searching the MeSH Term "binge eating disorder", with specific regard to classification, diagnosis and treatment, in major computerized literature databases including: Medline, PubMed, PsychINFO and Science Direct.

RESULTS

A total of 233 studies were found and, among them, 71 were selected and included in the review.

REVIEW

Although Binge Eating Disorder diagnostic criteria showed empirical consistency, core psychopathology traits should be taken into account to address treatment strategies. The available body of evidence shows psychological treatments as first line interventions, even if their efficacy on weight loss needs further exploration. Behavioral and self-help interventions evidenced some efficacy in patients with lower psychopathological features. Pharmacological treatment plays an important role, but data are still limited by small samples and short follow-up times. The role of bariatric surgery, a recommended treatment for obesity that is often required also by patients with Binge Eating Disorder, deserves more specific studies. Combining different interventions at the same time does not add significant advantages, planning sequential treatments, with more specific interventions for non-responders, seems to be a more promising strategy.

CONCLUSIONS

Despite its recent inclusion in DSM-5 as an autonomous disease, BED diagnosis and treatment strategies deserve further deepening. A multidisciplinary and stepped-care treatment appears as a promising management strategy. Longer and more structured follow-up studies are required, in order to enlighten long term outcomes and to overcome the high dropout rates affecting current studies.

Embodied and exbodied mind in clinical psychology. A proposal for a psycho-social interpretation of mental disorders

A brief theoretical review of the current state of the art of embodiment research in clinical psychology has been expounded in order to highlight the key role that embodied conceptualization has on the understanding and explanation of several mental disorders, such as eating disorders, schizophrenia and depression. Evidence has suggested that mental disorders may be explained as disturbances of embodiment, from the disembodiment to the hyperembodiment. In order to understand how some clinical conditions are affected by cultural models, we propose and define a new framework called Exbodiment, complementary to the Embodiment approach to cognition. Mental disorder is strictly related to the subject-culture interaction that may be explained as a two way process in which embodiment and exbodiment are complementary points of view. In this perspective, embodiment may be seen as the “top-down” process, while exbodiment the “bottom-up” one. The introduction of exbodiment conceptualization highlights how subject is both receiver and interpreter of social influence. Subject is the target of a cultural pressure and, at the same time, enacts its own embodied culture in world. Exbodiment conceptualization may help clinicians to better understand and explain the role of culture in the onset and maintenance of mental disorders.