Loss of control over eating reflects eating disturbances and general psychopathology

This study examined the clinical significance of the loss of control over eating as a key component of eating disorders. It investigated the association of eating-related psychopathology and general psychopathology with objective bulimic episodes (OBEs; experiencing a loss of control while consuming large amounts of food) and subjective bulimic episodes (SBEs; experiencing a loss of control while consuming small/moderate amounts). A community sample of 81 women with a range of disordered eating was recruited: binge-eating disorder, bulimia nervosa, subclinical eating disturbances, or no eating disorders. They were interviewed using the Eating Disorder Examination and completed measures of eating-related and general psychopathology. Both OBE and SBE frequencies correlated significantly with measures of eating-related and general psychopathology, and no significant differences were found between the magnitudes of the correlations with either binge episode type. SBE frequency significantly and independently predicted global eating disorder psychopathology. The loss of control over eating, without consuming large amounts of food, was as closely associated with specific eating disorder psychopathology and general mental health as were traditionally defined OBEs. SBEs may be an important target of treatment and should be considered for future diagnostic classifications of eating disorders.     

Guided self-help for disordered eating: A randomised control trial

Treatment guidelines recommend evidence-based guided self-help (GSH) as the first stage of treatment for bulimia nervosa and binge eating disorder. The current randomised control trial evaluated a cognitive behavioural therapy-based GSH pack, ‘Working to Overcome Eating Difficulties,’ delivered by trained mental health professionals in 6 sessions over 3 months. It was congruent with the transdiagnostic approach and so was intended as suitable for all disordered eating, except severe anorexia nervosa. Eighty one clients were randomly allocated to either a GSH or waiting list condition. Eating disorder psychopathology (EDE-Q), key behavioural features and global distress (CORE) were measured at pre- and post-intervention, and 3- and 6-month follow-up. Results showed significant improvements in eating disorder psychopathology, laxative abuse, exercise behaviours, and global distress, with the GSH condition being superior to the waiting list on all outcomes. Treatment gains were maintained at 3 and 6 months. This study adds to the evidence supporting GSH for disordered eating, including EDNOS. However, further work is needed to establish the factors that contribute to observed therapeutic improvements and determine for whom GSH is most suitable.     

Loss of control over eating in obese youngsters

OBJECTIVE: To investigate loss of control over eating in a sample of obese youngsters seeking treatment. METHOD: Obese youngsters (aged 10-16) were categorized into those having experienced loss of control (LC) and those who had not (NoLC) using the child version of the Eating Disorder Examination. Furthermore, the LC group was subdivided into an objective binge eating (OBE) and a subjective binge eating (SBE) group. The groups were compared on psychological measures. RESULTS: LC subjects (17.9%) showed more concern about eating, weight and shape. They also reported more emotional and external eating behaviors and more depression. Youngsters who report SBE show resemblances to both NoLC and OBE subjects. DISCUSSION: LC subjects are characterized by more eating-related psychopathology and higher levels of depression. Especially obese youngsters with OBE turned out to be a pathological group.     

Clarifying boundaries of binge eating disorder and psychiatric comorbidity: a latent structure analysis

Binge eating disorder (BED) presents with substantial psychiatric comorbidity. This latent structure analysis sought to delineate boundaries of BED given its comorbidity with affective and anxiety disorders. A population-based sample of 151 women with BED, 102 women with affective or anxiety disorders, and 259 women without psychiatric disorders was assessed with clinical interviews and self-report-questionnaires. Taxometric analyses were conducted using DSM-IV criteria of BED and of affective and anxiety disorders. The results showed a taxonic structure of BED and of affective and anxiety disorders. Both taxa co-occurred at an above-chance level, but also presented independently with twice-as-large probabilities. Within the BED taxon, diagnostic co-occurrence indicated greater general psychopathology, lower social adaptation, and greater premorbid exposure to parental mood and substance disorder, but not greater eating disorder psychopathology. Eating disorder psychopathology discriminated individuals in the BED taxon from individuals in the affective and anxiety disorders taxon. Diagnostic criteria of BED were more indicative of the BED taxon than were criteria of affective and anxiety disorders. The results show that at the latent level, BED was co-occurring with, yet distinct from, affective and anxiety disorders and was not characterized by an underlying affective or anxiety disorder.     

A randomized controlled trial for obesity and binge eating disorder: low-energy-density dietary counseling and cognitive-behavioral therapy

The present study examined a dietary approach – lowering energy density – for producing weight loss in obese patients with binge eating disorder (BED) who also received cognitive-behavioral therapy (CBT) to address binge eating. Fifty consecutive participants were randomly assigned to either a six-month individual treatment of CBT plus a low-energy-density diet (CBT + ED) or CBT plus General Nutrition counseling not related to weight loss (CBT + GN). Assessments occurred at six- and twelve-months. Eighty-six percent of participants completed treatment, and of these, 30% achieved at least a 5% weight loss with rates of binge remission ranging from 55% to 75%. The two treatments did not differ significantly in weight loss or binge remission outcomes. Significant improvements were found for key dietary and metabolic outcomes, with CBT + ED producing significantly better dietary outcomes on energy density, and fruit and vegetable consumption, than CBT + GN. Reductions in energy density and weight loss were significantly associated providing evidence for the specificity of the treatment effect. These favorable outcomes, and that CBT + ED was significantly better at reducing energy density and increasing fruit and vegetable consumption compared to CBT + GN, suggest that low-energy-density dietary counseling has promise as an effective method for enhancing CBT for obese individuals with BED.     

Self-help for binge eating disorder in primary care: A randomized controlled trial with ethnically and racially diverse obese patients

Objective

The objective was to examine the effectiveness of a self-help treatment as a first line primary care intervention for binge eating disorder (BED) in obese patients. This study compared the effectiveness of a usual care plus self-help version of cognitive behavioral therapy (shCBT) to usual care (UC) only in ethnically/racially diverse obese patients with BED in primary care settings in an urban center.

Method

48 obese patients with BED were randomly assigned to either shCBT (N = 24) or UC (N = 24) for four months. Independent assessments were performed monthly throughout treatment and at post-treatment.

Results

Binge-eating remission rates did not differ significantly between shCBT (25%) and UC (8.3%) at post-treatment. Mixed models of binge eating frequency determined using the Eating Disorder Examination (EDE) revealed significant decreases for both conditions but that shCBT and UC did not differ. Mixed models of binge eating frequency from repeated monthly EDE-questionnaire assessments revealed a significant treatment-by-time interaction indicating that shCBT had significant reductions whereas UC did not during the four-month treatments. Mixed models revealed no differences between groups on associated eating disorder psychopathology or depression. No weight loss was observed in either condition.

Conclusions

Our findings suggest that pure self-help CBT did not show effectiveness relative to usual care for treating BED in obese patients in primary care. Thus, self-help CBT may not have utility as a front-line intervention for BED for obese patients in primary care and future studies should test guided-self-help methods for delivering CBT in primary care generalist settings.     

Slower eating rate reduces the food intake of men, but not women: implications for behavioral weight control

This study tested a central tenet of behavioral weight control: does slower eating rate reduce food intake and positively affect appetite ratings. This study used direct behavioral observation of participants' (n=48; 25BMI35) eating behavior using Universal Eating Monitors. Food intake and ratings of "desire to eat" (collected each minute during meals) were represented as a function of time. Based on an acclimation meal, participants' eating rate was modified by instructing them to eat a bite of food when prompted by a computer, which generated three types of meals: (1) baseline (eating rate was the same as the acclimation meal), (2) reduced-rate (eating rate was reduced by 50%), and (3) combined-rate (eating rate at the beginning of the meal was identical to that of the acclimation meal, subsequently eating rate was reduced by 50%). All meals were ad libitum. Slower eating rate during the reduced-rate and combined-rate meals resulted in less food intake compared to the baseline meal for men, but not women. Ratings of desire to eat, normalized for the amount of food consumed, were lower during the combined-rate meal for men and women. Thus, this basic premise of behavioral weight control was supported for men, but not for women.     

Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder

Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".     

Eating behavior in obese BED, obese non-BED, and non-obese control participants: A naturalistic study

Laboratory studies have shown considerable differences between the eating behavior, particularly binge eating behavior, of participants with and without binge eating disorder (BED). However, these findings were not replicated in two field experiments employing ecological momentary assessment (EMA) in which obese BED and obese non-BED participants reported comparable binge eating behavior. In the current study, we examined differences in binge eating with an innovative assessment scheme employing both EMA and a standardized computer-based dietary recall program to avoid some of the limitations of past laboratory and field research. Obese BED, obese non-BED, and non-obese control participants reported significant differences in eating patterns, loss of control, overeating, and binge eating behavior. Of particular importance was the finding that BED participants engaged in more overeating and more binge eating episodes than non-BED participants. These findings suggest that the use of EMA in combination with dietary recall may be a relatively objective and useful approach to assessing binge eating behavior. The findings further suggest that individuals with BED are observably different from those without the disorder, which may have implications for eating disorder diagnoses in DSM-V.     

An examination of the interpersonal model of loss of control eating in children and adolescents

The interpersonal model of binge eating disorder proposes that social problems lead to negative affect which, in turn, precipitates binge eating episodes. However, no study to date has examined this model among youth who report loss of control (LOC) eating. Participants were 219 non-treatment-seeking children and adolescent volunteers, age 8-17 years (13.1 ± 2.8y; 50% female). Children's social problems were assessed by parent report. Youth completed self-report questionnaires of negative affect that assessed depressive symptoms and anxiety. Participants were interviewed to determine the presence or absence of LOC eating in the month prior to assessment. Structural equation modeling analyses found that social problems were positively related to LOC eating presence (p = .02). Negative affect mediated the relationship between social problems and LOC eating (95% CI Product = .00247, .01336). These preliminary results suggest that the interpersonal model of binge eating may describe one possible pathway for the development of LOC eating among non-treatment-seeking youth.     

Assessment of eating disorder psychopathology in obese children and adolescents: interview versus self-report questionnaire

The present study compared two methods for assessing binge eating and related eating disorder psychopathology in obese children and adolescents. A comparison was made between the child version of the Eating Disorder Examination (ChEDE) and the self-report version of the interview (ChEDE-Q). A total of 139 children and adolescents (aged 10-16 years) seeking inpatient treatment for obesity completed the ChEDE questionnaire and were administered the ChEDE interview afterwards. The ChEDE and ChEDE-Q were significantly correlated for the four subscales: restraint, eating concern, weight concern and shape concern. The ChEDE-Q generated consistently higher levels of eating disorder psychopathology. There was a significant discrepancy for the assessment of a more complex feature such as binge eating. Overall, the current study found lower levels of agreement between the EDE and EDE-Q than previously reported in adult samples. It appears that children and adolescents have difficulties in identifying binge-eating episodes when they receive no detailed instruction. It is concluded that a clinical interview is necessary to identify eating disorders in obese children and that a self-report questionnaire can only be used as a screening tool. Even then, thorough clarification of the definition of the eating disorder features is needed when using a self-report questionnaire.     

Self-control strength and physical exercise: An ecological momentary assessment study

ObjectiveWe tested predictions made by the self-control strength model on a day level using ecological momentary assessment methodology. The study examined the relationship between self-control strength and physical exercise in participants who intended to exercise on a regular basis. We hypothesized that individuals would exercise more on days when their self-control strength was high than on days when their self-control strength was low and that trait self-control would moderate this relationship.MethodsN = 63 students aged between 19 and 32 years participated in the study. Self-control strength and physical exercise were assessed daily over a period of 20 days with an electronic diary.ResultsMultilevel analyses revealed that the level of self-control strength was positively associated with physical exercise (p = 0.01), and this relationship was stronger in individuals with low trait self-control than in those with high trait self-control (interaction effect: p = 0.03).ConclusionThese findings highlight the interplay between momentarily fluctuating variables such as self-control strength and dispositional variables such as trait self-control in the prediction of physical exercise.     

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.     

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.     

An ecological momentary assessment study of affectively-charged motivational states and physical activity

The physical activity (PA) intention-behavior gap has prompted researchers to explore other explanatory factors such as affective mechanisms which might better explain PA engagement. Affectively-charged motivations (e.g., desire, dread) are thought to influence the pursuit or avoidance of future behavior. This study examined whether affectively-charged motivations for PA changed across the day and were differentially associated with PA intensity. Participants (N = 60) wore ActiGraph GT3X accelerometers and answered EMA (M = 134.7 prompts/person) about affectively-charged motivations for upcoming PA using a 0-to-100-point scale (dread-excitement) in the morning, pre-activity, at-random, and evening for 14 days. Affectively-charged motivations for PA were lower in the morning and at-random compared to pre-activity (p = .004) and evening (p < .001). On average, individuals who rated morning affectively-charged motivations for PA 10-points higher engaged in 28 additional min/week of moderate-to-vigorous PA (p = .048). These findings suggest that affectively-charged motivations occurring in the morning may have greater salience for PA.     

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: Another nail in the coffin of a problematic distinction

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.     

Exploring Criterion Confounding in the Measurement of Binge Eating Symptoms and Negative Affect

Common measures of eating disorder symptoms contain affect-related items. When associations between negative affect and eating disorder symptoms are examined, criterion confounding is possible. The current study explored whether criterion confounding biases estimates of relations between symptoms of binge eating and negative affect. Data were collected from first-year university student women via 14-day web-based daily diaries. The Minnesota Eating Behavior Survey (MEBS) measured daily symptoms of binge eating, and the Positive and Negative Affect Schedule (PANAS) measured daily negative affect. The inclusion of affect-related items in the MEBS biased mean level tests of negative affect, correlations of negative affect with symptoms of binge eating, and associations between the likelihood of reporting behavioral symptoms of binge eating and same-day negative affect. Converging results demonstrated the need to measure associated features and risk factors separately from problematic eating behavior symptoms.

Overvaluation of shape and weight among overweight children and adolescents with loss of control eating

Little is known about the phenomenology of pediatric loss of control (LOC) eating. Overvaluation of shape and weight, however, appears to be diagnostically meaningful among binge eating adults. We explored the significance of shape and weight overvaluation among children and adolescents with LOC eating. Participants (n = 526) included 149 overweight youth with LOC eating and 377 overweight controls (CON). Participants were categorized as those reporting at least moderate overvaluation (LOC-Mod, n = 74; CON-Mod, n = 106) or less than moderate overvaluation (LOC-Low, n = 75; CON-Low, n = 271), and compared on measures of eating-related and general psychopathology. LOC-Mod evidenced lower self-esteem than CON-Low, and greater behavioral problems than CON-Mod and CON-Low, but did not differ from LOC-Low in these domains. With the exception of LOC-Low and CON-Mod, all groups differed on global eating-disorder severity, with LOC-Mod scoring the highest. Overvaluation of shape and weight appears to be of questionable importance in defining subtypes of youth with LOC eating. However, as overvaluation and LOC eating each independently predicts eating-disorder onset, their confluence may confer even further risk for eating-disorder development. Longitudinal studies should address this possibility. Developmentally appropriate discussion about body image disturbance may be indicated in interventions targeting pediatric LOC eating and/or obesity.     

Effects of analytical and experiential self-focus on stress-induced cognitive reactivity in eating disorder psychopathology

Previous research suggests distinct modes of self-focus, each with distinct functional properties: Analytical self-focus appears maladaptive, with experiential self-focus having more adaptive effects on indices of cognitive-affective functioning (e.g., Watkins, Moberly, & Moulds, 2008). The authors applied this framework to eating disorder (ED) psychopathology and manipulated the mode of self-focus prior to exposure to a stressor (imagining eating a large meal; Shafran, Teachman, Kerry, & Rachman, 1999). Study 1 showed that students high in ED psychopathology reported lower post-stressor feelings of weight or shape change and less subsequent attempts to neutralise (e.g., imagining exercising) after experiential relative to analytical self-focus. Study 2 found that partially weight restored patients with anorexia nervosa had lower post-stressor estimates of their own weight and reported lower urge to cancel stressor effects following experiential compared to analytical self-focus. Experiential self-focus was also followed by less neutralisation than analytical self-focus. Results suggest that the mode of self-focus affects cognitive reactivity following a stressor in individuals with ED psychopathology. Examining the mode within which individuals with ED psychopathology focus on self and body may raise important implications for understanding of psychopathology and open new possibilities for augmenting current treatments.     

Homesickness in social context: An ecological momentary assessment study among 1st-year university students

Homesickness is common among university students and associated with mental health problems. Most previous studies assessed homesickness as a summary of the past weeks. However, there may be significant fluctuations across situations. At the current residence, homesickness may especially be triggered during (phone) interactions with attachment figures. Dutch and international 1st-year students (n = 92) completed the Utrecht Homesickness Scale and subsequently used a smartphone application to record social interactions for 14 days (ecological momentary assessment [EMA]). For each interaction they reported the social context (e.g. location, contact type) and their affective state, including homesickness. Homesickness in the past weeks and momentary homesickness were both higher in international students than in Dutch students. Feeling homesick was highest at participants' current residency, when interacting with parents, or when using video-chat. When participants felt more homesick, they reported less pleasant and more unpleasant affect. In conclusion, EMA provided insight in cross-situational variations in homesickness.