Dialectical Behavior Therapy Modified for Adolescent Binge Eating Disorder: A Case Report

Given the lack of empirically supported treatments available for adolescents with eating disorders, it is important to investigate the clinical utility of extending treatments for adults with eating disorders to younger populations. Dialectical behavior therapy for binge eating disorder, based on the affect-regulation model, conceptualizes binge eating as a behavioral attempt to influence, change, or control painful emotional states. With promising research findings in adult women, it is of clinical interest whether the dialectical behavior therapy for binge eating disorder treatment manual could be usefully adapted for an adolescent population. This report describes adolescent-specific modifications (including the use of family sessions) to standard dialectical behavior therapy for binge eating disorder, with an illustrative case study. While more rigorous case studies are needed prior to establishing justification for a randomized trial, this pilot case provides preliminary support for a modified version of dialectical behavior therapy for binge eating disorder as a therapeutic option for adolescents with binge eating disorder.     

Perfectionistic self-presentation, body image, and eating disorder symptoms

A specific model for eating disorder symptoms involving perfectionistic self-presentation and two different moderators (i.e., body image evaluation and body image investment) was tested. Participants completed measures of perfectionistic self-presentation, body image dysfunction, and eating disorder symptoms. Findings indicated that all three dimensions of perfectionistic self-presentation were associated with eating disorder symptoms. Results also showed that perfectionistic self-presentation predicted eating disorder symptoms in women who were dissatisfied with their bodies, but that it did not predict eating problems in women who liked their bodies and felt there was little or no discrepancy between their actual and ideal appearances. Body image investment did not moderate the relationship between perfectionistic self-presentation and eating disorder symptoms, suggesting that ego-involvement alone is insufficient to promote eating disturbance in the context of perfectionism. The importance of self-presentation components of perfectionism and specific body image difficulties in predicting eating disorder symptoms are discussed.     

DISORDERED EATING, ACCULTURATION, AND TREATMENT-SEEKING IN A COMMUNITY SAMPLE OF HISPANIC, ASIAN, BLACK, AND WHITE WOMEN

The purpose of this study was to examine disordered eating, acculturation, and treatment-seeking in a community sample of Hispanic, Asian, Black, and White women. Participants were 118 women with disordered eating (49 Hispanic, 21 Asian, 23 Black, and 25 White) and 118 healthy controls. Interviews were conducted to assess eating and weight-related behaviors, psychiatric symptoms, acculturation, and health care usage. Results indicated that the four ethnic groups were equally likely to present behavioral symptoms of bulimia, anorexia, or a binge-eating disorder. Hispanics were the most likely to use diuretics, and Black women were the most likely to use laxatives. Despite psychological distress among the eating disorder group, only a small percentage had received treatment during the past year; the eating disorder group was more likely than the controls to report that they had been denied treatment. More acculturated individuals were more likely to suffer from eating problems, and among the eating disorder group, less acculturated individuals were less likely to have received treatment.     

Perceived acceptability of anorexia and bulimia in women with and without eating disorder symptoms

Perceptions of the acceptability of eating‐disordered behaviour were examined in young adult women with (n = 44) and without (n = 268) eating disorder symptoms. All participants viewed vignettes of anorexia nervosa (AN) and bulimia nervosa (BN) and responded to the same series of questions—addressing different possible ways in which the conditions described might be seen to be acceptable—in relation to each vignette. Participants with eating disorder symptoms perceived eating‐disordered behaviour to be more acceptable than asymptomatic participants, and this was the case for both AN and BN vignettes and for a range of different items. Differences on items tapping the perception that it ‘might not be too bad’ to have an eating disorder and that an eating disorder is ‘nothing to be concerned about’ were particularly pronounced. The findings could not be accounted for by between‐group differences in body weight. The findings indicate the ambivalence towards eating‐disordered behaviour that exists among a subgroup of young women in the community and the clear association between such ambivalence and actual eating disorder symptoms. The perceived acceptability of eating‐disordered behaviour may need to be addressed in prevention and early‐intervention programs for eating disorders.     

An Examination of the Connections Between Eating Disorder Symptoms,Perceived Burdensomeness,Thwarted Belongingness,and Suicide Risk Among Undergraduate Students

Suicide attempts and premature mortality due to suicide are elevated in people with eating disorders. Informed by the interpersonal theory of suicide, two studies examined the role of perceived burdensomeness and thwarted belongingness in explaining the association between eating disorder symptoms and suicide risk. Results indicated that various eating disorder symptoms had an indirect effect on suicide risk through perceived burdensomeness and thwarted belongingness. Targeting perceived burdensomeness and thwarted belongingness may be useful for decreasing suicide risk among undergraduates with eating disorder symptoms.     

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.     

Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity

Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a “fully recovered” group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.     

Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters.     

Relations of Eating Disorder Symptomology with Perceptions of Pressures from Mother, Peers, and Media in Adolescent Girls and Boys

This study examined the relations of adolescents’ perceptions of pressures from the media, their mothers, and their peers with the development of eating disorder symptomology. Participants were 333 male and female adolescents in high school grades 10–12 from a suburban area of the Midwestern US. During the school day, students completed Likert-type scales of perceived pressures and eating disorder symptomology. Canonical correlations showed that students who perceived greater pressures across all three environmental contexts also reported more eating disorder symptomology. However, the patterns of relations between the perceived pressures and specific eating disorder symptoms differed by gender. Implications for future research and prevention programs are discussed.     

Using the PAI with an eating disordered population: scale characteristics,factor structure,and differences among diagnostic groups

Psychometric properties of the Personality Assessment Inventory (PAI; Morey 1991) within an eating disordered sample seeking treatment (N = 238) and differences among eating disorder diagnostic groups on the PAI were examined. The PAI showed acceptable alpha coefficients, item-total correlations, and interitem correlations. The factor structure was similar to that reported by Morey (1991), with the addition of another factor related to interpersonal coolness and distance. Those with binge eating disorder (BED) reported fewer problems and less distress in general compared to other eating disordered groups. The BED and bulimia nervosa groups were different from the anorexia nervosa groups in frequency of matching on two PAI clusters. Use of the PAI with an eating disordered population and its utility in understanding eating disorder diagnostic groups is supported.     

Transdiagnostic Theory and Application of Family-Based Treatment for Youth with Eating Disorders

This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.     

Binge Eating,Purging, and Restriction Symptoms: Increasing Accuracy of Prediction Using Machine Learning

Eating disorders are severe mental illnesses characterized by the hallmark behaviors of binge eating, restriction, and purging. These disordered eating behaviors carry extreme impairment and medical complications, regardless of eating disorder diagnosis. Despite the importance of these disordered behaviors to every eating disorder diagnosis, our current models are not able to accurately predict behavior occurrence. The current study utilized machine learning to develop longitudinal predictive models of binge eating, purging, and restriction in an eating disorder sample (N = 60) using real-time intensive longitudinal data. Participants completed four daily assessments of eating disorder symptoms and emotions for 25 days on a smartphone (total data points per participant = 100). Using data, we were able to compute highly accurate prediction models for binge eating, restriction, and purging (.76–.96 accuracy). The ability to accurately predict the occurrence of binge eating, restriction, and purging has crucial implications for the development of preventative interventions for the eating disorders. Machine learning models may be able to accurately predict onset of problematic psychiatric behaviors leading to preventative interventions designed to disrupt engagement in such behaviors.     

Perfectionism in depression, obsessive-compulsive disorder and eating disorders

High levels of perfectionism have been observed in major depression, anxiety disorders and eating disorders. Though few studies have compared levels of perfectionism across these disorders, there is reason to believe that different dimensions of perfectionism may be involved in eating disorders than in depression or anxiety [Bardone-Cone, A. M. et al. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 84-405]. The present study compared patients with major depression, obsessive-compulsive disorder, and eating disorders on dimensions of perfectionism. Concern over Mistakes was elevated in each of the patient groups while Pure Personal Standards was only elevated in the eating disorder sample. Doubts about Actions was elevated in both patients with obsessive-compulsive disorder and eating disorders, but not in depressed patients. Analyses of covariance indicated that Concern over Mistakes accounted for most of the variance in the relationship of perfectionism to these forms of psychopathology.     

Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study

Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre-surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.     

Case Conceptualization and Treatment of Comorbid Body Dysmorphic Disorder and Bulimia Nervosa

Body dysmorphic disorder (BDD) and eating disorders often co-occur and share some clinical features. In addition, the co-occurrence of BDD and an eating disorder may be associated with greater impairment in functioning. Furthermore, clinical impressions suggest that this comorbidity may be more treatment resistant than either disorder alone. The current article discusses the treatment of a 48-year-old female diagnosed with BDD and comorbid bulimia. We attempted to address these co-occurring disorders in a strategic, formulation-based manner using a variety of cognitive-behavioral strategies such as cognitive restructuring, rational disputation, exposure with response prevention, and mirror retraining. Despite the complexity of this case, results suggest that comorbid BDD and bulimia nervosa can be effectively managed with cognitive behavioral therapy.     

Eating disorder pathology among overweight treatment-seeking youth: clinical correlates and cross-sectional risk modeling

Preliminary research suggests that pediatric overweight is associated with increased eating disorder pathology, however, little is known about which overweight youth are most vulnerable to eating disorder pathology. We therefore investigated 122 overweight treatment-seeking youth to describe eating disorder pathology and mental health correlates, and to identify psychopathological constructs that may place overweight youth at increased risk for eating disorder pathology. Youth participated in a comprehensive assessment of eating disorders, mood and anxiety disorders, general psychopathology, and risk variables involving semi-structured clinical interviews and self- and parent-report questionnaires prior to the initiation of weight-loss treatment. Ten youth met criteria for an eating disorder, and over one-third endorsed recent binge eating. Eating disorder pathology was associated with depressive and anxious symptoms (p's<0.001). Structural equation modeling indicated increased negative affect, teasing experience, and thin-ideal internalization, and decreased perfectionism were associated with increased eating disorder pathology. Findings corroborate earlier work indicating that eating disorder pathology is elevated and clinically significant in overweight treatment-seeking youth, bolstering the need for mental health assessment of such individuals. Cross-sectional modeling proposed key variables that relate to eating disorder pathology in overweight treatment-seeking youth, which following prospective replication, may inform the development of effective interventions for overweight and eating disorders.     

Eating disorders: relations with inconsistent discipline,anxiety, and drinking among college women

Since as many as 20% of all college women report symptoms of eating disorders, the present study examined the relationship between self-reported eating disorder symptoms. anxiety, drinking, and retrospective reports of inconsistent parenting during childhood. 101 college women, 85% Euro-Americans of mean age 19 yr., completed an anonymous survey including questions from the Eating Disorder Index-1, the Retrospective Family Unpredictability Scale, the Trait Anxiety Scale, and measures of drinking in the previous month. Eating disorder symptoms correlated with self-reported drinking quantity, anxiety, and retrospective ratings of inconsistent discipline. This appears to be the first time eating disorder symptoms have been associated with inconsistent discipline. Implications for etiology and treatment of eating disorders are discussed.     

情绪智力在身体自尊与进食障碍倾向间的调节作用

采取整群抽样对1043名中学生进行问卷调查,主要探讨身体自尊、情绪智力与青少年进食障碍倾向之间的关系,检验情绪智力的调节作用。结果表明：（1） BMI、性别、年级和年龄均是青少年进食障碍倾向的预测因素。（2）青少年身体自尊负向预测其进食障碍倾向。（3）青少年情绪智力在身体自尊和进食障碍倾向之间起调节作用,具体来说,无论情绪智力高低,青少年身体自尊均显著预测其进食障碍倾向,然而,相对于高情绪智力被试,低情绪智力被试的身体自尊对其进食障碍倾向的预测力更大。     

Eating Disorder Recovery

Abstract

Qualitative studies addressing the eating disorder recovery process from the client's point of view are notably absent in the literature. For this case study, we conducted a retrospective examination of the recovery process, as recounted by a 37-year-old female who was diagnosed with anorexia nervosa, binge eating/purging subtype at the age of 30. Two in-person interview sessions provided insight into coping skills, multidisciplinary intervention strategies, and long-term treatment challenges. In sum, the client's perspective can add new information to the understanding of eating disorder recovery from feminist and other theoretical frameworks.     

Attentional bias for body and food in eating disorders: increased distraction, speeded detection, or both?

Previous research suggests that eating disorder patients show an attentional bias for body- and food-related information. However, so far little is known about the mechanisms that underlie the attentional favoring of this particular information in eating disorder patients. In the present study, we used both a body and a food visual search task to study speeded detection and increased distraction in eating disorder patients (n=67) and healthy controls (n=60). Compared with controls, eating disorder patients showed evidence of speeded detection of body-related information, and increased distraction by food information. These results suggest that the mechanism underlying the biased attentional allocation of eating disorder patients varies, and is dependent upon the type of information they are presented with.