Process Analyses of Impulsive Behavior in Binge-Eating Disorder During the Randomized Controlled IMPULS Trial

Impulsivity represents a risk factor for patients with binge-eating disorder, and we therefore investigated the treatment process of impulsive behaviors including binge-eating episodes in the randomized controlled IMPULS trial. Using 8 weekly online questionnaires throughout the assessment period, we compared 41 patients participating in the IMPULS program, which emphasized impulsive eating behavior (IG), with 39 control patients who received no intervention (CG). We assessed the frequency of binge eating, other impulsive behaviors, situations in which such behaviors could be inhibited, and the execution of alternative behaviors. Results indicate a stronger binge-eating reduction in the IG compared to the CG at the fifth, seventh, and eighth treatment weeks. Overall, both groups reduced other impulsive behaviors. They did not differ in the amount of inhibited impulsive behaviors and showed similar alternative behaviors, “distraction” most frequently used. IG patients evaluated the IMPULS program as very helpful. The stronger reduction of binge eating in the IG and positive evaluation of the treatment indicate a specific treatment effect regarding impulsive eating behavior. The reduction of other impulsive behaviors across both groups, and the initial reduction of binge eating within the CG, could be explained by an increased degree of self-observation.     

Thinness and eating expectancies predict subsequent binge-eating and purging behavior among adolescent girls

One's expectancies for reinforcement from eating or from thinness are thought to represent summaries of one's eating-related learning history and to thus influence the development of binge-eating and purging behavior. In a 3-year longitudinal study, the authors tested this hypothesis and the hypothesis that binge eating also influences subsequent expectancy development. The authors used trajectory analysis to identify groups of middle school girls who followed different trajectories of binge eating, purging, eating expectancies, and thinness expectancies. Initial eating and thinness reinforcement expectancies identified girls whose binge eating and purging increased during middle school, and expectancies differentiated girls who began these problem behaviors from girls who did not. Initial binge-eating scores differentiated among eating expectancy developmental trajectories. The onset of most behaviors can be understood in terms of learned expectancies for reinforcement from these behaviors. The same model can be applied to the risk for eating disorders.     

BODY OBJECTIFICATION, SOCIAL PRESSURE, AND DISORDERED EATING BEHAVIOR IN COLLEGE WOMEN: THE ROLE OF SORORITY MEMBERSHIP

Social pressure to conform to the thin ideal is believed to play a decisive role in the development of eating disorders. In this field study at a college with only sophomore rush, 99 sorority women, 80 nonsorority women past their first year, and 86 first-year women completed three subscales of the Eating Disorders Inventory-2 ( Garner, 1991 ), the Objectified Body Consciousness Scale ( McKinley & Hyde, 1996 ), and a measure of peer social pressure. It was hypothesized that women belonging to sororities as well as those who intended to join would score higher than nonsorority and first-year women with no intention to join on these measures of disordered eating, body objectification, and social pressure. It also was predicted that the amount of time spent living in a sorority house as well as degree of social pressure would correlate positively with higher scores on body objectification and disordered eating. Results supported nearly all hypotheses, suggesting both that sororities attract at-risk women and that living in a sorority house is associated with increased likelihood of disordered eating.     

Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls.

This study explored friendship variables in relation to body image, dietary restraint, extreme weight-loss behaviors (EWEBs), and binge eating in adolescent girls. From 523 girls, 79 friendship cliques were identified using social network analysis. Participants completed questionnaires that assessed body image concerns, eating, friendship relations, and psychological family, and media variables. Similarity was greater for within than for between friendship cliques for body image concerns, dietary restraint, and EWLBs, but not for binge eating. Cliques high in body image concerns and dieting manifested these concerns in ways consistent with a high weight/shape-preoccupied subculture. Friendship attitudes contributed significantly to the prediction of individual body image concern and eating behaviors. Use of EWLBs by friends predicted an individual's own level of use.     

Bulimia,dietary restraint,and concern for dieting

The concept of dietary restraint has recently been used to explain binge-eating in dieters. It has been proposed that the violation of various restraint rules typically leads to hinging in individuals exhibiting high dietary restraint. This study examined the role of dietary restraint in a clinical sample of bulimics. After eating a preload to break dietary restraint, bulimic binge-eaters (those who binge but do not purge) were found to eat significantly more than bulimics who binged and purged (bulimia nervosa) and significantly more than normals. In addition, purging bulimics were found to have more concern about dieting than binge-eaters, while normals were found to have less concern about dieting and less anxiety about eating than both bulimic groups. These data suggest that the psychopathology of bulimia nervosa and bulimia (binge-eating) may be substantially different. It was proposed that the most distinguishing characteristic may be the preoccupation with dieting, weight, and body size, which is more extreme in bulimia nervosa.     

Guided and unguided self-help for binge eating

This study compared the relative short- and longer-term efficacy of therapist-guided and unguided use of a cognitive behavioral self-help manual for binge eating [Fairburn, C. G. (1995). Overcome binge eating. New York: The Guilford Press.] Forty women (82.5% with binge eating disorder) were randomized to one of the two treatment levels. Results indicate that both conditions represent viable means of treating binge eating. Overall, patients improved their eating behavior, eliminated any inappropriate compensatory behaviors, reduced their shape concern, weight concern, and other symptoms of eating-related psychopathology, and improved their general psychological functioning. The guided self-help condition was notably superior in reducing the occurrence of binge eating and its associated symptomatology, as well as lowering interpersonal sensitivity. A high degree of general psychopathology was a negative prognostic indicator. The implications for a stepped-care approach to treating binge eating are discussed.     

Early Change Trajectories in Cognitive-Behavioral Therapy for Binge-Eating Disorder

Rapid response is considered the most well-established outcome predictor across treatments of binge-eating disorder (BED), including cognitive-behavioral therapy (CBT). This study sought to identify latent trajectories of early change in CBT and compare them to common rapid response classifications. In a multicenter randomized trial, 86 adults with BED (DSM-IV) or subsyndromal BED provided weekly self-reports of binge eating over the first 4 weeks of CBT, which were analyzed to predict binge eating, depression, and body mass index at posttreatment, 6-, and 18-month follow-up. Using latent growth mixture modeling, three patterns of early change—including moderate and low decreasing—as well as low stable binge eating were identified, which significantly predicted binge-eating remission at 6-month follow-up. Other classifications of rapid response based on Receiver Operating Characteristics curve analyses or on the literature (≥ 10% reduction in binge eating at week 1, ≥ 70% reduction in binge eating at week 4) only predicted posttreatment remission or overall depression, respectively. Latent change trajectories, but not other rapid response classifications, predicted binge-eating frequency over time. A fine-grained analysis of change over the first 4 weeks of CBT for BED revealed different trajectories of early change in binge eating that led to an improved prediction of binge-eating outcome, compared to that of common rapid response classifications. Thorough monitoring of early change trajectories during treatment may have clinical utility.     

Reformulating and testing the perfectionism model of binge eating among undergraduate women: a short-term, three-wave longitudinal study

The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking, supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating.     

The Empirical Status of Cue Exposure and Response Prevention Treatment for Binge Eating: A Systematic Review

Approximately 50% of individuals fail to obtain treatment benefits when undergoing cognitive-behavioral therapy (CBT) for binge-eating behaviors, making it necessary to evaluate additional approaches. Cue exposure and response prevention (CERP) is one such approach, although its effectiveness across studies has been inconsistent. This may be due to inconsistent implementation of theoretically based CERP strategies. This possibility has not yet been systematically investigated. To address this gap, this review investigated which CERP strategies have been incorporated into treatment protocols for binge eating, and if the use of certain strategies improves treatment effectiveness. Relevant studies were identified through reference lists, grey literature, and searches of electronic databases using multiple search terms related to CERP and binge eating, which resulted in 18 eligible studies. Most studies were underpowered, many were of low methodological quality, and none of the included studies utilized all of the strategies that have been recommended to optimize CERP. Despite these weaknesses, CERP appeared to reduce the frequency of binge eating in the short and long term. This review underscores the need for higher quality research that utilizes larger samples and uniform outcome measures that are more strongly grounded in theory. Such research would help improve treatment outcomes for binge eating.     

情绪对饮食行为的影响

人类的饮食行为受到诸多因素的影响, 包括生理因素、心理因素及社会文化因素等, 其中情绪对饮食行为的影响日益受到研究者的重视, 这种影响一般表现为摄入量的多少和食物(热量)的选择。通过探讨不同情绪下临床和非临床个体食物摄入量的表现, 总结发现消极情绪导致个体暴饮暴食的可能更大。积极情绪影响下的饮食行为的研究结果则存在分歧: 生理角度解释为积极情绪能够促进个体的享乐机制, 导致进食行为增加; 而自我控制理论则认为积极情绪增加了个人资源以抵制美食诱惑。此外, 进一步探讨了情绪影响下饮食行为的神经生理机制。未来在饮食相关的临床研究和治疗上, 需要对情绪影响下的饮食行为有更深入的神经机制方面的探究。     

Prevalence of bulimic behaviors and trends in eating attitudes among Turkish late adolescents

The eating attitudes and the prevalence of bulimic behaviors in a group of 300 late adolescents were investigated using the key questions from the Bulimia Investigatory Test, Edinburgh (BITE), and additional questions. Only four subjects (1.3%) scored above the cut-off point on the BITE, and prevalence rates of males and females were the same. Results showed that higher symptom scale scores were associated with the emergence of binge eating behavior and high energy intake. Females were less likely than males to see themselves as normal eaters and more likely to feel "miserable" when they binge. Higher score groups evidenced more dieting behavior than other groups and also more abnormal eating behavior. It was concluded that the prevalence of bulimic behaviors in Turkish late adolescents was low, but there was an increasing risk since they share Western ideals of slimness and engage in dieting.     

Judging a Book by Its Cover: The Differential Impact of Attractiveness on Predicting One's Acceptance to High‐ or Low‐Status Social Groups

Emerging research suggests that the cues we glean from first impressions depend on our goals. This research uses sorority recruitment to examine whether groups that vary in social status rely on disparate cues to form first impressions of potential new group members. Current sorority members were given 500 ms to view pictures of women who wanted to join their sororities, and were then asked how likely it was that each prospective member would receive a bid from their sorority (bid expectancy). Prospective members were also rated on their attractiveness. Data were analyzed separately for high‐ vs. low‐status houses. Results revealed that attractiveness was more predictive of liking and bid expectancy for the high‐status houses, as compared to the low‐status houses.     

The Effects of College Residence Groups On Students' Self-Concepts,Goals, and Achievements

This study compared the traits and achievements of students in various living groups. Students in fraternities and sororities were found to be more socially oriented, and students in off-campus rooms or at home were less socially oriented on a wide variety of measures. When students' pre-college scores were controlled, there were few differences among the groups on self-ratings or life goals. Fraternity and sorority students had more college social achievements but were not superior in other areas of non-academic achievement or in grades. These results were interpreted as showing that the effects of living groups are small.     

Do friends share similar body image and eating problems? The role of social networks and peer influences in early adolescence

This study examined the role of friendship networks and peer influences in body image concern, dietary restraint, extreme weight loss behaviours (EWLBs) and binge eating in a large community sample of young adolescent females. Based on girls' self-reported friendship groups, social network analysis was used to identify 173 friendship cliques. Results indicated that clique members shared similar scores on measures of dieting, EWLB and binge eating, but not body image concern. Average clique scores for dieting, EWLB and binge eating, were also correlated significantly with clique averages on measures of perceived peer influence, body mass index and psychological variables. Multiple regression analyses indicated that perceived peer influences in weight-related attitudes and behaviours were predictive of individual girls' level of body image concern, dieting, EWLB use and binge eating. Notably, an individual girl's dieting and EWLB use could be predicted from her friends' respective dieting and EWLB scores. Findings highlight the significance of the peer environment in body image and eating problems during early adolescence.     

Adolescent Girls and Their Mothers Talk About Experiences of Binge and Loss of Control Eating

Evidence suggests that adolescents’ experience of binge eating (BE) might differ in important ways from that of adults. Moreover, although BE appears more common in African American women than other disordered eating behaviors, little is known about the influence of cultural factors on this behavior in adolescents. The current investigation used qualitative methodology to examine the perceptions of White and African American adolescent girls and their mothers regarding experiences of binge and loss of control eating. Five focus groups were completed with 19 adolescent girls (aged 13–17, 58 % African American, 41 % White) who endorsed loss of control eating behaviors. Their mothers (N = 19) also completed separate, concurrent focus groups addressing food and eating behaviors. Responses to focus group questions were analyzed using thematic qualitative analysis. Adolescents’ awareness of their eating behaviors varied greatly. Girls reported some awareness of how emotions influence their eating behaviors, and described using food to achieve autonomy. Mothers evidenced awareness of their daughters’ problematic eating behaviors, the effects of emotions on eating for both their daughters and themselves, and sociocultural factors influencing diet. Data from these focus groups can inform the development of innovative interventions for adolescent girls engaging in loss of control eating.     

Adapted motivational interviewing for women with binge eating disorder: a randomized controlled trial

In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms.     

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.     

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.     

Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder

Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12–20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.