Primary Care Provider Familiarity with Binge Eating Disorder and Implications for Obesity Management: A Preliminary Survey

Current guidelines for the evaluation and treatment of obesity recommend referring individuals with binge eating disorder (BED) to a mental health professional. However, it is unclear how familiar primary care providers are with BED. The purpose of this study was to assess providers' familiarity with BED diagnosis and treatment. Providers in two primary care clinics completed a questionnaire, which assessed perceived familiarity with BED and demonstrated familiarity with BED diagnosis and treatment. Results indicated that 61% of respondents demonstrated familiarity with the essential symptoms of BED, and 80% reported familiarity with the diagnosis of BED. However, 35% of respondents who perceived themselves as familiar with BED did not demonstrate familiarity with the most basic symptoms. These results demonstrate that while many providers in primary care are familiar with BED, steps to improve provider familiarity with the disorder and provide appropriate mechanisms to address BED are 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.

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.     

Mindfulness and Acceptance in the Treatment of Disordered Eating

Mindfulness and acceptance-based approaches to the treatment of clinical problems are accruing substantial empirical support. This article examines the application of these approaches to disordered eating. Theoretical bases for the importance of mindfulness and acceptance in the treatment of eating problems are reviewed, and interventions for eating problems that incorporate mindfulness and acceptance skills are briefly described. Empirical data are presented from a pilot study of mindfulness-based cognitive therapy adapted for treatment of binge eating.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Diagnosing,Conceptualizing, and Treating Eating Disorders Not Otherwise Specified: A Comprehensive Practice Model

This article presents research and evidence‐based practices for identifying, understanding, diagnosing, conceptualizing, and providing a continuum of treatment for the most commonly experienced types of eating‐related counseling concerns—namely, eating disorders not otherwise specified—among the population most likely to present these types of needs: adolescent girls and young adult and adult women.     

Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents

This study aimed to describe the course of early onset eating disorders in a population-based sample followed from 14 to 20 years; identify variables that could account for the persistence of eating disorders from 14 to 20 years; and describe outcome of early onset eating disorders with reference to general and psychological functioning at age 20. Participants (N?=?1,383; 49 % male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to young adulthood. Eating disorder symptoms were assessed using an adapted version of the Eating Disorder Examination-Questionnaire, at ages 14, 17 and 20. At age 14, 70 participants met DSM-IV criteria for a binge eating or purging eating disorder. Nearly half (44 %) of these adolescents ceased to meet criteria for an eating disorders at ages 17 and 20, whilst one-quarter still met criteria for an eating disorder at age 20 and one-fifth met criteria for an eating disorder at all three time points. Purging at age 17 and externalising behaviour problems at age 14 were the strongest predictors of eating disorder persistence to age 20. Participants who experienced a persistent eating disorder were less likely to complete high school than other participants, and reported pronounced depressive and anxiety symptoms at age 20. This study provides new data the course and outcome of early onset eating disorders at a population level. Behavioural difficulties in early adolescence and purging in middle adolescence may predict persistent eating pathology to young adulthood.     

Dysfunctional Eating in an Australian Community Sample: The Role of Emotion Regulation,Impulsivity, and Reward and Punishment Sensitivity

This study aimed to examine the role of emotion regulation and reinforcement sensitivity in dysfunctional eating behaviours. Two hundred twenty‐eight adults from the Australian community completed self‐report inventories assessing the variables. Dysfunctional restrained eaters differed from those who did not engage in restrained eating in terms of their emotion regulation, impulsivity, and sensitivity to reward. Difficulties in emotion regulation, low impulsivity, and sensitivity to reward predicted engagement in restrained eating. Emotional eaters significantly differed from those who did not engage in dysfunctional levels of emotional eating in terms of their emotion regulation, impulsivity, and sensitivity towards reward, and difficulties in emotion regulation predicted emotional eating. Finally, dysfunctional external eaters differed from non‐dysfunctional external eaters in terms of their emotion regulation, impulsivity, sensitivity towards reward, as well as sensitivity towards punishment, and difficulties with emotion regulation and sensitivity towards reward predicted external eating. These findings highlight the importance of the inclusion of emotional functioning in models of development and maintenance of eating disorders, and support the potential implementation of treatment interventions that address emotion regulation and include strategies to cope with impulsivity and reinforcement sensitivities.     

Eating Issues in Schools: Detection,Management, and Consultation With Allied Professionals

School counselors play a crucial role in the prevention, assessment, treatment, and overall management of eating‐related problems among children and adolescents. This article provides a framework for conceptualizing these difficulties on a continuum of severity and includes recommendations at each level for intervention and consultation. Collaboration with other professionals is encouraged when confronted with these multifaceted issues. Efforts by school counselors are vital to prevention and recovery from eating disorders.     

Prospective Relations between Overeating,Loss of Control Eating,Binge Eating,and Depressive Symptoms in a School-Based Sample of Adolescents

A sample of 353 community adolescents (grades 9 to 12, 57.6 % female) participated in a 2-wave longitudinal study of eating behaviors (overeating, loss of control eating [LOC], and binge eating) and depression. The study addresses 4 hypotheses. (1) The prospective relations between eating behaviors and depressive symptoms will be reciprocal, with each predicting the other over time. (2) These relations will be stronger for girls than for boys. (3) These relations will be stronger for adolescents with high (not low) body mass index (BMI). (4) LOC will show incremental predictive utility in relation to depressive symptoms over and above overeating. Evidence supported reciprocal relations between binge eating and depressive symptoms and between overeating and depressive symptoms, but not between LOC and depressive symptoms. Sex and BMI did not substantially moderate these relations. Taken separately, overeating but not LOC predicted depressive symptoms. Taken together, neither predictor was significant controlling for the other. Results raise questions about the importance of LOC alone in predicting depressive symptoms in adolescence.     

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self‐Help Program for Mexican American Women With Binge Eating Disorders

Data on the compatibility of evidence‐based treatment in ethnic minority groups are limited. This study utilized focus group interviews to elicit Mexican American women's (N= 12) feedback on a cognitive behavior therapy guided self‐help program for binge eating disorders. Findings revealed 6 themes to be considered during the cultural adaptation process and highlighted the importance of balancing the fidelity and cultural relevance of evidence‐based treatment when disseminating it across diverse racial/ethnic groups.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Disordered Eating in Women of Color: Some Counseling Considerations

There is little attention devoted to studying eating disorder symptoms in racially and ethnically diverse groups despite the fact that the prevalence rates among women of color for eating disorder symptoms are similar to those of European American women. This article reviews research related to eating disorders in women of color, including a discussion of sociocultural factors that could influence the manifestation of eating disorders in women of color. Considerations for counseling practice and research are provided.     

Social Competence and Eating Disorders: Development and Validation of the Anorexia and Bulimia Problem Inventory

Incompetence at solving interpersonal problems is a possible antecedent of anorexic and bulimic behaviors in college-age women. A role-play measure of interpersonal competence, the Anorexia and Bulimia Problem Inventory (ABPI), was developed empirically and then was tested in two validation studies. ABPI scores for two samples of college women were compared: a subclinical sample [extremely high scores on the Eating Attitudes Test (EAT)] and a control sample (extremely low EAT scores). Groups differed as predicted. The second study replicated and extended these findings. The ABPI scores of clinical, subclinical, and control samples of college women differed significantly. Bulimic bingers, purgers, and laxative users were least competent on the ABPI. A lack of group differences on the Helping Situations Inventory supported the ABPI's discriminant validity. A correlation between the ABPI and Beck Depression Inventory supported the ABPI's convergent validity. ABPI competence appears to be related to certain subtypes of eating disorders.     

Young Women at Risk for Eating Disorders: Perceived Family Dysfunction and Parental Psychological Problems

These results of this study are consistent with theories of eating disorders that highlight the role of family factors in the etiology and maintenance of eating disorders. When 27 young women at risk for eating disorders who scored above the clinical cut-off score on the EDI-II were compared with age and SES matched controls, they were found to obtain more dysfunctional scores on the Family Assessment Device and on ratings of perceived maternal and paternal symptomatology on the SCL-90-R.     

Separating the Effects of Gender and Weight-Loss Desire on Body Satisfaction and Disordered Eating Behavior

The purpose of this study was to separate the effects of gender from those of desired weight loss on body satisfaction and eating disordered behavior. Therefore, we explored gender differences in a sample (N = 191) of men and women who wanted to lose weight. We expected that controlling for desire to lose weight would minimize gender differences; this was supported for (a) overall body dissatisfaction, and (b) degree of concern about, effect of, and importance of weight and appearance. Nevertheless, women reported (a) less satisfaction with several body parts, (b) stronger relations between body satisfaction and self-esteem, and (c) use of more weight-loss strategies. Exploratory analyses also were conducted to examine within-group differences among men. Implications are discussed.     

Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.     

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.