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.

Mixture Modeling of Nonsuicidal Self-Injury and Binge Eating: Behaviors and Motives

Nonsuicidal self-injury (NSSI) and binge eating frequently co-occur. These behaviors are often used to alleviate distress. Previous studies examining this co-occurrence have used a variable-centered approach. The current study used a person-centered approach (mixture modeling) to examine how individuals cluster in groups based on their past-month NSSI, past-month objective and subjective binge episodes (OBEs and SBEs, respectively), and endorsement of coping motives for NSSI and eating in two large samples of emerging adults. Validators included self-report measures of emotion regulation, impulsivity, and negative affect. In Study 1, additional validators included lifetime history of mental health treatment and suicide attempts. In Study 2, additional validators included child abuse history. In both Study 1 and Study 2, a three-class solution provided the most interpretable fit with classes characterized as (a) low psychopathology; (b) the presence of OBEs and NSSI, and endorsement of NSSI coping motives; and (c) the presence of SBEs and NSSI, and endorsement of high levels of NSSI coping motives. In both studies, eating motives were equivalent in Classes 2 and 3, but NSSI motives were most strongly endorsed by Class 3. In Study 1, Class 2 endorsed higher rates of lifetime suicide attempts than Class 3. In Study 2, both Class 2 and Class 3 endorsed higher rates of child abuse than Class 1, although they did not differ from each other. The class structure and validator analysis were consistent across samples and measures. Results suggest that binge eating and NSSI tend to cluster together in otherwise healthy emerging adults.     

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.     

Weight-Related Abuse: Impact of Perpetrator-Victim Relationship on Binge Eating and Internalizing Symptoms

Disordered eating and weight problems are associated with experiencing childhood abuse. While weight-related abuse (WRA; teasing and verbal abuse specific to one’s weight) uniquely predicts disordered eating and mood problems in adulthood, the link between WRA and adult outcomes is largely unexplored. Relationships between perpetrators and victims (e.g., family member vs. stranger) have demonstrated an impact on outcomes in research on sexual abuse, and may elucidate important aspects of the relationship between psychopathology and abuse. Thus, we investigated the effect of the perpetrator’s relationship to the victim on disordered eating symptoms in a population of young adults (N = 371) oversampled for current overweight and obesity. Parent perpetration of WRA was the strongest predictor of both depression and abuse-related emotional impact ratings. In contrast, friend and classmate perpetration of WRA were the sole predictors of binge eating and anxiety symptoms, respectively. Results highlight the importance of investigating the impact of multiple types of perpetrators of WRA, as well as the need to examine family and other close relationships in the treatment of disordered eating and internalizing symptoms.     

Thematic Analysis of the Intersection of Spirituality and Eating Disorder Symptoms

The authors interviewed 12 female participants about the intersection of their spiritual beliefs and eating disorder symptoms. Three main themes emerged from the data: (a) spiritual beliefs as helpful, (b) choice not to ask for spiritual help, and (c) guilt.     

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.     

Understanding Women's Experiences of Defending Against Eating Disorder Symptoms: An Interpretive Phenomenological Analysis

Body dissatisfaction predicts eating disorder symptomatology for some women but not for others. To better understand this disparity, the authors interviewed 7 college women who reported body dissatisfaction and no engagement in eating disorder symptoms. The authors identified 4 factors that may protect body‐dissatisfied women from engaging in eating disorder symptoms.     

Suicidal Ideation and Eating Disorder Symptoms in Adolescents: The Role of Interoceptive Deficits

Eating disorder symptoms and suicidal ideation are relatively common, and often begin to emerge in adolescence. Interoceptive deficits, or the inability to perceive and accurately identify the physiological condition of the body, is an established risk factor for both eating disorders and suicidal thoughts and behaviors. Despite this, longitudinal research examining the temporal dynamics between these variables is scarce, especially within adolescent samples. Using a three-wave longitudinal design, the present study tested bidirectional relationships between interoceptive deficits, eating disorder symptoms, and suicidal ideation to examine whether interoceptive deficits predicted eating disorder symptoms and suicidal ideation over the course of a year among a sample of adolescents. Participants were 436 community adolescents recruited from local middle- and high-schools. Data were collected at baseline, 6-month follow-up, and 12-month follow-up. Study measures assessed current suicidal ideation, eating disorder symptom severity, and interoceptive deficits. Autoregressive cross-lagged modeling was conducted in MPlus. We found baseline eating disorder symptoms significantly predicted suicidal ideation at 6-month follow-up when controlling for baseline suicidal ideation. Baseline interoceptive deficits significantly predicted eating disorder symptoms 6-months later, while 6-month follow-up interoceptive deficits significantly predicted 12-month follow-up suicidal ideation. Our findings highlight the need for early and regular assessment of suicidal ideation and eating disorder symptoms in adolescents. Given that interoceptive deficits was a shared risk factor for both conditions within this sample, these results underscore the need for targeted interventions aimed at improving interoception.     

Associations Between Peer Pressure and Adolescents’ Binge Behaviors: The Role of Basic Needs and Coping

Framed from a framework based on the integration of self-determination theory (Ryan &; Deci, 2000 Ryan, R. M., &; Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. doi:10.1037/0003-066X.55.1.68[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and Endler and Parker’s (1990) conception of coping strategies, the authors analyzed the relationships between peer pressure and binge behaviors (binge eating and binge drinking) in adolescence. Moreover, the authors explored the mediating role of satisfaction/frustration of basic psychological needs and coping strategies in these associations. Participants were 570 high school students (M?=?15.75 years, SD?=?1.14 years) living in Italy. The study design was cross-sectional and adolescents were administered self-report questionnaires. Path analysis showed significant and positive direct associations of peer pressure with both binge eating and binge drinking. Moreover, findings show that there is an indirect path in which peer pressure is positively associated with need frustration that is related to the use of emotion-oriented coping strategies that, on their turn, are associated with binge eating. Differently, binge drinking seems to be only directly related to peer pressure. The authors put light to the complex nature of the relationships between peer pressure and binge behaviors in adolescence, taking into account the separate contribution of need satisfaction and need frustration, as well as of coping strategies. Finally, practical implications of the study are discussed.     

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.     

大学生进食障碍症状的潜在剖面分析及其与抑郁的关系

为了解大学生进食障碍症状的类别特征及其与抑郁和性别的关系,使用进食障碍检查自评问卷6.0和9项患者健康问卷对575名大学生施测,采用带预测变量（抑郁）和分类结果变量（性别）的潜在剖面法进行数据分析。结果表明：大学生进食障碍症状可划分为体形关注组（62.4%）、体像顾虑组（28.0%）和进食障碍风险组（9.6%）;抑郁得分越高,个体被归为体像顾虑组或进食障碍风险组的可能性越大;女性属于体像顾虑组和进食障碍风险组的可能性比男性高。     

Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors

Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one’s own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.     

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.     

青少年饮食失调：同伴的表现形式及作用机制

饮食失调在青少年群体中非常普遍, 同伴被认为是一种重要的影响因素。梳理其作用机制, 对青少年饮食失调的预防和干预有重要意义。研究表明, 同伴对青少年饮食失调具有消极影响, 主要表现为感知到的同伴行为、实际的同伴行为、身体不满意的中介作用、以及同伴质量的影响。研究者从直接、间接的角度就同伴对青少年饮食失调的作用机制及影响进行了阐释。未来的研究应深化研究内容, 如增加关于同伴影响的长期效应、同伴属性划分、影响路径作用大小以及同伴与饮食失调的其它社会影响因素间的交互作用等方面的研究。