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.     

Examining the Association Between Body Mass Index and Weight Related Quality of Life in Black and White Women

Obesity not only increases risk for morbidity/mortality, but also impacts the quality of life of obese individuals. In the United States, black women have the highest prevalence of obesity of any other group with approximately 80% of black women over age 20 having a body mass index (BMI)????25?kg/m². We aimed to examine the association between BMI and quality of life in this high risk population compared to this association in white women, using the Impact of Weight on Quality of Life (IWQOL)-Lite questionnaire. Data from 172 black women (mean BMI?=?35.7; age?=?40.5) and 171 white women (mean BMI?=?35.5; age?=?40.4) were collected between 2000 and 2010 analyzed in 2010. The mean IWQOL-Lite total score was 81.6 for black women compared to 66.9 for white women, a statistically significant difference. Hierarchical linear regression models revealed a significant BMI-by-race interaction indicating that the relationship between BMI and IWQOL-Lite score was moderated by race. Our findings suggest notable differences in weight-related quality of life in black and white women. At similar BMIs, black women consistently reported better quality of life than white women on all IWQOL-Lite subscales. The greatest difference in IWQOL-Lite scores between black and white women was seen in the self-esteem subscale. Additional research is needed to understand how to incorporate the weight perspectives of black women into weight management messages and interventions.     

Examination of the Relationship Between Perfectionism and Religiosity as Mediated by Psychological Inflexibility

A relationship between perfectionism and religiosity has been suggested in the literature, and this relationship is clarified further when the adaptive and maladaptive dimensions of both constructs are compared. Literature in both areas implicates the idea of a rigid and inflexible personality style that may explain why well meaning high standards can be associated with negative outcomes such as perfectionism. This investigation examined the relationship of perfectionism and religiosity, using adaptive and maladaptive dimensions, as mediated by psychological inflexibility. Validated measures of perfectionism, religiosity, and psychological inflexibility were given to 376 undergraduate college students in an anonymous online survey. Adaptive perfectionism (high standards) was found to be significantly correlated (r = .26, p < .01, two-tailed) with adaptive religiosity (intrinsic orientation). Maladaptive perfectionism (discrepancy) was found to be significantly correlated (r = .13, p < .05, two-tailed) with maladaptive religiosity (extrinsic orientation). Psychological inflexibility was found to be significantly correlated with the maladaptive dimensions of both perfectionism and religiosity. It was also shown to mediate the relationship between maladaptive (extrinsic) religiosity and maladaptive (discrepancy) perfectionism. Implications and future directions are discussed.     

Daily mood patterns and bulimic behaviors in the natural environment

Objective

Negative affect has been purported to play an important role in the etiology and maintenance of bulimic behaviors. The objective of this study was to identify daily mood patterns in the natural environment exhibited by individuals with bulimia nervosa and to examine the relationship between these patterns and bulimic behaviors.

Method

One hundred thirty-three women aged 18-55 meeting DSM-IV criteria for bulimia nervosa were recruited through clinical referrals and community advertisements. Ecological momentary assessment was used to collect multiple ratings of negative affect, binge eating and purging each day for a two-week period using palmtop computers. Latent growth mixture modeling was used to identify daily mood patterns.

Results

Nine distinct daily mood patterns were identified. The highest rates of binge eating and purging episodes occurred on days characterized by stable high negative affect or increasing negative affect over the course of the day.

Conclusions

These findings support the conclusion that negative mood states are intimately tied to bulimic behaviors and may in fact precipitate such behavior.     

Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.     

Cognitive biases in the perception of discrimination: The importance of format

Previous work has shown that people seem less able to perceive sex discrimination on a personal level than on a societal level. The present experiment was performed to test the hypothesis that this phenomenon is in part an information-processing bias; that is, the perception of discrimination is more difficult when one makes case-by-case comparisons than when one encounters information in aggregate form. The experiment demonstrated the importance of formatting for the perception of discrimination. Among subjects with little or no emotional investment in the issue of sex discrimination, the format of the pertinent information has a large effect on information processing: subjects perceived less discrimination when they encountered the relevant information in little chunks than when they saw the total picture at a single shot.     

Clarifying and measuring the concept of traditional vs. egalitarian roles in marriages

To clarify and develop a measure of the concept of traditional vs. egalitarian marriages, a 13-item scale was developed and administered to two traditional groups (N=35) and three egalitarian groups (N=51), and then to four cross-validation groups (N=52). Two distinct factors or dimensions were identified. In both analyses the traditional and egalitarian groups were significantly different on the first factor, designated “the leader,” and not on the second, socioemotional factor. Reliability and initial validity of the scale in measuring leadership in the marital dyad are thus demonstrated. However, the concept of traditional vs. egalitarian marriages either needs to be narrowed to refer to leadership only or there needs to be empirical demonstration that other dimensions can be fruitfully included.     

School-Based Secondary Prevention for Children with Disruptive Behavior: Initial Outcomes

First through fourth graders from 22 suburban elementary schools were screened for cross-setting disruptive behavior as eligibility criteria for participation in a longitudinal secondary prevention study aimed at reducing the risk for serious externalizing behavioral disorders. Three hundred nine subjects participated in either a multicomponent competence enhancement intervention (MCEI) or an information/attention control (IAC) condition over a 2-year period. Following baseline measurements, initial intervention effects were assessed at the end of intervention Year 1, at the beginning of intervention Year 2 (fall of the next school year), and at the end of intervention Year 2. Multisource assessments were not supportive of the efficacy of the MCEI over the IAC condition. Children in both groups rated themselves as improved over time in terms of increased adaptive skills and decreased school problems and internalizing symptoms. Teacher and parent ratings of externalizing behavior did not yield evidence of positive change, but teachers noted improved problem solving and observers noted a decrease in behavioral interference in both groups over time, possibly as a result of maturation.