Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder

Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".     

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.     

Individual differences in trait urgency moderate the role of the affect heuristic in adolescent binge drinking

This study investigated the roles of the affect heuristic and outcome beliefs in explaining the relationship between negative urgency and adolescent binge drinking behaviour. The sample consisted of 391 Australian high school students, who were selected to be low or high on urgency. We hypothesised that highly urgent adolescents would be more likely than adolescents low in urgency to utilise the affect heuristic (i.e., to rely upon affective input) when making alcohol-related decisions. Multiple-group path analysis supported this prediction. Adolescents high in urgency exhibited greater use of the affect heuristic by displaying a direct path from affective associations to binge drinking; whereas adolescents low in urgency exhibited greater reliance upon rational processing by displaying an indirect path via outcome beliefs.     

Thin-Ideal Internalization: Mounting Evidence for a New Risk Factor for Body-Image Disturbance and Eating Pathology

Body-image disturbance and eating disorders are a significant physical and mental health problem in Western countries. We describe emerging work on one newly identified variable that appears to be a potent risk factor for the development of these problems internalization of societal standards of attractiveness. Work conducted independently in our labs over the past decade has included scale development, correlational studies, prospective risk-factor studies, randomized experiments, and randomized prevention trials. Findings collectively suggest that internalization is a causal risk factor for body-image and eating disturbances, and that it appears to operate in conjunction with other established risk factors for these outcomes, including dieting and negative affect. Future research is needed to examine the specific familial, peer, and media influences that promote internalization and to replicate and extend our prospective and experimental studies.     

Selective processing of food,weight, and body-shape words in nonpatient women with bulimia nervosa: Interference on the Stroop task

The study investigated whether the Stroop interference effect could be found in nonpatients with a self-report consistent with a diagnosis of bulimia nervosa. The nonpatient bulimic group showed significantly more interference to disorder-specific words (food, weight, and body shape) than to control words. The two nonpatient comparison groups, a depressed-nonbulimic group and a nonbulimic-nondepressed group, showed no interference. These results indicate that nonpatients with bulimia nervosa can be used to test various models of the cognitive and emotional processes involved in bulimia nervosa with the modified Stroop task. Methodological issues in the use of the computerized Stroop task with clinical populations are also noted.     

Selective information processing and schematic content related to eating behavior

An adaptation of the Stroop color-naming task was used to investigate selective information processing related to eating behavior in 90 undergraduate women. This study differed from previous studies by (a) treating eating behavior as a continuous variable and (b) looking at five separate categories of words including color, neutral, food, body shape, and other emotionally salient words. We did not find a strong pattern of relation between the Stroop task and eating and body image measures. Results suggest that in a nonclinical population, direct methods of accessing cognitions related to eating may be more fruitful than indirect measures.     

The influence of caloric information on cafeteria food choices

We evaluated the effect of posting caloric information on food purchases at a cafeteria. Purchases of more than 14,300 entrees, vegetables, and salads by 6,970 customers were unobtrusively monitored via the cash register inventory control system during 15 evening observations. A quasi-multiple-baseline design across food groups was used to test the additive effect of labeling the three lowest caloric choices for vegetables, salads, and entrees. A linear logit analysis confirmed that labeling increased the probability of low calorie selections for vegetables and salads, but not for entrees. Observations of meals purchased by a subsample of 413 customers indicated labeling did not change the total caloric content of meals. The number of customers and total sales per evening were unaffected by the labeling intervention. The results suggest that manipulating environmental cues may be an effective method for changing food purchases in a cafeteria, but labeling individual items may not be the best way to decrease total calories purchased.     

RESPONSE INTERRUPTION AND DRL FOR THE REDUCTION OF RAPID EATING

We assessed the efficacy of several procedures for reducing the rate of eating responses during mealtime by three institutionalized mentally retarded clients. A time-based (15 s) response interruption procedure was implemented which resulted in little change in eating responses for 2 of 3 subjects. A spaced-responding DRL 15-s procedure resulted in decreases in eating responses to target levels only after a prompting procedure was added. Procedures were evaluated using a multiple baseline across subjects design with assessment of generalization to nontreated meals. A change in eating behavior during breakfast occurred only after direct training in the breakfast setting. Maintenance data were collected at 1- and 5-month follow-up periods.     

IMPACT OF PARENTAL BINGE EATING DISORDER: EXPLORING CHILDREN'S EMOTIONAL/BEHAVIORAL PROBLEMS AND THE QUALITY OF PARENT–CHILD FEEDING INTERACTIONS

This study examines psychopathological problems in children of parents with binge eating disorder (BED), particularly the effect of parental diagnosis on their offspring's psychopathology and the mediating power of the quality of parent–infant feeding interactions. Two hundred parents and their offspring were administered a questionnaire for the assessment of their children's psychopathology at 18 (T1) and 36 (T2) months of age. An observational measure to evaluate feeding interactions was administered at T1. Children with both parents with BED showed the highest affective, anxiety, oppositional/defiant, and autism spectrum problems, but no influence of paternal diagnosis was found on the offspring's psychopathology. Maternal BED had an influence on children's affective and autism spectrum problems, and diagnosis of BED in both parents had an effect on infants’ affective problems. Paternal BED had an effect on oppositional/defiant problems through the quality of father–infant interactions, and maternal BED had an effect on the offspring's affective and anxiety problems through the mediation of mother–infant interactions. These results suggest the importance of intervention programs focusing both on parental psychopathology and on mother–child and father–child feeding interactions in families with parents with BED.