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Cooper Z, Fairburn CG. Refining the definition of binge eating disorder and nonpurging bulimia nervosa. Int J Eat Disord.34(suppl):S89-S95
International Journal of Eating Disorders
Abstract
The diagnostic concept of binge eating disorder (BED) was introduced in response to the clinical observation of Stunkard (1959) that some people with obesity have recurrent episodes of binge eating. We suggest that the DSM-IV concept of BED has resulted in the recruitment of heterogeneous research samples, amongst which are some people with BED, as described by Stunkard, some with bulimia nervosa, some with other types of eating disorder, and some with no eating disorder. We consider the difficulties distinguishing BED from other forms of overeating, especially in patients with obesity, and from nonpurging bulimia nervosa. We propose revised diagnostic criteria for BED and bulimia nervosa that are designed to minimize these problems.
... 3,[5][6][7][8][9][10] Binge-eating disorder also appears to be associated with substantial medical 11,12 and psychiatric 3,6,12-16 morbidity, some likely mediated through obesity and some independently associated with BED itself. 4,[12][13][14]16 Collectively, these findings suggest that BED is a major public health problem and a contributor to the obesity epidemic. ...
... It is known, for example, that various pharmacological, [17][18][19] psychological, 20,21 and surgical 22 treatments are efficacious in BED, but it is unknown whether these treatments work via a direct effect on BED per se or merely via a generic effect on appetite or eating patterns. 4,16 One way to discriminate among these possibilities is to determine whether BED aggregates in families independently of obesity. Evidence for such aggregation would suggest that BED is caused in part by familial factors distinct from those for obesity itself. ...
... Binge eating disorder (BED) has been classified as an official independent diagnostic entity in DSM-5. 1 BED was first described among patients seeking treatment for obesity. [2][3][4] In this setting, BED appears very common. 5 The few community-based studies of BED conducted to date generally find much lower lifetime prevalences, ranging from <1% to 4.7%. ...
... 11 Finally, distinguishing BED from other forms of overeating and bulimia nervosa is not always straightforward. 3,28 In the Netherlands, the prevalences of bulimia nervosa vs. BED were 0.8% vs. 2.1% 11 ; in our setting in Finland, 2.3% vs. 0.7%. 29 Therefore, differences in drawing the line between BED and non-purging bulimia nervosa may explain some of the observed differences. ...
Objective
To assess the population prevalence and incidence of binge eating disorder (BED) among young women.Method
In a nationwide longitudinal study of Finnish twins born 1975–1979, the women participated in five surveys from age 16 until their mid-thirties. At Wave 4 (mean age 24 years), the women (N = 2,825) underwent a 2-stage screening for eating disorders. We assessed the lifetime prevalence, incidence, and clinical characteristics of DSM-5 BED.ResultsWe detected 16 women who met DSM-5 criteria for BED, yielding a lifetime prevalence of 0.7% (95% confidence interval [CI] 0.4–1.2%). The incidence of BED among women between 10 and 24 years of age was 35 (95% CI 20–60) per 100,000 person-years. The mean age of onset of BED was 19 years (range 13–27 years). Of the cases, 13/16 (81%) were currently ill. Duration of illness at the time of assessment ranged from less than a year to 13 years (median 6 years). Of women with BED, only two had a history of other eating disorders, but six had lifetime major depressive disorder. Two-thirds of the women with BED belonged to the highest weight quartile at age 16, and their mean BMI at age 22–27 year was 26.2 kg/m2 (range 22.1–32.5 kg/m2).DiscussionIncident BED as defined by DSM-5 was relatively rare among younger women and was often preceded by relative overweight. BED often occurred without a history of other eating disorders, but comorbidity with major depressive disorder was common. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015).
... A similar eating disorder to BN is Binge Eating Disorder (BED), which has similar diagnostic criteria as BN; a large amount of consumption, or a loss of self-control. In addition, a definition of " binge " in either BED or BN also includes temporal dimension such as within 2 hour period for food consumption (Cooper and Fairburn, 2003; Latner and Clyne, 2008; Wolfe et al., 2009) once a week for 3 months. However, diagnosis of BED has to be associated with at least 3 following characteristics; 1) Eating much more rapidly than normal. ...
... Feeling disgusted with oneself, depressed, or very guilty after overeating (American Psychiatric Association, 2000). Moreover, binge eating in BED is not associated with the regular use of inappropriate compensatory behaviors (Cooper and Fairburn, 2003). Although BN and BED share many clinical symptoms, they have distinct diagnostic criteria which are the primary basis to develop separate animal models. ...
Feeding is a fundamental process for basic survival and is influenced by genetics and environmental stressors. Recent advances in our understanding of behavioral genetics have provided a profound insight on several components regulating eating patterns. However, our understanding of eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating, is still poor. The animal model is an essential tool in the investigation of eating behaviors and their pathological forms, yet development of an appropriate animal model for eating disorders still remains challenging due to our limited knowledge and some of the more ambiguous clinical diagnostic measures. Therefore, this review will serve to focus on the basic clinical features of eating disorders and the current advances in animal models of eating disorders.
... Although some critics have questioned the validity of the BED diagnosis (e.g., Stunkard & Allison, 2003), accumulating evidence has provided support for the clinical utility of BED as an independent diagnosis (Striegel-Moore & Frank, 2008; Wilfley et al., 2003). Nevertheless, Cooper and Fairburn (2003) raised concerns that the current BED criteria may identify a heterogeneous sample of eating disorder patients. For example, they suggested that the DSM- IV criteria might capture four different groups, including: (1) individuals with true BED, as described by Stunkard (1959), (2) individuals with a form of non-purging bulimia nervosa, (3) individuals with other forms of eating disorder not otherwise specified, and (4) individuals without an eating disorder (e.g., obese individuals; Cooper & Fairburn, 2003). ...
... In the current study, LCA was used to provide an empirical test of the existence of heterogeneity within the population of overweight or obese individuals all meeting strict DSM-IV criteria for BED. Variables in the LCA were chosen on the basis of: previous research (e.g., negative affect; Stice et al., 2001), the ability to identify groups similar to those described by the Cooper and Fairburn (2003), or clinical relevance. Objective overeating episodes were also included in the LCA, as patients with BED report more overeating episodes than similarly obese individuals without an eating disorder (Engel et al., 2009), which suggests these episodes may be an important component of a disordered eating pattern. ...
The purpose of the study was to explore heterogeneity and differential treatment outcome among a sample of patients with binge eating disorder (BED).
A latent class analysis was conducted with 205 treatment-seeking, overweight or obese individuals with BED randomized to interpersonal psychotherapy (IPT), behavioral weight loss (BWL), or guided self-help based on cognitive behavioral therapy (CBTgsh). A latent transition analysis tested the predictive validity of the latent class analysis model.
A 4-class model yielded the best overall fit to the data. Class 1 was characterized by a lower mean body mass index (BMI) and increased physical activity. Individuals in Class 2 reported the most binge eating, shape and weight concerns, compensatory behaviors, and negative affect. Class 3 patients reported similar binge eating frequencies to Class 2, with lower levels of exercise or compensation. Class 4 was characterized by the highest average BMI, the most overeating episodes, fewer binge episodes, and an absence of compensatory behaviors. Classes 1 and 3 had the highest and lowest percentage of individuals with a past eating disorder diagnosis, respectively. The latent transition analysis found a higher probability of remission from binge eating among those receiving IPT in Class 2 and CBTgsh in Class 3.
The latent class analysis identified 4 distinct classes using baseline measures of eating disorder and depressive symptoms, body weight, and physical activity. Implications of the observed differential treatment response are discussed.
... Особый интерес в этом разрезе представляют исследования Z. Cooper, C.G.Fairburn [37], M.D. Marcus и соавторов [62], S.Z. Yanovski, N.G. ...
In the article, we analyze the diagnosis of psychogenic overeating (ICD-10), consider the problem of its diagnostic criteria, similarities and differences with the diagnosis of binge-eating disorder (DSM-V), which complicate the work of researchers. We are looking at the need to differentiate the different types of binge eating disorder. The role of psychogenic overeating is noted as a pathogenetic factor that triggers the process of gaining excess weight. We describe in detail the biological (gender and hereditary predisposition), psychological (individual psychological personality traits, adaptive and compensatory resources) and sociocultural (style of family education, social ideas about the reference body image, features of communicative behavior, etc.) groups of factors involved in the formation of psychogenic overeating. The article emphasizes the role of psychological triggers of the disease associated with the emotional-volitional sphere, the specificity of reactions to stressful influences, psychological defenses and perception of the image of one’s body. The article also raises the problem of the lack of adapted and standardized psychodiagnostic tools aimed at studying psychogenic overeating, which complicates the formulation of an accurate diagnosis and the choice of methods of its treatment. The article also discusses such therapeutic approaches to the treatment of the described nosology, such as psychoanalysis, positive psychotherapy, gestalt therapy, transactional analysis, body-oriented therapy. Particular attention is paid to the cognitive-behavioral approach, which has shown high efficiency when working with patients with eating disorders. It is noted, that it is promising to develop algorithms for diagnostics and therapy of the described nosology, the feasibility of identifying individual targets of psychotherapeutic interventions to create personalized complex programs that increase the effectiveness of therapy in relation to immediate and long-term results.
... The episodes are then followed by inappropriate compensatory behaviors (such as self-induced vomiting, misuse of laxatives, fasting, or excessive exercise) in order to preclude weight gain. BED patients also present repetitive and uncontrolled episodes of binge eating but do not engage in the inappropriate compensatory behaviors of BN; thus, they have a heightened risk of excessive weight gain and obesity [1,5,6]. EDs represent an important public health problem in continuous growth, affecting about 2-5% of the general population worldwide [7]. ...
Eating disorders (EDs) include a range of chronic and disabling pathologies characterized by persistent maladaptive eating habits and/or behaviors aimed at controlling body shape and size, with important consequences on physical health. Different animal models of EDs have been developed to investigate pharmacological, environmental, and genetic determinants that contribute to the development and maintenance of these disorders as well as for the identification of potential therapeutic targets. In this chapter, we will provide an overview of the most useful animal models of EDs, focusing mainly on those used to study anorexia nervosa and binge eating disorder.
... A subjective loss of control is difficult to be evaluated and to be differentiated from the overeating [41]. Considering CIDI rather underdiagnosed eating disorder than overdiagnosed it [42], the BE defined in our study is less likely to be overestimated. ...
Eating disorders comorbid with depression are an established risk factor for suicide. In this study, we aimed to determine the effects of binge eating (BE) symptoms on suicidality and related clinical characteristics in major depressive disorder (MDD). A total of 817 community participants with MDD were included. We compared two groups (with and without lifetime BE symptoms). The MDD with BE group was subdivided into a frequent BE (FBE) subgroup (BE symptoms greater than twice weekly) and any BE (ABE) subgroup (BE symptoms greater than twice weekly). The MDD with BE group comprised 142 (17.38%) patients. The FBE and ABE subgroups comprised 75 (9.18%) and 67 (8.20%) patients, respectively. Comorbid alcohol use disorder, anxiety disorder, post-traumatic stress disorder (PTSD) and history of suicide attempt were significantly more frequent in the MDD with BE group than MDD without BE group. Sexual trauma was also reported more frequently in MDD with BE group. No significant differences were observed between the ABE and FBE subgroups. Multivariate logistic regression revealed an association of suicide attempt with BE symptoms and sexual trauma. Structural equation modeling showed that sexual trauma increased BE (β = 0.337, P <0.001) together with alcohol use (β = 0.185, P <0.001) and anxiety (β = 0.299, p<0.001), which in turn increased suicide attempt (β = 0.087, p = 0.011). BE symptoms were associated with suicide attempt in MDD after adjusting for other factors associated with suicidality. BE symptoms also moderated an association between suicide attempt and sexual trauma.
... In BED, binge episodes are typically not associated with inappropriate compensatory behaviors (such as vomiting, excessive physical activity, and laxative use) aimed to counteract the excessive intake of calories. Therefore, bingeing people incur a higher risk of weight gain which, in the majority of them (approximately 70%), leads to obesity [1][2][3][4]. ...
... Introduction of binge eating disorder as a separate disease entity aimed at distinguishing it from overeating and emphasizing the acute nature of this disorder and its serious physical and mental consequences. BED is characterized by: repeatable episodes of voracity (eating considerably bigger amount of food than it is normal to eat in a given period of time by an average person), loss of control over quantity and quality of ingested food and the way of eating, emotionally triggered eating (e.g., because of anger, anxiety, depression, boredom) and a feeling of significant discomfort due to binge episodes (Cooper, Fairburn, 2003). BED occurs in 2.8 -6.6% of general population and in 25% of obese people ( Grucza et al., 2007, Hudson et al., 2007). ...
Disordered eating habits among adolescents remains a major global problem that can affect their physical, mental and behavioral development. In spite of the advances that have been made in feeding practices, adolescents in many environments consume diets that are nutritionally inadequate, in that they do not provide adequate amounts of essential nutrients. Adolescence is a period which is critical and characterized by various growth spurts. Some of these growth spurts are psychological and emotional. Good dietary habits have also been found to be crucial in the development and growth of the adolescent during these periods. These psychological and emotional changes can lead to eating disorders if not well attended to. The three main types of disordered eating habits that can affect adolescents are anorexia nervosa, bulimia nervosa and binge eating disorder. In this review the use of a multidisciplinary approach in ensuring optimum adolescent growth was addressed. This approach included the use of parents/care-takers, teachers, dieticians, clinical psychologists and counsellors to ensure healthy eating habits of some adolescents. The results indicated the invaluable contribution of all the stakeholders in achieving good nutrition among adolescents.
... Exploration of the subject literature shows that there is a variety of other terms used to refer to the aforementioned disorder which is frequently labeled as compulsive overeating disorder, paroxysmal recurrent overeating, gluttony, riotous eating, or binge eating. Numerous studies have addressed this issue, which has been described in the subject literature [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. ...
Aim: This paper reports the results of the author's own research aimed at diagnosing specific psychological (personality) traits and body image characteristics in a population of selected females suffering from binge eating disorder (BED). Method: The methods applied in this research included an inventory (i.e. a Polish version of the Eating Disorder Inventory (EDI) devised by David Garner, Marion P. Olmsted, and Janet Polivy, adapted by Cezary Zechowski; and the Socio-cuiturai Attitudes towards the Body and Appearance Questionnaire, constructed by the author of this study, based on the results of factor analysis and subject literature), as well as projective techniques such as Thompson's Silhouette Test and a thematic drawing: "body image". The inventories and projective techniques applied in the research procedures aimed at diagnosing the level of selected psychological traits in the examined females. Results: Statistical analysis of the data obtained as a result of this research revealed that the examined females suffering from psychogenic overeating were overweight. Analysis of the study data concerning the subject's evaluation of their body image pointed to a substantial discrepancy between the individuals' perception of their current body shape, which they clearly did not approve of, and the ideal thin body that the females desired. The study data obtained as a result of the EDI inventory, aimed at diagnosing the level of selected psychological (personality) traits exhibited by the examined females, revealed that the subjects received the highest (inappropriate) score in the scale describing the individuals' preoccupation with pursuit of thinness. It was also discovered that the study participants had a high level of internalization of socio-cultural norms about the ideal female body, promoting the "cult of thinness", and they exhibited the feeling of insecurity and personal worthlessness, as well as a low level of interpersonal trust. It was also found out that the research subjects experienced considerable difficulties in establishing interpersonal bonds, and exhibited inappropriately low level of interoceptive awareness of body sensations, as well as increased perfectionism. Conclusions: A psychological diagnosis of body image characteristics combined with an examination of dominant personality traits in individuals suffering from binge eating disorder might be a significant element of treatment process. The research findings suggest that the females diagnosed with BED, who tend to "eat up" their emotions and exhibit an inadequate level of drive for thinness, low self-evaluation (the feeling of worthlessness), and experience difficulties in establishing and maintaining close relationships, require complex treatment which should combine such methods as regular medical examination of the patients' somatic condition, long-term depth psychotherapy, elements of cognitive-behavioral therapy focused on body image and the vicious circle of overeating, and dietary treatment.
... The prevalence of BN is 1.5 % in young females and 0.5% in men 13 . BED is characterized by recurrent binge-eating episodes without compensatory behaviours that cause obesity [14][15][16][17][18] . The prevalence of BED ranges from 1% and 5% 9 13 . ...
Summary
Background
The present review summarizes published papers reporting the
results of both open-label and double-blind studies, which explored
the potential efficacy of antidepressants, antipsychotics
and mood stabilizers in the treatment of anorexia nervosa (AN)
and bulimia nervosa (BN).
Methods
The literature was sourced from recent searches on Pubmed updated
to January 2013 using the terms “eating disorders”, “pharmacotherapy”,
“anorexia nervosa”, “bulimia nervosa”, “therapy”
or “treatment”. Studies were selected for inclusion if they met a
level of evidence that minimized the risk of bias such as randomized
controlled trials (RCTs) or systematic review of RCTs.
Results
This critical review seems to suggest that selective serotonin
reuptake inhibitors (SSRI) have a proven efficacy in BN. Antipsychotics
seem to be potentially promising options in the
treatment of severe adult and adolescent AN patients, revealing
positive psychopathological effects and good tolerability. Other
treatments, such as the anticonvulsant topiramate in BN, may
be promising.
Conclusion
Even if there have been useful researches on the efficacy of pharmacotherapy
in the treatment of BN, there are still many unsolved
issues regarding the optimal management of other EDs.
Future directions for pharmacological treatment researches in
EDs should include randomized controlled trials with different
medications, inpatient versus outpatient trials and the assessment
of medication effects for relapse prevention in recovered
patients.
Key words
Pharmacologic treatment • Eating disorders • Anorexia nervosa • Bulimia
nervosa • Binge eating disorder
... In Indonesia, it has recently been reported that the prevalence of overweight in adolescents increased drastically from 1.4% in 2007 to 7.3% in 2013 [3]. Eating habits such as snacking, binge eating and overeating as well as low physical activity have been associated with increasing risk of obesity [4][5][6][7]. There are evidences showing that eating pattern is not purely controlled by environmental factors but also genetically inherited [8]. ...
Obesity has been linked to high dietary intake and low physical activity. Studies showed that those factors were not only regulated by environment but also by genetic. However, the relationship is less been understood in obese children and adolescents.
The objective of this study was to examine the role of SNPs in GHSR rs292216 and rs509035 on dietary intake in obese female adolescents.
This is an observational study with cross sectional design. Respondents were obese female adolescents enrolled from obesity screening done in six junior high schools in Yogyakarta. Dietary intake was measured using 6 days 24 hours inconsecutive dietary recall. Genotyping of 2 SNPs from GHSR was done using FRLP-PCR.
There were 78 obese female adolescents joined this study. We found that no significant association between SNPs GHSR and dietary intake (p < 0.05). In addition, a SNP-SNP interaction analysis shown there is no difference between combination of GHSR rs292216 and rs509035 on dietary intake (p < 0.05).
We concluded that SNPs on GHSR rs292216 and rs509035 were not related to dietary intake in Indonesian obese female adolescents. Further study is necessary to investigate the effect of those genes on dietary intake in the broader population.
... Lo mismo ocurre en el caso de la bulimia nerviosa, en Tabla 4, pues también se modifica la frecuencia a una vez a la semana y se mantiene un periodo de tres meses de duración, homogenizando frecuencias semanales y de duración en el tiempo con trastorno por atracones. Se ha sugerido reevaluar en el caso de bulimia nerviosa el establecer subtipos, en particular el subtipo no purgativo, por su similitud a un trastorno por atracones (17,18). Todos los cambios en los manuales de diagnóstico finalmente tienen su aplicación en la práctica clínica y serán los usuarios y la experiencia los que irán conformando los criterios que se mantienen. ...
La obesidad es una enfermedad crónica con múltiples causas. Su etiopatogenia es un desequilibrio entre la ingesta y el gasto energético. Factores sociales, psiquiátricos y psicológicos influyen en un patrón de ingesta alterado, uno de ellos son los trastornos de alimentación. Los trastornos de alimentación más frecuentemente asociados a la obesidad son los no especificados, el trastorno por atracones, el síndrome del comedor nocturno y la bulimia nerviosa. El objetivo de este artículo es revisar su presentación clínica, evolución y tratamiento.
... The diagnosis of BED must be associated with at least 3 of the following characteristics: (1) eating much more rapidly than normal, (2) eating until feeling uncomfortably full, (3) eating large amounts of food when not feeling physically hungry, (4) eating alone because being embarrassed of how much one is eating, or (5) feeling disgusted with oneself, depressed, or very guilty after overeating [14]. Moreover, binge eating in BED is not associated with the regular use of inappropriate compensatory behaviors [31]. ...
Objective. Despite evidence from case series, the comorbidity of eating disorders (EDs) with schizophrenia is poorly understood. This review aimed to assess the epidemiological and clinical characteristics of EDs in schizophrenia patients and to examine whether the management of EDs can be improved. Methods. A qualitative review of the published literature was performed using the following terms: "schizophrenia" in association with "eating disorders, " "anorexia nervosa, " "bulimia nervosa, " "binge eating disorder, " or "night eating syndrome. " Results. According to our literature review, there is a high prevalence of comorbidity between schizophrenia and EDs. EDs may occur together with or independent of psychotic symptoms in these patients. Binge eating disorders and night eating syndromes are frequently found in patients with schizophrenia, with a prevalence of approximately 10%. Anorexia nervosa seems to affect between 1 and 4% of schizophrenia patients. Psychopathological and neurobiological mechanisms, including effects of antipsychotic drugs, should be more extensively explored. Conclusions. The comorbidity of EDs in schizophrenia remains relatively unexplored. The clearest message of this review is the importance of screening for and assessment of comorbid EDs in schizophrenia patients. The management of EDs in schizophrenia requires a multidisciplinary approach to attain maximized health outcomes. For clinical practice, we propose some recommendations regarding patient-centered care.
... Further, and also consistent with the DSM-5 criteria for BED, inclusion in the LOC subgroups required that regular LOC eating occurred in the absence of the regular use of extreme weight-control behaviours. In the absence of any agreedupon operational definition of "regular extreme weightcontrol behaviours", a conservative threshold, namely, twice per month, was employed in order to clearly distinguish participants in the LOC subgroups from individuals with a sub-threshold form of bulimia nervosa [32]. Thus, regular purging was defined as self-induced vomiting or misuse of laxatives or diuretics as a means of controlling weight or shape at least twice in the past 28 days. ...
The overvaluation of weight and/or shape (“overvaluation”), a diagnostic criterion for anorexia nervosa and bulimia nervosa, is increasingly supported for inclusion in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria of binge eating disorder (BED). However, current evidence has been largely confined to adult populations. The current study aims to examine the status of overvaluation among adolescents with loss of control (LOC) eating recruited from a large, population-based sample.
Subgroups of female adolescents – LOC eating with overvaluation (n = 30); LOC eating without overvaluation (n = 58); obese no LOC eating (“obese control”) (n = 36); and “normal-weight control” (normal-weight, no LOC eating) (n = 439) – recruited from secondary schools within the Australian Capital Territory (ACT) were compared on measures of eating disorder psychopathology, general psychological distress and quality of life.
Participants in the LOC eating with overvaluation subgroup reported significantly higher levels of eating disorder psychopathology than all other groups, while levels did not differ between participants in the LOC eating without overvaluation and obese control subgroups. On measures of distress and quality of life there were no significant differences between LOC eating with and without overvaluation subgroups. Both reported significantly greater distress and quality of life impairment than normal-weight controls. LOC eating with overvaluation participants had significantly higher levels of distress and quality of life impairment than obese controls, whereas scores on these measures did not differ between LOC eating without overvaluation and obese control subgroups.
The results suggest that the presence of overvaluation among adolescents with LOC eating indicates a more severe disorder in terms of eating disorder psychopathology, however may not indicate distress and disability as clearly as it does among adults with BED.
... Frequencies of disordered eating behaviors including binge eating and various compensatory behaviors are also assessed. Based on this questionnaire, "extreme dietary restraint" was defined with reference to the EDE-Q "food avoidance" item, namely "going without food for a period of eight or more waking hours on average three or more times per week in order to influence weight or shape" [31,32]. For the EDE-Q, norms for anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified are available for young women [29,30,33]. ...
Background
There has been limited research about disordered eating in middle-aged women, and to date, few data exist about restrained eating behavior in postmenopausal women. Therefore, the aim of this study was to examine eating behavior with a specific focus on menopause as an associated factor in restrained eating. Beyond this, we were interested in how postmenopausal status and self-esteem would interact to determine eating patterns in women in middle age.
Methods
We conducted an online survey in women aged between 40 and 66. Eating behavior was assessed with the Eating Disorder Examination-Questionnaire (EDE-Q) in premenopausal (N = 318) and postmenopausal women (N = 250). All participants rated their self-esteem using the Rosenberg Self-Esteem Scale (RSE) and reported their weight, height, waist circumference, and hip circumference.
Results
15.7% of all participants showed clinically meaningful scores on restrained eating. Postmenopausal women showed significantly higher scores on the EDE-Q subscale of restrained eating as compared to premenopausal women, but when controlling for body mass index, however, this finding was no longer significant. Further exploratory analyses suggest that particularly low or high self-esteem levels are associated with restrained eating. Self-esteem might serve as a mediator between menopausal status and restrained eating, however results of these additional analyses were inconsistent.
Conclusions
Restrained eating may appear in middle-aged women. Particularly in postmenopausal women, restrained eating might be associated with lower and higher self-esteem.
... The inference that individuals who compensate for binge eating by means of extreme dietary restriction or excessive exercise, but not purging behaviors, more closely resemble individuals with binge eating disorder (than individuals who binge eat and purge) is also problematic, precisely because "how to define non-purging inappropriate behaviors (e.g., fasting or excessive exercise) is unclear" [12,[17][18][19]. If liberal criteria for these terms (e.g. ...
Proposed changes to the classification of bulimic-type eating disorders in the lead up to the publication of DSM-5 are reviewed. Several of the proposed changes, including according formal diagnostic status to binge eating disorder (BED), removing the separation of bulimia nervosa (BN) into purging and non-purging subtypes, and reducing the binge frequency threshold from twice per week to once per week for both BN and (BED), have considerable empirical evidence to support them and will likely have the effect of facilitating clinical practice, improving access to care, improving public and professional awareness and understanding of these disorders and stimulating the additional research needed to address at least some problematic issues. However, the omission of any reference to variants of BN characterized by subjective, but not objective, binge eating episodes, and to the undue influence of weight or shape on self-evaluation or similar cognitive criterion in relation to the diagnosis of BED, is regrettable, given their potential to inform clinical and research practice and given that there is considerable evidence to support specific reference to these distinctions. Other aspects of the proposed criteria, such as retention of behavioral indicators of impaired control associated with binge eating and the presence of marked distress regarding binge eating among the diagnostic for BED, appear anomalous in that there is little or no evidence to support their validity or clinical utility. It is hoped that these issues will be addressed in final phase of the DSM-5 development process.
... In addition, Q2 ("Have you gone for long periods of time [8 waking hours or more] without eating anything at all to influence your shape or weight?") was used as a measure of extreme dietary restriction (e.g., [13]; see also [36]). 'Undue influence of weight and shape' was also included as an eating disorder attitudinal variable. ...
... Uncertainty regarding definitional and threshold issues related to dieting/fasting and excessive exercise may have limited the clinically utility of BN-NP. 13 Some may have been diagnosed with EDNOS or BED if nonpurging compensatory behaviors were not fully assessed. 10 A review justifying changes in DSM-5 examined studies comparing BN-NP to either BN-P or BED. ...
DSM-5 has dropped subtyping of bulimia nervosa (BN), opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype (BN-NP) within a broad BN category. Some contend however that BN-NP is more like binge eating disorder (BED) than BN-P. This study examines clinical characteristics, eating disorder symptomatology, and Axis I comorbidity in BN-NP, BN-P, and BED groups to establish whether BN-NP more closely resembles BN-P or BED.
Women with BN-P (n = 29), BN-NP (n = 29), and BED (n = 54) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating. Measures included the Structured Clinical Interviews for DSM-IV, Eating Disorder Examination, and Eating Disorder Inventory-2.
The BN-NP subtype had BMIs between those with BN-P and BED. Both BN subtypes had higher Restraint and Drive for Thinness scores than BED. Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P. Higher Restraint and lower BMI predicted BN-NP relative to BED. BN-NP resembled BED with higher lifetime BMIs; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype. Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype DISCUSSION: These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment. These results support retaining the BN-NP group within the BN category. Further research is needed to determine whether there are meaningful differences in outcome over follow-up. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).
... Chronically, low circulating ghrelin levels are found in obese patients compared to normal subjects, and also in subjects with insulin resistance and thus high insulin levels: this is probably explained by a direct effect of insulin (Poykko et al., 2003;Purnell et al., 2003). Eating disorders include a broad spectrum of patterns and several have been associated with obesity, for example "snacking" or "grazing" (frequent small meals, producing an almost continuous eating pattern), binge eating (sudden periodic large amounts of food intake), "overeating" (unusually large amount of food consumed at meal times), and night eating (Adair and Popkin, 2005;Cooper and Fairburn, 2003). A reduction in ghrelin levels after food intake is blunted in patients with bulimia nervosa compared to BMI-matched healthy controls (Kojima et al., 2005;Monteleone et al., 2003). ...
Growth hormone secretagogue receptor (GHSR), a G protein-coupled receptor that binds ghrelin, plays an important role in the central regulation of pituitary growth hormone secretion, food intake, and energy homeostasis. Ghrelin receptor (GHSR) modulates many physiological effects and therefore is a candidate gene for sheep production performance. Polymorphism of the GHSR gene was detected by PCR-SSCP and DNA sequencing methods in 463 individuals. Two different structures in protein and nine single nucleotide polymorphisms (SNPs) were identified. The evaluation of the associations between these SSCP patterns with carcass traits suggests a positive effect of genotype TT and B structure on carcass weight, and body length (P<0.05). In addition, the animal with TC had greater abdominal fat than those with TT and CC (P<0.05) while CC genotype contributed to low blood cholesterol (P=0.04). The results confirm the hints suggesting that GHSR is a preferential target for further investigation on mutations that influence carcass trait variations.
... Cooper and Fairburn argued that the BN-NP diagnosis lacks utility because only a few cases were identified. 32 Fichter et al. used both the fact that the diagnosis BN-NP is rarely used clinically, and the diagnostic overlap with BED, as arguments to discard it as a relevant category for research. 33 The rarity of the diagnosis is confirmed in our review that required the study inclusion of patients with BN-NP: in a period of 16 years of research the studies found contained only 694 patients with BN-NP. ...
Objective:
To review the evidence for the validity and utility of subtyping bulimia nervosa (BN) into a purging (BN-P) and a nonpurging subtype (BN-NP), and of distinguishing BN-NP from binge eating disorder (BED), by comparing course, complications, and treatment.
Method:
A literature search of psychiatry databases for studies published in peer-reviewed journals that used the DSM-definitions of BN and BED, and included both individuals with BN-NP and individuals with BN-P and/or BED.
Results:
Twenty-three studies compared individuals with BN-NP (N = 671) to individuals with BN-P (N = 1795) and/or individuals with BED (N = 1921), two of which reported on course, 12 on comorbidity and none on treatment response-the indicators for validity and clinical utility. The differences found were mainly quantitative rather than qualitative, suggesting a gradual difference in severity from BN-P (most severe) through BN-NP to BED (least severe).
Discussion:
None of the comparisons provided convincing evidence for the validity or utility of the BN-NP diagnosis. Three options for the position of BN-NP in DSM-V were suggested: (1) maintaining the BN-NP subtype, (2) dropping nonpurging compensatory behavior as a criterion for BN, so that individuals currently designated as having BN-NP would be designated as having BED, and (3) including BN-NP in a broad BN category.
... First, rather than being subthreshold forms of anorexia nervosa or bulimia nervosa, many eating disorder NOS cases are 'mixed' with the features of anorexia nervosa and bulimia nervosa occurring in different combinations. Second, if binge eating is carefully distinguished from more everyday overeating, 17 our experience is that binge eating disorder is not as common as is widely thought. ...
The DSM-IV scheme for classifying eating disorders is a poor reflection of clinical reality. In adults it recognises two conditions, anorexia nervosa and bulimia nervosa, yet these states are merely two presentations among many. As a consequence, at least half the cases seen in clinical practice are relegated to the residual diagnosis 'eating disorder not otherwise specified'. The changes proposed for DSM-5 will only partially succeed in correcting this shortcoming. With DSM-6 in mind, it is clear that comprehensive transdiagnostic samples need to be studied with data collected on their current state, course and response to treatment. Only with such data will it be possible to derive an empirically based classificatory scheme that is both rooted in clinical reality and of value to clinicians.
Binge-watching is a notable phenomenon that is changing the production, distribution, and consumption of television programs. This study conceptualizes binge-watching by comparing and contrasting binge-watching with binge-eating and binge-drinking. Applying the uses and gratifications theory, this study also investigates differences between binge-watchers and non-binge-watchers, and identifies predictors of binge-watching behaviors including frequency, the amount of time spent binge-watching, and the quantity of binge-watching episodes. A national survey of U.S. adults (N = 663) found significant differences between binge-watchers and nonbinge-watchers in terms of the degree to which they depend on television shows to satisfy various psychological needs. Results also indicate that entertainment, habitual passing of time, and escape motives, as well as age and preference for action/adventure, crime, and mystery genres predict binge-watching frequency.
Eating disorders in the sports community are increasingly common, yet still considerably hidden diseases. Over the past decades, studies have shown a higher prevalence of eating disorders among athletes than in the general population. The risk of suffering an eating disorder differs in relation to gender, characteristics, and sports categories. The review article summarizes the available information on eating disorders in relation to endurance sports. The author also categorizes and identifies the risk factors leading to an eating disorder, common for both the general population and athletes.
Weight cycling, the process of losing and then gaining weight repeatedly, is presented negatively in both the mainstream obesity and critical health studies literature. In this paper, I present an alternative perspective through the use of Lacanian psychoanalytic theory coupled with the qualitative method of autotheory. Specifically, I contest the notion of weight maintenance, suggesting instead that repeated weight loss and gain can be seen as the maintenance of the subject’s desire – something that has an ethical basis in psychoanalytic terms.
Objective:
Gastrointestinal (GI) problems are common in eating disorders, but it is unclear whether these problems predate the onset of disordered eating. Recurrent abdominal pain (RAP) is the most prevalent GI problem of childhood, and this study aimed to explore longitudinal associations between persistent RAP (at ages 7 and 9) and fasting for weight control at 16.
Method:
The Avon Longitudinal Study of Parents and Children (ALSPAC) is a UK population cohort of children. Childhood RAP was reported by mothers and defined as RAP 5+ (5 pain episodes in the past year) in our primary analysis, and RAP 3+ (3 pain episodes) in our sensitivity analysis. Fasting for weight control was reported by adolescents at 16. We used logistic regression models to examine associations, with adjustments for potential confounders.
Results:
After adjustments, we found no association between childhood RAP 5+ and adolescent fasting for weight control at 16 (OR 1.30 (95% Confidence Intervals [CI] 0.87, 1.94) p = .197). However, we did find an association between RAP 3+ and later fasting, in the fully adjusted model (OR 1.50 [95% CI 1.16, 1.94] p = .002), and after excluding those with pre-existing anxiety (OR 1.52 [95% CI 1.17, 1.97] p = .002).
Discussion:
Our findings suggest a possible independent contribution of RAP to later risk of fasting for weight control, and RAP should be enquired about in the assessment of eating disorders. However, frequency of childhood abdominal pain (as captured by ALSPAC) may be less important to long-term outcomes than functional impairment.
Eating disorders, like binge eating, have a strong association with schizophrenia. Illness characteristics like disordered eating, cognition, and behavior can lead to eating disorders. Previous research highlighted the neurobiological structural similarity and the role of hormonal factors, like hypocretin, in the etiology of eating disorders in schizophrenia. Modifying the obesogenic environment by adapting healthy eating styles has been effective in reducing binging episodes. Antipsychotic medications also have a role in altering eating patterns that result in binge eating disorder. Adolescents with psychosis have a higher incidence of eating disorders. Here, we present an elderly female with schizophrenia who had obesogenic behaviors along with binge eating disorder. Interestingly, the patient had atypical age of onset and presentation and no psychopathological symptoms as a reason for binging.
Medical imaging techniques like PET and SPECT have been applied for investigation of brain function in anorexia and bulimia nervosa. Regional abnormalities have been detected in cerebral blood flow, glucose metabolism, the availability of several neurotransmitter receptors (serotonin 1A and 2A, dopamine D2/D3, histamine H1, mu-opioid, GABA(A)-benzodiazepine, and cannabinoid CB1), stimulant-induced dopamine release, presynaptic FDOPA influx, and the density of serotonin transporters. Different subtypes of eating disorders appear to be associated with specific functional changes. It is hard to judge whether such changes are a consequence of chronic dietary restrictions or are caused by a putative anorexia (or bulimia) nervosa endophenotype. Many abnormalities (particularly those of glucose metabolism) appear to be reversible after restoration of weight or normal patterns of food intake and may represent consequences of purging or starvation. However, some changes of regional flow and neurotransmitter systems persist even after successful therapy which suggests that these reflect traits that are independent of the state of the illness. Changes of the serotonergic system (altered activity of 5-HT1A and 5-HT2A receptors and 5-HT transporters) may contribute to dysregulation of appetite, mood, and impulse control in eating disorders and may represent a trait which predisposes to the development of anxiety, obsessionality, and behavioral inhibition. Assessment of functional changes in the brain with PET or SPECT may have prognostic value and predict neuropsychological status after several years of therapy.
In the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) binge eating disorder (BED) is listed as a distinct diagnostic category with specific diagnostic criteria. BED is associated with elevated eating disorder psychopathology, psychiatric and medical comorbidity, impairment in social and occupational functioning, and reduced quality of life. Overvaluation of weight and shape and body dissatisfaction seem to occur to a comparable degree in BED as in anorexia nervosa and bulimia nervosa. Body dissatisfaction, overvaluation of weight and shape, internal weight bias, and low self-esteem may lead to binge eating and play a key role in prevention programs and treatment strategies. However, a body image disturbance is not yet required among diagnostic criteria for BED.
The objective of this study was to examine the relationship between overvaluation of weight/shape (‘overvaluation’) and emotion regulation (ER) difficulties among women with binge eating disorder (BED) symptoms. Four groups of women were recruited from a community-based sample and compared on ER difficulties: individuals with probable BED with (n = 102) and without (n = 72) overvaluation, and non-binge eating obese (n = 40) healthy-weight (n = 40) control participants. Data for patients with a formal diagnosis of BED receiving treatment from a previous study were included for numerical comparative purposes. Women with probable BED and overvaluation reported significantly greater ER difficulties than all other groups and had similar levels of ER difficulties to BED patients. Women with probable BED in the absence of overvaluation were comparable to the obese control group on total ER difficulties and the majority of the ER difficulties subscales. The findings provide further evidence for the clinical significance of overvaluation among individuals with BED symptomatology. BED in the absence of overvaluation does not appear to align with current models of the disorder in which ER difficulties are viewed as a core etiological mechanism. Further research is needed to elucidate the status of this presentation.
Based on their length of existence, research base, and a variety of other factors, binge eating disorder, pathological gambling, Internet addiction, and video game addiction in children and adolescents have achieved varying degrees of acceptance by the psychiatric community. This chapter reviews the limited scientific evidence currently available about these disorders as they relate to children and adolescents.
Eating disorders (EDs) include a range of chronic and disabling related psychiatric pathologies characterized by aberrant eating patterns or weight-control behavior and distorted body image. The etiology of EDs is complex and not yet completely understood. The endocannabinoid system has been widely reported to be involved in the regulation of feeding and energy balance, and cannabinoid type-1 receptors (CB1Rs) are expressed in many brain regions that control food intake. Animal and human studies indicate that CB1R agonists possess orexigenic effects enhancing appetite and increasing the perceived reward value of food. Conversely, CB1R antagonists have been shown to inhibit food intake. Previous clinical and preclinical evidence has led us to hypothesize a link between defects in the endocannabinoid system and EDs and supports the development of drugs that modulate this system in ED-related pathologies.
We sought to elucidate the nature and extent of impairment in quality of life among individuals with binge eating disorder (BED) with and without the overvaluation of weight or shape ("overvaluation").
Subgroups of women - probable BED with overvaluation (n = 102), probable BED without overvaluation (n = 72), obese individuals reporting no binge eating ("obese control", n = 40), and "normal weight" individuals reporting no binge eating ("healthy control," n = 40) - were recruited from a community-based sample in which individuals with eating disorder symptoms were over-represented. They were compared on measures of eating disorder psychopathology and generic and disease-specific measures of quality of life. Scores on these measures among individuals with BED receiving specialist treatment were also considered.
Participants with BED and overvaluation had high levels of eating disorder psychopathology and impairment in both generic and disease-specific quality of life, comparable to those of BED patients receiving specialist treatment, and significantly higher than all other subgroups, whereas participants with BED in the absence of overvaluation did not differ from obese controls on any of these measures.
The findings provide further evidence for the need to consider reference to overvaluation among the diagnostic criteria for BED. The relative merits of the inclusion of overvaluation as a diagnostic criterion or as a diagnostic specifier for BED warrant greater consideration.
Copyright © 2015. Published by Elsevier Ltd.
The objective of this work was to further examine the status of the overvaluation of weight/shape in binge-eating disorder (BED) by examining correlates of probable BED with and without overvaluation. Subgroups of women – probable BED with overvaluation (n = 37), probable BED without overvaluation (n = 78), obese individuals who reported no binge eating (‘obese controls’) (n = 194), and normal-weight individuals who reported no binge eating (‘healthy controls’) (n = 573) – recruited from a general population sample, were compared on measures of eating disorder psychopathology, general psychological distress, and psychosocial functioning. Women with probable BED with overvaluation reported significantly higher levels of eating disorder psychopathology and general psychological distress, and significantly poorer psychosocial functioning, than those with probable BED without overvaluation. No significant differences on any outcome measures were found between women with probable BED without overvaluation and obese controls. The findings provide additional evidence for the role of overvaluation in indicating disorder severity among individuals with BED and variants of this disorder. Moreover, it highlights the need for further consideration of the status of overvaluation in relation to BED diagnostic criteria.
Background:
Overeating and harmful alcohol and tobacco use have been linked to the aetiology of various non-communicable diseases, which are among the leading global causes of morbidity and premature mortality. As people are repeatedly exposed to varying sizes and shapes of food, alcohol and tobacco products in environments such as shops, restaurants, bars and homes, this has stimulated public health policy interest in product size and shape as potential targets for intervention.
Objectives:
1) To assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children.2) To assess the extent to which these effects may be modified by study, intervention and participant characteristics.
Search methods:
We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, eight other published or grey literature databases, trial registries and key websites up to November 2012, followed by citation searches and contacts with study authors. This original search identified eligible studies published up to July 2013, which are fully incorporated into the review. We conducted an updated search up to 30 January 2015 but further eligible studies are not yet fully incorporated due to their minimal potential to change the conclusions.
Selection criteria:
Randomised controlled trials with between-subjects (parallel-group) or within-subjects (cross-over) designs, conducted in laboratory or field settings, in adults or children. Eligible studies compared at least two groups of participants, each exposed to a different size or shape of a portion of a food (including non-alcoholic beverages), alcohol or tobacco product, its package or individual unit size, or of an item of tableware used to consume it, and included a measure of unregulated selection or consumption of food, alcohol or tobacco.
Data collection and analysis:
We applied standard Cochrane methods to select eligible studies for inclusion and to collect data and assess risk of bias. We calculated study-level effect sizes as standardised mean differences (SMDs) between comparison groups, measured as quantities selected or consumed. We combined these results using random-effects meta-analysis models to estimate summary effect sizes (SMDs with 95% confidence intervals (CIs)) for each outcome for size and shape comparisons. We rated the overall quality of evidence using the GRADE system. Finally, we used meta-regression analysis to investigate statistical associations between summary effect sizes and variant study, intervention or participant characteristics.
Main results:
The current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Ninety-six per cent of included studies (69/72) manipulated food products and 4% (3/72) manipulated cigarettes. No included studies manipulated alcohol products. Forty-nine per cent (35/72) manipulated portion size, 14% (10/72) package size and 21% (15/72) tableware size or shape. More studies investigated effects among adults (76% (55/72)) than children and all studies were conducted in high-income countries - predominantly in the USA (81% (58/72)). Sources of funding were reported for the majority of studies, with no evidence of funding by agencies with possible commercial interests in their results.A meta-analysis of 86 independent comparisons from 58 studies (6603 participants) found a small to moderate effect of portion, package, individual unit or tableware size on consumption of food (SMD 0.38, 95% CI 0.29 to 0.46), providing moderate quality evidence that exposure to larger sizes increased quantities of food consumed among children (SMD 0.21, 95% CI 0.10 to 0.31) and adults (SMD 0.46, 95% CI 0.40 to 0.52). The size of this effect suggests that, if sustained reductions in exposure to larger-sized food portions, packages and tableware could be achieved across the whole diet, this could reduce average daily energy consumed from food by between 144 and 228 kcal (8.5% to 13.5% from a baseline of 1689 kcal) among UK children and adults. A meta-analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (SMD 0.25, 95% CI -0.14 to 0.65).One included study (50 participants) estimated a large effect on consumption of exposure to differently shaped tableware (SMD 1.17, 95% CI 0.57 to 1.78), rated as very low quality evidence that exposure to shorter, wider bottles (versus taller, narrower bottles) increased quantities of water consumed by young adult participants.A meta-analysis of 13 independent comparisons from 10 studies (1164 participants) found a small to moderate effect of portion or tableware size on selection of food (SMD 0.42, 95% CI 0.24 to 0.59), rated as moderate quality evidence that exposure to larger sizes increased the quantities of food people selected for subsequent consumption. This effect was present among adults (SMD 0.55, 95% CI 0.35 to 0.75) but not children (SMD 0.14, 95% CI -0.06 to 0.34).In addition, a meta-analysis of three independent comparisons from three studies (232 participants) found a very large effect of exposure to differently shaped tableware on selection of non-alcoholic beverages (SMD 1.47, 95% CI 0.52 to 2.43), rated as low quality evidence that exposure to shorter, wider (versus taller, narrower) glasses or bottles increased the quantities selected for subsequent consumption among adults (SMD 2.31, 95% CI 1.79 to 2.83) and children (SMD 1.03, 95% CI 0.41 to 1.65).
Authors' conclusions:
This review found that people consistently consume more food and drink when offered larger-sized portions, packages or tableware than when offered smaller-sized versions. This suggests that policies and practices that successfully reduce the size, availability and appeal of larger-sized portions, packages, individual units and tableware can contribute to meaningful reductions in the quantities of food (including non-alcoholic beverages) people select and consume in the immediate and short term. However, it is uncertain whether reducing portions at the smaller end of the size range can be as effective in reducing food consumption as reductions at the larger end of the range. We are unable to highlight clear implications for tobacco or alcohol policy due to identified gaps in the current evidence base.
Grazing, or the uncontrolled, repetitive eating of small amounts of food is being
increasingly recognised as an important eating behaviour associated with obesity.
In spite of the need for a better understanding of this eating behaviour for improved
obesity treatment, currently there is no empirically validated self-report measure to
assess grazing. Therefore, to contribute to a better understanding of this relatively
understudied eating pattern, a new self-report questionnaire of grazing was developed
in this study. Questionnaire items were designed to reflect previous empirical
descriptions of grazing. A group of 248 university students completed the Grazing
Questionnaire, other measures of eating-related behaviours and cognitions, and
negative emotion. Sixty-two participants completed the Grazing Questionnaire a
second time to calculate its temporal stability. Exploratory factor analysis revealed
a clear two-factor solution for the questionnaire, reflecting repetitive eating behaviour
and a perception of loss of control. Scores on the Grazing Questionnaire
were positively associated with other measures of disordered eating, especially with
binge eating. Initial psychometric properties of the new questionnaire are promising.
Future research is now needed to examine the prevalence of this eating behaviour
in more diverse populations, including those with binge eating disorder and obesity.
This article aims to analyze and describe the results of cognitive performance of children
and young people diagnosed with different subtypes of Attention Deficit Disorder and Hyperactivity
(ADHD) in Wechsler Intelligence Scale for Children (WISC-III). We analyzed data from 24 records
of children and young people between 06 and 14 years, both sexes, attending elementary school,
who were diagnosed with ADHD. The results showed that the performance of the combined subtype
group was better than combined subtype group in all IQs and factor indexes evaluated, albeit with
significant differences only in relation to verbal IQ, total IQ, verbal comprehension Index and
Resistance to Distraction Index.
My original article on bulimia nervosa appeared in the August 1979 issue of Psychological Medicine. It is timely to examine whether the description of this new disorder and the formulated diagnostic criteria have stood the test of time. A similar question is whether it was right to describe the new syndrome as an ominous variant of anorexia nervosa. The answers to these questions should really be given by other investigators. My own view is that the main clinical description and the diagnostic criteria of bulimia nervosa have proved reasonably robust, as has its close relationship to anorexia nervosa. On the other hand, my view about the ominous nature of bulimia nervosa was unduly pessimistic. The original description of bulimia nervosa had a significant impact on the clinical and scientific literature, which showed an accelerated growth during the 1980s, largely due to articles on bulimia and bulimia nervosa. The historical question ‘Is bulimia nervosa a new disorder?’ has hitherto been neglected. The evidence for answering this question in the affirmative is very strong and is derived from searches of the older psychiatric literature as well as more recent cohort studies which throw light on when the new syndrome burst from the blue upon modern society. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.
In a community sample of women who reported the use of extreme weight-control behaviors in the absence of binge eating, subgroups of participants who reported (n = 23) and who did not report (n = 42) recurrent subjective bulimic episodes (SBEs) were compared on a range of outcomes, including current levels of eating disorder and comorbid psychopathology.
Participants who reported SBEs had higher levels of eating disorder psychopathology, impairment in role functioning, and general psychological distress, than those who did not. Scores on these measures among participants who reported SBEs were similar to those of eating disorder patients receiving specialist treatment, whereas those of participants who did not have recurrent SBEs tended to be intermediate between eating disorder patients and healthy women.
The findings are consistent with the hypothesis that it is the combination of SBEs and extreme weight-control behaviors, rather than extreme weight-control behaviors per se, that indicates clinical significance. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010
The dramatically increasing prevalence of obesity, associated with potentially life-threatening health problems, including cardiovascular diseases and type II diabetes, poses an enormous public health problem. It has been proposed that the obesity epidemic can be explained by the concept of 'food addiction'. In this review we focus on possible similarities between binge eating disorder (BED), which is highly prevalent in the obese population, and drug addiction. Indeed, both behavioral and neural similarities between addiction and BED have been demonstrated. Behavioral similarities are reflected in the overlap in DSM-IV criteria for drug addiction with the (suggested) criteria for BED and by food addiction-like behavior in animals after prolonged intermittent access to palatable food. Neural similarities include the overlap in brain regions involved in food and drug craving. Decreased dopamine D2 receptor availability in the striatum has been found in animal models of binge eating, after cocaine self-administration in animals as well as in drug addiction and obesity in humans. To further explore the neurobiological basis of food addiction, it is essential to have an animal model to test the addictive potential of palatable food. A recently developed animal model for drug addiction involves three behavioral characteristics that are based on the DSM-IV criteria: i) extremely high motivation to obtain the drug, ii) difficulty in limiting drug seeking even in periods of explicit non-availability, iii) continuation of drug-seeking despite negative consequences. Indeed, it has been shown that a subgroup of rats, after prolonged cocaine self-administration, scores positive on these three criteria. If food possesses addictive properties, then food-addicted rats should also meet these criteria while searching for and consuming food. In this review we discuss evidence from literature regarding food addiction-like behavior. We also suggest future experiments that could further contribute to our understanding of behavioral and neural commonalities and differences between obesity and drug addiction. Copyright © 2012 S. Karger GmbH, Freiburg.
G. Stanley Hall, the first person to earn a Ph.D. in psychology in the United States, did research on eating behaviors in the nineteenth century (Lepore in The New Yorker, 2011). Research on psychological aspects of obesity accelerated in the 1950s and there has been a great deal done at this point. We review areas of considerable activity and relevance.
The difficulties encountered in regards to defining the diagnosis of patients with an Eating Behavior Disorder (EBD) have favored the use of multidimensional models. This study has aimed to identify which psychopathological and neurobiological variables could have a discriminating capacity regarding the different EBD diagnostic subtypes.
A total of 42 patients with an EBD diagnosis (11 Restrictive Anorexia (R-AN), 10 Purgative Anorexia (P-AN), 7 Non-purgative Bulimia (NP-BN), 14 Purgative Bulimia (P-BN)), according to DSM-IV criteria, were selected from those who came for treatment in the Ciudad Real General Hospital Eating Disorder Unit. Twelve healthy controls were also included. All of the subjects underwent a brain SPECT to measure regional cerebral blood flow (rCBF) in baseline situation (rest). A second one was performed after a visual neutral stimulus (sight of a calm sea) and another one after confronting them with their own corporal image, filmed two weeks before. A battery of questionnaires was administered to evaluate general and eating psychopathology.
Patients with NP-BN showed less eating and general psychopathology. Furthermore, unlike patients with R-AN and P-BN, they did not experience an increase of the rCBF when confronted with their own body image. Discriminant variables were body dissatisfaction measured with the BSQ, BMI; BITE scores, ideal silhouette scores, and temporal right hyperactivation when they were shown their own body image.
The subgroup of patients diagnosed with NP-BN showed less emotional alteration and less emotional response when they were shown their own body image than the rest of patients with EBD. These differences might have implications from the therapeutic, prognostic or even taxonomic viewpoint.
Viele lebensstilorientierte Interventionsprogramme zur Gewichtsreduktion sind, was den langfristigen Therapieerfolg betrifft, meist als entmutigend zu betrachten und erfordern die Entwicklung wirksamer Präventionsstrategien. Bei der vorliegenden Begleitforschung handelt es sich um eine retrospektive Längsschnittbefragung der ehemaligen M.O.B.I.L.I.S.-Teilnehmer ein Jahr nach Abschluss des Programms, d.h. nach einem Jahr ohne Betreuung. Es sollte überprüft werden, welche Faktoren für den Erfolg bzw. Misserfolg der Therapie ausschlaggebend sind. Die Angaben zum Gewichtsmanagement, zur aktuellen sportlichen Aktivität und zum Elterneinfluss wurden mit einem allgemeinen Fragebogen erhoben, die Angaben zum auffälligen Essverhalten sowie zu den Kompetenz- und Kontrollüberzeugungen mit standardisierten Instrumenten. Vor der Befragung fand eine Gruppeneinteilung der ehemaligen Teilnehmer hinsichtlich ihres Therapieerfolges statt: Non-Completer (Studienabbrecher), Non-/Low-Responder (relative Gewichtszunahme oder Gewichtsabnahme 0 - 4,9 %) und High-Responder (relative Gewichtsabnahme > 10 %).
Von insgesamt 538 ausgehenden Anfragen nahmen 288 Personen an der Begleitforschung teil, dies entspricht einem Rücklauf von 53,5 %. Beim Vergleich der drei Teilnehmergruppen, konnten die High-Responder ihr geringeres Körpergewicht weiterhin bestätigen (30,6 kg/m²; p < 0,001), allerdings haben sie im Vergleich zu den Non-Completern und den Non-/Low-Respondern die größte mittlere Gewichtszunahme mit 3,4 kg (p < 0,01). Die geringsten Differenzen zwischen Gewichtsstagnation, -zunahme und -abnahme wurden bei den Non-/Low-Respondern angegeben (0,38 kg; p < 0,01). 91,0 % aller Teilnehmer bemühen sich weiterhin um eine Gewichtsreduktion mit Hilfe von kontrolliertem Essen sowie mit Bewegung und Sport. Bei der Untersuchung des auffälligen Essverhaltens machen die Score-Werte der Non-/Low-Responder ein „auffälliges Essverhaltensprofil“ und Essattacken wahrscheinlich (p < 0,05). Die Regressionsanalyse zur Bestimmung von Prädiktoren für ein erfolgreiches Gewichtsmanagement identifizierte den Prädikator „Essverhaltensprofil“ (r = 0,5, p < 0,001). Tatsächlich haben die Teilnehmer mit auffälligen Essverhalten im Vergleich zu den Teilnehmern mit normalen Essverhalten einen höheren BMI (34,55 kg/m²; p < 0,001), ein größeres Risiko für eine Gewichtszunahme (3,19 kg; p < 0,05) und eine geringere sportliche Aktivität (2,83 h/Woche; p < 0,05).
Die vorliegenden Daten der retrospektiven Befragung belegen die langfristige Wirksamkeit des M.O.B.I.L.I.S.-Programm für die erfolgreichen Teilnehmer. Die Daten der nicht erfolgreichen Teilnehmer zeigen ein auffälliges Essverhaltensprofil und Essattacken. Das auffällige Essverhalten wurde außerdem als Prädikator für ein größeres Risiko an einer Gewichtszunahme identifiziert. Die Ergebnisse untersteichen die Notwendigkeit eines multidisziplinären Therapieansatzes, dabei sollte besonders die komplexe Problematik des Essverhaltens in Zukunft berücksichtigt werden.
Synopsis
There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for either of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme.
A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity.
The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.
The purpose of this study was to assess the efficacy of fluvoxamine in the treatment of binge-eating disorder. Binge-eating disorder is a newly described eating disorder characterized by recurrent episodes of binge eating but without purging behaviors. Uncontrolled reports have suggested that serotonin selective reuptake inhibitors (SSRIs) may be effective in treating this disorder.
Eighty-five outpatients with a DSM-IV diagnosis of binge-eating disorder were randomly assigned to receive either fluvoxamine (N=42) or placebo (N=43) in a 9-week, parallel-group, double-blind, flexible dose (50-300 mg) study at three centers. The primary outcome measures were frequency of binge eating, expressed as log ([binges/week]+1), and Clinical Global Impression (CGI) scale ratings. Secondary measures included the level of response (based on the percentage change in frequency of binges), body mass index, and Hamilton Rating Scale for Depression score. Except for the level of response, the outcome measures were analyzed by random regression methods; the treatment-by-time interaction was the measure of treatment effect.
Compared with placebo, fluvoxamine was associated with a significantly greater rate of reduction in the frequency of binges, rate of reduction in CGI severity scores, rate of increase in CGI improvement scores, level of response for patients who completed the 9-week study, and rate of reduction in body mass index. There was no significant difference between placebo and fluvoxamine groups in the rate of decrease in Hamilton depression scale scores. A significantly greater proportion of patients receiving fluvoxamine than those receiving placebo discontinued treatment because of an adverse medical event.
In this placebo-controlled trial, fluvoxamine was found to be effective according to most outcome measures in the acute treatment of binge-eating disorder.
Objective:
To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment.Design:
Randomized controlled trial involving three psychological treatments. Two planned comparisons, CBT with interpersonal psychotherapy (IPT), and CBT with BT. Closed 12-month follow-up period. Independent assessors.Setting:
Secondary referral center.Patients:
Seventy-five consecutively referred patients with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded.Interventions:
Cognitive behavior therapy, IPT, BT conducted on an individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no concurrent treatment.Main Outcome Measure:
Frequency of binge eating and purging.Results:
High rate (48%) of attrition and withdrawl among the patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects.Conclusions:
Bulimia nervosa may be treated successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The behavioral version of CBT was markedly less effective than the full treatment.
This article reviews the assessment and treatment of binge eating disorder (BED). BED is a new eating disorder category for which research criteria are included in DSM-IV. BED is defined by recurrent episodes of binge eating without the presence of the extreme compensatory weight control practices that define bulimia nervosa. Individuals with BED are frequently obese and have high rates of medical and psychiatric morbidity. The accumulating literature regarding this new diagnosis is reviewed with a particular focus on assessment and treatment. Recommendations for multimodal assessment of BED and its associated features are offered. Preliminary data suggest that behavioral weight control treatment may be efficacious for both binge eating and weight loss and that cognitive-behavioral and interpersonal psychotherapies may be efficacious for binge eating. Reductions in binge eating and improvements in psychological functioning appear to be well maintained following behavioral weight control, cognitive behavioral, and interpersonal therapies. Preliminary data suggest that antidepressants may produce significant acute reductions in binge eating. Although little is known about maintenance, the few available data suggest that relapse is frequent and rapid following discontinuation of medication. Little is known about how best to sequence treatments for nonresponders. Implications for practice and future research are discussed.
The specific psychopathology of anorexia nervosa and bulimia nervosa is complex in form. Although for many purposes self-report questionnaires are a satisfactory measure of this psychopathology, for detailed psychopathological studies and for investigations into the effects of treatment, more sensitive and flexible assessment measures are required. For this reason a semi-structured interview was developed. This interview, the Eating Disorder Examination, is designed to assess the full range of the specific psychopathology of eating disorders, including these patients' extreme concerns about their shape and weight.
[This volume] is devoted to a comprehensive and current review of all aspects of obesity and the eating disorders—including the interface of these with factors affecting weight regulation.
Section I . . . covers such factors as genetic influences and physiological, psychological, and energy related factors. Section II focuses on the importance of dieting in our world today; social and cultural influences and their relation to body image and the eating disorders are covered in some detail, as is the entire controversy over dieting itself. Section III highlights the issue of measurement and covers everything from assessments of body energy stores to food intake, energy expenditure, and measures of psychopathology. Sections IV through VII cover all aspects of the eating disorders including history, clinical features, theories of pathogenesis and complications, as well as detailed views on approaches to treatments. Sections VIII and IX cover obesity in a similar fashion.
This book contains . . . information on all aspects of eating disorders and obesity so that professionals with clinical or research questions in this area [and students] will have the . . . information at hand in one volume. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Diagnostic criteria have been developed for a new eating disorder, binge eating disorder (BED), to describe the many individuals who have problems with recurrent binge eating but do not engage in the characteristic compensatory behaviors of bulimia nervosa, vomiting, or use of laxatives. The results of a multisite field trial involving 1,984 subjects indicate that the disorder is common (30.1%) among subjects attending hospital-affiliated weight control programs, but is relatively rare in the community (2.0%). The disorder is more common in females than in males and is associated with severity of obesity and a history of marked weight fluctuations. Based on these results, the DSM-IV Work Group on Eating Disorders has recommended that the disorder be considered for inclusion in DSM-IV, either as an official category or in an appendix of categories requiring further study.
This report deals with certain theoretical and clinical aspects of the problem of overeating and obesity. It considers the advantages, especially in psychiatric research, if obesity were found to represent, not one disease, but the end stage of a variety of different conditions with differing etiologies. Experimentally-induced obesity in animals serves as a model of such a contingency since it can be produced by different methods, which result in different types of obesity. Some of the most striking differences have been found in the field of behavior, a recent study having demonstrated characteristic differences between the feeding patterns of obese and non-obese mice, and even between the feeding patterns of mice afflicted with different forms of obesity.
The eating behavior of obese human subjects is considered from this point of view, and three distinctive eating patterns are described. The first of these patterns is that of the night-eating syndrome, characterized by morning anorexia, evening hyperphagia, and insomnia. The second pattern is that of the eating binge, in which large amounts of food are consumed in an orgiastic manner at irregular intervals. The third pattern is that of eating-without-satiation which has been observed in persons suffering from damage to the central nervous system.
A subset of the obese population (25-30%) has been reported to engage in binge eating at least twice weekly (bingers) and to exhibit personality traits and food attitudes similar to those of normoweight bulimic women (bulimics). Tricyclic antidepressants and opiate antagonists effectively suppress binge eating in normoweight bulimics. This 8-wk placebo-controlled, double-blind trial investigated the effect of naltrexone and imipramine on 33 obese bingers and 22 bulimics. Naltrexone (100-150 mg/d) produced a significant reduction in binge duration in bulimics (36 +/- 16%, median +/- SIQR; P = 0.02) whereas imipramine significantly reduced binge duration in obese bingers (88 +/- 31%; P = 0.02). A strong placebo effect was observed in obese bingers and, although a reduction in binge frequency occurred with both naltrexone and imipramine, it was not significantly different from the effect in placebo control subjects. We conclude that naltrexone and imipramine may be useful agents in the treatment of binge eating.
It has been suggested that a new diagnostic category be added to the section on eating disorders in DSM-IV. This new diagnosis has been termed binge eating disorder. In this article we argue that for two main reasons it would be a mistake to include binge eating disorder in DSM-IV: first, too little is known about binge eating and other related forms of recurrent overeating to justify its inclusion in DSM-IV; and second, its inclusion would be a source of diagnostic confusion. We argue that it is premature to crystallize this specific subgroup from amongst those who recurrently overeat and that to do so would impede the acquisition of knowledge rather than enhance it. We advocate a research strategy that involves studying broad samples of those with recurrent overeating rather than narrow ones.
Binge eating disorder (BED) is a new eating disorder that describes the eating disturbance of a large number of individuals who suffer from recurrent binge eating but who do not regularly engage in the compensatory behaviors to avoid weight gain seen in bulimia nervosa. This multisite study of BED involved 1,785 subjects drawn from 18 weight control programs, 942 subjects from five nonpatient community samples, and 75 patients with bulimia nervosa. Approximately 29% of subjects in weight control programs met the criteria for BED. In the nonpatient community samples BED was more common than purging bulimia nervosa. The validity of BED was supported by its strong association with (1) impairment in work and social functioning, (2) overconcern with body/shape and weight, (3) general psychopathology, (4) significant amount of time in adult life on diets, (5) a history of depression, alcohol/drug abuse, and treatment for emotional problems.
To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment.
Randomized controlled trial involving three psychological treatments. Two planned comparisons, CBT with interpersonal psychotherapy (IPT), and CBT with BT. Closed 12-month follow-up period. Independent assessors.
Secondary referral center.
Seventy-five consecutively referred patients with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded.
Cognitive behavior therapy, IPT, BT conducted on an individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no concurrent treatment.
Frequency of binge eating and purging.
High rate (48%) of attrition and withdrawal among the patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects.
Bulimia nervosa may be treated successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The behavioral version of CBT was markedly less effective than the full treatment.
The purpose of this study was to assess the efficacy of the appetite suppressant d-fenfluramine in the treatment of binge eating disorder.
The authors conducted an 8-week double-blind, placebo-controlled clinical trial of the drug with 28 severely obese female patients meeting full criteria for binge eating disorder. The primary outcome measure was number of binges per week, as recorded in binge diaries and reviewed weekly with the principal investigators.
Random effects linear regression analysis showed that the rate of binge eating in the d-fenfluramine group fell three times more rapidly than that in the placebo group, a result that was both clinically and statistically significant. At 4-month follow-up the binge frequency of the d-fenfluramine group had increased to pretreatment levels and no longer differed from that of the placebo group.
d-Fenfluramine reduced the frequency of binge eating by obese women with binge eating disorder.
This study investigated the relationship between binge eating and the outcome of weight loss treatment. Participants in a 48-week trial of a structured diet combined with exercise and behavior therapy were classified into one of four groups: no overeating; episodic overeating; subthreshold binge-eating disorder(BED); and BED. Binge eating status was not associated with either dropout or adherence to the diet, but did affect weight loss and mood. The BED group lost significantly more weight at the end of treatment than all other groups, even when adjusting for initial weight. At 1-year follow-up, there were no differences among groups in weight loss or weight regain. The BED group began treatment with significantly higher BDI scores, but improvement in mood occurred by week 5. On the basis of these findings, and a review of the recent literature, we conclude that obese binge eaters respond as favorably to standard dietary and behavioral treatments as do obese nonbingers.
Research suggests that cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic treatment for bulimia nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects. The present study is designed to repeat this important comparison.
Two hundred twenty patients meeting DSM-III-R criteria for bulimia nervosa were allocated at random to 19 sessions of either CBT or IPT conducted over a 20-week period and evaluated for 1 year after treatment in a multisite study.
Cognitive-behavioral therapy was significantly superior to IPT at the end of treatment in the percentage of participants recovered (29% [n=32] vs 6% [n=71), the percentage remitted (48% [n=53] vs 28% [n = 31]), and the percentage meeting community norms for eating attitudes and behaviors (41% [n=45] vs 27% [n=30]). For treatment completers, the percentage recovered was 45% (n= 29) for CBT and 8% (n= 5) for IPT. However, at follow-up, there were no significant differences between the 2 treatments: 26 (40%) CBT completers had recovered at follow-up compared with 17 (27%) IPT completers.
Cognitive-behavioral therapy was significantly more rapid in engendering improvement in patients with bulimia nervosa than IPT. This suggests that CBT should be considered the preferred psychotherapeutic treatment for bulimia nervosa.
The authors' goal was to assess the efficacy of sertraline in the treatment of binge eating disorder.
Thirty-four outpatients with DSM-IV binge eating disorder were randomly assigned to receive either sertraline (N=18) or placebo (N=16) in a 6-week, double-blind, flexible-dose (50-200 mg) study. Except for response level, outcome measures were analyzed by random regression methods, with treatment-by-time interaction as the effect measure.
Compared with placebo, sertraline was associated with a significantly greater rate of reduction in the frequency of binges, clinical global severity, and body mass index as well as a significantly greater rate of increase in clinical global improvement. Patients receiving sertraline who completed the study demonstrated a higher level of response, although the effect was not significant.
In a 6-week trial, sertraline was effective and well tolerated in the treatment of binge eating disorder.
Eating disorders are an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. They are much less frequent in men. Eating disorders are divided into three diagnostic categories: anorexia nervosa, bulimia nervosa, and the atypical eating disorders. However, the disorders have many features in common and patients frequently move between them, so for the purposes of this Seminar we have adopted a transdiagnostic perspective. The cause of eating disorders is complex and badly understood. There is a genetic predisposition, and certain specific environmental risk factors have been implicated. Research into treatment has focused on bulimia nervosa, and evidence-based management of this disorder is possible. A specific form of cognitive behaviour therapy is the most effective treatment, although few patients seem to receive it in practice. Treatment of anorexia nervosa and atypical eating disorders has received remarkably little research attention.
To describe the evidence for the constellation of symptoms known as binge eating disorder (BED) and to evaluate the utility of this diagnosis.
Examination of the definition, prevalence, psychiatric comorbidity, and treatment of BED through a selective review of the literature.
The objective definition of a binge (its size and duration) remains problematic. Persons with BED have extensive comorbid psychopathology. Pharmacologic treatments effectively reduce binge eating, but only somewhat more than placebos, whereas psychotherapeutic treatments reduce binge eating, but do not produce weight loss. Traditional behavioral weight loss programs produce both weight loss and decreases in binge eating. The course of BED is variable and often remits with nonspecific attention or during wait-list conditions.
Although there is consensus on the criteria for BED, its great variability limits the implications that can be drawn from its diagnosis, and it may be most useful as a marker of psychopathology.
- Fairburn