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Correlates of the Over-Evaluation of Weight and Shape in Binge Eating Disorder and Mixed Eating Disorder Samples: A Meta-Analytic Review

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Correlates of the Over-Evaluation of Weight and Shape in Binge Eating Disorder and Mixed Eating Disorder Samples: A Meta-Analytic Review

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Abstract

This meta-analysis assessed the strength of the association between correlates of shape and weight over-evaluation across binge eating disorder and mixed eating disorder samples. Across 32 studies, over-evaluation correlates were divided into demographic, eating pathology, or psychosocial. Shape and weight over-evaluation was associated with higher eating pathology and psychosocial impairment. The method of assessment (interview versus self-report questionnaire) moderated some of the relationships. Over-evaluation was unrelated to demographics and treatment outcome. These findings highlight the importance of addressing shape and weight over-evaluation during treatment, and supports the idea of using shape and weight over-evaluation as a severity specifier for binge eating disorder.

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... Delineating the determinants of distress and role functioning impairment may also assist in the refinement of the diagnostic criteria of this relatively new In regards to binge-eating frequency, studies have consistently found that binge eating on an at-least weekly basis is associated with significant psychosocial impairment (e.g., Mitchison, Hay, Slewa-Younan, & Mond, 2012), although greater binge-eating frequency may be associated with higher levels of distress and disability and poorer treatment outcomes (Dakanalis, Colmegna, Riva, & Clerici, 2017). While the overvaluation of body weight and/or shape ("overvaluation") is not currently included as a diagnostic feature of BED, many individuals with BED experience overvaluation and there is good evidence that overvaluation is predictive of illness severity (Linardon, 2017) and treatment outcomes (Grilo, White, Gueorguieva, Wilson, & Masheb, 2013). ...
... On the other hand, inclusion of overvaluation as a diagnostic criterion for BED may result in a significant proportion of individuals who do experience distress and impairment "falling through the gaps". Hence, others have argued for the inclusion of overvaluation as a diagnostic specifier for BED instead (Grilo et al., 2013;Linardon, 2017). Further, the association between binge frequency and levels of distress and disability observed in the current study supports the use of binge frequency as a severity specifier for BED. ...
Article
Objective: This study aimed to investigate the relative contributions of binge eating, body image disturbance, and body mass index (BMI) to distress and disability in binge-eating disorder (BED). Method: A community sample of 174 women with BED-type symptomatology provided demographic, weight, and height information, and completed measures of overvaluation of weight/shape and binge eating, general psychological distress and impairment in role functioning. Correlation and regression analyses examined the associations between predictors (binge eating, overvaluation, BMI), and outcomes (distress, functional impairment). Results: Binge eating and overvaluation were moderately to strongly correlated with distress and functional impairment, whereas BMI was not correlated with distress and only weakly correlated with functional impairment. Regression analysis indicated that both overvaluation and binge eating were strong and unique predictors of both distress and impairment, the contribution of overvaluation to variance in functional impairment being particularly strong, whereas BMI did not uniquely predict functional impairment or distress. Discussion: The findings support the inclusion of overvaluation as a diagnostic criterion or specifier in BED and the need to focus on body image disturbance in treatment and public health efforts in order to reduce the individual and community health burden of this condition.
... Overvaluation may also occur in people with binge eating disorder (BED) and other specified or unspecified feeding or eating disorders (OS/UFED) [3]. Although it is not a core criterion for the latter disorders, weight/shape overvaluation is associated with greater impairment in people with BED and OS/UFED [4][5][6]. Further, overvaluation appears to be an increasing problem in the general population and is associated with reduced health related quality of life (HRQoL) [7]. ...
... As noted, the prevalence of overvaluation was higher in all groups studied in 2015/6 than in 2005. It is worth highlighting that several studies have verified the relation of overvaluation with a greater impairment in general population [4][5][6][7]. However, a recent study with the same population of the present research suggested that at lower Content courtesy of Springer Nature, terms of use apply. ...
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Purpose To investigate the prevalence of overvaluation across sociodemographic features and weight status over time. Methods The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n = 3047), 2008 (n = 3034), 2009 (n = 3007), 2015 (n = 3005) and 2016 (n = 3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed. Results Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04–3.99; 2008/9: OR 1.74, CI 1.50–2.01; 2015/6: OR 1.54, CI 1.34–1.76), had a BMI > 30 (2005: OR 3.93, CI 1.49–10.34; 2008/9: OR 2.22, CI 1.31–3.78; 2015/6: OR 2.09, CI 1.19–3.67), had left school (2015/6: OR 1.36, CI 1.14–1.63), and lived in the country (2015/6: OR 1.95, CI 1.69–2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p < 0.001). Conclusions Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005–2016. Evidence-based medicine Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.
... Research has sought to examine the clinical significance of these distinct components of body image in individuals with eating disorders. For example, a recent meta-analysis reported robust relationships between shape and weight over-evaluation and impairments in psychological functioning in binge-eating disorder and BN cases (Linardon, 2016). A previous meta-analysis also found that cases with AN who exhibited a fear of weight gain reported significantly greater levels of eating disorder psychopathology than cases with AN who did not exhibit a fear of weight gain (Thomas, Vartanian, & Brownell, 2009). ...
... Preoccupation ("has thinking about your shape or weight made it very difficult or you to concentrate on things you are interested in"?) and fear of weight gain ("have you had a definite fear that you might gain weight?") were assessed with a single item, rated along a seven point scale, ranging from zero (no days) to six (everyday). These items have been used in several studies (Linardon, 2016;Linardon & Mitchell, 2017;Mond et al., 2013). (Berg, Peterson, Frazier, & Crow, 2012). ...
... Indeed, treatment-seeking and communitybased individuals with both BED and overvaluation of shape and weight report more severe eating-related psychopathology and psychological impairment (e.g., depression, low self-esteem, poor quality of life) than those with BED and subclinical overvaluation of shape and weight (10)(11)(12)(13), as well as an overweight comparison group (10). These data have been confirmed by a meta-analysis of 32 studies on BED and mixed eating disorder samples, which concluded that overvaluation of shape and weight is associated with higher eating pathology and psychosocial impairment (14). Some studies have also found that higher baseline overvaluation of shape and weight predicts the poorest outcomes at the end of treatment and at follow-up in patients with BED (3,15,16). ...
... These findings are also supported by the strength of association found between overvaluation of shape and weight and eating concern, general psychopathology, and mental functioning. These data overlap with those reported in patients with BED (14), and they may be used, as has been proposed for BED (10), to identify a subgroup of patients with obesity, subclinical eating disorder psychopathology, and impaired psychological and mental quality of life. Moreover, our data confirm the Grilo et al. (33) findings, which reported a significant association between overvaluation of shape and weight and dietary restraint and shape concern in a sample of persons categorized with overweight or obesity. ...
Article
Objective: This study aimed to evaluate the presence of the overvaluation of shape and weight and its associated features in patients with obesity but no eating disorder who were seeking treatment from a specialist unit. Methods: Overall, 1,134 patients with obesity but no Diagnostic and Statistical Manual of Mental Disorders eating disorder diagnosis were included. The Eating Disorder Examination interview was administered by expert clinicians to assess the eating disorder psychopathology and overvaluation of shape and weight. Patients also completed the Symptom Check List-90-Revised and the 36-Item Short Form Health Survey to assess general psychopathology and quality of life, respectively. Results: Roughly 20% of the patients with obesity presented with clinical overvaluation of shape and weight, which was associated with the female gender, higher expected weight loss, more severe eating-related psychopathology, higher general psychopathology, and lower mental quality of life. Linear and logistic regression analyses indicated that the clinical variables independently correlated with overvaluation of shape and weight in these patients were female gender, Eating Disorder Examination Eating Concern subscale score, and 36-Item Short Form Health Survey mental component summary score. Conclusions: These findings are sufficient to justify routine assessment of overvaluation of shape and weight in patients seeking treatment for obesity.
... A later study found that overvaluation was a risk factor for binge eating onset and was associated with subjective social status impairment in adolescents who were overweight and who were binge eating (Sonneville et al., 2015). Linardon (2016) in a recent meta-analysis reported consistent relationships between overvaluation and impairments in psychological functioning in people with BED and bulimia nervosa. ...
... Missing data were observed within each survey year in regard to BMI, as not all participants disclosed self-reported weight and height. Missingness of this data ranged from 7.7% in 2005, 10.1% in 2008/2009, to 8.8% in 2015/2016 were considered significant at p < 0.05. ...
Article
Objective To investigate the relationships between weight/shape overvaluation, health‐related quality of life (HRQoL) and functional role impairment (days out of role [DOR]) in the general population over 11 years. Method Five cross‐sectional surveys of men and women representative of the South Australian population were conducted in 2005, 2008, 2009, 2015, and 2016 (ntotal = 15,140). Data were collected on demographics, overvaluation, HRQoL, DOR, and eating disorder behaviours. Results Between 2005 and 2016, the prevalence of moderate overvaluation increased from 18.1% to 40.0%, marked overvaluation from 7.5% to 23.7%, and extreme overvaluation from 3.1% to 9.2% (all p < 0.001). Overvaluation at any level was associated with more DOR in 2005 but not in 2016, and the association between HRQoL impairment and overvaluation weakened over time. Conclusion Although the population prevalence of overvaluation has increased significantly in the past decade, the impairment associated with it appears to have reduced.
... Glashouwer et al. (2019) concluded that perceptual, cognitive-affective, and behavioral body image disturbances are associated with the course of AN, although evidence is not strong to confirm they are a causal risk factor for onset of AN. A meta-analysis by Linardon (2017) found that clinical levels of weight/shape overvaluation are linked to body dissatisfaction, disordered eating behaviors and cognitions, lower self-esteem and quality of life impairment. In addition, Sattler, Eickmeyer, and Eisenkolb (2019) found body image disturbance to play an important role in AN and BN among children and adolescents. ...
Article
Body image disturbance is core to the psychopathology of eating disorders (EDs), and related disorders such as muscle dysmorphia (MD). Global measures of body image fail to quantify specific aspects of body image disturbance that characterizes EDs, and may be differentially associated to outcomes. The aim of this systematic review was to provide an overview of specific body image facets and synthesize findings from controlled studies that compared clinical ED/MD and control-comparison groups in body image disturbance. One-hundred sixty-seven studies met inclusion criteria, and reported on comparisons among 30,584 individuals in 28 body image facets, which were more broadly grouped into evaluative, perceptual, cognitive-affective and motivational categories for the purpose of the present review. Effect sizes were calculated as Cohen’s d for every comparison between ED and control groups. Body dissatisfaction (evaluative category) was the most prevalent facet assessed across studies (62 %), and differences between clinical and control groups were the largest in this category, especially for bulimia nervosa (d = 1.37). Scarcity of studies with male and MD clinical samples, and use of single-item and non-validated measures, should encourage development of instruments for body image facets pertinent to EDs and MD that can be validly applied across gender.
... Higher scores reflect greater symptom severity. We also calculated participants' overevaluation of weight and shape ("core psychopathology"), which is a related but distinct construct from shape and weight concerns (Linardon, 2017). Overevaluation was calculated by averaging participants' scores on Items 22 and 23 (i.e., importance of weight/shape placed on self-worth). ...
Article
The Body Image Acceptance and Action Questionnaire (BI-AAQ), a measure designed to assess body image flexibility, was originally developed for and psychometrically investigated with nonclinical populations, but it has been recently administered to people with binge-eating disorder (BED) symptomatology. Tests of measurement invariance are needed to understand whether the BI-AAQ operates in the same way for BED and non-BED populations, thereby ensuring meaningful comparison across these groups. We thus tested the measurement invariance of the BI-AAQ in participants with and without clinically significant BED symptomatology. Data were analyzed from 358 community-based participants. Participants were either classified as with (n = 179) or without (n = 179) "probable BED" based on self-reported symptom frequency. An unacceptable model fit was found across both groups, indicating that the unidimensional structure of the BI-AAQ was not replicated. We then sought to confirm the unidimensional structure of a recently proposed five-item version of the BI-AAQ. A unidimensional structure of this abbreviated version was replicated, and tests of measurement variance were upheld. Internal consistency, convergent validity, and incremental validity were documented for both the original and abbreviated BI-AAQ across individuals with and without BED symptomatology. Present findings provide further psychometric support for an abbreviated five-item BI-AAQ, although it is important for future research to replicate both the full and abbreviated BI-AAQ in more diverse samples. Overall, an abbreviated BI-AAQ may be an attractive alternative for researchers studying body image flexibility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Shape and weight overevaluation was assessed using two items (i.e., "how often has your weight/shape influenced how you feel as a person") from the Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 1994). Both items are rated along a seven-point scale, ranging from zero (not at all) to six (markedly), and averaged to create a composite score, consistent with previous research (Goldschmidt et al., 2010;Hrabosky, Masheb, White, & Grilo, 2007;Linardon, 2016;Linardon & Mitchell, 2017). The distinctiveness of the over-evaluation factor from the shape and weight concerns factor and the body dissatisfaction factor has been reported in previous factor analytic research (Grilo et al., 2010;Grilo, Reas, Hopwood, & Crosby, 2015) and in a latent genetic and environmental risk factor twin study (Wade, Zhu, & Martin, 2011). ...
Article
Previous research has established a robust relationship between symptoms of social anxiety and disordered eating. However, the mechanisms that may underpin this relationship are unclear. Appearance-based rejection sensitivity (ABRS)—the tendency to anxiously expect and overreact to signs of appearance-based rejection—may be a crucial explanatory mechanism, as ABRS has been shown to maintain social anxiety symptoms and predict disordered eating. We therefore tested whether ABRS mediated the relationship between social anxiety symptoms and various indices of disordered eating (over-evaluation of weight/shape, restraint, binge eating, compulsive exercise, and vomiting). Data from community-based females (n = 299) and males (n = 87) were analyzed. ABRS was shown to mediate the relationship between social anxiety and the over-evaluation, restraint, binge eating, and compulsive exercise frequency, but not vomiting. These effects also occurred for both females and males separately. Findings demonstrated that ABRS may be an important mechanism explaining why socially anxious individuals report elevated symptoms of disordered eating. Future research testing all proposed mediating variables of the social anxiety-disordered eating link in a single, integrative model is required to identify the most influential mechanisms driving this relationship.
... These distinct components of body image have also been shown to be important risk and/or maintaining factors for eating disorder psychopathology. For example, early meta-analytic research of prospective studies has shown body dissatisfaction to be a strong predictor of eating pathology in non-clinical samples (Stice, 2002), and a recent meta-analysis of cross-sectional stud-ies of clinical samples (binge-eating disorder and bulimia nervosa) reported robust links between shape and weight over-evaluation and disordered eating and psychological distress (Linardon, 2016). Recent research also suggests that preoccupation with shape and weight is a strong and independent predictor of problematic eating patterns even after controlling for other facets of body image (i.e., dissatisfaction and over-evaluation; Linardon et al., 2018;Lydecker et al., 2017;Mitchison et al., 2017). ...
... However, this study has some limitations. Firstly, we used single items to assess different components of body-image concern-a strategy commonly used by other studies evaluating body image concern in patients with eating disorder (Linardon & Mitchell, 2017;Linardon, 2017;Mitchison, Mond, Slewa-Younan, & Hay, 2013;Mitchison et al., 2017;Mond et al., 2013). Secondly, the use of many statistical tests on our relatively small population of patients with anorexia nervosa could limit the results. ...
Article
Objective: The study aimed to evaluate the trajectories of change over time in body-image concern components in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioural therapy. Moreover, it aimed to study the role of body-image concern components in changes in eating and general psychopathology as well as work and social functioning. Method: Sixty-six adult patients with anorexia nervosa were recruited. Body mass index (BMI); Eating Disorder Examination 'Dietary Restraint' and 'Eating Concern' subscales; Brief Symptom Inventory (BSI); and Work and Social Adjustment Scale (WSAS) scores were recorded at admission, end of treatment, and at 6- and 12-month follow-ups. The trajectories of change of three components of body image concern, namely 'preoccupation with shape or weight', 'fear of weight gain' and 'feeling fat', were assessed. Results: The treatment was associated with a significant improvement in outcome variables and body-image concern components. Baseline 'preoccupation with shape or weight' predicted improvement in Eating Concern, BSI and WSAS scores, while the change in 'fear of weight gain' was associated with improvement in dietary restraint. Baseline and end-of-therapy scores for all three measured body-image concern components predicted achievement of BMI ≥18.5 kg/m2 at 6- and 12-month follow-ups. Discussion: These findings highlight the importance of assessing and addressing body-image concern in the management of patients with anorexia nervosa.
... Several researchers in the field have examined the relationship between binge eating and binge-eating disorder with key weight/shape concern factors, such as overvaluation of weight/shape (e.g., Grilo et al., 2013;Mitchison et al., 2018). The high frequency of weight/shape concerns across individuals who meet criteria for bingeeating disorder as well as the associated indicators of impairment suggest that overvaluation of weight and shape should be considered for inclusion in the diagnostic criteria of binge-eating disorder, either as a specifier or criterion (Grilo et al., 2013;Linardo, 2017). This is especially important when considering the moderating role of higher BMI on the relationship between fear of negative evaluation and weight/shape concerns (Trompeter et al., 2018), as adolescents who meet criteria for binge-eating disorder typically also have a higher BMI compared to their peers (Kessler et al., 2013). ...
Article
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Objective: Fear of negative evaluation has been proposed as a transdiagnostic factor associated with the development of eating disorders and has been shown to relate to disorders of body image, especially those with weight/shape concerns such as eating disorders and muscle dys- morphia. The current study aimed to investigate whether fear of negative evaluation was a transdiagnostic factor of disorders diagnostically characterized by weight/shape concerns. The study examined whether fear of negative evaluation was associated with higher odds for meet- ing criteria for an eating disorder and/or muscle dysmorphia, especially those disorders diagnos- tically characterized by weight/shape concerns. Method: Data were used from a subgroup of the first wave of the EveryBODY study, a longitu- dinal investigation of eating disorders and body image concerns among Australian adolescents (N = 4,030). Participants completed measures on demographics, weight/shape concerns, disor- dered eating, psychological distress, muscularity concerns, and fear of negative evaluation. Results: Findings revealed that fear of negative evaluation was associated with higher odds of meeting criteria for any eating disorder but significantly more so for those characterized by weight/shape concerns diagnostically, as well as binge-eating disorder. Similar results were found for muscle dysmorphia. Discussion: The findings suggest that fear of negative evaluation constitutes a transdiagnostic feature for developing and/or maintaining an eating disorder.
... However, although we have follow-up data on BMI centile, we did not assess psychopathology at these time-points. Moreover, we used single items to assess different components of body-image concern, a strategy that has, however, commonly been used by other studies evaluating body-image concern in patients with eating disorder (Linardon, 2017;Linardon & Mitchell, 2017;Mitchison et al., 2017; Weight concern 3.7 (1.8) 2.2 (1.4) 6.47 <.001 ...
Article
Objective To ascertain the role of baseline measures of body‐image concern (BIC) in changes in body mass index (BMI) centile and psychopathological outcomes associated with intensive enhanced cognitive behavioral therapy (CBT‐E) in adolescents with anorexia nervosa (AN). Method The BMI centile of 62 adolescent patients with AN was recorded at four time‐points over 12 months, and Eating Disorder Examination interview (EDE) and Brief Symptom Inventory (BSI) scores, were recorded at admission and discharge from CBT‐E. Changes in three BIC components, namely “Preoccupation with shape/weight”, “Fear of weight gain” and “Feeling fat”, were assessed at admission and discharge. Results CBT‐E was associated with a significant improvement in outcome variables and BIC components. Among completers, 96.4% reached an end‐of treatment BMI centile corresponding to a BMI ≥ 18.5 at 18 years, which fell slightly to 78.7% and 80.4% at 6‐ and 12‐month follow‐ups, respectively. Baseline “Preoccupation with shape/weight” and “Feeling fat” predicted improvement in BMI centile over time, and all three baseline BIC components independently predicted end‐of‐treatment EDE Eating Concern subscale score. Baseline “Feeling fat” also predicted end‐of‐treatment EDE Dietary Restraint subscale and BSI scores. Discussion These findings highlight the importance of assessing and addressing body image when managing adolescent patients with AN.
... Understanding which constructs/symptoms meet this criteria for clinical significance in BED is important for informing decisions around what to target or prioritize during treatment, and it may also help with the refinement of the diagnostic criteria of this new eating disorder subtype (Mitchison et al., 2018). Current evidence in BED consistently highlights the importance of overvaluation of weight and shape, binge eating behaviour, and comorbid obesity as potential factors contributing to, or explaining variance in, the distress and impairment experienced in this population (Harrison et al., 2015;Linardon, 2016;Mitchison et al., 2018;Perez and Warren, 2012). However, the clinical significance of FA in BED, in terms of its ability to also explain unique variance in distress and impairment, is unknown. ...
Article
The Yale Food Addiction Scale 2.0 (YFAS) assesses addiction-like eating of palatable foods based on the 11 diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study was the first to investigate the factor structure, psychometric properties, and clinical significance of the YFAS 2.0 in individuals with binge-eating disorder (BED) symptomatology. Data were analysed from 220 community-based participants who met criteria for “probable BED” based on self-report symptom frequency. Classification of food addiction (FA) was met by 42.3% of the sample. The YFAS 2.0 exhibited a unidimensional structure, adequate internal consistency, and convergent and incremental validity. YFAS 2.0 scores contributed the largest percentage of unique variance in psychological distress and impairment over other BED features (overvaluation of weight and shape, binge eating, BMI), highlighting the clinical significance of the FA construct in BED. Support for the validity and reliability of the YFAS 2.0 in individuals with BED-like symptoms was found. Findings also suggest that the presence of FA may represent a more disturbed group of BED characterised by greater general and eating disorder-specific psychopathology. Our findings overall highlight the potential need to screen and assess addictive-like eating behaviours during interventions for BED.
... Study findings also demonstrated that OSW was directly associated with eating-related psychopathology and depressive symptoms, such that increasing degrees of OSW were associated with higher levels of eating-related psychopathology and depressive symptoms, relationships which were not fully mediated by LOC-eating frequency. These results align with previous research demonstrating associations between OSW, mood and eating-related psychopathology [14,27], and extend the literature by demonstrating the relevance of OSW for bariatric surgery candidates who do not endorse disordered eating behaviors such as LOC-eating. Approximately 36% of the sample endorsed LOC-eating behavior, higher than other estimates of objective binge eating (10.3-21.5%) ...
Article
Overvaluation of shape and weight (OSW), or self-evaluation based primarily on body shape and weight, is associated with cognitive and behavioral aspects of eating disorders (including dietary restraint; concerns about eating, shape, and weight; and loss of control eating (LOC-eating), as well as psychological distress. We explored associations among OSW, depressive symptoms, and various forms of eating-related psychopathology, including whether frequency of LOC-eating mediates observed associations, among 88 bariatric surgery candidates. OSW was positively correlated with LOC-eating frequency, eating-related psychopathology, and depressive symptoms. There was a direct effect of OSW on depressive symptoms and eating-related psychopathology. LOC-eating frequency partially mediated the association between OSW and eating-related psychopathology. These findings demonstrate that OSW is important to assess as a marker of psychosocial distress.
... Eating problems are noted to be highest among those with negative body image problems owing to failed dieting and depression [68]. Body shape and weight over-evaluation with impairments in psychological functioning exhibited a robust relationship on binge eating disorders [69,70]. On the contrary, another study reported that BID is not associated with eating attitudes and is present among adolescents irrespective of whether they exhibit behaviors that make them vulnerable to eating disorders [71]. ...
Article
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Background: Adults with body image dissatisfaction (BID) are more likely to be depressed, anxious, and suicidal when compared to those without intense dissatisfaction over their appearance. The current study aimed to estimate the prevalence and factors associated with BID among out-patients with mental illness in Singapore. Methods: Data was collected from 310 psychiatric out-patients using a self-administered questionnaire. Measurements used were socio-demographic characteristics, Body Mass Index scores, Body Shape Questionnaire, Binge Eating Scale, Eating Attitudes Test, Beck’s Depression Inventory, Beck’s Anxiety Inventory and Alcohol Use Disorders Identification Test. Results: A prevalence of 30.9% of BID was established among psychiatric out-patients in Singapore. Being female, having higher BMI scores, binge eating behavior, eating disorders, and those diagnosed with depression were positively associated with BID. Conclusion: BID is prevalent among those with psychiatric illnesses which could lead to a higher degree of psychological distress and the emergence of eating disorders.
... It is unknown, however, how fear of WG and sensitivity to WG present in individuals with BED or how this presentation may differ from their counterparts with excess weight who do not have BED. It is feasible that in individuals with overweight or obesity, who also are seeking to lose weight, greater fear of WG and sensitivity to WG might be related to unhealthy eating behaviors, poor body image, and depression, as with individuals in the underweight or healthy weight body mass index (BMI) ranges [9,18,19]. Alternatively, fear of WG and sensitivity to WG could be adaptive and contribute to active steps toward better health. ...
Article
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Purpose Weight concern, including fear of weight gain and sensitivity to weight gain, is indicative of disordered eating in individuals with underweight or healthy weight. It is unknown, however, whether or how these constructs present in individuals with excess weight, particularly among those with binge-eating disorder (BED). This study sought to characterize fear of weight gain and sensitivity to weight gain and examine their relationship with disordered eating and depression symptoms, in individuals seeking weight loss treatment, both with and without BED. Methods Adults seeking weight loss treatment in an urban primary care clinic (N = 131) completed the Eating Disorder Examination interview and Beck Depression Inventory. Height and weight were collected. Results Clinical levels of fear of weight gain and sensitivity to weight gain were present in this sample. Individuals with BED reported experiencing fear of weight gain (48.6%), significantly more than those without BED (20.9%); both groups reported similar and clinically elevated sensitivity to weight gain. Both constructs were related to greater levels of disordered eating and depression symptoms, at times based on BED status. Fear of weight gain was associated with overvaluation of weight and shape for those without BED only. Objective and subjective bulimic episodes were unrelated to fear of weight gain or sensitivity to weight gain, regardless of BED status. Conclusion Fear of weight gain and sensitivity to weight gain were common in this sample and may be maladaptive, as evidenced by associations with elevated eating psychopathology. Future studies should examine these variables within larger samples and should employ longitudinal designs. Level of evidence Level III: case–control analytic study.
... • Probable bulimia nervosa (BN). At least four objective binge-eating episodes in the past 28-days; AND persistent (defined as at least four episodes) extreme weight control behavior in the past 28-days (fasting, self-induced vomiting, laxative misuse, or driven exercise); AND clinically significant overvaluation of weight and shape (an average score of 5 or more on the two overvaluation items; see Linardon, 2016). ...
Article
Objective E‐therapy shows promise as a solution to the barriers that stand in the way of people receiving eating disorder (ED) treatment. Despite the potential for e‐therapy to reduce the well‐known treatment gap, little is known about public views and perspectives on this mode of intervention delivery. This study explored attitudes toward, and preferences for, e‐therapy among individuals spanning the spectrum of eating pathology. Method Survey data assessing e‐therapy attitudes and preferences were analyzed from 713 participants recruited from the public. Participants were categorized into one of five subgroups based on the type of self‐reported ED symptoms and severity/risk level, ranging from high risk to a probable threshold or subthreshold ED. Results Attitudes toward e‐therapies appeared to be relatively positive; participants largely supported health care insurance coverage of costs for e‐therapies, and were optimistic about the wide‐ranging benefits of e‐therapy. Although three‐quarters of participants expressed a preference for face‐to‐face therapy, a significant percentage of participants (∼50%) reported an intention to use an e‐therapy program for current or future eating problems, with intention ratings highest (70%) among those with probable bulimia nervosa (BN). Variables associated with an e‐therapy preference were not currently receiving psychotherapy, more positive e‐therapy attitudes, and greater stigma associated with professional help‐seeking. Variables associated with e‐therapy intentions were more positive e‐therapy attitudes and a probable BN classification. Conclusions Present findings have important implications for increasing online intervention acceptance, engagement, and help‐seeking among those at different stages of illness.
... These negative self-evaluations are a major source of distress that in turn foster the various attitudinal and behavioural symptoms of EDs and associated impairment (Fairburn, 2008). Indeed, a strong body of cross-sectional (e.g., Grilo et al., 2009;Linardon, 2016; and longitudinal (e.g., Sharpe et al., 2018;Tabri et al., 2015) evidence in both clinical and community samples has found shape and weight overvaluation to be independently and robustly associated with ED symptoms and related distress and impairment, indicating that shape and weight overvaluation may be a clinically important construct used as a marker of psychopathology. ...
... This is central to the diagnosis of several eating disorders (American Psychiatric Association, 2013). Among those with eating disorders, OSW has been associated with higher levels of disordered eating attitudes and behaviors as well as poorer body image (Linardon, 2017). Among non-pregnant samples of those without eating disorders, OSW has been associated with higher levels of psychological distress (Harrison et al., 2015) and dietary restraint (Mitchison et al., 2017;Watson et al., 2011). ...
Article
Excessive gestational weight gain is associated with negative outcomes and the identification of contributing psychosocial factors may be useful in prevention and intervention. Pregnant women ( N = 70) completed self-report measures of eating pathology, depressive symptomatology, and gestational weight gain. Global eating pathology was positively associated with overvaluation of shape and weight, dietary restraint, frequency of binge eating, and depressive symptoms. Depressive symptoms significantly predicted excessive gestational weight gain, while global eating pathology predicted excessive gestational weight gain at a trend level. Results suggest that depressive symptoms more strongly predict excessive gestational weight gain than eating pathology.
... In contrast to what is observed for autism, symptoms of eating disorders are less likely to be recognised in males, and are more likely to remain undiagnosed (Murray et al. 2017). Eating disorders are increasingly conceptualised trans-diagnostically, whereby a core psychopathology (over-evaluation of eating, weight, shape and their control, and dietary restriction and restraint) underpins disordered eating across the diagnostic spectrum (Fairburn et al. 2003;Linardon 2017). Moreover, as with autism and autistic traits, symptoms of disordered eating can be detected in non-clinical groups, i.e. symptoms are distributed dimensionally not categorically in the population (Keel et al. 2007). ...
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Previous studies have reported positive correlations between autistic traits and disordered eating, though it is unclear whether the association is moderated by sex/gender or whether it is independent of anxiety or depression. We present the findings of an online survey of 691 participants who completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), and Eating Attitudes Test-26 (EAT-26). Following a pre-registered analysis plan, we observed positive cor- relations between AQ and EAT-26 in males and females, with the association being significantly stronger in females. AQ also remained a significant predictor of EAT-26 when anxiety and depression were controlled for statistically. These find- ings may be relevant when considering therapeutic interventions in disordered eating populations that exhibit autistic traits.
... La più comune è l'eccessiva valutazione del peso e della forma del corpo, cioè valutare se stessi in modo predominante sulla base del peso e della forma del corpo, che sembra essere presente in circa il 50% degli individui con BED (Grilo, 2013). Gli individui della popolazione con BED ed eccessiva valutazione del peso e della forma del corpo, rispetto a quelli con BED senza questa forma di psicopatologia, hanno una psicopatologia generale e un danno psicologico più gravi (cioè, depressione, bassa autostima e peggiore qualità della vita) Mond, Hay, Rodgers, & Owen, 2007), un dato confermato da una meta-analisi di 32 studi (Linardon, 2017). Inoltre, un'eccessiva valutazione del peso e della forma corporea più elevata in basale sembra essere un predittore negativo di risposta al trattamento del BED (Grilo, 2013;. ...
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Binge-eating disorder (BED) is characterized by the presence of recurrent binge-eating episodes not followed by the recurrent use of compensatory behaviors, occurring at least once a week for three months, and associated with marked distress. According to the most recent data, BED has a lifetime prevalence of 0.85% (men 0.42% and women 1.25%). The disorder, although it is also present in normal-weight individuals, is more frequent in those with obesity. BED often coexists with specific mental disorders (e.g., depressive disorders, anxiety disorders, substance use disorders, or impulse control disorders) and with general medical conditions (e.g., cardiometabolic diseases). Psychological treatments, such as cognitive behaviour therapy (CBT), produce remission of binge-eating episodes in about 50-55% of patients, but have a limited effect on weight loss when BED is associated with obesity. Pharmacological treatments for anxiety and depression have limited effects on the symptoms of BED, while some drugs that have shown promising results, such as lisdexamfetamine and dasotraline, are often burdened with important side effects and are not available in Italy. The need to develop a treatment able to determine both a modest, but clinically significant, weight loss and a simultaneous remission of binge-eating episodes and associated psychopathology, has led to design a new treatment, under evaluation, called “CBT-BO”, which integrates strategies and procedures of the CBT-E for eating disorders and CBT for obesity.
... BN symptomatology was defined as at least four objective bingeeating episodes in the past 28-days; and persistent (≥ 4 least four episodes) extreme weight-control behavior in the past 28-days (i.e., fasting, self-induced vomiting, laxative misuse, or driven exercise); and clinically significant overvaluation of weight and shape (i.e., a composite score of 5 or 6 on the two overvaluation items; see Linardon, 2016). Using this algorithm, 145 participants met criteria for BN. ...
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This study aimed to (1) examine the unique role of mindfulness and self-compassion on eating disorder (ED) psychopathology and functional impairment, and (2) compare levels of mindfulness and self-compassion between health controls and individuals categorized with bulimia nervosa (BN), and binge-eating disorder (BED). Data were analyzed from 1101 community-based participants, of which 145 met criteria for BN, 150 for BED, and 286 for healthy controls. Results from a series of multiple regressions revealed that self-compassion accounted for substantially more variance in ED psychopathol-ogy and functional impairment than mindfulness in the total sample and across the three subgroups, at times explaining 20 times more variance than mindfulness. Results remained unchanged when excluding the mindfulness subscale from the Self-Compassion Scale. When comparing these variables across the three study groups, results showed that self-compassion and mindfulness levels were lowest in the BN group, followed by the BED group, and then the healthy control group. Findings overall suggest that non-judgmental awareness may be less important in explaining levels of ED psychopathology than the nature of one's interaction with emotionally charged, negative experiences. Findings also point to possible priority intervention targets in indicated prevention and treatment programs.
... A score of 5 or 6 indicates clinically significant levels of feeling fat [12]. A shape/weight overvaluation composite score was also assessed through two EDE-Q items, each rated along a 7-point scale from 0 (not at all) to 6 (markedly), and averaged to produce a composite score [15]. In this study, the dietary restraint subscale, eating concern subscale, and the frequency of objective binge eating episodes were selected as criterion variables. ...
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... "how often has your weight influence how you feel as a person" and "how often has your shape influenced how you feel as a person"), each rated along a six point scale. The items were averaged to create a composite score where higher scores indicate greater levels of shape and weight over-evaluation (Fairburn, Peveler, Jones, Hope, & Doll, 1993;Linardon, 2016 (Stunkard & Messick, 1985). A dichotomous response format (true/false) is used for the first 13 items while a four-point scale ranging from one (never) to four (at least once a week/always) is used for remaining items. ...
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Accumulating evidence suggests that the presence of shape/weight overvaluation in binge-eating disorder (BED) is associated with more severe psychopathology and impairment. To further inform the role of the overvaluation construct in BED, we examined whether those with and without shape/weight overvaluation differ on four core processes that underpin the contextual behaviour therapies: distress tolerance, self-compassion, mindfulness, and experiential avoidance. These four processes were investigated as each are considered important change mechanisms in contextual behavioural therapies and are either compatible or incompatible with the emotion dysregulation known to precipitate binge eating. Participants were categorized into one of four study groups: probable BED with overvaluation (n = 60); probable BED without overvaluation (n = 108); obese control (n = 59); healthy control (n = 123). Analyses of covariance showed that the probable BED with overvaluation group reported lower levels of self-compassion and distress tolerance, and higher levels of experiential avoidance than the three other groups. The probable BED without overvaluation group did not differ to control groups on these processes, except experiential avoidance levels. Findings highlight potentially important intervention targets and constructs among a subgroup of individuals with BED.
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Consistent predictors, and more especially moderators, of response to psychological treatments for eating disorders have not been identified. The present exploratory study examined predictors and moderators of outcome in adult patients who took part in a randomised clinical trial comparing two leading treatments for these disorders, enhanced cognitive behavioural therapy (CBT-E) and interpersonal psychotherapy (IPT). Four potentially important findings emerged. Firstly, patients with a longer duration of disorder were less likely to benefit from either treatment. Second, across the two treatments the presence, at baseline, of higher levels of over-evaluation of the importance of shape predicted a less good treatment outcome. Third DSM-IV diagnosis did not predict treatment outcome. Fourth, with the exception of patients with baseline low self-esteem who achieved a better outcome with CBT-E, it was generally not possible to identify a subgroup of patients who would differentially benefit from one or other treatment.
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Significant discrepancies have been found between interview- and questionnaire-based assessments of psychopathology; however, these studies have typically compared instruments with unmatched item content. The Eating Disorder Examination (EDE), a structured interview, and the questionnaire version of the EDE (EDE-Q) are considered the preeminent assessments of eating disorder symptoms and provide a unique opportunity to examine the concordance of interview- and questionnaire-based instruments with matched item content. The convergence of EDE and EDE-Q scores has been examined previously; however, past studies have been limited by small sample sizes and have not compared the convergence of scores across diagnostic groups. A meta-analysis of 16 studies was conducted to compare the convergence of EDE and EDE-Q scores across studies and diagnostic groups. With regard to the EDE and EDE-Q subscale scores, the overall correlation coefficient effect sizes ranged from .68 to .76. The overall Cohen's d effect sizes ranged from .31 to .62, with participants consistently scoring higher on the questionnaire. For the items measuring behavior frequency, the overall correlation coefficient effect sizes ranged from .37 to .55 for binge eating and .90 to .92 for compensatory behaviors. The overall Cohen's d effect sizes ranged from -0.16 to -0.22, with participants reporting more binge eating on the interview than in the questionnaire in 70% of the studies. These results suggest the interview and questionnaire assess similar constructs but should not be used interchangeably. Additional research is needed to examine the inconsistencies between binge frequency scores on the 2 instruments.
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As publication of DSM-V draws near, research is needed to validate the diagnostic scheme for binge eating disorder (BED). Shape and weight overvaluation has stimulated considerable debate in this regard, given associations with psychosocial impairment and poor treatment outcome in BED. This study sought to further explore the convergent validity and diagnostic specificity of shape and weight overvaluation in BED. A total of 160 women with BED, and 108 women with non-eating disordered psychiatric disorders were recruited from the community. Women with BED were classified as more or less severe based on a global measure of eating-related psychopathology; subsequent receiver operating characteristics analysis determined that a threshold of at least "moderate" overvaluation best predicted membership into a more severe group. BED participants with threshold overvaluation exhibited poorer psychosocial functioning than those with subthreshold overvaluation, as well as participants with other psychiatric disorders. Discriminant function analysis revealed that threshold overvaluation predicted a diagnosis of BED versus other psychiatric disorder with 67.7% accuracy. Results suggest that shape and weight overvaluation is a useful diagnostic specifier in BED. Continued research is warranted to examine its predictive validity in natural course and treatment outcome studies.
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Little is known about how psychological treatments work. Research on treatment-induced mediators of change may be of help in identifying potential causal mechanisms through which they operate. Outcome-focused randomised controlled trials provide an excellent opportunity for such work. However, certain conceptual and practical difficulties arise when studying psychological treatments, most especially deciding how best to conceptualise the treatment concerned and how to accommodate the fact that most psychological treatments are implemented flexibly. In this paper, these difficulties are discussed, and strategies and procedures for overcoming them are described.
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Seventy-five patients with bulimia nervosa were treated with 1 of 3 short-term psychological treatments and were then entered into a closed 1-year period of follow-up. Pretreatment predictors of 3 measures of outcome were sought. Only 2 variables were significantly associated with outcome: attitudes toward shape and weight, and self-esteem. The nature of the relation between attitudinal disturbance and outcome was complex and unexpected. The data set was also used to test the major prediction of the cognitive view of bulimia nervosa, namely that among patients who have responded to treatment, the residual level of attitudinal disturbance will predict subsequent outcome. This prediction was confirmed.
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This systematic review synthesised the literature on predictors, moderators, and mediators of outcome following Fairburn's CBT for eating disorders. Sixty-five articles were included. The relationship between individual variables and outcome was synthesised separately across diagnoses and treatment format. Early change was found to be a consistent mediator of better outcomes across all eating disorders. Moderators were mostly tested in binge eating disorder, and most moderators did not affect cognitive-behavioural treatment outcome relative to other treatments. No consistent predictors emerged. Findings suggest that it is unclear how and for whom this treatment works. More research testing mediators and moderators is needed, and variables selected for analyses need to be empirically and theoretically driven. Future recommendations include the need for authors to (i) interpret the clinical and statistical significance of findings; (ii) use a consistent definition of outcome so that studies can be directly compared; and (iii) report null and statistically significant findings.
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Objective: This review aimed to (a) examine the effects of rapid response on behavioral, cognitive, and weight-gain outcomes across the eating disorders, (b) determine whether diagnosis, treatment modality, the type of rapid response (changes in disordered eating cognitions or behaviors), or the type of behavioral outcome moderated this effect, and (c) identify factors that predict a rapid response. Method: Thirty-four articles met inclusion criteria from six databases. End of treatment and follow-up outcomes were divided into three categories: Behavioral (binge eating/purging), cognitive (EDE global scores), and weight gain. Average weighted effect sizes(r) were calculated. Results: Rapid response strongly predicted better end of treatment and follow-up cognitive and behavioral outcomes. Moderator analyses showed that the effect size for rapid response on behavioral outcomes was larger when studies included both binge eating and purging (as opposed to just binge eating) as a behavioral outcome. Diagnosis, treatment modality, and the type of rapid response experienced did not moderate the relationship between early response and outcome. The evidence for weight gain was mixed. None of the baseline variables analyzed (eating disorder psychopathology, demographics, BMI, and depression scores) predicted a rapid response. Discussion: As there is a solid evidence base supporting the prognostic importance of rapid response, the focus should shift toward identifying the within-treatment mechanisms that predict a rapid response so that the effectiveness of eating disorder treatment can be improved. There is a need for future research to use theories of eating disorders as a guide to assess within-treatment predictors of rapid response. © 2016 Wiley Periodicals, Inc.
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Research addressing the assessment of binge eating and associated eating disorder psychopathology has steadily increased in recent years. Few studies have examined the relationship between the various assessment methods. This study compared an investigator-based interview, the Eating Disorder Examination (EDE), with a self-report version of that interview, the EDE-Q. Fifty-two individuals (six men and 46 women) with binge eating disorder (BED) completed both instruments. Modest-to-good agreement and significant correlations (P < 0.0001) were found between the two methods on all four subscales assessing specific eating disorder psychopathology (i.e., Restraint, Eating Concern, Weight Concern, and Shape Concern subscales). However, higher levels of disturbance were consistently reported on the EDE-Q than the EDE interview. The two methods were not significantly or reliably related to one another when assessing binge eating. This may be due in part to the difficulty inherent in identifying binges in subjects with BED. Examination of individual item scores suggest that it might be possible to improve the performance of the EDE-Q by clarifying the definitions of certain complex features, although this should not be at the expense of compromising the practical utility of its self-report format.
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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.
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Objective: Undue influence of body shape or weight on self-evaluation--referred to as overvaluation--is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This article addresses the relevance of a feature reflecting disturbance in body image for the diagnosis of BED. Method: The distinction between overvaluation of shape/weight and body dissatisfaction is discussed, and empirical research regarding the concurrent and predictive significance of overvaluation of shape/weight for BED is reviewed. Results: The literature suggests that overvaluation does not simply reflect concern or distress commensurate with excess weight, is reliably associated with greater severity of eating-related psychopathology and psychological distress, and has reliably shown negative prognostic significance. Discussion: Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED.
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Objective: To determine if the relationships between additional maintaining factors and core eating disorder maintaining mechanisms outlined in the cognitive-behavioural model of eating disorders are transdiagnostic. Method: Patients (n = 1451) diagnosed with anorexia nervosa, bulimia nervosa (BN) or eating disorder not otherwise specified completed the Eating Disorder Examination Questionnaire, Eating Disorder Inventory-2 and Personality Assessment Inventory prior to entering treatment. Results: Multi-group structural equation modelling results suggested that low self-esteem, overevaluation of weight and shape, and mood intolerance processes were transdiagnostic. However, some differences between diagnostic groups were observed. Dietary restraint was only positively associated with binge eating in BN, interpersonal difficulties were only associated with dietary restraint in eating disorder not otherwise specified and perfectionism was not associated with core eating disorder maintaining mechanisms in BN. Discussion: A mixture of transdiagnostic and disorder-specific processes was implicated in the maintenance of eating disorders, although longitudinal research is needed to validate results.
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Background: Undue influence of body shape or weight on self-evaluation - referred to as overvaluation - is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This study examined the concurrent and predictive significance of overvaluation of shape/weight in obese patients with BED participating in a randomized clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method A total of 90 participants were randomly assigned to 6-month group treatments of CBT or BWL. Assessments were performed at baseline, throughout- and post-treatment, and at 6- and 12-month follow-ups after completing treatments with reliably administered semi-structured interviews and established measures. Results: Participants categorized with overvaluation (n = 52, 58%) versus without overvaluation (n = 38, 42%) did not differ significantly in demographic features (age, gender and ethnicity), psychiatric co-morbidity, body mass index or binge eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology and poorer psychological functioning (higher depression and lower self-esteem) than the non-overvaluation group. Overvaluation of shape/weight significantly predicted non-remission from binge eating and higher frequency of binge eating at the 12-month follow-up, even after adjusting for group differences in depression and self-esteem levels. Conclusions: Our findings suggest that overvaluation does not simply reflect concern commensurate with being obese or more frequent binge eating, but also is strongly associated with heightened eating-related psychopathology and psychological distress, and has negative prognostic significance for longer-term treatment outcomes. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity and treatment outcome.
Article
Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.
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Research addressing the assessment of binge eating and associated eating disorder psychopathology has steadily increased in recent years. Few studies have examined the relationship between the various assessment methods. This study compared an investigator-based interview, the Eating Disorder Examination (EDE), with a self-report version of that interview, the EDE-Q. Fifty-two individuals (six men and 46 women) with binge eating disorder (BED) completed both instruments. Modest-to-good agreement and significant correlations (P < 0.0001) were found between the two methods on all four subscales assessing specific eating disorder psychopathology (i.e., Restraint, Eating Concern, Weight Concern, and Shape Concern subscales). However, higher levels of disturbance were consistently reported on the EDE-Q than the EDE interview. The two methods were not significantly or reliably related to one another when assessing binge eating. This may be due in part to the difficulty inherent in identifying binges in subjects with BED. Examination of individual item scores suggest that it might be possible to improve the performance of the EDE-Q by clarifying the definitions of certain complex features, although this should not be at the expense of compromising the practical utility of its self-report format.
Article
Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors, psychiatric and personality disorder comorbidity, eating disorder psychopathology, psychological features, and 2 subtyping methods (negative affect, overvaluation of shape/weight) were tested as predictors and moderators for the primary outcome of remission from binge eating and 4 secondary dimensional outcomes (binge-eating frequency, eating disorder psychopathology, depression, and body mass index). Mixed-effects models analyzed all available data for each outcome variable. In each model, effects for baseline value and treatment were included with tests of both prediction and moderator effects. Results: Several demographic and clinical variables significantly predicted and/or moderated outcomes. One demographic variable signaled a statistical advantage for medication only (younger participants had greater binge-eating reductions), whereas several demographic and clinical variables (lower self-esteem, negative affect, and overvaluation of shape/weight) signaled better improvements if receiving CBT. Overvaluation was the most salient predictor/moderator of outcomes. Overvaluation significantly predicted binge-eating remission (29% of participants with vs. 57% of participants without overvaluation remitted). Overvaluation was especially associated with lower remission rates if receiving medication only (10% vs. 42% for participants without overvaluation). Overvaluation moderated dimensional outcomes: Participants with overvaluation had significantly greater reductions in eating disorder psychopathology and depression levels if receiving CBT. Overvaluation predictor/moderator findings persisted after controlling for negative affect. Conclusions: Our findings have clinical utility for prescription of CBT and medication and implications for refinement of the BED diagnosis.
Article
To examine whether overvaluation of shape and weight is associated with initial symptom severity or treatment outcome among patients with binge eating disorder (BED). Patients with BED (n = 116) completed assessments at baseline and treatment termination, including the Eating Disorder Examination (EDE) and self-report measures of eating-related cognitions and behaviors, depression, and self-esteem. Clinical overvaluation was determined by EDE. The clinical overvaluation group demonstrated significantly higher pre-treatment scores on measures of depression, behavioral and cognitive aspects of binge eating, and eating-related psychopathology, and lower self-esteem scores than individuals without overvaluation. At treatment termination, patients with overvaluation continued to display elevated scores on measures of binge eating severity at a trend level. Overvaluation of shape and weight was associated with symptom severity in patients with BED, but additional research is needed to determine whether this construct holds clinically useful predictive validity for treatment outcome.
Article
The original cognitive-behavioural model of bulimia nervosa (BN) has been enhanced to include four additional maintaining mechanisms: low self esteem, clinical perfectionism, interpersonal problems, and mood intolerance. These models have been used to guide cognitive-behavioural treatment for BN, but the enhanced model has yet to be directly evaluated as a whole in a clinical sample. This study aimed to compare and evaluate the original and the enhanced cognitive-behavioural models of BN using structural equation modelling. The Eating Disorder Examination and self-report questionnaires were completed by 162 patients seeking treatment for BN (N = 129) or atypical BN (N = 33). Fit indices suggested that both the original and enhanced models provided a good fit to the data, but the enhanced model accounted for more variance in dietary restraint and binge eating. In the enhanced model, low self esteem was associated with greater overevaluation of weight and shape, which, in turn, was associated with increased dietary restraint. Interpersonal problems were also directly associated with dietary restraint, and binge eating was associated with increased purging. While the current study provides support for some aspects of the enhanced cognitive-behavioural model of BN, some key relationships in the model were not supported, including the important conceptual relationship between dietary restraint and binge eating.
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Underweight patients with eating disorder not otherwise specified without the over-evaluation of shape and weight (EDNOS-W) represent a diagnostic challenge. We aimed to evaluate their clinical characteristics and treatment outcome, compared with anorexia nervosa (AN) cases. Eighty-eight consecutive patients (81 females; age range 13-50 years, 71 AN, and 17 EDNOS-W) were studied. The differential diagnosis of AN and EDNOS-W was based on the eating disorder examination. Compared with AN, EDNOS-W cases had a milder eating disorder psychopathology, but no differences in anthropometric and clinical data. The response to inpatient cognitive behavioral treatment was good and similar between groups, and no differences in the dropout rate or time-to-dropout were observed. The normalization of body weight in EDNOS-W cases was not associated with the appearance of the over-evaluation of shape and weight. The data gives preliminary support to the proposal to include EDNOS-W in the diagnosis of AN.
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This article is to establish recommendations for conducting quantitative synthesis, or meta-analysis, using study-level data in comparative effectiveness reviews (CERs) for the Evidence-based Practice Center (EPC) program of the Agency for Healthcare Research and Quality. We focused on recurrent issues in the EPC program and the recommendations were developed using group discussion and consensus based on current knowledge in the literature. We first discussed considerations for deciding whether to combine studies, followed by discussions on indirect comparison and incorporation of indirect evidence. Then, we described our recommendations on choosing effect measures and statistical models, giving special attention to combining studies with rare events; and on testing and exploring heterogeneity. Finally, we briefly presented recommendations on combining studies of mixed design and on sensitivity analysis. Quantitative synthesis should be conducted in a transparent and consistent way. Inclusion of multiple alternative interventions in CERs increases the complexity of quantitative synthesis, whereas the basic issues in quantitative synthesis remain crucial considerations in quantitative synthesis for a CER. We will cover more issues in future versions and update and improve recommendations with the accumulation of new research to advance the goal for transparency and consistency.
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Although normal-weight individuals comprise a substantial minority of the binge eating disorder (BED) population, little is known about their clinical presentation. This study sought to investigate the nature and severity of eating disturbances in normal-weight adults with BED. We compared 281 normal-weight (n = 86) and obese (n = 195) treatment-seeking adults with BED (mean age = 31.0; s.d. = 10.8) on a range of current and past eating disorder symptoms using ANOVA and χ(2) analyses. After controlling for age and sex, normal-weight participants reported more frequent use of a range of healthy and unhealthy weight control behaviors compared to their obese peers, including eating fewer meals and snacks per day; exercising and skipping meals more frequently in the past month; and avoiding certain foods for weight control. They also endorsed more frequent attempts at dieting in the past year, and feeling more frequently distressed about their binge eating, at a trend level. There were no group differences in binge eating frequency in the past month, age at onset of binge eating, overvaluation of shape/weight, or likelihood of having used certain weight control behaviors (e.g., vomiting, laxative use) or having sought treatment for an eating disorder in the past. Based on our findings, normal-weight individuals appear to be a behaviorally distinct subset of the BED population with significantly greater usage of both healthy and unhealthy weight control behaviors compared to their obese peers. These results refute the notion that distress and impairment in BED are simply a result of comorbid obesity.
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Three cognitive constructs are risk factors for eating disorders: undue influence of weight and shape, concern about weight and shape, and body dissatisfaction (BD). Undue influence, a diagnostic criterion for eating disorders, is postulated to be closely associated with self-esteem whereas BD is postulated to be closely associated with body mass index (BMI). We understand less about the relationships with concern about weight and shape. The aim of the current investigation was examine the degree of overlap across these five phenotypes in terms of latent genetic and environmental risk factors in order to draw some conclusions about the similarities and differences across the three cognitive variables. A sample of female Australian twins (n=1056, including 348 complete pairs), mean age 35 years (S.D.=2.11, range 28-40), completed a semi-structured interview about eating pathology and self-report questionnaires. An independent pathways model was used to investigate the overlap of genetic and environmental risk factors for the five phenotypes. In terms of variance that was not shared with other phenotypes, self-esteem emerged as being separate, with 100% of its variance unshared with the other phenotypes, followed by undue influence (51%) and then concern (34%), BD (28%) and BMI (32%). In terms of shared genetic risk, undue influence and concern were more closely related than BD, whereas BMI and BD were found to share common sources of risk. With respect to environmental risk factors, concern, BMI and BD were more closely related to each other than to undue influence.
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Given the prevalence and health significance of binge eating disorder (BED) it is important to determine if time-efficient self-reports can adequately assess BED and its features in primary care settings. We compared the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), administered to obese patients with BED in primary care setting to the Eating Disorder Examination (EDE) interview. Sixty-six participants completed the questionnaires and were interviewed. The EDE interview was significantly correlated with the EDE-Q (binge eating, four subscales, and global score) and the QEWP-R (binge eating, distress, and body image). The EDE-Q yielded significantly lower estimates of binge eating and significantly higher scores on the EDE subscales. The QEWP-R yielded significantly higher scores on the behavioral indicators and distress about binge eating and body image variables. These findings suggest that these two self-report measures have potential utility for identifying BED in obese patients in primary care.
Article
Despite the widespread use of the Eating Disorder Examination (EDE) as a primary assessment instrument in studies of eating and weight disorders, little is known about the psychometric aspects of this interview measure. The primary purpose of this study was to evaluate the factor structure of the EDE interview in a large series of patients with binge-eating disorder (BED). Participants were 688 treatment-seeking patients with BED who were reliably administered the EDE interview by trained research clinicians at three research centers. Exploratory factor analysis (EFA) performed on EDE interview data from a random split-half of the study group suggested a brief 7-item 3-factor structure. Confirmatory factor analysis (CFA) performed on the second randomly selected half of the study group supported this brief 3-factor structure of the EDE interview. The three factors were interpreted as Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction. In this series of patients with BED, factor analysis of the EDE interview did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE interview in this and other eating-disordered groups. The implications of these factor analytic findings for understanding and assessing the specific psychopathology of patients with BED are discussed.
Article
A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.
Article
There has been particular confusion concerning two aspects of the psychopathology of bulimia nervosa: dissatisfaction with body shape and overvalued ideas about shape and weight. Whilst these features are closely related, they are nevertheless distinct. Body shape dissatisfaction is commonly found in these patients but is not necessarily present; whilst the over-valued ideas about shape and weight are a necessary diagnostic feature. Analysis of the relationship between these two features and depressed mood and self-esteem showed that, in the course of treatment, change in body shape dissatisfaction was closely associated with change in mood; and change in the overvalued ideas was closely associated with change in self-esteem. This finding supports the distinction between these two facets of the core psychopathology of bulimia nervosa.
Article
A cognitive behavioural theory of the maintenance of anorexia nervosa is proposed. It is argued that an extreme need to control eating is the central feature of the disorder, and that in Western societies a tendency to judge self-worth in terms of shape and weight is superimposed on this need for self-control. The theory represents a synthesis and extension of existing accounts. It is 'new', not so much because of its content, but because of its exclusive focus on maintenance, its organisational structure and its level of specification. It is suggested that the theory has important implications for treatment.
Article
To compare three related but different measures of excessive concerns about shape and weight in bulimia nervosa (BN): influence of shape and weight (influence; DSM-IV Criterion D), overconcern with shape and weight (overconcern; DSM-III-R Criterion E), and dissatisfaction with shape and weight (dissatisfaction). One-hundred twenty BN patients, 27 restrained eaters (RE), and 28 normal controls (NC) were assessed via the Eating Disorders Examination and self-report measures. Influence and overconcern, but not dissatisfaction, successfully discriminated BNs from NCs but not from REs. A minority of patients with BN obtained low scores on both influence and overconcern. However, there were few differences between those patients with low scores and those with high scores on numerous clinical characteristics. Influence and overconcern are equally valid measures of the excessive concerns about shape and weight characteristic of BN.
Article
The authors compared 3 methods for assessing the features of eating disorders in patients with binge eating disorder (BED). Participants were administered the Eating Disorder Examination (EDE) interview and completed the EDE Questionnaire (EDE-Q) at baseline. Participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. The EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating) and on the Dietary Restraint, Eating Concern, Weight Concern, and Shape Concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes were not significant, but scores on the 4 subscales differed significantly, with the EDE-Q yielding higher scores. At 4 weeks, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes, and the mean difference between methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. Thus, in patients with BED, the 3 assessment methods showed some acceptable convergence, most notably for objective bulimic episodes.
Article
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.
Article
This study examined the distinction between body dissatisfaction and self-evaluation unduly influenced by body shape and weight, and their longitudinal relationships to depressive symptomatology and self-esteem in patients with binge eating disorder (BED). Ninety-seven patients with BED completed measures tapping these constructs at baseline and again 4 weeks later. Change in body dissatisfaction was significantly correlated with both change in depressive symptomatology and change in self-esteem over time, whereas change in self-evaluation was significantly correlated only with change in self-esteem. In addition, change in shape concern, but not change in weight concern, was significantly correlated with change in self-esteem only. These findings suggest that self-evaluation unduly influenced by body shape is a more useful indicator for BED than body dissatisfaction or self-evaluation unduly influenced by weight.
Article
This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
Article
The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN). Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC). The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other. These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse.
Article
Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".
Article
The excessive influence of shape or weight on self-evaluation--referred to as overvaluation--is considered by some a central feature across eating disorders but is not a diagnostic requirement for binge eating disorder (BED). This study examined shape/weight overvaluation in 399 consecutive patients with BED. Participants completed semistructured interviews, including the Eating Disorder Examination (EDE; C. G. Fairburn & Z. Cooper, 1993) and several self-report measures. Shape/weight overvaluation was unrelated to body mass index (BMI) but was strongly associated with measures of eating-related psychopathology and psychological status (i.e., higher depression and lower self-esteem). Participants were categorized via EDE guidelines into 1 of 2 groups: clinical overvaluation (58%) or subclinical overvaluation (42%). The 2 groups did not differ significantly in BMI or binge eating frequency, but the clinical overvaluation group had significantly greater eating-related psychopathology and poorer psychological status than the subclinical overvaluation group. Findings suggest that overvaluation does not simply reflect concern commensurate with being overweight but is strongly associated with eating-related psychopathology and psychological functioning and warrants consideration as a diagnostic feature for BED.
Article
Body image disturbances play a significant role in the development of eating disorders. Since body image can vary in diverse contexts, the aim of the present experiment was to investigate whether it is affected by recent food intake. Fifty-seven females without clinically relevant eating disorders were randomly assigned to an experimental group (EG, n=28) that consumed a milkshake while watching a neutral film and a control group (CG, n=29) that only viewed the movie. Before and after the tasks, participants filled in the "Body Image States Scale" and the "Mood Questionnaire" and indicated their own "actual", "felt" and "ideal" body dimensions with a digital distortion technique based on a photograph of themselves. It was shown that after milkshake consumption, state body dissatisfaction as well as the discrepancy between "actual-ideal" and "felt-ideal" body size estimations was higher in the EG than in the CG. Judgements of the "actual", "felt" and "ideal" body dimensions and of mood were not affected. Further analyses revealed that the effect of milkshake consumption on body image and mood was higher the more the participants displayed restrained eating or eating, weight and shape concerns in general. Clinical implications are discussed.
Article
Body checking behaviours and cognitions are seen as underlying the core pathology of eating disorders-the over-evaluation of eating, shape and weight. While it has been demonstrated that levels of behaviours and cognitions differentiate eating-disordered women from non-eating-disordered women, little is known with regard to how these findings relate to diagnostic group. This study aimed to determine whether body checking cognitions and behaviours are best understood with regard to diagnostic category or symptom presentation. Eighty-four eating-disordered women (with diagnoses of anorexia nervosa, bulimia nervosa, binge eating disorder or other Eating Disorders Not Otherwise Specified) completed measures of body checking behaviours and cognitions and eating psychopathology. Results showed that different aspects of body checking were more closely associated with diagnosis and with symptom presentation. Anorexia nervosa and binge-eating-disorder patients had particularly low levels of body checking behaviours and some related cognitions. However, the belief that body checking allows one to be accurate in knowing one's weight was associated with binging and vomiting behaviours, rather than diagnosis. Future directions for research include understanding the links between body checking phenomena and neurological features. Clinical implications are discussed.
Article
Given the absence of known predictors and moderators for binge eating disorder (BED) treatment outcome and recent findings regarding meaningful sub-categorizations of BED patients, we tested the predictive validity of two subtyping methods. Seventy-five overweight patients with BED who participated in a randomized clinical trial of guided self-help treatments (cognitive-behavioral therapy (CBTgsh) and behavioral weight loss (BWLgsh)) were categorized in two ways. First, a cluster analytic approach yielded dietary-negative affect (29%) and pure dietary (71%) subtypes. Second, research conventions for categorizing patients based upon shape or weight self-evaluation yielded clinical overvaluation (51%) and subclinical overvaluation (49%) subtypes. At the end of treatment, participants subtyped as dietary-negative affect reported more frequent binge episodes compared to the pure dietary subtype, and those with clinical overvaluation reported greater eating disorder psychopathology compared to the subclinical overvaluation group. Neither method predicted binge remission, depressive symptoms, or weight loss. Neither sub-categorization moderated the effects of guided self-help CBT and BWL treatments on any BED outcomes, suggesting that these two specific treatments perform comparably across BED subtypes. In conclusion, dietary-negative affect subtyping and overvaluation subtyping each predicted, but did not moderate, specific and important dimensions of BED treatment outcome.
Article
Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n=92), BED participants with subclinical levels of overvaluation (n=73), and participants in an overweight comparison group without BED (n=45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier.
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Does the overvaluation of shape 580
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Ojserkis, R., Sysko, R., Goldfein, J. A., & Devlin, M. J. (2012). Does the overvaluation of shape 580