Prognostic significance of two sub-categorization methods for binge eating disorder: Negative affect and overvaluation predict, but do not moderate, specific outcomes

Department of Psychiatry, Yale Psychiatric Research, Yale University School of Medicine, 301 Cedar Street, PO Box 208098, New Haven, CT 06520, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 05/2008; 46(4):428-37. DOI: 10.1016/j.brat.2008.01.004
Source: PubMed


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.

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Available from: Robin Masheb, Mar 03, 2014
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    • "Additionally we investigate the predictive effect of therapeutic process variables (Flückiger, Regli, Zwahlen, Hostettler, & Caspar, 2010; Hilbert, Saelens, et al., 2007; Masheb & Grilo, 2008a). "
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    ABSTRACT: Objective: The aim of the study was to assess the long-term efficacy of Cognitive-Behavioral Treatment (CBT) and Behavioral Weight-Loss-Treatment (BWLT) in patients with binge eating disorder (BED) and to identify potential predictors of long-term treatment success. Method: In a sample of overweight to obese BED patients from a randomized comparative trial we evaluated the efficacy of four months of CBT or BWLT, followed by 12 months extended care, and a final follow-up assessment 6 years after the end of active treatment. Outcomes included binge eating, eating disorder pathology, depressive feelings, and body mass index. Results: After a strong improvement during active treatment, outcomes worsened during follow-up, yet remained improved at 6-year follow-up relative to pretreatment values. Long-term effects between CBT and BWLT were comparable. Rapid response during the early treatment phase was the only characteristic that was predictive of favorable treatment outcome in the long term. Conclusions: Both CBT and BWLT can be considered to be comparably efficacious in the long-term. Patients not responding strongly enough during the first four therapy sessions might be in need of tailored interventions early during the treatment phase.
    Full-text · Article · Sep 2012 · Behaviour Research and Therapy
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    • "Finally, the one-factor model was also marginally fit the data. This was not an unexpected result, since the Global EDE-Q factor has been often used as a broad indicator of eating disturbances (Masheb & Grilo, 2008). Another aim of this study was to investigate the internal consistency of the G-EDE-Q global scale and the four subscales . "
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    ABSTRACT: This study investigates the latent structure and the psychometric characteristics of the attitudinal subscales of the Greek translation of the EDE-Q (G-EDE-Q) using two samples. The first sample consisted of 500 university female students and tested the latent structure of the G-EDE-Q. The second sample consisted of 164 female psychology students and examined the internal consistency as well as the concurrent, convergent, and discriminant validity of the G-EDE-Q. The results from confirmatory factor analysis (CFA) showed that a three-factor solution fit the data better than the other models examined, providing evidence to contradict the originally proposed structure of the instrument. The results support both, the internal consistency as well as the concurrent, convergent, and discriminant validity of the G-EDE-Q global scale and its subscales. The discussion focuses on the critical review of previous statistical procedures employed and the clinical and research implications of the present findings.
    Full-text · Article · Jan 2012 · European Journal of Psychological Assessment
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    • "This approach differs from LCA as it does not make strict assumptions about the degree of homogeneity within each subtype and does not generate fit statistics that allow an evaluation of the quality of the subtypes generated (Aldenderfer & Blashfield, 1984). The identification of two clusters, the pure dietary subtype and the dietarynegative affect subtype, in the initial study (Stice et al., 2001) and subsequent replications (Grilo et al., 2001; Masheb & Grilo, 2008) provided the first indication that differences in symptom presentation can be identified statistically among two groups of patients with a common BED diagnosis. Stice and colleagues (2001) found a differential treatment response among the dietary-negative affect subtype group, with an remission rate for binge eating of approximately one half that of the pure dietary subtype. "
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    ABSTRACT: The purpose of the study was to explore heterogeneity and differential treatment outcome among a sample of patients with binge eating disorder (BED). A latent class analysis was conducted with 205 treatment-seeking, overweight or obese individuals with BED randomized to interpersonal psychotherapy (IPT), behavioral weight loss (BWL), or guided self-help based on cognitive behavioral therapy (CBTgsh). A latent transition analysis tested the predictive validity of the latent class analysis model. A 4-class model yielded the best overall fit to the data. Class 1 was characterized by a lower mean body mass index (BMI) and increased physical activity. Individuals in Class 2 reported the most binge eating, shape and weight concerns, compensatory behaviors, and negative affect. Class 3 patients reported similar binge eating frequencies to Class 2, with lower levels of exercise or compensation. Class 4 was characterized by the highest average BMI, the most overeating episodes, fewer binge episodes, and an absence of compensatory behaviors. Classes 1 and 3 had the highest and lowest percentage of individuals with a past eating disorder diagnosis, respectively. The latent transition analysis found a higher probability of remission from binge eating among those receiving IPT in Class 2 and CBTgsh in Class 3. The latent class analysis identified 4 distinct classes using baseline measures of eating disorder and depressive symptoms, body weight, and physical activity. Implications of the observed differential treatment response are discussed.
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