Criterion validity of the multiaxial assessment of eating disorders symptoms

OBJECTIVE: The purpose of this investigation was to establish the criterion validity of the Multiaxial Assessment of Eating Disorders Symptoms (MAEDS). The MAEDS is a brief, comprehensive, self-report measure for the evaluation of eating disorders treatment outcome. It assesses six symptoms associated with eating disorders with subscales for binge eating, purgative behavior, avoidance of forbidden foods, restrictive eating, fear of fatness, and depression. METHOD: To establish criterion validity, we compared the subscale scores of the MAEDS across four eating disorder diagnoses, specified by subtype (bulimia nervosa, purging type; anorexia nervosa, binge-eating/purging type; anorexia nervosa, restricting type; and binge eating disorder). Participants who did not meet the full diagnostic criteria for an eating disorder, but who did meet criteria for a partial syndrome eating disorder, were grouped with the full eating disorder diagnostic subtypes. RESULTS: The criterion validity of the MAEDS was supported by the pattern of subscale scores for the different eating disorder diagnostic groups. Also, with few exceptions, persons diagnosed with anorexia nervosa, bulimia nervosa, and binge eating disorder, in comparison to subthreshold cases of anorexia nervosa, bulimia nervosa, and binge eating disorder, had equivalent scores on the subscales of the MAEDS. DISCUSSION: These findings support the criterion validity of the MAEDS and add to a growing literature that questions differences in severity of eating disorder symptoms in full syndrome versus partial syndrome cases.     

Applying a cognitive model to binge eating in a female community sample

ObjectiveLittle is known about a potential cognitive model for binge eating, although cognitive behavioural techniques have been proposed as appropriate models of intervention. This study initiated the development of a cognitive model by applying an established cognitive model for bulimia nervosa.MethodA community sample of women was recruited via the internet and participants completed measures of eating disorder thoughts, negative self-beliefs, attachment, mood and binge eating severity.ResultsEating disorder thoughts and negative self-beliefs were applicable to women in the community who binge eat. Attachment relationships characterised by decreased emotional warmth and increased overprotection, were correlated with binge eating in women and this relationship was mediated by eating disorder thoughts and negative self-beliefs.DiscussionThe cognitive model of bulimia was applicable to some extent to women in the community who binge eat. Attachment may also be related to binge eating and this relationship may be mediated by cognition.     

Baclofen for binge eating: an open-label trial

OBJECTIVE: Baclofen is a GABA-B agonist that may be useful in the treatment of substance use disorders, and also reduces 'binge-like' eating in rodents. We hypothesized that baclofen might be effective in reducing binge eating episodes in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Seven women with BED (n = 4) or BN (n = 3) took baclofen (60 mg/day) for 10 weeks. RESULTS: Six out of seven patients completed the full 10-week trial. Five out of seven participants (3 BED; 2 BN) demonstrated 50% or greater reduction of frequency of binge eating from beginning to end of the study. Three out of seven participants (2 BED; 1 BN) were free of binge eating at study end. Four out of seven participants elected to continue baclofen at study end. Baclofen was well tolerated by the participants. CONCLUSION: In this open-label trial, baclofen was associated with decreased binge eating frequency in patients with BED and BN.     

Correlates of subjective and objective binge eating in binge-purge syndromes

OBJECTIVE: Research has begun to challenge the idea that a large amount of food is a diagnostically relevant distinction in classifying binge eating. This study examined the relationship between both objective and subjective (i.e., feeling out of control while eating an appropriate amount of food) binge eating frequency and factor analytically derived measures of dieting and psychopathology. METHOD: Participants were 40 women who were admitted for inpatient treatment for bulimia nervosa, anorexia nervosa, binge-purge type, or eating disorder not otherwise specified with binge-purge symptoms. RESULTS: Controlling for subjective binge frequency, neither the psychopathology nor the dieting factors were related to objective binge frequency. Controlling for objective binge frequency, dieting, but not psychopathology, was related to subjective binge frequency. There was no correlation between frequency of subjective and objective binge eating. DISCUSSION: The results are discussed in light of research on restrained eating. Implications for diagnosis and the role of loss of control in defining binge behavior are also discussed.     

Schema-level cognitions in patients with binge eating disorder: a case control study

OBJECTIVE: This study examined the schema-level cognitions (core beliefs) of patients with binge eating disorder to determine whether these patients differ from those with bulimia nervosa. A case control method (matching groups for age and body mass index [BMI]) was used, to avoid the confounding factors that are found in most studies of this sort. METHOD: All clinical women were recruited from a specialist eating disorder clinic. The index group consisted of 25 women with DSM-IV diagnoses of binge eating disorder, who were compared with a clinical group of 25 women with bulimia nervosa and a group of 25 women with no eating disorder. Groups were closely matched for age and BMI. Each participant completed a well-validated measure of core beliefs. RESULTS: Although the binge eating disorder group had a range of more negative core beliefs than nonclinical women, the differences between the clinical groups were much smaller. The binge eating disorder group had more negative core beliefs than the bulimia nervosa group in many areas. However, the bulimia nervosa group was distinguished by having the highest level of abandonment beliefs, and this difference may account for the difference in the presence of purging behaviors. CONCLUSIONS: Levels of abandonment beliefs seem to be crucial in understanding the behavioral differences between these clinical groups--particularly the absence of purging behaviors. However, the relevance of these beliefs to treatment outcome and to other aspects of psychopathology remains to be established.     

Binge eating disorder in females: a population-based investigation

OBJECTIVE: The authors investigated the prevalence of binge eating behavior in a general female Austrian population. METHOD: A random sample of 1,000 women (age range 15a to 85a) was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. RESULTS: Of the entire sample, 122 met the diagnostic criteria for binge eating, 84 for binge eating syndrome, and 33 for binge eating disorder (BED). The point prevalence of bulimia nervosa was 1.5%. Women with binge eating episodes carried out more frequently one or more diets within the previous year, and more frequently exhibited a restrained eating behavior than did women without binge eating behavior. Underweight women more often met the diagnostic criteria for bulimia nervosa nonpurging type than did normal weight, overweight, and obese women, while overweight and obese women more frequently met the diagnostic criteria for BED. DISCUSSION: Our findings indicate that binge eating appears to be a fairly common behavior in women. Dieting, chronic restrained eating, and excessive exercise may be important triggers for BED and bulimia nervosa.     

Binge eating disorder and bulimia nervosa: differences in the quality and quantity of binge eating episodes

OBJECTIVE: This study sought to examine the differences in the quantity and quality of binges between binge eating disorder (BED) and bulimia nervosa. METHOD: Patients (N = 77) seeking treatment for eating disorders were assessed on binge content. RESULTS: Results suggest no differences in binge quantity with BED and bulimia, but there were differences in the binge quality. The binges of bulimics were higher in carbohydrates and sugar than those with BED. DISCUSSION: The higher levels of obesity of our BED individuals may account for the lack of differences between those with bulimia and BED. The importance of increasing our knowledge of the continuum of weight and binging is discussed.     

The dietitian's role in the treatment of eating disorders

Eating disorders have both psychological and physiological elements and so require treatment that combines expertise in both. Professionals who treat patients with an eating disorder need to have knowledge of the nutritional effects and physiological consequences of the illness. This is rare within a predominantly mental health setting. The extreme dieting behaviour in anorexia nervosa leading to the severe weight loss and symptoms of semi‐starvation; binge‐eating behaviour, seen in cases in bulimia nervosa and binge eating disorder; and the patient’s distorted beliefs about nutrition and dietary requirements all underpin the need for the expertise provided by dietitians. They now have an essential role within the multi‐disciplinary assessment and treatment programmes for all three major eating disorders.     

Importance of size in defining binge eating episodes in bulimia nervosa

OBJECTIVE: This study sought to determine if amount of food consumed is important in defining binge eating episodes in individuals with bulimia nervosa (BN). METHOD: Women (N = 30) with DSM-IV BN (OBN) and women (N = 25) who would have met DSM-IV criteria for BN except that their binge episodes were not objectively large (SBN) were recruited from the community. Subjects completed telephone interviews and questionnaires. RESULTS: Results demonstrated no significant differences between women with OBN and SBN in levels of dietary restraint, disinhibition, or hunger; no significant differences in general psychopathology; and significant differences in frequency of binge/purge episodes and impulsiveness. Differences in impulsiveness remained after controlling for frequency of binge/purge episodes. DISCUSSION: These results partially validate current diagnostic criteria for bulimia nervosa and elucidate one factor, impulsiveness, that may be important in understanding objective binge episodes in bulimia nervosa.     

The cognitive behavioural model for eating disorders: a direct evaluation in children and adolescents with obesity

OBJECTIVE: The cognitive behavioural model of bulimia nervosa [Fairburn, C.G., Cooper, Z., & Cooper, P.J. (1986). The clinical features and maintenance of bulimia nervosa. In K.D. Brownell, and J.P. Foreyt (Eds.), Handbook of eating disorders: physiology, psychology and treatment of obesity, anorexia and bulimia (pp. 389-404). New York: Basic Books.] provides the theoretical framework for cognitive behaviour therapy of Bulimia Nervosa. For a long time it was assumed that the model can also be used to understand the mechanism of binge eating among obese individuals. The present study aimed to test whether the specific hypotheses derived from the cognitive behavioural theory of bulimia nervosa are also valid for children and adolescents with obesity. METHOD: The prediction of the model was tested using structural equation modeling. Data were collected from 196 children and adolescents. RESULTS: In line with the model, the results suggest that a lower self-esteem predicts concerns about eating, weight and shape, which in turn predict dietary restraint, which then further is predictive of binge eating. DISCUSSION: The findings suggest that the mechanisms specified in the model of bulimia nervosa is also operational among obese youngsters.     

Review of the prevalence and incidence of eating disorders

OBJECTIVE: To review the literature on the incidence and prevalence of eating disorders. METHODS: We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found. Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases. RESULTS: An average prevalence rate for anorexia nervosa of 0.3% was found for young females. The prevalence rates for bulimia nervosa were 1% and 0.1% for young women and young men, respectively. The estimated prevalence of binge eating disorder is at least 1%. The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year. The incidence of anorexia nervosa increased over the past century, until the 1970s. DISCUSSION: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care.     

Binge eating behavior in patients with eating disorders

The purpose of this study was to determine whether the objectively observed binge eating behavior of obese subjects meeting the proposed DSM-IV criteria for binge eating disorder would be similar to that observed in patients with bulimia nervosa. Non-obese patients with bulimia nervosa (BN), obese subjects with binge eating disorder (BED), obese and non-obese women without eating disorders were each instructed to binge eat single- and multiple-item meals. In the multiple-item meal, the obese subjects with BED ate significantly more (1515 kcal) than obese subjects without BED (1115 kcal), but they ate less than the normal-weight bulimic patients (2680 kcal). The non-obese controls ate amounts similar to the obese non-binge-eating-disordered group (1093 and 1115.2 kcal, respectively). In the single-item meal, consisting of ice cream, patients with BN ate significantly more than any other group (1307 kcal), while obese subjects with or without binge-eating disorder ate significantly more (762 kcal) than non-obese controls (308 kcal). This study has demonstrated that although both BN and BED are characterized by recurrent episodes of binge eating, quantitatively there appear to be differences between the eating disturbances in the two disorders. Because single- and multiple-item meals differ in external cues, these results also suggest that the obese subjects with BED may be disinhibited by external cues, while obese subjects without BED may be inhibited by external cues.     

Cognitive-behavioral therapy for adolescents with binge eating syndromes: a case series

OBJECTIVE: Published empirically based studies of psychotherapies for bulimia nervosa (BN) have been conducted solely with adult populations. The current study extends the extant literature by piloting a version of cognitive-behavioral therapy (CBT) for BN adapted for an adolescent population. METHOD: The participants were referred for treatment for binge eating and purging behaviors at a university clinic. Patients received pretreatment and posttreatment interviews assessing the frequency of their binge eating and purge behaviors, and they also completed pretreatment and posttreatment assessments with the Eating Disorders Examination (EDE). RESULTS: Results indicated significant reductions in the frequency of binge eating from pretreatment to posttreatment. Furthermore, all subscale scores of the EDE showed significant declines from pretreatment to posttreatment. CONCLUSION: The authors concluded that CBT adapted for adolescents with bulimic symptoms appears to be a promising intervention worthy of further study in adolescents.     

Hedonics of binge eating in women with bulimia nervosa and binge eating disorder.

OBJECTIVE: Potential differences in the hedonics of binge eating between female subjects with bulimia nervosa (BN) and female subjects with binge eating disorder (BED) were examined. METHOD: Women seeking treatment for BN (N = 29) and BED (N = 49) completed the Eating Hedonics Questionnaire. RESULTS: Subjects in both groups reported similar precipitants and levels of distress associated with binge eating. Of interest, BED subjects were more likely to report that they enjoyed the food, the taste of the food, the smell and the texture of the food while binge eating. In addition, the BED group reported more relaxation and less physical discomfort and anxiety as a consequence of binge eating compared to the BN group. DISCUSSION: There are interesting and potentially important differences between individuals with BN and BED in the cognitions and behaviors associated with binge eating.     

Three studies on the factorial distinctiveness of binge eating and bulimic symptoms among nonclinical men and women

OBJECTIVE: According to DSM-IV's proposed nosology, binge eating disorder is separable from bulimia nervosa. The basis for separation rests with compensatory behaviors (e.g., induced vomiting)-people with bulimia nervosa engage in compensatory behaviors, whereas those with binge eating disorder do not. We addressed the validity of this nosology. METHODS: In three studies on 2,015 young men and women, we used factor-analytic techniques to assess whether bulimic and binge eating symptoms are separable in men and women. Results and Discussion Results of the three studies converged: Although binge eating symptoms may be distinct from bulimic symptoms among young men, the two syndromes are factorially inseparable among young women. Nosologic and sociocultural implications are noted.     

Accuracy of self-reported weight in patients with binge eating disorder

OBJECTIVE: This study was designed to evaluate the accuracy of self-reported weight in patients with binge eating disorder. METHOD: Subjects were 108 adults who were consecutively evaluated for outpatient clinical trials and met DSM-IV criteria for binge eating disorder. Self-reported and measured weights were taken and participants were administered a battery of measures to examine correlates of reporting error. In addition, accurate reporters of weight (i.e., individuals who reported their weight within 5 lb of their measured weight) were compared to underreporters (i.e., individuals who underreported their weight by more than 5 lb) on eating disorder psychopathology and conceptually related measures. RESULTS: Overall, most binge eating disorder subjects were accurate in reporting weight: 73% were accurate within 5 lb and 82% were accurate within 10 lb. Self-reported and measured body mass index were highly correlated and the magnitude of the difference was nonsignificant. Body mass index was not significantly associated with the degree of accuracy, that is, accurate reporters weighed about the same as underreporters. Accurate reporters and underreporters did not differ on measures of overeating behaviors, eating disorder psychopathology, and conceptually related measures. DISCUSSION: These findings suggest that most patients with binge eating disorder were accurate in self-reporting weight. Unlike findings in healthy samples, heavier patients with binge eating disorder were not more likely to underreport weight. Similar to findings in patients with bulimia nervosa, eating disorder psychopathology was not related to reporting error.     

Impulsivity as an underlying factor in the relationship between disordered eating and sexual behavior

OBJECTIVE: Previous research has reported associations between bulimia nervosa (BN), increased sexual activity, and impulsivity. However, most studies have examined these topics separately and have not examined the role of impulsivity in associations between bulimic and sexual behaviors. The current study sought to examine relationships between disordered eating, sexual behaviors, and impulsivity, as well as to investigate impulsivity as a third variable in these relationships. METHOD: The participants were 500 female undergraduate students from a large midwestern university who completed self-report questionnaires of binge eating, the use of compensatory behavior, sexual behavior, and impulsivity. RESULTS: Compensatory behavior, but not binge eating, was significantly correlated with sexual experiences. Partial correlations indicated that impulsivity is a third variable that partially underlies this relationship. CONCLUSION: Compensatory behaviors and increased sexual activity likely represent risky behaviors that are influenced by impulsivity levels.     

Binge eating and satiety in bulimia nervosa and binge eating disorder: effects of macronutrient intake

OBJECTIVE: The current study tested the hypothesis that supplemental dietary protein would reduce binge eating frequency and test meal intake in women with bulimia nervosa (BN) or binge eating disorder (BED). METHOD: Eighteen women with BN or BED ingested high-carbohydrate or high-protein supplements (280 kcal) three times daily over two 2-week periods. On the morning after each period, participants were given a high-protein or high-carbohydrate supplement (420 kcal) 3 hr before an ad libitum meal. RESULTS: Binge eating episodes occurred less frequently during protein supplementation (1.12 episodes per week) than during carbohydrate supplementation (2.94 episodes per week) or baseline (3.01 episodes per week). Participants reported less hunger and greater fullness, and consumed less food at test meals, after protein than after carbohydrate (673 vs. 856 kcal). DISCUSSION: Adding protein to the diets of women with BN and BED reduced food intake and binge eating over a 2-week period. These findings may have implications for the longer-term treatment of these disorders.     

Effect of inositol on bulimia nervosa and binge eating

OBJECTIVES: This study aimed to determine whether inositol has therapeutic value in patients with bulimia nervosa and binge eating. METHOD: A double-blind crossover trial using 18 g inositol versus placebo was performed in 12 patients for 6 weeks in each arm. RESULTS: Inositol was significantly better than placebo on the Global Clinical Impression, the Visual Analogue Scale, and the Eating Disorders Inventory. DISCUSSION: Inositol is as therapeutic in patients with bulimia nervosa and binge eating as it is in patients with depression and panic and obsessive-compulsive disorders. This increases its parallelism with serotonin selective reuptake inhibitors.