Subjective binge eating with compensatory behaviors: A variant presentation of bulimia nervosa

Objectives:

To determine whether a variant bulimic‐type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., “subjective bulimia nervosa,” SBN), has comparable clinical severity to established eating disorders, particularly BN.

Method:

Treatment‐seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN‐R) (N = 45), and AN‐binge/purge type (AN‐B/P) (N = 24) were compared.

Results:

Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN‐R and AN‐B/P.

Discussion:

Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment‐seeking, and outcomes. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa

OBJECTIVE: To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating. RESULTS: In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress. CONCLUSION: Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood.     

Assessment of eating disorders in adolescents with anorexia nervosa: self-report questionnaire versus interview

OBJECTIVE: To compare the Eating Disorder Examination (EDE) with the self-report version (EDE-Q) in a population of adolescents with anorexia nervosa. METHOD: Twenty-eight adolescent women meeting criteria for anorexia nervosa were assessed using both measures. The self-report version (EDE-Q) was given both before and (Time 1) after (Time 2) administration of the interview-based version (EDE). RESULTS: The results comparing the EDE with the EDE-Q at Time 1 were consistent with previous studies. Specifically, high correlations were generated on each of the four subscales (Dietary Restraint, Eating Concern, Shape Concern, Weight Concern) where the EDE-Q consistently overestimated the EDE. However, significant differences between the two measures were found on all subscales except Dietary Restraint. Agreement was best for the Weight Concern subscale and worst for the Eating Concern subscales. Comparing the EDE with the EDE-Q at Time 2, agreement improved for all subscales whereas significant differences were found on only two of the four subscales (Eating Concern and Shape Concern). DISCUSSION: Adolescents with anorexia nervosa report information on the EDE-Q as well as any of the other populations that have been studied. The results suggest that providing information to participants before they complete the self-report measure could improve scores on the EDE-Q.     

Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: implications for DSM-5

Objective:

We assessed the impact of reducing the binge eating frequency and duration thresholds on the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED).

Method:

We estimated the lifetime population prevalence of BN and BED in 13,295 female twins from the Swedish Twin study of Adults: Genes and Environment employing a range of frequency and duration thresholds. External validation (risk to cotwin) was used to investigate empirical evidence for an optimal binge eating frequency threshold.

Results:

The lifetime prevalence estimates of BN and BED increased linearly as the frequency criterion decreased. As the required duration increased, the prevalence of BED decreased slightly. Discontinuity in cotwin risk was observed in BN between at least four times per month and at least five times per month. This model could not be fit for BED.

Discussion:

The proposed changes to the DSM‐5 binge eating frequency and duration criteria would allow for better detection of binge eating pathology without resulting in a markedly higher lifetime prevalence of BN or BED. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)     

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.     

Pathways to help-seeking in bulimia nervosa and binge eating problems: a concept mapping approach

OBJECTIVE: To conduct an in-depth study, using concept mapping, of three factors related to help-seeking for bulimia nervosa and binge eating: problem recognition, barriers to help-seeking, and prompts to help-seeking. METHOD: Semistructured interviews were conducted to elicit information about help-seeking with 63 women (18-62 years) with past or present bulimic behaviors. RESULTS: Using Leximancer software, factors identified as associated with problem recognition were Changes in Behavior, Interference with Life Roles, Comments about Changes and Psychological Problems. Salient barriers to help-seeking were Fear of Stigma, Low Mental Health Literacy/Perception of Need, Shame, Fear of Change and Cost. Prompts to help-seeking were increased Symptom Severity, Psychological Distress, Interference with Life Roles, Health Problems, and Desire to Get Better. CONCLUSION: Results highlighted the need for awareness campaigns to reduce both self and perceived stigma by others towards bulimic behaviors, and the need to enhance awareness of available interventions for people ready to engage in treatment, to increase help-seeking.     

Attrition and outcome in self-help treatment for bulimia nervosa and binge eating disorder: a constructive replication

The aim of the study was to assess the efficacy of a 12-week CBT-based pure and guided self-help among 29 patients with full and subthreshold bulimia nervosa, and binge eating disorder. In the intention-to-treat analyses, self-help had a moderately positive and sustained effect on the patients' eating problems. The patients reduced their mean number of objective bulimic episodes and purging behavior by 26% and 22% over the course of treatment. The corresponding reduction levels for the treatment completers (n=21) were 41% and 34%, respectively. As in the previous study, there were no significant differences between the pure and guided self-help mode in terms of outcome, and the results were sustained 6 months after the end of the treatment. The findings are discussed in relation to the shorter duration of the self-help, the lower rate of attrition, and the characteristics of the sample compared to the earlier trial.     

Self-harm and substance use in a community sample of Black and White women with binge eating disorder or bulimia nervosa

OBJECTIVE: This study evaluated rates of self-harm and substance use in women with either bulimia nervosa (BN) or binge eating disorder (BED) and assessed whether differences in self-harm and substance use are related to sexual or physical abuse. METHOD: Alcohol abuse, self-harm, and use or abuse of various illicit drugs were evaluated in a sample of 53 women with BN and 162 women with BED. RESULTS: Self-harm and substance use generally did not differentiate BED and BN cases, but rates of self-harm and substance use were elevated among women with a history of sexual or physical abuse relative to women without such a history. DISCUSSION: Elevated rates of self-harm and substance use may not be related uniquely to BN diagnostic status, but may be related to a characteristic shared by women with BN and BED, such as a history of sexual or physical abuse.