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.     

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.     

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.     

Health services use in women with a history of bulimia nervosa or binge eating disorder

OBJECTIVE: The current study examined health services use during the past 12 months in a sample of young women with a history of an adolescent eating disorder (bulimia nervosa [BN] or binge eating disorder [BED]). METHOD: A community sample of 1,582 young women (mean age = 21.5 years) was classified, based on a screening interview (and, for eating disorder diagnosis, confirmatory diagnostic interview), into one of three groups: BN or BED (n = 67), other psychiatric disorder (n = 443), and no adolescent psychiatric disorder (n = 1,072). RESULTS: A history of BN/BED in adolescence was associated with elevated health services use, but this was a general effect associated with having a psychiatric disorder, not an effect specific to the diagnosis of an eating disorder. Total service days, outpatient psychotherapy visits, and emergency department visits were elevated in the combined group of BN/BED and other psychiatric disorder participants relative to the healthy comparison group. The women with BN/BED did not differ significantly from the women with a non-eating-related psychiatric disorder in the use of these services. DISCUSSION: The similarity of health services use in young women with BN or BED and those with other psychiatric disorders underscores the clinical and economic impact of these eating disorders.     

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)     

Alcohol and drug-related negative consequences in college students with bulimia nervosa and binge eating disorder

OBJECTIVE: The purpose of this study was to investigate the association between disordered eating and substance use in a nonclinical sample of college students. METHOD: Participants completed the Eating Disorder Diagnostic Scale (EDDS), which includes full diagnostic criteria for bulimia nervosa (BN), binge eating disorder (BED), and anorexia nervosa (AN) as outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, as well as assessments of both alcohol and drug use and use-related consequences. RESULTS: Individuals meeting criteria for BN reported more alcohol-related negative consequences despite the fact that they did not drink significantly more alcohol and did not drink more frequently than non-eating-disordered individuals. Similarly, individuals with BN reported more negative consequences related to illicit drug use than non-eating-disordered individuals, although no differences in lifetime and recent use of drugs were found. DISCUSSION: Results highlight the importance of distinguishing between use and consequences in evaluating eating disorders and comorbid substance use problems.     

The relationship of weight suppression and dietary restraint to binge eating in bulimia nervosa

OBJECTIVE: Recent research has raised important questions about the relationships between weight suppression (WS) (discrepancy between highest-ever and current weight), dietary restraint, and binge eating in bulimia nervosa (BN). METHOD: In the current study, these variables were studied cross-sectionally through secondary analyses of baseline data collected in a multi-site treatment study. Participants (N = 182) were treatment-seeking women diagnosed with BN. Dietary restraint and binge eating were measured via the Eating Disorders Examination. RESULTS: WS was directly and dietary restraint was inversely related to frequency of binge eating. The inverse relationship between dietary restraint and binge eating may be explained in part by the fact that the most restrained patients with BN had the greatest desire to lose weight. CONCLUSION: Implications of these findings for future research on the perpetuation and treatment of BN are discussed.     

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.     

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)     

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.