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.     

A placebo‐controlled pilot study of the novel opioid receptor antagonist ALKS‐33 in binge eating disorder

Objective:

To assess preliminarily the effectiveness of a novel opioid antagonist, ALKS‐33, in binge eating disorder (BED).

Method:

In this randomized, placebo‐controlled, flexible dose, proof‐of‐concept trial, 62 outpatients with BED and obesity received ALKS‐33 (N = 26) or placebo (N = 36) for 6 weeks. Outcome measures of binge eating, body weight, and eating pathology were assessed.

Results:

A large decrease in binge eating episode frequency was observed following both ALKS‐33 and placebo treatment. There was no significant difference between treatment groups in binge eating episode frequency or any other measure of binge eating, body weight, or eating pathology.

Discussion:

In this preliminary proof‐of‐concept study in BED, ALKS‐33 did not separate from placebo. Although a failed trial cannot be excluded, the finding is consistent with earlier observations in bulimia nervosa with other opioid antagonists and suggests ALKS‐33, at least when administered daily for 6 weeks, may not be efficacious for BED. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

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)     

Course and predictors of maternal eating disorders in the postpartum period

Objective:

To investigate course and predictors of eating disorders in the postpartum period.

Method:

A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM‐IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS‐P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum.

Results:

Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS‐P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED.

Discussion:

This is the first large‐scale population‐based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Duloxetine in the treatment of binge eating disorder with depressive disorders: a placebo-controlled trial

Objective:

This study evaluated duloxetine in the treatment of binge eating disorder (BED) with comorbid current depressive disorders.

Method:

In this 12‐week, double‐blind, placebo‐controlled trial, 40 patients with Diagnostic and Statistical Manual of Mental Disorders‐IV‐TR BED and a comorbid current depressive disorder received duloxetine (N = 20) or placebo (N = 20). The primary outcome measure was weekly binge eating day frequency.

Results:

In the primary analysis, duloxetine (mean 78.7 mg/day) was superior to placebo in reducing weekly frequency of binge eating days (p = .04), binge eating episodes (p = .02), weight (p = .04), and Clinical Global Impression‐Severity of Illness ratings for binge eating (p = .02) and depressive disorders (p = .01). Changes in body mass index and measures of eating pathology, depression, and anxiety did not differ between the two groups.

Discussion:

Duloxetine may be effective for reducing binge eating, weight, and global severity of illness in BED with a comorbid current depressive disorder, but this finding needs confirmation in larger, placebo‐controlled trials. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)     

Personality pathology in purging disorder and bulimia nervosa

Objective:

To compare levels of personality pathology in women with purging disorder (PD), bulimia nervosa (BN), and controls and to compare women with PD and BN on associations between personality pathology and shared eating disorder features.

Method:

Women with BN (n = 73), PD (n = 48), and controls (n = 64) completed interviews and self‐report questionnaires.

Results:

BN and PD were associated with significantly greater personality pathology compared to controls. Cluster C symptoms and trait anxiety were greater in BN compared to PD, but groups did not differ on Cluster B symptoms or impulsivity. Subjective binge episodes were associated with anxious and impulsive personality traits in PD but not BN. Purging in PD was associated with trait anxiety, while purging in BN was associated with impulsivity.

Discussion:

Although BN and PD share eating disorder features and personality disturbance, some of the underlying associations between these eating disorder and personality features differ between groups. © 2011 by Wiley Periodicals, Inc.     

Objective and subjective binge eating in underweight eating disorders: associated features and treatment outcome

Objective:

To define the utility of the DSM‐IV‐TR definition of binge eating, as it applies to anorexia nervosa (AN) and underweight eating disorder not otherwise specified (ED‐NOS).

Method:

We investigated the psychopathological features associated with bulimic episodes in 105 underweight individuals with eating disorders who reported regular objective bulimic episodes with or without subjective bulimic episodes (OBE group, n = 33), regular subjective bulimic episodes only (SBE group, n = 36) and neither objective nor subjective bulimic episodes (n = 36, no‐RBE group). The Eating Disorder Examination (EDE), anxiety, depression, and personality tests were administered before and upon completion of inpatient cognitive behavior therapy (CBT) treatment 6 months later.

Results:

Compared with the SBE group, OBE subjects had higher body mass index, and more frequent self‐induced vomiting, while both OBE and SBE groups had more severe eating disorder psychopathology and lower self‐directness than the no‐RBE group. Dropout rates and outcomes in response to inpatient CBT were similar in the three groups.

Discussion:

Despite a few significant differences at baseline, the similar outcome in response to CBT indicates that categorizing patients with underweight eating disorder on the basis of the type or frequency of bulimic episodes is of limited clinical utility. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;)     

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.     

Research on energy expenditure in individuals with eating disorders: a review

OBJECTIVE: This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD: Individual studies are reviewed and their results summarized. RESULTS: The most consistent finding is evidence of reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION: The ability to reliably and cost-effectively measure REE may aid in the refeeding of patients with AN where REE is reduced. Changes in BN and BED subjects have yet to be identified consistently.     

What constitutes clinically significant binge eating? Association between binge features and clinical validators in college‐age women

Objective:

To investigate the association between binge features and clinical validators.

Method:

The Eating Disorder Examination assessed binge features in a sample of 549 college‐age women: loss of control (LOC) presence, binge frequency, binge size, indicators of impaired control, and LOC severity. Clinical validators were self‐reported clinical impairment and current psychiatric comorbidity, as determined via a semistructured interview.

Results:

Compared with women without LOC, those with LOC had significantly greater odds of reporting clinical impairment and comorbidity (ps < 0.001). Among women with LOC (n = 252), the indicators of impaired control and LOC severity, but not binge size or frequency, were associated with greater odds of reporting clinical impairment and/or comorbidity (ps < 0.05).

Dicussion:

Findings confirm that the presence of LOC may be the hallmark feature of binge eating. Further, dimensional ratings about the LOC experience—and possibly the indicators of impaired control—may improve reliable identification of clinically significant binge eating. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Prevalence of eating disorders in middle‐aged women

Objective: Little is known about the prevalence and correlates of eating disorders (ED) in middle‐aged women. Method: We mailed anonymous questionnaires to 1,500 Austrian women aged 40–60 years, assessing ED (defined by DSM‐IV), subthreshold ED, body image, and quality of life. We broadly defined “subthreshold ED” by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM‐IV criteria for frequency or severity of these symptoms. Results: Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3–6.4%] reported symptoms meeting full DSM‐IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4–6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full‐syndrome diagnoses. Discussion: ED appear common in middle‐aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the “classical” diagnoses of anorexia and bulimia nervosa. Interestingly, middle‐aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full‐scale ED. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:320–324)     

Comparative prevalence,correlates of impairment,and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders

Objective:

The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non‐Latino Whites.

Method:

Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used.

Results:

The prevalence of anorexia nervosa (AN) and binge‐eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non‐Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non‐Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non‐Latino Whites for respondents with a lifetime history of any eating disorder.

Discussion:

These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2011)

     

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.     

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.     

Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: reduction of eating disorder not otherwise specified and validity

Objective:

Revised Eating Disorder (ED) diagnostic criteria have been proposed for the Diagnostic and Statistical Manual (DSM)‐5 to reduce the preponderance of eating disorder not otherwise specified (EDNOS) and increase the validity of diagnostic groups. This article compares DSM‐IV and proposed DSM‐5 diagnostic criteria on number of EDNOS cases and validity.

Method:

Participants (N = 397; 91% female) completed structured clinical interviews in a two‐stage epidemiological study of EDs. Interviewers did not follow standard skip rules, making it possible to evaluate alternative ED diagnostic criteria.

Results:

Using DSM‐IV versus DSM‐5 criteria, 34 (14%) versus 48 (20%) had anorexia nervosa, 43 (18%) versus 44 (18%) had bulimia nervosa, and 163 (68%) had EDNOS versus 20 (8%) had binge eating disorder (BED), and 128 (53%) had EDNOS, respectively, reflecting a significant decrease in EDNOS. Validation analyses supported significant differences among groups with some improvement associated with delineation of BED.

Discussion:

Proposed revisions to EDs in the DSM‐5 significantly reduced reliance on EDNOS without loss of information. © 2011 by Wiley Periodicals, Inc.     

Full syndromal versus subthreshold anorexia nervosa,bulimia nervosa,and binge eating disorder: a multicenter study

OBJECTIVE: The diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) establish symptom severity levels, which are used to separate full cases from partial cases. However, the value of these distinctions is unclear. METHOD: Three hundred eighty-five women with full or partial AN, BN, or BED were assessed at entry into a longitudinal study of eating disorders. RESULTS: Stepwise discriminant analysis revealed that full and partial BN were discriminated by the Yale-Brown-Cornell Eating Disorders Scale total scores (kappa =.46). However, it was not possible to discriminate between full and partial AN or BED. Discriminant analysis also demonstrated clear differences between full AN, BN, and BED. DISCUSSION: Full BN can be differentiated from partial BN by more severe eating disorder symptoms, whereas both full and partial AN and full and partial BED appear quite similar. These results emphasize the distinct nature of AN, BN, and BED, as well as the similarities between full and partial cases.     

Changes in weight and body image over time in women with eating disorders

BACKGROUND: This study examined the changes in body image and weight in young women with an adolescent eating disorder, relative to women without an eating disorder (noED). METHOD: Three diagnostic groups, anorexia nervosa (AN; n = 10), bulimia nervosa (BN; n = 27), and binge eating disorder (BED; n = 42) and three comparison groups (noED; n = 659 each) were compared on body mass index (BMI) and self-reported current body size, ideal body size, and weight dissatisfaction. Dependent variables were examined 2 and 1 year before the onset, the onset year, and 1 and 2 years after the onset of the eating disorder in a model that was adjusted for ethnicity and BMI. RESULTS: BMI was lower in the AN group at all time points except 2 years before onset. AN girls evidenced a significantly stronger relation between BMI and current self-ratings and weight dissatisfaction than noED girls. BMI did not differ between the BN group and the noED group. Girls with BN reported larger current body sizes and greater weight dissatisfaction across all time points. The BED group had higher BMI than the noED group across time. BED girls reported greater current body size ratings and weight dissatisfaction than the noED girls. Girls with AN, BN, or BED did not differ from the noED girls on body ideal ratings. DISCUSSION: Body weight seems to influence perception of body size more so for girls with AN than for noED girls. No support was found for an accelerated weight gain over time for BN. Weight may increase over time for the BED group relative to the noED group, but larger studies are needed. Across all three groups, ideal body size appears to be unrelated to diagnostic status. Rather, the risk for developing an eating disorder appears to arise from size overestimation and related weight dissatisfaction.     

Outcomes of eating disorders: a systematic review of the literature

OBJECTIVE: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on factors associated with outcomes among individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) and whether outcomes differed by sociodemographic characteristics. METHOD: We searched electronic databases including MEDLINE and reviewed studies published from 1980 to September, 2005, in all languages against a priori inclusion/exclusion criteria and focused on eating, psychiatric or psychological, or biomarker outcomes. RESULTS: At followup, individuals with AN were more likely than comparisons to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders. Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced. The only consistent factor across studies relating to worse BN outcomes was depression. A substantial proportion of individuals continue to suffer from eating disorders over time but BN was not associated with increased mortality risk. Data were insufficient to draw conclusions concerning factors associated with BED outcomes. Across disorders, little to no data were available to compare results based on sociodemographic characteristics. CONCLUSION: The strength of the bodies of literature was moderate for factors associated with AN and BN outcomes and weak for BED.     

Eating disorder symptomatology among ballet dancers

OBJECTIVE: The current study sought to compare eating disorder symptomatology among ballet dancers and individuals with restricting anorexia nervosa (RAN), bulimia nervosa (BN), and no eating pathology. METHOD: Twenty-nine female ballet dancers completed assessments and were compared with an archival dataset of 26 women with RAN, 47 women with BN, and 44 women with no eating pathology. Eating disorder diagnoses and behaviors were assessed with a semi-structured clinical interview, the Eating Disorder Inventory (EDI), and a weight history interview. RESULTS: Eighty-three percent of dancers met lifetime criteria for AN (6.9%), BN (10.3%), AN+BN (10.3%), or EDNOS (55.0%). Moreover, dancers looked more similar to eating-disordered individuals than to control individuals on measures of eating pathology. CONCLUSION: Despite previous emphasis on the pathology AN, the current findings suggest that dancers frequently engage in binge eating and purging behaviors. Moreover, it appears that their pathology is as severe as that of non-dancing women with eating disorders.     

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.