Content of Children's Loss of Control Eating Episodes Assessed by Self‐Report and Laboratory Test Meal

Pediatric loss of control (LOC) eating heightens risk for excessive weight gain and further disordered eating. Assessment of LOC typically involves self‐report interview or laboratory test meal, although no study has concurrently examined data from both methods. We gathered eating episode data via interview (Child Eating Disorder Examination; ChEDE) and a laboratory test meal, among 22 overweight girls (aged 7–12 years) reporting LOC eating. Children consumed more energy during ChEDE episodes, although ChEDE and test meal episodes did not differ in macronutrient content. Episodes' correlation for amount consumed (grams) did not reach significance, p = .076. In exploratory analyses among the seven children reporting LOC during the test meal, episodes were significantly correlated for grams consumed. Findings provide preliminary data to suggest that semi‐structured interviews accurately capture children's LOC episode quantity. Episodes did not qualitatively differ, although children reported consuming more energy during self‐reported episodes. Replication is warranted in larger studies. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Effects of an Internet‐based Prevention Programme for Eating Disorders in the USA and Germany — A Meta‐analytic Review

A cross‐cultural comparison of a cognitive–behavioural, Internet‐based, 8‐week prevention programme for eating disorders (StudentBodies?) evaluated in the USA and in Germany was performed. Six US and four German randomized controlled trials with a total (N) of 990 female high school and college students were included in the review. Two of the US and two of the German trials explicitly addressed high risk samples in a selective prevention approach. Effect sizes for main outcomes (disordered eating, weight and shape concerns) were calculated at postintervention and at follow‐up. The intervention was associated with moderate improvements in eating disorder‐related attitudes, especially reductions of negative body image and the desire to be thin. The reported effects remained significant at follow‐up. No clear differences between US and German samples could be found on any of the outcome measures at postintervention. In conclusion, StudentBodies? seems equally suitable and effective for American and German students. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Improving Inhibitory Control Abilities (ImpulsE)—A Promising Approach to Treat Impulsive Eating?

Although there is preliminary evidence that inhibitory control training improves impulsive eating, less is known about the effects on eating behaviour and weight loss in clinical samples. Sixty‐nine treatment‐seeking adults with obesity (binge‐eating disorder 33.3%; other specific feeding and eating disorders 40.6%) were randomly blockwise allocated to ImpulsE, an intervention to improve inhibitory control and emotion regulation abilities or a guideline‐appropriate cognitive behavioural therapy (CBT)‐based treatment as usual. Self‐reported and performance‐based impulsivity, eating disorder pathology and BMI were compared at baseline (T1), post‐treatment (T2) and 1‐ or 3‐month follow‐up. ImpulsE led to better food‐specific inhibition performance (p = .004), but groups did not differ regarding improvements in global Eating Disorder Examination Questionnaire (EDE‐Q) score at T2. At 3‐month follow‐up, binge eaters benefited most from ImpulsE (p = .028) and completers of ImpulsE demonstrated a significantly greater weight reduction (p = .030). The current findings propose ImpulsE as a promising approach to treat obesity, illustrating acceptability and additional benefits for course of weight. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Comparative Effectiveness of Treatments for Binge‐Eating Disorder: Systematic Review and Network Meta‐Analysis

Psychological and pharmacological interventions for binge‐eating disorder have previously demonstrated efficacy (compared with placebo or waitlist control); thus, we aimed to expand that literature with a review of comparative effectiveness. We searched MEDLINE,® EMBASE,® Cochrane Library, Academic OneFile, CINAHL® for binge‐eating disorder treatment articles and selected studies using predetermined inclusion and exclusion criteria. Data were sufficient for network meta‐analysis comparing two pharmacological interventions; psychological interventions were analysed qualitatively. In all, 28 treatment comparisons were included in this review: one pharmacological comparison (second‐generation antidepressants versus lisdexamfetamine) and 26 psychological comparisons. Only three statistically significant differences emerged: lisdexamfetamine was better at increasing binge abstinence than second‐generation antidepressants; therapist‐led cognitive behavioural therapy was better at reducing binge‐eating frequency than behavioural weight loss, but behavioural weight loss was better at reducing weight. The majority of other treatment comparisons revealed few significant differences between groups. Thus, patients and clinicians can choose from several effective treatment options. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Influence of Parental Expressed Emotions on Children's Emotional Eating via Children's Negative Urgency

We investigated whether parental expressed emotion (criticism and emotional overinvolvement) is related to children's emotional eating and whether this relationship is mediated by children's negative urgency. One hundred children, aged 8 to 13 years, either healthy or have binge‐eating disorder and/or attention‐deficit/hyperactivity disorder, completed the questionnaires, along with their parents. Parental criticism and, to a lesser extent, parental emotional overinvolvement were both positively related to children's emotional eating, and this relationship was mediated by children's negative urgency. Further exploratory analyses revealed that the mediating role of children's negative urgency in the relationship between parental criticism and children's emotional eating was pronounced in the clinical group of children with binge‐eating disorder and attention‐deficit/hyperactivity disorder but almost absent in the healthy control group. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

To Go or Not to Go: A Proof of Concept Study Testing Food‐Specific Inhibition Training for Women with Eating and Weight Disorders

Inefficient food‐specific inhibitory control is a potential mechanism that underlies binge eating in bulimia nervosa and binge eating disorder. Go/no‐go training tools have been developed to increase inhibitory control over eating impulses. Using a within‐subjects design, this study examined whether one session of food‐specific go/no‐go training, versus general inhibitory control training, modifies eating behaviour. The primary outcome measure was food consumption on a taste test following each training session. Women with bulimia nervosa and binge eating disorder had small non‐significant reductions in high‐calorie food consumption on the taste test following the food‐specific compared with the general training. There were no effects on eating disorder symptomatic behaviour (i.e. binge eating/purging) in the 24 h post‐training. The training task was found to be acceptable by the clinical groups. More research is needed with larger sample sizes to determine the effectiveness of this training approach for clinical populations. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Facets of Impulsivity and Compulsivity in Women with Anorexia Nervosa

This study sought to investigate independent associations of impulsivity and compulsivity with eating disorder (ED) symptoms. Women (N = 81) with full or subthreshold Diagnostic and Statistical Manual of Mental Disorders IV anorexia nervosa (AN) completed a semi‐structured interview and self‐report questionnaires. Multiple regression analyses were conducted using ED symptoms as dependent variables and facets of impulsivity and compulsivity as predictor variables (controlling for body mass index and AN diagnostic subtype). For impulsivity facets, lack of perseverance was uniquely associated with eating concern, shape concern and restraint, whereas negative urgency was uniquely associated with eating concern and frequency of loss of control eating; neither sensation seeking nor lack of premeditation was uniquely associated with any ED variables. Compulsivity was uniquely associated with restraint, eating concern and weight concern. Results support independent associations of impulsivity and compulsivity with ED symptoms in adults with AN, suggesting potential utility in addressing both impulsive and compulsive processes in treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings

This study examined racial differences in eating‐disorder psychopathology, eating/weight‐related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating‐disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating Disorder Examination Questionnaire (EDE‐Q): Norms for Undergraduate Japanese Women

The aim of the present study was to provide normative data for the Eating Disorder Examination Questionnaire (EDE‐Q) among undergraduate Japanese women and to compare these data to norms obtained from previous studies. Undergraduate Japanese women (n = 289), aged 18–24 years, were administered the EDE‐Q. The mean global score in the present study was 1.55 (SD = 1.03). Japanese women reported significantly higher scores of shape concern and weight concern in spite of lower body mass index but a significantly lower score of restraint, compared with women in other normative studies. There were significant differences with respect to the occurrence of some specific eating disorder behaviours between Japanese women and women in the previous studies. Differences in normative data for the EDE‐Q between young Japanese women and young women in the previous studies suggest that there may be certain cultural differences in eating disorder psychopathology. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Replication of a Modified Factor Structure for the Eating Disorder Examination‐Questionnaire: Extension to Clinical Eating Disorder and Non‐clinical Samples in Portugal

Psychometric investigations of the Eating Disorder Examination‐Questionnaire (EDE‐Q) have generally not supported the original scale structure. The present study tested an alternative brief factor structure in two large Portuguese samples: (1) a non‐clinical sample of N = 4117 female students and (2) a treatment‐seeking sample of N = 609 patients diagnosed with eating disorders. Confirmatory factor analysis revealed a poor fit for the original EDE‐Q structure in both the non‐clinical and the clinical samples but revealed a good fit for the alternative 7‐item 3‐factor structure (dietary restraint, shape/weight overvaluation and body dissatisfaction). Factor loadings were invariant across samples and across the different specific eating disorder diagnoses in the clinical sample. These confirmatory factor analysis findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified 7‐item, 3‐factor structure for the EDE‐Q. The reliable findings across different non‐clinical and clinical eating disorder groups provide confidence regarding the potential utility of this brief version. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Does Self‐Esteem Mediate the Relationship between Interpersonal Problems and Symptoms of Disordered Eating?

It has been proposed that interpersonal problems play a role in the maintenance of disordered eating because of an adverse effect on self‐esteem, which in turn encourages the pursuit of achievement in the valued domain of weight and shape. This study aimed to identify the types of interpersonal problems that are associated with disordered eating and to determine whether self‐esteem mediates the relationship between interpersonal problems and eating disorder symptoms. Female university students (n = 227) completed the Inventory of Interpersonal Problems‐32, Eating Disorder Examination Questionnaire and Rosenberg Self‐Esteem Scale. Regression analysis identified two forms of interpersonal problems that were associated with disordered eating: difficulties being sociable and being too dependent on the opinion of others. Self‐esteem mediated the relationship between interpersonal problems and overevaluation of weight and shape but did not mediate the relationship between interpersonal problems and dietary restraint. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Functional Significance of Shyness in Anorexia Nervosa

The defining features of anorexia nervosa (AN) include disordered eating and disturbance in the experience of their bodies; however, many women with AN also demonstrate higher harm avoidance (HA), lower novelty seeking, and challenges with interpersonal functioning. The current study explored whether HA and novelty seeking could explain variation in disordered eating and social functioning in healthy control women ( n = 18), weight‐restored women with a history of AN (n = 17), and women currently‐ill with AN (AN; n = 17). Our results indicated that clinical participants (AN + weight‐restored women) reported poorer social skills than healthy control participants. Moreover, the relationship between eating disorder symptoms and social skill deficits was mediated by HA. Follow‐up analyses indicated that only the ‘shyness with strangers’ factor of HA independently mediated this relationship. Collectively, our results suggest a better understanding of shyness in many individuals with eating disorders could inform models of interpersonal functioning in AN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Validating the eating disorder inventory (EDI‐2) in two danish samples: A comparison between female eating disorder patients and females from the general population

The Eating Disorder Inventory, Version 2 (EDI‐2) is a questionnaire used clinically and in research all over the world. EDI‐2 is cross‐culturally valid, yet normative values may depend on culture. Norms and reliability of the Danish version have to date been lacking, and will be presented in this article, comparing patients (N = 575) and controls (N = 881). Also, internal reliability of scales is tested for both groups. Differences between norms of the Danish and the North American version of EDI were small but significant for all scales except asceticism (eating disorder patients) and ineffectiveness, interpersonal distrust and maturity fears (normal controls). For both groups the internal consistency was >0.70 for all subscales except asceticism. Although differences across the eating disorder diagnostic groups were dubious, the EDI‐2 is useful to screen for eating problems in the general population as well as to rate progress and outcome among eating disorder patients. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

Quality of life,course and predictors of outcomes in community women with EDNOS and common eating disorders

We investigated the 2‐year course and putative predictors of outcome of 87 young community women with common eating disorders (n = 59, 68% with Eating Disorder not Otherwise Specified) following a health literacy (informational) intervention. Participants were recruited in 3‐phases: community survey, interview and then invitation to a longitudinal study. The health literacy intervention was provided randomly to half participants at baseline and half at 1 year. Eating disorder symptoms and mental health related quality of life (MHQoL), general psychological function, help‐seeking, and defence style were assessed at baseline, and after 2 years by questionnaire. Multiple linear regression analyses were used to identify features predictive of eating disorder symptom levels and MHQoL. Eating disorder psychopathology remained high and MHQoL remained poor. In the multivariate models, a higher baseline level of immature defence style significantly predicted higher levels of eating disorder symptoms, poorer MHQoL and more disability as measured by ‘days out of role’. In addition, higher educational attainment, baseline general psychological disturbance, lower BMI and having main work outside the home were associated with poorer MHQoL. Women with common eating disorders followed to 2 years continued to be highly symptomatic and have poor quality of life. Psychological features important to outcome included an immature coping style and higher general psychological distress. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Affect consciousness and eating disorders. Short term stability and subgroup characteristics

The aim of the study was to analyse differences in observer rated affect consciousness (AC) between subgroups of patients diagnosed with eating disorders (N = 44; 30 with anorexia nervosa and 14 with bulimia nervosa), and a non‐clinical group (N = 40). Another aim was to study the short‐term stability of AC over 10–11 weeks of treatment and its relation to self‐reported eating pathology and general psychopathology. A moderate short‐term stability of AC was found but the levels were not correlated with eating pathology or psychopathology. No differences between the two diagnostic categories were found, but the eating disorder group as whole had significantly lower AC compared with a non‐eating disorder reference group. AC seems to be a moderately stable ability that differentiates patients diagnosed with eating disorders from a non‐clinical population. However, AC is not related to symptoms of eating disorder or general psychiatric symptoms in this group of patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Motivators for smoking in women with eating disorders

Women with eating disorders sometimes smoke to control their weight. This study examined the relative contributions of the range of factors that motivate smoking in women with eating disorders. Twenty‐five women with anorexia nervosa and 16 women with bulimia nervosa were compared with 21 women with a depressive mood disorder. Each completed measures of current and lifetime prevalence of smoking, motivation to smoke and dependence on smoking. Smoking was less prevalent in anorexia nervosa than in bulimia nervosa or in mood disorders. Although the eating‐disordered women had a higher motivation to smoke for weight control than the mood‐disordered group, overall motivation to smoke was higher in the eating‐disordered women. Their strongest motivator for smoking was coping with stress. The eating‐disordered women showed similar levels of dependence on smoking to the mood‐disordered group, but tended to have a lower desire to give up smoking. Clinical interventions for women with eating disorders who smoke might be targeted at helping them cope with stress, as well as viewing their smoking as a method of weight control. Assessment of women with eating disorders should address the use of nicotine and motivations for its use, to help identify targets for intervention. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Predictors of improved eating behaviour following body image therapy: A pilot study

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the ‘Eating Disorder Cognition Questionnaire’ both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to ‘body and self‐esteem’, ‘dietary restraint’, ‘eating and loss of control’, as well as ‘internalisation and social comparison’. Furthermore, the changes in dysfunctional cognitions were associated with a reduction in eating disorder psychopathology. Body image therapy is a worthy complementation to standardised eating disorder treatment programmes as it reduces negative eating related thoughts and changes attitudes towards the body. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Rumination in Patients with Binge‐Eating Disorder and Obesity: Associations with Eating‐Disorder Psychopathology and Weight‐bias Internalization

Overvaluation of shape and weight in binge‐eating disorder (BED) is associated with greater eating‐disorder psychopathology and greater weight‐bias internalization, which are—in turn—associated with poorer mental and physical health. Little is known, however, about the significance of other cognitive processes, such as rumination, in BED. This study examined rumination and overvaluation of shape/weight with eating‐disorder psychopathology and weight‐bias internalization among 237 treatment‐seeking patients with BED and comorbid obesity. Hierarchical multiple regressions indicated that rumination was associated with eating‐disorder psychopathology and weight‐bias internalization above and beyond the influence of overvaluation of shape/weight. Findings suggest that, among patients with BED/obesity, rumination is an important cognitive process associated with severity of eating‐disorder psychopathology even after accounting for overvaluation of shape/weight. Patients with greater rumination might be more likely to dwell on weight‐based discrimination experiences and internalize these negative attitudes. Additional controlled examination could determine whether rumination represents another potential target for BED/obesity treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self‐report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Psychological Factors Predict Eating Disorder Onset and Maintenance at 10‐year Follow‐up

The present study sought to identify psychological factors that predict onset and maintenance of eating disorders. Secondary analyses were conducted using data from an epidemiological study of health and eating behaviours in men and women (N = 1320; 72% female) to examine the prospective and independent influence of the Eating Disorder Inventory Perfectionism, Interpersonal Distrust, and Maturity Fears subscales in predicting the onset and maintenance of eating disorders at 10‐year follow‐up. Multivariate models indicated higher Perfectionism (p = .025), lower Interpersonal Distrust (p < .001), and higher Maturity Fears (p = .037) predicted increased risk for eating disorder onset at 10‐year follow‐up, but only Perfectionism (p = .004) predicted eating disorder maintenance. Differential prediction of eating disorder onset versus maintenance highlights potentially different psychological foci for prevention versus treatment efforts. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.