The need to consume: Hoarding as a shared psychological feature of compulsive buying and binge eating

IntroductionCompulsive buying and binge eating are two frequently co-occurring psychiatric conditions. Hoarding, which is the psychological need to excessively gather and store items, is frequently associated with both compulsive buying severity and binge eating severity. In the present study, we explored whether different dimensions of hoarding are a shared feature of compulsive buying and binge eating.MethodParticipants consisted of 434 people seeking treatment for compulsive buying disorder. Registered psychiatrists confirmed the diagnosis of compulsive buying through semi-structured clinical interviews. Participants also completed measures to assess compulsive buying severity, binge eating severity, and dimensions of hoarding (acquisition, difficulty discarding, and clutter). Two-hundred and seven participants completed all three measures.ResultsSignificant correlations were found between compulsive buying severity and the acquisition dimension of hoarding. Binge eating severity was significantly correlated with all three dimensions of hoarding. Hierarchical regression analysis found that compulsive buying severity was a significant predictor of binge eating severity. However, compulsive buying severity no longer predicted binge eating severity when the dimensions of hoarding were included simultaneously in the model. Clutter was the only subscale of hoarding to predict binge eating severity in step two of the regression analysis.ConclusionOur results suggest that the psychological need to excessively gather and store items may constitute a shared process that is important in understanding behaviors characterized by excessive consumption such as compulsive buying and binge eating.     

Oniomania--successful treatment with fluvoxamine and cognitive-behavioral psychotherapy

Compulsive buying (oniomania) is a disorder that has begun to receive attention from researchers in recent years. It has been estimated that disorder affects from 2 to 8% of the general adult population in the US (official data for Croatia are not available). About 90% of those affected are female. Onset occurs in the late teens or early twenties, and the disorder is generally chronic. Psychiatric comorbidity is frequent, particularly mood, anxiety, substance use, eating and personality disorders. Treatment has not been well delineated, but individual and group psychodynamic psychotherapy, cognitive-behavioural therapy and 12-step programmes may be helpful. Serotonin (5-hydroxytryptamine; 5-HT) re-uptake inhibitors may help some patients regulate their buying impulses. We have presented the case of a 32-year old woman with a history of excessive pathological buying treated successfully with combined therapy (fluvoxamine and cognitive-behavioral psychotherapy).     

Treatment of compulsive buying

Although compulsive buying is receiving increasing attention in research, it is largely ignored in clinical practice. Compulsive buying disorder (CBD) is defined as excessive and mostly senseless spending or excessive shopping impulses that cause marked distress, interfere with social or occupational functioning, and often results in financial problems. It is currently conceptualized as an "impulse control disorder not otherwise specified" (ICD-10 F63.9). CBD is associated with significant psychiatric co-morbidity particularly mood and anxiety disorders, obsessive-compulsive disorders, binge eating disorder, substance use disorders, personality disorders, and other impulse control disorders. Previous research indicates that many compulsive buyers also suffer from compulsive hoarding. There is no evidence-based treatment approach for CBD and treatment research on this topic is limited. Open label trials suggest that antidepressants could improve compulsive buying. However, small randomized controlled trials failed to demonstrate significant improvement over Placebo and the high placebo-response rate prevents any definitive statement on the efficacy of antidepressants. Two controlled cognitive-behavioral therapy (CBT) trials reported that group CBT is significantly more effective compared to waiting list control groups in the treatment of compulsive buying. Clinical and therapeutic implications are discussed.     

Impulse control disorders in women with eating disorders

We compared symptom patterns, severity of illness, and comorbidity in individuals with eating disorders with and without impulse control disorders (ICD), and documented the temporal pattern of illness onset. Lifetime ICD were present in 16.6% of 709 women with a history of eating disorders. The most common syndromes were compulsive buying disorder and kleptomania. ICD occurred more in individuals with binge eating subtypes, and were associated with significantly greater use of laxatives, diuretics, appetite suppressants and fasting, and with greater body image disturbance, higher harm avoidance, neuroticism, cognitive impulsivity, and lower self-directedness. In addition, individuals with ICD were more likely to have obsessive-compulsive disorder, any anxiety disorder, specific phobia, depression, cluster B personality disorder, avoidant personality disorder, and to use psychoactive substances. Among those with ICD, 62% reported the ICD predated the eating disorder and 45% reported the onset of both disorders within the same 3-year window. The presence of a lifetime ICD appears to be limited to eating disorders marked by binge eating and to be associated with worse eating-related psychopathology, more pathological personality traits, and more frequent comorbid Axis I and II conditions. Untreated ICD may complicate recovery from eating disorders.     

Pathological buying -- a literature review

This review summarizes the literature on pathological buying published during the past 15 years. Pathological or compulsive buying is defined as frequent preoccupation with buying or impulses to buy that are experienced as irresistible, intrusive, and/or senseless. The buying behavior causes marked distress, interferes with social functioning, and often results in financial problems. Studies on the phenomenology, diagnosis, classification, comorbidity, epidemiology, and treatment are presented. Pathological buying should be diagnosed as impulse control disorder not otherwise specified (ICD-10 F63.9). Psychiatric comorbidity is frequent, particulary mood, anxiety, substance use, eating, impulse control and obsessive-compulsive disorders. The positive results of pharmacological treatment with antidepressants (usually SSRI) and opioid antagonists could not be confirmed in controlled trials. A disorder specific cognitive-behavioral group treatment manual was published in USA. A controlled study is currently conducted in USA and since 2003 at the Department of Psychosomatics and Psychotherapy at the University Hospital Erlangen.     

Essst?rungen bei Adipositas und Diabetes mellitus

Binge eating disorder is one of the most frequent comorbid mental disorders associated with overweight and obesity. Binge eating disorder patients often suffer from other mental disorders and longitudinal studies indicate a continuous weight gain during the long-term course. As in other eating disorders gender is a risk factor, but the proportion of male binge eating disorder patients is surprisingly high.In young women with type 1 diabetes the prevalence of subclinical types of bulimia nervosa is increased. In addition, insulin purging as a characteristic compensatory behavior in young diabetic women poses a considerable problem. In patients with type 1 diabetes, disturbed eating and eating disorders are characterized by insufficient metabolic control and early development of late diabetic sequelae. Patients with type 2 diabetes are often overweight or obese. Binge eating disorder does not occur more frequently in patients with type 2 diabetes compared to healthy persons. However, the comorbidity of binge eating disorder and diabetes type 2 is associated with weight gain and insulin resistance. Especially in young diabetic patients a screening procedure for disturbed eating or eating disorders seems to be necessary. Comorbid patients should be offered psychotherapy.     

Comorbidity of eating disorders with bipolar disorder and treatment implications

OBJECTIVES: To review the scientific evidence examining the comorbidity among eating disorders and bipolar disorder (BD). METHODS: We reviewed all published English-language studies addressing the comorbidity of anorexia nervosa, bulimia, bulimia nervosa, and binge eating disorder in patients with BD and studies of comorbidity of BD in patients with eating disorders. In addition, we discuss the pharmacologic treatment implications from reviewed studies of agents used in BD and eating disorders. RESULTS: Community and clinical population studies of the lifetime prevalence rates of eating disorders in patients with BD, and of BD in patients with eating disorders, particularly when subthreshold and spectrum manifestations of these disorders are included, indicate high rates of comorbidity among these illnesses. CONCLUSIONS: Pharmacologic treatment approaches to patients with BD and a co-occurring eating disorder require examination of the possible adverse effects of the treatment of each syndrome on the other and attempts to manage both syndromes with agents that might be beneficial to both.     

The Efficacy of Psychodynamic Psychotherapy in Specific Mental Disorders: A 2013 Update of Empirical Evidence

This article reviews the empirical evidence for psychodynamic therapy for specific mental disorders in adults. The focus is on randomized controlled trials (RCTs). However, this does not imply that RCTs are uncritically accepted as the gold standard for demonstrating that a treatment works. According to the results presented here, there is evidence from RCTs that psychodynamic therapy is efficacious in common mental disorders, that is, depressive disorders, anxiety disorders, somatic symptom disorders, personality disorders, eating disorders, complicated grief, posttraumatic stress disorder (PTSD), and substance-related disorder. These results clearly contradict assertions repeatedly made by representatives of other psychotherapeutic approaches claiming psychodynamic psychotherapy is not empirically supported. However, further research is needed, both on outcome and processes of psychodynamic psychotherapy. There is a need, for example, for RCTs of psychodynamic psychotherapy of PTSD. Furthermore, research on long-term psychotherapy for specific mental disorders is required.     

A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder

OBJECTIVE: The purpose of this study was to determine the efficacy of panic-focused psychodynamic psychotherapy relative to applied relaxation training, a credible psychotherapy comparison condition. Despite the widespread clinical use of psychodynamic psychotherapies, randomized controlled clinical trials evaluating such psychotherapies for axis I disorders have lagged. To the authors' knowledge, this is the first efficacy randomized controlled clinical trial of panic-focused psychodynamic psychotherapy, a manualized psychoanalytical psychotherapy for patients with DSM-IV panic disorder. METHOD: This was a randomized controlled clinical trial of subjects with primary DSM-IV panic disorder. Participants were recruited over 5 years in the New York City metropolitan area. Subjects were 49 adults ages 18-55 with primary DSM-IV panic disorder. All subjects received assigned treatment, panic-focused psychodynamic psychotherapy or applied relaxation training in twice-weekly sessions for 12 weeks. The Panic Disorder Severity Scale, rated by blinded independent evaluators, was the primary outcome measure. RESULTS: Subjects in panic-focused psychodynamic psychotherapy had significantly greater reduction in severity of panic symptoms. Furthermore, those receiving panic-focused psychodynamic psychotherapy were significantly more likely to respond at treatment termination (73% versus 39%), using the Multicenter Panic Disorder Study response criteria. The secondary outcome, change in psychosocial functioning, mirrored these results. CONCLUSIONS: Despite the small cohort size of this trial, it has demonstrated preliminary efficacy of panic-focused psychodynamic psychotherapy for panic disorder.     

Psychotherapy based on object relation with object and psychodynamic attitude to treatment of eating disorders

The article presents a proposal of integrating the basic concepts of object relations theory with the psychodramatic techniques by Moreno in treatment of eating disorders (anorexia and bulimia nervosa). The author pays attention to the common elements and also on the differences in psychopathology of eating disorder from a medical perspective, psychoanalytic and psychodynamic paradigm and moreover psychodrama by Moreno. Moreover she points to common elements and the possibility of applying psychodramatic and psychodynamic therapeutic techniques in individual and group psychotherapy in persons with eating disorders. The presented attempt of integrating psychotherapy based on relation with object and psychodramatic techniques by Moreno can enlarge the repertoir of therapeutic techniques which intensify the recovery process in the group of persons with eating disorders (anorexia and bulimia nervosa).     

Compulsive disorders

Compulsive disorders include a diverse group of conditions characterized by excessive thoughts or preoccupations combined with poorly controlled behaviors. They include trichotillomania, kleptomania, pathologic gambling, compulsive buying disorder, compulsive sexual behavior, and compulsive computer use. Some investigators have suggested that these conditions constitute a spectrum of disorders linked to obsessive-compulsive disorder. Others have questioned the validity of this conceptualization, and have debated the relationship between these disorders. Nevertheless, much has been learned about compulsive disorders, and there have been some successes with psychotherapeutic and psychopharmacologic treatments. Recent therapy-based interventions have moved from psychodynamic treatments toward cognitive-behavioral modalities. Serotonin reuptake inhibitors remain the best-studied pharmacologic treatment, but researchers have also explored other antidepressants, opioid agonists, mood stabilizers, and atypical antipsychotics.     

Topiramate use in obese patients with binge eating disorder: an open study.

OBJECTIVE: To assess topiramate's efficacy and tolerability in a group of obese binge eaters with no neuropsychiatric comorbidity. METHOD: We consecutively selected 8 obese patients with binge eating disorder (BED) and no medical or psychiatric comorbidity from individuals seeking treatment for obesity. Treatment with topiramate at 150 mg daily was administered over a 16-week period. To assess outcome, we employed the days with binge episodes per week (DBE), the Binge Eating Scale (BES), the Beck Depression Inventory (BDI), and body weight evaluation. RESULTS: Of the 6 patients who completed the trial, all showed reduced binge eating. Four patients presented a total remission, and 2 had a marked reduction in binge eating frequency. The mean DBE decreased significantly from 4.3 to 1.1 (P = 0.03), as did the BES scores, which fell from 31.8 to 15.3 (P = 0.04). Moreover, there was a statistically significant weight loss (mean 4.1 kg, P = 0.04). The most frequent side effects were paresthesias, fatigue, and somnolence. CONCLUSION: Topiramate may be an effective and well-tolerated agent in the treatment of BED in obese patients.     

Clinical aspects of impulsive compulsive behaviours in Parkinson's disease

Impulsive-compulsive behaviours (ICBs) are an increasingly well-recognised adverse-effect of dopaminergic medications used to treat Parkinson's disease. ICBs include pathological gambling, compulsive sexual behaviour, compulsive buying, and binge eating, together with punding and the addiction-like compulsive use of dopamine replacement therapy, or dopamine dysregulation syndrome. The prevalence of ICBs was approximately 14% in a large study undertaken in specialist movement disorder clinics. Dopamine dysregulation syndrome is more associated with compulsive l-dopa use, whereas other ICBs are more linked with oral dopamine agonist use. Other mechanisms implicated in the development and perpetuation of ICBs in PD include aberrant learning from reward-related situations, including decreased learning from negative feedback, increased measures of impulsivity or sensation seeking, and strong preference for immediate over future rewards. Treatment options for impulsive-compulsive behaviours include pharmacological, surgical and psychological interventions. The early recognition and prevention of ICBs, coupled with awareness of clinical risk factors for the development of these behaviours is of paramount importance, given the lack of specific treatments for these sometimes debilitating behaviours.     

Bulimia treated with imipramine: a placebo-controlled, double-blind study

Bulimia, the syndrome of compulsive binge eating, is a common and often severe disorder frequently resistant to known therapies. Recent evidence suggesting a link between bulimia and affective disorder prompted the authors to perform a double-blind study of imipramine versus placebo with 22 chronically bulimic women. Imipramine was associated with a significantly reduced frequency of binge eating and with improvement on several other measures of eating behavior. On 1- to 8-month follow-up, 18 of the 20 treated subjects (90%) had responded to imipramine or a subsequent antidepressant. This finding augments the growing evidence that bulimia may be related to affective disorder.     

Binge eating in Parkinson's disease: prevalence, correlates and the contribution of deep brain stimulation

Of 96 Parkinson's disease patients surveyed at the University of Florida Movement Disorders Center, one (1%) met diagnostic criteria for binge-eating disorder. Eight (8.3%) exhibited subthreshold binge eating. Psychometric criteria classified problem gambling in 17.8%, hoarding in 8.3%, compulsive buying in 11.5%, hypersexuality in 1.0%, and mania in 1.0% of patients. More overeaters met psychometric criteria for at least one additional impulse-control disorder (67% versus 29%). No more overeaters than non-overeaters were taking a dopamine agonist (44% versus 41%). More overeaters had a history of subthalamic deep brain stimulation (DBS; 44% versus 14%). History of DBS was the only independent predictor of overeating.     

Parental substance use history of overweight men and women with binge eating disorder is associated with distinct developmental trajectories and comorbid mood disorder

Objective

To examine the significance of parental histories of substance use disorders (SUDs) in the expression of binge eating disorder (BED) and associated functioning.

Method

Participants were 127 overweight patients with BED assessed using diagnostic interviews. Participants were administered a structured psychiatric history interview about their parents (N = 250) and completed a battery of questionnaires assessing current and historical eating and weight variables and associated psychological functioning (depression and self-esteem).

Results

Patients with BED with a parental history of SUD were significantly more likely to start binge eating before dieting, had a significantly earlier age at BED onset, and reported less time between binge eating onset and meeting diagnostic criteria for BED than did patients without a parental history of SUD. For psychiatric comorbidity, patients with BED with a parental history of SUD were significantly more likely to meet the criteria for a mood disorder. A parental history of SUD was not significantly associated with variability in current levels of binge eating, eating disorder psychopathology, or psychological functioning.

Discussion

Our findings suggest that a parental history of SUD is associated with certain distinct trajectories in the development of binge eating (earlier binge onset predating dieting onset) and with elevated rates of comorbidity with mood disorders in patients with BED.     

Psychodynamic psychotherapy for posttraumatic stress disorder related to childhood abuse--Principles for a treatment manual

In this article, the authors present a psychodynamically oriented psychotherapy approach for posttraumatic stress disorder (PTSD) related to childhood abuse. This neurobiologically informed, phase-oriented treatment approach, which has been developed in Germany during the past 20 years, takes into account the broad comorbidity and the large degree of ego-function impairment typically found in these patients. Based on a psychodynamic relationship orientation, this treatment integrates a variety of trauma-specific imaginative and resource-oriented techniques. The approach places major emphasis on the prevention of vicarious traumatization. The authors are presently planning to test the approach in a randomized controlled trial aimed at strengthening the evidence base for psychodynamic psychotherapy in PTSD.     

A case study of psychodynamic group psychotherapy for bipolar disorder

BACKGROUND: This study examines the effectiveness of long-term outpatient psychodynamic group psychotherapy for individuals with bipolar disorder who may have psychiatric comorbidity. METHOD: The Integrative Outpatient Model (IOM) includes psychoeducation regarding illness, illness management, and exploration of dynamic and interpersonal issues. RESULTS: At one-year follow up, group members had significantly less depressive symptomatology and were less likely to be in a mood episode, compared to controls. There were no between-group differences in manic symptoms or global assessments of functioning. For group-treated patients, the number of days well per week improved significantly; there were no significant improvements in the control group. CONCLUSIONS: This pilot study indicates that psychodynamic group psychotherapy is feasible as a component of treatment for bipolar disorder diagnoses. The results suggest benefits on depressive, but not manic symptoms. The 73% retention rate suggests that further study of this treatment is warranted, especially in the cases of patients for whom pharmacotherapy alone is not sufficient.