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.     

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.     

Subtypes of binge eating disorder based on psychiatric history

OBJECTIVE: This investigation sought to identify subtypes of binge eating disorder (BED) based on history of mood disorder (MOOD) and substance use disorder (SUD). METHOD: Eighty-four women who met criteria for BED were administered semistructured interviews and completed self-report questionnaires assessing eating pathology, depressive symptoms, self-esteem, body dissatisfaction, and personality traits. RESULTS: Thirty-nine participants (46.4%) had a lifetime history of a SUD and 60 (71.4%) had a lifetime history of a MOOD. The SUD subtype was associated with a greater impulsivity and frequency of binge eating episodes compared with the no SUD subtype. The MOOD subtype participants reported greater distress, more psychopathology, less dietary restraint, lower self-esteem, more frequent binge eating, higher levels of negative affect, and more frequent trauma and abuse history than the no MOOD subtype. DISCUSSION: The results of this study indicate that subtypes of BED on the basis of MOOD and SUD may be associated with a more severe variant of the disorder.     

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.     

Relation of binge eating age of onset to functional aspects of binge eating in binge eating disorder

OBJECTIVE: This study examined whether age of binge eating onset in binge eating disorder (BED) is related to affective binge eating antecedents and consequences. METHOD: Participants included women (N = 44) with BED who participated in a group cognitive-behavioral therapy (CBT) study. Measures included the Eating Hedonics Questionnaire, Beck Depression Inventory, Multidimensional Personality Questionnaire Negative Emotionality factor, Restraint Scale, Three-Factor Eating Questionnaire Restraint factor, and Eating Behaviors-IV. Participants were classified according to reported age of binge eating onset, with early onset defined as 13 years (LOB; n = 19). RESULTS: Compared with LOB, EOB was associated with reductions in postbinge subjective anxiety, but not depression. DISCUSSION: This study suggested that EOB in BED may be associated with binge eating as an affective means of coping, particularly with anxiety, and further supported age of binge eating onset as a clinically meaningful way to delineate BED subclassifications.     

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)     

A comparison of energy intake and food selection during laboratory binge eating episodes in obese women with and without a binge eating disorder diagnosis

OBJECTIVE: The purpose of the study was to compare energy intake and food selection of laboratory binge eating episodes in obese women with and without binge eating disorder (BED). METHOD: Twenty women, 12 meeting BED criteria, and 8 BMI and age matched obese controls, engaged in a laboratory binge eating episode. RESULTS: BED participants consumed significantly more total food in kilocalories than the non-BED obese group and more kilocalories of fat. However, there were no differences between the groups in the proportion of calories from any macronutrient. There was a nonsignificant trend for the BED group to consume more total grams of food. During the binge, the BED group consumed more dairy products. CONCLUSION: Results of the study confirmed that women with BED consumed significantly more total food in kilocalories than the non-BED obese women when they were allowed to have a binge eating episode in a laboratory setting.     

Risk factors and patterns of onset in binge eating disorder

OBJECTIVE: The current study examined risk factors in women with binge eating disorder (BED) who began binging before dieting (binge-first [BF]) compared with women with BED who began dieting before binging (diet-first [DF]). It further aimed to replicate findings regarding eating disorder and general psychopathology among BF versus DF subtypes. METHOD: One hundred fifty-five women with BED completed the Oxford Risk Factor Interview to retrospectively assess risk factors occurring before eating disturbance onset. Clinical interview assessed eating disorder and general psychopathology. RESULTS: Overall, no significant differences in risk factors emerged between the groups. The BF group had a significantly earlier onset of BED than the DF group. In contradistinction to previous studies, the DF group endorsed more eating disorder psychopathology and lifetime diagnosis of any substance use disorder. CONCLUSION: Limited support was seen for different risk factors in BF versus DF women, suggesting similar etiologic pathways in both subtypes.     

A comparison of the binge eating scale, questionnaire for eating and weight patterns-revised, and eating disorder examination questionnaire with instructions with the eating disorder examination in the assessment of binge eating disorder and its symptoms

OBJECTIVE: The current study assesses concordance between self-administered measures and a diagnostic standard for assessment of binge frequency and diagnosis of binge eating disorder (BED) in a sample of binge eaters. METHOD: The Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), Binge Eating Scale (BES), two items from the Eating Disorder Examination Questionnaire with Instructions (EDE-Q-I), and the Eating Disorder Examination (EDE) were administered. Participants were 157 adults volunteering for a clinical study, of whom 129 (79%) were diagnosed with BED using the EDE as the diagnostic standard. RESULTS: In the identification of BED, the QEWP-R yielded a sensitivity value of .74 and a specificity value of .35. The BES yielded a sensitivity value of .85 and a specificity value of .20. Frequency of binge eating days and episodes on the EDE-Q-I correlated highly with the EDE (.65 and .48, respectively; p < .001). DISCUSSION: The accuracy of diagnosis and symptomatology among self-administered questionnaires is variable. The BES and the QEWP-R performed satisfactorily as initial screens for the diagnosis of BED, but were less accurate in identifying non-BED individuals and the frequency of binge eating. The EDE-Q-I most accurately assessed the frequency of binge eating.     

Eating Disorder Examination-Questionnaire with and without instruction to assess binge eating in patients with binge eating disorder

OBJECTIVE: The current study examined whether adding written definitions and examples of binge eating to the Eating Disorder Examination-Questionnaire enhances its utility to assess binge frequency in patients with binge eating disorder (BED). METHOD: Eighty-nine women and men with BED completed the EDE-Q (without instruction; n = 37) or the EDE-Q-I (with instruction; n = 52) before receiving the EDE interview. Binge frequency was measured as the number of binge days (days on which one or more objective binge episodes occurred) over the past 28 days. RESULTS: Binge frequency correlations between the EDE and EDE-Q-I were strongly significant (r = .543, p = .000), whereas correlations between the EDE and EDE-Q were not significant (r = .197, p = .242). DISCUSSION: Providing brief detailed instructions improves the performance of the EDE-Q when evaluating binge eating in patients with BED. This suggests that, with relatively minor modifications, the EDE-Q may be a viable alternative to the EDE in assessing binge frequency in this population.     

Predictors of relapse following successful dialectical behavior therapy for binge eating disorder

OBJECTIVE: To identify predictors of relapse at 6-month follow-up for women with binge eating disorder (BED). METHOD: Participants were 32 women with BED who had initially achieved abstinence from binge eating after 20 weeks of dialectical behavior therapy (DBT) adapted for patients with BED. Posttreatment predictor variables included the subscales Restraint, Weight Concerns, and Shape Concerns from the Eating Disorders Examination (EDE), the Emotional Eating Scale score, the Rosenberg Self-Esteem Scale, body mass index, and early versus late age of binge eating onset. RESULTS: The largest effect sizes for predicting relapse were found with early onset of binge eating and higher EDE Restraint scores. DISCUSSION: Previous findings that earlier age of onset (age 16 years or younger) is linked to less successful treatment outcome are now extended to the 6-month follow-up assessment. The finding that higher restraint scores after treatment predict relapse adds to the literature concerning the role of restraint in patients with BED.     

Timing and sequence of the onset of overweight, dieting, and binge eating in overweight patients with binge eating disorder

OBJECTIVE: To examine the self-reported sequence and timing of onset of overweight, binge eating, and dieting in adult patients diagnosed with binge eating disorder (BED). METHOD: Participants were 284 treatment-seeking adults (73 men and 211 women) who met DSM-IV research criteria for BED. Patients were interviewed with structured diagnostic interviews and were queried regarding history of overweight, dieting, and binge eating behaviors. Questionnaires were also administered to assess current eating disturbances, body dissatisfaction, and general functioning. Participants were classified as Overweight First, Binge First, or Diet First, and the three groups were compared on developmental sequence and using the battery of measures. RESULTS: Sixty-three percent of the 284 participants reported becoming overweight prior to the onset of dieting or binge eating. Participants who reported they were overweight first had significantly greater BMI at the time of assessment. The 16% of the participants who reported binge eating first were significantly younger at the onset of BED diagnosis and reported significantly less dietary restraint. Onset order differed significantly by gender; proportionally more women (25%) than men (11%) reported that dieting preceded overweight or binge eating. CONCLUSION: Weight problems preceded dieting and binge eating behaviors for a majority of treatment-seeking overweight participants diagnosed with BED.     

Gender differences in patients with binge eating disorder

OBJECTIVE: This study examined gender differences in patients with binge eating disorder (BED). METHOD: Participants were 182 adults (35 male, 147 female) who were consecutively evaluated for outpatient clinical trials and met criteria for BED as outlined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. They were administered a battery of measures to examine developmental, eating and weight-related disturbances, and psychological features associated with BED. RESULTS: Men and women did not differ significantly on several developmental variables (age at first overweight, age at first diet, age at onset of regular binge eating, or number of weight cycles). Men had significantly higher current body mass index (BMI), highest adult BMI, and were significantly more likely to be classified as obese. Men and women did not differ significantly on measures of current eating disorder features (binge eating, eating concerns, weight or shape concerns) but women reported significantly greater body image dissatisfaction and drive for thinness. Men and women did not differ significantly on current depression or self-esteem but men reported a greater frequency of past drug abuse problems. DISCUSSION: Although men and women who present for treatment for BED show many similarities in current eating disorder features, we observed a number of gender differences on important developmental and physical variables as well as associated psychological features.     

Effectiveness of spouse involvement in cognitive behavioral therapy for binge eating disorder

OBJECTIVE: This study examined whether involving the spouse in group cognitive behavioral therapy (CBT) for binge eating disorder (BED) enhances treatment outcome relative to standard group CBT. METHOD: Ninety-four overweight women with BED were randomly assigned to either (1) standard group CBT, (2) group CBT with spouse involvement, or (3) a wait-list control group. Eating and general psychopathology assessments were completed at baseline, after treatment, and at 6-month follow-up. RESULTS: Although both CBT groups fared significantly better than the wait-list control group on measures of binge eating, weight, eating psychopathology, and general psychopathology, CBT with spouse involvement did not result in any additional benefit over and above standard CBT. DISCUSSION: These results are in contrast to the success of spouse involvement in the treatment of several other physical and psychological disorders. Possible reasons for this disparity, and suggestions for improving spouse involvement in BED treatment, are discussed.     

Hedonics of binge eating in women with bulimia nervosa and binge eating disorder.

OBJECTIVE: Potential differences in the hedonics of binge eating between female subjects with bulimia nervosa (BN) and female subjects with binge eating disorder (BED) were examined. METHOD: Women seeking treatment for BN (N = 29) and BED (N = 49) completed the Eating Hedonics Questionnaire. RESULTS: Subjects in both groups reported similar precipitants and levels of distress associated with binge eating. Of interest, BED subjects were more likely to report that they enjoyed the food, the taste of the food, the smell and the texture of the food while binge eating. In addition, the BED group reported more relaxation and less physical discomfort and anxiety as a consequence of binge eating compared to the BN group. DISCUSSION: There are interesting and potentially important differences between individuals with BN and BED in the cognitions and behaviors associated with binge eating.     

Binge eating and binge eating disorder in a small-scale, indigenous society: the view from Fiji

OBJECTIVE: Although the cross-cultural prevalence of anorexia and bulimia nervosa has been investigated in multiple studies, little is known about the prevalence and correlates of binge eating and binge eating disorder (BED) cross-culturally. No published studies to date have explored BED in small-scale, indigenous, or developing societies. The current study investigated the prevalence and correlates of binge eating in a community sample of Fijian women living in rural Fiji. METHODS: Fifty ethnic Fijian women completed a self-report measure developed for this study on dieting and attitudes toward body shape and change, a Nadroga-language questionnaire on body image, and the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Their height and weight were also measured. Patterns of dieting, high body mass index (BMI), and attitudes toward eating and body image were compared between women with and without a history of binge eating. RESULTS: Ten percent of respondents reported at least weekly episodes of binge eating during the past 6 months and 4% endorsed symptoms consistent with BED. Binge eating in this sample was associated significantly with a BMI value above 35, a history of dieting, and a high concern with body shape. Binge eating was not associated with several markers of acculturation in this sample, although it was associated with a key, nontraditionally Fijian (i.e., acculturated) attitude toward the body. DISCUSSION: Binge eating occurred in a social context with traditions concerning weight and diet widely disparate from Western populations. However, correlates of binge eating in this sample suggest that nontraditional Fijian attitudes toward weight and body shape play a contributory role.     

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.     

Comparison of binge eating disorder and bulimia nervosa in a community sample.

OBJECTIVE: This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN). METHOD: Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14). RESULTS: The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN. DISCUSSION: Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN.     

Satiety and test meal intake among women with binge eating disorder

OBJECTIVE: The purpose of the study was to measure test meal consumption and the changes in hunger and fullness during a test meal in obese individuals with and without binge eating disorder (BED) and normal-weight controls. METHOD: Twelve women with BED, 12 obese control participants, and 12 normal-weight control participants participated in two single-item test meal sessions. In one session participants were instructed to "binge," and the other eat a normal meal. Participants made ratings of hunger and fullness on visual analog scales after every 75-g increment of food. RESULTS: In comparison to obese or normal-weight controls, patients with BED consumed significantly more food to reach a similar level of fullness or hunger. CONCLUSION: Individuals with BED consumed significantly more food and showed blunted changes in hunger and fullness during both the binge and nonbinge meals. These findings suggest that individuals with BED may have disturbances in satiety that in some ways resemble those described among individuals with bulimia nervosa.     

The diagnostic validity of the criteria for binge eating disorder

OBJECTIVE: This paper considers whether the criteria currently used to classify the diagnosis of binge eating disorder (BED) are valid and appropriate. METHOD: We review evidence that reflects on the validity of the current criteria for binge eating episodes and BED, using literature retrieved through major psychology and psychiatry search engines (e.g., PsycInfo, PubMed). RESULTS: Evidence from experimental research points to the relative importance of episode frequency, the amount of food consumed at episodes, the subjective sense of loss of control over eating, and several additional criteria associated with binge episodes in BED. Evidence on the differences in psychopathology between BED and bulimia nervosa and between BED and obesity without binge eating, as related to diagnostic criteria, is reviewed. CONCLUSION: Although evidence concerning the diagnostic criteria of BED is mixed, broadening certain diagnostic criteria for binge eating episodes and BED might more accurately reflect the research literature and increase the number of individuals eligible for inclusion in treatment programs.