Characterization of eating disordered behavior in obese binge eaters

In the present study, the Eating Disorder Examination (EDE), a clinical interview designed to characterize the psychopathohgy specific to eating disorders, was administered to 17 obese women seeking treatment for binge eating problems. Subjects also completed questionnaires to assess binge severity, depression, and weight history. Obese binge eaters obtained EDE subscale scores that did not differ from those reported for normal weight bulimia nervosa patients on the Overeating, Shape Concern, Weight Concern, and Eating Concern Sub-scales of the EDE; however, bulimia nervosa patients had higher scores on the EDE Restraint Subscale. Questionnaire data indicated that obese binge eaters had considerable depressive symptomatology and that early onset obesity, frequent weight losses, and family histories of obesity were common. These findings suggest that obese binge eaters and bulimia nervosa patients have similar levels of eating disorders psychopathohgy, but that future research directly comparing overweight and normal weight patients is needed.     

Binge eating in obese children and adolescents

OBJECTIVE: The first goal of the current study was to examine the extent to which a population of obese children and adolescents have developed binge eating problems. The second goal was to generate variables that would distinguish obese binge eaters from obese non-binge eaters. METHOD: A group of 126 children and adolescents seeking residential care because of their obesity was selected. A self-report version of the Eating Disorder Examination was administered. RESULTS: Binge eating episodes were reported by 36.5% of the obese youngsters. Six percent reported two or more episodes of binge eating a week. Obese binge eaters differed significantly from obese non-binge eaters in self-esteem and in a broad range of eating-related characteristics. Compared with obese non-binge eaters, the obese binge eaters were slightly younger. Obese binge eaters did not differ from obese non-binge eaters in degree of overweight or depression. DISCUSSION: Results suggest that binge eating is a prevalent problem among obese children and adolescents seeking help for their obesity. The marked difference between obese children with and without binge eating suggests the need for special treatment to focus on the problems of obese binge eaters.     

Applying a cognitive model to binge eating in a female community sample

ObjectiveLittle is known about a potential cognitive model for binge eating, although cognitive behavioural techniques have been proposed as appropriate models of intervention. This study initiated the development of a cognitive model by applying an established cognitive model for bulimia nervosa.MethodA community sample of women was recruited via the internet and participants completed measures of eating disorder thoughts, negative self-beliefs, attachment, mood and binge eating severity.ResultsEating disorder thoughts and negative self-beliefs were applicable to women in the community who binge eat. Attachment relationships characterised by decreased emotional warmth and increased overprotection, were correlated with binge eating in women and this relationship was mediated by eating disorder thoughts and negative self-beliefs.DiscussionThe cognitive model of bulimia was applicable to some extent to women in the community who binge eat. Attachment may also be related to binge eating and this relationship may be mediated by cognition.     

Is there another binge eating disorder? A review of the literature on overeating in the absence of bulimia nervosa

The current DSM-Ill-R psychiatric diagnostic system recognizes only one disorder of overeating, bulimia nervosa. Our clinical work has led us to believe that there are a number of individuals who believe that they have a serious overeating problem, but do not meet criteria for bulimia nervosa. We surveyed the literature for studies pertaining to overeating among individuals not meeting criteria for bulimia nervosa. Studies of obese binge eaters and of binge eating among young women suggest the existence of a significant proportion of obese and non-obese individuals with such a problem. However, the limitations in the existing data for addressing this question preclude definitive conclusions. Further work is needed to establish the defining features of an additional binge eating syndrome, to assess the reliability and validity of such a syndrome, and to determine its clinical utility.     

Binge eating disorder in females: a population-based investigation

OBJECTIVE: The authors investigated the prevalence of binge eating behavior in a general female Austrian population. METHOD: A random sample of 1,000 women (age range 15a to 85a) was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. RESULTS: Of the entire sample, 122 met the diagnostic criteria for binge eating, 84 for binge eating syndrome, and 33 for binge eating disorder (BED). The point prevalence of bulimia nervosa was 1.5%. Women with binge eating episodes carried out more frequently one or more diets within the previous year, and more frequently exhibited a restrained eating behavior than did women without binge eating behavior. Underweight women more often met the diagnostic criteria for bulimia nervosa nonpurging type than did normal weight, overweight, and obese women, while overweight and obese women more frequently met the diagnostic criteria for BED. DISCUSSION: Our findings indicate that binge eating appears to be a fairly common behavior in women. Dieting, chronic restrained eating, and excessive exercise may be important triggers for BED and bulimia nervosa.     

Circulating levels of neuroactive steroids in patients with binge eating disorder: a comparison with nonobese healthy controls and non-binge eating obese subjects

OBJECTIVES: Increased plasma levels of allopregnenolone (3alpha,5alpha-tetrahydroprogesterone [3alpha,5alpha-THP]), dehydroepiandrosterone (DHEA), and DHEA sulphate (DHEA-S) have been reported in patients with anorexia nervosa or bulimia nervosa. To assess whether those changes are related to malnutrition, we investigated plasma levels of neuroactive steroids in women with binge eating disorder (BED) who compulsively binge as bulimic patients, but do not incur malnutrition. METHODS: Sixty-eight women participated in the study (31 nonobese healthy controls, 9 nonobese patients with BED, 16 obese patients with BED, and 12 obese non-binge eating women). Blood samples were collected in the morning for determination of plasma levels of 3alpha,5alpha-THP, DHEA, DHEA-S, and cortisol. RESULTS: Nonobese BED women had significantly higher plasma levels of DHEA, DHEA-S, and 3alpha,5alpha-THP than nonobese healthy women. Similarly, obese individuals with BED exhibited significantly higher neurosteroid plasma levels than non-binge eating obese subjects. No significant differences in plasma cortisol levels were observed among the groups. DISCUSSION: This study shows increased plasma levels of neuroactive steroids in BED patients. These findings could have been influenced by methodologic limitations (e.g., the absence of diurnal sampling). However, they suggest that if malnutrition is involved in the determination of increased plasma levels of neuroactive steroids in people with anorexia or bulimia nervosa, then different factors may induce similar effects in people with BED. Alternatively, common unknown factors could be responsible for neurosteroid changes in anorexia nervosa, bulimia nervosa, and BED.     

Three studies on the factorial distinctiveness of binge eating and bulimic symptoms among nonclinical men and women

OBJECTIVE: According to DSM-IV's proposed nosology, binge eating disorder is separable from bulimia nervosa. The basis for separation rests with compensatory behaviors (e.g., induced vomiting)-people with bulimia nervosa engage in compensatory behaviors, whereas those with binge eating disorder do not. We addressed the validity of this nosology. METHODS: In three studies on 2,015 young men and women, we used factor-analytic techniques to assess whether bulimic and binge eating symptoms are separable in men and women. Results and Discussion Results of the three studies converged: Although binge eating symptoms may be distinct from bulimic symptoms among young men, the two syndromes are factorially inseparable among young women. Nosologic and sociocultural implications are noted.     

Psychiatric and metabolic characteristics of childhood versus adult-onset obesity in patients seeking weight management

The purpose of the study was to examine whether childhood-onset obesity differed from adult-onset obesity in lifetime prevalence of mood and eating disorders, and metabolic abnormalities, in currently obese adults seeking weight loss. A subgroup of childhood-onset obesity participants (N=44) was compared with a subgroup with adult-onset obesity (N=69) on a number of clinical and metabolic features. The results showed high lifetime prevalence rates of mood (78%) and eating (81%) disorders, and metabolic syndrome (45%), in the group as a whole. However, patients with childhood-onset obesity had a significantly higher lifetime prevalence of eating disorders in general, and of bulimia nervosa in particular, than patients with adult-onset obesity. Our results support findings of substantial comorbidity among obesity, mood and eating disorders, and metabolic syndrome in weight loss seeking populations. Early recognition and attention to eating and mood dysregulation, including, but not limited to binge eating disorder and bulimia nervosa, in some persons, might help reduce their lifetime risk for obesity.     

Genetic and environmental contributions to obesity and binge eating

OBJECTIVE: Binge eating is present in a substantial proportion of obese individuals. A tendency toward obesity has been identified as a risk factor for eating disorders such as bulimia nervosa and binge eating disorder. The purpose of this article was to determine the extent of overlap between genetic and environmental factors that contribute to the liability to obesity and binge eating. RESEARCH METHOD: In a population-based sample of 2163 female twins, we conducted bivariate twin modeling to explore the relation between the genetic and environmental risk factors for obesity and binge eating. RESULTS: Bivariate twin modeling revealed substantial heritability for obesity (0.86: 95% CI, 0.77-0.94), moderate heritability for binge eating (0.49: 95% CI, 0.38-0.61), and a modest genetic correlation of +.34 (95% CI, 0.19-0.50) between the two traits. CONCLUSIONS: Both binge eating and obesity are heritable conditions, and there seems to be only modest overlap in the genetic risk factors that increase liability to each condition.     

Binge eating behavior in patients with eating disorders

The purpose of this study was to determine whether the objectively observed binge eating behavior of obese subjects meeting the proposed DSM-IV criteria for binge eating disorder would be similar to that observed in patients with bulimia nervosa. Non-obese patients with bulimia nervosa (BN), obese subjects with binge eating disorder (BED), obese and non-obese women without eating disorders were each instructed to binge eat single- and multiple-item meals. In the multiple-item meal, the obese subjects with BED ate significantly more (1515 kcal) than obese subjects without BED (1115 kcal), but they ate less than the normal-weight bulimic patients (2680 kcal). The non-obese controls ate amounts similar to the obese non-binge-eating-disordered group (1093 and 1115.2 kcal, respectively). In the single-item meal, consisting of ice cream, patients with BN ate significantly more than any other group (1307 kcal), while obese subjects with or without binge-eating disorder ate significantly more (762 kcal) than non-obese controls (308 kcal). This study has demonstrated that although both BN and BED are characterized by recurrent episodes of binge eating, quantitatively there appear to be differences between the eating disturbances in the two disorders. Because single- and multiple-item meals differ in external cues, these results also suggest that the obese subjects with BED may be disinhibited by external cues, while obese subjects without BED may be inhibited by external cues.     

Stress response and binge eating disorder

In clinical practice, obese patients report stress as a primary trigger for binge eating. However, the biological mechanism underlying this relationship is poorly understood. This paper presents, a theoretical overview of how cortisol secretion, a major component of the stress response, could play a role in binge eating, given that exogenous glucocorticoids can lead to obesity by increasing food intake. I will discuss findings from recent studies demonstrating links between laboratory stress, cortisol, food intake and abdominal fat in humans. Cortisol is elevated following laboratory stressors in women with anorexia nervosa (AN), bulimia nervosa (BN), and obesity, but has not been widely studied in women with binge eating disorder (BED). Additionally, I will review recent findings demonstrating a greater cortisol response to stress in obese women with BED compared to non-BED.     

Binge eating disorder and bulimia nervosa: differences in the quality and quantity of binge eating episodes

OBJECTIVE: This study sought to examine the differences in the quantity and quality of binges between binge eating disorder (BED) and bulimia nervosa. METHOD: Patients (N = 77) seeking treatment for eating disorders were assessed on binge content. RESULTS: Results suggest no differences in binge quantity with BED and bulimia, but there were differences in the binge quality. The binges of bulimics were higher in carbohydrates and sugar than those with BED. DISCUSSION: The higher levels of obesity of our BED individuals may account for the lack of differences between those with bulimia and BED. The importance of increasing our knowledge of the continuum of weight and binging is discussed.     

Cognitive deficits in obese persons with and without binge eating disorder. Investigation using a mental flexibility task

Objective: Studies suggest that cognitive deficits and attentional biases play a role in the development and maintenance of obesity and eating disorders. In this study, we simultaneously examine attentional biases, as well as inhibitory control and mental flexibility, which are keys to controlling unwanted behaviors and thoughts in obese patients with and without binge eating disorder. Methods: 16 obese patients with binge eating disorder and 16 patients without binge eating disorder were compared with 16 normal-weight controls on a “food/body-mental flexibility task”, which allows the investigation of inhibitory control, mental flexibility and attention for stimuli related to the body and food. Results: All obese patients made significantly more errors (i.e., pressing a key when a distracter displayed) and more omissions (i.e., not pressing a key when a target displayed) than controls in both food and body sections of the task. Obese participants with binge eating disorder made significantly more errors and omissions than those without binge eating disorder. No difference between groups was found concerning mental flexibility and cognitive biases for food- and body-related targets. Discussion: These results suggest that obese patients have a general inhibition problem and difficulty focusing attention, which do not depend on the types of stimuli processed. The results also suggest that these cognitive deficits are more severe in obese patients with binge eating disorder, which indicates that there is a continuum of increasing inhibition and cognitive problems with increasingly disordered eating. These cognitive deficits may contribute to problematic eating behaviors.     

Binge eating before the onset of dieting: a distinct subgroup of bulimia nervosa?

OBJECTIVE: While most individuals with bulimia nervosa begin dieting prior to the onset of binge eating, some individuals begin binge eating prior to dieting. The purpose of this study was to assess the differences between these two groups. METHODS: Participants (N = 120) in a treatment study for bulimia nervosa were separated into two groups (Binge First vs. Diet First) based on the ages they reported for the onset of binge eating and of dieting and then compared across a number of variables. RESULTS: Individuals in the Binge First group reported higher weight, higher shape and weight concern, lower age of onset of eating disorder symptoms, and an altered relationship of binge eating to vomiting when compared to individuals in the Diet First group. DISCUSSION: The differences between the two groups suggest that there may be subgroups of individuals with purging bulimia nervosa and that individuals in the Binge First group more closely resemble individuals with binge eating disorder than do those in the Diet First group.     

Binge eating in adolescents: Its relation to behavioural problems and family-meal patterns

The aim of the study was to explore the relationship between binge eating, behavioural problems and family-meal patterns in a sample of adolescents. Two hundred and fifty-nine adolescents from a public secondary school completed the Bulimic Investigatory test, Edinburgh (BITE) [Henderson, M., & Freeman, C. P. (1987). A self-rating scale for bulimia. The “BITE”. British Journal of Psychiatry, 150, 18–24.] and the Youth Self-Report (YSR) [Achenbach, T. M. (1991). Manual for the Youth Self-Report and 1991 profile. Burlington, VT: University of Vermont.], as well as 13 additional questions regarding the eating episodes and family-meal patterns. The results show that binge eating is a frequent behaviour in adolescence with 33.2% of the sample reporting binge eating at least once in the last six months. The adolescents who reported binge eating had higher scores on most of the YSR first-order factors compared to those who do not engage in this behaviour. No differences were found in family meal patterns. Questions regarding the binge-eating episodes were also analysed making comparisons by age and gender.     

Disordered eating and food cravings among urban obese African American women

OBJECTIVE: The prevalence of night eating syndrome (NES), binge eating disorder (BED), and bulimia nervosa (BN) and the general experience of food cravings were examined in 88 obese urban African American women. METHOD: Participants were administered The Questionnaire on Eating and Weight Patterns-R, the Night Eating Syndrome Questionnaire, and the State and Trait Food Cravings Questionnaire, Trait version (FCQ-T). RESULTS: Twenty-eight percent reported symptoms of eating disorders (18.9% NES, 6.4% recurrent binge eating, 2.2% both NES and recurrent binge eating). Those reporting disordered eating had significantly higher total FCQ-T scores than those not reporting disordered eating. Persons endorsing recurrent binge eating had the highest mean score, followed by those reporting NES. Those who identified themselves as binge eaters and night eaters were not significantly different from each other, but both groups were significantly different than the no eating disorder symptoms group on various subscales of the FCQ-T. DISCUSSION: Obese African American women report significant levels of NES and binge eating which may contribute to the development and/ or maintenance of obesity.     

Dieting in bulimia nervosa is associated with increased food restriction and psychopathology but decreased binge eating

The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the maintenance of binge eating. However, correlational and experimental studies suggest that additional clarification is needed about the nature of this relationship. Dieting, weight, eating disorder psychopathology, and depression were assessed at admission among 166 patients with BN presenting for residential treatment. As in past research, a significant fraction (43%) of patients with BN reported not currently dieting. A comparison of weight loss dieters and non-dieters found greater food restriction and eating disorder psychopathology among weight loss dieters. However, dieters reported less frequent binge eating. There were no significant group differences in depression. Results suggest that 1) while many individuals with BN are attempting to restrict their food intake, the goal of losing weight fundamentally alters the effect of such restriction on binge eating, and 2) treatment may benefit from helping patients to establish a healthier approach to achieving long-term weight stability.     

Binge eating and psychopathology in severely obese adolescents

OBJECTIVE: The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating. METHOD: Obese adolescents (n = 102) were assessed with the Binge Eating Scale (BES), the State-Trait Anxiety Inventory for Children (STAIC), the Beck Depression Inventory (BDI), Coopersmith's Self-Esteem Inventory (SEI), and the Body-Esteem subscale from the Piers-Harris Children's Self-Concept Scale (PHCSS). They were also evaluated with the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA). Two subgroups (i.e., binge eaters and non-binge eaters) were then established according to the BES score. RESULTS: Binge eating symptoms were frequent in this population and the binge eating dimension was related to high levels of anxiety and depression, as well as to low levels of self-esteem and body-esteem. The dimensions of anxiety and depression were associated specifically with binge eaters. DISCUSSION: As observed in the obese adult population, binge eating symptoms were found frequently in severely obese adolescents seeking treatment and were related strongly to studied parameters. Obese adolescents who binge eat are a subgroup with high psychopathologic distress.     

Recurrent binge eating in black American women

CONTEXT: Recurrent binge eating is a core diagnostic feature of bulimia nervosa and binge eating disorder, and in samples of white women has been associated with obesity and psychiatric symptoms. Eating disorders have been believed to occur primarily among white women; in fact, the limited preliminary data available suggest that black women may be as likely as white women to report binge eating. OBJECTIVE: To examine race differences in prevalence of behavioral symptoms of eating disorders and clinically significant recurrent binge eating. DESIGN: Community survey. SETTING: General community in Connecticut and Boston, Mass. PARTICIPANTS: A community sample of 1628 black women and 5741 white women (mean age, 29.7 years) participated in a telephone survey designed to ascertain the presence, during the preceding 3 months, of binge eating and extreme weight control behaviors (vomiting, laxative or diuretic abuse, or fasting). MAIN OUTCOME MEASURE: Interviewer-based phone assessment of recurrent binge eating and behavioral symptoms of eating disorders. RESULTS: Black women were as likely as white women to report binge eating or vomiting during the preceding 3 months, and were more likely to report fasting and the abuse of laxatives or diuretics. Recurrent binge eating was more common among black women than among white women. In both race groups, recurrent binge eating was associated with elevated body weight and increased psychiatric symptoms. CONCLUSION: Results suggest that recurrent binge eating is a significant problem among black and white women. Health professionals need to be ready to respond to this health risk behavior.