Importance of size in defining binge eating episodes in bulimia nervosa

OBJECTIVE: This study sought to determine if amount of food consumed is important in defining binge eating episodes in individuals with bulimia nervosa (BN). METHOD: Women (N = 30) with DSM-IV BN (OBN) and women (N = 25) who would have met DSM-IV criteria for BN except that their binge episodes were not objectively large (SBN) were recruited from the community. Subjects completed telephone interviews and questionnaires. RESULTS: Results demonstrated no significant differences between women with OBN and SBN in levels of dietary restraint, disinhibition, or hunger; no significant differences in general psychopathology; and significant differences in frequency of binge/purge episodes and impulsiveness. Differences in impulsiveness remained after controlling for frequency of binge/purge episodes. DISCUSSION: These results partially validate current diagnostic criteria for bulimia nervosa and elucidate one factor, impulsiveness, that may be important in understanding objective binge episodes in bulimia nervosa.     

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.     

Ethnic-racial differences in feelings of embarrassment associated with binge eating and fear of losing control

OBJECTIVE: Limited research exists on ethnic-racial differences in the objective and subjective experiences of binge eating among women in the United States. The present study examined binge eating related psychopathology in a nationally representative sample of White, Black, Native American, Asian, and Hispanic women. METHOD: A subsample of 5,726 women between the ages of 19 and 27 years were selected from the National Longitudinal Study of Adolescent Health. RESULTS: Ethnic-racial differences in binge eating related psychopathology were found. Asians and Native Americans were more likely than Whites to report they would feel embarrassment related to binge eating. Hispanics were more likely than Whites and Blacks to report they would be afraid to start eating for fear of losing control. CONCLUSION: Findings suggest that the affective dimensions associated with binge eating are differentially represented among ethnic-racial groups. Implications for treatment and prevention programs are discussed.     

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.     

The relationship of weight suppression and dietary restraint to binge eating in bulimia nervosa

OBJECTIVE: Recent research has raised important questions about the relationships between weight suppression (WS) (discrepancy between highest-ever and current weight), dietary restraint, and binge eating in bulimia nervosa (BN). METHOD: In the current study, these variables were studied cross-sectionally through secondary analyses of baseline data collected in a multi-site treatment study. Participants (N = 182) were treatment-seeking women diagnosed with BN. Dietary restraint and binge eating were measured via the Eating Disorders Examination. RESULTS: WS was directly and dietary restraint was inversely related to frequency of binge eating. The inverse relationship between dietary restraint and binge eating may be explained in part by the fact that the most restrained patients with BN had the greatest desire to lose weight. CONCLUSION: Implications of these findings for future research on the perpetuation and treatment of BN are discussed.     

Schema-level cognitions in patients with binge eating disorder: a case control study

OBJECTIVE: This study examined the schema-level cognitions (core beliefs) of patients with binge eating disorder to determine whether these patients differ from those with bulimia nervosa. A case control method (matching groups for age and body mass index [BMI]) was used, to avoid the confounding factors that are found in most studies of this sort. METHOD: All clinical women were recruited from a specialist eating disorder clinic. The index group consisted of 25 women with DSM-IV diagnoses of binge eating disorder, who were compared with a clinical group of 25 women with bulimia nervosa and a group of 25 women with no eating disorder. Groups were closely matched for age and BMI. Each participant completed a well-validated measure of core beliefs. RESULTS: Although the binge eating disorder group had a range of more negative core beliefs than nonclinical women, the differences between the clinical groups were much smaller. The binge eating disorder group had more negative core beliefs than the bulimia nervosa group in many areas. However, the bulimia nervosa group was distinguished by having the highest level of abandonment beliefs, and this difference may account for the difference in the presence of purging behaviors. CONCLUSIONS: Levels of abandonment beliefs seem to be crucial in understanding the behavioral differences between these clinical groups--particularly the absence of purging behaviors. However, the relevance of these beliefs to treatment outcome and to other aspects of psychopathology remains to be established.     

Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa

OBJECTIVE: To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating. RESULTS: In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress. CONCLUSION: Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood.     

Detailed analysis of binges in obese women with binge eating disorder: Comparisons using multiple methods of data collection

OBJECTIVE: This study compares multiple methods of assessing food intake in obese women with binge eating disorder (BED). METHOD: Twelve women meeting BED criteria completed six random 24-hour dietary recalls, engaged in a laboratory binge eating episode, and completed the EDE interview. RESULTS: There was not a significant difference in total or macronutrient intake when binge eating episodes were assessed via the recall and laboratory methods. However, within-individual correlations were low for the size of different binge eating episodes collected by the two methods. Significantly more calories were consumed during objective than during subjective binges, and significant differences in macronutrient composition were observed. Meal patterning data collected by the EDE and the recalls were comparable. CONCLUSION: The findings suggest only moderate agreement between the methods that were examined. Future investigations with larger sample sizes are needed to examine the relationship among these different methods of assessing food intake.     

Prevalence of eating disorders and weight control practices in Germany in 1990 and 1997

OBJECTIVE: To investigate whether the prevalence of bulimic behaviors and weight control practices changed between 1990 and 1997. METHOD: In November 1997, we surveyed a representative sample of 2,130 adult subjects in West Germany and 2,155 subjects in East Germany. We asked subjects about binge eating, vomiting, use of laxatives, appetite suppressants and diuretics, and about dieting, weighing, and exercise. As the same questions had been used in a representative survey (N = 1,773) in autumn 1990 in West Germany, trend comparisons for prevalence between 1990 and 1997 are possible. RESULTS: The prevalence of severe eating binges twice a week dropped nonsignificantly between 1997 and 1990 from 3.1% to 2.4% in men and from 2.3% to 1.3% in women. In men, the prevalence of binge eating disorder dropped nonsignificantly from 2.4% to 1.5%, the prevalence of bulimia nervosa from 2.1% to 1.1%. In women, the prevalence of binge eating disorder dropped nonsignificantly from 1.5% to 0.7% and that of bulimia nervosa from 2.4% to 1.1%. CONCLUSION: The prevalence of bulimic behaviors decreased slightly during 1990 and 1997 in the West German population.     

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

Objective:

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

Method:

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

Results:

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

Discussion:

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

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.     

Symptom severity in obese women with binge eating disorder as a function of smoking history

OBJECTIVE: To compare obese female former smokers with binge eating disorder (BED) to women with BED with no smoking history in the severity of binge eating and associated symptoms. METHOD: A consecutive series of 91 obese women with current diagnoses of BED were administered structured diagnostic and investigator-based interviews and self-report questionnaires to assess symptoms associated with eating disorders. Participants were classified as "never" or "former" smokers and symptom profiles were compared across smoking groups. RESULTS: Former and never-smoking groups did not differ in age, body mass index, or current binge frequency. Former smokers reported significantly higher levels of dietary restraint, rigid dieting strategies, and avoidance of eating. CONCLUSION: Former smokers were significantly more likely than never-smokers to endorse specific symptoms of eating pathology (i.e., rigid dieting strategies). Despite the average 15-year interval since smoking cessation, the former smokers in this patient group resembled current smokers with other eating disorders in terms of rigid and restrictive weight control methods. Obese patients with a smoking history may benefit from treatment to address rigid/pathological dieting and strategies.     

Dieting history in obese youngsters with and without disordered eating

OBJECTIVE: This article examines the relationship between the emergence of disordered eating and the history of weight and dieting in obese youngsters. METHOD: Both child and parent reports were obtained from 40 obese disordered eaters (objective bulimic episodes, n = 20; objective overeating episodes, n = 20) and 40 obese matched controls aged 10-16 years. RESULTS: No significant differences between subsamples with regard to weight and dieting history were found. In dieters, it was shown that overweight onset preceded dieting onset, which in turn preceded dietary restraint onset. Despite some discordance regarding precise onset ages of different behaviors, parent and child re ports revealed the same temporal sequences. CONCLUSION: A developmental pathway from weight problems through dieting to binge eating is plausible for a subgroup of obese children. Convergence between parent and child reports supports the assumption that children's reports are a viable means of monitoring dieting and weight behaviors.     

Influence of race, gender, and socioeconomic status on binge eating frequency in a population-based sample

OBJECTIVE: This study investigates race and gender differences in the demographic and socioeconomic determinants of frequency of binge eating using a population-based sample. METHOD: An analysis of self-reported data on 573 women and 360 men (range, 18-97 years) from a cross-sectional, multistage area probability sample of individuals aged 18 years and older residing in the Detroit metropolitan area conducted in 1995. RESULTS: For women, the frequency of binge eating is negatively associated with age and family income, and positively associated with being married, depression, and time residing in polluted neighborhoods. For men, the frequency of binge eating is negatively associated with age. The frequency of binge eating was not affected by education, race, obesity, or current dieting. CONCLUSION: The frequency of binge eating is highest among adults younger than 40 years. It follows an income gradient for women, but not for men. After controls for individual disadvantage, there is no residual Black/White difference in binge eating.     

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.     

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.     

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.     

Prevalence of eating disorders in middle‐aged women

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

Subtyping binge eating-disordered women along dieting and negative affect dimensions.

OBJECTIVE: Because etiologic and maintenance models of binge eating center around dieting and affect regulation, this study tested whether binge eating-disordered (BED) individuals could be subtyped along dieting and negative affect dimensions and whether subtypes differed in eating pathology, social functioning, psychiatric comorbidity, and response to treatment. METHOD: Three independent samples of interviewer-diagnosed BED women (N = 218) were subtyped along dieting and negative affect dimensions using cluster analysis and compared on the outcomes of interest. RESULTS: Cluster analyses replicated across the three independent samples and revealed a dietary subtype (63%) and a dietary-depressive subtype (37%). The latter subtype reported greater eating and weight obsessions, social maladjustment, higher lifetime rates of mood, anxiety, and personality disorders, and poorer response to treatment than did the dietary subtype. DISCUSSION: Results suggest that moderate dieting is a central feature of BED and that affective disturbances occur in only a subset of cases. However, the confluence of dieting and negative affect signals a more severe variant of the disorder marked by elevated psychopathology, impaired social functioning, and a poorer treatment response.     

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)