Unequivocally large, but not enormous: An examination of the nutritional content of objective and subjective binge-eating episodes using ecological momentary assessment data.

OBJECTIVE: This study compared the macronutrient profiles of subjective binge-eating episodes (SBEs), objective binge-eating episodes (OBEs), and typical eating episodes. METHOD: Twenty-one adults with binge eating completed ecological momentary assessment of all eating episodes for 2 weeks, including detailed monitoring of food types and portions. Binge-eating episodes (N = 237) were coded as OBEs (n = 76) or SBEs (n = 161). Calories and macronutrients were computed using manufacturer information and USDA Food and Nutrient Database for Dietary Studies. Multilevel regression models compared the eating episode types on caloric and macronutrient content. RESULTS: OBEs contained an average of 121.5 (95.1) g fat, 363.7 (289.1) g carbohydrates, 65.2 (38.2) g protein, 20.9 (16.4) g fiber, and 2856.2 (1869.2) calories. SBEs contained 31.6 (30.5) g fat, 76.5 (54.0) g carbohydrates, 20.5 (21.6) g protein, 5.3 (5.9) g fiber, and 695.1 (505.9) calories. Although OBEs contained significantly more calories and grams of all macronutrients than SBEs (p < .001), the macronutrient proportions of OBEs and SBEs did not differ. The proportions of carbohydrates (p = .005) and protein (p < .001) in SBEs significantly differed from typical eating episodes. DISCUSSION: Our findings offer preliminary evidence that OBEs and SBEs are more comparable in macronutrient profile than typical eating episodes. PUBLIC SIGNIFICANCE STATEMENT: The present study compared the calories and grams of macronutrients in objectively large binge-eating episodes, subjectively large binge-eating episodes, and typical meals and snacks. Results suggest that objectively and subjectively large binge-eating episodes demonstrate similar profiles of macronutrients, which are different from the macronutrient profile of meals and snacks. These results may help the eating disorder field better study the impact of subjectively large binge-eating episodes.

[Effects of inpatient treatment on eating disorder symptoms, health-related quality of life and personal resources in anorexia and bulimia nervosa]. / Effekte stationärer Psychotherapie auf Essstörungssymptomatik, gesundheitsbezogene Lebensqualität und personale Ressourcen bei Anorexia und Bulimia nervosa.

The aim of the present prospective-naturalistic study was the evaluation of psychosomatic inpatient treatment for anorexia nervosa (AN) and bulimia nervosa (BN). 128 patients with eating disorders (n=59 AN and n=69 BN) were investigated on admission and discharge using the following standardized questionnaires: eating disorder symptoms (EDI), general psychopathology (BSI), quality of life (SF-12), and personal resources (SOC-13, SWE). Moderate to large effect sizes were achieved for the eating disorder symptoms; in addition, general psychopathology was substantially reduced at the end of treatment, and quality of life as well as personal resources were enhanced. Personal resources were found to be the strongest predictors for therapy outcome. Based on our data, important insights and recommendations may be gained for the inpatient treatment of eating disorders, especially with regard to the potential influence of personal resources.

Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment.

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = -0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode.

The functional assessment of maladaptive behaviors: a preliminary evaluation of binge eating and purging among women.

This study applied a functional approach to the study of bingeing and purging behaviors. Based on a four-function theoretical model of bingeing and purging, it was hypothesized that these behaviors are performed because of their intrapersonally reinforcing (e.g., emotion regulation) and/or interpersonally reinforcing (e.g., help-seeking, attention-getting behavior) properties. Participants were 298 adult females who had engaged in bingeing or purging in the last 3 months and who provided data via an online survey of these behaviors. Confirmatory factor analyses revealed support for a four-function model of bingeing and purging in which people use these behaviors for intrapersonal reinforcement functions and also for interpersonal reinforcement. Understanding the functions of binge eating and purging has direct implications for assessment and treatment of these behaviors.

The utility of considering interpersonal problems in the assessment of bulimic features.

Previous research suggests that heterogeneity in bulimic features can be explained in part by pathoplastic, or varying, interpersonal problems. The present study compared groups of women with bulimic features (N=110) defined by varying interpersonal problems (warm-dominant, warm-submissive, cold-submissive, or cold-dominant) with regard to comorbid psychopathology, personality characteristics, and the influences of dietary restraint and negative affectivity on bulimic psychopathology. As predicted, group differences were not explained by severity of eating-related pathology, socially desirable responding, or the interpretability of interpersonal profiles, although groups unexpectedly differed in depressive symptoms. The warm-submissive group had highest scores on adaptive personality characteristics, including, agreeableness, extraversion, and conscientiousness. As hypothesized, the influence of negative affect and dietary restraint on bulimic symptoms differed as a function of interpersonal style, perhaps suggesting that interpersonal problem heterogeneity may mark different etiological pathways for bulimic psychopathology. Finally, interpersonal problems incremented bulimic features in predicting depressive symptoms. Overall, these results highlight the added value of considering pathoplastic interpersonal problems in addition to clinical diagnoses in the assessment of eating disorders.

An assessment of daily food intake in participants with anorexia nervosa in the natural environment.

OBJECTIVE: To examine the caloric intake in women with anorexia nervosa (AN) and how it varies by day as a function of the presence or absence of binge eating and/or purging behaviors. METHOD: Female participants with AN (n = 84, mean age = 24.4, range 18-51) were recruited from three different sites. Data on food intake were obtained through the use of 24-h dietary recall using the Nutritional Data Systems for Research, and data on binge eating and purging behaviors were collected on palmtop computers using an ecological momentary assessment paradigm. Daily macronutrient intake was compared on days during which binge eating and/or purging behaviors did or did not occur. RESULTS: On days during which binge eating and purging behaviors both occurred, participants reported significantly greater kilocalorie intake when compared with days when neither behavior occurred, or when only binge eating or purging occurred. Binge eating episodes were only modest in size on days when purging did not occur. Energy intake overall was higher than expected. DISCUSSION: Intake on days where binge eating occurred varied dramatically based on whether or not purging occurred. Whether markedly increased binge eating intake was causally related to purging is unclear. Nonetheless eating episodes were at times quite large and equivalent to those reported by participants with bulimia nervosa in other research.

Caring for patients who have eating disorders.

This article gives an overview of the nurse's role when caring for patients with eating disorders. While mental health nurses are more likely than general nurses to be dealing with patients with eating disorders, such disorders can influence an individual's ability to recover from other illnesses so knowledge of this area is relevant in all settings.

Health-Related Quality of Life for Eating Disorders questionnaire version-2 was responsive 1-year after initial assessment.

OBJECTIVES: To assess the responsiveness of the Health-Related Quality of Life for Eating Disorders questionnaire version-2 (HeRQoLEDv2) and present the psychometric characteristics of a new binge domain. STUDY DESIGN AND SETTING: Patients with an eating disorder completed the HeRQoLEDv2, the Eating Attitudes Test-26, Short Form Health Survey-12, and two items from the Eating Disorder Inventory-2, at baseline and after 1 year. At the second assessment, patients completed the HeRQoLEDv2, as part of the battery of tests, along with health transitional questions. Validity and reliability analyses of the new binge domain were performed. Responsiveness was evaluated using distributional and anchor-based approaches, comparison of mean changes, mean change correlations, the minimal detectable change (MDC) at the individual and group level, and the minimal important difference (MID). RESULTS: Items in the binge domain loaded above 0.40. Cronbach alpha was 0.82. Regarding responsiveness, the mean changes detected by the HeRQoLEDv2 correlated above 0.30 with the criterion measures. Patients who reported improvement showed significant changes, and effect sizes above 0.30. The MDC(90%ind) was larger than the MID. CONCLUSION: The HeRQoLEDv2 includes the new binge domain. It responded to change at the group level. Further research regarding the MID is needed.

A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders.

OBJECTIVE: To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. METHOD: Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. RESULTS: Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories. CONCLUSIONS: Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.

Gastrointestinal complaints in patients with eating disorders.

BACKGROUND: Patients with eating disorders (EDs) typically have numerous somatic and gastrointestinal complaints. Early referral to treatment may result in improved outcomes. We sought to determine whether patients with EDs were presenting to gastroenterologists or primary care physicians with gastrointestinal complaints early in the disease course, when referral for specialized, comprehensive treatment would be most beneficial. STUDY: Over a 1-year period, we administered a structured interview to a cohort of patients presenting for inpatient ED treatment. We also conducted the same interview on an age-matched cohort of medical students to determine baseline incidences of various gastrointestinal healthcare behaviors. RESULTS: Patients with bulimia nervosa were significantly more likely to seek healthcare for a gastrointestinal complaint before seeking treatment for an ED than were controls. Patients with EDs were significantly more likely to be prescribed medication for the gastrointestinal tract than were controls. CONCLUSION: Gastroenterologists and primary care physicians should employ available instruments to screen young women of low to normal weight with gastrointestinal complaints for possible EDs. Referral to specialized treatment programs should be made promptly when an ED is identified.

Correlates of the use of purging and non-purging methods of weight control in a community sample of women.

OBJECTIVE: To inform the classification of bulimic-type eating disorders, the correlates of purging and non-purging methods of weight control were examined in a large community sample of young adult women reporting recurrent episodes of binge eating. METHOD: Scores on self-report measures of eating disorder psychopathology, functional impairment and health-service utilization were compared among individuals who reported (recurrent episodes of binge eating and) the use of either purging (self-induced vomiting, laxative or diuretic misuse; n = 41) or non-purging (extreme dietary restriction, excessive exercise, or use of diet pills; n = 62) methods of weight control. Individuals who reported recurrent binge eating in the absence of extreme weight control behaviours (n = 442) were also included in the analysis. RESULTS: Non-purgers tended to be younger and heavier and have higher levels of eating disorder psychopathology and functional impairment than purgers and non-compensating binge eaters, however these differences were not statistically significant. Purgers were more likely than non-purgers to have sought treatment specifically for a problem with eating, however this difference was no longer significant after age and body mass index were statistically controlled. In multivariate analysis, frequency of extreme dietary restriction was the best predictor of functional impairment. CONCLUSIONS: These findings call into question the validity of subtyping of bulimia nervosa into purging and non-purging forms as outlined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Validação da sessão de transtornos alimentares do DAWBA (Levantamento sobre o Desenvolvimento e Bem-Estar de Crianças e Adolescentes) / Validation of the eating disorders section of the DAWBA (Development and Well-Being Assessment)

Esta tese teve por objetivo validar e pesquisar a confiabilidade da Sessão de Transtornos Alimentares do DAWBA (Development and Well-Being Assessment), um pacote de entrevistas e técnicas de avaliação aplicável por entrevistadores sem experiência clínica prévia, para rastrear e diagnosticar transtornos alimentares em crianças e adolescentes do sexo feminino, de 7 a 17 anos, em estudos epidemiológicos. Participaram deste estudo 174 meninas de 8 a 17 anos, de três grupos: (1) 48 com transtornos alimentares; (2) 55 controles clínicos - em tratamento para depressão unipolar, para transtorno obsessivo-compulsivo ou para doença gastrointestinal – e (3) 71 controles comunitários. A Sessão de Transtornos Alimentares do DAWBA apresentou boa validade e confiabilidade...

This thesis concerns the validation and investigation of the reliability of The Eating Disorders Section of The Development and Well-Being Assessment (DAWBA), a package of interviews and assessment techniques designed to be administered by trained interviewers without previous experience in eating disorders, for screening and diagnosis in epidemiological studies of eating disorders in female children and adolescents, from 7 to 17 years old. This study was carried out with the participation of 174 girls, from 8 to 17 years old, from three groups: (1) 48 with eating disorders; (2) 55 clinical controls – in treatment for unipolar depression, for obsessive compulsive disorder or for gastrointestinal disease – and (3) 71 community controls. The Eating Disorders Section of the DAWBA presented good validity and reliability...

A preliminary study of EAT and BITE scores for one school year in Bermuda: increased early anorexic measures related to socio-economic factors.

BACKGROUND: Bermuda is a unique heterogeneous ethnic population in which it is possible to study the interaction of ethnicity, culture, gender and economic factors that influence abnormal eating attitudes. METHOD: A cross-sectional survey of 836 adolescents, one total school year in Bermuda. The BITE and EAT self-report questionnaires were administered in a classroom setting. The analysis was for caseness and for total scores. Caseness represents possible developing anorexic or bulimic eating disorder pathology for this non-adult population. RESULTS: 7.3% fulfilled EAT caseness, 0.24% fulfilled BITE caseness. There was no gender or ethnic difference for caseness. Multivariate analysis for EAT caseness found Odds Ratios of 2.89 (95% CI 1.37, 6.11) for Manual maternal job status. CONCLUSION: Despite the limitation of a questionnaire analysis, lower socioeconomic status increases the risk of possible eating disorder pathology in this adolescent population. Developing anorexic eating attitudes were more prevalent compared to bulimic attitudes for schoolchildren in this unique cultural setting.

The relation between perceived need for mental health treatment, DSM diagnosis, and quality of life: a Canadian population-based survey.

OBJECTIVES: Prevalence estimates of mental disorders were designed to provide an indirect estimate of the need for mental health services in the community. However, recent studies have demonstrated that meeting criteria for a DSM-based disorder does not necessarily equate with need for treatment. The current investigation examined the relation between self-perceived need for mental health treatment and DSM diagnosis, with respect to quality of life (QoL) and suicidal ideation. METHODS: Data came from an Ontario population-based sample of 8116 residents (aged 15 to 64 years). The University of Michigan Composite International Diagnostic Interview was used to diagnose mood, anxiety, substance use, and bulimia disorder according to DSM-III-R criteria. We categorized past-year help seeking for emotional symptoms and (or) perceiving a need for treatment without seeking care as self-perceived need for treatment. We used a range of variables to measure QoL: self-perception of mental health status, a validated instrument that measured well-being, and restriction of activities (current, past 30 days, and long-term). RESULTS: Independent of subjects' meeting criteria for a DSM-III-R diagnosis, self-perceived need for treatment was significantly associated with poor QoL (on all measures) and past-year suicidal ideation. CONCLUSIONS: Self-perceived need for mental health treatment, in addition to DSM diagnosis, may provide valuable information for estimating the number of people in the population who need mental health services. The relation between self-perceived need for treatment and objective measures of treatment need requires future study.

The Eating Disorders Section of the Development and Well-Being Assessment (DAWBA): development and validation

OBJETIVOS: Desenvolvimento e validação da Sessão de Transtornos Alimentares do Development and Well-Being Assessment (DAWBA). Essa sessão é um pacote de questionários, entrevistas e técnicas de avaliação, desenvolvido para gerar diagnósticos baseados no DSM-IV e CID-10 de anorexia, bulimia nervosa e as respectivas síndromes parciais em estudos epidemiológicos, em jovens de 7 a 17 anos. Os pais são entrevistados em todos os casos, assim como as jovens de 11 anos ou mais. MÉTODOS: 174 meninas, divididas em três grupos, foram avaliadas com a Sessão de Transtornos Alimentares do Development and Well-Being Assessment: 48 jovens com transtornos alimentares, 55 controles clínicos (com depressão, transtorno obsessivo-compulsivo ou doença gastrintestinal) e 71 controles da comunidade. Sensibilidade, especificidade e valores preditivos do instrumento foram pesquisados pela comparação dos diagnósticos pelo Development and Well-Being Assessment com diagnósticos psiquiátricos independentes. A confiabilidade teste-reteste foi investigada reaplicando-se o instrumento em 55 sujeitos após duas ou três semanas. RESULTADOS: Para a detecção de qualquer transtorno alimentar segundo o DSM-IV e o CID-10, o diagnóstico final pelo Development and Well-Being Assessment apresentou sensibilidade de 100%, especificidade de 94%, valor preditivo positivo de 88%, valor preditivo negativo de 100% e 95% de concordância entre testes e retestes (Kappa de 0,81). CONCLUSAO: A Sessão de Transtornos Alimentares do Development and Well-Being Assessment tem boas propriedades psicométricas para o uso em estudos clínicos e epidemiológicos.

Assessment of patients with anorexia nervosa: interview versus self-report.

OBJECTIVE: The current study compared the agreement between the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in the diagnosis and assessment of eating disorder pathology in a sample of women with anorexia nervosa. METHOD: First, a physician administered a clinical interview to each patient. Then, before hospital admission, all subjects were given the EDE-Q and the EDE interview. RESULTS: Results indicate that agreement between the EDE and the EDE-Q on the individual items informing the overall diagnosis of anorexia nervosa ranges from low to moderate. Agreement for the overall diagnosis of anorexia nervosa and for the binge/purge subtype was more impressive. Although correlations between subscale scores as well as eating disorder behaviors were strong, higher levels of disturbance were consistently reported on the EDE-Q than on the EDE interview. DISCUSSION: The pattern of findings suggests that the EDE-Q may be used in place of the interviewer-based measure when assessing overall diagnosis and subtype, as well as specific, well-defined features (vomiting/laxative use). However, there was a low level of agreement with respect to less-defined features, like binge eating, for which significantly higher frequencies were generated by the self-report questionnaire.

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.

Assessment of eating disorder psychopathology in obese children and adolescents: interview versus self-report questionnaire.

The present study compared two methods for assessing binge eating and related eating disorder psychopathology in obese children and adolescents. A comparison was made between the child version of the Eating Disorder Examination (ChEDE) and the self-report version of the interview (ChEDE-Q). A total of 139 children and adolescents (aged 10-16 years) seeking inpatient treatment for obesity completed the ChEDE questionnaire and were administered the ChEDE interview afterwards. The ChEDE and ChEDE-Q were significantly correlated for the four subscales: restraint, eating concern, weight concern and shape concern. The ChEDE-Q generated consistently higher levels of eating disorder psychopathology. There was a significant discrepancy for the assessment of a more complex feature such as binge eating. Overall, the current study found lower levels of agreement between the EDE and EDE-Q than previously reported in adult samples. It appears that children and adolescents have difficulties in identifying binge-eating episodes when they receive no detailed instruction. It is concluded that a clinical interview is necessary to identify eating disorders in obese children and that a self-report questionnaire can only be used as a screening tool. Even then, thorough clarification of the definition of the eating disorder features is needed when using a self-report questionnaire.