Adapting dose-response methodology to improve clinical trial design for psychotherapies.

OBJECTIVE: Conventional randomized controlled trials (RCTs) have long served as the foundation of research in clinical psychology; however, most treatments for eating disorders show only modest effects on reduction of symptoms and maintenance of long-term remission. New options for psychotherapy treatment development research, beyond continuing to pursue additive or subpopulation approaches, are needed. METHODS: One option is to apply dose-response designs, which are commonplace in studies of pharmacology, toxicology, and medical research, and characterized by the evaluation of the amount of exposure (dose) to an intervention, and the resulting changes in body function or health (response). RESULTS: Eating disorder interventions are particularly well-suited for dose-response treatment designs. The deadly nature of eating disorders makes it imperative that patients are not turned away for not being "ready" to engage with treatment. By identifying optimal doses, research will likely yield a more parsimonious course of treatment, which will lend itself to reduced costs, greater uptake, and reduced drop-out. DISCUSSION: Limited use of within-subject designs in trials for patients with eating disorders has produced fast-track efficacy studies and omitted key elements in the treatment development pathway. To decrease reliance on RCT's, dose-response methods should be applied as an alternative study design. PUBLIC SIGNIFICANCE: Eating disorders are associated with medical and psychiatric comorbidities, poor quality of life, and high mortality. Access to evidence-based services for patients with eating disorders is limited, and identifying additional effective treatment options can be difficult because of challenges inherent to randomized-controlled trials. This manuscript describes an alternative trial methodology to maximize the information that can be gathered prior to utilizing a standard large-scale efficacy design.

Phase-Transitions in Disgust During Self-Initiated Eating Among Adolescents With Anorexia Nervosa and Related Low-Weight Eating Disorders and Matched Controls.

BACKGROUND: Understanding the emotional context of feeding behavior may help identify causal mechanisms of food avoidance among individuals with anorexia nervosa. Although predominant food avoidance models assume fear of fat drives feeding behavior, disgust may be more theoretically and proximally relevant to moment-to-moment experiences of feeding. This study, therefore, aimed to examine affect and food avoidance using automated affect analysis from facial response by measuring time-specific transitions in disgust during a laboratory eating paradigm. We hypothesized that phase transitions in disgust would distinguish temporally self-initiated eating from food avoidance. METHODS: Sixty-three adolescents with anorexia nervosa or another low-weight eating disorder (LWED) and 27 age- and sex-matched controls were recruited as part of a larger study; 45 patients and 22 controls provided data on autonomous eating and facial affect during a laboratory meal. Dynamic structural equation models quantified moment-to-moment relationships between disgust and feeding behavior. RESULTS: Self-initiated eating was associated with greater increases in disgust, but not fear, intensity among those with LWED relative to control participants and greater disgust intensity predicted lower likelihood of self-initiated eating. DISCUSSION: Phasic transitions in disgust provide moment-to-moment evidence of affective influence on self-initiated eating and lend credibility to the hypothesis that disgust contributes to food avoidance and initiation in individuals with LWED.

Treatment fidelity in eating disorders and psychological research: Current status and future directions.

OBJECTIVE: The evaluation and use of treatment fidelity procedures are rare in the development and implementation of psychological interventions. This article aims to review the construct of treatment fidelity, highlight limitations to currently available measures, and introduce a conceptual framework for studying and adapting fidelity measures in clinical research and practice using eating disorders as an example. METHOD: As treatment fidelity assesses whether an intervention was delivered as intended, we operationalized this construct as: (a) treatment adherence, (b) therapist competence, and (c) treatment differentiation. RESULTS: There is a significant gap in the literature assessing and documenting treatment fidelity. Available studies indicate that existing adherence measures can be time consuming, costly, and are not widely used in the field. Furthermore, therapist competence is a complex and context-dependent construct that is challenging to measure. Finally, treatment differentiation is often inferred by ensuring adherence. DISCUSSION: The development of simplified formal tests of treatment fidelity would help draw conclusions about treatment efficacy and improve the dissemination and implementation of interventions to promote optimal clinical outcomes.

Lessons learned developing and testing family-based interoceptive exposure for adolescents with low-weight eating disorders.

BACKGROUND: Anorexia nervosa (AN) usually develops in early adolescence and is characterized by high rates of morbidity and mortality. Family-based therapy (FBT) is the leading evidence-based treatment for adolescents with AN, but not all patients experience sufficient improvement. The purpose of this manuscript is to describe the development and subsequent experience with a Family-Based Interoceptive Exposure (FBT-IE) for adolescents with a broader form of low-weight eating disorders. METHODS: The novel IE-based behavioral intervention is a six-session family-based treatment module designed to directly target and modify disgust by altering the prefrontal regulation of the insula response to aversive stimuli by decreasing visceral sensitivity (e.g., bloating). Each session teaches a new skill regarding tolerating distress to visceral sensations associated with disgust and an in-vivo "IE exercise," in which the family is provided with a meal replacement shake of unknown content and caloric density. RESULTS: In this novel treatment, the patient learns to tolerate disgust in the context of a challenging food stimulus as a way to increase consumption of restricted foods outside of session. CONCLUSION: We discuss successes and challenges executing this treatment with patients with low-weight eating disorders and propose future directions for the intervention.

Applying the disgust conditioning model of food avoidance: A case study of acceptance-based interoceptive exposure.

OBJECTIVE: The current case report details the treatment of a 16-year-old adolescent with anorexia nervosa utilizing a novel adjunct, acceptance-based interoceptive exposure, prior to family-based treatment (FBT) for eating disorders. METHOD: The exposure-based module focused particularly on the tolerance of disgust. For six sessions, the clinician taught the client skills that could be used to tolerate distress to visceral sensations associated with disgust. These skills were to be used during in- and between-session exposures. Each session included exposure to physical sensations that occurred while drinking a milkshake. RESULTS: Across six sessions, the client reported improvement in symptoms in addition to gaining weight. Additionally, she consumed more calories of a test meal following the intervention. Within broader FBT, the client reached an established weight goal, was able to return to physical activity, and reported an increased ability to manage distress. DISCUSSION: Given the client's improvement on the Eating Disorders Examination-Questionnaire (EDE-Q) within six sessions, we believe IE may be a useful adjunct to FBT. Interoceptive exposure may augment the efficacy of FBT for anorexia nervosa as it provides clients with skills to utilize during the refeeding phase of treatment.

Relationship between three factor eating questionnaire-restraint subscale and food intake.

OBJECTIVE: Dietary restraint refers to an individual's intention to restrict food intake, measured via self-report questionnaires, whereas dietary restriction refers to actual reduction in caloric intake. The aim of this research was to investigate the association between dietary restraint scales and actual caloric restriction. METHOD: Data were collected from six previously published or two ongoing eating behavior studies in which participants (n = 183) completed the Three Factor Eating Questionnaire (TFEQ) and Eating Disorders Examination Questionnaire (EDE-Q) and participated in a laboratory-based research lunch meal. Participants were individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC). The primary analysis was the association between TFEQ Restraint subscale and caloric intake in the meal. RESULTS: There was a significant negative correlation between total caloric intake and TFEQ Restraint scores (r = -.60, p < .001) and EDE-Q Restraint scores (r = -.54, p < .001). For TFEQ Restraint score, this relationship was significant within each diagnostic group (HC: r = -.32, p = .007; AN: r = -.38, p < .001; BN: r = -.43, p = .02). DISCUSSION: These results suggest that the TFEQ Restraint scale is a useful measure of dietary restriction, especially among individuals with eating disorders.

Rigor and reproducibility via laboratory studies of eating behavior: A focused update and conceptual review.

OBJECTIVE: The eating behavior of individuals with eating disorders has been examined in laboratory settings over the last 30 years. In this focused review, we build on prior research and highlight several feeding laboratory paradigms that have successfully demonstrated quantifiable and observable behavioral disturbances, and thereby add rigor and reproducibility to the examination of disturbances of eating behavior. This review describes the measures commonly obtained via these laboratory techniques. Supporting Information Appendices with detailed information about implementation are provided to allow for the reproducible execution of these techniques across labs. METHODS/RESULTS: Literature documenting the existence of objective abnormalities in eating behavior among individuals with eating disorders or in comparison to healthy controls (n > 40) is briefly summarized. These protocols, conducted across at least 17 independent labs, are sensitive and reproducible, can be used to assess subjective and physiological parameters associated with eating, and elucidate the impact of treatment. Laboratory studies from patients with eating disorders compared with healthy controls reproducibly demonstrate both that patients with Anorexia Nervosa ingest fewer calories and that individuals with Bulimia Nervosa and Binge-Eating Disorder ingest more calories when asked to binge-eat. DISCUSSION: Feeding laboratory studies have the potential for quantifying the characteristic behavioral psychopathology of patients with eating disorders, and may provide a useful tool to explore the potential utility of new treatments for individuals with Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder.

Development of a methodology to combine fMRI and EMG to measure emotional responses in patients with anorexia nervosa.

OBJECTIVE: Individuals with eating disorders are theorized to have basic impairments in affective appraisal and social-emotional processing that contribute to pathogenesis of the disease. We aimed to determine if facial electromyography could be used to discriminate between happy and disgust emotions during simultaneous acquisition of an fMRI BOLD sequence in efforts to establish a novel tool for investigating emotion-driven hypotheses about eating pathology. In line with standards for rigor and reproducibility, we provide detailed protocols and code to support each step of this project. METHOD: Sixteen adolescents with low-weight eating disorders viewed emotional faces (Happy or Disgust) and were asked to mimic their facial expression during simultaneous BOLD and EMG (Corrugator supercilli, Lavator lavii, Zygomaticus major) acquisition. Trials were repeated with the scanner off and again with scanner on (i.e., fatigue). RESULTS: The Levator and Zygomaticus activation patterns discriminated disgust and happy faces successfully. The pattern held between scanner on and off conditions, but muscle activation attenuated in the Fatigue condition, especially for the Zygomaticus. DISCUSSION: Simultaneous fMRI-EMG is a new tool capable of discriminating specific emotions based on muscle activation patterns and can be leveraged to answer emotion-driven hypotheses about clinical populations characterized by difficulty labeling or processing emotions.

Using Factor Mixture Models to Evaluate the Type A/B Classification of Alcohol Use Disorders in a Heterogeneous Treatment Sample.

BACKGROUND: The type A/B classification model for alcohol use disorders (AUDs) has received considerable empirical support. However, few studies examine the underlying latent structure of this subtyping model, which has been challenged as a dichotomization of a single drinking severity dimension. Type B, relative to type A, alcoholics represent those with early age of onset, greater familial risk, and worse outcomes from alcohol use. METHODS: We examined the latent structure of the type A/B model using categorical, dimensional, and factor mixture models in a mixed-gender community treatment-seeking sample of adults with an AUD. RESULTS: Factor analytic models identified 2 factors (drinking severity/externalizing psychopathology and internalizing psychopathology) underlying the type A/B indicators. A factor mixture model with 2 dimensions and 3 classes emerged as the best overall fitting model. The classes reflected a type A class and 2 type B classes (B1 and B2) that differed on the respective level of drinking severity/externalizing pathology and internalizing pathology. Type B1 had a greater prevalence of women and more internalizing pathology and B2 had a greater prevalence of men and more drinking severity/externalizing pathology. The 2-factor, 3-class model also exhibited predictive validity by explaining significant variance in 12-month drinking and drug use outcomes. CONCLUSIONS: The model identified in this study may provide a basis for examining different sources of heterogeneity in the course and outcome of AUDs.

Randomized controlled trial comparing smartphone assisted versus traditional guided self-help for adults with binge eating.

OBJECTIVE: Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application designed to facilitate CBT-GSH (CBT-GSH + Noom), on study retention, adherence, and eating disorder symptoms compared to traditional CBT-GSH. METHOD: Sixty-six men and women with DSM-5 binge-eating disorder (BED) or bulimia nervosa (BN) were randomized to receive eight sessions of CBT-GSH + Noom (n = 33) or CBT-GSH (n = 33) over 12 weeks. Primary symptom outcomes were eating disorder examination objective bulimic episodes (OBEs), subjective bulimic episodes (SBEs), and compensatory behaviors. Assessments were collected at 0, 4, 8, 12, 24, and 36 weeks. Behavioral outcomes were modeled using zero-inflated negative-binomial latent growth curve models with intent-to-treat. RESULTS: There was a significant effect of treatment on change in OBEs (ß = -0.84, 95% CI = -1.49, -0.19) favoring CBT-GSH + Noom. Remission rates were not statistically different between treatments for OBEs (ßlogit = -0.73, 95% CI = -1.86, 3.27; CBT-GSH-Noom = 17/27, 63.0% vs. CBT-GSH 11/27, 40.7%, NNT = 4.5), but CBT-GSH-Noom participants reported greater meal and snack adherence and regular meal adherence mediated treatment effects on OBEs. The treatments did not differ at the 6-month follow-up. DISCUSSION: Smartphone applications for the treatment binge eating appear to have advantages for adherence, a critical component of treatment dissemination.

Mild, moderate, meaningful? Examining the psychological and functioning correlates of DSM-5 eating disorder severity specifiers.

OBJECTIVE: This study evaluated the DSM-5 severity specifiers for treatment-seeking groups of participants with anorexia nervosa (AN), the purging form of bulimia nervosa (BN), and binge-eating disorder (BED). METHOD: Hundred and sixty-two participants with AN, 93 participants with BN, and 343 participants with BED were diagnosed using semi-structured interviews, sub-categorized using DSM-5 severity specifiers and compared on demographic and cross-sectional clinical measures. RESULTS: In AN, the number of previous hospitalizations and the duration of illness increased with severity, but there was no difference across severity groups on measures of eating pathology, depression, or measures of self-reported physical or emotional functioning. In BN, the level of eating concerns increased across the severity groups, but the groups did not differ on measures of depression, self-esteem, and most eating pathology variables. In BN, support was also found for an alternative severity classification scheme based upon number of methods of purging. In BED, levels of several measures of eating pathology and self-reported physical and emotional functioning increased across the severity groups. For BED, however, support was also found for an alternative severity classification scheme based upon overvaluation of shape and weight. Preliminary evidence was also found for a transdiagnostic severity index based upon overvaluation of shape and weight. DISCUSSION: Overall, these data show limited support for the DSM-5 severity specifiers for BN and modest support for the DSM-5 severity specifiers for AN and BED.

Impulsivity and test meal intake among women with bulimia nervosa.

Many patients with bulimia nervosa (BN) also meet criteria for a lifetime alcohol use disorder (AUD). In order to understand possible mechanisms contributing to the co-occurrence and perpetuation of these disorders, this study investigated the importance of impulsivity and test meal intake among patients with BN by comparing women with BN only (n = 18), BN and current/past AUDs (n = 13), and healthy controls (n = 12). All participants completed assessments of eating disorder symptoms, frequency of alcohol use, binge eating, and purging via questionnaires and semi-structured interviews over two sessions. Measures of impulsivity consisted of computerized and self-report measures, and laboratory test meals. Significant differences between individuals with BN with/without comorbid AUDs were not found for test meal intake, impulsivity measures, or self-reported psychological symptoms. As hypothesized, compared to healthy controls, individuals with BN had significantly higher scores on two subscales and the total score of the Barratt Impulsiveness Scale, a trait measure of impulsivity, and consumed significantly more calories in the binge instruction meal. Total Barratt Impulsiveness Scale scores were also significantly related to kcal consumed during the laboratory test meal when individuals were instructed to binge eat (BN groups). Data from this study add to the existing literature implicating impulsivity in the psychopathology of disorders of binge eating, including BN, and also support the use of laboratory meals as a symptom-specific measure of this trait in eating disorder populations.

The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders.

OBJECTIVE: Existing measures for DSM-IV eating disorder diagnoses have notable limitations, and there are important differences between DSM-IV and DSM-5 feeding and eating disorders. This study developed and validated a new semistructured interview, the Eating Disorders Assessment for DSM-5 (EDA-5). METHOD: Two studies evaluated the utility of the EDA-5. Study 1 compared the diagnostic validity of the EDA-5 with the Eating Disorder Examination (EDE) and evaluated the test-retest reliability of the new measure. Study 2 compared the diagnostic validity of an EDA-5 electronic application ("App") with clinician interview and self-reported assessments. RESULTS: In Study 1, the kappa for EDE and EDA-5 eating disorder diagnoses was 0.74 across all diagnoses (n = 64), with a range of κ = 0.65 for other specified feeding or eating disorder/unspecified feeding or eating disorder to κ = 0.90 for binge eating disorder. The EDA-5 test-retest kappa coefficient was 0.87 across diagnoses. For Study 2, clinical interview versus App conditions revealed a kappa of 0.83 for all eating disorder diagnoses (n = 71). Across individual diagnostic categories, kappas ranged from 0.56 for other specified feeding or eating disorder/unspecified feeding or eating disorder to 0.94 for BN. DISCUSSION: High rates of agreement were found between diagnoses by EDA-5 and the EDE, and EDA-5 and clinical interviews. Because this study supports the validity of the EDA-5 to generate DSM-5 eating disorders and the reliability of these diagnoses, the EDA-5 may be an option for the assessment of anorexia nervosa, bulimia nervosa, and binge eating disorder. Additional research is needed to evaluate the utility of the EDA-5 in assessing DSM-5 feeding disorders.

Suicidal Ideation and Behaviours Among Adolescents Receiving Bariatric Surgery: A Case-Control Study.

OBJECTIVE: This study examined the prevalence and correlates of suicidal ideation and behaviour (SI/B) among adolescents receiving bariatric surgery. METHOD: Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the programme n = 31, 15%) were case matched on gender, age and surgery type to 31 adolescents reporting current or past psychiatric treatment and 31 adolescents denying lifetime SI/B or psychiatric treatment. RESULTS: Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p = 0.01) and greater depressive symptoms (p = 0.004) in comparison with candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery. CONCLUSIONS: As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre-operative or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B.

Distinct Topological Properties of the Reward Anticipation Network in Preadolescent Children With Binge Eating Disorder Symptoms.

OBJECTIVE: Few studies have considered the neural underpinnings of binge eating disorder (BED) in children, despite clinical and subclinical symptom presentation occurring in this age group. Symptom presentation at this age is of clinical relevance, as early onset of binge eating is linked to negative health outcomes. Studies in adults have highlighted dysfunction in the frontostriatal reward system as a potential candidate for binge eating pathophysiology, although the exact nature of such dysfunction is currently unclear. METHOD: Data from 83 children (mean age 9.9 years, SD = 0.60) with symptoms of BED (57% girls) and 123 control participants (mean age 10.0 years, SD = 0.60) (52% girls) were acquired from the 4.0 baseline release of the Adolescent Brain Cognitive Development Study. Task-based graph theoretic techniques were used to analyze data from anticipation trials of the monetary incentive delay task. Network and nodal properties were compared between groups. RESULTS: The BED-S group showed alterations in topological properties associated with the frontostriatal subnetwork, such as reduced nodal efficiency in the superior frontal gyrus, nucleus accumbens, putamen, and in normal sex-difference patterns of these properties, such as diminished girls-greater-than-boys pattern of betweenness-centrality in nucleus accumbens observed in controls. CONCLUSION: Distinct network properties and sex-difference patterns in preadolescent children with BED-S suggest dysregulation in the reward system compared to those of matched controls. For the first time, these results quantify this dysregulation in terms of systems-level properties during anticipation of monetary reward and significantly inform the early and sex-related brain markers of BED symptoms.

An exploratory structural equation modelling (ESEM) of the Eating Disorders Examination Questionnaire (EDE-Q) in bariatric patients.

Several studies in clinical and non-clinical populations indicate differences between rationally and empirically derived subscales for the Eating Disorder Examination Questionnaire (EDE-Q), including samples of patients seeking bariatric surgery. This study aimed to use exploratory structural equation modelling (ESEM) to estimate the factor structure of the EDE-Q and assess for the additive value of alternative measurement of eating disorder symptoms. Adolescents and adults completed the EDE-Q and a psychiatric evaluation prior to bariatric surgery. Data from 330 participants were analysed using the original four-factor and modified three-factor structure of the EDE-Q using both confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM). Age, ethnicity, and body mass index were examined as covariates in the best fitting model, and model subscales used to generate a predictive model of clinician screened DSM-5 eating disorder diagnoses for criterion validity. A CFA of the four-factor EDE-Q provided poor model fit for a pre-surgical bariatric population, but the three-factor EDE-Q and an ESEM of the four-factor EDE-Q provided excellent model fit. The Eating Concern subscale of the four-factor ESEM model significantly predicted eating disorder diagnosis and was positively correlated with age. Our results suggest the ESEM derived factors of the EDE-Q offered some improvements to the original empirically derived factor structure, as subscale scores based on the original items and cross-loading items yielded an adequate prediction of clinician diagnoses.

Development and initial pilot validation of a treatment fidelity instrument for family-based interoceptive exposure for adolescents with low-weight eating disorders.

BACKGROUND: This pilot study outlines the development and psychometric evaluation of a therapist adherence coding measure for a novel treatment, Family-Based Treatment Interoceptive Exposure (FBT-IE). METHODS: The IE Adherence Coding Framework (IE-ACF) was developed from the FBT-IE Manual using an iterative process. Items on the IE-ACF were coded by two independent coders as either present or absent with therapists considered adherent if both independent coders coded the item as "present." Videotaped sessions of FBT-IE of 30 adolescents with low-weight eating disorders (DSM-5 typical/atypical anorexia nervosa) and their families were coded. Participants received the FBT-IE intervention as part of a randomized controlled trial. RESULTS: Seventy FBT-IE videos were coded. The IE-ACF identified a mean (SD) rating of 80% (±5%) therapist adherence to the protocol across the six-session treatment, with a per item adherence ranging from 36-100%. Two independent coders demonstrated moderate to almost perfect inter-rater reliability (κ range 0.78-0.96) across the sessions. CONCLUSION: IE-ACF measured therapist adherence to our novel FBT-IE treatment for adolescents with low-weight eating disorders. Through this study, we demonstrated that 1) our therapists were adherent to the FBT-IE manual in the context of an ongoing clinical trial and 2) that independent coders reliably coded sessions using our novel IE-ACF.

Genome-wide analysis of a model-derived binge eating disorder phenotype identifies risk loci and implicates iron metabolism.

Binge eating disorder (BED) is the most common eating disorder, yet its genetic architecture remains largely unknown. Studying BED is challenging because it is often comorbid with obesity, a common and highly polygenic trait, and it is underdiagnosed in biobank data sets. To address this limitation, we apply a supervised machine-learning approach (using 822 cases of individuals diagnosed with BED) to estimate the probability of each individual having BED based on electronic medical records from the Million Veteran Program. We perform a genome-wide association study of individuals of African (n = 77,574) and European (n = 285,138) ancestry while controlling for body mass index to identify three independent loci near the HFE, MCHR2 and LRP11 genes and suggest APOE as a risk gene for BED. We identify shared heritability between BED and several neuropsychiatric traits, and implicate iron metabolism in the pathophysiology of BED. Overall, our findings provide insights into the genetics underlying BED and suggest directions for future translational research.

Test-retest reliability of the proposed DSM-5 eating disorder diagnostic criteria.

The proposed DSM-5 classification scheme for eating disorders includes both major and minor changes to the existing DSM-IV diagnostic criteria. It is not known what effect these modifications will have on the ability to make reliable diagnoses. Two studies were conducted to evaluate the short-term test-retest reliability of the proposed DSM-5 eating disorder diagnoses: anorexia nervosa, bulimia nervosa, binge eating disorder, and feeding and eating conditions not elsewhere classified. Participants completed two independent telephone interviews with research assessors (n=70 Study 1; n=55 Study 2). Fair to substantial agreements (κ=0.80 and 0.54) were observed across eating disorder diagnoses in Study 1 and Study 2, respectively. Acceptable rates of agreement were identified for the individual eating disorder diagnoses, including DSM-5 anorexia nervosa (κ's of 0.81 to 0.97), bulimia nervosa (κ=0.84), binge eating disorder (κ's of 0.75 and 0.61), and feeding and eating disorders not elsewhere classified (κ's of 0.70 and 0.46). Further, improved short-term test-retest reliability was noted when using the DSM-5, in comparison to DSM-IV, criteria for binge eating disorder. Thus, these studies found that trained interviewers can reliably diagnose eating disorders using the proposed DSM-5 criteria; however, additional data from general practice settings and community samples are needed.

Does the overvaluation of shape and weight predict initial symptom severity or treatment outcome among patients with binge eating disorder?

OBJECTIVE: To examine whether overvaluation of shape and weight is associated with initial symptom severity or treatment outcome among patients with binge eating disorder (BED). METHOD: Patients with BED (n = 116) completed assessments at baseline and treatment termination, including the Eating Disorder Examination (EDE) and self-report measures of eating-related cognitions and behaviors, depression, and self-esteem. Clinical overvaluation was determined by EDE. RESULTS: The clinical overvaluation group demonstrated significantly higher pre-treatment scores on measures of depression, behavioral and cognitive aspects of binge eating, and eating-related psychopathology, and lower self-esteem scores than individuals without overvaluation. At treatment termination, patients with overvaluation continued to display elevated scores on measures of binge eating severity at a trend level. DISCUSSION: Overvaluation of shape and weight was associated with symptom severity in patients with BED, but additional research is needed to determine whether this construct holds clinically useful predictive validity for treatment outcome.