binge eating disorder research paper

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Binge eating disorder research paper

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The presence of a trained therapist who leads the group sessions gives a better short-term outcome and less group contrast, but significant differences have not been showed so far as regards outcomes between guided and self-help groups at follow-up [ 62 , 63 ]. Some preliminary studies have also evaluated the efficacy of Internet guided self-help programs, but their efficacy is still debated [ 62 ]. This therapy showed to be effective in binge reduction and in lowering concerns about food and body shape similarly to CBT, but it has not provided clear results on weight loss, depression, or anxiety [ 64 , 65 ].

It seems to be effective also when negative outcome predictors occur as earlier age at binges onset and higher personality disturbances [ 7 , 48 ]. Some preliminary findings show DBT to be effective also when administered as a self-help intervention, a suitable low-intensity treatment option for BED [ 66 ]. This technique focuses on personal relations and role transitions that could have a predisposing and maintaining role in EDs, in order to achieve better social interactions and to cope with interpersonal conflicts [ 41 - 43 ].

This disease in fact often emerges in adolescence [ 4 ], in a context of interpersonal and maturation difficulties, and its maintenance over the years can be related to dysfunctional relational styles that triggers depression, anxiety, and anger feelings in turn underlying eating impulsiveness [ 11 ].

It appears in any case effective on depression and psychosocial discomfort [ 41 , 43 ]. It has been observed that CBT and IPT have comparable efficacy in binge reduction, both at the end of therapy and at one-year follow-up, with a significant reduction of psychiatric comorbidities and in some cases a significant decrease in body weight.

Therapeutic results are stable at a 4-year follow-up [ 67 , 42 , 43 ]. All in all, psychotherapeutic approaches to BED, mostly based on CBT models, are useful first-line treatments, even more than pharmacological approaches [ 36 , 43 ].

Pharmacological therapy in BED is specifically focused on the reduction of eating impulsiveness, binges and negative feelings, constituting a co-cause and a complication of eating symptoms. It has been noticed a statistically significant drug action on short-term binge remission and also on weight loss, although this does not hold significant at longer follow-up [ 36 , 38 ].

Unfortunately, few data exist on long-term efficacy of pharmacotherapy as stand-alone treatment for BED, and in some studies combined treatment of drugs and psychotherapy interventions failed to enhance outcome significantly [ 55 , 35 ]. Most treatment options currently used in BED have at first demonstrated their efficacy on binge reduction in BN, but non-psychoactive drugs, borrowed from obesity treatment, are also in use in selected cases or in combination with other treatments like psychotherapies [ 68 ].

As an additional element supporting the specificity of BED diagnosis, it is noteworthy that psychopharmacological therapy showed higher efficacy in BED than in non-BED obese population and that placebo response was consistent with the one observed in other major psychiatric diseases [ 69 ].

Antidepressants are the most widely studied and applied medications in BED treatment, showing efficacy on eating impulsiveness and eating and general psychopathology, but also on anxiety and depressive symptoms, with supposed secondary positive effects on eating impulsiveness due to lowering of negative affects that trigger binges [ 36 , 38 ]. In any case it is recommended to use compounds showing side effects on weight and hunger, and it is better to choose pro-anorectic antidepressants molecules to improve treatment compliance.

It is for this reason that tricyclic antidepressants are not commonly used in EDs, while selective serotonin reuptake inhibitors SSRIs are preferred given their anti-impulsive action [ 68 ]. On the other hand, when eating impulsiveness is not related to a specific psychopathology, it is possible to evaluate in selected cases the use of medications that act directly on hunger regulation and food absorption, without influencing mood [ 36 ].

SSRI at high doses have showed efficacy on binge reduction and associated psychopathology, with some limited evidences of effectiveness on weight loss, which are of questionable clinical significance [ 38 , 68 ]. Even if differences in long-term action among SSRI still have to be clearly established, fluoxetine is the most widely studied and prescribed because of its registration for BN [ 70 ]. It proved significant efficacy above placebo on binge reduction, weight loss and mood improvement [ 69 , 70 ], but uncertain clinical relevance and consistently lower effects than CBT, also in combination treatments [ 55 , 70 ].

Sertraline and fluvoxamine have showed similar results to fluoxetine, while citalopram and paroxetine are scarcely implied because of their side-effects on hunger and weight gain [ 68 , 70 , 71 ]. Duloxetine in some initial studies was reported to reduce hunger and binges and promote weight loss [ 72 , 73 ], even the current body of evidence is still lacking [ 68 ]. Reboxetine showed significant reductions in binge frequency and BMI in a small preliminary open-label trial of week [ 67 ].

Bupropion showed effectiveness on binge eating, anxiety, and depressive symptoms in a single study, with better efficacy than sertraline on sexual side-effects and weight loss [ 71 ]. Among anti-epileptic drugs, topiramate reduced hunger, promotes weight loss, and can obtain a significant reduction in daily and weekly binge episodes and impulsivity.

Nevertheless, it has not showed efficacy on psychopathological distress or depressive symptoms, while its results on weight loss are still debated [ 68 , 74 , 75 ]. Lamotrigine showed preliminary efficacy on weight loss and metabolic dysfunction but without results on general and eating psychopathology, and global severity of illness [ 76 ]. Also zonisamide seems to be able to suppress appetite and increase eating control, leading to BMI reduction [ 75 , 68 ].

Psychostimulants like atomoxetine, naltrexone and glutamate-modulating agents seems to be promising treatments, acting on binge reduction and weight loss when compared to placebo [ 68 ]. Acamprosate was associated at endpoint analysis with improvements on binge frequency, food craving and quality of life compared to placebo [ 77 ].

Sodium oxibate, in a small sample without control group, show reductions of binge episodes, related psychopathology, and also weight loss [ 78 ]. In conclusion, current literature data evidence still unclear efficacy of pharmacological treatments for BED. Nevertheless they are widely applied in clinical practice and play an important role in BED management [ 68 ]. Even though these treatments produced a significant reduction of binges and eating impulsiveness, and in some cases also weight losses, clinical relevance of these modifications is still doubtful and limited by small sample sizes, high dropout rates, and short follow-up times [ 38 , 68 ].

Also the usefulness of pharmacotherapy as association treatment, with the purpose to enhance effects of BWL or psychotherapies, is still highly unclear, with scarce data and discordant findings at support [ 35 , 36 , 38 , 68 ]. However obese individuals with BED frequently experience weight-related impairments in mood and quality of life, which improve with weight loss [ 19 ].

This improvement of wellness and quality of life acts as a protective factor against binge vulnerability, making bariatric surgery a useful option in severe obesity linked to BED [ 81 ]. On the other hand, an ED diagnosis was once considered a major contraindication to bariatric surgery. This limitation has been reduced over time and bariatric surgery interventions can now be suitable for selected BED patient, even if the extent of weight loss depends on the presence of binge episodes after the intervention [ 83 ].

Faulconbridge and coworkers [ 81 ] explored the effects of bariatric surgery in BED patients with severe obesity, trying to enlighten if observed improvements are due to weight loss itself or to additional aspects of treatment, such as therapeutic support or acquisition of cognitive-behavioral skills. They found significant improvements in mood and quality of life at follow-up both in patients who undergo surgery and in controls enrolled in a BWL intervention, but they evidenced no differences between the groups at month Nevertheless, bariatric surgery showed a significantly higher efficacy on weight reduction [ 81 ].

Wadden and coworkers [ 82 ] found no relevant differences in post-surgical weight loss between patients with and without BED, higher than weight loss obtained with lifestyle modifications at 1 year follow-up. The mean number of binge eating days fell sharply both with surgery and with BWL interventions [ 82 ]. These treatments should then be proposed after a careful evaluation of psychological conditions, and a psychiatric and psychological assessment before and after surgical intervention is recommended.

In fact, bariatric surgery or lifestyle modification treatments led to comparable results on mood and quality of life at the 1-year follow-up [ 84 ]. To achieve good outcome it is fundamental to provide the patient with a framework of nutritional-metabolic and psychological rehabilitation, focused on empowering and stimulating an active and informed collaboration [ 84 ].

In the first months after surgery, patients with BED who present a high gastric capacity before intervention can show an initial weight loss even higher than usual and complete binges remission [ 82 ]. However binge behaviors tend to resume partially after 12 months follow-up [ 82 ]. Binge recurrence may occur when patients learn to manage their new condition, and to circumvent eating limitations caused by the intervention — e.

It is noticeable from these data that a stable binge control, obtained with pharmacological o psychological intervention, should be a primary outcome to be pursued in BED patients that undergo bariatric surgery [ 83 ]. It predicts better prognosis which is frequently not significantly different from that of non—BED obese individuals [ 81 , 82 , 84 ]. Despite its recent inclusion in DSM-5 as an autonomous disease, further research is needed on BED diagnosis and treatment strategies, through larger samples and longer follow-up times [ 36 ].

Although present diagnostic criteria has showed their empirical consistency other core psychopathologic features like body and weight overvaluation may be of clinical and prognostic relevance [ 27 ]. Binge stability and spontaneous remission rates should be better explored [ 9 ], deepening the identification of prognostic factors able to address treatment choices and to favor more specific and cost-effective interventions [ 36 , 37 ]. Also the importance of comorbidities and weight maintenance in treatment adherence and remission should be extensively investigated because of its influence on prognosis and treatment [ 18 ].

Multidisciplinary treatment choices seems to emerge as the best treatment strategy for long-term management of this disease, with primary goals on binge abstinence and at a second time a sustainable weight loss [ 44 , 45 ]. Nevertheless treatment should also target secondary outcomes as the increase and maintenance of motivation, the reduction of drop-out rates and the management of relapses [ 43 , 46 ].

Further studies are however required to enlighten most promising treatment combinations, considering evidences of limited usefulness of combining different treatments at the same time [ 35 , 36 , 38 , 39 ]. Stronger literature support stepped-care treatments, with a rising intensity of intervention tailored on disease severity [ 40 - 43 ]. Psychotherapeutic approaches to BED, mostly based on CBT models, are recommendable as first-line treatments with the wider evidences of efficacy also at long-term follow-up, but still unclear results on weight loss [ 36 ].

Otherwise simpler and cheaper interventions like BWL treatments, psychoeducational interventions and self-help treatments have showed significant efficacy in patients with lower disease severity and less comorbidity [ 43 , 44 , 53 ]. Drug therapy, especially SSRIs can be useful in lowering eating impulsivity and improving psychiatric comorbidities [ 36 ].

Unfortunately, long-term efficacy of pharmacotherapy as a stand-alone treatment for BED needs further research, as well as long-term effects of integrated treatment combining drugs and psychotherapy [ 36 , 38 ]. Even if bariatric surgery is not a recommended treatment for BED according to current guidelines [ 79 ], its clinical relevance in BED coupled with severe obesity deserves more careful clarifications [ 80 ].

In summary, even if literature data about BED diagnosis and treatment are gradually deepening and improving in detail and significance, further studies, especially literature review and meta-analysis, are still required with major regard to long term outcomes, stepped care treatment, improving of weight loss also with surgery treatment and lowering dropout rates.

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Predicting premature termination within a randomized controlled trial for binge-eating patients. Behav Ther. Review and meta-analysis of pharmacotherapy for binge-eating disorder. Adding mindfulness to CBT programs for binge eating: a mixed-methods evaluation. Eat Disord. A randomized controlled trial for obesity and binge eating disorder: low-energy-density dietary counselling and cognitive-behavioural therapy.

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Arch gen psychiatr. Psychological Treatments for Binge Eating Disorder. Curr Psychiatry Rep. Rapid response predicts month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications. A receiver operator characteristics analysis of treatment outcome in binge eating disorder to identify patterns of rapid response. Emotion-focused therapy and dietary counselling for obese patients with binge eating disorder: a propensity score-adjusted study.

A systematic review on physical therapy interventions for patients with binge eating disorder. Disabil Rehabil. Epub Apr Does rapid response to two group psychotherapies for binge eating disorder predict abstinence? Exploring weight gain in year before treatment for binge eating disorder: a different context for interpreting limited weight losses in treatment studies.

Substantial weight gains are common prior to treatment-seeking in obese patients with binge eating disorder. Efficacy and predictors of long-term treatment success for Cognitive-Behavioural Treatment and Behavioural Weight-Loss-Treatment in overweight individuals with binge eating disorder. Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: a randomized controlled trial.

Group psychoeducational psychotherapy in Binge Eating Disorder. Minerva Psichiatr. Predictors and moderators of response to cognitive behavioural therapy and medication for the treatment of binge eating disorder. A cognitive- behavioural therapeutic program for patients with obesity and binge eating disorder: short- and long- term follow-up data of a prospective study. Behav Modif. Comparison of individual and group cognitive behavioral therapy for binge eating disorder.

A randomized, three-year follow-up study. A non-randomized direct comparison of cognitive-behavioural short- and long-term treatment for binge eating disorder. Obes Facts. Predictors for treatment outcome of binge eating with obesity: a naturalistic study. Cognitive behavioural guided self-help for the treatment of recurrent binge eating. Cognitive—behavioral guided self-help for eating disorders: Effectiveness and scalability. Clin Psychol Rev.

Randomised controlled trial of a guided self-help treatment on the Internet for binge eating disorder. The efficacy of self-help group treatment and therapist-led group treatment for binge eating disorder. Am J Psychiatry. Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition. Eur Eat Disord Rev. Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behaviour therapy adapted for binge eating to an active comparison group therapy.

A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder. Long-term efficacy of psychological treatments for binge eating disorder. Br J Psychiatry. Pharmacological management of binge eating disorder: current and emerging treatment options.

Ther Clin Risk Manag. Placebo response in binge eating disorder: a pooled analysis of 10 clinical trials from one research group. Epub Jan 8. A randomized, double-blind trial comparing sertraline and fluoxetine 6-month treatment in obese patients with Binge Eating Disorder. Prog Neuropsychopharmacol Biol Psychiatry. Bupropion versus sertraline in the treatment of depressive patients with binge eating disorder: retrospective cohort study.

Psychiatr Q. Duloxetine in the treatment of binge eating disorder with depressive disorders: a placebo-controlled trial. Duloxetine in obese binge eater outpatients: preliminary results from a week open trial. Hum Psychopharmacol.

Efficacy of topiramate in bulimia nervosa and binge-eating disorder: a systematic review. Gen Hosp Psychiatry. The EBQ is a valid and reliable measure with demonstrated psychometric properties [ 40 , 41 ]. The total score of the EBQ was used as the measure of eating beliefs in this study.

Structural equations modelling was conducted using the AMOS version 22 program [ 42 ]. According to Hu and Bentler [ 43 ], values over. The hypothesised model Model 1; see Fig. However, all other pathways described in Table 2 were significant. This model did not demonstrate acceptable fit across a number of the goodness-of-fit indices see Table 3.

Inspection of the regression weights, covariances, and correlations, as well as a discussion of the theoretical meaning of the pathways in the model between the authors, led to a series of changes to the model for the purpose of improving the fit. The final model Model 5 demonstrated good fit to the data across all the goodness-of-fit indicators see Table 3.

The regression weights for the final model are presented in Table 4 all significant and the pathways of the final model as shown in Fig. The aim of the present study was to develop and test a new psychological model of binge eating which included variables hypothesised by the leading existing cognitive and behavioural theoretical models on the maintenance of binge eating.

In particular, our model bears a number of shared variables with the models of functional analysis of binge eating [ 19 ], the transdiagnostic model of eating disorders [ 17 ], and the cognitive model of BN [ 23 ]. In addition, significant bivariate relationships were found amongst all the included variables. The originally hypothesised model did not demonstrate acceptable fit to the data, and the pathway between dietary restraint and eating beliefs was not found to be significant.

Once this non-significant pathway was removed and a number of additional pathways between variables that had strong covariances were added, a modified model demonstrated good fit to the data. Therefore, the results indicated that the final revised model Model 5; refer to Fig. We present this final model as a new way to conceptualise the maintaining factors for binge eating; that is, the integrated cognitive and behavioural model of binge eating.

The results of this study provide further support for the relationship between the predicted variables Core Low Self-Esteem, Negative Affect, Difficulty with Emotional Regulation, Dietary Restraint, and Eating Beliefs and the outcome of binge eating. In particular, the role of Core Low Self-Esteem has been highlighted as particularly important, with the significant pathways from Core Low Self-Esteem to Binge Eating being mediated through a number of direct via Dietary Restraint or Eating Beliefs and indirect via negative affect or Difficulty with Emotional Regulation pathways.

Also of interest is the strength of the bivariate relationship between Eating Beliefs and Binge Eating, as well as the strength of the relationship between Eating Beliefs and the two predicted preceding variables: Core Low Self-Esteem and Difficulty with Emotional Regulation. Of the included variables, Eating Beliefs showed the least amount of existing evidence supporting its role in the maintenance of binge eating in the literature due to its relative novelty in the field, being first proposed in whilst the other variables first appeared in the literature in between and Furthermore, the results of this study provide support for the role of dietary restraint as an important predictive factor for binge eating.

Of particular interest is the non-significant pathway between Dietary Restraint and Eating Beliefs indicating that these two variables act independently from one another. The first, mediated by Dietary Restraint, more closely resembles the pathways to binge eating hypothesised in the transdiagnostic model [ 17 ]. This first pathway could represent the type of binge eating that is more strongly maintained by a sense of loss of control and may be more commonly observed in people with restrictive eating disorders such as AN-BP and certain cases of BN.

The second, mediated by Eating Beliefs, more closely resembles the pathway to binge eating proposed in the cognitive model of BN [ 23 ]. This second type of binge eating could represent the type of binge eating that is more strongly maintained by its function to comfort and self-soothe, and may be more commonly observed in people who do not restrict their eating such as BED, certain cases of BN, and sub-clinical binge eating.

The new model presented in this paper posits that core low self-esteem is a major underlying predisposing factor for binge eating. This is in line with the functional analysis of binge eating [ 19 ], the transdiagnostic model [ 17 ], the cognitive model of BN [ 23 ], and a number of other binge eating models [ 12 ] that also identify low self-esteem as an important predisposing factor for the development of binge eating.

The new model proposes that when core low self-esteem is triggered experienced as a range of feelings and beliefs, measured by negative statements about the self , negative affect is experienced in line with the cognitive model of BN [ 23 ]. The new model then suggests that a difficulty with regulating the negative affect is experienced, and as such, the individual responds in one of two ways:.

Beliefs about eating are activated and themselves trigger binge eating as a means of functionally coping with negative affect as in the cognitive model of BN [ 23 ]. In addition to synthesising the main evidence-based variables hypothesised to lead to and maintain binge eating, the new model presented in this paper also offers some unique insights into the way in which these variables relate to one another to lead to binge eating, above and beyond what has already been demonstrated in previous studies.

The relevance and necessity of dietary restraint in the development and maintenance of binge eating has been contested in the literature and amongst clinicians [ 19 , 45 ]; the dual pathway presented in this new model provides an alternative in that binge eating can be triggered either by restrained eating or by the activation of particular beliefs about eating.

Furthermore, the new model presented in this paper provides an integrated cognitive-behavioural model of binge eating which is transdiagnostic, and focused on behavioural symptoms rather than simply the presence or absence of a diagnosis. It is important to note that the results of this study need to be interpreted in the context of a number of limitations. Firstly, the results are limited by the instruments used to measure the variables and associated constructs.

For example, both binge eating and dietary restraint were measured by the same instrument, the EDE-Q, and therefore it is possible that the relationship between these two variables might have been artificially enhanced due to the fact that they were measured together. Also, the instruments used assess different time periods, for example, while the EDE-Q assesses symptoms experienced over the previous days, the items in the DASS refer to the past week.

Therefore, in order to be able to more accurately assess if binge eating behaviours are occurring at the same time as negative affect it is recommended that future studies utilise measures referring to the same period of time and to test the model with a range of different measures for each factor.

Future research should also assess the stability of the model fit if alternative questionnaires are used to measure the proposed predictive variables. This is especially important with regard to the measurement of binge eating, as the EDE-Q has received some criticism with regard to the accuracy of the measurement of binge eating [ 33 , 34 , 46 ].

Secondly, the participants included in this study were non-clinical, and the eating disorder symptoms including binge eating were based on a self-report measure. Furthermore, it is important to emphasise that this paper represents a preliminary investigation of this new model, and further research is required to assess the utility and validity of this new model in longitudinal research and in intervention-based research.

Based on the existing literature, a cognitive and behavioural model of transdiagnostic binge eating was developed and tested. The resultant model provides a good fit to the data and offers a novel way to conceptualise binge eating that supports, integrates, and builds upon the current existing psychological models of binge eating.

The model can provide a framework for understanding the causal and maintenance factors of binge eating and provides several areas for intervention. Based on the model, treatments that target the core low self-esteem and improve emotional regulation skills are likely to lead to reductions in binge eating.

Results presented here are preliminary, and further investigation is required to assess the accuracy and the clinical utility of the model for individuals seeking treatment for binge eating. American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord. Article Google Scholar. Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia.

PLoS One. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. The prevalence and correlates of binge eating disorder in the World Health Organization world mental health surveys.

Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort. Aust N Z J Psychiatry. How abnormal is binge eating? Acta Psychiatr Scand. Prevalence and correlates of binge eating disorder related features in the community.

Comorbid psychopathology in binge eating disorder: relation to eating disorder severity at baseline and following treatment. J Consult Clin Psychol. The clinical significance of binge eating disorder. Int J Eat Disord. Cognitive-behavioral theories of eating disorders. Behav Modif. Conceptualising binge eating: a review of the theoretical and empirical literature. Behav Chang. Herman CP, Mack D. Restrained and unrestrained eating.

J Pers. Polivy J, Herman CP. Dieting and binging: A causal analysis. Am Psychol. Stice E, Burger K. Dieting as a risk factor for eating disorders. The Wiley handbook of eating disorders. The clinical features and maintenance of bulimia nervosa. Behav Res Ther. Dual pathway model of bulimia nervosa: longitudinal support for dietary restraint and affect-regulation mechanisms.

J Soc Clin Psychol. McManus F, Waller G. A functional analysis of binge-eating. Clin Psychol Rev. Cognitive content in bulimic disorders: Core beliefs and eating attitudes. Eat Behav. Binge eating as escape from self-awareness. Psychol Bull. Binge eating: nature, assessment, and treatment. A cognitive model of bulimia nervosa.

Br J Clin Psychol. The importance of distinguishing between the different eating disorders sub types when assessing emotion regulation strategies. Psychiatry Res. Binge antecedents in bulimic syndromes: an examination of dissociation and negative affect.

Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: a conceptual review of the empirical literature. Emotion regulation model in binge eating disorder and obesity-a systematic review. Neurosci Biobehav Rev. Binge eating in binge eating disorder: a breakdown of emotion regulatory process?

Cognitive content among bulimic women: the role of core beliefs. Schema modes in eating disorders compared to a community sample. Waller G. Schema-level cognitions in patients with binge eating disorder: a case control study. A cross-sectional analysis of the cognitive model of bulimia nervosa. Assessment of eating disorders: interview or self-report questionnaire? PubMed Google Scholar. Psychometric evaluation of self-report measures of binge eating symptoms and related psychopathology: a systematic review of the literature.

Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. The structure of negative emotional states: comparison of the depression anxiety stress scales DASS with the Beck depression and anxiety inventories.

Psychometric properties of the item and item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess. Fairchild H, Cooper M. A multidimensional measure of core beliefs relevant to eating disorders: preliminary development and validation. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale.

J Psychopathol Behav Assess. The revised short-form of the eating beliefs questionnaire: measuring positive, negative, and permissive beliefs about binge eating. Beliefs about binge eating: psychometric properties of the eating beliefs questionnaire EBQ in eating disorder, obese, and community samples.

Arbuckle J. AMOS Hu Lt BPM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J. Kenny DA. Measuring model fit.

SPORT DISSERTATION PROPOSAL

The first, mediated by Dietary Restraint, more closely resembles the pathways to binge eating hypothesised in the transdiagnostic model [ 17 ]. This first pathway could represent the type of binge eating that is more strongly maintained by a sense of loss of control and may be more commonly observed in people with restrictive eating disorders such as AN-BP and certain cases of BN.

The second, mediated by Eating Beliefs, more closely resembles the pathway to binge eating proposed in the cognitive model of BN [ 23 ]. This second type of binge eating could represent the type of binge eating that is more strongly maintained by its function to comfort and self-soothe, and may be more commonly observed in people who do not restrict their eating such as BED, certain cases of BN, and sub-clinical binge eating.

The new model presented in this paper posits that core low self-esteem is a major underlying predisposing factor for binge eating. This is in line with the functional analysis of binge eating [ 19 ], the transdiagnostic model [ 17 ], the cognitive model of BN [ 23 ], and a number of other binge eating models [ 12 ] that also identify low self-esteem as an important predisposing factor for the development of binge eating.

The new model proposes that when core low self-esteem is triggered experienced as a range of feelings and beliefs, measured by negative statements about the self , negative affect is experienced in line with the cognitive model of BN [ 23 ].

The new model then suggests that a difficulty with regulating the negative affect is experienced, and as such, the individual responds in one of two ways:. Beliefs about eating are activated and themselves trigger binge eating as a means of functionally coping with negative affect as in the cognitive model of BN [ 23 ]. In addition to synthesising the main evidence-based variables hypothesised to lead to and maintain binge eating, the new model presented in this paper also offers some unique insights into the way in which these variables relate to one another to lead to binge eating, above and beyond what has already been demonstrated in previous studies.

The relevance and necessity of dietary restraint in the development and maintenance of binge eating has been contested in the literature and amongst clinicians [ 19 , 45 ]; the dual pathway presented in this new model provides an alternative in that binge eating can be triggered either by restrained eating or by the activation of particular beliefs about eating. Furthermore, the new model presented in this paper provides an integrated cognitive-behavioural model of binge eating which is transdiagnostic, and focused on behavioural symptoms rather than simply the presence or absence of a diagnosis.

It is important to note that the results of this study need to be interpreted in the context of a number of limitations. Firstly, the results are limited by the instruments used to measure the variables and associated constructs. For example, both binge eating and dietary restraint were measured by the same instrument, the EDE-Q, and therefore it is possible that the relationship between these two variables might have been artificially enhanced due to the fact that they were measured together.

Also, the instruments used assess different time periods, for example, while the EDE-Q assesses symptoms experienced over the previous days, the items in the DASS refer to the past week. Therefore, in order to be able to more accurately assess if binge eating behaviours are occurring at the same time as negative affect it is recommended that future studies utilise measures referring to the same period of time and to test the model with a range of different measures for each factor.

Future research should also assess the stability of the model fit if alternative questionnaires are used to measure the proposed predictive variables. This is especially important with regard to the measurement of binge eating, as the EDE-Q has received some criticism with regard to the accuracy of the measurement of binge eating [ 33 , 34 , 46 ]. Secondly, the participants included in this study were non-clinical, and the eating disorder symptoms including binge eating were based on a self-report measure.

Furthermore, it is important to emphasise that this paper represents a preliminary investigation of this new model, and further research is required to assess the utility and validity of this new model in longitudinal research and in intervention-based research.

Based on the existing literature, a cognitive and behavioural model of transdiagnostic binge eating was developed and tested. The resultant model provides a good fit to the data and offers a novel way to conceptualise binge eating that supports, integrates, and builds upon the current existing psychological models of binge eating.

The model can provide a framework for understanding the causal and maintenance factors of binge eating and provides several areas for intervention. Based on the model, treatments that target the core low self-esteem and improve emotional regulation skills are likely to lead to reductions in binge eating. Results presented here are preliminary, and further investigation is required to assess the accuracy and the clinical utility of the model for individuals seeking treatment for binge eating.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord. Article Google Scholar. Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia. PLoS One. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.

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Download references. The authors declare that this research received no specific grant from any funding agency in the public, commercial or nor-for-profit sectors. You can also search for this author in PubMed Google Scholar. AB prepared the manuscript. MA and AB were involved in the conception and design of the study, the analysis and interpretation of the data. MA contributed to the revision of the manuscript. All authors read and approved the final manuscript.

Correspondence to Maree J. All participants were provided with a participant information statement and provided their consent to participate in the study. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Burton, A.

Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating. J Eat Disord 7, 18 Download citation. Received : 26 November Accepted : 12 May Published : 07 June Skip to main content. Search all BMC articles Search. Download PDF. If no measures were available for a particular time, then the baseline value was used. Exploratory analyses of nonspecific predictors and moderators included using all baseline measures as potential predictors and moderators of remission from binge eating.

Logistic regression was used, and center, negative affect status, and all interactions were also included in the model. Figure 1 summarizes the flow of participants through the study. Patients were considered dropouts if they missed 3 consecutive sessions for nonemergency reasons or wished to terminate treatment at any point. Of the latter, some were willing to participate in subsequent assessments, whereas others were not.

Interpersonal psychotherapy was unaffected by negative affect. There were no site differences for dropout rate or assessment completion at posttreatment. There were no significant site differences on baseline patient characteristics. Similarly, no differences were found on the EDE subscales of eating, weight, or shape concerns nor for BDI or the self-esteem scale. The hypothesized moderator effect of negative affect did not reach statistical significance Table 2. Table 3 summarizes the weight and global EDE outcomes at each assessment for all treatments.

Remission from binge eating was associated with a significantly greater percent change in weight. In both instances, high negative affect resulted in less improvement. At 1 year, no significant differences among treatments on any measure of binge eating were found. There was no relationship between sustained remission from binge eating and percent change in weight at 1 year. No significant moderator effect of negative affect subtype on remission from binge eating was found Table 2.

Behavioral weight loss was no longer significantly different from the other treatments in terms of weight loss. There were no site differences on measures of binge eating or weight. There was no significant association between sustained remission from binge eating and percent change in weight.

Patients with low self-esteem who underwent BWL fared much worse than those with high self-esteem in the context of both high and low global EDE score Figure 3. Patients with both low self-esteem and high EDE score did worse. Prior studies comparing BWL with a specialty treatment for BED have been limited by small sample sizes, inadequate measurement of BED, and the absence of longer-term follow-up.

The current study has the largest sample size and longest follow-up of any controlled outcome study of carefully assessed BED to date. Consistent with some previous studies, 11 , 13 ours found no difference among the 3 interventions at posttreatment on binge eating; specific eating disorder psychopathology of body weight, shape, and eating concern; or general psychopathology.

Devlin et al, 37 , 38 in a randomized double-blind placebo-controlled study, found that the addition of CBT—but not antidepressant medication—to BWL treatment significantly enhanced outcomes at posttreatment and month follow-up. Our dropout rate for BWL was consistent with previous research. This might also explain the difference in suitability ratings. Additional evidence of the specificity of treatment effects with BED derive from our moderator analyses.

At the 2-year follow-up, low self-esteem undermined the effects of BWL in eliminating binge eating, but had no influence on IPT. Guided self-help based on CBT was unaffected by low self-esteem in patients with low global EDE scores, but was substantially less effective in interaction with high EDE scores.

Although self-esteem emerged as a moderator, we did not find, as hypothesized, that negative affect defined by the BDI moderated outcome. Prior studies showing that negative affect predicted treatment outcome defined the construct in terms of both BDI and Rosenberg Self-Esteem Scale scores derived from cluster analyses. The novel finding that global EDE score moderated treatment outcome is consistent with a latent class analysis of the patients with BED described here, in which Sysko et al 40 found 4 different latent classes within the sample.

The one characterized by the most specific eating disorder psychopathology ie, most severe objective and subjective bulimic episodes and highest body shape and weight concerns , which would be reflected in high global EDE scores, responded the most to IPT. Overall CBTgsh did not differ in outcome from the intensive specialty treatment IPT , though its attrition rate was higher.

Moreover, overall CBTgsh fared as well as IPT despite patients' significantly lower initial suitability ratings and expectations about its effectiveness as a treatment for BED. Given its brevity and advantages in disseminability to a wider range of health providers than a specialty therapy, CBTgsh is a cost-effective treatment of BED.

Other research has shown that nonspecialists can effectively deliver CBTgsh for binge eating, though specific competencies of therapists in particular service settings remain unclear. Unlike BWL, it was unaffected by low self-esteem unless this was combined with a high level of specific eating disorder psychopathology. Behavioral weight loss treatment produced significantly increased dietary restraint and reduction in body weight at posttreatment.

The latter 3. Whereas some showed no effect of binge eating status on BWL treatment, 44 , 45 others indicated either a negative 6 , 46 or even positive effect 12 on weight loss. Collectively, these studies pose problems of interpretation owing to small sample sizes, self-report measures of binge eating, and a focus on binge eating rather than on the formal BED diagnosis. Despite high rates of improvement in patients with BED in terms of binge eating, specific eating disorder characteristics, and more general psychopathology, effective methods for producing longer-term weight loss remain elusive.

Consistent with previous research, 4 patients who had ceased binge eating lost more mean percent weight than those who continued to binge at posttreatment. At follow-up, the difference disappeared. Patients with sustained remission from binge eating did not show greater mean percent weight loss than those never in remission during the 2 years of follow-up. The study had limitations.

Treatment at both sites was delivered within the context of specialty eating disorder clinics. Accordingly, the generalizability of our results to other populations and treatment in nonspecialist settings is limited. Strengths of the study include its large sample size, rigorous assessment of BED, and absence of any treatment differences across sites despite the different degrees of experience with the treatments at the Rutgers University and Washington University clinics.

Our findings show that all 3 treatments had similar outcomes on binge eating at posttreatment, with IPT showing the lowest attrition. At the 2-year follow-up, both those undergoing IPT and CBTgsh not only successfully maintained their improvement but had significantly superior improvement compared with those in the BWL group, who had substantial relapse, with no differences in body mass index across treatments.

Correspondence: G. Submitted for Publication: December 11, ; final revision received March 12, ; accepted April 24, Additional Contributions: Christopher G. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. View Large Download. Table 1. Baseline Measures Across Centers and Treatments. Yanovski SZ Binge eating disorder and obesity in could treating an eating disorder have a positive effect on the obesity epidemic?

Behav Ther ;25 2 Google Scholar Crossref. Grilo CMMasheb RM A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge-eating disorder. Grilo CMMasheb RMSalant SL Cognitive behavioral therapy guided self-help and orlistat for the treatment of binge eating disorder: a randomized, double-blind, placebo-controlled trial. Grilo CM Guided self-help for binge-eating disorder. Psychother Res ;8 4 Google Scholar Crossref.

Fairburn CG Interpersonal psychotherapy for bulimia nervosa. Handbook of Treatment for Eating Disorders. Binge Eating: Nature, Assessment, and Treatment. Rosenberg M Conceiving of the Self. Obes Res ;15 7 Google Scholar Crossref.

Sysko RWalsh BT A critical evaluation of the efficacy of self-help interventions for the treatment of bulimia nervosa and binge-eating disorder. Obes Res ;14 7 Google Scholar Crossref. Save Preferences. Privacy Policy Terms of Use. This Issue. Citations View Metrics. Original Article. January Wilfley, PhD ; W. Bryson, MA, MS. Interpersonal Psychotherapy.

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Beat is the UK's eating disorder charity. We exist to end the pain and suffering caused by eating disorders. We are a champion, guide and friend to anyone. The robust relationship between BED and obesity prompted researchers in many fields such as eating disorders, addictions, pediatrics, cardiology. The proposed model of binge eating was developed, models of binge eating, this study presents a new integrated cognitive and behavioural.