Elise M. Rossiter

Binge eating increases with increasing adiposity

Self-report and interview data were obtained from 81 obese patients to evaluate the distribution of binge eating, defined by DSM-III criteria for bulimia, across a range of adiposity. Binge eating was found to be significantly more prevalent as the degree of obesity increased.

Cluster B personality disorder characteristics predict outcome in the treatment of bulimia nervosa

The Personality Disorders Examination (PDE) was administered to 71 bulimia nervosa patients at baseline assessment in a study comparing the effectiveness of cognitive-behavioral treatment with desipramine or the combination of both treatments. Personality disorder subscales were combined into single DSM-III-R cluster scores. A high cluster B score (consisting of antisocial, borderline, histrionic, and narcissistic features) significantly predicted poor outcome at 16 weeks and was a better predictor of outcome than borderline personality characteristics alone or any other DSM-III-R cluster score or combination of cluster scores. In contrast pretreatment depression level, self-esteem, degree of dietary restraint, frequency of purging, and history of anorexia nervosa were not significantly related to outcome. At 1-year follow-up there was still a trend toward high cluster B scores predicting poor treatment outcome. Cluster B score was not significantly correlated with percentage of sessions attended nor did subjects with higher cluster B scores have a better outcome with either specific treatment. These results suggest that further investigation of alternative treatments is warranted with high cluster B individuals to determine if treatment effectiveness can be improved.

An empirical test of the DSM-III-R definition of binge

Caloric consumption during 343 binges was calculated from the 7-day, self-monitored food records of 32 subjects with bulimia nervosa. A second analysis was performed that examined only the first two binges recorded by each subject in order to control for the unequal number of binges among subjects. The results of these analyses were similar with subjects consuming, on average, 1200 kilocalories during episodes of binge eating with a standard deviation of approximately 1000 kilocalories. Twenty-eight percent of binges consisted of fewer than 500 kilocalories and another 28% consisted of 501 to 1000 kilocalories. The within-subject ranges of caloric intake during binge eating episodes averaged 1905 kilocalories with only three of 32 subjects having a range <850 kilocalories. These findings suggest that both among and within patients with bulimia nervosa there is much variability in the number of kilocalories consumed during episodes of binge eating with most subjects exhibiting both large and small binges. On the basis of these findings, we recommend that future additions of the DSM be modified to de-emphasize the importance of the size of eating binges.

Bulimia nervosa and dietary restraint.

Patients with bulimia nervosa were compared with non-bulimic restrained and unrestrained eaters on several questionnaire and interview measures related to eating patterns, preoccupation with dieting and food, and general psychopathology. Bulimic subjects did not differ significantly from non-bulimic restrained eaters on measures of fear of weight gain, dietary restraint, and the Eating Disorders Inventory (EDI) subscales of Drive for Thinness and Body Dissatisfaction, although both groups scored significantly higher on these measures than unrestrained eaters. Subjects with bulimia nervosa differed significantly from both restrained and unrestrained eaters on the Eating Habits Checklist, the Beck Depression Inventory, the EDI total score and Interoceptive Awareness, Introversion and Bulimia subscales, the Three Factor Eating Questionnaire (TFEQ), Disinhibition subscale and the Symptom Checklist 90-revised version. These findings show that bulimic patients may be quite similar to their restrained, non-bulimic counterparts on dietary concern and ideals of slenderness and suggest the importance of including a restrained control group in attempts to isolate the variables that differentiate individuals with the clinical eating disorder from their peers who demonstrate normative discontent about body weight and shape.

Nonpurging bulimia: a distinct subtype of bulimia nervosa

Bulimics whose primary method of purgation was self-induced vomiting (purgers) were compared to bulimics who did not purge (nonpurgers), using standardized diagnostic instruments. Differences in eating patterns, demographic characteristics, past and present DSM-III-R diagnoses, mood and personality traits were found. Purgers were younger, more likely to be single, and binged more frequently than nonpurgers. More purgers had Major Depression, Panic Disorder, or past Anorexia Nervosa than did nonpurgers. Purgers scored higher on the narcissistic, masochistic (self-defeating), and borderline scales of the Personality Disorders Examination. In contrast, nonpurgers were more likely to be overweight and have history of substance abuse than purgers. These findings support the view that nonpurging bulimics constitute a distinct clinical group, and suggest that differences between purging and nonpurging bulimics may reflect differences in core pathology.

Dietary restraint of bulimic subjects following cognitive-behavioral or pharmacological treatment

Abstract The pre and posttreatment self-monitored caloric intake of bulimic subjects treated with either cognitive-behavioral therapy or imipramine was compared. Results indicated that both groups equally and successfully reduced purged calories but that only cognitive-behaviorally treated subjects increased non-purged caloric intake. These results show that cognitive-behavioral treatment lessens dietary restraint whereas imipramine treatment of bulimia nervosa does not. These findings are discussed and it is suggested that they may account for the superior therapeutic maintenance following cognitive-behavioral treatment when compared with pharmacological treatment of bulimia nervosa.

Comparing the cost effectiveness of psychiatric treatments: bulimia nervosa

We conducted an exploratory post hoc study that compared the cost effectiveness of five treatments for bulimia nervosa: 15 weeks of cognitive behavioral therapy (CB) followed by three monthly sessions, 16 weeks (Med16) and 24 weeks (Med24) of desipramine (< or = 300 mg/day), and CB combined with desipramine for those durations (Combo16 and Combo24). We illustrate how a treatments cost effectiveness varies according to when evaluation is done and how effectiveness and cost are defined. At 32 weeks, Med16 appears the most cost-effective treatment, and Combo16 appears the least. At 1 year, Med24 appears the most cost-effective treatment, and Combo16 appears the least. Using this post hoc analysis as an example, we discuss the pitfalls and limitations of cost-effectiveness analysis of psychiatric treatments.

Changes in self-reported food intake in bulimics as a consequence of antidepressant treatment

Twenty females with bulimia nervosa over the age of 18 monitored their eating behavior and purge frequency for 1 week before and after 16 weeks of treatment with imipramine or placebo using a standard diary. There was a significantly greater decrease in purged calories for subjects in the imipramine group once pretreatment group differences were covaried out, confirming the action of imipramine on binge eating. Subjects in both groups consumed approximately 1000 kcal/day excluding purged calories with no significant difference between groups on this measure. Nonpurged caloric intake did not increase over time, indicating continuation of a highly restricted eating pattern following medication treatment. During binges subjects in both groups combined, before and after treatment, consumed an average of 1485 kcal, although there was considerable variability associated with this mean.