Kathleen L. Eldredge

Effectiveness of an Internet-Based Program for Reducing Risk Factors for Eating Disorders

This study evaluated an Internet-delivered computer-assisted health education (CAHE) program designed to improve body satisfaction and reduce weight/shape concerns--concerns that have been shown to be risk factors for the development of eating disorders in young women. Participants were 60 women at a public university randomly assigned to either an intervention or control condition. Intervention participants completed the CAHE program Student Bodies. Measures of body image and disordered eating attitudes were assessed at baseline, postintervention, and 3-month follow-up. At follow-up, intervention participants, compared with controls, reported a significant improvement in body image and a decrease in drive for thinness. This program provides evidence for the feasibility and effectiveness of providing health education by means of the Internet.

Weight loss, cognitive-behavioral, and desipramine treatments in binge eating disorder. An additive design

The aim of this study was to compare the effects of weight loss treatment, cognitive-behavioral treatment, and desipramine on binge eating and weight in a three group additive design involving 108 overweight participants with binge eating disorder. Subjects were allocated at random to either 9-months weight-loss-only treatment; 3-months of cognitive-behavioral treatment followed by weight loss treatment for 6-months; or the combination treatment with desipramine added for the last 6-months. After 3-months of treatment, those receiving cognitive-behavioral therapy had reduced binge eating significantly more than participants receiving weight loss therapy only, and the weight loss only group had lost significantly more weight than those in the cognitive-behavioral groups. The addition of medication did not lead to greater reductions in the frequency of binge eating. Hence, there was no evidence that either cognitive-behavioral therapy or desipramine added to the effectiveness of weight loss therapy. However, those receiving medication lost significantly more weight than the comparable group without medication at follow-up. Abstinence from binge eating was associated with significantly greater weight losses. Overall, however, the achieved weight losses were small and the abstinence rates low. Moreover, there were no differences between the three groups either at the end of treatment or at follow-up. Suggestions for further research aimed at improving the therapeutic results for this difficult clinical problem are discussed.

Weight and shape overconcern and emotional eating in binge eating disorder

OBJECTIVE This study investigated two issues: the level of weight and shape concerns, and the self-reported tendency to eat in response to negative emotions among obese individuals with binge eating disorder (BED), eating disorder not otherwise specified (EDNOS), and no eating disorder (CONTROL). METHOD On the basis of demographic and diagnostic surveys, 156 participants in a weight loss program were categorized on two dimensions, eating disorder category and weight (BED vs. EDNOS vs. CONTROL/low vs. high body mass index), yielding a 2 x 3 experimental design. RESULTS Individuals with BED reported a greater tendency to eat in response to negative mood states than CONTROL subjects and low weight EDNOS subjects, but not high weight EDNOS subjects. Weight did not influence self-reported weight and shape concerns. Individuals with BED expressed greater concern for weight and shape than non-eating disordered CONTROLs. DISCUSSION The findings suggest that overconcern with weight and shape be further investigated as a diagnostic feature of BED and that emotional eating is associated with BED but not obesity per se.

The effects of extending cognitive-behavioral therapy for binge eating disorder among initial treatment nonresponders.

OBJECTIVE The study was designed with the aim of determining whether extending group cognitive-behavioral therapy (CBT) would enhance outcome among individuals with binge eating disorder (BED) who failed to stop binge eating after an initial 12-week CBT intervention. METHOD Forty-six participants who met diagnostic criteria for BED were randomly allocated to either a 12-week group CBT intervention or a waiting list control condition. At the end of 12 weeks, treated participants who met clinical criteria for improvement subsequently received 12 sessions of behavioral weight loss. Remaining participants received 12 additional sessions of CBT for binge eating. RESULTS Fifty percent of treated participants improved with the initial 12-week course of CBT. There was a strong trend for the extension of CBT to affect improvement in binge eating among initial nonresponders (6 of 14 subjects no longer met diagnostic criteria for BED). Overall, extending CBT led to clinical improvement in 66.7% of all treated participants, with treatment gains occurring through session 20. DISCUSSION The results suggest that an extended course of CBT (i.e., longer than 12 weeks) will likely maximize the number of potential responders to treatment.

Binge eating disorder: Current state and future directions

Abstract This article reviews the empirical evidence that has been accumulated regarding Binge Eating Disorder (BED). Numerous studies have provided a fairly clear picture of the prevalence of this disorder, both in community and clinical samples. Consistent findings have also emerged concerning comorbidity of BED, especially with regard to depression and anxiety. Furthermore, several types of treatment have shown to be effective for individuals with BED. Support for the model of etiology underlying these therapeutic approaches, however, is clearly lacking. Although more research needs to be conducted, it is concluded that there is enough empirical evidence to justify the difference made in the DSM-IV between binge eaters who purge (Bulimia Nervosa) and those who do not (BED). To guide future research, however, it is suggested that a new classification of binge eating problems be adopted in DSM-V.

Binge eating syndromes: a review of assessment and treatment with an emphasis on clinical application

Binge eating is characterized by the ingestion of a large amount of food accompanied by a sense of loss of control and is pathognomonic of bulimia nervosa and binge eating disorder (BED). Research on syndromes of binge eating has burgeoned in the previous decade. This paper reviews the literature on bulimia nervosa and BED, with particular attention to issues of diagnosis, etiology, assessment, and treatment that are relevant to clinicians treating individuals with binge eating syndromes

Patterns of interpersonal problems associated with binge eating disorder

OBJECTIVE To determine if interpersonal problems reported by individuals with binge eating disorder (BED) are distinct from psychiatric norms, and whether specific types of interpersonal problems are predictive of BED treatment outcome. METHOD Subjects were 88 females with BED who completed a treatment trial for binge eating and weight loss. Pretreatment data on the Inventory of Interpersonal Problems (IIP) was compared (1) to that of psychiatric and nonpsychiatric norms and (2) for individuals with good versus poor outcome for eating disorder symptoms and weight loss. RESULTS BED patients reported less distress for problems with being too vindictive (hostile dominance) than psychiatric norms. Patients with good eating disorder outcome reported less distress for problems with social avoidance; patients with good weight loss outcome reported greater distress over problems with vindictiveness. DISCUSSION BED treatment may be enhanced by an initial focus on specific interpersonal difficulties.

An investigation of the influence of dieting and self-esteem on dietary disinhibition

Recent research on the eating behavior of restrained eaters following a dietary preload indicates that both dieting and self-esteem may influence consumption. While Polivy, Heatherton, and Herman (Journal of Abnormal Psychology, 97, 354-356, 1988) found a forced preload to lead to increased consumption by low self-esteem restrained eaters, Lowe, Whitlow, and Bellwoar (International Journal of Eating Disorders, 10, 461-471, 1991) found restrained dieters to decrease their consumption following a dietary preload. The current study was designed to investigate the influences of self-esteem and dieting on the eating behavior of restrained eaters while in a negative mood state. Subjects were 80 normal weight undergraduate women in a 2 x 2 x 2 design (Restrained/Unrestrained by Success/Failure by Low Self-Esteem/High Self-Esteem). Current dieting, though not self-esteem, was found to influence consumption. Restrained dieters consumed significantly less in a negative mood state than when in a positive mood state, while nondieters, irrespective of restraint status, consumed comparable amounts in both mood states.

Instability of restraint among clinical binge eaters: A methodological note

The Three Factor Eating Questionnaire was administered to 47 clinical binge eaters at the end of days on which they had and had not binged. Scores on each of the subscales of the questionnaire differed significantly for binge versus nonbinge days. Implications for methodological improvements in future studies are suggested.