W. Stewart Agras

Predicting onset and cessation of bulimic behaviors during adolescence : A longitudinal grouping analysis

Because research has not examined the predictors of the onset and cessation of specific bulimic behaviors, the present study tested whether a series of putative risk factors predicted the onset and cessation of binge eating and compensatory behaviors over a 9-month period in a community sample of female adolescents (N = 218). Greater perceived social pressure to be thin, internalization of the thin-ideal, body dissatisfaction, dieting, and negative affect predicted the onset of binge eating and compensatory behaviors. Further, lower thin-ideal internalization, body dissatisfaction, and dieting predicted the cessation of these behaviors. Multivariate analyses suggested that this set of risk factors predicted the onset of binge eating and compensatory behaviors, but showed weaker relations to the cessation of these behaviors. Results support the assertion that these variables constitute risk factors for the development of bulimic behaviors, but suggest that somewhat different processes may serve to maintain bulimic symptoms.

The emotional eating scale: The development of a measure to assess coping with negative affect by eating

The development of the Emotional Eating Scale (EES) is described. The factor solution replicated the scales construction, revealing Anger/Frustration, Anxiety, and Depression subscales. All three subscales correlated highly with measures of binge eating, providing evidence of construct validity. None of the EES subscales correlated significantly with general measures of psychopathology. With few exceptions, changes in EES subscales correlated with treatment-related changes in binge eating. In support of the measures discriminant efficiency, when compared with obese binge eaters, subscale scores of a sample of anxiety-disordered patients were significantly lower. Lack of correlation between a measure of cognitive restraint and EES subscales suggests that emotional eating may precipitate binge episodes among the obese independent of the level of restraint.

Psychological Treatments of Binge Eating Disorder

CONTEXT Interpersonal psychotherapy (IPT) is an effective specialty treatment for binge eating disorder (BED). Behavioral weight loss treatment (BWL) and guided self-help based on cognitive behavior therapy (CBTgsh) have both resulted in short-term reductions in binge eating in obese patients with BED. OBJECTIVE To test whether patients with BED require specialty therapy beyond BWL and whether IPT is more effective than either BWL or CBTgsh in patients with a high negative affect during a 2-year follow-up. DESIGN Randomized, active control efficacy trial. SETTING University outpatient clinics. PARTICIPANTS Two hundred five women and men with a body mass index between 27 and 45 who met DSM-IV criteria for BED. Intervention Twenty sessions of IPT or BWL or 10 sessions of CBTgsh during 6 months. MAIN OUTCOME MEASURES Binge eating assessed by the Eating Disorder Examination. RESULTS At 2-year follow-up, both IPT and CBTgsh resulted in greater remission from binge eating than BWL (P < .05; odds ratios: BWL vs CBTgsh, 2.3; BWL vs IPT, 2.6; and CBTgsh vs IPT, 1.2). Self-esteem (P < .05) and global Eating Disorder Examination (P < .05) scores were moderators of treatment outcome. The odds ratios for low and high global Eating Disorder Examination scores were 2.8 for BWL, 2.9 for CBTgsh, and 0.73 for IPT; for self-esteem, they were 2.4 for BWL, 1.9 for CBTgsh, and 0.9 for IPT. CONCLUSIONS Interpersonal psychotherapy and CBTgsh are significantly more effective than BWL in eliminating binge eating after 2 years. Guided self-help based on cognitive behavior therapy is a first-line treatment option for most patients with BED, with IPT (or full cognitive behavior therapy) used for patients with low self-esteem and high eating disorder psychopathology. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00060762.

Dissonance prevention program decreases thin‐ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment

OBJECTIVE Because psychoeducational primary prevention programs for eating disorders have met with little success, this preliminary experiment tested a dissonance-based targeted preventive intervention. METHOD Female undergraduates (N = 30) with elevated body image concerns were assigned to a three-session intervention, wherein they voluntarily argued against the thin ideal, or a delayed-intervention control condition. Participants completed a baseline, termination, and a 1-month follow-up survey. RESULTS The intervention resulted in a subsequent decrease in thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptomatology, with most changes remaining at the 1-month follow-up. DISCUSSION These preliminary results suggest that this dissonance-based targeted prevention intervention reduces bulimic pathology and known risk factors for eating disturbances, and provide experimental support for the claim that thin-ideal internalization contributes to body dissatisfaction, dieting, negative affect, and bulimic symptoms.

Obesity, binge eating and psychopathology: Are they related?

Obese female subjects with binge eating disorder BED; (N = 107) completed the Beck Depression Inventory, Symptom Checklist-90, Inventory of Interpersonal Problems, and Rosenberg Self-Esteem Scale. Subjects were divided into moderate or severe binger on the basis of scores on the Binge Eating Scale, and grouped into moderately or severely obese by performing a median split on their weights. Spearman correlational analyses were performed to determine the relationship between psychopathology and obesity and psychopathology and binge eating. Analyses of variance (ANOVAs) were then performed using scores on the psychological measures with subjects grouped both by severity of obesity and severity of binge eating. The results indicated that in our sample, obesity and scores on the measures of psychiatric symptomatology were unrelated. However, a significant positive relationship was found between binge eating severity and degree of psychiatric symptomatology. We suggest that binge eating may account for the observed relationship between obesity and psychopathology reported in previous studies. We discuss the importance of assessing BED when conducting research with obese individuals.

Test-retest reliability of the eating disorder examination.

OBJECTIVE The purpose of this investigation was to determine the test-retest reliability of the Eating Disorder Examination (EDE). METHOD This study examined the test-retest and interrater reliability of the EDE in 20 adult women with a range of eating disorder symptoms. Trained assessors administered the EDE to participants on two separate occasions, ranging from 2 to 7 days apart. RESULTS Test-retest correlations were.7 or greater for all subscales and measures of eating disorder behaviors except for subjective bulimic episodes and subjective bulimic days. Interrater reliability was uniformly high with correlations above.9. DISCUSSION Results provide further support for the reliability of the EDE, but suggest that smaller binge episodes may not be reliable indicators of eating pathology.

The effects of caloric deprivation and negative affect on binge eating in obese binge-eating disordered women

Sixty obese women meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV ; American Psychiatric Association, 1994 ) research criteria for binge-eating disorder were randomly allocated either to a 14-hour period of caloric deprivation or to no deprivation. These women were then randomized within each deprivation condition to an induced negative or neutral mood before being served a multi-item buffet. Negative mood, but not caloric deprivation, significantly increased loss of control over eating. For self-defined binges, negative mood, but not caloric deprivation, significantly increased the occurrence of binge eating. However, for investigatordefined binges, both deprivation and negative mood increased the occurrence of binge eating. Caloric deprivation also led participants to eat significantly more during the buffet, but not over the laboratory day. Fat intake was significantly higher in both self-defined and investigator-defined binges as compared to overeating episodes. For those in the negative mood condition, anxiety had significantly declined by the end of the buffet.

Behavioral Validation, Precursors, and Concomitants of Picky Eating in Childhood

OBJECTIVES To validate the concept of parent-reported picky eating using objective, laboratory-based measures and to identify both child and parental precursors and concomitants of picky eating. METHOD One hundred thirty-five infants were monitored from birth to 5.5 years. Behavioral measures of picky eating were obtained from standardized feedings at ages 3.5 and 5.5 years in the laboratory and at home. Child precursors were measures of infant sucking behavior; parental precursors were disinhibition of eating, restrained eating, body dissatisfaction, and body mass index. Parentally reported attitudes and behaviors thought to be related to pickiness and parental concomitants were taken from the Stanford Feeding Questionnaire. Child Temperament was assessed by the Childrens Behavior Questionnaire. RESULTS Picky eaters ate fewer foods and were especially more likely to avoid vegetables. Picky girls decreased their caloric intake between ages 3.5 and 5.5, whereas all other children increased their caloric intake. None of the included parental precursors was significantly related to pickiness. Picky eaters demonstrated a different sucking pattern with fewer sucks per feeding session at weeks 2 and 4. Finally, picky children displayed more parent-reported negative affect than nonpicky children. CONCLUSIONS Parentally reported picky eating is associated with a consistent pattern of inhibited and selective eating beginning in infancy.

Binge eating in females: A population-based investigation†

Four hundred fifty-five females from a community-bgased, randomly sampled population were interviewed by telephone to estimate the prevalence of binge eating and to describe demographic and topographical characteristics of binge eating behaviour. Binge eaters were classified according to the DSM-111-R criteria for bulimia, excluding purging behavior. The estimate for subjects meeting criteria was 1.8%, while the percentage of females who met all but frequency criteria was estimated at 3.8%. The majority of binge eaters in this study was found to engage in behaviors typically associated with binge eating episodes. On average, this group of binge eaters was older and heavier than has been reported previously, which supported observed associations between binge eating and overweight in clinical populations [Telch, Agras, & Rossiter (1988). International Journal of Eating Disorders, 7, 115-119].

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.