ABSTRACT
BACKGROUND: The long-term efficacy of psychological treatments for binge eating disorder remains largely unknown. AIMS: To examine the long-term efficacy of out-patient group cognitive-behavioural therapy (CBT) and group interpersonal psychotherapy (IPT) for binge eating disorder and to analyse predictors of long-term non-response. METHOD: Ninety people with binge eating disorder were assessed 4 years after treatment cessation within a randomised trial (trial registration: NCT01208272). RESULTS: Participants showed substantial long-term recovery, partial remission, clinically significant improvement and significant reductions in associated psychopathology, despite relapse tendencies in single secondary outcomes. Body mass index remained stable. While the IPT group demonstrated an improvement in eating disorder symptoms over the follow-up period, the CBT group reported a worsening of symptoms, but treatments did not differ at any time point. CONCLUSIONS: The results document the long-term efficacy of out-patient CBT and IPT for binge eating disorder. Further research is warranted to elucidate the time course and mechanisms of change of these treatments for binge eating disorder.
Subject(s)
Binge-Eating Disorder/therapy , Cognitive Behavioral Therapy/methods , Models, Statistical , Psychotherapy, Group/methods , Adult , Ambulatory Care , Binge-Eating Disorder/psychology , Body Mass Index , Female , Follow-Up Studies , Humans , Interpersonal Relations , Male , Middle Aged , Psychiatric Status Rating Scales , Secondary Prevention , Time Factors , Treatment Outcome , Weight LossABSTRACT
Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affect regulation) are re-interpreted from the standpoint of negative social evaluation thereby further explicating IPT's efficacy as an intervention for individuals with an eating disorder.
Subject(s)
Feeding and Eating Disorders/therapy , Interpersonal Relations , Psychotherapy/methods , Affect , Feeding and Eating Disorders/psychology , Humans , Models, Psychological , Self Concept , Social PerceptionABSTRACT
OBJECTIVE: A goal of the DSM-IV revision is to increase clinical and research utility by improving diagnostic validity through reliance on empirical evidence. Currently defined eating disorder (ED) categories have limited validity and require refinement based on data. METHOD: The available scientific evidence is considered in evaluating the current ED nosology. RESULTS: Specific recommendations include modifying ED classification by retaining categories but adding a dimensional component; removing the amenorrhea criterion for anorexia nervosa (AN); removing the subtypes for AN and bulimia nervosa (BN); making binge eating disorder (BED) an official diagnosis; and unifying the frequency and duration cut-points for BN and BED to once per week for 3 months. Priority research areas should include epidemiologic studies of full-range ED symptomatology and should focus on empirical validation for individual criterion. CONCLUSION: There are significant issues to address in revising ED nosology as we move toward a more valid and useful DSM-V.
