Parental feeding practices in families with children aged 2-13 years: Psychometric properties and child age-specific norms of the German version of the Child Feeding Questionnaire (CFQ).

The Child Feeding Questionnaire (CFQ) is a self-report questionnaire for assessing parental attitudes to child weight and parental feeding practices. Previous evaluations of its psychometric properties were conducted primarily with small to medium-sized samples (N < 500) and a small range of children's age. The present study aims to analyze the psychometric properties of the CFQ in a large German community sample and, for the first time, to establish normative data. Within the population-based LIFE Child study, the CFQ was administered to N = 982 mothers of 2- to 13-year-old children. Psychometric analyses on item statistics and internal consistency were conducted. Using structural equation modeling, four empirically-based factorial models of the CFQ were evaluated, and measurement invariance across child age groups and sex was examined. Age-specific norms for the CFQ subscales were computed. Item statistics were highly favorable for the majority of items, but floor and ceiling effects were found for 14 of 31 items. Internal consistency of the CFQ subscales ranged from acceptable to excellent (0.71 ≤ α ≤ 0.91), except for the subscale Perceived Responsibility (α = 0.65). Regarding factorial validity, an eight-factor model with the newly created Reward subscale provided the best fit to the data. This model was factorial invariant across child sex and adjacent age groups. Maternal and child weight status showed large effects on CFQ subscale scores. The analyses established good psychometric properties for the German version of the CFQ and confirmed an eight-factor model. The provided norms allow for the comparison of individual parental feeding practices and change over time. The CFQ's sensitivity to change and longitudinal associations of parental feeding practices and child weight status warrant further research.

Family Functioning in Adolescents with Binge-Eating Disorder.

OBJECTIVE: While the importance of family factors on the development and maintenance of adolescent anorexia and bulimia nervosa has been well documented, virtually nothing is known about these impacts in binge-eating disorder (BED). Therefore, this study sought to examine family functioning (FF) in families of adolescents with BED. METHOD: A total of 40 adolescents meeting diagnostic criteria for full-syndrome or sub-threshold BED were compared to 40 matched adolescents without any eating disorder symptoms (CG). Adolescents', mothers', and fathers' perspectives of various FF components were assessed using self-report questionnaires. RESULTS: Adolescents with BED reported significantly less emotionality and affective involvement, and lower adaptability compared to the CG, although all FF subscales fell within the normal range (T score < 60). CONCLUSIONS: This study provided evidence for decreased FF in families with an adolescent with BED. Further research is needed to clarify associations between FF and the onset and course of BED. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Cognitive and emotional functioning in binge-eating disorder: A systematic review.

OBJECTIVE: Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating and is associated with eating disorder and general psychopathology and overweight/obesity. Deficits in cognitive and emotional functioning for eating disorders or obesity have been reported. However, a systematic review on cognitive and emotional functioning for individuals with BED is lacking. METHOD: A systematic literature search was conducted across three databases (Medline, PubMed, and PsycINFO). Overall, n = 57 studies were included in the present review. RESULTS: Regarding cognitive functioning (CoF), individuals with BED consistently demonstrated higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues), whereas CoF in the context of neutral stimuli appeared to be less affected. Thus, results suggest disorder-related rather than general difficulties in CoF in BED. With respect to emotional functioning (EmF), individuals with BED reported difficulties similar to individuals with other eating disorders, with a tendency to show less severe difficulties in some domains. In addition, individuals with BED reported greater emotional deficits when compared to obese and normal-weight controls. Findings suggest general difficulties in EmF in BED. Thus far, however, investigations of EmF in disorder-relevant situations are lacking. DISCUSSION: Overall, the cross-sectional findings indicate BED to be associated with difficulties in CoF and EmF. Future research should determine the nature of these difficulties, in regards to general and disorder-related stimuli, and consider interactions of both domains to foster the development and improvement of appropriate interventions in BED.

Therapist adherence in individual cognitive-behavioral therapy for binge-eating disorder: assessment, course, and predictors.

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

Childhood loss of control eating over five-year follow-up.

OBJECTIVE: Emerging prospective evidence from mixed samples, mostly covering short-term follow-up periods, suggests that childhood loss of control (LOC) eating predicts significant impairment in mental and physical health. This study sought to investigate the natural course of childhood LOC eating over the long term and in relation to binge-eating disorder (BED) diagnosis, psychopathology, and body weight trajectory in the community. METHOD: A total of 60 children (8-13 years) with LOC eating within the past 3 months and 60 demographically matched children without LOC history were assessed with the Eating Disorder Examination adapted for Children and self-report questionnaires over a 5.5 year follow-up period. Missing data were imputed. RESULTS: Over follow-up, 38.3% of children showed persistent LOC eating, and 28.3% revealed an onset of LOC eating. Persistent LOC eating significantly predicted onset of partial-/full-syndrome BED at follow-up. Negative prognostic effects on eating disorder psychopathology, depressive symptoms, and body mass index were nonsignificant. DISCUSSION: The results indicate a moderate stability of LOC eating over the long term. LOC eating, especially if stable, was suggested as a variable risk factor of clinically relevant eating disturbances. In contrast, a prognostic value for psychopathology and body mass index was not confirmed.

The therapeutic process in psychological treatments for eating disorders: a systematic review.

OBJECTIVE: For eating disorders, a vast number of investigations have demonstrated the efficacy of psychological treatments. However, evidence supporting the impact of therapeutic process aspects on outcome (i.e., process-outcome research) has not been disentangled. METHOD: Using the Generic Model of Psychotherapy (GMP) to organize various process aspects, a systematic literature search was conducted on psychological treatment studies for anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified. RESULTS: Improved outcomes resulted for family-based treatment compared to individual treatment, for individual compared to group treatment, booster sessions, and positive patient expectations (GMP contract aspect); for nutritional counseling and exercising but not exposure with response prevention as adjunct interventions (therapeutic operations); for highly motivated patients and, to a lesser extent, for therapeutic alliance (therapeutic bond); as well as for rapid response and longer overall treatment duration (temporal patterns). Regarding other GMP aspects, studies on self-relatedness were completely lacking and in-session impacts were rarely investigated. DISCUSSION: As most studies assessed only a limited number of process aspects, the ability to draw conclusions about their overall impact regarding outcome is rather limited. Therefore, future process-outcome research is needed beyond investigations of treatment efficacy for eating disorders.

Implicit cognitive processes in binge-eating disorder and obesity.

OBJECTIVES: Binge-eating disorder (BED) is characterized by recurrent binge eating episodes, associated eating disorder and general psychopathology, and commonly occurs in obese individuals. Explicit self-esteem and explicit weight bias have been linked to BED, while little is known about implicit cognitive processes such as implicit self-esteem and implicit weight bias. METHODS: Obese participants with BED and an individually matched obese only group (OB) and normal weight control group (CG; each N = 26) were recruited from the community to examine group differences and associations in explicit and implicit self-esteem and weight bias, as well as the impact of implicit cognitive processes on global eating disorder psychopathology. Implicit cognitive processes were assessed using the Implicit Association Test. RESULTS: Significantly lower explicit self-esteem, as well as higher exposure to explicit weight bias, compared to CG and OB was found in the BED group. All groups showed positive implicit self-esteem, however, it was significantly lower in BED when compared to CG. BED and CG demonstrated equally high implicit weight bias whereas OB did not. Explicit and implicit measures were not significantly correlated. Global eating disorder psychopathology was predicted by explicit and implicit self-esteem. CONCLUSIONS: The results of the present study add to the importance of implicit self-esteem and implicit weight bias beyond explicit measures in BED, while both were previously shown to be associated with onset and maintenance of BED. In conclusion, implicit cognitive processes should be focused on in interventions for BED to investigate their impact on psychological treatments.