Subtyping patients with binge-eating disorder by dietary restraint and negative affect: Characteristics and treatment outcome.

OBJECTIVE: This study examined patients with binge-eating disorder (BED) subtyped by dietary restraint (DR) and the negative affect (NA) dimension of depression, anxiety, hostility, and self-esteem, comparing clinical features and outcome of evidence-based psychological treatments. It was hypothesized that individuals with DR and high NA (DR-HNA) would have lower functioning and poorer immediate and long-term BED treatment outcomes compared to those with DR and low NA (DR-LNA). METHOD: Cluster analysis was conducted (n = 159) as a secondary analysis of data from a randomized group cognitive-behavioral therapy and interpersonal psychotherapy trial of women and men with BED. RESULTS: At pretreatment, participants with DR-HNA were higher in eating disorder and general psychopathology, emotional eating, and poor social adjustment. At post-treatment, differences in binge days between cluster groups were small and statistically nonsignificant, and differences in rates of binge-eating abstinence were only marginally significant. However, by 1-year follow-up, patients with DR-HNA had a greater increase in binge days, less abstinence from binge eating, a higher risk for relapse, and were significantly less likely to be in BED remission than those with DR-LNA. CONCLUSIONS: DR-HNA served as a predictor of poorer maintenance of BED therapeutic improvement. Future directions to better sustain outcomes among patients with DR-HNA include developing a brief measure to assess for the full construct of NA prior to and throughout treatment, enhancing BED interventions by focusing more on NA, and augmenting treatment dose. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What's driving the binge in binge eating disorder?: A prospective examination of precursors and consequences.

OBJECTIVE: Previous research, mostly using retrospective reports, indicated a relation of negative affect and dietary restraint with the occurrence of binge episodes in binge eating disorder (BED). We employed Ecological Momentary Assessment (EMA) to better understand precursors and consequences of binge eating. METHOD: Thirty-three females with BED carried a handheld computer for 7 days, and were periodically prompted to indicate their current emotions, hunger, and binge status. RESULTS: Negative mood and hunger were significantly higher at prebinge than at nonbinge times, but negative mood was even higher at postbinge. Participants attributed binge episodes to mood more frequently than to hunger or abstinence violation. CONCLUSION: The finding that negative mood is actually heightened subsequent to a binge suggests the need to further investigate what is reinforcing about a binge, including possible escape from self-awareness. Strengths of EMA technology are discussed, as well as its broad utility in BED assessment and treatment.

A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder.

BACKGROUND: Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of binge eating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BED-related symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED. METHODS: One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment. RESULTS: Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through follow-up. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients' relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up. CONCLUSIONS: Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED.