An exploratory study to subtype obese binge eaters by personality traits.

BACKGROUND: Obesity and binge eating disorder (BED) are prevalent conditions that severely affect the quality of life of many people in developed countries, but an effective treatment remains elusive. Personality traits have been studied extensively in this population, leading to different, and at times conflicting, results. Subtyping BED people along these features could add to our knowledge of the disorder. METHODS: We applied a two-step cluster analysis, followed by bootstrapping validation, to the Temperament and Character Inventory scores of 462 subjects affected by obesity and BED or subthreshold BED. RESULTS: We found two clusters of subjects; however, the categorization in clusters 1 and 2 did not appear to strictly overlap with the distinction between BED and subthreshold BED. The first cluster showed higher harm avoidance and a lower self-directedness. Cluster 1 patients had higher depression, higher eating impulsivity, greater problems with their body image and poorer quality of life than cluster 2 patients. CONCLUSIONS: Our results seem to confirm the heterogeneity of the binge eater population and suggest the importance of harm avoidance and self-directedness to subtype these subjects. These results could generate exploratory works regarding personality in obese people with BED to discover more targeted treatments.

Hypomania across the binge eating spectrum. A study on hypomanic symptoms in full criteria and sub-threshold binge eating subjects.

BACKGROUNDS: Obese subjects affected by binge eating can be distinguished between those showing full criteria Binge Eating Disorder (BED) and those who show binge eating of insufficient frequency to satisfy DSM criteria, or sub-threshold BED (s-BED). The present paper aims to investigate whether subjects with BED full criteria show more hypomanic symptoms than those with s-BED, after controlling for personality variables as potential confounders. METHODS: The Hypomania Checklist (HCL-32), the Beck Depression Inventory (BDI) and the Temperament and Character Inventory (TCI) were administered to 103 obese patients with binge eating. RESULTS: Full criteria BED subjects were more likely to be female and showed higher HCL-32 scores and lower scores in character dimensions (Self-directedness and Cooperativeness) compared to s-BED subjects. A logistic regression with Eating Disorder Diagnosis as outcome measure (BED or s-BED) revealed that lower Cooperativeness, higher Hypomania scores and female sex predicted having BED full criteria. LIMITATIONS: Further research is necessary to replicate these findings in a larger sample. CONCLUSIONS: Patients with more severe binge eating might be more likely to have a comorbid bipolar spectrum disorder. Hypomanic symptoms should be assessed and mood stabilizing treatment should be considered in these patients.

Oxcarbazepine for the treatment of trichotillomania.

OBJECTIVE: There is no pharmacological treatment of trichotillomania that has consistently demonstrated efficacy, although good results have been obtained with antidepressants and other drugs such as atypical antipsychotics, bupropion, lithium, and topiramate. The anticonvulsant oxcarbazepine has also been used as mood stabilizer and has been tested for treating binge eating, but there is no report on oxcarbazepine in trichotillomania. CASE: We report the case of an obese 43-year-old woman with a diagnosis of trichotillomania in comorbidity with binge eating disorder who was treated with a flexible dose of the anticonvulsant oxcarbazepine. RESULT: We administered oxcarbazepine at a dosage of 1200 mg/d, and this subject improved both in hair pulling and in eating behaviors with no relapse after 9 months. CONCLUSIONS: Further studies with a wide sample of patients are needed to prove the efficacy of oxcarbazepine and the long-term maintenance of these benefits. Relationships of trichotillomania with bipolar spectrum should also be investigated.

Duloxetine in obese binge eater outpatients: preliminary results from a 12-week open trial.

OBJECTIVE: Attempts have been made to find appropriate drug regimens to treat binge eating disorder (BED). Several reports have examined the use of selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers; both serotonin and noradrenalin reuptake inhibitors (SNRIs) have been reported to be useful for binge eating, but the available data are limited. We evaluated the efficacy of duloxetine, an SNRI, in 45 obese patients who reported binge eating. METHODS: Forty-five patients with BED or binge eating with sub-threshold symptoms (s-BED) with high eating impulsivity, received duloxetine 60-120 mg/day for 12 weeks. RESULTS: A significant reduction in number of binges/week was observed in BED patients; statistical analyses performed on the whole sample revealed significant reductions in scores on the binge eating scale (BES) and the Beck depression inventory (BDI), weight, body mass index (BMI), clinical global impression, and the bulimia scale of the eating disorder inventory-2. The reduction in BES and BDI scores was not statistically different between BED and s-BED subjects. CONCLUSIONS: Although preliminary, results from this open trial suggest that duloxetine may be a successful option to reduce binge eating and depressive symptoms in both obese BED and s-BED outpatients.

Personality trait interactions in parents of patients with borderline personality disorder: a controlled study using the Temperament and Character Inventory.

Family environment is a pathogenic factor of borderline personality disorder (BPD). However, the personality traits of patients with BPD and their parents have never been assessed using the same instrument and then examined for relationships. In the present study, we explored the temperament and character traits of BPD patients and their parents to investigate possible interactions. In total, 56 patients with BPD and their parents were evaluated with the Temperament and Character Inventory (TCI) and compared with 53 control families. Discriminant and correlation analyses indicated that subjects with BPD displayed higher levels of novelty seeking, harm avoidance, and self-transcendence and lower levels of self-directedness than control subjects. Their fathers displayed higher levels of novelty seeking and lower levels of persistence and self-directedness, and their mothers displayed lower levels of self-directedness compared with levels in control parents. In BPD families, temperament and character traits displayed high levels of discriminatory power. Novelty seeking in offspring with borderline personality disorder was significantly correlated with their mothers' novelty seeking and their fathers' self-transcendence. Self-directedness in borderline offspring was significantly correlated with both their mothers' and fathers' novelty seeking, and their self-transcendence was significantly correlated with their mothers' novelty seeking and harm avoidance. The different correlational pattern for borderline and control families is discussed. Characteristic personality patterns were found in BPD offspring and in both parents. The relationship between personality traits of borderline offspring and those of their parents may be related to both genetic transmission and family dynamics. Ramifications for treatment are discussed.

Oxcarbazepine for the treatment of binge eating disorder: a case series.

We present a case series of nine obese outpatients with a diagnosis of binge eating disorder who were treated with a flexible dose of the anticonvulsant oxcarbazepine. The drug has not previously been used to treat this disorder. Five patients dropped out at various points of the study, giving only fragmented data. Where data were available, all patients reported side effects (n=7) and some showed a reduction (n=4) or no change (n=3) in binge episode frequency. Some patients lost weight over the study period (n=3; range, 3-5 kg); others showed no change (n=2) or an increase in weight (n=3; range, 1.8-2.9 kg). Our results were inconsistent, but the drug was effective for some patients who showed marked impulsivity in eating behaviours and depressive symptoms.