The validity of DSM-5 severity specifiers for anorexia nervosa, bulimia nervosa, and binge-eating disorder.

OBJECTIVE: The DSM-5 includes severity specifiers (i.e., mild, moderate, severe, extreme) for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), which are determined by weight status (AN) and frequencies of binge-eating episodes (BED) or inappropriate compensatory behaviors (BN). Given limited data regarding the validity of eating disorder (ED) severity specifiers, this study examined the concurrent and predictive validity of severity specifiers in AN, BN, and BED. METHOD: Adults with AN (n = 109), BN (n = 76), and BED (n = 216) were identified from previous datasets. Concurrent validity was assessed by measures of ED psychopathology, depression, anxiety, quality of life, and physical health. Predictive validity was assessed by ED symptoms at the end of the treatment in BN and BED. RESULTS: Severity categories did not differ in baseline validators, though the mild AN group evidenced greater ED symptoms compared to the severe group. In BN, greater severity was related to greater end of treatment binge-eating and compensatory behaviors, and lower likelihood of abstinence; however, in BED, greater severity was related to lower ED symptoms at the end of the treatment. DISCUSSION: Results demonstrated limited support for the validity of DSM-5 severity specifiers. Future research is warranted to explore additional validators and possible alternative indicators of severity in EDs.

Meal patterning in the treatment of bulimia nervosa.

OBJECTIVE: This study examined the relationship between changes in meal and snack consumption and eating disorder behaviors in a treatment sample of bulimic adults. METHOD: Eighty adults with bulimia nervosa (BN) were randomized to one of two treatments. Meal and snack consumption, binge eating frequency, and purging behavior frequency were assessed at baseline, end-of-treatment, and at four month follow-up using the Eating Disorder Examination (EDE). RESULTS: Generalized linear models indicated that increased consumption of evening meals over the course of treatment was related to a significant decrease in the rate of binge eating and purging at four month follow-up; these results remained significant when controlling for changes in depression over the course of treatment. CONCLUSIONS: The findings support the importance of focusing efforts on developing a pattern of regular evening meal consumption among individuals in the treatment of BN.

Body Contouring After Bariatric Surgery.

Individuals who undergo bariatric surgery generally experience rapid and dramatic weight loss. While the weight loss typically confers significant health benefits, an undesirable consequence is often excessive quantities of hanging, surplus skin. Some patients undergo body-contouring surgery (BCS) in order to improve health, mobility, appearance and psychological adjustment. While the majority of post-bariatric patients desire BCS in one or more body regions, a small percentage of patients receive such surgeries. Lack of knowledge about procedures, cost and (in the USA and several other countries) difficulty obtaining insurance reimbursement likely prevents many patients from undergoing BCS. Those who do undergo BCS appear to be at heightened risk for wound-healing complications. Despite these complications, the majority of patients report satisfactory BCS outcomes. The extant literature in this area provides a great deal of information about these issues; nevertheless, additional research is needed to further inform clinical management and improve patient outcomes.

Learning effects in the block design task: a stimulus parameter-based approach.

Learning effects were assessed for the block design (BD) task, on the basis of variation in 2 stimulus parameters: perceptual cohesiveness (PC) and set size uncertainty (U). Thirty-one nonclinical undergraduate students (19 female) each completed 3 designs for each of 4 varied sets of the stimulus parameters (high-PC/high-U, high-PC/low-U, low-PC/high-U, and low-PC/low-U), ordered randomly within a larger set of designs with mixed stimulus characteristics. Regression analyses revealed significant, although modest, learning effects in all conditions. Negative-logarithmic learning slopes (growth factors) were greatest for high-U/high-PC designs and smallest for low-U/low-PC designs. Comparison of these slopes with known Wechsler Adult Intelligence Scale (3rd ed.; D. Wechsler, 1997; and 4th ed.; D. Wechsler, 2008) BD subtest gain scores demonstrated that presenting novel test items matched on stimulus parameters in multiple administrations reduced learning effects compared with the repeated use of the same test items. The results suggest that repeated administration of novel test items of the BD subtest, matched for PC and U, would result in more accurate assessments of changes in examinees' abilities over time than would the use of the same items. Difficulties inherent in implementing this method are also discussed.