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.

Cultural representations of thinness in women, redux: Playboy magazine's depiction of beauty from 1979 to 1999.

Playboy's portrayal of the male ideal of feminine beauty, in terms of overall body size, percent normative weight, and waist-to-hip ratios (WHRs), was analyzed for the years 1979-1999. Trends were examined through body measurements obtained from Playboy centerfolds. Results reveal a continuation of the low body mass index (BMI) found in the Playmates by earlier studies; however, for the 21 years examined, the trend towards increasing thinness seems to have stabilized and may have begun to actually reverse. There was also an increase in the centerfolds' WHRs over the 21-year time period. Overall, the results support the continued valuing in American society of a thin ideal for women; while the images of beauty have become somewhat heavier over the 21-year period reviewed, the Playmates remain markedly below weights normative for their age group.

Impact of the media on adolescent body image.

The mass media have become a powerful force throughout the world and strongly influence how people see themselves and others. This is particularly true for adolescents. This article discusses how the media affect body image and self-esteem and why the media seem to have such strong effects on adolescents. The differences in responses to the media in adolescents of different ethnic, racial, and cultural backgrounds are discussed. Although this article focuses primarily on teenage girls, the data for adolescent boys is reviewed as well. Finally, this article discusses possible ways to help adolescents become more active viewers of the media and help prevent the decrease in body esteem that so often occurs during adolescence.

Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: results from a controlled trial.

OBJECTIVE: Negative body image, a common problem among college-age women in the United States, strongly correlates with low self-esteem, disturbed eating behavior, and eating disorders. Psychoeducational programs have inconsistently shown improvement in body image, thin-ideal internalization, eating behaviors, psychosocial functioning, and self-esteem. METHOD: In the current study, college women with body image concerns (N = 84) were randomly assigned to a cognitive dissonance-based, thin-ideal internalization, single-session workshop (DTI; n = 26); a psychoeducational, healthy behavior, single-session workshop (HB; n = 24); or a wait-list control (WL; n = 34). RESULTS: Comparing baseline data with 4-week follow-up data, results indicated that both DTI and HB participants reported improvement in body image, thin-ideal internalization, and eating behaviors. DISCUSSION: Results provide evidence that both interventions effectively reduce risk factors for eating pathology.

Primary prevention of eating disorders through attitude change: a two country comparison.

Primary prevention of eating disorders though increasing the knowledge base about eating disorders has been ineffectual, and in some cases has had a deleterious effect. The following study compared the efficacy of a classroom intervention using cognitive dissonance and repetition, in Italy and the U.S. In each country, health education classes of tenth grade students (U.S. n = 50, Italy n = 138) were randomly assigned to intervention and non-intervention sections. Subjects in the non-intervention sections received the standard health classes taught by their usual teacher. Students in the intervention sections received five classes taught by a psychologist (in the U.S.) or a psychiatrist (in Italy) specializing in eating disorders. Subjects in the intervention group also completed a cognitive dissonance essay designed to persuade a same sex friend that self-esteem should not be based solely on appearance. Intervention and non-intervention groups completed questionnaires before and after the intervention as well as at the end of the semester. The U.S. group had significantly higher Perfectionism scores and significantly lower Drive for Thinness scores (DT) than the Italian group. There was a significant decrease in DT for the intervention group in Italy. The intervention did not affect any other measures in the Italian group. There are clearly ethnic differences in comparing these two samples that may account for the baseline differences in eating attitudes. However, despite otherwise differing profiles, girls from each country had a desire to diet. This program appears to have made some impact in changing the attitudes away from a desire for thinness for Italian subjects. It is possible that many attitudes about weight, shape, and eating are established in this age group and a younger target audience would be more appropriate in the future.

Risk factors for eating disorders: surprising similarities between middle school boys and girls.

This study examined body dissatisfaction (BD), drive for thinness (DT), and self-esteem in middle school students. Participants were 40 girls and 36 boys aged 11-13. Students completed BD and DT Eating Disorder Inventory subscales and the Rosenberg self-esteem questionnaire. There were no significant differences on these measures. For boys and girls, self-esteem was negatively correlated with BD, and Body Mass Index (BMI) was positively correlated with BD. For boys, BMI was positively correlated with DT. DT was negatively correlated with self-esteem in girls. The relationship between body dissatisfaction and self-esteem is cause for concern and may be a higher risk for developing eating disorders.

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.

Short-term group CBT versus psycho-education on an inpatient eating disorder unit.

The purpose of the current study was to compare, on an inpatient eating disorder unit, short-term cognitive behavior group therapy with a psycho-education group.