An open trial evaluating an attention bias modification program for overweight adults who binge eat.

BACKGROUND AND OBJECTIVES: Binge eating is prevalent and is associated with significant psychiatric and medical comorbidities. To date, the most effective psychological treatments for individuals who binge eat are not effective for all patients and they do not result in significant weight loss. Dual process theories suggest that implicit factors, such as attention bias, may influence behavior, even when the behavior is in opposition to long-term goals. Attention bias modification programs have been tested in other areas of psychopathology, and could be utilized to improve outcomes for people who binge eat. Thus, the aim of this open trial was to conduct a preliminary evaluation of an attention bias modification program (ABM-Food) designed to train attention away from food cues. METHODS: Adults who binge eat and were overweight or obese enrolled in an 8-week ABM-Food program, which consisted of one session in the lab each week and two training sessions at home. Nine participants completed the ABM-Food training program and the post-treatment assessment, and 8 completed the 3-month post-treatment assessment. RESULTS: Results showed that the ABM-Food program is a feasible and acceptable treatment for adults who binge eat. Initial effectiveness data showed decreases in weight, eating disorder symptoms, binge eating, loss of control and responsivity to food in the environment, as well as changes in attention bias. The majority of these effects remained at the 3-month follow-up time point. LIMITATIONS: This study is limited by the single-group open label trial, and the small sample size. CONCLUSIONS: This open trial provides initial evidence for the feasibility, acceptability and effectiveness of ABM-Food for individuals who binge eat and are overweight or obese.

Short-term exercise combined with Acipimox administration induces an increase in plasma ACTH and its subsequent fall in the recovery phase in bulimic women.

OBJECTIVE: Free fatty acids (FFA)-adrenocorticotropin (ACTH) feedback loop between adipose tissue and the hypothalamic-pituitary centers in the brain has been suggested to be affected by the exercise and by administration of anti-lipolytic drugs. Also leptin may be affected by exercise. Dysfunction of FFA-leptin-ACTH secretion might be involved in binge eating and subsequent purging as is the case in bulimia nervosa (BN). METHODS: In the present single-blind, randomized study, we explored responses of plasma ACTH, leptin and FFA concentrations to exercise (45 min, 2 W/kg of lean body mass [LBM]) with Acipimox (Aci), an anti-lipolytic nicotinic acid analog, or placebo randomly received in nine women with BN and nine healthy women. RESULTS: The exercise with Aci administration resulted in plasma ACTH (p<0.001) and leptin increase higher in BN patients and a decrease in the plasma FFA levels in both groups. The falling of plasma ACTH (p<0.01) levels in the post-exercise recovering phase (90-minute) with Aci administration is more expressed in BN patients. The exercise induced an increase in plasma ACTH (p<0.05) and FFA levels and a decrease in the plasma leptin level in both groups. CONCLUSIONS: We demonstrated that the Aci-induced elevation in plasma ACTH (p<0.001) levels after the exercise higher in BN patients and that the falling of plasma ACTH (p<0.01) levels in the post-exercise recovering phase (90-minute) with Aci administration is suppressed only in BN patients, while Aci increased plasma leptin levels in this recovering phase more in BN patients. Therefore, these observations led us to suggesting that FFA-leptin-ACTH are involved in the dysregulation of neuroendocrine profile in this syndrome and that Aci affects a FFA-independent mechanism. In conclusion, Aci can be considered acceptable in the treatment of eating disorders, and it may also serve as an alternative low-dose dexamethasone suppression test (LDDST) in these patients. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000309886.

Outcome of dialectical behaviour therapy for concurrent eating and substance use disorders.

AIM: The current study examined the preliminary efficacy of dialectical behaviour therapy (DBT) adapted for concurrent eating disorders (EDs) and substance use disorders (SUDs). METHOD: A matched randomized controlled trial was carried out with 25 female outpatients diagnosed with concurrent ED and SUD. Participants randomized to the intervention condition received DBT, whereas those randomized to the control condition received treatment as usual (TAU), both for a period of 1 year. A series of measures related to disordered eating, substance use and depression were administered to the participants at the beginning of treatment and at 3, 6, 9 and 12 months into treatment, followed by 3-month and 6-month follow-up assessments. FINDINGS: Participants randomized to the DBT condition evidenced a superior retention rate relative to their counterparts in the TAU condition at various study time points, including post-treatment (80% versus 20%) and follow-up (60% versus 20%). Due to the unexpected elevated dropout rates and the worsening of ED-SUD symptomatology in the TAU condition, recruitment efforts were terminated early. Results from the DBT condition revealed that the intervention had a significant positive effect on behavioural and attitudinal features of disordered eating, substance use severity and use, negative mood regulation and depressive symptoms. Finally, increases in participants' perceived ability to regulate and cope with negative emotional states were significantly associated with decreases in emotional eating and increases in levels of confidence in ability to resist urges for substance use. CONCLUSION: Results suggest that the adapted DBT might hold promise for treating individuals with concurrent ED and SUD. KEY PRACTITIONER MESSAGE: The current study is the first study to report positive effects of DBT on individuals with concurrent eating and substance use disorders. Although the results require replication and extension, they suggest that the DBT may be promising for this population. The results suggest that clinicians treating individuals with concurrent eating and substance use problems should be particularly cautious of poor treatment retention and treatment complications. The results bear upon the highly salient and important issue of whether individuals with concurrent substance use need to be excluded from research studies and treatment programmes.

Personality heterogeneity in female adolescent inpatients with features of eating disorders.

OBJECTIVE: This study examined evidence for personality variability in adolescents with eating disorder features in light of previous evidence that personality variability in adult women with eating disorder symptoms carries important clinical implications. METHOD: Millon Adolescent Clinical Inventory personality data from adolescent girls with disturbed eating who were psychiatrically hospitalized were cluster analyzed, and resulting groups were compared in eating and comorbid psychopathology. RESULTS: Three subgroups were identified among the 153 patients with eating disorder features: high functioning, internalizing, and externalizing. The internalizing group was marked by eating-related and mood dysfunction; the externalizing group by elevated eating and mood psychopathology as well as impulsivity, aggression, and substance use; and the high-functioning group by lower levels of psychopathology and relatively high self-esteem. CONCLUSIONS: These findings converge with previous research using different personality models in adult samples and highlight the clinical use of considering personality heterogeneity among adolescent and adult women with disturbed eating.

State self-esteem ratings in women with bulimia nervosa and bulimia nervosa in remission.

OBJECTIVE: Bulimia nervosa (BN) is associated with low self-esteem. This study was designed to assess whether low self-esteem persists in nondepressed individuals who have recovered from BN (BN-R). METHOD: Study groups included BN (n = 22), BN-R (n = 20), and healthy controls (n = 42). Participants were medication-free, and none met criteria for current major depression. Assessment instruments included the State Self-Esteem Scale (SSES), a self-rating scale designed to measure state-related changes in self-esteem. RESULTS: Consistent with previous reports, SSES scores for BN were lower than for controls (p < .001). For BN-R, SSES scores were higher than for BN (p < .001), but lower than for controls (p < .025). For BN-R, scores on the SSES Appearance subscale were inversely correlated with ratings of dietary restraint (p < .005). CONCLUSION: This study provides new evidence for persistent low self-esteem following recovery from BN. Follow-up studies are needed to assess whether low self-esteem contributes to recurrent dieting and risk for relapse.

[Intensive psychiatric treatment system for bulimic patients by group therapy].

Concurrent bulimia nervosa/purging type and anorexia nervosa/binge-purging type including binge eating and purging behaviors are considered chronic types of eating disorders. The bulimic patients in this study had both these disorders. Psychiatric treatment for patients with eating disorders must focus on therapy of these bulimic patients, because bulimic patients are more prevalent in the psychiatric hospital and clinic, and they have more comorbid psychiatric disorders and more other addictive behaviors than other patients with eating disorders. We have devised an intensive psychiatric treatment system for bulimic patients by group therapy that consists of inpatient treatment, group therapy for parents and group rehabilitation. Inpatient treatment, called the Eating Disorders Education Program (EDEP), consists of group psychological education, group cognitive-behavioral therapy, group nutrition education, and group exercise. Group therapy for parents consists of psychological education and group meetings. Group rehabilitation consists of many group activities in a house named "Mimoza". Bulimic patients come to understand their own disorders and symptoms objectively and understand recovery from their disorders by the intensive treatment system. Bulimic patients generally recover very slowly from eating disorders, but our intensive psychiatric treatment system promotes rapid recovery.

Changes in eating behaviour following group therapy for women who binge eat: a pilot study.

Survey research is demonstrating that binge eating and compulsive eating may be a significant problem in the obese population. There is higher incidence of binge eating among women, associated with subjective distress and poor prognosis for weight control. Despite attendant health risks, researched clinical responses have not been developed. A before and after uncontrolled pilot study aimed to evaluate the effectiveness of group therapy for women who binge eat and compulsively eat. Participants attended a weekly integrative therapy group for 6 months. Measurements before and after the group intervention were taken using the Binge Eating Scale and Clinical Outcomes in Routine Evaluation inventories. Before and after interviews were thematically analysed for changes in eating behaviour. Following the group intervention, all participants demonstrated changes in eating behaviour measured by the Binge Eating Scale, the overall effect from baseline to 1 year demonstrates statistical significance. Qualitative data revealed four categories that underpinned reduction in binge eating: changes in dichotomous thinking, awareness of eating behaviour, detachment from food and dietary changes. An integrative model of group therapy warrants further research and refinement for this population, a group protocol for nurses working in the field of obesity and eating disorders could be developed.

Personality traits after recovery from eating disorders: do subtypes differ?

OBJECTIVE: We compared individuals recovered from anorexia (AN) and bulimia nervosa (BN) to determine characteristics that are shared by or distinguish eating disorder (ED) subtypes. METHOD: Sixty women recovered for > or = 1 year from AN or BN were compared with 47 control women (CW). Assessments included the Yale-Brown-Cornell Eating Disorder Scale, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, the Yale-Brown Obsessive Compulsive Scale, the Temperament and Character Inventory, and Structured Clinical Interviews for DSM-IV. RESULTS: Individuals recovered from an ED had similar scores for mood and personality variables that were significantly higher than the scores for CW. Few recovered subjects had Cluster B personality disorder. Most individuals recovered within 6 years of their ED onset. A latent profile analysis identified an "inhibited" and "disinhibited" cluster based on personality traits. CONCLUSION: A wide range of symptoms persist after recovery and do not differ between subtypes of ED. These findings may aid in identifying traits that create vulnerabilities for developing an ED.

Normal brain tissue volumes after long-term recovery in anorexia and bulimia nervosa.

BACKGROUND: Individuals who are ill with anorexia (AN) and bulimia nervosa (BN) often have increased cerebrospinal fluid (CSF) volumes and decreased total gray and white matter volumes. It is unclear whether such disturbances persist after recovery from an eating disorder. METHODS: Magnetic resonance imaging was performed on 40 women who were long-term recovered (>1 year no binging, purging, or restricting behaviors, normal weight, and menstrual cycles, not on medication) from restricting or binge/purging type AN or BN and 31 healthy control women (CW). Voxel-based morphometry (VBM) was used for data analysis. RESULTS: Recovered AN and BN subgroups were similar to CW in terms of cerebrospinal fluid (CSF) volume as well as total or regional gray or white matter volume. CONCLUSIONS: These findings suggest that structural brain abnormalities are reversible in individuals with eating disorders after long-term recovery.

Gender differences in the progression of co-morbid psychopathology symptoms of eating disordered patients.

This study examined the utility of the Personality Assessment Inventory (PAI) in screening for comorbid psychopathology in eating disordered males and females undergoing residential treatment. The PAI, a self-administered screening tool containing 344 items to provide information on 11 clinical constructs, was administered at admission and discharge to 181 patients, 154 females and 27 males. Average age was 26.88 years (SD=9.35) and average length of stay was 58.31 days (SD=39.94). The results showed that both male and female patients exhibit several comorbid disorders at admission to residential treatment and the severity of these symptoms was statistically significantly reduced over the course of treatment. When comparing differences among genders, the results show that females present with more psychopathology symptoms at the start of treatment but make better progress than males in reducing these symptoms over time. When comparing patients across eating disorder diagnoses, subjects with bulimia displayed more severe comorbid symptomatology as compared to those with anorexia or other eating disorders. A thorough clinical assessment of eating disordered patients including comorbid psychopathology disorders is relevant for clinical diagnosis, treatment planning, and perhaps ultimately the outcome of treatment.

Sesgos cognitivos en una tarea experimental de atención selectiva focalizada en los trastornos de la conducta alimentaria / Cognitive biases in an experimental task of focalized selective attention in eating disorders

Introducción. Se investigan las diferencias en el procesamiento cognitivo, basadas en los patrones atencionales sesgados ante palabras relacionadas con los trastornos de la conducta alimentaria. Desarrollamos una prueba computarizada que replica el efecto Stroop, con la que presentamos cuatro tipos de palabras (alimentos, conductas relacionadas con el trastorno, emocionales y neutras) con el objeto de valorar las diferencias en el procesamiento de estos estímulos. Método. Participaron 144 mujeres con trastornos de la conducta alimentaria (anorexia, bulimia o una combinación de ambas) y 172 mujeres controles. Resultados. Consistentes con las predicciones, los tres grupos clínicos emplearon significativamente más tiempo en responder a la tarea que el grupo de control. Conclusiones. Estos resultados sugieren la existencia de sesgos en el procesamiento de los estímulos relacionados con los trastornos de la conducta alimentaria

Introduction. Cognitive processing differences based on attentional biases of words pertaining to eating disorders were investigated. We performed a computerized Stroop color-naming task in which the subjects named the colors of four word groups (food-related, eating disorders behaviours-related, emotional and neutral) to measure differences in the processing of these stimuli. Method. Participants were 144 females with eating disorders (anorexia nervosa, bulimia nervosa, or a combination of both) and 172 female controls. Results. In agreement with predictions, the three eating disorder groups were significantly slower than the controls in identifying the color of all word groups. Conclusions. These findings indicate the existence of biases in stimuli processing related with eating behavior disorders

[Cognitive biases in an experimental task of focalized selective attention in eating disorders]. / Sesgos cognitivos en una tarea experimental de atención selectiva focalizada en los trastornos de la conducta alimentaria.

INTRODUCTION: Cognitive processing differences based on attentional biases of words pertaining to eating disorders were investigated. We performed a computerized Stroop color-naming task in which the subjects named the colors of four word groups (food-related, eating disorders behaviours-related, emotional and neutral) to measure differences in the processing of these stimuli. METHOD: Participants were 144 females with eating disorders (anorexia nervosa, bulimia nervosa, or a combination of both) and 172 female controls. RESULTS: In agreement with predictions, the three eating disorder groups were significantly slower than the controls in identifying the color of all word groups. CONCLUSIONS: These findings indicate the existence of biases in stimuli processing related with eating behavior disorders.

Response of Taiwanese obese binge eaters to a hospital-based weight reduction program.

OBJECTIVE: To investigate the characteristics and prevalence of binge eating among overweight Taiwanese and to determine the effect of binge eating on outcome of weight loss treatment. METHODS: One hundred and eighty-nine participants in a 12-week traditional weight-reduction program were classified on the basis of the Bulimic Investigation Test, Edinburgh (BITE) scores into binge eaters (>/=20), subthreshold binge eaters (10-19), and nonbinge eaters (0-9). RESULTS: This study found a 15.9% prevalence of binge eating. The binge-eating groups (binge eaters and subthreshold binge eaters) were younger, had an earlier onset of obesity, and more psychological distress than nonbinge eaters. Differences in obesity treatment weight loss among binge eaters, subthreshold binge eaters, or nonbingers by last observation carried forward (LOCF) method were not significant. At the end of treatment, the subthreshold binge eaters had the greatest weight loss. Although their binge eating and mood significantly improved, binge eaters and subthreshold binge eaters still had significant pathology in eating behaviors at completion of the program. CONCLUSION: Alternative treatment strategies focusing on disordered eating behaviors are needed to supplement standard dietary management of overweight treatment-seeking binge eaters.

Social and health adjustment of bulimic women 7-9 years following therapy.

OBJECTIVE: To examine the long-term social adaptation and long-term follow-up of bulimic women after therapy. METHOD: Eighty women with bulimia nervosa were investigated 7-9 years after the beginning of either conflict-oriented in-patient therapy or systemic out-patient therapy. Data was gathered through interviews and patient questionnaires. RESULTS: At the time of follow-up, 28.9% still had DSM-III-R bulimia, 10.1% suffered from subthreshold bulimia or anorexia (EDNOS), 61.2% did not suffer from any DSM-III-R eating disorder. Compared with statistics on the normal population, the social adaptation of the women was quite good with regard to work, household and living conditions. Some dimensions representing probable aetiological factors (i.e. restrictions of intake, feelings of ineffectiveness) showed a delayed reaction to therapy. CONCLUSION: Long-term outcome of bulimia nervosa may be expected to be moderately good. During therapy, greater attention should be paid to characteristics of the disorder less responsive to treatment.

Eating disorders symptomatology and inpatient treatment experience in eating-disordered subjects.

OBJECTIVE: This study aimed to examine whether eating disorder (ED) subjects with and without a history of inpatient treatment differ in the severity of symptoms as measured by the Eating Disorders Inventory (EDI-1). METHOD: In a sample of 222 women (66 women with anorexia nervosa, 126 women with bulimia nervosa, and 30 women with eating disorders not otherwise specified), the history of inpatient treatment was assessed and the EDI was administered. RESULTS: Fifty percent of the participants had received previous inpatient treatment. The group with past inpatient treatment had significantly higher scores on the EDI subscales Body Dissatisfaction, Ineffectiveness, and Interpersonal Distrust than the group without inpatient treatment experience. DISCUSSION: ED subjects with and without inpatient treatment showed different profiles on the EDI subscales. The fact that these two groups differ in specific ED symptoms may represent a bias in ED studies when samples with heterogeneous treatment contact history are recruited.

Psychiatric comorbidity and inpatient treatment history in bulimic subjects.

Bulimia nervosa (BN) is often associated with other forms of psychopathology. There is a need to clarify which specific factors of psychopathology are linked with the referral to psychiatric or psychotherapeutic inpatient treatment. This study examined which factors of psychopathology are linked with the referral of BN patients to inpatient treatment while controlling for history of suicide attempts and history of underweight. 126 females with a current diagnosis of BN purging type were assessed with the Structured Clinical Interview for DSM-IV and interviewed about their history of treatment for the BN, history of weight, and history of suicide attempts. Logistic regressions were conducted to examine whether psychiatric comorbidity, suicide attempts, and underweight were associated with inpatient treatment history. Axis I comorbidity in general, but no specific axis I disorder, was associated with inpatient history. Axes II comorbidity, especially Cluster B disorders and to a lesser degree depressive/negativistic personality disorders, was associated with a history of inpatient treatment. History of suicide attempts was also linked with inpatient experience, but history of underweight was not. The results showed that BN patients with specific types of comorbidity are more likely to be hospitalized than others.

Pain perception in recovered bulimia nervosa patients.

OBJECTIVE: Decreased pain sensitivity is found in individuals who are ill with bulimia nervosa (BN). The purpose of this study is to determine whether altered pain perception persists after recovery from bulimia nervosa (RBN). METHODS: Eleven women who were recovered from BN for more than 1 year were compared with 15 healthy volunteer women. The participants received two pain evaluations--thermal pain stimulation (TPS), which evaluates threshold and tolerance to heat, and the submaximal effort tourniquet test (SETT), which assesses threshold and tolerance to ischemic pain induced by inflation of a blood pressure cuff. RESULTS: Compared with the controls, the RBN women showed elevated pain threshold as measured with the SETT and a tendency to elevated pain threshold on the TPS. DISCUSSION: Decreased pain sensitivity persists after recovery from BN and may reflect altered modulatory function in this illness.

[Treatment of bulimia nervosa--results from Modum Bads Nervesanatorium]. / Behandling av bulimia nervosa--resultater fra Modum Bads Nervesanatorium.

BACKGROUND: Hospital admission for bulimia nervosa is rather uncommon, but may be indicated in cases of psychiatric comorbidity, long duration of treatment and previous treatment failures. We describe a multicomponent inpatient treatment programme consisting of cognitive-behavioural group and individual therapy, physical training and steps to normalize eating patterns. MATERIALS AND METHODS: All 47 patients treated between 1998 and 2000 were studied. Patients were interviewed and completed self-report instruments at admission and discharge. RESULTS: At discharge, a significant improvement with respect to bulimic as well as general psychiatric symptoms had occurred. INTERPRETATIONS: The results may indicate that improvement occurs even for severe bulimia with personality disorders, and that hospital treatment may be needed to accomplish this kind of change. Follow-up studies are necessary in order to corroborate these findings.

The treatment of eating disorders as addiction among adolescent females.

As science and medicine enter the new millennium, the influences of genetics and neurochemistry as high-risk determinants in the etiology and development of eating disorders are increasingly manifest in professional literature. Eating disorders are now recognized as major medical and psychiatric problems affecting millions throughout the world. Psychoeducational, cognitive, behavioral, and psychopharmacologic treatments form the basis of most interventions which, for the most part, tend to view the eating disorder as a symptom of underlying psychopathology. The Israel Counseling and Treatment Center of the North has been treating eating disorders as addictive disease by applying the twelve step program of the Anonymous Fellowships as an adjunct to counseling and treatment for those who suffer from compulsive overeating and bulimia. Following the ongoing program of interventions with adults, a counseling group for adolescent females was co-facilitated under the supervision of the author. A co-therapist, in recovery from bulimia and comulsive overeating, uses the twelve step philosophy and served as a role model in this group intervention. Another sample of adolescent females was offered individual counseling adhering to the same addiction treatment approach. Success rates were operationally defined and measured by weight loss in the obese population and the cessation of purging behaviors among bulimic subjects for a six-month period. The two adolescent treatment samples had success rates of 62% and 33% respectively. A higher success rate of 71% was observed with adult bulimic females who participated in group counseling. A mean weight loss of 3.9 kg for the small sample of adolescents and a 9.7 kg. mean weight loss for obese adults in treatment was reported. The theoretical basis of the addiction treatment paradigm for eating disorders is presented. Results and problems encountered specific to treating the adolescent population are discussed.