Body image concerns in Binge Eating Disorder (BED) have been examined almost exclusively in overweight individuals with BED. The current study extends past research by including overweight and normal weight BED and non-BED groups to assess the multifactorial construct of body image using subscales of the Eating Disorder Examination 16.0 (EDE-16.0) and a Body Comparison Task. Independent of weight status and when controlling for age and race, women with BED are distinguished from those without BED by significantly greater overvaluation of shape and weight on the EDE -16.0 and significantly reduced weight satisfaction after a Body Comparison Task. Both BED diagnosis and weight status were independently associated with weight and shape concern subscales on the EDE-16.0. Taken together, these data provide further support for the consideration of body image concerns in the diagnostic criteria for BED. / Psychology

Although research describing relationships between psychosocial factors and various eating patterns is growing, a model which explains the mechanisms through which these factors may operate is lacking. A model to explain overeating patterns among normal weight college females was developed and tested. The model contained the following variables: global adjustment, eating and weight cognitions, emotional eating, and self-efficacy. Three hundred ninety-one participants completed the following self-report indices: the Questionnaire on Eating and Weight Patterns-Revised, the Student Adaptation College Questionnaire, the Weight Efficacy Life-Style Questionnaire, the Center for Epidemiological Studies on Depression, the State-Trait Anxiety Inventory, the State-Trait Anger Expression Inventory, the Emotional Eating Scale, the COPE, the Dutch Eating Behaviors Questionnaire - Restraint Scale, and a self-reported frequency of current eating patterns. Forty participants were excluded based on responses suggestive of obesity (BMI>27.3), severe dietary restraint, or bulimia nervosa, resulting in a final sample of 351. Correlational matrices, factor analysis and structural equation modeling with LISREL 8.B were progressively used to develop the best measurement model and assess the goodness of fit of the proposed structural model. The model provided an excellent fit to the data (GFI=.95; AGFI = .92; RMSEA = .048) and explained as large amount of the observed variance in overeating patterns among normal weight college females (R² = .78). An alternative model, which included dietary restraint as a predictor variable was also tested and compared to the proposed structural model. On all indices of model fit and model parsimony, the proposed model without dietary restraint appeared superior. Moreover, dietary restraint was not a significant direct contributor to the explanation of overeating patterns among normal weight college females. In the final structural model, all variables had a significant direct effect on eating patterns (p < .01). Further examination revealed a large total effect of adjustment as well as a strong direct influence of emotional eating on overeating patterns (direct effect =.52, p <.001). Because emotional eating captures the extent to which negative emotions produce an urge to eat, treatment and prevention programs should specifically target acquisition and practice of alternative coping strategies for dealing with negative emotions. / Ph. D.

The purpose of this dissertation is to identify the variables associated with abstinence from binge-eating disorder and Bulimia Nervosa in the twelve-step recovery program of Overeaters Anonymous. The data were gathered through the completion of a survey by 231 active members of Overeaters Anonymous in the Washington metropolitan area. In addition to assessing the demographic composition of the aforementioned population, the variables that were assessed comprise the 'tools' of Overeaters Anonymous. They include: attendance at OA meetings, reading/writing from the Twelve Step literature, adhering to a food plan, having a sponsor, giving service, taking time for prayer and meditation, and making phone calls to other members. The activities of binge eating and bulimic participants were also examined to determine whether or not statistically significant differences exist between these two populations. Results revealed the typical OA participant to be a college educated (80%), Caucasian (89%) female (84%), between the ages of 34 and 44 (30%), married or living with a partner (44%), and employed in a full-time capacity (71%). Eight-four percent of the respondents were binge eaters, 15% were bulimic, and 1% anorexic. Multiple regression analyses revealed longer lengths of involvement in OA, a decrease in the frequency of relapse or 'slips', performing service, greater attendance at meetings, and progress on the ninth step, to be predictors of abstinence at the .05 level of significance. A lower frequency of relapse was predicted by longer lengths of involvement in OA, greater adherence to a food plan, increased frequency of phone calls to other members, and more time spent writing about one's thoughts and feelings at the .05 level of significance. Lastly, Independent Sample t-tests revealed bulimics to have significantly longer mean lengths of abstinence than did binge eaters. Alternately, the difference in the frequency of relapse or 'slips' between the two populations was not significant, suggesting that both bulimics and binge eaters have a comparable likelihood to relapse or slip back into eating disordered behaviors. / Ph. D.

Fragestellung: Während der Einfluss der Familie bei Anorexia Nervosa und Bulimia Nervosa im Kindes- und Jugendalter gut belegt ist und bereits mehrmals in Übersichtsarbeiten zusammengefasst wurde, liegen derzeit wenige Befunde zum Zusammenhang zu Essanfällen ohne kompensatorische Verhaltensweisen vor. Ziel dieser systematischen Übersichtsarbeit ist es daher, familiäre Einflussfaktoren auf die Entstehung und Aufrechterhaltung von Essanfällen zu beschreiben. Methodik: Eine systematische Datenbanksuche für Studien zum Zusammenhang von familiären Faktoren und Essanfällen wurde durchgeführt. Ergebnisse: Die eingeschlossenen Studien zeigten einheitlich, dass eine unsichere Bindung des Kindes, eine geringere Familienfunktionalität und geringere emotionale Unterstützung mit Essanfällen assoziiert sind, elterliche Arbeitslosigkeit sowie elterliche Depressionen retrospektive Korrelate darstellen und weniger Familienmahlzeiten und häufige kritische Kommentare über Figur und Gewicht innerhalb der Familie variable Risikofaktoren für Essanfälle sind. Inkonsistente Befunde fanden sich hingegen bezüglich der Familienstrukturen, dem Vorliegen elterlicher Essstörungen und Diäthalten sowie dem Erkennen von Essanfällen beim eigenen Kind. Geschlechterunterschiede im Zusammenhang zu familiären Beziehungen und gewichtsbezogener Stigmatisierung wurden identifiziert. Schlussfolgerungen: Ebenso wie bei anderen Essstörungen scheinen familiäre Einflussfaktoren auch bei Essanfällen eine wichtige Rolle einzunehmen. Daher könnten eine Diagnostik familiärer Einflüsse und familientherapeutische Interventionen in der Behandlung von Essanfällen im Kindes- und Jugendalter hilfreich sein. Mithilfe von prospektiven Studiendesigns könnten die divergierenden Ergebnisse aufgeklärt werden. / Objective: While family factors in childhood and adolescent anorexia nervosa and bulimia nervosa are well-documented and were often reviewed before, less is known about these influences on binge eating without compensatory behavior. Therefore, the aim of this systematic review is to describe family factors in the development and maintenance of binge eating. Method: A systematic literature search was conducted for studies on associations between binge eating, loss of control eating and family outcomes. Results: Consistent evidence was found for associations between binge eating and insecure attachment of the child, lower family functioning and lower parental involvement, for parental unemployment and parental depression as retrospective correlates and for variable risk factors in fewer family meals and more critical comments about weight or shape by parents. In contrast, rather inconsistent findings referred to the influence of family structures, parental eating disorders, dieting and their knowledge about child’s eating behaviour. Gender differences in associations with family relationships and weight stigmatization were identified. Conclusions: The results underline the importance of familial factors in binge eating as compared to other eating disorders. Consequently, family assessment and family-based interventions might be helpful in the treatment of childhood and adolescent binge eating. More research should clarify inconsistent findings using prospective designs.

Während Leitlinien „Gold-Standards“ für die Psychotherapie bei bulimischen Essstörungen (Bulimia Nervosa und Binge-Eating-Störung) empfehlen, ist über psychotherapeutische Prozessfaktoren bei Essstörungen wenig bekannt. Ziel war es, mit Hilfe des etablierten Generic Model of Psychotherapy zur Systematisierung psychotherapeutischer Prozessfaktoren die aktuelle Literatur zum Einfluss dieser Faktoren auf den Therapieerfolg, operationalisiert als Symptomreduktion oder -remission, auf Basis einer systematischen Datenbanksuche zu sichten. Während der Einfluss des therapeutischen Settings nach bisheriger Forschungslage kaum Schlüsse hinsichtlich des Therapieerfolgs zulässt, konnte dieser durch spezifische Interventionen, frühe Symptomreduktionen und eine gute therapeutische Beziehung vorhergesagt werden. Weitere Forschung zu Prozessfaktoren bei bulimischen Essstörungen erscheint notwendig, um die praktische psychotherapeutische Arbeit zu unterstützen und Behandlungen effektiver gestalten zu können. / While guidelines recommend gold standards for psychotherapy in bulimic eating disorders (bulimia nervosa and binge eating disorder), less is known about psychotherapeutic process aspects. We aimed to summarize the current literature on the impact of process aspects on significant symptom reductions and/or abstinence as treatment outcome using the Generic Model of Psychotherapy. A systematic literature search was conducted. While effects of treatment settings can not yet be estimated, specific interventions, rapid response, and the therapeutic bond repeatedly predicted outcome. Process-outcome research in bulimic eating disorders will be necessary to support clinical practice and to enhance treatment efficacy.

Die vorliegende Literatursichtung belegt, gerade im Lichte neuen Störungswissens und für neue diagnostische Kategorien, die Notwendigkeit, die Wirksamkeit bestehender Therapieformen zu erhöhen und/oder neue Behandlungen für Essstörungen, speziell für Bulimia Nervosa und Binge Eating-Störung, zu entwickeln. Ein wesentlicher Erkenntnisgewinn wird zudem von einer systematischen Analyse des therapeutischen Prozesses sowie von Moderatoren und Mediatoren erwartet. Darüber hinaus stellen die Dissemination evidenzbasierter Therapiemethoden in die Praxis und eine Überprüfung gestufter Behandlungsmodelle wichtige Aufgaben zukünftiger Forschung dar. / The consideration of existing literature, especially in light of new knowledge of eating disorders and new diagnostic categories, highlights the necessity to increase the efficacy of current forms of therapy, and to develop novel therapies for eating disorders. This pertains, in particular, to bulimia nervosa and binge eating disorder. A considerable gain in knowledge is to be expected from a systematic analysis of the therapeutic process as well as the moderators and mediators. Furthermore, dissemination of evidence-based treatment methods in practical settings and an examination of stepped care models are important avenues of future research.

Objective: Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self-evaluative processes, as conceptualized in the process model of self-stigma, and implications for other health-related outcomes, remain to be clarified. Design and Methods: In a representative general population sample of N = 1158 overweight and obese individuals, the impact of core self-evaluation as a mediator between weight bias internalization and mental and global health outcomes as well as between weight bias internalization and health care utilization, was examined using structural equation modeling. Results: In overweight and obese individuals, greater weight bias internalization predicted lower core self-evaluation, which in turn predicted greater depression and anxiety, lower global health, and greater health care utilization. These mediational associations were largely stable in subsample analyses and after controlling for sociodemographic variables. Conclusions: The results show that overweight and obese individuals with internalized weight bias are at risk for impaired health, especially if they experience low core self-evaluation, making them a group with which to target for interventions to reduce self-stigma. Weight bias internalization did not represent a barrier to health care utilization, but predicted greater health care utilization in association with greater health impairments.

No description available.

Binge-eating disorder (BED) was first included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) within the Feeding and Eating Disorders section.1 BED’s hallmark feature is recurrent binge eating, involving the consumption of an amount of food that is definitively larger than what others would eat under comparable circumstances within a certain time, associated with a feeling of loss of control over eating. Diagnosis of BED according to DSM-5 (307.59) requires this objective binge eating to occur at least once per week over 3 months. In contrast to binge eating in bulimia nervosa, binge eating in BED occurs without regular inappropriate compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, fasting, or laxative misuse. Binge eating in BED is further characterized by behavioral abnormalities, such as eating rapidly or until feeling uncomfortably full, and results in marked distress.

A sizeable body of research has documented Expressed Emotion (EE) to predict clinical outcomes in various psychiatric disorders, including eating disorders. Patients’ perceptions of relative’s EE, however, were found to play an important role in the processing of EE. This study aimed to examine the level of perceived EE in adolescent binge-eating disorder (BED) and its impact on eating disorder psychopathology. Adolescents (12 – 20 years) seeking treatment for BED (n = 40) were compared to adolescents without current or lifetime eating disorder (CG; n = 40). Both groups were stratified according to age, sex, body mass index (BMI, kg/m2), and socio-economic status. The Five Minute Speech Sample (FMSS) and the Brief Dyadic Scale of EE were administered to assess patients’ perceived maternal EE. Additionally, adolescents and mothers completed questionnaires on eating disorder and general psychopathology. On the FMSS, 37.5% of patients with BED perceived their mothers as high EE (vs. 12.5% in the CG). On the Brief Dyadic Scale of EE, patients with BED reported significantly higher levels of perceived maternal criticism, emotional overinvolvement, and lower levels of perceived warmth than controls. After controlling for the diagnosis of BED, perceived criticism and warmth, as assessed by questionnaire, significantly explained adolescents’ global eating disorder psychopathology. Negative perceptions of maternal behavior and emotional atmosphere towards the child are characteristic of adolescent BED. As documented for other eating disorders, family factors are likely to have substantial implications for the maintenance and treatment of adolescent BED.