O transtorno de compulsão periódica (TCAP) é uma categoria diagnóstica recente sendo considerada uma forma de transtorno alimentar sem outras especificações e seus critérios diagnósticos estão incluídos no apêndice B do DSMIV. As características essenciais deste transtorno são episódios recorrentes de compulsão alimentar periódica, na ausência de comportamentos compensatórios inadequados característicos da bulimia nervosa (vômitos auto-induzidos, uso de diuréticos e laxativos, exercícios físicos em excesso e jejum prolongado), associados com prejuízo no controle e sofrimento significativo relacionados aos ataques de hiperfagia. Medicações antidepressivas são efetivas, pelo menos a curto prazo, na supressão do comer compulsivo e na redução de psicopatologia associada.O Objetivo deste trabalho foi avaliar a efetividade e segurança da reboxetina, um inibidor seletivo da recaptação de noradrenalina, no tratamento de pacientes obesos com TCAP.Nove pacientes obesos ambulatoriais com índice de massa corpórea (IMC = calculado como o peso em kilogramas dividido pelo quadrado da altura em metros) entre 30-45 kg/m,2 com TCAP de acordo com o DSM-IV e sem nenhuma comorbidade psiquiátrica associada, foram selecionados e receberam reboxetina 8 mg/dia durante 12 semanas de tratamento. O número de dias com compulsão alimentar periódica por semana, a escala de compulsão alimentar periódica (ECAP), o peso, o IMC, a escala de Impressão Clínica Global - Severidade (CGI-S) e a escalade avaliação de qualidade de vida da Organização Mundial de Saúde - versão abreviada (WHOQOL-BREF) foram utilizados como medidas de eficácia. Na análise estatística dos dados foi utilizado o Teste t pareado para avaliar mudanças nos escores pré e pós-tratamento e uma análise por intenção de tratar foi utilizada incluindo na análise a última visita de cada sujeito no estudo. Cinco pacientes completaram o estudo e apresentaram uma remissão completa do TCAP ao final do tratamento. A média do número de dias com compulsão alimentar periódica por semana modificou-se significativamente de 4,6 ± 1,8 para 0,2 ± 0,6 ao final do estudo (p = 0,0002). A média dos escores da ECAP caiu de 32,3 ± 6,32 para 9,3 ± 6,8 (p = 0,0003). Houve também uma redução estatisticamente significativa do IMC de 36,5 ± 4,48 para 35,06 ± 4,49 (p = 0,01) e na CGI-S de 5,1 ± 0,92 para 1,4 ± 1,01 (p = 0,0002). Uma redução significativa do peso corporal (média = 4,24 kg) também foi observada entre o baseline e o final do estudo (p= 0,01). A qualidade de vida foi avaliada pela WHOQOL-BREF no pré e pós-tratamento e houve diferença com significância estatística nas duas questões de qualidade de vida geral (p= 0,02) e no domínio psicológico (p= 0,03). Nenhum evento adverso sério foi observado.A reboxetina pode ser um agente efetivo e bem tolerado no tratamento do TCAP em pacientes obesos. / Binge Eating Disorder (BED) is a recent diagnostic category considered a non-specified eating disorder whose diagnostic criteria are listed in Appendix B of DSM-IV. Its essential characteristics are recurrent episodes of binge eating and the absence of inadequate compensatory behavior that is characteristic of bulimia nervosa (self-induced vomits, use of laxative and diuretics, excessive exercise, and prolonged fasting), associated with loss of control and significant distress related to the episodes of hyperphagia. At least in the short term, antidepressants are effective in the suppression of compulsive eating and in the reduction of associated psychopathology.The aim of this study was to assess in an open clinical trial the effectiveness and safety of reboxetine, a selective noradrenaline reuptake inhibitor, in the treatment of obese patients with binge eating disorder.Nine obese outpatients with body mass index (the Body Mass Index [IMC] value equals a person's weight in kilograms divided by the square of the person's height in meters) between 30-45 kg/m2, with BED according to DSM-IV, and with no associated psychiatric co-morbidity, received reboxetine 8 mg/day during 12 weeks of treatment. The number of days of binge eating per week, the Binge Eating Scale (BES), body weight, BMI, the Clinical Global Impression- Severity (CGI-S) scale and the World Health Organization Quality of Life Assessment Scale (WHOQOL-BREF) were used to measure efficacy. Paired t-test was used in the data statistical analysis to evaluate changes in pre and posttreatmentscores; an intention-to-treatment analysis including the last visit of study participants was also used. Five patients completed the study and presented a complete remission of binge eating by the end of the treatment. Mean number of binge days per week showed a significant change, down from 4.6 ± 1.8 to 0.2 ± 0.6 at the end of the study (p = 0.0002). Mean scores of BES were down from 32.3 ± 6.32 to 9.3 ± 6.8 (p = 0.0003). Statistically significant decreases were found in BMI, from 36.5 ± 4.48 to 35.06 ± 4.49 (p = 0.01), in CGI-S, from 5.1 ± 0.92 to 1.4 ± 1.01 (p = 0.0002). Also, a significant decrease in body weight (mean = 4.24 kg) was seen between baseline and the end of the study (p= 0.01). The quality of life was evaluated with WHOQOLBREF in pre and posttreatment.It was showed a statistically significant improve on overall quality of life and general health (p= 0,02) and on psychological domain (p= 0,03). No severe side effects were observed.Reboxetine may be an effective and well-tolerated agent in the treatment of BED in obese patients.

M. Tech. / Binge eating is defined as eating an inordinate amount of food in a discrete period of time, during which the eater experiences a subjective loss of control (American Psychiatric Association, 2000). The event is often followed by emotional distress, including feelings of disgust, shame, fear, guilt or discomfort (Herrin, 2003). Binge eating is found in all eating disturbances, and is especially associated with binge eating disorder, which affects all races and both genders almost equally (Fairburn & Brownell, 2002). Current treatment protocols include psychotherapy, pharmacotherapy and traditional weight loss programmes (Birmingham & Treasure, 2010; Mitchell & Peterson, 2005; Wadden & Stunkard, 2002). The role of homoeopathy in the treatment of binge eating remains poorly explored. This research study was designed to examine the efficacy of homoeopathic similimum treatment on binge eating in males, following ten case studies. The research was carried out at the University of Johannesburg Homoeopathy Health Centre, from 8 July 2010 to 24 November 2010. Ten male participants, all between the ages of 23 and 42, took part in this research. Each participant was screened telephonically before their first consultation. Inclusion criteria included eating a large volume of food within a short space of time, and feeling a loss of control over eating habits. Exclusion criteria included a prior diagnosis of anorexia nervosa, bulemia nervosa or any morbidity associated with obesity, including diabetes mellitus and heart disease. Each participant attended a total of four consultations over a 12 week period. Follow-up consultations took place every three weeks. During each interview, the participants' severity and frequency of binge eating was assessed through their history, a self-assessment calender for recording binging incidence between consultations and by completing a psychometric evaluation. On the second and third consultation, each participant was issued with an individuated similimum prescription based on the totality of their case history, to be taken as directed. v. All data was collected and analyzed, with the following results: – All participants reported a variable decrease in their binging frequency and severity. – Most participants experienced a concurrent improvement in other aspects of their health, such as their sleeping habits, libido, blood pressure, level of confidence or an overall sense of well-being. – Statistical analysis of the participants' measured results confirms a significant improvement in both binging frequency and severity after similimum treatment. The researcher concluded that this study shows the possible benefits of homoeopathic similimum treatment in binge eating in males, by decreasing both binging frequency and severity.

Hetsätningsstörning är en av de vanligaste ätstörningarna i USA och antalet patienter med hetsätningsstörning ökar konstant. Flertalet patienter väljer att avsluta sin behandling kort efter att de påbörjat den. Anledningen är vanligtvis att relationen mellan sjuksköterska och patient inte fungerat, eller att behandlingen inte är lättillgänglig för patienten. Syftet var att undersöka patientens upplevelse av vård vid hetsätningsstörning. Detta för att öka kunskapen om hur vården uppfattas från patientens perspektiv och för att förbättra vården inom denna sjukdom. Resultatet visade att patienter som drabbats av hetsätningsstörning ansåg att vården var för oböjlig och inte tillräckligt individanpassad. Patienterna menade även på att sjuksköterskan inte alltid verkade förstå deras känslor och tankar de hade kring hetsätningen. Det ansågs positivs att ha en kontaktperson som redan genomgått behandling som komplettering till den standardiserade vården för sjukdomen. Personcentrerad vård och en möjlighet för patienten att sätta upp sina egna mål i behandlingen samt en god kommunikation mellan sjuksköterska och patient ansågs vara de viktigaste åtgärderna för att åtgärda problemen som uppstår när en patient med hetsätningsstörning söker vård. / Binge eating disorder is one of the most common eating disorders in the USA and the number of patients suffering from the disease is constantly increasing. Many patients choose to refrain from treatment shortly after it’s begun. The cause for this is usually due to a poor relationship between the nurse and the patient, or that the treatment is not easily accessible by the patient. The aim of the study was to investigate the patients experience of care when suffering from Binge eating disorder. The purpose of this aim was to increase the knowledge about how care is perceived by the patient as well as improve the care for the disorder. The result revealed that patients afflicted by Binge eating disorder considered the care too non-flexible and not adjusted to individual needs. The patients also mentioned that the nurse did not always understand their feelings and thoughts around binge eating. Having a contact person that had already undergone treatment was considered a positive experience. Person-centered care, the possibility for the patient to set up individual treatment goals as well as the communication between the nurse and the patient were considered the most important aspects when treating patients with binge eating disorder.

Cognitive impairments and changes in the structure and function of related brain regions, namely the prefrontal cortex and striatum, have long been implicated in drug addiction. However, it is unknown whether these abnormalities predate substance abuse, potentially serving as risk factors for dependence, or if they are the consequence of protracted use. To address this question, endophenotype research using stimulant-dependent individuals’ biological siblings has been used to investigate traits implicated in the pathology of addiction. Impairments present in both groups suggest an underlying risk-state for dependence, while additional abnormalities present only in stimulant-dependent individuals reflect potential effects of the drugs themselves. Contrastingly, there are also individuals who use stimulant drugs in a controlled manner without developing dependence. These ‘recreational users’ may lack the underlying traits that comprise a greater risk for dependence, or they might maintain additional protective factors against the development of addiction. Experiments in the first half of this dissertation used functional magnetic resonance imaging to investigate neurocognitive similarities and differences between dependent stimulant users, their non-dependent siblings, recreational users of cocaine, and unrelated healthy control volunteers. In Chapter 2, performance on a colour-word Stroop task was impaired in both stimulant-dependent individuals and their siblings, suggesting an endophenotype of cognitive inefficiency. However, neural activity significantly differed between the groups, indicating additional changes specific to the use of stimulant drugs. In Chapter 3, dependent users showed significant attentional bias to salient stimuli on a cocaine-word Stroop task, with a concurrent increase in prefrontal activation. Conversely, recreational users showed resilience in the face of cocaine cues and a decrease in arousal. Finally, Chapter 4 explored differences in reward sensitivity to both generic and drug-specific reinforcers, comparing the effects of personal and family history of stimulant exposure on a monetary incentive delay task. It is also under debate whether the neurocognitive differences seen in stimulant-dependent individuals are unique to substance abuse, or if parallel changes in behaviour and neurobiology are present in similar addiction-spectrum disorders, such as binge eating leading to obesity. In Chapter 5, stimulant-dependent and obese individuals with binge-eating behaviours showed differences in their substance-specific and general reward responsivity on a novel reward-valuation task. However, in Chapter 6 a similar decline in orbitofrontal cortex grey matter volume in relation to both years of stimulant use and body mass index was identified, implicating an overlap in this area between both conditions. These findings are integrated in Chapter 7, discussing the neurocognitive risk and protective factors that underlie an individual’s vulnerability for addiction, not only to stimulant drugs, but also potentially for other addictive behaviours.

The current dissertation is comprised of two studies that examined the relationship between group dynamics, attachment anxiety, and post-treatment outcomes in a sample of women (N = 102) with binge eating disorder (BED) who received Group Psychodynamic Interpersonal Psychotherapy. The first study explored the relationship between the development of group cohesion, the individuals’ level of attachment anxiety, and frequency of binge eating, symptoms of depression, and self-esteem at post-treatment. The second study explored the relationship between the interpersonal learning, individuals’ level of attachment anxiety, and outcomes. Interpersonal learning was conceptualized as the convergence between multiple perspectives of group cohesion: one’s own and the group’s perception of one’s cohesion to the group. Parallel measures of individual self-rated cohesion (CQ-I) and mean group-rated cohesion (CQ-G) were developed based on the original Cohesion Questionnaire (CQ; Piper et al., 1983) for this study. Participants were assigned to homogeneous groups composed of either high or low attachment anxiety to assess the impact of pre-treatment attachment anxiety. Findings indicated significant growth in cohesion over time, and a significant convergence in multiple ratings of cohesion. These processes did not differ significantly based on level of attachment anxiety. Growth in cohesion was related to greater reductions in binge eating for those high in attachment anxiety, while the convergence in ratings of cohesion (i.e., interpersonal learning) was related to improvements in self-esteem for individuals in both attachment anxiety conditions. The findings support the importance of group interventions for BED that are sensitive to individuals’ attachment anxiety, and that emphasize cohesiveness, and interpersonal learning to improve outcomes.

No description available.

The central aim of the present study was to examine the role of expectancies in binge eating behavior. Two distinct statistical techniques were used to accomplish this goal. First, regression analyses were conducted using variables previously identified in the literature, as well as eating expectancies as measured by the Eating Expectancy Inventory (EEI). For both females and males, regression equations including expectancies accounted for a substantial portion of the variance in binge eating behavior. Second, memory modeling techniques were used to model the probable organization of eating expectancies. Memory modeling of hypothetical expectancy networks has lead to successful interventions in alcohol use, and preliminary work in eating revealed a fundamental difference in the way that individuals with high levels of pathology activate and store eating related messages. In the present study, Individual Differences Scaling was used to model the two-dimensional organization of an eating expectancy memory network in relation to binge eating. INDSCAL weights indicated that participants with higher levels of binge eating placed more emphasis on the positive-negative dimension, and examination of group means revealed that high binge eaters expected more change in mood in response to eating. All findings are discussed in terms of implications for enhancing assessment, treatment, and prevention strategies.

Research suggests binge eating (BE) is equally prevalent across racial/ethnic groups. However, the majority of data concerning the assessment and treatment of BE come from clinical trials or specialty clinics where racial/ethnic minorities are underrepresented. Data regarding symptoms and treatment are needed from urban clinical settings where minorities are more likely to seek treatment. The current study assessed racial/ethnic group differences in BE prevalence, clinical and cognitive symptoms, and treatment retention in an ethnically-diverse weight loss treatment-seeking sample. Participants included 127 Hispanic, 204 African-American and 99 Caucasian adults who completed self-report measures of BE frequency, distress, eating-related cognitive symptoms including shape and weight concerns and dietary restraint, depression, stress, and treatment barriers. Data concerning number of treatment sessions attended and body mass index (BMI) were collected at 6-month follow up. The first study developed and validated the Dimensional Assessment of Loss of Control Eating (DALC) scale. The 2-factor DALC demonstrated good internal consistency and convergent, construct and incremental validity. The DALC contributed to variance in eating pathology and depression beyond existing BE measures. The second study examined racial/ethnic differences in BE prevalence, eating-related cognitive symptoms, and BMI. As hypothesized, no racial/ethnic differences in BE frequency were found and the rate of recurrent BE was 20% to 30%; participants with recurrent BE had higher BMIs, levels of depression, and global eating pathology than individuals without; African-American participants with BE had higher BMIs than other racial/ethnic groups, controlling for demographic variables. The hypotheses that Hispanic participants have higher weight and shape concerns, and that African-Americans have higher levels of restraint, were not supported. The third study examined the hypothesis that ethnicity is associated with obesity treatment retention and outcome. African-American participants had lower retention rates than Hispanics and Caucasians combined, and had lower levels of obesity-based stigma, which accounted for their lower retention rates. African-Americans lost less weight than Caucasians but this difference disappeared after accounting for age and income. The findings suggest high BE rates among racial/ethnic minorities at a common entry point for health services utilization. Stigma and African-American ethnicity should be considered when developing retention interventions.

This study investigated the extent biological, cultural, and psychological factors predispose individuals to eating disorders and compared the prevalence between (N = 103) male and female students (18-27 years of age) from Mississippi State University (MSU). Data was collected from the Eating Disorder Screen for Primary Care (ESP), a media consumption questionnaire, the Contour Drawing Rating Scale (CDRS), the Diet History Questionnaire III (DHQ III), the Eating Attitudes Test-26 (EAT-26), and the Rosenberg Self Esteem Scale. Age of onset was collected if participants identified as having an eating disorder. Data was analyzed using the Mann-Whitey U test and Pearson correlations to determine biological, cultural, and psychological susceptibility. This study determined that there are significant biological, cultural, and psychological predispositions that should be considered when diagnosing and treating individuals with eating disorders. Findings from MSU students were compared to current evidence and provides a basis for the development of future studies.

Diagnostic practices utilized in studies of participants with Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder were investigated. A reliable coding system was used by two reviewers to analyze the diagnostic documentation practices in articles from the top-thirty most cited articles for each diagnostic category. Interrater agreements were all above .95. Results showed that many important diagnostic practices and criteria are either not being employed or not being documented. Uniform reporting procedures are necessary to help readers know how each article’s sampling procedure and subject pool differs from other samples used in the literature. Researchers reported the most details about sample characteristics with the recently proposed Binge-Eating Disorder category. Discussion focuses on identifying the specific diagnostic and sampling procedures deserving better documentation in the eating disorder literatures.