Marburg, Universiẗat, Diss., 2000.

Introduction: Defensive functioning may play an important role in the development and treatment of binge-eating disorder (BED). The Defense Mechanism Rating Scale (DMRS) is a widely used observer rating measure of defensive functioning. However, there is little research on defensive functioning and the DMRS in BED. This dissertation includes three studies on defensive functioning in individuals with BED. Study one assessed the validity and reliability of the DMRS when used to rate Adult Attachment Interview (AAI) transcripts, and compared defensive functioning between women with and without BED. Study two compared change in defensive functioning in women with BED who received Group Psychodynamic-Interpersonal Psychotherapy (GPIP) versus those in a waitlist no treatment control condition. Study three assessed the impact of other group therapy members’ defensive functioning on an individual group member’s treatment outcomes (i.e., binge-eating frequency and interpersonal functioning). Thus, the overall goals of this dissertation were to better understand the role of defensive functioning in BED, the degree to which defensive functioning changes due to group therapy, and the impact in the context of the therapy group’s defensive functioning on individual outcomes. Method: Participants with for this study were recruited from three previous investigations. Two clinical trials of group psychotherapy provided data of individuals with BED: (1) a randomized trial (N = 85) in which participants were assigned to GPIP (n = 35) or a waitlist control (n = 50), and (2) an uncontrolled study in which all participants with BED (N = 101) received GPIP. A total of 17 therapy groups were formed across both studies, with each group consisting of five to 11 members. In addition, a third study provided data from two comparison groups without BED: women who were overweight/obese (body mass index [BMI] > 27 kg/m2; n = 47) and women who were normal weight (BMI = 20 to 25 kg/m2; n = 49). Participants with BED completed a battery of questionnaires and the AAI at two time-points (i.e., pre-treatment/pre-waitlist and six months post-treatment/post-waitlist). Participants without BED completed the same battery of questionnaires and the AAI at one time-point and did not receive treatment. All AAI audio recordings were transcribed and used to code defensive functioning. Results: In study one, the DMRS coded from AAI transcripts demonstrated acceptable inter-rater reliability; good convergent validity, as it was significantly correlated with other related constructs (i.e., interpersonal functioning, reflective functioning, and attachment insecurity); and acceptable predictive validity, as women with BED had significantly lower defensive functioning than normal weight women without BED. In study two, those who received GPIP had significantly greater improvements in defensive functioning from pre-treatment to six months post-treatment compared to the waitlist control group. Follow-up analyses revealed that the average number of High Adaptive defenses significantly increased from pre-treatment to six months post-treatment in the GPIP condition, but not in the waitlist control condition; and significantly more participants assigned to the waitlist control condition deteriorated in their defensive functioning from pre-waitlist to six months post-waitlist than those assigned to GPIP. In study three, individual defensive functioning scores at pre-treatment were not significantly associated with either treatment outcome (i.e., binge-eating frequency or interpersonal distress) at six months post-treatment. However, other group members’ mean defensive functioning scores at pre-treatment were significantly associated with individual interpersonal distress, but not binge-eating frequency, at six months post-treatment. Discussion: Overall, this dissertation lends further support to the role of defensive functioning in the maintenance and treatment of BED. Individuals with BED tend to use less adaptive defensive functioning, but this can be improved through GPIP. Further, context of the therapy group in terms of defensive functioning is particularly important for improving treatment outcomes in individuals with BED. These findings should be replicated across more diverse samples and other types of group psychotherapy. Group therapists can help their patients with BED confront their maladaptive defense mechanisms and binge-eating by tackling their interpersonal distress, and placing sufficient emphasis on the group’s composition in terms of defensive functioning.

A plethora of research has linked negative affect with binge eating in people with binge eating disorder (BED). Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) have not traditionally addressed emotional regulation deficits. Failure to address emotional aspects of binge eating may explain why some individuals do not respond to CBT or IPT, and why many of those who do respond relapse shortly after finishing treatment. Dialectical behaviour therapy (DBT) specifically targets the inability to accurately recognise and regulate affect. Preliminary investigations have shown that DBT may be efficacious in treating BED. However, it can take up to 10 months, and a shorter intervention targeting affect regulation and recognition may produce similar effects. Four studies evaluating a ten session emotion-focussed group psychoeducational intervention for BED were conducted. In the first, 25 women diagnosed with subthreshold or full syndrome BED (using DSM-IV-TR criteria) were treated. The second study tested whether the specific components of the intervention, or the treatment as a whole, was required to produce positive outcomes in women. Study three, examined the efficacy of the treatment programme with three men diagnosed with subthreshold or full syndrome BED (also using DSM-IV-TR criteria). The fourth study compared the women's and men's response to treatment. Following the intervention with women, binge abstinence rates, comparable to those of CBT and IPT, and various other positive changes to eating and general pathology, were observed. These effects were well-maintained up to one-year later. Overall, it was concluded that the whole treatment programme was necessary to produce the optimum outcome for BED in women. A positive outcome was measured in the men, although the effects were not as dramatic as those found in the women. Suggestions for improvements, and suggestions for further research, are discussed. The results provide support for the Affect Regulation Model of BED in women and men.

Binge eating disorder (BED) is the most prevalent of all eating disorders and is characterized by recurrent episodes of eating a large amount of food in the absence of control. There have been various kinds of research of BED, but the phenomenon remains poorly understood. This thesis reviews the results of research on BED to provide a synthetic view of the current general understanding on BED, as well as the neural correlates of the disorder and treatments. Research has so far identified several risk factors that may underlie the onset and maintenance of the disorder, such as emotion regulation deficits and body shape and weight concerns. However, neuroscientific research suggests that BED may characterize as an impulsive/compulsive disorder, with altered reward sensitivity and increased attentional biases towards food cues, as well as cognitive dysfunctions due to alterations in prefrontal, insular, and orbitofrontal cortices and the striatum. The same alterations as in addictive disorders. Genetic and animal studies have found changes in dopaminergic and opioidergic systems, which may contribute to the severities of the disorder. Research investigating neuroimaging and neuromodulation approaches as neural treatment, suggests that these are innovative tools that may modulate food-related reward processes and thereby suppress the binges. In order to predict treatment outcomes of BED, future studies need to further examine emotion regulation and the genetics of BED, the altered neurocircuitry of the disorder, as well as the role of neurotransmission networks relatedness to binge eating behavior.

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.

Abstract: Binge eating disorder (BED) is the most common eating disorder, affecting approximately 2% of men and 3.5% of women. BED has a complex etiology that includes both physical and psychological co-morbidities. Up to 50% of overweight and obese people seeking weight loss treatment have BED. Treatment includes pharmacological therapy and psychotherapy with the main goals of reducing binge frequency and weight reduction. Three categories of medications have been identified for the pharmacological treatment of BED: antidepressants, centrally acting appetite suppressants, and anticonvulsants Behavioral weight loss (BWL) includes modest weight reduction typically by reducing fat intake, eating regular meals and snacks and increasing weekly exercise. Interpersonal psychotherapy, Cognitive behavioral therapy and dialectical behavior therapy are the most successful forms for psychotherapy used to treat BED. In conclusion, BED etiology is multifaceted and successful treatment must address the complexities of the disorder. / text

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.

A plethora of research has linked negative affect with binge eating in people with binge eating disorder (BED). Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) have not traditionally addressed emotional regulation deficits. Failure to address emotional aspects of binge eating may explain why some individuals do not respond to CBT or IPT, and why many of those who do respond relapse shortly after finishing treatment. Dialectical behaviour therapy (DBT) specifically targets the inability to accurately recognise and regulate affect. Preliminary investigations have shown that DBT may be efficacious in treating BED. However, it can take up to 10 months, and a shorter intervention targeting affect regulation and recognition may produce similar effects. Four studies evaluating a ten session emotion-focussed group psychoeducational intervention for BED were conducted. In the first, 25 women diagnosed with subthreshold or full syndrome BED (using DSM-IV-TR criteria) were treated. The second study tested whether the specific components of the intervention, or the treatment as a whole, was required to produce positive outcomes in women. Study three, examined the efficacy of the treatment programme with three men diagnosed with subthreshold or full syndrome BED (also using DSM-IV-TR criteria). The fourth study compared the women's and men's response to treatment. Following the intervention with women, binge abstinence rates, comparable to those of CBT and IPT, and various other positive changes to eating and general pathology, were observed. These effects were well-maintained up to one-year later. Overall, it was concluded that the whole treatment programme was necessary to produce the optimum outcome for BED in women. A positive outcome was measured in the men, although the effects were not as dramatic as those found in the women. Suggestions for improvements, and suggestions for further research, are discussed. The results provide support for the Affect Regulation Model of BED in women and men.

Binge eating disorder (BED) is characterized by compulsive consumption of food within a short time period accompanied by loss of control over eating. Recent literature provides the basis for consideration of BED as an addiction-like disorder. In this study, we aimed to determine the effects of Trace Amine-Associated Receptor 1 (TAAR1) agonism on maladaptive forms of feeding behaviors. TAAR1 is an intracellular receptor preferentially expressed in monoaminergic cells, and involved in reward and motivation. For this purpose, we trained male rats to self-administer either a sugary, highly palatable diet (Palatable rats) or a chow diet (Chow rats) for 1 hour/day under a Fixed Ratio 1 (FR1) schedule of reinforcement. Following escalation and stabilization of binge-like eating of palatable food, we tested the effects of the TAAR1 agonist RO5256390 on i) binge-like eating and eating rate in the FR1 schedule, ii) compulsive eating in a light/dark conflict test, iii) food reward using a conditioned place preference test, and lastly iv) food seeking behavior using a second-order schedule of reinforcement. Results showed that RO5256390 blocked binge-like eating, compulsive eating, food reward, and food seeking behavior selectively in Palatable rats without affecting Chow controls’ performance. Results provide evidence that TAAR1 may be a potential pharmacological target for Binge Eating Disorder. / 2018-06-16T00:00:00Z

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.