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Executive functioning (EF) problems may serve as vulnerability or maintenance factors for Binge-Eating Disorder (BED). However, it is unclear if EF problems observed in BED are related to overweight status or BED status. The current study extends this literature by examining EF in overweight-BED (n=32), normal-weight BED (n=23), overweight healthy controls (n=48), and normal-weight healthy controls (n=48). Participants were administered an EF battery which utilized tests from the National Institutes of Health (NIH) toolkit and Delis-Kaplan Executive Function System (D-KEFS). After controlling for years of education and minority status, overweight individuals with and without BED performed more poorly than normal-weight individuals with and without BED on a task of cognitive flexibility (p < 0.01) requiring generativity and speed and on psychomotor performance tasks (p < 0.01). Normal-weight and overweight BED performed worse on working memory tasks compared to normal-weight healthy controls (p = 0.04). Unexpectedly, normal-weight BED individuals out-performed all other groups on an inhibitory control task (ps < 0.01). No significant differences were found between the four groups on tasks of planning. Our findings support a link between poorer working memory performance and BED status. Additionally, overweight status is associated with poorer psychomotor performance and cognitive inflexibility. Replication of the finding that normal-weight BED is associated with enhanced inhibitory control is needed. / Psychology

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.

Binge Eating Disorder (BED) is a common, early-onset mental health condition characterised by uncontrollable episodes of overeating followed by negative emotions such as guilt and shame. An improved understanding of the neurocognitive mechanisms underlying BED is central to the development of more targeted and effective treatments. This thesis comprises a systematic review and three empirical studies contributing to this endeavour. BED can be thought of as a disorder of cognitive-behavioural control. Indeed, self-report evidence points towards enhanced impulsivity and compulsivity in BED. However, retrospective self-reports do not capture the mechanisms underlying impulsive and compulsive lapses of control in the moment. The systematic review therefore focussed on the experimental literature on impulsivity and compulsivity in BED. The evidence was very mixed, although there was some indication of altered goal-directed control and behavioural flexibility in BED. We highlight poor reliability of experimental paradigms and the failure to properly account for weight status as potential reasons for inconsistencies between studies. Moreover, we propose that impulsivity and/or compulsivity may be selectively enhanced in negative mood states in BED and may therefore not be consistently detected in lab-based studies. In the empirical studies, we explored the role of behavioural flexibility in BED using experimental and neuroimaging methods in concert with computational modelling. In the first empirical study, we assessed the reliability of a common measure of behavioural flexibility, the Probabilistic Reversal Learning Task (PRLT). We demonstrate that the behavioural and computational metrics of the PRLT have sufficient reliability to justify past and future applications if calculated using hierarchical modelling. This substantially improves reliability by reducing error variance. The results support the use of the PRLT in the second and third empirical studies on development and BED. Because a majority of patients develop BED as adolescents or young adults, we speculated that it may emerge as a consequence of disrupted or deficient maturation of behavioural flexibility. Little is known about typical development in this domain. We therefore investigated normative development of reversal learning from adolescence to adulthood in the second empirical study. Typically- developing adolescents exhibited less adaptive and more erratic and explorative behaviour than adults. This behaviour was accounted for by reduced sensitivity to positive feedback in a reinforcement learning model, and partially mediated by reduced activation reflecting uncertainty in the medial prefrontal cortex, a region known to mature substantially during adolescence. In the third empirical study, we investigated reversal learning in BED, paying special attention to potential biases associated with learning from wins vs learning from losses. We speculated that negative urgency could make it more difficult for BED patients to learn and make decisions under pressure to avoid losses. To dissociate between effects of excess weight and BED, we collected data from obese individuals with and without BED as well as normal-weight controls. As hypothesised, there were subtle neurocognitive differences between obese participants with and without BED with regard to learning to obtain rewards and to avoid losses. Obese individuals showed relatively impaired learning to obtain rewards, while BED patients showed relatively impaired learning to avoid losses. This was reflected in differential learning signals in the brain and associated with BED symptom severity. In sum, this thesis shows that the evidence on impulsivity and compulsivity in BED is inconsistent and offers potential explanations for this inconsistency. It highlights the need for reliability in interindividual difference research and indicates ways to improve it. Further, it charts the typical development of reversal learning from adolescence to adulthood and underscores the relevance of exploration in the context of learning and decision-making in adolescence. Finally, it demonstrates qualitative differences between BED and obesity, hinting at a pivotal role of aversive states in loss of control in BED. / Binge-Eating-Störung (BES) ist eine weit verbreitete psychische Erkrankung, die häufig im Jugend- oder jungen Erwachsenenalter beginnt und von Episoden unkontrollierten Überessens gefolgt von negativen Emotionen wie Schuld und Scham gekennzeichnet ist. Ein verbessertes Verständnis der neurokognitiven Mechanismen, die der BES zugrunde liegen, ist zentral für die Entwicklung zielgerichteterer und effektiverer Therapieansätze. Die vorliegende Dissertation umfasst eine systematische Übersichtsarbeit und drei empirische Studien, die zu diesem Vorhaben beitragen. BES kann als eine Störung der kognitiven oder Verhaltenskontrolle betrachtet werden. Selbsteinschätzungsdaten aus Fragebogenstudien deuten klar auf erhöhte Impulsivität und Zwanghaftigkeit hin. Retrospektive Selbsteinschätzungsdaten können jedoch wenig Aufschluss über die Mechanismen geben, die impulsiven und zwanghaften Kontrollverlusten zugrunde liegen. Als Ausgangspunkt dieser Arbeit haben wir daher eine systematische Übersicht der experimentellen Literatur zu Impulsivität und Zwanghaftigkeit bei BES erstellt, die in dieser Hinsicht mehr Einblick verspricht. Die Studienlage war sehr heterogen, aber es gab vorläufige Hinweise auf veränderte zielgerichtete Kontrolle und Verhaltensflexibilität bei BES. Wir zeigen auf, dass unzureichende Reliabilität experimenteller Paradigmen und mangelnde Berücksichtigung wichtiger Störvariablen wie Körpergewicht mögliche Gründe für die großen Inkonsistenzen zwischen Studien sein könnten. Weiterhin vermuten wir, dass Impulsivität und/oder Zwanghaftigkeit im Rahmen der BES selektiv erhöht sein könnten, wenn Patient*innen sich in negativen Gemütszuständen befinden, und daher in Laborstudien nicht konsistent nachgewiesen werden können. Die empirischen Studien untersuchten die Rolle von Verhaltensflexibilität bei BES anhand experimenteller und bildgebender Verfahren sowie mathematischer Modellierung. In der ersten empirischen Studie untersuchten wir die Reliabilität der Probabilistic Reversal Learning Task (PRLT), eines gängigen Maßes der Verhaltensflexibilität. Wir konnten zeigen, dass die Verhaltensmaße und Metriken der mathematischen Modelle der PRLT adäquate Reliabilität aufweisen – allerdings nur, wenn sie anhand von hierarchischen Modellen errechnet werden. Letzteres reduziert die Fehlervarianz und verbessert die Reliabilität damit erheblich. Die Ergebnisse stützen die Verwendung der PRLT in unseren Studien zu Verhaltensflexibilität in der Entwicklung und bei BES. Da BES seine Erstmanifestation oft im Jugend- oder frühen Erwachsenenalter hat, liegt die Vermutung nahe, dass sie sich als Folge einer gestörten oder defizitären Reifung der Verhaltensflexibilität entwickeln könnte. Da jedoch wenig über die typische Entwicklung in diesem Bereich bekannt ist, haben wir in der zweiten empirischen Studie zunächst die normative Entwicklung von Reversal- Learning vom Jugend- zum Erwachsenenalter untersucht. Gesunde Jugendliche zeigten weniger adaptives, erratischeres und explorativeres Verhalten als Erwachsene. Unser mathematisches Modell des Verstärkungslernens erklärt dieses Muster durch eine verringerte Empfindlichkeit gegenüber positivem Feedback. Zudem konnten wir zeigen, dass dieses Verhalten teilweise durch reduzierte Aktivierung des medialen prefrontalen Kortex vermittelt war, einer Region, die im Jugendalter eine substanzielle Reifung durchmacht. In der dritten empirischen Studie haben wir schließlich Reversal-Learning bei BES untersucht und dabei spezielles Augenmerk auf potenzielle Verzerrungen im Lernen zum Erlangen von Belohnungen im Gegensatz zum Lernen zur Verlustvermeidung gelegt. Um Effekte von BES und Adipositas zu unterscheiden, haben wir Daten von adipösen Personen mit und ohne BES, sowie gesunden Normalgewichtigen erhoben. Wie erwartet gab es subtile neurokognitive Unterschiede zwischen adipösen Proband*innen mit und ohne BES im Hinblick auf Lernen zum Erlangen von Belohnungen und Vermeiden von Verlusten. So war Adipositas durch relativ beeinträchtigtes Lernen zum Erlangen von Belohnungen gekennzeichnet, während BES durch relativ beeinträchtigtes Lernen zur Vermeidung von Verlusten gekennzeichnet war. Dieser Unterschied spiegelte sich in der neuronalen Kodierung von Lernsignalen wieder und korrelierte mit der Symptomschwere der BES. Zusammenfassend zeigt diese Dissertation, dass die Literatur zu Impulsivität und Zwanghaftigkeit in BES inkonsistent ist und legt Gründe für diese Inkonsistenzen nahe. Sie hebt die kritische Rolle der Reliabilität von Instrumenten in der Forschung in differentieller und klinischer Psychologie sowie Psychiatrie hervor und zeigt Möglichkeiten auf, diese zu verbessern. Weiterhin zeichnet sie ein Bild der Entwicklung von Reversal Learning vom Jugend- zum Erwachsenenalter und unterstreicht die Relevanz von Explorationsverhalten im Kontext von Lernen und Entscheiden im Jugendalter. Schließlich zeigt sie qualitative Unterschiede zwischen BES und Adipositas auf und legt weitere Forschung in Hinblick auf eine möglicherweise zentrale Rolle negativer Emotionen für Kontrollverlust bei BES nahe.

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.