Objective: Adolescents with binge-eating disorder (BED) are suffering from weight teasing and, as found in adults with BED, are likely to internalize weight bias. Weight teasing by mothers accounts for psychopathology in overweight, but sources of stigmatization are largely unknown in BED. This study sought to address familial weight bias in adolescents with overweight and BED by examining adolescents’ perceived parental weight teasing and weight bias internalization in relation to their eating disorder psychopathology and maternal stigmatizing attitudes and beliefs. Method: Adolescents with overweight and BED (BED; n = 40) were compared to a socio-demographically matched group with overweight only (OW) and a normal-weight control group (NW; each n = 25). They filled out the Perception of Teasing Scale, with parents as the source of teasing, the Weight Bias Internalization Scale and the Eating Disorder Examination-Questionnaire. Their mothers filled out the Attitudes Toward and Beliefs about Obese Persons Scales. Results: Significantly higher perceived parental weight teasing and weight bias internalization were found in BED compared to OW and NW. Maternal stigmatizing attitudes and beliefs did not differ between groups and were not correlated with adolescents’ perceptions of being stigmatized. Perceived parental weight teasing predicted adolescents’ eating disorder psychopathology, however, this association was fully mediated by weight bias internalization. Discussion: These results indicate that adolescents with overweight and BED perceive weight teasing in their own families. As we found no significant association between adolescents’ perceptions of being stigmatized and maternal stigmatizing attitudes, future research should examine weight-related parent-child interaction or implicit measures of stigmatizing attitudes.

Studies indicate an attentional bias towards food in binge-eating disorder (BED), however, more evidence on attentional engagement and disengagement and processing of multiple attention-competing stimuli is needed. This study aimed to examine visual attention to food and non-food stimuli in BED. In n = 23 participants with full-syndrome and subsyndromal BED and n = 23 individually matched healthy controls, eye-tracking was used to assess attention to food and non-food stimuli during a free exploration paradigm and a visual search task. In the free exploration paradigm, groups did not differ in initial fixation position. While both groups fixated non-food stimuli significantly longer than food stimuli, the BED group allocated significantly more attention towards food than controls. In the visual search task, groups did not differ in detection times. However, a significant detection bias for food was found in full-syndrome BED, but not in controls. An increased initial attention towards food was related to greater BED symptomatology and lower body mass index (BMI) only in full-syndrome BED, while greater maintained attention to food was associated with lower BMI in controls. The results suggest food-biased visual attentional processing in adults with BED. Further studies should clarify the implications of attentional processes for the etiology and maintenance of BED.

Introduction: Among eating disorders, the binge eating is the most common disorder with prevalence to 7,8%. It is frequently connected with overweight, or obesity. Current treatment of binge eating is based on psychotherapy, pharmacotherapy and regime approach. Recently, repetitive transcranial magnetic stimulation appears as hopeful therapeutic method, for example used with success as an alternative therapy to treatment of resistant major depresion. Because of its non-invasiveness, good tolerability and minimal side effects, new options of its use are studied. It seems to be a promising therapeutic method for treatment of eating disorders. Dorsolateral prefrontal cortex is considered as main experimental target of stimulation for treatment of binge eating disorder. Methods: Study was conceived randomized double-blind placebo controlled. The active group was stimulated by high-frequency rTMS, with stimulation parameters: frequency 10Hz, 1500 pulses, 107s inter-train, 100 % minimal motor threshold and 10 sessions of stimulation. The control grooup was stimulated by sham rTMS coil. Both groups completed FCQ-S and FCQ- T questionnaire before stimulation, after 10. session and one month after 10. session. Results: We noticed statistically significant decrease of craving in FCQ-S questionnaire after 10. session...

Editorial on the Research Topic. Extreme Eating Behaviours.

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Objective: Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating and is associated with eating disorder and general psychopathology and overweight/obesity. Deficits in cognitive and emotional functioning for eating disorders or obesity have been reported. However, a systematic review on cognitive and emotional functioning for individuals with BED is lacking. Method: A systematic literature search was conducted across three databases (Medline, PubMed, and PsycINFO). Overall, n = 57 studies were included in the present review. Results: Regarding cognitive functioning, individuals with BED consistently demonstrated higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues), whereas cognitive functioning in the context of neutral stimuli appeared to be less affected. Thus, results suggest disorder-related rather than general difficulties in cognitive functioning in BED. With respect to emotional functioning, individuals with BED reported difficulties similar to individuals with other eating disorders, with a tendency to show less severe difficulties in some domains. In addition, individuals with BED reported greater emotional deficits when compared to obese and normal-weight controls. Findings suggest general difficulties in emotional functioning in BED. Thus far, however, investigations of emotional functioning in disorder-relevant situations are lacking. Discussion: Overall, the cross-sectional findings indicate BED to be associated with difficulties in cognitive and emotional functioning. Future research should determine the nature of these difficulties, in regards to general and disorder-related stimuli, and consider interactions of both domains to foster the development and improvement of appropriate interventions in BED.

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.

Background: Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Objectives: This study sought to investigate the prevalence of BED and NES and associations with various forms of non-normative eating behavior and psychopathology in prebariatric patients. Setting: Within a consecutive multicenter registry study, patients in six bariatric surgery centers in Germany were recruited. Methods: Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures. Results: Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Comorbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED. Conclusions: BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with non-normative eating behavior and psychopathology point to their clinical significance and discriminant validity.

This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.

Hintergrund. Für die durch wiederkehrende Essanfälle gekennzeichnete Binge Eating-Störung (BES) wurde die Kognitive Verhaltenstherapie (KVT) als Behandlungsmethode der Wahl etabliert. Zum Psychotherapieprozess, welcher das Therapieergebnis beeinflusst, ist jedoch wenig bekannt. Fragestellung. Da Untersuchungen zum Prozessaspekt der therapeutischen Adhärenz Unterschiede zwischen Patienten eines Therapeuten sowie zwischen verschiedenen Therapeuten belegen, soll der Einfluss von Patienten- und Therapeutenmerkmalen auf die therapeutische Adhärenz geprüft werden. Methode. In einer prospektiven, multizentrischen, randomisiert-kontrollierten Behandlungsstudie zum Wirksamkeitsvergleich von KVT und Internet-basierter angeleiteter Selbsthilfe (INTERBED) wurde die therapeutische Adhärenz in der KVT durch unabhängige Rater erfasst. Patienten- und Therapeutenmerkmale wurden mittels Interview und Selbstbericht erhoben. Ergebnisse. Soziodemografische Merkmale wie ein geringeres Bildungsniveau der Patienten und weibliches Geschlecht der Therapeuten wurden als signifikante Prädiktoren einer höheren therapeutischen Adhärenz identifiziert. Störungsspezifische Merkmale der Patienten waren nicht mit der therapeutischen Adhärenz assoziiert. Therapeutenmerkmale wie ein geringerer Ausbildungsgrad, eine geringere erlebte therapeutische Kompetenz und höhere Erwartungen sowie ein höheres emotionales Wohlbefinden der Therapeuten sagten eine höhere therapeutische Adhärenz vorher. Diskussion. Die etablierte hohe therapeutische Adhärenz erschien unabhängig vom Patienten, während einige Therapeutenmerkmale als Prädiktoren identifiziert wurden. Ungünstige Einflüsse auf die therapeutische Adhärenz bedürfen weiterer Erforschung und einer stärkeren Berücksichtigung in der Ausbildung von Therapeuten. / Background. Cognitive-behavioral therapy (CBT) has been established as the treatment of choice for binge-eating disorder (BED) which is characterized by recurrent binge eating episodes. However, only little is known about the impact of the psychotherapeutic process on treatment outcomes. Objectives. While studies concerning the process aspect of therapist adherence found differences between patients from one therapist as well as differences between therapists, the impact of patient and therapist characteristics on therapist adherence will be investigated. Methods. In a prospective multicenter randomized-controlled trial comparing CBT to Internet-based guided self-help (INTERBED), the therapist adherence to CBT was determined by independent raters. Patient and therapist characteristics were obtained via interview and self-report questionnaires. Results. Sociodemographic characteristics including lower education in patients and female sex in therapists were identified as predictors of higher therapist adherence. Disorder-specific characteristics of patients were not associated with the therapist adherence. Therapist characteristics including less postgraduate therapist training, lower self-rated therapeutic competence, and higher expectations as well as higher emotional well-being of therapists predicted higher therapist adherence. Conclusions. The high level of therapist adherence was mostly independent from patients, while some therapist characteristics were identified as predictors. Adverse impacts on therapist adherence should be investigated further and might be considered in therapeutic training.