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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

In a survey sent to the senior women's administrator at all three hundred and thirty (N= 330) NCAA Division I intercollegiate athletic departments across the nation, this study examines the differences between Division I athletic department's having an eating disorder (ED) policy and those that that do not and the variables that lead to those differences. Over a 12-month period, from March 2004 through March 2005, one variable that this study addresses is whether having an ED policy influences the number of reported incidences. Likewise, another variable is whether education on ED for the student-athletes influences the number of reported incidences. Lastly, the final variable investigates those intercollegiate athletic departments that have other policies for their student-athletes such as alcohol, tobacco, and drug, and whether this influences having an ED policy. As the following research indicates, ED primarily affects the female gender. In addition, although ED are deemed a medical issue in which the head athletic trainer or the team physician is likely to work closely in treating the athlete, the senior women's administrator is chosen to complete the survey because of their gender, and this study focuses more on the policy itself, from an administrative prospective. For those universities surveyed who do not have such a policy, this paper examines the need, along with the legal responsibilities that intercollegiate athletic programs have toward their student-athletes concerning ED. / Ed. 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.

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.

Binge-eating disorders are a common problem affecting up to 5 percent of the American population in any given 6-month period. Currently, the most widely accepted treatment is some variation of Cognitive Behavior Therapy. Although there is an abundance of research showing positive effects, the abstinence rates following this type of treatment are currently around 50%. A recent study by Bosch, Miltenberger, Gross, Knudson, and Brower-Breitwieser (2008) explored the effects of extinction on binge-eating behavior that was hypothesized to be maintained by relief from negative emotional responding. The study involved four women who engaged in binge-eating behavior, one of whom met the diagnostic criteria for Bulimia Nervosa. The treatment was successful, with three of the four participants obtaining abstinence. To date, this has been the only study examining this procedure and with only four participants. The purpose of the current study was to further evaluate extinction of binge eating maintained by automatic negative reinforcement with women who met diagnostic criteria for Bulimia Nervosa. Four young women enrolled in the study, three of whom met criteria for Bulimia Nervosa. The results showed that the treatment decreased binge eating to zero for all four women, although one dropped out of the study shortly after beginning the intervention.

Introduction: Eating disorders are serious psychiatric disorders that often require specialized care. Associated psychiatric comorbidity is frequent, with the most common comorbid conditions being anxiety and mood disorders. Eriksbergsgården in Örebro is one of Sweden’s specialized eating disorder treatment units.Aim: Primary aims were to describe clinical characteristics of the adult patient group at Eriksbergsgården and to evaluate treatment outcome and patient satisfaction at the one-year follow-up. An additional aim was to examine if factors such as psychiatric comorbidity affected treatment outcome.Methods: This study used data from Riksät and Stepwise, two large-scale Swedish registers for eating disorder treatment. Data for this study was registered into Stepwise and Riksät at Eriksbergsgården between August 2010 and December 2017 and 489 adult patients of both genders constituted the study group. Patient characteristics and DSM-IV axis I psychiatric comorbidity were assessed at the initial evaluation. At the one-year follow-up, treatment outcome and patient satisfaction were evaluated.Results: The most common diagnoses in this patient material were eating disorder not otherwise specified, 56.6 %, followed by bulimia nervosa, 26.4 %. At the initial evaluation, 62.0 % of the patients suffered from psychiatric comorbidity. Of the patients with initial comorbidity, 43.3 % were recovered at the one-year follow-up, compared to 62.8 % of the patients with no initial comorbidity, p=0.021.Conclusion: Our results confirm the previously known fact that psychiatric comorbidity among eating disorder patients is common. Also, the results identify psychiatric comorbidity as a possible factor to have negative effect on the treatment outcome.