Yes / Aims: Several studies funded by the UK government have been influential in understanding `binge drinking¿ rates in the UK. This analysis aims to establish consistency between results and clarify UK rates of binge drinking. Method: The relevant sections of these surveys were compared: the Scottish Health Survey (SHS) 1998, the General Household Survey (GHS) 2002 and the Health Survey for England (HSE) 2003. In addition the methodology used by the Health Protection Agency in the Adult Drinking Patterns in Northern Ireland (2003) was compared to the approach used by the SHS, GHS and HSE. Results: Marked differences were observed between the results of the GHS 2002 and both the SHS 1998 and the HSE 2002 despite each using a similar methodology, with the HSE 2003 reporting a rate of binge drinking in young males of 57%, and the GHS a rate of 35%. These difference may be largely attributed to variations in the criteria in binge drinking in each study. These differences in interpretation do not appear to have been acknowledged. Indeed several key alcohol harm reduction documents made inaccurate citations of previous surveys. Conclusion: The media rhetoric on escalating rates of binge drinking in the UK should be regarded with caution until trends are based on standardized recording and reporting .

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.

Yes / Binge drinking has sparked considerable interest and concern. However despite this interest little is known about the lay understanding of binge drinking and whether there are differences in understanding by gender, age and level of deprivation. Aims: This study investigated the beliefs and attitudes of a sample in the Inverclyde area to binge drinking. Methods: Using both cluster and quota sampling, 586 subjects completed a structured interview, using open questions about their beliefs on binge drinking and was it a problem generally and locally. Findings: Definitions of binge drinking tended to concentrate on intoxication and some described a dependent drinking pattern. Causes and solutions offered were varied but pointed up levels of deprivation in respect of jobs and entertainment. More subjects regarded binge drinking as a problem in society than locally, which is consistent with research suggesting that misperceptions of others¿ drinking increases with social distance. Differences in beliefs were found by age and level of deprivation but not gender. It was marked that no subject offered the `official¿ definition of bingeing or even an approximation of it. Conclusions: Further research is required if future mass media campaigns and interventions are to be relevant to the population.

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.

Während Leitlinien „Gold-Standards“ für die Psychotherapie bei bulimischen Essstörungen (Bulimia Nervosa und Binge-Eating-Störung) empfehlen, ist über psychotherapeutische Prozessfaktoren bei Essstörungen wenig bekannt. Ziel war es, mit Hilfe des etablierten Generic Model of Psychotherapy zur Systematisierung psychotherapeutischer Prozessfaktoren die aktuelle Literatur zum Einfluss dieser Faktoren auf den Therapieerfolg, operationalisiert als Symptomreduktion oder -remission, auf Basis einer systematischen Datenbanksuche zu sichten. Während der Einfluss des therapeutischen Settings nach bisheriger Forschungslage kaum Schlüsse hinsichtlich des Therapieerfolgs zulässt, konnte dieser durch spezifische Interventionen, frühe Symptomreduktionen und eine gute therapeutische Beziehung vorhergesagt werden. Weitere Forschung zu Prozessfaktoren bei bulimischen Essstörungen erscheint notwendig, um die praktische psychotherapeutische Arbeit zu unterstützen und Behandlungen effektiver gestalten zu können. / While guidelines recommend gold standards for psychotherapy in bulimic eating disorders (bulimia nervosa and binge eating disorder), less is known about psychotherapeutic process aspects. We aimed to summarize the current literature on the impact of process aspects on significant symptom reductions and/or abstinence as treatment outcome using the Generic Model of Psychotherapy. A systematic literature search was conducted. While effects of treatment settings can not yet be estimated, specific interventions, rapid response, and the therapeutic bond repeatedly predicted outcome. Process-outcome research in bulimic eating disorders will be necessary to support clinical practice and to enhance treatment efficacy.

Objective: Emerging prospective evidence from mixed samples, mostly covering short-term follow-up periods, suggests that childhood loss of control (LOC) eating predicts significant impairment in mental and physical health. This study sought to investigate the natural course of childhood LOC eating over the long term and in relation to binge eating disorder (BED) diagnosis, psychopathology, and body weight trajectory in the community. Method: A total of 60 children (8-13 years) with LOC eating within the past three months and 60 demographically-matched children without LOC history were assessed with the Eating Disorder Examination adapted for Children and self-report questionnaires over a 5.5 year follow-up period. Missing data were imputed. Results: Over follow-up, 38.3% of children showed persistent LOC eating, and 28.3% revealed an onset of LOC eating. Persistent LOC eating significantly predicted onset of partial-/full-syndrome BED at follow-up. Negative prognostic effects on eating disorder psychopathology, depressive symptoms, and body mass index were non-significant. Discussion: The results indicate a moderate stability of LOC eating over the long term. LOC eating, especially if stable, was suggested as a variable risk factor of clinically relevant eating disturbances. In contrast, a prognostic value for psychopathology and body mass index was not confirmed.

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.

Objective: Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self-evaluative processes, as conceptualized in the process model of self-stigma, and implications for other health-related outcomes, remain to be clarified. Design and Methods: In a representative general population sample of N = 1158 overweight and obese individuals, the impact of core self-evaluation as a mediator between weight bias internalization and mental and global health outcomes as well as between weight bias internalization and health care utilization, was examined using structural equation modeling. Results: In overweight and obese individuals, greater weight bias internalization predicted lower core self-evaluation, which in turn predicted greater depression and anxiety, lower global health, and greater health care utilization. These mediational associations were largely stable in subsample analyses and after controlling for sociodemographic variables. Conclusions: The results show that overweight and obese individuals with internalized weight bias are at risk for impaired health, especially if they experience low core self-evaluation, making them a group with which to target for interventions to reduce self-stigma. Weight bias internalization did not represent a barrier to health care utilization, but predicted greater health care utilization in association with greater health impairments.