The purpose of this project is to gather an understanding of binge eating disorder and effective treatment approaches used for the reduction of binge eating symptoms for adult females. The research focus of this study will be, what are the attitudes and perspectives of binge eating disorder treatments for adult females among students who are in a masters of social work field or study. This research project utilized a post-positivist paradigm where data was gathered qualitatively through the implementation of interviews with MSW students of diverse ethnic backgrounds (e.g. Hispanics, whites, and blacks, professional and personal experiences) from California State University of San Bernardino. The researcher utilized literature review to prepare for the study execution, and participants were provided with an inform consent and debriefing statement. The researcher prepared questions, and audio recorded, transcribe, and then analyzed the interviews. Master’s students’ first-hand knowledge and perspectives contributed to a better understanding of what needs to be known in order to effectively treat binge eating disorder. The results consisted of the following themes: knowledge; basic knowledge of eating disorders, limited knowledge or awareness about binge eating disorder among adult females, no knowledge in regards to effective treatments for adult females with binge eating disorder, need for knowledge or awareness, perceptions; negative perceptions of binge eating disorder and treatments for adult females, experiences; personal and school experiences, and treatments; cognitive behavior therapy for treatment.

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 recurrent episodes of binge eating without the use of compensatory behaviors. Functional accounts of BED propose that negative affect is an antecedent to binge eating because binge eating serves to alleviate negative affect. However, previous studies investigating the association between negative affect and binge eating have yielded inconsistent findings, perhaps due to individual vulnerability factors that moderate the effects of negative affect on binge eating behavior. As one candidate, the current study investigated emotion regulation strategies that may be implicated in the maintenance of binge eating in BED, particularly under conditions of negative affect: brooding rumination, distress tolerance, and mood-related expectancies for eating. These emotion regulation strategies were: a) compared in 38 women with BED vs. 36 non-eating disordered female controls, b) examined in relation to markers of current binge eating severity among BED women, and c) used as predictors of caloric intake and urge to eat in response to a personally-relevant dysphoric mood induction upon presentation of snack foods in a "taste task." Results revealed that women with BED endorsed higher brooding rumination, more positive expectancies that eating serves to ameliorate negative affect, and lower distress tolerance than controls. Among women with BED, higher brooding rumination was associated with greater binge eating severity, and stronger expectancies that eating reduces negative affect were associated with more frequent binge eating episodes and greater urge to eat in response to depression. Surprisingly, better distress tolerance was associated with more frequent binge eating episodes. Women with BED consumed more calories and reported greater loss of control as well as a greater sense of guilt in response to the taste task relative to control participants. Contrary to hypothesis, there were no direct or indirect effects of any of the three emotion regulation strategies on change in urge to eat or calories consumed on the taste task following sad mood induction in BED women. In controls, better distress tolerance and stronger expectancies that eating alleviates negative affect were associated with decreased caloric intake on the taste task after mood induction. Overall, these findings highlight the importance of considering trans-diagnostic processes in BED as well as the need to identify other theoretically-relevant factors that contribute to the cognitive and behavioral features of BED. Limitations and directions for future studies are discussed.

Binge Eating Disorder (BED) is characterized by recurrent episodes of binge eating without the use of compensatory behaviors. Functional accounts of BED propose that negative affect is an antecedent to binge eating because binge eating serves to alleviate negative affect. However, previous studies investigating the association between negative affect and binge eating have yielded inconsistent findings, perhaps due to individual vulnerability factors that moderate the effects of negative affect on binge eating behavior. As one candidate, the current study investigated emotion regulation strategies that may be implicated in the maintenance of binge eating in BED, particularly under conditions of negative affect: brooding rumination, distress tolerance, and mood-related expectancies for eating. These emotion regulation strategies were: a) compared in 38 women with BED vs. 36 non-eating disordered female controls, b) examined in relation to markers of current binge eating severity among BED women, and c) used as predictors of caloric intake and urge to eat in response to a personally-relevant dysphoric mood induction upon presentation of snack foods in a "taste task." Results revealed that women with BED endorsed higher brooding rumination, more positive expectancies that eating serves to ameliorate negative affect, and lower distress tolerance than controls. Among women with BED, higher brooding rumination was associated with greater binge eating severity, and stronger expectancies that eating reduces negative affect were associated with more frequent binge eating episodes and greater urge to eat in response to depression. Surprisingly, better distress tolerance was associated with more frequent binge eating episodes. Women with BED consumed more calories and reported greater loss of control as well as a greater sense of guilt in response to the taste task relative to control participants. Contrary to hypothesis, there were no direct or indirect effects of any of the three emotion regulation strategies on change in urge to eat or calories consumed on the taste task following sad mood induction in BED women. In controls, better distress tolerance and stronger expectancies that eating alleviates negative affect were associated with decreased caloric intake on the taste task after mood induction. Overall, these findings highlight the importance of considering trans-diagnostic processes in BED as well as the need to identify other theoretically-relevant factors that contribute to the cognitive and behavioral features of BED. Limitations and directions for future studies are discussed.

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.

Thesis advisor: Maureen E. Kenny / Recent research suggests that eating disorders exist across genders, races and ethnicities (e.g., Smolak & Striegel-Moore, 2001; Striegel-Moore & Smolak, 2000; Talleyrand, 2002, 2006; Taylor, Caldwell, Baser, Faison, & Jackson, 2007; Thompson, 1994, 1996), but most findings and frameworks within the eating disorders literature are based on research with White women who engage in restrictive eating patterns. Given the rapid rise in rates of obesity and related illnesses in the United States — particularly among Black American women (e.g., Hedley et al., 2004), an understanding of overeating that accounts for race-related factors is needed. By exploring the relationship between perceived racism, racial socialization, perceived stress, and overeating patterns among Black American women, the current study sought to develop a model of disordered eating that accounts for the unique contextual, emotional, and behavioral factors in the lives of Black American women. Using a sample of Black American women (N = 201), the results of the data analysis revealed that perceived racism was related to overeating by way of perceived stress. This finding supports theories that race–related factors underlie the development of eating disorder symptoms (e.g., Harris & Kuba, 1997) and that perceived racism may be a significant etiological factor in the development of eating disturbances among Black American women (Mastria, 2002; Root, 1990; Smolak & Striegel-Moore, 2001; Thompson, 1994, 1996; Talleyrand, 2006). This finding also adds to the larger body of literature, which links perceived racism to a range of negative psychological, behavioral, and physical outcomes (e.g., Mays et al., 2007). Racial socialization was not found to have a significant moderating effect in the relationship between perceived racism and overeating, but was unexpectedly found to be related to disinhibition around food. Although the explanation for this finding is unclear, it is consistent with some evidence that that identification with Black American culture may promote greater levels of comfort regarding food (Talleyrand, 2006; Villarosa, 1994). / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

Binge eating is a harmful, maladaptive behavior associated with comorbid psychopathology. Theory posits that increases in maladaptive, transdiagnostic emotions following binge eating in individuals with BN may predict the experience of comorbid symptoms. The current study served as a laboratory test of the first part of this theory: whether state increases in maladaptive emotions occur following engagement in binge eating behavior in women with BN compared with healthy controls. Women (n = 51) were recruited from the community if they met DSM-5 criteria for BN or OSFED BN (of low frequency) (n = 21) or were free of lifetime disordered eating and current psychopathology (n = 30). Participants completed questionnaires assessing eating disorder symptoms (preoccupation with weight and shape, urge to vomit), state shame, and state negative affect before and after consuming a test meal in which they were instructed to binge. Women with BN endorsed significantly greater preoccupation with weight and shape and urge to vomit following test meal consumption compared with controls. Women with BN reported significant increases in state shame, but not state negative affect, following test meal consumption, compared with controls. Results are consistent with a model indicating binge eating precipitates increases in state shame among women with BN. Given shame’s status as a transdiagnostic risk factor, future work should clarify whether state shame following binge eating predicts increases in comorbid symptoms.

Recent research indicates that 2% to 4% of the population meet diagnostic criteria for the newly proposed binge eating disorder, and that it is much more common (30%) among the treatment-seeking obese. Although recognized as a significant problem, binge eating disorder is l1l not well understood, and there is debate about whether binge eating disorder is a distinct disorder. It has been argued that binge eating disorder is simply a variant or milder form of bulimia nervosa and not a separate and distinct disorder. Researchers have begun to study this population in greater depth in order to assess the characteristics of individuals with binge eating disorder, the similarities and differences between individuals with binge eating disorder, bulimia nervosa, and obese individuals who do not engage in binge eating, and the effectiveness of various treatments for binge eating disorder. Previous reviews of the literature (using non-meta-analytic strategies) have examined these areas and have yielded inconsistent conclusions. Therefore, a more comprehensive, current, and empirical integration of the data was conducted. In total, 297 studies of individuals with binge eating disorder, bulimia nervosa and/or obese individuals who do not engage in binge eating were collected, coded, and statistically analyzed across studies (by calculating standardized mean difference effect sizes). The key characteristics of individuals with binge eating disorder were assessed, diagnostic groups were systematically compared, and treatment outcomes (from 19 studies) were evaluated. The results indicated that individuals with binge eating disorder have a number of differences from both bulimia nervosa and obese non binge eating individuals. However, the extent of these differences was not great, and there was a general trend for binge eating disorder individuals to fall between the two groups on most measures of disturbed eating and psychopathology. These findings tend to support the continuum/variant conceptualization of binge eating disorder rather than that of a distinct disorder. In addition, data from primary research studies on the treatment of binge eating disorder indicated that, overall, psychosocial interventions were helpful in decreasing binge eating and psychopathological symptoms, but were less effective at reducing weight. The clinical implications of these findings are discussed, as are suggestions for future research.

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.

Animal models of bingeing have typically used stress to induce bingeing. A recent model, limited-access to high-fat diet (HFD), has shown that caloric restriction and stress were not required to induce bingeing in rats. This study replicated this model in mice, explored the fat content within the model, and investigated locomotor activation associated with binge-eating. Adult mice were maintained on a restricted feeding (RF) schedule of 2 h/d of access to chow or ad lib access to chow, and then provided limited access to 45% HFD or 84% HFD for 30 min 3 d/ week for 6 total snack sessions. Circadian activity was monitored for RF animals offered 84% HFD, and after 6 snack sessions were complete, allowed continuous access to the 45% HFD or the 84% HFD for two weeks to explore rebound feeding. Bingeing, defined by increasing intakes across days, was reported for mice offered 45% HFD regardless of deprivation state (RF or ad lib), while mice offered 84% HFD only exhibited bingeing when they were restricted. Comparison of male and female mice maintained RF, offered 45% HFD snack, showed that females had higher intake (kcals/g-bw) while ad lib fed mice exhibited no sex differences. Circadian recordings for female RF mice offered 84% HFD showed shifts in activity from the first hour of dark cycle to the hour preceding the snack and supported that offering the HFD produced alterations in food-associated arousal. During rebound, female RF mice given 84% HFD showed the highest intakes in week 1, and then exhibited a marked decline in week 2. The week 1 intake for RF animals were to regain lost body weight and that homeostatic-like intake in week 2 allowed normal body weight maintenance. Results of this investigation support human data that females are more susceptible to binge-type eating disorder, shows that limited access to palatable foods for females under caloric restriction induces changes in circadian activity, and reveals that using mice in this model requires more investigation to optimize binge-behavior. Diet comparisons also suggest that homeostatic and reward mechanisms may have an additive effect on bingeing.