Publications by authors named "Scott J Crow"

170 Publications

Affective response to binge eating as a predictor of binge eating disorder treatment outcome.

Clin Psychol Sci 2021 Jul 13;9(4):752-760. Epub 2021 Apr 13.

Department of Biobehavioral Research, Sanford Health, Fargo, ND.

This report examined baseline affective response to binge eating as a predictor of binge-eating disorder (BED) treatment outcome. Baseline affective response was defined as: (1) each individual's average net change (i.e., area under the curve [AUC]) of positive affect (PA) or negative affect (NA) before and after binge-eating episodes and (2) post-binge eating slope of PA or NA across seven-days of ecological momentary assessment (EMA). Adults with BED completed Integrative Cognitive-Affective Therapy (ICAT-BED) or cognitive behavioral therapy guided self-help (CBTgsh). Individuals with greater net increases in PA (AUC) following binge eating at baseline exhibited better treatment response in ICAT-BED at end-of-treatment and follow-up. NA affective response was only significant at end-of-treatment; individuals with less rapid post-binge improvements in NA (slope) did better in ICAT-BED, while individuals with lower net improvements in NA (AUC) did better in CBTgsh. Affective response to binge eating may be a marker of BED treatment response.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2167702620985198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579466PMC
July 2021

An empirical taxonomy of reward response patterns in a transdiagnostic eating disorder sample.

Eat Behav 2021 08 24;42:101531. Epub 2021 May 24.

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA; The Emily Program, Minneapolis, MN, USA.

Reward response patterns may contribute to risk and maintenance of eating disorders (EDs), and there may be clinically meaningful heterogeneity in behavioral responses to different actual and anticipated rewards across ED diagnoses. We used an empirical approach to classify individuals with EDs based on self-reported tendencies for responding to reward-related stimuli. Latent profile analysis was conducted in a transdiagnostic ED sample (N = 104) using Temperament and Character Inventory (Cloninger et al., 1993) subscales to categorize participants on reward responses of behavioral activation towards immediate, hedonic rewards (Novelty Seeking subscale), persistence towards long-term rewards (Persistence subscale), and maintenance by social rewards (Reward Dependence subscale) rewards. Two profiles were identified: (1) Behavioral Activation group (elevated Novelty Seeking; n = 62); and (b) Behavioral Persistence group (elevated Persistence; n = 42). Generalized linear models comparing profiles showed that frequency of these reward response profiles did not differ in probable AN, BN, or OSFED groups; however, individuals with probable BED more often demonstrated the Behavioral Activation profile (p = .041). These profiles exhibited comparable ED severity, but different presentations. Across probable ED diagnoses, the Behavioral Activation group reported greater binge eating (p = .006, d = 0.32) and had higher BMIs (p = .001, d = 0.57); the Behavioral Persistence group endorsed greater driven exercise (p = .042, d = 0.33). Categorization by activation to novel, immediate rewards versus persistence towards long-term rewards was associated with different symptoms across diagnoses, potentially supporting the role of specific reward response profiles in ED phenomenology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eatbeh.2021.101531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380651PMC
August 2021

An empirical taxonomy of reward response patterns in a transdiagnostic eating disorder sample.

Eat Behav 2021 08 24;42:101531. Epub 2021 May 24.

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA; The Emily Program, Minneapolis, MN, USA.

Reward response patterns may contribute to risk and maintenance of eating disorders (EDs), and there may be clinically meaningful heterogeneity in behavioral responses to different actual and anticipated rewards across ED diagnoses. We used an empirical approach to classify individuals with EDs based on self-reported tendencies for responding to reward-related stimuli. Latent profile analysis was conducted in a transdiagnostic ED sample (N = 104) using Temperament and Character Inventory (Cloninger et al., 1993) subscales to categorize participants on reward responses of behavioral activation towards immediate, hedonic rewards (Novelty Seeking subscale), persistence towards long-term rewards (Persistence subscale), and maintenance by social rewards (Reward Dependence subscale) rewards. Two profiles were identified: (1) Behavioral Activation group (elevated Novelty Seeking; n = 62); and (b) Behavioral Persistence group (elevated Persistence; n = 42). Generalized linear models comparing profiles showed that frequency of these reward response profiles did not differ in probable AN, BN, or OSFED groups; however, individuals with probable BED more often demonstrated the Behavioral Activation profile (p = .041). These profiles exhibited comparable ED severity, but different presentations. Across probable ED diagnoses, the Behavioral Activation group reported greater binge eating (p = .006, d = 0.32) and had higher BMIs (p = .001, d = 0.57); the Behavioral Persistence group endorsed greater driven exercise (p = .042, d = 0.33). Categorization by activation to novel, immediate rewards versus persistence towards long-term rewards was associated with different symptoms across diagnoses, potentially supporting the role of specific reward response profiles in ED phenomenology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eatbeh.2021.101531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380651PMC
August 2021

Differences in Affective Dynamics Among Eating Disorder Diagnostic Groups.

Clin Psychol Sci 2020 09 23;8(5):857-871. Epub 2020 Jun 23.

Department of Psychiatry, University of California, San Francisco; San Francisco, CA.

Emotion regulation theories suggest that affect intensity is crucial in the development and maintenance of eating disorders. However, other aspects of emotional experience, such as lability, differentiation, and inertia, are not as well understood. This study is the first to use ecological momentary assessment (EMA) to examine differences in several daily negative affect (NA) indicators among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Using EMA data from three large studies, a series of linear mixed models showed that participants in the AN and BN groups experienced significantly greater NA intensity and better emotion differentiation than participants in the BED group. Alternatively, the BN group demonstrated significantly greater NA lability than the AN group and greater NA inertia than the BED group. These results suggest that several daily affective experiences differ among eating disorders diagnostic groups and have implications towards distinct conceptualizations and treatments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2167702620917196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983702PMC
September 2020

Relationships Between Childhood Abuse and Eating Pathology Among Individuals with Binge-Eating Disorder: examining the Moderating Roles of Self-Discrepancy and Self-Directed Style.

Eat Disord 2021 Mar 18:1-14. Epub 2021 Mar 18.

Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA.

Childhood maltreatment appears to increase the risk for eating disorders (EDs). The current study examined potential moderating factors (i.e., self-discrepancy and negative self-directed style), which may increase or decrease the impact of maltreatment (i.e., emotional abuse, physical abuse, sexual abuse) on later ED symptoms. One hundred seven men and women with binge-eating disorder (BED) completed semi-structured interviews and questionnaires assessing childhood maltreatment, self-discrepancy, negative self-directed style, and ED pathology. Linear regression was used to examine the moderating role of self-discrepancy and negative self-directed style in the associations between each type of abuse and level of ED severity. Actual:ought self-discrepancy (i.e., the difference between one's self and who one believes they ought to be) moderated the relationships between ED pathology and emotional abuse (=.26 =.007), as well as physical abuse (=.23, =.02). Results suggest that the relationship between childhood abuse (i.e., emotional abuse, physical abuse) and ED pathology may be stronger for those with higher levels of actual:ought self-discrepancy. Further clarification of the relationships between actual:ought self-discrepancy and distinct forms of childhood abuse is needed, as well as intervention studies examining whether targeting actual:ought self-discrepancy provides an additional benefit for trauma-exposed individuals with BED.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10640266.2020.1864588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448781PMC
March 2021

Examining the roles of emotion dysregulation and impulsivity in the relationship between psychological trauma and substance abuse among women with bulimic-spectrum pathology.

Eat Disord 2021 May-Jun;29(3):276-291. Epub 2021 Mar 16.

Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA.

Individuals with bulimia nervosa report elevated rates of childhood maltreatment, which appears to increase risk for co-occurring substance use problems and negatively impact clinical course. The current study sought to examine the mechanistic pathways by which specific forms of childhood maltreatment may give rise to substance use problems among individuals with bulimic-spectrum pathology. Women with bulimic-spectrum disorders ( = 204) completed measures of childhood trauma, emotion dysregulation, impulsivity, and substance use. Path analysis was used to examine emotion dysregulation and impulsivity as mediators of the relationship between distinct forms of childhood trauma (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and the presence of problematic alcohol/drug use. In the full path model, significant pathways from childhood emotional abuse to emotion dysregulation, childhood emotional neglect to impulsivity, and emotion dysregulation to problematic substance use emerged. Further, emotion dysregulation significantly mediated the relationship between emotional abuse and substance use. Results indicate that emotion dysregulation may be an important mechanism linking a history of childhood emotional maltreatment to later eating and substance use problems, and therefore may be an important treatment target among individuals with co-occurring eating and substance use concerns.Childhood emotional abuse was related to greater emotion dysregulation.Childhood emotional neglect was related to greater impulsivity.Emotion dysregulation was related to greater problematic substance use.Emotional abuse may impact substance use through emotion dysregulation.Creating emotion dysregulation may improve substance and eating disorder symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10640266.2021.1891370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373646PMC
October 2021

Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: Examining the roles of childhood abuse and post-traumatic stress disorder.

Eur Eat Disord Rev 2021 Jul 4;29(4):611-621. Epub 2021 Mar 4.

Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.

Objective: To examine childhood abuse and post-traumatic stress disorder (PTSD) as predictors and moderators of binge-eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive-Affective Therapy with cognitive-behavioural therapy administered using guided self-help.

Method: In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM-IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate-adjusted regression models predicting binge-eating frequency and EDE global scores at end of treatment and 6-month follow-up were conducted.

Results: Lifetime PTSD predicted greater binge-eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge-eating frequency at follow-up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge-eating frequency at follow-up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge-eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed.

Conclusions: Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/erv.2823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187312PMC
July 2021

Descriptives and baseline ecological momentary assessed predictors of weight change over the course of psychological treatments for binge eating disorder.

J Psychosom Res 2021 04 29;143:110373. Epub 2021 Jan 29.

Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America.

Objective: The objectives were to examine individual variability in weight change across psychological treatments for binge-eating disorder (BED) and to examine baseline predictors (i.e., BED symptoms, affect, and appetite) of weight change using ecological momentary assessment (EMA).

Method: Adults with BED (N = 110) enrolled in a randomized clinical trial in which they received one of two psychological treatments for BED. At baseline, participants completed a 7-day EMA protocol measuring BED symptoms, affect, and appetite. Height and weight were measured at baseline, mid-treatment, end-of-treatment, and follow-up, and body mass index (BMI) was calculated.

Results: On average, participants evidenced a 2% increase in BMI at end-of-treatment and a 1% increase between end-of-treatment and 6-month follow-up assessments. Although results showed that BMI increased over time, the quadratic term reflected a deceleration in this effect. There were interactions between positive affect and the linear trajectory across time predicting BMI, indicating that individuals reporting higher positive affect at baseline evidenced a flatter trajectory of weight gain. There was a main effect of overeating as assessed by EMA and interactions between overeating and linear and quadratic trajectories across time predicting BMI. Individuals who reported greater overeating at baseline had higher BMI across time. However, the BMI of individuals with lower overeating increased linearly, and increases in BMI among those with average or high rates of overeating appeared to stabilize over time.

Conclusion: Despite the variability in weight change, baseline positive affect and overeating may be ecological targets for improving weight outcomes in psychological treatments for BED.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychores.2021.110373DOI Listing
April 2021

Comparative Costs of a Parent-Only and Parent and Child Treatment for Children with Overweight or Obesity.

Obesity (Silver Spring) 2021 02;29(2):388-392

Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.

Objective: Models such as family-based treatment (FBT), delivered to both the parent and child, are considered the most efficacious intervention for children with obesity. However, recent research suggests that parent-based treatment (PBT; or parent-only treatment) is noninferior to FBT. The aim of this study was to evaluate the comparative costs of the FBT and PBT models.

Methods: A total of 150 children with overweight and obesity and their parents were randomized to one of two 6-month treatment programs (FBT or PBT). Data was collected at baseline, during treatment, and following treatment, and and trial-based analyses of the costs were conducted from a health care sector perspective and a limited societal perspective.

Results: Results suggest that PBT, compared with FBT, had lower costs per parent-child dyad from the health care sector perspective (PBT = $2,886; FBT = $3,899) and from a limited societal perspective (PBT = $3,231; FBT = $4,279).

Conclusions: These findings suggest that a PBT intervention has lower costs and is noninferior to an FBT intervention for both child and parent weight loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/oby.23069DOI Listing
February 2021

Comparative Costs of a Parent-Only and Parent and Child Treatment for Children with Overweight or Obesity.

Obesity (Silver Spring) 2021 02;29(2):388-392

Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.

Objective: Models such as family-based treatment (FBT), delivered to both the parent and child, are considered the most efficacious intervention for children with obesity. However, recent research suggests that parent-based treatment (PBT; or parent-only treatment) is noninferior to FBT. The aim of this study was to evaluate the comparative costs of the FBT and PBT models.

Methods: A total of 150 children with overweight and obesity and their parents were randomized to one of two 6-month treatment programs (FBT or PBT). Data was collected at baseline, during treatment, and following treatment, and and trial-based analyses of the costs were conducted from a health care sector perspective and a limited societal perspective.

Results: Results suggest that PBT, compared with FBT, had lower costs per parent-child dyad from the health care sector perspective (PBT = $2,886; FBT = $3,899) and from a limited societal perspective (PBT = $3,231; FBT = $4,279).

Conclusions: These findings suggest that a PBT intervention has lower costs and is noninferior to an FBT intervention for both child and parent weight loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/oby.23069DOI Listing
February 2021

Predictors of treatment response durability in psychotherapy for binge-eating disorder: Examining the roles of self-discrepancy, self-directed style, and emotion dysregulation.

Int J Eat Disord 2020 12 29;53(12):1918-1927. Epub 2020 Oct 29.

Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.

Objective: To examine changes in hypothesized maintenance mechanisms during treatment as predictors of treatment response durability in binge-eating disorder (BED) treatment, using data from a randomized clinical trial comparing the efficacy of Integrative Cognitive-Affective Therapy for BED with cognitive-behavioral therapy delivered using guided self-help.

Method: Adults with BED (N = 112) received 17 weeks of treatment. Regression models were conducted to examine the extent to which changes in hypothesized maintenance mechanisms from baseline to end of treatment predicted treatment outcomes at 6-month follow-up, adjusting for demographics, study site, and baseline level of treatment outcome.

Results: During-treatment reductions in negative self-directed style and emotion dysregulation predicted reductions in the primary treatment outcome (i.e., binge-eating episode frequency) at follow-up. During-treatment reductions in emotion dysregulation also predicted improvements at follow-up across all three secondary treatment outcomes examined (i.e., global eating disorder [ED] psychopathology, depressive symptoms, and anxiety symptoms), as did during-treatment reductions in actual-ideal self-discrepancy and actual-ought self-discrepancy. Increases in positive self-directed style (e.g., self-affirmation) and reductions in negative self-directed style (e.g., self-blame) during treatment each predicted improvements in anxiety symptoms at follow-up. When predictors were examined simultaneously, the most salient predictors of treatment response durability identified were negative self-directed style for binge-eating episode frequency, actual-ought self-discrepancy and emotion dysregulation for depressive symptoms, and emotion dysregulation for anxiety symptoms. No predictors emerged as most salient for global ED psychopathology.

Discussion: Results indicate that negative self-directed style and emotion dysregulation are particularly important treatment targets in relation to behavioral treatment outcomes in BED.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718374PMC
December 2020

Are the Criterion B binge-eating symptoms interchangeable in understanding binge-eating severity? An item response theory analysis.

Int J Eat Disord 2020 12 18;53(12):1983-1992. Epub 2020 Sep 18.

Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.

Objective: The Criterion B binge-eating symptoms represent five symptoms associated with binge eating. Any three out of five symptoms can be used to meet Criterion B. However, Criterion B symptoms may not be interchangeable in terms of how binge-eating severity is associated with each symptom. Item response theory (IRT) can test how endorsing each symptom relates to the overall level (i.e., severity) of binge-eating measured by Criterion B. We used IRT to identify (a) how each Criterion B symptom corresponded with binge-eating severity in a transdiagnostic binge-eating sample and (b) how well each symptom differentiated individuals with differing levels of severity.

Method: Participants (N = 219) were adults (80.8% female) with a current ED that included objective binge-eating episodes assessed via semi-structured interview. A two-parameter logistic IRT model evaluated how endorsement of each Criterion B symptom corresponded with the level of latent binge-eating severity.

Results: "Eating large amounts when not hungry" and "eating alone" reflected the highest binge-eating severity. "Eating alone" was the best discriminator across different binge-eating severity levels, whereas "uncomfortably full" was the poorest discriminator across binge-eating severity levels.

Discussion: Criterion B symptoms were not interchangeable in terms of what level of binge-eating severity corresponded with symptom endorsement. "Eating large amounts when not hungry" or "eating alone" may signify elevated binge-eating severity, whereas "uncomfortably full" and "feeling disgusted/depressed/guilty" were not necessarily indicative of elevated severity. Results suggested that Criterion B may need to be revised to eliminate symptoms that are redundant with other binge-eating diagnostic criteria.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23383DOI Listing
December 2020

Dynamic Stress Responses and Real-Time Symptoms in Binge-Eating Disorder.

Ann Behav Med 2021 07;55(8):758-768

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.

Background: Stress is a dynamic construct that predicts a range of health behaviors and conditions, including binge eating and excess weight. Thus far, there have been limited and inconsistent findings regarding stress responses in binge-eating disorder (BED) and insufficient consideration of temporal patterns of stress responses across the weight spectrum.

Purpose: The present study used ecological momentary assessment (EMA) to examine stress reactivity (i.e., the magnitude of the initial stress response), recovery (i.e., how long the stress response lasts before returning to baseline), and pileup (i.e., accumulation of repeated experiences of stressors and responses over time) as predictors of binge-eating symptoms (BES) and food craving in BED.

Methods: Adults with BED (N = 115) completed a 7 day EMA protocol assessing stressful events, perceived stress, binge eating, and food craving prior to being randomized to a behavioral intervention.

Results: Generalized estimating equations indicated that moments of greater stress pileup predicted greater subsequent BES (within-person effect). Participants with higher perceived stress and pileup reported greater overall BES and craving, and those with better recovery reported higher overall craving (between-person effects).

Conclusions: Findings highlight the importance of considering the dynamic nature of stress responses and, particularly, that the accumulation of stress over the day is an important trigger for BES.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/abm/kaaa061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311786PMC
July 2021

Relationships between nonappearance self-discrepancy, weight discrepancy, and binge eating disorder symptoms.

Eat Weight Disord 2021 Jun 8;26(5):1571-1580. Epub 2020 Aug 8.

Center for Bio-Behavioral Research, Sanford Research, Fargo, ND, USA.

Purpose: Self-discrepancy (i.e., perceived differences between one's actual self and personal standards) has been associated with binge eating disorder (BED) symptoms. However, little is known about how weight discrepancy (i.e., the difference between one's actual and ideal weights) interacts with or is distinguished from nonappearance self-discrepancy (discrepancy unrelated to weight or shape) in predicting BED severity. The current study examined how these two forms of discrepancy independently and interactively relate to BED and associated symptoms to elucidate how facets of self-discrepancy may operate to precipitate and maintain BED.

Methods: Adults with BED (N = 111) completed questionnaires and interviews prior to treatment that assessed self-discrepancy (computerized selves) and weight discrepancy (assessed during the Eating Disorder Examination [EDE]) as predictors of global eating disorder (ED) symptomatology (EDE Global score), depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), self-esteem (Rosenberg Self-Esteem Scale), and ED-related impairment (Clinical Impairment Assessment).

Results: Multivariate regression models indicated nonappearance self-discrepancy and weight discrepancy were not significantly related to the severity of global ED symptoms, but both independently predicted impairment (ps < 0.05). Nonappearance self-discrepancy, but not weight discrepancy, was also associated with higher depression (p = 0.001), anxiety (p < 0.001), and lower self-esteem (p < 0.001).

Conclusion: These findings suggest distinct associations of weight discrepancy and nonappearance self-discrepancy with ED and related symptoms, as well as each of these constructs' relevance to everyday functioning in BED. The results also highlight potential avenues for future research to examine mechanistic pathways by which self-discrepancy influences BED severity.

Level Of Evidence: V, descriptive cross-sectional study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40519-020-00975-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868469PMC
June 2021

Micro-level de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment.

Psychol Med 2020 Jun 29:1-9. Epub 2020 Jun 29.

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA.

Background: While negative affect reliably predicts binge eating, it is unknown how this association may decrease or 'de-couple' during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes.

Methods: Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment.

Results: There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up.

Conclusions: Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0033291720001804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770007PMC
June 2020

Comparing integrative cognitive-affective therapy and guided self-help cognitive-behavioral therapy to treat binge-eating disorder using standard and naturalistic momentary outcome measures: A randomized controlled trial.

Int J Eat Disord 2020 09 25;53(9):1418-1427. Epub 2020 Jun 25.

Sanford Research, Fargo, North Dakota, USA.

Objective: Innovative treatments and outcome measures are needed for binge-eating disorder (BED). This randomized controlled trial compared Integrative Cognitive-Affective Therapy (ICAT-BED), an individual psychotherapy targeting momentary behavioral and emotional precipitants of binge eating, with an established cognitive-behavioral guided self-help (CBTgsh) treatment using standard and ecological momentary assessment (EMA) outcome measures.

Method: A total of 112 participants were randomized to 17 weeks of treatment (21 sessions for ICAT-BED and 10 sessions for CBTgsh). Binge-eating frequency was assessed with the Eating Disorder Examination (EDE) as well as EMA using cell phone-based real-time, naturalistic assessment at end of treatment (EOT) and 6-month follow-up. Hypothesized maintenance mechanisms were assessed using self-report questionnaires.

Results: Binge-eating frequency as measured by the EDE and real-time assessment showed significant reductions at EOT and follow-up, with no significant differences between treatments. Hypothesized maintenance mechanisms, including emotion regulation, cognitive self-discrepancy, self-directed style, as well as measures of associated eating disorder psychopathology, depression, anxiety, impulsivity, and negative affect, showed similar improvement at EOT and follow-up with no differences between treatments. Abstinence rates at EOT (ICAT-BED: 57.1%; CBTgsh: 42.9%) and 6-month follow-up (ICAT-BED: 46.4%; CBTgsh: 42.9%) were not significantly different. Treatment retention was significantly higher for ICAT-BED (87.5%) than CBTgsh (71.4%).

Discussion: These findings suggest that ICAT-BED and CBTgsh were associated with similar improvements in binge eating, psychopathology, and putative maintenance mechanisms as measured by traditional self-report and momentary, naturalistic assessments and that these changes were generally sustained at 6-month follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23324DOI Listing
September 2020

Moving towards specificity: A systematic review of cue features associated with reward and punishment in anorexia nervosa.

Clin Psychol Rev 2020 07 27;79:101872. Epub 2020 May 27.

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America.

Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpr.2020.101872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335637PMC
July 2020

Naturalistically assessed associations between physical activity, affective functioning, and binge eating among adults with binge-eating disorder.

Eat Disord 2020 May 13:1-14. Epub 2020 May 13.

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA.

Binge-eating disorder (BED) is associated with overweight/obesity, physical inactivity, and disturbances in affective functioning. While research suggests that physical activity (PA) may have beneficial effects on BED symptoms, little is known about the daily correlates of PA. As a first step in understanding the processes linking PA and binge eating, this study examined associations between PA (i.e., self-reported time engaged in moderate-to-vigorous PA), affective functioning (i.e., positive and negative affect, body satisfaction, emotion regulation), and eating-related cognitions and behaviors (i.e., craving, overeating, loss of control eating) measured via ecological momentary assessment (EMA). Adults with BED ( = 91) completed a seven-day EMA protocol during which they completed repeated measures of these variables. Results indicated individuals who reported greater time engaged in PA over the EMA protocol evidenced higher positive affect and body satisfaction, and lower overeating (between-subjects effects). No significant within-subjects effects were observed. Findings demonstrate that individual differences in PA levels were related to more adaptive affective functioning and eating regulation in daily life. Results highlight the relevance of PA in BED, and the need for future studies to identify the timescale of these relationships using objective measurements of PA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10640266.2020.1746121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628298PMC
May 2020

Predictors and moderators of treatment outcome in a randomized clinical trial for binge-eating disorder.

J Consult Clin Psychol 2020 Jul 27;88(7):631-642. Epub 2020 Apr 27.

Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School.

Objective: The current study examined predictors and moderators of two interventions for binge-eating disorder (BED).

Method: Participants were 112 adults with BED ( = 39.7 ± 13.4 years; = 35.1 ± 13.4 kg/m²; 82% female; 91% Caucasian) randomly assigned to integrative cognitive-affective therapy for BED (ICAT-BED) or guided self-help cognitive-behavioral therapy (CBTgsh). Generalized linear models examined predictors and moderators of objective binge-eating episode (OBE) frequency and OBE abstinence at end-of-treatment (EOT) and 6-month follow-up (FU).

Results: Lower levels of baseline dietary restraint and emotion regulation difficulties predicted greater reductions in OBE frequency at EOT and FU, respectively. At EOT, greater pretreatment self-control predicted greater reductions in OBE frequency in ICAT-BED than CBTgsh (s < .05). In addition, low shape/weight overvaluation predicted greater reductions in OBE frequency in ICAT-BED than CBTgsh, whereas high shape/weight overvaluation predicted comparable reductions in OBE frequency across treatments at EOT (s < .02). At EOT and FU, greater baseline actual-ideal self-discrepancy predicted significantly greater reductions in OBE frequency in ICAT-BED, than CBTgsh (s < .02). No significant predictor or moderator effects were observed for models examining OBE abstinence.

Conclusion: This study identified two general predictors and four moderators of BED treatment response. However, only one predictor (actual-ideal self-discrepancy) interacted with treatment type to differentially predict OBE frequencies at both EOT and FU. Altogether, findings suggest that ICAT-BED may confer specific and durable improvements in OBE frequencies among individuals with high actual-ideal self-discrepancy. Therefore, patients demonstrating these characteristics may be more likely to benefit from ICAT-BED. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/ccp0000503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970631PMC
July 2020

Not all body image constructs are created equal: Predicting eating disorder outcomes from preoccupation, dissatisfaction, and overvaluation.

Int J Eat Disord 2020 06 18;53(6):954-963. Epub 2020 Apr 18.

Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Objective: Diverse terminology has been used to operationalize body image disturbance in eating disorders. However, the differential validity of these terms and their underlying constructs to predict outcomes among heterogeneous eating disorders is unknown. This study evaluated the validity of body image constructs to predict eating disorder and negative psychological symptoms concurrently and prospectively over 2 years in a transdiagnostic clinical sample.

Methods: Women with heterogeneous eating disorder diagnoses (n = 448) completed assessments at baseline, 12-month, and 24-month follow-up. Cross-sectional and cross-lagged generalized linear models examined effects of three body image constructs (i.e., weight and shape preoccupation, overvaluation, and dissatisfaction) on concurrent and subsequent outcomes (i.e., global eating disorder symptoms, binge eating, purging, fasting, self-esteem, and depression).

Results: In concurrent analyses, preoccupation was significantly associated with all outcomes (ps = .01 to <.001), overvaluation with all outcomes (ps = .01 to <.001) except binge eating (p = .06), and dissatisfaction with all outcomes (ps < .001) except purging (p = .38). In prospective analyses, preoccupation predicted Eating Disorder Examination global (p = .003) and fasting (p < .001), overvaluation predicted binge eating (p = .01), and body dissatisfaction did not predict any outcomes.

Discussion: Preoccupation, overvaluation, and dissatisfaction are differentially related to eating disorder and psychiatric outcomes, indicating that no one body image construct can capture clinical risk in eating disorders. Preoccupation was the most consistent concurrent and longitudinal predictor; this construct may warrant further attention in assessment and diagnosis. Further investigation of these constructs in diverse samples is encouraged.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23277DOI Listing
June 2020

The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study.

J Abnorm Psychol 2020 May 26;129(4):387-396. Epub 2020 Mar 26.

Sanford Research.

Affect regulation models of eating disorder behavior, which predict worsening of affect prior to binge-eating episodes and improvement in affect following such episodes, have received support in anorexia nervosa and bulimia nervosa. However, limited work has examined the trajectories of affect surrounding binge eating in binge-eating disorder (BED). In the current study, ecological momentary assessment data from 112 men and women with BED were used to examine the trajectories of positive affect (PA), negative affect (NA), guilt, fear, hostility, and sadness relative to binge-eating episodes. Prior to binge episodes, PA significantly decreased, whereas NA and guilt significantly increased. Following binge episodes, levels of NA and guilt significantly decreased and PA stabilized. Overall, results indicate improvements in affect following binge-eating episodes, suggesting that binge eating may function to alleviate unpleasant emotional experiences among individuals with BED, which is consistent with affect regulation models of eating pathology. Because improvements in negative affect were primarily driven by change in guilt, findings also highlight the relative importance of understanding the relationship between guilt and binge-eating behavior within this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/abn0000517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174093PMC
May 2020

Machine learning enhances prediction of illness course: a longitudinal study in eating disorders.

Psychol Med 2020 Feb 28:1-11. Epub 2020 Feb 28.

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.

Background: Psychiatric disorders, including eating disorders (EDs), have clinical outcomes that range widely in severity and chronicity. The ability to predict such outcomes is extremely limited. Machine-learning (ML) approaches that model complexity may optimize the prediction of multifaceted psychiatric behaviors. However, the investigations of many psychiatric concerns have not capitalized on ML to improve prognosis. This study conducted the first comparison of an ML approach (elastic net regularized logistic regression) to traditional regression to longitudinally predict ED outcomes.

Methods: Females with heterogeneous ED diagnoses completed demographic and psychiatric assessments at baseline (n = 415) and Year 1 (n = 320) and 2 (n = 277) follow-ups. Elastic net and traditional logistic regression models comprising the same baseline variables were compared in ability to longitudinally predict ED diagnosis, binge eating, compensatory behavior, and underweight BMI at Years 1 and 2.

Results: Elastic net models had higher accuracy for all outcomes at Years 1 and 2 [average Area Under the Receiving Operating Characteristics Curve (AUC) = 0.78] compared to logistic regression (average AUC = 0.67). Model performance did not deteriorate when the most important predictor was removed or an alternative ML algorithm (random forests) was applied. Baseline ED (e.g. diagnosis), psychiatric (e.g. hospitalization), and demographic (e.g. ethnicity) characteristics emerged as important predictors in exploratory predictor importance analyses.

Conclusions: ML algorithms can enhance the prediction of ED symptoms for 2 years and may identify important risk markers. The superior accuracy of ML for predicting complex outcomes suggests that these approaches may ultimately aid in advancing precision medicine for serious psychiatric disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0033291720000227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483262PMC
February 2020

Role of appetitive phenotype trajectory groups on child body weight during a family-based treatment for children with overweight or obesity.

Int J Obes (Lond) 2019 11 7;43(11):2302-2308. Epub 2019 Oct 7.

Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.

Objective: Emerging evidence suggests that individual appetitive traits may usefully explain patterns of weight loss in behavioral weight loss treatments for children. The objective of this study was to identify trajectories of child appetitive traits and the impact on child weight changes over time.

Methods: Secondary data analyses of a randomized noninferiority trial conducted between 2011 and 2015 evaluated children's appetitive traits and weight loss. Children with overweight and obesity (mean age = 10.4; mean BMI z = 2.0; 67% girls; 32% Hispanic) and their parent (mean age = 42.9; mean BMI = 31.9; 87% women; 31% Hispanic) participated in weight loss programs and completed assessments at baseline, 3, 6,12, and 24 months. Repeated assessments of child appetitive traits, including satiety responsiveness, food responsiveness and emotional eating, were used to identify parsimonious grouping of change trajectories. Linear mixed-effects models were used to identify the impact of group trajectory on child BMIz change over time.

Results: One hundred fifty children and their parent enrolled in the study. The three-group trajectory model was the most parsimonious and included a high satiety responsive group (HighSR; 47.4%), a high food responsive group (HighFR; 34.6%), and a high emotional eating group (HighEE; 18.0%). Children in all trajectories lost weight at approximately the same rate during treatment, however, only the HighSR group maintained their weight loss during follow-ups, while the HighFR and HighEE groups regained weight (adjusted p-value < 0.05).

Conclusions: Distinct trajectories of child appetitive traits were associated with differential weight loss maintenance. Identified high-risk subgroups may suggest opportunities for targeted intervention and maintenance programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41366-019-0463-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858531PMC
November 2019

Pharmacologic Treatment of Eating Disorders.

Authors:
Scott J Crow

Psychiatr Clin North Am 2019 06 3;42(2):253-262. Epub 2019 Apr 3.

Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55434, USA; The Emily Program, St Paul, MN 55108, USA. Electronic address:

Medications are a useful adjunct to nutritional and psychotherapeutic treatments for eating disorders. Antidepressants are commonly used to treat bulimia nervosa; high-dose fluoxetine is a standard approach, but many other antidepressants can be used. Binge eating disorder can be treated with antidepressants, with medications that diminish appetite, or with lisdexamfetamine. Anorexia nervosa does not generally respond to medications, although recent evidence supports modest weight restoration benefits from olanzapine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psc.2019.01.007DOI Listing
June 2019

Longitudinal associations between emotion regulation skills, negative affect, and eating disorder symptoms in a clinical sample of individuals with binge eating.

Eat Behav 2019 01 28;32:69-73. Epub 2018 Dec 28.

University of Minnesota Medical School, Department of Psychiatry, United States of America.

Objective: Although deficits in emotion regulation have been implicated in the maintenance of binge eating, few prospective studies have examined longitudinal associations between emotion regulation and eating disorder symptoms, which are needed to test these theoretical models.

Method: Using a naturalistic design, the current study utilized longitudinal multilevel analyses to examine whether improvements in emotion regulation during treatment are associated with decreased binge eating frequency and eating disorder cognitions in a heterogeneous sample of adults with binge eating (N = 97). Analyses also accounted for between- and within-person differences in negative affect to inform specific targets for intervention.

Results: Significant within-person associations between emotion regulation, negative affect, and eating disorder severity support hypotheses that emotion dysregulation and negative affect co-occur with eating disorder psychopathology. Only between-person differences in negative affect demonstrated associations with binge eating frequency over time.

Discussion: Data suggest that momentary interventions targeting negative affect and emotion regulation skills may decrease eating disorder cognitions, but not binge eating frequency, among adults with binge eating.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eatbeh.2018.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043891PMC
January 2019

Change in eating disorder symptoms following pediatric obesity treatment.

Int J Eat Disord 2019 03 14;52(3):299-303. Epub 2019 Jan 14.

Department of Pediatrics, University of California, San Diego, La Jolla, California.

Objective: The purpose of this study is to evaluate whether children with overweight or obesity participating in an evidence-based treatment, family-based behavioral treatment (FBT) for obesity, or a parent-only variant of FBT (PBT), experience an increase of eating disorder (ED) symptoms during and following treatment.

Method: Children (N = 150) participating in a randomized controlled trial of FBT or PBT completed measures of EDs attitudes and behaviors at baseline, following 6-months of treatment, 6 months, and 18 months after treatment.

Results: Linear-mixed effects models suggest that ED attitudes did not significantly increase. Rather, significant decreases of shape, weight, and eating concerns were shown following treatment. Loss of control over eating significantly decreased over treatment and follow-up. No participant endorsed purging at any time point.

Discussion: Results confirm the hypothesis that ED symptoms do not increase after participating in FBT or a FBT-based treatment. These findings should help assuage fears of parents that enrolling their child will exacerbate ED symptoms and aid children to access evidence-based treatments that may help reduce significant physical and psychosocial complications of childhood obesity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408261PMC
March 2019

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms.

J Psychopathol Behav Assess 2018 Dec 6;40(4):691-700. Epub 2018 Apr 6.

Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, RI, USA.

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN ( = 118). Frost Multidimensional Perfectionism Scale (Frost et al. , 14(5), 449-46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms ( < .001), purging ( = .005), restrictive eating ( < .001), and body checking ( < .001) frequency, depressive ( < .001) and anxiety ( < .001) symptoms, and negative ( = .001) and positive ( < .001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10862-018-9672-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326583PMC
December 2018

Resting state functional connectivity of networks associated with reward and habit in anorexia nervosa.

Hum Brain Mapp 2019 02 25;40(2):652-662. Epub 2018 Sep 25.

Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota.

Neurobiological disturbances associated with reward and/or habit learning are theorized to maintain symptoms of anorexia nervosa (AN). Although research has investigated responses in brain regions associated with reward and habit to disorder-specific cues (e.g., food) and presumed rewards (e.g., money), little is known about the functional organization of the circuits underlying these constructs independent of stimulus. This study aimed to provide initial data on the synchrony of networks associated with reward and habit in AN by comparing resting-state functional connectivity (RSFC) patterns between AN and healthy control (HC) participants in these circuits and delineating how these patterns relate to symptoms. Using theoretically selected seeds in the nucleus accumbens (NAcc), ventral caudate, and dorsal caudate, reflecting a continuum from reward- to habit- oriented regions, RSFC patterns were compared between AN restricting subtype (n = 19) and HC (n = 19) participants (cluster threshold: p < .01). Exploratory correlations between RSFC z-scores and Eating Disorder Examination (EDE) scores, BMI, and illness duration were conducted. The AN group demonstrated lower RSFC between the NAcc and superior frontal gyrus, between the ventral caudate and frontal and posterior regions, and between the dorsal caudate and frontal, temporal, and posterior regions. In the AN group, lower NAcc- superior frontal gyrus RSFC correlated with greater EDE Global scores (r = -.58, CI: -.83, -.13). These resting-state synchrony disruptions of the ventral and dorsal frontostriatal circuits, considered in context of the broader literature, support the utility of further investigating possible reward and habit disturbances supporting symptoms in AN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hbm.24402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314844PMC
February 2019

Associations among eating disorder behaviors and eating disorder quality of life in adult women with anorexia nervosa.

Psychiatry Res 2018 09 31;267:108-111. Epub 2018 May 31.

Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States; The Emily Program, St. Paul, MN, United States.

The study examined associations between eating disorder behaviors measured via ecological momentary assessment (EMA) and eating disorder quality of life (EDQOL) in anorexia nervosa (AN). Women with AN (N = 82) completed an EDQOL measure and two-weeks of EMA. Greater frequency of EMA-assessed restriction and bulimic behavior were independently related to lower EDQOL scores. Lower psychological EDQOL was associated with increased EMA dietary restriction; lower work-related EDQOL was associated with increased EMA binge eating; aspects of EDQOL were unrelated to EMA purging. Findings suggest that severity of restriction and bulimic behaviors may serve as severity indicators of EDQOL in AN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2018.05.077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760249PMC
September 2018

Weight Change over the Course of Binge Eating Disorder Treatment: Relationship to Binge Episodes and Psychological Factors.

Obesity (Silver Spring) 2018 05 13;26(5):838-844. Epub 2018 Mar 13.

Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Objective: Treatment for binge eating disorder (BED), a condition associated with both excess adiposity and psychological distress, has not typically produced significant weight loss despite reducing binge eating. Characterizing factors that promote or inhibit weight loss in individuals with co-occurring BED and obesity may help explain overall nonsignificant weight changes during treatment.

Methods: In this study, 189 adults with BED participated in a randomized clinical trial evaluating the efficacy of 5 months of cognitive behavioral therapy. Assessments included measured height and weight at baseline, midtreatment, end of treatment (EOT), and 6-month follow-up, the Eating Disorder Examination interview, and questionnaires.

Results: During treatment, there was a mean weight gain of 1.3 ± 12.0 lb. Twenty-two percent of the sample lost ≥ 5 lb, and 25% of the sample gained ≥ 8 lb. Results showed that baseline objective binge eating episodes predicted weight over treatment. Changes in weight were significantly positively related to concurrent changes in shape concern, weight concern, and disinhibition, but not binge eating episodes. Changes in objective binge eating episodes from baseline to EOT were associated with changes in weight from EOT to follow-up.

Conclusions: Further investigation of eating behavior during BED treatment to understand the energy balance contributions to weight change or stability is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/oby.22149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915913PMC
May 2018
-->