The classification of bulimic eating disorders: a community-based cluster analysis study

Published online by Cambridge University Press 09 Jul 2009There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for either of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme. A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity. The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.P. J. Hay, C. G. Fairburn and H. A. Dol

The Reliability and Validity of the Clinical Perfectionism Questionnaire in Eating Disorder and Community Samples

Background: Clinical perfectionism is a risk and maintaining factor for anxiety disorders, depression and eating disorders. Aims: The aim was to examine the psychometric properties of the 12-item Clinical Perfectionism Questionnaire (CPQ). Method: The research involved two samples. Study 1 comprised a nonclinical sample (n = 206) recruited via the internet. Study 2 comprised individuals in treatment for an eating disorder (n = 129) and a community sample (n = 80). Results: Study 1 factor analysis results indicated a two-factor structure. The CPQ had strong correlations with measures of perfectionism and psychopathology, acceptable internal consistency, and discriminative and incremental validity. The results of Study 2 suggested the same two-factor structure, acceptable internal consistency, and construct validity, with the CPQ discriminating between the eating disorder and control groups. Readability was assessed as a US grade 4 reading level (student age range 9–10 years). Conclusions: The findings provide evidence for the reliability and validity of the CPQ in a clinical eating disorder and two separate community samples. Although further research is required the CPQ has promising evidence as a reliable and valid measure of clinical perfectionism

The effect of pre-treatment psychoeducation on eating disorder pathology among patients with anorexia nervosa and bulimia nervosa

Pre-treatment psychoeducation can be effective for bulimic groups, but little is known about its effect on patients with anorexia nervosa. This study investigated the impact of a pre-treatment psychoeducational intervention on outpatients with diagnoses of full or atypical anorexia nervosa (N = 54) or bulimia nervosa/atypical eating disorder at a normal weight (N = 43). Each attended a four-session psychoeducational group whilst awaiting outpatient treatment. They completed measures of eating and personality disorder pathology pre-intervention, repeating the measures of eating pathology post-intervention. Effectiveness was tested for each diagnostic group using intention-to-treat analyses. Results confirm that such psychoeducational groups reduce unhealthy eating attitudes among bulimic patients, regardless of initial levels of eating and personality pathology. In contrast, the groups were not effective for anorexia nervosa sufferers. Such groups should be considered routinely during waiting periods for bulimia nervosa treatment, but further research is needed to determine how to help anorexia nervosa patients at this stage

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses

BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion

Background Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow‐up assessments. Developing mindfulness and self‐compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation‐, mindfulness‐, and compassion‐based components for treating women with binge eating and obesity. Objective To test the acceptability and efficacy up to 6‐month postintervention of a psychological program based on psychoeducation, mindfulness, and self‐compassion for obese or overweight women with BED. Design A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3‐ and 6‐month follow‐up. Results BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self‐criticism, body‐image psychological inflexibility, and body‐image cognitive fusion; and in improving obesity‐related quality of life and self‐compassion when compared to a WL control group. Results were maintained at 3‐ and 6‐month follow‐up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences. Conclusions These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self‐compassion when treating BED in obese or overweight women. Key Practitioner Message The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree); Developing mindfulness and self‐compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity; Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6‐month postintervention

Toward an understanding of risk factors for anorexia nervosa: A case-control study

Prospective, longitudinal studies of risk factors for anorexia nervosa (AN) are lacking and existing cross-sectional studies are generally narrow in focus and lack methodological rigor. Building on two studies that used the Oxford Risk Factor Interview (RFI) to establish time precedence and comprehensively assess potential risk correlates for AN, the present study advances this line of research and represents the first case-control study of risk factors for AN in the USA

New body scales reveal body dissatisfaction, thin-ideal, and muscularity-ideal in males

The aim of the current study was to develop, test, and re-test two new male body dissatisfaction scales: The Male Body Scale (MBS; consisting of emaciated to obese figures) and the Male Fit Body Scale (MFBS; consisting of emaciated to muscular figures). These scales were compared to the two most commonly used visually-based indices of body dissatisfaction (Stunkard Figure Rating Scale, SFRS; and Somatomorphic Matrix, SM). Male participants rated which body figure on each scale most represented their current figure, then their ideal figure, and then rated which one of the three scales (MBS, MFBS, and SFRS) best represented their current and ideal body overall. Finally, they completed the Drive for Muscularity Scale (DMS), the Eating Disorder Examination Questionnaire (EDE-Q 6.0), and their actual body composition was calculated. This was followed by a re-test and manipulation check two to six weeks later. Participants’ actual body mass index, fat- and muscularity-percentage were all highly related to their current body figure choice, and both new scales were consistently valid and more reliable between test and re-test than the SFRS and SM body dissatisfaction scores. Importantly, each scale was sensitive to different types of body dissatisfaction within males. Specifically, the MBS revealed that males’ desire for the thin-ideal significantly corresponded to higher eating disorder tendencies as identified by EDE-Q 6.0 scores, whilst the MFBS revealed much higher body dissatisfaction toward the larger, muscularity-ideal, predicting higher drive for muscularity as identified by DMS scores. Results validated the new scales, and inform male-focused eating disorder research