Resistance to treatment in eating disorders: a critical challenge

The Special Issue “Treatment resistance in Eating Disorders” gathers together the contributions provided by several experienced groups of researchers in the field of Eating Disorders (EDs). The main topic is addressed from multiple perspectives ranging from pathogenesis (including developmental and maintaining factors) to treatment. An explicative model of resistance in EDs is also proposed

Treatment of obese patients with binge eating disorder using topiramate: a review

Topiramate is an anticonvulsant drug used for the treatment of epilepsy and prophylaxis of migraine. Some authors have proposed its use as a mood stabilizer and have reported its efficacy in reducing impulsiveness and improving mood regulation, possibly via its antagonism to glutamatergic transmission in the lateral hypothalamus, although this indication is still controversial. Weight loss is a side effect consistently reported in the medical literature in patients treated with topiramate. Given its potential role in stabilizing mood and reducing impulse control problems and weight, topiramate has been proposed as a treatment for obese patients with binge eating disorder (BED). The aim of this paper is to review published data on the efficacy and safety of topiramate for the treatment of obese subjects with BED. Although the evidence is preliminary, topiramate appears to be a relatively safe and effective treatment for obese subjects with BED. Limitations of the studies and future directions for research are discussed

Temperament and Eating Attitudes in an Adolescent Community Sample: A Brief Report

Objective. Temperament traits like high harm avoidance (HA) have been proposed as putative risk factors for the development of eating disorders (EDs). We aimed at studying the relationship between temperament and eating attitudes on a large community sample of adolescents. Method. We recruited 992 high school students aged 14–18. In addition to measuring body mass index (BMI), participants were asked to complete the temperament and character inventory and the food frequency questionnaire. Results. Sixty-two percent of the sample reported overeating, 22.8% reported normal eating, and 15.2% reported under eating. Under and normal eaters had higher BMI than that of over eaters. Harm avoidance was found to be significantly higher in those participants with lower eating intakes whilst novelty seeking was found to be higher in over eaters. Conclusion. An interesting association between temperament (high HA) and food approach (under eating) emerged. Longitudinal studies are needed to evaluate whether these traits represent a risk factor for the development of EDs

Binge-eating disorder diagnosis and treatment: A recap in front of DSM-5

INTRODUCTION: Binge Eating Disorders is a clinical syndrome recently coded as an autonomous diagnosis in DSM-5. Individuals affected by Binge Eating Disorder (BED) show significantly lower quality of life and perceived health and higher psychological distress compared to the non-BED obese population. BED treatment is complex due to clinical and psychological reasons but also to high drop-out and poor stability of achieved goals. The purpose of this review is to explore the available data on this topic, outlining the state-of-the-art on both diagnostic issues and most effective treatment strategies. METHODS: We identified studies published in the last 6 years searching the MeSH Term “binge eating disorder”, with specific regard to classification, diagnosis and treatment, in major computerized literature databases including: Medline, PubMed, PsychINFO and Science Direct. RESULTS: A total of 233 studies were found and, among them, 71 were selected and included in the review. REVIEW: Although Binge Eating Disorder diagnostic criteria showed empirical consistency, core psychopathology traits should be taken into account to address treatment strategies. The available body of evidence shows psychological treatments as first line interventions, even if their efficacy on weight loss needs further exploration. Behavioral and self-help interventions evidenced some efficacy in patients with lower psychopathological features. Pharmacological treatment plays an important role, but data are still limited by small samples and short follow-up times. The role of bariatric surgery, a recommended treatment for obesity that is often required also by patients with Binge Eating Disorder, deserves more specific studies. Combining different interventions at the same time does not add significant advantages, planning sequential treatments, with more specific interventions for non-responders, seems to be a more promising strategy. CONCLUSIONS: Despite its recent inclusion in DSM-5 as an autonomous disease, BED diagnosis and treatment strategies deserve further deepening. A multidisciplinary and stepped-care treatment appears as a promising management strategy. Longer and more structured follow-up studies are required, in order to enlighten long term outcomes and to overcome the high dropout rates affecting current studies