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Porto, Portugal | September 20-22, 2012
47
F18
MODERATORS OF POST-BINGE NEGATIVE AFFECT
Kyle P De Young
1
, Jason M Lavender
2
, Stephen A Wonder-
lich
2,3
, Ross D Crosby
2,3
, Scott G Engel
2,3
, James E Mitchell
2,3
,
Scott Crow
4
, Carol B Peterson
4
, Daniel Le Grange
5
1
University of North Dakota, Grand Forks, ND, USA,
2
Neuro-
psychiatric Research Institute, Fargo, ND, USA,
3
University of
North Dakota School of Medicine and Health Sciences, Fargo,
ND, USA,
4
University of Minnesota, Minneapolis, MN, USA,
5
The University of Chicago, Chicago, IL, USA
Purpose:
Research suggests that negative affect (NA) is
a common antecedent of binge eating, although findings
regarding post-binge changes in affect have been mixed,
calling into question models of binge eating that posit negative
reinforcement functions. To identify person- and situation-level
variables that might influence the function of binge eating, this
study examined immediate (within 1 hour) changes in post-
binge NA and tested whether these changes were moderated
by eating disorder diagnosis and the presence of self-induced
vomiting (SIV).
Methods:
47 women with anorexia nervosa
(AN) and 121 with bulimia nervosa (BN) completed a 2-week
ecological momentary assessment protocol, providing multiple
daily ratings of NA and recording episodes of binge eating
and SIV.
Results:
Linear mixed models indicated that, while
overall NA decreased during the first post-binge hour, this
decrease was not moderated by diagnosis or the presence
of SIV. Guilt (a specific facet of NA) also decreased during
the first post-binge hour, but this change
was
moderated by
both diagnosis and SIV. Specifically, guilt decreased more
rapidly in BN than AN, and the presence of SIV was related
to an
increase
in guilt, whereas its absence was associated
with a
decrease
.
Conclusion:
These results indicate that both
diagnosis and SIV influence post-binge changes in guilt and
suggest that examining moderators and specific facets of NA
may be useful for elucidating the functions of binge eating.
F19
Internet-Based Guided Self-Help for Overweight and
Obese Patients With Binge Eating Disorder: A Multi-
Center, Randomized Trial («INTERBED»)
Martina de Zwaan
1
, Wolfgang Herzog
2
, Brunna Tuschen-Caf-
fier
3
, Stephan Zipfel
4
, Stephan Herpertz
5
, Alexandra Martin
6
,
Anja Hilbert
7
1
Hanover Medical School, Hannover, Germany,
2
University
of Heidelberg, Heidelberg, Germany,
3
University of Freiburg,
Freiburg, Germany,
4
University of Tübingen, Tübingen,
Germany,
5
University of Bochum, Bochum, Germany,
6
Univer-
sity of Erlangen, Erlangen, Germany,
7
University of Leipzig,
Leipzig, Germany
The aim of the study is to assess short- and long-term efficacy
of internet-based guided self-help with respect to the number
of binge eating days compared with individual cognitive-be-
havioral therapy. The study is designed as a multi-center,
prospective, randomized, non-inferiority trial with two parallel
arms. Key secondary endpoints are other eating disorder
symptoms, weight loss (BMI), co-morbid psychopathology,
negative affectivity, self-esteem, quality of life, and compli-
ance. In addition, moderators and mediators of therapeutic
change will be investigated. The outpatient internet-based
guided self-help program (GSH) was developed by Netunion®
and translated into German by the PIs of this study. The
outpatient individual cognitive behavioral therapy (CBT) is
regarded as the gold-standard in the treatment of BED; a pub-
lished treatment manual is used (Hilbert & Tuschen-Caffier,
2010). The duration of both interventions lasts 4 months, a fol-
low-up will be performed 6 months after the end of treatment.
The completer analysis will contain 140 patients, 70 patients
in each group. The study is funded by the Federal Ministry of
Research and Education (BMBF) within the Psychotherapy
Network “Treatment of Eating Disorders (EDNET)”. Recruit-
ment was completed in February 2012, 178 patients were
randomized to GSH (n=89) and CBT (n=89). The treatment
phase will be finished in April 2012. As of March 2012 the
drop-out rate was 25 (14% of 178).
F20
r-TMS in Bulimia Nervosa and Anorexia Nervosa: Prelimi-
nary results from a pilot trial
Jonathan Downar, Patricia Colton, Marion P Olmsted, D Blake
Woodside
Toronto General Hospital, Toronto, ON, Canada
This paper reports on preliminary results of an ongoing pilot
study of repetitive transcranial stimulation(r-TMS) in anorexia
nervosa, binge-purging subtype(ANBN), and bulimia ner-
vosa(BN). We have completed two subjects, and are currently
treating three others. Both subjects were treated with 20 ses-
sions of high-dose repetitive transcranial magnetic stimulation
(rTMS) of the dorsomedial prefrontal cortex (DMPFC) using a
novel technique. Both showed complete remissions from their
severe BN by ten sessions. The second subject also report-
ed a cessation of chronic stealing behavriour. Neuroimaging
studies suggest that the DMPFC has an important role to play
in impulse control, and may be underactive in BN. rTMS may
have enhanced these patients’ ability to deploy previously ac-
quired strategies to avoid binging and purging via a reduction
in impulsivity. We plan to complete a 10-subject pilot study lat-
er this year, and larger sham-controlled trial of DMPFC-rTMS
for binging-purging behaviour may be warranted.
F21
COMPULSORY TREATMENT AND MENTAL COMPETENCY
IN ANOREXIA NERVOSA: A REVIEW
Isis F.F.M. Elzakkers
1
, Unna N. Danner
1
, Hans W. Hoek
1,3,4,5
,
Annemarie A. van Elburg
1,2
1
Altrecht Eating Disorders Rintveld, Utrecht, Netherlands,
2
University Medical Center Utrecht, Utrecht, Netherlands,
3
Parnassia Bavo Psychiatric Institute, The Hague, Nether-
lands,
4
Department of Psychiatry, University Medical Center
Groningen, Groningen, Netherlands,
5
Department of Epidemi-
ology, Mailman School of Public Health, Columbia University,
New York, New York, NY, USA
Purpose of the study ANis a severe psychiatric disorder with
a high mortality and morbidity. Given the severity, it is remark-
able that patient engagement in treatment is characterised
by ambivalence. This raises questions on the mental compe-
tency of patients. In severe cases, compulsory treatment is
sometimes invoked. It is important to know the effectiveness
of compulsory treatment. In this review the literature was
searched regarding mental competency and compulsory
treatment in anorexia nervosa. Methods A systematic search
of databases (PubMed, Psycinfo, Scopus) was performed
using the following search terms: anorexia nervosa, eating
disorders, mental competency, mental capacity, decision
making, compulsory treatment, coercive treatment, involun-
tary treatment and treatment refusal. Results Little research
has been done regarding mental competency. In this review
two small studies were retrieved. They show different results.
Regarding compulsory treatment six studies were retrieved.
Regarding compulsory treatment the following can be said:
duration of stay is longer, results at discharge are similar,
comorbidity tends to be more severe, the therapeutic relation
does not seem to worsen and the long term effectiveness is
not well known. Conclusion More research is needed in both
areas. Compulsory treatment should be considered in severe
cases although the long term effectiveness is not well estab-
lished as yet.
F24
TREATMENT OF IMPULSIVITY AND EMOTIONAL REGU-
LATION IN EATING DISORDERS: PRELIMINARY RESULTS
OF A COMPUTERIZED APPROACH
Fernando Fernandez-Aranda
1,2,3
, Susana Jimenez-Murcia
1,2,3
,
Juan J. Santamaría
1,2
, Isabel Sanchez
1
1
Psychiatry, University Hospital Bellvitge-IDIBELL, Barce-
lona, Spain,
2
CIBER Fisiopatología Obesidad y Nutrición
(CIBERObn), Barcelona, Spain,
3
School of Medicine, Univer-
sity of Barcelona, Barcelona, Spain
Based on the current difficulty to treat specific areas in Eating
Disorders (ED) ,(e.g. some impulsive traits, emotional regula-
tion, tolerance to frustration) even after using evidence-based
POSTER SESSION 2 ABSTRACTS