21
Bethesda, Maryland | September 19-21, 2013
PARALLEL PAPER SESSION
Friday, 1:30 - 2:45 PM
Waterford
Adult Binge Eating
26
TRAJECTORY OF NEGATIVE AFFECT PRIOR TO AND FOLLOWING
EPISODES OF OVEREATING-ONLY, LOSS OF CONTROL EATING-
ONLY, AND BINGE EATING IN OBESE ADULTS
Kelly C Berg
1
,
Carol B Peterson
1
,
Li Cao
2
,
Ross D Crosby
2
,
Scott J Crow
1
,
Scott G Engel
2
,
Stephen A Wonderlich
2
1
University of Minnesota, Minneapolis, MN, USA,
2
2
Neuropsychiatric
Research Institute/University of North Dakota School of Medicine and
Health Sciences, Fargo, ND, USA
Introduction:
In women with bulimia nervosa (BN), ecological momentary
assessment (EMA) data suggest that negative affect (NA) increases
prior to and decreases following episodes of binge eating and that these
changes are driven by fluctuations in Guilt. The current study sought to
replicate these findings in a sample of obese adults.
Methods:
Fifty obese adults with and without binge eating disorder
completed a 2-week EMA protocol. Momentary global NA was assessed
using the PANAS. Facets of NA (Fear, Guilt, Hostility, and Sadness)
were derived from the PANAS subscales. Trajectories of global NA as
well as the NA facets were modeled prior to and following episodes of
overeating-only (OE), loss of control eating-only (LOC), and binge eating
(
BE).
Results:
Consistent with previous findings, global NA and Guilt
increased prior to and decreased following episodes of binge eating (all
p
s<.05). Guilt also significantly decreased following OE (
p
<.05). There
was no significant relationship between the other three facets of NA (Fear,
Hostility, Sadness) and any of the three types of eating episodes (OE,
LOC, BE). Furthermore, there was no relationship between LOC and
either global NA or any of the facets of NA.
Conclusions:
These results
suggest that BE, in contrast to OE and LOC, may function to regulate
global NA and more specifically, Guilt. These data replicate findings
from previous investigations in women with BN and implicate Guilt in the
maintenance of BE among obese adults.
27
WHAT IS “GRAZING”? DEFINITION, PREVALENCE AND CLINICAL
CHARACTERISTICS OF THIS UNDERSTUDIED EATING BEHAVIOR
Eva M Conceicao
1,2
,
James E. Mitchell
2,3
,
Scott Engel
2,3
,
Stephen
Wonderlich
2,3
,
Kathryn Lancaster
2,3
,
Paulo PP Machado
1
1
University of Minho, School of Psychology, Braga, Portugal,
2
Neuropsychiatric Research Institute, Fargo, ND, USA,
3
University of North
Dakota School of Medicine and Health Sciences, Fargo, ND, USA
Introduction
:
Grazing is characterized by a repetitive eating pattern that
has been seen in eating disorders (EDs) and is considered a high-risk
eating behavior among the bariatric surgery (BS) patients because it
has been associated with poorer weight outcomes. However, different
definitions and terminology have been used, preventing the accurate
measurement of this phenomena and comparison of data across studies.
This paper reviews the existing definitions and associated clinical features
in different samples. Finally, a standardized definition of this eating
behavior will be suggested.
Methods
:
Based on a literature review, the
main criteria used to define grazing were included in a survey that was
sent to 23 key researchers and clinicians in the field. These experts were
asked to check which features should be considered as core criteria.
Results
:
This is a frequent behavior in the BS population as well as in ED
and community samples. Its association with psychopathology in ED is
not clear, but its impact on weight outcomes after BS has been supported.
The repetitive aspect of the behavior is the most accepted feature, but
there is little agreement on the requirement of loss of control. Based on
the survey data, a final consensus was reached regarding the definition
of this behavior.
Conclusions
:
Given its clinical relevance among the BS
patients, the importance of a unique definition is crucial to better study its
associated features and impact on different populations.
28
CALORIC RESTRICTION BEGETS BINGE EATING, WHICH BEGETS
CALORIC RESTRICTION, IN ANOREXIA NERVOSA
Kyle P De Young
1
,
Jason M Lavender
2
,
Ross D Crosby
2,3
,
Stephen A
Wonderlich
2,3
,
Scott G Engel
2,3
,
James E Mitchell
2,3
,
Scott J Crow
4
,
Carol B
Peterson
4
,
Daniel Le Grange
5
1
University of North Dakota, Grand Forks, ND, USA,
2
Neuropsychiatric
Research Institute, Fargo, ND, USA,
3
University of North Dakota School of
Medicine, Grand Forks, ND, USA,
4
University of Minnesota, Minneapolis,
MN, USA,
5
University of Chicago, Chicago, IL, USA
Introduction
:
This study examined the association between caloric
restriction (CR) and binge eating (BE) in anorexia nervosa (AN) using
data collected in the natural environment.
Method
:
Women (
N
=118)
with DSM-IV full or subthreshold AN reported eating disorder behaviors,
including BE episodes and going ≥ 8 waking hours without eating (ie, CR),
during 2 weeks of ecological momentary assessment (EMA). Time-lagged
generalized estimating equations tested the following hypotheses: 1) CR
would predict BE while controlling for BE the previous day; 2) BE would
predict CR the subsequent day while controlling for CR the previous day.
Results
:
The likelihood of BE increased as the number of consecutive
days of CR increased when BE had occurred the previous day but not
when BE did not occur the previous day (
p
=.037). In addition, BE predicted
a greater likelihood of CR the subsequent day even after controlling for
CR that day (
p
=.041).
Conclusion
:
The relationship between BE and
CR appears bidirectional, such that each may maintain the other. This is
the first study to evaluate the relationship between CR and BE in women
with AN using data collected via EMA. Future research should aim to
uncover the mechanisms underlying this relationship (eg, physiological
hunger, disinhibition, negative affect, drive for thinness) and target these
mechanisms in treatment.
29
EVALUATION OF A TREATMENT TARGETING INTERNAL CUES OF
HUNGER AND EXTERNAL CUES TO EAT FOR OBESE ADULTS WITH
BINGE EATING
Kerri N. Boutelle
1
,
Carol B. Peterson
2
,
Jordan Carlson
1
1
University of California, San Diego, CA, USA,
2
University of Minnesota,
Minneapolis, MN, USA
Purpose
:
Current treatments for binge eating do not directly address
the incentive salience of food or the management of food cravings. We
tested a 4-month treatment program, called Regulation of Cues (ROC),
which targets improvement of internal cues of satiety and decreases in
responsivity to external cues to eat.
Methods
:
Twenty-seven overweight
binge eaters (82% female, 60% married, mean BMI=38.7(10.2))
participated in a proof of concept single-group pilot. Assessments
were conducted at baseline (T1), post-treatment (T2), and 3-months
post-treatment (T3).Results: Intention-to-treat mixed effects regression
models showed significant decreases in frequency of loss of control
eating episodes for past month (T1=15.0(13.5);T2=4.6(4.8);p=.001) and
significant decreases in the number of overeating days in past month
(
T1=12.4(7.9);T2=4.3(4.1);p<.001) from baseline to post-treatment.
Additionally, BMI significantly decreased from baseline to post-treatment
(
T1=38.7(10.2);T2=37.8(10.4);p=.005).
Results
for overeating days and
BMI were maintained at T3; results for loss of control were not sustained.
Acceptability ratings of the treatment were high.
Conclusions
:
In summary,
the ROC program which targets causal mechanisms for binge eating, was
well accepted by adult binge eaters, lead to a reduction in the frequency of
overeating episodes, and resulted in decreases in weight. Next steps are
to test the efficacy of this model in a large randomized controlled trial.
30
ASSOCIATION OF BULIMIA NERVOSA AND BINGE EATING
DISORDER SYMPTOMS WITH INTERNALIZING AND EXTERNALIZING
DIMENSIONS OF PSYCHOPATHOLOGY
Karen Mitchell
1,2
,
Erika Wolf
1,2
,
Mark Miller
1,2
1
VA Boston Healthcare System, Boston, MA, USA,
2
Boston University
School of Medicine, Boston, MA, USA
Introduction:
Eating disorders (EDs) have been associated with
both internalizing (INT; depression, anxiety) and externalizing (EXT;
substance use, antisocial personality disorder) forms of psychopathology
(
Adambegan et al., 2012). Although the INT/EXT distinction has been
supported by previous factor analytic investigations, these studies typically
have not included EDs (Krueger et al., 2001). We compared several
models of the location of bulimia nervosa (BN) and binge eating disorder
(
BED) within the INT/EXT framework.
Method:
Data were from two studies
of veterans and their intimate partners (
N
= 326 men and 214 women).
Participants were administered the Structured Clinical Interview for
DSM-
IV
without skip-outs. Symptom severity scores were used in models to
maximize power. Mplus 7.0 was used to estimate confirmatory factor
analytic models of INT and EXT disorders.
Results:
Models initially included paths from both INT and EXT factors to
BN and BED. Among women, BN and BED loaded significantly on the INT
factor (factor loading [FL
BN
]
=.38,
p
<.001; FL
BED
=.32,
p
<.001) but not EXT.
Similarly, BN and BED loaded significantly on only INT among men (FL
BN
=.22,
p
<.001; FL
BED
=.43,
p
<.001). All models fit the data well.
Conclusion:
BN and BED loaded only onto an INT factor of psychopathology and not
on EXT. A similar pattern of results was observed for men and women.
Future work should explore gender similarities and differences in patterns
of comorbidity with EDs.
ORAL ABSTRACTS
