Objective The objective was to determine whether treatments with demonstrated efficacy for binge eating disorder (BED) in specialist treatment centers can be delivered effectively in primary care settings to racially/ethnically diverse obese patients with BED. This study compared the effectiveness of self-help cognitive-behavioral therapy (shCBT) and an anti-obesity medication (sibutramine), alone and in combination, and it is only the second placebo-controlled trial of any medication for BED to evaluate longer-term effects after treatment discontinuation. Method 104 obese patients with BED (73% female, 55% non-white) were randomly assigned to one of four 16-week treatments (balanced 2-by-2 factorial design): sibutramine (N=26), placebo (N=27), shCBT+sibutramine (N=26), or shCBT+placebo (N=25). Medications were administered in double-blind fashion. Independent assessments were performed monthly throughout treatment, post-treatment, and at 6- and 12-month follow-ups (16 months after randomization). Results Mixed-models analyses revealed significant time and medication-by-time interaction effects for percent weight loss, with sibutramine but not placebo associated with significant change over time. Percent weight loss differed significantly between sibutramine and placebo by the third month of treatment and at post-treatment. After the medication was discontinued at post-treatment, weight re-gain occurred in sibutramine groups and percent weight loss no longer differed among the four treatments at 6- and 12-month follow-ups. For binge-eating, mixed-models revealed significant time and shCBT-by-time interaction effects: shCBT had significantly lower binge-eating frequency at 6-month follow-up but the treatments did not differ significantly at any other time point. Demographic factors did not significantly predict or moderate clinical outcomes. Discussion Our findings suggest that pure self-help CBT and sibutramine did not show long-term effectiveness relative to placebo for treating BED in racially/ethnically diverse obese patients in primary care. Overall, the treatments differed little with respect to binge-eating and associated outcomes. Sibutramine was associated with significantly greater acute weight loss than placebo and the observed weight-regain following discontinuation of medication suggests that anti-obesity medications need to be continued for weight loss maintenance. Demographic factors did not predict/moderate clinical outcomes in this diverse patient group.

Background: Nonsuicidal self-injury (NSSI) is widely thought to serve an emotion-regulatory function. Method: The focus of the present paper is to provide a conceptual framework for understanding how NSSI might modify a person's emotions. Results: Drawing upon the process model of emotion regulation, we argue that 5 families of emotion regulation strategies may be engaged by NSSI. Individuals may engage in NSSI as an alternative to more distressing situations. They also may use NSSI to modify their social environment. Individuals may shift their attention away from unpleasant emotions or thoughts via NSSI. NSSI may change cognitions about the self via self-punishment or transformation of the self from higher-order to lower-order awareness. NSSI may also bring about various physiological effects, such as changes in endogenous opioids or parasympathetic nervous system activation, as a way of modulating emotional responses. Conclusion: Simply labeling NSSI as ‘emotion regulatory' does not tell us precisely what is going on. This is because at any given moment, NSSI can serve to regulate emotions in many different ways. One key challenge is to clarify the precise functions NSSI may be serving for a given individual in a particular context.

Metabolic syndrome is common in obese patients with BED in primary care settings and is associated with fewer dieting behaviors. These findings suggest that certain lifestyle behaviors, such as increased dietary restriction, may be potential targets for intervention with metabolic syndrome.

No abstract

Studies have evaluated the prevalence of domestic violence in populations of patients in emergency and primary care settings, but there are little data on patients admitted to hospitals. We undertook a study to evaluate the prevalence of domestic violence among female inpatients. Of 131 consecutive female patients between the ages of 18 and 60 admitted to a nontrauma urban teaching hospital asked to complete a self-administered survey about domestic violence, 101 completed the questionnaire. Twenty-six percent of the respondents reported being in an abusive relationship at one time. Domestic violence accounts for one third of all intentional assaults against women, and it is a significant risk factor for suicide, substance abuse, and chronic somatic disorders. 1,2 Studies of patients in outpatient and emergency settings have shown prevalence rates from 8% to 54% and incidence rates of 9% to 14%. [3][4][5][6][7][8] Little is known about the degree to which domestic violence contributes to inpatient admissions of women. This study investigates domestic violence in female inpatients and its relation to inpatient admissions. METHODSA 32-item questionnaire was developed to evaluate the prevalence and incidence of domestic violence in women admitted to an urban, nontrauma hospital with 277 beds. The questionnaire included nine questions about demographic information and seven questions about violence within the individual's neighborhood. One question asked about violence within intimate relationships: "At any time, has a husband or partner ever hit you, kicked you, or physically hurt you?" A woman responding affirmatively to this question was identified as having experienced domestic violence, and these women were asked another 14 questions about the violence they had experienced as well as medical treatment they had received for injuries resulting from the violence.Female patients admitted consecutively from October through December 1994 were evaluated for entry into the study. Patients were excluded from the study if they could not speak English, or were too ill to cooperate. Women under age 18 or over age 60 were excluded because the mandated reporting requirements for minors and elders would potentially reduce the response rate for all age groups. Consent was obtained from patients in their hospital rooms with no friends or family present. The questionnaire was either self-administered (77%) or verbally administered by one of the investigators (23%) depending on patient preference. Each patient's medical record was abstracted for demographic information and for whether any nurse or physician documented screening for domestic violence in the patient's admitting notes.Proportions were compared using 2 analysis, with 95% confidence intervals (CI) included. RESULTSDuring the study period, 195 women between 18 and 60 years of age were admitted; 64 women were excluded because of admission to an intensive care unit or intubation ( n ϭ 42), altered mental status ( n ϭ 11), inability to understand English ( n ϭ 9), or iso...