Association between objective and subjective binge eating and psychopathology during a psychological treatment trial for bulimic symptoms

Abstract

Although loss of control while eating (LOC) is a core construct of bulimia nervosa (BN), questions remain regarding its validity and prognostic significance independent of overeating. We examined trajectories of objective and subjective binge eating (OBE and SBE, respectively; i.e., LOC eating episodes involving an objectively or subjectively large amount of food) among adults participating in psychological treatments for BN-spectrum disorders (n=80). We also explored whether changes in the frequency of these eating episodes differentially predicted changes in eating-related and general psychopathology and, conversely, whether changes in eating-related and general psychopathology predicted differential changes in the frequency of these eating episodes. Linear mixed models with repeated measures revealed that OBE decreased twice as rapidly as SBE throughout treatment and 4-month follow-up. Generalized linear models revealed that baseline to end-of-treatment reductions in SBE frequency predicted baseline to 4-month follow-up changes in eating-related psychopathology, depression, and anxiety, while changes in OBE frequency were not predictive of psychopathology at 4-month follow-up. Zero-inflation models indicated that baseline to end-of-treatment changes in eating-related psychopathology and depression symptoms predicted baseline to 4-month follow-up changes in OBE frequency, while changes in anxiety and self-esteem did not. Baseline to end-of-treatment changes in eating-related psychopathology, self-esteem, and anxiety predicted baseline to 4-month follow-up changes in SBE frequency, while baseline to end-of-treatment changes in depression did not. Based on these findings, LOC accompanied by objective overeating may reflect distress at having consumed an objectively large amount of food, whereas LOC accompanied by subjective overeating may reflect more generalized distress related to one’s eating- and mood-related psychopathology. BN treatments should comprehensively target LOC eating and related psychopathology, particularly in the context of subjectively large episodes, to improve global outcomes.

Are loss of control while eating and overeating valid constructs? A critical review of the literature

“…One study found higher baseline SBE frequency to be predictive of non‐remission from an eating disorder , while another found OBE, but not SBE, to predict remission status . Finally, while two studies reported that individuals with OBE and SBE generally did not differ from one another or from controls with no LOC eating in terms of changes in eating‐related and general psychopathology , another found that changes in SBE, but not OBE, predicted changes in eating‐related and general psychopathology during and after psychological treatment .…”

“…Ultimately, developing and implementing efficacious interventions for binge eating‐related problems across the size and LOC‐severity spectrum should be a priority. Research has shown that SBE may be less responsive than OBE to psychological treatments addressing behavioural and affective antecedents , suggesting that there may be unique triggers of LOC in the absence of overeating that aren't adequately addressed in current interventions. Treatments focused on improving distorted cognitions about one's eating behaviour (e.g.…”

The effect of trauma and dissociation on the outcome of cognitive behavioural therapy for binge eating disorder: A 6‐month prospective study

“…Two main outcomes were considered in the current study based on previous studies showing the importance of baseline bingeing frequency as an indicator of general psychopathology and treatment outcome (Goldschmidt et al, ; Peterson et al, ) and on an established methodology for the analysis of outcomes in psychotherapeutic treatments (Jacobson & Truax, ). First, the level of improvement was defined as the percentage of reduction in BPW between the baseline assessment and the end of treatment.…”

Reduced Inferior and Orbital Frontal Thickness in Adolescent Bulimia Nervosa Persists Over Two-Year Follow-Up

“…Both comorbid depression or anxiety and the use of selective serotonin reuptake inhibitors (SSRIs) may influence changes in both CT 26, 27 and BN symptoms 28, 29 over time. Thus, growth curve and multilevel models were conducted with these additional time-varying covariates (i.e., comorbid depression or anxiety and current SSRI use) at each time point.…”