Lecture 15 Binge Eating Flashcards
diagnostic criteria for BE
A. recurrent episodes of binge eating. An episode is characterised as both:
- eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances
- a sense of lack of control over eating during this episode, some report dissociative quality
loss of control present when do not have objectively large amount of food -> subjective binge eating
B. binge-eating episode associated with 3+:
- eating faster
- eating until uncomfortably full
- eating large amount when not feeling hungry
- eating alone
- feeling disgusted, depressed, guilty afterward
C. marked distress: typically ashamed of eating problems, attempt to conceal
D. once a week for 3 months
E. not associated with compensatory behaviour
specifiers
current severity
mild: 1-3/week
moderate: 4-7 (once a day)
severe: 8-13
extreme: 14+ (twice a day)
BE associated with
early onset obesity
severity of obesity
increased rate of psychopathology
relationship between BE and obesity
41% overweight/obese in community meet criteria for BE
52% overweight/obese in weight loss programmes meet criteria for BE
88% individuals with BE had obesity at some point in their lives
prevalence of BE
increases linearly over time, rates in 2015 6x 1998
1998: 2.7% once weekly, 1.1% twice weekly
2015: 13% once weekly, 3.5% twice weekly
3 month prevalence of DSM-5 ED in 2008/9
AN: 0.46%
BN: 0.66%
BE 5.58%
sub-threshold BED 6.92%
how abnormal is BE
health-related quality of life impairment attenuated over time, such that BE scored similarly to population norms on measures of HRQoL
weekly BE no longer associated with increased days out of role compared to 2005
in 2015, 50% of once/twice weekly BE report do not experience distress related to the act of BE, but distress related to QoL impairment and higher number of days out of role
risk factors of BE
single greatest risk factor: dieting
runs in family, genetic influence: 17% to 39% of variance
trauma (esp. early-life), low self-esteem, body dissatisfaction, negative emotionality, overevaluation of weight and shape, difficulty regulating emotional states, parental substance use
triggers: negative affect, interpersonal stressors, dietary restraint, boredom
comorbid conditions
similar to other ED
depression and anxiety most common (54% depression, 37% anxiety)
substance use and personality disorders ( 25%)
few gender differences observed, men had higher lifetime rates of substance use disorder, current rates of OCD
assessment tools
SCOFF: 5-item screening tool, simple administration and scoring, not BE-specific
Binge Eating Scale: 16-item self-report, scoring more complicated
BEDS-7: 7-item diagnostic screener, follows DSM-5 criteria
psychological treatment of BED
major systematic review 2012, 13 studies of BED treatment, 5 studies with mixed samples including BED
CBT most common, ~70% DBT Interpersonal Psychotherapy (IPT) Brief Strategic Therapy (BST) Behavioural Weight Loss (BWL)
outcome: binge abstinence
end treatment
DBT (64%) > IPT (60%) > CBT (46%) > BWL (38%)
follow-up
IPT (63%) > CBT (59%) > BWL (41%) > BST (20%)
duration:
BST (6m) < CBT (6-24m) < BWL/IPT (12-24m)
treatment of BED
overall evidence
CBT > self-help = IPT > DBT = BWL
reduced BE
CBT = IPT = DBT > self-help > BWL
reduced weight
BWL > self-help/CBT/IPT/DBT
HAPIFED
a healthy approach to weight management and food in eating disorders
problem: psychological therapies for BE while impacting binge frequency do not lead to weight reduction
solution: integrate best of BWL with CBT
sustain weight loss by reducing disordered eating, enhancing psychological wellbeing and improving appetite regulation
treatment feature
Hapifed:
- CBT formulation
- psycho-education of ED and obesity
- dietician
- monitoring with appetite cues
- cognitive therapy
- multidisciplinary
- 30sessions, 6mth
- mood regulation
- weight loss
- behavioural activation
CBT-E
- no dietitian
- no multidisciplinary
- 20/4
- no weight loss
- no behavioural activation
BWL
- no cognitive therapy
- 16/4
- no mood regulation
pilot study changes in ED from baseline to end of treatment
Weight: -1.1 kg slow and modest weight loss eating concern: -2.4 weight concern: -1.5 shape concern: -1.4 global score: -1.1 objective BE: -4.0 subjective BE: -1.0
changes in mental health from baseline to end of treatment
depression: -5.0
stress: -4.0
anxiety: -3.0
binge eating e-therapy
online CBT intervention: 28-access to food diary, daily SMS reminders
significant decrease in binge frequency, binge days and associated loss of control
37% decrease in binge episode frequency
no significant changes in compensatory behaviours
significant decrease in dietary restraint, eating concern, shape concern, global EDE-Q scores
vyvanse
LDX approved for adult moderate to severe BED in US, Canada, Australia
LDX produced statistically significant and clinically meaningful reductions in BE days/week compared with PBO
time to relapse significantly favoured LDX over PBO
percentage of participants with observed relapse:
32.1% for PBO, 3.7% for LDX
BE abstinence, reduced BE frequency, reduced related psychopathology, weight loss, sympathetic nervous system arousal
