Intensive Nutritional Counselling in Bulimia Nervosa: A Role for Supplementation with Fluoxetine?

1997 ◽  
Vol 31 (4) ◽  
pp. 514-524 ◽  
Author(s):  
Pierre J.V. Beumont ◽  
Janice D. Russell ◽  
Stephen W. Touyz ◽  
Cathy Buckley ◽  
Kitty Lowinger ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Active Treatment ◽  
Effective Means ◽  
Post Treatment ◽  
Weight Concern ◽  
Nutritional Counselling ◽  
Eating Disorder Examination ◽  
Shape Concern

Objective: The aims of the paper are to determine whether nutritional counselling is associated with an improvement in bulimic symptomatology, whether this improvement is maintained during post-treatment follow-up, and whether the addition of fluoxetine 3 × 20 mg/day confers additional benefit. Method: Psychological, pharmacological and combined psychopharmacological treatments of bulimia nervosa were reviewed briefly. Sixty-seven patients referred to specialist eating disorder services who fulfilled strict diagnostic criteria were treated with intensive nutritional counselling and randomly assigned to either fluoxetine 3×20 mg/day or placebo. After a 1-week ‘wash-out’, active treatment was given over 8 weeks, followed by post-treatment interviews at 12 and 20 weeks. Results: Both groups of patients improved significantly during treatment. In some respects, the fluoxetine group did slightly better as demonstrated by the items ‘restraint’, ‘weight concern’ and ‘shape concern’ (p<0.05 vs p<0.0001) on the Eating Disorder Examination (EDE). Fluoxetine patients decreased their energy intake and lost a modest amount of weight. They went on to regain weight during the follow-up period, returning to levels higher than they were initially. These patients also appeared more likely to have a recurrence of symptoms, as shown by the fall in percentage of binge-free patients and by changes in the EDE. Conclusion: Nutritional counselling is an effective means of treating bulimia nervosa, with improvement maintained up to 3 months follow-up. The addition of fluoxetine may confer some benefit during active treatment, but its discontinuation may contribute to a higher rate of recurrence of symptoms post treatment. Of course, this study cannot be extrapolated to the efficacy of fluoxetine when used as the only form of treatment in patients for whom intensive nutritional counselling or other structured psychological programs are not available.

Eating Disorder Examination: Deutschsprachige Version des strukturierten Essstörungsinterviews

Diagnostica ◽  
2004 ◽  
Vol 50 (2) ◽  
pp. 98-106 ◽  
Author(s):  
Anja Hilbert ◽  
Brunna Tuschen-Caffier ◽  
Martina Ohms
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Weight Concern ◽  
Eating Disorder Examination ◽  
Shape Concern ◽  
Deutschsprachige Version

Zusammenfassung. Das Eating Disorder Examination (EDE) von Fairburn und Cooper (1993) ist ein strukturiertes Essstörungsinterview zur Erfassung der spezifischen Psychopathologie von Essstörungen. In der klinischen Forschung und Praxis gilt es weithin als Methode der Wahl für die Essstörungsdiagnostik. Die in diesem Beitrag vorgestellte deutschsprachige, reübersetzte Version des EDE zeigte in Stichproben von 80 Patientinnen mit Bulimia Nervosa, 144 Patientinnen mit Binge-Eating-Störung und 20 Patientinnen mit Anorexia Nervosa hohe Interrater-Reliabilitäten der Items sowie der Subskalen. Als Indikatoren für die konvergente Validität waren die EDE-Subskalen Shape Concern und Weight Concern mit Selbstbeurteilungsskalen zum Körperbild, z.B. dem Fragebogen zum Figurbewusstsein, hoch korreliert. Die EDE-Subskalen Restraint und Eating Concern zeigten signifikante Zusammenhänge mit dem in Ernährungstagebüchern protokollierten Essverhalten, z.B. Mahlzeiten- oder Essanfallshäufigkeit oder Nährstoffaufnahme. Die Subskalen des EDE unterschieden zwischen Gruppen mit verschiedenen Essstörungsdiagnosen und bildeten Veränderungen durch psychologische Psychotherapie sensitiv ab. Somit steht mit der deutschsprachigen Version des EDE ein dem englischsprachigen Original entsprechendes, geeignetes Instrument für die Erfassung der spezifischen Psychopathologie von Essstörungen zur Verfügung.

scholarly journals Managing Risk of Non-Communicable Diseases in Women with Bulimia Nervosa or Binge Eating Disorders: A Randomized Trial with 12 Months Follow-Up

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1887 ◽  
Author(s):  
Therese Mathisen ◽  
Jorunn Sundgot-Borgen ◽  
Jan Rosenvinge ◽  
Solfrid Bratland-Sanda
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Physical Fitness ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Communicable Diseases ◽  
Post Treatment ◽  
Dietary Therapy ◽  
Non Communicable Diseases

Persons with bulimia nervosa (BN) or binge eating disorder (BED) have an elevated risk of non-communicable diseases (NCDs). However, lowering this risk is rarely addressed in standard cognitive-behavioral treatment (CBT). We aimed to compare CBT with an intervention combining physical exercise and dietary therapy (PED-t), and hypothesized that the PED-t would do better than CBT in lowering the risk of NCD both initially and longitudinally. In this study, 164 women with bulimia nervosa or binge eating disorder were randomly assigned to 16-weeks of outpatient group therapy with either PED-t or CBT. Body composition (BC) was measured by dual-energy X-ray absorptiometry. Measures of physical fitness (VO2peak and one repetition maximum (1RM) in squats, bench press, and seated row) were also recorded. All measurements were completed baseline, post-treatment, and at 6- and 12-month follow-ups, respectively. Our results showed that PED-t improved more than CBT on mean (99% CI) absolute Vo2peak; 57,2 (84.4, 198.8) mL (g = 0.22, p < 0.001) post-treatment. There were small to medium long-term differences in 1RM after PED-t compared to CBT. BC deteriorated in both groups during follow-up. Neither the PED-t nor the CBT lowered the risk for NCDs. Clearly, other approaches need to be considered to promote physical fitness and lower the risk of NCDs among individuals with BN and BED.

Elevated total plasma-adiponectin is stable over time in young women with bulimia nervosa

2017 ◽  
Vol 41 (1) ◽  
pp. 30-36 ◽  
Author(s):  
M. Syk ◽  
M. Ramklint ◽  
R. Fredriksson ◽  
L. Ekselius ◽  
J.L. Cunningham
Keyword(s):  
Morbid Obesity ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Symptom Severity ◽  
Eating Behaviour ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Plasma Adiponectin ◽  
Eating Disorder Examination

AbstractBackgroundBulimia nervosa (BN) is characterized by dysregulated eating behaviour and present data suggest adipokines may regulate food intake. We investigated a possible association between BN and adipokine levels and hypothesized that plasma (P)-adiponectin would be elevated and P-leptin and P-leptin-adiponectin-ratio would be reduced in women with BN.MethodsThe study was designed as a cross-sectional study with a longitudinal arm for patients with BN. Plasma-adiponectin and leptin was measured in 148 female patients seeking psychiatric ambulatory care and 45 female controls. Fifteen patients were diagnosed with BN and the remaining with other affective and anxiety disorders. P-adiponectin and P-leptin levels were compared between patients with BN, patients without BN and controls. At follow-up 1–2 years later, adipokines were reassessed in patients with BN and the Eating Disorder Examination Questionnaire was used to assess symptom severity.ResultsP-adiponectin was elevated in patients with BN at baseline and at follow-up when compared to patients without BN and controls (P < 0.004 and < 0.008 respectively). The difference remained significant after controlling for body mass index. P-adiponectin was correlated to symptom severity at follow-up in patients with BN without morbid obesity (ρ = 0.72, P < 0.04). P-leptin-adiponectin-ratio was significantly lower in patients with BN compared to controls (P < 0.04) and P-leptin non-significantly lower.ConclusionsFindings indicate a stable elevation of P-adiponectin in women with BN. P-adiponectin at follow-up correlates to eating disorder symptom severity in patients without morbid obesity, indicating that P-adiponectin should be further investigated as a possible potential prognostic biomarker for BN.

scholarly journals Norms for Eating Disorder Examination Questionnaire (EDE-Q) among Secondary School Students in Kuala Lumpur, Malaysia

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Musa R ◽  
Bujang MA ◽  
Haniff J ◽  
Mohamad NA ◽  
Omar Kd ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Secondary School ◽  
Secondary School Students ◽  
Weight Concern ◽  
Kuala Lumpur ◽  
School Students ◽  
Cross Sectional ◽  
Eating Disorder Examination Questionnaire ◽  
Eating Disorder Examination ◽  
Shape Concern

Introduction: The Eating Disorder Examination Questionnaire (EDE-Q) has been widely used as a tool to detect eating disorders. We aimed to identify the EDE-Q normative data among secondary school students in Kuala Lumpur, Malaysia. Methods: This is a cross-sectional study involving four secondary schools in an urban area. The respondents of secondary school students were selected using stratified sampling. Results: There were 298 teenagers 12 to 17 years of age who participated in the study. The EDE-Q mean scores ± standard deviation was 1.27 ± 1.08 for the total score (Global Score), 0.78 ± 0.95 for Restraint Domain, 1.02 ± 1.03 for Eating Concern, 1.76 ± 1.55 for Shape Concern and 1.54 ± 1.43 for Weight Concern. Conclusion: Mean values obtained from this study were relatively lower when compared to western populations. Shape Concern and Weight Concern had higher scores compared to the other domains. These values are useful for EDE-Q interpretation in Malaysia.

scholarly journals The Presentation of Eating Disorders in Saudi Arabia

2020 ◽  
Vol 11 ◽  
Author(s):  
Aisha Jawed ◽  
Amy Harrison ◽  
Dagmara Dimitriou
Keyword(s):  
Eating Disorders ◽  
Saudi Arabia ◽  
Eating Disorder ◽  
Structured Interview ◽  
Self Report ◽  
Weight Concern ◽  
Global Score ◽  
Eating Disorder Examination ◽  
Shape Concern ◽  
Report Measure

Objective: There is lack of information on the presentation of eating disorders (EDs) in Saudi Arabia using gold standard clinical tools. The present study aimed to provide data on the presentation of EDs in Saudi Arabia using clinically validated measures.Method: Hundred and thirty-three individuals (33 male) with a mean age of 22 years (2.63) completed three measures: the Eating Disorder Examination (EDE), a semi-structured interview, the Eating Disorder Examination Questionnaire (EDE-Q), a self-report measure, and the Depression Anxiety and Stress Scale (DASS-21) to measure comorbid symptoms.Results: Individuals in Saudi Arabia reported higher levels of restraint, eating concern and shape concern and a higher global score, but lower levels of weight concern on the EDE-Q compared to the EDE. Female participants reported a higher global score, alongside significantly higher scores on the restraint, shape concern and weight concern subscales than males. The most common ED subtype was other specific feeding or ED. Compared with Western community samples, symptom severity in this purposive sample obtained from community settings was significantly higher in this sample.Discussion: Individuals with eating, weight and shape concerns in Saudi Arabia may feel more comfortable expressing their symptoms on a self-report tool compared with a face to face interview. However, it is possible that a self-report measure may over-estimate the severity of symptoms. The data suggest that clinicians in Saudi Arabia should regularly screen for EDs in all genders. It is also important to note that ED symptoms are a cause for concern in young people in Saudi Arabia.

scholarly journals Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1511
Author(s):  
Katherine Nameth ◽  
Theresa Brown ◽  
Kim Bullock ◽  
Sarah Adler ◽  
Giuseppe Riva ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Eating Disorder ◽  
Binge Eating ◽  
Real World ◽  
Exposure Therapy ◽  
Post Treatment ◽  
Cue Exposure ◽  
Treatment Gains ◽  
Intent To Treat

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial

2020 ◽  
pp. 1-10
Author(s):  
Rayane Chami ◽  
Valentina Cardi ◽  
Natalia Lawrence ◽  
Pamela MacDonald ◽  
Katie Rowlands ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Implementation Intentions ◽  
Effect Sizes ◽  
Post Intervention ◽  
Eating Frequency ◽  
Eating Disorder Psychopathology

Abstract Background This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. Methods Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks. Results Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable. Conclusions The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.

Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder

2021 ◽  
pp. 1-9
Author(s):  
Rebecca G. Boswell ◽  
Ralitza Gueorguieva ◽  
Carlos M. Grilo
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Treatment Outcomes ◽  
Binge Eating Disorder ◽  
Pharmacological Treatment ◽  
Rapid Change ◽  
Post Treatment ◽  
Controlled Clinical Trial ◽  
Eating Disorder Psychopathology

Abstract Background Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes. Methods In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes. Results Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores. Conclusions Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.

scholarly journals A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

2013 ◽  
Vol 44 (3) ◽  
pp. 543-553 ◽  
Author(s):  
S. A. Wonderlich ◽  
C. B. Peterson ◽  
R. D. Crosby ◽  
T. L. Smith ◽  
M. H. Klein ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Cognitive Behavioral Therapy ◽  
Bulimia Nervosa ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
Bulimic Symptoms ◽  
Intent To Treat

BackgroundThe purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, ‘enhanced’ cognitive-behavioral therapy (CBT-E).MethodEighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat).ResultsBoth treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different.ConclusionsICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.

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