title: Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study.
abstract: The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40-50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.
authors.affiliation: Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy. antonios.dakanalis@unipv.it.
authors.forename: Antonios
authors.initials: A
authors.lastname: Dakanalis
authors.affiliation: Division of Psychiatry, Faculty of Brain Sciences, University College of London, Gower Street, London, WC1E 6BT, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carrà
authors.affiliation: School of Psychology, University of Kent, Canterbury, Kent, CT2 7NZ, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Calogero
authors.affiliation: Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy.
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Zanetti
authors.affiliation: Centre for Integrated Research, Area of Diagnostic Imaging, University "Campus Bio-Medico di Roma", Via Pietro Tacchini 24, 00197, Rome, Italy.
authors.forename: Santino
authors.initials: S
authors.lastname: Gaudio
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caccialanza
authors.affiliation: Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy.|Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Riva
authors.affiliation: Department of Neurosciences and Biomedical Technologies, University of Milano-Bicocca, Medical School, Via Cadore, 48, 20052, Monza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Clerici
mesh_terms: D000328:Adult; D056912:Binge-Eating Disorder / Q000175:diagnosis / Q000534:rehabilitation*; D052018:Bulimia Nervosa / Q000175:diagnosis / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008960:Models, Psychological; D055815:Young Adult
keywords: Binge eating; Bulimic-type eating disorders; Cognitive-behavioural theory; DSM-5; Latent variable structural equation modelling; Maintenance factors