title: Association between objective and subjective binge eating and psychopathology during a psychological treatment trial for bulimic symptoms.
abstract: Although loss of control (LOC) while eating 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.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA. Electronic address: andrea.goldschmidta@lifespan.org.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Goldschmidt
authors.affiliation: Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Erin C
authors.initials: EC
authors.lastname: Accurso
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Clinical Neuroscience, The University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Cao
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA.
authors.forename: Jo
authors.initials: J
authors.lastname: Ellison
authors.affiliation: VA South Central Mental Illness Research, Education & Clinical Center, VA HSR&D Center for Innovations in Quality, Effectiveness & Safety (IQuEST), Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Department of Psychiatry, University of Wisconsin, Madison, WI, USA.
authors.forename: Marjorie H
authors.initials: MH
authors.lastname: Klein
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Clinical Neuroscience, The University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA; The Emily Program, St. Paul, MN, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Crow
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Clinical Neuroscience, The University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wonderlich
authors.affiliation: Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Carol B
authors.initials: CB
authors.lastname: Peterson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D002032:Bulimia / Q000523:psychology*; D052018:Bulimia Nervosa / Q000523:psychology* / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000523:psychology*; D008297:Male; D011599:Psychopathology; D012649:Self Concept; D013315:Stress, Psychological / Q000523:psychology
keywords: Binge eating; Bulimia nervosa; Loss of control eating; Psychopathology; Validity