Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Archives of Psychiatry and Clinical Neuroscience
Published in: European Archives of Psychiatry and Clinical Neuroscience 8/2015

01-12-2015 | Original Paper

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study

Authors: Antonios Dakanalis, Giuseppe Carrà, Rachel Calogero, Maria Assunta Zanetti, Santino Gaudio, Riccardo Caccialanza, Giuseppe Riva, Massimo Clerici

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 8/2015

Login to get access

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.
Appendix
Available only for authorised users
Footnotes
1
It is should be noted that, although both CB models posit that binge eating may encourage in some individuals compensatory behaviours aimed at counteracting the effects of binge eating on weight [6, 13] for details, in the current manuscript we focused on binge eating and did not incorporate compensatory behaviours neither in the form of purging nor in the form of non-purging for three main reasons: (1) the scheme distinguishing purging and non-purging BN subtypes has been eliminated from DSM-5 (Online Resource 1); (2) the DSM-5 BN and BED diagnoses are distinguished by the presence versus absence of recurrent inappropriate compensatory behaviours (Online Resource 1); and (3) the necessary prerequisite of the advanced statistical procedure (see “Statistical Analyses”) used for evaluating if the strength of the conceptual relationships of both CB maintenance models (Fig. 1) is similar or different across DSM-5 BN, BED, and bulimic-type EDNOS (that includes also sub-threshold BED cases) is that the model under investigation should contain the same number of latent variables, each of which includes the same number of measured/observed variables for all groups of interest [39].
 
2
Data were analysed first by research clinicians and subsequently by the principal investigator (AD) of the project (κ = 1.0).
 
3
Approximately 20 % of the SCID-II conducted were audio-recorded and rated by a blinded clinician to establish inter-rater reliability (κ = .99).
 
4
The concept of restraint has been operationalized in various ways, frequently distinguishing the components of dietary restriction (concrete efforts to achieve a desired weight by effecting a negative energy balance between caloric intake and expenditure) versus dietary restraint (the intent to diet and attempts to follow dietary rules or control intake, regardless as to whether or not such attempts are successful) [47]. The subscale used here, coherently with the underpinnings of both CB models [6, 13], assesses dietary restraint, and it should not be considered as a valid measure of actual caloric consumption [47].
 
5
In our SEM analyses, we did not control for any other socio-demographic and clinical characteristics (i.e. age, age of onset, presence/absence of comorbidity) though evaluated and reported in this manuscript, since preliminary analyses indicated that they were unrelated to scales/subscales used to specify our latent variables.
 
6
In each model, factor loadings between the groups were held invariant [39]; however, error variances and path coefficients from the covariates to the latent variables were allowed to vary across groups [17, 39].
 
7
The results did not change when both CB models were tested separately in each DSM-5 bulimic-type ED diagnostic group. For fit of the measurement and structural (original and enhanced) CB models, see Online Resource 5.
 
8
The significant group differences associated with body image concerns persisted even after adjusting for significant group differences in BMI, age, and depression levels; these are available from the corresponding author upon request.
 
Literature
1.
Hay P (2013) A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. Int J Eat Disord 46:462–469CrossRefPubMed
2.
Wilson TG, Grilo CM, Vitousek KM (2007) Psychological treatment of eating disorders. Am Psychol 62:199–216CrossRefPubMed
3.
Stice E, Marti C, Rohde P (2013) Prevalence, incidence, impairment and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol 22:445–457CrossRef
4.
Keel PK (2010) Epidemiology and course of eating disorders. In: Agras WS (ed) The Oxford handbook of eating disorders, 1st edn. Oxford University Press, New York, pp 25–34
5.
6.
Fairburn CG, Cooper Z, Cooper PJ (1986) The clinical features and maintenance of bulimia nervosa. In: Brownell KD, Foreyt JD (eds) Handbook of eating disorders: physiology, psychology and treatment of obesity, anorexia and bulimia, 1st edn. Basic Books, New York, pp 389–404
7.
Fairburn CG (2008) Cognitive behaviour therapy and eating disorders. Guildford Press, New York
8.
Blechert J, Ansorge U, Beckmann S, Tuschen-Caffier B (2011) The undue influence of shape and weight on self-evaluation in anorexia nervosa, bulimia nervosa and restrained eaters: a combined ERP and behavioral study. Psychol Med 41:185–194CrossRefPubMed
9.
Lampard AM, Byrne SM, McLean N, Fursland A (2011) An evaluation of the enhanced cognitive-behavioural model of bulimia nervosa. Behav Res Ther 49:529–535CrossRefPubMed
10.
Williamson DA, White MA, York-Crowe E, Stewart TM (2004) Cognitive-behavioural theories of eating disorders. Behav Modif 28:711–718CrossRefPubMed
11.
Agras WS, Walsh T, Fairburn CG, Wilson GT, Kraemer HC (2000) A multicenter comparison of cognitive-behavioural therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psychiatry 57:459–466CrossRefPubMed
12.
Cooper Z, Fairburn CG (2011) The evolution of “Enhanced” cognitive behaviour therapy for eating disorders: learning from treatment nonresponse. Cognit Behav Pract 18:394–402CrossRef
13.
Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a transdiagnostic theory and treatment. Behav Res Ther 41:509–528CrossRefPubMed
14.
Steinhausen H, Weber S (2009) The outcome of bulimia nervosa: findings from one-quarter century of research. Am J Psychiatry 166:1331–1341CrossRefPubMed
15.
Tasca GA, Presniak MD, Demidenko N, Balfour L, Krysanski V, Trinneer A, Bissada H (2011) Testing a maintenance model for eating disorders in a sample seeking treatment at a tertiary care center: a structural equation modeling approach. Compr Psychiatry 52:678–687CrossRefPubMed
16.
Daley KA, Jimerson DC, Heatherton TF, Metzger ED, Wolfe BE (2008) State self esteem ratings in women with bulimia nervosa and bulimia nervosa in remission. Int J Eat Disord 41:159–163CrossRefPubMed
17.
Dakanalis A, Timko CA, Riva G, Madeddu F, Clerici M, Zanetti MA (2014) A comprehensive examination of the transdiagnostic cognitive behavioral model of eating disorders in males. Eat Behav 15(1):63–67CrossRefPubMed
18.
Shafran R, Cooper Z, Fairburn CG (2002) Clinical perfectionism: a cognitive-behavioural analysis. Behav Res Ther 40:773–791CrossRefPubMed
19.
Lampard AM, Tasca GA, Balfour L, Bissada H (2013) An evaluation of the transdiagnostic cognitive-behavioural model of eating disorders. Eur Eat Disord Rev 21:99–107CrossRefPubMed
20.
Hoiles KJ, Egan SJ, Kane RT (2012) The validity of the transdiagnostic cognitive behavioural model of eating disorders in predicting dietary restraint. Eat Behav 13:123–126CrossRefPubMed
21.
Goldschmidt AB, Wonderlich SA, Crosby RD, Engel SG, Lavender JM, Peterson CB, Crow SJ, Cao L, Mitchell JE (2014) Ecological momentary assessment of stressful events and negative affect in bulimia nervosa. J Consult Clin Psychol 82:30–39PubMedCentralCrossRefPubMed
22.
Hilbert A, Tuschen-Caffier B (2007) Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa. Int J Eat Disord 40:521–530CrossRefPubMed
23.
Fursland A, Byrne S, Watson H, La Puma M, Allen K, Byrne S (2012) Enhanced cognitive behaviour therapy: a single treatment for all eating disorders. J Couns Dev 90:319–329CrossRef
24.
Allen KL, Byrne SM, McLean NJ (2012) The dual-pathway and cognitive-behavioural models of binge eating: prospective evaluation and comparison. Eur Child Adolesc Psychiatry 21:51–62CrossRefPubMed
25.
Stice E, Fairburn CG (2003) Dietary and dietary-depressive subtypes of bulimia nervosa show differential symptom presentation, social impairment, comorbidity, and course of illness. J Consult Clin Psychol 71:1090–1094CrossRefPubMed
26.
Grilo CM, Masheb RM, Wilson GT (2001) Subtyping binge eating disorder. J Consult Clin Psychol 69:1066–1072CrossRefPubMed
27.
Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Bohn K, Hawker DM, Wales JA, Palmer RL (2009) Transdiagnostic cognitive-behavioural therapy for patients with eating disorders: a two-site trial with 60-week follow-up. Am J Psychiatry 166:311–319PubMedCentralCrossRefPubMed
28.
Wonderlich SA, Peterson CB, Crosby RD, Smith TL, Klein MH, Mitchell JE, Crow SJ (2013) A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioural therapy (CBT-E) for bulimia nervosa. Psychol Med 44(3):543–553CrossRefPubMed
29.
30.
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington
31.
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington
32.
Walsh BT (2009) Report of the DSM-5 eating disorders work group. American Psychiatric Association DSM-5, Washington
33.
Fairburn C, Bohn K (2005) Eating disorder NOS (EDNOS): an example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behav Res Ther 43:691–701PubMedCentralCrossRefPubMed
34.
Machado PPP, Goncalves S, Hoek HW (2013) DSM-5 reduces the proportion of EDNOS cases: evidence from community samples. Int J Eat Disord 46:60–65CrossRefPubMed
35.
Keel PK, Brown TA, Holm-Denoma J, Bodell LP (2011) Comparison of DSM–IV versus proposed DSM-5 diagnostic criteria for eating disorders: reduction of eating disorder not otherwise specified and validity. Int J Eat Disord 44:553–560CrossRefPubMed
36.
Dakanalis A, Timko CA, Zanetti MA, Rinaldi L, Prunas A, Carrà G, Riva G, Clerici M (2014) Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: a latent mediated and moderated structural equation modeling analysis across diagnostic groups. Psychiatry Res 215:176–184CrossRefPubMed
37.
First MB, Spitzer RL, Gibbon M, Williams JBW (1996) Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P, Version 2.0). New York State Psychiatric Institute, Biometrics Research Department, NewYork
38.
Fairburn CG, Cooper Z (1993) The eating disorder examination. In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment, and treatment, 1st edn. Guilford Press, New York, pp 317–360
39.
Byrne B (2011) Structural equation modeling with Mplus basic concepts. Application and Programming, Routledge
40.
First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) Structured clinical interview for DSM-IV Axis II personality disorders (SCID-II). American Psychiatric Press Inc, Washington
41.
Beck AT, Steer RA, Brown GK (1996) Beck depression inventory second edition manual. The Psychological Corporation Harcourt Brace & Company, Texas
42.
Celio AA, Wilfley DE, Crow SJ, Mitchell J, Walsh BT (2004) A comparison of the binge eating scale, questionnaire for eating and weight patterns-revised, and eating disorder examination questionnaire with instructions with the eating disorder examination in the assessment of binge eating disorder and its symptoms. Int J Eat Disord 36:434–444CrossRefPubMed
43.
Gormally J, Black S, Daston S, Rardin D (1982) The assessment of binge eating severity among obese persons. Addict Behav 7:47–55CrossRefPubMed
44.
Garner DM (2004) Eating disorder inventory-3 professional manual. Psychological Assessment Resources, Odessa
45.
Frost RO, Marten P, Lahart C, Rosenblate R (1990) The dimensions of perfectionism. Cognit Ther Res 14:449–468CrossRef
46.
Reid HM (2014) Introduction to statistics: fundamental concepts and procedures of data analysis. Sage Publications, London
47.
Stice E, Presnell K (2010) Dieting and the eating disorders. In: Agras WS (ed) The Oxford handbook of eating disorders, 1st edn. Oxford University Press, New York, pp 148–179
48.
Stice E (2002) Risk and maintenance factors for eating pathology. A meta-analytic review. Psychol Bull 128:825–848CrossRefPubMed
49.
Muthén LK, Muthén BO (1998) Mplus User’s Guide, 6th edn. Muthén and Muthén, Los Angeles
50.
51.
Wonderlich SA, Crosby RD, Joiner T, Peterson CB, Bardone-Cone A, Klein M, Crow SJ, Mitchell JE, Le Grange D, Steiger H, Kolden G, Johnson F, Vrshek S (2005) Personality subtyping and bulimia nervosa: psychopathological and genetic correlates. Psychol Med 35:649–657CrossRefPubMed
52.
Harrison A, Sullivan S, Tchanturia K, Treasure J (2010) Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation. Psychol Med 40:1887–1897CrossRefPubMed
53.
Hopwood CJ, Clarke AN, Perez M (2007) Pathoplasticity of bulimic features and interpersonal problems. Int J Eat Disord 40:652–658CrossRefPubMed
54.
Burton E, Stice E (2006) Evaluation of a healthy-weight treatment program for bulimia nervosa: a preliminary randomized trial. Behav Res Ther 44:1727–1738PubMedCentralCrossRefPubMed
55.
Masson PC, von Ranson KM, Wallace LM, Safer DL (2013) A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder. Behav Res Ther 51(11):723–728CrossRefPubMed
56.
Stice E, Marti C, Durant S (2011) Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 49:622–627PubMedCentralCrossRefPubMed
57.
Dakanalis A, Timko CA, Carrà G, Clerici M, Zanetti MA, Riva G, Caccialanza R (2014) Testing the original and the extended dual-pathway model of lack of control over eating in adolescent girls. A two-year longitudinal study. Appetite 82:180–193CrossRefPubMed
58.
Fairburn CG, Stice E, Cooper Z, Doll HA, Norman PA, O’Connor ME (2003) Understanding persistence in bulimia nervosa: a 5-year naturalistic study. J Consult Clin Psychol 71:103–109CrossRefPubMed
59.
Lowe MR, Thomas J, Safer DL, Butryn ML (2007) The relationship of weight suppression and dietary restraint to binge eating in bulimia nervosa. Int J Eat Disord 40:640–644CrossRefPubMed
60.
Waters A, Hill A, Waller G (2001) Bulimics’ responses to food cravings: is binge eating a product of hunger or emotional state? Behav Res Ther 39:877–886CrossRefPubMed
61.
Bruce KR, Steiger H, Young SN, Ng Ying Kin NMK, Israel M, Le´vesque M (2009) Impact of acute tryptophan depletion on mood and eating related urges in bulimic and nonbulimic women. J Psychiatry Neurosci 34:376–382PubMedCentralPubMed
62.
Kaye WH, Gendall KA, Fernstrom MH, Fernstrom JD, Mc-Conaha CW, Weltzin TE (2000) Effects of acute tryptophan depletion on mood in bulimia nervosa. Biol Psychiatry 47:151–157CrossRefPubMed
63.
Steiger H, Bruce KR, Groleau P (2011) Neural circuits, neurotransmitters, and behavior serotonin and temperament in bulimic syndromes. In: Adan RAH, Kaye WH (eds) Behavioral neurobiology of eating disorders, 1st edn. Springer, Berlin, pp 126–138
64.
Anderson M, Parry-Billings M, Newsholme EA, Fairburn CG, Cowen PJ (1990) Dieting reduces plasma tryptophan and alters brain 5-HT function in women. Psychol Med 20:785–791CrossRefPubMed
65.
Ehrlich S, Franke L, Scherag S, Burghardt R, Schott R, Schneider N, Brockhaus S, Hein J, Uebelhack R, Lehmkuhl U (2010) The 5-HTTLPR polymorphism, platelet serotonin transporteractivity and platelet serotonin content in underweight and weight-recovered females with anorexia nervosa. Eur Arch Psychiatry Clin Neurosci 260:483–490CrossRefPubMed
66.
Steiger H, Gauvin L, Engelberg MJ, Ying NMK, Israel M, Wonderlich SA, Richardson J (2005) Mood- and restraint-based antecedents to binge episodes in bulimia nervosa: possible influences of the serotonin system. Psychol Med 35:1553–1562CrossRefPubMed
67.
Marlatt GA, Gordon JR (1985) Relapse prevention: maintenance strategies in the treatment of addictive behaviors. Guilford Press, New York
68.
Johnson WG, Schlundt DG, Barclay DR, Carr-Nangle RE, Engler LB (1995) A naturalistic functional analysis of binge eating. Behav Ther 26:101–118CrossRef
69.
Stein RI, Kenardy J, Wiseman CV, Dounchis JZ, Arnow BA, Wilfley DE (2007) What’s driving the binge in binge eating disorder?: a prospective examination of precursors and consequences. Int J Eat Disord 40(3):195–203CrossRefPubMed
70.
Hilbert A, Hartmann AS (2013) Body Image disturbance. In: Alexander J, Goldschmidt AB, Le Grange D (eds) A clinician’s guide to binge eating disorder, 1st edn. Routledge, New York, pp 78–90
71.
Hrabosky JI (2011) Body image and binge-eating disorder. In: Cash TF, Smolak L (eds) Body image: a handbook of science, practice, and prevention, 2nd edn. Guilford Press, New York, pp 296–304
72.
Grilo CM, Masheb RM, Crosby RD (2012) Predictors and moderators of response to cognitive behavioural therapy and medication for the treatment of binge eating disorder. J Consult Clin Psychol 80:897–906PubMedCentralCrossRefPubMed
73.
Mitchell JE, Devlin MJ, de Zwaan M, Crow SJ, Peterson CB (2008) Binge-eating disorder: clinical foundations and treatment. Guilford Press, New York
74.
Munsch S, Dubi K (2005) Binge eating disorder: specific and common features. A comprehensive overview. In: Munsch S, Beglinger C (eds) Obesity and binge eating disorder, 1st edn. Karger, Basel, pp 197–216CrossRef
75.
van Hoeken D, Veling W, Sinke S, Mitchell JE, Hoek HW (2009) The validity and utility of subtyping bulimia nervosa. Int J Eat Disord 42:595–602CrossRefPubMed
76.
Santonastaso P, Ferraro S, Favaro A (1999) Differences between binge eating disorder and nonpurging bulimia nervosa. Int J Eat Disord 25:215–218CrossRefPubMed
77.
78.
Clerici M, Dakanalis A (2014) Binge eating and binge eating disorder in Italy: overview. In: Fairburn CG (ed) Overcoming binge eating-second edition: the proven program to learn why you binge and how you can stop, 2nd edn. Raffaelo Cortina Editore, Milan, pp 1–5
79.
Dakanalis A, Zanetti MA, Clerici M, Madeddu F, Riva G, Caccialanza R (2013) Italian version of the Dutch eating behavior questionnaire. Psychometric properties and measurement invariance across sex, BMI-status and age. Appetite 71:187–195CrossRefPubMed
80.
Dakanalis A, Carrà G, Clerici M, Riva G (2014) Efforts to make clearer the relationship between body dissatisfaction and binge eating. Eat Weight Disord. doi:10.​1007/​s40519-014-0152-1
81.
Dakanalis A, Carrà G, Calogero R, Fida R, Clerici M, Zanetti MA, Riva G (2014) The developmental effects of media-ideal internalization and self-objectification processes on adolescents’ negative body-feelings, dietary restraint, and binge eating. Eur Child Adolesc Psychiatry. doi:10.​1007/​s00787-014-0649-1 PubMed
Metadata
Title
Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study
Authors
Antonios Dakanalis
Giuseppe Carrà
Rachel Calogero
Maria Assunta Zanetti
Santino Gaudio
Riccardo Caccialanza
Giuseppe Riva
Massimo Clerici
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Psychiatry and Clinical Neuroscience / Issue 8/2015
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI
https://doi.org/10.1007/s00406-014-0560-2

Other articles of this Issue 8/2015

European Archives of Psychiatry and Clinical Neuroscience 8/2015 Go to the issue

Original Paper

Reduced cortical thickness in gambling disorder: a morphometric MRI study

Original Paper

Perception and evaluation of women’s bodies in adolescents and adults with anorexia nervosa

Original Paper

Postmortem volumetric analysis of the nucleus accumbens in male heroin addicts: implications for deep brain stimulation

Original Paper

Increased iPLA2 activity and levels of phosphorylated GSK3B in platelets are associated with donepezil treatment in Alzheimer’s disease patients

Letter to the Editor

A step forward in elucidating the mystery of OCD

Original Paper

Effects of gender and executive function on visuospatial working memory in adult obsessive–compulsive disorder