Disorders - Bulimia Nervosa
Barone, J., Oliveri, M., Bonaventura, R. E., Mangano, G. R.
Aim: This study aimed to explore the effect of intermittent theta
burst stimulation (iTBS) of the right and left dorsolateral prefrontal cortex (DLPFC) in people with self-reported dysregulated eating behaviors but
without a diagnosis of eating disorders (EDs). Methods: Participants were randomly divided into two equivalent groups according to the side (right or
left) of the hemisphere to be stimulated and they were tested before and after a single iTBS session. Outcome measurements were scores on self-report
questionnaires assessing psychological dimensions related to eating behaviors (EDI-3), anxiety (STAI-Y), and tonic electrodermal activity. Results:
The iTBS interfered with both psychological and neurophysiological measures. Significant variations of physiological arousal after iTBS of both the
right and left DLPFC were witnessed by increased mean amplitude of non-specific skin conductance responses. With regard to the psychological
measures, the iTBS on the left DLPFC significantly reduced the scores of the EDI-3 subscales drive for thinness and body dissatisfaction.
Interestingly, these two scales are two of the three EDI-3 clinic scales (drive for thinness, body dissatisfaction, and bulimia) used as specific
markers to assess the onset and/or maintenance of eating disorders. Conclusion: Our results show that the left DLPFC iTBS has an impact on the
psychological dimensions that are risk factors for the onset of eating disorders, suggesting that an altered hemispheric asymmetry similar to that
encountered in clinical populations is present in normal subjects even in the absence of clinical symptoms.
Frontiers in Human Neuroscience, 17 : ArtID 1108869
- Year: 2023
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Transcranial magnetic stimulation
(TMS)
An, Z., Kwag, K. H., Kim, M., Yang, J. W., Shin, H. J., Treasure, J., Kim, Y.
R.
Objective: Heightened sensitivity toward social rejection has been implicated in
eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM-I) targeting the
interpretation of ambiguous social situations in individuals with comorbid ED and PD. Method(s): A total of 128 participants [33 with ED and PD, 22
with ED-only, 22 with PD-only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final
analyses. The participants were randomly assigned to a CBM-I task with benign resolutions or a control task with neutral resolutions in a
counterbalanced order in two sessions using a within-subject design. Interpretation bias toward social stimuli was measured using the ambiguous
sentence completion task before and after completing the assigned task. Result(s): The CBM-I task increased benign and decreased negative
interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were
also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and
negatively associated with baseline positive affect. Discussion(s): The results suggest that modifying interpretation bias has the potential as a
transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted. Public
Significance: Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training
intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a
moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment
treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity. Copyright © 2023
Wiley Periodicals LLC.
International Journal of Eating
Disorders, 56(7) : 1341-1352
- Year: 2023
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Stentz, L. A., Wilver, N. L., McDermott, K. A., Cougle, J. R.
Background: Conceptualizations of body image-related disorders suggest that targeting safety behaviors (SB)
may help reduce eating disorder (ED) symptoms. No consensus exists regarding the mechanism underlying the relationship between SBs and ED symptoms,
though one hypothesized construct is overvaluation of appearance.
Cognitive Therapy and Research, 46(5) : 1006-
1015
- Year: 2022
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Monteleone, A.
M., Pellegrino, F., Croatto, G., Carfagno, M., Hilbert, A., Treasure,
J., Wade, T., Bulik, C. M., Zipfel, S., Hay, P., Schmidt, U., Castellini, G., Favaro, A., Fernandez-Aranda, F., Il Shin, J., Voderholzer, U., Ricca, V., Moretti, D., Busatta, D., Abbate-Daga, G., Ciullini, F., Cascino,
G., Monaco, F., Correll, C. U., Solmi, M.
Treatment efficacy for eating disorders (EDs) is modest and guidelines
differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA
of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to
December 15th, 2020. Standardized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. Interventions
involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with
bulimia nervosa (BN). In adults with BN, individual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control; also,
antidepressants outperformed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active
control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based
therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as
psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults). Copyright © 2022 Elsevier Ltd
Neuroscience and Biobehavioral Reviews, 142 (no pagination) :
- Year: 2022
- Problem: Eating Disorders
(any), Anorexia Nervosa, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy
D'Adamo, L., Monterubio, G., Claire, A., Balantekin, K., Taylor, C., Fitzsimmons-Craft, E., Wilfley, D.
Background: Binge-type eating disorders (EDs; i.e., bulimia nervosa and binge eating disorder) are common among young adults with
overweight/ obesity, yet few interventions target both conditions. We tested an online guided self-help intervention that provided cognitive
behavioral therapy (CBT)-based tools for EDs and multicomponent behavioral weight loss (BWL) strategies to young adults with binge-type EDs and
overweight/obesity. Program engagement and change in weight and ED symptoms from baseline to post-intervention were compared between the combined
intervention (CBT+BWL) and an ED-only intervention. Method(s): 60 young adults with clinical/subclinical binge-type EDs and overweight/obesity (BMI M
= 34.4+/-7.4; global ED psychopathology M = 3.7+/-0.9, range = 0-6; binge episode frequency M over the last 28 days = 11.1+/-9.3) were randomized to
CBT+BWL or an EDonly condition. Participants received self-help session content for 8 weeks and self-reported ED symptoms and weight at baseline, 4-
weeks, and post-intervention (8-weeks). Linear mixed models, negative binomial models, Chi-squared tests, and t-tests compared changes in global ED
psychopathology, binge episode frequency, program completion, and session engagement. Result(s): No differences in weight change, ED symptom change,
program completion, or session engagement emerged between the conditions. Both groups achieved significant reductions in ED psychopathology (by 1.3
points in CBT+BWL and 1.4 points in EDonly) and binge frequency (by 4.9 episodes in CBT+BWL and 7.7 episodes in ED-only) from baseline to 8-weeks
(ps<.01). Neither condition achieved significant reductions in weight. 47% of participants completed all 8 sessions. Conclusion(s): CBT+BWL produced
similar improvements in ED symptoms versus CBT alone, suggesting that adding BWL content did not increase risk for EDs. Research should explore BWL
components that may promote weight change in young adults and evaluate their influence on ED risk, as well as for whom a CBT+BWL intervention may
impact ED risk.
Obesity, 30(Supplement
1) : 152
- Year: 2022
- Problem: Eating Disorders
(any), Binge Eating Disorders, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Reas, D. L., Grilo, C. M.
PURPOSE: Eating disorders are prevalent public health problems
associated with broad psychosocial impairments and with elevated rates of psychiatric and medical comorbidities. Critical reviews of the treatment
literature for eating disorders indicate that although certain specialized psychological treatments and specific medications show efficacy to varying
degrees across the different eating disorders, many patients fail to derive sufficient benefit from existing treatments. This article addresses
whether combining psychological and pharmacologic interventions confers any additional benefits for treating eating disorders.\rMETHODS: This study
was a critical review of randomized controlled trials (RCTs) testing combined psychological and pharmacologic treatment approaches for eating
disorders with a focus on anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED).\rFINDINGS: For AN, 3 of the 4 RCTs reported
no significant advantage for combining treatments; the fourth reported a statistically significant, albeit clinically modest, advantage. For BN, 10
of the 12 RCTs reported no significant advantage for combining treatments; 2 RCTs found that combining fluoxetine with specific psychological
treatments enhanced outcomes relative to medication only but not relative to the psychological treatments only. For BED, of the 12 RCTs, only 2 (both
with antiseizure medications) significantly enhanced both binge-eating and weight outcomes, and only 2 (with orlistat, a weight-loss medication)
enhanced weight loss but not binge-eating outcomes.\rIMPLICATIONS: Despite the public health significance of eating disorders, the scope of research
performed on the utility of combining treatments is limited. To date, the few RCTs testing combined pharmacologic plus psychological treatments for
eating disorders have yielded mostly nonsignificant findings. Future RCTs should focus on testing additive benefits of medications with relevant
mechanisms of action to available effective psychological interventions. In addition, future RCTs that test additive effects should use adaptive
designs, which could inform treatment algorithms to enhance outcomes among both responders and nonresponders to initial interventions.
Clinical Therapeutics, 43(1) : 17-
39
- Year: 2021
- Problem: Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Naumann, E., Svaldi, J.
The goal of the present study was to investigate the influence of
expressive suppression and cognitive reappraisal on eating-related symptomatology in anorexia nervosa (AN) and bulimia nervosa (BN). Secondly, on the
background of theoretical models proposing a reciprocal relationship between suppression and rumination, we sought to understand whether inhibition
of emotional expression also affects ruminative thinking in eating disorders. Women with AN (n = 39), BN (n = 37) and a control group (CG, n = 41)
were randomly assigned to either engage in suppression or reappraisal during a sadness-eliciting film clip. Levels of drive to eat, anticipated loss
of control over eating and ruminative thoughts were rated before and after the induction of emotion regulation. Induced expressive suppression led to
a decrease of reported drive to eat in AN and an increase of anticipated loss of control over eating in BN. All groups responded to suppression with
greater rumination, whereas no significant changes were found for reappraisal. Mediation analyses on trait questionnaires pointed to rumination as a
partial mediator of the correlation between suppression and eating disorder pathology. Results are discussed in line with recent empirical research
and current emotion regulation theories. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Behaviour Research and Therapy Vol 141
2021, ArtID 103851, 141 :
- Year: 2021
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Maglia,
M., Corello, G., Caponnetto, P.
According to the WHO definition,
\"telemedicine is the provision of health services, where distance is a critical factor, by all health professionals who use information and
communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of diseases, research and evaluation,
and for the continuous training of health professionals, all in the interest of advancing the health of individuals and their communities\". The
purpose of our review work is specifically to investigate the effects of telemedicine in the treatment and prevention of eating disorders in
adolescents. From June 2021 to (September 2021) in the databases of the Web of Science, EMBASE, PsycINFO and CINHAL, using search terms such as
telehealth, eating disorder, adolescents, Internet/online treatments CBT and FB-T, anorexia nervosa, bulimia nervosa and binge eating disorder. The
articles resulting from the search phases in the databases listed above produced a total of 176 items. Once the procedures for selecting the works
were completed, only four studies were included in the review. Modern e-health psychological approaches in the treatment of eating disorders provide
potential bases of continuous assistance that are decidedly less burdensome in the costs of territorial services in the case that they are not
identified as necessary. Copyright © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
International Journal of Environmental Research and Public Health, 18(23) (no
pagination) :
- Year: 2021
- Problem: Eating Disorders
(any), Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Kwag, K. H., Lee, Y. K., Lee, H. R., Kim, Y. R.
Purpose: The aim of this study was to evaluate the feasibility, acceptability, and effectiveness of an internet-based
guided self-help intervention for female college students with bulimia nervosa (BN) or binge eating disorder (BED). Material(s) and Method(s): A
total of 19 female college students with either BN or BED participated in the study. We assessed eating psychopathology and affective symptoms at
baseline, post-intervention, and 1-month follow-up. Result(s): Our results demonstrated that the participants in the intervention showed the
reduction of eating psychopathology and affective symptoms at post-intervention and the reduced conditions were maintained at 1-month follow-up. The
participants in the intervention showed lowered eating psychopathology (binge/overeating and types of compensatory behaviors) compared to those in
the control group. Conclusion(s): The internet-based intervention program is feasible, acceptable, and effective for improving eating psychopathology
and affective symptoms in young adult women with bulimic-type eating disorders.
, 13(SUPPL 1) :
- Year: 2021
- Problem: Binge Eating Disorders, Bulimia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Self-help, Technology, interventions delivered using technology (e.g. online, SMS)
Zeeck, Almut, Schlegel, Sabine, Jagau, Friederike, Lahmann,
Claas, Hartmann, Armin
Background: Unhealthy attitudes towards sport
and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is
a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg
sport therapy program for eating disorders (FSTP).\rMethods: Outpatients with ED were randomized either to a 3 month sport therapy program (sport
therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The
intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale,
CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive
Exercise Test, CET subscales) and exercise quantity (accelerometer).\rResults: Recruitment was challenging. Fifteen patients were randomized to the
STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome
criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG.
Improvements (STG) were maintained at follow up.\rConclusions: There was no statistically significant difference in the reduction of unhealthy
attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale.
Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major
limitation is the small sample size.
Journal of Eating Disorders Vol 8 2020, ArtID 31, 8 :
- Year: 2020
- Problem: Eating Disorders
(any), Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Physical activity, exercise, Other service delivery and improvement
interventions
Svaldi, J., Schmitz, F., Baur, J., Hartmann, A. S., Legenbauer, T., Thaler, C., vonWietersheim, J., deZwaan, M., Tuschen-Caffier,
B.
BACKGROUND: Bulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological,
nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the
efficacy of these interventions in up to 19 different interventions. METHOD(S): Database search terms were combined for BN and RCTs from database
inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom
severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome
variables. Retrieved RCTs were meta-analyzed using fixed and random effects models. RESULT(S): RCT (79 trials; 5775 participants) effects post-
treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome
variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to
very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and
combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the
sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help,
pharmacotherapy, and combined therapies. CONCLUSION(S): Most psychological and pharmacological interventions revealed to be effective in BN
treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration,
CBT can be recommended as the best intervention for the initial treatment of BN.
Psychological Medicine, 49(6) : 898-910
- Year: 2019
- Problem: Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Svaldi, J., Schmitz, F., Baur, J., Hartmann, A. S., Legenbauer, T., Thaler, C., vonWietersheim, J., deZwaan, M., Tuschen-Caffier, B.
BACKGROUND: Bulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological,
nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the
efficacy of these interventions in up to 19 different interventions. METHOD(S): Database search terms were combined for BN and RCTs from database
inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom
severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome
variables. Retrieved RCTs were meta-analyzed using fixed and random effects models. RESULT(S): RCT (79 trials; 5775 participants) effects post-
treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome
variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to
very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and
combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the
sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help,
pharmacotherapy, and combined therapies. CONCLUSION(S): Most psychological and pharmacological interventions revealed to be effective in BN
treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration,
CBT can be recommended as the best intervention for the initial treatment of BN.
Psychological Medicine, 49(6) : 898-910
- Year: 2019
- Problem: Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)