1.
Binge eating behaviours in bipolar disorders.
Boulanger, H, Tebeka, S, Girod, C, Lloret-Linares, C, Meheust, J, Scott, J, Guillaume, S, Courtet, P, Bellivier, F, Delavest, M
Journal of affective disorders. 2018;225:482-488
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Plain language summary
Bipolar disorder (BD) is a mental health condition that is often found alongside other health conditions including eating disorders such as anorexia nervosa and bulimia nervosa. More recently, it has been also associated with binge eating disorder (BED) which is characterised by frequent episodes of binge eating (BE), often involving a lot of food in a short space of time and a loss of control. It is estimated that 15-17% of people with BD binge eat, compared to 2-5% of the general population. The added burden of binge eating for those with BD includes increased mood instability, anxiety, additions, episodes of psychosis, obesity, suicide, and cardiovascular disease. This study aimed to explore the prevalence and characteristics of binge eating behaviour in those with BD attending BD clinics in France. Individuals with BD with and without binge eating behaviour were compared on factors including demographics and behavioural elements like eating habits. 145 outpatients with BD were included and assessed for binge eating using the Binge Eating Scale. 19% of BD patients were found to binge eat and was more likely in those with a shorter duration of BD, being emotional reactive and having higher levels of anxiety. However, the small sample meant it was hard to assess any differences in personality characteristics like impulsivity.
Abstract
BACKGROUND Recent research, especially from the USA, suggests that comorbid binge eating (BE) behaviour and BE disorder are frequent in individuals with Bipolar Disorder (BD). Although basic clinical associations between BD and BE have been investigated, less is known about psychological or temperamental dimensions and qualitative aspects of eating habits. In a French cohort of patients with BD, we investigated the prevalence of BE behaviour and any associations with illness characteristics, anxiety, impulsivity, emotional regulation and eating habits. METHODS 145 outpatients with BD (I and II) were assessed for the presence of BE behaviour using the Binge Eating Scale (BES). Characteristics identified in univariate analyses as differentiating BD cases with and without BE behaviour were then included in a backward stepwise logistic regression (BSLR) model. RESULTS In this sample, 18.6% of BD patients met criteria for BE behaviour. Multivariate analysis (BSLR) indicated that shorter duration of BD, and higher levels of anxiety and emotional reactivity were observed in BD with compared to BD without BE behaviour. LIMITATIONS Relatively small sample referred to specialist BD clinics and cross-sectional evaluation meant that it was not possible to differentiate between state and trait levels of impulsivity, emotional instability and disinhibition. These dimensions may also overlap with mood symptoms. CONCLUSION BE behaviour is common in females and males with BD. Emotional dysregulation and anxiety may represent important shared vulnerability factors for worse outcome of BD and increased likelihood of BE behaviour.
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Randomized controlled trial comparing smartphone assisted versus traditional guided self-help for adults with binge eating.
Hildebrandt, T, Michaelides, A, Mackinnon, D, Greif, R, DeBar, L, Sysko, R
The International journal of eating disorders. 2017;50(11):1313-1322
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Free full text
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Plain language summary
Mobile technology offers the potential for greater accessibility to patients, and a reduced treatment burden, which could increase adherence to self-help treatments. The aim of this randomised controlled study was to test the efficacy of a smartphone app – Noom Monitor - compared to traditional cognitive behaviour therapy in the management of binge eating episodes. The study recruited 66 adults who were randomized into two groups: cognitive-behaviour therapy through self-guided help or cognitive-behaviour therapy through self-guided help using Noom Monitor. Results show that patients receiving cognitive-behaviour therapy through self-guided help using Noom Monitor experienced a greater reduction in objective bulimic episodes and purging, and an increase in weekly meal and snack adherence. Authors conclude that smartphone apps can improve initial outcomes of cognitive-behaviour therapy through self-guided help and may offer a useful way to improve participant adherence among those who stay engaged in the treatment.
Abstract
OBJECTIVE Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application designed to facilitate CBT-GSH (CBT-GSH + Noom), on study retention, adherence, and eating disorder symptoms compared to traditional CBT-GSH. METHOD Sixty-six men and women with DSM-5 binge-eating disorder (BED) or bulimia nervosa (BN) were randomized to receive eight sessions of CBT-GSH + Noom (n = 33) or CBT-GSH (n = 33) over 12 weeks. Primary symptom outcomes were eating disorder examination objective bulimic episodes (OBEs), subjective bulimic episodes (SBEs), and compensatory behaviors. Assessments were collected at 0, 4, 8, 12, 24, and 36 weeks. Behavioral outcomes were modeled using zero-inflated negative-binomial latent growth curve models with intent-to-treat. RESULTS There was a significant effect of treatment on change in OBEs (β = -0.84, 95% CI = -1.49, -0.19) favoring CBT-GSH + Noom. Remission rates were not statistically different between treatments for OBEs (βlogit = -0.73, 95% CI = -1.86, 3.27; CBT-GSH-Noom = 17/27, 63.0% vs. CBT-GSH 11/27, 40.7%, NNT = 4.5), but CBT-GSH-Noom participants reported greater meal and snack adherence and regular meal adherence mediated treatment effects on OBEs. The treatments did not differ at the 6-month follow-up. DISCUSSION Smartphone applications for the treatment binge eating appear to have advantages for adherence, a critical component of treatment dissemination.