Recurrent episodes of binge eating: Eating an abnormally large amount of food in one sitting.
Perception of lack of control over eating: Feeling unable to stop eating.
Recurrent inappropriate compensatory behavior: Actions taken to prevent weight gain (e.g., vomiting, laxatives).
Frequency: Occurring at least twice per week over a three-month period.
Self-evaluation: Unduly influenced by body shape and weight.
Exclusion: Not occurring exclusively in the context of Anorexia Nervosa. (APA, 2013)
Prevalence and Course
Prevalence: 1-3% lifetime prevalence.
Gender: 10 times more common in females than males.
Onset: Typically in late adolescence or early adulthood.
Course: Can be chronic and intermittent.
Severity Spectrum
The spectrum ranges from less severe to more severe, including:
Binge Eating Disorder
Bulimia Nervosa without Purging Behavior
Bulimia Nervosa with Purging Behavior
CBT Conceptualization
Psychosocial influences: Current cultural milieu. Correlation between cultural pressure to be thin and eating disorder prevalence, across and within cultural groups (Hsu, 1990).
Family factors
Vulnerability factors (Fairburn et al., 1997)
Similarity between BN and OCD (see Rubenstein, 1995). BN patients show higher levels of obsessional traits than normal controls.
CBT Model of BN
Societal Milieu
Streigel-Moore et al. (1986)
Hsu (1990)
Family Comments Regarding Eating / Weight
Fairburn et al. (1997)
Rigid Standards for Control of Eating
Fairburn (1997)
Vulnerability Factors
Obesity / Psychological Factors
Fairburn et al. (1997)
Overvalued Importance of Shape / Weight
Fairburn (1997)
Vulnerability to Eating Disorders
Strober et al. (2000)
Disordered Chaotic Eating
Attempts to Diet
Patton et al. (1990)
Hunger
Lapse
Negative Reinforcement
Reduced Distress
Loss of Control
Binge
Purge
Increase in Distress
Breakdown in normal conditioning processes that regulate eating. (Wilson & Pike, 2001)
The Role of Dieting in BN
Dieting behavior is a risk factor for BN.
In 15-year-old schoolgirls, those who diet were 8 times more likely to develop an eating disorder within a one-year period than those who did not restrict food intake.
But dieting was not a sufficient factor alone in BN. Only 20% of those dieting went on to develop an ED. (Patton et al., 1990)
Patients consistently report the onset of binge eating behavior following a period of dieting. (Wilson & Pike, 2001)
Cognitive Model of Bulimia Nervosa
Cognitive: Extreme Concerns About Shape and Weight
Perfectionism & Dichotomous Thinking
Negative Self-Evaluation
Intense and Rigid Dieting
Binge Eating
Self-Induced Vomiting or Laxative Misuse
Negative Affect
Treatment Outcome for BN
Whittal, Agras, & Gould (1999) Meta analysis of 26 studies evaluating CBT with BN. (N=460) Found effect sizes of 1.22 to 1.35 of CBT on Binge eating, Purging, Depression symptoms, Eating attitudes
Hay & Bacaltchuk (2000) Cochrane Review Identified 21 controlled studies of BN Compared CBT vs no treatment, delayed treatment, alternative psychotherapy, self-help CBT.
CBT found to be superior to no treatment or delayed treatment
CBT approached significance in comparison to other psychotherapies (Wilson & Fairburn, 2002)
BN is the eating disorder with the most research into treatment outcome, and treatment outcome studies of the highest quality. Response rates are generally reported at around 50% (Wilson, Fairburn & Agras, 1997)
Cognitions must be addressed in addition to behavioral techniques to prevent relapse (Cooper & Steere, 1995)
Anderson & Maloney (2001) were critical of the use of bingeing and purging behavior as the only outcome measure and reported variable findings of the impact of CBT on core cognitive symptoms. (Wilson & Fairburn, 2002)