This paper reviews five peer-reviewed studies exploring the psychological and behavioral mechanisms underlying binge eating disorder (BED). The research examines how body image dissatisfaction, shame, self-criticism, and depressive symptoms contribute to binge eating behaviors, as well as the role of attachment anxiety and social difficulties. The paper also evaluates clinical treatment outcomes, including rapid response to cognitive-behavioral therapy and psychodynamic interpersonal psychotherapy. Collectively, these studies suggest that BED involves complex interactions between body image disturbance, emotional regulation difficulties, and interpersonal attachment patterns, and that targeted psychotherapeutic interventions can address both eating behaviors and underlying social-emotional deficits.
The paper by Duarte et al. (2014) explores multiple facets of behavior and emotion associated with binge eating disorder, specifically examining shame, self-criticism, self-disgust, and depression and anxiety to determine their relationships to binge eating and to one another. The authors conducted original research using written assessments in which participants completed a variety of surveys with scaled responses indicating their level of agreement with statements. Duarte et al. investigated whether "the association between body image shame (exogenous variable) and binge eating would be mediated by both self-criticism and depressive symptoms" (Duarte et al., 2014, p. 640). The study population consisted of approximately 400 women, roughly two-thirds of whom were college students.
The results indicated that all of these factors were indeed related to binge eating, and that self-criticism and shame led to depression. Body dissatisfaction—specifically dissatisfaction with weight—was identified as the source of self-criticism and shame. This research suggests that by addressing some of the emotional and cognitive ramifications of binge eating, individuals and clinicians can help others overcome binge eating disorder and potentially additional eating disorders as well.
The article by Ahrberg et al. (2011) takes a comparative approach, exploring different aspects of "cognitive-affective, perceptual and behavioral components" (p. 375) as they relate to body image. The authors examined these factors by comparing their effects on the body images of obese individuals and those who suffer from binge eating disorder. A particularly significant finding is that those with BED are more concerned about body shape and weight than obese individuals are, although BED patients "show a similar degree of body discontent to that of obese persons without BED" (Ahrberg et al., 2011, p. 378).
Unlike the Duarte et al. study, Ahrberg et al. conducted no original research. Instead, the article functions as a prolonged literature review in which the authors examined numerous articles pertaining to body image disturbance in binge eating disorder and as it applies to obesity. This distinction is noteworthy for several reasons. Articles with original research are typically more insightful than those without it, and literature reviews often function best as components of larger areas of independent research. Additionally, the authors did not systematically reveal the method they used in their research; the reader cannot determine what search criteria were included or excluded, or from which databases the articles were obtained. Nevertheless, the findings indicate that body image disturbance frequently accompanies binge eating disorder, which the authors confirmed by stratifying this disorder in relation to its behavioral, perceptual, and cognitive-affective aspects.
The article by Grilo et al. (2015) provides clinically proven methods of counteracting the effects of binge eating disorder and, by extension, obesity. The focus was on rapid response to treatment, defined as a "65% reduction in binge eating by the fourth treatment week" (Grilo et al., 2015, p. 1). By randomly assigning four different treatments—placebo, placebo and short-term cognitive-behavioral therapy (shCBT), shCBT and sibutramine, and sibutramine alone—to 104 obese patients with binge eating disorder, the authors determined that rapid response was related to "greater decreases in binge-eating or eating-disorder psychopathology, depression and percent weight loss" (Grilo et al., 2015, p. 1). This finding has important implications for predicting which patients will achieve meaningful symptom improvement early in treatment.
The article by Maxwell et al. (2013) is of considerable merit because it identifies causes of binge eating disorder beyond those explicitly related to dissatisfaction with self-image or weight. Instead, this article provides empirical evidence supporting the claim that binge eating disorder functions as a way of coping with larger social interaction problems, specifically "attachment anxiety and avoidance" (Maxwell et al., 2013, p. 57) in social situations. This longitudinal study was based on results from women with binge eating disorder who underwent 16 Group Psychodynamic Interpersonal Psychotherapy sessions, with follow-up measures for one year afterward. The results demonstrated that these women were able to decrease their social anxiety, which correlated with a reduction in personal problems as well. These findings have significant implications for addressing binge eating disorder within the overall context of the lives of those suffering from it.
The study by Keating et al. (2013) also examines facets of attachment anxiety as demonstrated through Group Psychodynamic Interpersonal Psychotherapy sessions for women afflicted with binge eating disorder. This study attempted to determine whether attachment anxiety for one's therapy group could change during the course of treatment and follow-ups, which lasted approximately one year. The results indicated that "group attachment avoidance" and "individual attachment security" were reduced during the tenure of the study.
"Group therapy reduces attachment avoidance and improves security"
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