Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T04:25:43.465Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric comorbidity as predictor and moderator of binge-eating disorder treatment outcomes: an analysis of aggregated randomized controlled trials

Published online by Cambridge University Press:  14 April 2021

Janet A. Lydecker Open the ORCID record for Janet A. Lydecker [Opens in a new window]  and
Carlos M. Grilo
Janet A. Lydecker*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Carlos M. Grilo
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Psychology, Yale University, New Haven, CT, USA
*
Author for correspondence: Janet A. Lydecker, E-mail: janet.lydecker@yale.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Psychiatric comorbidity is common in binge-eating disorder (BED) but effects on treatment outcomes are unknown. The current study aimed to determine whether psychiatric comorbidity predicted or moderated BED treatment outcomes.

Methods

In total, 636 adults with BED in randomized-controlled trials (RCTs) were assessed prior, throughout, and posttreatment by doctoral research-clinicians using reliably-administered semi-structured interviews, self-report measures, and measured weight. Data were aggregated from RCTs testing cognitive-behavioral therapy, behavioral weight loss, multi-modal (combined pharmacological plus cognitive-behavioral/behavioral), and/or control conditions. Intent-to-treat analyses (all available data) tested comorbidity (mood, anxiety, ‘any disorder’ separately) as predictors and moderators of outcomes. Mixed-effects models tested comorbidity effects on binge-eating frequency, global eating-disorder psychopathology, and weight. Generalized estimating equation models tested binge-eating remission (zero binge-eating episodes during the past month; missing data imputed as failure).

Results

Overall, 41% of patients had current psychiatric comorbidity; 22% had mood and 23% had anxiety disorders. Psychiatric comorbidity did not significantly moderate the outcomes of specific treatments. Psychiatric comorbidity predicted worse eating-disorder psychopathology and higher binge-eating frequency across all treatments and timepoints. Patients with mood comorbidity were significantly less likely to remit than those without mood disorders (30% v. 41%). Psychiatric comorbidity neither predicted nor moderated weight loss.

Conclusions

Psychiatric comorbidity was associated with more severe BED psychopathology throughout treatment but did not moderate outcomes. Findings highlight the need to improve treatments for BED with psychiatric comorbidities but challenge perspectives that combining existing psychological and pharmacological interventions is warranted. Treatment research must identify more effective interventions for BED overall and for patients with comorbidities.

Keywords

Behavior therapybinge-eating disordercognitive-behavioral therapycomorbidityeating disordersobesitypharmacotherapytreatment
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 16 , December 2022 , pp. 4085 - 4093
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2004). Diagnostic and statistical manual of mental disorders (Fourth, Text Revision ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2006). Practice guidelines for the treatment of patients with eating disorders (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Boswell, R. G., Potenza, M. N., & Grilo, C. M. (2021). The neurobiology of binge-eating disorder compared with obesity: Implications for differential therapeutics. Clinical Therapeutics, 41(1), 50–69. doi:10.1016/j.clinthera.2020.10.014.CrossRefGoogle Scholar
Brownell, K. D. (2000). The LEARN program for weight management. Dallas: American Health Publishing.Google Scholar
Coffino, J. A., Udo, T., & Grilo, C. M. (2019). Rates of help-seeking in U.S. adults with lifetime DSM-5 eating disorders: Prevalence across diagnoses and sex and ethnic/racial differences. Mayo Clinic Proceedings, 94, 1415–1426. doi:10.1016/j.mayocp.2019.02.030.CrossRefGoogle Scholar
Devlin, M. J., Goldfein, J. A., Petkova, E., Liu, L., & Walsh, B. T. (2007). Cognitive behavioral therapy and fluoxetine for binge eating disorder: Two-year follow-up. Obesity, 15, 1702–1709. doi: 10.1038/oby.2007.203.CrossRefGoogle ScholarPubMed
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York: Guilford Press.Google ScholarPubMed
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–371.10.1002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Fairburn, C. G., & Cooper, Z. (1993). The eating disorder examination. In Fairburn, C. G. & Wilson, G. T. (Eds.), Binge eating: Nature, assessment, and treatment (pp. 317–360). New York: Guilford Press.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV axis I disorders (SCID-I), clinician version. Washington, DC: American Psychiatric Press.Google Scholar
Grilo, C. M. (2017). Psychological and behavioral treatments for binge-eating disorder. Journal of Clinical Psychiatry, 78(Suppl 1), 20–24. doi: 10.4088/JCP.sh16003su1c.04.CrossRefGoogle ScholarPubMed
Grilo, C. M., & Masheb, R. M. (2005). A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder. Behaviour Research and Therapy, 43, 1509–1525. doi: 10.1016/j.brat.2004.11.010.CrossRefGoogle ScholarPubMed
Grilo, C. M., Masheb, R. M., & Crosby, R. D. (2012). Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder. Journal of Consulting and Clinical Psychology, 80, 897–906. doi: 10.1037/a0027001.CrossRefGoogle ScholarPubMed
Grilo, C. M., Masheb, R. M., & Salant, S. L. (2005a). Cognitive behavioral therapy guided self-help and orlistat for the treatment of binge eating disorder: A randomized, double-blind, placebo-controlled trial. Biological Psychiatry, 57, 1193–1201.10.1016/j.biopsych.2005.03.001CrossRefGoogle ScholarPubMed
Grilo, C. M., Masheb, R. M., White, M. A., Gueorguieva, R., Barnes, R. D., Walsh, B. T., … Garcia, R. (2014). Treatment of binge eating disorder in racially and ethnically diverse obese patients in primary care: Randomized placebo-controlled clinical trial of self-help and medication. Behaviour Research and Therapy, 58, 1–9. doi: 10.1016/j.brat.2014.04.002.CrossRefGoogle ScholarPubMed
Grilo, C. M., Masheb, R. M., & Wilson, G. T. (2001a). A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 317–322.CrossRefGoogle ScholarPubMed
Grilo, C. M., Masheb, R. M., & Wilson, G. T. (2001b). Subtyping binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1066–1072.10.1037/0022-006X.69.6.1066CrossRefGoogle ScholarPubMed
Grilo, C. M., Masheb, R. M., & Wilson, G. T. (2005b). Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: A randomized double-blind placebo-controlled comparison. Biological Psychiatry, 57, 301–309.10.1016/j.biopsych.2004.11.002CrossRefGoogle ScholarPubMed
Grilo, C. M., Masheb, R. M., Wilson, G. T., Gueorguieva, R., & White, M. A. (2011). Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79, 675–685. doi: 10.1037/a0025049.CrossRefGoogle ScholarPubMed
Grilo, C. M., McElroy, S. L., Hudson, J. I., Tsai, J., Navia, B., Goldman, R., … Loebel, A. (2020a). Efficacy and safety of dasotraline in adults with binge-eating disorder: A randomized, placebo-controlled, fixed-dose clinical trial. CNS Spectrums, 1–10. doi: 10.1017/S1092852920001406.Google ScholarPubMed
Grilo, C. M., Reas, D. L., & Mitchell, J. E. (2016). Combining pharmacological and psychological treatments for binge eating disorder: Current status, limitations, and future directions. Current Psychiatry Reports, 18, 1–11. doi: 10.1007/s11920-016-0696-z.Google ScholarPubMed
Grilo, C. M., White, M. A., Barnes, R. D., & Masheb, R. M. (2013a). Psychiatric disorder co-morbidity and correlates in an ethnically diverse sample of obese patients with binge eating disorder in primary care settings. Comprehensive Psychiatry, 54, 209–216. doi: 10.1016/j.comppsych.2012.07.012.CrossRefGoogle Scholar
Grilo, C. M., White, M. A., Gueorguieva, R., Barnes, R. D., & Masheb, R. M. (2013b). Self-help for binge eating disorder in primary care: A randomized controlled trial with ethnically and racially diverse obese patients. Behaviour Research and Therapy, 51, 855–861. doi: 10.1016/j.brat.2013.10.002.CrossRefGoogle ScholarPubMed
Grilo, C. M., White, M. A., Ivezaj, V., & Gueorguieva, R. (2020ba). Randomized controlled trial of behavioral weight loss and stepped care for binge-eating disorder: 12-month follow-up. Obesity (Silver Spring), 28, 2116–2124. doi: 10.1002/oby.22975.CrossRefGoogle ScholarPubMed
Grilo, C. M., White, M. A., & Masheb, R. M. (2009). DSM-IV psychiatric disorder comorbidity and its correlates in binge eating disorder. International Journal of Eating Disorders, 42, 228–234. doi: 10.1002/eat.20599.CrossRefGoogle ScholarPubMed
Grilo, C. M., White, M. A., Masheb, R. M., Ivezaj, V., Morgan, P. T., & Gueorguieva, R. (2020b). Randomized controlled trial testing the effectiveness of adaptive ‘SMART’ stepped-care treatment for adults with binge-eating disorder comorbid with obesity. American Psychologist, 75, 204.CrossRefGoogle ScholarPubMed
Hilbert, A., Petroff, D., Herpertz, S., Pietrowsky, R., Tuschen-Caffier, B., Vocks, S., & Schmidt, R. (2019). Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. Journal of Consulting & Clinical Psychology, 87, 91–105. doi: 10.1037/ccp0000358.CrossRefGoogle ScholarPubMed
Hudson, J. I., Hiripi, E., Pope, H. G. Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358.CrossRefGoogle ScholarPubMed
Hudson, J. I., McElroy, S. L., Ferreira-Cornwell, M. C., Radewonuk, J., & Gasior, M. (2017). Efficacy of lisdexamfetamine in adults with moderate to severe binge-eating disorder: A randomized clinical trial. JAMA Psychiatry, 74, 903–910.CrossRefGoogle ScholarPubMed
Javaras, K. N., Pope, H. G., Lalonde, J. K., Roberts, J. L., Nillni, Y. I., Laird, N. M., … Hudson, J. I. (2008). Co-occurrence of binge eating disorder with psychiatric and medical disorders. Journal of Clinical Psychiatry, 69, 266–273. doi: 10.4088/jcp.v69n0213.CrossRefGoogle ScholarPubMed
Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.CrossRefGoogle ScholarPubMed
Lydecker, J. A., White, M. A., & Grilo, C. M. (2016). Black patients with binge-eating disorder: Comparison of different assessment methods. Psychological Assessment, 28, 1319–1324. doi: 10.1037/pas0000246.CrossRefGoogle ScholarPubMed
Masheb, R. M., & Grilo, C. M. (2008). Examination of predictors and moderators for self-help treatments of binge-eating disorder. Journal of Consulting & Clinical Psychology, 76, 900–904. doi: 10.1037/a0012917.CrossRefGoogle ScholarPubMed
McElroy, S. L. (2017). Pharmacologic treatments for binge-eating disorder. Journal of Clinical Psychiatry, 78(Suppl 1), 14–19. doi: 10.4088/JCP.sh16003su1c.03.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2017). Eating disorders: recognition and treatment. NICE Guideline (NG69).Google Scholar
Reas, D. L., & Grilo, C. M. (2020). Psychotherapy and medications for eating disorders: Better together? Clinical Therapeutics, 43(1), 17–39. doi:10.1016/j.clinthera.2020.10.006.CrossRefGoogle ScholarPubMed
Reas, D. L., Grilo, C. M., & Masheb, R. M. (2006). Reliability of the Eating Disorder Examination-Questionnaire in patients with binge eating disorder. Behaviour Research and Therapy, 44, 43–51. doi: 10.1016/j.brat.2005.01.004.CrossRefGoogle ScholarPubMed
Trivedi, M. H., Rush, A. J., Wisniewski, S. R., Nierenberg, A. A., Warden, D., Ritz, L., … McGrath, P. J. (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR* D: Implications for clinical practice. American Journal of Psychiatry, 163, 28–40.CrossRefGoogle ScholarPubMed
Udo, T., & Grilo, C. M. (2018). Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of US adults. Biological Psychiatry, 84, 345–354. doi: 10.1016/j.biopsych.2018.03.014.CrossRefGoogle Scholar
Udo, T., & Grilo, C. M. (2019). Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. International Journal of Eating Disorders, 52, 42–50. doi: 10.1002/eat.23004.CrossRefGoogle Scholar
Vall, E., & Wade, T. D. (2015). Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 48, 946–971. doi: 10.1002/eat.22411.CrossRefGoogle ScholarPubMed
Wadden, T. A., Foreyt, J. P., Foster, G. D., Hill, J. O., Klein, S., O'Neil, P. M., … Dunayevich, E. (2011). Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: The COR-BMOD trial. Obesity, 19, 110–120. doi: 10.1038/oby.2010.147.CrossRefGoogle ScholarPubMed
Wilfley, D. E., Friedman, M. A., Dounchis, J. Z., Stein, R. I., Welch, R. R., & Ball, S. A. (2000). Comorbid psychopathology in binge eating disorder: Relation to eating disorder severity at baseline and following treatment. Journal of Consulting & Clinical Psychology, 68, 641–649.CrossRefGoogle ScholarPubMed
Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E., … Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59, 713–721.10.1001/archpsyc.59.8.713CrossRefGoogle ScholarPubMed
Wilson, G. T., Grilo, C. M., & Vitousek, K. M. (2007). Psychological treatment of eating disorders. American Psychologist, 62, 199–216. doi: 10.1037/0003-066x.62.3.199.CrossRefGoogle ScholarPubMed
Wilson, G. T., Wilfley, D. E., Agras, W. S., & Bryson, S. W. (2010). Psychological treatments of binge eating disorder. Archives of General Psychiatry, 67, 94–101. doi: 10.1001/archgenpsychiatry.2009.170.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lydecker and Grilo supplementary material

Tables S1 and S2

Download Lydecker and Grilo supplementary material(File)
File 22.7 KB