A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

This article reviews the 6-month followup data of a randomized, multicenter, parallel-group study conducted at five clinical sites in three European cities, which compared two second-level treatments for bulimia nervosa (BN) and binge eating disorder (BED): virtual reality-based cue exposure therapy (VR-CET) versus additional cognitive behavioral therapy (A-CBT). Post-treatment outcomes of this study were previously published and details of its design can be found at clinicaltrials.gov (identifier: NCT02237300). This article focuses on the evolution of symptoms assessed after 6 months of followup in a subgroup of 58 patients from the original study. In this study 64 patients with eating disorders (EDs) (35 with BN and 29 with BED), who still showed active episodes of binge eating by the end of a structured CBT program (first-level treatment), were randomly assigned to one of two second-level treatments (A-CBT or VR-CET). Frequency of binge and purge episodes, and attitudinal features of binge-related EDs (bulimia, drive for thinness, and body dissatisfaction) were assessed before starting the second-level treatment (n = 64), at the end (n = 64), and at 6-month followup (n = 58). Mixed between-within subject analyses of variance were used to compare outcomes of both second-level treatments over time. Although both treatment conditions showed statistically significant improvements at the end and after 6-month followup, obtained reductions were greater after VR-CET, regarding binge and purge episodes, as well as the decrease of self-reported tendency to engage in overeating episodes. Accordingly, abstinence from binge episodes were higher in VR-CET than A-CBT at followup (70 percent vs. 26 percent, respectively; χ = 11.711, p = 0.001). These results provide further support for the use of VR-CET as an effective second-level intervention for BN and BED treatment-resistant patients.

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Background/Objective: Eating disorders (EDs) represent serious yet understudied mental health issues, particularly amongst young adult men attending colleges, who are at the average age of onset. Despite this and recent evidence that in young adult men the core ED symptoms are prevalent and remain relatively stable over the college period, little is known about factors associated with both the onset and maintenance of diagnosable EDs in this population. This work sought to address these research gaps. Method: Logistic regression analyses were conducted using data from an on-going longitudinal study of eating and mental health issues to examine the influence of theoretically relevant factors in predicting the onset and maintenance of men's (DSM-5) EDs at 4-year follow-up (N = 2,507). Results: Body dissatisfaction, self-objectification, appearance-ideal internalization, dieting, and negative affectivity were all predictors of ED onset and maintenance. Self-objectification was the largest contributor to both ED onset and maintenance. Conclusions: The findings highlight potentially similar psychosocial foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are discussed.

Despite the theorized role of body checking behaviours in the maintenance process of binge eating, the mechanisms by which they may impact binge eating remain unclear. Using objectification model of eating pathology as a theoretical framework, the authors examined the potential intervening roles of body shame, appearance anxiety, and dietary restraint in the pathway between body checking and binge eating. Data collected from a large sample of treatment-seeking people with Bulimic-type Eating Disorders (N = 801) were analysed trough structural equation modelling. Results showed that, regardless of specific DSM-5 diagnostic categories, body checking behaviours were indirectly associated with binge eating and dietary restraint through body shame and appearance anxiety, whereas dietary restraint was directly linked to binge eating. The findings have clinical utility as they contribute to gaining insight into how critical scrutiny of one's body may act in several indirect ways to affect binge eating. We discuss practical implications of the findings.