Does the evidence point to a binge eating phenotype?: Comment on Gordon et al. (2007) and Wonderlich et al. (2007)

Abstract

The article by Gordon et al. 1 presents a very understandable description of taxometric analyses. These writers are to be commended for taking this complex topic and making it comprehensible to those who are not experts in the field of taxometrics and classification research. Gordon et al. 1 conclude that the results of taxometric studies suggest the existence of three diagnostic groups, bulimia nervosa, anorexia nervosa, restricting type, and binge eating disorder. They recommend conceptualizing bulimia nervosa and binge eating disorder as categorical classes, but conceptualize anorexia nervosa as a dimensional or continuous entity. Wonderlich et al. 2 take a step back from the esoteric specifics of classification research and note that conclusions about the validity of any classification scheme will necessarily involve a series of value laden decisions.Both articles 1,2 report on recent scientific findings related to the validity of classification schemes of eating disorders. Wonderlich et al. suggest a comprehensive research strategy for validating eating disorder classification models. Both articles 1,2 observe that eating disorders involving binge eating can be conceptualized as qualitatively distinct types or classes and they conclude that psychopathological and personality features other than frank eating disorder symptoms, e.g., concern with body size/shape, binge eating, purging, and restrictive eating, are important aspects of eating disorder diagnoses. Factor Analytic Studies of Eating Disorder SymptomsEight factor analytic studies of eating disorder symptoms 3 have yielded findings that are relevant to the conclusions of the Gordon and Wonderlich articles. All of the factor analytic studies that included measures of ''general psychopathology'' found a very strong and stable factor that reflected personality characteristics and ''neurotic'' symptoms, e.g., mood disturbances, anxiety, obsessive thinking. The factor analytic solutions indicated that this ''general psychopathology'' factor was separate and distinct from other factors that reflected symptoms generally regarded as specific to eating disorders, e.g., binge eating, restrictive eating, fear of fatness, and drive for thinness. These findings suggest that a diagnostic model that only specifies personality characteristics, e.g., the model of Figure 1d in the Wonderlich article, would be inadequate to capture a complete set of relevant features of the eating disorders. The results also suggest that classification models that ignore personality and general psychopathology features of eating disorders, e.g., the models of Figures 1a, 1b, and 1c, will also be inadequate. In my view, the personality features of eating disorders can be viewed as conditions that sometimes accompany the more specific behavioral and attitudinal features of eating disorders. A second consistent finding of the factor analytic studies was the presence of a strong and stable binge eating/bulimic behaviors factor. The fact that binge eating has also been identified as a late...

Personality Disorders in Eating Disorder Not Otherwise Specified and Binge Eating Disorder

“…Given the support for BED as a clinically relevant diagnosis (Javaras et al, 2008;Pope et al, 2006;Williamson, 2007;Wilson et al, 2007), one could expect a higher proportion of PDs in BED than in the clinically more heterogeneous EDNOS category (excluding BED), in which more patients are in a process of recovery compared with BED (Agras et al, 2009). However, because the levels of eating pathology and general psychopathology between EDNOS and BED have been reported comparable in a previous meta-analysis (Thomas et al, 2009), there is insufficient evidence to make any strong predictions.…”

“…It is subsumed under EDNOS but is increasingly recognized as a distinct diagnostic disorder on the basis of taxometric analyses (Williamson, 2007), family aggregation studies (Javaras et al, 2008), treatment response research (Wilson et al, 2007), and studies of clinical course (Pope et al, 2006). Two extensive reviews (StriegelMoore and Franko, 2007;Wonderlich et al, 2009) also conclude positively with respect to the merit of BED as a distinct eating disorder diagnosis, and hence, it is now proposed as a separate ED diagnosis in the DSM-5 (APA, 2012).…”

Different Moderators of Cognitive-Behavioral Therapy on Subjective and Objective Binge Eating in Bulimia Nervosa and Binge Eating Disorder: A Three-Year Follow-Up Study

“…Different studies supported the variability in the phenomenology of binge eating associated with BN and BED syndromes [2,9,10,11,12]. The feelings and the affects experienced during binge episodes seem to be different in BN and BED, with less prebinge emotional activation in BED [13], and it has been suggested that the association between impulsivity, eating psychopathology and different emotions with binge eating plays different roles in BN and BED [14,15,16,17].…”

“…Objective binge eating is characterized by the consumption of a large amount of food and a sense of loss of control, whereas a subjective binge involves the same sense of loss of control but the consumption of a small to moderate amount of food. It has been observed that a person’s definition of ‘large amount’ is highly subjective and influenced by personal beliefs and rules, which can vary from day to day, and that subjective binges are often associated with significant eating disorder psychopathology and clinical impairment, similar to objective binges [4,5,6,7,8,9]. …”