Incremental validity of the episode size criterion in binge‐eating definitions: An examination in women with purging syndromes

Abstract

Objective Of the two primary features of binge eating, loss of control (LOC) eating is well validated while the role of eating episode size is less clear. Given the ICD-11 proposal to eliminate episode size from the binge-eating definition, the present study examined the incremental validity of the size criterion, controlling for LOC. Method Interview and questionnaire data come from four studies of 243 women with bulimia nervosa (n=141) or purging disorder (n=102). Hierarchical linear regression tested if the largest reported episode size, coded in kilocalories, explained additional variance in eating disorder features, psychopathology, personality traits, and impairment, holding constant LOC eating frequency, age, and body mass index (BMI). Analyses also tested if episode size moderated the association between LOC eating and these variables. Results Holding LOC constant, episode size explained significant variance in disinhibition, trait anxiety, and eating disorder-related impairment. Episode size moderated the association of LOC eating with purging frequency and depressive symptoms, such that, in the presence of larger eating episodes, LOC eating was more closely associated with these features. Neither episode size nor its interaction with LOC explained additional variance in BMI, hunger, restraint, shape concerns, state anxiety, negative urgency, or global functioning. Discussion Taken together, results support the incremental validity of the size criterion, in addition to and in combination with LOC eating, for defining binge-eating episodes in purging syndromes. Future research should examine the predictive validity of episode size in both purging and non-purging eating disorders (e.g., binge eating disorder) to inform nosological schemes.

Are loss of control while eating and overeating valid constructs? A critical review of the literature

“…Associations between LOC and body weight were stronger and less influenced by episode size among treatment‐seeking relative to community‐based adults, which may reflect a tendency for individuals with more severe conditions to present in clinical settings ; therefore, associations between binge eating and increased body weight may be accounted for by the greater severity of binge eating seen in clinical samples, whereas these associations may be less clear in non‐clinical samples in which binge eating may be less severe when present. OBE and SBE were indistinguishable on most measures of psychosocial functioning, suggesting that LOC, irrespective of overeating, may be driving associations between binge eating and distress/impairment; however, some recent research indicates that assessing episode size adds incremental value to the convergent validity of LOC . The convergent validity of the overeating construct, independent of LOC, was not addressed in most studies.…”

Obesity and Eating Disturbance: the Role of TFEQ Restraint and Disinhibition

“…Both Disinhibition and Restraint are found to be related to the psychopathology of disturbed eating behavior and eating disorders. Disinhibition appears to be a behavioral indicator of a loss of control over eating, where an individual consumes greater quantities of food, independently of their level of Restraint [65]. This is reflected in those who have a binge eating disorder (BED) diagnosis possessing a higher Disinhibition and Hunger [66].…”

An Investigation of the Clinical Utility of the Proposed ICD-11 and DSM-5 Diagnostic Schemes for Eating Disorders Characterized by Recurrent Binge Eating in People with a High BMI

“…ICD-11 differs in the inclusion of subjective binge eating episodes (SBEs), where the amount consumed is normal or small although subjectively considered as large by the individual. This is supported by a large body of research [ 10 , 11 , 12 , 13 ]. A second point of difference between the DSM-5 and proposed ICD-11 criteria for BN and BED is the duration of binge eating episodes.…”