Janet A Lydecker1, Carlos M Grilo1,2. 1. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. 2. Department of Psychology, Yale University, New Haven, CT, USA.
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.
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.
Authors: Carlos M Grilo; Robin M Masheb; Marney A White; Ralitza Gueorguieva; Rachel D Barnes; B Timothy Walsh; Katherine C McKenzie; Inginia Genao; Rina Garcia Journal: Behav Res Ther Date: 2014-05-02
Authors: Kristin N Javaras; Harrison G Pope; Justine K Lalonde; Jacqueline L Roberts; Yael I Nillni; Nan M Laird; Cynthia M Bulik; Scott J Crow; Susan L McElroy; B Timothy Walsh; Ming T Tsuang; Norman R Rosenthal; James I Hudson Journal: J Clin Psychiatry Date: 2008-02 Impact factor: 4.384
Authors: Denise E Wilfley; R Robinson Welch; Richard I Stein; Emily Borman Spurrell; Lisa R Cohen; Brian E Saelens; Jennifer Zoler Dounchis; Mary Ann Frank; Claire V Wiseman; Georg E Matt Journal: Arch Gen Psychiatry Date: 2002-08
Authors: Carlos M Grilo; Susan L McElroy; James I Hudson; Joyce Tsai; Bradford Navia; Robert Goldman; Ling Deng; Justine Kent; Antony Loebel Journal: CNS Spectr Date: 2020-05-19 Impact factor: 3.790
Authors: Carlos M Grilo; Heather Thompson-Brenner; Rebecca M Shingleton; Douglas R Thompson; Debra L Franko Journal: Int J Eat Disord Date: 2021-09-02 Impact factor: 5.791
Authors: Francisco Romo-Nava; Anna I Guerdjikova; Nicole N Mori; Frank A J L Scheer; Helen J Burgess; Robert K McNamara; Jeffrey A Welge; Carlos M Grilo; Susan L McElroy Journal: Front Nutr Date: 2022-09-08