Explore the vast range of titles available.

Background Rates of suicide are increasing in the US. Although psychiatric disorders are associated with suicide risk, there is a dearth of epidemiological research on the relationship between suicide attempts (SAs) and eating disorders (EDs). The study therefore aimed to examine prevalence and correlates of SAs in DSM-5 EDs—anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)—in a nationally representative sample of US adults. In addition, prevalence and correlates of SAs were examined in the two subtypes of AN—restricting (AN-R) and binge/purge (AN-BP) types. Methods The study included 36,171 respondents in the Third National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III) who completed structured diagnostic interviews (AUDADIS-5) and answered questions regarding SA histories and psychosocial impairment associated with EDs. We evaluated lifetime prevalence of SA, psychosocial impairment, clinical profiles, and psychiatric comorbidity in adults with EDs with and without SA histories, and temporal relationships between age onset of SA and EDs. Results Prevalence estimates of suicide attempts were 24.9% (for AN), 15.7% (for AN-R), 44.1% (for AN-BP), 31.4% (for BN), and 22.9% (for BED). Relative to respondents without specific EDs, adjusted odds ratios (AORs) of SAs were significantly greater in all EDs: AN = 5.40 (95% confidence intervals [CIs] = 3.80–7.67), AN-R = 3.16 (95% CIs = 1.82–5.42), AN-BP = 12.09 (95% CIs = 6.29–23.24), BN = 6.33 (95% CIs = 3.39–11.81), and BED = 4.83 (95% CIs = 3.54–6.60). Among those with SA history, mean age at first SA and number of SAs were not significantly different across the specific EDs. SA was associated with significantly earlier ED onset in BN and BED, longer duration of AN but shorter duration of BN, greater psychosocial impairment in AN and BN, and with significantly increased risk for psychiatric disorder comorbidity across EDs. Onset of BED was significantly more likely to precede SA (71.2%) but onsets of AN (50.4%) and BN (47.6%) were not. Conclusions US adults with lifetime DSM-5 EDs have significantly elevated risk of SA history. Even after adjusting for sociodemographic factors, those with lifetime EDs had a roughly 5-to-6-fold risk of SAs relative to those without specific EDs; the AN binge/purge type had an especially elevated risk of SAs. SA history was associated with distinctively different clinical profiles including greater risk for psychosocial impairment and psychiatric comorbidity. These findings highlight the importance of improving screening for EDs and for suicide histories.

Eating disorders are prevalent public health problems associated with broad psychosocial impairments and with elevated rates of psychiatric and medical comorbidities. Critical reviews of the treatment literature for eating disorders indicate that although certain specialized psychological treatments and specific medications show efficacy to varying degrees across the different eating disorders, many patients fail to derive sufficient benefit from existing treatments. This article addresses whether combining psychological and pharmacologic interventions confers any additional benefits for treating eating disorders. This study was a critical review of randomized controlled trials (RCTs) testing combined psychological and pharmacologic treatment approaches for eating disorders with a focus on anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED). For AN, 3 of the 4 RCTs reported no significant advantage for combining treatments; the fourth reported a statistically significant, albeit clinically modest, advantage. For BN, 10 of the 12 RCTs reported no significant advantage for combining treatments; 2 RCTs found that combining fluoxetine with specific psychological treatments enhanced outcomes relative to medication only but not relative to the psychological treatments only. For BED, of the 12 RCTs, only 2 (both with antiseizure medications) significantly enhanced both binge-eating and weight outcomes, and only 2 (with orlistat, a weight-loss medication) enhanced weight loss but not binge-eating outcomes. Despite the public health significance of eating disorders, the scope of research performed on the utility of combining treatments is limited. To date, the few RCTs testing combined pharmacologic plus psychological treatments for eating disorders have yielded mostly nonsignificant findings. Future RCTs should focus on testing additive benefits of medications with relevant mechanisms of action to available effective psychological interventions. In addition, future RCTs that test additive effects should use adaptive designs, which could inform treatment algorithms to enhance outcomes among both responders and nonresponders to initial interventions.

An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO’s focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.

Emerging work indicates divergence in the neurobiologies of binge-eating disorder (BED) and obesity despite their frequent co-occurrence. This review highlights specific distinguishing aspects of BED, including elevated impulsivity and compulsivity possibly involving the mesocorticolimbic dopamine system, and discusses implications for differential therapeutics for BED. This narrative review describes epidemiologic, clinical, genetic, and preclinical differences between BED and obesity. Subsequently, this review discusses human neuroimaging work reporting differences in executive functioning, reward processing, and emotion reactivity in BED compared with obesity. Finally, on the basis of the neurobiology of BED, this review identifies existing and new therapeutic agents that may be most promising given their specific targets based on putative mechanisms of action relevant specifically to BED. BED is characterized by elevated impulsivity and compulsivity compared with obesity, which is reflected in divergent neurobiological characteristics and effective pharmacotherapies. Therapeutic agents that influence both reward and executive function systems may be especially effective for BED. Greater attention to impulsivity/compulsivity-related, reward-related, and emotion reactivity–related processes may enhance conceptualization and treatment approaches for patients with BED. Consideration of these distinguishing characteristics and processes could have implications for more targeted pharmacologic treatment research and interventions.

Binge-eating disorder (BED), the most prevalent eating disorder, is associated strongly with obesity and functional impairments. Few evidence-based treatments for BED exist; a pharmacotherapy effective in reducing both binge eating and weight needs to be identified. This placebo-controlled double-blind pilot RCT evaluated the acute effects of naltrexone + bupropion (NB) on BED with obesity and examined the longer-term effects through 6-month follow-up after the discontinuation of medication. Twenty-two adult patients with BED were randomized to receive 12 weeks of double-blind treatment with fixed-dose NB (naltrexone + bupropion XL 50/300 mg) or placebo. Independent (blinded) researcher–clinicians evaluated patients at major outcome time points (baseline, posttreatment, and 6-month follow-up after the treatment period); patients were also evaluated for the tracking of course/tolerability throughout treatments and at 3-month follow-up. Primary outcomes were changes from baseline in binge-eating frequency and percentage weight. Secondary outcomes were changes in eating-disorder psychopathology and depression. A total of 22 patients were enrolled (86.4% women; mean age, 50.4 years), with 77.3% of patients completing treatments; completion rates (NB, 83.3%; placebo, 70.0%) and adverse events did not differ significantly between NB and placebo. Analyses revealed significant reductions from baseline in binge-eating, eating-disorder psychopathology, depression, and weight during treatment, but these changes with NB did not differ significantly from those with placebo. The percentage of patients who attained 3% weight loss was significantly greater with NB than with placebo (45.5% vs 0%); weight-loss and binge-eating reductions were significantly correlated in the group that received NB. At 6-month follow-up, outcomes remained improved relative to baseline, with no significant differences between NB and placebo. The findings from this pilot RCT suggest that NB was well-tolerated in these patients with BED and comorbid obesity. Most outcomes were not statistically different between NB and placebo. A larger-scale, adequately powered RCT is needed for determining the efficacy of NB in the treatment of BED. ClinicalTrials.gov identifier: NCT02317744.

Background The Eating Disorder Examination-Questionnaire (EDE-Q) is increasingly used in studies with bariatric surgery patients although little is known about psychometric properties of this self-report measure in this clinical group. The current study evaluated the factor structure and construct validity of the EDE-Q in bariatric surgery candidates. Methods Participants were a consecutive series of 174 obese bariatric surgery candidates who completed the EDE-Q and a battery of behavioral and psychological measures. Results Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with obese samples. CFA supported a seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. The three factors converged with other relevant collateral measures. Conclusions These factor analytic findings, which replicate recent findings from studies with diverse obese samples, demonstrated convergent validity. Implications of these findings for clinical assessment and research with bariatric surgery patients are discussed.

To investigate, in a nationally representative sample of US adults, the prevalence of help-seeking in individuals with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) eating disorders (EDs) and to examine sex and ethnic/racial differences. The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N=36,309) included respondents who met the criteria for specific lifetime DSM-5 EDs and answered questions regarding help-seeking for their ED symptoms (anorexia nervosa [AN]: n=275; bulimia nervosa [BN]: n=91; and binge-eating disorder [BED]: n=256). The prevalence (standard error) estimates of ever seeking any help for AN, BN, and BED were 34.5% (2.80%), 62.6% (5.36%), and 49.0% (3.74%), respectively. Adjusting for sociodemographic characteristics, men and ethnic/racial minorities (non-Hispanic blacks and Hispanics) were statistically significantly less likely to ever seek help for BED than were women or non-Hispanic whites, respectively. Hispanics also were significantly less likely to seek help for AN relative to non-Hispanic whites. This was the first study in a nationally representative sample of US adults to examine rates of help-seeking, including by sex and ethnic/racial differences, across DSM-5–defined EDs. These findings emphasize the need to develop strategies to encourage help-seeking among individuals with EDs, particularly among men and ethnic/racial minorities.

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. 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). 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. 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.

Certain treatments have demonstrated acute efficacy for binge-eating disorder (BED) but there is a dearth of controlled research examining pharmacotherapies as maintenance treatments for responders to initial interventions. This gap in the literature is particularly critical for pharmacotherapy for BED which is associated with relapse following discontinuation. The current study tested the efficacy of naltrexone/bupropion maintenance treatment amongst responders to acute treatments for BED. Prospective randomized double-blind placebo-controlled single-site trial, conducted August 2017-December 2021, tested naltrexone/bupropion as maintenance treatment for responders to acute treatments with naltrexone/bupropion and/or behavioral weight-loss therapy for BED with comorbid obesity. Sixty-six patients (84.8% women, mean age 46.9, mean BMI 34.9 kg/m ) who responded to acute treatments were re-randomized to placebo ( = 34) or naltrexone/bupropion ( = 32) for 16 weeks; 86.3% completed posttreatment assessments. Mixed models and generalized estimating equations comparing maintenance treatments (naltrexone/bupropion placebo) included main and interactive effects of acute treatments. Intention-to-treat binge-eating remission rates following maintenance treatments were 50.0% ( = 17/34) for placebo and 68.8% ( = 22/32) for naltrexone/bupropion. Placebo following response to acute treatment with naltrexone/bupropion was associated with significantly decreased probability of binge-eating remission, increased binge-eating frequency, and no weight loss. Naltrexone/bupropion following response to acute treatment with naltrexone/bupropion was associated with good maintenance of binge-eating remission, low binge-eating frequency, and significant additional weight loss. Adult patients with BED with co-occurring obesity who have good responses to acute treatment with naltrexone/bupropion should be offered maintenance treatment with naltrexone/bupropion.