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European Archives of Psychiatry and Clinical Neuroscience
Erschienen in: European Archives of Psychiatry and Clinical Neuroscience 8/2015

01.12.2015 | Original Paper

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study

verfasst von: Antonios Dakanalis, Giuseppe Carrà, Rachel Calogero, Maria Assunta Zanetti, Santino Gaudio, Riccardo Caccialanza, Giuseppe Riva, Massimo Clerici

Erschienen in: European Archives of Psychiatry and Clinical Neuroscience | Ausgabe 8/2015

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Abstract

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.
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Fußnoten
1
It is should be noted that, although both CB models posit that binge eating may encourage in some individuals compensatory behaviours aimed at counteracting the effects of binge eating on weight [6, 13] for details, in the current manuscript we focused on binge eating and did not incorporate compensatory behaviours neither in the form of purging nor in the form of non-purging for three main reasons: (1) the scheme distinguishing purging and non-purging BN subtypes has been eliminated from DSM-5 (Online Resource 1); (2) the DSM-5 BN and BED diagnoses are distinguished by the presence versus absence of recurrent inappropriate compensatory behaviours (Online Resource 1); and (3) the necessary prerequisite of the advanced statistical procedure (see “Statistical Analyses”) used for evaluating if the strength of the conceptual relationships of both CB maintenance models (Fig. 1) is similar or different across DSM-5 BN, BED, and bulimic-type EDNOS (that includes also sub-threshold BED cases) is that the model under investigation should contain the same number of latent variables, each of which includes the same number of measured/observed variables for all groups of interest [39].
 
2
Data were analysed first by research clinicians and subsequently by the principal investigator (AD) of the project (κ = 1.0).
 
3
Approximately 20 % of the SCID-II conducted were audio-recorded and rated by a blinded clinician to establish inter-rater reliability (κ = .99).
 
4
The concept of restraint has been operationalized in various ways, frequently distinguishing the components of dietary restriction (concrete efforts to achieve a desired weight by effecting a negative energy balance between caloric intake and expenditure) versus dietary restraint (the intent to diet and attempts to follow dietary rules or control intake, regardless as to whether or not such attempts are successful) [47]. The subscale used here, coherently with the underpinnings of both CB models [6, 13], assesses dietary restraint, and it should not be considered as a valid measure of actual caloric consumption [47].
 
5
In our SEM analyses, we did not control for any other socio-demographic and clinical characteristics (i.e. age, age of onset, presence/absence of comorbidity) though evaluated and reported in this manuscript, since preliminary analyses indicated that they were unrelated to scales/subscales used to specify our latent variables.
 
6
In each model, factor loadings between the groups were held invariant [39]; however, error variances and path coefficients from the covariates to the latent variables were allowed to vary across groups [17, 39].
 
7
The results did not change when both CB models were tested separately in each DSM-5 bulimic-type ED diagnostic group. For fit of the measurement and structural (original and enhanced) CB models, see Online Resource 5.
 
8
The significant group differences associated with body image concerns persisted even after adjusting for significant group differences in BMI, age, and depression levels; these are available from the corresponding author upon request.
 
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Metadaten
Titel
Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study
verfasst von
Antonios Dakanalis
Giuseppe Carrà
Rachel Calogero
Maria Assunta Zanetti
Santino Gaudio
Riccardo Caccialanza
Giuseppe Riva
Massimo Clerici
Publikationsdatum
01.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Psychiatry and Clinical Neuroscience / Ausgabe 8/2015
Print ISSN: 0940-1334
Elektronische ISSN: 1433-8491
DOI
https://doi.org/10.1007/s00406-014-0560-2

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