124 Chapter 5 individuals with higher shape concerns or higher shape/weight overvaluation. The latter finding is in line with the results of Anderson and colleagues (2020) when they compared differential outcome between an emotion-focused treatment (ICAT-BED) and CBT-gsh. However, in Anderson et al (2020), low shape/weight overvaluation signaled greater reductions in OBE frequency in the emotion-focused treatment (ICAT-BED) rather than in the CBT-treatment (CBT-ghs). These contradicting findings underline the importance of to better understanding how shape/weight overvaluation might influence symptom change in BED treatments. Future research should address this. Second, in the current study, significant main and interaction effects were observed for shape concern but not weight concern. Although the lack of the latter finding could arguably be attributed to the questionable internal consistency, in Grilo, Thompson-Brenner et al. (2021), significant findings showed weight concern, not shape concern, to predict and moderate outcomes in CBT and CBT-gsh for BED (Grilo, Thompson-Brenner et al., 2021; internal consistencies were not reported in this study). This may lead one to underline an earlier recommendation (Grilo, Thompson-Brenner et al., 2021) that shape and weight concerns should be considered separately, whereas the finding that most of the shape and weight concern items form one factor in factor analyses (Peterson et al., 2007; Wade et al., 2008) pleads for the opposite, viz. combine the subscales in analyses (Wade et al., 2011). Third, the current sample comprises individuals with BED and rather high levels of shape/weight overvaluation (overall M=4,99 SD=1,58). Although higher than some clinical samples (e.g. Grilo et al., 2013; Hrabosky et al ., 2007; Lydecker et al., 2017), this is not uncommon (Anderson et al., 2020; Grilo et al., 2019). This in itself is interesting as overvaluation is not included in the DSM-5 criteria for BED and has been advocated to include as a severity-specifier (Forrest et al., 2022; Grilo 2013). Overall, results of the current study add to previous findings that body image constructs may be of special importance in predicting who will benefit more, or less, from (a specific) BED treatment (Anderson et al., 2020; Grilo et al., 2012; Grilo, Thompson-Brenner et al., 2021; Lammers et al., 2015), and underlines the need for further studies into the relevance and distinction of the various constructs. The current study has several strengths. These include the selection of predictors/ moderators, based on the conceptual models underlying the treatments of interest. Second, the use of a large sample size at baseline (CBT+ N = 132, DBT-BED N = 71) and, third, the fact that the sample consisted of individuals who were referred to help for their eating disorder through regular channels and got treatment in everyday clinical practice. This makes the data relevant for other regular clinical settings. Also, both EOT and FU outcome were assessed, thus including the possibility to investigate if significant findings are sustained six months after treatment and if nonsignificant findings at EOT may turn out to be significant at FU.
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