12 Chapter 1 shape/weight concerns, but no substantial weight loss is attained (Brownley et al., 2016). Concurrently, this implies that up to 50% of individuals do not fully respond to treatment. Given the physical, psychological and social burden associated with BED (Ágh et al., 2015; Thornton et al., 2017; Udo & Grilo, 2019), these data emphasize the need to improve the effectiveness of treatment. One way to improve treatment outcome is to develop new interventions that may better fit the needs and possibilities of patients. CBT is based on the transdiagnostic model of eating disorders, which implies that distinctive eating disorders are maintained by similar mechanisms (Fairburn et al., 2003). The model proposes that, in all eating disorders, self-worth is primarily defined in terms of control over body shape and weight. This shape and weight overvaluation leads to rigid rules regarding food and eating that are very difficult to maintain. Breaking a dietary rule may lead to breaking all attempts to control eating, and thus to a binge eating episode. In turn, binge eating strengthens patients’ concerns about their ability to control shape and weight, hence encouraging greater dietary restraint and increasing the risk of binge eating. Clinical perfectionism, interpersonal difficulties, low self-esteem and mood intolerance are acknowledged to act as possible co-occurring maintaining factors in many patients. However, the core CBT-protocol focusses on behavior (i.e. strict dieting) that is related to the overvaluation of body shape and weight (Fairburn, 2008). Although CBT is the first line treatment for BED, there are several issues that raise questions about whether CBT is the best suited treatment for individuals with BED. First of all, contrary to AN and BN, the central transdiagnostic concept of shape and weight overvaluation is not a defining characteristic of BED (DSM-5: APA, 2013). In addition, dietary restriction seems to be stronger in AN and BN than in BED (Elran-Barak et al., 2015; Raymond et al., 2012). And notably, evidence suggests that binge eating in obese BED individuals is not so much associated with dietary restraint (Carrard et al., 2012; Goldschmidt et al., 2011; Welsh & King, 2016), but is particularly triggered by high levels of negative affect (e.g. Haedt-Matt & Keel, 2011; Leehr et al., 2015). Eating in response to negative emotions (emotional eating) has been considered an atypical stress response, as the typical response to stress is suppressed appetite (e.g. Tsenkova et al., 2013). Emotional eating has been associated with higher levels of emotion regulation difficulties (Sultson & Akkermann, 2019) and with other affect-related problems like emotional dysregulation, poor interoceptive awareness and high alexithymia (van Strien, 2018). All in all, interventions that specifically target affect-related difficulties may likely improve outcome in individuals with BED.
RkJQdWJsaXNoZXIy MjY0ODMw