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Background: Binge eating disorder (BED), as the most prevalent eating disorder, is strongly related to obesity and other somatic and psychiatric morbidity. Despite evidence-based treatments a considerable number of BED patients fail to recover. There is preliminary evidence for the association between psychodynamic personality functioning and personality traits on treatment outcome. However, research is limited and results are still contradictory. Identifying variables associated with treatment outcome could improve treatment programs. The aim of the study was to explore whether personality functioning or personality traits are associated with Cognitive Behavioral Therapy (CBT) outcome in obese female patients with BED or subthreshold BED. Methods: Eating disorder symptoms and clinical variables were assessed in 168 obese female patients with DSM-5 BED or subthreshold BED, referred to a 6-month outpatient CBT program in a pre-post measurement design. Personality functioning was assessed by the Developmental Profile Inventory (DPI), personality traits by the Temperament and Character Inventory (TCI). Treatment outcome was assessed by the Eating Disorder Examination-Questionnaire (EDE-Q) global score and self-reported binge eating frequency. According to the criteria of clinical significance, 140 treatment completers were categorized in four outcome groups (recovered, improved, unchanged, deteriorated). Results: EDE-Q global scores, self-reported binge eating frequency and BMI significantly decreased during CBT, where 44.3% of patients showed clinically significant change in EDE-Q global score. Treatment outcome groups showed significant overall differences on the DPI Resistance and Dependence scales and the aggregated ‘neurotic’ scale. Significant overall differences were found between groups on TCI Harm avoidance, although post hoc t-tests were non-significant. Furthermore, multiple logistic regression analysis, controlling for mild to moderate depressive disorde

This thesis considers the effectiveness of psychological treatments for adults with eating disorders, and, as it is can occur in individuals who are morbidly obese, the effectiveness of psychological interventions for eating disorder pathology. In Part I, Chapter 2 we assess whether specialized treatments for patients with anorexia are superior to non-specialized, control treatments by conducting a meta-analysis. We hypothesized that differences in clinical treatment effect would be found in favor of specialized psychological treatments. The meta-analyses indicated that no differences between psychological treatments and control conditions could be established. Our findings suggest that studies including patients over 18 years were more effective on weight gain than studies including younger patients. In high-quality studies and in studies in which therapist training was reported, larger effects were found on both weight gain and on quality of life. At the same time, in sensitivity analyses including high-quality studies only, no differences between psychological and control conditions were found. Part II examines the (cost-)effectiveness of Cognitive behavior therapy-Enhanced (CBT-E), an evidence-based psychological treatment. Chapter 3 presents a consecutive cohort study in which differential (cost-)effectiveness of treatment-as-usual and CBT-E for eating disorder patients with a body mass index over 17.5 kg/m2 was examined. Chapter 4 presents findings on examining differential (cost-)effectiveness of CBT-E compared to treatment-as-usual for patients with anorexia. We hypothesized that effectiveness and cost-effectiveness would be superior in the CBT-E cohort, both for normal weight and underweight patients. For normal weight patients, no comparative differences on clinical outcome were found. In both cohorts, eating disorder pathology decreased. With regard to cost-effectiveness, findings indicated a 71% likelihood of CBT-E dominating TAU and leading to more remi

This thesis considers the effectiveness of psychological treatments for adults with eating disorders, and, as it is can occur in individuals who are morbidly obese, the effectiveness of psychological interventions for eating disorder pathology. In Part I, Chapter 2 we assess whether specialized treatments for patients with anorexia are superior to non-specialized, control treatments by conducting a meta-analysis. We hypothesized that differences in clinical treatment effect would be found in favor of specialized psychological treatments. The meta-analyses indicated that no differences between psychological treatments and control conditions could be established. Our findings suggest that studies including patients over 18 years were more effective on weight gain than studies including younger patients. In high-quality studies and in studies in which therapist training was reported, larger effects were found on both weight gain and on quality of life. At the same time, in sensitivity analyses including high-quality studies only, no differences between psychological and control conditions were found. Part II examines the (cost-)effectiveness of Cognitive behavior therapy-Enhanced (CBT-E), an evidence-based psychological treatment. Chapter 3 presents a consecutive cohort study in which differential (cost-)effectiveness of treatment-as-usual and CBT-E for eating disorder patients with a body mass index over 17.5 kg/m2 was examined. Chapter 4 presents findings on examining differential (cost-)effectiveness of CBT-E compared to treatment-as-usual for patients with anorexia. We hypothesized that effectiveness and cost-effectiveness would be superior in the CBT-E cohort, both for normal weight and underweight patients. For normal weight patients, no comparative differences on clinical outcome were found. In both cohorts, eating disorder pathology decreased. With regard to cost-effectiveness, findings indicated a 71% likelihood of CBT-E dominating TAU and leading to more remi

Objective: This meta-analysis examines the efficacy of recently developed psychological treatments for anorexia nervosa, compared with control condition. Outcome criteria are weight gain, eating disorder pathology, and quality of life. Method: Twelve thousand nine hundred ninety-seven abstracts, published between 1980 and 2017, were retrieved. End-of-treatment data from 1,279 participants, from 15 of 17 eligible studies, were used to calculate pooled-effect sizes (Hedges' g) for outcome using random-effects model. Subgroup analyses were used to explore the influence of various patient and study characteristics. Results: No significant differences between psychological treatment and controls were found on weight gain, g = 0.07, 95% CI [−0.09, 0.23], eating disorder pathology, g = 0.06, 95% CI [−0.10, 0.21], and quality of life, g = −0.11, 95% CI [−0.36, 0.15]. Studies including only patients over 18 years of age were more effective on weight gain than studies including adolescents as well. High-quality studies and studies with reported therapist training had larger effects on weight gain and quality of life compared with low-quality studies and studies without reported training. Conclusions: Despite progress in the development of specialized treatments, the efficacy of psychological treatment over an active control condition could not be established. Outcomes, however, are obscured by low-quality and heterogeneous studies.

Objective: This meta-analysis examines the efficacy of recently developed psychological treatments for anorexia nervosa, compared with control condition. Outcome criteria are weight gain, eating disorder pathology, and quality of life. Method: Twelve thousand nine hundred ninety-seven abstracts, published between 1980 and 2017, were retrieved. End-of-treatment data from 1,279 participants, from 15 of 17 eligible studies, were used to calculate pooled-effect sizes (Hedges' g) for outcome using random-effects model. Subgroup analyses were used to explore the influence of various patient and study characteristics. Results: No significant differences between psychological treatment and controls were found on weight gain, g = 0.07, 95% CI [−0.09, 0.23], eating disorder pathology, g = 0.06, 95% CI [−0.10, 0.21], and quality of life, g = −0.11, 95% CI [−0.36, 0.15]. Studies including only patients over 18 years of age were more effective on weight gain than studies including adolescents as well. High-quality studies and studies with reported therapist training had larger effects on weight gain and quality of life compared with low-quality studies and studies without reported training. Conclusions: Despite progress in the development of specialized treatments, the efficacy of psychological treatment over an active control condition could not be established. Outcomes, however, are obscured by low-quality and heterogeneous studies.