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An Integrative Group Treatment Model for Women with Binge Eating Disorder: Mind, Body and Self in Connection

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Abstract

Binge eating disorder (BED) is the most prevalent eating disorder reported among women, and its recent diagnostic recognition in the DSM-5 (APA 2013) calls for further discussion on effective treatment. Women with BED commonly report a diet/binge cycle that can exacerbate a disconnection between mind and body and reinforce feelings of shame and isolation. This article presents an integrative group treatment model for women with BED that has shown positive outcomes in clinical practice. The group model addresses key biopsychosocial factors associated with BED and incorporates mindfulness principles tailored to problems of the disorder. A core foundation of the group model is the relational context that fosters connections between women members and promotes self-efficacy. The discussion includes etiology of BED and current empirical support for integrating mindfulness skills in treatment for binge eating problems, as well as the author’s clinical experience in formulating a short-term group model. The eight-session semi-structured group format integrates evidence-based treatments in resonance with treatment-based evidence that reflects the distinct clinical needs of women with BED. Clinical vignettes illustrate how the group model can provide an anchoring therapeutic support to women with BED for linking experiences of mind, body, and self.

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References

  • Agras, W. S., Telch, C. F., Arnow, B., Eldredge, K., Detzer, J. J., Henderson, J., & Marnell, M. (1995). Does interpersonal therapy help patients with binge eating disorder who fail to respond to cognitive behavioral therapy? Journal of Consulting and Clinical Psychology, 63(3), 356–360.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Binge eating disorder. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 350–353). Arlington, VA: American Psychiatric Publishing.

  • Baer, R. A., Fischer, S., & Huss, D. B. (2005). Mindfulness and acceptance in the treatment of disordered eating. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23, 281–300.

    Article  Google Scholar 

  • Barry, D. T., Grilo, C. M., & Masheb, R. M. (2002). Gender differences in patients with binge eating disorder. International Journal of Eating Disorders, 31(1), 63–70.

    Article  PubMed  Google Scholar 

  • Beato, L., Rodriguez-Cano, T. R., & Belmonte, A. (2003). Relationship of dissociative experiences to body shape concerns in eating disorders. European Eating Disorders Review, 11(1), 38–45.

    Article  Google Scholar 

  • Beebe, B., & Lachmann, F. (1998). Co-constructing inner and relational processes: Self and mutual regulation in infant response and adult treatment. Psychoanalytic Psychology, 15(4), 480–516.

    Article  Google Scholar 

  • Bromberg, P. M. (2001). Treating patients with symptoms and symptoms with patience: Reflections on shame, dissociation, and eating disorders. Psychoanalytic Dialogues, 11(6), 891–912.

    Article  Google Scholar 

  • Brownell, K. D. & Schwartz, M. B. (2001). Vulnerability to eating disorders in adulthood. In R. E. Ingram & J. M. Price (Eds.) Vulnerability to psychopathology: Risk factors across the lifespan (pp. 412–446). New York: Guilford Press.

  • Ciano, R., Rocco, P. L., Angarano, A., Biasin, E., & Balestriei, M. (2002). Group-analytic and psychoeducational therapies for binge eating disorders: An exploratory study of efficacy and persistence of effects. Psychotherapy Research, 12(2), 231–239.

    Article  Google Scholar 

  • Clyne, C., & Blampied, N. M. (2004). Training in emotion regulation as a treatment for binge eating: A preliminary study. Behavior Change, 21(4), 269–281.

    Article  Google Scholar 

  • Comstock, D. L. (2002). The relational–cultural model: A framework for group process. Journal for Specialists in Group Work, 27(3), 254–272.

    Article  Google Scholar 

  • Dalen, J., Smith, B. W., Shelley, B. M., Sloan, A. L., Leahigh, L., & Begay, D. (2010). Pilot study: Mindful eating and living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Therapeutic Medicine, 18, 260–264.

    Article  Google Scholar 

  • Devlin, M. J., Goldfein, J. A., & Dobrow, I. (2003). What is this thing called BED? Current status of binge eating disorder nosology. International Journal of Eating Disorders, 34(suppl), S2–S18.

    Article  PubMed  Google Scholar 

  • Duros, P., & Crowley, D. (2014). The body comes to therapy too. Clinical Social Work Journal, 42, 237–246.

    Article  Google Scholar 

  • Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993). Cognitive–behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment. New York: Guilford Press.

    Google Scholar 

  • Fairburn, C. G., & Wilson, G. T. (1993). Binge eating: Definition and classification. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 3–14). New York: Guilford Press.

    Google Scholar 

  • Fallon, P., Katzman, M. A., & Wooley, S. C. (Eds.). (1994). Feminist Perspectives on Eating Disorders. New York: Guilford Press.

    Google Scholar 

  • Goldfield, G. S., Adamo, K. B., Rutherford, J., & Legg, C. (2008). Stress and the relative reinforcing value of food in female binge eaters. Physiology & Behavior, 93, 579–587.

    Article  Google Scholar 

  • Grilo, C. M. (2000). Binge eating disorder: A need for additional diagnostic criteria. Comprehensive Psychiatry, 41(3), 59–162.

    Article  Google Scholar 

  • Grilo, C., White, M. A., Barnes, R. D., & Masheb, R. (2012). Posttraumatic stress disorder in women with binge eating disorder in primary care. Journal of Psychiatric Practice, 18(6), 408–412.

    Article  PubMed Central  PubMed  Google Scholar 

  • Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.

    Article  PubMed  Google Scholar 

  • Grucza, R. A., Przybeck, T. R., & Cloninger, C. R. (2007). Prevalence and correlates of binge eating disorder in a community sample. Comprehensive Psychiatry, 48, 124–131.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gutwill, S. (1994). Women’s eating problems: Social context and the internalization of culture. In C. Bloom, A. Gitter, S. Gutwill, L. Kogel, & L. Zaphiropoulos (Eds.), Eating problems: A feminist psychoanalytic treatment model (pp. 1–28). New York: Basic Books.

    Google Scholar 

  • Hallings-Pott, C., Waller, G., Watson, D., & Scragg, P. (2005). State dissociation in bulimic eating disorders: An experimental study. International Journal of Eating Disorders, 38(1), 37–41.

    Article  PubMed  Google Scholar 

  • Hanh, T. N., & Cheung, L. (2010). Savor: Mindful eating, mindful life. New York: Harper Collins.

    Google Scholar 

  • Hegeman, E. (2002). The role of dissociation in eating disorders: Considerations for group structure and technique. Psychoanalysis & Psychotherapy, 19(1), 21–39.

    Google Scholar 

  • Hepworth, N. (2011). A mindful eating group as an adjunct to individual treatment for eating disorders: A pilot study. Eating Disorders, 19, 6–16.

    Article  PubMed  Google Scholar 

  • Hudson, J.L., Hiripi, E., Pope, H.G., Jr., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358. (Published correction appears in Biological Psychiatry, 2012, 72(2), 164).

  • Jordan, J. V. (1992). The relational self: A new perspective for understanding women’s development. Contemporary Psychotherapy Review, 7, 56–71.

    Google Scholar 

  • Jordan, J. V. (2000). The role of mutual empathy in relational/cultural therapy. Journal of Clinical Psychology, 56(8), 1005–1016.

    Article  PubMed  Google Scholar 

  • Jordan, J. V. (2001). A relational–cultural model: Healing through mutual empathy. Bulletin of the Menninger Clinic, 65, 92–103.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.

    Google Scholar 

  • Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.

    Google Scholar 

  • Katterman, S., Kleinman, B., Hood, M., Nackers, L., & Corsica, J. (2014). Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systemic review. Eating Behaviors, 15, 197–204.

    Article  PubMed  Google Scholar 

  • Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R. (2006). Mindfulness-based approaches to eating disorders. In R. Baer (Ed.), Mindfulness and acceptance-based interventions: Conceptualization, application, and empirical support (pp. 75–89). San Diego, CA: Elsevier.

    Google Scholar 

  • Kristeller, J. L., & Hallett, C. B. (1999). An exploratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4, 357–363.

    Article  PubMed  Google Scholar 

  • Kristeller, J. L., & Wolever, R. Q. (2011). Mindfulness-based eating awareness training for treating binge eating disorder: The conceptual foundation. Eating Disorders: The Journal of Treatment and Prevention, Special Issue: Eating Disorders and Mindfulness, 19(1), 49–61.

    Article  Google Scholar 

  • Kristeller, J. L., Wolever, R. Q., & Sheets, V. (2014). Mindfulness based eating awareness training MB-EAT for binge eating: A randomized clinical trial. Mindfulness, 5(3), 282–297.

    Article  Google Scholar 

  • Krueger, D. (1989). Body self & psychological self. New York: Brunner Mazel.

    Google Scholar 

  • Krystal, H. (1988). Integration & self healing: Affect, trauma & alexithymia. New Jersey: The Analytic Press.

    Google Scholar 

  • Leahey, T. M., Crowther, J. H., & Irwin, S. R. (2008). A cognitive behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients. Cognitive and Behavioral Practice, 15(4), 364–375.

    Article  Google Scholar 

  • Linehan, M. (1993). DBT skills training manual. New York, NY: Guilford Press.

    Google Scholar 

  • Linehan, M. (2015). DBT skills training manual (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Maine, M., & Bunnell, D. W. (2010). A perfect biopsychosocial storm: Gender, culture and eating disorders. In M. Maine, B. H. McGilley, & D. W. Bunnell (Eds.), Treatment of eating disorders: Bridging the research-practice gap (pp. 3–16). San Diego, CA: Elsevier Academic Press.

    Chapter  Google Scholar 

  • McShane, J. M. (2005). Dissociation in the binge-purge cycle of bulimia nervosa. Journal of Trauma and Dissociation, 9(4), 463–479.

    Article  Google Scholar 

  • Orbach, S. (1978). Fat is a feminist issue. London: Arrow Books.

    Google Scholar 

  • Orbach, S. (2009). Bodies. New York: Picador/St. Martin’s Press.

    Google Scholar 

  • Peterson, C. B., Mitchell, J. E., Crow, S. J., Crosby, R. D., & Wonderlich, S. A. (2009). The efficacy of self-help group treatment and therapist-led group treatment for binge eating disorder. American Journal of Psychiatry, 166(12), 1347–1354.

    Article  PubMed Central  PubMed  Google Scholar 

  • Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48.

    Article  PubMed  Google Scholar 

  • Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy adapted for bulimia: A case report. International Journal of Eating Disorders, 30(1), 101–106.

    Article  PubMed  Google Scholar 

  • Safer, D. L., Telch, C. F., & Chen, E. Y. (2009). Dialectical behavior therapy for binge eating and bulimia. New York: The Guilford Press.

    Google Scholar 

  • Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Schore, A. N. (2003). Affect regulation and the repair of the self. New York: W.W. Norton.

    Google Scholar 

  • Siegel, D. J. (2010). The mindful therapist: A clinician’s guide to mindsight and neural integration. New York: W.W. Norton.

    Google Scholar 

  • Smith, B. W., Shelley, B. M., Leahigh, L., & Vanleit, B. (2006). A preliminary study of the effects of a modified mindfulness intervention on binge eating. Complementary Health Practice Review, 11(3), 133–143.

    Google Scholar 

  • Spitzer, R. L., Yanovski, S. Z., Wadden, T., Wing, R., Marcus, M. D., Stunkard, A., et al. (1993). Binge eating disorder: Its further validation in a multisite study. International Journal of Eating Disorders, 13(2), 137–153.

    Article  PubMed  Google Scholar 

  • Starkman, H. (2005). A qualitative study on binge eating disorder in women: Experiences of body and self (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses (Accession Order No. 2005-990170034).

  • Stern, D. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books.

    Google Scholar 

  • Striegel-Moore, R. H., & Smolak, L. (2001). Challenging the myth of the golden girl: Ethnicity and eating disorders. In R. A. Striegel-Moore & L. Smolak (Eds.), Eating disorders: Innovative directions in research and practice (pp. 111–132). Washington, D.C.: American Psychological Association.

    Chapter  Google Scholar 

  • Stunkard, A. J. (1959). Eating patterns and obesity. Psychiatric Quarterly, 33, 284–295.

    Article  PubMed  Google Scholar 

  • Tantillo, M., Nappa Bitter, C., & Adams, B. (2001). Enhancing readiness for eating disorder treatment: A relational/motivational group model for change. Eating Disorders: The Journal of Treatment and Prevention, 9(3), 203–216.

    Google Scholar 

  • Tasca, G. A., & Bone, M. (2007). Individual versus group psychotherapy for eating disorders. International Journal of Group Psychotherapy, 57(3), 399–403.

    Article  PubMed  Google Scholar 

  • Teasdale, J. D., Williams, J. M., & Segal, Z. V. (2014). The mindful way workbook (pp. 98–99). New York: Guilford Press.

    Google Scholar 

  • Telch, C. F., Agras, W. S., & Linehan, M. M. (2000). Group dialectical behavior therapy for binge-eating disorder: A preliminary uncontrolled trial. Behavior Therapy, 31, 569–582.

    Article  Google Scholar 

  • Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061–1065.

    Article  PubMed  Google Scholar 

  • Van der Kolk, B. (1996). Traumatic stress: The effects of overwhelming experience on mind, body & society. New York: Guilford.

    Google Scholar 

  • Wheeler, K., Greiner, P., & Boulton, M. (2005). Exploring alexithymia, depression, and binge eating in self-reported eating disorders in women. Pespectives in Psychiatric Care, 41(3), 114–123.

    Article  Google Scholar 

  • Whiteside, U., Chen, E., Neighbors, C., Hunter, D., Lo, T., & Larimer, M. (2007). Difficulties regulating emotions: Do binge eaters have fewer strategies to tolerate and modulate negative affect? Eating Behaviors, 8(2), 162–169.

    Article  PubMed  Google Scholar 

  • Wilfley, D. E., Iacovino, J. M., & Van Buren, D. J. (2012). Interpersonal psychotherapy for eating disorders. In J. D. Markowitz & M. M. Weissman (Eds.), Casebook of interpersonal psychotherapy. New York: Oxford University Press.

    Google Scholar 

  • Wilfley, D. E., Robinson Welch, R., Stein, R. I., Borman Spurell, E., Cohen, L. R., Saelens, B. E., et al. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59(8), 713–721.

    Article  PubMed  Google Scholar 

  • Wilson, G. T. (2010). Cognitive behavioral therapy for eating disorders. In W. S. Agras (Ed.), The Oxford handbook of eating disorders (pp. 331–347). Oxford, England: Oxford University Press.

    Google Scholar 

  • Wiser, S., & Telch, C. F. (1999). Dialectical behavior therapy for binge eating disorder. Journal of Clinical Psychology, 55(6), 755–768.

    Article  PubMed  Google Scholar 

  • Yalom, I., & Leszca, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York: Basic Books.

    Google Scholar 

  • Zerbe, K. (1993) The body betrayed: Women, eating disorders and treatment. Washington, DC: American Psychiatric Press (Published in paperback, Carlsbad, CA: Gurze Books, 1995).

  • Zerbe, K. (1996). Feminist psychodynamic psychotherapy of eating disorders: Theoretical integration informing clinical practice. Psychiatric Clinics of North America, 19(4), 811–827.

    Article  PubMed  Google Scholar 

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  1. Quinnipiac University, Hamden, CT, USA

    Holly Starkman

  2. Private Practice, 20 Dunk Rock Road, Guilford, CT, 06437, USA

    Holly Starkman

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Starkman, H. An Integrative Group Treatment Model for Women with Binge Eating Disorder: Mind, Body and Self in Connection. Clin Soc Work J 44, 57–68 (2016). https://doi.org/10.1007/s10615-015-0571-0

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