The relationship between non-purging compensatory behaviors, clinical severity, and treatment outcomes in adults with binge-spectrum eating disorders

ABSTRACT

Non-purging compensatory behaviors (NPCB; e.g. driven exercise, fasting, other extreme behaviors) are a subcategory of compensatory behaviors typically characterized as infrequent and less severe. Limited prior research has studied NPCB despite their increasing prevalence among adults with binge-spectrum eating disorders (B-ED). More research is needed to understand the types of NPCB present among B-ED and the association between NPCB, clinical severity, and treatment outcomes. Secondary analyses were conducted among 155 adults with B-ED in cognitive-behavioral (CBT)-based clinical trials. At baseline and post-treatment, clinical interviews of eating pathology assessed binge eating frequency, purging compensatory behavior frequency, and global eating pathology. The following NPCB were also assessed: driven exercise, 24-h fasting, 8+ waking hours of compensatory fasting, chewing and spitting, and other extreme weight control behaviors. Participants engaging in NPCB reported higher global eating pathology than those not engaging in NPCB. Frequency of chewing and spitting and 24-h fasting significantly decreased over treatment. Engagement in NPCB at baseline did not predict CBT outcomes. The current study highlights the prevalence and clinical severity of NPCB in B-ED but offers promising results regarding the potential for CBT to improve these behaviors. More research is needed on other extreme weight control behaviors reported qualitatively in our sample and on the maintenance of improvements in non-purging behaviors after CBT.

Acknowledgments

The current study used data from the following NIMH-funded clinical trials: R43-MH-121205, R34-MH-116021, R01-MH-122392, R34-MH-118353.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data from the current study will be available upon reasonable request.

Ethical Statement

The current study was approved by the Drexel University Institutional Review Board.

Additional information

Funding

The work was supported by the National Institute of Mental Health [R43MH121205, R34MH116021, R01MH122392, R34MH118353].