Interpersonal relationships, mood states, and self-esteem in a sample of obese binge eaters.

Abstract

The Binge eating Disorder (BED) diagnostic criteria have been included in DSM-IV (APA, 1994) at the experimental stage, considering the BED like a disorder to master at a diagnostic level. Binge eating disorder is characterized by recurrent episodes of binge eating, accompanied by a sense of loss of control over eating during the episode, and it is not associated with the regular use of inappropriate compensatory behavior (APA, 2000). Clinical studies have pointed out that from 23% to 46% of obese individuals have binge eating behaviours (Spitzer et al., 1993; Yanovsky, 1999; Ricca et al., 2000), whereas, in the whole community, the presence of such episodes is lower (range: 1,8-4,6%) (Stunkard, Berkowitz, Tanrikut, Reiss & Young, 1996). Although it has been showed that the use of a strict diagnostic methodology reduces BED prevalence in obese individuals, it is well known that obese people exhibit a psychological distress linked to BED. This fact can mainly be seen among people with severe obesity (BMI > 40; de Zwaan, 2001) and among individuals who have attended bariatric surgery interventions (Hsu et al., 2002). 
Moreover, several clinical studies have suggested that binge eating obese individuals show a greater comorbidity with different psychiatric disorders than obese individuals without BED (National Task Force on the Prevention and Treatment of Obesity, 2000). Several studies have demonstrated the presence of a greater psychiatric comorbidity in obese individuals with BED than obese individuals without BED (Grilo, 2002; Yanovski, 1999). The presence of binge eating appears to be associated with different weight fluctuations (Spitzer et al., 1993), with a lower self-esteem, with a greater psychological suffering and with psychiatric disorders in axis I (Allison et al., 2005; Bulik et al., 2002; Grucza et al., 2007), and axis II (Yanovski et al., 1993; Marcus, 1995, Masheb & Grilo, 2006). Moreover, the impact of binge eating on quality of lifeof obese individuals has also been demonstrated (de Zwaan et al., 2002). Finally, the BED influence in obese individuals has also been studied in an Italian sample (Ramacciotti et al., 2000). 
Up to date, there are inconclusive findings regarding the association between obesity and psychological distress, especially with treatment-seeking obese people: little is known whether psychological and psychiatric concerns in treatment-seeking obese individuals may be related more to BED than to their degree of obesity. Several studies enforce the hypothesis that the higher psychiatric comorbility in obese subjects must be due more to the acuity of BED than to the level of obesity (Telch & Agras, 1994; Wilfley et al., 2000). Moreover, it has been showed that obese subjects with BED request more psychotherapeutic interventions or psychological counseling  (Yanovski et al., 1993; Ramacciotti et al., 2008).
Finally, research on personality showed that there were no differences between obese binge eaters and obese no binge eaters on several personality variables (e.g., impulsiveness, dependence) (Davis et al., 2008).
The aim of this study is to investigate whether obese binge eaters have higher level of psychological distress than no binge eating obese individuals, in terms of interpersonal relationships, self-esteem, quality of life, and mood states.