Background: Binge eating disorder (BED) is the most common eating disorder. It has a detrimental effect on individual’s health and well-being, as it may lead to obesity, depressive symptoms and substance abuse. Onset of eating disorder symptoms, including binge eating, is typically in adolescence. It is estimated that up to 5% of adolescents may binge eat occasionally, including both girls and boys, with 1-2% meeting the diagnostic criteria for BED. Yet, knowledge about BED is relatively sparse, particularly among adolescents.
Research among adults using Experience Sampling (ES) to assess daily emotions and activities suggest that mood changes precede binge eating episodes among BED patients. Although it is arguable that the same underlying processes apply to adolescents, this assumption clearly needs to be verified. There is also a need to identify risk factors for the onset and progression of binge eating symptoms, and to further investigate the preliminary evidence on gender-specific risk pathways. Such information is needed to define individualized treatment targets, and to provide an evidence-base for BED treatment in adolescence, which is now substantially based on a few adult clinical samples.
• To describe the prevalence, developmental course and correlates of subclinical binge eating symptomatology in adolescence;
• To develop and evaluate an ES app for adolescents with binge eating symptoms;
• Using the ES app to unravel which emotional and situational factors immediately precede (sub)clinical binge eating episodes in community and treatment seeking samples;
• To examine whether the ES app is a useful tool in BED treatment.
We hypothesize that binge eating occurs relatively frequently in both female and male adolescents, with gender and sociodemographic differences in the presentation of eating disorder symptomatology. Using ES in clinical and non-clinical samples, we expect to find that stress-inducing situations and negative affect (indicated by self-reported anger, fear, and sadness, and increases in heart rate) precede binge eating episodes among adolescents. We also expect that the ES app is a practical and informative tool for treatment among adolescents with BED.
Design and methods: The project consists of three unique parts with different designs and study populations, each fully matched to the research questions and contributing to improved knowledge on BED and individualising interventions using modern eHealth technology.
Study 1 is embedded in the Generation R Study in which self-reported information on binge eating is obtained among 13-14 year olds (N˜5000). These data are used to describe the prevalence of subclinical binge eating in a population-based sample, and to identify risk factors (e.g. gender, sociodemographics, mental health, overweight) for the onset and poor developmental course of binge eating. Of note, given the large underrepresentation of males in clinical samples, our population-based design is well-suited to elucidate gender differences in binge eating symptoms.
Study 2 is conducted in a subsample of Generation R participants who reported the occurrence of binge eating episodes. These adolescents are invited to participate in an ES study (N˜165). We will develop a smartphone app for adolescents containing a short assessment of current activities, emotions, and binge eating, and a heart rate assessment. In two 5-day periods, adolescents fill out this assessment about 4-5 times daily, either after a randomly-timed signal or when a binge occurs.
Study 3 is conducted in a clinical sample of adolescents aged 13-18 years diagnosed with BED, recruited via psychiatric and obesity clinics. This sample (N˜100) receives treatment as usual during which the ES app is used to improve awareness of binge triggers and to monitor therapy effects. The sampled data (and Study 2 data) are used to examine which factors immediately precede binge eating episodes. Then, in a qualitative study among therapists and adolescents, we evaluate the value and practical use of the app as a therapeutic tool.
Relevance: Understanding of the aetiology and presentation of binge eating as early as symptoms emerge contributes to identifying potential treatment targets and high-risk groups that may benefit from screening and early interventions. As such, the development of chronic full syndrome BED and associated comorbidities can be prevented. The use of ES among adolescents is exceptional, also in the field of eating disorders, but has high potential to shorten and improve treatment by individualizing therapy.
Project group: This unique multidisciplinary project is led by dr. Pauline Jansen. She has an excellent track record in research at the intersection of different disciplines. In this project, she unites researchers and clinicians, with many of whom she has worked with successfully in the past. Each project member has specific expertise uniquely contributing to the successfulness of this project.