Subtyping Patients With Binge-Eating Disorder by Dietary Restraint and Negative Affect: Characteristics and Treatment Outcome

Objective: This study examined patients with binge-eating disorder (BED) subtyped by dietary restraint (DR) and the negative affect (NA) dimension of depression, anxiety, hostility, and self-esteem, comparing clinical features and outcome of evidence-based psychological treatments. It was hypothesized that individuals with DR and high NA (DR–HNA) would have lower functioning and poorer immediate and long-term BED treatment outcomes compared to those with DR and low NA (DR–LNA). Method: Cluster analysis was conducted (n = 159) as a secondary analysis of data from a randomized group cognitive–behavioral therapy and interpersonal psychotherapy trial of women and men with BED. Results: At pretreatment, participants with DR–HNA were higher in eating disorder and general psychopathology, emotional eating, and poor social adjustment. At post-treatment, differences in binge days between cluster groups were small and statistically nonsignificant, and differences in rates of binge-eating abstinence were only marginally significant. However, by 1-year follow-up, patients with DR–HNA had a greater increase in binge days, less abstinence from binge eating, a higher risk for relapse, and were significantly less likely to be in BED remission than those with DR–LNA. Conclusions: DR–HNA served as a predictor of poorer maintenance of BED therapeutic improvement. Future directions to better sustain outcomes among patients with DR–HNA include developing a brief measure to assess for the full construct of NA prior to and throughout treatment, enhancing BEDinterventions by focusing more onNA, and augmenting treatment dose.