European Psychiatry - Volume 33 - March 2016

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S184 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S116–S348
EW203
Randomized controlled trial testing
behavioral weight loss versus
multi-modal stepped-care treatment
for binge eating disorder
C. Grilo
Yale University School of Medicine, Psychiatry, New Haven, USA
Introduction Binge eating disorder (BED) is prevalent, associated
with obesity and elevated psychiatric co-morbidity, and represents
a treatment challenge.
Objective and aims A controlled comparison of multi-modal,
stepped-care versus behavioral-weight-loss (BWL) for BED.
Methods One hundred and ninety-one patients (71% female,
79% white) with BED and co-morbid obesity (mean BMI 39)
were randomly assigned to 6 months of BWL (n = 39) or stepped-
care ( n = 152). Within stepped-care, patients started BWL for
one month; treatment-responders continued BWL while non-
responders switched to cognitive-behavioral-therapy (CBT) and
all stepped-care patients were additionally randomized to anti-
obesity medication or placebo (double-blind) for five months.
Independent assessmentswere performed by research-clinicians at
baseline, throughout treatment, and post-treatment (90% assessed)
with reliably-administered structured interviews.
Results Intent-to-treat analyses of remission rates (0
binges/month) revealed BWL and stepped-care did not differ
significantly overall (74% vs 64%); within stepped-care, remission
rates differed (range 40% - 79%) with medication significantly
superior to placebo (P < 0.005) and among initial non-responders
switched to CBT (P< 0.002). Mixed-models analyses of binge eating
frequency revealed significant time effects but BWL and stepped-
care did not differ overall; within stepped-care, medication was
significantly superior to placebo overall and among initial non-
responders switched to CBT. Mixed models revealed significant
weight-loss but BWL and stepped-care did not differ overall;
within stepped-care, medication was significantly superior to
placebo overall and among both initial responders continued on
BWL and non-responders switched to CBT.
Conclusions Overall, BWL and stepped-care treatments produced
improvements in binge-eating and weight loss in obese BED
patients. Anti-obesity medication enhanced outcomes within a
stepped-care model.
Disclosure of interest The author has not supplied his/her decla-
ration of competing interest.
EW204
Binge-eating disorder and major
depressive disorder co-morbidity:
Sequence and clinical significance
C. Grilo ∗, D. Becker
1 Yale University School of Medicine, Psychiatry, New Haven, USA
2 University California- San Francisco, Psychiatry, San Francisco, USA
∗ Corresponding author.
Introduction Binge-eating disorder (BED) is associated with obe-
sity and with elevated rates of co-occurring major depressive
disorder (MDD) but the significance of the diagnostic comorbid-
ity is ambiguous—as is the significance of the onset sequence for
MDD and BED.
Objective and aims We compared eating-disorder psychopathol-
ogy and psychiatric comorbidity in three subgroups of BED
patients: those inwhomonset of BEDpreceded onset of MDD, those
with onset of MDD prior to onset of BED, and those without MDD
or any psychiatric comorbidity.
Methods A consecutive series of 731 treatment-seeking patients
meetingDSM-IV-TR research criteria for BEDwere assessed reliably
by doctoral-clinicians with semi-structured interviews to evaluate
lifetime psychiatric disorders (SCID-I/P) and ED psychopathology
(EDE Interview).
Results Based on SCID-I/P, 191 (26%) patients had onset of BED
preceding onset of MDD, 114 (16%) had onset of MDD preceding
onset of BED, and 426 (58%) had BED without co-occurring dis-
orders. Three groups did not differ with respect to age, ethnicity,
or education, but a greater proportion of the group without MDD
was male. Three groups did not differ in body-mass-index or binge-
eating frequency, but groups differed significantly with respect to
eating-disorder psychopathology, with both MDD groups having
significantly higher levels than the group without co-occurring dis-
orders. The group having earlier onset of MDD had elevated rates
of anxiety disorders compared to the group having earlier onset of
BED.
Conclusions MDD in combination with BED—with either order of
onset—has a meaningful adverse effect on ED psychopathology and
overall psychiatric co-morbidity.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW205
ARFID in adults: Problems with the
DSM 5 and ICD-11 conceptualization
of restrictive eating disorders
R. Gupta ∗, V. Krishnan , K.S. Deb , A. Mahapatra , P. Sharan
All India Institute of Medical Sciences, Psychiatry, New Delhi, India
∗ Corresponding author.
Introduction The nosology of eating disorders is undergoing a
vast change. As a part of the revision process, the new diagnos-
tic category of “Avoidant/Restrictive Food Intake Disorder” (ARFID)
replaces the “Feeding Disorder of Infancy or Early Childhood” of
DSM-IV to include those patients who have restrictive patterns of
diet, but do not endorse weight or body shape concerns as the pri-
mary reasons for these restrictions. DSM-5 broadened the scope of
ARFID to also include adults with restrictive eating patterns, which
cannot be explained otherwise.
Aims & objectives To highlight the nosological issues with ARFID
as a diagnosis among adults.
Methods A case series describing four cases presenting with dis-
ordered eating causing significant dysfunction that occurred for the
first time in adulthood.
Results In each case, anxieties regarding the consequences of
eating multiple types of food led to significant restrictions of the
quantity or kinds of diet which was associated with distress and
dysfunction, and, significant weight loss. However, in all the cases,
the restriction was secondary to the fear of physical symptoms
which could be explained by underlying ICD-10 somatoform dis-
order. The cases do not match the classic western description of
ARFID.
Conclusions This series highlights some of the issues relating
to eating disorder, particularly its clinical and nosological status.
Problems relating to classification in a non-western setting are
also reflected by the difficulty in labeling eating-related problems
amidst the interplay of somatization, culture and eating.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW206
Changes in the electrical properties of
the tissues in patients with anorexia
nervosa measured by bioelectrical
impedance analysis
H. Karakula-Juchnowicz ∗, M. Teter , G. Kozak ,
A. Makarewicz , J. Kalinowska , T. Małecka-Massalska