Binge-Eating-Störung: Grundlagen und Psychotherapieprozess

Prospective and retrospective studies established low explicit self-esteem and high explicit experiences of weight bias as factors associated with binge-eating disorder (BED). In contrast, studies investigating implicit self-esteem and implicit weight bias are lacking. Regarding the treatment of BED, recommendations of (inter)national guidelines are available while less is known about the impact of the psychotherapeutic process. The present thesis consists of two larger parts to extend the current research on the development/maintenance and the psychotherapeutic process of BED. Data for two studies were gathered in a population-based sample (development/maintenance) and a large multi-center treatment study (psychotherapeutic process). A systematic literature search was conducted for two systematic reviews (psychotherapeutic process). Significant impairments in explicit as well as implicit self-esteem and weight bias in obese participants with BED were found compared to obese only and normal weight/healthy controls. Implicit and explicit measures were not correlated. Further, explicit and implicit self-esteem emerged as a significant predictor of the global eating disorder psychopathology. Regarding the systematic reviews, impacts of several aspects of the psychotherapeutic process on treatment outcomes for various psychological treatments across all eating disorders (including BED) were found. However, some process aspects were rarely investigated and only few studies analysed several process aspects simultaneously. A new measure to assess the process aspect of therapeutic adherence (allegiance to the manual) within cognitive-behavioral therapy for BED was developed in a second study. Good psychometric properties were established. Overall, high levels of adherence were found. Furthermore, significant associations with therapeutic alliance, patient and therapist characteristics emerged. The findings regarding the implicit self-esteem and weight bias extend the knowledge about developmental and maintenance factors in BED. The findings regarding the psychotherapeutic process summarized the current process-outcome-research. Based on these, research and clinical implications can be derived. The establishment of high therapeutic adherence can be viewed as a prerequisite for the final analyses of the multi-center treatment study.