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Eating Disorders

Characterizing Motivation to Change Specific Compensatory Behaviors In Binge Spectrum Eating Disorders

(PS7-14) Characterizing Motivation to Change Specific Compensatory Behaviors in Binge Spectrum Eating Disorders

Saturday, November 16, 2024
8:30 AM – 9:30 AM EST
Location: Franklin Hall, Level 4, Marriott Downtown
Abstract Text: Motivation to change (MTC)–the drive to alter behavior–is a crucial mechanism of therapeutic alliance, treatment completion, and treatment outcomes for binge spectrum eating disorders (BSED). Yet standard MTC measures used in BSED samples do not differentiate between specific compensatory behaviors, which are crucial treatment targets. Critically, MTC likely differs across compensatory behaviors: more egosyntonic behaviors (e.g., restriction) or ones seen as "normative" (e.g., driven exercise) may be more resistant to change as compared to other behaviors (e.g., self induced vomiting–SIV). Understanding how patients’ MTC differs across behaviors can inform which behaviors may be slow to respond to treatment and require earlier, more intentional targeting. Also, BSED patients entering treatment with lower compensatory behavior frequency, with a BED spectrum ED (≥ 12 loss of control episodes and ﹤6 compensatory behaviors in the past 3 months) could show differing MTC than individuals with higher compensatory behavior frequency, with a BN spectrum ED (≥ 12 loss of control episodes and ≥ 6 compensatory behaviors in the past 3 months). The present study characterized MTC specific compensatory behaviors in 63 treatment seeking adults (Mage = 45.76, SD = 10.90; 82.09% identified as female) with a BN or BED spectrum diagnosis. The sample comprised 47.6% (N = 30) participants with a BN spectrum ED, and 52.4% (N = 33) with a BED spectrum ED. Participants rated their MTC eating disorder behaviors on a scale of 1-5, with a modified version of the Bulimia Nervosa Stages of Change Questionnaire (BN-SOCQ), adapted to include specific compensatory behaviors (i.e., SIV, driven exercise, laxative use, diuretic use). Results showed that mean MTC specific compensatory behaviors in BN spectrum EDs was lower for driven exercise (M = 2.43, SD = 1.50) and for diuretics (M = 3.00 , SD = 2.83). Motivation to change was higher for SIV (M = 3.67 , SD = 1.75) and laxatives (M = 3.50, SD = 1.64). In BED spectrum EDs, MTC was also lowest for driven exercise (M = 3.44, SD = 1.51), and higher for laxatives (M = 4.33, SD = 1.15), SIV (M = 4.00, SD = 1.41) and diuretics (M = 4.00, SD = 1.41). Between diagnoses, MTC driven exercise was markedly lower in BN spectrum EDs, with a difference of 1.01, and most similar for SIV, with a difference of 0.33. MTC compensatory behaviors often thought of as normative (driven exercise), was lowest across both diagnoses. In BN spectrum EDs, MTC driven exercise was in the contemplation stage of change (SOC), but in BED spectrum EDs, in the preparation SOC. Patients with driven exercise may show reduced improvement in this behaviors, as opposed to behaviors with higher MTC (i.e., SIV). This may be especially true for BN spectrum EDs. Behaviors often seen as disordered such as SIV were associated with higher MTC. Those with BED spectrum EDs had equal to higher MTC compensatory behaviors compared to those with BN spectrum EDs, indicating patients with BED spectrum EDs may show faster reductions across their compensatory behaviors during treatment. Future research should explore methods to increase MTC specific to behaviors, especially for driven exercise. Future work should also examine the association between MTC and specific behavior change, and treatment outcomes.