IS IT BINGE EATING DISORDER?
Binge eating disorder (BED) is a type of feeding and eating disorder that was added as an official diagnosis in DSM V (Diagnostic and Statistical Manual of Mental Disorders 5th edition).
It affects approx 3.5% of women and 2% of men worldwide and can cause serious health issues linked to diet, such as high cholesterol levels and diabetes.
Feeding and Eating Disorders are triggered by a variety of circumstances and then frequently maintained as an adaptation to another issues or another psychological condition, such as anxiety,low self-esteem or depression.
This article looks at the symptoms, causes, and health risks of BED, as well as how to get the help and support you need to recover
SO WHAT ARE THE SYMPTOMS? DO I HAVE BINGE EATING DISORDER?
If you have BED you may eat a lot of food in a short amount of time, even if you're not hungry.Intense or high emotions, emotional stress or distress often plays a role and might trigger a period of binge eating.
BED is not about 'over-indulging', which is often a pleasurable experience associated with celebrations, like Christmas.If you struggle with BED you probably find it difficult to stop during a binge even if you want to; some clients describe feeling disconnected from what they're doing during a binge, even to the point of not being able to remember what they've eaten.
You probably feel a sense of release or relief during a binge but experience feelings of shame or loss of control afterward (1,2)
To be diagnosed with BED, three or more of the following symptoms must be present:
eating much more rapidly than normal eating until uncomfortably full
eating large amounts without feeling hungry
eating alone due to feelings of embarrassment and shame
feelings of guilt or disgust with oneself
You may frequently experience feelings of extreme unhappiness and distress about overeating, body shape, and weight (1,2,3)
WHAT CAUSES BINGE EATING DISORDER?
The causes of BED are thought to be due to a variety of risk factors, including:
Genetics. People with BED may have increased sensitivity to dopamine. Dopamine is a neurotransmitter in the brain responsible for the feelings of motivation and energy that reward us after certain actions and experiences. It's the 'carrot' designed to reward us after certain life-sustaining activities like eating, drinking water and being in positive relationships, so we keep doing these healthy things repeatedly. Clearly the action of dopamine can become connected with negative and unhealthy actions and experiences, which can then become addictive or compulsive due to the reward of dopamine.
Changes in the brain. There are indications that people with BED may have changes in brain structure that result in a heightened response to food coupled with decreased self-control (4).
Trauma. Traumatic life events, such as abuse, bereavement, separation from a family member, or accident, are known to be risk factors. Childhood bullying due to weight may also contribute (12, 13, 14).
Other psychological conditions. Almost 80% of people with BED have at least one other psychological disorder, such as phobias, depression, post-traumatic stress disorder (PTSD), bipolar disorder, anxiety, or substance abuse (1, 8).
Mood intolerance. An episode of binge eating can be triggered by stress, dieting, negative feelings about body weight or body shape, the availability of food, o boredom (1)
HOW IS BED DIAGNOSED?
The onset of BED is typically later than anorexia, tending to start in the late teens to early twenties, although it can occur at any age. People generally need support to help overcome BED and develop a balanced relationship with food and themselves. Left unaddressed, BED can last several years.
To be diagnosed, you must have had at least one binge eating episode per week for a minimum of three months.
BED can be characterized as mild when you are struggling with one to three binge eating episodes per week, to severe, which involves 14 or more episodes per week. (1,2)
If you are suffering form BED rather than bulimia, you don't compensate for the binge with purging, laxative abuse or over-exercise.
Like all eating disorders, BED is more common in women than men; BED is more common in men than other types of eating disorders. (16)
WHAT ARE THE HEALTH RISKS?
BED is associated with several significant physical, emotional, and social health risks.
Risks can include obesity, heart disease, stroke, type 2 diabetes and cancer.
Other health risks associated with BED include sleep problems, chronic pain conditions, asthma, and irritable bowel syndrome (IBS)
In women, the condition is associated with a risk of fertility problems, pregnancy complications, and the development of polycystic ovary syndrome (PCOS)
Research, along with clinical experience, has shows that people with BED report difficulties with relationships and emotional and physical intimacy.
Although these health risks are significant, there are a number of effective treatments for BED.
TREATMENT FOR BED
The treatment plan for BED depends on the causes and severity of the eating disorder, as well as individual goals.
Current treatment on the NHS for BED focuses on guided self-help materials based on CBT. In this format, you would usually be given a manual to work through on your own, along with the opportunity to attend some additional meetings with a therapist to help guide you and set goals
If guided self-help doesn't help, you would be offered group CBT, if it's available.
My own clinical experience has shown an effective and powerful treatment for BED is cbt-e (enhanced cognitive behavioural therapy). Therapist-led CBT has been demonstrated to be the most effective treatment for people with BED,one study finding that after 22 sessions of CBT, 79% of participants were no longer binge eating, (18)
cbt-e is a transdiagnostic personalised treatment for all eating disorders, although I have found it to be particularly beneficial for those struggling with BED.
Enhanced Cognitive behavioral therapy (CBT-e) for BED focuses on analyzing the relationships between negative thoughts, feelings, and behaviours related to food, eating, body shape, and weight.
Once the causes of negative emotions and patterns have been identified, strategies can be developed to help you change them.
Specific interventions include setting goals, self-monitoring, achieving regular meal patterns, changing thoughts about self and weight, and,in my work with BED, encouraging balance, self-esteem and self-compassion.
Treatment targets areas including binge eating behaviours, body image, self-esteem, social relationships, mood intolerance,mental health issues, or a combination of these.
Interpersonal psychotherapy (IPT) has also been found to be effective in the treatment of BED. It's based on the idea that binge eating is a coping mechanism for unresolved personal problems such as grief, relationship conflicts, significant life changes, or underlying social problems.
The goal is to identify the specific problem linked to the negative eating behaviour, acknowledge it, and then make positive changes over 16 weeks (19)
Therapy may either be in a group format or on a one-to-one basis with a trained therapist, and it may sometimes be combined with CBT.
IPT is the only therapy with long-term outcomes as positive as CBT-E.
DIALECTICAL BEHAVIOURAL THERAPY
Dialectical behavior therapy (DBT) views binge eating as an emotional reaction to negative experiences that the person doesn't have the right skills to cope with;It teaches people to regulate their emotional responses so that they can cope with negative situations in daily life without needing to binge.
The four key areas of treatment in DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
A small study of BED sufferers who underwent DBT showed that 89% of them stopped binge eating by the end of therapy, (although this dropped to 56% by the 6-month follow-up) .
There is currently limited information on the long-term effectiveness of DBT and how it compares with CBT and IPT.
Some medications may be helpful in the treatment of BED but none are as effective as behavioural therapies. Research has found that medications have an advantage over a placebo for the short-term reduction of binge eating. Medications have been shown to be 48.7% effective, while placebos have been shown to be 28.5% effective.
Antidepressants including SSRIs and Tricyclic antidepressants
The anti epileptic drug topiramete (Topamax)might work better for binge eating than anti-depressants, but can cause serious side-effects, such as memory problems; it isn't considered a medicine that helps with mood intolerance.
The hyperactive disorders, lisdexamfetamine (Vyvanse).It's not really certain clear how the drug works in BED, but it's thought to control the impulsive behaviour that can lead to bingeing
Researchers are continuing to look for new BED treatments, and it looks like anti-addiction drugs may help in the future.
In addition, side effects of treatment may including headaches, stomach problems, sleep disturbances, increased blood pressure, and anxiety , which is why eating disorder specialists don't tend to prescribe them for BED.
RECOVERING FROM BED
CBT and CBT-E are generally the most effective treatment; depending on how severe your BED and where you are in your recovery one therapy or a combination of approaches may be best for you.
No matter which treatment strategy is used, it is important to make positive, balanced choices and consider sustaining and satisfying food choices.
Here are some additional helpful strategies:
Keep a 'food and mood' journal Identifying your triggers is an important step in learning how to control binge impulses.
Practice mindfulness. This can help increase awareness of your bingeing triggers. Mindfulness is also great for increasing self-acceptance and self-compassion.
Open up to someone. It is important to have support, whether it is through a partner, family, a friend, binge eating support groups, or online forums or groups.
Choose balanced foods. A diet consisting of foods high in protein and healthy fats, regular meals, and whole foods will help satisfy hunger and provide needed nutrients.
Get enough sleep. Lack of sleep is irregular eating patterns. It’s recommended to get at least 7–8 hours of good sleep per night
It's important that you realise you don't have to suffer with BED.With time and the right support, recovery is completely possible for you.
2. Pub Med Central, 2015.'Binge Eating Disorder In Adults' Kimberly A.Brownley et al
3. Annals Of Internal Medicine, 2016. 'Binge Eating Disorder Comes Of Age' Michael J. Devlin