Binge eating disorder

Binge Eating Disorder Definition

Binge eating disorder (BED) is an eating disorder where an individual consumes large amounts of food in a short time and feels out of control or powerless to stop. Although nearly everybody overeats on certain occasions, this goes on to a compulsive state and becomes a frequent occurrence in BED patients.

The disorder was first described by researcher and psychiatrist Albert Stunkard as Night Eating Syndrome (NES). The term Binge Eating Disorder was used to indicate the same eating problem without the nocturnal aspect.

Binge Eating Disorder Causes

Binge eaters normally indulge in their compulsive eating habits in a secretive manner. A person having this disorder may also feel deeply embarrassed about eating and plan to stop, even though unsuccessfully. Binge- eating episodes generally last for around 2 hours. However, some people can binge throughout the day. BED sufferers frequently eat even if they are not hungry. Sometimes, they can eat very quickly even without registering what they are eating or tasting.

Like most other psychological problems, determining a single specific cause for binge eating disorder is difficult. A complex assortment of psychological, genetic and environmental factors is believed to be responsible for binge eating disorder. The condition is likely to involve abnormalities in several different portions of the brain. A relation between dietary restraint and binge eating has also been drawn. While binge eaters are often believed to lack self-control, their compulsive eating habits may be traced to a rigid and inflexible dieting practice. The condition may commence when an individual recovers from a phase of strict dieting habits. When the individual follows a strict diet that imitates starvation, the body prepares itself for a new eating behavior pattern, in which he or she consumes large amounts of food in a very short duration of time. This relationship between dieting and binging explains why many people experience repeated cycles of dieting and gaining weight, frequently gaining higher weights after each phase of dieting and compulsive eating.

BED can also be caused by biological abnormalities. Improper working of the hypothalamus (the portion of a human brain that controls appetite) and sending incorrect signals about hunger and stomach fullness may give rise to the disorder. Certain genetic mutations also seem to cause binge eating disorders. Evidence also suggests that lower levels of brain chemical serotonin may play a part in compulsive eating.

Social pressures to be thin often make binge eaters shameful about their physical body and encourage emotional eating. In some cases, parents unwittingly encourage their children to be binge eaters by using food as a means to dismiss, comfort or reward them. Children who have been exposed to criticism about their bodies and weight or have been sexually assaulted as a child are also highly prone to be binge eaters.

Individuals suffering from depression or have been depressed before, or have difficulties in controlling their impulses or managing and expressing their feelings have a high chance of developing binge eating disorder at some point in their lives. Various contributory factors to this disorder include:

  • Anxiety
  • Body dissatisfaction
  • Panic disorder
  • Phobias
  • Loneliness
  • Low self-esteem

Other psychological problems associated with binge eating include:

  • Feeling of isolation
  • Impulsive behavior
  • A feeling of being out of control

BED is also sometimes associated with substance abuse.

Binge Eating Disorder Risk Factors

There are certain risk factors which might aggravate the susceptibility of a person to BED. These include the following:

Age

Even though binge eating disorder can affect individuals of any age, it is mostly seen in adults of around 40 or 50 years of age.

Dieting

Habits of dieting can also lead to the development of BED.

Sexual abuse

Some individuals having BED are often found to have been sexually abused during their childhood.

Other eating disorders

Patients of other eating disorders like bulimia or anorexia are highly prone to BED.

Social expectations

An exaggerated importance to physical appearance, body shape and weight might trigger BED in certain individuals.

Biology

The biological structure of an individual is also important while considering a person’s vulnerability to BED. The genes and the brain chemicals might play a significant role in determining whether or not an individual will be affected by this disorder.

Psychological issues

BED patients often act impulsively, feeling a lack of control over eating. Many people having this disorder have problems adjusting with anxiety, stress, anger, boredom, sadness and worrying. The condition is also linked with depression.

Professional requirements

Certain jobs such as that of sports, acting and modeling where physical beauty and image plays an important role demand that the people involved look good – whatever be the circumstances. This pressure of looking good may actually cause depression, which may eventually lead to binge eating.

Binge Eating Disorder Signs and Symptoms

The symptoms of this disorder normally begin around late adolescence or during early childhood, frequently after going through a major diet. There are no specific physical signs and symptoms for this disorder. A BED-affected individual may gain weight and become obese, or may have normal weight. However, the patient may exhibit several emotional and behavioral signs and symptoms, which include the following:

  • Eating unusually large quantities of food
  • Eating rapidly during the binge episodes
  • Eating even when not hungry or already full
  • Eating as long as uncomfortably full
  • Feeling nauseated, due to consumption of large amounts of food
  • Choosing to eat alone frequently
  • Eating when bored or depressed
  • Sensation of eating habits having gone out of control
  • Feelings of anxiousness, disgust, depression, despair, shame and guilt about eating habits
  • Feelings of isolation and difficulty to talk about feelings
  • Dieting frequently without any signs of weight loss
  • Yo-yo dieting or repeated episodes of losing and gaining weight
  • Experiencing a strong craving for sugar
  • Experiencing pain in the stomach
  • Having frequent headaches
  • Finding it difficult to bear higher or lower temperatures
  • Having low self-esteem
  • Having panic attacks
  • Lacking focus
  • Tending to collect food items
  • Hiding empty food boxes
  • Numbness while binging
  • Embarrassment or guilt over amounts of food eaten

In case a person gains weight due to overeating, he or she may also have the following health problems:

  • Heart disorders
  • Type 2 Diabetes
  • High cholesterol
  • Gallbladder disease
  • Some forms of cancer
  • Hypertension or high blood pressure

Binge Eating Disorder Prevention

Although there is no definite way to prevent BED, people having binge eating symptoms are advised to seek professional help. If you find an individual close to you having these symptoms, you can help him or her in the following way:

  • Reinforce and cultivate a positive body image no matter what is his or her age, size or shape.
  • Try to consult a pediatrician if your child is having these symptoms, as they can easily identify early indications of any eating disorder.

Binge Eating Disorder Diagnosis

Much like the diagnosis of any other mental health disorder, there is no single definite test that clearly indicates that an individual has got BED. Hence, healthcare practitioners have to first collect comprehensive information on medical, familial and mental-health history. A medical practitioner also has to perform a complete physical examination to evaluate the overall health of the person. These will include lab tests as well.

While evaluating the mental health of a person, psychiatrists not only ask questions relating to symptoms and signs of BED and other eating disorders but also inquire about possible signs of:

  • Depression
  • Anxiety
  • Mania
  • Substance abuse
  • Delusions or hallucinations
  • Behavioral disorders

People suffering from BED may display symptoms similar to Obsessive Compulsive Disorder (OCD). The practitioners may provide patients with a self-test or a quiz to evaluate them for BED or any other eating disorders. As some symptoms of this disorder may also occur along with other conditions, a screening process is designed in order to determine if the patient is having any emotional problems.

In order to be confirmed with BED, one must meet the criteria for this disorder as listed by the DSM or Diagnostic and Statistical Manual of Mental Disorders published by the APA or American Psychiatric Association.

  • Frequent episodes of eating in binge, accompanied by eating abnormally large quantities of food and experiencing loss of control over consumption of food
  • Binge eating associated with other factors such as eating hastily; eating even when one is not hungry, eating as long as one is uncomfortably full, eating alone due to embarrassment or disgust, feeling guilt and depressed after eating
  • Having concern about one’s binge eating habits
  • Binge eating for at least 2 times in a week for 6 months
  • Binge eating not accompanied by purging habits like self-induced vomiting

Binge Eating Disorder Treatment

While treating BED, the main goal of a healthcare provider is to reduce the tendency of a patient to indulge in binge eating and to improve the mental and emotional state of a patient as well as to help him or her lose weight if necessary. As BED is closely linked with shame, guilt, self disgust, poor self-image, and other negative feelings, treatment of the disease requires to address these as well as other psychological issues. Getting help to treat this disorder will allow a patient to lose weight properly and keep off from gaining extra weight.

BED is treated in the following 4 main ways:

Psychotherapy

Psychotherapeutic sessions can be held in group sessions or individually to teach the patient how to change his or her unhealthy habits into healthy ones and cut down on the binging episodes. Psychotherapy includes the following forms of therapy:

Cognitive behavioral therapy or CBT: Cognitive behavioral therapy allows one to cope better with the issues that can potentially trigger binge eating episodes, such as depressive moods or negative ideas about one’s body. It also allows one to have more control over one’s eating patterns and general behavior. Apart from CBT, an overweight person also needs weight-loss counseling to deal with his or her weight problem.

Interpersonal psychotherapy: This form of psychotherapy manages the current relationships a patient has with other people. The main goal of this therapy is to improve one’s interpersonal skills, teaching the patient how to relate with others, including friends, family and colleagues. This can help to reduce binge eating triggered by unhealthy relationships and poor communication skills.

Dialectical behavior therapy: Dialectical behavior therapy teaches one behavioral skills that help one to tolerate stress, manage emotions and improve relations with others. All these eventually help an individual to reduce the tendency of binge eating.

Medications

There are no medications that are specifically designed to cure binge eating disorder. However, there are different types of medications that help in reducing symptoms when they are combined with psychotherapy. These include the following:

Antidepressants

Antidepressants like tricyclic antidepressants or TCAs and selective serotonin reuptake inhibitors or SSRIs are helpful in dealing with binge eating disorder. Although it is not fully clear how these medications can check binge eating, it is believed that these medications can influence certain brain chemicals that affect an individual’s mood.

Anticonvulsant topiramate

This type of medication (Topamax), that is generally used to cure seizures, has been found to be able to minimize binge eating episodes. Sibutramine (Meridia) is also an appetite suppressant effective in dealing with BED.

Behavioral weight-loss programs

Medical records suggest that many individuals having BED also have a history of repeated failed attempts for losing weight through strict dieting. Weight-loss programs are generally not recommended as long as the disorder is completely treated. This is because low calorie diets can trigger a fresh binge eating episode.

Weight loss programs are commonly held under medical supervision when it is felt appropriate to meet the nutritional requirements of a patient. Such programs are helpful in addressing binge triggers when combined with cognitive behavioral therapy.

Self help strategies

BED patients can also choose to help themselves in various ways like:

  • Reading self help books
  • Watching videos
  • Going through internet programs
  • Joining support groups

In some cases, eating disorder programs also offer self help manuals that the patient can use on his or her own or with a little guidance from various mental health experts. However, one still requires undergoing treatment from professional psychotherapists and doctors.

Binge Eating Disorder Complications

Some of the medications used to treat BED may give rise to certain side effects. Topiramate may cause difficulty in thinking, daytime sleepiness as well as poor coordination. The most common after-effects of Sibutramine include:

  • Constipation
  • Headache
  • Insomnia
  • Stomach upset
  • Painful menstrual periods

More serious side effects of Sibutramine include:

  • Nausea
  • Vomiting
  • Chest pain
  • Palpitations
  • Shortness of breath

Other complications linked with this disorder include the following:

  • Obesity
  • Insomnia
  • Joint pain
  • Headache
  • Depression
  • Muscle pain
  • Heart disease
  • Type 2 diabetes
  • High cholesterol
  • Suicidal thoughts
  • Digestive problems
  • Gallbladder disease
  • High blood pressure
  • Menstrual problems
  • Some forms of cancer

How to overcome Binge Eating Disorder?

The following guidelines can assist a person to overcome BED:

  • Stick to the treatment: Avoid skipping therapy sessions. If you are having a meal plan, try your best to keep up with it and don’t allow setbacks to derail you from your overall efforts.
  • Eat breakfast: People having this disorder often choose to skip their breakfast. However, if one eats a proper breakfast, he or she will be less likely to gorge into a higher calorie meal later during the day.
  • Avoid dieting: Dieting can trigger more binging episodes. Hence one should avoid dieting and instead consult the doctor to decide on an appropriate weight management strategy.
  • Do not stock up food: Try keeping less food than you usually do. This will curb your tendencies to binge.
  • Manage your nutritional needs: Consult your doctor about the vitamins and minerals that you require and get yourself supplements if necessary.
  • Stay active: Take your healthcare provider’s advice on physical activities that are appropriate for you.
  • Stay connected: Avoid isolating yourself from caring friends and family members who are eager to see you become healthy. Understand that these people love you and want the best for you.

Binge Eating Disorder Prognosis

BED sufferers are highly prone to conditions such as type II diabetes, high blood pressure as well as abnormal cholesterol levels. After around 6 years of intensive treatment, a little more than 50% of individuals have shown significant signs of improvement while one-third of the population has only shown an intermediate outcome. Around 6% patients have shown poor outcome, and 1% of patients have even died during this period. It is however important to remember that the prognosis of this disorder seems to change significantly over time.

Binge Eating Disorder Statistics

Nearly 2% of all adults living in United States suffer from BED. Nearly 10 to 15% of individuals who are somewhat moderately obese and have tried to lose weight through commercial weight loss programs or on their own have got this disease. It is also highly common in individuals who are extremely obese.

 

Binge eating disorder can severely affect the normal life and even the day-to-day functioning of a patient. Many people having this disorder are also known to skip school or offices in order to binge eat. Proper medical help is necessary to diagnose and treat this disorder as quickly as possible and to avoid more serious health complications.

References:

http://en.wikipedia.org/wiki/Binge_Eating_Disorder#Treatment

http://www.womenshealth.gov/publications/our-publications/fact-sheet/binge-eating-disorder.cfm

http://psychcentral.com/disorders/eating_disorders/eating_binge.htm

http://www.mayoclinic.com/health/binge-eating-disorder/DS00608

 

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