Binge eating disorder (BED) is characterized by a loss of control over eating behaviors. The binge eater consumes unnaturally large amounts of food in a short time period, but unlike a bulimic, doesn't regularly engage in any inappropriate weight-reducing behaviors (like excessive exercise, vomiting, taking laxatives) after the binge episodes.
Description
About three percent of women and one-tenth as many men have duffered from either bulimia or binge eating disorder at some time in their lives. BED typically strikes individuals between their adolescent years and their early 20s. Because of the nature of the disorder, most BED patients are overweight or obese. Studies of weight loss programs have shown that an average of 30% of individuals enrolling in these programs report binge eating behavior. Binge eating in milder forms is even more common, as are attempts to compensate for the binges.
Causes & symptoms
Binge eating episodes may act as a psychological release for excessive emotional stress. Other circumstances that may predispose an individual to BED include heredity and mood disorders, such as major depression. BED patients are also more likely to have an additional diagnosis of impulsive behaviors (for example, compulsive shopping), post-traumatic stress disorder (PTSD), panic disorder, or personality disorders. More than half also have a history of major depression. In 2002, the American Psychiatric Association was considering including BED as a psychiatric diagnosis.
Individuals who develop BED often come from families who put an unnatural emphasis on the importance of food. For example, these families may use food as a source of comfort in times of emotional distress. As children, BED patients may have been taught to clean their plates regardless of their appetite, or to be a good girl or boy and finish all of the meal. Cultural attitudes towards beauty and thinness may also be a factor in BED.
During binge episodes, BED patients experience a definite sense of lost control over their eating. They eat quickly and to the point of discomfort, even if they aren't hungry. They typically binge alone two or more times a week, and often feel depressed and guilty when the episode is over.
Diagnosis
BED is usually diagnosed and treated by a psychiatrist and/or a psychologist. In addition to an interview with the patient, personality and behavioral inventories, such as the Minnesota Multiphasic Personality Inventory (MMPI), may be administered as part of the assessment process. One of several clinical inventories, or scales, may also be used to assess depressive symptoms, including the Hamilton Depression Scale (HAM-D) or Beck Depression Inventory (BDI). These tests may be administered in an outpatient or hospital setting.
Treatment
Many BED individuals binge after long periods of excessive dieting; therapy helps normalize this pattern. The initial goal of BED treatment is to teach the patient to gain control over his or her eating behavior by focusing on eating regular meals and avoiding snacking. Cognitive behavioral therapy, group therapy, or interpersonal psychotherapy may be used to uncover the emotional motives, distorted thinking, and behavioral patterns behind the binge eating. The overweight BED patient may be placed on a moderate exercise program and a nutritionist may be consulted to educate the patient on healthy food choices and strategies for weight loss.
Initial treatment may focus on curbing the depression that is a characteristic feature of BED. Recommended herbal remedies to ease the symptoms of depression may include damiana (Turnera diffusa), ginseng (Panax ginseng), kola (Cola nitida), lady's slipper (Cypripedium calceolus), lavender (Lavandula angustifolia), lime blossom (Tilia x vulgaris), oats (Avena sativa), rosemary (Rosmarinus officinalis), skullcap (Scutellaria laterifolia), St. John's wort (Hypericum perforatum), valerian (Valeriana officinalis), and vervain (Verbena officinalis).
Binge-eating episodes that appear to be triggered by stress may be curbed by educating the patient in relaxation exercises and techniques, including aromatherapy, breathing exercises, biofeedback, music therapy, yoga, and massage. Herbs known as adaptogens may also be prescribed by an herbalist or holistic healthcare professional. These herbs are thought to promote adaptability to stress, and include Siberian ginseng (Eleutherococcus senticosus), ginseng (Panax ginseng), wild yam (Dioscorea villosa), borage (Borago officinalis), licorice (Glycyrrhiza glabra), chamomile (Chamaemelum nobile), and nettles (Urtica dioica). Tonics of skullcap (Scutellaria lateriafolia), and oats (Avena sativa), may also be recommended to ease anxiety.
Allopathic treatment
Treatment with antidepressants may be prescribed for BED patients. Selective serotonin reuptake inhibitors (such as Prozac) are usually preferred because they offer fewer side effects. However, clinical studies don't show much effectiveness for use of antidepressants in treating BED. Psychotherapy shows better results. Once the binge eating behavior is curbed and depressive symptoms are controlled, the physical symptoms of the disorder can be addressed.
Expected results
The poor dietary habits and obesity that are symptomatic of BED can lead to serious health problems, such ashigh blood pressure, heart attacks, and diabetes, if left unchecked. BED is a chronic condition that requires ongoing medical and psychological management. To bring long-term relief to the BED patient, it is critical to address the underlying psychological causes behind binge eating behaviors. It appears that up to 50% of BED patients will stop bingeing with cognitive behavioral therapy.
BOOKS
Abraham, Suzanne and Derek Llewellyn-Jones. Eating Disorders: The Facts. 4th ed. Oxford: Oxford University Press, 1997.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
Siegel, Michele, Judith Brisman, and Margot Weinshel. Surviving an Eating Disorder: Strategies for Family and Friends, 2nd ed. New York: Harper Perennial, 1997.
PERIODICALS
Brewerton, Timothy D. "Binge Eating Disorder: Recognition, Diagnosis, and Treatment." Medscape Mental Health 2, no. 5 (1997). http://www.medscape.com.
"Treatment of Bulimia and Binge Eating." Harvard Mental Health Letter (July 2002).
Tufts University. "Binge Eating Disorder Comes Out of the Closet: Experts Say Leading Obesity Factor Has Long Been Overlooked." Tufts University Diet & Nutrition Letter 14, no. 11 (January 1997): 4-5.
ORGANIZATIONS
American Psychiatric Association (APA). Office of Public Affairs. 1400 K Street NW, Washington, DC 20005. (202) 682-6119. http://www.psych.org/.
American Psychological Association (APA). Office of Public Affairs. 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700. http://www.apa.org/.
Eating Disorders Awareness and Prevention. 603 Stewart St., Suite 803, Seattle, WA 98101. (800) 931-2237. http://www.edap.org
National Eating Disorders Organization (NEDO). 6655 South Yale Ave., Tulsa, OK 74136. (918) 481-4044.
