0 What You Should Know About Binge Eating Disorder: 3 Doctors Discuss

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD



Holly Peek, M.D., MPH Follow @PsychGumbo



Mona Amini, M.D., MBA Follow @MonAmiMD

What Causes Binge Eating Disorder? 

With up to 4 million Americans having binge eating disorder, it's a significant health issue for our nation.  Binge eating disorder has a wide variety of causes, and sometimes it can be caused by several different reasons, even in the same individual.

To understand why someone develops binge eating disorder, we need to recognize binging triggers. These triggers often result in binging behavior, and they are often negative feelings or thoughts toward body shape, weight, or food. Triggers to binging may also include worry, anxiety, difficult relationships with loved ones, or even boredom. Some people binge eat because it helps them numb these feelings in the short term. But later, they find the binge eating to be harmful to their own self-perception.

Sometimes dieting may be a major factor for binge eating. While dieting tends to happen after binge eating disorder has started, missing meals or not eating enough can lead to binging episodes. If left untreated, binging behaviors become more and more ingrained and harder to control.

Depression has also been linked to binge eating disorder. People who have depression or have been depressed in the past are more at risk. Binge eating is also higher in people who have bipolar disorder or anxiety disorder. Some evidence suggests that it may be more common in people who have addictions to recreational drugs.

Binge eating disorder may be more common in families where the condition is already present. Therefore it seems that our genetics are also an important factor to consider. Researchers continue to explore more scientific explanations on why binge eating disorder happens including studying the neurochemicals and pathways of the brain. 

How is Binge Eating Disorder Treated? 

The treatment goal for binge eating disorder focuses on binge eating and weight control. Treatment also addresses conditions that commonly occur with binge eating disorder, including depression, difficulty in work or relationships, and distortions in body image.

Treatment outcomes are generally good with psychological treatment often being more helpful than medication based management, although in some cases both are used. There is evidence that cognitive behavioral therapy (CBT), a type of talk therapy, is successful in treating binge eating disorder. Multiple research studies point to benefits with its use. CBT works by disrupting the “binge-diet cycle” by promoting healthy and structured eating patterns, improving body shape and weight concerns, and encouraging healthy weight-control behaviors.

Another type of talk therapy used in treatment is interpersonal psychotherapy (IPT). IPT helps people express and manage their negative feelings without turning to food to cope. Research shows that 20 sessions of CBT and IPT can provide improvements for more than 70% of people with binge eating disorder.

Reading self-help guides like Overcoming Binge Eating by Christopher Fairburn in combination with therapy sessions can also have substantial benefits.

Medications may also be used to ease binge eating disorder symptoms. Serotonin selective reuptake inhibitors (SSRIs), commonly used for anxiety and depression, have been found effective for reducing some binge eating disorder symptoms as well. SSRIs can help with depression often occurring in people with binge eating disorder. Continued research will examine how other medications, including anti-obesity medication and mood stabilizers, may also treat people suffering from binge eating disorder. 

What Should I Say to My Friend / Family Member Who is Suffering?

It is important to take the approach of talking to your loved one with serious intent. Though some people can overcome eating disorders, seeking professional help usually has more lasting positive results. In seeking the care of a professional, both the patient and his/her family benefit from the information presented by the doctor. The first step to talking to someone you care about who has an eating disorder may feel nearly impossible.

• Patience is key. Being patient and learning facts about eating disorders will guide you (and your loved one). Due to the complexity of binge-eating disorders, communicating your concerns regarding their eating habits and other behaviors will initiate a cumulative effect.


• Be prepared for a range of responses. Rejection, denial, anger, and shame are just some of the emotions that your loved one may express when you approach her/him for the first time.


• Avoid judgment, criticism, and simple solutions to disorder. Instead, you should provide encouragement and compassion regarding their feelings and relationships. Your concern and support may be enough for them to seek professional help but know that this is not guaranteed.


• Recognize binge eating may be just tip of the iceberg. Understanding that binge eating disorder, or any eating disorder, involves food and weight issues as mere symptoms of a deeper and more complex behavioral problem will help your loved one realize they need to acquire healthier coping tools.


• Know when to ask for assistance. Don't forget that health professionals can alleviate some of the imminent issues that may need to be treated before full recovery is possible. 

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0 Raising Awareness for Binge Eating Disorder

By Sarah Johnson, M.D.

What is Binge Eating Disorder?

Binge Eating Disorder involves frequent overeating during a discreet period of time (at least once a week for three months), combined with lack of control and is associated with three or more of the following:

• 
  Eating more rapidly than normal
  
  


• 
  Eating until feeling uncomfortably full
  
  


• 
  Eating large amounts of food when not feeling physically hungry
  
  


• 
  Eating alone because of feeling embarrassed by how much one is eating
  
  


• 
  Feeling disgusted with oneself, depressed, or very guilty afterward 
  
  

Binge Eating Disorder also causes marked distress and does not occur during the course of another eating disorder, such as Anorexia Nervosa or Bulimia.

What is the Diagnostic and Statistical Manual of Mental Disorders?

The Diagnostic and Statistical Manual of Mental Disorders is used by mental health professionals around the world to help them accurately diagnose psychiatric disorders. The fifth edition of this manual (DSM-5) will be released in May 2013 after 14 years of extensive research studies and input from the best experts in the field.

What is different about Binge Eating Disorder in DSM-5?

Binge Eating Disorder was previously categorized as a “diagnosis for further study.” In DSM-5, it is defined as a unique psychiatric condition with more specific criteria.

Why is it important that Binge Eating Disorder is being recognized as a unique psychiatric condition in DSM-5?

Being recognized as a true mental disorder will raise public awareness of this troubling condition and may help individuals identify themselves as needing support. Increased awareness can lead to increased interest and funding in the research community, so that we may continue to learn more about this disorder and find better treatments. This designation as a “disorder” may also make insurance companies more likely to cover therapy and medications used to treat Binge Eating Disorder. 

What should I do if I think I am suffering from Binge Eating Disorder?

Binge Eating Disorder treatment is complex and individualized. It can include therapy, medications, and addressing other psychiatric conditions or health problems such as obesity that are also occurring. If you think that you, or a loved one, are suffering from this condition, you should contact a mental health professional for diagnosis and treatment recommendations.

How is Binge Eating Disorder treated?

If you decide to see a psychiatrist for treatment of Binge Eating Disorder, he or she will start by asking questions about your medical and psychiatric history and symptoms that you are concerned about. Common components of a treatment plan might include addressing any underlying medical problems such as obesity or high blood pressure and psychotherapy to help with depression, anxiety, or other emotional problems. Medications may also be used if your doctor thinks it is indicated. There is no magic cure for Binge Eating Disorder, and your psychiatrist will work with you to create an individualized treatment plan.

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0 Female Athlete Triad: Sport Gone Bad

By Claudia L. Reardon, M.D.

Psychiatrists encourage nearly everyone to participate in sports and exercise. Sports not only improve physical health but also can greatly improve mental well-being. However, if girls and women take involvement in sports too far, they can suffer a well-described triad of symptoms. The so-called female athlete triad consists of the following three inter-linked health problems:

1. Insufficient caloric intake/disordered eating


2. Menstrual problems


3. Weak bones

Girls and women who participate in “leanness sports” that emphasize thinness (running, ballet, gymnastics, figure skating, and others) are particularly at risk. If they receive the message that being thinner could result in greater athletic success, they may try to cut down on their caloric intake to levels too low to support their levels of physical activity. This can result in full-blown eating disorders, irregular menstrual cycles, and weak bones (including osteoporosis at young ages).

Some common myths about the female athlete triad include the following:

• If an athlete’s performance has not started suffering, then she must not have a problem. FACT:  Even if an athlete’s performance has not started suffering, it eventually will.  Not taking in enough calories to match activity level is not sustainable in the long-run.


• It is normal for female athletes to stop menstruating. FACT:  It is never normal for a female athlete to stop menstruating. There are serious health risks, especially bone loss, to not menstruating. Studies show that after three years of not menstruating, bone loss is likely to be permanent. Loss of future reproductive function could also occur.


• If an athlete is not eating enough to match activity level, she is aware of what she's doing. FACT: Denial is powerful. Athletes will very often feel that they are being as healthy as possible, and that meticulous attention to diet is a sign of dedication to sport. Coaches, parents, and professionals will need to help the athlete see the problems with the behaviors.


• An athlete who eats “healthy," is a top performer on the team, and excels in class is unlikely to have an eating disorder. FACT: Traits that are desirable in an athlete can make them more at risk of developing an eating disorder. Mental toughness, pursuit of excellence, performance despite pain, commitment to training, and being a team player are very similar to excessive exercise, perfectionism, denial of discomfort, and being self-less.

What can you do if someone you know might be suffering from the female athlete triad?

1. Share your concerns with the athlete.


2. Talk with the coach, athletic trainer, or school counselor.


3. Encourage the athlete to see a physician and dietitian. Not all health care professionals are familiar with the details of the female athlete triad; to help them out, you can send along this brochure with the athlete to the appointment.

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0 Yes, Food Addiction is Real. Do You Know Someone Suffering?

By Sarah Johnson, M.D.

The obesity epidemic is a huge problem (no pun intended) due to associated medical problems and their burden on the healthcare system. In 2009, an estimated 25% of Americans met criteria for obesity. This figure has steadily increased since the 1970’s.



Obesity leads to heart disease, strokes, high blood pressure, diabetes, and may be associated with increased risk for depression. It has been suggested that over-eating and other eating behaviors associated with obesity may share features with drug and alcohol addiction. This would certainly explain why this epidemic is so difficult to combat.  



The DSM IV-TR defines substance dependence as three or more of the following symptoms occurring within one year: tolerance, withdrawal symptoms, substance taken in larger amounts or for a longer duration than intended, attempts to cut back, excessive time spent pursuing, using, or recovering from use, reduction or discontinuation of important activities because of use, and continued use despite adverse consequences. 

Food cravings associated with binge eating can trigger the same area of the brain that is activated in drug craving. Although research is preliminary and limited at this time, specific foods such as carbohydrates may actually have a direct effect on mood in those who crave them.


Certain eating behaviors, such as restriction combined with overeating or binge-purge cycles may emulate addictive behaviors. Personality traits such as impulsivity have been found in samples of addicts and obese individuals. Children with behavior disorders such as ADHD and Conduct Disorder may be at increased risk for both addictions and obesity.  



Prevention is the best way to reduce the impact of behaviors associated with obesity. While eating may have similarities with addiction, we live in a toxic food environment, and awareness is key in prevention. Family members can seek help from medical professionals for loved ones who may be exhibiting pathological eating behaviors. 



For more information: Corsica JA, Pelchat ML. Food addiction: true or false? Curr Opin Gastroenterol. 2010 Mar;26(2):165-9.
Wilson GT. Eating disorders, obesity, and addiction. Eur Eat Disord Rev. 2010 Sep-Oct; 18(5):341-51.

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0 Caring for the Mental Health of Your College Student

By Roberto A. Blanco, M.D.

A recently released national survey on the state of mental health for entering college students revealed that this year's freshmen class has the highest stress levels in the history of the 25 year survey.  There are several reasons.  According to study authors, students face increased competitiveness and demands in high school as well as more financial challenges due to today's economy.

Although it's an exciting time, your child's transition to college can be a difficult one - especially if he or she suffers from a mental illness.  Here are some things that you and your prospective college student should be thinking about prior to choosing a university and heading off to school:

1.    What can I do to ease the college transition? 

Some schools offer an orientation program over the summer to help students become comfortable with the campus and surroundings, learn organizational and study skills and socialize with fellow freshmen.  

Apart from these organized programs, it is important that, as a parent, you work on transition issues and independence.  Make sure that your child has all materials needed for school including an organizer and a computer.  If your child is getting psychiatric treatment, teach your son or daughter the importance of their medicines, therapy and attending their appointments regularly.  If they haven’t yet been self-administering their medications, before going to college, it is important that they learn and start taking their medicines without supervision.

If you have serious concerns about how your child will do with the college transition, you may want to consider schools close to home.  Depending on the amount of concern, it may be best to choose a school which would allow your child to drive home for the weekend if needed.

2.   What’s the quality of the college's mental health program?

Some colleges and universities do not have mental health services available through the school.  If they don’t, you need to understand how a student can go about getting help.  If the school is not in a major city, you need to make sure that there are enough providers close by so that your child can get the services that he or she needs in a timely manner.

Some universities have therapists but no psychiatric providers on staff.  Others offer both counseling and psychiatric services but put a cap on the number of appointments at the university mental health center prior to referring students out to the community.  All of this information should be provided by each individual school.  And you should know all of this information prior to committing to a particular school, especially if your child is likely to use mental health services.

3.    What is the educational environment of the university?

Some universities are known to be high-pressure, unforgiving environments.  This could be due to the rigor, expectations or challenges of courses.  Sometimes, this can be eased by a strong academic support team or advising system.  Often, peers can make the university culture overly competitive in unhealthy ways.  Some places are notorious for students stealing other students’ lecture materials and notes or not helping out when needed.  If your child is particularly sensitive to stress, it may be best to go to a school where the environment is more collegial and supportive.

Other schools are notorious for having easy access to drugs or alcohol on campus.  While drugs and alcohol are available at most schools, they are easier to get at some schools which are located in major cities or areas of high accessibility.  If your child has a history of drug or alcohol abuse, you should be extra considerate of these location factors.

4.    Will the financing of this school put my child in overwhelming debt?

While a good college education is one of the most important investments, your child should not mortgage his or her future by creating large amounts of unnecessary debt.  In addition, universities with higher tuition may necessitate your child working during school to avoid excessive debt.  This can also add stress.  If schools are relatively equivalent in meeting your child’s long-term career goals, choose the college which will put your child in a better financial position after he or she graduates.

Of course, after your children go to college, you will want to monitor how they are doing intermittently.  Particularly stressful times are usually at the beginning of school, around exam time (midterms and finals) and anytime a romantic relationship ends.  Checking in around these times may be the most beneficial.  If it turns out that they need more help than some parental TLC, make sure that they see a professional.

I hope that these suggestions have been helpful.  Feel free to leave comments or questions for further discussion.

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0 Family-Based Treatment May Benefit Teens with Anorexia

By Molly McVoy, MD



A recent Wall Street Journal article reported on a study regarding teens with anorexia. The results of the study, published in the Archives of General Psychiatry, indicate that having parents actively involved in the treatment of adolescents with eating disorders is more effective than the traditional one-on-one treatment with a therapist.

The study looked at 120 teenagers using the Maudsley model versus traditional one-on-one therapy. The Maudsley model encourages parents to take charge of the eating habits of their children with eating disorders, such as anorexia. At one year, the study found that about 50 percent of patients treated with this family based therapy were in remission versus 23 percent in the more traditional individual therapy.



Anorexia nervosa is a serious, often life-threatening illness in which patients fear gaining weight to such a degree they restrict their diet and maintain a body weight below the 85 percent of a healthy weight. Successful treatment is intensive, involving medical monitoring, dietary interventions, therapy and, at times, medication.



This study adds to accumulating evidence that family involvement is critical in successful treatment of adolescents with eating disorders. As more studies are published with similar data, treatment centers for eating disorders and increasingly involving families in the intensive treatment programs.



The HealthyMinds.org has more information on eating disorders. 



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