Binge Eating Disorder

1 What is Binge Eating Disorder?

 Binge-eating disorder is a serious but treatable eating disorder in which you consume unusually large quantities of food with a feeling of loss of control over eating. Most of us do overeat, particularly on a special occasion or a holiday, but for some people excessive overeating that feels out of control becomes a regular occurrence that crosses the limits to binge-eating disorder. When you have binge-eating disorder, you may feel embarrassed about your overeating habit and vow to stop. However, you feel such a compulsion that you are unable to resist the urges and continue binge eating. If you have binge-eating disorder, talk to your psychiatrist or psychologist. In some cases, medications may help.

2 Symptoms

Usually, people with binge-eating disorder are overweight or obese. Behavioral and emotional signs and symptoms of binge-eating disorder include:

  • Eating more food than others during a specific amount of time, such as over a 2-hour period
  • Feeling that you cannot control the amount of food you eat 
  • Continuing to eat even when you feel full or eating when you are not hungry
  • Eating more quickly than normal during binge episodes
  • Eating enough until you are uncomfortably full
  • Eating alone or in secret
  • Feeling depressed, disgusted, ashamed, guilty or upset after eating too much
  • Frequent dieting, possibly without weight loss

The severity of binge-eating disorder is determined by how frequent bingeing episodes occur during a week.

People with binge eating disorder do not try to compensate for extra calories gained by overeating through vomiting, using laxatives or vigorous exercise.

 Other health problems related to gaining weight or unhealthy eating may develop such as type 2 diabetes, high blood pressure, or heart diseases. 

When to see a doctor

   If you have symptoms of binge-eating disorder, seek medical help as early as possible. Binge-eating disorder does not get better on its own, rather it may get worse if left untreated. Talk to your primary care doctor or a mental health provider regarding your symptoms and feelings. If you are reluctant to seek treatment, talk to someone you trust about what you are going through. A friend, loved one, teacher or faith leader may help you take the initial steps required for successful treatment of binge-eating disorder.

Helping a loved one who has symptoms

People with binge-eating disorder will often be experts at hiding their behavior, which makes it difficult for others to find out the problem. If you feel your loved one may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns.

Provide encouragement and support. You can provide support to your loved one by helping him/her find a qualified doctor or mental health provider and make an appointment. You might even accompany your loved one to the appointment.

3 Causes

The causes of binge-eating disorder are not clearly known. Genetic factors, biological factors, long-term dieting, and psychological issues increase your risk of developing this eating disorder.

4 Making a Diagnosis

For a diagnosis of binge-eating disorder to be made, your doctor may recommend a psychological evaluation, which includes a thorough discussion on your eating habits.

Your doctor may also order other tests to check for health consequences of binge-eating disorder such as high cholesterol, high blood pressure, heart diseases, diabetes, GERD, and some sleep-related breathing disorders. These tests may include:

  • A physical examination
  • Blood and urine tests
  • A sleep disorder center consultation

Evaluation of binge-eating disorder often requires a multidisciplinary team approach that includes medical providers, mental health providers, and dietitians with special experience in eating disorders.

Here is some information that helps you get ready for your appointments, and know what to expect from your health care team. Ask whether your family member or a friend can accompany you to the appointment, if possible. This helps you remember key points discussed during your appointment.

What you can do

Make a list of the following in advance:

   Symptoms that you have, including those that may seem unrelated to the reason for your appointment

   Key personal information, including any major stresses or recent life changes

   All regular medications you are taking, as well as any herbs, vitamins or other supplements with their dosages

   A typical day's eating, which can help your doctor understand your eating habits

Questions to ask your doctor include:

  • Is this condition temporary or long lasting?
  • What treatments are available, and which one do you recommend?
  • If medications are a part of my treatment, is a generic drug available?
  • Are there any brochures or other printed material that I can take home?
  • What websites do you recommend for further information?

What to expect from your doctor

   Your doctor may ask you several questions, such as:

  • What does your typical daily food intake include?
  • Do you eat food in very large amounts until you are uncomfortably full?
  • Do you feel that you are eating without any control?
  • Have you ever tried to lose weight? If so, how?
  • Do you like to think about food every time?
  • Do you eat even if your stomach feels full or when you are not hungry?
  • Do you ever eat in secret or alone?
  • Do you feel depressed, disgusted, ashamed or guilty about yourself after eating?
  • Do you ever induce vomiting to get rid of those extra calories you have taken?
  • Are you too concerned about your weight or your appearance?
  • Do you perform exercises? How often?

Criteria for diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association has listed these points as a diagnostic criteria for binge-eating disorder:

    Recurring episodes of eating an unusually large amount of food

    Feeling of lack of control while bingeing, such as on the amount of food and whether you can stop eating

    Binge eating that is associated with at least three of these factors: 

  • eating rapidly; 
  • eating until uncomfortably full; 
  • eating large amounts when you are not hungry; 
  • eating alone out of embarrassment; 
  • feeling disgusted, depressed or guilty after eating
  • Concern about your binge eating
  • Binge eating episodes that have occurred at least once in a week in a period of three consecutive months
  • Binge eating that is not followed by purging, such as self-induced vomiting, or other mechanism to lose weight, such as vigorous exercising or use of laxatives

5 Treatment

The goals of binge-eating disorder treatment are to reduce eating binges, and to reduce weight. As binge eating is always linked with shame, poor self-image and other negative emotions, the treatment addresses these and other psychological problems. While getting treated for binge eating, you can learn how to feel more in control of your eating.

Psychotherapy

Psychotherapy, also called talk therapy is provided in individual or group sessions, teaches you how to exchange your unhealthy eating habits for healthy ones and reduce bingeing episodes. Examples of psychotherapy include:

   Cognitive behavioral therapy (CBT): CBT helps you to cope better with issues that can trigger binge-eating episodes, such as negative emotions about your body or a depressed mood. It may give you a better control over your behavior, and can help you regulate your eating habits.

   Interpersonal psychotherapy: This therapy concentrates on your relationships with other people. The objective of this therapy is to improve your interpersonal skills that means how you relate to others, including your family, friends and colleagues. This help manage binge eating that was triggered due to poor relationships and unhealthy communication skills.

   Dialectical behavior therapy: This therapy helps you learn behavioral skills that can help you manage stress, regulate your emotions, and improve your relationships with others, altogether can decrease your desire to binge eat.

Medications

Lisdexamfetamine dimesylate (Vyvanse): This drug that was earlier used to treat attention-deficit hyperactivity disorder, is now approved to be used in the treatment of binge-eating disorder in adults. This drug is the first FDA-approved medication for the treatment of moderate to severe binge-eating disorder. Vyvanse is a stimulant and can be habit-forming and abused. Common side effects include dry mouth and insomnia, but more serious side effects may occur.

Other medications that help reduce symptoms include:

   Anticonvulsant-topiramate (Topamax): Commonly used to control seizures, topiramate has also been found to be effective in reducing binge-eating episodes. However, there may be side effects, such as dizziness and kidney stones.

   Antidepressants: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may be helpful. However, their mechanism in binge eating is not clear, but it may be linked to how they affect certain brain chemicals that are associated with mood.

Behavioral weight-loss programs

A majority of people with binge-eating disorder have a history of several failed attempts to lose thier weight. However, weight-loss programs are generally not recommended until the binge-eating disorder is completely treated as dieting can trigger more episodes of binge-eating resulting unsuccessful weight loss programs.

When it is appropriate, weight-loss programs are usually done under your doctor's supervision so that your nutritional requirements are met. Weight-loss programs that address triggers of binge eating can be very helpful when you are undergoing cognitive behavioral therapy.

6 Prevention

There is no certain method that can help you prevent binge-eating disorder. If you have symptoms of binge eating, it is important to seek professional help at the earliest. Your primary care doctor or other health care provider will advise you on where to get help.

If you think your friend or a loved one has binge-eating problem, guide them towards adopting a healthier behavior and professional treatment before their condition worsens. If you have children with binge-eating disorder:

   Encourage and reinforce development of a healthy body image, no matter what their size or shape is.

   Consult your pediatrician. Pediatricians may be able to identify early indicators of an eating disorder and help prevent its further development.

7 Alternative and Homeopathic Remedies

Consult with your physician before starting any alternative and homeopathic remedies for binge eating disorder.

Dietary supplements and herbal products developed to aid in suppressing the appetite for weight loss may be used excessively by people with binge-eating disorders.

Weight-loss supplements or even herbs may have serious side effects and harmfully interact with other medications.

If you want to use dietary supplements or herbs, discuss the potential risks with your doctor.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with binge eating disorder.

Generally, self-treatment of binge-eating disorder is ineffective.

In addition to professional treatment, you can follow these self-care steps that further reinforces your treatment plan:

  Stick to your treatment plan: Do not skip your treatment sessions. If you have been advised a meal plan, do your best to stick to it and do not let setbacks undermine your efforts.

   Do not start dieting, unless supervised: Dieting can trigger more binge episodes, leading to a vicious cycle that is difficult to get rid of. Discuss with your doctor about weight management plans appropriate for you, and do not diet unless it is advised as your eating disorder treatment and supervised by your doctor.

   Do not skip your breakfast: Many people with binge-eating disorder do not eat their breakfast. It is important to eat your breakfast well beacuse you will be less prone to eating high calorie meals later in the day.

   Arrange your environment: Availability of certain foods may trigger binges in some people. Therefore, avoid keeping tempting binge foods out of your home or limit your exposure to those foods as best as possible.

   Get the wholesome nutrients needed: Only because you eat a lot during binges, it does not mean that you are eating the right kinds of food that give all your essential nutrients. Ask your doctor whether you need vitamin and mineral supplementation

  Stay connected with your friends and family members: Do not move away from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart.

  Be physically active: Ask your doctor about the kind of physical activity that is most appropriate for you, especially if you have health problems related to being overweight.

Coping and support

Living with an eating disorder can be stressful as you have to deal with food on a daily basis. Here are some tips that may help you cope with your eating disorder:

  Be patient and ease up on yourself. Do not be a target of your own self-criticism and stop blaming yourself.

  Try and recognize situations that trigger your destructive eating behavior so that you can develop a plan to deal with them.

  Find a positive role model who can boost your self-esteem. Remind yourself that the skinny models or actresses portrayed in women's magazines do not represent healthy, realistic bodies at all.

  Try finding a trusted relative or friend to whom you can talk about what you feel.

  Try to find someone who can be your partner in your battle against binge eating, for instance, someone you can call upon for support instead of bingeing.

  Find healthy ways to support yourself by doing something just for fun or to relax, such as Yoga, meditation or simply go for a refreshing walk.

  Consider journaling about your feelings and behaviors. It can make you know more about your feelings and actions, and how they are related.

Get support

If you have binge-eating disorder, you and your family may help you find support groups. The support groups provide encouragement, hope, and advice on coping. Support group members can understand better what you are going through because they have been there themselves. Ask your doctor if he or she knows of a support group near your place.

9 Risks and Complications

The risk factors that increase your chances of developing binge-eating disorder include:

   Family history: You are more likely to develop an eating disorder if your parents or siblings have (or had) an eating disorder. This shows that inherited genes play a role in increasing the risk of eating disorder.

   Psychological problems: Most people with binge-eating disorder often feel negative about themselves, their skills, and accomplishments. Triggers for bingeing can include stress, poor body self-image, food and boredom.

   Dieting: Most people with binge-eating disorder have a history of dieting. Dieting or restricting calories may trigger an urge to binge eat, especially if you have low self-esteem and symptoms of depression.

  Your age: Although people can have binge-eating disorder at any age, it usually begins in the late teens or early 20s.

Complications

 You may develop psychological as well as physical consequences related to binge eating. Complications that may be caused by binge-eating disorder include:

  • Problems functioning at work, with your personal life or in social situations
  • Thinking negatively about yourself or your life
  • Poor quality of life
  • Social isolation
  • Obesity
  • Medical conditions related to obesity such as joint problems, heart diseases, type 2 diabetes, gastroesophageal reflux disease (GERD), and some sleep-related breathing disorders

Psychiatric disorders that are often linked with binge-eating disorder include:

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