Treatment Experts on the Latest Research, Best Practices and Treatment Options – October 2015
The conventional definition of binge eating is consuming more food in a short period of time than a person typical – to the point of being uncomfortably full. It’s a common condition. This is not to be confused with the definition of the disorder of binge eating as stated in the DSM-5.
Nevertheless, it is possible to treat BED. As with many addictions, people who struggle with compulsive eating can learn to manage their symptoms and cravings through various physical and psychological therapies that enable them to understand, monitor, and control the triggers for binge eating incidents, as well as work through the underlying factors that may contribute to their compulsions to binge eat.
Physical illness or other disorders may also co-occur with BED, either alongside the eating disorder or, more commonly, resulting from the physical issues that may arise from compulsive overeating, such as obesity.
The co-occurring conditions can add to the underlying issues that contribute to BED, creating a cycle that can be hard to break. For example, a person struggling with BED may gain excess weight and become embarrassed or upset about the weight gain, which in turn leads to a worsening of depression symptoms, triggering more bingeing, which then results in further weight gain. Because of this cycle, treating both issues of the dual diagnosis is the most effective way to help the individual achieve a more effective recovery.
In fact, about 30 percent of the participants in weight loss programs have symptoms meeting the BED diagnostic criteria. For this reason, it cannot be assumed that someone who is not obese does not have BED.
There has been much research into finding methods that accurately diagnose BED. There are no specific medical tests for the condition, but a combination of other assessments can help in diagnosing individuals who may be struggling with this disorder.
Interestingly, sleep assessments can also help to screen for BED. Night eating patterns have been found to be correlated with testing on the binge eating scale (BES), and in particular a disorder called night eating syndrome is highly correlated with BED. Assessing night eating behaviors can help uncover symptoms of BED that may not otherwise be obvious.
These tests in combination can be extremely helpful in assessing suspected cases of BED while ruling out other eating disorders or non-disordered obesity.
Cognitive Behavioral Therapy (CBT) can help treat the psychological aspects of many compulsive behaviors, including compulsive eating. CBT is a method that helps individuals observe, recognize, and develop strategies in response to the situations that may cause them to binge eat.
Psychological treatments of various kinds have had the most positive effect on the behavioral patterns of those struggling with BED
One type of CBT is particularly tuned to people who may have suffered some sort of trauma that contributes to the emotional aspects of their compulsive overeating. Trauma-focused CBT (TFCBT) has specifically been noted for helping people feel a qualitative reduction in their PTSD symptoms, which reduces some of the underlying symptoms that can contribute to chronic binge eating.
Another form of CBT that can help people become aware of the triggers of their undesirable behaviors, and then analyze and apply alternative responses that prevent them from repeating the undesired behaviors. This type of therapy can significantly reduce binge eating by the time treatment is over, but may need other supportive therapies to help maintain recovery in the long-term after treatment ends.
This support may find a form in Motivational Interviewing (MI), which is a post-therapy method that provides occasional interventions after treatment is over to remind individuals of their work in an attempt to help them maintain motivation.
This method has been shown to be even more likely than CBT to help people with their BED. In fact, a study showed that for up to four months post-treatment, about 95 percent of people treated using this method no longer met the criteria for BED.
Yoga also showed promise in providing support for psychological treatments in reducing binges. As an added benefit, both aerobic exercise and yoga helped people reduce their body mass index (BMI) for improvement in co-occurring obesity. In other words, these activities help people to reduce both the frequency of their binges and their weight.
Physically, treating BED can often help obesity, along with other disorders and medical illnesses. Although not all people who recover from BED are able to lose weight, many are able to, and others are at least able to stop gaining weight.
While obesity and BED do often co-occur, being overweight or obese does not necessarily mean someone has BED. Obesity is sometimes a result of chronic binge eating, but some people can be overweight and not have BED; at the same time, some people can have BED and not be overweight.
People who have BED are more likely to be obese than people who have typical eating patterns. Among people who seek weight control treatment, the number who have BED can be as much as 30 percent. Nevertheless, people who are obese can have a healthy relationship with food, while some people who are not overweight or not significantly overweight can have BED.
This imbalance can be the result of several factors, one of which is adrenal insufficiency, where the adrenal glands don’t make enough of the hormone cortisol; other chemicals that regulate hunger are leptin and ghrelin, both of which have been shown to be unbalanced for some people who are experiencing BED.
Whatever the cause, the end result is that the imbalance of these chemicals causes the brain to send signals to the body that it needs more food. The result is that the individual feels some degree of desire to eat, ranging from cravings to hunger, all the time – even when the person is already full.
Because of this, treating adrenal insufficiency may help in decreasing the desire to binge for people with BED. Testing cortisol levels can also help to determine whether someone who is exhibiting symptoms of compulsive eating fully meets the diagnostic criteria for BED.
Generally, the number of fat cells a person has is settled in adolescence. People who are obese in childhood can end up with more than twice as many fat cells as people who aren’t, and their fat cells may be larger than those of people who are not obese, too. However, even with people who are obese, the number of fat cells in their bodies are constant through adulthood, and the rate of cellular replacement is the same as for those who are not obese, no matter how much weight they lose or gain.
Finding a treatment program designed specifically to treat BED as separate from other eating disorders is the most helpful way for people to learn to manage their disorders. In particular, a residential program that provides research-based medical and psychological interventions is most likely to help a person recover from BED and maintain healthy eating habits.
It is important to keep in mind that the main goal of this treatment is to recover from BED. Research shows that approaching treatment as a weight loss plan – referred to as behavioral weight loss – is not as effective as CBT, DBT, or IPT in reducing binge eating. These other therapies treat the whole condition, making it easier to gain control over the relationship with food, which may then lead to weight loss.
For this reason, it is helpful to introduce activity and nutritional education as part of the treatment for BED. Getting exercise and learning to eat healthier meals, in combination with the psychological therapies that can help reduce cravings and binge eating episodes, can help reverse prediabetes and lower the risk of the additional medical complications that may arise, with or without diabetes.
However, this does not mean it can help in weight loss. Alcohol does not get stored in the body as fat, but it does suppress the use of the fat already stored by the body. In particular, while drinking alcohol does not seem to directly affect weight gain in people who are not overweight, it can contribute to further weight gain in those who are already overweight. This potentially accounts for the perception that alcohol consumption slows metabolism and stalls weight loss.
The human body is always burning calories. Calories are required for all bodily functions, including breathing, circulation, brain function (including dreaming), and other automatic physical processes that take place even when we’re not thinking about them.
However, when it comes to BED, bingeing at night can be an issue. A person who has an uncontrollable urge to eat excessive amounts of food at night – especially in order to hide their eating habits from others – may be dealing with compulsive overeating. In fact, there is a strong correlation between people who have issues with night eating syndrome and BED.
Nevertheless, our conscious brains are able to overcome the instinctive drives related to eating based on the season because of modern conveniences. Because of this, we don’t have to relegate our eating habits to some primordial or seasonal drive. However, this also means that if people have compulsive eating behaviors based on psychological factors – as well as hormonal imbalance – they will not necessarily be affected by changes in the weather.
Rather than letting the weather determine our eating habits, we can help our brains by setting our habits through conscious, therapy-based strategies to change eating patterns. Using Cognitive Behavioral Therapy or other constructive counseling methods, it is possible to teach ourselves to eat in a way that is healthy and control eating urges that may not be as good for the body.
As discussed above, psychological counseling like CBT or IPT can help manage the underlying psychological issues that can contribute to the physical manifestation of chronic binge eating. Without these elements, this type intervention may work in the short-term, but it is less likely to provide long-lasting results and tools that can help individuals maintain recovery and control over binge eating episodes.
Comprehensive treatment that includes physical intervention, psychological therapy, and education to manage triggers and cravings with mindful eating habits is the method most likely to result in management of BED and reduction of the risks that come with compulsive eating and resultant physical health issues.