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When Comfort Food Does Not Give Comfort

According to research by the Binge Eating Disorder Association, eating disorders have the highest mortality rate of all psychiatric disorders (www.bedaonline.com). Eating disorders, partly due to the physical toll they take on the body of the individual diagnosed, and partly due to their comorbidity rate (the rate of other health issues related to these disorders), are very serious conditions.

Of the various eating disorders, binge eating especially warrants a closer look, in part because the name itself may be seen as a misnomer. We may refer to our eating habits as a binge on Thanksgiving evening or when we go a little crazy during a quality weekend with mom and her famous baked goods. However, binge eating disorder is not simply overeating during a holiday meal or overindulging in a favorite snack. It is a diagnosed addictive condition and the most common disorder in the US today.

BED impacts three times the number of those diagnosed with anorexia and bulimia combined, and has no distinction between race, age, gender or socioeconomic level. It can commonly be associated with higher weight in individuals impacted, and typically presents with depression and other mood disorders (McElroy et al, 2015).  This disorder is defined as engaging in periods of unhealthful eating, unable to control the intake of food and feeling shame and self-loathing after the episode (Grilo et al, 2012).  Binge eating was just recently updated to reflect as a standalone disorder in the DSM-5, which contains and classifies all psychological disorders and paraphilia.

The biopsychosocial perspective of the Binge Eating Disorder offers a trifecta of insights. From the biological side, the possibility of developing the disorder has genetic components as well as abnormal neurotransmitter levels.  There is also evidence of abnormal hypothalamus brain structure of those diagnosed with the disorder.  Psychological components are comorbidities that are usually present with the disorder; the social perspective offers insight into the events that might have influenced the disorder such as family life or experiences of abuse.

This perspective offers a closer view of the causes of Binge Eating Disorder, which vary by person and could be hard to identify. Some additional impacts favorable to developing the BED are genetics; history of struggling with weight and diets; mood disorders; emotional issues, addictions, or abuse (Butcher et al, 2014).   There are possibilities of complications for those affected by the disorder, both physical and emotional.  Kessler et al (2016), posit that individuals with Binge Eating Disorder are prone to exhibit both compulsive and impulsive behaviors as well as display “altered reward sensitivity” neurologically, craving it even after physically satiated (233).  Based on their studies, once the neurological and neurochemical impacts of the disorder are better understood, pharmacotherapy will become the preferred treatment method for the disorder (Kessler et al, 2016).

Treatment is indeed necessary for Binge Eating Disorder, and is crafted as an individualized approach. Weight loss alone will not address the underlying causes of the disorder; rather, group and individual therapy support is needed to understand the roots of the behaviors and to change the view of and approach to eating and food.  Otherwise the recurring behaviors will present again and again. Medication may be needed to supplement therapy as well (Grilo et al, 2012).

Several research studies were performed to determine the efficacy of medication; group therapy; self- and peer-led therapies etc. One of such studies compares self-help groups to therapist-led groups for treating the binge eating disorder (Peterson et al, 2009). The study looks at 259 adults randomly assigned to 20 weeks of treatment in one of three groups: self-led; therapist-led and therapist-assisted.  The researchers measured behaviors and outcomes at the end of the study timeframe, the main one being abstinence rate from the binge eating behaviors (Peterson et al, 2009).

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The results show that the therapist-led group had the highest efficacy rate (51.7%) and the therapist-assisted group was second-highest (33.3%) (1348). The self-help group came in with 17.9% efficacy rate. This allowed the researchers to conclude that the therapist-led group had a higher probability of maintaining abstinence rates as well as lesser frequency in bingeing episodes on a short-term basis (Peterson et al, 1349).  However, there was no noticeable difference after some time had elapsed and the subjects attended a follow-up appointment.  Over a period of time the rates of behavior recurrence as well as abstinence rates were virtually the same, allowing for the conclusion that “self-help group treatment may be a viable alternative to therapist-led interventions” (Peterson et al, 1350).

Other treatment approaches such combining cognitive behavior therapy with psychopharmacology, most notably, to help treat depression, is effective as well. However, it appears that when treated at a younger age vs older, the remission rates are significantly lower (Grilo et al, 2012). . Hilbert et al (2015), share their research which indicates that a great predictor of long-term improvement in binge eating frequency reduction is the early response rate (over the first 4 weeks of treatment) to the CBT and the Interpersonal Psychotherapy (IPT). It is also important to understand the current age of the participants as well as the age at the onset of the disorder, as early engagement will yield the best results in remission occurrence (650).

Alternative treatment methods such as equine and art therapies are relatively new to the scene of treating the BED and further research is needed as to the efficacy of this approach, whether alone or in combination with other therapies.

Similar to other psychopathological disorders, early recognition and involvement seem to be key for the most successful treatment approach of the Binge Eating Disorder. Studies also agree that it is important to address not just the physical side of the disorder such as healthy weight maintenance habits and eating habits but also the underlying psychological reasons for binge eating as well as the comorbidities.

Article References
  1. Butcher, J. N., Hooley, J. M., & Mineka, S. (2014). Abnormal psychology (16th ed.). Boston, MA: Pearson.
  2. Grilo, Masheh and Crosby. Predictors and Moderators of Response to Cognitive Behavioral Therapy and Medication for the Treatment of Binge Eating Disorder. journal of Consulting and Clinical Psychology © 2012 American Psychological Association 2012, Vol. 80, No. 5, 897–906 0022-006X/12/$12.00 DOI: 10.1037/a0027001
  3. Hilbert, A., Hildebrandt, T., Agras, W., Wilfley, D., Wilson, T. (2015). Rapid Response in Psychological Treatments for Binge Eating Disorder.The State University of New Jersey Journal of Consulting and Clinical Psychology . 83 (3), 649–654
  4. Kessler, R., Hutson, J., Herman, B., Potenza, M. (2016) The neurobiological basis of binge-eating disorder. Neuroscience and Biobehavioral Reviews 63 (2016) 223–238.
  5. McElroy S,.(2015). The Brown University Psychopharmacology Update. JAMA Psychiatry, published online Jan 14, 2015;  Retrieved January 13, 2017 from doi: 10.1001/jamapsychiatry.2014.2162]
  6. Peterson, C., Mitchell, J., Crow, S., Crosby, R (2009). The efficacy of self-help group treatment and therapist-led group treatment for binge eating disorder  American Journal of Psychiatry,  166 (12), 1347-1354.  Retrieved from DOI: http://dx.doi.org/10.1176/appi.ajp.2009.09030345
  7. www.bedaonline.com. Retrieved January 15, 2017.

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Julia Hewitt, M.S. Psychology
Julia Hewitt, M.S. Psychology

Julia is passionate about helping others on their self-discovery path, be it with relationships, life's purpose, personal goals or simply coping skills. She believes in the power of words, thoughts and in the beauty of language. She holds a Masters in Psychology and a Masters in Organizational Leadership from the University of Phoenix as well as a Bachelors from Arizona State University, and volunteers on a teen crisis hotline.

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