End Binge Eating Now
The difference between DSM-IV and ICD-10 in the time criterion for the diagnosis of schizophrenia has already been mentioned, as has the distinction between conversion and dissociative disorders made in DSM-IV but not in ICD-10. Furthermore, the two systems classify eating disorders differently. DSM-IV includes two distinct forms of anorexia (the restricting type and the binge eating type) and two distinct types of bulimia (the purging and the non-purging types), whereas ICD-10 only includes only anorexia, bulimia, and their (undefined) atypical forms.
Dieting and binge eating The eating habits of patients with bulimia nervosa are characterized by strict dieting punctuated by repeated episodes of binge eating ( Fig. .2). The dieting is extreme, in that little tends to be eaten, and it is governed by multiple self-imposed dietary rules. These rules tend to be applied to all aspects of eating, including when to eat, what to eat, and how much to eat. As a result, the food eaten (when not binge eating) is restricted in quantity and range. Recurrent episodes of 'binge eating' interrupt this dieting. (The term binge eating denotes discrete episodes of eating that have two characteristics first an unusually large amount of food is eaten, given the circumstances, and second there is a sense of loss of control at the time. ( 0)) The frequency and regularity of the binges varies. Some patients have episodes almost every day, whereas in others the episodes are intermittent. In DSM-IV, it is specified that the binges should occur on average at...
Once established, bulimia nervosa tends to run a chronic course with the proviso that it tends to improve over the long term (see below). There are a number of processes which account for its self-perpetuating character which are discussed in ChapteL4J.Q.J They include the ongoing influence of the extreme concerns about shape and weight the form of these patient's dieting, which encourages binge eating the moodmodulating effect of binge eating and the fact that the loss of control over eating perpetuates fears of weight gain.
Antidepressant drugs are more effective than placebo at reducing the frequency of binge eating and purging. On average, among treatment completers there is about a 60 per cent reduction in the frequency of binge eating and a cessation rate of about 20 per cent. The therapeutic effect is more rapid than that seen in depression. There is generally little change in the placebo group. The drop-out rate varies but averages about 30 per cent. 3. Few studies have evaluated the effects of antidepressant drugs on features other than binge eating and purging. Mood improves as the frequency of binge eating declines but this effect is common to all treatments for bulimia nervosa. Antidepressant drugs do not appear to modify the patient's extreme dieting which may account for the apparently poor maintenance of change.
Spitzer, R.L., Devlin, M., Walsh, T.B., et al. (1992). Binge eating disorder a multisite field trial of the diagnostic criteria. International Journal of Eating Disorders, 11, 191-203. 8. Spitzer, R.L., Yanovski, S.Z., Wadden, T.A., et al. (1993). Binge eating disorder its further validation in a multisite trial. International Journal of Eating Disorders, 13, 137-53.
There is a sizeable body of research that supports this cognitive view on the maintenance of anorexia nervosa and bulimia nervosa. (7) This includes descriptive and experimental studies of the clinical characteristics of these patients and the research on dietary restraint and 'counter-regulation' (a possible analogue of binge eating).(8) However, it is the research on the effects of treatment that provides the strongest support. Thus indirect support comes from the large body of research indicating that cognitive-behaviour therapy has a major and lasting impact on bulimia nervosa (see ChapteL4.10,2). Further support comes from the finding that 'dismantling' cognitive-behaviour therapy by removing those procedures designed to produce cognitive change attenuates its effects and results in patients being markedly prone to relapse.(9) The most direct support comes from the finding that, among patients who have recovered in behavioural terms, the severity of concerns about shape and...
The introduction of this pattern of eating has the effect of displacing the episodes of binge eating with the result that there is generally a rapid decline in their frequency. The pattern must be tailored to suit the patient's daily commitments, and there must be some degree of flexibility. Some patients are reluctant to eat meals or snacks since they fear that this will result in weight gain. They can be reassured that this is rarely the case since this pattern of eating will result in a decrease in their frequency of binge eating with the result that their energy intake will decline. Despite such reassurances, it is common for patients to select meals and snacks which are low in energy. There need be no objection to this since the emphasis at this stage is on establishing a pattern of regular eating rather than on changing what foods they eat.
Cognitive-behaviour therapy for bulimia nervosa may be regarded to some extent as modular since it contains groups of procedures directed at particular facets of the disorder. Thus there are techniques for addressing binge eating, the various forms of dieting, concerns about shape and weight, and the risk of relapse. Such techniques may also be used, within an overall cognitive-behavioural perspective, with patients who show just some of these features. As a result cognitive-behaviour therapy has a wide application since, as noted in C.h.ap.te.L.4 1 0. .2., there are many patients seen in clinical practice who have a significant eating disorder yet do not meet full diagnostic criteria for anorexia nervosa or bulimia nervosa.
Binge eating is consuming large quantities of food in a short period of time, even when no longer hungry or already feeling 'full.' Some people say they' just cannot stop eating, even though they are not hungry. e. Do you think you need help with your binge eating Yes No Question 23 is important in helping identify a possible binge eating disorder. The prevalence of binge eating disorder (BED) is not known. Earlier studies by Spitzer et al. suggested 29 of people seeking obesity treatment have a BED 3 . More recent studies suggest the prevalence is between 8.9 and 18.8 4,5 . Whatever the actual percentage, the reality is that many patients who want obesity treatment in the primary care physician's office have a BED.
Recurrent episodes of 'binge eating' (defined below). Fig. 1 A Venn diagram illustrating the relationship between the diagnoses anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS). (Reproduced with permission from C.G. Fairburn and G.T. Wilson (1993). Binge eating definition and classification. In Binge eating nature, assessment and treatment (ed. C.G. Fairburn and G.T. Wilson), pp. 3-14. Guilford Press, New York.) In DSM-IV, a provisional new eating disorder diagnosis was introduced which is termed binge eating disorder. It is placed in an appendix designed for possible future diagnostic concepts. Patients with binge eating disorder have recurrent episodes of binge eating, like those seen in bulimia nervosa, but they do not fulfil the diagnostic criteria for either anorexia nervosa or bulimia nervosa. This is a controversial category about which much remains to be learned. (78)
Two major changes in Louis's life contributed to the expression of psychopathology and increased distress. One was his retirement from the law practice, and the other was the development of hypertension and cardiovascular disease leading to his discontinuing community activities. Together, these effectively created a double retirement. Subsequently, Louis manifested several problematic behaviors. He developed sleep difficulties and began to grossly overeat, gaining considerable weight, which added to his medical morbidity. Now at home for most of the day, he became watchful of Marie and sharply critical of her every move, lashing out at her for not doing things the right way or for being sloppy. On one occasion, he swept the contents of a kitchen cabinet onto the floor in a pique of anger after discovering that Marie had not securely replaced the cap on a peanut butter jar. Typically, Louis's temper outbursts were followed by his verbal self-flagellation and compulsive overeating. I...
Drawing on the work of Fairburn and colleagues, Wilfley et a 75 modified IPT in a group format, meeting once a week for 16 weeks, and compared it with group CBT and a waiting-list control for 56 women with non-purging bulimia. At termination, IPT-G and CBT each significantly reduced binge eating, whereas the waiting-list control did not. These results persisted at 1-year follow-up. A randomized clinical trial of 162 women is now comparing group IPT and CBT for 20 sessions over 20 weeks. The initial IPT phase, in which the therapist identifies the problem area and presents IPT concepts and the treatment contract, is conducted individually. Groups meet for 90 minutes.
Binge eating is the only feature that is not obviously a direct expression of the concerns about shape and weight. It is present in all patients with bulimia nervosa (by definition) and a subgroup of those with anorexia nervosa. It is likely to be the result of these patients' particular type of dieting and their perfectionist standards. Patients with anorexia nervosa and bulimia nervosa severely restrict their food intake and are therefore under continuous physiological pressure to eat, but it is the form of their dieting that makes them particularly prone to binge. Rather than having general guidelines about how they should eat, these patients impose upon themselves multiple extreme, and highly specific, dietary rules. These rules concern when they should eat (or rather when they must not eat, for example not before 6 p.m.), exactly what they should eat (or rather, what they must not eat, so that most patients have a large list of 'forbidden foods'), and the overall amount of food...
Much of our experience has come through the treatment of type-2 diabetic patients suffering from obesity 24 . More than 80 of our type-2 diabetic patients are overweight, very often due to dietary behavior of a binge-eating disorder. The usual nutritional approach is insufficient, since even ideal teaching of dietary knowledge, and the fat contents of foods does not bring about a lasting loss of weight. Even multiplying the number of practical teaching exercises on food management, shopping habits, slimming recipes, etc., only brings a very slight improvement in long-term results. The cognitive-behavioral approach has allowed us to make a great step forward in our interdisciplinary approach and to maintain behavioral changes in the long term 12, 24, 25 .
Binge eating may cause gastric rupture, the most serious complication, is uncommon. More often, patients describe nausea, abdominal pain and distention, prolonged digestion and weight gain. The combination of heightened anxiety, physical discomfort and intense guilt provokes the drive to purge the food by self-induced vomiting, excessive exercise or the misuse of ipecac, laxatives or diuretics. These purgative methods are associated with the more serious complications of bulimia nervosa. Binge eating
Eating disorders and in particular binge eating are common among the obese, with prevalence estimates of 23-46 in those seeking treatment (46). Binge eating disorder has also been reported to be associated with Type 2 diabetes, but would appear to precede Type 2 diabetes in most patients. The prevalence of binge eating disorder in those with Type 2 diabetes was recently estimated as 10 among a sample of 322 German patients (47). Other forms of disordered eating, including night eating syndrome, should also be considered when assessing an obese individual.
The treatment has three overlapping and evolving stages with stage 1 occupying about eight sessions. With patients with highly disturbed eating habits, the first four to six sessions are best held twice weekly. Stage 1 has three major aims to explain the rationale underpinning the treatment, to educate patients about the disorder, and to displace the binge eating with a stable pattern of regular eating. immediately becomes clear to patients that their behaviour is both comprehensible, given their attitudes to shape and weight, and open to change. Once the cognitive view has been discussed, the therapist reviews its implications. The major point that is stressed is that there is more to the patient's eating problem than binge eating. Patients need to appreciate that they will have to make changes in many areas if they are to achieve a full and lasting recovery. 2. Physical effects of binge eating, self-induced vomiting, laxatives, and diuretics fluid and electrolyte abnormalities...
Tricyclic antidepressants reduce binge eating by 47 to 91 percent and vomiting by 45 to 78 percent. Desipramine (Norpramin) , 150 to 300 mg per day, imipramine, 176 to 300 mg per day, and amitriptyline (Elavil), 150 mg per day, are recommended. B. Selective serotonin reuptake inhibitors. At the 20-mg dosage, fluoxetine (Prozac) therapy results in a 45 percent reduction in binge eating, compared with a 33 percent reduction with placebo. Vomiting was reduced by 29 percent. Fluoxetine in a dosage of 60 mg per day results in a 67 percent reduction in binge eating and a 56 percent reduction in vomiting.
Cognitive-behavioral therapy principally involves a systematic series of interventions aimed at addressing the cognitive aspects of bulimia nervosa, such as the preoccupation with body, weight and food, perfectionism, dichotomous thinking and low self-esteem. Therapy should address the behavioral components of the illness, such as disturbed eating habits, binge eating, purging, dieting and ritualistic exercise.
Because theory can only suggest possibilities, it must always be followed up by empirical research. Studies have shown that the antisocial is indeed the most common personality disorder among alcoholics (Hesselbrock, Meyer, & Keener, 1985). Other personality disorders, however, have also been observed. In addition to the antisocial, Morgenstern, Langenbucher, Labouvie, and Miller (1997) found high numbers of borderline and paranoid personalities. Although these disorders have no exact parallel in Cloninger's model, their vulnerability to alcoholism can nevertheless be understood in terms of their characteristic traits. As noted in DSM-IV, borderlines are disposed to indulge themselves impulsively in self-damaging ways, including excessive spending, reckless driving, binge eating, and substance abuse. Excessive alcohol consumption serves the same end. Moreover, as the borderline personality has frequently been associated with mood swings and chronic depression, it is likely that...
We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.