Binge eating disorder

There may be genetic influences or learned behavior, but most often the person has found his or her way to deal with some psychological wound.

Binge eating disorder (photo credit: Wikimedia Commons)
Binge eating disorder
(photo credit: Wikimedia Commons)
From the moment we are born, we are nurtured with food, so it would seem counterintuitive to imagine that for some people, food-related behavior could be the source of a powerful and sometimes life-threatening addiction. Binge eating disorder is the most common eating disorder, with an estimated worldwide prevalence rate of 2%.
The disorder is characterized by eating “in a discrete period of time an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances” (American Psychiatric Association, DSM-5, 2013). People who suffer from binge eating disorder have a lack of control during their repetitive episodic experiences. They eat until they feel uncomfortably full, and they often eat alone because they are embarrassed and disgusted by their behavior.
Natalie, in her late 40s, came to therapy for help with her depression and binge eating disorder. At the beginning of therapy, Natalie described how she constantly resupplied her supply of oatmeal. She did so because she regularly had episodes of extreme bingeing on the high-carbohydrate food. There was no stopping point. Natalie’s life was quite lonely. She had not been successful in having a relationship with men, and she had a history of growing up in a very dysfunctional household.
It was not at all difficult for me to trace back to the source of her unhappiness; clearly, it was in her family history. At some point in her adult years, Natalie discovered that whenever she was anxious, depressed or lonely, not only did food became her best friend, it also became her worst enemy. Her weight would get so high that she could not fit into her clothing. She was clearly addicted to this binge behavior and desperately wanted help.
Sam, also in his 40s, a lawyer in private practice, is married and has children. His wife, however, was unhappy about his obesity and pushed Sam to go for help. During the earlier part of treatment, I wanted to understand what Sam’s eating habits were like. It appeared that Sam was eating a normal diet. Sam confided in me his deep, dark secret. Stashed away in his office desk were dozens of his favorite chocolate bars. Frequently at work, Sam would binge on these chocolate bars.
The reasons for binge-eating behavior are complex. There may be genetic influences or learned behavior, but most often the person has found his or her way to deal with some psychological wound, trauma, depression or anxiety by resorting to binge-eating behavior. Moreover, once this behavior gets started, it quickly is habituated into a full-blown addiction with all of the classic hallmark symptoms of addictions: loss of control, inability to cut back, and continuation of the behavior in spite causing harm to oneself or others.
Studies have shown that for some people, the same reward and pleasure centers of the brain that are stimulated by using drugs like cocaine and heroin are also activated by food, especially highly tasty foods that are rich in sugar, fat and salt. The binge-eating episode activates dopamine, the brain’s reward chemical.
In addition, the behavior is further conditioned by associative learning, when the person pairs the experience to the surrounding environmental cues that are present during the binge experience. For example, whenever Sam entered the elevator in his office building, he was already craving his chocolate bars. This explains why people crave the food just by being exposed to the triggers that are associated with the activity.
Treatment for a binge-eating addiction requires a holistic approach. The first stage of treatment is to assess whether there are any coexisting psychological disorders that play a major part in the person’s binge-eating addiction. More often than not, there are coexisting mood or anxiety disorders that may require treatment with psychiatric medication.
The therapeutic treatment of choice for a binge eating disorder is cognitive behavioral therapy (CBT). This includes the use of motivational interventions to strengthen the person’s desire to change his or her behavior. Another useful treatment is relapse prevention, which is a self-management type of CBT that teaches the person how to manage his thoughts about food, his environment and his behavior.
One example of relapse prevention is teaching clients specific skills to change behavior in order to minimize the possibility of coming into contact with a “high-risk situation.” Natalie was helped to stay away from stores where she had purchased her oatmeal. I instructed Sam to get rid of all his chocolate bars and to try to use mindfulness, a relaxation technique, whenever he got a craving for indulging his habit. However, one of most central and critical components for a successful eating addiction intervention is participation in a 12-step group like Overeaters Anonymous (OA), where binge eaters can get both personal and group support and tools from other food addicts.
Natalie and Sam have been attending OA for years, and both have gotten tremendous help. I asked Natalie if there were any OA sayings that she felt were useful to share for this article.
“Insanity is doing the same thing over and over again and expecting different results.”
“If I have a problem and eat over it, then I will have two problems.”
“The sooner I surrender the better.”
The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Ra’anana.; [email protected]