Binge-eating disorder

Binge-eating disorder is a
serious eating disorder in which you frequently consume unusually large
amounts of food. Almost everyone overeats on occasion, such as having
seconds or thirds of a holiday meal. But for some people, overeating
crosses the line to binge-eating disorder and it becomes a regular
occurrence, shrouded in secrecy.

When you have binge-eating disorder, you may be deeply embarrassed about
gorging and vow to stop. But you feel such a compulsion that you can't
resist the urges and continue binge eating.

Although binge-eating disorder is the most common of all eating
disorders, it's still not considered a distinct psychiatric condition.
But if you have binge-eating disorder symptoms, treatment can help you.

Symptoms

When you have binge-eating disorder you often have numerous behavioral and emotional signs and symptoms, such as:

* Eating large amounts of food
* Eating even when you're full
* Eating rapidly during binge episodes
* Feeling that your eating behavior is out of control
* Eating a lot even though you're not hungry
* Depression
* Anxiety
* Frequent dieting, possibly without weight loss
* Frequently eating alone
* Feeling depressed, disgusted or upset about your eating

After a binge, you may try to diet or eat normal meals. But restricting
your eating may simply lead to more binge eating, creating a vicious
cycle.

You may have no obvious physical signs or symptoms when you have
binge-eating disorder. You may be overweight or obese, or you may be of a
normal weight.

When to see a doctor
If you have any binge-eating disorder symptoms, seek medical help as
soon as possible. Binge-eating disorder usually doesn't get better by
itself, and it may even get worse if left untreated.

If you have a primary care doctor, talk to him or her about your
binge-eating symptoms and feelings. Or seek help directly from a mental
health provider. If you're reluctant to seek treatment, try to work up
the courage to talk to someone about what you're going through, whether
it's a friend or loved one, a health care professional, a teacher, a
faith leader or someone else you trust. They can help you take the first
steps to successful binge-eating disorder treatment.

Helping a loved one with binge-eating disorder symptoms
If you have a loved one you think may have symptoms of binge-eating
disorder, have an open and honest discussion about your concerns. You
may not be able to force someone to seek professional care, but you can
offer encouragement and support. You can also help your loved one find a
qualified doctor or mental health provider and make an appointment. You
may even be able to go to an appointment with him or her.

Causes

The cause of binge-eating disorder is unknown. As with many mental
illnesses, it's thought that a variety of factors are at play in
binge-eating disorder, such as:

* Biological factors. People with binge-eating disorder may have
inherited genes that made them more susceptible to developing an eating
disorder. In addition, brain chemicals may be altered in people with
binge-eating disorder.
* Psychological factors. Psychological and emotional factors may
also play a role in binge-eating disorder. You may have low self-worth
and trouble controlling impulsive behaviors, managing moods or
expressing anger.
* Environmental factors. Modern Western culture often cultivates and
reinforces a desire for thinness. Although most people who have
binge-eating disorder are overweight, they are probably acutely aware of
their appearance and may get angry with themselves after eating binges.

Risk factors

Factors that can increase the risk of developing binge-eating disorder are:

* Being female. Women are slightly more likely than men to develop binge-eating disorder.
* Your age. Although people of any age can have binge-eating
disorder, it often begins when people are in late adolescence or their
early 20s.
* Family history. If you have close relatives — siblings or parents —
who've had an eating disorder, you have an increased risk of developing
an eating disorder yourself.
* Dieting. People with binge-eating disorder have a mixed history of
dieting — some have dieted to excess dating back to childhood, while
others haven't dieted. Dieting may trigger an urge to binge eat.
* Psychological issues. Certain behaviors and emotional problems are
more common when you have binge-eating disorder. As with bulimia, you
may act impulsively and feel a lack of control over your behavior. You
may have a history of depression or substance abuse. Binge eaters may
have trouble coping with stressful situations, anger, sadness, boredom
and worry.

Complications

Generally, people with binge-eating disorder don't enjoy eating to
excess. And you may even develop psychological and physical problems
related to binge eating, making you even more miserable and further
reducing your quality of life.

Some of these complications can arise from being overweight as a result
of frequent bingeing. Other complications may occur because of unhealthy
yo-yo eating habits — binging followed by harsh dieting. In addition,
food consumed during a binge is often high in fat and low in protein and
other nutrients, which could lead to health problems.

Complications that binge-eating disorder may cause or be associated with include:

* Depression
* Suicidal thoughts
* Insomnia
* Obesity
* High blood pressure
* Type 2 diabetes
* High blood cholesterol
* Gallbladder disease and other digestive problems
* Heart disease
* Joint pain
* Muscle pain
* Headache

Preparing for your appointment

Treatment of binge-eating disorder may require a team approach that
includes medical providers, as well as mental health providers and
dietitians with experience in eating disorders.

Here's some information to help you get ready for your appointments, and
what to expect from your doctor and other health providers.

What you can do

* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Ask a family member or friend to come with you, if possible.
Sometimes it can be difficult to remember all of the information
provided to you during an appointment. Someone who accompanies you may
remember something that you missed or forgot. A family member may also
be able to give your doctor a fuller picture of your home life.
* Write down questions to ask your doctor so you'll remember to cover everything you wanted to.

Some potential questions you might want to ask your doctor or other health care provider include:

* What kinds of tests do I need? Do these tests require any special preparation?
* Is this condition temporary or long lasting?
* What treatments are available, and which do you recommend?
* If medication is a part of treatment, is a generic drug available?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask, don't hesitate
to ask questions of any of your providers anytime that you don't
understand something.

What to expect from your doctor
Your doctor or other health care provider is likely to ask you a number of questions, such as:

* How long have you been worried about your weight?
* Do you exercise? How often do you exercise?
* Have you found any other ways to lose weight?
* Are you having any physical symptoms?
* Have you ever vomited because you were uncomfortably full?
* Have you ever taken medications for weight loss?
* Do you think about food often?
* Do you ever eat in secret?
* Have any of your family members ever had symptoms of an eating
disorder or have any been diagnosed with an eating disorder?

Tests and diagnosis

Binge-eating disorder isn't yet officially classified as a mental
disorder, and not all experts agree on whether or not it should be.
Binge eating is similar to bulimia nervosa, another eating disorder, and
some experts think it may be a form of bulimia. But unlike people with
bulimia who try to rid themselves of the extra calories after a binge
through vomiting, exercise or other means, people with binge-eating
disorder don't attempt to purge themselves of the extra calories they
consume. That's why many people with binge-eating disorder are
overweight.

In any case, when doctors suspect someone has an eating disorder, they typically run a number of tests including:

* A physical exam
* Blood and urine tests
* A psychological evaluation, including discussion of your eating habits

Your doctor may want you to undergo other tests to check for health
consequences of binge-eating disorder, such as heart problems or
gallbladder disease.

Criteria for diagnosis
All these evaluations help doctors determine if you meet the criteria
for binge-eating disorder or if you may have another eating disorder,
such as bulimia. The criteria to diagnose mental health conditions are
set forth in the Diagnostic and Statistical Manual of Mental Disorders
(DSM), which is published by the American Psychiatric Association.

DSM diagnostic criteria for binge-eating disorder include:

* Recurrent episodes of binge eating, including eating an abnormally
large amount of food and feeling a lack of control over eating
* Binge eating that's associated with at least three of these
factors: eating rapidly; eating until you're uncomfortably full; eating
large amounts when you're not hungry; eating alone out of embarrassment;
or feeling disgusted, depressed or guilty after eating
* Concern about your binge eating
* Binge eating occurs at least twice a week for at least six months
* Binge eating isn't associated with inappropriate methods to compensate for overeating, such as self-induced vomiting

Treatments and drugs

The goals for treatment of binge-eating disorder are to reduce eating
binges, to improve your emotional well-being and, when necessary, to
lose weight. Because binge eating is so entwined with shame, poor
self-image, self-disgust and other negative emotions, treatment needs to
address these and other psychological issues.

There are four main types of treatment for binge-eating disorder.

Psychotherapy
Psychotherapy, whether in individual or group sessions, can help teach
you how to exchange unhealthy habits for healthy ones and reduce
bingeing episodes. Examples of the types of psychotherapy that may be
helpful include:

* Cognitive behavioral therapy. Cognitive behavioral therapy may
help you cope better with issues that may trigger binge-eating episodes,
such as negative feelings about your body or a depressed mood. It may
also give you a better sense of control over your behavior and eating
patterns. However, cognitive behavioral therapy hasn't been shown
helpful in reducing weight. So if you're overweight, you may need
additional treatment.
* Interpersonal therapy. Interpersonal therapy focuses on your
current relationships with other people. This may help reduce binge
eating that's triggered by poor relationships and unhealthy
communication skills. The goal is to improve your interpersonal skills —
how you relate to others, including family, friends and colleagues. You
learn how to evaluate the way you interact with others and develop
strategies for dealing with relationship and communication problems.
* Dialectical behavior therapy. This form of therapy can help you
learn behavioral skills to help you tolerate stress, regulate your
emotions and improve your relationships with others, all of which can
reduce the desire to binge eat.

Medications
There's no medication specifically designed to treat binge-eating
disorder. But, several types of medication have been found to be helpful
in reducing the symptoms of binge-eating disorder. Combining therapy
with medications may be more effective than either treatment alone. The
types of medications that may be helpful for binge-eating disorder
include:

* Antidepressants. Antidepressants known as selective serotonin
reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be
helpful for binge eating. It's not clear how these can reduce binge
eating, but it may be related to how they affect certain brain chemicals
associated with mood.
* The anticonvulsant topiramate (Topamax). Normally used to control
seizures, topiramate has also been found to reduce binge-eating
episodes. However, it can cause serious side effects, including a numb,
burning or tingling sensation, and trouble in thinking.

Behavioral weight-loss programs
Weight-loss programs typically aren't recommended until the binge-eating
disorder is treated, because very low calorie diets may trigger more
binge-eating episodes.

However, when necessary, weight-loss programs for people with
binge-eating disorder are generally done under medical supervision to
ensure that your nutritional requirements are met. Some programs are
known as very low calorie diet programs because they include an initial
period of strict calorie restriction for fast weight loss.

Weight-loss programs may also address issues that tend to trigger
binges, but generally to a lesser extent than psychotherapy does.
However, weight-loss programs, especially those that are not medically
supervised, may not be appropriate for everyone with binge-eating
disorder.

Self-help strategies
Some people with binge-eating disorder find self-help books, videos and
support groups effective. Some eating disorder programs offer self-help
manuals that you can use on your own or with guidance from mental health
experts. Self-help strategies may not be effective on their own,
though. You still may need professional treatment with psychotherapy or
medications.


Lifestyle and home remedies

Binge-eating disorder generally isn't an illness that you can treat on
your own. But you can do some things for yourself that will build on
your treatment plan. In addition to professional treatment, follow these
self-care steps for binge eating:

* Stick to your treatment. Don't skip therapy sessions. If you have
meal plans, do your best to stick to them and don't let setbacks derail
your overall efforts.
* Avoid dieting. Trying to diet can trigger more binge episodes, leading to a vicious cycle that's hard to break.
* Eat breakfast. Many people with binge-eating disorder skip
breakfast. But, if you eat breakfast, you may be less prone to eating
higher calorie meals later in the day.
* Don't stock up. Keep less food in your home than you normally do.
That may mean more-frequent trips to the grocery store, but it may also
take away the temptation and ability to binge eat.
* Get the right nutrients. Just because you may be eating a lot
during binges doesn't mean you're eating the kinds of food that supply
all of your essential nutrients. Talk to your doctor about vitamin and
mineral supplements.
* Stay connected. Don't isolate yourself from caring family members
and friends who want to see you get healthy. Understand that they have
your best interests at heart.
* Get active. Talk to your health care providers about what kind of
exercise is appropriate for you, especially if you have health problems
related to being overweight.

Alternative medicine

Although yoga has not yet been well studied as a treatment for people
with eating disorders, some research has found that yoga may be
beneficial as an additional treatment. It may help people with eating
disorders by increasing a sense of well-being and promoting relaxation.

Coping and support

When living with an eating disorder you may face an especially difficult
struggle to cope, since food is essential to survival. There's no
avoiding it — you have to deal with food on a daily basis. Having an
eating disorder and being overweight is a double whammy. Here are some
tips to help you cope:

* Ease up on yourself. Don't buy into your own self-criticism.
* Identify situations that may trigger destructive eating behavior
so that you can develop a plan of action to deal with them.
* Look for positive role models who can help lift your self-esteem,
even if they're not easy to find. Remind yourself that the ultrathin
models or actresses showcased in women's magazines or gossip magazines
often don't represent healthy, realistic bodies.
* Try to find a trusted confidant you can talk to about what's going
on. Together, you may be able to come up with some treatment options.
* Try to find someone who can be your partner in the battle against
binge eating — someone you can call on for support instead of bingeing.
* Find healthy ways to nurture yourself by doing something just for
fun or to relax, such as yoga, photography, meditation or simply a walk.
* Consider journaling about your feelings and behaviors. Journaling
can make you more aware of your feelings and actions, and how they're
intertwined.

Get Support
Some people find support groups helpful. Support group members can truly
understand what you're going through because they've been there
themselves. They can also offer encouragement, hope and advice on
coping. If you're interested in joining a support group, you can ask
your doctor if he or she knows if there's a group in your area, or you
can call the National Association of Anorexia Nervosa and Associated
Eating Disorders (ANAD) helpline at 630-577-1330. (This is not a free
phone call.) You can also find information on its Web site. Overeater's
Anonymous (OA) also offers support groups. You can contact OA through
its Web site, or by calling 505-891-2664. (This is not a free phone
call.)


Prevention

There's no sure way to prevent binge-eating disorder. But, if you notice
a family member or friend with low self-esteem, severe dieting,
frequent overeating, hoarding of food or dissatisfaction with
appearance, consider talking to him or her about these issues. Although
you may not be able to prevent binge-eating disorder or another eating
disorder from developing, you can talk about healthier behavior or
treatment options.