Is Binge Eating a Mental Disorder? – An Insight

In the last 3 decades or more, there is increasing awareness around eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder.

Worldwide, an average of 0.9% of people suffers from binge eating disorder or BED, with the figures being 1.4% in women alone. Unlike the past, when BED was regarded as a behavioral anomaly, it is increasingly regarded as a serious and genuine psychological disorder. BED is not a problem for the rich or poor. It can affect people of all genders, classes, age groups, races, ethnic origins, body shapes or sizes, weights, sexual orientations, educational qualifications, and professional backgrounds.

In the 5^th edition of the Diagnostic and Statistical Manual of  Mental Disorders published by The American Psychiatric Association, BED has been listed as a treatable psychological disorder. The National Eating Disorders Association (NEDA) in the US conducts research on this ailment, while the Binge Eating Disorder Association (BEDA) offers counselling to patients. So let’s understand this disorder in depth.

Symptoms

While everybody likes to overeat once in a while when the food is delicious or it’s a special occasion (like a festival), BED is a lot more than that. People suffering from BED display the following behaviors:

• Eating hurriedly, or faster than normal, and gulping food
• Eating more than a normal amount and till the person is uncomfortably full
• Eating even when the person is not hungry
• Eating alone so that no one can see or know how much food the person has had
• Feeling ashamed, guilty, embarrassed, disgusted, or depressed about eating this way
• Avoiding questions about weight and eating
• Hiding food, shoplifting food, hoarding food
• Spending large amounts of money on food
• A new-found interest in cooking
• Being anti-social or withdrawn, preferring to be alone
• Substance abuse attempts to harm oneself, or even suicide

Causes and Risk Factors

What causes BED is not known exactly, but there are some risk factors:

• Genes: People with BED may be unusually sensitive to dopamine, a chemical in the brain that regulates feelings of reward and pleasure. Scientists have found evidence that the disorder may be inherited.
• Brain structure: People who have undergone changes to the structure of the brain may show an extreme response to food and less self-control about it
• Obesity: As much as 50% of people with BED are obese or overweight. In fact, people seeking weight-loss surgery are screened for BED.

• Self-image: Dissatisfaction or negative image around one’s body shape or size may cause low self-esteem and trigger BED eventually.
• History: Adults with BED may have shown symptoms of BED in their childhood or adolescent years.
• Emotional distress: Stressful or unhappy incidents such as abuse or bullying in childhood, death or separation from a family member, accidents, and injuries can trigger BED over time.
• Psychological ailments: In as much as 80% of the cases, people with BED also have one or more psychological disorders such as bipolar disorder, anxiety, substance abuse, depression, phobia, and post-traumatic stress disorder (PTSD).

Consequences and Complications

If BED is not treated on time, the person can suffer from one or more of these:

• Obesity: While obesity is one of the causes for BED, it’s one of the consequences in most patients. Unlike bulimia, where the person eats and throws up to eat again, people with BED do not throw up. They keep eating till they are uncomfortably full. This results in obesity over time.
• As a natural outcome of obesity, there is an increased risk of developing type-2 diabetes, hypertension, heart disease, cancer, stroke, etc
• Chronic pain under existing ailments
• Worsening asthma
• Sleep problems
• Polycystic ovarian syndrome (PCOS) in women
• Irritable bowel syndrome
• Fertility issues in women
• Complications during pregnancy
• Arthritis and joint pain
• Muscle pain
• Digestive issues
• Irregular menstruation in women
• Reduced quality of life as a result of all the above

Diagnosis

The first step to treating binge eating disorder is to stop feeling ashamed or guilty about it. It’s not about will-power or fighting with oneself to suppress the condition. It’s not a choice made by the person and is a serious, biologically influenced disease. It can disrupt one’s social, professional, and personal lives. It increases the risk of medical complications and suicide. While these were the grim facts, the good news is that BED is completely curable. Over the years, many drugs and therapies have emerged that successfully treat BED, even as research continues on new options.

To seek treatment, it is evaluated using psychometric tools administered by qualified professionals.

BED treatment is quite advanced and involves specialists such as a psychiatrist, a psychologist, a family therapist, a nutritionist/dietitian, and a social worker. The doctor may also order a blood and urine test to check for other ailments, general physical examination, and consultation or therapy at a sleep disorder center.

Treatment Options

• Cognitive behavioural therapy: One of the most effective and popular options, CBT, involves analysis of the person’s thoughts, behaviours, emotions, and feelings around body image, self-esteem, body shape, weight, etc. The therapist will set goals, and the person must monitor the same till the correct weight and eating patterns are established.
• Interpersonal psychotherapy: This treats BED caused by hidden or suppressed grief about a death, disability, separation, or any other social issue. The therapy aims at acknowledging the emotion and overcoming it over several counselling sessions.
• Dialectical behavioural therapy: This treats BED that arises out of an impulse reaction to negative emotions such as anger, hurt, bitterness, elation, anxiety, hate, and stress due to familial, professional, or health issues. The therapy provides remedies to handle the negative emotion without choosing binge eating as an outlet.
• Weight-loss therapy: Given that obesity can be cause, consequence, or both for the BED, it’s important that the person loses weight. As the person loses more and more weight, his/her self-image improves, and this provides the psychological boost required to stop binging. The weight-loss treatment is holistic and includes exercise, dietary, and lifestyle changes.
• Medication: Various drugs are prescribed that address the physical or psychological condition that is triggering the BED. Anti-depressants are given to reduce depression and anxiety; topiramate, an anti-epileptic drug helps curb the desire to binge, while lisdexamfetamine that is used to treat hyperactive disorders also helps suppresses the urge.
• Relaxation techniques such as meditation, yoga, massage therapy, exercise, and indulging in a hobby are recommended as they bring down anxiety and the urge to binge besides keeping the person calm.
• A nutritionist will design the diet, which will help prevent or manage type-2 diabetes and cholesterol issues.

In addition to the above, the doctors will teach the patient some tips and tricks to overcome binging.

Outlook

Binge eating disorder is not a behavioral or discipline issue. As the name implies, it’s a recognized medical condition with serious implications if left untreated. However, the good news is that it’s completely curable.

If you or any of your dear ones are diagnosed with BED, do not panic. Consult a reputed hospital. They will diagnose your condition precisely, along with checking every aspect of your health. Thereafter, the right treatment will be provided that will put you on a path of quick recovery and rehabilitation.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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