NPR: Binge Eating Officially Defined As A Mental Disorder

The American Psychiatric Association is releasing a new draft of its book of mental disorders Wednesday. Often described as the bible of psychiatry, this new version of the Diagnostic and Statistical Manual of Mental Disorders proposes some significant changes to classification of bipolar disorder, Asperger's syndrome, "cutting" — and binge eating.


Experts from the APA say there's now enough evidence to call binge eating a mental disorder, adding it to the group of eating disorders that includes anorexia and bulimia.

Reworking The Book Of Mental Disorders

When clinicians see a patient with mental health issues, part of their job is to determine if the patient is experiencing temporary emotional struggles or if the patient has an illness. To do this, doctors rely on the bible of psychiatry, a book called the Diagnostic and Statistical Manual of Mental Disorders. The DSM lists all the mental disorders recognized by the American Psychiatric Association.

The book is also used by insurance companies to decide which treatments they'll pay for, and by courts to help determine insanity or other mental conditions.

The APA is releasing a new draft of the DSM Wednesday, the first major revision since 1994. This latest version of the book, the DSM-V, proposes some significant changes to the following disorders:

Bipolar Disorder

Asperger's Syndrome

"Cutting"

Binge eating is defined as eating large amounts of food when you're not hungry and then feeling disgusted and depressed afterward. But most people do this from time to time. It's the frequency of a person's binge eating — and the depth of the anguish he or she feels — that raises flags.

Previously the DSM had listed binge eating in the manual's appendix, as a tentative category. Research that has come out since the last major revisions to the DSM 15 years ago justifies the classification of binge eating as a disorder in its own right, says Dr. B. Timothy Walsh, a psychiatry professor at Columbia University Medical Center and chairman of the eating disorders work group for this version of the DSM.

Some doctors treated binge eating with therapy or with medication even before it was recognized as a disorder. In some cases, a binge eater's treatment included a weight-loss regime that basically ignored the psychological aspect of the disorder.

"We're not talking intermittent overeating — that is normal — but this is recurrent, persistent, frequently occurring, accompanied by lots of distress, guilt and unhappiness," Walsh says. "We do have data that this affects a small percentage — 2 to 5 percent — of Americans throughout their lifetime."
Researchers and doctors still don't really know what causes these issues, he says, and various factors appear to contribute.

"There's no consensus as to what is the best treatment," Walsh says. "Several types of medications appear helpful, as do several types of psychological treatment."

Binge eating is associated with middle-aged men and women, and it is not always linked with obesity. That's why treatments that address weight loss alone aren't necessarily helpful, Walsh says. He is hopeful that the categorization of binge eating as a disorder will stimulate further research. In particular, he says, he'd like to see some study of how mental health treatments for binge eating affect a patient's outcome.

Treatments for Binge Eating: New Trials Give Reason for Hope

The new and improved versions of Cognitive Behavioral Therapy (CBT) are Transdiagnostic CBT and Dialectical Behavior Therapy (DBT). Until recently, Cognitive Behavioral Therapy (CBT) has been considered the most effective treatment in helping binge eaters overcome their eating disorders.


According to the Mayo Clinic, CBT is “…a type of talk therapy…[CBT] helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones….based on the idea that your own thoughts — not other people or situations — determine how you behave.”

A study of Transdiagnostic CBT was published in The American Journal of Psychiatry in 2008 and was conducted by Christopher G. Fairburn, D.M., F. Med. Sci. and his colleagues. The study states, “Despite its [EDNOS] prevalence, there have been no studies of the treatment of ‘eating disorder not otherwise specified (EDNOS).’” This is unbelievable that there have been absolutely NO studies that include EDNOS: binge eating falls into this category as I reported in my last piece. So now we’re getting somewhere.

In the study, two different types of CBT were administered to adult outpatients. In fact, Psychotherapybrownbag.com’s Joye C Anestis, M. S., looked into this study and explains the two types of CBT. One was, she writes “a form [of CBT] which focuses exclusively on the eating disorder and [the other] a broad form which addresses….self-esteem, perfectionism, interpersonal problems and mood intolerance.”

The doctors determined that “both Transdiagnostic treatments appear to be suitable for the majority of out-patients with an eating disorder.” More study needs to be done, but that binge eating patients were included for the first time in a trial is a start. That should have happened long ago.

Moreover, the other form of CBT, Dialectical Behavior Therapy, Michael D Anestis, M.S. also of psychotherapybrownbag.com claims, “Is the most fulfilling approach to therapy in which I have been trained. I cherish the experiences I’ve had co-leading skills groups.”

A study just published in “Eating Disorders: The Journal of Treatment and Prevention” Michael Anestis explained that “…protocol was referred to as DBT-informed.” It consisted of, “twice weekly DBT skills training… weekly group sessions involving motivation and commitment, goal setting, and behavioral chain analysis….daily diary cards…weekly yoga and a ‘DBT-in-action’ group that promoted the practice of DBT skills…. taught clients healthy eating practices.”


DBT skills include mindfulness training. I could use more practice being mindful and calm and many of the other skills taught in this trial.

Again, Michael Anestis concluded that “Although more research on the use of DBT in eating disorders in general and BN and BED in particular is necessary, all of the research to date supports this approach as an efficacious treatment.”

Alleluia!

Binge Eating: Why an Official Diagnosis Is Crucial

“A half-gallon of ice cream was only the beginning. I was capable of consuming 3,000 calories at a sitting. Many mornings I awakened to find partly chewed food still in my mouth….My despair was profound, and one night in the midst of a binge I became suicidal. I had lost control of my eating; it was controlling me, and I couldn’t go on living that way.” Reporter Jane Brody described her binge eating experience in an article for The New York Times.

According to National Institute of Mental Health, binge eating affects from 2 to 5 percent of the population, more than anorexia and bulimia combined. Yet it does not have a formal diagnosis. How can the medical community find treatments for binge eating if it is not elevated to at least the status of a disorder?

In fact, in an article written by Melissa Healy in latimes.com, the author of “Crave: Why You Binge Eat and How to Stop,” researcher and eating disorder specialist, Cynthia Bulik Ph.D., claimed the medical community won’t produce the studies to discover the genetic components of binge eating and therapy won’t be covered if we don’t have a firm definition of binge eating. Definitions are serious business in the medical world.

Even though, it is not officially considered a disorder there is a Binge Eating Disorder Association (BEDA). On their website, bedaonline.com, they list binge eating as one of the leading causes of obesity with a plethora of complications including type 2 diabetes, high blood pressure, high blood cholesterol, gallbladder disease, heart disease, certain types of cancer, osteoarthritis, joint and muscle pain, gastrointestinal problems, depression, anxiety and sleep apnea.

Sounds serious, but in the Diagnostic and Statistical Manual of Mental Disorders (DSM), binge eating is now listed as an eating disorder not otherwise specified (EDNOS).

Furthermore, Michael D Anestis, M.S of psychotherapybrownbag.com writes that “…between 50 to 70 percent of eating disorder diagnoses are EDNOS.”  Explaining why this is a bad idea he said, “…knowing that somebody has EDNOS tells us very little about… what symptoms are causing them distress and/or impairment.” However, Anestis states “… this diagnosis [EDNOS] is…what we are most likely to see listed in the case file.”


Just imagine, you’ve spent the night binging. You feel like you’re going to die so you call 911. By the time the EMTs arrive you’ve passed out. They rush you to the Emergency Room of your hospital and when the ER doctor opens your medical file, he sees the diagnosis of “eating disorder not otherwise specified.” What does that tell the doctor and how will the doctor begin to know how to effectively treat you?

According to Anestis there is hope. Several researchers are working to group together eating disorders with similar symptoms so that there will be less EDNOS diagnoses and a clearer explanation of what the patient is actually suffering from.

Hopefully, placing larger numbers of patients in official eating disorder categories may prompt additional financial coverage and, as importantly, the further studies needed to find effective treatments for the victims who suffer from eating disorders.

http://www.nytimes.com/2007/02/20/health/20brod.html
http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-dis...
http://www.bedaonline.com/aboutBED.html
http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/11/e...

Ask The Expert: Week 4

Each Friday, I will post a question answered by Dr. Kathryn J. Zerbe. The questions are part of an on-going coversation with Dr. Zerbe from the New York Times.

NY Times Bio
Dr. Zerbe is the author of “The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment” (Gurze Books, 1993) and “Integrated Treatment of Eating Disorders: Beyond the Body Betrayed” (Norton, 2008). She has had 25 years of experience working with individuals with eating disorders and directed the Eating Disorder Unit at the Menninger Clinic for five years. She also served on the American Psychiatric Association’s Work Group on Eating Disorders in 2000 and 2006.


Week Four
(Edited to correct typos/spelling in original question)

There is so little focus in our society given to binge-eating. General sentiment seems to be, “go on a diet.” Yet there are some people who’s eating disorders actually manifest themselves via binging and not purging.

Do you think this is changing/will change? Also, are there treatment programs for this? I’ve looked at a couple of web sites, but binge eating seems to be regarded as sort of an “also ran” alongside anorexia and bulimia.

Thanks for your input.

Dr. Zerbe responds:
You are certainly correct that binge eating disorder gets less attention than anorexia or bulimia, but we are learning much more about it because research is starting to focus on it a lot. Doctors are using some medications for it, such as fluoxetine (Prozac), but cognitive-behavioral therapy also can help people who suffer learn coping skills that help them avoid binging.

I certainly agree with you that “going on a diet” is not the answer. One needs to learn what might be causing the person to binge in certain circumstances and to find ways to deal with food that is “all around us” in the modern world. Many people turn to food in times of stress because in our modern society it is so readily available (think of the fast food restaurant down the street or the multitude of snacks and candies in your local grocery store) and how relatively inexpensive food is compared to 50 years ago.

We also tend to eat alone a lot more than in the past (snacking by the computer; having lunch at our desks), so we learn to eat faster and without thinking or talking to anybody. Family mealtimes slow our eating down, and we get psychological nurturance when talking with our loved ones, but so many times nowadays this just doesn’t seem to happen as often as it might.

One concrete suggestion I have for the binge eater is to never get too hungry. Try to eat protein at every meal and always have some low calorie snacks available, especially in the car or at times when you might be tempted to binge. Then, begin to look at the triggers that might cause you to binge. Journal about them, and if at all possible, seek out a professional with experience in eating disorders to discuss them with. You might also consider looking for a helpful book about binge eating that fits your needs by going to the Gurze Books Web site on Eating Disorders at http://www.gurze.com.