Fundamentals of Human Nutrition/Binge Eating Disorder

As defined by the Mayo Clinic, binge-eating disorder is a serious condition in which a person frequently compulsively overeats and feels powerless and unable to stop eating. Binge-Eating Disorder (B.E.D) cannot be self-diagnosed and people who think they have B.E.D should see a health care provider who can diagnose this medical condition when the specific criteria are met Persons that fit this criterion are often embarrassed about their overeating but are unfortunately unable to resist the urges to eat and continue on a pattern of overeating.

Out of all eating disorders that adults can suffer from, Binge Eating Disorder is the most prevalent. According to a national survey, B.E.D has an effect on 2.8 million adults, which makes it more prevalent in young adults than both bulimia and anorexia combined. While this disorder affects both men and women, women are two times more affect than men by B.E.D (What is binge eating disorder, 2015). B.E.D also does not discriminate based on race. Binge Eating Disorder is and often is associated with illnesses that are linked to obesity, poor quality of life, eating disorder psychopathology, and poor functioning in society (Turan, Poyraz & Özdemir, 2015). This condition is also found to be linked to suicidal ideation and associated with other eating disorders (Lipsky & McGuinness, 2015).

The DSM-5 defines binge eating episodes as fitting along with at least three of these descriptions (APA, 2013):

•	Eating more quickly than what is considered normal

•	Eating until one feels extremely full to the point that it is uncomfortable

•	Eating a large amount even when not feeling physically hungry

•	Eating alone due to embarrassment about the amount of food that one is consuming

•	Experiencing feelings of disgust with themselves, depression, or guilt after eating

In addition to meeting that criteria, the DSM-5 states that in order for to be diagnosed with Binge Eating Disorder, one must have frequent and persistent episodes of binge eating, experience stress in regards to binge eating, and have the absence of behaviors that are compensatory, like purging, for example. Frequent binge eating episodes are defined as once per week for three consecutive months.

What is Binge Eating Disorder?
Binge eating disorder is a mental health condition consisting of extensive episodes of compulsive eating. Binges can be characterized by rapidly eating large quantities of food periodically, while being unable to stop oneself due to loss of control or feelings of numbness. Individuals may binge on and off all day, however, one episode could last up to two hours.Many people with B.E.D eat when they are not hungry and continue to eat for a long time way after they feel full. Binges allow a person to feel comfort for a brief period of time, until they come back to reality with social stigmas, which create feelings of regret and distress. In addition, people suffering from compulsive eating often eat alone or in secret. Although BED is severe and life threatening, it is treatable with the proper help.

The History of Binge Eating Disorder

Binge Eating Disorder (BED) was not considered a psychiatric disorder until recent years. The first record of any BED episode was recorded by psychiatrist Albert Stunkard in 1959. At this time the disorder was coined for eating during the night. Twenty-eight years later in 1987, the American Psychiatric Association (APA) associated binge eating with the already-known eating disorder, Bulimia. The APA mentioned binge eating in its Diagnostic and Statistical Manual of Mental Disorders (DSM). This is an important step in defining the disorder because people were then able to obtain medical treatment for the condition. In 1994 the APA increased awareness for BED by listing “binge eating” in the appendix of the DSM-4 under “eating disorder not otherwise specified.” As binge eating disorder rapidly became recognized as a psychiatric illness, a nonprofit called Binge Eating Disorder Association was started in 2008. This organization took a stand as a support group for people struggling with BED while running several events and a conference every year. In 2013 the APA gave BED its own section under eating disorders in the DSM-5. This is an important step as insurance plans could now cover treatment for BED. In January 2015, drug treatment for BED was approved by the Food and Drug Administration. Lisdexamfetamine dimesylate (Vyvanse) is the drug to be used. Studies performed by the Journal of the American Medical Association showed that 50 to 70 milligrams was an appropriate dosage.

Risk Factors
•	Family history

•	Psychological issues- negative feelings about skills and accomplishments for oneself. Triggers can include stress, poor body self image, food and boredom

•	Dieting

•	Age- binge eating disorder often begins in the late teens or early twenties (although can occur at any age)

•	Biological abnormalities- o	The hypothalamus, which is the part in the brain that is responsible for controlling appetite) may not be sending correct messages back to the body about hunger and fullness o	Genetic mutation o	Low levels of serotonin (Smith, Segal & Segal 2016)

Characteristics of Binge-Eating Disorder
Binge-eating disorder can be associated with physical, emotional, and behavioral characteristics that make identifying a subject of the disorder more clearly.

Physical characteristics include:
 * Variation of body weight. Weight can fluctuate from normal to mild, then from mild to overweight, then from overweight to obese.
 * Weight gain is not always associated with binge-eating disorder. There is an elevated correspondence between those who binge and the characteristic of being overweight however, not everyone with binge-eating disorder is overweight.

Emotional characteristics include: •One of the biggest causes of binge eating disorder, is the inability to manage ones emotions, especially negative emotions like stress or depression
 * Dissatisfaction with one’s body image or body size. This can sometimes be traced back to the subject being the subject of bullying in childhood due to their body size or a specific characteristic regarding their physical appearance.
 * Dissatisfaction with one’s body image or body size. This can sometimes be traced back to the subject being the subject of bullying in childhood due to their body size or a specific characteristic regarding their physical appearance.
 * Depression is a common occurrence and cause of those who experience the impulse to binge.
 * Common among binge-eating disorder and many other eating disorders is the need to be in control and a desire for perfectionism.

Behavioral characteristics include:
 * Binge-eaters are often very secretive when it comes time for them to binge. They often eat in places where they will not be found or seen such as eating alone or in their car. In an effort to be secretive, these subjects tend to hide food wrappers or empty containers that held their food. They will also hide or hoard food for later use.
 * Binge-eaters do not exhibit normal eating patterns. They will often skip meals, engage in repetitive dieting or fasting, not planning meals but rather eating constantly throughout the day, and sometimes will only eat a certain food group for an extended period of time. If they do eat in front of other, they will eat normally and then later binge later when they are by themselves
 * They often create scheduled times throughout their day to allow for themselves to binge-eat.
 * Eating way beyond the point of feeling uncomfortably full. These periods of eating are usually impulse driven, uncontrolled, and continuous.
 * Will not purge following a binge-eating session.

Characteristics of Binge-Eating Disorder: National Eating Disorders Association. Retrieved November 14, 2015, from https://www.nationaleatingdisorders.org/binge-eating-disorder

Binge Eating Disorder affects 3.5% of adult women, 2% of adult men, and 1.6% of children and adolescents (Marx, 2013). This disorder usually affects women in their early adult life, while men will be affected mostly in the middle of their life. Two- thirds of people that have binge eating disorder are obese, as well, which causes them to suffer from other medical problems, as a result (Marx, 2013).

Physical and Psychological Effects
Physical Effects

Physical effects of binge eating disorder can be both short term and long term. Although individuals who are obese do not have binge eating disorder, those struggling with binge eating disorder can become obese or heavier than their average weight. However, most physical health risks for binge eating disorder are associated with clinical obesity. This includes high blood pressure, high cholesterol levels, cardiovascular disease, type II diabetes, gall bladder disease, fatigue, joint pain (knees and hips), and sleep apnea (breathing that stops many times during the night).

The health risks that result from binge eating disorder, like high blood pressure and high cholesterol levels, can result in even greater physical issues that can eventually lead to traumatic events such as a heart attack or stroke. It is so important to deal with Binge Eating Disorder early on to prevent these serious effects from taking place.

Psychological Effects

While many physical and psychological effects of binge eating disorder can go hand-in-hand, many psychological effects are a domino effect of one another. Effects of compulsive eating include feelings of distress, shame and guilt. Compared to individuals who do not have binge eating disorder, those suffering report a lower quality of life, and increased levels of anxiety and depression throughout their life. Overwhelming feelings of stress or tension may arise and can only be relieved by eating. Consequently, individuals may possess embarrassment over the amount one eats, lacking satisfaction despite the amount of food previously consumed, along with guilt, disgust and or depression. These psychological effects can also cause social conflicts such as significant desperation to control eating habits and body weight, loneliness and isolation. The more social conflicts individuals experience such as loneliness, guilt and isolation, the greater the chances are of continuing to binge and the lower the changes are of stopping.

Treatment
Along with therapy for binge eating disorder, it is also important to set goals and make some lifestyle changes in order to overcome the desire to binge. Some important things to learn are how to manage stress, exercise, get sufficient amount of sleep each night, and refrain from dieting. Exercise is important because exercise can help to improve your self-body image and it can always be a good outlet to relieve stress. Meal planning plays a crucial role in BED treatment because it allots specific times to eat. This includes three meals a day (breakfast, lunch, and dinner) and healthy snacks sporadically throughout the day. Aside from meal planning, it is beneficial to monitor the types of food that is found within an individual’s home. Instead of purchasing junk food and candy, which are tempting foods to binge on, recovering individuals should choose healthy foods in their homes. Individuals battling B.E.D should also find ways to overcome their boredom Instead of going to food when they have nothing to do, having a plan and other activities can stop those who binge eat when they are bored. It is also very important to understand your body and know the difference between emotional and physical hunger. Physical hunger is when your body needs food in order to support activities within the body and emotional hunger is when people look for food to temporarily solve their problems (Smith, Segal & Segal 2016). Professional help can come from therapists, who can help in a number of ways including cognitive-behavioral, interpersonal, and dialectical behavior therapy.

Not only can altering one’s diet and eating habits treat Binge Eating Disorder, but there are additional ways to handle this disorder, as well. Binge Eating Disorder has been treated using medications or pharmacotherapy. For example, they have treated this disorder using drugs that also treat attention deficit hyperactivity disorder (ADHD). This disorder can also be treated using psychotherapy, which can come in the form of cognitive behavioral therapy and interpersonal therapy (Marx, 2013). It has been treated through surgery to the stomach or intestines, in order to help with weight loss (Turan, Poyraz & Özdemir, 2015).

How to Help Someone With Binge-Eating Disorder
One of the first steps in helping someone with this disorder is voicing your concern of their problem to them. It is quite common for a subject of Binge-Eating Disorder to become defensive, angry, or deny the issue when confronted and it may take time for them to open up to discuss their struggles with food (Smith, 2015). Encouraging them to seek help can show that you are there for support and that there are other people out there who can help cure B.E.D.

Do not give up on the person you are trying to help. Defensive actions often mean they are having trouble admitting they have a problem. Be aware of signs or habits that the person struggling with BED is returning to their old ways such as empty food containers, wrappers, cabinets, refrigerators, and any hidden stashes of food they are likely to binge on. If the person does, assure them that it is okay and recovery is possible. Binge eaters are already struggling with shame and guilt, so avoid lecturing them about any setbacks that may occur. Always provide supportive words and supportive actions even if they take a step back in their progress. Try to keep nutritious foods in the house and not unhealthy snacks that will tempt bingeing and remind them of old habits. Adapt a healthy lifestyle yourself including the right foods and frequent exercise to set a positive example for the person struggling with BED. Do not hesitate to seek counseling from a professional for yourself as helping someone with any psychiatric disorder can give rise to stress and requires a grounded mindset.