Medical Mondays 2Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, she reaches out to Megan Riddle, M.D./Ph.D—whose research has focused on the biological mechanisms of eating disorders—for answers to questions on binge eating. Dr. Riddle is a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program.

 

Dear Dr. Pat:

I am a 53-year-old woman, married, the mother of two great kids and a successful businesswoman. To outsiders, it must look as if I have my life together. Maybe I appear to have it all, but for a long time I have been struggling with my eating. I try to eat well and set a good example for my kids; we sit down to dinner at night as a family at least a few times a week, and we have lots of healthy food in the house. However, at night, after everyone has gone to bed, I can’t stop eating. It’s not every night—most nights I can keep myself to just a little snack before bed. But other times, I can down an entire carton of ice cream myself, or eat all the leftovers from dinner. It’s not always at night. Sometimes, when I’m driving home from work, I’ll stop by the doughnut shop, intending to get a treat for the family, but I end up getting a dozen doughnuts and eating them all myself. I feel terrible after I’ve eaten like this—uncomfortably full and completely disgusted by what I’ve just done. I always hide any evidence, taking out the trash at night or cleaning food boxes out of my car, so I don’t think my family has any idea.

My internist recently saw me; I am not overweight, but I worry that if this continues, I will be. I never make myself vomit afterwards, so I know I’m not bulimic, but is there something else going on with me? I feel so bad afterwards, you’d think I could just stop. Why do I do this?

Thank you,

Rebecca

 

Dr. Riddle Responds:

Dear Rebecca:

You are describing the classic signs of Binge Eating Disorder (BED), a newly recognized diagnosis that affects up to about 5 percent of women and about 2 percent of men. BED is more common than either anorexia nervosa or bulimia nervosa. As you describe, individuals dealing with BED have episodes of eating that feel out of control—they may eat rapidly, eat past the point of fullness, or eat large amounts of food despite not feeling hungry. Those feelings of shame and disgust are also hallmarks of this illness; individuals typically feel very distressed about the episodes of bingeing, often eating alone and hiding the episodes from loved ones. As you mention, while both bulimia nervosa and BED are characterized by bingeing, individuals with BED do not attempt to purge afterwards.

binge eatingYou don’t say how long you have been having this issue. BED has its peak of onset in the early 20s, and some people may cope with it for years without seeking treatment. However,  a recent study looking at eating disorders across the life-span suggests that around the time of menopause there is a second peak of onset of eating disorders. While those suffering from BED may be a healthy weight like you, it can lead to obesity and is more common amongst those who are overweight or obese. It is also associated with a number of medical issues, including high blood pressure, increased cholesterol levels, heart disease, diabetes, and gall bladder disease.

We don’t completely understand what causes BED. For many, food is a source of comfort, and finding solace in a bag of cookies after a rough day at work or argument with a family member can become a habit. However, what makes one person grab for an occasional extra bite of cake and another reach for the entire cake remains an interesting area of research, and it is likely a combination of genetic predisposition and environment. Some studies have suggested that bingeing may have a similar neurochemical pathway to those that are active in addictions to drugs or alcohol. Some studies have even shown that after bingeing on sugar, the “withdrawal” causes changes in brain chemistry similar to those seen when withdrawing from opiates. A recent study showed increased rates of eating-addictive behaviors in individuals who had undergone traumatic experiences resulting in post-traumatic stress disorder, supporting a hypothesis that overeating may be part of a maladaptive coping strategy – the idea of food as comfort taken to an unhealthy extreme.

The good news is the BED is treatable. You have taken a big step by expressing your concern and being willing to address the problem. Individuals with BED respond well to therapeutic approaches, specifically cognitive behavioral therapy (CBT). This form of CBT focuses on looking at the relationship between your thoughts, feelings, and behaviors surrounding food, and focusing on helping you establish healthier patterns in your life. For some, the addition of an antidepressant can also aid in recovery. For best results, look for a practitioner who has experience treating individuals with eating disorders. I’ve included links at the bottom of this article to help you find a specialist in your area; your primary care provider may also be able to provide a recommendation. Seeking treatment will help you reclaim control over your food.

Food should nourish the lives we want to live, not dictate the lives we lead.

—Megan Riddle, M.D., Ph.D.

Finding a treatment provider in your area

http://www.nationaleatingdisorders.org/seeking-and-securing-treatment
http://www.nedc.com.au/get-help
http://www.anad.org/eating-disorders-get-help/treatment-centers/

References

  1. National Association of Anorexia and Associated Disorders. Binge Eating Disorder. http://www.anad.org/get-information/about-eating-disorders/binge-eating-disorder/
  2. National Eating Disorder Association. Binge Eating Disorder. https://www.nationaleating disorders.org/binge-eating-disorder.
  3. Schreiber LR, Odlaug BL, Grant JE (2013): The overlap between binge eating disorder and substance use disorders: Diagnosis and neurobiology. Journal of Behavioral Addictions. 2:191-198.
  4. Selis S (2007): Binge Eating Disorder: Surprisingly Common, Seriously Under-treated. Psychiatric Times. http://www.psychiatrictimes.com/articles/binge-eating-disorder-surprisingly-common-seriously-under-treated
  5. Wilson GT (2011): Treatment of binge eating disorder. The Psychiatric Clinics of North America. 34:773-783.

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  • Peter October 24, 2014 at 6:12 pm

    I recommend mindfulness therapy for healing the core emotions, including shame that underlies binge eating and bulimia.

    Reply