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"Compulsive Overeating"
by
Sandy
Copyright 2002-2004 by Nikicj5/Medical Madness Newsletters@
Definition
A compulsive overeater (binge eater) is an individual who compulsively
eats but does not purge and usually becomes overweight. The overeater may
eat three meals a day plus frequent snacks. He or she may overeat
continually throughout the day, rather than consume large amounts of food
during binges.
How Does Someone Know if He or She Has Binge Eating Disorder?
Most of us overeat from time to time, and many people often feel they've
eaten more than they should have. Eating a lot of food does not always
mean that a person has binge eating disorder.
Doctors generally agree that most people with serious binge eating
problems often:
•
Feel their eating is out of control
•
Eat what most people would think is an unusually large amount of food
•
Eat much more quickly than usual during binge episodes
•
Eat until so full they are uncomfortable
•
Eat large amounts of food, even when they are not really hungry
•
Eat alone because they are embarrassed about the amount of food they eat
•
Feel disgusted, depressed, or guilty after overeating
Binge eating also takes place in another eating disorder called bulimia
nervosa.
Persons with bulimia nervosa, however, usually purge, fast, or do
strenuous exercise after they binge eat. Purging means vomiting or using a
lot of diuretics (water pills) or laxatives to keep from gaining weight.
Fasting is not eating for at least 24 hours. Strenuous exercise, in this
case, means exercising for more than an hour just to keep from gaining
weight after binge eating. Purging, fasting, and over exercising are
dangerous ways to try to control your weight.
Binge eating disorder is probably the most common eating disorder.
Most people with this problem are either overweight or obese, but
normal-weight people also can have the disorder. (The 1998 NIH Clinical
Guidelines on the Identification, Evaluation, and Treatment of Overweight
and Obesity in
Adults define overweight as a body mass index (BMI) of 25 to 29.9 and
obesity as a BMI of 30 or more.
BMI is calculated by dividing weight (in kilograms) by height (in meters)
squared.)
About 2 percent of all adults in the United States (as many as 4
million Americans) have binge eating disorder. About 10 to 15 percent of
people who are mildly obese and who try to lose weight on their own or
through commercial weight-loss programs have binge eating disorder. The
disorder is even more common in people who are severely obese.
Binge eating disorder is a little more common in women than in men;
three women for every two men have it. The disorder affects blacks as
often as whites. No one knows how often it affects people in other ethnic
groups.
People who are obese and have binge eating disorder often became
overweight at a younger age than those without the disorder. They might
also lose and gain back weight (yo-yo diet) more often.
Side Effects
Most people with binge eating disorder have tried to control it on
their own, but have not been able to control it for very long. Some people
miss work, school, or social activities to binge eat.
Persons who are obese with binge eating disorder often feel bad about
themselves and may avoid social gatherings.
Most people who binge eat, whether they are obese or not, feel ashamed
and try to hide their problem. Often they become so good at hiding it that
even close friends and family members don't know they binge eat.
Health Hazards
People with binge eating disorder can get sick because they may not be
getting the right nutrients. They usually eat large amounts of fats and
sugars, which don't have a lot of vitamins or minerals.
People with binge eating disorder are usually very upset by their binge
eating and may become very depressed.
People who are obese and also have binge eating disorder are at risk
for:
*Diabetes
*High blood pressure
*High blood cholesterol levels
*Gallbladder disease
*Heart disease
*Certain types of cancer
People who are not overweight should avoid dieting because it sometimes
makes their binge eating worse. Dieting here means skipping meals, not
eating enough food each day, or avoiding certain kinds of food (such as
carbohydrates). These are unhealthy ways to try to change your body shape
and weight. Many people with binge eating disorder have health problems
because of their weight. These people should try to lose weight and keep
it off. People with binge eating disorder who are obese may find it harder
to stay in a weight-loss program. They also may lose less weight than
other people, and may regain weight more quickly. (This can be worse when
they also have problems like depression, trouble controlling their
behavior, and problems dealing with other people.) These people may need
treatment for binge eating disorder before they try to lose weight.
Symptoms
Symptoms of binge-eating disorder include:
Recurrent episodes of binge eating, characterized by eating an excessive
amount of food within a discrete period of time and by a lack of control
over eating during the episode.
The binge-eating episodes are associated with at least 3 of the following:
eating much more rapidly than normal;
eating until feeling uncomfortably full;
eating large amounts of food when not feeling physically hungry;
eating alone because of being embarrassed by how much one is eating;
feeling disgusted with oneself, depressed, or very guilty after
overeating.
Marked distress about the binge-eating behavior.
Binge eating occurs, on average, at least 2 days a week for 6 months.
Binge eating is not associated with the regular use of inappropriate
compensatory behaviors (e.g., purging, fasting, excessive exercise)
People with binge-eating disorder experience frequent episodes of
out-of-control eating, with the same binge-eating symptoms as those with
bulimia.
The main difference is that individuals with binge-eating disorder do not
purge their bodies of excess calories.
Therefore, many with the disorder are overweight for their age and height.
Feelings of self-disgust and shame associated with this illness can lead
to bingeing again, creating a cycle of binge eating.
Causes
No one knows for sure what causes binge eating disorder.
As many as half of all people with binge eating disorder have been
depressed in the past.
Whether depression causes binge eating disorder or whether binge eating
disorder causes depression is not known.
Many people who are binge eaters say that being angry, sad, bored, or
worried can cause them to binge eat. Impulsive behavior (acting quickly
without thinking) and certain other emotional problems can be more common
in people with binge eating disorder.
It is also unclear if dieting and binge eating are related. Some
studies show that about half of all people with binge eating disorder had
binge episodes before they started to diet.
Researchers also are looking into how brain chemicals and metabolism
(the way the body uses calories) affect binge eating disorder. This
research is still in the early stages.
Treatment
People with binge eating disorder, whether or not they want to lose
weight, should get help from a health professional such as a psychiatrist,
psychologist, or clinical social worker for their eating behavior. Even
those who are not overweight are usually upset by their binge eating, and
treatment can help them. There are several different ways to treat binge
eating disorder. Cognitive-behavioral therapy teaches people how to keep
track of their eating and change their unhealthy eating habits. It also
teaches them how to change the way they act in tough situations.
Interpersonal psychotherapy helps people look at their relationships with
friends and family and make changes in problem areas. Drug therapy, such
as antidepressants, may be helpful for some people.
Researchers are still trying to find the treatment that is the most
helpful in controlling binge eating disorder. The methods mentioned here
seem to be equally helpful. For people who are overweight, a weight-loss
program that also offers treatment for eating disorders might be the best
choice.
The treatment goals and strategies for binge-eating disorder are similar
to those for bulimia, and studies are currently evaluating the
effectiveness of various interventions. The primary goal of treatment for
bulimia is to reduce or eliminate binge eating and purging behavior. To
this end, nutritional rehabilitation, psychosocial intervention, and
medication management strategies are often employed. Establishment of a
pattern of regular, non-binge meals, improvement of attitudes related to
the eating disorder,
encouragement of healthy but not excessive exercise, and resolution of
co-occurring conditions such as mood or anxiety disorders are among the
specific aims of these strategies. Individual psychotherapy (especially
cognitive-behavioral or interpersonal psychotherapy), group psychotherapy
that uses a cognitive-behavioral approach, and family or marital therapy
have been reported to be effective. Psychotropic medications, primarily
antidepressants such as the selective serotonin reuptake inhibitors (SSRIs),
have been found helpful for people with bulimia, particularly those with
significant symptoms of depression or anxiety, or those who have not
responded adequately to psychosocial treatment alone. These medications
also may help prevent relapse.
People with eating disorders often do not recognize or admit that they are
ill. As a result, they may strongly resist getting and staying in
treatment. Family members or other trusted individuals can be helpful in
ensuring that the person with an eating disorder receives needed care and
rehabilitation. For some people, treatment may be long term.
If you think you might have binge eating disorder, it's important to know
that you are not alone.
Most people who have the disorder have tried but failed to control it on
their own. You may want to get professional help. Talk to your health care
provider about the type of help that may be best. The good news is that
most people do well in treatment and can overcome binge eating.
Treatment can save the life of someone with an eating disorder. Friends,
relatives, teachers, therapists, dietitians, peer support groups and
physicians all play an important role in helping the ill person start and
stay with a treatment program. Encouragement, caring, and persistence, as
well as information about eating disorders and their dangers, may be
needed to convince the ill person to get help, stick with treatment, or
try again.
Psychology Today Magazine © Copyright 1991-2004 Sussex Publishers
~~~~~~~~~~~~~~~~~~~~~~~~~
PORTRAIT OF A BINGE EATER
Shifting Symptom
Pathology marches on. The disturbance in body image that characterizes
anorexia nervosa is changing shape. Where once patients' claims of feeling
fat even when emaciated were typical, patients today are more apt to deny
the seriousness of their low body weight or to put "undue influence" on
body shape and weight in evaluating themselves.
What's more, the disorder has evolved into two distinct subtypes. There
are those anorexics whose pursuit of thinness is so singular can restrict
food intake all the way. And there are now those who break out in
recurrent episodes of binge eating.
Such is the lot of America's psychologists and psychiatrists that every
few years they must round up the latest manifestations of disorder and
update the details of dysfunction. With any luck, the diagnostic bible of
the mental health professions, Diagnostic and Statistical Manual (DSM
III), now in a revised third edition, will reflect the shifting symptoms
of eating disorders in a fourth edition due out later next year.
The topic of binge eating, too, is due for an overhaul. If today's
observers have anything to say about it, they will restrict the definition
of bulimia nervosa to only those who follow their binges with purges,
either by vomiting or laxative use. It's getting harder and harder to find
anyone who compensates for bingeing solely by restricting food intake. But
whether in anorexia or bulimia, purgers have more pathology, the DSM's
Eating Disorders Work Group reports in the Journal of Abnormal Psychology.
And there's no way to tell a binge eater simply by looking at their body
weight. Bingers, it now appears, come in all shapes and sizes; some purge
and some don't. Obese bingers, says the Work Group, are the hardest of all
eating-disorder patients to treat.
But all are alike in one highly unhappy way. They are all most likely to
evaluate themselves by a single dimension only: Body shape
~~~~~~~~~~~~~~~~~~~~~~~
NIGHT EATERS
Light may be a deterrent to binge eating, so long as it's not the
fluorescent glow of the fridge. People are more apt to give in to food
cravings in dimly lit surroundings because they feel uninhibited,
according to Joseph Kasof, Ph.D., research associate at the University of
California at Irvine. Kasof's survey of 401 undergraduates built upon
earlier studies associating binge eating with dimmer light, nighttime and
winter.
Kasof hopes his findings, published in Personality and Individual
Differences, will help treat those with bulimia and other eating
disorders. "An intervention that has never been attempted is simply to use
brighter lights when eating," he says.
But snacking throughout the night can be more than a lack of willpower—or
illumination.
Night Eating Syndrome is a disorder in which individuals regularly wake
one to three times a night to eat, consuming more than half their daily
calories during these episodes.
Norwegian researchers now attribute this behavior to hormonal
disturbances. Grethe Birketvedt, Ph.D., an obesity specialist at the
University of Tromo in Norway, found irregularities among night eaters in
the way the hypothalamus controls activity in the pituitary and adrenal
glands.
Night eaters had a lowered response to a stress-inducing intravenous
hormone, meaning their hormones were already overtaxed. When hormonal flow
is stressed during the day, hormones cannot function correctly at night.
Subjects with the disorder do not secrete adequate levels of the satiating
hormone leptin or the sleep-inducing melatonin. The results were published
in The American Journal of Physiology—Endocrinology and Metabolism
Sadness and Overeating
Summary: Depression in kids is often linked with obesity. But it seems
to be a case of chicken and egg. While the two often occur together, it is
unclear which is cause and which effect.
Depression in kids is often linked with obesity. But it seems to be a case
of chicken and egg. While the two often occur together, it is unclear
which is cause and which effect.
Obesity rates are soaring. One of the latest studies, published in
Pediatrics, found that the longer a child is substantially overweight, the
more they are at risk for depression and other mental health disorders.
The study followed nearly 1,000 white children in North Carolina, ages 9
to 16, over eight years. Young boys, but not girls, proved especially
prone to the dual problem of obesity with depression.
"The link could have to do with social factors or it could be
neuroendocrine related," says Sarah Mustillo, Ph.D., researcher in
psychiatry and behavioral sciences at Duke Medical Center. "It could be
that if you're only obese for six months, there's not much of an effect as
if you were obese for five years."
At the center of the biological focus of obesity-depression link is the
hormonal pathway known as the HPA axis. It is the route of communication
between the hypothalamus, the peanut-sized part of the brain that governs
parts of the nervous system, and the pituitary and adrenal glands, which
secrete a variety of hormones.
These three points of the body work together to maintain chemical
equilibrium when the body is under stress. The HPA axis is responsible for
releasing cortisol, the so-called "stress hormone" that also plays a
critical role in energy metabolism as well as many other functions.
Cortisol released in response to stress prompts the human body to deposit
fat around the abdomen, a pattern of fat accumulation that is especially
hazardous to health. Chronic stress also begets depression.
"Obesity, depression and behavioral disorders have all been linked to
abnormal functioning of the HPA axis," says Mustillo. While social factors
such as teasing and isolation may contribute to depressed mood in kids who
are obese, Mustillo believes the problem is much more complex.
"It's probably a combination of the social and biological factors," she
says, noting that "there's an interaction between what's outside your body
and what's inside." Obesity carries a large social stigma and may bring on
depression if it negatively affects self-esteem, body image or social
mobility. It may even disrupt the normal hormonal pathways. Then again,
depression may also bring on obesity, if a child lacks the energy to
exercise or is immobilized by stress.
About 15% of the children Mustillo studied were chronically obese, while
another 12% were obese at some point in childhood or adolescence. She
believes the obesity epidemic among children is actually three to four
times worse than has been characterized by the U.S. Centers for Disease
Control.
Depression, of course, is not the only problem for these kids. Another
recent study, published in Journal of the American Medical Association,
found obese kids were 5.5 times more likely to have an impaired quality of
life than healthy kids, putting their life experience on par with that of
kids undergoing chemotherapy treatment for cancer.
"Obese children reported scores [on a quality of life survey] that were as
bad as cancer patients in each and every domain of life," says Jeffrey
Schwimmer, M.D., assistant professor of pediatrics at the University of
California San Diego. "We were surprised it was that bad."
Obese children also missed an average of four days of school a month,
compared to less than a day for children at an average weight. "The
potential ramifications for that are huge," says Schwimmer, who believes
the low quality of life among overweight kids hinges on their medical
problems--physically unable to take part in many activities--as well as on
how other children treat them.
The best thing parents can do is to treat obesity as a health issue, not a
problem of appearance, and to accurately record their child's height and
weight. He urges parents, physicians and psychologists to press insurance
companies to cover behavioral therapy for obesity.
It's also important to recognize that obesity isn't necessarily caused by
overeating, says Elizabeth Goodman, M.D., professor of child and
adolescent health at Brandeis University. She believes that the
obesity-depression link will prove to be very complex .
"There are different types of depression and there are different types of
obesity," she says. It's easy to say that it's all behavioral. That makes
it sound like there's a choice, but I'm not sure that it is."
Sadness and Overeating
By
Willow Lawson
-- Publication Date: May 30, 2003
"IMPORTANT"
If you think you might have binge eating disorder, it's important to
know that you are not alone. Most people who have the disorder have tried
but failed to control it on their own. You may want to get professional
help. Talk to your health care provider about the type of help that may be
best. The good news is that most people do well in treatment and can
overcome binge eating.
We are in this together.......Sandy~
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