Binge Eating Disorder: A Diagnosis for Healing

By age 6, Chevese Turner had already begun binging. It started with a box of ice cream cones she snuck into her bedroom. She then proceeded to devour them all. “I was always sneaking food. I would hide it. I would store it,” says Turner, founder and CEO of the Binge Eating Disorder Association. “It wasn’t necessarily that I even ate more than most people, but I was preoccupied with food. I was essentially learning to use food to cope with life.”

Her eating pattern of binging, followed by restriction – the latter a form of compensation and punishment that actually set her up for more binging – continued into adulthood. Eventually, Turner, now 45, conquered the disorder by accepting herself and learning healthy coping skills to handle stress.

Binge eating disorder (BED) is perhaps one of the most widely misunderstood mental disorders despite the fact that it affects as many as 3.5 percent of American women and 2 percent of American men. This illness, which is characterized by compulsive, out-of-control episodes of eating followed by shame, guilt and depression has long been underdiagnosed or misdiagnosed as a mental health issue, due in large part to BED’s classification as only a provisional eating disorder diagnosis in the Diagnostic and Statistical Manual (DSM).

However, this serious mental illness, which can significantly impact quality of life and is often accompanied by serious medical and psychiatric conditions, will be included as an official diagnosis in the fifth edition of the manual that mental health professionals use to diagnose and treat mental disorders, due out this month. This important change to the DSM — the first significant update to the eating disorders section of the manual in almost 20 years — will clearly define diagnostic criteria for BED and validate the illness as a treatable behavior pattern.

Previously, clinicians that observed the symptoms of BED in their patients had to assign a diagnosis of eating disorder not otherwise specified (EDNOS), a “catch-all diagnosis” referring to abnormal eating without all the symptoms needed to be diagnosed with anorexia nervosa or bulimia nervosa. For example, a person with EDNOS may binge eat and purge afterwards, but does so with less frequency or intensity than the criteria outlines for a diagnosis of bulimia. The new classification of BED in the latest edition of the DSM confirms that binge eating is a separate issue people struggle with, and validates destructive eating behaviors and patterns of thinking that professionals in the healthcare community have seen become increasingly prevalent.

It is clear that the inclusion of BED as an official diagnosis in the DSM-5 provides important validation and definition to an illness that impacts the health and quality of life of so many men, women and children. However, it remains to be seen how the official designation of BED as an eating disorder diagnosis will impact access to care for the patients and families that need it, particularly with regard to insurance coverage for specialized BED treatment.

The issue of insurance coverage for BED treatment has to do with mental health parity laws. Mental health parity laws mandate that coverage for treatment of biologically based mental illnesses is no less extensive than the coverage provided for any other physical illness. However, parity laws vary by state and often differ with regard to the specific parity requirements for eating disorders; in other words, what conditions are considered “equal” and qualify for coverage. In fact, while more and more state mental health parity laws require that insurers cover treatment for anorexia and bulimia as well as several common psychiatric conditions (including depression, anxiety and bipolar disorder), EDNOS — the umbrella, “catch-all diagnosis” previously used to diagnose BED — has not traditionally been included on the parity law list of conditions to be covered.

Binge eating disorder (BED) will become an official mental health diagnosis this May when it is included – for the first time – in the fifth edition of the Diagnostic and Statistical Manual (DSM), the manual that mental health professionals use to diagnose and treat mental disorders. According to Eating Recovery Center, an international center providing comprehensive treatment for eating disorders, this shift has the potential to dramatically improve the quality of life of individuals struggling with this devastating disease.

“BED has long been underdiagnosed or misdiagnosed as a mental health issue, due in large part to its classification as only a provisional eating disorders diagnosis in the DSM,” said Emmett Bishop, MD, FAED, CEDS, founding partner and medical director of outpatient services and program development for Eating Recovery Center. “The acceptance of BED as a recognized and treatable mental illness has the potential to lead to more access to care, open new avenues to insurance coverage and diminish the stigma that many of its sufferers have faced.”

BED is characterized by compulsive, out-of-control episodes of eating followed by shame, guilt and depression and is often accompanied by serious medical and psychiatric comorbidities. The most common eating disorder, BED affects as many as 3.5 percent of American women and 2 percent of American men.

To help healthcare providers and the general community better understand why this shift is so significant, Eating Recovery Center shares the top four reasons why BED’s inclusion in the DSM-V is a life-changing development for the millions of individuals struggling with this disease.

1.      Better understanding and less stigma. With a clearly defined set of diagnostic criteria, healthcare professionals will be better able to help patients and families identify the issue and seek effective eating disorders treatment. In addition, the acknowledgement of BED as an officially recognized mental illness is likely to help families and friends understand that their loved one cannot simply “go on a diet,” “stop eating so much” or “sign up for Weight Watchers.” The underlying issues are much more complex.

2.      Validation of BED symptoms. Not merely a casual description of occasional overeating, BED is a serious condition with clearly articulated diagnostic criteria. People with BED have learned to cover up negative feelings such as anger, sadness, boredom, stress or guilt through food. Binge eating behaviors can also be accompanied by an unhealthy preoccupation with body image, size and compulsive behaviors, including over-exercise or over-spending.

3.      Increased access to eating disorders treatment coverage. Mental health parity laws require that coverage for treatment of biologically based mental illnesses, such as eating disorders, be no less extensive than the coverage provided for any other physical illness. Although the inclusion of BED as an official diagnosis in the DSM-V does not guarantee improved coverage, clinicians are hopeful that the change will further validate this illness and spur changes to insurance coverage standards that could improve access to BED treatment.

4.      Less misdiagnosis among BED sufferers. Because BED is frequently misunderstood, it is not uncommon for clinicians to recommend patients to seek help for their weight issues at weight-loss or gastric bypass clinics. In reality, these individuals require binge eating disorder treatment to address their underlying relationship with food, eating and body image. In addition, BED is also often overlooked in individuals that are normal weighted due to widespread misperception that sufferers of BED must be overweight.

“For too long, people who have struggled with binge eating disorder have been stigmatized and misunderstood,” said Dr. Bishop. “The classification of binge eating disorder as an official mental illness will help us promote education, dismantle common misperceptions and help patients and families secure appropriate treatment that supports lasting recovery.”

In response to increasing demand for specialized binge eating disorder treatment, Eating Recovery Center offers comprehensive binge eating disorder programming. For more information about binge eating disorder treatment, visit EatingRecoveryCenter.com.

Download Audio

ACT: Taking Hurt to Hope – Struggling with Emotional Eating: Feeding [or starving] your Feelings

Welcome to ACT taking hurt to hope. Today we are going to have a discussion about something we all do but when we do it alot, we get ourselves into trouble. Eating or not eating for emotional reasons.

Think about why you eat. You already know what foods are healthy for you and what are so called ‘junk foods’ . Despite knowing all this that you probably find yourself craving potato chips or chocolate or cookies. When you feel happy you might want to feel even better by ordering a pizza. If you feel sad you might crave some ice cream. Emotional eating is about eating especially high calorie, high sugar and salt foods with the aim of changing feelings, or more specifically trying to get rid of bad feelings like boredom, loneliness, anxiety. Emotional hunger can feel like an obsession that needs to be satisfied instantly with certain foods, what is often called comfort foods. Comfort foods are available everywhere and usually much cheaper than healthy foods. According to research, 75%of overeating is caused by emotions we are trying to manage.

Today you will get the chance to speak to an expert Dr Emmett Bishop, Medical Director, Adult Services, Eating Recovery Center in Denver, Colorado. He is a past president and fellow of the International Association of Eating Disorder Professionals and a fellow of the Academy for Eating Disorders.

7 Ways to Help Kids Cope with Stress

Stress can spark disordered eating. While the relationship between the two is complex and varies by person, many people turn to food — or away from food — in times of stress. Controlling food intake becomes a way to cope.

In other words, “many people react to stress by under- or over-eating,” according to Jamie Manwaring, PhD, a primary therapist atEating Recovery Center’s Child and Adolescent Behavioral Hospital.

When stress strikes, kids may also seek comfort in bingeing or restricting how much they eat.

Parents and caregivers can help their kids learn to cope with stress healthfully and create a safe and open environment. Here are expert tips on how to help.

1. Help your child create more downtime.

Kids who are driven and perfectionistic can unwittingly increase their stress. “For children and adolescents, overscheduling and the desire to achieve in multiple clubs, AP classes [and] sports can cumulatively lead to stress that is dealt with in unhealthy ways, such as disordered eating or exercise,” according to Manwaring.

That’s why she suggested helping “your child decrease the amount of clubs, activities, and competitive sports in their lives to allow for more play and downtime.”

It’s important for parents to be proactive, especially “when you have a perfectionistic child who may have difficulty making these decisions themselves.”

Plus, downtimes teaches kids “how to regulate themselves and realize that they do not have to be constantly on the go,” said Mehri D. Moore, MD, founder and medical director at The Moore Center.

2. Be a role model for stress relief and reasonable schedules. 

“Parents also need to model, as much as possible, balance in their own lives between work, family and fulfilling their own needs so their children can learn from example,” Dr. Moore said.

3. When your child comes to you, give them your full attention.

In other words, avoid distractions like electronic devices. Don’t scan your cell phone, for instance, Manwaring said.

Healthy Habits: Compulsive Exercising and Eating Disorders

Professionals specializing in the treatment of men, women and children with eating disorders are observing a growing trend among their patients, who are increasingly engaging in compulsive exercise. According to Eating Recovery Center, an international center providing comprehensive treatment for eating disorders, the connection between excessive exercise and eating disorders generally stems from food-, body- or weight-related issues that drive the excessive physical activity. In fact, a study by Brewerton found that nearly 40 percent of patients with anorexia nervosa engaged in compulsive exercise behaviors.
 
Lombardi and the eating disorders experts at Eating Recovery Center explain that individuals engaging in compulsive exercise generally fall into one of two categories: those exhibiting significant exercise compulsion as part of their eating disorder; or individuals that did not initially exhibit excessive exercise behaviors, but began to do so as their eating disorders improved.

In other words, some eating disordered individuals abuse exercise as a compensatory behavior following a bingeing session or to give themselves “permission” to eat. Others may begin to engage in excessive exercise as what they believe to be a “healthy” part of eating disorders recovery. What these individuals do not realize, is that the frequency and volume of their exercise has taken the place of other eating disordered behaviors as an anxiety management tool and poses significant health complications, including joint injuries, stress fractures, muscle tears, tendonitis, fatigue and dehydration.

Eating Recovery Center encourages families, friends and healthcare professionals to be mindful of five common warning signs of compulsive exercise behaviors, including:

1. Exercising excessively “just because” as opposed to intentional exercise in preparation for a competition.
2. Refusing to miss a workout, regardless of weather or injury.
3. Exercising takes precedence over all other activities, including work, school and spending time with friends and family.
4. Experiencing a heightened level of anxiety if unable to engage in exercise.
5. Displaying an elevated rigidity and perfectionism with regard to exercise behaviors.

However, it is important to note that popular cultural narratives around exercise in the United States can pose significant challenges to identifying compulsive exercise—alone or occurring alongside an eating disorder.

• Exercise is healthy. There has been a major cultural shift around the notion that exercise helps us, not only in supporting general health and maintenance of a healthy weight during an obesity “epidemic,” but also as a tool to manage anxiety and stave off depression. This idea, and myriad variations of encouraged and acceptable frequencies of exercise (30 minutes each day; five days a week; etc.) can challenge the identification of dangerous patterns and/or normalize compulsivity, even during assessment by medical professionals.

The concept of nutrition and healthy eating is increasingly pervasive in the United States, particularly as our country is faced with both an emerging obesity “epidemic” as well as a startling rise in the number of men, women and children struggling with eating disorders. Each March, the Academy of Nutrition and Dietetics seeks to focus attention on the importance of making informed food choices and developing sound eating and physical activity habits during National Nutrition Month. In addition to underscoring the important role that nutrition plays in our everyday lives, National Nutrition Month is an ideal opportunity to gain insight and perspective on the importance of nutrition in eating disorders treatment and recovery.

Nutrition plays a fundamental role in the treatment of an eating disorder. Patients’ thoughts and behaviors around food are generally negative and destructive, and many individuals need to restore weight in order to regain the clarity of mind necessary to fully engage in therapy. Even for those patients who are at a normal weight at the time they seek eating disorders treatment, nutrition counseling and education are critical in addressing issues related to their underlying relationship with food.

In general, nutrition counseling seeks to help patients overcome their fear of food and eating by providing support and structure during meals, education on a balanced pattern of nutrition and collaborative care to achieve a healthy weight for optimal recovery. For individuals struggling with eating disorders, there are no “good” or “bad” foods—all foods are fine in moderation as part of a diet characterized by balance and variety.

These notions are reinforced by Marla Scanzello, MS, RD, director of dietary services for Eating Recovery Center.

“The primary goal of nutrition counseling for individuals with eating disorders is to help them normalize eating and optimize health. Dietitians also challenge the distorted thoughts their patients often have and correct misinformation about food and diets that is often perpetuated by the media.”

There are various levels of care in eating disorders treatment, ranging from inpatient hospitalization for severely underweight or medically compromised patients to occasional outpatient appointments with a dietitian, which is usually appropriate for individuals in recovery or those with more minor food and body image issues. At each level of care, nutrition counseling plays a different role. At the inpatient level of care, dietitians may work closely with internal medicine physicians, psychiatrists and therapists to help the patient restore sufficient weight so that they may engage meaningfully in therapy. Whereas, a dietary professional working with an individual on an outpatient basis may lead group education classes or participate in a supervised meal, providing support and information to the patient as they plate and portion his or her food.

Compulsive exercise more often linked to eating disorders

People joke that they are addicted to hot yoga, running or even boot camp. But medical professionals who specialize in eating disorders are more often diagnosing a real and acute illness called compulsive exercise.

One study found nearly 40 percent of patients with anorexia engaged in compulsive exercise behaviors, according to the Eating Recovery Center of Denver.

But how do you tell if an exercise addition is dangerous and unhealthy? A disorder isn’t defined by the number of minutes or hours someone exercises.

“It’s important to look at the intention behind the movement, if there is a sense of urgency or agitation when individuals can’t engage in the exercise behavior, there is likely an issue,” said Jennifer Lombardi, executive director of Summit Eating Disorders and Outreach Program, which works with Eating Recovery Center. “It’s also important to consider exercise in the larger context of an individual’s eating and body image history.”

Therapists find that people with eating disorders sometimes compulsively exercise while they are suffering from the eating disorder, or in some cases, after their eating disorder has improved.

Some “abuse” exercise after an eating binge or to give themselves “permission” to eat, Lombardi said. And some begin to exercise with such frequency and volume as they are recovering from an eating disorder, it becomes an unhealthy part of recovery. The exercise — not the eating — becomes the new anxiety management tool.