Treatment Options for Binge Eating Disorder

Question from a lovely reader this morning: 

I was wondering what the treatment options are for Binge Eating Disorder. Obviously there are different severities of the disorder and different treatments needed for different people on a case-by-case basis, but I was wondering if maybe you could summarize some of the options out there for some of us.

Basically what I’m saying is, I have Binge Eating Disorder, and it is currently running and ruining my life. I really really need help but I want to know what I’m in for. Is inpatient a thing that happens with BED, ever? Is it usually therapy? What goes on for a typical patient, what is considered “severe,” etc…. I don’t know if there’s one good question in there to answer, but I’m really hoping you might have a bit of input, given that you are a) in recovery and b) on your way to becoming a therapist.

All right, guys. Here’s the truth. Binge eating disorder (BED) has been around for a LONG TIME, but only recently has it officially become a mental illness diagnosis. Research still remains relatively new, but it is emerging! In fact, studies indicate that more people suffer and will suffer from BED than Anorexia Nervosa, Bulimia Nervosa, or Eating Disorder NOS. 

Okay, so how do I know if I have this thing?

First of all, this NOT intended to diagnose. These are simply the guidelines. 

As taken from the DSM-V (released in May, 2013). 

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
    2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  2. The binge-eating episodes are associated with three (or more) of the following:
    1. Eating much more rapidly than normal.
    2. Eating until feeling uncomfortably full.
    3. Eating large amounts of food when not feeling physically hungry.
    4. Eating alone because of feeling embarrassed by how much one is eating.
    5. Feeling disgusted with oneself, depressed, or very guilt afterward.
  3. Marked distress regarding binge eating is present.
  4. The binge eating occurs, on average, at least once a week for 3 months.
  5. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Specify if:

In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.

In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met ofr a sustained period of time.

Specify current severity: the minimum level of severity is based on the frequency of episodes of binge eating. The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: 1-3 binge-eating episodes per week

Moderate: 4-7 binge-eating episodes per week

Severe: 8-13 binge-eating episodes per week

Extreme: 14 or more binge-eating episodes per week

My biased opinion on the new diagnosis:

Binge-eating disorder embodies a long overdue addition to our mental illness realm. This disorder is prevalent among both sexes and seems to be the most common eating disorder. Furthermore, binge-eating seems to carry more shame than other eating disordered behaviors, because it is the  “opposite” of what an eating disorder typically does, which is create and facilitate weight loss.  Beyond dieting measures, few people actually receive clinical help for this issue, even though it can be just as fatal and deadly as its other eating disorder counterparts. I think the DSM-V did a good job in explaining the binge-eating disorder diagnosis and creating a sustainable criteria. However, I disagree with the severity quotients. I do not consider just 1-3 episodes of binge-eating as “mild.” Maybe once a week can be considered mild, but three times a week comprises nearly half the week.

Okay, so I want help…what if I have very limited to no money? 

Schools and universities: Most provide free mental health services as part of the overall tuition. This is where I initially started my recovery process as a young adult. Unfortunately, I was denied treatment simply because I was so active in my disorder, but they were able to provide me with referrals. If you are in middle/high school, there are guidance counselors and school psychologists available. Again, this is a good way to get started and obtain referrals for community resources. You never know. Some work on symptom management and reduction. It’s always worth a shot. 

Low-cost therapy: If you live in a metropolitan city, many agencies and even private practitioners offer sliding-scale therapy based on your finances. Other than absolutely free, I’ve seen sessions run for as little as $5. I currently intern for an agency that charges approximately $25-40 per hour. I do not recommend going directly to inpatient without working with a trained outpatient therapist, unless you feel you are in a medical or psychiatric emergency. A trained clinician will be able to assess your situation. Sometimes, inpatient work is necessary, but this tends to happen in extreme cases. 

Eating disorder support groups: There are an abundance. Google is your friend. 

Oa.org (I have written extensively about this Twelve-Step organization modeled after Alcoholics Anonymous. Please refer to my blog archives or email me if you have any concerns. Most people in the rooms identify themselves as compulsive overeaters and have struggled with binge eating. There are online meetings available for those who cannot be physically present).

Eatingdisordersanonymous.org (similar to the OA but lesser-known. I have no experience with this organization, but it caters to the entire eating disordered spectrum).

Community therapy groups. Again, use Google. I know therapists who run groups for as low as $10-$15 for 2 hours worth of eating disorder psychoeducation, interventions, and support. 

How do I find a therapist?

First of all, there are so many ways. If you have health insurance, look into your options. You may need to talk with your doctor to see what kind of help is available.

Typical therapy consists of weekly sessions, although it is not uncommon to have more or less frequent ones (ex: 2-3x a week or 1-2 times a month. It depends on the severity. Explore with a therapist. You don’t have to know what kind of care you need just yet. That’s their job). 

Therapists.Psychologytoday.com is a good place to start. Or simply Google “eating disorder therapists in (your city).” Look up their credentials. Make sure they are licensed. Call them and inquire. You are potentially a paying customer. You are allowed to be nosy and inquisitive. You deserve the best quality of care! 

I highly recommend finding a therapist who specializes in working with eating disorders. Graduate schools and training programs skim over this disease and few really comprehend the emotional and physical toxicity eating disorders can cause on individuals and their treatment. When making the first contact with the therapist, here are some sample questions to ask: Do you have experience working with eating disorders? Which ones? I have a problem with bingeing; do you know effective treatments that may help me? What is your theoretical orientation? What do you think of the word, “recovered?” 

Cognitive-behavioral therapy is an evidence-based treatment commonly used for bulimia and binge eating.  This therapy targets dysfunctional thoughts and beliefs and helps to identify and conceptualize the binge-eating pattern. Eventually, the client learns his/her triggers and learns appropriate ways to handle them. Ideally, one learns how to cope without food as an emotional mechanism. CBT will also work on rigid distortions about one’s body weight, dieting, perfectionist thinking, and desire for control, all of which are prevalent in BED. CBT sessions are structured, require a relatively high level of motivation, and often include homework.

Dialectical-Behavioral Therapy is similar to CBT except that it focuses exclusively on mindfulness, emotional regulation, and radical self-acceptance  It was designed for treatment of Borderline Personality Disorder, but it has been used in eating disorders and substance abuse populations as well, simply because many individuals with these diseases cannot understand how to live in the present moment and accept what they cannot control. I am personally a huge fan of DBT and am working with a client with Borderline Personality Disorder right now using some of these interventions. So much of her inner self-loathing models that of the eating-disordered mindset. 

Family therapy is often used with adolescents. This systemic therapy takes on the pretense that the eating disorder embodies a familial issue, rather than an an individual one (similar to other addictions). This therapy exhibits the roles each of the family members subconsciously (or consciously) assume in order to maintain the eating disorder homeostasis. This type of therapy has been very effective for treatment of anorexia, but less research has been shown on success rates regarding binge eating. 

What about rehabilitation centers or inpatient care?

I regret to inform that I am NOT well-knowledged on either of these options. However, I do recognize that both of them are typically used in severe cases, and yes, most centers to treat the spectrum of eating disorders, including BED and compulsive overeating. I HIGHLY recommend working with an individual therapist before exploring more intensive care (unless, of course, you are facing a severe medical or psychiatric emergency or simply believe you CANNOT wait any longer). However, he/she will be able to provide you with options, referrals, and a general opinion. 

Rehabilitation centers are extremely expensive, although some do offer scholarships and financial assistance. You will have to do your research. Some have extensive waiting lists. These treatment centers typically offer group and individual therapy, nutrition and meal planning, expressive therapy, weigh-ins, family meetings, etc. 

Again, I am not an expert in either of these options, so I recommend that you consult a medical doctor or mental health professional if you need assistance. 

Will medication help me? 

Maybe. You need to consult with a medical doctor or psychiatrist to obtain a full assessment. The research is mixed. However, because BED is highly correlated with other disorders, especially depression and anxiety, medication may provide some relief, especially if one of the disorders triggers and amplifies the eating disorder.

SSRI’s (antidepressants) remain the standard treatment of choice for eating disorders.

Toparimate (Topamax) has also been used in the treatment of bulimia/binge eating, although it is designed as an anticonvulsant medication for seizures.

Side note: When taking medication, it is BEST to always be working alongside a professional clinician doing some kind of psychotherapy work. The MOST effective evidence-based studies with medication include a therapy component. We all know magic solutions do not exist in a pill. 

Can I just do this on my own? 

Maybe. Plenty of people do! Plenty of people don’t! You are no more inferior or superior than anyone else if you can do it on your own or not!

What are some ways to “do it on my own” right now?

1. Find a way to EXPRESS. For me, it’s this blog. For you, it may be private journals, song lyrics, poetry, artwork, painting, talking aloud in the car about it. You will be FLOODED with thoughts if you don’t have some kind of way to make them tangible.

2. Start a gratitude list. Write down as many things as you can. Add at least one thing everyday. Spend as long as you need to add to it. But keep adding. It will get easier. Life will seem better.

3. Buy some books. I recommend anything by Christopher Fairburn (the scientific pioneer of bulimia/binge-eating treatment) or Geneen Roth (the more holistic, natural author of compulsive and binge eating). Check out Amazon. Browse a library. Books helped me tremendously at the beginning. It was so reassuring to read those pages and just feel like someone finally understood.

4. Do your own CBT! Go to this website: http://media.psychologytools.org/Worksheets/English/CBT_Thought_Record.pdf

These worksheets will help you link your thoughts/feelings/experiences. And they’re free! Commit to a week of doing this. See how your perspective shifts.

5. Learn how to deep breathe. Sounds cheesy. Sounds cliched. But people wouldn’t be doing meditation for 348349837439874 years if it didn’t work. Get into yoga. Or just lie naked on your bed and inhale for as long as you can and exhale for as long as you can. Repeat.

6. Do. Not. Starve. Yourself. Under. Any. Conditions. That. You. Have. Control. Over.

7. If you have an iPhone, download the app, “Recovery Record.” It’s free and you can record your meals, track your feelings, jot down thoughts, and watch your progress overtime.

8. Practice positive affirmations. Every fucking day. Collect quotes. I became a quote-fanatic when I first started recovery. I needed that inspiration and motivation.

9. Know your triggers. And make a plan. Whether you follow it or not is a different story, but have some kind of realistic plan for what you will do in a certain situation (ex: at a restaurant/party, alone at home, when eating a favorite food, etc.) It’s important to recognize your triggers. You may have dozens of them. That’s okay. Awareness is key at this point.

10. Recognize the process. It’s shitty; I won’t lie. But in that shit lies some beautiful diamonds. <—- That’s an awkward statement, and I’m tempted to delete it, but whatever. It’s the truth. You just have to keep going. It could take months or several years. Every process is unique. None of them are “better.”

*Some questions to get you started. Some points to ponder (Ps: I’m making them all up on the spot, but I’ve gotten pretty good with my therapeutic open-ended questions, so hopefully these get your noggins thinking). 

What thoughts run through my mind right before a binge? During? After? The next day? 

What’s going well in my life right now? What do I want to change? 

In what ways does bingeing affect my overall functioning and well-being? 

In what ways has my bingeing served me? Harmed me? 

What fears do I have about giving up bingeing?

How would my life be different if I didn’t binge?

 

What feelings cause me discomfort? How would I tell my best friend to cope with those feelings?

If my five-year-old self could see me during a binge, what would he/she tell me? 

What am I willing to do to work recovery? MAKE THIS ANSWER AS ELABORATE, DETAILED, AND SPECIFIC AS YOU POSSIBLY CAN, BECAUSE THIS QUESTION WILL CHALLENGE YOU EVERY SINGLE DAY AND POSSIBLY MULTIPLE TIMES A DAY. 

What challenges do I anticipate during recovery?

 

 

 

Whew!! I have probably forgotten things, but it’s nearly midnight, and I’m waking up early tomorrow to run my first expressive therapy group! I was going to do this post sometime this weekend, but I figured if I could potentially influence just one person tomorrow, it will have been worth it. 

Please never hesitate to ask questions! I know how isolating and overwhelming eating disorders are. I will ALWAYS do the best I can to help you in any way shape or form XO 

 

Goodnight to all my beautiful readers. Shine on! 

We suck at educating people about eating disorders.

Dear Bee, 

In one of my classes this summer, we each have to present an evidence-based treatment on a specific disorder. Last night, the presenters for disorders typically diagnosed in childhood and adolescence (eating disorders, ADHD, conduct disorder, etc.) spoke. 

Now, I know that every mental illness has its own pathology. Nothing is black-and-white. Nothing is as straightforward as a treatment goal or intervention. Therapy was never meant to be simple, and if treatment for such disorders was easy, I would probably be out of job.

 I hate to say it, but we are completely undertrained to work with eating disorders. And by we, I am referring to graduate students studying to become therapists. Obviously, most professionals who specialize in this kind of treatment receive some kind of specific training, but it saddens me to know that if any of my classmates happen to receive an individual with an eating disorder as a client, they may have no idea how to handle the situation. Beyond the basic level, and we all know, that eating disorders are multi-facted, complex shitstorms. I’m not saying I know exactly how to treat eating disorders either, and I’m not saying I’m an over-qualified individual (I would have no idea how to do therapy on someone with, say, schizophrenia or antisocial personality disorder at this point in my training, either). But, still, this annoys me. Why? Because eating disorders are prevalent. And they are on the increase. And they are fatal. 

In our training, we tend to talk about the physical symptoms including weight restoration, reduction of harmful disordered behaviors, and normal pattern of eating, with little to no emphasis on the eating disordered mentality. Okay, sometimes, my professors mention challenging cognitive distortions. These evidence-based treatment plans are effective, sure, but not in the cookie-cutter way they are presented. For example, the presentation on Anorexia Nervosa demonstrated the Maudsley Family-Based Therapy, which is proven to be very beneficial for individuals who still live with their parents. Family-Based Therapy exists on the premise that Anorexia Nervosa is a family problem, meaning the eating disorders is simply a tangible manifestation of the dysfunction within the household. I believe that. There is a TON of research that shows how family interactive patterns correlate with eating disorders, and there are several predictors that indicate a child may develop anorexia. However, retraining a parent to force their kid to eat is simply a bandaid on a broken arm. The real healing takes so much longer than just monitoring a dinner meal. 

And while I fully recognize that eating disorders are medical problems, given that Anorexia Nervosa still embodies the most fatal mental illness, the idea of discharging an individual after he or she achieves weight restoration simply terrifies me. It’s not just about weight restoration. At all. In fact, without proper restructuring of the anorectic mindset, without addressing the underlying issues and core beliefs, without retraining self-worth and creating a healthy definition of control, what will happen once that individual is released into the real world? He or she may actually be worse than before treatment. 

This, ladies and gentleman, is why, despite all the research, literature, and professionals, relapse rates remain so incredibly high for eating disorders. I’ve said it once on here, and I’ll say it again: Eating disorders are diseases of the MIND. Not diseases of the body.

I’ll even take a wild leap and say they are extremely similar to a personality disorder, in the sense that they completely skew how an individual approaches him/herself, the world, and others in a pervasive, all-encompassing way. 

Anyway, I guess it’s my job to change the stigmatization and way professionals approach eating disorders. Because, we need good therapists, and unfortunately, there are a lot of bad or misinformed ones out there. At some point in my life, I imagine I will work with this population. I will never undermine an eating disorder as some black-and-white, simple behavioral problem. Because, recovery or not, it isn’t. Ideally, we just need INFORMATION out there. We need to teach kids from a young age. Just as parents are willing to talk about drugs, alcohol, and sex to their children, we need them to be willing to talk about food, body image, and weight. Eating disorders are the good kid’s drug. They slip under the radar. In middle to upper-class Westernized cultures, they are almost “expected.” Skinny is the norm. Dieting is a bonding experience. Not everyone who is skinny or diets develops an eating disorder, but some do, and unlike the many teenagers who experiment with drugs and alcohol, a teenager cannot just easily experiment or turn on and off an eating disorder. Once it’s there, it’s there. 

In other news, things with THE BOY are going exceedingly well. Like more than I ever could have imagined. I saw him last night; we were going to go out, but we just ended up talking about everything in life and cuddling at his place until three in the morning. 

I’m excited and terrified at the same time, but the body cannot distinguish the two sensations, so I’ll just say I’M EXCITED. He’s literally everything I could want in someone at this point, and that amazes me. 🙂 

Therapy with Momma

Dear Bee,

Overcame another milestone yesterday. I’m just kicking your ass lately. The more I hand you over to others, the less important you are in my life.

I had a therapy session with my mom. It was interesting. Most of the time, I actually felt like I was back in elementary school in a parent-teacher conference. While the “grown-ups” sat around discussing my progress, I occasionally interjected, nodded my head, and answered their questions. This probably would have been more beneficial when I was younger and more dependent on my parents, but I was so enmeshed with you that I never would have allowed that to happen. You kept me so secretive and ashamed. The fact that I can even openly talk about you to other people at all is a miracle. This blog blows my mind away! Honesty is an uncomfortable color for me to wear, but embracing my truth has completely spun my life.

I expected the session to be more intense and emotional, but my therapist maintained appropriate pacing and dialogue, keeping most of the content relatively surface-level. This was my mom’s first time even stepping foot in a therapy office, so she naturally had no idea what to expect. I’m glad my therapist recognized that and kept a stable atmosphere. My mom told me she enjoyed the experience and needed to process the session. Processing therapy can be a challenge, but it’s worth the occasional mental insanity.

Regarding my eating disorder, it was mostly psychoeducation for my mom, with my therapist explaining the progressiveness of it, how recovery works, and the distorted mindset. Nothing I don’t already know, but it was eye-opening for my mom. I am just so grateful for her support and willingness to help me. I know I am extremely lucky to have that, and I wish it were the same for everyone.

Anyway, I am writing all this on my phone in the car…because I’m on the road! I’m spending Memorial Day weekend at my best friend’s parents’ lake house. Looking forward to a weekend of sunshine, boating, swimming, relaxing, and whatever else. Nothing you throw in my way can possibly ruin my positivity.

Life is beautiful.

Eating disorders and sex, family, travel, and religion

Dear Bee,

I’ve been thinking about how liberating it will feel to totally remove your existence from my life. I know I need to practice gratitude and patience and focus on the journey right now, rather than simply focusing on the destination.

For so long, I thought you only controlled one aspect of my life: food. Now, I realize that I simply underestimated your power. You controlled nearly EVERY aspect. Talk about a consuming relationship. Let’s look at a few.

Eating disorders and sex?

Even in the peak of my eating disorder, I believed I was having a happy and fulfilling sex life.  I had a boyfriend took care of me in every way I thought a girl “should” be loved and treated. What I failed to understand that sex often satisfied me for the wrong reasons: for validation that I was worthy and beautiful enough, for reassurance that someone loved me, for satisfying another person’s fantasies and lust. Eating disorders evoke body shame and distortion; for some, sex simply surfaces these issues. For me, however, I liked sex, as it allowed me to fully trust that my body was wanted and desirable because someone else had told and shown me that it was. For this reason, I know that my perception of healthy and emotionally satisfying sex was tainted. My ego was so fragile then; if my ex-boyfriend had ever told me I had so much of an ounce of fat or criticized an article of clothing or made any derogatory remark about my figure (he never did any of this), I would have been triggered into complete internal chaos.

Eating disorders and family?

Most family therapy models actually treat eating disorders as a “family” problem, rather than an individual one, with the basis that the entire household is dysfunctional, and the person suffering is simply manifesting the aversive symptoms. Eating disorders can easily shatter families; parents may react with fear, self-blame, or anger that their child cannot just “stop” the behavior; siblings may feel jealous, resentful, or scared. Even though the individual may be desperate for help, he or she may be absolutely unwilling to accept it because the eating disorder has become so potent and consuming. My problem was not “outwardly” evident; neither of my parents ever knew the extent of my disorder until I confessed it to them. Yet, it definitely affected our interactions. For example, I remember feeling upset with my mom for bringing home treats, believing like she was just trying to maliciously tempt me.  I can recall resenting my dad when he finished the last of one of my safe foods, as if he knew that doing so would provoke such internal turmoil.

Eating disorders and travel?

 I was born a wild child with an unquenchable thirst for adventure and novelty. Subsequently, I seek to explore the world and immerse myself in the meshing multitude of diverse cultures. Travel and eating disorders do not mix well. Travel is about spontaneity; eating disorder is about rigid routine. Travel embraces “expect the unexpected”; eating disorders run away from anything that might threaten their set ideations. Travel involves new people, experiences, and stretches the imagination in different dimensions; eating disorders keep us trapped in the same relationships, doing the same thing day in and day out, fearing any change or disruption to the equilibrium maintaining our dysfunctional homeostasis.

Eating disorders and religion?

I was raised in a non-religious household. I never turned to prayer in times of need, and although I celebrated the obligatory holidays according to my religion, I often just went through the motions. By nature, I am a skeptical person. I do not like accept information with a blind eye or ignorant mind. Some can heal their trauma and illnesses through higher power or spiritual recovery; I am not opposed to trying this out, but I am not sure how it works. I just feel that eating disorders can make turning to religion very tempting, as it seems desirable to  have faith that everything will be okay during the times when everything is falling apart.