Binge-Eating Disorder (BED) is was not officially recognized by the psychological community until added to the 5th version of the Diagnostic and Statistical Manual in 2013 (DSM-V). BED is distinguished by recurring behaviors of :
- Eating large amounts of food in one sitting
- A sense of loss of control while bingeing
- Feelings of shame and guilt afterward
- The lack of compensatory behaviors for the binge
To better understand evidence-based treatments for Binge Eating Disorder, I spoke with Dr. Kari Anderson, a nationally respected expert on treating the disorder.
Q: How do you understand the development and practice of Binge Eating-Disorder?
Dr. Anderson: BED is mainly an attachment/anxiety disorder. We are designed to regulate our nervous systems through relationships. Our social engagement process using cranial nerves around the eyes, ears, and mouth communicate safety through another cranial nerve, the Vagus, to the heart, diaphragm, and deep into our “gut.”
As a result of trauma or perceived unsafe situations in our life, it is easy to attach to food, as a replacement to relationships. The process of eating uses the same cranial nerves as in face-to-face conversations.
We can indeed be in love with eating as a way to keep us feeling safe. We have a culture that reinforces this behavior—as an individual eats more, their body size changes and weight bias drives them to isolate and eat alone.
Q: What evidence-based treatments are used for BED?
Dr. Anderson: The first is Cognitive Behavioral Therapy-Enhanced (CBTe), which has the meal structure and self-monitoring to normalize eating patterns. It educates and addresses the eating pathology that drives binge eating. CBTe is a protocol-driven, stage driven treatment.
Dialectical Behavioral Therapy (DBT): DBT is considered the third wave of Cognitive Behavioral Therapy, meaning it is mindfulness-based. DBT is also very good at bolstering skills in emotional regulation, distress tolerance, and interpersonal relationships.
Therefore, it targets one’s inability to regulate their nervous system, curb impulsivity, and negotiates closeness with others. Interestingly, most of the research with binge eating and DBT exclude the interpersonal effectiveness modules, which is curious to me.
Interpersonal Psycho-Therapy (IPT): Studies have shown IPT to be as effective as CBT in treating BED. It encourages a strong therapeutic relationship with a therapist (key to learning to co-regulate in a trusting face to face relationship) and works through interpersonal crises and conflicts.
Acceptance and Commitment Therapy (ACT): Another third wave cognitive therapy, ACT, is becoming so popular in treating anxiety-based disorders, including eating disorders, that I believe it will be added to the list of evidence-based therapy for BED. ACT focuses on psychological inflexibility, a cornerstone to most of our suffering and eating pathology.
Q: What contribution does nutritional science make in treating BED?
Dr. Anderson: Nutritional science is advancing in areas of food’s addictive qualities, hormone regulation, and the microbiome’s effect on feeding and eating behaviors, especially as related to the Standard American Diet.
For decades, the eating disorder treatment field has proclaimed, “it isn’t about the food” (unless you are refeeding an anorexic), and yet, we must now explore how cravings are not just “emotional.” This controversial subject is being addressed on this year’s iaedp Symposium in March in Orlando, Florida, in a presentation by Dr. Lesley Williams and myself.
Q: What is the best setting for treating BED?
Dr. Anderson: This depends on the severity and level of care needed to intervene on the specific behaviors and medical complications. One important aspect is that most treatment centers haven’t done well at creating a safe environment for the larger-bodied client. I think homogenous groups are preferred to encourage more participation by those with BED.
Also, the focus on weight gain for low weight patients, the limitations on movement, and challenging fear foods can alienate the larger bodies BED clients.
Unless there are medical complications or suicidal tendencies, rarely will an insurance company keep a BED patient in residential or inpatient. The short time spent is largely intake and orientation, using up valuable treatment dollars that may be better spent on a longer-term IOP setting. That said, stopping the binge process sometimes needs a week or two to interrupt and reset.
Q: What is the role of intuitive eating in treating Binge Eating Disorder?
Dr. Anderson: Similar to anorexia, [intuitive eating] is the end goal, yet BED has the same problem with poor interoception regulated by the insula in the brain. Interoception is the ability, or lack thereof, to sense and read our internal feedback loops like hunger.
Leaving someone with out-of-control-eating and/or a restrict-binge cycle to determine when, what, and how much to eat is not helpful. They need more guidance in the beginning. Similar to resetting your sleep clock in circadian disorder, we have to reset our eating cycles.
The other thing many don’t understand is that BED in regards to eating disorder pathology looks very similar to other eating disorders in that it is largely driven by the thin ideal and diet or restrictive mindset. It is the restrictive behavior and mindset that evokes a counteraction of bingeing out of our own internal (or natural) drive to survive.
There is a whole psychological side to wanting what we can’t have, so when prescribing food plans, it has to be executed with care. That’s where mindful eating comes in, changing eating patterns must come from the inside out; an intrinsic change that is value-driven. Such as feeling better instead of looking better…you can see that the end game involves mechanisms that first have to restore interoception and challenge the thin ideal.
Q: Any final thoughts?
Dr. Anderson: I think our biggest challenge with treating BED is reaching those suffering. Most people with BED don’t consider themselves to have an eating disorder. They believe they have a weight disorder, and that’s exactly where they end up in professional weight loss settings, including bariatric surgery centers. And that’s another conversation altogether.
Kari Anderson is owner and therapist at myEatingDoctor.com, which is a counseling, coaching, and consulting business for disordered eating. Having specialized in eating disorder treatment for 30 years, Kari has positioned herself as a respected clinician and leader in the field. Her new book, Food, Body, and Love, will be released in 2020.
National Eating Disorder Association. (2018, February 22). Binge Eating Disorder. Retrieved January 6, 2020, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed.
About the Author:
Travis Stewart, LPC has been mentoring others since 1992 and became a Licensed Professional Counselor in 2005. His counseling approach is relational and creative, helping people understand their story while also building hope for the future. Travis has experience with a wide variety of issues which might lead people to seek out professional counseling help.
This includes a special interest in helping those with compulsive and addictive behaviors such as internet and screen addiction, eating disorders, anxiety, and perfectionism. Specifically, he has worked with eating disorders since 2003 and has learned from many of the field’s leading experts. He has worked with hundreds of individuals facing life-threatening eating disorders in all levels of treatment. His website is wtravisstewart.com
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published January 16, 2020, on EatingDisorderHope.com
Reviewed & Approved on January 16, 2020, by Jacquelyn Ekern MS, LPC