Abnormal Psychology 3018 Binge Eating Disorder

A ‘diagnosis in need of further study’.

The DSM-5. In previous editions the act of binge eating was included in the diagnosis of Bulimia Nervosa and as a subclinical disorder.

A. Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:

1. Eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time, under similar circumstances.

2. A sense of lack of control over eating during the episode.

Around a two-hour period.

Because it depends on the person and the situation. The clinician needs to have flexible judgement.

‘Subjectively’ means that the individual thinks they have eaten a large amount of food.
‘Objectively’ means that others consider it to be a large amount of food.

Recurrent episodes of binge eating characterised by a ‘large amount of food’, in a ‘certain period of time’.

Feeling out of control during the episode (e.g., feeling that one cannot stop eating or control how much they are eating).

Feeling ‘dissociated’ during or following a binge episode.

Someone may feel they have binge eaten when eating only a small amount of food, but if they feel ‘out of control’ then it still constitutes as a subjective binge episode.

B. 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 guilty afterward.

C. Marked distress regarding binge eating is present.
- individuals with Binge Eating Disorder are typically ashamed of their eating problems and attempt to conceal their symptoms. Binge eating usually occurs in secrecy or as inconspicuously as possible.

Distress over binge eating episodes must be present, otherwise it cannot be considered a disorder.

D. The binge eating occurs, on average, at least once a week for 3 months.

The frequency of disordered eating episodes was lowered in the DSM-5. This was because people who had eating disorders ‘not otherwise specified’ (or Other Specified Feeding and Eating Disorders - OSFED), can now be classified under full criteria syndromes and can be treated accordingly, depending on the severity of their disorder.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in Bulimia Nervosa and does not occur exclusively during the course of Bulimia Nervosa or Anorexia Nervosa.

Those with Binge Eating Disorder do not partake in compensatory behaviours to try and eliminate excess calories and are therefore often overweight. Those with Bulimia Nervosa are often able to maintain a normal weight.

If the person’s weight is severely low, then regardless of binging behaviours, they classify as having Anorexia Nervosa.

Specifier - Current Severity.

The severity is based on the frequency of binge eating episodes, however the severity may increase as it reflects other levels of functional impairment.

1. Mild: 1-3 episodes/week.

2. Moderate: 4-7 episodes/week.

3. Severe: 8-13 episodes/week.

4. Extreme: 14 or more episodes/week.

1. Early onset obesity.

2. Severity of obesity.

3. Increased rates of ‘general’ psychopathology.

• 41% of overweight/obese individuals in the community meet the criteria for one of the binge eating illnesses.

• 52% of overweight/obese individuals in weight loss programs meet the criteria for one of the binge eating illnesses.

• 88% of individuals with Binge Eating Disorder have been classified as obese at some point in their life.

Once a week binge:

- 1998: 2.7%.

- 2015: 13%

Twice a week binge:

- 1998: 1.1%.

- 2015: 3.5%

It is hard to tell if this data is a real increase, however it is unlikely that the destigmatisation of binge eating would have that much affect, so there is most likely some real increase happening.

Binge Eating Disorder is by far the most common eating disorder.

In 1998, those with Binge Eating Disorder reported less health-related quality of life. However, today the impact of binge eating has lessened and 50% of people do not experience distress relating to binge episodes. However, there is still distress related to quality of life impairment, and ‘days out of role’.

17 - 39%.

Dieting.

• trauma.

• low self-esteem.

• body dissatisfaction.

• negative emotionality.

• over-valuing the importance of weight and shape.

• difficulty regulating emotional states.

• parental substance use.

• negative mood.

• interpersonal stressors.

• dietary restraints.

• boredom.

• Depression (54% of BED).

| - Anxiety (37% of BED).

• Substance use (25% of BED).

| - Personality Disorder (25% of BED).

They are in the impulse/control classification. The theory is that binge eating is associated with an urge and impulse and then the inability to control oneself, resulting in a binge episode.
Personality Disorders also have lots of urges and behaviours that are impulsive.

It is fairly evenly split. But men are more likely to experience BED with substance use disorders and OCD.

• SCOFF: a 5-item screening tool that covers all eating disorder behaviours (not BED specific). If the client gets two points, they're in.

• Binge Eating Scale: is a 16-item self-report scale and is specific to binge eating.

• BEDS-7: a 7-item diagnostic screener which follows DSM-5 criteria for BED.

• Cognitive Behavioural Therapy (CBT): 46%, 59%.

• Dialectical Behaviour Therapy (DBT): 64%.

• Interpersonal Psychotherapy (IPT): 60%, 63%.

• Brief Strategic Therapy (BST): 20%

• Behavioural Weight Loss (BWL): 38%, 41%.
  DBT & IPT are superior at the end of treatment, but CBT catches up in the follow-up.

The psychological therapies and behavioural weight loss components have been separated. It seems they need to be combined to have really good long-term efficacy.

• good evidence ++.

• binge eating lessens ++.

• no impact on excess weight loss +/-.

• great evidence +++.

• binge eating lessens a lot +++.

• no impact on excess weight +/-.

• good evidence ++.

• binge eating lessons a lot +++.

• no impact on excess weight +/-.

• little evidence +.

• binge eating lessons a little +.

• weight decreases a lot ++.

• little evidence +.

• binge eating lessons a lot +++.

• no impact on excess weight +/-.

Healthy Approach (HAP) to weIght management (I) and Food in Eating Disorders (FED).
It integrates CBT with weight loss management techniques for BED.

To integrate the best behavioural weight loss programs with cognitive behavioural therapy. To sustain weight loss by reducing disordered eating, enhancing psychological wellbeing & improving appetite regulation.

CBT-e (CBT-enhanced) is an adapted version of CBT to help treat those with Anorexia Nervosa. CBT is really helpful in reducing symptoms of Bulimia Nervosa and BED, but not AN.
The 'e' element addresses emotions, mindfulness, etc. The problem is that is still works better for BED and BN, but not so well for AN.

Trans-diagnosis removes the categories in mental disorders - however, many clinicians believe that this is not very helpful.

The EDE is the Eating Disorder Examination, a clinician administered tool used to diagnose.

Objective episodes reduced by 4 episodes per week.

| Subjective episodes reduced by 1 episode per week.

Depression, anxiety and stress were all significantly reduced.

The median change was a reduction of 1.1kg.

It is an app were the patient records their mood, food, can challenge thoughts, perform behavioural experiments.

The first session involves fundamental aspects of CBT for any eating disorder.

• Session 1: psychoeducation about regular eating, learning how to monitor, learning the three/four hour rule

That everyone needs to eat every 3-4 hours. After 4 hours the body will begin to seek calories. For those suffering with BED or BN, abstaining from food for too long can ultimately lead to a binge episode.

Over the four weeks of using the app, there was a significant decrease (37%) in binge eating frequency, binge days and the associated loss of control.

No significant changes in compensatory behaviours, however there was a 29% decrease in purging frequency.

There was a significant decrease in dietary restraint, eating concerns, shape concerns, and global EDE-Q scores.

The EDE-Q is the self-report version of the EDE diagnostic tool (eating disorder examination).

It is an amfetamine, slow release drug used to treat Binge Eating Disorder and ADHD.

A significant decrease in binge eating, compared to a placebo. It is the first promising drug in the treatment of BED.

Placebo: relapse after 15 days.
Vyvnase: no relapse even after 195 days.

Vyvanse: 3.7%.
Placebo: 32.1%

Compared to other therapies, Vyvanse is incredibly effective in reducing binge episodes AND reducing weight. But it can only be used extremely carefully. It should not be prescribed to anyone who hasn't done a good course of CBT and have the knowledge about regular eating. Otherwise, a person can flip into having the other spectrum of eating disorders - AN.

The reward systems.