Bulimia & binge eating disorder

Question 1

What is “Healthy Eating”?

Answer 1

• Difficult to determine
• Largely influenced by beliefs and sociocultural norms

Question 2

History: BED

Answer 2

Included in DSM-4 in EDNOS (most common), later added into the DSM-5

Question 3

BED DSM-5 Criteria

Answer 3

A: Recurrent episodes of binge eating (both of the following)
- Eating in a discrete period of time
- Lack of control
B: Associated with 3 or more:
- Eating more rapid than normal
- Uncomfortably full
- Eat when no physically hungry
- Eating alone because embarrassed how much one eats
- Disgusted, depressed or guilty afterwards
C: Marked distress
D: Behaviors occur at least once per week for 3 months
E: No associated with recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during BN or AN

Question 4

Associated features

Answer 4

• BED By far the most common of the eating disorders compared to AN or BN
• 4% of people had an eating disorder, 47% had BED
• BED more common in men and older individuals
• More prevalent in individuals seeking weight-loss treatment (e.g., bariatric treatment) than in the general population.
• BED occurs in normal-weight/overweight and obese individuals
• Cross over from BED to other eating disorders is uncommon

Question 5

Psychiatric comorbidities?

Outcomes?

Answer 5

BED associated with significant psychiatric comorbidity compared to AN and BN
- Mostly comorbid with bipolar disorders, depressive disorder, anxiety disorders and substance abuse disorders
- Psychiatric comorbidity linked to the severity of BED and not degree of obesity

Outcomes:
- High mortality rate related to health complications from obesity
- BED associated with obesity, but they are distinct - not all with obesity engage in recurrent binge eating.

Obesity is NOT a psychological disorder

Question 6

Obesity and Stigma

Answer 6

If ideal body type is thin, then opposite is unacceptable.
- Experiment which showed that children rated the obese children as the least liked (77%).

Question 7

Health promotion concerns

Answer 7

Implication for health promotion: it CAN be harmful
- Ideal approach is focused on not trying to just lose weight, but the common elements which are protective factors for health
- Weight and eating conditions often occur in an environment where ambiguous and opposing demands and messages are present
- “Taking diet pills will help you lose weight and therefore good for health” presented alongside “taking diet pills are dangerous”
Goal: a healthy, disease-free population who eat well, are physically active and satisfied with their bodies.

Leading areas of concern:
- Overemphasis of BMI/weight as indicators of health
- Moralization of eating; e.g., labelling foods as good/bad or right/wrong

Question 8

Treatment for BED

Answer 8

CBT-E
- Identify and target unhelpful behaviors and thinking patterns around weight/shape
Targets behaviors and cognitions around restriction or over-exercise

DBT - primarily designed for BPD, helps people deal with fluctuations and emotions

IPT- Moderate effect

Pharmacotherapy
- SSRIS reduce BED behaviors and depressive symptoms
- Anticonvulsants

Question 9

OSFED (NOT IN FINAL EXAM) - Other specified feeding or eating disorder

Answer 9

• Individuals who do not meet criteria for an ED but still experience clinically significant symptoms (not necessarily milder or less severe)

Atypical anorexia nervosa: All criteria met, except despite significant weight loss, individuals’ weight within or above normal range
Bulimia nervosa: all of the criteria are met, except that binge eating/compensatory behaviors occur less than once/week and/or less than 3 months.
Binge eating disorder: All criteria met, except binge eating occurs, on average, less than once/week and/or less than 3 months.
Purging disorder: Recurrent purging behavior in absence of binge eating.
Night eating syndrome: recurrent episodes of night eating, causing functional issues.

OSFED have comparable physical and medical morbidities to AN, BN and BED

Question 10

Common myths of Eating disorders

Answer 10

1. It is a choice
2. Only effect young, white, middle-class women
3. Can tell by looking at them if they have it.
4. Families are to blame
5. Society alone is to blame
6. Genes are destiny
7. They are benign
8. They are for life