Eating Disorders: BED Flashcards
Was BED in the DSM IV
No, it was considered to be a ‘diagnosis in need of further study’
It is now included in DSM-V as a diagnosis
What are the two qualifying criteria for a binge-eating episode?
A. Recurrent episodes of binge-eating:
> eating, in a discrete period of time, an amount which is definitely larger than what is socially acceptable
> a sense of lack of control over eating during the episode
(some patients have subjective binge-eating -> they feel that just eating a mars bars whilst on a diet is a binge [they still feel bad about their behaviour])
What are the other criteria for BED
B. the binge-eating episodes are associated with three (or more) of the following:
> eating much more rapidly than normal
> eating until feeling uncomfortably full
> eating large amounts of feed even when not feeling hungry
> eating alone because they are embarrassed by their behaviour
> feeling disgusted with oneself, depressed, or very guilty afterwards
C. marked distress regarding binge-eating is present
D. the binge-eating occurs, on average, at least once a week for 3 months
E. The binge eating is not associated with any recurrent inappropriate compensatory behaviour - if there is, it is considered BN
What qualifies partial and full remission?
Partial: After meeting full criteria, binge-eating occurs less than once a week for a sustained period of time
Full: After meeting full criteria, none of the criteria have been met for a sustained period of time
What are the severity specifiers (binge-eating episodes per week)
Mild: 1-3
Moderate: 4-7
Severe: 8-13
Extreme: 14 or more
What is the prevalence of BED
Women: 2.5 - 4.5%
Men: 1.0 - 3.0%
Note: closer prevalence in M/F than in any other eating disorder.
When?
> typically begins in early childhood (ie early to mid twenties)
What are the risk factors?
> Tends to run in famalies, which suggests genetic influences
Dieting is greatest risk factor for developing BED
trauma
low self-esteem etc
What are the triggers fro BED
> negative affect - depression, anxiety etc
interpersonal stressors
dietary restraints
boredom
What are the three overarching protective factors?
Personal: > high self-esteem > emotional well being > ability to regulate emotional states Family: > eating meals together > not constantly hooked up on weight and physical attractiveness Society:
What are comorbid disorders?
It is similar to other eating disorders
> depression and anxiety are most common
> substance use and personality disorder are also very common
It is also associated with obesity and the related health conditions
How can you assess BED
> Eating Disorder examination (EDE) or the self-report questionnaire (EDE-Q)
Binge Eating Scale (BES)
What are the treatment methods for BED
Psychological therapy - “first line
> Cognitive Behavioural Therapy (CBT)
> Interpersonal Therapy (IPT) - more psychodynamic, focuses on relationships not on the eating behaviour
> Dilectical Behavioural Therapy (DBT) - used to help with emotional and impulse control -> used for other disorders such as borderline personality
Pharmacological treatment
> Selective serotonin reuptake inhibitors (SSRIs)
> Selector noradrenalin reuptake inhibitors (SNRIs)
What are the targets of BED
Psychological: > Have to stop the person from bingeing! > Sustainable weight loss > Increase in ability to cope with negative affect - how to deal with feeling down > Relapse prevention
Pharmacological:
> Lowering impulsivity to eat
> Mood is implicated, so keep moods stable - removing one risk factor
Approx what are the binge abstinence rates for the treatment methods?
Average post-treatment 50%, which increases in follow up studies - the longer you practice the treatment, the better at it you become!
What is one of the most difficult aspects of treating BED
Ability to help patients cease binge-eating episodes and then continue to lose weight
