BingeEatingDisorderandthemythsthatsurroundit

PresentedbyHildaDulinLee

THREEGREATMYTHSOFBINGEEATING

• #1BingeEatingisthesameasovereating

• #2Peoplewhobingearelazy&self-indulgent;theysimplylackthestrengthofcharacter&motivationtochange

• #3“IfIcouldjustfindtherightdietandexertenoughwill-power,Icouldsolvemyproblem”

Myth#1BingeEatingistheSameasOvereating

• Threemaincomponentsofbingeeating• Eatingwhatmostpeoplewouldconsideraninappropriatelylargeamountoffood• Feelinglossofcontrol• Extremedistress

• Othercommonelementsofbingeeating• Soothed&comforted• Euphoria&relief• Frenzied&accelerated• Numb&disconnected• Alone&insecret• Shame&remorse

• Reading*

BingeEatingDisorder(BED)

• Bingeeatingdisorder(BED)isaneatingdisorderinwhichapersonbinges,onaverage,onceaweekoverathree-monthperiod(AmericanPsychiatricAssociation’sDSM-5)• Morecommonthananorexiaandbulimiacombined• 8millionAmericansmeetthiscriteria• Another8-10milliondon’tmeetthecriteriaforBEDbutare,nonetheless,affectedbybingeeating• BEDistheonlyeatingdisorderthataffectsmeninlargenumber

Myth#2Peoplewhobingearelazy&self-indulgent;theysimplylackthestrengthofcharacterandmotivationtochange

• Deepdown,mostofuswhobingefeelthatoursecreteatingistheresultofsomedarkcharacterflaw,somemoralfailing• Obeseindividuals,especiallythosewhobingeeat,haveasenseofworthlessnessinstilledearly• Studieswith5th graders&preschoolers*• PeoplewithBEDareoftenhighlycompetitiveperfectionistswhoareextremelyself-critical• OnestudyexaminedperfectionismandBEDandfoundthattheobesebinge-eatinggroupscoredsignificantlyhigheronperfectionismthantheobese,non-bingeinggroupandthenormalweightgroup• Thehighstandardsthatwesetforourselvesmayhelpusbecomesuccessful,buttheyactuallycontributetoourbingeingbehavior• Soifit’snotacharacterflaw,whatcausesapersontodevelopBED?

FactorsThatContributetotheDevelopmentofBED

•EarlyChildhoodTrauma•Psychological&EmotionalFactors•Genetics•Dieting

FactorsthatContributetotheDevelopmentofBED

• EarlyChildhoodTrauma*• Highcorrelationbetweenanunsafehome&thedevelopmentofBED.Why?• Amygdala:theprimitivepartofthebrainresponsiblefortriage&emergencyaction(fight-or-flight)• Beingconstantlyvigilanttodangerintheearlyyearschangesthephysicalarchitectureofthebrain.Theroutethroughtheamygdalabecomesrutted&wedevelopahair-triggerfight-or-flightresponse• Theamygdalalearnsthatcertainsights,sounds,andsmellsinourenvironmentaredangercues(theseareespeciallyimprintedduringourearlyyears)• Astensionsrise,weareforcedtoseekimmediaterelief,andfoodistheearliestandmostprimalofsoothingbehaviors• Plus,dangeroushomesgiveuslittleopportunitytolearnself-soothingskillsinthoseearlyyears

FactorsThatContributetotheDevelopmentofBED

• EarlyChildhoodTrauma• Psychological&EmotionalFactors• Depression• Anxiety• Suicidalthoughts&actions• Poorself-esteem• Poor&inaccuratebodyimage

Poorbodyimageisdamaging

I’msofat!

FactorsThatContributetotheDevelopmentofBED• EarlyChildhoodTrauma• Psychological&EmotionalFactors• Genetics• Somefamiliesaresimplymorepronetocertaineatingdisorders• Twinstudiesshowtheinheritabilityofbingeeating

• BEDis3Xstrongerbetweenidenticaltwinsthanfraternaltwins• Severalstudiesshowbingeingisabout50%heredity&50%environment

• HighcorrelationbetweenBEDandalcohol&drugabuse• 10%inthegeneralpopulationvs.50%inBEDpatients)

• Brainscans• Studiessuggestthereisagenetictraitforimpulsivityandrisk-takingthatiscommontobothBED&otherimpulsivebehaviors(likegambling,shop-lifting,sexualaddiction,compulsiveshopping,alcoholism,drugaddiction)• Fred

Genetics(continued)

• PatientswithBEDandtheirfamiliestendtobeimpulsive,unrestrained,stimulus-seekingpeoplewhogoaftertheexciting,novel,intenseexperience.Ourhomesareoftenloudandrancorous.Weareoftenrisk-takers,whichcansometimesleadtodangerousbehaviors.• Thisislikelywhyyoufindmanywhohavetheseimpulsivetraitsamonginmatesinprisonsandamongpatientsinrehabcenters• BUT…• It’salsowhyyoufindmanywithBEDandotheraddictionsamongentrepreneursandbusinessleaders(especiallysinceoftenpairedwithperfectionism)• Thereisaconnectionbetweenaddictivepersonalityandsuccessfulleaders*• Ontheotherhand,patientsw/anorexiaandtheirfamiliesareoftenhighlyaversetorisk-takingandshowmuchmoreemotionalcontrol,followtherules,andavoidconflictandconfrontation

Genetics(continued)

• Onestudyexaminedthegeneticmakeupof1000’sofseverelyobeseindividuals(whobecameobesebeforetheageof10)• 1in20hadavariationintheMC4Rgene• Peoplewiththisvariationaremissingcertainneurochemicalreceptorsthatcontrolsatiety.Theirbrainssimplynevergetthemessagethattheyarefull.• Firststudythatdirectlylinkedgenestothebehavior ofbingeing• Pairedthosewiththegenevariationtoanequallymatchedpersonsinthestudy(age,gender,ethnicity,BMI,%bodyfat,etc.)butwithoutthevariation• 100%ofthosewiththisvariationmetthecriteriaforBED• Only14%ofthosewithoutitmetthecriteriaforBED

Genetics(continued)• Variationsindopamineandopioidreceptorgenestremendouslyaffectaperson’slikelihoodofdevelopingBED(ex:DRD2,OPRM1)• Thegeneticconnectionisstillinitsinfancy,butholdspromiseforallsortsofaddictions—andtheirtreatment• Ex:naltrexoneisanopioidblockersometimesusedforalcoholism&certaindrugaddictions• StudiesshowthatalcoholicswhohaveacertainvariationintheirOPRM1genearemorelikelytorespondtotreatmentwithnaltrexone• OneresearchertoldmehewasgettingareductioninbingeingwithsomeBEDpatientswhenheusednaltrexone• …thosewithapersonalorfamilyhistoryofalcoholism

• NaltrexoneisoneoftheingredientsinContrave(aobesitydrug).Theotheringredientinthatmedicationistheanti-depressantWellbutrin(wellknownforit’suseinnicotineaddiction)

FactorsThatContributetotheDevelopmentofBED

• EarlyChildhoodTrauma• Psychological&EmotionalFactors• Genetics• Dieting• Definitionofdiet• Di’-et:theusualfoodordrinkofapersonoranimal• Di’-et:restrictoneselftosmallamountsorspecialkindsoffoodinordertoloseweight

• Dietingisthemostimmediatetriggerforabinge• Leadsustothenextmyth

Myth#3“IfIcouldjustfindtherightdietandexertenough

will-power,Icouldsolvemyproblem.”

Dieting,especiallychronic,stringent,low-caloriedieting,isABSOLUTELYthewrongapproachtosolvingabingeproblem.WHY?

• Hunger&deprivation• Chronic,stringentdietingoveraperiodoftimechangesthebrainchemistry• Reducescertainneurochemicalsthatcontrolsatiety;dampensourinnatesignalsofhungerandfullness

• InBED,foodisnotbeingusedtonourishthebodybutrathertomanageemotionalneeds• Foodissimplyourdrugofchoice

Dietingisourworstenemy!!…sowhatsolutionsdidIuse?

AnatomyofaBingeCycle

NegativeEmotions

Binge

Shame&Remorse

Resolve:NewDiet

DietFails

Eatsomethingtorelieveincreasingtension

All-or-nothing:“I’veblownit…”

Relieved,soothed,euphoria,numb,disconnected

“ThistimeI’llbeperfect.”

“Ihavenowillpower…I’msuchafailure…Whataloser…”

Hunger,deprivation,depression

Exhausted,humiliated,embarrassed

Conclusion

Take-awayOvercomingbingeeatingisaboutsomuchmorethanstoppingthe

behaviorofbingeingorlosingweight*

Itisabouttransformationandpeace

IntheLabyrinthofBingeEating

ContactmeforspeakingeventsHildaDulinLee

hdlee@comporium.net