Understanding Binge Eating Disorder and Treatment Approaches

Binge Eating Disorder (BED)

Recurrent episodes of binges without compensatory behavior, greater weight and shape concerns, more personality disturbance, greater likelihood of mood/anxiety disorders, more executive function deficits, loss of control.

Obesity

Over 30.0 kg/m and above and Over 95th percentile in children.

DSM-5 Criteria for BED

Persistent episodes of binge eating (1/week) for 3 months.

Cognitive Behavioral Therapy (CBT)

Phase 1: Behavioral Changes
Phase 2: Cognitive Restructuring
Phase 3: Maintenance and Relapse Prevention.

Overweight criteria

85-95th percentile of BMI.

Obese criteria

95% percentile of BMI.

BMI

Easy to use but only a screening tool and does not take into account body composition.

DEXA scan

Comprehensive by looking at fat vs non-fat in body but expensive.

Bod Pod

Air displacement.

Skinfold measures

Method to assess body fat using calipers.

Waist circumference

Measurement used to assess body fat distribution.

Obesogenic environment

Environment that provides unhealthy foods and advertises unhealthy foods, makes it much easier and accessible, desk jobs and places that encourage sedentary lifestyles.

Family-Based Therapy (FBT)

Parenting Skills
Positive Reinforcement
Goal Setting
Stimulus Control
Relapse Prevention
Self-Monitoring.

Traffic Light Diet

Dietary approach categorizing foods into red, yellow, and green based on their nutritional value.

Behavioral Weight Loss for adults

Dietary and physical activity recommendations
behavior change
therapeutic support.

Surgical Procedures for obesity

For BMI over 40 kg/m or serious health risks. Includes gastric banding, sleeve gastrectomy, gastric bypass.

Pharmacotherapy

NOT a standalone treatment
within treatment program
appetite suppressant
inhibits fat absorption.

Muscle dysmorphia

Core fear of insufficient muscularity.

Myths about eating disorders in men

Men can't get EDs; EDs present the same way as females.

Differences in eating disorders presentation in men

Less likely to seek treatment
later age of onset
previous history of overweight
greater psychiatric comorbidity
differences in expression of body dissatisfaction and specific ED symptoms.

Dialectical Behavior Therapy

Designed for severe and chronic multi-diagnostic, difficult-to-treat patients with mood & personality disorder symptoms.

Structure of Traditional DBT

Includes individual therapy, group skills training (two hours a week for one year), consultation team, telephone coaching, and optional parent training/family therapy for adolescents.

Gold standard for borderline personality disorder

DBT is considered the gold standard for treating borderline personality disorder, suicidality, and self-injurious behaviors.

DBT Assumptions about Patients

Patients are doing the best they can, want to improve, must learn new behaviors in all relevant contexts, cannot fail in DBT, may not have caused all their problems but must solve them, need to try harder, and their lives are unbearable as currently lived.

Family Treatment - Fundamental Assumptions

Includes an agnostic view of the illness, a non-authoritarian therapeutic stance, externalization of the illness, initial focus on symptoms, and parents being part of the solution and responsible for weight gain.

Diagnosis of AN

Includes being younger than age 18, living at home with family, and family being able and willing to put significant time commitment into treatment.

Diagnosis of AN - Phase I: Weight Restoration

Treatment goals include taking history of the illness and separating the illness from the patient.

Diagnosis of AN- Phase II: Return control to adolescent

Goals include maintaining weight at a minimum of 87% IBW and gradually returning food and weight control to the patient.

Diagnosis of AN - Phase III: Establish healthy adolescent identity

To establish that the adolescent-parent relationship no longer needs eating disorder symptoms as a way of communicating.

CBT - Two versions - FBT

Includes focused (the core treatment) and broad (mood intolerance, clinical perfectionism, low self-esteem, and interpersonal difficulties).

CBT - Two Versions - Enhanced

Created because normal CBT was not working for ED patients

CBT - Two intensities

20-session version (BMI > 17.5) and 40-session version (15.0 < BMI > 17.5).

Stage One of CBT

Focuses on establishing the foundations of treatment and achieving early change within the first 4 weeks through 8 sessions twice a week.

Stage Two of CBT

Involves reviewing progress, identifying emerging barriers to change, and designing Stage Three through 2 appointments over 2 weeks.

Stage Three of CBT

Addresses the main maintaining mechanisms of the eating disorder.

Stage Four of CBT

Focuses on maintaining the changes obtained and minimizing the risk of relapse through 8 weekly sessions.

Role of the registered dietician in integrated care

Involves providing dietary therapy and support for patients with eating disorders.

Major components of dietary therapy

Includes establishing regular eating patterns, addressing dietary rules, and managing clinical perfectionism and mood intolerance.

Role of Nutritional Counseling

Nutritional counseling, nutritional education, medical nutrition therapy

Establish Weight Range

Monitor weight changes and educate accordingly, monitor nutrition-related labs and medical complications, prescribe health exercise, prescribe meal plan, optimize resting metabolic rate

Role of Psychiatrist in Eating Disorder Care

Mainly to address eating disorders that also have substance abuse. May prescribe medicine in order to help with psychological and substance abuse/problems.

Diagnosis of Co-occurring Disorders (COD)

A diagnosis that occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms.

Criteria for Co-occurring Disorders

The presence of at least 2 of 11 criteria, clustered in 4 groups.

Impaired Control Criteria

Taking more or for longer than intended
Unsuccessful efforts to stop or cut down use Spending a great deal of time obtaining
Using or recovering from use
Craving for substance.

Social Impairment Criteria

Failure to fulfill major obligations due to use
Continued use despite problems caused or exacerbated by use
Important activities given up or reduced because of substance use.

Risky Use Criteria

Recurrent use in hazardous situations
Continued use despite physical or psychological problems that are caused or exacerbated by substance use.

Pharmacologic Dependence Criteria

Tolerance to effects of the substance
Withdrawal symptoms when not using or using less.

Medications for Eating Disorders

Prozac for Bulimia Nervosa (BN)
Vyvanse for Binge Eating Disorder (BED), Remeron and Zyprexa for Avoidant/Restrictive Food Intake Disorder (ARFID)
Topiramate for BED and BN.

Medications for Co-occurring Conditions

Antidepressants can help reduce symptoms of depression or anxiety, which frequently occur along with eating disorders. Olanzapine and Quetiapine are commonly prescribed.

Common Substances Misused

Alcohol, Caffeine, Cannabis, Hallucinogens, Inhalants, Opioids.

Integrated Care for ED & SUD

____________________ for patients with comorbid Eating Disorders (ED) & Substance Use Disorders (SUD) should be organized in a comprehensive & integrated manner.

Components of Integrated Care

Comprehensive, evidence-based screenings for ED, SUD, other psych disorders, medical conditions & relevant lab testing
Individualized treatment plans that encompass both ED & SUD
Therapists & treatment teams that are trained in evidence-based treatments for COD
Services that are provided in the same location by the same providers in a stepwise, integrated fashion.

Definition of Self-Compassion

Being open to and moved by one's own suffering, experiencing feelings of caring and kindness toward oneself, taking an understanding, nonjudgmental attitude toward one's inadequacies and failures, and recognizing that one's own experience is part of the common human experience.

Components of Self-Compassion

Self Kindness + Common Humanity + Mindfulness.

Compassion-Focused Therapy (CFT)

__________ has been studied across multiple populations (psychotic-related disorders, personality disorders, mixed outpatient and inpatient samples, mood disorders, anxiety disorders, etc.).

Target Audience for CFT

_________ targeted towards people who have mental health problems primarily linked to high shame and self-criticism.

Effects of CFT on Shame and Depression

_________has been associated with reductions in shame, depression, and anxiety.

Effects of CFT on Positive Outcomes

_________has been associated with increases in compassion, happiness, and self-reassurance.