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Friday, May 31, 2013

Name-calling Has Its Place: BED is Now Named as a Distinct Eating Disorder. So what’s in it for you?


What’s in a name?


Perhaps it sounds like an existential question, but if it doesn’t have a name, does it even exist? Labeling Binge Eating Disorder (BED) what it is—a painful struggle living with frequent overeating large amounts of food—makes real the impact on mood, thoughts, energy level, physical wellbeing and hopelessness, to name a few. 
Living with Binge Eating Disorder when it was not yet recognized as a diagnosis, you might not have felt sick enough or eligible to be treated, because it just wasn’t taken seriously enough by those around you. 

Being added as a condition all its own validates this not-uncommon eating disorder whose sufferers live with their secret relationship with food, silently and ashamed.

Like adulterers you may sneak around family members and friends consuming large quantities of food—rarely lean protein or vegetables, I’ll add—but typically those foods and nutrients deemed forbidden. Yes, adulterers, as you carry on a relationship you may fail to acknowledge, cheating only yourself.

You eat quickly, masking the empty packages for fear of the response. “Who finished the cookies?” you dread hearing. You may eat salads or nothing at all in the workplace or with others, then stop at the convenience store or the fast food drive in and eat more than a day’s worth of calories, before even getting home. And then perhaps eat dinner as if nothing had ever happened. There may be a short-lived thrill preceding the binge, but a lingering guilt-filled regret to follow.


I should be mindfully eating? 


Binge eaters rarely taste their food, nor do they enjoy it mindfully—from the accounts of my patients over the past 26 years. They eat cakes and cookies and ice cream, but they don’t consume them with permission—their own permission, that is. They may be quite unaware of what and how much they have eaten. And although there are exceptions, they rarely truly enjoy what they are binging on—although the experience may be quite pleasurable—in the short-term. Friday’s new patient diagnosed with BED would never come in for a follow up—that much was certain—if I dared to suggest he’d have to give up his nightly, longed for ritual of binge eating. Yes, making change takes time—and hard work.


Why oh why do I do this?


You may find yourself eating impulsively, wondering why, even though you know better, you can’t follow through with your intended control over food. 

Let’s start with one basic fact. You are not stupid. It is not for lack of knowledge that you maintain your binge eating pattern, but likely because it meets some needs.  It may temporarily numb you, a drug of choice for some, or may help manage your anxiety. Or it may be triggered by impulsivity, even greater in those who get too hungry and those who struggle with impulse control—like those with ADHD. Now don’t get me wrong. I’m not endorsing binge eating to meet your needs. Rather, hopefully providing some insight so you can begin to move from the place you are stuck.

Binge eating typically, although not always, follows deprivation and food restriction. Ever notice that your binging is worse after dieting or fearing you will be without food? 

Thoughts like “I’ve already blown it so I may as well keep going”, what I call the what the heck effect, adds flames to the fire, contributing to continued overeating. Or you may preplan a binge—a very much-controlled binge, counter to the uncontrolled binges often described.


“What’s your point?”


I just sent a family member a link to a popular press article about a parallel situation- trichotillomania (compulsive hair pulling) is also now added to the new DSM-5, the mental health manual of diagnoses. In response to the link, the trich sufferer responded, “So what’s your point?” So let me clarify for all. The point is, if you are described in these posts, then you deserve to have your condition acknowledged and treated. And that includes getting support from a mental health professional (one who’s trained in CBT, Cognitive Behavioral Therapy). And for BED sufferers, adding a Registered Dietitian who specializes in eating disorders is essential as well.
It takes time to shift your eating pattern and your thoughts, and to find alternative ways to manage things that cause distress, but recovery is possible. 

How do you change and move from being a binge eater? Five areas tend to need to be addressed. You’ll need to:


  1. Eat enough calories throughout the day. Guidance from an RD can be quite helpful here.
  2. Watch your eating pattern to avoid long periods without eating. Excessive hunger leads to excessive intake. Think about a pendulum; swinging to one extreme results in an equal swing in the opposite direction. We are looking to be swinging in a much more narrow range!
  3. Move toward mindful eating. Start by separating eating from distractions, such as TV, reading, computer, driving, phone use. Keep food in the kitchen or dining room only. And try to use your senses when eating. Yes, you deserve to experience and taste what you eat.
  4. Once you are preventing excessive hunger and mindfully eating, it’s time to reintroduce foods you view as ‘forbidden’. Remember that if you are listening to your hunger and eating when you need the fuel, you are no worse off for choosing something you really enjoy eating—be it ice cream or chocolate chip cookies. But keep in mind that while you’re working on liberalizing your ‘forbidden’ foods, work on…
  5. Distinguishing physical hunger from emotional eating triggers, such as stress, reward, depression, anxiety, the need for self-punishment.


Now that it is a recognized condition, it’s my hope that MDs will no longer direct their overweight patients for lap band or gastric bypass surgery, never inquiring about or addressing the underlying problem behaviors. Perhaps the medical community will also begin to distinguish those who are overweight yet healthy—yes, they do co-exist—from those that are struggling with their thoughts and behaviors.

What I like most about this new diagnosis it that it puts the focus on your behavior, not your body weight. Now let’s hope that the medical community begins to ask the questions to open discussion about eating behaviors so that you and others can get the support and direction you need to recover.

Check out these older posts on binge eating and related themes:

Many more posts on the subject can be found by clicking on the relevant labels on the right of the blog.
I'd love to hear from you! Thanks for reading.


9 comments:

  1. Hey Lori,

    I just recently started following your blog
    I'm 30 and I've had anorexia/bulimia for about 13 years
    I've been to treatment numerous times but have never managed to make any real progress
    I see an ED practitioner now and she really is great
    However despite seeing her for a year now, I still have not got the purging under control
    This post echoes what she says to me
    To eat mindfully
    To eat enough so I don't feel like I'm binging
    I want to want to get well if that makes sense but am resisting weight gain
    It always stops me from going that bit further

    So I was wondering if you had any advice about fear of weight gain and fear of living life
    Staying this way feels safe but I know that's not the reality

    I enjoy your blog a lot
    I've had to unfollow all the blogs that I find triggering
    It's quite hard to find a blog with a positive spin on it so I thank you for writing yours and trying to help sufferers
    It's a living hell x

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    Replies
    1. Are you working both with a therapist and an RD with this specialty? Having the whole team in place can really make the difference.
      As for fear of weight gain, I'll start with some simple advice: don't weigh yourself or discuss numbers with your treatment team for now. This may create a bit of anxiety, but it will allow you to focus on the benefits--physical, psychological, cognitive--that result with changes in eating and behaviors and allow you to continue to move forward.
      Thanks for commenting!

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  2. Lori,

    Its definitely been easier to deal with my binge eating and restricted eating once I was finally diagnosed with an eating disorder...it made such a difference and allowed me to start the recovery that I have been trying to work on for the past 12 years.

    Thank you for everything!!

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    Replies
    1. So glad it's coming together for you!

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  3. I am very happy to seeing that BED has been recognized as an eating disorder, just as painful and life interrupting as anorexia or bulimia. Our minds can play such tricks on us...when is it over eating? vs. when is it a binge? I have found that I eat because I am unsatisfied, and then find myself sinking lower and lower as the cookies and cakes and wonderfully luxurious foods fail to satisfy the irking discontentment. What is it that lies beneath the binge eating? What is it we are REALLY hungry for?

    For many years I have struggled with disordered eating. After a full year in therapy, I have finally begun to realize that it's not just the food that is the problem. There is something deeper. Recently I have begun to take a medication for AD(H)D to potentially help with impulsivity, as mentioned in the post above. I finally feel like I can begin to have a moment before the binge begins to think to myself, How will this serve me? That brief instant is allowing me to intervene with the binge, and finally begin to chip away at what REALLY lies at the bottom of the eating disorder.

    This blog is wonderful! I first saw a mention of AD(H)D and binge eating/disordered eating on this blog, and it spurred me to further research the topic which has led me to finally begin moving forward after many stagnant months. So happy to have found this blog!!!

    ReplyDelete
    Replies
    1. Comments like yours--knowing that a post can make such a different in even one person's life--inspires me to continue to write. Thanks, Christina, for the feedback and so glad it's helping!

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  4. Being unrecognized.... that's what a diagnosis of EDNOS feels like.

    ReplyDelete
    Replies
    1. FYI, other formerly labeled EDNOS conditions will similarly be eligible for a name change. For instance, ammenorhea is being eliminated as a necessary condition for the diagnosis of anorexia, so more NOS will be anorexia. And another new label--ARFID--avoidant restrictive food intake disorder will also minimize the NOS!

      That said, even if you don't quite fit a diagnosis your pain shouldn't be minimized! Be sure to seek out a treatment team for support!

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  5. Is there any truth to the health benefits and weight loss benefits of cambogia garcinia? I saw it on dr. Oz and then read about it in a magazine. I worry about these types of 'supplements' but it sounds more healthy bc it lowers cholesterol, etc.

    ReplyDelete