Background: This presentation will address the diagnostic criteria of Binge Eating Disorder, medical considerations, factors contributing to its development, and pharmacological and non-pharmacological treatment. Several case studies will be presented. Night Eating Syndrome will also be discussed.
Presentation Outline
Binge Eating Disorder: Practical Strategies for Patient Assessment and Treatment
<>I. Diagnostic criteria for BED <>A. Recent changes <>B. History of BED <>C. Nature of BED <>D. Significance <>E. Demographics <>II. Medical and psychological considerations <>A. Medical complications <>B. Functional impairment <>C. BED and type II diabetes <>D. BED and bariatric surgery <>E. Implications for women's health <>1. Infertility <>2. BED in pregnancy <>3. Nutritional concerns in pregnancy <>III. Interface between BED and other mental health disorders <>A. Prevalence of co-existing psychiatric diagnoses <>B. Psychological and physiologic contributors to BED <>C. Food Addiction <>IV. Cultural aspects of BED <>A. Emotional differences in specific ethnic-racial groups <>V. BED and youth <>A. Understanding “loss of control” <>B. Children's BED Scale (C-BED) <>C. Rural vs urban childhood obesity <>D. Treatment goals for children and adolescents with BED <>VI. BED outcome data <>VII. BED treatment options <>A. CBT <>1. Goals of treatment <>B. Pharmacological treatments <>1. Antidepressants <>2. Antiepileptic agents <>3. Psycho-stimulants <>4. Memantine <>C. What's the best treatment for BED? <>1. What to focus on first: obesity or BED? <>VIII. Night eating syndrome <>A. Diagnostic criteria <>B. Demographics <>C. Causes <>D. Treatment options <>E. Night eating questionnaire <>IX. Assessing for BED in primary care setting <>A. Eating disorder screening question <>B. Role of primary healthcare provider and/or therapist <>X. Case Studies <>A. 15 year old girl <>B. 29 year old woman <>C. 49 year old woman <>XI. Resources for patients and providers <>XII. Bibliography
Much attention has been given to the 2013 DSM-5 revisions in the diagnostic criteria for eating disorders. One result is that binge eating disorder has earned its own bonified diagnosis in the DSM, but is by no means a "new" diagnosis. Binge eating disorder (BED) is often an over-looked diagnosis and primary medical and mental health providers need to learn how to identify and screen for this disorder, as well as understand its treatment.
There are multiple medical consequences and psychological considerations to be addressed. BED can complicate the treatment of obesity (including bariatric surgery), diabetes, and other co-existing mental health disorders.
BED involves genetic factors. Emotions associated with BED may be experienced differently by individuals from specific ethnic-racial groups.
Recent research on BED in youth has recognized "loss of control" as a primary factor. The Children's Binge Eating Disorder Scale (C-BEDS) can be helpful to interview and diagnose youth with BED. Obesity commonly results from BED. Whether a child or adolescent lives in a rural or urban area plays a part in determining if they will develop obesity. The focus of treatment for this younger population focuses on treating underlying depression or anxiety, improving self-esteem and normalizing eating patterns.
BED outcome can be optimized through: early detection and referral to ED specialists, incorporating a multi-disciplinary treatment team to address the physical, psychological,nutritional and spiritual aspects of the disorder.
Obesity has a strong association with infertility and menstrual irregularities. Overweight and obese women also have poorer outcomes following fertility treatment. BED also presents nutritional concerns during pregnancy.
CBT is the leading evidence based treatment for eating disorders, including BED. This should be facilitated by a highly trained therapist or eating disorder specialist. Antidepressants, especially SSRI's, can be helpful additions to treat underlying depression or anxiety. Bupropion can decrease depression and contribute to weight loss. Antiepileptic agents such as topiramate and zonisamide decrease pre-occupation with food and promote weight loss. In specific cases, Naltrexoce, psychostimulants or memantine have also been effective treatments.
A separate, but related eating disorder, Night Eating Syndrome (NES), is best addressed by treating underlying anxiety and/or stress.
Laura Clauss has treated persons with eating disorders in NH for 38 years and is co-owner and Medical Director of The Center for Eating Disorders Management in Bedford, NH (an outpatient treatment facility), where she developed an intensive outpatient program. Laura has been involved in eating disorders professional education in NH for 15 years. She is a member of the clinical faculty of Massachusetts College of Pharmacy and Health Sciences Physician Assistant program and Plymouth State University's graduate Eating Disorder Institute, and has published articles on anorexia, body image and binge eating disorder.
