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Binge Eating Disorder and the Brain: Clinical Implications for the Treatment of BED as A Neurobehavioral Disorder

Saturday, February 20, 2016: 11:00 AM-12:30 PM
Magnolia E (Omni Amelia Island Plantation)

Background: This presentation will conceptualize BED as a neurobehavioral disorder, and will apply behavioral therapies that have long been used to treat obsessive compulsive spectrum disorders, to this unique population. A behavioral approach to BED treatment using exposure therapy, habit reversal training, and mindfulness will be demonstrated using case examples.

  1. Core clinical features 
    1. Substance Use Disorder 
      1. repeated use of mood altering substance despite significant negative consequences
    2. Binge Eating Disorder
      1. repeated episodes of binge eating that cause marked emotional distress
    3. OCD
      1. obsessions: recurrent, persistent thoughts, images, and impulses that the person experiences as unwanted/intrusive and that cause marked distress.
      2. compulsions: repetitive and deliberate behaviors or mental acts that the person feels driven to perform in response to an obsession. 
  2.   Comorbidity and common clinical  features
    1. 40% of patients seeking eating disorders treatment will meet diagnostic criteria for OCD
    2. 25 percent of individuals entering treatment for eating disorders will meet criteria for substance abuse problems
    3. Common clinical features: 
      1. recurrent urges to engage in a behavior that serves to alter brain function and alleviate internal distress
      2. sense of psychological need or reliance on the behaviors 
      3. intense psychological distress if these behaviors are prevented
  3. Pitfalls of treating BED using addiction model of treatment
    1. flaws in research supporting the  idea that certain foods are highly addictive 
    2. “forbidden fruit syndrome” and the concept of “psychological deprivation”
    3. concept that the client is powerless over their behavioral response to urges
  4. BED as a neurobehavioral disorder
    1. cerebral cortex versus subcortical structures
    2. compulsive urges arise from subcortical structures responsible for insticutal drives 
    3. role of pre-frontal lobe in inhibting impulses and ability to exercise voluntary control over response to urges arising from subcortical structures
    4. neurological changes noted after Exposure with Response Prevention Treatment for OCD patients
  5. Review of medications used to treat BED
    1. short versus long term efficacy and side effects
    2. appetite suppression versus development of new behavioral response to compulsive urges 
  6. Application of Exposure with Response Prevention to treatment of BED
    1. concept of repeated exposure to “triggering” stimuli with goal of habituation to stimuli
    2. use of “fear hierarchy” to create gradual graded exposure to triggers
    3. gradual loss of automatic association between the trigger and the binge behaviors (conditioned response)
    4. new neural paths are formed that allow triggering food item/situation to be associated with “normal” eating behaviors as opposed to binge behaviors (extinction)
  7.   Application of Habit Reversal Training to BED
    1. awareness Training
    2. competing response training
    3. contingency management
    4. mindfulness
  8. Application to case example 

This session will begin with comparing and contrasting the diagnostic features of Binge Eating Disorder, Substance Use Disorders, and Obsessive Compulsive Disorders.  Common clinical features will be highlighted including the experience of recurrent, powerful urges to engage in a specific behavior that alters brain function, and serves to alleviate internal distress.  BED is often conceptualized as an addiction to food, and has been treated using the addiction model of treatment.  Common pitfalls in the application of the addiction model to BED will be explored including issues surrounding abstinence approach to trigger foods.  The use of psychotropic medication in the treatment of BED will be discussed including short versus long term efficacy.   

This presentation will then propose a new model of Binge Eating Disorder (BED) as a neurobehavioral disorder.  Research on the biochemical and neurological foundations of BED will be reviewed.   Behavioral therapy approaches that have long been proven effective in treating other neurobehavioral disorders (obsessive compulsive spectrum disorders) will be applied to BED using case examples.  Specifically, exposure with response prevention therapy will be applied as a method of safely reintegrating typical binge foods back into a client’s repertoire of daily intake.   Elements of habit reversal training including awareness training and mindfulness will be applied to management of recurrent binge urges.  The primary goal of teaching patients to pay attention to their internal experience, and tolerate highly distressing emotional states, without acting to alleviate their distress will be highlighted.

Primary Presenter:
Jennifer Lafferty O'Connor, PhD

Dr. Jennifer O'Connor is an expert in the field of anxiety and eating disorder treatment, and has been featured on the Anderson Cooper show and CNN Headline News, providing expertise in these areas. Dr. O’Connor worked for 7 years in intensive inpatient eating disorder and anxiety disorder treatment, and currently runs a private practice in San Clemente treating children, teens, and adults with anxiety and eating issues. She is a member of International Association of Eating Disorder Professionals and the International Obsessive Compulsive Disorders Foundation, and has presented frequently on topics related to evidenced-based treatment for eating and anxiety disorders.

Lesley L. Williams, MD, CEDS

Dr. Williams is a certified eating disorder specialist. She received her medical training in Family Medicine from the illustrious Mayo Clinic in Arizona. Dr. Williams is a sought after speaker and has given numerous local and national presentations on various eating disorder topics. Dr. Williams spent over 10 years at Remuda Ranch providing exemplary compassionate medical care for the patients she served. She has since branched out to co-found Liberation Center. Dr.Williams is passionate about holistic health and promoting the mission of Liberation Center, to inspire eating disorder freedom and happy, healthy living.

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