by Adina Silvestri
as seen in “American Counseling Association”

Binge Eating: Easy to Swallow, Hard to Digest

When I first heard of cheat meals, I was concerned because it was coming out of the mouth of a 20-something, thin-framed client at the prime of her life. Then the dreaded body competition stories began, and it all made sense. Restrictive dieting to binge eaters is like porn to a sex addict—one vicious cycle. The problem with this addiction (unlike the others I treat) is that there is no abstinence from food. This is one of the many reasons why treatment for individuals with Binge Eating Disorder (BED) can be difficult.

Why are carbs something to fear and scales something to obsess over? Why is there such a high rate of extreme dieting in the Body Building community? How can we help shelter young healthy women and men from the damage being done to their bodies just for the sake of prepping for a show? These are just a few questions I have asked myself (and my clients) in working with this disorder.

The Struggle

I believe the struggle to overcome BED is exhausting. Individuals have to eat. But when we essentially starve our body, because we just binged, our body becomes confused. Clients tell me it is difficult to know when they are hungry and when they are full. Individuals with BED suffer with anxiety when they go out with friends, so to avoid the anxiety of not wanting to eat, they isolate themselves, which is a trigger. Depression is also a symptom to look for with this population. They do not want to eat in front of others because of their restrictive diets, and they often carry poor self-esteem around like heavy luggage as they wait for the next pound to drop. When they do binge, it resembles an addict getting their fix: the shame and guilt are immeasurable.

BED Research Studies

There is a dearth of research surrounding BED. Although it finally made it into the DSM V as an actual diagnosis, studies on the subject are almost non-existent. Is this because society continues to believe BED is not a real disorder? Have we fooled ourselves into thinking overeating can do little harm in comparison to substances like alcohol, cigarettes, or harder drugs like heroin? At least with the previously mentioned substances, there is a way to escape their presence, and our body is not dependent on them to survive.

We have all read the recent post that Shire Pharmaceuticals was able to get the ADHD medication Vyvanse approved for treatment in BED. For most, this is shocking because of the drug’s addictive qualities. Antidepressants are the clear choice for treatment of BED.

So far, the treatment I have recommended to clients resembles what I give the individuals with substance abuse disorders. Dopamine is an essential piece of a recovery plan.

Dopamine & the Neuropsychology of Addiction

I have heard time and time again of a “funny” feeling or tingling sensation when thinking about binging. Could this be the neurotransmitter, Dopamine, hard at work? Is it priming the brain to seek the reward and at the same time overriding the decision-making frontal lobe?

More research is needed to help us treat BED patients.

Binge Eating Disorder Client Care

As abuse counselors, we are often able to see the truth of a client’s lifestyle, and we have a role to support them in whatever way we can. When the data is scarce, this can be difficult; however, with BED, treatment possibilities could include:

1. utilizing a relapse prevention plan that takes into account psychological, medical, and behavioral components
2. incorporating other partners such as a nutritionist, family members, or a therapy group
3. eliminate binging so that dopamine can return to normal levels
4. SSRI’s to assist with depression/anxiety

This population, like that of any addict, does not always see the facts for what they really are. Food is neither an enemy nor a salvation. What we see in the mirror is 90% in our heads and only 10% in the glass. A person’s value is found in more important things.

It’s time for the counselling community to focus on our Binge Eating Disorder clients. We have to take this condition seriously so that the world will follow suit.