Flashcards in Eating Disorders: BED Deck (18)
Was BED in the DSM IV
No, it was considered to be a 'diagnosis in need of further study'
It is now included in DSM-V as a diagnosis
What are the two qualifying criteria for a binge-eating episode?
A. Recurrent episodes of binge-eating:
> eating, in a discrete period of time, an amount which is definitely larger than what is socially acceptable
> a sense of lack of control over eating during the episode
(some patients have subjective binge-eating -> they feel that just eating a mars bars whilst on a diet is a binge [they still feel bad about their behaviour])
What are the other criteria for BED
B. the binge-eating episodes are associated with three (or more) of the following:
> eating much more rapidly than normal
> eating until feeling uncomfortably full
> eating large amounts of feed even when not feeling hungry
> eating alone because they are embarrassed by their behaviour
> feeling disgusted with oneself, depressed, or very guilty afterwards
C. marked distress regarding binge-eating is present
D. the binge-eating occurs, on average, at least once a week for 3 months
E. The binge eating is not associated with any recurrent inappropriate compensatory behaviour - if there is, it is considered BN
What qualifies partial and full remission?
Partial: After meeting full criteria, binge-eating occurs less than once a week for a sustained period of time
Full: After meeting full criteria, none of the criteria have been met for a sustained period of time
What are the severity specifiers (binge-eating episodes per week)
Extreme: 14 or more
What is the prevalence of BED
Women: 2.5 - 4.5%
Men: 1.0 - 3.0%
Note: closer prevalence in M/F than in any other eating disorder.
> typically begins in early childhood (ie early to mid twenties)
What are the risk factors?
> Tends to run in famalies, which suggests genetic influences
> Dieting is greatest risk factor for developing BED
> low self-esteem etc
What are the triggers fro BED
> negative affect - depression, anxiety etc
> interpersonal stressors
> dietary restraints
What are the three overarching protective factors?
> high self-esteem
> emotional well being
> ability to regulate emotional states
> eating meals together
> not constantly hooked up on weight and physical attractiveness
What are comorbid disorders?
It is similar to other eating disorders
> depression and anxiety are most common
> substance use and personality disorder are also very common
It is also associated with obesity and the related health conditions
How can you assess BED
> Eating Disorder examination (EDE) or the self-report questionnaire (EDE-Q)
> Binge Eating Scale (BES)
What are the treatment methods for BED
Psychological therapy - "first line
> Cognitive Behavioural Therapy (CBT)
> Interpersonal Therapy (IPT) - more psychodynamic, focuses on relationships not on the eating behaviour
> Dilectical Behavioural Therapy (DBT) - used to help with emotional and impulse control -> used for other disorders such as borderline personality
> Selective serotonin reuptake inhibitors (SSRIs)
> Selector noradrenalin reuptake inhibitors (SNRIs)
What are the targets of BED
> Have to stop the person from bingeing!
> Sustainable weight loss
> Increase in ability to cope with negative affect - how to deal with feeling down
> Relapse prevention
> Lowering impulsivity to eat
> Mood is implicated, so keep moods stable - removing one risk factor
Approx what are the binge abstinence rates for the treatment methods?
Average post-treatment 50%, which increases in follow up studies - the longer you practice the treatment, the better at it you become!
What is one of the most difficult aspects of treating BED
Ability to help patients cease binge-eating episodes and then continue to lose weight
What is the most effective treatment for BED
CBT - it is the most validated and effective treatment, and you can still use it without negatively affecting comorbid conditions
What are some of the negative aspects of CBT treatment
> individual CBT is cost and time intensive
> it has only modest effect on weight loss