Friday, July 26, 2013

What You Should Know About Binge Eating Disorder: 3 Doctors Discuss

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD

Holly Peek, M.D., MPH Follow @PsychGumbo

Mona Amini, M.D., MBA Follow @MonAmiMD

What Causes Binge Eating Disorder? 

With up to 4 million Americans having binge eating disorder, it's a significant health issue for our nation.  Binge eating disorder has a wide variety of causes, and sometimes it can be caused by several different reasons, even in the same individual.
To understand why someone develops binge eating disorder, we need to recognize binging triggers. These triggers often result in binging behavior, and they are often negative feelings or thoughts toward body shape, weight, or food. Triggers to binging may also include worry, anxiety, difficult relationships with loved ones, or even boredom. Some people binge eat because it helps them numb these feelings in the short term. But later, they find the binge eating to be harmful to their own self-perception.
Sometimes dieting may be a major factor for binge eating. While dieting tends to happen after binge eating disorder has started, missing meals or not eating enough can lead to binging episodes. If left untreated, binging behaviors become more and more ingrained and harder to control.
Depression has also been linked to binge eating disorder. People who have depression or have been depressed in the past are more at risk. Binge eating is also higher in people who have bipolar disorder or anxiety disorder. Some evidence suggests that it may be more common in people who have addictions to recreational drugs.
Binge eating disorder may be more common in families where the condition is already present. Therefore it seems that our genetics are also an important factor to consider. Researchers continue to explore more scientific explanations on why binge eating disorder happens including studying the neurochemicals and pathways of the brain

How is Binge Eating Disorder Treated? 

The treatment goal for binge eating disorder focuses on binge eating and weight control. Treatment also addresses conditions that commonly occur with binge eating disorder, including depression, difficulty in work or relationships, and distortions in body image.
Treatment outcomes are generally good with psychological treatment often being more helpful than medication based management, although in some cases both are used. There is evidence that cognitive behavioral therapy (CBT), a type of talk therapy, is successful in treating binge eating disorder. Multiple research studies point to benefits with its use. CBT works by disrupting the “binge-diet cycle” by promoting healthy and structured eating patterns, improving body shape and weight concerns, and encouraging healthy weight-control behaviors.
Another type of talk therapy used in treatment is interpersonal psychotherapy (IPT). IPT helps people express and manage their negative feelings without turning to food to cope. Research shows that 20 sessions of CBT and IPT can provide improvements for more than 70% of people with binge eating disorder.
Reading self-help guides like Overcoming Binge Eating by Christopher Fairburn in combination with therapy sessions can also have substantial benefits.
Medications may also be used to ease binge eating disorder symptoms. Serotonin selective reuptake inhibitors (SSRIs), commonly used for anxiety and depression, have been found effective for reducing some binge eating disorder symptoms as well. SSRIs can help with depression often occurring in people with binge eating disorder. Continued research will examine how other medications, including anti-obesity medication and mood stabilizers, may also treat people suffering from binge eating disorder. 

What Should I Say to My Friend / Family Member Who is Suffering?

It is important to take the approach of talking to your loved one with serious intent. Though some people can overcome eating disorders, seeking professional help usually has more lasting positive results. In seeking the care of a professional, both the patient and his/her family benefit from the information presented by the doctor. The first step to talking to someone you care about who has an eating disorder may feel nearly impossible.
  • Patience is key. Being patient and learning facts about eating disorders will guide you (and your loved one). Due to the complexity of binge-eating disorders, communicating your concerns regarding their eating habits and other behaviors will initiate a cumulative effect.
  • Be prepared for a range of responses. Rejection, denial, anger, and shame are just some of the emotions that your loved one may express when you approach her/him for the first time.
  • Avoid judgment, criticism, and simple solutions to disorder. Instead, you should provide encouragement and compassion regarding their feelings and relationships. Your concern and support may be enough for them to seek professional help but know that this is not guaranteed.
  • Recognize binge eating may be just tip of the iceberg. Understanding that binge eating disorder, or any eating disorder, involves food and weight issues as mere symptoms of a deeper and more complex behavioral problem will help your loved one realize they need to acquire healthier coping tools.
  • Know when to ask for assistance. Don't forget that health professionals can alleviate some of the imminent issues that may need to be treated before full recovery is possible. 

Monday, July 15, 2013

Talking to Men about Mental Health

While visiting with my dad for Father’s Day last month, I was inspired to write about the importance of talking to the male species about mental health. When I was a medical student coming home over Christmas (hyper-vigilant about all potential medical issues as most med students are), I noticed a mole on my father’s forehead that looked cancerous to my post-dermatology rotation eyes. After nearly a year of “reminders” to go to the doctor and have it checked, he finally agreed and luckily it was benign.
Now that I’m a psychiatrist, I often get calls from patients and friends who are worried about the mental health of men in their lives (fathers, husbands, boyfriends, brothers, friends) but have met resistance when trying to talk about their concerns with these men.
Reflecting on my personal challenge of getting one of the important men in my life to have something as minor and non-stigmatized as a mole checked out, I would like to offer some suggestions to help start the mental health conversation with a man or anyone you believe may be suffering from a mental illness.
  • Use “I” statements. People are less likely to feel attacked and be open to suggestions when approached with “I” statements. For example, “I am concerned that you seem down, and I would like for you to consider seeing a counselor because I care about you,” instead of “You seem depressed and need to see someone.”
  • Present mental health conditions such as anxiety and depression as medical conditions - which they are (your brain is part of your body). Unfortunately, many individuals stigmatize mental illness and do not like to see themselves as suffering from one. One of my favorite questions to ask those who resist getting care for their mental health is, “Would you seek help for high blood pressure or diabetes?” Of course you would!
  • Be encouraging and reassure him that he won't be seen as “less of a man” if he seeks help. Seeking help is a sign of strength.
  • Ask him to consider seeking help rather than telling him. Most people are more likely to follow through with a task they view as unpleasant when they are asked rather than told.
  • Be mindful and also take care of your own mental health needs. It can be very stressful and tiring to be close to someone suffering from an untreated mental illness. Use your family and friends for support and don’t be afraid to seek help yourself if you find you’re struggling with excessive worry.

We are lucky to live in a time when there are effective treatments readily available for mental health disorders. Try these tips the next time you start the mental health conversation with the important men in your life. Your support and care can make a big difference in his recovery.