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. 

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Talking to Men about Mental Health

By Sarah Johnson, M.D.

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!

• Offer factual evidence regarding mental health conditions. Many patient resources are available at www.psychiatry.org/mentalhealth (check out the Let’s Talk Facts brochures you can print). It is helpful to realize that psychiatric conditions are common. Remind him that he’s not alone.

• 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. 

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Is It Time For A Timeout? 4 Tips For Managing Your Anger

By Uyen-Khanh Quang-Dang, M.D., M.S., Resident Psychiatrist, UCSF School of Medicine &

Arshya Vahabzadeh, M.D., Resident Psychiatrist, Emory University School of Medicine Follow @VahabzadehMD

When does anger become a problem?

Anger is an emotion that everyone experiences at some point in their life. Anger in and of itself is not a bad thing. Anger becomes a problem when the anger itself, or how we express the anger, causes problems in our lives. For example, anger can be felt too intensely, too frequently, or it can be expressed inappropriately, leading to harm to oneself or to others. Poorly managed anger can result in damage to our mental health, physical well-being, social relationships, and employment.

When we feel angry, the most important consideration is how we manage this emotion. In many cases, we may manage anger in a similar way to people around us. Many children learn how to deal with anger from observing their parents and other family members. The way that we respond to anger may also be as a result of what happens when we become angry; it may help us to get things that we want, thereby reinforcing our behavior. There are many practical strategies which may be adopted to help overcome problems with anger management. Here are four tips on how to deal with anger:

#1 Make a list of events or situations that trigger your anger. It can be a helpful perspective to notice that each of us get triggered by different things – while some of us may get outraged by an inconsiderate roommate who leaves dishes in the sink, others may instead fume while driving in congested traffic. Having a better awareness of triggering events will help you to better manage and possibly prevent your anger.

#2 Take a timeout. Timeouts aren’t just for kids – they are an essential anger management strategy that should be in everyone’s anger management “toolbox”. Basically, timeouts help us think instead of impulsively reacting in the heat of the moment. Timeout strategies can range from taking a few deep breaths and taking note of how your anger is experienced in your body, to leaving the situation that is causing the anger. You can have a pre-arranged agreement where any of the parties involved can call a timeout during an upsetting interaction and return to the conversation at a later point.

#3 Engage in Exercise! We all know that exercise is good for your physical health, but it’s also great for your mental and emotional health as well. Regular exercise can be an effective preventative anger management strategy. In addition to cardiovascular exercise, try yoga – either in live classes or through videos available on iPad apps and YouTube videos if live classes are too expensive.

#4 Use the A-B-C-D Model. The A-B-C-D Model (developed by Albert Ellis) helps us to change our underlying irrational beliefs that perpetuate our anger.

“A” stands for an activating event that triggers our anger.

“B” stands for our beliefs about the activating event. What do you tell yourself in reaction to the triggering event? What are your beliefs and expectations of others? For example, when a friend arrives late, you may tell yourself, “This friend is a bad friend. If he respected me, he wouldn’t be late. I can’t be friends with this person.”

“C” stands for consequences – emotional responses about the triggering event based on your self talk. For example, you may feel sadness or contempt.

“D” stands for dispute, where you examine your beliefs related to the event, identify any irrational beliefs, and dispute them with more rational or realistic ways of reacting to the activating event. The point of this model is to replace maladaptive self-statements that exacerbate anger with adaptive self-statements that reduce anger and help you have a more realistic reaction to the event.

While these tips may be helpful, you may need support from a counselor or mental health professional. Keep in mind that you don’t have to deal with anger all on your own. There are effective anger management therapies available in individual and group settings that can help you learn healthy ways of managing anger. 

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Boston Marathon Runner & Psychiatrist Shares Personal Story of Patriots' Day 2013

Special guest post by psychiatrist Brent Forester, M.D.

"People here need to talk about what they have been through,” says Dr. Forester. “I spoke with my medical students after the race, and they all wanted to do something to help. I told them that the injured, their families, and first responders all need a lot of emotional support.”

Monday, April 15, 2013 began as a sunny, chilly early spring day...a perfect respite to our long, dark, cold winter that brought challenges to the months of training required to run a marathon. My wife, Kim, was giving me a hard time for the training schedule I was keeping, perhaps secretly knowing what I did not yet realize: I was destined to run Boston in 2013.

What began as a challenge from Kim to run a half marathon in 1999 had morphed into a full blown passion and time consuming avocation: running long distance races to fundraise for the Alzheimer’s Association and this year, a mentoring program for future geriatric psychiatry clinicians. But after a personal best in the Chicago Marathon in October 2012, I had decided to spend 2013 focusing on a more “normal” distance of 13.1 miles, setting a goal of running 50 half marathons by my 50^th birthday (35 down with three years to go!).

Perhaps by fate, one of my running buddies was felled by a foot injury and offered me his number for Boston in late February, with only six weeks to go until race day. Luckily, I had been training with this most incredible group of friends, all neighbors and fellow runners, meeting five days a week at 5:40 a.m. (or earlier!) at the corner of Ledge and Mossman in Sudbury. Sadly, a year of brainstorming had yet to generate a team name.

On Saturday before the marathon, our families and friends gathered for a festive night of pasta to celebrate all the hours and miles of running, lack of sleep, painful legs, and cross-training efforts that included early morning TRX and spin classes and a Tuesday night yoga group for runners (minus the see-through Lululemon wear). Anticipation and excitement for Monday, Patriots’ Day, was at a peak.

The Boston Marathon is known for Heartbreak Hill, the cheering Wellesley women, the rowdy and inebriated Boston College students, the biker bar patrons on the Hopkinton/Ashland line yelling in their black leather outfits drinking beers on a Monday Morning. Where else does this happen? The Boston Marathon is all about the crowds. They are loud, deep, diverse, and hysterically funny with signs and outrageous costumes. The same fans cheering on the world’s elite, yell even louder for the “normal” charity and barely qualified runners, distributing beer, oranges, pretzels, and even Vaseline on a stick to reduce the inevitable burning and blistering skin.

Monday, April 15^th was a tough run for me. It was warmer in the sun than expected, and a pacing problem during the first half of the race left me weary climbing Heartbreak Hill. But a running buddy neighbor of mine ran a mile with me through the Newton Hills, and then I took off, determined to complete this race in less than four hours. It would be very close. The Red Sox crowd had just spilled into Kenmore Square when I arrived, and they were loud…but I stayed focused, down and up Commonwealth Ave. crossing beneath Massachusetts Ave., then a right on Hereford, a surprisingly tough hill up to Boylston, and a left hand turn down the long, endless 800 meters to the finish line near Dartmouth.

3:58:46. I did it! Exhausted. About to break out into tears reflecting my emotional sense of accomplishment and relief, when I heard behind me a massive explosion. I ducked. We shook. And then I looked behind me at a cloud of smoke and debris. “Oh my God,” I thought immediately of the many lives that had instantaneously ended or changed forever. But it was all very confusing: Where were my wife and daughter? I’ve got to get out of here. Where were the water and the silver warming cape? Was that a terrible accident or… And then the second bomb, panic; we were under attack.

Where was the next bomb going to strike? I borrowed a cell phone, “Kim, there was a bomb at the finish line; I am fine. Where are you?” She was driving on Huntington and Dartmouth, a block away…oh no. “Stay away from the Westin, do not park; drive to the corner of Boylston and the Commons.” How come everyone was so calm? The volunteers handed out our water, the silver cape, food, and the precious finisher’s medal, and then I left on Berkeley to the buses for my yellow bag and the port-o-potties, but were they even safe?

I do not recall well the four block walk to that meeting spot; it seemed endless, and there was no Kim when I arrived. And no cell phone service. Then, three of our psychiatry residents came walking across the street, calmly and not sure of what was happening. They are a godsend of emotional support with cell phones. I am shivering. I have not eaten or even sipped any water. An hour passes; finally Kim and my daughter arrive, unscathed. We were safe.

And then the “what ifs” race through your mind: What if I had taken my usual port-o-potty break or not pushed through those last few miles to break the four hour mark? I cannot really think about these realities.

Will the marathon, Patriots’ Day, Boston, Fenway Park, and all the stadiums hosting our beloved local sports teams ever be the same again?

The timing of the bombs was such that the charity runners were crossing the finish line, the four hour gang, not the elites or the sub-three hour athletes, but the everyday guy and gal who train though ice and snow for this moment, to cross the finish line in Boston cheered on by hundreds of thousands of loud supporters, strangers who seem to care about you and want to see you reach your goals whatever they may be. They were the targets of the Boston bombers.

Boston strong, the theme that has risen from the ashes of this tragedy, carries us forward and brings us closer together as a community of runners, spectators, first responders, healthcare professionals, firefighters, and police. We are all together now as one, culminating in the heroic 24 hour siege and Boston area lockdown, another surreal event capturing the intensity, exhaustion, and ultimately relief of a region.

Finally, at 8:42 p.m. on April 19^th, it is over. In a boat on Franklin Street, five blocks from my old Watertown apartment. The local hero is a regular guy who spies the blood and then the suspect.

It’s now time to go to sleep. I'll be up in five hours to meet my running crew for a slow six miles around our neighborhood, running for the first time since Hopkinton and sharing our stories, our grief, our anger, and our triumphs. This is the way we process our emotions and move forward. We still need a name for our crew; Sudbury Strong may work.

The American Psychiatric Association's website has resources for coping with traumatic events and how to help children.

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Depression in People with Parkinson’s Disease

By Dr Mizrab Khan MRCPsych Member of the Royal College of Psychiatrists, United Kingdom

Arshya Vahabzadeh, M.D. Resident Psychiatrist, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine Follow @VahabzadehMD

Since April is Parkinson’s Awareness Month, we wanted to discuss its connection to clinical depression.

Parkinson’s and Mental Health

Parkinson’s disease is a chronic and progressive neuropsychiatric condition that affects more than one million Americans, with over 60,000 people being diagnosed every year. People with Parkinson’s often develop physical symptoms such as tremors at rest, stiffness, and a general slowing of movement.

Today, there’s a better understanding of the psychiatric and mental health concerns of people with Parkinson’s disease. Parkinson’s disease affects several parts of the brain connected to control of mood. This may cause depression and other mental illnesses that harm the quality of life of people with Parkinson’s disease.

Depression in People with Parkinson’s

People with Parkinson’s disease often suffer from clinical depression (more than one third of individuals). Depressive symptoms include apathy as well as changes in sleep, appetite, and self-esteem. It’s far more than feeling sad or “blue” after being diagnosed with Parkinson’s. Studies show that clinical depression may even come before the development of physical symptoms of Parkinson’s. Becoming depressed is also thought to be independent of the physical symptoms, with some people with mild Parkinson’s developing severe mood symptoms. Detecting the depression may be more difficult in Parkinson’s disease because there’s an overlap between the signs of depression and the physical symptoms of Parkinson’s.

If someone with Parkinson’s disease is increasingly apathetic with changes in mood, sleep, appetite, or low self-esteem, then he or she should see a doctor for a psychiatric assessment. People with Parkinson’s are at a higher risk of suicidal thoughts and actions, so it’s important to pay close attention to these warning signs and seek a mental health evaluation.

Can Depression in Parkinson’s Disease be Treated?

Yes, just as depression can be treated for those without Parkinson’s, depression in people with Parkinson’s disease can be improved using both psychological and medication treatments. However, a personalized treatment plan should be created, and any antidepressant medication should be prescribed by a physician who is aware of the other medications that are commonly used in Parkinson’s disease. Ongoing research will help determine the best method to treat this depression.  

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