Monday, November 1, 2010

Beating the Binge: Who’s in control?

According to the National Eating Disorders Association, about 1-5% of Americans binge eat, a disorder characterized by recurrent overeating episodes and loss of control over eating. You know, like when you start out saying, “I’m going to have a muffin;” and two hours later you’ve had four of them, plus a pint of chocolate mint ice cream and a big bag of sour cream and onion chips. Then the guilt, shame, anger and sadness kick in. “I can’t believe I did that- I am such a loser.” You probably vow never to do this again, and sadly, repeat the experience the following night. The distress you feel about your weight or shape is much like the regret an alcoholic experiences after a night of binge drinking. It’s the loss of control that distinguishes binge eating from simply overeating.
Last week Marty, the Healthywage coach, suggested some helpful questions to help determine if you’re a binge eater (see 10/26 blog). He used the guidelines from Overeater’s Anonymous (OA). This model of treatment is called the addiction model of binge eating.
Experts are split as to whether binge eating really is an addiction similar to alcoholism. Healy reports in an LA Times article dated 11/23/09 that brain imaging studies show significant overlap between the brain circuits activated by a drug addict’s “craving” and those of a binge eater pondering an eating jag.
On the other side of the debate, Steven Wonderlich, a University of North Dakota eating specialist, cautions that the brain’s reward circuitry is complex, involved in many behaviors including but not limited to pathological craving. Therefore, we need more research before making this connection conclusive.
What we DO know for certain is that people who binge eat often experience other problems such as anxiety, depression, and relationship issues. Because of these co-existing issues, the treatment is often done by a team of experts including a psychotherapist, psychiatrist, and nutritionist.
Goals for treatment:
1. To normalize eating by sticking to regularly scheduled meals and snacks throughout the day in appropriate portion sizes.
2. To improve emotional well-being by treating the underlying anxiety, depression, shame, poor self-image, self-disgust, and other negative emotions.
3. When necessary, to lose weight.
4. To learn behavioral maintenance strategies once you’ve reached goal weight.
Types of therapies used to treat binge eating:
  • Cognitive Behavioral Therapy
CBT looks at how your thoughts influence your mood and resulting food related behaviors. The questions: “What am I thinking? ’What am I feeling?” and “What is it I REALLY need right now?” guide this treatment approach. You learn to talk back to sabotaging thoughts with accurate and healthy responses. Sabotaging thought: “I had a fight with my best friend. I was so upset I couldn’t stop eating the apple pie until it was gone. I don’t even remember eating it all.” Helpful response: “I need to calm down and figure out how to resolve what happened between us. Bingeing on pie will not help mend the friendship and will only make me feel worse about myself.”

  • Interpersonal Therapy
IPT for binge eating is based on the idea that binge eating occurs in the context of specific social and interpersonal problems. IPT helps a person face and heal what are called role disputes– when you and at least one significant person in your life have differing expectations of your relationship. IPT also teaches assertiveness skills dealing with how to express and manage grief and role transitions, i.e., loss of a job or relationship. The theory is that you will not use food for comfort if you develop these skills to handle your stressors.

  • Dialectical Behavior Therapy

DBT is a comprehensive treatment program based on cognitive and behavioral principles and complemented by the use of acceptance-based strategies derived primarily from Zen Buddhism. DBT teaches you skills to tolerate distress, regulate your emotions, and improve your relationships with others. These skills can reduce the desire to binge eat.
These treatments are sometimes combined with medications such as antidepressants and/or Topomax, an anticonvulsant drug used to reduce binge eating episodes.
Although the treatment options available for binge eating vary, the essential components are to address the underlying thoughts and emotions that trigger your unhealthy relationship with food.

Which method seems best for you?

Ellen Resnick is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss,
You can email Ellen at
Copyright © 2010 Ellen N. Resnick, LCSW