Binge Eating: Mirasol Clinicians Discuss a Hot Topic!
In 2013, Binge Eating Disorder was recognized by the Fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In early 2015, the FDA approved Vyvanse for the treatment of binge eating disorder, and the manufacturer launched an aggressive campaign aimed at raising awareness about the disorder and promoting the use of a drug originally developed for the treatment of ADHD. These days it's hard to turn on the TV or open a magazine without seeing an ad that might leave you wondering where to draw the line between over-indulgence and a full-blown eating disorder. How do you tell if you have binge eating disorder and, more importantly, what can you do about it?
- Maeve Shaughnessy, Clinical Director
- Katie Klein, Director of Utilization Review and Special Projects
- Mariah Hunter, Medical Director
- Anne Ganje, Nutrition Director
- Allison McCabe, Primary Therapist
- Sharon Davis, DBT Therapist
Download Audio: M4A
Moderator: "Binge eating has been in the news so much for the last few years, and I know some of that is because of the introduction of the drug Vyvanse — and I'm sure we all have our own opinions on that — but other than that, what is this obsession with binge eating and what do we at Mirasol do about it?"
Katie Klein: "The reason we're probably hearing about it more now is the addition of binge eating order to DSM-5. I think people are generally more aware of the disorder now, and as you mentioned, there's also that pharmaceutical piece. The drug Vyvanse, and other medications are also being advertised, like Contrave, a mixture of naltrexone and bupropion which was historically used to reduce alcohol and drug cravings."
Anne Ganje: "In the past, binge eating was associated with gluttony or the inability to stop eating, and I think we are now recognizing it as a disease, and something people do need to seek support for. And there are places — like Mirasol — where we deal with it in a very non-shaming way, and recognize it as an eating disorder."
Moderator: "How do you know if you have a binge eating disorder?"
Katie Klein: "The way binge eating is characterized is 'eating in a discrete period of time an amount of food that would be larger than most people would eat in a similar period of time' and then a sense of loss of control over eating during that episode."
Moderator: "So some of it is the quantity and the frequency, and a part of it is also the emotional issues that accompany it?"
Katie Klein: "Absolutely. And the DSM also says if you have three of these symptoms — eating more rapidly than normal, eating until you are uncomfortably full, eating large amounts of food when you're not feeling physically hungry, eating alone because you feel embarrassed about how much you're eating and feeling disgusted with oneself."
Anne Ganje: "If you recognize it as something that is getting in the way of living your life the way you want, if you're starting to disconnect from family and friends, or isolate yourself from social or work situations, where you're no longer engaging with life and where you're using food as a medicator. It's usually a cycle — binging or compulsive eating followed by guilt, which leads to more binging and compulsive eating." "
Moderator: "Is treating binge eating different from treating other eating disorders?"
Anne Ganje: "I think it's like opposite sides of the same coin — using food as a medicator, using food to disconnect from uncomfortable feelings. The presentation really doesn't matter. Whether you're anorexic, bulimic, orthorexic or struggling with exercise addiction — you're usually dabbling in one or more of these disorders. So it really doesn't matter how the DSM defines what you do specifically, it's 'are you using these behaviors?' And we treat the person as a whole. We deal with every client on a physical, emotional and spiritual level." "
Moderator: "Everybody says, 'we treat the whole person,' but at Mirasol what does that mean?"
Alison McCabe: "One of the approaches we use here is mindfulness. And so we use those techniques with binge eating disorder in the same way that has we do with anorexia or bulimia. And part of the idea behind that is to bring awareness to the present moment, especially involving mealtimes and foods, and to connect with the process of eating. To speak to the difference between binge eating disorder and occasional overeating, a lot of that has to do with disconnecting. You might occasionally decide to have an extra dessert, and there will likely be pleasure with that experience, and you will likely be present for that experience. With binge eating, we often see the opposite effect, so we practice mindfulness to bring the client back to the present to connect with the experience and also connect with their bodies and an awareness of how much is 'too much'."
Moderator: "What are some of the ways that we support mindfulness?"
Sharon Davis: "One of the therapies that we use to support mindfulness is DBT — dialectical behavioral therapy. Clients are taught a number of techniques to begin engaging their 'wise minds' — that part of the themselves that both thinks rationally and observes and works with emotions to access their inner wisdom. So we might use different tools that involve the breath, observing the environment and observing internal emotions through body sensations.
Maeve Shaughnessy: "When somebody has an eating disorder, there's no connection with their body. They may have been disconnected for years. So among the ways that we bring them into their bodies are modalities like Reiki and polarity therapy, where body work helps facilitate movement of energy through their bodies, sometimes helping them to connect and enjoy being in their bodies. We also do experiential activities. It's hard to be out of your body when you're 40 feet in the air. You need to be aware that your legs are shaking and you're freaking out."
Moderator: "You mean during challenge courses, which are part of our family program?"
Maeve Shaughnessy: "Exactly. And also during hiking and camping. Getting themselves up to a peak or summit may something they've never done before and really enjoying that may help them feel gratitude for their bodies."
Anne Ganje: "We do neurofeedback, we do equine, circus arts, yoga. Our clients work with EMDR which is helpful with trauma. They see me for nutrition counseling, they work closely with medical and nursing staff."
Moderator: "What about medical treatment options? Is a drug like Vyvanse something people should look at?"
Mariah Hunter: "Vyvanse has been found to be effective for some people. For others, it simply increases their anxiety level and interferes with their sleep."
Moderator: "Clients who are binge eaters might be surprised to learn that we're going to feed them six times a day. They might be concerned that it will be difficult to lose weight or even maintain their weight."
Anne Ganje: "The number one goal in the treaetment of binge eating disorder is definitely not weight loss, it's cessation of eating disorder behaviors in a supportive enviornment. Typically because of the meal plan and because of the way we help clients with their food, weight loss is kind of a side effect."
Maeve Shaughnessy: "One of the barriers for someone with a binge eating disorder is that they think they're not sick enough to need residential treatment. Because it may have been normalized to say, 'you don't really have an eating disorder, you're just overweight.' There's a lot of shame, like everyone has mentioned, with binge eating disorder, and so I ofren hear 'I'm not sick enough to go into residential treatment,' 'I'm not skinny enough for residential treatment', which is absolutely not the case."
Alison McCabe: "The truth is, [binge eating] is very common. It's the most common eating disorder in the country, and it's more than three times as prevalent as anorexia and bulimia combined. So, it's out there, and what we're trying to do is spread that awareness, and do that outreach, and get people to seek help when they need it."
Katie Klein: "One of the unfortunate things that we at Mirasol are trying to counteract is the lack of knowledge and awareness within the professional community and the medical community about binge eating disorder. I can't tell you how often I have talked to doctors who have said, 'This client just needs to lose weight. Why do you say she has binge eating disorder?' There's just so much ignorance about binge eating disorder and toll it takes on your life."
Anne Ganje: "If this was as simple as diet, everyone who walks into a bookstore or turns on their computer or television would be able to stop doing this. But if we don't get at the underlying issues, we can't deal with it. Here at Mirasol, we create an environment that is almost like a cocoon to decrease and completely eliminate behaviors in a safe and supportive environment, with the ultimate goal of getting at the underlying issues, and ultimately leaving with freedom from the disease altogether."