Me: I think many people are afraid of this illness, and some of those who has it are treated badly. Because people don't understand it, fear it and some think it is to be ashamed of. I think that is a tragedy and a huge burdon for the people who has this illness to carry. I think many have found comfort in food, so the fear is perhaps based on that, but I wonder if it is biological reasons to why they start as kids to eat extra amounts. I wonder if it in fact is first of all a physical reason for the need for more food than normal. Is it an unbalance or do these people really need extra food and have a higher BMI than avarage? May the unbalance of hormones, or is it inflammation?, be caused by emotions? I would like to know these things so the misunderstanding can be treated by knowledge.
I understand that the whole picture will never be finished, but how much is understood till now?
Can emotions effect hormones and hormones effect emotion?
Gwyneth:
Yes people don't understand it. Primarily they are unaware that it is not an eating disorder at all and that its inclusion in the DSM-5 was not based on any science that it is an eating disorder either.
There is no single cause for these symptoms appearing, but the they are very rare and involve a lot of other psychological distress and symptoms.
BED is essentially non-purging 'bulimia' in its current iteration within the DSM-5. In its definition prior to DSM-5 it was not a standalone eating disorder. It was rather a set of symptoms that could arise for those with serious Axis II disorders (psychosis, schizophrenia, and several personality disorders) and that was based on 30 years' worth of work done by Albert Stunkard and his colleagues. It was also very rare.
And whenever this question is asked on these forums it's usually because yet another new member is anxious and concerned that he or she has binge eating disorder.
Binge eating disorder is not associated with restrictive eating disorders at all. If you restrict, then you cannot have binge eating disorder. At all.
It's not about eating extra amounts as a kid. It's about serious mental illness. These individuals are often not able to reside in the community and if they do they have many points when they need 24/7 psychiatric care.
It's not about comfort in food, imbalanced hormones, emotions or inflammation. And frankly, their eating behaviours are usually the least worrisome of their symptoms associated with their overall serious mental illness.
It's commendable that you have empathy and consideration for their plight, but these forums are designed for those dealing with the restrictive eating disorder spectrum. Restrictive eating disorders are standalone eating disorders and they are all treated with rest, unrestricted re-feeding and brain retraining.
Those with binge eating symptoms have nothing in common with those with restrictive eating disorders and they usually require much higher levels of psychiatric support and intervention than most with restrictive eating disorders will ever require.
We would want anyone who has binge eating disorder to be free from shame and abuse however there are no binge eating disorder patients on these forums. Of more immediate concern to me is that those with restrictive eating disorders who are active on these forums do not end up anxious about a condition that they have no chance of developing.
Me: I was hoping you would answer. Thank you very much. The link: "more details found here" is not working. I come to "page not found". Hope to be able to read it.
I am surprised to read in the article about BED and NES that BED maybe should not be called an eating disorder. Is that because those with BED don't have much in common, have different body size and different mental conditions?
I am very greatful that I read years ago that you think one can not go from anorexia to a binge eating disorder, because I got very disappointed and scared thinking that I had become a binge eater when eating much after a long time with no or almost no food. I felt I could trust my body even less when it was possible ( as I thought) that I was changed so much in a sudden. I don't think it is too bad or very wrong to say we can go from anorexia to a binge eating disorder, but it is important to know it is not permanent, that we in recovery will not feel the need to eat a lot forever. I remember I found it extremely difficult to throw up when I was in a period of eating a lot after restriction contrary to before. It was like my body was holding on to the food so hard in hunger.
This says a lot: The bulimia nervosa group scored high on the features of binge eating and fear of fatness/compensatory behaviors but not on drive for thinness. The binge eating disorder group scored high on binge eating but not on the other two features. And:
Fear of fat/compensatory behaviors and drive for thinness are not present for those with clinical BED.
What i don't know is why the BED's don't try to be thin when they hate their body. Do they feel helpless, thinking they can not do it? Is that it? Or are they destructive and feel they deserve to be "big and bullied"? I know some use their big body as a shield towards the world and therefor don't want to be thin.
Gwen: Fixed the link -- sorry about that.
No, it is important to be accurate. You do not go from anorexia to binge eating disorder.
In recovery, you experience hyperphagia (extreme eating) and that is to rectify the huge energy deficit in your body.
Binge eating disorder facets must necessarily involve no energy deficit within your body. It must involve consumption of food in excess of your energy requirements. And that is not happening in recovery.
Eda -- you likely don't know anyone personally who has binge eating disorder. It is an extremely rare condition.
It might be better to analyze why you are worried about how those with BED may think and feel. Your more immediate concern is presumably taking care of your own recovery needs right now.
BED has about as much in common with a restrictive eating disorder as Alzheimer's does. That's not to say that BED is related to Alzheimer's (it's not) but I think you may want to disengage yourself from the topic -- it has no bearing on your recovery efforts and it has no bearing on anyone you likely know in your own life either.
G.
Me: "Binge eating disorder facets must necessarily involve no energy deficit within your body. It must involve consumption of food in excess of your energy requirements. And that is not happening in recovery." Interesting.
Ok, it was just that I read about a girl being called a whale and I felt sorry for her and thought that it is so unnecessary , and i thought about the lack of knowledge and misconseption underneth the behaviour. We either try to find the truth or think and act like a fool. But it's really hate that causes namecalling like that so I rest my case. We need wisdom, but also love to be nice to each other.
More i found on the forum about the subject written by Gwen:
I got the following by e-mail:
I was wondering if you have any scientific evidence to back up your claims that REDs and BED cannot occur in the same person (or very rarely occur in the same person) due to the genes being completely different? I've gone through YE but haven't been able to find anything. Thank you!
Here's the response I gave:
Thank you for your inquiry. Perhaps you would like to provide the direct reference to the claims you say I have made? Given that the genotype associated with restrictive eating disorders has not been fully identified and we only have some likely gene candidates that may be implicated in the onset of restrictive eating disorders, I doubt that I made the claim that restrictive eating disorders are unrelated to binge eating disorders due to genetic variation. If I have done so, then I would like to know where because I will need to correct such an assertion!
However, I do provide the clinical data that identify BED as an extremely rare condition wherein absolutely no compensatory behaviours are applied (they don’t try to get back on a diet etc.). An individual with BED is not suffering from a distinct eating disorder, but rather symptoms of bingeing that are actually indicative of a serious psychopathology. Albert Stunkard and his colleagues provide heaps of solid clinical data on the topic — the condition does not arise from restrictive eating disorders. The condition is rather a sign of Axis II psychological disorders [Wilfley DE, Friedman MA, Dounchis JZ, et al. Comorbid psychopathology in binge eating disorder: relation to eating disorder severity at baseline following treatment. J Consult Clin Psychol 2000; 68:641-649]. Axis II disorders are where a patient can lose touch with consensus based reality — things like borderline personality disorder, bipolar disorder, schizophrenia and the like. Restrictive eating disorders are Axis I disorders — like anxiety and depression where the patient is still grounded in reality even as behaviours and thoughts might be causing distress or even denial for the patient.
For a patient to develop an Axis I disorder first and then progress into an Axis II disorder is certainly feasible, but will be extremely rare. Axis II disorders tend to have quite an early onset in childhood development.
As for evidence that binge eating disorder cannot occur in someone with a restrictive eating disorder, you simply have to look at the criteria for diagnosing binge eating disorder: namely, that anorexia nervosa and bulimia nervosa have been excluded as a possible alternate diagnosis. As per the direct language from the Diagnostic and Statistical Manual (V5): "recurrent binge eating [disorder] is much less common, far more severe, and is associated with significant physical and psychological problems” [emphasis mine].
Binge eating disorder is rare and cannot involve any compensatory behaviours. Compensatory means any attempt to try to restrict in response to having “binged”.
Having had the opportunity recently to discuss the current inclusion of BED in the DSM V with one of the psychiatrists who formed part of the ED committee drawing up the DSM V [Dr. Steven Wonderlich], I can also confirm from the recent trial data he and his colleagues have published show individuals with BED are actually most commonly under-eating but will self-identify as having a bingeing problem. In essence, the inclusion of BED in the DSM V was applied because the psychiatric community identified that a portion of the community actually need help to eat enough food to support their energy needs, but they believe their issue is actually one of over-eating.
The inclusion of BED in the DSM V is not actually being applied in the community as the same BED that Stunkard and his colleagues studied for some 30 years to make the following conclusion on its existence in the population: BED is a marker for underlying psychopathology and not a standalone eating disorder. [Stunkard, Albert J., and Kelly C. Allison. "Binge eating disorder: disorder or marker?." International Journal of Eating Disorders 34.S1 (2003): S107-S116l; Stunkard, Albert J., and Kelly Costello Allison. "Two forms of disordered eating in obesity: binge eating and night eating." International journal of obesity 27.1 (2003): 1-12].
The BED classified within the DSM V is actually being used out in the community (for treatment purposes) as indistinguishable from non-purging bulimia nervosa — attempts to constantly under eat followed by cycles of reactive eating as the body attempts to redress the energy deficit.
And finally, I would encourage you to look out any clinical data that would confirm patients with a remitted restrictive eating disorder history subsequently develop confirmed cases of binge eating disorder as it is defined within the DSM (not as it is applied within treatment). So far, I have yet to even find a single case study in the literature, let alone any kind of broad prospective or retrospective review of patients with restrictive eating disorders who develop binge eating disorder. And as I said, I am speaking of binge eating disorder in its original classification — where the patient does not attempt to compensate for a binge with either going back on her diet or exercising or swearing off of “bad” foods again.
There is of course more than enough clinical data to confirm that approximately 62% of patients with anorexia nervosa will develop bulimia nervosa within 8 years of the onset of the anorexia (if untreated) [Eddy, Kamryn T., et al. "Longitudinal comparison of anorexia nervosa subtypes." International Journal of Eating Disorders 31.2 (2002): 191-201]. As the body is depleted of energy progressively through years of restrictive eating behaviours, eventually there is an increased drive to rectify the energy deficit with reactive eating sessions (bingeing). In the absence of the patient developing subsequent purging behaviours, then she will have moved from anorexia nervosa to non-purging bulimia nervosa now also indistinguishable from binge eating disorder within the treatment community.
The treatment for the BED is the same as for bulimia nervosa — the patient is encouraged to begin eating enough to support her actual energy requirements in a constant daily process which subsequently lowers the instances of reactive eating (often called “bingeing”).
I will be discussing all these recent clinical findings (delivered at the UCSD Eating Disorders Conference 2014) in an upcoming blog post.
Essentially (and the involved psychiatrists are still in hot debate on the topic) the inclusion of BED in the DSM V appears to be driven by an attitude of “if you can’t beat them join them”. The treatment community recognized that a portion of predominantly average or above-average weighted men and women would remain utterly untreated if they have self-identified as having a problem with over-eating and therefore believe that classifications of restrictive eating disorders do not apply to them at all. The inclusion of BED allows for these patients to be treated for actual under-eating issues but they will readily seek treatment because the condition is identified as one of “bingeing”—which they can relate to. I am not entirely sure if I agree with this “ends justify the means” approach to clinical care, but it is nonetheless what is happening.
Best wishes, Gwyneth.
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