End Binge Eating Now

End Binge Eating Disorder

In this ebook youll learn the seven factors that may contribute to the development of Binge Eating Disorder according to the latest research and how they affect you. The five ways you can achieve a healthy, positive body image right now even if you are at your lowest point (page 102).Why dieting is a Big no-no if you are a binge eater and what steps to take so that you never have to diet again (page 43). How you can implement one single thing into your life and see profound changes in all areas of you life (page 73) How the media plays a major roll in your thinking even leading you to binge, and how you can get in control so that the media has no influence on your life (page 60). The simple three-step process enables you to finally stop jumping on the diet of the month train, while still losing weight (page 37). The easy to follow four-week plan that enabled me to see results almost instantly and how you can do the same (page 114). How your daily routine may be adding fuel to your binge eating and the simple changes that you can make to see immediate results. How to overcome your fear- yes, even positive changes in your life can spring up some new fears.A little known technique that will not only help you overcome binge eating, but it will also put you on the fast track of living the life you have always imagined. Read more here...

End Binge Eating Disorder Summary

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Binge Eating Disorder

Psychotherapy research involving binge eating disorder has been largely based on treatments for bulimia nervosa and, because substantial numbers of binge eating disorder patients are overweight or obese, on psychotherapy treatment research for obesity. Because obesity is a common comorbid condition, researchers have been concerned with how to relate treatments designed to reduce binge eating behavior with those designed to enhance weight loss. Based on available studies, most experts agree that initial therapeutic aims should focus on reducing binge eating episodes. Once binge eating has been controlled weight loss programs may be more effective. Nevertheless, when results are examined at 5 years after treatment the enduring impact of weight loss programs is not very impressive. For obese patients, non-diet approaches that stress self-acceptance, improving body image, and improving health and fitness through exercise and better nutrition, are being developed as alternatives to...

Assessment of Binge Eating

A binge episode is defined as the consumption of a large amount of food within a discrete period of time, accompanied by a sense of loss of control over eating. Researchers and clinicians have agreed that loss of control involves the subjective feeling that one cannot stop eating or control what or how much is being eaten. However, there has been much less agreement about the size and duration of a binge eating episode. Specifically, there is no consensus as to what constitutes a large amount of food, and the duration of binge eating episodes can vary widely, sometimes continuing throughout an entire day. Many individuals have difficulty delineating binges into discrete episodes but can more readily recall whether a binge occurred or not on a given day. Thus, the BED diagnosis is made based on binge 'days' rather than 'episodes.' Similarly, many observers have concluded that the loss of control, rather than the amount of food ingested during a binge (i.e., a 'large' amount), is the...

Cognitivebehavioral Model Of Bulimia Nervosa Precipitation And Maintenance

And manipulation of body weight and shape. BN-related dysfunctional beliefs occur in several domains, including (a) body weight expectation, (b) meaning of body weight and shape, and (c) food and eating pattern. In particular, persons with BN often hold unrealistic expectations for how low their own body weight should be, and believe that acquiring a specific (usually thin) body appearance will result in a host of desired consequences (e.g., increased interpersonal popularity and prowess, increased self-esteem, decreased negative emotion). Thus, obtaining the ideal body is viewed as a principal strategy for achieving idiosyncratically defined positive life outcomes and coping with or solving life problems. Dietary restriction is employed in an attempt to conform the body to ideal specifications. Dietary restriction typically includes restricting how often food is eaten, how much food is eaten, and what types of foods are eaten. This restrictive eating pattern results in both...

Cognitivebehavioral Model Of Bulimia Nervosa Treatment

Phase 1 focuses on reducing excessive dietary restriction. During this phase, clients monitor their eating pattern and food intake on a daily basis in order to identify the ways in which they typically restrict and to identify any additional triggers for binge eating or purging. Clients are then helped to regularize their eating pattern by developing regimented times for eating and by identifying activities that are incompatible with binge eating or purging to use at times when they feel the urge to engage in either of these behaviors. Clients are also educated about (a) the ineffectiveness of vomiting and laxative use in expelling calories and controlling weight, (b) the effects of dietary restriction on increased binge eating and on metabolism, and (c) healthy body mass index for their body. Clients are encouraged to weigh themselves once a week to test (unfounded) predictions that altering their restrictive eating pattern will result in weight gain. Exposure-based interventions are...

Theoretical Bases

Obesity is not a psychiatric disorder. However, it has been estimated that as many as 10 to 25 of individuals seeking obesity treatment engage in binge eating behavior. It is important to note, however, than not all obese individuals binge eat. As defined by the American Psychiatric Association Diagnostic and Statistical Manual for Mental Disorders, 4th Edition, binge eating occurs when one consumes an amount of food that is significantly larger than normal in a discrete period of time. During binge episodes, individuals report feelings of loss of control over their eating. Research indicates that binge eating frequently arises in response to dietary restraint as individuals engage in strict dietary restriction, they experience strong physiological hunger, which then leads them to binge eat. Further, individuals with rigid rules about the kinds of foods they will allow themselves to eat may engage in binge eating once they have broken a rule about eating. Binge eating may also arise...

Applications And Exclusions

Associated with obesity is binge eating disorder. Binge eating disorder is characterized by recurrent episodes of binge eating in which the individual consumes large amounts of food and perceives a loss of control over eating. Unlike the pattern of behavior observed in bulimia nervosa, binge eating episodes in binge eating disorder do not occur with compensatory behaviors to prevent weight gain (e.g., fasting, purging, exercise). Binge eating disorder occurs in less than 2 of obese people, although binge eating as a behavioral symptom is much more common (10 to 25 ). Other problems that are often observed include bulimia nervosa, nonpurging type and preoccupation with body size and shape, as the source of all of the person's problems. When such problems are identified, the treatment strategy should incorporate a component to reduce the frequency of binge episodes and overconcern with body size and shape. In addition, clinicians should carefully monitor the emergence of other eating...

Psychosocial Treatments

Treatments for binge eating have been adapted from those that have been shown to be effective in reducing binge eating among individuals with BN. The majority of the research on psychosocial treatments has supported two structured, focused, short-term psychotherapies CBT and interpersonal psychotherapy (IPT) both of which have been shown to be more effective than no treatment in decreasing the frequency of binge eating and improving the psychopathology associated with binge eating. In addition, the use of DBT shows promise as an alternative treatment for BED. Cognitive behavioral therapy CBT has been the most extensively studied treatment for individuals with binge eating. CBT for BED is based on the assumption that binge eating is maintained in the context of ongoing dietary restraint, weight concerns, negative emotions, and low self-esteem. Treatment focuses first on normalizing eating and then on the identification and restructuring of maladaptive thoughts and beliefs, particularly...

Dbt Model Of Eating Disorders

Previous treatments for eating disorders have focused on various factors maintaining ED symptoms including the violation of dietary restraint (cognitive-behavioral therapy for BN) or interpersonal problems (interpersonal psychotherapy for BN), or maturational difficulties (Crisp's psychobiological theory of AN), or a combination of clinical perfectionism, low self-esteem, mood intolerance, and interpersonal difficulties (transdiagnostic theory of ED). Parsimoniously, DBT theory suggests that the processes purported to maintain disordered eating (distorted body image, interpersonal difficulties, poor self-efficacy for meeting pubertal demands, perfectionist standards, and pervasive low self-esteem) are mediated by the effects of emotional responses and the inability of the individual to prevent, tolerate, or modulate these emotional responses. So, for instance, DBT postulates that it may be the secondary emotion of shame that is the important mediator in the relationship between...

Premorbid Body Weight

In BN, unlike in AN, individual and familial overweight and critical comments about weight shape and eating habits appear to play a significant role as precursors. A greater proportion of patients reported childhood obesity than either healthy controls or general psychiatric control subjects, and BN patients reported more parental obesity than either control group 51 . The McKnight investigators 52 identified thin body preoccupation and social pressure as predictive for the onset of BN, for the partial syndrome BN and for binge eating disorder. Greater previous weight fluctuations and rates of dieting emerged as predisposing variables in the twin study by Kendler et al. 53 .

Behavior Modification

Research is now directed towards finding ways of improving the results of such programs in terms of long-term weight loss maintenance. An increased focus on weight-maintaining behavior rather than weight loss, a stronger emphasis on increasing activity and exercise, and better relapse strategies are being evaluated. Targeting the needs of specific subgroups, for example those with binge eating disorders or dysfunctional family circumstances, is another way in which behavioral therapy may be improved.

Psychological Consequences

Among obese people were the topic of a literature review that reported that weight cycling was not associated with depression or other psychopathology or depressogenic cognitive styles. It was observed, however, that weight cycling was associated with decreased perceptions of health and well-being, decreased eating self-efficacy, and weak increases in binge eating severity. Subsequently, it was concluded that an individual's perception of being a weight cycler may be more related to psychological problems than the actual number of pounds lost and regained over time. In 2000, the National Task Force on the Prevention and Treatment of Obesity concluded that concerns that dieting induces eating disorders or other psychological dysfunction in overweight and obese adults are generally not supported by empirical studies. This is in contrast to the wide belief that dieting is a necessary precursor for subsequent development of eating disorders.

Winnie Eng and Richard G Heimberg

Bulimia nervosa has been treated with CBT for many years, beginning with the work of Christopher G. Fair-burn in the 1970s. CBT has been associated with reductions in frequency of binge eating and purging, levels of dietary restraint, and concern over shape and weight. Furthermore, CBT for bulimia has been shown to improve general functioning (including social functioning) and to increase self-esteem. As in the case of the anxiety disorders, CBT for bulimia seems to be effective in the long term, suggesting that clients learn skills that they can continue to apply on their own once treatment has ended. In comparison studies, CBT has been shown to be more effective than alternative therapies, drug therapies or a combination of drug therapy and CBT. The one treatment besides CBT that seems to hold particular promise for individuals with bulimia is IPT (described above). Fairburn and his colleagues compared CBT and IPT and found that although CBT seemed to work more quickly than IPT, the...

Precursors For Bulimia Nervosa Chronic Caloric Restriction and Dieting

Food deprivation in healthy individuals, which is experienced as a stress by the organism, has been known to increase the risk of binge eating. As described by Keys et al. 50 , if normal individuals, after having undergone chronic food restriction, regain access to food, they experience food cravings and uncomfortable overeating to the point of eating ''immense'' meals. Such overeating occasionally leads to compensatory behaviours such as vomiting to relieve the discomfort. Dieting exposure has been identified as a risk factor for BN by Fairburn et al. 51 .

Jesse H Wright and D Kristen Small

2000), PTSD (Rothbaum et al., 2001), and body image problems in persons with binge eating disorder (Riva, Bacchetta, Baruffi, & Molinari, 2002). Applications of virtual reality technology focus on producing computergenerated simulations of feared objects, situations, or images that can be used for exposure-based interventions. Three-dimensional computer graphics, head sets, speakers, body tracking instruments, and other sensory input devices are used to immerse patients in realistic scenes such as glass-enclosed elevators. In a preliminary study, Rothbaum et al. (1995) observed that virtual reality exposure therapy (VR) for height phobia was more effective than a wait-list control condition. This research group also has reported that VR was equal to standard exposure therapy and superior to a wait list in helping persons with fear of flying (Rothbaum et al., 2000). Another VR application was evaluated in a small controlled study that compared a multidimensional treatment approach...

Marsha M Linehan and Eunice Y Chen

Keywords dialectical behavior therapy, DBT, bulimia nervosa, anorexia nervosa, eating disorders not otherwise specified, binge eating disorder, borderline personality disorder The reasons for developing DBT for ED are (1) current treatments for binge eating disorder (BED) and bulimia nervosa (BN) are effective for only 50 of clients and even less for chronic anorexia (AN), (2) BPD and parasuicidal behavior is common among ED clients with suicide being a leading cause of death in AN, (3) ED involve emotion regulation difficulties and skills deficits despite clients' apparent competence in other areas of their lives, (4) ED are often stigmatized as trivial problems despite high death rates in AN and significant impairment of functioning in other ED, and (5) ED, especially AN, differ from other mental illnesses in the significant degree of ambivalence about symptoms and treatment. BRIEF DEFINITION OF BULIMIA NERVOSA, ANOREXIA NERVOSA, EATING DISORDERS NOT OTHERWISE SPECIFIED, AND BINGE...

Sensory And Perceptual Factors Flavor

Other eating problems have likewise been associated with extreme partiality toward highly palatable foods. Although the evidence is conflictual (26), binge eating in normal-weight individuals is often interpreted as targeted specifically on highly palatable carbohydrates (27), which elevate serotonin levels and, ultimately, mood (19). Conceivably, this view might be extended in the direction of proposing that some flavors are deemed palatable precisely because of their central hedonic consequences.

Very Low Calorie Diets and Meal Planning

Brian was seen in individual therapy for over 2 years. Family therapy was also incorporated into the treatment plan. Treatment followed the protocol described by Williamson and colleagues in 1996. Initially Brian was seen once per week in individual therapy and the frequency of therapy sessions was gradually faded to biweekly and then once per month over the course of the first year. He was seen about once per month during the second year of therapy. All components of the behavioral management program (described earlier) were used in Brian's therapy program, including self-monitoring, stimulus control procedures, reinforcement shaping, goal setting, behavioral contracting, problem-solving, meal planning, modification of physical activity, relapse prevention, and enhancement of social support. Toolbox approaches were used to individualize treatment. Behavioral therapy for binge eating was used to modify skipping meals and cognitive approaches were used to modify beliefs about the...

Early Detection Of Eating Disorders

The DSM-IV comprises three syndromes AN, BN and eating disorder not otherwise specified, whereas the ICD-10 includes, in addition to AN and BN, atypical AN and atypical BN, overeating associated with other psychological disturbances, vomiting associated with other psychological disturbances, other eating disorders, and eating disorders unspecified. There is close agreement on the criteria for the two major syndromes discussed in this chapter. Regarding AN, the principal conceptual difference is the strong emphasis on an attitudinal dimension as a principal criterion in the DSM-IV, namely the individual's ''refusal'' to maintain a minimally normal body weight as opposed to the assessment of ''body weight loss'' as the primary criterion in the ICD-10. Another difference is the subdivision into the restricting and binge eating purging subtypes in the DSM-IV. This subdivision is important, because subtype differences go beyond the clinical manifestations and have implications for...

Description Of Treatment Processes

The clinical observations of Hilde Bruch underscored key features seen in patients with eating disorders that demand attention in psychotherapy, particularly distorted perceptions and misconceptions of body size awareness, interoception, bodily functions, hunger and satiety, and issues regarding control of body functions. Bruch also emphasized the diversity of psychological and family features to be found in these disorders. Her observations and ideas have endured and have formed the theoretical basis for therapeutic conceptions and interventions of decades of therapists using psychodynamically oriented and cognitive-behavioral techniques. The eating disorders inventory and the influential cognitive analyses of David Garner and colleagues, which identified common examples of all or none thinking in eating disorders patients, was heavily influenced by Bruch's formulations. These conceptions have, in turn, influenced the systematic cognitive-behavioral psychotherapies for patients with...

Anorexia Nervosa And Bulimia Nervosa

Bulimia nervosa is a variant of anorexia nervosa and shares many of its clinical and demographic features. It is closely related to the purging form of anorexia nervosa. One of the major differences is that bulimic patients maintain normal weight. The condition generally involves persistent dietary restriction that is eventually interrupted by episodes of binge eating with compensatory behaviors such as vomiting and laxative abuse. Behavioral disturbances often become the focus of intense guilt feelings. In the early stages of the disease, all patients attempt to control their weight by dieting and abstaining from high-energy foods.

Outcome Research On Cbgt

A number of studies support the effectiveness of CBGT in the treatment of eating disorders. For example, Telch, Agras, Rossiter, Wilfley, and Kenardy in 1990 assessed the effectiveness of CBGT in treating binge eating disorders Forty-four female patients who binged were randomly assigned to either CBGT (n 23) for ten sessions or a waiting list control condition (n 21). At posttreatment assessment, between-group comparisons revealed that subjects in the intervention group reported significantly reduced binge eating episodes compared with subjects in the waiting list control group. CBGT participants continued to binge significantly less frequently than at baseline. However, bingeing was usually not eliminated entirely.

Empirical Status Of Therapy For Bulimia Nervosa

The efficacy of CBT for BN has been evaluated in nearly 30 controlled studies. The percentage reduction in binge eating and purging across all clients receiving CBT is typically 80 or more compared to virtually 0 reduction in wait-list controls. Approximately 50 of those treated with CBT report complete cessation of all binge eating and purging at treatment termination. Large effect sizes for CBT are found for both behavioral symptoms (e.g., binge frequency 1.28) and cognitive symptoms (e.g., eating attitudes 1.35) (Whittal, Agras, & Gould, 1999 see also Lewandowski, Gebing, Anthony, & O'Brien, 1997). Furthermore, symptom reduction and cessation are fairly well-maintained across time with the majority of clients retaining therapeutic changes 1 year after treatment. The study with the longest follow-up period found that two-thirds of clients treated with CBT had no eating disorder at a 5-year posttreatment assessment (Fairburn et al., 1995). Furthermore, CBT has effects on the...

Dietary Management

Education is essential to ensure that people understand why they are being asked to abandon what are some of the only coping mechanisms they have. They feel anxious that by giving up the pattern of dieting, binge eating, and purging they will gain excessive amounts of weight. These fears are very real and failure to address them with sensitivity can sabotage any attempt to control the disorder. This is

Behavioral Weight Control

Because the majority of individuals with BED are also overweight and want to lose weight, and because obesity is associated with significant medical and psychosocial consequences, weight loss is a potentially important outcome in the treatment of BED. Numerous studies have documented that calorie restriction does not exacerbate binge eating in BED patients. Indeed, participation in behavioral weight control programs that focus on calorie restriction, provide education about sound nutritional principles, and promote physical activity may decrease binge eating and improve mood in BED patients. Therefore, concerns about the

Hierarchy of Constraints

See also Appetite Physiological and Neurobiological Aspects Psychobiological and Behavioral Aspects. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Energy Balance Adaptation. Hunger. Obesity Definition, Etiology and Assessment. Religious Customs, Influence on Diet. Socio-economic Status.

Selection of Treatment for Specific Patients

Eating disorder and obesity history A history of early onset of binge eating, binge eating in the absence of obesity, or obesity in combination with numerous bouts of weight loss and regain over time ('yo-yo' dieting) suggests a course of psychosocial treatment. Such patients can be reassured that significant improvements in the aberrant eating and eating disorders psychopathology associated with BED can be obtained without weight loss. On the other hand, clinical experience suggests that patients who report adult onset of binge eating and obesity, and do not have a history of marked weight fluctuations, may be more likely to benefit from a behavioral weight control approach. Behavioral weight control may also be indicated for patients who remain overweight after a trial of eating disorders treatment. Although behavioral weight control appears to be beneficial on average, it is important for each individual to evaluate the likelihood that he or she will be able to sustain lifelong...

Prevalence and Risk Factors

More diverse, affecting relatively more men and minority groups than BN or anorexia nervosa. Furthermore, binge eating is more prevalent among obese individuals in both clinical and community samples. It is estimated that up to one-third of individuals who present for treatment in university-based weight control clinics report significant binge eating. In order to improve our understanding of how multiple factors interact to determine the onset and maintenance of binge eating, prospective risk factor studies including males and females of different racial groups are needed. As suggested previously, biological (e.g., obesity), psychological (e.g., negative self-evaluation), and social (e.g., exposure to repeated negative comments about shape, weight, or eating) factors have been implicated in the patho-genesis of binge eating. Emergent research also has linked binge eating in a small proportion of individuals to a mutation in MC4R, a candidate gene for the control of eating behavior....

Dietary Intake Measurement

See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors. Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Follic Acid Physiology, Dietary Sources, and...

Empirical Evidence

Finally, several quasi-experimental studies from program evaluations and pilot studies have produced encouraging results, expanding the research base on the efficacy of DBT when adapted for other settings and when extended to treat different treatment populations. These include treatment on inpatient units and in forensic settings, and with suicidal adolescents, and women with binge-eating disorder. These studies do not have the scientific rigor of an experimental design, but taken together, they suggest that extensions of DBT across setting and disorder warrant further investigation. In sum, the research evidence to date suggests that across studies, DBT reduces severe dysfunctional behaviors that are targeted for intervention (e.g., parasui-cide, substance abuse, and binge eating), enhances treatment retention, and reduces psychiatric hospital-

Psychological Complications

Dieting efforts correlate positively with the prevalence of eating disorders, particularly binge eating. A correlation of eating disorders with abuse of drugs and alcohol has been shown. In strictly dieting female college freshmen who were not alcohol abusers at baseline, the frequency of alcohol abuse was reported to increase after 1 year compared to nondieters.

Diagnostic Criteria

The behavior at the center of the disorder, binge eating, has been progressively redefined. A priority has been to separate binge eating from mere indulgence and everyday overeating. Accordingly, two features of a true binge have been identified consumption of unusually large amounts of food and an aversive sense of lack of control over eating. The size of binges varies but is typically between 1000-2000 kcal. and prevalence but has increased the numbers of those with atypical eating disorders. Failing to exhibit one or more of the key diagnostic features, such as an insufficient frequency of binge eating, is classified variously as atypical, partial syndrome or 'eating disorders not otherwise specified' (EDNOS). It is also useful to note that the diagnostic criteria for another eating disorder, binge eating disorder (BED), are included in DSM-IV, albeit for research purposes. The key difference between BED and bulimia nervosa is the absence of the extreme compensatory behaviors that...

Nutritional Findings

A key feature of bulimia nervosa is the extreme dietary restraint that is exhibited in between episodes of binge eating. Such behavior has been described as all or nothing, so that on a good day the sufferer may describe consuming a very low-energy diet, whereas a bad day will consist of several episodes of uncontrolled eating. This will be accompanied by the purging behaviors previously described. To sustain binge eating episodes, the person with bulimia nervosa may spend hundreds of pounds on food, selecting foods normally avoided during periods of dietary restraint which are easy to eat and subsequently remove from the body. To them, it is this overeating that is seen as the basic problem, not the dietary restraint that precedes it. Yet, it is this dietary restraint that drives the disorder. When not binge eating, it is common for patients to avoid eating for long periods, with 80 reporting consumption of one meal a day or less. While restricting their intake, they will consume...

Comorbidity

Binge eating is strongly associated with both obesity and psychiatric disorder. It is well documented that obesity is linked to adverse medical and psychosocial outcomes. Preliminary findings also suggest that BED may be associated with poor health, independent of the effects of comorbid psychopathology or comorbid obesity. Severity of binge eating is positively associated with degree of overweight. Additionally, there are important differences between overweight individuals with and without BED. BED patients report earlier onset of obesity, along with a history of more severe obesity, dieting, and weight fluctuations. When compared with equally overweight individuals without binge eating problems, BED patients report considerably less 'restraint' or control overeating, lower self-esteem, more fear of weight gain, more preoccupation with food, and higher body dissatisfaction. Individuals with BED endorse high rates of psychiatric symptoms and disorders. For example, when compared to...

Pharmacotherapy

Antidepressant treatment Because of their efficacy in ameliorating binge eating and purge behaviors in BN, antidepressants have been used in the treatment of BED. Early research comparing tricyclic anti-depressants, such as desipramine and imipramine, to placebo showed greater reductions in binge eating among obese binge eaters treated with the drug than with a placebo. Recently, several selective serotonin reuptake inhibitors (e.g., fluoxetine) have been shown to be associated with moderate reductions in binge eating in BED patients. Moreover, the effects of antidepressant treatment on binge eating are independent of any effects on mood. Antidepressant treatment also may be useful in treating depression associated with BED and has been associated with weight loss among obese binge eaters. Antidepressant treatment also may enhance dietary restraint or improve compliance with a weight loss program. Thus, it seems possible that longer term antidepressant treatment may be useful in...

Outcome Validation

Because so much of the technology still remains new, and to many, an unproven area, researchers worldwide have embarked on a peer-review method for researching effectiveness. Even the most useful, established applications seemed at first to be little more than novel high-tech variations on more traditional approaches. Now as some technologies have matured, researchers are more closely examining their cost-effectiveness, level of public acceptance, and ways they can provide treatment that would simply not be possible otherwise. In looking at the durability of technology-based behavioral interventions, initial findings have supported the long-term efficacy of self-help, computer-based treatment (Gilroy, Kirkby, Daniels, Menzies, & Montgomery, 2003). A 6-month follow-up on binge eating disorders comparing a multifactorial treatment, which included VR, to traditional cognitive therapy found that a significantly higher number of patients (77 versus 56 ) had quit bingeing after 6 months,...

Change Strategies

In Stage III DBT, at each session, a diary card modified for ED is reviewed (including ratings of urges to binge, binge eating, mindless eating, apparently irrelevant behavior e.g., easy access to binge foods , goal capitulation, food cravings, food preoccupation, and weekly weight). The client reports on the key link in the chain analysis (a description of the problem, its antecedents, its consequences, and its context) that led to the bingeing, or otherwise, a lower-ranked target for behavioral change, and what skills the client has used or will use in the future (solution analysis). The therapist establishes reasons for skills failure, reinforces approximations of skills, and ensures broad skills use rather than overreliance on one skill.

Research Directions

I., Telch, C. F., & Agras, W. S. (2002). Predictors of relapse following successful dialectical behavior therapy for binge eating disorder. International Journal of Eating Disorders, 32, 155-163. Telch, C. F., Agras, W. S., & Linehan, M. M. (2000). Group dialectical behavior therapy for binge-eating disorder A preliminary, uncontrolled trial. Behavior Therapy, 31, 569-582. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061-1065. Wiser, S., & Telch, C. F. (1999). Dialectical behavior therapy for binge-eating disorder. Journal of Clinical Psychology, 55, 755-768.

Rumination

Postprandial vomiting and regurgitation are regular features of BN except in cases when excessive exercise is used to burn calories from binge eating. The ability to learn to reverse habitually oesophageal peristalsis or to regurgitate in BN bears a relationship to rumination disorder of infancy. Rumination is a syndrome characterized by effortless repetitive regurgitation of small amounts of food from the stomach. The food is then partially or completely rechewed, reswallowed, or expelled. There is preliminary evidence that rumination might be a precursor from a report by Blinder

Bulimia Nervosa

The fact that binge eating and purging episodes are relatively easily counted has stimulated and facilitated psychotherapy research for this disorder. Accordingly, a large number of studies have examined the efficacy of several different types of individual and group psy-chotherapies for bulimia nervosa. Cognitive-behavior therapy (CBT) has been most extensively researched, and is the approach for which most substantial evidence for efficacy exists. Twelve to 20 sessions of CBT treatments, often manualized to permit reliable duplication from center to center, have proven to be highly effective in reducing the number of binge eating and purging episodes and in changing dysfunctional attitudes regarding weight and shape. The treatment is usually conducted in several distinct phases. Initial sessions are usually devoted to helping patients restore healthy patterns of eating and nutrition, enabling them to consume sufficient food without purging so that periods of hunger are avoided....

Cognitive Factors

Direct effects on eating (ie, because these factors can be interpreted as affecting eating directly, without the mediation of decisions that add little in the way of explanation) most analyses of eating do not bother to include deliberation or conscious choice as important elements. When we find that people eat in a manner opposed to both internal and external pressures, however, some sort of deliberative element seems necessary to account for the behavior. If someone were to continue eating an unpalatable food despite being sated, it would probably be necessary to have access to that individual's phenomenology to help provide an explanation. More commonly, people fail to eat despite their evident hunger and the availability of palatable food. Such dietary restraint demands an analysis that adds a set of mental factors to the control of eating in addition to physiological and environmental stimuli to which the person responds more or less reflexively (40). Such cognitive dietary...

Joel Yager

Binge eating disorder A condition in which individuals binge eat large quantities of food in very short periods of time, often 1000 to 2000 calories or more at a time beyond their nutritional needs, at least several times per week for months on end, and have accompanying feelings of shame, disgust, and being out of control. In contrast to individuals with bulimia nervosa, they do not purge. As a result, these individuals often tend to be obese, some severely so. at least several times per week for months on end. The condition is usually related to overconcern with one's weight and shape, and is accompanied by feelings of shame, disgust, and being out of control. eating disorders not otherwise specified (EDNOS) A mixed group of disorders that include psychological and behavioral elements of anorexia nervosa and bulimia nervosa but that, technically speaking, do not fully meet the strict criteria set forth in the diagnostic manuals. For example, this category might include individuals...

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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