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BED7787 - Binge Eating Disorder: An Introductory Guide

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BINGE EATING DISORDER: AN INTRODUCTORY GUIDE

by Iréné E. Celcer, MA, LCSW


Iréné Celcer, LCSW is a Licensed Clinical Social Worker with over twenty years experience working with eating disordered patients. She is a member of the Board of EDIN (Eating Disorders Informational Network), an organization based in Atlanta whose mission is to educate and prevent eating disorders, and the author of two books and numerous articles. Additionally, Ms. Celcer has delivered a number of workshops and presentations to other clinicians and the public on the subject of anorexia nervosa, bulimia nervosa and binge eating disorder. She has appeared in numerous TV programs in the USA and abroad.

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Course length

7 contact hours: core clinical

OBJECTIVES

The objective of this course is to provide the healthcare professional with a comprehensive introductory overview of Binge Eating Disorder (BED). When the trainee completes this course, he/she will:

- Understand the classification and status of BED, according to the DSM-IV
- Understand the similarities and differences between BED, Bulimia Nervosa (BN) and Anorexia Nervosa (AN) according to the DSM-5
- Know the prevalence of binge eating disorder and its incidence among males and females
- Comprehend causes and mechanisms underlying binge eating disorder.
- Know mental disorders commonly associated with and co-morbid with BED
- Learn how to recognize, evaluate and assess for BED
- Discuss ways to interview, assess, motivate, and refer patients for treatment
- Comprehend the different treatment modalities effective in addressing BED, including the appropriate use of medications.

This course is primarily designed for clinicians in the earlier stages of their career, or for more advanced clinicians reviewing basic concepts in this area.

Recommendations for Preparing for the Post-test

Please take special note of the BED factoids. They are designed to provide clinicians with key foundation knowledge about BED.

Important facts and concepts are typically italicized and highlighted in color.

Issues related to successful treatment outcomes are of particular importance and will be emphasized in the test, including statistics related to outcomes.

Factors related to the etiology and development of BED are important for clinicians to understand and will be emphasized in the test.

BED/ED Factoid

Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.

Source: NIMH www.nimh.nih.gov/

 

Forward
Section I: Questions and Answers about Binge Eating Disorder
Section 2: Causes and Risk Factors for BED
Section 3: Examination of the Socio-cultural Aspects of BED
Section 4: Intervention with the Eating Disordered Patient
Section 5: The Treatment Process
Section 6: Additional Issues in Treatment: Fear of Fat and Cultural Pressure
Section 7: Hands-On Exercises for Patients suffering from BN, AN, ED-NOS and Body Image Problems

References and Test

 

 

 

Forward

Most clinicians who work with individuals, couples or families will be confronted at some point in time with one or more clients whose problem may be - or may include - the symptoms and behaviors of BED. Sometimes, such clients may be referred by an internist, an endocrinologist, or a gastroenterologist trying to help the client get a handle on their weight and health issues.

In other instances, the client may present with some other kind of health problem and the BED may be uncovered in the course of the treatment. As we will see, there is a sizeable amount of correlation between BED and depression, among other health problems.

Because there is a certain measure of shame attached to BED, it may be more comfortable for some clients to underplay or hide that component of their difficulties – at least until the treatment relationship feels a little safer. By that point in time, though, the relationship may be well enough established that a transfer to a BED specialist may create a difficult transition for the client.

In such instances the clinician will be asked to determine whether the need for a BED specialist is compelling enough to warrant the disruption of the established relationship, or whether the clinician can bring sufficient knowledge about BED to the treatment that the patient's needs can be successfully addressed.

There will be two groups of clinicians for whom this course will be appropriate. The first group is the larger group: those clinicians who will not necessarily become BED specialists, but who will need a solid foundation in the nature, course and treatment of BED in order to possess both skill and knowledge when a patient with BED appears as part of their practice.

Because this represents the more usual circumstance, the course will have as its focus providing this target group with the most useful information possible.

For this group of trainees, this course does not pretend to serve as a comprehensive training of the sort that would allow a clinician subsequently to present himself or herself as a specialist and expert in the treatment of Binge Eating Disorder. Rather, it will provide a solid foundation for knowing how to proceed with such cases when they arrive on the clinician's doorstep. This knowledge base – for the non-specialist – may need to include how to make successful referrals to clinicians who do specialize in BED.

The second – and smaller - group will consist of those clinicians who may indeed wish to become eating disorder specialists, but who are just at the beginning phases of preparing themselves for that path. The hope is that this training course will also provide for them a solid and detailed foundation for their professional journey, with some direction about other areas of study that may be required on the way to achieve expertise in this kind of work.

There are a number of basic facts about BED that both groups of trainees must understand.

There are a number of basic facts about BED that both groups of trainees must understand. For instance, there has not been complete agreement within the mental health and medical communities concerning whether BED is a separate nosological entity, or a subgroup of Bulimia Nervosa non-purging type. With the publication of the DSM-5, the representation of BED as a new and separate diagnostic category has to some degree attempted to settle this disagreement, but some clinicians are still not in agreement.

Another basic piece of knowledge that both groups of trainees need to know is that some researchers believe that BED cannot be accurately described as a behavioral subtype of obesity, either. Certain researchers take this position for a very specific reason. Successful treatment for binge eating does not seem to result in a significant weight loss for obese patients. This fact tends to undercut the supposition that BED is best described as a subtype of obesity. (22)

Currently there is at least one study that views four models with which some researchers and clinicians conceptualize BED. Each of the models seems to have some aspects that have been validated, and therefore each model contributes to the understanding of BED. Each model however, also has flaws and components that seem to be disconfirmed in the understanding of BED. (22)

The models in question are:

Model 1) BED as a Distinct Eating disorder
Model 2) BED as a variant of Bulimia Nervosa
Model 3) BED as a subtype of behavior of obesity
Model 4) BED as an associated feature of another primary psychological disorder (22)


We will see how this issue and these models play themselves out in the understanding and treatment of BED in the next several years as the DSM-5 is fully adopted and critically examined. In addition to keeping track of these four models, it will also be helpful to examine the cluster of symptoms from which most BED patients suffer. The cluster of symptoms consists of: obesity, body image distress and psychopathology, especially depression. (22)

Apart from the diagnostic questions, both the models and the symptom clusters will be considered part of the foundation base of knowledge concerning BED. This overall knowledge base will need to be fairly broad, as many aspects of this knowledge base will have an impact on whether the clinician can successfully perform his or her key role at the point of initial contact - inviting the patient into accepting treatment services.

The clinician must first have sufficient awareness to determine if BED is present (even if the patient does not volunteer all the pertinent information). This will require a substantial amount of knowledge of what to look for and how the symptoms will present themselves. Very importantly, it will also demand that the clinician put aside any preconceived ideas about how obese people eat.

The clinician must then have knowledge of what forces are operating in the patient's overall symptomatology. In order to circumvent the patient's resistance to acknowledging the problem (i.e., many BED feel ashamed of their behavior and looks), the clinician must be prepared to address each factor that contributes to binge eating at the level at which it is operating in the patient - without blaming him or her.

Next, the clinician must have a reasonable overview of what approaches are used by specialists to intervene with BED. If the clinician is going to incorporate this knowledge into the treatment plan, there must be a solid enough foundation to work with some competence. Conversely, if the clinician is going to be successful in referring a generally resistant patient - or a patient who is in distress - to a BED specialist, that clinician must have sufficient knowledge to answer the patient's questions about what treatment with the BED specialist will entail.

It is vital for the clinician interviewing a patient suffering from BED to be prepared to intervene with knowledge and skill if these patients arrive for treatment. For this reason, two sections will be presented concerning treatment.

One of the sections will provide an overview of treatment models used to address BED. The other section will present some information about interactional styles that may be used by BED specialists, as well as intervention content and how it is used. This will allow the non-specialist to both answer pertinent questions of what awaits the patient and to align the initial assessment interventions with the broader scope of treatment.
This course has been developed to provide the fundamental knowledge base that will also allow a clinician to review the latest research on BED and operate with some confidence and competence.

Some sections, like those covering recent statistics on incidence and prevalence, are designed to provide the clinician with important overview information that may correct common misperceptions in the field.

Other sections, like those covering socio-cultural factors contributing to the BED - such as life stressors, genetics, family dynamics and socio cultural forces - will be useful in shaping the dialogue with the patient when it comes to building motivation for change. Still other sections will cover more concrete skills that will be useful in identifying and responding to BED.

The common thread throughout is that each section has been composed with an eye towards offering the most complete and useful information for the clinician. Every attempt has been made to be as brief as possible, while including all of the substantial information necessary to provide a comprehensive overview.
BED/ED Factoid

At any given time, 10% of adolescent and adult women report symptoms of an eating disorder

Source: The Academy for Eating Disorders

 

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