Eating Disorders: Binge Eating (cont.)
Member: I cannot eat normal amounts of certain foods -- I binge on pasta. I cannot just eat a serving -- rather, I eat huge quantities. I am OK with most foods; just not pasta. Help.
Fairburn: Usually people who binge eat on a very specific food either are actively avoiding that food at all other times or have very specific association attached to that food. Does either of these situations apply to you?
Member: I didn't actively avoid the food until I realized it was what I binged on.
Fairburn: This might seem bizarre, but your "solution" to your problem of binging on pasta might well be making it much worse. With most people, it is extremely helpful in trying to stop this type of binge eating for them to actually eat in small quantities the food they're trying to avoid eating, but only at times when they feel in control. I suggest that you try eating pasta on occasions in which you're feeling in control and see what happens to the binges.
Member: Dr. Fairburn, I binge in response to my emotions, whether happy, sad, lonely, whatever. I tell myself and others that I respond to stress well with exercise, but I seem to find myself binging and exercising like mad as a response to the same stresses.
Fairburn: What you describe is common. Binge eating is one way of affecting one's mood, as is exercising. So both forms of behavior can come to be used as a means of coping with feeling bad. The basic problem is that you are having difficulty coping with and accepting your mood states, and so either binge or exercise to adjust your mood. You might want to consider getting help for this.
Moderator: What are the long-term health consequences of binge eating?
Fairburn: There are none. That is to say there are no adverse effects of binge eating itself, but if anyone overate regularly, they are going to be at risk of developing obesity. This has many adverse health consequences, as we all know. The only other associated problem is if one purges -- that is, vomits or takes laxatives -- after binge eating, then the purging has adverse effects on one's health.
Member: In all my many years of therapy for my eating disorder I've heard that we often eat for emotional reasons and if we could get to that underlying reason and solve that, we could then deal with the food issues, but it seems like I eat just because I WANT to eat.
Fairburn: It is very difficult for me to answer your question. Often emotional problems of the type we've discussed already contribute significantly to binge eating, but I would want to make a distinction between what caused you to start binge eating in the first place and what is keeping your binge eating going now.
On the other hand, it is definitely true that there's a small group of people who seem to binge eat simply because they enjoy eating, although usually these people are not truly binge eating, since they don't have a sense of loss of control at the time.
Member: Dr. Fairburn, how do you go about finding the cause of a person's binge eating?
Fairburn: This is a complex and interesting problem. If the goal is to help someone overcome their binge eating problem, then the main question is why are they binging now. In other words, the question of importance is, what is keeping their eating problem going? What is maintaining it? A separate question is, what started the person's binge eating in the first place?
Often people seek help for binge eating problems many years after they first started to binge. In this instance, what caused them to binge in the first place -- say when they were 15 years old --may not be relevant to them now when they are 25 years old. So, from the point of view of overcoming a binge eating problem, the issue is what is keeping the person binge eating now, rather than why did they start binge eating many years ago.
The typical sorts of thing that keep binge eating problems going are the following:
Member: So are you suggesting that therapy is a solution?
Fairburn: There is good researched evidence that certain specific types of therapy have a marked effect on binge eating problems. Equally, there is certain evidence that certain types of other therapy are less effective. So, it is important to get the right type of therapy.
Member: Which types?
Fairburn: Good question. There are two leading evidence-based therapies. The first is called cognitive behavior therapy, and the second is called interpersonal therapy. Both therapies are well known and well tested.
Member: Do antidepressants help reduce episodes of binging? How do you know when it's time to try an antidepressant?
Fairburn: Another good question. One type of binge eating problem is called bulimia nervosa. People with this problem may benefit from antidepressant drugs. It has been shown that these drugs reduce their frequency of binge eating (and purging), although not many people stop altogether. The beneficial effects of antidepressant drugs in bulimia happen whether or not one is depressed in mood -- in other words, one does not need to feel depressed to necessarily benefit.
It must be added that not much is known about how long the beneficial effect of antidepressant drugs last in terms of their effect on binge eating. In contrast, it is well established that the effects of the two psychotherapies that I mentioned earlier are, in most cases, lasting.
Member: How readily will doctors use antidepressants if you present them with the evidence of a binge eating disorder?
Fairburn: If you present doctors with evidence that you have bulimia nervosa -- that is, you binge eat and purge afterwards -- then many doctors will readily prescribe antidepressant medication, since their effect on bulimia nervosa is well known.
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