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Definition Of The Disorder Psychology Essay

Eating disorders are characterized by severe disturbances in eating behavior. Anorexia nervosa and bulimia nervosa are the two most well known ED that constitute a significant source of psychiatric morbidity (Fairburn & Cooper, 1993), and an important public health concern in the Western world. Binge Eating Disorder (BED) is proposed as a new diagnostic category within the spectrum of Eating Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR, 2000). The disorder falls into the category "Eating Disorders Not Otherwise Specified (EDNOS). In European literature BED is also referred to as Compulsive Overeating (CO). It is characterized by recurrent episodes of binge eating (which cause marked anxiety or distress, negative feelings and guilt). The essential features of Binge Eating Disorder are recurrent eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. Additionally such episodes provoke a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating) (criterion A). In order to fulfill criterion B the binge-eating episode should be associated with at least 3 of the following: eating much more rapidly than normal or/and eating until feeling uncomfortably full or/and Eating large amounts of food when not feeling physically hungry, or/and eating alone because of feeling embarrassed by how much one is eating or/and feeling disgusted with oneself, depressed, or very guilty after overeating. When the person has recognized the severity of this behavior, feels extremely distressed (criterion C). Criterion D suggests that the binge eating occurs, on average, at least once a week for 3 months and Criterion E specifies the difference between Bulimia Nervosa and Anorexia Nervosa since the binge eating is not associated with the recurrent use of inappropriate compensatory behavior.

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A DSM-IV diagnosis of BED is made when all five criteria above are met.

However, loss of control and distress about overeating are not the only characteristics of the individuals with BED. There is a considerable amount of satisfaction gained, a sense of relaxation and reported enjoyment in terms of taste, smell and texture.

Generally individuals with Eating Disorder also have intrusive ideas about body image, continuous concern about how their body shape influence their self esteem. More specifically individuals with BED have low self-esteem, a higher lifetime prevalence of psychiatric disorder, in particular depression and personality disorders, more commonly a history of treatment for emotional problems and great impairment in work and social functioning (Striegel-Moore et al., 1998). According to studies conducted in 1999 by Agras individuals with BED often start bingeing first, and then dieting and they present psychological distress and psychiatric comorbidity with depression and Obsessive Compulsive Disorder (OCD) or Post Traumatic Stress Disorder (PTSD).

However, common difficulties in patients with eating disorders include low self-esteem, sorrow or anger, difficulties in expressing one's feelings, problems in interpersonal relationships or within the family, traumatic experiences such as sexual abuse and pressures arising from the society regarding which body type is considered as pretty and acceptable.

Eventually, eating disorders probably have various different causes. Frequently though, they arise either from a simple diet or as a means to control one's environment and to conform to cultural body standards. It doesn't take long, though, before this situation takes its course and becomes a dependency, influencing one's emotions and thoughts.

Despite the fact that the development of eating disorders may result from one's preoccupation with food and body weight, eating disorders are frequently attributed to other factors. An eating disorder is a complex condition that arises from a combination of long-term behavioral, emotional, psychological, interpersonal and social factors. Even if scientists and researchers have not given up research on the underlying causes of these emotionally and physically harmful conditions, some of the more general factors that trigger these conditions are still to be investigated.

People who develop eating disorders often use food and control over it as a means to compensate for feelings which would otherwise overwhelm them. In some cases, people make a habit of dieting, binge eating so as to deal with painful feelings and feel being in control of their lives. In the end though, these unhealthy eating habits ruin their emotional and physical well-being and annihilate the feelings of self-respect, competence and control.

The psychological factors that can contribute to BED are low self-esteem, feelings of inadequacy or lack of control over one's life, depression, anxiety, anger and loneliness. Among the most frequent interpersonal factors we could mention a troubled family environment and strained interpersonal relationships, difficulty expressing one's feelings, a history of bullying about body weight and size or even a history of psychical or sexual abuse.

Among the social factors that may contribute to BED we could mention the social pressures that glorify "thinness" and place value on obtaining perfectionism in every aspect. In addition to that definitions of beauty that include only women and men of specific body weights and shapes as well as cultural norms that value people on the basis of physical appearance and not on the basis of inner qualities and competence may trigger disturbances in eating behaviors.

What may trigger an episode of binge eating depends on the context and the person who suffers. Individuals, who repeat a cycle of dieting and weight gain, often gain weight after each round of dieting and binging. Hunger is one of the main reasons an individual may recur to a binge episode. The glucose levels are extremely low among dieters; usually food restriction is the source of a continuous hunger which becomes dangerous in case of loss of control over eating. We should also mention that during a diet, rules should be followed in order to achieve the goals. In case one rule is broken, the individual with BED feels disappointed, physically and mentally exhausted, "ruined" and worthless. Then they abandon any effort and start again a new cycle. There are cases of individuals with BED who stay away from any kind of food for a long period of time so as to gain in "satisfaction" during a binge episode (Fairburn & Cooper, 1993).

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Negative feelings, tiredness, anger, boredom and anxiety trigger a binge episode; the individual "blocks" or responds to these negative feelings by offering a "treat".

The person often attempts to stay away from people in order to have a binge eating behaviour. In times, he or she waits until others are away or asleep. Following an episode the feeling may vary. Once the episode is over some individuals feel full of energy, deliberated from the tension that provoked the binging and happy to go on. Some others become depressive, need to take some rest and sleep so as to forget it as soon as possible. The way each person behaves after a binging episode reflects the coping strategies one can use in order to deal with and further rationalize life stressors in general. Usually, following a binging episode the person takes the resolution that this will never happen again and that the next time he or she will be stronger to avoid it. Actually, such promises are hard to be kept and the person feels helpless again (Fairburn & Cooper, 1993).

In an effort to draw the binge eater profile we could say that symptoms of the disorder can be found among both men and women of all ages. However research findings show that women are more likely to accept and therefore ask for help probably because they are more sensitive to the effects on their appearance. Most BED sufferers tend to put and attend to the needs of others and not themselves, they have difficulty knowing or expressing their needs they lack of clarity about how they feel and cannot manage their feelings properly. Low self esteem and a constant need to be liked and accepted by others seems to be a leitmotiv in their lives (Hoek, 1993). According to Masheb & Grilo (2002), there is a close relationship of dissatisfaction with body shape and self evaluation influenced by body shape and weight to changes in depressive symptomatology and self esteem


Binge eating disorder (BED) is considered to be relatively new in the focus of epidemiological research. It was first described approximately 60 years ago and early clinical studies suggested that a distinct subgroup of obese patients experienced recurrent binge eating episodes but did not purge (Stunkard, 1959). BED was introduced in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) as a specific example of eating disorder not otherwise specified (EDNOS) and as a provisional diagnosis that is distinct from BN given that BED lack of the inappropriate compensatory behaviors that define bulimia nervosa (BN). Very few epidemiological studies have investigated the prevalence of BED in different populations i.e. in general populations and in specific populations (e.g. male, female, adolescent and obese populations) (Striegel-Moore, Franko, 2003).

Three studies have examined the prevalence of BED in the general population (Spitzer et al., 1992; Spitzer, Yanovski, Wadden, & Wing, 1993; Hay, 1998) that reported a prevalence of 3.3% in their first study and 2% in their second study. In an Australian community-based survey 1% of the population had BED (Hay, 1998).

Studies examined random samples of women in France (Basdevant et al., 1993), Norway (Götestam & Agras, 1995) and Austria (Kinzl, Traweger, Trefalt, Mangweth, & Biebl,

1999) and found that 0.7%, 3.2% and 3.3% respectively met the criteria for BED. Two studies investigated the prevalence of eating disorders among young female students and found that 1.0% (Rosenvinge, Borgen, & Borresen, 1999) and 0.2% (Cotrufo, Barretta, Monteleone, & Maj, 1998) satisfied the BED criteria. Kinzl et al. (1999) reported a prevalence of 0.8% in an all male community sample. BED seems to be distributed equally among the sexes (Spitzer et al., 1993; Hay, 1998; Striegel-Moore, 1995).

Additionally, another study revealed that 75% of the participants had a history of dieting, with an average of four diets in the past 5 years and 65% reported a weight gain after dieting. Thus, it appears that for binge eating patients, these difficulties are particularly long-standing and support the literature on binge eating as a way of life for many women (Wheeler, Greiner, Boulton, 2005).

Epidemiologic studies focus on two related questions: (1) How many individuals in a population meet diagnostic criteria for the disorder of interest? (2) Who in the population in particular is likely to meet criteria for the disorder? In addition, there are a few controversies given that BED is not a formal diagnosis within the DSM-IV. Assessing BED remains difficult especially when it is self reported, objectivity issues are to be overcome. However, attempts are still ongoing to refine the definition of a binge episode and to develop valid and reliable diagnostic criteria for BED. Researchers and clinicians are often unsuccessful in assessing what is an unusually large amount of food. First, they are inconsistent in recognizing eating continuously throughout the day from eating enormous quantities of planned meals and in suggesting what constitutes a truly large portion size from normal behavior, overindulgence, or circumstances (e.g., holiday). These inconsistencies make it difficult to determine the true number of binge episodes experienced by a patient or research participant. Second, patients are incapable to determine if loss of control was present during the binge eating episode. Because of subjective differences in the definition, loss of control is difficult to measure. Some individuals may report loss of control after eating a small amount of food whereas others may only experience a sense of loss of control after a much larger amount of food (Bulik, Brownley, Shapiro, 2007). Moreover, many individuals with BED are not diagnosed, or even misdiagnosed, many patients do not seek treatment feeling guilty and unsafe.

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The overall prevalence of BED is equal in males and females. However, we should stress on the fact that further research has to be conducted since binge eating has only recently attracted the attention of clinicians and researchers. The gender differences within this disorder are similar. In general, men and women do not differ in terms of other variables such as age at which they were first overweight, age at first diet, age at onset of binge eating, self-esteem, and eating related to psychopathology. In most of the studies conducted women reported higher body dissatisfaction and eating in response to negative emotions while men had a higher history of substance abuse problems related to anxiety and depression that trigger distorted eating behaviors (Linzer et al., 1996).

In terms of overall prevalence of BED among primary care patients in the United States, men were significantly less likely than women to meet criteria for BED. We should also mention that men are less likely than women to report distress over binge eating, a symptom required for diagnosis of BED. This would suggest that even if men are as likely as women to engage in recurrent binge eating, men may be less likely to meet full-syndrome criteria for BED (Lewinsohn et al., 2002).

Although initially thought to be a disorder of adulthood, there is growing recognition that BED also occurs in adolescents and children. Such recognition has created the need of age-appropriate and age relevant assessment measures such as an adjusted version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) and the Child Eating Disorder Examination interview (ChEDE).

In terms of cultural differences little research has been conducted. A recent study by Bennett and Dodge in 2007 showed that culture and ethnicity can affect a person's feelings of embarrassment, guilt, loss of control, and distress. Because of this, the emotions associated with binge eating may be experienced differently by individuals from specific ethnic-racial groups within the U.S. Feelings of embarrassment experienced by Asian and Native American women may keep them from seeking help, and the diagnosis of BED may be overlooked in these groups. The emotional aspects of BED may serve as a barrier to treatment for these women (Bennett, Dodge, 2007).

Complications common to BED include anxiety (i.e., generalized anxiety disorder) with panic symptoms and depression. A study conducted in 2009 by Grilo et. al examined DSM-IV psychiatric disorder comorbidity and its relationship to demographic, historical obesity-related variables, and current clinical variables within a consecutive series of 404 patients with BED assessed using semistructured diagnostic and clinical interviews. Patients with BED who presented for treatment frequently had additional lifetime and current psychiatric disorders. Mood, anxiety, and substance use disorders were the most common lifetime and current disorders. Mood and anxiety disorder comorbidity differed little by gender (except for

higher current rates of OCD in men), while men had higher lifetime rates of substance use disorders. Patients with BED with additional current psychiatric disorders reported earlier onsets of first diets and higher ''lifetime high'' BMI. Patients with current comorbidity also had greater current eating disorder psychopathology, higher depression scores, and lower self-esteem relative to patients with lifetime histories, who differed little from those without any history of psychiatric disorders. Overall, 74% of patients with BED had at least one additional lifetime psychiatric disorder and 43% had at least one current psychiatric disorder.

Lifetime wise, mood (54.2%), anxiety (37.1%), and substance use (24.8%) disorders were most common. In terms of current comorbidity, mood (26.0%) and anxiety (24.5%) were most common, whereas substance use disorders were infrequent (2.7%) (Grilo et al., 2009).

Other studies focused on depression and BED but also investigated aspects such as quality of life. Patient with BED report more frequently worse quality of life than those without BED as well as higher levels of depression and psychological symptoms (Marano, 2010).

In relation to Obsessive Compulsive Disorder (OCD), a common sign that is seen in both BED and OCD is the obsession and ritualistic behaviors that tend to be cyclic and incapacitating to the patient. As mentioned above Binge Eating is also referred to as compulsive overeating which can be described as a condition in which one periodically consumes extremely large amounts of food. Individuals with Binge Eating Disorder have a strong motivational drive for food and experience great difficulty in their attempts to restrain their eating. Moreover, the urges experienced by patients with Binge Eating Disorder are similar to those experienced in some Impulse Control Disorders such as Trichotillomania (Linzer et al., 1996).

Research has shown that anxiety disorders are common among individuals with eating disorders. The prevalence of anxiety disorders is significantly high among people with anorexia nervosa (AN) or bulimia nervosa (BN) in nonclinical populations. Although fewer research has examined anxiety disorders in people with BED. Sawaoka et al compared obese individuals who regularly binge eat, normal-weight persons with BN, and those with either social phobia or panic disorder on measures of anxiety and depression. They found similarities among the 4 groups with respect to levels of anxiety and depression, as well as incidence, prevalence, and clinical severity of anxiety disorders. Of the anxiety disorders, social phobia is one of the most commonly diagnosed among binge eaters. Social phobia is marked by high levels of social anxiety, which is defined as a lack of confidence in social situations, difficulty interacting with other people, and fear of negative evaluations from others. Despite findings connecting social phobia to binge eating, little work has explored social anxiety in BED. Clinically, social anxiety has long been thought to be common in people who binge eats, although it has received relatively little empirical attention. I has been found that specific aspects of social anxiety and high public self-consciousness (ie, concerns about the opinions of others regarding the self) were significantly associated with body dissatisfaction in individuals with BN. Striegel-Moore (2003) posited that individuals with BED are extremely sensitive to the evaluations others make of them and are particularly attuned to their physical appearance, thus making social anxiety and self-consciousness important influences on how they feel about their bodies.

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