1. Jenni L. Harshbarger, Ph.D. Robert J. Dole VAMC 03/05/2013

2. As I See It...

3.  Binge Eating Disorder (BED) is a type of eating disorder.  It’s normally characterized by recurrent binge eating without the regular use of compensatory behaviors.  What is a binge?

4.  Frequent episodes of eating abnormally large amount of food.  Frequent feelings of being unable to control what or how much is being eaten.

5.  Several of the following:  Eating much more rapidly than usual  Eating until uncomfortably full  Eating large amounts of food, even when not physically hungry  Eating alone out of embarrassment at the quantity of food being eaten  Feelings of disgust, depression, or guilt after eating

6.  BED is probably the most common eating disorder.  BED is estimated to affect 2% of all adults (about 1 million to 2 million Americans.)  BED is slightly more common in women than men (about 60% of people with BED are female).  BED is equally distributed across different races and ethnicities.

7. Bio PsychoSocial GeneticsPersonality Styles Media Mood DisordersFamily Styles Peer Pressure Obsessive CompulsiveAll or Nothing Thinking Messages re Dieting Physical Effects of DietingTransitions AddictionsStress

8.  Diseases that accompany obesity, including:  Diabetes  High blood pressure  High cholesterol levels  Gallbladder disease  Heart disease  Certain types of cancers

9.  Lowered Self Esteem  Decreased productivity through missed work, school, or social activities to binge  Increased depression, anxiety and other mental health disorders

10.  As humans we are biologically programmed to focus on food when we’re under stress  As a culture, food is a cornerstone of tradition, family and connection  Food can serve as a distraction or a numbing agent

11. EMOTIONAL HUNGER  Is sudden  Is specific for food  Is “above the neck”  Is urgent  Is paired with an upsetting emotion  Involves automatic eating  Does not notice fullness  Feels guilty about eating PHYSICAL HUNGER  Is gradual  Is open to different foods  Is Based in the stomach  Is patient  Occurs out of physical need  Involves deliberate choices  Stops when full  Realizes eating is necessary

12. The Food-Feeling Connection

13.  Cognitive Behavioral Therapy  How do our thoughts, feelings and actions interact?  Interpersonal Psychotherapy  What is the role of relationships, disputes, intimacy and feelings of loneliness?

14.  Medications  The role of antidepressants  Self-help groups  The role of support  Researchers are still trying to determine which method or combination of methods is the most effective for controlling BED.

15.  Incorporate relaxation techniques into your daily routine. Take a yoga class, meditate for 20 minutes every morning and night, or simply take “quiet time” to be away from others an alone with your thoughts  Give yourself permission to eat what you crave, but do it with a capable support person who understands your goal is to increase self-awareness, not to binge. Then spend time talking about your feelings or writing them down.

16.  Call or visit a “long lost” childhood friend whom you have thought about over the years but haven’t seen. Track them down. Catch up on each other’s life. They will not judge you for your binge eating; they have their own stories to tell.  Make lists about your life: likes and dislikes; goals; priorities; accomplishments; things to do; people to call etc… Lists are good for organizing your thoughts instead of letting them spin.

17.  Practice saying “NO.” Be assertive and express your needs, small or large. Set your own limits and boundaries. This may feel risky at first, but it gets easier as you get stronger. Always remember you have a fundamental human right to your own opinions and decision.

18.  Take a vacation. Get away from your usual routine, and decide not to binge while away. Be a “new” you while you are gone, and think about ways to continue with that attitude when you return home.

19.  Try visual imagery, which can help you to later act out a situation in a positive way. Picture yourself doing something before you do it. For example, before dinner, mentally see yourself walking into the kitchen, preparing a healthy meal, eating it in a pleasant environment, and cleaning up afterwards. Imagine the scenario as purely enjoyable, then replicate it in reality.  Be wary of the scale!!!!

20.  Perfection is not possible – or necessary!  When you make a mistake – don’t miss the lesson!  Small changes slowly add up to big changes.

21. Mindful Eating Exercise

22. Chapter 1 I walk down the street. There is a deep hole on the sidewalk. I fall in. I am lost. I am helpless. It isn’t my fault. It takes forever to find a way out. Chapter 2 I walk down the same street. There is a deep hole in the sidewalk. I pretend I don’t see it. I fall in again. I can’t believe I am in the same place, but it isn’t my fault. It still takes a long time to get out. Chapter 3 I walk down the same street. There is a deep hole in the sidewalk. I see it there. I still fall in. It’s a habit. My eyes are open. I know where I am. It is my fault. I get out immediately. Chapter 4 I walk down the same street. There is a deep hole in the sidewalk. I walk around it. Chapter 5 I walk down another street.

23. Questions?