Binge Eating Disorder Linked to Social Anxiety

The Vicious Cycle of Binge Eating and Social Isolation

The connection between negative body image and anxiety around social interactions is extremely common, and often has its origins in the pre-teens.  The usual pattern follows a predictable path:  Adolescent is bullied about their appearance, size, or weight which ultimately causes the victim to seek solace in the safety of their home.  When other kids are out attending dances or football games, someone with a negative body image sits in their bedroom, saving the world from having to even look at them.

Self-disgust over perceived flaws become unreasonably magnified, causing anxiety, which in time can lead to a desire to quell these negative emotions.  Many times the individual being teased about their weight or appearance buys into the cruel criticism about their looks, and begins to believe they are so unappealing to look at that they might as well save others from having to look at them.  This results in a social phobia or social anxiety, where intense fear becomes associated with being in a social setting where one can be judged.

To manage this anxiety, some young people resort to substance abuse—drugs and/or alcohol to ease the emotional pain caused by the bullying and self-disgust.  For some, the substance abused is food.  The repetitive cycle that emerges is very similar to a substance addiction, with many of the same characteristics present.

What is Binge Eating Disorder?

Binge eating disorder (BED) is exactly what its name implies:  Recurrent episodes (versus occasional overeating) of eating large amounts of food in a subconsciously attempt to numb negative emotions, such as a deep sense of worthlessness, shame, and self-loathing related to a negative body image.  The consuming of excessive amounts of food has become a BED when the following criteria are present, as defined by the Diagnostic Statistical Manual (DSM-5):

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
  2. The binge eating episodes are associated with three (or more) of the following:
    • Eating much more rapidly than normal.
    • Eating until feeling uncomfortably full.
    • Eating large amounts of food when not feeling physically hungry.
    • Eating alone because of feeling embarrassed by how much one is eating.
    • Feeling disgusted with oneself, depressed, or very guilty afterward.
  3. Marked distress regarding binge eating is present.
  4. The binge eating occurs, on average, at least once a week for 3 months.

The binge eating is not associated with the recurrent use of inappropriate    compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

BED is the most common of all the eating disorders, with about 3.5% of women, 2% of men, and 1.6% of teens suffering from it.  It can lead to various debilitating health risks, such as diabetes, high blood pressure, sleep apnea, heart disease, and gallbladder disease.  Just as devastating, living with a BED can severely curtail one’s ability to function socially, at school, or at work.

A study out of Yale University in 2012 examined the link between social anxiety and the eating disorder psychopathology in BED.  By studying 113 participants with BED who were administered a battery of tests and participated in various clinical interviews they were able to conclude that there was higher levels of social anxiety were associated with binge eating frequency in patients with BED.

What does BED Look Like?

There are certain characteristics common among those who suffer from BED.  Like a drug or alcohol addiction, people suffering from a BED obsess about their next binge episode, planning for it and going to great lengths to hide it from others.  Also, like with a drug addiction, there is an inability to cease using the food in a self-abusive manner, even though the negative consequences are beginning to cause them great distress, such as weight gain and social isolation.

Signs that a loved one may have a BED include:

  • Finding empty food wrappers hidden under beds, in closets, drawers, etc.
  • Secretive food behaviors, like stealing, hiding or hoarding food, and insisting on eating alone
  • Unusual eating patterns develop, such as not eating at the usual mealtimes, eating all day long, skipping meals, developing food rituals, engaging in fasting or repetitive dieting

In addition to the tendency to avoid social situations where they feel they will be ridiculed and teased, other co-occurring mental conditions may be present, such as depression.  The vicious cycle of shame and self-disgust over their negative body image leads to the use of food as a form of temporary comfort, which then leads to self-loathing and depression after they have binged—just entrenching the problem further.

Casa Serena can Help

At Casa Serena, we understand that one of the first steps in treating an individual with BED is to identify the source of the emotional pain that has led to the disorder.  Cognitive behavioral therapy (CBT) is considered the most effective treatment modality for identifying the triggers and thought patterns, and replacing them with healthy thought and behavioral responses.  The compassionate staff at Casa Serena helps to navigate those with a BED towards the healthy, productive life that they deserve.  Contact us today at (925) 682-8252.

Sources:

http://www.ncbi.nlm.nih.gov/pubmed/22152497

http://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/anxiety/body-image-and-social-anxiety

https://www.nationaleatingdisorders.org/binge-eating-disorder

The Benefits of Intensive Outpatient Treatment for Eating Disorders

 As with any important decision in life, choosing the right treatment option for an eating disorder (ED) comes down to need and lifestyle.  Factors such as the severity of the ED, finances, and family/work/academic obligations will determine whether an individual is in need of intensive inpatient care, basic outpatient services, or an intensive outpatient program (IOP). An IOP is at the center of the treatment spectrum for an eating disorder, an elevation above basic outpatient services that may not provide enough structure or breadth in services to adequately address the needs of the client.  Intensive outpatient programs often fulfill the needs of a patient just discharged from an inpatient program, allowing for some independence without sacrificing the important treatment elements they have become accustomed to while in a residential program.

The various treatment levels of care for an ED include:

Inpatient residential treatment:  A dedicated residential treatment facility is indicated if the disorder is deeply entrenched and life threatening, where physical and/or psychological instability may require acute hospitalization.  An example of this would be a serious eating disorder, such as anorexia nervosa, that has impacted vital organs and has caused serious damage to the body.  An inpatient treatment program can offer cardiac monitoring, IV fluids to restore electrolyte balance, and medications for anxiety, depression, and agitation.

Intensive outpatient program:  An IOP is often utilized for patients coming from a residential program, once mental and physical health are stabilized.  Mental health providers have determined their symptoms to be under control and the patients are considered able to function in their daily lives while continuing to progress in recovery.

The Intensive Outpatient Program option is also a step-up in care for those with progressive eating disorders not managed sufficiently in a basic outpatient program.  For these clients, despite working with an outpatient team a couple of times a week, the basic services do not provide enough continuity and structure to produce a stable recovery from their eating disorder.

Basic outpatient services:  A basic outpatient program (BOP) typically offers services two days a week for those with newly formed eating disorders who do not meet the criteria for a higher level of care.  The BOP will offer treatment management and group therapy, but does not offer adjunct treatment services such as art and music therapy, equine therapy, meal therapy, or body image classes.

Teen IOP versus Adult IOP

 The stage of life an individual is in when they seek treatment can dictate not only their scheduling needs, but also the content of the program itself.  Because of the differing demands and responsibilities between an adult and a teen, it is helpful to find an IOP designed accordingly.  Casa Serena offers intensive outpatient programs exclusively, thus making us specialists in this level of care.  Therefore, we have created effective programs designed to accommodate the specific needs of both teens and adults.

Adult IOP:

An IOP designed for adults accommodates the need for the client to continue to work at their job, whether inside or outside the home.  Some adults who have parenting responsibilities may need to be present during the day for their children, while others simply cannot take time off of their jobs.  For adults, an evening program like the one offered at Casa Serena—four hours per evening, four days a week—is a perfect fit.  In the adult program, the client will learn better ways to manage anxiety, depression, or low self-esteem, factors often at the root of the disordered eating habits.  By addressing the underlying issue that fuels the disorder, the clients are taught new coping skills to overcome it.  The adult treatment components include:

  • Classes in body image, nutrition, and living skills
  • Group therapy (4 per month)
  • Dialectical Behavior Therapy (DBT)
  • Yoga and mindfulness group (2 per month)
  • Supportive meal groups (4 per month)

Teen IOP:

For teens aged 13-18, the IOP must take their school schedules and academic obligations into account.  Because of this, Casa Serena offers a program that meets after school hours four days a week for four hours, but allows the teen plenty of time in the evening to tackle homework.  The teen years are especially challenging, with emotions running high, hormone shifts, and plenty of peer pressure that can all trigger disordered eating patterns.  With a focus on helping the teens overcome destructive behaviors and developing new coping skills, our teen program helps them manage the issues that drive their eating disorder.  The teen program treatment components include:

  • Individual counseling appointments daily
  • Dialectical Behavior Therapy (DBT)
  • Group therapy (2 per month)
  • Yoga and mindfulness group (2 per month)
  • Classes in nutrition, body image, living skills
  • Expressive arts
  • Multi-family group

Casa Serena can Help

Casa Serena provides a well-rounded, comprehensive IOP that is designed for the demands in the client’s life, be they an adult or a teen.  Our expert clinicians treat all clients with the compassion and support necessary to overcome an eating disorder.  Call us today for details about our programs at (925) 682-8252.

Sources:

http://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disorder-treatment/art-20046234

https://www.nationaleatingdisorders.org/treatment-settings-and-levels-care

https://www.nationaleatingdisorders.org/sites/default/files/NEDA%20Webinar%20Levels%20of%20Treatment.pdf