On Thursday 4th March 2021, Nightingale Hospital held a webinar event on binge eating disorders in support of National Eating Disorders Awareness Week.
In this webinar, key clinicians from our QED-accredited eating disorders team provided a multidisciplinary overview of binge eating disorders, and how they can be treated. This panel was formed by Dr Helen Murphy, lead consultant psychiatrist for eating disorders; Dr Joanna Silver, counselling psychologist and lead therapist for eating disorders; Talia Cecchele, dietitian and chaired by Shahin Alvis, eating disorder ward manager. We were particularly honoured to be joined by Rosie, an official ambassador from Beat (the UK’s leading charity for eating disorders), who shared her powerful lived experience of binge eating.
Dr Helen Murphy, Dr Joanna Silver and Talia follow up on this event by answering key questions asked by our audience, below.
If you’ve had multiple years of active bulimia, can you permanently mess up your digestive process?
Dr Helen Murphy says: Yes, some permanent changes in the gastrointestinal tract can occur. Long-term vomiting can cause damage to the ring of muscle at the bottom of the oesophagus, the oesophageal sphincter, leading to acid reflux. This can be relieved by medication such as proton pump inhibitors.
Chronic exposure to stomach acid can lead to precancerous changes in the lower oesophagus, known as Barratt’s oesophagus. There is a low risk of progression to cancer, but if this condition is present, it requires monitoring.
It is possible that chronic abuse of stimulant laxatives (e.g. senna or Dulcolax) can lead to permanent damage to the smooth muscle of the colon, causing it to contract less effectively and become ‘floppy’. More research is needed on this, to establish if the relationship is causative.
Talia adds: Under-eating can lead to gastrointestinal changes such as constipation, diarrhoea, abdominal pain and bloating. Many people experience IBS symptoms and food intolerance as the gut becomes undernourished, the muscle walls weaken, digestion slows and food is not digested and absorbed as efficiently as within a nourished gut.
How useful do you find the “MARSIPAN” assessment tool? Is it relevant for bulimic patients who are maybe more at risk?
Dr Helen Murphy says: MARSIPAN is specifically designed for risk assessment and management of anorexia. However, eating disorders specialists are currently working on the third revision of MARSIPAN that will cover all eating disorders, not just anorexia.
Prescription medications, do any work and what is/is not available to prescribe in the UK?
Dr Helen Murphy says: There are currently no drugs licensed for the treatment of binge eating disorder in the UK. However, fluoxetine is licensed for the treatment of bulimia, so it is also used in binge eating disorders. In the US, the drug lisdexamfetamine is licensed for the treatment of binge eating disorder, so it is sometimes used off-licence in the UK. There are small studies suggesting some benefits from topiramate, bupropion and naltrexone, but to date, they have not been licenced in the UK or in the US.
Can CBT therapies work alongside psychodynamic treatments (e.g. MBT) when there is a dual pathology of eating disorder and personality disorder?
Dr Joanna Silver says: I think that CBT and MDT can be used together if this makes sense in terms of the patient’s formulation. It is important to look at what the function of binge eating is in the context of the patient. CBT therapies can provide some practical ways to manage urges and cravings and reduce binges. A lot of these strategies can be adaptable to other ways that a person may regulate emotions, for example self-harming.
What are some practical tools to help patients manage binge eating cravings/urges?
Dr Joanna Silver says: Firstly, it can be helpful for patients to keep a note of their cravings and urges to see if there is a pattern to them. Often at first, it seems as if cravings/urges are random but on closer examination, there may be certain things that are triggering. For example, some urges may be amplified by hunger or certain emotions such as sadness or anger.
If cravings/urges are triggered by hunger (physiological), it is important to make sure that the person eats regularly so that they do not get into a position of being so hungry that they are likely to binge. In terms of strategies to manage cravings and urges, patients may find it helpful to try and postpone a binge (give themselves 10 minutes before bingeing and then another 10 minutes etc).
Other strategies include:
- Brushing teeth when the urge comes
- Going for a walk and leaving the environment that the person is in
- Writing down the pros and cons of bingeing
- Listening to music (it can be helpful to prepare songs in advance)
- Phoning a close friend
- Having a cold shower
- Looking at motivational statements (prepared in advance)
- Breathing exercises
Everyone will have different strategies that they find useful, and I would encourage patients to try out several strategies so that they can create their own personalised ‘toolbox’ for dealing with triggers.
Talia says: One of the most important strategies to manage cravings is to eat regular meals and snacks to stabilise blood sugar levels, insulin levels and cravings. It is vital to include a source of complex carbohydrates with each main meal and try to include high-fibre and high-protein snacks.
Nutritional balance and including all types of foods (including high energy and ‘junk’ foods) will help to reduce cravings as the body doesn’t feel deprived.
Having a good relationship with all foods, not labelling them as ‘good’ or ‘bad’, will help in neutralising the value of these foods. This will allow people to include them in their diets without fear, therefore stopping them from being ‘trigger’ foods.
Question: How to deal with family dynamics if a daughter had anorexia, and a father has aspects of BED that influences her recovery?
Dr Joanna Silver says: I think in a situation like this, family therapy can be very useful and can provide a space to discuss how to manage these dynamics. We very much see families as being part of the solution to an eating disorder. It is important for people who are recovering from an eating disorder to find a way to focus on their own meal plan and their own recovery.
Binge eating disorder: Reading and recommended resources from our team
- Overcoming Binge Eating – Christopher Fairburn
- Sick Enough – Jennifer L. Gaudiani
- Intuitive Eating – Evelyn Tribole and Elyse Resch
- Caring For Your Loved One with an Eating Disorder – Janet Treasure
- Help Your Child Beat an Eating Disorder – James Lock
- Beat – The UK’s charity for eating disorders: Support services
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- Binge eating disorder (BED)
- Anorexia nervosa
- Bulimia nervosa
- Other Specified Feeding or Eating Disorders (OSFED)