Jessica Dalrymple

PSY 100-01 Introduction to Psychology

May 7, 2017

Dr. Jaime Rice

Approaching the Treatment of Binge Eating Disorder from Three Different Perspectives
 Binge eating disorder (BED), a severe, life-threatening, but treatable eating disorder, is

the most common eating disorder in the United States (Binge Eating Disorder Overview and

Statistics, National Eating Disorders Association, 2016). It is characterized by quickly eating

large amounts of food, feeling a loss of control during a binge, feeling ashamed, distressed, or

guilty afterwards, and not unhealthily purging afterwards to counter the binge eating (Binge

Eating Disorder Overview and Statistics, National Eating Disorders Association, 2016). BED

was not formally recognized as an eating disorder in the Diagnostic and Statistical Manual of

Mental Disorders until the most recent revision in 2013. Treatment can be approached from the

biological, psychological, social perspectives. Treatment from the biological perspective

consists of the measurement of food intake, the examination of gender differences in order to

know how to go about treating the disorder, and the investigation of hypomania in BED.

Treatment from the psychological perspective consists of group therapy, therapeutic alliance, and

psychotherapy. Therapeutic alliance refers to the relationship between a healthcare professional

and a patient. Psychotherapy, which is also known as talk therapy, helps teach people how to

exchange their unhealthy habits for healthier ones and reduce the number of binge eating

episodes they have. Treatment from the social perspective consists of Acceptance and

Commitment Therapy (ACT), cognitive-behavioral therapy (CBT), and other innovative

intervention treatments. ACT is a unique psychological intervention that uses acceptance and

mindfulness strategies along with commitment and behavior change strategies to increase

psychological flexibility. CBT can help patients cope with better issues that can trigger binge-

eating episodes, such as negative feelings about your body or behavior and help patients regulate

their eating patterns.

 The treatment of binge eating disorder (BED) can be approached through the biological

perspective by means of measuring food intake, examining gender differences in order to know

how to go about treating the disorder, and investigating hypomania in BED. Psychologists from

the Department of Psychology at Rhodes College and the Department of Psychiatry at the

University of North Carolina at Chapel Hill examined stress-induced eating behaviors and the

relationship between stress and snacking in three different groups of women (Klatzkin, Gaffney,

Cyrus, Bigus, Brownley, 2016). The researchers found that caloric consumption was positively

correlated with stress-induced anxiety changes and correlated negatively with dietary restraint in

a group of women who has BED and were obese (Klatzkin, Gaffney, Cyrus, Bigus, Brownley,

2016). A group of women who maintained a normal weight ate a larger amount of the snack

food they poured into their bowls than the other two groups of obese women after controlling for

negative affect and dietary restraint (Klatzkin, Gaffney, Cyrus, Bigus, Brownley, 2016). The

results of this study suggest that greater caloric intake is associated with lower dietary restrain

and greater anxiety among obese women who have BED, and are in line with evidence of a

relationship between disordered eating behaviors and an increase in dietary restraint in BED and

bulimia (Klatzkin, Gaffney, Cyrus, Bigus, Brownley, 2016). Dietary restraint is associated with

snack food intake in obese women who have BED and the smaller percentage of poured snack

food that was eaten by obese women with BED could be explained by a motivational drive to eat

that is induced by stress coupled with dietary restraints influence on caloric consumption

(Klatzkin, Gaffney, Cyrus, Bigus, Brownley, 2016). The researchers concluded that

differentiation in moderators of stress-induced snacking between the three different groups of

women suggest that multiple prevention and treatment strategies may be needed for obesity and

BED, and that therefore, future studies that provide a more precise approach to measuring food
intake could help advance the field by uncovering eating behaviors that distinguish eating that is

induced by stress in both obesity and BED (Klatzkin, Gaffney, Cyrus, Bigus, Brownley, 2016).

Psychologists from the University of Calgary and the University of Alberta conducted a

study investigating the degree to which impulsiveness predicted the presence and the severity of

binge-eating symptoms in a sample of men and women (Farstad, von Ranson, Hodgins, El-

Guebaly, Casey, and Schopflocher, 2015). Negative urgency was a common predictor of binge

eating in women and men, predicting increased severity in men and being the strongest risk

factor for binge eating among women (Farstad, von Ranson, Hodgins, El-Guebaly, Casey, and

Schopflocher, 2015). These findings are consistent with other studies of men and women that

have shown high levels of negative urgency that are associated with many types of

psychopathology, including binge eating (Farstad, von Ranson, Hodgins, El-Guebaly, Casey, and

Schopflocher, 2015). In addition, evidence of disorder-specific personality predictors of a lack

of persistence was found among men, which was consistent with the researchers hypothesis that

a lack of persistence would be a prominent predictor for men (Farstad, von Ranson, Hodgins, El-

Guebaly, Casey, and Schopflocher, 2015). This evidence is partially consistent with results from

a study conducted by Claire M. Peterson and Sarah Fischer where they found that a lack of

persistence predicted future binge eating (Farstad, von Ranson, Hodgins, El-Guebaly, Casey, and

Schopflocher, 2015). Findings from this study have important implications regarding gender-

specific treatments for BED and suggest that specific traits of impulsiveness that are targeted

during treatment may vary depending on the clients gender (Farstad, von Ranson, Hodgins, El-

Guebaly, Casey, and Schopflocher, 2015).

Psychologists from the Department of Neuroscience at the University of Turin in Turin,

Italy investigated whether patients with BED showed more hypomanic symptoms than those who
had sub-threshold BED (s-BED) (Amianto, Lavagnino, Leombruni, Gastaldi, Daga, Fassino,

2010). Patients with BED showed higher scores on the Hypomania Checklist than patients with

s-BED and hypomanic symptoms show a direct correlation with the severity of binge eating

(Amianto, Lavagnino, Leombruni, Gastaldi, Daga, Fassino, 2010). Higher rates of hypomania

suggest a dimension of mood instability that is independent of trait personality features assessed

by the Temperament and Character Inventory (Amianto, Lavagnino, Leombruni, Gastaldi, Daga,

Fassino, 2010). Future clinical studies should investigate whether the treatment of obese patients

that have BED with a severe degree of binge eating and a higher presence of hypomanic

symptoms can lead to better control over binge eating through mood stabilization and the

improvement of instability compared to antidepressant treatment (Amianto, Lavagnino,

Leombruni, Gastaldi, Daga, Fassino, 2010). There is also a need for prospective studies to

determine whether or not higher levels of hypomania can lead to a higher risk of binge eating

(Amianto, Lavagnino, Leombruni, Gastaldi, Daga, Fassino, 2010). The researchers concluded

that hypomanic symptoms are more present in obese BED patients than those who have s-BED

(Amianto, Lavagnino, Leombruni, Gastaldi, Daga, Fassino, 2010).

The treatment of BED can also be approached through the psychological perspective

through group therapy, therapeutic alliance, and psychotherapy. Holly Starkman, from

Quinnipiac University worked to find an effective treatment for women with BED that exhibits

positive results in clinical practice (Starkman, 2015). BED is currently the most prevailing

eating disorder in women and self-regulation is becoming the more common goal of clinical

interventions rather than weight management (Starkman, 2015). An understanding of the

problems of binge eating in women is required when creating a treatment model that fosters a

womans ability to teach herself mindful awareness of her body, mind, and self-needs, especially
when self-care is compromised (Starkman, 2015). Starkman has clinical experience treating

women with eating disorders, including BED, and used her experience to create an integrative

short-term group therapy treatment that uses mindfulness principles and skills (Starkman, 2015).

As part of the treatment, the acronym F.E.E.D, which stands for Focus, Engage, Eat, Decide, was

introduced as a way to counter binge eating and increase self-awareness, and to sustain self-

efficacy (Starkman, 2015). It is initially facilitated through therapeutic application and is then

reinforced through empathy and support among the group members, so that they can continue

connecting experiences of mind, body, and self (Starkman, 2015). Starkman concluded that

research, theory, and evidence-based treatment on BED helped her formulate her group therapy

treatment (Starkman, 2015).

Giorgio A. Tasca from the University of Ottawa and Ottawa Hospital in Ottawa, Ontario,

Canada, and psychologists from the Universita degli studi di Bergamo examined the relationship

between therapeutic alliance and its outcomes across 20 sessions of emotionally focused group

therapy (Tasca, Compare, Zarbo, Brugnera, 2016). The researchers found that greater change in

therapeutic alliance was associated with lower symptom levels when temporal precedence

between the changing of the alliance and symptoms was accounted for (Tasca, Compare, Zarbo,

Brugnera, 2016). This finding supports the therapeutic alliance theory, which states that an

increasing alliance is necessary for the occurrence of symptom reduction (Tasca, Compare,

Zarbo, Brugnera, 2016). In addition, the results of the study indicate that change in alliance is

associated with binge-eating levels, and that alliance growth is a key predictor of a patients

progress (Tasca, Compare, Zarbo, Brugnera, 2016). The researchers used a time lag design

within a multilevel modeling approach while conducting their research and found evidence that

the increase of therapeutic alliance may precede lower binge eating levels throughout sessions
(Tasca, Compare, Zarbo, Brugnera, 2016). This indicates that both therapists and groups can

benefit from a weekly monitoring of both symptoms and therapeutic alliance to identify a decline

or rupture in alliance (Tasca, Compare, Zarbo, Brugnera, 2016). The researchers concluded that

findings related to temporal precedence between alliance growth and binge eating symptom level

suggest that therapeutic alliance in group therapy is a key factor that precedes the improvement

of binge eating symptoms (Tasca, Compare, Zarbo, Brugnera, 2016).

Kathryn Zerbe from the Oregon Health and Science University discusses how during

psychotherapy, therapists must probe their patients for secrets about their personal and family

history and pursue them so that the patient can embrace a truer sense of self (Zerbe, 2015).

Looking at the impact of shame, secrets, no-entry, and false body defenses helps therapists to

better understand and help patients with binge eating problems to gain ground in recovery

(Zerbe, 2015). However, approaching this issue from a psychodynamic perspective takes into

account that the disorder of psyche and soma is difficult to remediate until the patient embraces a

fuller sense of self (Zerbe, 2015). The process requires the patient to acknowledge aspects of

his/her past, such as a desire for a different life, difficulties, or even finally accepting help, and

embrace a truer sense of self by warding off shame (Zerbe, 2015). Zerbe concluded that the

incorporation of the psychodynamic perspective into an integrated psychotherapeutic treatment

plan for binge eating disorder has the ability to yield rewards for both the patient and the

clinician over time, as well as further teaching health care professionals about why these

problems become chronic so often (Zerbe, 2015).

Finally, the treatment of BED can be approached through the social perspective of

psychology by using Acceptance and Commitment Therapy (ACT), cognitive-behavioral therapy

(CBT), and other innovative treatments, such as an intervention called LIBER8. Psychologists
from Drexel University conducted research on how to create and acceptance-based group

treatment for BED and drew from ACT pathology (Juarascio, Manasse, Schumacher, Espel,

Forman, 2017). ACT is one of the most well-studied Acceptance-Based Behavioral Treatment

and postulates that a large amount of the distress and pain that humans experience result from an

overattachment to their thoughts, feelings, and behaviors in a way that relieve short-term distress,

but ultimately move the person away from what they care about most (Juarascio, Manasse,

Schumacher, Espel, Forman, 2017). The goal of ACT is to increase psychological flexibility

because it holds promise for a decrease in eating pathology (Juarascio, Manasse, Schumacher,

Espel, Forman, 2017). Psychological flexibility is the ability to experience the present moment

fully and without judgement, and to change or persist in behavior because doing so serves valued

ends (Juarascio, Manasse, Schumacher, Espel, Forman, 2017).

Tams Dmtr Szalai from the Semmelweis University Institute of Behavioral Sciences

in Budapest, Hungary wanted to construct a treatment model which integrated attachment

interventions and cognitive-behavioral therapy (CBT) into the transdiagnostic treatment of eating

disorders such as bulimia nervosa and BED (Szalai, 2016). CBT is the leading evidence-based

treatment for bulimia nervosa and BED (Szalai, 2016). Attachment-related and cognitive-

behavioral models of eating disorders are usually not integrated into the same treatment because

of their different theoretical origins (Szalai, 2016). However, the negative core self-esteem that

is a key factor in the cognitive-behavioral model of eating disorders is closely related to negative

self-concept found in insecure attachment (Szalai, 2016). It is suggested that key domains of

dysfunctional attachment could interact with cognitive-behavioral maintaining factors of bulimia

nervosa and BED symptoms (Szalai, 2016). According to a study conducted by Christopher

Fairburn from the University of Oxford, it has also been found that cognitive-behavioral
maintaining mechanisms can interact with other factors and may influence outcomes in eating

disorders. A hypothetical multilevel model was then created about interactions between adult

attachment functioning and the four cognitive-behavioral maintaining factors (Szalai, 2016).

Szalai concluded from his research that a multilevel treatment targeting aspects of attachment

and cognitive-behavioral functioning can be suggested when attachment dysfunctions contribute

to the triggering or the maintaining of mechanisms of eating disorder symptoms (Szalai, 2016).

Psychologists from Virginia Commonwealth University, Yale School of Medicine, the

University of North Carolina at Chapel Hill, Uniformed Services University, the University of

Haifa, and the University of South Florida studied a form of intervention called Linking

Individuals Being Emotionally Real (LIBER8) after talking to adolescents about how autonomy

issues can influence binge eating behavior (Mazzeo, Palmberg, Gow, Bean, Lydecker, Harney,

Thornton, Bulik, Kelly, Tanofsky-Kraff, Latzer, Stern, 2016). Participants noted a decrease in

concerns they had about eating, shape, and attitudes about eating, so it can be concluded that this

approach seemed to have reduced maladaptive eating symptoms (Mazzeo, Palmberg, Gow,

Bean, Lydecker, Harney, Thornton, Bulik, Kelly, Tanofsky-Kraff, Latzer, Stern, 2016). The

results of this study also suggest that LIBER8 holds promise for reducing eating disorders in

teenagers (Mazzeo, Palmberg, Gow, Bean, Lydecker, Harney, Thornton, Bulik, Kelly, Tanofsky-

Kraff, Latzer, Stern, 2016). LIBER8 teaches coping, self-evaluation, and mindfulness, which

helps participants become more aware of their eating habits and provides tools to improve these

behaviors (Mazzeo, Palmberg, Gow, Bean, Lydecker, Harney, Thornton, Bulik, Kelly, Tanofsky-

Kraff, Latzer, Stern, 2016). LIBER8 also focuses on emotion regulation skills, so individuals

with emotional eating problems could benefit from this (Mazzeo, Palmberg, Gow, Bean,

Lydecker, Harney, Thornton, Bulik, Kelly, Tanofsky-Kraff, Latzer, Stern, 2016). It is important
that experienced clinicians conduct LIBER8 because it involves advanced therapeutic concepts

and skills (Mazzeo, Palmberg, Gow, Bean, Lydecker, Harney, Thornton, Bulik, Kelly, Tanofsky-

Kraff, Latzer, Stern, 2016).

Binge eating disorder (BED) is a severe and life-threatening eating disorder and is the

most common eating disorder in the United States (Binge Eating Disorder Overview and

Statistics, National Eating Disorders Association, 2016). Treatment for BED can be approached

from the biological, psychological, and social perspectives. It can be approached through the

biological perspective by measuring food intake, examining gender differences in BED symptom

severity, and investigating hypomania in BED. Psychologists concluded that a difference in

moderation of stress-induced snacking suggest that multiple treatment and prevention strategies

could be needed for BED, and that future studies providing a more precise approach to

measuring food intake may help advance the field by uncovering eating behaviors that

distinguish eating that is induced by stress in both obesity and BED (Klatzkin, Gaffney, Cyrus,

Bigus, Brownley, 2016). In addition, the findings from a study of gender differences in the

severity of BED symptoms have important implications regarding gender-specific treatments for

BED and suggest that specific traits of impulsiveness that are targeted during treatment may vary

depending on the clients gender (Farstad, von Ranson, Hodgins, El-Guebaly, Casey, and

Schopflocher, 2015). Psychologists also concluded that symptoms of hypomania are more

present in BED patients who are obese than patients who have s-BED (Amianto, Lavagnino,

Leombruni, Gastaldi, Daga, Fassino, 2010). Treatment can also be approached through the

psychological perspective by means of group therapy, therapeutic alliance, and psychotherapy.

Psychologist Holly Starkman formulated her group therapy treatment with the help of research,

theory, and evidence-based treatment of BED (Starkman, 2015). Psychologists also concluded
that findings that are related to the temporal precedence between alliance growth and the level of

symptoms in binge eating suggest that therapeutic alliance in group therapy is a key factor that

precedes binge eating symptoms and their improvement (Tasca, Compare, Zarbo, Brugnera,

2016). In addition, psychologist Kathryn Zerbe concluded that incorporating the psychodynamic

perspective into an integrated psychotherapeutic treatment plan for BED has the ability to yield

rewards for both the patient and the clinician during treatment (Zerbe, 2015). Finally, treatment

of BED can be approached through the social perspective through the use of Acceptance and

Commitment Therapy (ACT), cognitive-behavioral therapy, and other innovative treatments.

Psychologists found that ACT has the ability to decrease eating pathology (Juarascio, Manasse,

Schumacher, Espel, Forman, 2017). In addition, psychologist Tams Dmtr Szalai concluded

from his research that when attachment dysfunctions contribute to the triggering or the

maintaining of mechanisms of eating disorder symptoms, a multilevel treatment targeting aspects

of attachment and cognitive-behavioral functioning can be suggested (Szalai, 2016). Lastly,

psychologists discuss how important it is that experienced clinicians conduct innovative

treatments for BED because they incorporate advanced therapeutic concepts and skills (Mazzeo,

Palmberg, Gow, Bean, Lydecker, Harney, Thornton, Bulik, Kelly, Tanofsky-Kraff, Latzer, Stern,

2016).
 References

Amianto, F., Lavagnino, L., Leombruni, P., Gastaldi, F., Daga, G. A., & Fassino, S. (2010).

/var/folders/36/8m41zth535v93zccdylyvqz80000gn/T/com.apple.Preview/com.apple.Pre

view.PasteboardItems/Binge Eating Disorder Biological #3 (dragged).pdf. Journal of

Affective Disorders.

http://www.sciencedirect.com/science/article/pii/S0165032711002163

Binge Eating Disorder Association. (2016). Binge Eating Disorder Treatment Options and

Providers. Retrieved May 3, 2017, from http://bedaonline.com/understanding-binge-

eating-disorder/treatment-options-and-providers/

Farstad, S. M., von Ranson, K. M., Hodgins, D. C., El-Guebaly, N., Casey, D. M., &

Schopflocher, D. P. (2015). The Influence of Impulsiveness on Binge Eating and Problem

Gambling: A Prospective Study of Gender Differences in Canadian Adults. Psychology

of Addictive Behaviors.

http://psycnet.apa.org/index.cfm?fa=search.displayrecord&uid=2015-20856-001

Juarascio, A. S., Manasse, S. M., Schumacher, L., Espel, H., & Forman, E. M. (2017).

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder:

Rationale and Challenges. Cognitive and Behavioral Practice.

http://www.sciencedirect.com/science/article/pii/S1077722916000237

Klatzkin, R. R., Gaffney, S., Cyrus, K., Bigus, E., & Brownley, K. A. (2016). Stress-induced

eating in women with binge-eating disorder and obesity. Biological Psychology.

http://www.sciencedirect.com/science/article/pii/S0301051116303374

Mazzeo, S. E., Lydecker, J., Harney, M., Palmberg, A. A., Kelly, N. R., Gow, R. W., . . . Stern,

M. (2016). Development and preliminary effectiveness of an innovative treatment for

 binge eating in racially diverse adolescent girls. Eating Behaviors.

http://www.sciencedirect.com/science/article/pii/S1471015316300940

National Eating Disorders Association. (2016). Binge Eating Disorder Overview and Statistics.

Retrieved May 3, 2017, from https://www.nationaleatingdisorders.org/binge-eating-

disorder

Starkman, H. (2015). An Integrative Group Treatment Model for Women with Binge Eating

Disorder: Mind, Body and Self in Connection. Springer Science+Business Media New

York. https://link.springer.com/article/10.1007%2Fs10615-015-0571-0

Szalai, T. D. (2016). Cognitive-behavioral and attachment interventions in the transdiagnostic

treatment of bulimia nervosa and binge eating disorder. Journal of Mental Health and

Psychosomatics. http://akademiai.com/doi/abs/10.1556/0406.17.2016.4.3

Tasca, G. A., Compare, A., Zarbo, C., & Brugnera, A. (2016). Therapeutic Alliance and Binge-

Eating Outcomes in a Group Therapy Context. Journal of Counseling Psychology.

http://psycnet.apa.org/index.cfm?fa=search.displayrecord&uid=2016-23900-001

Zerbe, K. (2015). Psychodynamic Issues in the Treatment of Binge Eating: Working with

Shame, Secrets, No-Entry, and False Body Defenses. Springer Science+Business Media.

https://link.springer.com/article/10.1007%2Fs10615-015-0559-9