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BINGE EATING DISORDER (BED) WHAT CLIENTS, PARENTS, TEACHERS AND HEALTH PROFESSIONALS NEED TO KNOW ABOUT DISORDER? INFORMATION AWARENESS FACTSHEET ABOUT CHILDREN (0 – 18 YEARS OLD) AND YOUNG PEOPLE (19 – 25 YEARS) AFFECTED BY BEDWHAT IS BINGE EATING DISORDER?Nutritional plays a crucial role in health maintenance and prevention of diseases throughout the life from the moment child is born, childhood, adolescence when major biological changes takes place creating higher demand on the body than ever during lifetime (Martin et al., 2016). Failure to meet nutritional demands could hinder healthy development and growth, leading to further health complications. Binge eating disorder (BED) is the most common form of eating disorders (ED), with the lifetime prevalence of 1.4% (Blanchet et al., 2018) which is higher than bulimia nervosa (BN) and anorexia (AN) combined (Kessler et al., 2013). It affects 1.6% of youth, 3.5% of women, 2% of men (National Eating Disorders Association, 2018).Negative emotions like sadness, anger, disappointment, being hurt or feeling of loneliness and maladaptive emotional regulation strategies play a significant role in initial onset and later maintenance of BED (Dingemans, Danner & Parks, 2017). Epidemiological studies suggest that onset of BED symptoms start in the late adolescent or early adulthood (Ghaderi et al., 2018). Current research suggested a strong link between binge eating (BE) and obesity (He, Cai, & Fan, 2017) and related co-morbidity, such as depression and an anxiety (Rosenbaum & White, 2013). BED was first recognized as an eating disorder in the DSM-5, which was published in 2013 by American Psychiatric Association and is defined when two of the following symptoms are present (APA, 2013) or three (National Eating Disorder Association, 2018).• Feeling disgust, guilt, or depression after binging• Eating until one is uncomfortably full• Eating large amounts of food, even when one is not hungry• Eating more quickly than normal• Eating alone—this is due to feeling ashamed or embarrassed over how much one is eatingHOW THEORY AND SCIENCE EXPLAIN BED?• The restrain model (RM) of BED suggested that weight and shape were the cause of the dietary restriction followed very soon by binge eating (Elran-Barak et al., 2015). Children and young adults suffering with BED tend to eat more often, food is more caloric, and will experience weight fluctuation (McCuen‐Wurst, Ruggieri & Allison, 2018).• Escape theory (ET) explains BED as a ’running away’ from self-awareness and the redirecting the thoughts from the real problem into binge eating as a way of malfunctioned coping strategy (Haedt‐Matt et al., 2014).• Regulation model (RM) refer to binge eating (BE) as a distracting mechanism put in place to decrease negative battery of feelings manifesting through BE. In the line with this concept, BED was considered as a dysfunctional coping mechanism for emotional dysregulation (McManus, Waller, 1995).• Reward model (RM) mechanism of BED rooted in rewards system as an alteration in acetylcholine (ACh) and dopamine (DA) and opioid systems (Avena & Bocarsly, 2012) dietary restraint, cravings, impulsivity, cravings, body and shape concerns (Schulte, Grilo & Gearhardt, 2016). WARNING SIGNS OF BINGE EATING DISORDER EVERYBODY (parent, teacher, grandparents, doctor, nurse, educational psychologist, social worker) SHOULD PAY ATTENTION TO:• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food• Develops food rituals (e.g., eats only a particular food or food group [e.g., condiments], excessive chewing, doesn’t allow foods to touch)• Steals or hoards food in strange places• Hides body with baggy clothes• Creates lifestyle schedules or rituals to make time for binge sessions• Skips meals or takes small portions of food at regular meals• Has periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full• Does not purge• Engages in sporadic fasting or repetitive dieting• Body weight varies from normal to mild, moderate, or severe obesity (National Eating Disorders Association, 2018).WHAT CAUSES BINGE EATING DISORDER?At present the exact cause of BED remain unknown because they are different factors influencing development and maintenance of the condition• Psychological: According to National Eating Disorder Association (2018) symptoms of BED are typically driven by overwhelming emotional and psychological components which later will be inappropriately managed with the misuse of food. Very often at the root of BED there is significant distressing experience or/and some form of trauma (sexual abuse, car accident, physical or emotional abuse, emotional neglect, bullying, conflict at home; parental divorce or separation, rejection by peers or loved ones, recurrent public humiliation). Low self-esteem and difficulty coping with feelings can be a contributing factor to BED.• Biological: Although the biological mechanisms underlying BED is still unknown, they are an evidence suggesting chronic brain dysfunction (Volkow & Morales, 2015) identifying that biological abnormalities, such as genetic mutation and hormonal irregularities, may be associated with binge eating (Chawla, Cordner, Boersma & Moran, 2017). There is established evidence between symptoms of BED and depression, anxiety (Rosenbaum & White, 2013) and mood swings and sleeping problems (McCuen-Wurst, Ruggieri & Allison, 2018).• Social and Cultural: Children and young people are more at risk to be a subject of critical comments about their bodies and weight because of the exposure to social media and overpowering theme and pressures to be slim. Children and young people can be especially vulnerable to those factors and can trigger emotional and binge eating. Through frequent media exposure children and young people can learn that being thin is sociocultural beauty standard especially for girls. This can lead to internalisation of such unrealistic and most importantly unhealthy expectations and cause low self-esteem and body dissatisfaction (Lee & Lee, 2019). STATISTICS ABOUT BINGE EATING DISORDER.BED have serious impact on the health of individuals and globally. It is classified as mental health condition under DSM-5 (2013). 12.8% of young people aged 5-19 meet clinical criteria for a mental health disorder (Schulte Grilo & Gearhardt, 2016). Impact of mental health disorders on children and young people are tremendous. Only one in eight children come to the attention of statutory agency follow sexually abuse (Children’s Commissioner for England, 2015).About 10% of young people aged 8-15 experience a low sense of self-esteem and well-being decrease as the age increase (Rees et al., 2013). Mental health problems are one the largest cause of overall burden of disease in the UK and estimated cost annually is £105 billion (Mental Health Statistics, 2019). Clinical data suggest that high sugar and fat intake negatively correlates with children’s and young people’s memory, executive functioning, cognitive flexibility and attention time (Chawla, Cordner, Boersma & Moran, 2017).The consequences of BED involve not only emotional difficulties but physical and social. Complications of BED include Insomnia/Sleep apnoea, Depression, Anxiety, Type 2 Diabetes, Gastrointestinal difficulties, Hypertension, Muscle or joint pain, Cardiovascular and Gallbladder Disease (National Eating Disorders Association, 2018).FROM DIGNOSING TO TREATMENT OF BINGE EATING DISORDER.As reported by Hawkes (2017) time in terms of diagnosing a child or young adult is a paramount, the longer it takes an individual with BED to get treatment, the harder it is to achieve full recovery. Assessing children and young peoples with disordered eating habits can be complex for multiple reasons because it is not only about gathering report but also building therapeutic alliance with the client affected by binge eating with collaboration of the closest family to create foundation for successful recovery (He, Cai & Fan, 2017). If after initial assessment an eating disorder is suspected, immediate refer to age-appropriate eating disorder community-based service is required for further assessment and treatment (NICE 2, 2017). Professional support and treatment from trained professionals specializing in the treatment of BED, including therapists, nutritionists and psychiatrists, combined together can be one of the most effective ways to address BED (National Eating Disorders Association, 2018).Assessing children and young peoples with disordered eating habits can be complex for multiple reasons because it is not only about gathering report but also building therapeutic alliance with the client affected by binge eating but with the closest family in order to create foundation for successful recovery and maintain it (He, Cai & Fan, 2017). As argued by Marino (2017) getting to the causes of binge eating is crucial. The strategies as much as they seems to be simple they are not. If someone has emotional relationship with food it vital to reach out for help, sometimes speaking to dietician can be enough. Helping client reconnecting with the body by learning technique to read body language, asking how satisfied you feel after meal, accepting all food as there is no such a thing as bad and good food. All food has a different purpose, by eliminating certain food this can make people preoccupied with food. However, by getting rid of mindless eating especially when watching TV and so on, it is important to take time to eat and taste the food, making eating as social event. Binge eating disorder (BED) – The Cycle that continue to feed itself Marino (2017).TREATMENT OPTIONS FOR BINGE EATING DISORDER.As much as they are lots of treatment options it is important to understand that something which works for an adult not necessary will work for a child. It is crucial to take into account emotional, social and cognitive development when choosing intervention for ED. Successful intervention for a child can involve different skills, resources and professionals involved in the process and it is important to stay open on the journey to healing and recovery. Here are an example of evidence based interventions used effectively for the treatment of children and young adults diagnosed with BED.Cognitive Behavioural Therapy (CBT) is one of the most frequently researched and most effective established psychological interventions frequently described as ‘talking therapy’ with remission rates as high as 60% (Blanchet et al., 2018). It is a therapeutic approach aiming for intervention that is created to ‘finding out’ the root of binge eating through guided or unguided self-help, increase relaxation, but decrease dysfunctional behaviour contributing to BED (Wagner et al., 2016). CBT can be delivered in different form, depending on the individual need of the client and can include eating education, cognitive therapy, relaxation technique and eating restriction. As suggested by BPS (2019) the main aim of CBT is to make sense out of overwhelming issues causing binge eating and empower client to break the problem into smaller parts and deal with them effectively.Mindfulness is one of the interventions with non-judgemental awareness, emphasising on building reflection what is happening at present by encouraging acknowledging individual’s feelings, thoughts and senses frequently was used as complementary treatment for BED (Masuda, Marshall & Latner, 2018). One of the reasons why mindfulness is very effective when tackling symptoms of BED is because is going directly to the root of the problem. For some individuals low self-awareness, low self-image, low self-esteem make them to make irrational decisions with food choices, they feel like eating will make increase the self-esteem make them feel worthy or enough. Mindfulness aim to help individual to feel good about who they are without using food, teach to regain control over, quantity of food choices, recognising stressful moments and most importantly to stop emotional eating. Mindfulness help to understand that food have a function, but binge eating is one of maladaptive way to the cues (emotional, environmental, physical) causing binge eating.Physical activity (PA) when comes to deal with symptoms of BED is one of the most underutilised interventions in the treatment of BED. From the main principles, aims to introduce physical activity by encourage participants to make healthy dietary choices, and physical activity alone helps with eating regulation and effectively decreases episodes of binge eating (Mama et al., 2015). Taking into account current evidence suggesting a strong link between binge eating (BE) and obesity it is important to encourage individuals with BED to participate in PA to decrease chances of further complications (He, Cai & Fan, 2017). PA was more effective when combined with other therapies by boosting self-esteem, improve physical appearance, and positively influencing general mental health (Vancampfort et al., 2014). Due to positive changes observed on macro level it was suggested by Blanchet et al. (2018) that PA has potential for significant influence of reward system linked to neuropathology of BED.Pharmacotherapy is one of the interventions used with clients suffering with binge eating and involves administration of medication targeting specific symptoms which can manifest during the course of illness like: obesity, attention deficit hyperactivity disorder, depression (McElroy, Guerdjikova, Mori & Keck Jr, 2015). Current research suggests that pharmacotherapy is more effective when combined with psychological interventions like CBT for BED (Blanchet et al., 2018). Despite the positive and significant evidence for use of pharmacotherapy for clients with BED there is still lack of longitudinal studies experiencing the benefits of the therapy just to see how long the benefits of interventions lasted and what side effects participants encountered during the course of pharmacotherapy Grohol (2017).FACTS AND MYTHS ABOUT BINGE EATING DISORDER.Myth No 1: BED is one of the rarest types of ED.Fact: BED is the most common form of ED, with the lifetime prevalence of 1.4% (Blanchet et al., 2018) and affects 1.6% of youth, 3.5% of women, 2% of men (National Eating Disorders Association, 2018).Myth No 2: Overeating at meals or snack times is a binge eating.Fact: Binge eating occur when eating large amounts of food, even when one is not hungry, more quickly than usually alone, in private. Feeling disgust, guilt, or depression after binging is common, as they feel embarrassed over the quantity of food consumed.Myth No 3: BED only affects people who are considered clinically obese.Fact: Despite the current evidence based research, suggesting a strong link between binge eating (BE) and obesity (He, Cai & Fan, 2017) there is no body type which can define person with BED. In contrary individuals affected by disordered eating come from diverse background in terms of socioeconomic status, ethnicity, gender, age and body size (Engeln & Salk, 2016).Myth No 4: Individuals who suffer from BED are ‘food addict’.Fact: Despite the significant similarities shared with drug or alcohol addiction as losing control over quantity of food, is used in stressful situation or as malfunctioned way of coping. Brain activity during eating food is similar to the brain activity after consumption of drugs and alcohol. Unlikely to common addiction, food is necessary for all body function and surviving purposes. It is natural to experience pleasure from eating food (Novelle, Dieguez, Carlos Diéguez & Novelle, 2018).Myth No 5: There is no cure for BED.Fact: There are evidence-based treatments for BED, however their effectiveness varies due to individual differences, available support and knowledge (NICE 1, 2017; NICE 2, 2017).Eating disorders are tricky to diagnose and difficult to treat because it is very difficult sometimes to distinguish disordered eating habits from snacking. Many clients affected by binge eating will deny they have problem and be extremely reluctant to ask or seek help. Frequently clients and family affected by the condition do not ask for it simply because they feel ashamed and embarrassed. Although, many clients who received interventions were glad when someone stepped in and offered support, encouraged them to seek treatment. Thankfully, BED is a curable disorder and full recovery is possible. One of the best ‘medicine’ for child or a young person struggling with BED is healthy, supportive and non-judgmental environment. It is important to remember that you can feel overwhelmed by the disorder but you are not alone and if you need help is out there for you. Once again recovery from BED is absolutely possible.