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No Comfort

Photo illustration by Carol Nichols

No Comfort
Research looks at the relationship between stress and binge eating


Symptoms of Binge Eating Disorder

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Everybody has to eat. But Samantha had to eat seconds and more.

In the depths of depression and anxiety, whenever she felt low or stressed, Samantha says she felt "an overwhelming need to find something to eat."

The binge eating cycle started when Samantha was a girl. Childhood taunts that she was fat quickly became a self-fulfilling prophesy. She began hiding food in her room. She ate until she was uncomfortable and she never purged. When it was all over, when she couldn't eat another bite, she felt guilty and ashamed. And the cycle started again.

Her mother didn't buy a lot of junk food, so Samantha got very creative. One of her favorite concoctions: melted Marshmallow Fluff and butter mixed with cereal. She would eat two or three bowls at a time. When she made cookies, she ate the batter and most of the baked batch, leaving just enough so her binge eating wouldn't be too obvious.

As the years went on, Samantha smoked a lot of pot to get the munchies to "have an excuse to eat."

Now in her 30s, Samantha (who asked that her name be changed for this story) admits that it continues to be a constant battle to overcome the frequent urges to binge eat. Looking for answers and help, she volunteered to participate in studies being conducted by psychologists at the University of Maine to better understand binge eating disorder.

Samantha has received help from therapy and medication to stabilize depressive moods. Yet she still must consciously struggle with her inability to control her binge eating disorder, what she describes as a "gushing wound."

"I don't give up, either," she says. "Every day really is a new day."

According to the
National Institutes of Health, Samantha is one of 4 million Americans 2 percent of all adults in the United States who have binge eating disorder. One of the most common of the eating disorders, it is seen most in people who are overweight or obese, but normal-weight people also can have it.

In light of the sky-high rate of obesity in this country, the incidence of binge eating disorder is most likely underestimated, says UMaine clinical psychologist Sandra Sigmon. Not all people who are overweight are binge eaters, but Sigmon says as many as 50 percent could be.

In addition, binge eating was recognized as a disorder by the medical and psychological communities only in recent years. Researchers like those at the University of Maine are contributing to the literature one study at a time.

"In the past, I don't think people realized they had an eating disorder. But because of obesity rates, people are understanding that binging is more than just overeating and they can get help for it," says Sigmon, a professor of psychology. "Because of its health consequences, binge eating as a psychological disorder is now getting attention."

The National Institute of Mental Health describes binge eating disorder as a constellation of behaviors: eating excessively in a short time with the "sense of a lack of control over eating during the episode." People might eat faster than normal, eat until they're uncomfortably full, eat even when they're not hungry, eat alone out of shame and then feel disgusted for giving into the urge.

Unlike people with bulimia, who also feel the need to eat excessively, people with binge eating disorder do not purge.

Most people are diagnosed with binge eating disorder in their 20s and 30s, Sigmon says, often after seeking help for other health problems, such as depression or obesity. Left untreated, binge eating disorder can increase a person's risk of stroke, heart problems and diabetes.

"We have a complex relationship with food," says Sigmon. "It's a social thing. It's critical for survival. We can't just stop eating. We need food."
However, problems can arise when food takes on meanings other than sustenance, and chronic overeating results.

"This is something we probably learn in childhood and adolescence," she adds. "Parents often use food as a reward for children. When we are adults, food is a way to make ourselves feel better, without a prescription."

Just what causes
binge eating disorder remains a mystery. Scientists are studying the effects of brain chemicals, metabolism even genetic disposition on the disorder.

The National Eating Disorders Association (NEDA) says eating disorders "are most often about much more than food." Indeed, genetic links are more important than we previously thought, says Kari Augustyn, a NEDA program director. "There are a lot of family and life stressors that contribute," she says.

At UMaine, Sigmon and graduate student researchers are focusing on the relationship between stress and binge eating disorder. Sigmon's research focuses on women's physical and mental health. She studies seasonal affective disorder, which occurs four times more in women than men; and panic disorder, which is twice as likely in women. With a higher incidence of depression and anxiety in women, binge eating disorder also is a natural focus.

"In all three disorders, stress is a common denominator," she says.
Psychology Ph.D. student Stephanie LaMattina is studying the neuroendocrine response to physical and psychological stress, and its relationship to the urge to overeat. As part of her doctoral research, she is looking at cortisol levels before and after stress and episodes of binge eating. She is interested in the body's biological response to stress with the elevation of cortisol, a hormone produced in the brain that helps regulate metabolism and blood pressure. The question to be answered is whether there is a physiological correlate between elevated levels of cortisol and binge eating, or whether it is a cognitive reaction a perception of stress that triggers an urge to eat.

LaMattina also will look at the types of stressors that can lead to changes in cortisol levels in the body and to perceptions that a person is experiencing stress.

Work by Barbara Hermann, also a Ph.D. student in psychology, focuses on cognitive awareness or "mindful eating" consuming a few rather than all the potato chips, or making healthier choices.

Because food is so often revered as a compensation or a "comfort" in our society, binge eating disorder may begin very voluntarily. But over time, it can become involuntary, so that people automatically reach for food instead of seeking alternative stress relievers, like exercise. By that point, Sigmon says, binging has become a habitual process that's hard to break.

The key to treating binge eating disorder is in getting people to "think of themselves and food differently," Sigmon says. "They need to learn how to problem solve and address stressors in different ways besides overeating. They need to think of food as sustenance rather than a comfort or panacea."

Ironically, a treatment program for binge eating often starts with a focus on mealtimes. "We teach people to eat three times a day, with two small snacks in between. Then the focus is on portion size and exercise to be healthy," says Sigmon. "It seems contradictory, but we need people to eat regularly. Sometimes people justify binging because they've not eaten all day, but that just sets up a vicious cycle. It's important to teach people how to eat so they don't get as many urges."

In one study, the UMaine researchers are exploring the effectiveness of alternative ways of delivering treatment for disorders like binge eating. In particular, they are looking at the feasibility of providing clients with self-help resources combined with limited therapist contact. Such alternatives are particularly pertinent in rural states like Maine, where frequent trips to a therapist can be prohibitive.

Treatment for binge eating disorder traditionally involves both cognitive and behavioral components. Sigmon wants to know if the two are equally effective as separate treatments. Using the cognitive approach, clients are urged to change the way they think about themselves and about food; with the behavior method, people focus on eating three times a day, problem solving and exercising.

"With more treatment options, we'll reach more people whom we were not able to reach before, helping them learn how to eat in a more healthy way," says Sigmon.

By Clinton Colmenares and Margaret Nagle
November-December, 2006

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