Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download In the Labyrinth of Binge Eating
Document related concepts
Epigenetics of neurodegenerative diseases wikipedia , lookup
Genome (book) wikipedia , lookup
Human genetic variation wikipedia , lookup
Nutriepigenomics wikipedia , lookup
Microevolution wikipedia , lookup
Public health genomics wikipedia , lookup
Behavioural genetics wikipedia , lookup
Pharmacogenomics wikipedia , lookup
Medical genetics wikipedia , lookup
Transcript
BingeEatingDisorder andthemythsthatsurroundit Presentedby HildaDulinLee THREEGREATMYTHSOFBINGEEATING • #1BingeEatingisthesameasovereating • #2Peoplewhobingearelazy&self-indulgent;theysimplylackthe strengthofcharacter&motivationtochange • #3“IfIcouldjustfindtherightdietandexertenoughwill-power,I couldsolvemyproblem” Myth#1 BingeEatingistheSameasOvereating • Threemaincomponentsofbingeeating • Eatingwhatmostpeoplewouldconsideraninappropriatelylargeamountoffood • Feelinglossofcontrol • Extremedistress • Othercommonelementsofbingeeating • • • • • • Soothed&comforted Euphoria&relief Frenzied&accelerated Numb&disconnected Alone&insecret Shame&remorse • Reading* BingeEatingDisorder (BED) • Bingeeatingdisorder(BED)isaneatingdisorderinwhichaperson binges,onaverage,onceaweekoverathree-monthperiod (AmericanPsychiatricAssociation’sDSM-5) • Morecommonthananorexiaandbulimiacombined • 8millionAmericansmeetthiscriteria • Another8-10milliondon’tmeetthecriteriaforBEDbutare, nonetheless,affectedbybingeeating • BEDistheonlyeatingdisorderthataffectsmeninlargenumber Myth#2 Peoplewhobingearelazy&self-indulgent;theysimply lackthestrengthofcharacterandmotivationtochange • Deepdown,mostofuswhobingefeelthatoursecreteatingistheresultofsome darkcharacterflaw,somemoralfailing • Obeseindividuals,especiallythosewhobingeeat,haveasenseofworthlessness instilledearly • Studieswith5th graders&preschoolers* • PeoplewithBEDareoftenhighlycompetitiveperfectionistswhoareextremely self-critical • OnestudyexaminedperfectionismandBEDandfoundthattheobesebingeeatinggroupscoredsignificantlyhigheronperfectionismthantheobese,nonbingeinggroupandthenormalweightgroup • Thehighstandardsthatwesetforourselvesmayhelpusbecomesuccessful,but theyactuallycontributetoourbingeingbehavior • Soifit’snotacharacterflaw,whatcausesapersontodevelopBED? FactorsThatContributetotheDevelopmentof BED • EarlyChildhoodTrauma • Psychological&EmotionalFactors • Genetics • Dieting FactorsthatContributetotheDevelopmentof BED • EarlyChildhoodTrauma* • Highcorrelationbetweenanunsafehome&thedevelopmentofBED.Why? • Amygdala:theprimitivepartofthebrainresponsiblefortriage&emergency action(fight-or-flight) • Beingconstantlyvigilanttodangerintheearlyyearschangesthephysical architectureofthebrain.Theroutethroughtheamygdalabecomesrutted&we developahair-triggerfight-or-flightresponse • Theamygdalalearnsthatcertainsights,sounds,andsmellsinourenvironment aredangercues(theseareespeciallyimprintedduringourearlyyears) • Astensionsrise,weareforcedtoseekimmediaterelief,andfoodistheearliest andmostprimalofsoothingbehaviors • Plus,dangeroushomesgiveuslittleopportunitytolearnself-soothingskillsin thoseearlyyears FactorsThatContributetotheDevelopmentof BED • EarlyChildhoodTrauma • Psychological&EmotionalFactors • • • • • Depression Anxiety Suicidalthoughts&actions Poorself-esteem Poor&inaccuratebodyimage Poorbodyimageis damaging I’mso fat! FactorsThatContributetotheDevelopmentof BED • EarlyChildhoodTrauma • Psychological&EmotionalFactors • Genetics • Somefamiliesaresimplymorepronetocertaineatingdisorders • Twinstudiesshowtheinheritabilityofbingeeating • BEDis3Xstrongerbetweenidenticaltwinsthanfraternaltwins • Severalstudiesshowbingeingisabout50%heredity&50%environment • HighcorrelationbetweenBEDandalcohol&drugabuse • 10%inthegeneralpopulationvs.50%inBEDpatients) • Brainscans • Studiessuggestthereisagenetictraitforimpulsivityandrisk-takingthatis commontobothBED&otherimpulsivebehaviors(likegambling,shoplifting,sexualaddiction,compulsiveshopping,alcoholism,drugaddiction) • Fred Genetics(continued) • PatientswithBEDandtheirfamiliestendtobeimpulsive,unrestrained, stimulus-seekingpeoplewhogoaftertheexciting,novel,intense experience.Ourhomesareoftenloudandrancorous.Weareoftenrisktakers,whichcansometimesleadtodangerousbehaviors. • Thisislikelywhyyoufindmanywhohavetheseimpulsivetraitsamong inmatesinprisonsandamongpatientsinrehabcenters • BUT… • It’salsowhyyoufindmanywithBEDandotheraddictionsamong entrepreneursandbusinessleaders(especiallysinceoftenpairedwith perfectionism) • Thereisaconnectionbetweenaddictivepersonalityandsuccessful leaders* • Ontheotherhand,patientsw/anorexiaandtheirfamiliesareoften highlyaversetorisk-takingandshowmuchmoreemotionalcontrol, followtherules,andavoidconflictandconfrontation Genetics(continued) • Onestudyexaminedthegeneticmakeupof1000’sofseverelyobese individuals(whobecameobesebeforetheageof10) • 1in20hadavariationintheMC4Rgene • Peoplewiththisvariationaremissingcertainneurochemicalreceptorsthat controlsatiety.Theirbrainssimplynevergetthemessagethattheyarefull. • Firststudythatdirectlylinkedgenestothebehavior ofbingeing • Pairedthosewiththegenevariationtoanequallymatchedpersonsinthe study(age,gender,ethnicity,BMI,%bodyfat,etc.)butwithoutthevariation • 100%ofthosewiththisvariationmetthecriteriaforBED • Only14%ofthosewithoutitmetthecriteriaforBED Genetics(continued) • Variationsindopamineandopioidreceptorgenestremendouslyaffecta person’slikelihoodofdevelopingBED(ex:DRD2,OPRM1) • Thegeneticconnectionisstillinitsinfancy,butholdspromiseforall sortsofaddictions—andtheirtreatment • Ex:naltrexoneisanopioidblockersometimesusedforalcoholism& certaindrugaddictions • Studiesshowthatalcoholicswhohaveacertainvariationintheir OPRM1genearemorelikelytorespondtotreatmentwithnaltrexone • Oneresearchertoldmehewasgettingareductioninbingeingwith someBEDpatientswhenheusednaltrexone • …thosewithapersonalorfamilyhistoryofalcoholism • NaltrexoneisoneoftheingredientsinContrave(aobesitydrug).The otheringredientinthatmedicationistheanti-depressantWellbutrin (wellknownforit’suseinnicotineaddiction) FactorsThatContributetotheDevelopmentof BED • EarlyChildhoodTrauma • Psychological&EmotionalFactors • Genetics • Dieting • Definitionofdiet • Di’-et:theusualfoodordrinkofapersonoranimal • Di’-et:restrictoneselftosmallamountsorspecialkindsoffoodinorderto loseweight • Dietingisthemostimmediatetriggerforabinge • Leadsustothenextmyth Myth#3 “IfIcouldjustfindtherightdietandexertenough will-power,Icouldsolvemyproblem.” Dieting,especiallychronic,stringent,low-caloriedieting,isABSOLUTELYthe wrongapproachtosolvingabingeproblem.WHY? • Hunger&deprivation • Chronic,stringentdietingoveraperiodoftimechangesthebrainchemistry • Reducescertainneurochemicalsthatcontrolsatiety;dampensourinnatesignalsofhunger andfullness • InBED,foodisnotbeingusedtonourishthebodybutrathertomanageemotionalneeds • Foodissimplyourdrugofchoice Dietingisourworstenemy!! …sowhatsolutionsdidIuse? AnatomyofaBingeCycle “Ihavenowillpower…I’msuch afailure…Whataloser…” Negative Emotions Eatsomethingtorelieveincreasing tension All-or-nothing:“I’veblownit…” DietFails Binge Hunger,deprivation, depression “ThistimeI’llbeperfect.” Relieved,soothed,euphoria, numb,disconnected Resolve: NewDiet Shame& Remorse Exhausted,humiliated, embarrassed Conclusion Take-away Overcomingbingeeatingisaboutsomuchmorethanstoppingthe behaviorofbingeingorlosingweight* Itisabouttransformationandpeace IntheLabyrinthofBingeEating Contactmeforspeakingevents HildaDulinLee [email protected]
