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