Shelby has struggled with eating since she was 22 years old and in college. She has had a history of this when under stress and dealing with sadness. Now, she regularly exercises and is said to be living a “healthy” lifestyle. Then Shelby had a similar recurring event when she went home for her sister’s wedding. During the wedding rehearsal, she became so overwhelmed being surrounded by so many people that she snuck away to a dark place by herself where she consumed a large plate of food, more than a normal person would which is Criterion B4 in the DSM-5.
Shelby continued to eat for the next several hours with another large plate of food, desserts, and appetizers, basically everything that hadn’t been finished earlier in the day, even though she was not physically hungry (Criterion B3). After she would eat she expressed guilt and shame, and even suicidal thoughts (Criterion B5). She continued this eating habit 2-3 times a day for the next 2 weeks. She began worrying about her weight and described herself as “disgusting”. She withdrew from her family and work activities because she didn’t seem physically or emotionally stable.
Another potential diagnosis was Bulimia Nervosa because like Binge-Eating, it involves recurrent episodes of bingeing as well as being worried about ones weight and appearance. The factor that helped in ruling this one out was the compensatory behavior to help prevent weight gain by purging, laxatives and medication. Shelby didn’t use any of these because she wasn’t concerned with her weight gain because she was regularly exercising and living a “healthy” lifestyle. It never mentions whether or not she ever attempted or tried any of these, so that is something that I would ask to clarify. I knew right away it was not Anorexia Nervosa because he did not have an intense fear of gaining weight, or have restricted energy due to a significantly low weight in regards to age, sex, and physical health. I would have liked to have known when she was in college if she ever had a fear or concern of gaining weight. If so that could have made this scenario a different diagnosis and I would have more questions. Shelby has a Binge-Eating Disorder. When she was 22 and in her senior year of college, a boy she had been dating since her junior year of high school broke up with her. Growing up she was involved in strong friendships, family relationships and this was her first boyfriend.
She experienced a great deal of emotional stress. Shelby depended on him for everything, including driving her to class every day. This is when she had her first occurrence of bingeing. According to research when one experiences a traumatic and stressful event, a person experiences difficulty with regulating their negative emotions. So when she was going through this, Shelby used binge eating to cope and relieve herself from the pain she was experiencing. These memories came back to her when she went home for her sister’s wedding when she ran into her ex-boyfriend.
He was now engaged to another woman. This is where she began eating several large plates of food at the rehearsal dinner when her stress levels elevated once again. Binge-Eating Disorder (BED) is classified as a distinct eating disorder with recurrent binge eating episodes. A person will consume an unusually large amount of food that another person could not eat in the same period and setting. One could also have effects of eating faster than normal, eating without feeling hungry, eating privately due to a feeling of shame and guilt/disgust afterwards.
Episodes typically occur with distress and can happen at least once a week over a period of three months (Sulkowski, Dempsey J. , Dempsey A. G. , 2013) The study of Sulkowski et al. included 147 female undergraduates from a university in the southeast ranging from 18-25 years of age, and were ethnically diverse with just 64% being Caucasian. All participants were enrolled in psychology classes and received course credit for their participation. The assessments given included and Undergraduate Stress Questionnaire giving 82 common life stressors one might face and respond yes or no to each.
Then there was a Coping Styles Questionnaire including 60 items of behaviors/emotions students respond with in an event on a 4 point scale of: rational coping, detached coping, emotional coping, or avoidance coping. Lastly, the Binge Eating Scale was looked at with a 16item measure of frequency/severity of bingeing behaviors amount young adults and had to say which statements were true of their behaviors. From this study, we are able to determine that stress and binge eating were significantly and positively correlated (Sulkowski, 2013).
Therefor more people, especially college females, are likely to partake in bingeing and emotion focused coping when under a lot of stress. This is then said to cause self-blame and other aspects associated with bingeing, according from the research. It is relevant to note that negative emotions decreased during episodes of bingeing, whereas after the episode, the negative emotions would increase from guilt and shame of the after affect. There is evidence that Dialectical Behavior Therapy (DBT) is an effective treatment plan for recurrent Binge-Eating.
DBT is a cognitive behavior treatment that helps those who need assistance in changing their unhealthy behavior patterns that can include suicidal ideation. This treatment helps increase emotional and cognitive regulation which gets individuals in a state to develop coping skills from events, thoughts, and feelings that negatively impact them. In this study by Telch, Agras, and Linehan (2011) 465 females were screened via telephone and 377 excluded because they didn’t meet full DSM-5 criteria. Requirements included being a female 18-65 years old, and meeting full diagnostic material of the DSM-5, some of which I mentioned earlier.
Then after further screening and questions, only 44 individuals, 94% Caucasian, could partake in the experiment. They were recruited through newspaper advertisements that offered free treatment for binge eating disorders through Stanford University research. The woman were randomly assigned into a DBT group or put on the wait-list control and given a binge eating examination. The DBT covered weight, mood, and affect regulation at baseline and after 20 weeks of treatment, as well as at the 3 and 6 month period. Each treatment lasted 2 hours a week, and the first 2 treatments entailed rationale and setting up goals.
Then adaptive skills were taught in the following weeks: 3 weeks of mindfulness skills, 5 weeks of emotional regulation skills, and 5 weeks of distress tolerance skills. The last 2 weeks followed up with reviewing the skills taught and how to maintain those techniques. Assessments included measurements to determine severity of the disorder with structured interviews, questionnaires, and height and weight measurements. The results of this study by Telch (2011) showed that woman receiving treatment had significant improvement on their measures of bingeing compared with the controlled group.
89% of women stopped binge eating by the end of treatment who received DBT. The measures of weight, mood, and affect regulation were found not significant in the research and allows for more research to be conducted further as to why there is success with DBT. The implications from the study include having a small number of participants, and having one group be on a wait-list. Even with the implications, the data was still able to show significant aid. Therefore, I believe that using DBT as the primary treatment is a good technique for Shelby’s case.
