Binge Eating Disorder

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binge-eatingBinge eating disorder is an illness that resembles bulimia nervosa. Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging—occurring, on average, at least once a week for three months, according to DSM-5 (“Diagnostic and Statistical Manual, ” version 5).  However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. While they commonly eat fewer meals than people without eating disorders, when they do eat, they eat rapidly, consuming large quantities of food.  They do not stop until they are uncomfortably full. When binging, they typically do so alone because of feeling embarrassed by how much they are eating.  They tend to feel disgusted with themselves, depressed, or very guilty afterward. Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

Binge eating disorder is found in about two percent of the general population—more often in women than men. Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically-supervised, weight-control programs.

Because people with binge eating disorder are usually overweight, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at the National Institutes of Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses, especially depression.

Cognitive behavioral therapy and interpersonal therapy are the treatments found to produce the greatest degree of remission in patients with binge eating disorder.  These therapies result in improvements in specific eating disorder psychopathology and associated psychiatric problems, such as depression and psychosocial functioning (Wilson, 2011).

Epidemiology of Eating Disorders

 Estimates of the incidence or prevalence of eating disorders vary depending on the sampling and assessment methods.

  • An estimated five million Americans suffer from eating disorders at any given time, including approximately five percent of women and less than one percent of men.  The disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder.
  • Estimates of the male-female prevalence ratio range from 1:5 to 1:1 (although 19 to 30 percent of younger patient populations with anorexia nervosa are male).
  • The reported lifetime prevalence of anorexia nervosa among women has ranged from 0.5 percent for narrowly defined cases to four percent for more broadly defined cases of anorexia nervosa.
  • Estimates of the lifetime prevalence of bulimia nervosa among women have ranged from 1.1 to 4.2 percent. Some studies suggest that the prevalence of bulimia nervosa in the United States may have decreased slightly in recent years.
  • An estimated 85 percent of eating disorders have their onset during adolescence.
  • Approximately 5 to 1.0 percent of adolescents suffer from anorexia nervosa and one to five percent suffer from bulimia nervosa. Female college students are at highest risk of the latter.
  • The prevalence of anorexia nervosa and bulimia nervosa in children and younger adolescents is unknown.
  • While eating disorders have generally been recognized as affecting a narrow population of Caucasian adolescent or adult young women from developed Western countries, in recent years, data are steadily accumulating to document that:
  1. eating disorders have become more common in pre-pubertal children and women in middle and late adulthood in such countries.
  2. ethnic and racial minority groups in these countries are vulnerable to eating disorders.
  3. there is nothing uniquely “Western” about eating disorders, which are a global health problem (Pike et al, 2013).

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History of Meditation

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

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The earliest roots of meditation go back too far to trace with full confidence. We do know, however, that the practice of meditation was refined in the temples, caves, and monasteries of the East and Near East.  Meditation has found its way to the West in the past century. In slightly different form, meditation also appears in the Judeo-Christian tradition.

Meditation dates back to our earliest ancestors, who stared in wonder at the sky as they waited for hours to hunt for prey.  Perhaps these ancestors waited while communal fires burned. Our ancestors had plenty of time on their hands.  Because meditation entails a shift from thinking and doing to just “being,” these ancestors were probably able to meditate during the course of many of their days.

Long before the arrival of Buddha in the East, or the great Indian yogis, shamans — people with alleged access to what is good and evil — living in hunter-gatherer cultures all over the world used meditative techniques to enter altered states of consciousness known as trances. Focusing their minds using simple rhythms and chants, and sometimes employing hallucinogenic substances, these shamans traveled to the “spirit world” and returned with wisdom, healing abilities, magic abilities, and spirit blessings to bestow on their people.

Cave paintings dating back at least 15,000 years show figures lying on the ground in poses of meditative absorption. Scholars have determined that these were shamans in a trance state asking the spirits for a successful hunt. Other cave pictures showed shamans transformed into animals and taking on the animals’ magical powers.

Although shamanism has declined considerably, there are still world cultures that utilize shamans as healers, guides for the dead, and intermediaries between humans and spirits. Recent years have shown an upsurge of interest in shamanism, due in some part to the writings of Carlos Castaneda, Michael Harner, and Joseph Campbell.

But perhaps meditation’s deepest roots can be traced to India, where sadhus (traveling holy men and women) and yogis have practiced meditation in one form or another for more than 5,000 years. It was in India that meditation first flourished, and it is from India that meditation later traveled and spread to distant parts of the globe.

The earliest Indian scriptures, the Vedas, don’t have a word for meditation but described what are now known to be meditative rituals requiring great concentration. Over time, these practices evolved into a type of prayerful meditation that entailed the use of breath control with devotional focus on the Divine. From these earliest roots, three of India’s best-known meditative traditions blossomed:  yoga; Buddhism; and tantra (a range of religious traditions).

By Barbara Sternberg, Ph.D.

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Seasonal Affective Disorder

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

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Seasonal affective disorder (SAD), also known as winter depression and winter blues, is a type of mood disorder that is typically caused by low light levels. SAD generally begins in the fall and worsens during the winter months.  The rarer, reverse seasonal affective disorder (summer blues, summer depression) begins in the spring and worsens in the in the summer.

SAD is generally found more frequently in people who live in latitudes far north or south of the equator (for example, one percent in Florida; four percent in Washington, D.C.; 10 percent in Alaska).  Some patients experience a serious mood change when the seasons change. They may sleep too much, have little energy, and crave sweets and starchy foods. They may also feel depressed. Although symptoms may be severe, they generally resolve over several months.

SAD can be a serious disorder that may require hospitalization. There is a potential risk of suicide among some individuals experiencing SAD. The symptoms of SAD mimic those of clinical depression or dysthymia. The prevalence of SAD in the adult American population has been estimated at between 1.5 percent in Florida and about nine percent in the northern US.  Overall, 6.1 percent of the US population is affected by SAD. Subsyndromal seasonal affective disorder is a milder form of SAD estimated to affect 14.3 percent of the American population.

Seasonal affective disorder is more common in women than men and in people between the ages of 15 and 55 years. The risk of developing SAD for the first time decreases with age. People who have a close relative with SAD are also at greater risk.

CAUSES

There is strong evidence that SAD is caused by a lack of available sunlight. Decreased exposure to sunlight may have an effect on the body’s biological clock, which regulates mood, sleep, and hormone production. Exposure to light may reset the biological clock. Melatonin and serotonin synthesis may be altered in individuals with SAD. Exposure to light appears to correct both neurotransmitter deficits and changes in the biological clock.

SYMPTOMS

Symptoms of SAD include difficulty waking up in the morning, a tendency to oversleep, to overeat, and to crave carbohydrate-rich foods, often leading to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. Individuals with SAD are characterized by depression, pessimism, and a lack of pleasure in usual activities. Symptoms of SAD can include heightened anxiety as well as depression. For most people with SAD, symptoms start in September or October and end in April or May  and tend to occur at the same time every year.

TREATMENT

There are several treatment options for classic SAD. Bright-light treatment uses a specially designed lamp (or light box) — with an intense “full spectrum” or blue light at doses of 2,500 to 10,000 lux. The patient sits at a prescribed distance, usually 30 to 60 cm, in front of the box with eyes open but not staring at the light source for 30 to 60 minutes. Many individuals use the light box in the morning, and there is evidence that morning light is superior to evening light  although people may respond to evening light as well. One study found that up to 69 percent of patients find the treatment inconvenient, and as many as 19 percent stop use because of this.

There is evidence that dawn simulation is effective as well. In some studies, this has been found to be 83 percent more effective than other bright-light therapies. Most studies have found light therapies to work well — for several weeks — as seasonal treatment until greater amounts of natural light are available.

By Nikita Katz, MD, PhD

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