Category Archives: Eating Disorders

Details about eating disorders- especially Binge Eating Disorder.

Binge Eating and Compulsive Behavior

Binge-Eating-DisorderDopamine

  • Dopamine agonists can cause compulsive behaviors, including compulsive eating, hypersexuality and punding (repetitive, purposeless behaviors)
  • In obese people, striatal dopamine receptors are downregulated, as is seen in drug addicts.  This rapidly accelerates addiction-like reward deficits and the onset of compulsive food-seeking.

 

Seizure Type Activity and Anti-Convulsants

  • People who compulsively eat have abnormal EEG’s.  90% were treated successfully with diphenylhydantoin/phenytoin
  • Phenytoin is an antiepileptic.  It may be useful in stabilizing anxiety and mood.  It is very powerful and has many possible side effects; research it.
  • 47/59 people had a good response to phenytoin for compulsive eating, especially those with abnormal and paroxysmal EEG’s and patients with 14 and 6 second positive spikes.
  • Signs associated with compulsive eating in people with abnormal EEG’s: rage attacks, frequent headaches, dizziness, stomach aches, nausea, parenthesias, history of convulsions, perceptual disturbances, other compulsions, family history of epilepsy.  All were treated with phenytoin.
  • A trial of phenytoin reduced binges, and the reduction in binges continued even after the phenytoin was stopped.
  • Phenytoin reduces electrical conductance.
  • 80% of binge eaters were helped by phenytoin
  • Binge eaters had abnormal EEG’s and paroxysmal EEG’s
  • Binge eaters had lots of 14-6 second positive spikes.  These are short bursts lasting a second or less, that happen in light sleep.  Mostly in the posterior temporal region involving the parietal and occipital regions as well.  The spikes are not symmetric.  These spikes are considered vegetative and used to be considered similar to epileptic attacks.  The idea that they are similar to epileptic attacks has been dismissed because paroxysmal activity hasn’t ever been recorded in intra-critical EEG’s.  It is now believed that these spikes are indicative of electrical alteration associated with disorders of the neurovegetative area.
  • 14-6 second spikes are seen just as a person falls asleep and as they are waking up.  It is abnormal, indicating a dysfunction of the diencephalon

 

 

OCD

  • Disorders related to OCD include impulse control disorders like skin picking or gambling addiction and tic disorders like Tourette’s.
  • OCD is related to neurological problems like epilepsy, memory disorders and Tourette’s

 

 

Diencephalon

  • The diencephalon is composed of the thalamus and the hypothalamus.  The thalamus is the top of the brain stem.  Its two lobes are joined by the massa intermedia, which runs through the 3rd ventricle that the thalamus is on top of.  The surface of the thalamus is covered in myelin.  It has many pairs of nuclei, most connected to the cortex.  Some of these are for relaying sensory information.  It is also a part of motor and sensory pathways and those between different parts of the cortex and cerebellum.  The thalamus and cortex are profusely interconnected by reciprocal connections.  These connections are important in generating the rhythmic patterns in the brain and in attention.  They may also be involved in top-down effects in perception.  Because the thalamus is so well connected to every part of the cortex, these rhythmic patterns sweep through the cortex regularly and rapidly.  They are possibly a source for the rapid pacemaker that is hypothesized to exist for high speed inner sequencing.  The speed of thalamocortical rhythms ranges from 20 to 80 Hz (Hertz = cycles per second) in waking states and can be as slow as 1-4 Hz in deep sleep.
  • The hypothalamus is under the thalamus.  It regulates the pituitary gland, which dangles from it on the ventral surface of the brain.  On its surface is the optic chiasm, which is where the optic nerves from both eyes come together.  Also on the surface is the mammilary bodies, a pair of nuclei just behind the pituitary gland.
  • The diencephalon is part of the forebrain.  The forebrain controls body temperature, reproductive functions, eating, sleeping and any display of emotion.  The forebrain is composed of the diencephalon and the telencephalon or cerebrum.  The cerebrum is made up of the cerebral cortex, underlying white matter and the basal ganglia.
  • 14-6 second spikes are only seen when the electrodes are placed so they connect the occipital, temporal (posterior and mid) and central leads to the ear of that side of the head.
  • Paroxysmal voltage activity is activity that emerges from the background with a rapid onset, usually reaching quite high voltage and ending with an abrupt return to lower voltage activity
  • People with 14-6 second spikes have a history of being irritable, having stomach aches and headaches and being difficult to manage as children.
  • Zarontin was successfully used to treat oppositional defiant children who had 14-6 second spikes.
  • Girls with early menstruation are more likely to have an eating disorder.
  • Biofeedback with alpha-theta waves has successfully been used to treat addictions.
  • Women with BED are very likely to have depression and alexithymia (inability to express feelings with words)
  • Val66Met (AKA Rs6265, a gene variation/single nucleotide polymorphism in the BDNF gene) associated with eating disorders, substance abuse disorders and schizophrenia
  • Eating disorders associated with right frontal and temporal lobe damage
  • Blood levels of 17B-estradiol and prolactin were reduced in anorexics, bulimics and BED patients
  • Levels of leptin were highly correlated with weight/BMI.  However, researchers don’t think weight causes high-low leptin levels, because leptin was low in underweight anorexics and normal weight bulimics, but high in those with BED
  • People with BED had higher sensitivity to food reward and had stronger medial orbitofrontal cortex responses to seeing food.
  • People with BED have less ability to react to and recover from autonomic stress
  • People with BED often have depression and Borderline Personality traits
  • Obese people differed from normal controls in Novelty Seeking, Harm Avoidance, Cooperativeness and Self Directedness
  • Dialectical Behavior Therapy was developed to treat Borderline Personality Disorder, and is the only treatment that is proven to work on them.  It also helps people with mood disorders, self injury, sexual abuse survivors and chemical dependency
  • Obese people with BED were more impulsive than obese people without BED.  They were more likely to express anger outside themselves
  • People with BED have a higher risk of personality disorders
  • Independently related to the severity of BED: obsessive compulsiveness, interpersonal sensitivity, paranoid ideas and psychoticism
  • People with BED have higher rates of lifetime affective disorder, bulimia (Axis I) and Axis II B and C disorders, especially histrionic, borderline, avoidant personality and depression
  • Appetite Awareness Training helped people with BED reduce instances of bingeing and overeating.  This training emphasizes responding to moderate (as opposed to strong) hunger and fullness and reducing response to non-appetite cues.  Subjects who did the training had decreased urges to eat in several high-risk situations, decreased depression and less social anxiety
  • Circulating ghrelin is low in those with BED (whether normal weight or obese) and in obese people without BED, but not in bulimics
  • Women with BED have higher dissatisfaction with their bodies.  It is believed that women with BED have a memory bias for negative words about body/shape
  • Dialectical Behavior Therapy, in a 6 month study, helped 82% of subjects stop bingeing
  • Absence of amphetamines usage history, lower emotional eating and baseline bingeing severity predicted full recovery in the long term
  • Being overweight as a child, full BED diagnosis and frequent emotional eating predicted treatment resistance
  • 8 weekly group sessions for CBT (with 5 booster sessions after) significantly reduced bingeing symptoms up to 12 months
  • People with BED who had higher distress over their binge eating had more eating disorder characteristics
  • According to self-defined binges, people with BED believed mood predicted binges, not calorie deprivation.  But researchers found that both mood and calorie deprivation predicted binges, and calorie deprivation made them more severe.  For people with a negative mood, their anxiety had declined significantly after eating at a buffet
  • Obesity is usually associated with low levels of cortisol, but this relationship is not seen in those with BED.  It is believed that binge eating severity is a bigger regulator of cortisol production than obesity
  • People with BED have higher rates of comorbidity of psychiatric problems, more psychological distress, social problems and impaired self esteem
  • Emotional eating is positively correlated to the severity of binge eating.  People with BED had more concerns about eating, weight and shape than obese people without the disorder
  • Women are more likely to have BED.  They have higher hypomania scores, lower cooperativeness and self-directedness scores.  They may have a higher risk for bipolar disorder
  • CBT is effective against BED, but it is not effective in reducing obesity
  • Dialectical Behavior Therapy for BED aims to reduce binges by improving adaptive emotion-regulation skills.  It has been shown to be effective in a group therapy program, however those gains were not held at 3, 6 and 12 month follow up.
  • Women with BED make risky decisions significantly more than healthy women.  They also show impaired ability to process feedback to use to their advantage
  • People with BED have higher levels of Harm Avoidance.
  • Women with BED have a larger cortisol response to stress than those without BED
  • Obese people have a generalized inhibition problem, and difficulty focusing attention.  These problems are more severe in people with BED
  • A study comparing sertraline (Zoloft) and fluoxetine (Prozac) found that both improved scores on the Binge Eating Scale significantly.  Significant weight loss emerged after 6 months.  Researchers believe any SSRI may help with BED
  • Serotonin transmission aberrations are suspected in BED
  • Poor mood, low alertness, feelings of poor eating control and craving sweets preceded binges in people with BED
  • People with an early onset of BED were more likely to binge before dieting, have early onset obesity, early onset dieting, to have longer binge-free periods, more paternal obesity/binge eating, more eating disordered psychopathology, have a history of bulimia and mood disorders
  • BED is triggered by an immediate breakdown of emotional regulation, not an accumulation of negative mood.  In bulimia, there’s an accumulation of bad mood, then bingeing, then substantial improvement in mood.  People with BED don’t have much of a reinforcing change in mood after a binge.  It is more slight and longer lasting.
  • People with BED who had a parent with substance abuse problems were more likely to start bingeing before dieting, much earlier age of BED onset and more likely to have a mood disorder
  • College women with compulsive eating problems had higher inner tension, greater suspiciousness, less emotional stability, were more external in locus of control, had a greater need for approval and had a higher masculine self ideal
  • Overconsumption of palatable food triggers addiction-like changes in brain reward circuits and drives the development of compulsive eating (Nature Neuroscience, Paul M. Johnson, Paul J. Kenny)

 

Seizure Type Activity and Anti-Convulsants

  • People who compulsively eat have abnormal EEG’s.  90% were treated successfully with diphenylhydantoin/phenytoin
  • Phenytoin is an antiepileptic.  It may be useful in stabilizing anxiety and mood.  It is very powerful and has many possible side effects; research it.
  • 47/59 people had a good response to phenytoin for compulsive eating, especially those with abnormal and paroxysmal EEG’s and patients with 14 and 6 second positive spikes.
  • Signs associated with compulsive eating in people with abnormal EEG’s: rage attacks, frequent headaches, dizziness, stomach aches, nausea, parenthesias, history of convulsions, perceptual disturbances, other compulsions, family history of epilepsy.  All were treated with phenytoin.
  • A trial of phenytoin reduced binges, and the reduction in binges continued even after the phenytoin was stopped.
  • Phenytoin reduces electrical conductance.
  • 80% of binge eaters were helped by phenytoin
  • Binge eaters had abnormal EEG’s and paroxysmal EEG’s
  • Binge eaters had lots of 14-6 second positive spikes.  These are short bursts lasting a second or less, that happen in light sleep.  Mostly in the posterior temporal region involving the parietal and occipital regions as well.  The spikes are not symmetric.  These spikes are considered vegetative and used to be considered similar to epileptic attacks.  The idea that they are similar to epileptic attacks has been dismissed because paroxysmal activity hasn’t ever been recorded in intra-critical EEG’s.  It is now believed that these spikes are indicative of electrical alteration associated with disorders of the neurovegetative area.
  • 14-6 second spikes are seen just as a person falls asleep and as they are waking up.  It is abnormal, indicating a dysfunction of the diencephalon

 

 

 

 

Diencephalon

  • The diencephalon is composed of the thalamus and the hypothalamus.  The thalamus is the top of the brain stem.  Its two lobes are joined by the massa intermedia, which runs through the 3rd ventricle that the thalamus is on top of.  The surface of the thalamus is covered in myelin.  It has many pairs of nuclei, most connected to the cortex.  Some of these are for relaying sensory information.  It is also a part of motor and sensory pathways and those between different parts of the cortex and cerebellum.  The thalamus and cortex are profusely interconnected by reciprocal connections.  These connections are important in generating the rhythmic patterns in the brain and in attention.  They may also be involved in top-down effects in perception.  Because the thalamus is so well connected to every part of the cortex, these rhythmic patterns sweep through the cortex regularly and rapidly.  They are possibly a source for the rapid pacemaker that is hypothesized to exist for high speed inner sequencing.  The speed of thalamocortical rhythms ranges from 20 to 80 Hz (Hertz = cycles per second) in waking states and can be as slow as 1-4 Hz in deep sleep.
  • The hypothalamus is under the thalamus.  It regulates the pituitary gland, which dangles from it on the ventral surface of the brain.  On its surface is the optic chiasm, which is where the optic nerves from both eyes come together.  Also on the surface is the mammilary bodies, a pair of nuclei just behind the pituitary gland.
  • The diencephalon is part of the forebrain.  The forebrain controls body temperature, reproductive functions, eating, sleeping and any display of emotion.  The forebrain is composed of the diencephalon and the telencephalon or cerebrum.  The cerebrum is made up of the cerebral cortex, underlying white matter and the basal ganglia.
  • 14-6 second spikes are only seen when the electrodes are placed so they connect the occipital, temporal (posterior and mid) and central leads to the ear of that side of the head.
  • Paroxysmal voltage activity is activity that emerges from the background with a rapid onset, usually reaching quite high voltage and ending with an abrupt return to lower voltage activity
  • People with 14-6 second spikes have a history of being irritable, having stomach aches and headaches and being difficult to manage as children.
  • Zarontin was successfully used to treat oppositional defiant children who had 14-6 second spikes.
  • Girls with early menstruation are more likely to have an eating disorder.
  • Biofeedback with alpha-theta waves has successfully been used to treat addictions.
  • Women with BED are very likely to have depression and alexithymia (inability to express feelings with words)
  • Val66Met (AKA Rs6265, a gene variation/single nucleotide polymorphism in the BDNF gene) associated with eating disorders, substance abuse disorders and schizophrenia
  • Eating disorders associated with right frontal and temporal lobe damage
  • Blood levels of 17B-estradiol and prolactin were reduced in anorexics, bulimics and BED patients
  • Levels of leptin were highly correlated with weight/BMI.  However, researchers don’t think weight causes high-low leptin levels, because leptin was low in underweight anorexics and normal weight bulimics, but high in those with BED
  • People with BED had higher sensitivity to food reward and had stronger medial orbitofrontal cortex responses to seeing food.
  • People with BED have less ability to react to and recover from autonomic stress
  • People with BED often have depression and Borderline Personality traits
  • Obese people differed from normal controls in Novelty Seeking, Harm Avoidance, Cooperativeness and Self Directedness
  • Dialectical Behavior Therapy was developed to treat Borderline Personality Disorder, and is the only treatment that is proven to work on them.  It also helps people with mood disorders, self injury, sexual abuse survivors and chemical dependency
  • Obese people with BED were more impulsive than obese people without BED.  They were more likely to express anger outside themselves
  • People with BED have a higher risk of personality disorders
  • Independently related to the severity of BED: obsessive compulsiveness, interpersonal sensitivity, paranoid ideas and psychoticism
  • People with BED have higher rates of lifetime affective disorder, bulimia (Axis I) and Axis II B and C disorders, especially histrionic, borderline, avoidant personality and depression
  • Appetite Awareness Training helped people with BED reduce instances of bingeing and overeating.  This training emphasizes responding to moderate (as opposed to strong) hunger and fullness and reducing response to non-appetite cues.  Subjects who did the training had decreased urges to eat in several high-risk situations, decreased depression and less social anxiety
  • Circulating ghrelin is low in those with BED (whether normal weight or obese) and in obese people without BED, but not in bulimics
  • Women with BED have higher dissatisfaction with their bodies.  It is believed that women with BED have a memory bias for negative words about body/shape
  • Dialectical Behavior Therapy, in a 6 month study, helped 82% of subjects stop bingeing
  • Absence of amphetamines usage history, lower emotional eating and baseline bingeing severity predicted full recovery in the long term
  • Being overweight as a child, full BED diagnosis and frequent emotional eating predicted treatment resistance
  • 8 weekly group sessions for CBT (with 5 booster sessions after) significantly reduced bingeing symptoms up to 12 months
  • People with BED who had higher distress over their binge eating had more eating disorder characteristics
  • According to self-defined binges, people with BED believed mood predicted binges, not calorie deprivation.  But researchers found that both mood and calorie deprivation predicted binges, and calorie deprivation made them more severe.  For people with a negative mood, their anxiety had declined significantly after eating at a buffet
  • Obesity is usually associated with low levels of cortisol, but this relationship is not seen in those with BED.  It is believed that binge eating severity is a bigger regulator of cortisol production than obesity
  • People with BED have higher rates of comorbidity of psychiatric problems, more psychological distress, social problems and impaired self esteem
  • Emotional eating is positively correlated to the severity of binge eating.  People with BED had more concerns about eating, weight and shape than obese people without the disorder
  • Women are more likely to have BED.  They have higher hypomania scores, lower cooperativeness and self-directedness scores.  They may have a higher risk for bipolar disorder
  • CBT is effective against BED, but it is not effective in reducing obesity
  • Dialectical Behavior Therapy for BED aims to reduce binges by improving adaptive emotion-regulation skills.  It has been shown to be effective in a group therapy program, however those gains were not held at 3, 6 and 12 month follow up.
  • Women with BED make risky decisions significantly more than healthy women.  They also show impaired ability to process feedback to use to their advantage
  • People with BED have higher levels of Harm Avoidance.
  • Women with BED have a larger cortisol response to stress than those without BED
  • Obese people have a generalized inhibition problem, and difficulty focusing attention.  These problems are more severe in people with BED
  • A study comparing sertraline (Zoloft) and fluoxetine (Prozac) found that both improved scores on the Binge Eating Scale significantly.  Significant weight loss emerged after 6 months.  Researchers believe any SSRI may help with BED
  • Serotonin transmission aberrations are suspected in BED
  • Poor mood, low alertness, feelings of poor eating control and craving sweets preceded binges in people with BED
  • People with an early onset of BED were more likely to binge before dieting, have early onset obesity, early onset dieting, to have longer binge-free periods, more paternal obesity/binge eating, more eating disordered psychopathology, have a history of bulimia and mood disorders
  • BED is triggered by an immediate breakdown of emotional regulation, not an accumulation of negative mood.  In bulimia, there’s an accumulation of bad mood, then bingeing, then substantial improvement in mood.  People with BED don’t have much of a reinforcing change in mood after a binge.  It is more slight and longer lasting.
  • People with BED who had a parent with substance abuse problems were more likely to start bingeing before dieting, much earlier age of BED onset and more likely to have a mood disorder
  • College women with compulsive eating problems had higher inner tension, greater suspiciousness, less emotional stability, were more external in locus of control, had a greater need for approval and had a higher masculine self ideal
  • Overconsumption of palatable food triggers addiction-like changes in brain reward circuits and drives the development of compulsive eating (Nature Neuroscience, Paul M. Johnson, Paul J. Kenny)

 

 

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Eating Disorders and the Brain

 

  • People with bulimia and BED have larger medial orbitofrontal cortexes.  It is thought this structural abnormality is associated with dysfunction in reward processing for food and/or self regulation
  • Blood levels of leptin were found to be low in anorexics and bulimics, but high in those with BED

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Filed under Eating Disorders