Like other eating disorders, Binge Eating Disorder (BED) is a biological, brain-based illness. To best understand why evidence-based interventions for BED are so effective, we must first understand the BED brain pathways that are compromised by the disorder
Understanding Pathways in the BED Brain: From Ingestion to Anxiety
- Upon taking a bite of food, taste is registered as dull or even tasteless to the BED brain’s Awareness Stations.
- Lack of taste sensation is distressing to the brain, triggering the Emotion and Panic Stations.
- In an attempt to make sense of this experience and relieve anxiety, the brain will begin to create new rules and rituals surrounding food intake.
- In an attempt to get a response, a strong impulse is received from the brain to eat more food.
- The Pro/Con Station supports this impulse by signaling to the individual that the introduction of more and more food might be a good thing.
- The Mediation Station begins planning ways to get more food, bringing some pleasure to the individual. In most cases, this planning brings more pleasure than actually eating, reinforcing this destructive thought process.
- As this pattern continues it becomes faster and faster.
- The rituals and rules around food intake become cemented in the BED brain in an attempt to reduce anxiety.
- With each additional bite comes a momentary sense of calm. The cycle continues.
This information suggests that the brain’s dysfunctional planning pathway would be the most successful pathway to disrupt during intervention as it is causing the most “reward.” There is reinforcement in the form of anxiety reduction here.
Individuals with BED often experience increased difficulty making decisions and trusting their “gut.” We must explore this pathway to best understand how a behaviorally-based intervention such as CBT will work for an individual struggling with BED.
Decision Making and the BED Brain
- When someone without an ED makes a decision, there is a dopamine spike. This spike of pleasure neurochemical gives the individual a sense of confirmation and suggests that the decision feels good.
- For someone with BED there is a weakened pleasure sensation upon making a decision and little to no internal confirmation.
- Decision making becomes challenging and frustrating
- In spite of this, as demonstrated by the development of strict rituals and rules, an individual with BED has an increased ability to plan and execute tasks.
This research suggests that if unhealthy rituals can be shifted and fewer choices are offered, treatment will be successful. CBT is a proven, change-oriented intervention that targets those very pathways. Knowing what we know now, it is not surprising that fundamental to CBT is planning! As healthy rituals are discussed, planned and practiced, the brain begins to fire new brain pathways and replace the older, more destructive ones.
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Hill, L., PdhD, Dagg, D., MA, Levine, M., PhD, & Smolack, L., PhD. (2012). Family Eating Disorders Manuel (Vol. 1). CT: The Center for Balanced Living.