Several years ago, Dr. Jacqueline Carter-Major realized the focus of her research needed to change.
At the time, the professor of psychology had just moved back to Newfoundland and Labrador to teach at Memorial.
She found that while there were supports in place for people with anorexia and bulimia nervosa, there was a need for services for those on the other end of the eating disorder spectrum.
“Newfoundland and Labrador has the highest rate of obesity in Canada at 35 per cent,” she said. “It’s estimated that 30 per cent of them, or as many as 14,000 people, also struggle with binge eating.
“However, in this province there is no specialized treatment program for those with binge eating disorder. They have nowhere to go for help, unless they can afford to pay for a private mental health care professional.”
Managing uncomfortable emotions
Binge eating is characterized by eating an unusually large amount of food during a short period of time and feeling out of control over what, and how much, is eaten and when to stop.
It’s seen as a disorder when these episodes occur at least once a week for three or more months.
Recently, Dr. Carter-Major conducted a study to see if a self-help program could help when specialized therapy sessions with health-care professionals are not available.
“People often engage in binge eating behaviour to cope with emotions or uncomfortable feelings,” she said.
“One treatment approach, called dialectical behaviour therapy, or DBT, teaches people other healthier ways of tolerating and managing these uncomfortable emotions.”
Recently psychologists have translated that therapy program into a self-help book; Dr. Carter-Major advertised for participants in this province to test it out.
“We screened nearly 600 people who contacted us because they felt they were struggling with emotional overeating,” she said. “In the end, 71 people who met diagnostic criteria for binge eating disorder took part in our trial.”
Guided self-help
Participants were randomly assigned one of three treatment conditions. The first, called guided self-help, saw people receive the book and six half-hour support sessions with a graduate student in clinical psychology over a 12-week period.
A second group received the book with no support sessions, while the third group used another self-help book that focused on improving self-esteem but had nothing to do with binge eating.
“It’s important to emphasize that [binge eating] is actually a mental health issue.”
“The support sessions were conducted via videoconferencing to make the treatment accessible to people across the province,” said Dr. Carter-Major.
“It was also important to test an unguided self-help condition because we wanted to know if people could just go to Chapters or on Amazon and order a self-help book that could help them with strategies and advice.”
Her research group found that individuals in all three treatment conditions reduced their binge eating behaviour significantly, but the strongest effect was seen in the guided self-help DBT condition. Those participants reduced their binge eating by 75 per cent.
“That tells us that the people who are struggling and who currently have nowhere to turn, could be helped a lot by brief, simple interventions, like guided self-help,” said Dr. Carter-Major.
Increasing awareness and services
A member of the board of directors for the Eating Disorder Foundation of Newfoundland and Labrador, Dr. Jacqueline Carter-Major is working with the group to increase knowledge and awareness among mental health and health-care professionals about binge eating disorder, and to encourage the department of Health and Community Services to provide treatment services.
“A lot of people, when they hear of binge eating, think it’s just someone overindulging or who doesn’t have enough will power,” said Dr. Carter-Major. “It’s important to emphasize that while it has only recently gained official recognition in the field, this is actually a mental health issue.
“Those stigmatizing attitudes can be internalized by people with the disorder and they may not seek help because they think it’s their fault,” she continued. “Since binge eating episodes often occur in secret, there’s often intense shame and self-criticism associated with it, along with depression and anxiety.”
Early intervention
Dr. Carter-Major’s next project will be a collaboration with the Janeway Hospital’s lifestyle program to assess how common binge eating is, particularly in adolescents, and to investigate some early intervention treatments.
“As with many areas of mental health, the earlier you intervene the better, before these patterns of coping using food become ingrained. There’s a lot of evidence that this behaviour starts in childhood.”
