Binge eating: Cognitive mechanisms and therapeutic interventions
HARILA D.

Eating disorders can be described by the existence of three characteristics: maladaptive eating behavior, negative body image and attempts (successful or not) to lose weight. The clients with eating disorders usually suffer from depression, anxiety, personality disorders and low self esteem.

According to the cognitive behavior model, biological, family, social, cultural and psychological factors interact each other and contribute to the appearance and maintenance of eating disorders. It is common sense that these disorders concern mainly women due to their specific social role. The attitude of the family towards food, as well as the body image, may be one of the major factors for the development of dysfunctional beliefs about these aspects and maladaptive eating behavior to the daughters. Usually, there is also a history of eating disorders to the mothers of the clients. The families of bulimic women are usually characterized by poor communication skills and expression of negative feelings. The parents of bulimics are perfectionists, critical with no empathy and warmth. Also, they do not facilitate the autonomy of their children. Thus, bulimics try to fulfill the emotional emptiness or to take over control over their lives through the binge episodes.

The maladaptive behavior of binge eating characterizes mainly the bulimia nervosa and the binge eating disorder. Periods of diet very often precede the binge episodes. In bulimia the binge episodes are followed by compensatory behavior as a result of the intense fear of the client to gain weight. However, this behavior causes feelings of guilt which in turn may be the stimulus for the next binge episode (vicious circle). Women suffering from these two diseases are usually very anxious about the weight and shape of their body and they seek to modify them. They evaluate their self-esteem through their body image while their prevalent cognitive schemata are those of control, perfectionism and threaten. The most common cognitive distortions are those of dichotomous, catastrophic thinking and generalization. These clients have poor problem solving and social skills. Bulimics binge in order to handle their anxiety due to their incompetence, thus, binging is enhanced, since it reduces anxiety. The cognitive-behavior assessment of binge episodes take into account the stimuli this

behavior occurs in, the personal and familial history of the client, the responses (somatic, cognitive, emotional and behavioral), as well as the consequences of this behavior for the life of the client. The role of this maladaptive behavior to the client or her family/social environment is also assessed. The assessment of binging is based on the theory of self-regulation which includes three intra-connected stages: the self-observation, the self-control and the self-assessment.

The cognitive-behavior therapy is a well established therapeutic intervention which has been found to be effective for the treatment of bulimia and binge eating disorder. It focuses on the behavioral responses, the formation of these disorders, as well as the mechanisms which keep them on.

The therapy of bulimia and binge eating disorder includes two phases. The first stage focuses on the development of a good therapeutic relationship and the psychoeducation about the effects of the diet and the binging episodes, as well as, the regulation of the body's weight. In this phase, the main therapeutic goal is the change of the attitude towards food. The second phase includes the investigation of the causing stimuli for the binging episodes, as well as of the client's cognitions and emotions and of course, the restructuring of these cognitions. The therapeutic interventions applied at this stage, include mood regulation techniques, exposure, as well as methods for cognitive restructuring of the dysfunctional beliefs. Intervention programs for the improvement of problem solving and communication skills are also applied. In the case of adolescent clients family therapy is highly recommended.

Key words: Binge eating, cognitive-behaviour therapy, bulimia, dialectic therapy.