The vicious cycle of gorging followed by shame and guilt can be halted
Binge-eating disorder (or BED) is characterized by regularly and compulsively eating large amounts of food, often rapidly, and to the point of discomfort or pain. It affects more than 3.5% of women and 2% of men in the United States, making it the most common eating disorder in the country.
Almost everyone has overeaten on occasion, but BED is much more serious. People with BED have feelings of being “out of control” when they are eating. They often eat too much, too quickly, when they are not hungry, or after they are full. They may eat in secret or alone, and feel embarrassment, shame, or guilt about their eating behavior. Unlike a person with bulimia, they do not try to “undo” any weight gain by vomiting or using laxatives. They might vow to stop their emotional eating, their stress eating, or to diet, but find themselves binging again and again.
Most people with BED are overweight or obese, but many are not. It can affect people of all ages, races, gender, and body type. The severity of the disorder is measured by how regularly a person binge eats in a single week.
Millions of patients suffer from BED. Although it can be life-threatening if left untreated, there are many effective treatment options available for patients ready to get help and overcome BED.
As mentioned, BED is the most common eating disorder in the United States, estimated to affect between 1-5% of the general population. While other disorders are typically twice as common in women, binge eating is less discriminatory—of those suffering from BED, roughly 40% are male. It is most commonly found among women in early adulthood, and men as they reach middle age. It affects people of every race, ethnicity, and cultural background.
What Causes It?
For people with BED, food and their unhealthy relationship to it is a symptom of much larger and more significant underlying mental and emotional issues. The exact cause of binge eating disorder is still unknown, but it can most likely be attributed to a combination of psychological, behavioral, and environmental influences.
You may be more likely to develop BED if you have:
A family history of eating disorders. If your parent or siblings have, or had, an eating disorder, you are at a greater risk for developing one.
A history of psychological issues or negative self-worth. Certain thought patterns are closely associated with BED, including depression, anger, anxiety, a strong need to be in control, perfectionism and rigidity, a need to please others, and negative feelings about yourself, your body, and your accomplishments.
A history of dieting. While people with BED have a range of body types, they often have a long history of restricting calories.
Age. Although individuals of any age can have binge-eating disorder, it often begins in women’s late teens and early 20s, and men’s middle age.
Significant loss or traumatic experiences. People with post-traumatic stress disorder often develop BED as a way of distancing themselves from pain.
Problems with family or other significant relationships. Difficulties with your support network can lead to binge-eating behavior.
Experiences with weight discrimination or bullying. Many patients diagnosed with BED report a long personal history of dieting.
BED is characterized as an eating disorder. It was initially considered a subcategory of Eating Disorder Not Otherwise Specified. Today, the DSM-V considers binge eating a diagnosable eating disorder.
Signs & Symptoms
Almost everyone overeats occasionally, but a person who binges displays certain signs and symptoms that indicate overeating is regularly recurring, feels out of their control, and is negatively impacting their life.
If you have BED, you may:
Eat unusually large quantities of food when you are not hungry, or after you are full
Eat more rapidly than normal
Eat until you feel uncomfortable
Feel embarrassment, shame, depression, disgust, or guilt about binge eating
Eat alone or in secret so that others cannot see you binge eat
Feel “out of control” when you are eating, like you cannot stop, or control what or how much you eat
Experience episodes of binge eating at least once a week for three consecutive months
People with BED do not try to prevent weight gain or “compensate” by purging their food. If you make yourself vomit or you take laxatives to try to “undo” your calorie intake, you may be suffering from bulimia.
You may experience physical complications from BED, such as:
High blood pressure
Type II diabetes
Joint and muscle pain
Psychological conditions that are often linked with BED include:
Feeling bad about yourself or your life
Poor quality of life
Problems functioning at work, in your personal life, or while socializing
Anxiety, depression, bipolar disorder, and substance abuse disorder
Because BED stems from, and can cause, a variety of emotional, physical, and psychological issues, successfully addressing it can require a mix of therapeutic approaches. A team of mental health providers, medical providers, and nutritional experts can help guide you toward a safe and effective treatment plan.
If you suspect you have BED, immediately seek medical attention. BED is not a choice; it is an illness that requires proper diagnoses and medical treatment. If left untreated, it may steadily get worse. In extreme cases, it can be life-threatening.
Talk to your doctor or mental health provider about your binge eating, and the feelings that you associate with it. It may be helpful to make a list of symptoms that you are experiencing before the appointment. Include personal information like your family’s history of eating disorders, major stress, recent life changes, and a typical day’s eating. Don’t be afraid to include emotions, thoughts, or other information that may seem unrelated to binge eating—it is important to give your provider a full picture of your health.
Your provider may ask you questions about your daily food intake, your thoughts about food, and whether you eat quickly, in secret, or until you are uncomfortably full. He or she may want to know if you feel any guilt or embarrassment about eating, or if you are concerned about your weight and appearance.
Your provider may also want to conduct a physical exam, blood and urine tests, and other tests to evaluate whether you are suffering from the effects of binge eating.
You may want to consider asking your provider about their history treating patients with BED. Do not be afraid to ask them if they have worked with similar patients before, how they approach treating BED, what they see as your primary goal for recovery, how they define healthy weight, and what their training might be. If you are not satisfied with their experience, consider seeking a second opinion.
Depending on your unique signs and symptoms, an effective treatment plan may ultimately include assistance from a variety of medical providers, health and wellness experts, and mental health practitioners. This “team” of individuals can help you combat your BED by addressing underlying influences and unhealthy habits. Working with a support network, you can successfully reduce your food intake, make healthy long term changes, and overcome binge eating for good.
Treatment options for BED include:
Psychotherapy, or the practice of spending time with a trained therapist, either in a group or individual setting, to diagnose and treat mental, emotional, and psychological problems. A therapist may work with you to figure out the root influences of your binge-eating episodes, stress “triggers” that may help prompt binge-eating episodes, and coping mechanisms that will help you move from unhealthy habits to healthier ones.
Cognitive Behavioral Therapy is one-on-one therapeutic counseling that treats mental disorders, including depression. A cognitive behavioral therapist may allow you to explore your thoughts and feelings, helping to re-orient negative thinking patterns about yourself, your body, or your accomplishments.
Interpersonal Psychotherapy is a short-term treatment that focuses on the way people interact with others. An interpersonal psychotherapist may help you to address any social and communication issues impeding your mental health or encouraging you to binge eat.
Dialectical Behavior Therapy is a form of cognitive behavioral therapy that helps patients eliminate self-harming behaviors, negative thinking patterns, and substance abuse. While undergoing this therapy, you may learn how to better problem solve, cope with stress, and regulate your anxiety.
Group or Family Therapy may help your family come to terms with, and support, your efforts to stop binge eating. Social support is a crucial component to overcoming BED. It is important for your family members to be able to talk openly about its signs, symptoms, and emotional effects.
Pharmacotherapy, or the practice of administering pharmaceutical drugs to help treat underlying mental health issues that may be driving your BED. Medications, particularly when taken while undergoing other types of mental health treatments, may help you reduce your binge-eating episodes and regain a sense of control.
Selective Serotonin Reuptake Inhibitors (SSRI Antidepressants) may be helpful to address depression, anxiety, or other negative moods that could be contributing to your BED.
Specialized Nutritional Counseling or a healthy diet and exercise treatment plan under medical supervision may be appropriate to address binge-eating-episode triggers and help you meet your nutritional needs. These programs should only be considered after you feel that your BED is under control. Otherwise, they may inadvertently trigger binge eating.
Alternative Therapies may be offered through certain outpatient programs. They’re not medically proven to treat BED on their own, but interventions like movement classes, meditation and mindfulness instruction, yoga, equine therapy, and art therapy may help encourage increases in mood, body image, and your sense of control.
For people with BED, there is hope. Recovery is a lifelong journey of treatment, healing, and personal growth. With patience, self-care, and the right treatment plan, you can stop binge eating and begin to live a healthier, happier life.
By: Arnold Lieber, MD