What is binge eating disorder?
Those who struggle with a binge eating disorder consume vast amounts of food over a short period and experience episodes of overeating regularly. Sufferers with this emotionally challenging disorder often immediately regret their actions afterward.
A common misconception is that binge eating disorder is defined as the behaviors associated with binge eating. In reality, many who struggle with binge eating disorder experience extreme fear, anxiety, and shame around eating. One of the core issues driving binge eating, is actually a restrictive mindset.
People with BED often find that when they eat, they are experiencing a dissociative state. It, therefore, becomes difficult to be able to track hunger and fullness cues. The impulse is possibly tied to restrictive eating in the first place, making treatment that addresses underlying restriction the most effective for people with BED.
Diagnosing binge eating disorder
To diagnose binge eating disorder, a health care provider familiar with all forms of eating disorders will need to form a therapeutic alliance with the patient and be able to have a meaningful conversation around the patient's inner experience and relationship with food.
Many health care professionals who don’t specialize in treating eating disorders will often overlook the laboratory tests and other impacts of restriction beyond binge eating. In some cases, patients may be told to diet and lose weight, perpetuating the issue.
There are a multitude of issues associated with BED that can be missed without a thorough examination of the patient. Make sure your care team tests for things like high cholesterol, high blood pressure, heart health, and diabetes, and other signs of binge eating disorder.
These disorders include gastroesophageal reflux disease (GERD) and sleep-related breathing issues like snoring or obstructive sleep apnea. The tests may involve:
- Blood tests and urinalysis
- Physical examination, including thyroid studies, and hormonal evaluations
- Consultation with a sleep disorder clinic
These are only a few procedures someone with BED could expect to happen when diagnosed with this disorder. The patient's medical provider may decide more comprehensive tests are necessary. (1)
According to the diagnostic manual published by the American Psychiatric Association for mental disorders, the (DSM-V) criteria for diagnosing BED those with this condition will exhibit these behaviors: (2)
- Binge eating at least once a week for more than three months
- Eating more rapidly than normal
- Eating when not hungry
- Eating beyond feeling full
- Secretive eating
- Feelings of self-disgust
- Distress about bingeing
- Binge eating with the absence of purging
- Bingeing to relieve stress or anxiety
- Feelings of worthlessness
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Signs & symptoms of binge eating disorder
When examining the signs and symptoms of binge eating disorder, keep in mind that it is misguided to assume a person living in a larger body is overeating and a person living in a smaller body has a healthy relationship with food. The reality is that BED comes in all sizes, and causes pain and suffering regardless of body size.
The warning signs that a person is struggling with binge eating disorder include (but are not limited to): (3)
- Eating high volumes of food without the presence of hunger (no purging involved)
- Feeling of loss of control when eating
- Eating until painfully or uncomfortably full
- Secretive eating
- Hiding food
- Weight fluctuations (generally weight gain)
- Feelings of shame and guilt
- Low self-esteem
- Self-medicating with food
- High anxiety and/or depression
Effects of binge eating disorder
Binge eating disorder can result in several negative consequences, including depression and social isolation, and can lead to health issues, and substance use. The patient may experience metabolic complications and instability in their weight, including but not limited to weight cycling. (10)
There are both short and long-term effects of BED.
- Guilt and shame
- Poor quality of life
- Problems at work, school, or home
- Weight cycling and/or gain
- Certain cancers
- Digestive problems
- Gallbladder disease
- Heart disease
- High blood pressure
- High cholesterol levels
- Joint pain
- Muscle pain
- Sleep apnea
- Type 2 diabetes. (5)
There are a few co-occurring psychiatric illnesses that can drive forward or exacerbate this condition. Post-traumatic stress disorder is a common co-occurring condition due to the trauma related to micro and macro aggressions tied to living in a larger body (if that is how their condition manifests).
Other conditions that commonly co-occur with BED include, but are not limited to:
- High cholesterol
- High blood pressure
- Gallbladder disease
- Heart disease and cardiac problems
- Some types of cancers
- Post-traumatic stress disorder
- Depression mood disorder
- Attention deficit disorder (ADHD)
Treatment of binge eating disorder
Effective binge eating disorder treatment includes engaging in a therapeutic alliance in which they can begin to explore their relationship to themselves, their body, and food. Oftentimes patients need a great deal of support in being able to give themselves permission to eat, and will benefit from learning the principles of mindfulness.
Thankfully, no one has to navigate a binge eating disorder alone. There are support groups, therapies, and medications available to help treat BED. (1)
When treating binge eating disorders, a holistic approach focusing on the entire body is recommended by most medical professionals.
Therapies for binge eating disorder
Psychotherapy (also known as talk therapy) is a great way to change eating habits from unhealthy ones into healthy ones. Therapy can also help reduce how often a person engages in binge eating.
Here are a few types of therapy available for helping someone with binge eating disorder:
- Cognitive behavioral therapy (CBT): CBT treatment helps people cope with issues that trigger BED episodes. CBT helps people cope with negative feelings about their body. Treatment with CBT also gives them a sense of control over their behavior to improve eating habits by understanding the connection between these two variables.
- Nutrition Therapy/Mindful Eating: Working with a nutritionist to establish a better relationship with food is recommended for anyone with BED. Addressing active triggers, emotions, and associations with food, and eating will help the individual heal. It is often recommended that someone with BED seek out both psychotherapy, and a nutritionist specializing in eating disorders, as the two forms of therapy work well together.
- Group Therapies: Attending group therapy is a great way to connect with other people who have BED and share experiences. Learning that many people have BED, and that it is not an individual struggle can be incredibly healing. Group therapy for BED works best when attending in addition to other forms of therapy, and should not be seen as a replacement for speaking with your therapist.
- Interpersonal psychotherapy: Interpersonal psychotherapy focuses on communication and interpersonal skills. The goal is to improve relationships with others. Treatment with interpersonal psychotherapy could reduce binge eating stemming from problematic relationship dynamics or poor communication skills. Treatment may also lead to a decrease in bingeing behaviors.
- Dialectical behavior therapy (DBT): DBT can help people become more aware of their triggers, while teaching them to tolerate stress, regulate emotions, and improve relationships with others. All these things will reduce the desire to binge eat.
- Social Activism: Learning about weight stigma, and finding ways to share a better understanding of BED can also prove healing for some.
Medications for binge eating disorder
Vyvanse (lisdexamfetamine dimesylate), a stimulant used to treat moderate-to-severe binge eating disorders in adults, is the first FDA-approved medication for this purpose. Vyvanse can be habit-forming and misused. Its most common side effects are dry mouth or insomnia.
Vyvanse also carries more severe risks such as high blood pressure leading to heart failure. Also, involuntary twitching and uncontrolled muscle movements are associated with this medication.
Other medications can also reduce symptoms of BED:
- Dietary supplements
- Antidepressants and other psychiatric medications that address the common co-occurring conditions
Understanding binge eating disorder
Binge eating disorder affects people across all genders, sexualities, ethnicities, races, ages, and body types. But even with this disorder being a widespread issue, many still struggle in silence.
While people with BED may feel alone, they're not. In fact, 30% of people who seek out treatment for eating disorders struggle with BED specifically. (9)
Some people with BED do not feel safe in traditional eating disorder treatment facilities, and would benefit from private care with a psychotherapist, and nutritionist. Attending group therapy can also be healing with people with BED, to help them recognize they aren’t alone in their disorder. Special care must be paid to understanding the intense emotions behind BED which require compassionate treatment practices.
When a person is engaging in binge eating behavior they are often in a dissociative state and are not in control of their actions. The majority of the time, the underlying reason for binge eating is because of food or dietary restrictions put on them in the first place.
Always remember that although binge eating disorder is a serious condition, thoughtful treatment programs are available, and healing is possible.
Living with binge eating disorder
Living with an eating disorder is a constant struggle because a person must eat food daily. People with BED have to navigate periods of restriction, as well as episodes of binge eating, and the associated emotions that manifest with both behaviors every day.
Careful attention should be paid to food restriction around BED episodes. The reason being that the first step of a binge episode involves restricting food intake to the point of individuals being excessively hungry later in the day, which can lead to mindless eating. Keeping a food journal that documents what patterns led to the bingeing episode is therefore an incredibly valuable treatment tool.
Here are a few additional tips on dealing with BED:
- Identify triggers
- Set healthy boundaries
- Find a positive role-model
- Confide in a trusted friend or family member
- Find someone who can be supportive
- Attend group therapy for BED
- Focus on self-care
- Evaluate patterns with food paying attention to patterns of restriction
- Consider keeping a journal. (1)
History of binge eating disorder
Eating disorders have been around for thousands of years, with descriptions from the Hellenistic (323 BD-31 BC) and medieval times (5th-15th century AD). However, Dr. Albert Stunkard recognized BED in 1959. (8)
Binge eating disorder in pop culture
Pop culture in the United States is often associated with the diet culture, as many fight an internal battle with body image issues. Societal standards of beauty often cause people to develop unhealthy relationships with food.
A study by the National Institute of Health examined the increase in risk factors for developing BED due to exposure to pop culture and media influence. This cross-cultural study showed that those exposed to pop culture in America were more likely to be diagnosed with BED than other cultures like Mexican-born participants. (8)
Furthermore, the word “binge” is often overused in American pop culture. Binge is associated with such activities as “binge-watching” television shows, or “going on a shopping binge.” This cavalier use of the word is harmful and furthers the stigma BED sufferers feel about their condition for those who struggle with binge disorders.
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How to help someone with binge eating disorder
To those trying to overcome binge eating, support and connection from loved ones are not only helpful but essential. Here are ways to help someone with BED:
- Be educated about the disorder
- Avoid (and watch out for) talk of dieting
- Don't guilt or shame the binge eater
- Be careful not to enable the person struggling with BED
- Validate their feeling
- Consider family therapy
- Set healthy boundaries
Specialized treatment may be necessary to overcome BED. Yet, treatment is possible, and people do recover from this disorder.
At Within Health, we understand that everyone has a different body shape and size that is deserving of care and love regardless of what number presents on the scale or their specific challenges around food.
If you or a loved one are looking for binge eating disorder treatment or healing for another eating disorder, we are here to help. Call our admissions team now to build a healthy relationship with food.