What is binge eating disorder of low frequency and/or limited duration?
Binge eating disorder of low frequency and/or limited duration is classified as an other specified feeding or eating disorder (OSFED) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the reference manual for mental health disorders published by the American Psychiatric Association (APA). A person with BED of low frequency and/or limited duration meets all the criteria of binge eating disorder, but their binge eating behaviors occur fewer than once a week (low frequency) or for fewer than three months (limited duration). (2) Like those with BED, they do not purge after a binge. (3)
Someone who has BED eats large amounts of food in a short period of time. Those with BED often feel a loss of control over their eating and extreme shame or anxiety about food.
Those with BED of low frequency and/or limited duration tend to feel the same emotions toward food as those who have BED, even on days when they don't experience binge eating behaviors. But the main difference between low frequency and/or limited duration BED and full BED is how often binge eating behaviors occur. Those with low frequency BED have binge eating episodes fewer than once a week and for a shorter span of time, usually fewer than three months in a row.
BED of low frequency and/or limited duration is one of several OSFEDs. This classification of eating disorders encompasses any eating disorder that does not fall into the complete criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder. Additional OSFEDs include atypical anorexia nervosa, bulimia nervosa, purging disorder, and night eating syndrome.
Signs and symptoms of BED of low frequency and/or limited duration
The signs and symptoms of BED of low frequency and/or limited duration are the same as full BED. But it may be more challenging to notice the warning signs that a person is struggling with an eating disorder, because the episodes occur less frequently and often in secret. Though they may vary, the signs and symptoms of this eating disorder tend to include:
- Eating high volumes of food in short amounts of time
- Feeling a loss of control over one's eating behaviors
- Eating when not hungry or when full
- Eating quickly during a binge episode
- Eating alone or secretly
- Feeling guilty or ashamed about eating
Effects of BED of low frequency and/or limited duration
Living with BED of low frequency and/or limited duration can cause a range of physical, mental, and emotional effects, including progressing into full BED.
Short-term effects of low frequency and/or limited BED can include:
- Generalized anxiety that may spike around food or eating
- Guilt around food or eating
- Social isolation
- Challenges in daily home, school, or work life
Long-term effects of low frequency and/or limited BED can include:
- Full BED
- Digestive troubles
- High cholesterol
- High blood pressure
Various psychiatric disorders tend to co-occur with low frequency and/or limited duration BED, including depression and anxiety. Those with low frequency and/or limited duration BED also have a higher risk of developing full BED. Those with full BED have a higher risk of heart disease, Type 2 diabetes, and gastroesophageal reflux disease.
Diagnosing BED of low frequency and/or limited duration
When diagnosing low frequency or limited duration BED, a medical professional will often suggest a comprehensive psychological evaluation to understand a person's emotions and thoughts around food and eating.
Treatment of low frequency and/or limited duration BED
Effective treatment of low frequency or limited duration BED generally includes a mix of therapies to manage the signs and symptoms of the eating disorder. It may include medication to treat co-occurring conditions, such as anxiety or depression. Each person's experience with low frequency or limited duration BED is different, and treatments will vary depending on each individual’s needs.
Psychotherapy, or talk therapy, is an excellent option for individuals with an eating disorder to learn more about their eating behaviors and tactics to change them. There are many psychotherapies available to those living with any form of BED, including low frequency and/or limited duration.
- Cognitive behavioral therapy (CBT): CBT aims to help individuals with eating disorders understand their thinking and eating behaviors, then learn ways to change those behaviors. Those with any form of BED learn about why they binge eat, how to adjust their relationship to food to build more consistent eating habits, and other ways to respond to challenges in life or difficult emotions.
- Interpersonal therapy (IPT): IPT focuses on building interpersonal skills and relationships with others. Often interpersonal relationships and conflicts can prompt, or trigger, an individual to turn to disordered eating patterns to cope. IPT helps identify those triggers and ways to respond to them without binge eating.
- Nutrition therapy: In nutrition therapy, a nutritionist helps individuals repair their relationships with food and eating. Individuals learn why certain foods or eating behaviors make them feel specific ways. They also learn the importance of nutrition and how to eat mindfully.
Doctors may prescribe some individuals with BED of low frequency and/or limited duration medication in combination with therapy to help manage symptoms of co-occurring disorders, such as depression and anxiety.
Understanding low frequency and/or limited duration BED
BED of low frequency or limited duration can develop in any gender, race, age, or ethnicity. It can also affect a person of any size. There is a misconception that binge eating only occurs in people of higher weights. But BED of low frequency and limited duration are seen among people of all different weights.
Full BED is more prevalent among athletes than the general population. (6) Part of this is because athletes face a lot of pressure to keep their bodies at specific sizes during competitions. After competitions, athletes may fall into limited duration BED as they indulge in food they previously restricted from themselves. Then they experience physical changes, guilt, anxiety, and depression. As they prepare for their next competition, they no longer experience binge eating behaviors for an extended period.
Living with low frequency and/or limited duration BED
A person living with low frequency and/or limited duration BED may experience many of the same signs and symptoms as a person with full BED. They're often trying to find a balanced relationship with food and eating. Someone with low frequency BED might have a string of days, weeks, or months where they're feeling good and eating in a way that makes sense to them. Then, they suddenly hit a low or stressful period in their lives and have a binge eating episode, which leaves them feeling ashamed, guilty, or depressed. Those feelings may only last for a few hours or a few days. But individuals tend to fall into a cycle of not binge eating for some time, then binge eating and feeling ashamed, then struggling to feel confident and comfortable again.
Someone with BED of limited duration and/or low frequency may even go years without signs or symptoms of an eating disorder. So it can be challenging for doctors–and even individuals with the condition–to understand they have an eating disorder. People with low frequency BED may view their binge eating as a "bad day" and not necessarily an eating disorder, since they do not binge eat most days.
History of BED of low frequency and/or limited duration
BED was first mentioned in the paper "Eating Patterns and Obesity" by psychiatrist Albert Stunkard in 1959. (5) In 1987, the American Psychiatric Association (APA) mentioned binge eating in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, at that time, binge eating was listed as a criterion of bulimia. It wasn't until 2013 that the APA revised the DSM to acknowledge BED as its own disorder. Today, the APA recognizes BED and BED of low frequency and/or limited duration as an other specified feeding or eating disorder, or OSFED.
How to help someone with BED of low frequency and/or limited duration
There's a misconception BED of low frequency and/or limited duration does not require treatment. While some individuals can heal from this eating disorder on their own, most need professional treatment.
It takes courage to seek treatment for an eating disorder. If you think you or a loved one may have an eating disorder, it’s important to seek help right away. All eating disorders can have serious, life threatening consequences. But recovery is possible with the right treatment. Call our team at Within Health today to learn about our virtual care programs for binge eating disorder.