A Review of this Pervasive but Less Familiar Eating Disorder
Eating disorders are an insidious, complicated, treatment-resistant set of diseases. Unfortunately, most of us are familiar with the most commonly known eating disorders-anorexia nervosa and bulimia nervosa. The former is diagnosed when a patient weighs 85% less than their ideal body weight. This state is self-imposed and is the result of an individual purposely starving oneself in an effort to lose weight. The latter, bulimia nervosa, is diagnosed when a person engages in repeated bingeing and purging behavior also in an effort to lose or maintain body weight. In this context, bingeing behavior is comprised of an individual consuming an exceedingly large quantity of food and then purging it from the body in some fashion. Typically, the purging of the food occurs by self-imposed vomiting. However, other methods of “purging” the food can also include excessive exercising and diuretics. Another ubiquitous eating disorder-based condition is of course, obesity. Obesity is a label for ranges of weight that are greater than what is generally considered healthy for a given height and is typically a result of consistently unhealthy eating. While these diseases are complex and multi-layered, they are at least a known quantity.
However, there is another kind of eating disorder that is not such a known quantity. And, this disorder is likely as destructive and as common as the aforementioned conditions. It is called Binge Eating Disorder (BED). BED has recently been recognized as a separate category in the eating disorder community. In fact, some experts believe it is the most pervasive of all the eating disorders, impacting millions of Americans each year. BED is similar to bulimia nervosa in that large quantities of food are consumed on a regular basis. What is dissimilar and notable is that those with BED do not engage in compensatory behavior (purging, excessive exercising, extreme dieting, diuretics) in the wake of the binge. What makes it distinct from obesity is that the person’s behavior occurs in episodes rather than on a continuous basis so the person suffering with BED typically does not qualify for an obese or severely overweight diagnosis.
So why is this a problem? Perhaps, upon first blush, it seems like normal behavior. Sometimes a person overeats. Don’t we all? However, this condition is much different than an extra dessert at dinner or two orders of bacon at breakfast. With BED, the bingeing behavior becomes a systematic, all consuming way of life. It becomes an addiction. The individual spends most of their time thinking about the binge--when it will happen, what they will eat, and where they will do it. Often their whole day, each day, is psychologically and logistically planned around the above details of the binge. The binge itself has a frenetic and secretive feel to it. Usually the individual engages in the binge in private and attempts to keep others from knowing they are participating in this kind of behavior. During the binge, the individual eats an inordinate amount of food, typically in a very rapid (frenetic) manner. Most people with BED report feeling a “high” during the binge portion of this process. They feel a sense of escape, relief, satiation and comfort. However, once the binge is over, there is another set of rituals and emotions associated with this disease. The person naturally feels physically uncomfortable but also, invariably, feels psychologically distraught. Most BED sufferers report feeling anxious, depressed, guilty, shameful and disgusting after engaging in a binge. As a result, they spend a lot of time post-binge beating themselves up for the behavior and vowing never to do it again. Then when they do repeat the behavior, they feel even more terrible for not being “strong” enough to interrupt this pattern. This initiates a cycle of addiction marked my guilt and shame for repeatedly engaging in the behavior, despite the negative consequences. Paradoxically, it is these very feelings that contribute to the addict continuing to turn towards the behavior again and again in order to escape these unbearable emotions. And so it goes… a painful cycle of addiction. At this level, BED can become a consuming, destructive condition that interrupts one’s ability to thrive in relationships, at work, and in the world.
So why does this happen? What causes someone to engage in this kind of behavior and develop a full-blown eating disorder? This is the part of BED that does NOT differ from the other eating disorders. Most eating disorders are related to psychic pain that has not been properly resolved, addressed or processed. Eating disorders are not really about food. Sure, the day-to-day behavior is ALL about food, but the underneath is about psychological pain. Like any addiction, most people use eating disorders as a way to escape painful feelings or experiences. These painful feelings can be associated with past trauma, present conflicts or both. Eating disorders serve much like a drug or alcohol. They take you out of life. Life is instead consumed with thoughts about eating in the future, actual eating, and guilt about past eating. This allows a person to entirely escape deeply rooted anxiety, depression or trauma and instead focus on food. As the eating disorder gets more deeply entrenched, a person gets further away from having the life that they want as they tend to be isolative and disengaged from many aspects of their very existence.
BED is a painful, consuming disorder that requires professional intervention. Typically, a multi disciplinary approach is the most successful with a team comprised of experts that at least includes a therapist specializing in eating disorders, a psychiatrist, and a nutritionist. All eating disorders are resistant to treatment, much like any addiction. However, it is entirely possible to fully recover from BED and all eating disorders with the proper professional guidance. All that is required to begin the process of healing is hard work and a commitment and a desire to get well.
If you or anyone you care about is suffering from BED or any eating disorder, please reach out for professional assistance. The first contact should be to a therapist specializing in eating disorders (referral can be found on the internet via various eating disorder referral sites or by searching therapists by specialty) and to a primary care physician. All individuals suffering from eating disorders should be closely monitored by a physician due to the potential negative impact an eating disorder can have on one’s physical health.
Eating disorders are a complex, confounding set of diseases. It is critical that more people become familiar with this relatively new condition, BED, so more people suffering with this complicated condition can identify the symptoms and seek treatment.
Dr. Hillary Goldsher, Psy.D, MBA-an expert in eating disorders- is a licensed clinical psychologist who has a private practice in Beverly Hills, CA. For additional questions, please contact Dr. Hillary Goldsher at www.drhillarygoldsher.com
Symptoms of BED:
Diagnostic Criteria: DSM-IV
A. Recurrent episodes of binge eating. An episode is characterized by:
1. Eating a larger amount of food than normal during a short period of time (within any two hour period)
2. Lack of control over eating during the binge episode (i.e. the feeling that one cannot stop eating).
B. Binge eating episodes are associated with three or more of the following:
1. Eating until feeling uncomfortably full
2. Eating large amounts of food when not physically hungry
3. Eating much more rapidly than normal
4. Eating alone because you are embarrassed by how much you're eating
5. Feeling disgusted, depressed, or guilty after overeating
C. Marked distress regarding binge eating is present
D. Binge eating occurs, on average, at least 2 days a week for six months
E. The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
*From the DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Washington D.C.: American Psychiatric Association, 1994.