Binge Eating Disorder
What is binge eating disorder?
It's a behavioral disorder characterized -- as the name suggests -- by episodes of uncontrollable eating. If you have binge eating disorder (BED), you consume unusually large amounts of food at a single sitting -- probably in secret and until you're uncomfortably full. (This eating disorder is similar to bulimia, but people with BED don't try to compensate for their binges by purging the food; that is, they don't try to get rid of it through vomiting or taking laxatives.) You may feel overwhelmed by shame and embarrassment about both your weight (whether you're overweight or not) and your eating patterns. Most people diagnosed with BED are overweight or obese (obesity is defined as being more than 20 percent over a normal weight for their size), but the disorder also appears in people of normal weight.
Binge eating disorder first appeared in medical textbooks in 1992. Before this official diagnosis, people with the problem were called compulsive eaters or just plain "food addicts." A national survey recently found that 3.5 percent of women and 2 percent of men suffer from binge eating disorder at some point in their lives. It's also estimated that between 10 and 15 percent of people trying to lose weight on their own or following commercial weight-loss programs have the disorder. Binge eaters tend to be older than people with anorexia and bulimia, and slightly more women than men suffer from it.
What causes binge eating disorder?
While no one knows exactly what sets off any eating disorder, experts agree that people who suffer from BED consume food as an unhealthy way of coping with strong feelings, such as sadness and anger, or psychological problems such as depression and anxiety.
Some experts believe that conventional dieting can actually cause or worsen BED because so many people develop a craving for forbidden foods; they ultimately fall off their weight-loss plans and "pig out" on the coveted items. According to therapists at the National Center for Overcoming Overeating, conventional diets create a yo-yo cycle of deprivation and satiation, which ultimately leaves a person unable to tell whether she's genuinely hungry or eating for emotional reasons.
Depression also seems to be closely linked to BED. One recent study found that overall 25 percent of obese people have some sort of mood disorder -- and up to 44 percent if they are educated and white. About half of all obese binge eaters have been or are depressed, while only 5 percent of obese people who don't binge are diagnosed with depression.
Many people with eating disorders were sexually, physically, or emotionally abused as children. Recent studies, however, have shown that women with eating disorders are no more likely to have been abused than other women who are depressed or anxious.
What are the symptoms of BED?
Almost everyone overeats occasionally. But if you suffer from binge eating disorder, you'll consistently have some or all of the following symptoms:
- Eating binges
- Eating when you're not physically hungry
- Frequent dieting
- Feeling you can't voluntarily stop eating
- Awareness that your eating patterns aren't normal
- Weight fluctuations
- Depressed mood
- Feelings of shame
- Antisocial behavior
How is BED diagnosed?
To be diagnosed with BED, you must have binged at least two days a week for six months. (A binge is defined simply as uncontrolled eating of more than an average person would consume under similar circumstances.) BED binges are accompanied by a large degree of anger toward oneself, shame, and frustration.
What should I do if I someone I know seems to have BED?
Confronting someone about this problem can be tricky, especially since she may deny it and feel extremely ashamed that you've discovered her secret.
First, say experts, pick a good time to talk to your loved one, when the two of you are alone and there are no distractions. As nonjudgmentally as you can, tell her that you're concerned and you'd like her to get help. Without going into humiliating detail, cite specific examples of her behavior that illustrate the problem; for instance, you might say, "I notice you've been eating a lot in your room and don't seem to be feeling very social anymore."
Be careful not to get into an argument. Avoid making comments (positive or negative) about weight gain or loss; even assurances that "you look fine" can reinforce the disorder.
If she steadfastly denies having BED, stay supportive and make it clear you're still concerned. Offer to make appointments with counselors and to find out about support groups in her area.
If you think your child has BED, set up an appointment with her doctor for a thorough physical and ask the doctor to talk to her about the behavior you've observed. You can get a referral to a mental health professional if the doctor thinks your child is at risk.
Finally, don't forget to take care of yourself. This disorder can be hard on family and friends. Look into joining a support group where you can talk about your worry and frustration.
What are the treatment options?
Many people with BED are treated with conventional weight-loss programs. Unfortunately, these regimens seldom address the problem of bingeing. Newer treatment plans that have proven more effective include cognitive-behavioral therapy, psychotherapy, antidepressant medication, or some combination of these. Cognitive-behavioral therapy can teach you techniques to change your eating habits and the way you react to stress, depression, or intense emotions (that is, through bingeing). Psychotherapy can help you explore past traumas or stresses that have led to the disorder.
Some specialists say the key is swearing off conventional diets, which, they believe, foster the yo-yo cycle of dieting and bingeing. This approach, advocated by the National Center for Overcoming Overeating, holds that compulsive eaters need to give themselves permission to eat anything they want in order to end their obsession with "forbidden foods" and learn to eat in response to physical (not emotional) hunger.
"Compulsive eating may seem self-destructive, but it is always an attempt at self-help," says the NCOO. The group's goal "is to replace self-reproach and body hatred with self-care and self-acceptance."
One program known as The Solution, which is available at more than 100 hospitals nationwide, tries to get at the root of BED by teaching sufferers to fulfill their emotional needs in ways besides eating. In group sessions led by trained instructors, people learn to identify their feelings of anger, sadness, anxiety, and so on, and then to comfort themselves without turning to food. If someone tends to binge when she gets home from a stressful day at the office, for example, she could instead schedule a long walk or a massage after work as a special treat. When people learn to nurture themselves in healthful ways when they feel sad or afraid, the drive to overeat is turned off, says Laurel Mellin, the San Francisco Bay Area dietitian and professor who created The Solution. The program has reportedly helped many people stop bingeing and lose weight.
What might happen if BED isn't treated?
The main physical consequences of BED are the same as those for obesity: high blood pressure, high cholesterol, gallbladder disease, diabetes, heart disease, and diet-linked cancers. The psychological consequences may include low self-esteem, body hatred, and an unhealthy focus on food that leaves less time or energy for more important pursuits.
The National Association of Anorexia Nervosa and Associated Disorders, P.O. Box 640, Naperville, IL 60566, will mail you information as well as refer you to experts and support groups in your area. Web site: http://www.anad.org/
The National Eating Disorders Association can also mail information and refer callers to experts and support groups in their area.
The National Center for Overcoming Overeating, P.O. Box 1257, Old Chelsea Station, New York, NY 10113; (212) 875-0442, provides information on its approach to BED and can refer you to therapists and support groups in your area. Web site: http://www.overcomingovereating.com
National Institute of Diabetes and Digestive and Kidney Diseases. Binge Eating Disorders. http://www.niddk.nih.gov/health/nutrit/pubs/binge.htm
Weight-control Information Network. Binge eating disorder. June 2010. http://win.niddk.nih.gov/publications/binge.htm
Center for Health Studies. Group Health study finds significant link between obesity and depression. http://www.centerforhealthstudies.org/news/2006/060703.html
Mayo Clinic. Binge-eating disorder. http://www.mayoclinic.com/health/binge-eating-disorder/DS00608
American Psychiatric Association. Diagnostic Criteria, DSM-5. 2014.
Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 61 (3).
American Psychological Association. Binge-eating disorder: what's the best treatment? http://www.apa.org/monitor/mar02/binge.html