Dr. Angela Hanford
- Maddy is 16 years old who has many friends and a loving family. School has always come easily to Maddy. She is also active in sports and in her church’s youth group. However, she struggles to express herself emotionally and therefore, ends up struggling with her insecurities and sadness by herself.
At the end of the day, when everyone else is asleep, she finds herself drawn to the kitchen. She relaxes from the day’s stressors by eating all that she can get her hands on, be it ice cream or cookies or chips. She also has a stash of snacks in her bedroom, just in case she needs them.
Maddy initially experiences a feeling of relief when she eats (although she does not enjoy the feeling of being out of control) but then shame arises when she realizes how much she has eaten. She promises herself that this will be the last time, however, the cycle happens again as she becomes stressed or feels sad and needs an outlet. Maddy does not know where to go to for help or whether anyone can understand her struggle.
Brandon is thirteen and is known by others as a nice boy and the class clown. He has friends but also fears that his peers will not like him. In fact, this is why he makes jokes so frequently. Food to him is a way to feel happy, whether he is bored or sad or stressed or angry.
He did not realize this connection to his feelings until he started therapy. Prior to therapy he simply knew that he was always drawn to food and often felt out of control when he had access to food. He has felt a lot of shame toward his eating, as his parents make remarks about his eating habits. He has also been bullied by some of his peers due to his weight. Therapy is helping Brandon to notice and express what he is feeling, along with developing new skills for coping with his emotions.
Tamera is a 35 year-old female who has struggled with body image and self-esteem for most of her life. She was bullied as a child and developed a fear of trusting others with who she really is on the inside. Others see her as competent, but somewhat isolated. Her job is stressful, working in the fast paced world of stocks.
The two ways that she has found to relieve stress are alcohol and food. Whether it’s eating too much too quickly or having too many drinks, she later regrets her actions and promises to make changes. However, she is lonely and does not have other means of coping with her array of feelings. She has long thought about therapy but is scared because it means opening up all of those years of pain.
The idea of an “emotional eater” or eating as a way to cope is not a foreign concept to most people. However, Binge Eating Disorder (BED) is distinct from someone who eats for emotional reasons or even compulsively overeats, since neither one of these states necessarily constitutes a binge.
In terms of prevalence of BED, the American Psychiatric Association (2013) stated that for adults in the United States, the prevalence for BED in a year is 1.6% for females and 0.8% for males. Furthermore, although Binge Eating Disorder can begin in adulthood, it appears that BED often begins during the adolescent or young adult years (American Psychiatric Association, 2013).
It should be noted that, although there is an association between BED and obesity, most people who are obese do not meet criteria for BED (American Psychiatric Association, 2013). In fact, BED can occur in individuals of normal weight as well as those who are overweight or obese.
What is Binge Eating Disorder?
Binge Eating Disorder was added to the American Psychiatric Association’s most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) in 2013. Prior to this edition, BED was considered a category that needed further study, despite being recognized by many professionals for many years.
In order for BED to be diagnosed certain criteria must be met, such as:
- An individual must engage in recurring episodes of binge eating.
- A binge is defined as having at least three out of the following five characteristics:
- Eating much quicker than normal
- Continuing to eat until uncomfortably full
- Eating a lot of food despite not feeling hungry
- Solitary eating due to feeling embarrassed by the size of portions
- Feeling guilty, depressed, or very upset with oneself after engaging in binge behavior
- The individual who binges must also feel a significant amount of distress about the binge eating.
Unlike those who meet the criteria for bulimia nervosa, someone with BED does not frequently engage in compensatory behaviors aimed at preventing weight gain.
A binge is most often preceded by negative emotions, but also may be triggered by other stressors (American Psychiatric Association, 2013). Therefore, it is often thought that eating is used as a way to cope with negative emotions and/or stressor.
As previously noted, food is typically eaten at a faster than normal rate and without much mindfulness about what is being consumed. The individual may experience eating as an escape or relief from the emotion and/or stressor.
However, shame is often a component of BED, since people with BED typically feel intense shame regarding their eating and, therefore, attempt to hide their eating disorder behavior. This can then increase isolation and feelings of negative emotions, leading to a cyclical pattern of behavior.
Other Common Diagnoses
People who have BED often also meet criteria for other diagnoses. For example, common diagnoses that occur with BED are depressive disorders, anxiety disorders, and bipolar disorders (American Psychiatric Association, 2013). Substance use disorders may also co-occur with BED. Therefore, a trained professional will not only assess for symptoms of BED but also any additional diagnoses.
Binge eating disorder is serious since medical complications can occur. Several possible complications include obesity, high blood pressure, heart disease, type 2 diabetes, osteoarthritis, muscle, and joint pain, and gastrointestinal problems (BEDA, 2016). Therefore, it is important to include a medical evaluation as part of BED assessment.
Risk Factors for Binge Eating DisorderRisk factors are characteristics that are associated with a specific area and not necessarily causal in nature. As with any eating disorder, BED likely develops due to a combination of many different factors.
The following are risk factors that have been associated with BED (American Psychiatric Association, 2013; BEDA, 2016); Eating Disorder Hope, 2018). However, having a risk factor does not necessarily equate to developing BED.
- Genetic/Physiological: BED tends to be present in families. However, it is important to note that family dynamics are not necessarily causal or even a sole cause for someone developing an eating disorder, including BED (Grange, Lock, Loeb, & Nicholls, 2010).
- Dieting, which may occur after BED symptoms or prior to onset.
- History of significant weight changes
- Obesity (this factor may predate the onset of BED or be a consequence)
- Low self-esteem
- Difficulty expressing and coping with emotions
- Dissatisfaction with one’s body
- Other psychiatric disorder (e.g., depression, bipolar disorder, anxiety, substance use)
- Bullying or any type of weight discrimination
- Trauma (sexual, emotional, physical, neglect)
- Significant loss (e.g., the death of a loved one, a breakup)
BED Warning Signs
As a reminder, weight is not necessarily an indicator of Binge Eating Disorder, since BED can occur in normal-weight individuals. Furthermore, most people who are obese do not meet criteria for BED.
Many times, due to the shame involved, individuals struggling with BED attempt to hide their binge behaviors. Never the less, there are signs that may indicate someone (or yourself) is struggling with BED (Eating Disorder Hope, 2018, LEDP, 2018, NEDA, 2018). As with risk factors, someone who displays one or more of these signs does not necessarily have BED.
- Difficulty eating in front of others and/or a tendency to eat alone
- Obsession with food and/or planning of binges
- Rapidly eating, with a feeling of not being in control
- Constantly feeling bloated or constipated
- Continuing to eat even after fullness is achieved
- Hoarding food, large amounts of food disappearing, or finding many empty food wrappers
- Increased isolation and/or withdrawal from relationships and activities
- Frequently starting new diets or skipping meals or odd mealtime behaviors
- Weight fluctuation
- Fixation on body weight and/or shape
- Gastrointestinal problems
Treatment for Binge Eating Disorder
If you or someone you love displays symptoms of BED, it is important to have an evaluation by someone knowledgable in this area. Since BED can include medical complication, an evaluation by both a physician and a therapist is important.
A dietitian is also an important component of treatment, as dietitians can help someone with BED understand his or her body’s nutritional needs and aid in developing a healthy relationship with food. A psychiatric evaluation may also be recommended in order to determine if medication may be beneficial for treatment.
If it is determined that BED is present, there are a variety of psychological treatments that may be helpful. For example, the American Psychiatric Association (2010) has recommended the following treatment strategies: cognitive behavioral therapy, dialectical behavior therapy, and interpersonal psychotherapy.
- Cognitive Behavior Therapy (CBT): CBT helps individuals to understand the relationship between thoughts, feelings, and behaviors (e.g., binging) and to develop strategies to change negative patterns.
- Dialectical Behavioral Therapy (DBT): DBT has a focus on teaching skills to cope with emotions and to develop the capacity to regulate emotions. This is a type of therapy that includes both group and individual components.
- Interpersonal Psychotherapy (IP): IP helps people explore relationships (e.g., conflict, loss) and how they view themselves, along with other components that may underly the eating disorder behaviors.
There are additional types of treatment that may be recommended depending on your particular needs (e.g., trauma work). An experienced therapist can help direct you to the treatment approach that is right for you. Living with BED can be overwhelming and feel hopeless. However, there is always hope! If you are ready to start your journey toward recovery and healing, reach out today!
Binge Eating Disorder Association – https://bedaonline.com
National Eating Disorders Association: https://www.nationaleatingdisorders.org
American Psychiatric Association (2010). Practice Guidelines for the treatment of patients with eating disorders third edition. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/eatingdisorders.pdf. Retrieved on 10/27/18
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Binge Eating Disorder Association (BEDA) (2016). Binge eating disorder causes and risk factors. https://bedaonline.com/understanding-binge-eating-disorder/binge-eating-disorder-causes/. Retrieved on 10/25/18
Binge Eating Disorder Association (BEDA) (2016). Binge eating disorder complications. https://bedaonline.com/understanding-binge-eating-disorder/binge-eating-disorder-complications/. Retrieved on 10/26/18.
Eating Disorder Hope (2018). Being an eating disorder: Causes, symptoms, signs & treatment. https://www.eatingdisorderhope.com/information/binge-eating-disorder. Retrieved on 10/26/18.
Grange, D.L., Lock, J., Loeb, K, & Nicholls, D. (2010). Academy for eating disorders position paper: The role of the family in eating disorders. International Journal of eating disorders. January; 43: 1-5.
Laureate Eating Disorder Program (LEDP) (2018). Binge Eating Warning Signs. https://www.saintfrancis.com/laureate-psychiatric-clinic/eatingdisorders/pages/about-eating-disorders/binge%20eating/binge-eating-warning-signs.aspx. Retrieved on 10/26/18.
National Eating Disorder Association (NEDA) (2018). Binge Eating disorderhttps://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed. Retrieved on 10/26/18
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