What is Binge-Eating Disorder (BED) or Compulsive Overeating?
Binge-eating disorder (BED) or compulsive overeating is the
lesser-known eating disorder, following anorexia nervosa
and bulimia nervosa. It is characterized by eating when one
is not hungry or by continual eating without regard to
physiological cues. Binge eaters typically eat to the
point of feeling extreme discomfort or even pain. I have
worked with people whose bingeing behaviors are so severe
as to be experienced as a form of self-mutilation; one 33
year old patient of mine describes eating so much food at a
sitting that her skin hurts from being stretched. The
patient will typically report frequent episodes of binge
eating, with an inability to stop or to control the
behavior. One in five young women today report this
experience with food. Forty percent of binge-eating
disorders occur in men and boys.
- Deprivation-sensitive binge eating arises out of excessive dieting or food restriction;
- Addictive or dissociative binge eating is the practice
of self-medicating or self-soothing with behaviors that
typically evoke feelings of emotional tranquility or
numbness.
It is important to understand that not all people with
binge-eating disorder are overweight, that not all
overeaters are binge eaters, and that being overweight,
even to the point of obesity, does not qualify a person as
a binge eater.
The behaviors involved with binge eating are
compulsive in nature, and typically signify a sense of
inflexibility and excess, not only in the area of food
consumption, but also in other life spheres as well. At
times, and under certain circumstances, we all eat too
much, too fast and too often. yet, we are not all binge
eaters. Excessive behaviors do not qualify as binges
unless their function is to reduce or contain anxiety
(resolving emotional problems,) and they are experienced as
frequent, unavoidable, and beyond the control of the person
bingeing.
In some respects, binge eating disorder differs from anorexia and
bulimia
Typically experiencing an obsessive preoccupation with body
image, individuals with BED do not seek to avoid weight
gain through purging or other drastic measures. They tend
to exhibit less extensive levels of psychopathology and
show strong motivation to desist from these behaviors,
which can be tenacious and recurring. Because these aspects
of BED differ from those of other eating disorders, this
disease is mistakenly considered to be less serious and/or
not as deserving of intensive treatment. In many
instances, this disorder goes undiagnosed. A highly
functional and thin BED patient of mine has complained that
no one gives credence to the extent of her psychological
suffering, depression and self-loathing after a binge.
People say, "You're thin! You don't purge. What are you
complaining about?!" "Nobody seems to care that the next
day I am so depressed, I can't even get myself out of bed!"
It is significant to note that not all binges include large
quantities of food. For an anorexic person, eating five
grapes may be considered a binge. Remember what
characterizes an eating disordered binge is the element of
compulsion behind the eating behavior and the emotional
outcome that occurs as a result of the eating behavior.
The Experience of the Binge Eater
Binge eaters report a total preoccupation with food. One
of the problems that frequently occur with binge eaters is
nighttime eating. Patients describe getting out of bed in
the wee hours and walking in their sleep or in a
trance-like state into the kitchen where the bingeing
happens. Binge eaters sometimes do not know if their binge
was a dream or a reality until the next morning when
evidence of food wrappers and empty containers will appear
in the kitchen. Bingers often do their eating in secret,
and typically feel most vulnerable to succumbing to these
behaviors when they are alone. Patients describe eating in
their car, sometimes en route to and from work or errands,
where they feel compelled to drive into franchise
restaurants, such as Dunkin Donuts, Taco Bell, or Wendy's
and load up on food at each place. They describe having
persuasive internal conversations with themselves in an
effort to resist the temptation, but then report the all-
powerful trance-like compulsion taking over.
In most instances, once the bingeing process has begun,
patients report that it is virtually impossible for them to
regain the upper hand, stopping or even slowing down the
bingeing ritual. Because of the nature of this disease,
blood sugar levels are highly volatile, spiking and
dropping, a situation that adversely affects the brain and
results in chronic and severe fatigue.
Treating Binge Eating Disorders
Because many of the underlying issues of the binge eater
tend to be similar to those driving anorexia and bulimia,
the same treatment techniques apply. Cognitive-behavioral,
psychodynamic treatment with a family systems focus and in
the context of a secure treatment relationship is most
beneficial. Typically, the elements that drive these
disorders include brain and body chemistry, physiology,
unhealthy eating and other behavioral patterns, emotions,
and sociability issues. All of these factors need to be
addressed simultaneously in order to attain optimal
treatment results. As with the other eating disorders, if
victims of BED attempt to cease the dysfunctional eating
behaviors without simultaneously attending to the emotional
or relational issues underlying and driving them, their
efforts will invariably result in failure.
In my own practice, I have observed that binge eaters
benefit greatly from working together with others who share
similar problems in the context of support/therapy groups.
It is invaluable for people who tend to isolate themselves
and hide their behaviors to share their feelings with
others; in addition, group members are able to offer each
other helpful and practical ideas and inspiration for
making behavioral changes, increasing motivation and
accountability.
Some behavioral remedies for binge eating disorder
Along with psychotherapy, behavioral techniques that allow
the individual to avoid temptations are generally
effective. Behavioral techniques might include such
changes as,
- If bingeing occurs in the car, taking a
different route home where the patient will not be
confronted with the temptation of fast food restaurant
chains.
- Keeping a small cooler in one's car containing
one's own nutritionally dense food, prepared and
pre-packaged.
- Bringing a passenger along for the ride.
- Wearing an elastic band on one's wrist and snapping it
hard to remind oneself not to begin the out of control
bingeing process when the urges and temptations present
themselves.
- A solution for home bingers might be not
to bring unhealthy snack or trigger foods home, though for
those who live with family members who like their snacks,
eliminating snack foods from the pantry is an idea that is
typically does not go over well. This may need to become a
family decision made in the context of consensus,
compromise, and an action plan.
Binge eaters who have a genetic propensity tendency towards
addiction often report a craving and sensitivity to
carbohydrates, so that the more they eat, the more they
crave. There are some who claim that eliminating sugar
from the diet can be an integral part of reducing binge
eating episodes. This is a concept that is espoused by the
Overeaters Anonymous 12 Step groups and is a treatment
method that is very helpful for a great number of binge
eaters. The problem that some people run into in using
this alternative for healing is that restriction generally
breeds greater obsessiveness and compulsions.
(Some of this information appeared in the first
chapter of my book,
When Your Child Has an Eating Disorder:
A Step-by-Step Workbook for Parents and Other Caregivers,
Jossey Bass Publishers, 1999.)
Psychotherapist Abigail H. Natenshon has specialized in the treatment of eating disorders with individuals, families, and groups for the past 31years. She is the author of When Your Child Has An Eating Disorder, A Step-by-Step Workbook For Parents And Other Caregivers, Jossey-Bass, 1999. Based on hundreds of successful outcomes, this book shepherds concerned parents step-by-step through the processes of eating disorder recognition, confronting the child, finding the most effective treatment for patient and family, and evaluating and insuring a timely recovery. A guide to eating disorder prevention, this book is useful to parents, health professionals and school personnel alike in countering the pervasive epidemic of unhealthy eating and body image concerns, and destructive media and peer influences. Her work can be reviewed further at www.empoweredparents.com and www.empoweredkidZ.com,
www.treatingeatingdisorders.com.
