Overview of Binge Eating Disorder

Binge Eating Disorder (BED) is a clinical diagnosis that was added to the feeding and eating disorders section of the DSM-5 (the main diagnostic manual for mental health care providers) in 2013. 

Here is how to recognize BED: 

Recurrent episodes of feeling out of control of eating a large amount of food in a specific period of time with at least three of these:

• Eating faster than usual 
• Eating until you feel uncomfortably full
• Eating large amounts of food when not feeling physically hungry
• Eating alone because you feel embarrassed by how much you are eating
• Afterward feeling disgusted with yourself, very guilty or depressed
• Distress regarding your eating behaviors is present
• Binge eating occurs at least 1x a week on average for 3 months
• Indications of other eating disorders are absent

Levels of severity:

Mild: 1-3 binge eating episodes per week

Moderate: 4-7 binge eating episodes per week

Severe: 8-13 binge eating episodes per week

Extreme: 14 or more binge eating episodes per week

There is much debate around disorders and diagnosis in the mental health field, yet there is power in common language and descriptions.

In knowing that your symptoms are not uniquely yours, you might breathe a sigh of relief. You are definitely not alone! Knowing that there are shared human struggles and cultural forces at work to elevate something to be defined as a disorder can help us see bigger problems in our world.

For BED to be officially recognized in 2013 was important, as it is the most prevalent eating disorder. When we have the research and clinical experience to clearly name a problem, we see the problems people struggle with are shared problems, and that perhaps there is not something uniquely flawed about individuals, but about their circumstances. Binge eating disorder often makes a whole lot of sense in the context of a person’s life. As much you want to the binge eating episodes to decrease, you can also begin to see the ways binge eating might have helped you get through life and/or been a logical response to not getting enough to eat. There is wisdom in all coping, even that which is labeled a disorder. 

How is Binge eating different from overeating?

Sometimes food tastes so good we continue eating past fullness. Or, sometimes are we are distracted and do not get the fullness signals from our body so might eat what feels like too much. There are many reasons why people eat more than they need or want at times.

Occasional overeating is a regular part of being a normal eater. To understand normal eating, here is the definition put forth by internationally recognized authority on eating and feeding Ellyn Satter, RD, MS, MSSW: 

Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it—not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life. In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.

Binge eating causes distress beyond annoyance with your eating habits.

• Strong emotions (especially intense feelings labeled as negative)

• Restrictive eating (traditional dieting, “cleansing”, “detoxing”, following eating “lifestyles”)

• Relationship stress

• Worries about body weight and/or shape

We know that eating disorders are complex and often no single cause is clear. The causes and risk factors can vary from person to person.

The Binge Eating Disorder Association offers these possible factors:

• Experiences of weight stigma, weight-related discrimination, or bullying
• Dieting/restrictive or irregular eating patterns
• History of significant weight changes
• Depression, anxiety, other mood disorders, including bi-polar disorder
• Problems with family or other significant relationships
• Significant trauma/loss experiences
• Emotional/physical abuse or neglect
• Substance Use Disorders
• Sexual trauma
• Genetics

 What types of treatments help with Binge Eating Disorder? 

Some of the most researched psychotherapeutic approaches to treating BED are:

• Cognitive behavioral therapy (CBT)
• Mindfulness based interventions including Dialectical Behavioral Therapy (DBT)
• Internal Family Systems Therapy (IFS)
• Psychodynamic Psychotherapy

Other psychotherapeutic approaches can also be beneficial. For example if someone has unidentified, or unworked through, past trauma and eating behaviors have helped them to manage their symptoms, engaging in any trauma-informed, trauma-focused treatment such as EMDR (eye movement desensitization reprocessing) may help the trauma-related symptoms subside and the disordered eating behaviors also decrease.

Psychotherapy can help people learn to be with difficult emotions related to their eating behaviors and making connections between their mind and body as well as addressing relationship patterns and cultural pressures that could be contributing. Psychotherapy can be one-on-one with a licensed professional and/or done in a group.

For some people, binge eating can be connected to difficulty with telling the difference between emotional upset and physical hunger. So any treatment that promotes an increase in awareness of mind, body and self can be beneficial to decreasing binge eating episodes.

Nourished Energy is a holistic psychotherapy practice dedicated to bringing together the mind, body and spirit. Nourished Energy is founded on the principles of Body Trust® and Intuitive Eating which are rooted in practices linked to decreasing binge eating episodes such as self-compassion, embodiment, mindfulness, decreasing internalized weight stigma, increased resilience, rejecting diet culture, naming harmful systems, and more. The 9 week Hungerwise™ group program offered through Nourished Energy is another layer of group support that can be helpful to those healing from BED. 

In addition to psychotherapy, those with BED may also work with a Registered Dietitian who specializes in eating disorders, as well as a medical doctor and other types of practitioners. For some, inpatient treatment may be the best option.

Severity and the other existing issues faced by those seeking support determine the best treatment approaches. 

is weight management part of treatment for BED? 

No. Focusing on weight loss is contraindicated, or warned against, for those with BED.

According to the American Psychiatric Association, BED is more common among people seeking weight-loss help so moving the focus away from weight loss, can be a key part of the treatment. Keeping a focus on weight loss can keep people in the cycle of food restriction and binge eating.

There is a lack of long-term effective treatments for weight loss, yet there ARE effective treatments for BED. We can let the focus on weight loss go. People can recover from, or decrease the symptoms of BED and may not lose weight. This can bring up questions and concerns to work through with a trusted professional. Taking the time to work through your questions and concerns can be a main component of healing.

“In today’s weight obsessed culture, people with BED often assume recovery is synonymous with weight loss, and treatment recommendations are made in support of that erroneous goal. This ‘treatment’ is often promoted by well-intentioned friends, family, and professionals, but with binge eating, dieting is a causal factor in the development of BED. So it’s essential for treatment professionals to provide alternatives to dieting, and for improving health and body image. In fact, weight loss as a goal of treatment – as opposed to goals of improved self-care – can be damaging to the process of recovery.” Binge Eating Disorder Association

Research has helped solidify what we know, that BED is complex. It is influenced by biological and psycho-social factors. Some of the stigma around BED is due to a lack of awareness surrounding these complexities and understanding it is not something as simple as “choosing to overeat”.

People do not choose to have cancer or diabetes, and people do not choose to have binge eating disorder. Research supports this.

It is also important to note what we know from the research on any eating disorder, that sociocultural and sociopolitical influences play a part in the development for many, especially those with intersecting identities. Though eating disorders are manifested on the individual level, the trajectory of their development should not be placed squarely on the shoulders of individuals. We live in a culture with many inequalities and discrimination which places exorbitant stress on the ways people eat and how bodies look. This matters.

The correlation between trauma and binge eating has long been suggested, but only recently have studies started to examine the connection. New studies have revealed high percentages of post-traumatic stress disorder among people with eating disorders. A study in the International Journal of Eating Disorders revealed the majority of surveyed adults with eating disorders reported a history of interpersonal trauma.

Types of interpersonal trauma can include

• domestic violence
• sexual assault
• child abuse
• sexual abuse or exploitation
• financial abuse or exploitation
• person on person crimes such as a robbery or a physical assault.

There is undoubtedly more to learn and uncover about BED. Moving forward, we need to continue to take into account both what the research tells us and the lived experiences of those who are suffering.

What does someone suffering from bed look like? 

 Not any single way. BED does not discriminate, and anyone can develop BED. Some of the possible causes and common triggers have been named here, though there will certainly be additional causes and triggers depending on a person’s situation.

“Eating disorders have historically been associated with straight, young, white females, but in reality, they affect people from all demographics and they are not caused by any single factor. They arise from a combination of long-standing behavioral, biological, emotional, psychological, interpersonal, and social factors.” National Eating Disorders Association

• BED is a serious condition, most often requiring professional treatment.
• Anyone of any body size can struggle with BED, in fact there are plenty of people at the higher end of the weight spectrum that do not struggle with BED. 
• Weight loss is not a goal in the ethical treatment of BED, and believing that it should be a goal can make things worse, not better.
• Like any mental health concern, this is not a choice, those suffering cannot just stop suffering and expecting them to do so is unfair. This is not about willpower.
• Do not assume weight loss will be an outcome of effective treatment.

Final Words 

Even if you do not fit the criteria for BED or another eating disorder, yet your relationship to food, eating and your body is causing you distress…you are worthy of help. 

Learn more about the approaches I take and the training I have to help people heal. 

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