What is Binge Eating Disorder?
Binge eating disorder (BED) is an eating disorder which is characterised by regular bouts of overeating where the individual feels out of control and powerless to stop, even though they may be full or might not have been hungry to start with.
We all overeat on occasion. Perhaps we go overboard when on holidays, or during the festive season. Perhaps we overindulge with friends at the restaurant. Overeating is fine. At worst, it leaves us feeling a little bloated but, for most of us, life will go on unimpeded. Excessive overeating – that is, overeating week in and week out – is another thing entirely. In fact, it is a recognised disorder, appearing in the Diagnostic Statistics Manual as Binge Eating Disorder.
As the name suggests, binge eating disorder is characterised by episodes of binge eating or overeating. As common amongst men as it is amongst women, binge eating disorder is thought to be more common than other eating disorders including anorexia and bulimia.
Signs and Symptoms of Binge Eating Disorder
The full list of criteria for binge eating disorder can be found here, but the criteria include:
- Lack of control over eating.
- Binge eating episodes are associated with three (or more) of the following:
- Eating quicker than normal
- Eating until uncomfortably full
- Eating large amounts when not physically hungry
- Eating alone because of embarrassment
- Feeling disgusted with oneself, depressed, or guilty after overeating
- Marked distress regarding binge eating.
- Absence of regular compensatory behaviours (such as purging, fasting, or excessive exercise).
- It ranges from mild (1 to 3 episodes per week) to extreme (14 or more episodes per week).
What does Binge Eating Disorder look like?
Someone with binge eating disorder eats portions of food considerably larger than the norm, a diet often consisting of food that is fattening and high in calories. However, because they eat their food so quickly, it is seldom really tasted or enjoyed. After bingeing, because of how much they have eaten, they experience intense feelings of shame or self-loathing. Despite this, their compulsion is such that – the next time they consider overeating – they cannot resist the urge.
Unlike the person with bulimia, who purges after bingeing, the person with BED does not immediately compensate for their overeating. The person with binge eating disorder can hide the precise cause of their issue, often binges in secret, and maintains the appearance of ‘normal’ eating in front of others.
Sometimes, the person with binge eating disorder engages in compensation by restricting food intake. However, this can result in further binge eating.
Binge eating can have an impact on someone’s self-esteem and can also be linked to depression, which can result in further episodes of overeating. Eventually, the person with binge eating disorder can become trapped in a cycle of bingeing, restricting, and self-recrimination.
What are the causes of Binge Eating Disorder?
The causes of binge eating disorder can be unique to the individual. Several factors may be involved, including the individuals’ genetic make-up, their body image, social experiences, and family health history. There is often a cross diagnosis with other mental health issues, such as PTSD, anxiety, or impulsive behaviour; for example, compulsive shopping. In addition, binge eaters suffer from high rates of depression. It is not yet known whether binge eating causes depression, or whether depression causes binge eating.
While the causes of binge eating disorder can be individual, there are also some generalised theories. These include:
Restraining food intake takes considerable cognitive effort. In addition – because the body is in starvation mode – the binge eater experiences strong cravings. These may be so intense that they disrupt her cognitive effort. Other negative emotions, if they intrude, can have a similar disruptive effect. Were such disruption to result in a lapse in her diet, the binge eater often finds herself back at square one.
Counter-intuitively, treatment in this model includes giving up dieting. Instead, it addresses the underlying issues. The assumption is that, by resolving these underlying issues, normal eating habits will follow.
Affect Regulation Model:
There are several theories related to emotion and eating. These include escape theory and expectancy theory. These theories fall under the umbrella term of affect regulation model – affect being another word for emotion.
The affect regulation model posits that binge eating episodes are preceded by feelings of negative emotion, such as depression or anxiety. While binge eating relieves these emotions, any relief is short lived. Sooner or later tension builds up again, and the cycle repeats. Then, over time, binge-eating becomes habituated through negative reinforcement. Negative reinforcement means that the tendency to repeat a behaviour becomes stronger over time. Once strong enough, the behaviour becomes less of a conscious act and more of an automatic habit.
Awareness of the negative emotions that precede an episode can vary between individuals. One binge eater may recognise that a specific episode was triggered by a specific emotion. A second may report some nonspecific feeling of tension. While she has some awareness of the tension, she cannot identify its source. A third will use binge eating as a means of dissociation, reporting feeling ‘numb’ or ‘spaced out’ after a binge. A fourth will be completely unaware of her feelings. And so on.
Treatment in this model typically includes getting the individual in touch with her emotions, getting her in touch with the source of those emotions, and, finally, empowering her to find a more constructive means of processing them.
Food Addiction Model:
There are parallels between drug addiction and binge-eating disorder. Certain foods – especially those high in fat and sugar – act on the brain in the same way as drugs. Both activate the dopamine reward system. Throughout human evolution foods high in fat and sugar were difficult to obtain. Whenever they could be found our brain gave us a reward; a strong hit of dopamine, a reward which served as an incentive to seek out even more fat and sugar. However, this reward system has become dysfunctional in a world where fat and sugar are overabundant.
This model – assuming the hook is not to food, but to dopamine – treats binge eating disorder as an addiction.
The above theories are different perspectives on the same issue, general theories with considerable overlap between them. While general theories may apply, what the individual brings to the disorder – in terms of their personal history – should not be forgotten.
Treatment for Binge Eating Disorder
In general, therapy provides a setting in which to explore the root causes of the difficulty. In addition, therapy offers strategies to help alleviate the behaviour, helping us develop a healthier relationship with food. Therapy also focuses on the importance of talking about our feelings and how they might affect us. By recognising which feelings trigger an episode, we can begin to choose alternative ways of managing them. Therapy also focuses on changing perspective. This is especially important for those of us who use binge eating as a coping mechanism for trauma or some other experience. By changing our perspective of our experience, and, therefore, of ourselves, we can further change our relationship with food.
Similarly, therapy focuses on our relationships with those around us. Binge eating can be triggered by poor relationships and unhealthy communication skills. By improving our interpersonal skills – how we relate to family, friends, and colleagues – and by developing better communication strategies, we can reduce the urge to overeat. Improving communication has an added benefit. Not only does it offer us an alternative outlet for negative feelings but, having friends and family to lean on can help ensure accountability. Furthermore, improved communication strengthens our support system, which is necessary to heal binge eating disorder. In its initial phase, therapy provides this support until such time as we have the strength and confidence to seek it elsewhere.
Everybody has to eat, and, therefore, everybody has a relationship with food. Therapeutic treatment for binge eating disorder – by releasing us from the extreme cycles we find ourselves in – restores balance and moderation to that relationship.
How We Can Help
At Centric Mental Health, our therapists can provide effective treatment for binge eating disorder through therapeutic approaches, which can include Cognitive Behavioural Therapy (CBT). Our therapists have extensive experience in providing treatment to help people overcome BED.
We have a nationwide network of clinic locations that can provide counselling for binge eating, with 10+ clinics across North and South Dublin, as well as clinics in Cork, Kildare, Wicklow, Kilkenny, and Westmeath.
If any of the above symptoms sound familiar, please don’t hesitate to ask for help. Get in touch by contacting [email protected] or 01 611 1719, or by filling out the contact form on this page, to set up an appointment with us.