Binge-Eating Disorder

Binge Eating Disorder (BED) is the most prevalent eating disorder. In fact, it is three times more common than anorexia and bulimia, combined. But what is a binge? Don’t we all overeat from time to time?

According to the Diagnostic and Statistical Manual (DSM-5), a binge is characterized by:

  • Eating, in a discreet period of time, such as two hours, an amount of food that is considered larger than what most people would eat under similar circumstances
  • A sense of loss of control over how much that person is eating

When this lack of control is followed by a sense of shame, regret and self-loathing, and the binge behaviors happen at least once a week for three months, then the diagnosis of Binge Eating Disorder (BED) is complete.

Another diagnosis is available for those who binge eating less frequently, but still have the feelings of loss of control along with shame and guilt about the episode. That diagnosis is called Other Specified Feeding or Eating Disorder – subthreshold BED type.

Some additional signs of BED include:

  • Eating even when you’re full or not hungry
  • Eating rapidly during binge episodes
  • Eating until you’re uncomfortably full
  • Frequently eating alone or in secret
  • Feeling depressed, disgusted, ashamed, guilty or upset about your eating
  • Frequently dieting, possibly without weight loss

While BED is the most common eating disorder in men, it also is the least studied and understood (Striegel et al, 2011). BED has only been an official diagnosis since 2013, limiting opportunities for research funding until recently. As is true in most research of eating disorders, the predominant focus to date has been on women (Struther et al, 2012).

As is the case for all eating disorders in males, there is a stigma attached to the disease as being a female issue (Berger et al, 2005). Due to the issue of stigma and limited awareness of the signs and symptoms of BED, men often go without treatment, cycling in weight loss methods or compulsive exercise routines, and often struggling with depression, anxiety, and substance abuse disorders (Striegel et al, 2011).

Health professionals typically treat the physical symptoms, which include Type II diabetes, high blood pressure and cholesterol, heart disease, gallbladder disease, osteoarthritis, and gastrointestinal problems (Bulik et al, 2003). While not all those with BED will have these symptoms, they are common side-effects of the disease. Most medical providers will simply tell their patient to lose weight, ignoring the psychological precursor to the development of poor physical health.

This can cause significant exacerbation of the eating disorder via the cycle of binge eating, followed by regret, repentance, restriction, and repeating the behaviors again (May et al, 2014). Restriction, in hopes of undoing the perceived damage of a binge or assuaging the guilt and shame, is a common precursor to a binge episode (Mathes et al, 2010). As a result, many practitioners in the treatment of BED are leaning on the research of the Health at Every Size (HAES) model, which states that developing healthy behaviors and normalizing a relationship to food can lead to improvement in overall health regardless of weight loss.

How would a HAES model help me with binge eating?

The HAES model aims to reduce the stigma of weight bias and increase physical and mental health, which in turn can help reduce the symptoms of BED, by promoting the following:

  1. Accept your size: genetics plays a significant role in your body’s natural size. Self-acceptance leads to improved ability to nurture and care for yourself.
  2. Trust your body: we all have internal signals that we can learn to tap into to understand our natural signs of hunger, fullness, and appetite needs.
  3. Adopt healthy lifestyle habits: by developing all aspects of health, including social, emotional, and physical, the role of food finds it’s intended role of nourishment and pleasure
    1. Find joy in movement
    2. Eat when you’re hungry, stop when you’re full, and seek pleasure in satisfying foods
    3. Enjoy more nutritious foods while still allowing room for less nutritious foods as part of an overall healthy diet and lifestyle
  4. Embrace size diversity: humans come in a significant diversity of sizes and shapes. Learn to see the beauty found across the spectrum and support others in recognizing their unique attractiveness.

How can family help?

  • Learn about the disease 
  • Don’t judge the person for lack of will power, body size, or any other issue
  • Re-think meals as a time for community – cook together, eat together, offer encouragement, and put away the meal for them to limit temptation 
  • Family therapy is useful to learn about how everyone thinks about and deals with food, body image, and stress
  • Watch for increased warning signs like:
    • skipped meals
    • hidden wrappers
    • eating in secret
    • increased mood instability or depression