Binge Eating Disorder

Symptoms of Binge Eating Disorder

Binge eating is the consumption of large amounts of food in a relatively short time accompanied by a feeling of loss of control over eating. Most individuals engaged in a binge will stop eating only when they are interrupted or when they feel uncomfortably full from having eaten too much.

Binge eating disorder, in brief BED, is a life-threatening condition characterized by frequent incidences of binge eating (i.e., eating huge amounts of food quickly to the state of exhaustion and discomfort.).

The characteristic features of BED are recurrent episodes of binge eating but no inappropriate compensatory behaviors, as occur in Bulimia NervosaOpens in new window.

A person with this disorder frequently has the urge to consume large amounts of foods within a short time, and he/she feels unable to stop. It’s like a compulsionOpens in new window that cannot be resisted.

Most people who have this disorder don’t have control over the amount of food they eat at a given time. After binge eating, they feel guilty, shame, distress, and unhappy. To eliminate this guilt or bad feeling, some of them resort to damaging measures to compensate, one of which is purging, just to counteract their binge eating.

Eating binges in Binge-Eating Disorder are often characterized by eating much more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not hungry, eating alone because of embarrassment over how much the individual is eating, and feeling disgusted with himself or herself, depressed, or guilty afterward.

The eating binges occur regularly (i.e., at least once per week) and are relatively persistent (i.e., occurring over at least a 3-month period).

Binges can be large or small. It is important to distinguish between the two types of binges because during treatment large binges tend to disappear first, smaller ones later.

The foods consumed in small, or subjective, binges are usually characterized as “forbidden” by the individual and commonly include such items as chocolate, ice cream, or pastries.
The foods consumed in large, or objective, binges are usually sweet and high in fat content. Such foods may include ice cream, milk shakes, bread with butter and jam, cakes, cookies, cereals, pasta, and so on. Large binges do not tend to consist of meals (e.g., meat and potatoes). Some examples of binges follow.

Binge I: An entire large pizza, 20 breadsticks, four large slices of cake
Binge II: Two big plates of pasta with broccoli, zucchini, and tomato sauce; half an avocado with a large plate of salad greens; three bowls of nonfat chocolate and vanilla ice cream
Binge III: Five to six bowls of oats with brown sugar and strawberries, a plate of couscous, beans, broccoli, and peas left over from lunch, a heaped-up plate of oats with honey and ice cream.

As can be seen, there is much variety in binges, although each person may have favorite binge foods. There is, however, another type of binge eating, known as grazing, where individuals eat small amounts of snack foods every few minutes throughout the day. In the end, these small amounts add up to a considerable amount of food.

We have seen some of the triggers for binge eating, namely, dieting, hunger, and negative emotions.

Other triggers that can contribute to binge eating when combined with hunger and negative feelings may include having a small piece of a “forbidden” food, drinking alcohol, having a fight with someone close to you, reading a magazine with feature articles on staying in shape, and so on. These triggers, combined with eating very little earlier in the day and with chronically dieting, will likely lead to a rather large binge.

The immediate triggers for a binge can be quite complex, although all of them are potentially remediable. Although binges may be caused by triggers, they also, in a sense, serve to trigger a number of consequences, including numbing the emotions or even obliterating the triggering concerns.

Binge-Eating Disorder occurs in normal to overweight and obese individuals. The 12-month prevalence among the U.S. adult population is 1.6% in females and 0.8% in males. The ratio of women to men with Binge-Eating Disorder is more equal than for Bulimia Nervosa, and the disorder can be found in as many women from racial and ethnic groups as in white women. Binge eating can occur in children, and it is common in adolescents and college-age people.

Binge-Eating Disorder can be associated with poor social adjustment, impaired health-related quality of life, increased medical morbidity and mortality, and increased health care utilization.

Case study \| Eating Until It Hurts
Andrea Simpson, age 35, weighed 230 pounds when she returned to her therapist to get help for the eating and weight problems that had caused her grief since she was a child. She was again having uncontrollable eating binges and had gained over 50 pounds in 6 months. Ms. Simpson remembered being called “fatty” by her schoolmates in early elementary school and having frequent arguments with her mother about her excessive eating and weight throughout childhood and adolescence. During high school she nibbled throughout the day. After each bite she vowed to herself that this would be the last, and she would go on a diet but was never able to keep her vow. She felt very ashamed of her weight, but she gradually gained more. She did most of her eating in private so others would not see. At graduation from high school, with a height of 5’5”, she weighed 203 pounds. Ms. Simpson believes that her binge eating began in college. She lost about 40 pounds by dieting when she began college, and then she began to alternate between periods of dieting and overeating, lasting several weeks to several months. During periods of overeating, she often ate a large breakfast (e.g., several eggs with cheese, two or three slices of toast, and two large glasses of orange juice) in the university cafeteria. She would then take large quantities of food back to her dorm room (e.g., two or three peanut butter sandwiches, two or three dozen cookies, potato chips, cheese), which she ate over the next few hours. She ate until she felt physically uncomfortable and then fell asleep. She felt very depressed and ashamed about her weight during this time. She does not recall feeling out of control during the eating because she always believed that she would stop when she had finished whatever piece of food she was eating, although this seldom happened. She had a number of weight fluctuations in college; her weight ranged from 170 to 230 pounds. Ms. Simpson got down to a normal weight in her last year of college and got married after graduation. She began to overeat again on her honeymoon. Her husband was angry about the eating and weight gain. They argued a great deal about this issue and about her dishonesty concerning her eating (motivated largely by shame about what she had eaten). She feels that her eating problems contributed significantly to her subsequent divorce. Over the next several years, Ms. Simpson continued to struggle with her weight and eating. She went to Weight Watchers several times, tried numerous diets in magazines, used prescribed and illicit amphetamines to decrease her appetite, and spoke to internists about her weight and tried diets they gave her. However, she continued to be overweight with marked weight fluctuations. During periods of dieting, she was preoccupied with food and urges to eat. Ms. Simpson was in psychotherapy in her mid-20s for issues related to her divorce and family. Although she tried to discuss her weight and eating problems, the therapy was ineffective for these issues because the therapist’s interventions were largely limited to suggesting diets. Ms. Simpson describes the periods of binge eating as “a nighttime,” during which she is preoccupied with fighting the urge to eat, planning additional eating, and feeling guilty and ashamed about her eating and the inevitable weight gain that will follow. Her worst period of daily binge eating, lasting about 10 months, occurred approximately 2 years ago. She ate boxes of cookies, ice cream and other sweets; large amounts of peanut butter and bread; and many bowls of cereal when nothing else was in the house. She felt out of control of her eating and desperate about her inability to stop binge eating. She often ate until she had stomach pain, never felt hungry because she was always eating so much, essentially lost all semblance of a meal structure, avoided eating in front of others because she was ashamed of the eating, and constantly felt depressed. She gained 90 pounds during this period of binge eating. When she returned to her therapist at age 35, she was encouraged to join OA. She found the combination of OA and psychotherapy helpful. She lost about 80 pounds, without rigid or restrictive dieting, and has kept off 60 of these pounds for about 5 years. She is pleased that she does not often feel preoccupied with food or urges to eat between meals, although she continues to have trouble controlling the size of her meals. She feels quite sure that she will never be entirely free of her eating problem and could begin binge eating again at some unpredictable future time. For this reason, she continues to attend OA meetings.

Case study | Eating Until It Hurts

Andrea Simpson, age 35, weighed 230 pounds when she returned to her therapist to get help for the eating and weight problems that had caused her grief since she was a child. She was again having uncontrollable eating binges and had gained over 50 pounds in 6 months.

Ms. Simpson remembered being called “fatty” by her schoolmates in early elementary school and having frequent arguments with her mother about her excessive eating and weight throughout childhood and adolescence. During high school she nibbled throughout the day. After each bite she vowed to herself that this would be the last, and she would go on a diet but was never able to keep her vow. She felt very ashamed of her weight, but she gradually gained more. She did most of her eating in private so others would not see. At graduation from high school, with a height of 5’5”, she weighed 203 pounds.

Ms. Simpson believes that her binge eating began in college. She lost about 40 pounds by dieting when she began college, and then she began to alternate between periods of dieting and overeating, lasting several weeks to several months. During periods of overeating, she often ate a large breakfast (e.g., several eggs with cheese, two or three slices of toast, and two large glasses of orange juice) in the university cafeteria. She would then take large quantities of food back to her dorm room (e.g., two or three peanut butter sandwiches, two or three dozen cookies, potato chips, cheese), which she ate over the next few hours. She ate until she felt physically uncomfortable and then fell asleep. She felt very depressed and ashamed about her weight during this time. She does not recall feeling out of control during the eating because she always believed that she would stop when she had finished whatever piece of food she was eating, although this seldom happened. She had a number of weight fluctuations in college; her weight ranged from 170 to 230 pounds.

Ms. Simpson got down to a normal weight in her last year of college and got married after graduation. She began to overeat again on her honeymoon. Her husband was angry about the eating and weight gain. They argued a great deal about this issue and about her dishonesty concerning her eating (motivated largely by shame about what she had eaten). She feels that her eating problems contributed significantly to her subsequent divorce.

Over the next several years, Ms. Simpson continued to struggle with her weight and eating. She went to Weight Watchers several times, tried numerous diets in magazines, used prescribed and illicit amphetamines to decrease her appetite, and spoke to internists about her weight and tried diets they gave her. However, she continued to be overweight with marked weight fluctuations. During periods of dieting, she was preoccupied with food and urges to eat.

Ms. Simpson was in psychotherapy in her mid-20s for issues related to her divorce and family. Although she tried to discuss her weight and eating problems, the therapy was ineffective for these issues because the therapist’s interventions were largely limited to suggesting diets.

Ms. Simpson describes the periods of binge eating as “a nighttime,” during which she is preoccupied with fighting the urge to eat, planning additional eating, and feeling guilty and ashamed about her eating and the inevitable weight gain that will follow. Her worst period of daily binge eating, lasting about 10 months, occurred approximately 2 years ago. She ate boxes of cookies, ice cream and other sweets; large amounts of peanut butter and bread; and many bowls of cereal when nothing else was in the house. She felt out of control of her eating and desperate about her inability to stop binge eating. She often ate until she had stomach pain, never felt hungry because she was always eating so much, essentially lost all semblance of a meal structure, avoided eating in front of others because she was ashamed of the eating, and constantly felt depressed. She gained 90 pounds during this period of binge eating.

When she returned to her therapist at age 35, she was encouraged to join OA. She found the combination of OA and psychotherapy helpful. She lost about 80 pounds, without rigid or restrictive dieting, and has kept off 60 of these pounds for about 5 years. She is pleased that she does not often feel preoccupied with food or urges to eat between meals, although she continues to have trouble controlling the size of her meals. She feels quite sure that she will never be entirely free of her eating problem and could begin binge eating again at some unpredictable future time. For this reason, she continues to attend OA meetings.

Discussion of “Eating Until It Hurts”

Many individuals are concerned about their overeating and inability to maintain a normal weight. They may try a variety of diets and weight maintenance programs. A minority of them have recurrent eating binges during which they eat large amounts of food and feel that their eating is out of control.

When a pattern of binge eating more than once a week for longer than 3 months occurs, as it does in Ms. Simpson’s case, the diagnosis is Binge-Eating Disorder (DSM-5, p. 350). This diagnosis is not made if the individual engages in the inappropriate compensatory behavior that characterizes Bulimia Nervosa (e.g., self-induced vomiting or excessive exercise).

Individuals with Binge-Eating Disorder differ in several respects from individuals with Bulimia Nervosa. In clinical settings, individuals with Bulimia Nervosa are almost invariably in their 20s, but individuals with Binge-Eating Disorder have an average age in their 40s.

Bulimia Nervosa is extremely uncommon in males, whereas Binge-Eating Disorder occurs approximately equally in females and males. The typical individual with Bulimia Nervosa is of normal or near-normal weight but is preoccupied with being thin, whereas most individuals with Binge-Eating Disorder are overweight and would be delighted if they could bring their weight down to the normal range.

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Citation

Akkerman, K., Kaasik, K., Kiive, F., Nordquist, N., Oreland, L., & Harro, J. (2012, January). The impact of adverse life events and the serotonin transporter gene promoter polymorphism on the development of eating disorder symptoms. Journal of Psychiatric Research, 46(1), 38 – 43.
Alonso, D.R., Cortazar, A. E., Guillen, R.H., Fuentes, M.S., & Remesal, C. R. (2016, March). Food, body image, perfectionism. European Psychiatry, 33, S425.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental health disorders (5th ed.). Arlington, VA: The American Psychiatric Association.

Specialties

Binge Eating Disorder

Symptoms of Binge Eating Disorder

Discussion of “Eating Until It Hurts”

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