Living with Binge Eating Disorder

Living with Binge Eating DisorderIf you have binge eating disorder, please know that you’re alone. Binge eating disorder (BED) is actually the most common eating disorder. It affects about 3.5 percent of women and 2 percent of men.

You’re also not weak, wrong or crazy. BED “is not a reflection of who you are as a person,” said Karin Lawson, PsyD, a psychologist and clinical director of Embrace, the binge eating recovery program at Oliver-Pyatt Centers.

Binge eating may serve many functions, according to Amy Pershing, LMSW, ACSW, the executive director of Pershing Turner Centers, an eating disorder recovery outpatient clinic in Ann Arbor, Mich., and Annapolis, Md.

It might soothe stress and help you escape, especially when you’ve experienced trauma or significant shame, she said. “You have survived, perhaps in part because your relationship with food was a powerful coping strategy. There are better strategies now; you can learn them, and you can heal.”

Some people can get better by using self-help strategies, but BED most often requires treatment. People with BED typically suffer for many years, have co-occurring physical and mental health issues and severe body image issues, which perpetuate weight cycling and exacerbate the disorder, said Chevese Turner, founder and president of the Binge Eating Disorder Association and co-founder and managing director of Pershing Turner Centers.

But the good news is that BED is highly treatable, and you can recover, said Judith Matz, LCSW, co-author of Beyond a Shadow of a Diet: The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating and Emotional Overeating.

Below, you’ll learn more about what BED is (and isn’t) along with treatments that work (and don’t work) and helpful coping strategies.

What is Binge Eating Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines BED in this way:

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

  • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
  • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)

The binge-eating episodes are associated with three (or more) of the following:

  • eating much more rapidly than normal
  • eating until feeling uncomfortably full
  • eating large amounts of food when not feeling physically hungry
  • eating alone because of feeling embarrassed by how much one is eating
  • feeling disgusted with oneself, depressed, or very guilty afterwards

Marked distress regarding binge eating is present.

The binge eating occurs, on average, at least once a week for three months.

The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

Pershing stressed the importance of paying attention to the client’s experience with food, not just to the criteria. “[I]t is critical to remember that the most important issues are a lack of control over the eating behavior and distress/shame over the behavior.”

She noted that some clients may “graze” throughout the day, and eat significantly more than needed, but in a longer period of time than the DSM defines.

Lawson also defines BED more broadly. In addition to the lack of control and feelings of shame, she’s seen that most clients have a “preoccupation with food and/or body image [and] eating compulsively while feeling numb or checked-out.”

BED has a complex etiology. Family dysfunction, genetics, attachment ruptures, mood disorders, trauma (“rates are significantly higher with BED, especially complex trauma”) and environment (such as experiences with weight stigma) may all play a role, Pershing said.

It’s also serious. According to Turner, “Within the BED community, it is not unusual to hear of individuals who have experienced serious organ failure, suicidal ideation or completion, disability due to crippling co-morbid psychiatric conditions, and metabolic issues related to weight cycling and nutritional deprivation.”

Myths About BED

There are many myths about BED and its treatment. Here’s a selection:

  • Myth: If people had more willpower, they’d stop bingeing. BED has nothing to do with willpower. Again, it’s a serious disorder. This egregious myth only “contributes to the eating disorder voice that maintains and exacerbates the condition,” Turner said. “For people with BED, eating feels out of control … is disconnected from physical hunger, and is often connected to other issues such as anxiety or depression,” said Matz, LCSW, who treats BED in Skokie, Ill.
  • Myth: People with BED are “overweight.” Actually, they “come in all sizes,” Matz said. About 30 percent of people with the disorder are considered “normal” weight and one percent are underweight, according to body mass index, Turner said. (“There are people at higher weights who do not struggle with BED or other overeating problems,” Matz said.)
  • Myth: “BED is treated by a ‘sensible eating plan’ (i.e., a diet),” Pershing said. Diets are actually contraindicated for BED and may trigger it, she said. “[T]hey can lead to weight cycling (losing and then regaining weight), which is actually hard on the body and can lead to health issues,” Lawson said. Treatment requires that people with BED work through the psychological, physical and situational factors that trigger binge episodes, Pershing said. “Another diet will not change anything; all it will do it lighten your wallet and leave you with a 95 percent likelihood of regaining the weight in 3 years.”
  • Myth: BED doesn’t require the same level of intervention as anorexia or bulimia. Typically, it requires the same treatment as any other eating disorder, Pershing said. This may include: “individual therapy, nutrition professional, groups, expressive therapies [and] medication management.”

What Doesn’t Work in Treating BED

“People with BED may turn to weight management programs,” Matz said. In fact, about 30 percent of people who seek these interventions have BED. But food restrictions actually promote binge eating, she said.

Unfortunately, many professionals think weight loss is essential for recovery for individuals at higher weights. “This is a dangerous concept because the very behaviors that are prescribed for weight loss in those with BED are ‘diagnosed’ in eating disorders that do not involve higher weights,” Turner said.

“For example, individuals with BED are encouraged to count calories, limit food groups (sugar and fat particularly), and restrict food intake with no regard for hunger or satiety.”

The weight-loss approach only fuels feelings of failure and shame, perpetuating the cycle of “self-loathing, defeat, and further eating disorder behaviors,” said Turner, who described below what this feels like:

Having BED means living in a constant state of anxiety and yearning for something that is seemingly forever elusive. Imagine having a stomachache that never goes away. You get up daily and hope that today will be the day that your stomach feels normal again.

You are determined that you are going to find the cause, but each time you go to the doctor, she tells you that it is your fault you have this pain and that you just need to follow the very specific but easy directions she will provide to you. You go home and are determined to implement the doctor’s recommendations perfectly.

After some time, you realize that you are following the doctor’s orders to a “T,” but nothing has changed. Your stomach continues to hurt and you find you are more distressed than ever because you know that everyone around you is assuming that you are not following the recommendations. You are confident that you are the only one who is suffering like this and there is a major defect in your character that is propelling the stomach problems and your ability to control them.

You decide that you are going to isolate and keep everyone away because you do not deserve friends or love. You and your stomach pain are together forever — it’s all you have.

What Does Work for Treating BED

There are different treatment modalities, including cognitive-behavioral therapy, dialectical behavior therapy, internal family systems and trauma therapy, which have shown benefit for BED, Pershing said. The key is that the “client feels validated, taken seriously and respected.”

It’s important for treatment to target the emotional and behavioral aspects of BED, Matz said.

Clients learn the underlying emotional reasons they turn to food along with coping strategies to use when they’re emotionally distressed. They also learn to relinquish dieting and restrictive behaviors around food, which only perpetuate binge eating, she said.

It’s also important to have a multidisciplinary team, which ideally includes “a therapist, nutritionist, non-shaming physician, and a psychiatrist (particularly if there are co-morbid struggles, such as depression, anxiety, attention deficit hyperactivity disorder, obsessive compulsive disorder or substance abuse),” Lawson said.

She recommended seeing a registered dietitian who is well-versed in intuitive eating, which focuses on reconnecting to your body and your natural sense of hunger and fullness. This is in stark contrast, she said, to society’s belief that people with BED “can’t trust themselves, need to diet and rely on external numbers and messages.”

When you learn to trust your body, this trust spills over into other parts of your life. You become more confident in using your voice with others, setting boundaries and pursuing meaningful goals, Lawson said. “It all takes practice and none of it is easy, but food is the metaphor, not the problem, per se.”

People with BED commonly have physical issues, such as polycystic ovary syndrome (PCOS), hypothyroidism, low vitamin D, sleep apnea and inflammation, Lawson said. This is why having a physician on your team is helpful.

Health At Every Size

The Health At Every Size® (HAES) framework is “increasingly recognized as an important component of treating BED,” Matz said. HAES focuses on “physical, emotional and spiritual health, and well-being rather than weight.”

Instead of using thinness as a path to health, happiness and success, HAES helps people with BED focus on the direct behaviors that foster all three, without the harmful consequences that come from pursuing weight loss, she said. (When people turn to diets to lose weight, they usually experience a boost in binge eating in the short term and weight gain in the long term, she added.)

Learn more about HAES here.

Finding Weight-Neutral Professionals

Lawson stressed the importance of advocating for yourself and shopping for your treatment team or program. She suggested conducting a brief phone interview to get an idea about a practitioner’s approach and understanding of BED. Ask how frequently they’ve worked with people who have BED and their views on weight loss for recovery, she said.

The key is to find professionals who can help you “focus on health and positive body image rather than a goal of a specific weight or shape,” Pershing said. Also, clinicians must do their own work to heal any eating disorder or body image issues and biases about weight, she said.

If you can’t find a qualified clinician in your area, consider phone coaching, Matz said. (For instance, Ellen Shuman is an Emotional and Binge Eating Recovery Coach and has an online community for people with BED.)

Unfortunately, it’s also hard to find a non-shaming physician who will work on your health issues without focusing on weight loss as a remedy, Lawson said. She suggested asking around. Ask your therapist or nutritionist for names of doctors they like to work with. “Good reputations get around!”

When looking for a nutritionist who specializes in intuitive eating, start by searching online for “intuitive eating” and your location, Lawson said.

Valuable Practices

Below are activities and practices you can work on while getting treatment and beyond.

Practice mindful eating. Most people with BED think their access to food should be restricted, Lawson said. But it’s actually the opposite: Building a healthy relationship to food means there’s no restriction, which means “food becomes more pleasurable and yet less powerful.”

To practice mindful eating, Lawson suggested the following: Turn off all electronics, and sit down at the table. Plate your food so it’s visually pleasing. Take your time eating by paying attention to the temperature, texture and flavor of your food. Pause after several bites. Pay attention to your body. Are there any physical sensations of hunger or fullness? Next take a few more bites. Then pause, again. “Continue this process as you gain awareness of how food feels in your body and what cues you get that you are still hungry or are at a comfortable fullness.”

If you usually eat with others, suggest they try mindful eating, Lawson said. “No matter if someone has binge eating disorder or not, we could all stand to slow things down a little more and be more thoughtful of our simple everyday experiences, like eating,” Lawson said.

Rethink movement. In our society exercise is synonymous with pain or weight loss. But movement can be pleasurable. Pershing suggested readers reclaim your body’s right to enjoy movement simply for the sake of the experience. What movements sound fun to you? “Think about ways you loved to move, to play, as a child,” she said.

Movement is important. “It allows people to be in their bodies, to feel a sense of being capable and powerful. Our bodies are designed to move, to enjoy the world through action and tactile experience.”

Movement also is “powerful for survivors of any trauma where the body was the site of the damage,” Pershing added.

Practice self-care. “[B]e playful and experimental with your self-care and emotional life,” Lawson said. “See what is safe, soothing, releasing or empowering to you and be gentle with yourself if something you try doesn’t hit the spot.”

For instance, she suggested carving out alone time with no obligations; trying a hobby you used to enjoy; tapping into your creativity by writing a poem, coloring a picture or taking photos; creating a soothing playlist to listen to while eating mindfully; and engaging in body positive e-courses like this one.

Explore your own weight biases. For Turner, who struggled with BED for many years, addressing how she felt about bodies in higher weights, including her own, was a critical part of recovery. “If I could not accept that some bodies are bigger and might always be, including mine, then how would I step off of the binge cycle that resurfaced every time I tried to pursue weight loss? Acceptance and understanding the internalized weight biases that fuel many of my body image issues was a huge final step for me.”

Surround yourself with body and recovery positive information. Pershing recommended reading books such as Eating in the Light of the Moon along with the blog “About Face.” She also encourages clients to ditch magazines and TV shows, such as “The Biggest Loser,” which glorify thinness and perpetuate body shame.

Find healthy ways to process emotions. “I’m a big fan of mindfulness or meditation techniques that help you let go of ‘spinning’ thoughts and stress in your body,” Matz said. She also noted that some people find journaling helpful.

Build a support system. It can include “people who understand the benefits of quitting diets and practicing the Health At Every Size® approach,” Matz said. This might be in person or an online support group, she said.

Also, educate your support system on what works for you and what doesn’t, Pershing said. This might include requesting that they don’t discuss diets or ask you about weight loss or gain, she said.

Be honest with yourself and your team. If you binged or restricted, need more coping skills, or your emotions have been unpredictable lately, tell your team, Lawson said. Whatever the issue, be honest.

“I have heard time and time again from clients, ‘I actually feel better now that I told someone.’ The act of sharing takes away the power of anything that we deem is ‘too much to share.’ Nothing is too much to share,” Lawson said.

Practice self-compassion. Speak to yourself in the same way you’d speak to a close friend or child, Matz said. “Or imagine how someone who cares about you would talk to you.” Don’t worry if self-compassion feels foreign. It’s a skill you can learn.

Notice self-judgment. Do you still tell yourself that you’re “good” for eating certain foods, and “bad” for eating other foods? This is leftover judgment from the diet mentality.

“Instead, pay attention to when your eating experiences feel good (you ate something that satisfied you and stopped when full) and when they feel bad (you ate something that was too heavy and got so full you felt uncomfortable),” Matz said.

“It’s not just semantics! That same pizza can be the perfect match on one day, and feel uncomfortable at another time.”

Overall, remember that “there is freedom from food and body obsession,” Lawson said. “[I]t can be a rocky road, which is why it’s so important to have a support system of friends, family and professionals.”

Recovery is possible for everyone. It starts with seeking help.

Additional Resources

Binge Eating Disorder Association

Diet Survivors

Intuitive Eating by Evelyn Tribole and Elyse Resch

Reclaiming Yourself From Binge Eating: A Step-by-Step Guide to Healing by Leora Fulvio

The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care by Judith Matz and Ellen Frankel

Beyond a Shadow of a Diet: The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating and Emotional Overeating by Judith Matz and Ellen Frankel

 

Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 3 Nov 2014
    Published on PsychCentral.com. All rights reserved.