Binge Eating Disorder: What It Really Is, Who It Affects, and How to Heal

To begin with, this wasn’t planned. You were neither ravenous nor hungry. There was something in the combination of a lengthy day followed by a peaceful home that seemed to cause a shift - and before you knew what took place, you ate far too much or more than you intended to - and simultaneously experienced relief and shame. If this seems like your scenario, you are not the first person to experience this. Nor are you broken.
Binge Eating Disorder (BED) afflicts more adults than anorexia nervosa and bulimia nervosa. Despite its prevalence, Binge Eating Disorder remains one of the most misunderstood and discussed topics in mental health. Individuals afflicted by it often go without effective treatment for several years because they believe their actions are the direct result of a personal failing and not a diagnosed medical condition with evidence-based treatment options supported by science.
We wrote this article for you. Perhaps we wrote this article for someone you know. We hope it offers you true, empathetic answers to your questions.

What is Binge Eating Disorder? How does it differ from overeating?

Over-eating can happen to anyone. Birthday parties, holidays, the end of a week at work when you order takeout and sit down on the couch are all examples of occasional over-eating habits.

Binge Eating Disorder however is different than over-eating.

Binge Eating Disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as recurring episodes of consuming large portions of food during a brief duration. More importantly, people who have binging episodes report a loss of control while consuming the large quantities of food. Therefore, it is not only about the quantity of food consumed but also about losing control of eating once it starts.

According to the DSM-5, the binging episodes must have occurred at least weekly for at least three consecutive months. Additionally, at least three of the following must have been present:

• Eating substantially faster than usual.

• Continuing to consume large amounts of food after becoming uncomfortably full.

• Eating large portions of food regardless of whether or not the person is hungry.

• Eating secretly due to feelings of humiliation.

• After consuming large amounts of food, feeling disgusted, depressed or guilty.

An important difference between Binge Eating Disorder and Bulimia Nervosa is that unlike Bulimia Nervosa, which includes frequent purging (through vomiting or laxative use), or excessive exercise or restriction of dietary intake to compensate for calories consumed, Binge Eating Disorder does include any form of compensation. The individual consumes large amounts of food (binges). Then, he or she is silent and self-criticising and usually makes a private vow to themselves that "this" will not happen again. Even though the binge happens repeatedly.
The difference between binge eating and overeating is critical. Overeating is occasional and situational, whereas Binge eating disorder is chronic and is directly tied to patterns related to emotional regulation. Binge eating cannot be solved by sheer willpower or trying another weight loss program.

The Behavioural Signs of Binge Eating Disorder:

Binge Eating Disorder is characterised by a variety of behaviours that may go unnoticed for a long time by the individual experiencing them. Here are behavioural, emotional and lifestyle signs to be aware of:

Behavioural signs:

• Secretively hiding food or eating.

• Increasing or decreasing the food portions quickly while consuming a large amount of food.

• Stockpiling large amounts of food in unusual places.

• Consuming food until the point of extreme discomfort.

• Lack of ability to stop when one feels full.

• Continued consumption of food beyond being physically satisfied.

Emotional signs:

• Intense feelings of shame, guilt or disgust immediately following a binge episode.

• Mood swings connected to eating patterns.

• Using food as a means to cope with stress, loneliness, depression, or boredom.

• Numbness or being “zoned out” during binge episodes.

• Increased anxiety or distress regarding food and meals.

• Self-criticism towards food intake.

Lifestyle signs:

• Avoidance of social events involving food.

• Constant failure on diets and attempts to regain control.

• Excessive focus on food, body shape, and weight. 

• Social withdrawal from friends/family.

The Emotional Cycle of Binge Eating

Understanding Binge Eating Disorder involves understanding how Binge Eating Disorder affects the individual. Many individuals diagnosed with Binge Eating Disorder report that their binge episodes do not originate as a result of physical hunger. Instead, binge episodes often occur as a direct response to an emotional experience (e.g., stress from work, feeling lonely, having a difficult conversation, feeling numb, experiencing anxiety or boredom).
For most of those experiencing Binge Eating Disorder, the act of consuming food serves as a temporary solution to alleviate the discomfort associated with the experienced emotional sensation. However, upon completion of a binge episode, the individual experiences a plethora of additional negative emotional responses (e.g., shame, self-hatred, guilt, feelings of being "out-of-control"). These unpleasant emotional responses serve as an added stimuli for later binge episodes. This pattern is known as the cycle of compulsive eating:  

 
While these actions appear to indicate weakness and or inability to control oneself; they represent an ineffective coping strategy that was learned as a result of previous stressful events. Due to the fact that dieting is generally unsuccessful in treating binge eating disorders and is often counterproductive in terms of addressing the underlying physiological and emotional impulses. Individuals suffering from this disorder commonly continue to eat restrictively in an attempt to address their binge eating. In reality, this approach further fuels the emotional and physiological drive to continue binging. It is not the food itself that creates problems for the individual with Binge Eating Disorder; it is the role we assign to the food. 

Potential Effects of leaving Untreated Binge Eating Disorder

Binge Eating Disorder is neither a lifestyle choice nor a phase. If not treated, Binge Eating Disorder can significantly affect an individual’s overall quality of life through both physical and mental health issues. Some possible physical health consequences of Binge Eating Disorder include:

• Weight gain and obesity, which increases your chances of developing type II diabetes, cardiovascular disease, joint problems, etc.

• Gastrointestinal distress. (e.g., bloating, heartburn, stomach upset)

• Sleep disturbances.

• Fatigue or lack of energy.

• Nutritional deficiencies as a result of irregular eating habits.

Possible mental health consequences of Binge Eating Disorder include:

• Depression and persistent low mood

• Anxiety disorders

• Poor self-esteem and body image issues

• Social withdrawal and relationship difficulties

• Greater risk of substance abuse as an alternative means to cope with emotional pain

All the ways in which Binge Eating Disorder can affect you, the psychological aspect is often the biggest burden for many individuals with Binge Eating Disorder. Individuals with Binge Eating Disorder tend to harbour strong self-rejection or shame. Seeking help can be particularly difficult because it forces individuals with Binge Eating Disorder to acknowledge that they are struggling with something they find disgusting.

Common Myths About Binge Eating Disorder

Before going into treating Binge eating disorder (BED), let's examine some of the myths surrounding BED that could lead to the prevention of individual's ability to obtain proper treatment for their BED.

Myth #1: “Lack of will power”

BED involves actual neurological changes in the brain's reward system and emotional regulation system. Thus, viewing BED as simply a matter of lack of willpower is inaccurate. If someone has BED, don't tell them to "just eat less," since saying so to someone with BED is similar to telling someone with depression or anxiety to "get over it." Neither condition is that easy to solve. 

Myth #2: “Only overweight individuals suffer from BED”

Yes, many people who suffer from BED do tend to weigh more than average, however, anyone regardless of weight, can experience Binge eating disorder. Never evaluate your relationship with food based on what others observe about you. 

Myth #3: “BED is not a real eating disorder. Only anorexia and bulimia are true eating disorders”

In May 2013, BED became recognised as its own separate eating disorder within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). BED is indeed a real, severe mental disease. 

Myth #4: “You can manage BED on your own”

Many individuals who have BED attempt to use dieting, various apps, setting personal goals according to their willpower and other forms of self-help in order to manage their BED; yet, all too frequently still have difficulty managing their binge-eating behaviours. The effort made by those trying to control their binge eating behaviour does not show a failure on their part. Rather, it illustrates the reality that there are many underlying factors related to BED that require being treated through a proper type of therapy.

When to seek Professional Help - and what treatment looks like:

When you've experienced recurring Binge eating, and feel uncomfortable with this action, and/or this action is causing problems with your physical or mental well-being, or when you are unable to stop your binging actions - then it is time to get some help. You do not need to go past "rock bottom" before looking for assistance. Just recognising that your binging is causing you problems - is enough to start looking for support. 
There are multiple ways of providing treatment for Binge Eating Disorder - including ones that prove successful and enable individuals to establish long-term recovery. 

Psychotherapy for treating binge-eating disorder

One of the best studied approaches to treating BED is cognitive-behavioural therapy (CBT). Through CBT, you'll identify the thoughts, feelings and behaviours that create binge episodes, identify alternative ways of responding to those things that previously created binge episodes, create a new cycle of behaviours (began with distress - ended with binge - followed with shame), replace negative cycles of behaviours with greater understanding of your behaviours and alternatives ways of thinking about those behaviours. 

A second approach to psychotherapy is Dialectical Behaviour Therapy (DBT). While DBT can assist individuals in dealing with a variety of difficulties related to emotional regulation contributing to binge eating, DBT teaches specific skills to address emotional pain, develop strategies to regulate your emotions, teach strategies to avoid acting on impulse, develop alternative coping mechanisms. 
Finally, Interpersonal Therapy (IPT) is a third method of psychotherapy. IPT addresses how difficulties with interpersonal relationships and/or environment contribute to an individual's eating behaviours.

 Medication

In some cases, psychiatric care may include medication. Certain antidepressants (particularly SSRIs) and other medications have been shown to reduce binge frequency. Medication is typically most effective when combined with therapy rather than used alone.

Inpatient Care and the Daycare Programme

There will always be times when, due to the severity, duration or comorbidity with other mental health issues such as depression, anxiety or trauma, and weekly outpatient appointments might not offer sufficient support. When there is a strong possibility of harm from eating disorders, a multidisciplinary team in a structured in-patient hospital environment provides the best opportunity to deal with the eating disorder whilst addressing any additional mental health issues. An alternative to residential care would be a daycare programme which offers intensive structured care throughout the day; however, the person remains at home every evening. The program is also used as a transitional measure post-in-patient discharge to continue the progression to normal living.

You Don’t Have to Keep Living This Cycle

If you've read this far, something within these words has probably resonated with you. Possibly you have been quietly dealing with binge eating disorder for months or even years, keeping it hidden and asking yourself if things had to be different.

At Adayu, we offer in-patient psychiatric treatment for binge eating disorder which includes more than just talk therapies. Recovery from BED encompasses the mind, the body and behaviour - and therefore our multi-disciplinary team reflects that.

Our psychiatrist leads the clinical assessment and manages any co-existing conditions. The psychologist delivers cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT), providing strategies and skills for managing the emotions and thinking patterns that drive the binge cycle. The nutritionist works with individuals to develop a healthy, fear-free relationship with food - by developing understanding, not by restricting food intake. The yoga instructor introduces body awareness and nervous system regulation to assist individuals in reconnecting with their bodies in a non-judgmental space. Finally, our physiotherapist supports the physical aspects of recovery and provides support with regards to moving and exercising safely.

Just as important is the follow-up support provided post-discharge. As previously stated, recovery from binge eating disorder is a process and not an event. Therefore, Adayu continues its support of individuals throughout this recovery process. The type of support provided post-discharge will depend upon the individual’s needs at that specific point in time. Continuing care may consist of regularly scheduled OPD visits with both the psychiatry and psychology teams or transitioning to a daycare program which provides structured therapeutic support during the day allowing for a bridge between in-patient care and independent functioning. Individuals are never discharged from Adayu with a plan of "go home" and independently manage their recovery.

Recovery from binge eating disorder is about developing a new relationship with yourself based on understanding rather than shame.

FAQs about Binge Eating Disorder

Q: Is binge eating disorder the same as emotional eating? 
Binge eating disorder, clinically defined as eating emotionally in a manner that is recurrent, excessive, and out of control. While everyone eats emotionally at times and there are numerous definitions of emotional eating, emotional eating alone is not a clinical disorder. An example of how someone might eat emotionally includes eating in excess, to feel better, and then feeling guilty or ashamed of what they ate. Emotional eating could be contributing to a clinical diagnosis of binge eating disorder or occur separately and not result in a clinical diagnosis of binge eating disorder.

 Q: Can binge eating disorder ever be cured?
It’s typically inaccurate to say that a person has been “cured” of binge eating disorder. Full remission (no longer losing control while eating large quantities of food in a short amount of time, no longer feeling guilty or ashamed about eating) is achievable through appropriate treatment and interventions. A considerable number of individuals receive successful treatment with a combination of psychotherapy and/or medication. The sooner an individual seeks and receives appropriate treatment for their binge eating disorder, the higher their chance of achieving full remission. Regardless of when an individual receives treatment for their binge eating disorder, it is possible for the individual to reach full remission.

Q: What decides if in-patient treatment would be more advantageous than out-patient therapy?
You should consult with a psychiatrist or therapist to decide which form of treatment would be most beneficial for you. In-patient treatment is recommended when a person has severe symptoms of binge eating disorder, or when they have had binge eating disorder for a long period of time. In addition, in-patient treatment is recommended when other disorders co-exist (depression, anxiety, post-traumatic stress disorder) in conjunction with binge eating disorder. Also, in-patient treatment may be recommended when previous out-patient therapies have not produced adequate relief for an extended length of time or when an individual needs a high level of structure and support to begin their recovery process. In-patient treatment is not always considered as the last option for treatment. It is simply one of the options available to those who require additional support due to an increased level of need.

 Q: What should I do to talk to a family member/friend who I suspect has binge eating disorder?

When talking to a loved one about possibly having binge eating disorder, try to combine curiosity and care instead of concern or criticism. For instance, make a statement instead of drawing a conclusion: "I've noticed you seem really upset after meals", and show genuine concern for the person's well-being instead of showing fear. Avoid discussing the person's food choices and avoid mentioning body size. Finally, understand that your loved one may not want to listen immediately- and that's okay. Simply plant an idea gently without judgment.