Binge eating disorder (BED) is a serious condition characterized by episodes of uncontrolled eating, often followed by feelings of shame, distress, and guilt. It is the most prevalent eating disorder, affecting an estimated 1 to 5 percent of Americans. Unlike bulimia nervosa, BED does not involve compensatory behaviors like purging or excessive exercise. Individuals with BED often struggle with overweight or obesity, and face a higher risk of developing metabolic syndrome and other health complications. Fortunately, recovery is possible with the right strategies and support.
Understanding Binge Eating Disorder
Binge eating disorder (BED) is characterized by frequent episodes of overeating accompanied by feelings of loss of control without the use of compensatory behaviors. Full-threshold BED includes experiencing BE episodes that are objectively large in size at least once per week over the past 3 months, with three or more of the following features-rapid eating, eating until uncomfortably full, eating when not physically hungry, eating alone because of embarrassment, and feeling disgust, depressed mood, or guilt afterwards. Individuals who engage in BE to a clinically significant and distressing degree but who do not meet full DSM criteria (e.g., frequency of BE is less than once per week, the BE episodes are subjectively large in size) are considered to have subthreshold BED
Binge eating disorder involves chronic and distressing episodes of binge eating that occur regularly and persist over time, usually at least once a week for three months or more. With BED, episodes of binge eating often include eating quickly, eating until uncomfortably full, and eating when not physically hungry. The bingeing tends to happen alone or in secret, and afterward people may struggle with feelings of shame, guilt, or low mood.
Diagnosis of BED
To diagnose binge-eating disorder, a healthcare professional may recommend a mental health evaluation, including discussions about feelings and eating habits. Additional tests may be conducted to check for health problems that can be caused by BED, such as high cholesterol, high blood pressure, heart problems, diabetes, GERD, poor nutrition, and sleep-related breathing disorders.
The Link Between Binge Eating and Weight
Rates of BE in overweight and obese subjects are at least double those in normal-weight individuals, and BE occurs in approximately 30% of overweight or obese individuals seeking weight loss treatment. Over 65% of individuals with BED are obese, and over 25% of patients seeking treatment for obesity have BED. Obese individuals with BE are at greater risk of developing metabolic syndrome than individuals with obesity alone, and typically experience more severe obesity and increased risk for dyslipidemia and impaired glucose levels, as well as serious health problems associated with obesity generally.
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Complications of Binge Eating Disorder
Most patients with binge eating disorder are overweight or obese; associated complications of binge eating disorder are related to this include:
- Musculoskeletal pain
- Metabolic syndrome
- Hypertension
- Hyperlipidemia
- Diabetes
- Cardiovascular disease
- Menstrual dysfunction, such as amenorrhea and oligomenorrhea
- Cortisol dysregulation
- Sleep disorders, such as apnea and obesity hypoventilation
The Role of Dieting and Restriction
Restrictive dieting is a significant trigger for binge eating. According to Registered Dietician Kimberly Gomer, "restrictive dieting is pretty much starving yourself…that’s the problem, and the dieting culture we have encourages it. It makes you feel like you don’t have control, you’re a failure. You’re the problem.” Going on a calorie-counting diet fuels binge eating. The number one rule to successful weight loss is to never be hungry.
Individuals with BE typically approach dieting in a dichotomous, all-or-nothing manner and adopt rigid dieting rules, which, when broken, produce dysfunctional, all-or-nothing cognitions (e.g., “I’ve blown my diet so I may as well binge”) and negative affect (e.g., guilt, shame) that frequently trigger BE episodes. This pattern is consistent with the abstinence violation effect (AVE), which posits that individuals respond to a lapse in abstinence from a given behavior (e.g., eliminating specific foods or meeting a strict calorie goal) with negative cognitions and affective responses. Higher levels of these negative cognitions and affective reactions increase the intensity of the AVE, which in turn increases the likelihood of a subsequent lapse.
Strategies for Recovery
Breaking the Cycle: Unlearning the Behavior
Fortunately, "the behavior is learned, therefore it can be unlearned." Breaking an addiction often involves some form of abstinence, yet for people addicted to food, abstinence isn't an option. You need food to survive.
Therapy and Counseling
Talk therapy, also called psychotherapy, can help you learn how to exchange unhealthy habits for healthy ones and reduce binge eating. Talk therapy may be in individual or group sessions.
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Cognitive Behavioral Therapy (CBT): CBT may help you cope better with issues that can trigger binge eating, such as negative feelings about your body or a depressed mood. CBT also may give you a better sense of control over your behavior and help you gain healthy-eating patterns.
Integrative Cognitive-Affective Therapy (ICAT): This type of talk therapy may be helpful for adults with binge-eating disorder.
Dialectical Behavior Therapy: This type of talk therapy can help you learn behavioral skills to help you deal with stress, manage your emotions and improve your relationships with others. Mindfulness is a core part of the DBT frame of mind and helps the reader examine the link between his or her emotions and the behavior that interferes with his or her life.
Cognitive behavioral therapy focuses on identifying and changing maladaptive patterns of thought and behavior. Patients can be treated through a clinician or a self-help program, both being equally effective. Cognitive behavioral therapy self-help programs are comparable to behavioral weight loss methods, such as calorie restriction and increased activity, in short-term outcomes and are more effective in specialty settings.
Acceptance-Based Behavioral Treatment (ABBT)
This treatment approach alters the dietary and physical activity goals of traditional BWL interventions and incorporates psychological strategies to promote long-term success for individuals with BE. This treatment integrates treatment components from an ABBT weight control intervention incorporating both standard BWL and acceptance-based treatments components and was tailored to meet the unique treatment needs of individuals susceptible to BE. The central elements of the ABBT treatment integrated treatment components from an ABBT weight control intervention incorporating both standard BWL and acceptance-based treatments components and was tailored to meet the unique treatment needs of individuals susceptible to BE.
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Gradual and Flexible Approach to Calorie Management
To reduce calorie consumption, self-monitoring of food intake without recording calorie intake is reintroduced to regularize eating patterns (i.e., regular meals and/or snacks approximately every 4 hours). Once regular eating patterns were reestablished and participants were engaging in successful self-monitoring of eating habits, participants then added calorie recording, while making gradual weekly reductions in average daily calorie goals (starting at 300 calories below their baseline, which would produce just over 0.5 lbs of weight loss per week, and reducing by 100 calories each week if they were successful with initial reductions).
Optimal weight loss goals were presented as being 5%-10% of the participant’s initial body weight, an amount associated with clinically significant health benefits, rather than achieving a BMI in the “normal” range, which for many participants would lead to unrealistic goals or expectations.
Medication
Lisdexamfetamine dimesylate (Vyvanse) is a medicine for attention-deficit/hyperactivity disorder (ADHD). Food and Drug Administration to treat moderate to severe binge-eating disorder, but only in adults. Because it's a stimulant, this medicine can be habit-forming and misused.
Lifestyle Adjustments
Lifestyle change serves as the foundation upon which a holistic approach to weight loss and eating recovery is built. Imbalances in lifestyle have the potential to create vulnerability to binges. Loneliness can lead to using food for companionship, work-a-holism leads to reward eating, and boredom seeks food for stimulation. Clients are encouraged to explore potential lifestyle deficits and to reduce emotional vulnerability through lifestyle enrichment:
- Meaningful activity
- Adequate interpersonal support
- Productivity
- Leisure
- Self- care
- Healthy pleasures
Mindfulness and Intuitive Eating
Kimberly and the team of Nutrition experts at the Pritikin Center help guests learn how to use mindfulness while they are eating. Starting to be more mindful when you’re eating can be as simple as putting down the cell phone, television, and other screens.
Findings support the idea that mindfulness in eating is inversely related to binge eating and mood disturbances in university students in health-related disciplines.
Prioritize Sleep
If you haven’t slept, your body will produce the sleep hormone, cortisol. Cortisol influences insulin…there you are - if you don’t sleep, you can be hungry.
Practical Tips for Managing Binge Eating
- Stay with your treatment: Don't skip therapy sessions. If you have a meal plan, do your best to stay with it.
- Stay away from dieting: Eat regularly.
- Plan ahead for triggering situations: Being around certain foods can trigger eating binges for some people.
- Get the right nutrients: Just because you may be eating a lot during binges doesn't mean you're eating the kinds of food that have all the nutrients you need.
- Stay connected: Don't isolate yourself from caring family members and friends who want to see you get healthy.
- Get active.
- Monitor eating patterns: Track meals and snacks.
- Limit weight tracking: To avoid becoming preoccupied with the number.
- Identify and track triggers: Such as changes in eating behavior, substance use, and mood or anxiety symptoms.
- Avoid people, places, and things that trigger binges.
The Importance of Self-Compassion and Support
Living with an eating disorder can be difficult. Treat yourself with care. Be kind to yourself, even if you're not successful with the treatment plan right away. Identify situations that may trigger problem eating behavior. Look for positive role models. Find role models who don't accidentally add to your body dissatisfaction and pressure to eat in unhealthy ways. Look for a trusted relative or friend. Find healthy ways to take care of yourself. Consider writing in a journal about your feelings and behaviors.
If you have binge-eating disorder, you and your family may find support groups helpful for encouragement, hope and advice on coping.
Addressing Underlying Issues
Attention to triggers brings a very important “digging deeper” level to the recovery process. For example, a stress eater is likely to be using the food as a vehicle for seeking comfort or calming. The use of a more functional self -soothing technique, such as deep breathing or visualization, can produce the desired effect without the excess calories. By respecting the effect or heeding the need, clients probe the binge urge for the underlying effect or need it is seeking. Alternate interventions can then be used that meet the need in more functional ways. Effective Emotion Management is a vital part of BED recovery and weight control. There are indications that a high percent of binges are triggered by negative emotional states, and that they are an attempt to blunt, escape or stuff emotions.