Binge Eating Disorder: Treatment for a Secret Struggle

At 15 years old, Ava excels in school, loves her family, and has a lot of friends. An outside observer would probably not guess her hidden struggles with food. Ava deals with stress by eating. At the end of a long day, when her family is sleeping, she raids the kitchen for sweets and junk food. She even has a hidden snack stash in her bedroom “just in case.”

When she starts eating, Ava feels a sense of relief and euphoria, but these feelings soon turn to guilt and shame at the amount of food consumed. She feels unable to control her urge to eat. She resolves never to eat like this again, but there is always a next time – she’s stuck in a cycle of compulsive overeating.

Using Food to Cope with Emotions

Like Ava, Gavin is a teenager who seems happy from the outside looking in, but he struggles with insecurity and fear of not being accepted. In the tumultuous years of adolescence, food has become something Gavin can always count on to make him feel temporarily happy.

Eventually, Gavin’s parents notice his struggle and help him get to therapy, where he learns how his eating connects to his feelings. Before counseling, he only knew that he felt out of control around food and that at times his peers would bully him for being overweight. In counseling, Gavin starts to learn how to identify, express, and manage his emotions without using food.

Eating for Stress Relief

At age 35, Kathryn has been in an unhealthy relationship with food for most of her life. She has low self-esteem and fear of rejection, stemming from the bullying she endured as a child.

The people around Kathryn know that she’s good at her job as a stockbroker, but they also sense her isolation and lack of confidence.

Kathryn overindulges in two substances to cope with stress: alcohol and food. No matter which she chooses, she always feels guilty and ashamed afterward and promises herself she’s going to change. But without the tools to improve, she can’t make her resolutions stick. She’s considered going to therapy, but the thought of dealing with all the pain of her past is too overwhelming.

Binge Eating Disorder: The Reality

So, many of us are familiar with emotional eating in our own lives, whether or not we’ve ever binged. Binge Eating Disorder, otherwise known as BED, is not just a habit of emotional eating. It’s not even merely a habit of compulsive overeating. The definition of a binge is what’s essential for diagnosis.

According to the American Psychiatric Association, 1.6% of women and 0.8% of men have BED, and this disorder most commonly begins in adolescence or early adulthood.

Now, you may wonder if there’s a correlation between obesity and BED, but most individuals with an obese BMI do not meet BED criteria. This disorder can be a hidden struggle for anyone, whether they are overweight, obese, or a healthy weight.

What is Binge Eating Disorder?

In 2013, the American Psychiatric Association published the fifth edition of their Diagnostic and Statistical Manual of Mental Disorders, and they included Binge Eating Disorder. Before this time, professionals recognized BED for years, but there was not enough research for an official diagnosis.

So, if you or someone you know may have Binge Eating Disorder, these are the criteria you would have to meet for a diagnosis:

• Recurring episodes of binge eating.
• Significant distress about binge eating.
• Binges characterized by the following:
• Eating very quickly.
• Eating despite feeling full, even uncomfortably so.
• Eating without being hungry.
• Eating alone due to embarrassment.
• Feelings of shame, depression, or self-hatred following binges.

In many of its characteristics, BED is similar to bulimia nervosa. The difference is that someone with BED does not attempt to compensate for binging with other behaviors, such as purging or over-exercising, in an attempt to prevent weight gain.

Experts believe that negative emotions most commonly trigger binge eating, but other stressors may sometimes play a role. Because of these identifiable triggers, it’s often believed that binge eating is a coping mechanism for these stressors or emotions. Food can become an escape, especially since it is done very quickly and without mindfulness.

As mentioned above, someone with BED probably feels an intense amount of shame at different times throughout the cycle of binge eating, and most likely tries to hide their behavior from others. As the disorder takes hold, the secret-keeping naturally leads to greater isolation and more negative emotions, which can, in turn, become triggers for more binge eating.

Co-occurring Disorders

Often BED does not exist in a vacuum but may coincide with other diagnoses, including bipolar, anxiety, depressive, or substance use disorders (American Psychiatric Association, 2013). During therapy, a counselor will assess the client for symptoms of other possible diagnoses so that treatment can be most effective.

Medical Complications

It’s important not to underestimate the potential damage of this disorder. Complications of BED can range from heart disease and Type 2 Diabetes to high blood pressure and obesity, but an individual with BED may also have gastrointestinal problems, osteoarthritis, and muscle and joint pain as a result of the disorder. It’s vital that a client who is presenting with BED symptoms also be assessed for medical complications.

Risk Factors

As with other psychiatric conditions, risk factors are correlated but not necessarily the cause of Binge Eating Disorder. Depending on the individual, BED can develop due to a variety of factors.

The following are risk factors that are associated with BED (American Psychiatric Association, 2013; BEDA, 2016); Eating Disorder Hope, 2018). But, the presence of these risk factors does not necessarily mean that there will be a BED diagnosis.

• Difficulty expressing and managing emotions.
• Genetic or physiological factors. BED tends to run in families, but family dynamics don’t necessarily lead to the development of an eating disorder, including BED (Grange, Lock, Loeb, & Nicholls, 2010).
• Having another psychiatric disorder, such as anxiety, bipolar, depression, or substance use.
• A history of being bullied, especially about weight.
• A history of dieting, or dieting as a response to the disorder.
• A history of significant weight fluctuations.
• Low self-esteem.
• Obesity, either before developing the disorder or as a result of it.
• Poor body image.
• Significant loss, such as the breakup of a romantic relationship or the death of a loved one.
• Trauma, which may include emotional abuse, neglect, physical abuse, or sexual abuse.

Warning Signs

So, let’s recall that weight itself is not the identifying factor in Binge Eating Disorder. It may relate to the disorder, but not always, and most obese individuals do not have BED.

If you have a loved one who you think may have BED, remember that they are probably dealing with a lot of shame and the desire to hide their struggle. Despite the secret nature of this disorder, there are common warning signs that may indicate the possibility of BED (Eating Disorder Hope, 201, LEDP, 2018, NEDA, 2018).

• Constant bloating or constipation
• Continuing to eat after reaching the point of fullness
• Eating fast and feeling out of control
• Fixation on body image or weight
• Gastrointestinal problems
• Having strange behaviors or rituals around food or meals
• Hoarding behaviors around food, food disappearing too quickly, lots of empty wrappers
• Isolation and withdrawal from other people and activities
• Noticeable fluctuations in weight
• Obsession with food
• Planning binges
• Starting new diets or food plans frequently
• Wanting to eat alone as often as possible

Binge Eating Disorder Treatment

Do you think you may have BED, or know someone who does? Maybe you’ve noticed strange behavior in a roommate or friend, or you are aware of this secret struggle, and you feel like it’s spiraling out of control.

Please don’t downplay the seriousness of this disorder. It can cause severe and even life-threatening health problems. It’s important to get both a medical and psychiatric evaluation as soon as possible.

Once treatment is underway, an individual with BED will also work with a dietitian to gain a healthy relationship with food and nutrition. Psychiatric medication may be necessary for any co-occurring disorders.

In terms of Binge Eating Disorder treatment, experts recommend several possible treatment modalities, including:

• Cognitive Behavior Therapy (CBT): In CBT, an individual will learn to identify the connection between thoughts/feelings and behavior—in this case, binging. The goal is to develop strategies to change the behavior pattern.
• Dialectical Behavioral Therapy (DBT): In this therapy, an individual will learn skills to cope with their emotions and regulate them. DBT takes place in both individual and group settings.
• Interpersonal Psychotherapy (IP): In IP, people with BED can learn more about their relationships and themselves, as well as other factors that may contribute to their eating disorder.

Depending on any other needs you may have, you might need additional treatment. When you meet with an experienced counselor, you’ll learn more about the Binge Eating Disorder treatment options available to you.

If you are living with Binge Eating Disorder, you might begin to feel hopeless, but there is hope. Full recovery is possible, and you can live the rest of your life in freedom. Contact us (424) 361-6196 today to take the first step towards recovery.