Written by ‘Ai Pono Hawaii Staff Writer
Binge eating disorder (typically abbreviated as BED) is an eating disorder that’s characterized by two key features: first, eating a large quantity of food (the precise amount is not formally described but it’s usually greater than what most people would typically consume) within a short period of time (usually in less than two hours), and second, feeling out of control during such binging episodes. It is considered as the most common eating disorder in the world.
Everyone eats more than usual every now and then, but if a person consumes an unusually large amount of food at least once per week for a minimum of three months, he or she might already be suffering from this eating disorder.
Having BED is not simply about eating too much; it involves uncontrollable eating and a lot of resulting distress for doing so. Patients with BED usually derive comfort from overeating, which triggers a vicious loop: having a binge leads to feelings of guilt, sadness, and worthlessness, which makes them want to turn to overeating once more in order to alleviate their distress.
Roughly 3 percent of adults in the United States suffer from BED. According to research in the U.S. and in other countries around the globe, there are more people suffering from BED than even the total of two other well-known eating disorders—anorexia nervosa (or simply anorexia) and bulimia nervosa (or simply bulimia)—combined. It should not be surprising that BED affects around 2 percent of the global population
Common Characteristics of People with Binge Eating Disorder
Major symptoms of BED include repeated episodes of binge-eating and noticeable distress from overeating. To be diagnosed with BED, people who have episodes of binge eating should show at least three of the following features:
- Eating until they’re uncomfortably full
- Eating a large quantity of food even when they’re not hungry
- Eating more quickly than normal
- Eating alone due to feelings of shame over the amount of food they’re eating or their eating behavior
- Feeling guilty, depressed, or disgusted after they indulge in a binge
The vast majority of people with BED have significant issues with their body image; however, this is common in many (if not all) eating disorders and is not a required symptom to be diagnosed with this condition.
Moreover, approximately 50 percent of people struggling with BED are extremely anxious about their weight and figure, which is also quite common among people suffering from other eating disorders.
What Sets BED Apart From Other Eating Disorders
Unlike people with other eating disorders, people with BED don’t perform unhealthy weight control behaviors such as extreme food restriction (the main feature of anorexia), self-induced vomiting, excessive exercise, laxative abuse, and so on.
BED may appear very similar to bulimia. The key difference between the two is that people with BED overeat or binge, but they don’t engage in any compensatory behaviors.
Both anorexia and bulimia usually begin to develop—as well as peak—in adolescence and early adulthood. Binge Eating Disorders affect individuals of all genders and ethnicities.
On the other hand, BED is diagnosed in people of different ages—from childhood until retirement years. BED is seen almost equally among males and females (but slightly more among females). It’s also diagnosed at similar rates across various racial and ethnic groups.
Despite these differences, keep in mind that it’s possible for a person to suffer from multiple eating disorders in his or her lifetime.
Signs and Symptoms of Binge Eating Disorder
There are a number of things that can be observed in a person who’s struggling with BED. Binging must happen at least once every week over a period of at least three months in order for BED to be considered.
Common physical symptoms of binge eating disorder:
- Tiredness and weakness
- Weight fluctuations
- Cardiovascular problems
- Gastrointestinal problems, including constipation, bloating, stomach cramps, or new food intolerances
- Sleep problems
Common psychological symptoms of binge eating disorder:
- Feeling guilty, ashamed, or self-hate, particularly after an episode of overeating
- Obsession with one’s food, eating, weight, or figure
- Dissatisfaction or anxiety around one’s weight, body shape, or size
- A distorted view of one’s body, or extreme dissatisfaction with one’s figure
- Sensitivity to other people’s feedback regarding one’s diet, body, or exercise
- Feelings of severe anxiety, distress, or sadness, particularly after binging
- Low self-esteem
- Irritability and mood swings
- Anxiety
- Depression
Common behavioral symptoms of binge eating disorder:
- Repeated episodes of impulsive, uncontrolled, or continuous eating
- Eating until one is uncomfortably full and feeling incapable of stopping such episodes
- Preferring to eat by themselves or in secret
- Hoarding of food
- Avoiding questions related to their weight and eating behaviors
- Withdrawing from events and other social situations
- Spending a lot of money on food, or even stealing food
- Exhibiting extreme diet behaviors, including orthorexia (an unhealthy obsession with following a ‘healthy diet’)
- Making adjustments to one’s schedule in order to be able to binge
- Misusing or abusing substances (such as alcohol or drugs)
Risks and Possible Complications of Binge Eating Disorder
In addition to the red flags that were discussed above, BED can lead to weight gain, hypertension, high cholesterol levels, heart disease, joint pain, sleep apnea, vitamin deficiencies and other medical symptoms. It may also lead to severe and life-threatening dehydration, which can cause heart problems, seizures, kidney failure, and even death.
People who are struggling with BED also have a higher risk of experiencing comorbid conditions, including anxiety disorders, substance use disorders, mood disorders, and impulse control disorders.
They may also have suicidal thoughts and harm themselves. In severe cases or when left untreated, some may even attempt suicide. Thus, it is critical to seek treatment as soon as possible to avoid (or promptly treat) complications that are due to this eating disorder.
Treatment Objectives for Binge Eating Disorder Recovery
The main objectives in the treatment program for a patient who’s officially diagnosed with BED are to lessen (if not totally eliminate) binges as well as to develop a more balanced relationship with food. Since binge eating is strongly linked to a negative self-image, low self-esteem, shame, guilt, and other negative emotions, a holistic treatment plan should address body image issues and negative core beliefs as well.
If the patient is diagnosed with coexisting or comorbid psychological issues (such as depression), treatment for those will also be included in the personalized treatment program.
It’s important to seek an experienced and professional team of eating disorder treatment specialists in order to avoid complications and improve chances of lasting recovery from BED.
Standard Treatment Options for Binge Eating Disorder
Treating BED involves a combination of multiple therapies. Certain psychological and behavioral therapies are particularly beneficial for patients with BED because they quickly eliminate or dramatically prevent binging episodes. Such therapies also enhance patients’ psychological health and foster lasting change.
As with other eating disorders, treating BED involves an entire team of specialists working with the patient and his or her family. Once a patient is formally diagnosed with BED, a team of healthcare professionals who have extensive experience in treating eating disorders will be formed. This team normally includes a psychologist, psychiatrist, and dietitian. Depending on the patient’s case, a social worker, family therapist, and other specialists may also be involved.
Depending on the severity of BED, an individual may receive treatment in a residential, PHP, or IOP setting. Others may choose to start with an outpatient therapist and dietitian and then have the option to increase in level of care as indicated by their treatment team.
Treatment options for BED may be provided on a one-to-one or individual basis, in a group setting, or in a self-help setup, and typically include the following:
Psychotherapuetic Approaches for Binge Eating Disorder
Usually called talk therapy or psychological counseling, psychotherapy for BED is usually performed either individually or in group sessions. At present, the leading evidence-based psychotherapies used for treating BED are CBT and IPT, followed by DBT:
COGNITIVE BEHAVIORAL THERAPY
Frequently shortened to CBT, this therapy (particularly therapist-led CBT) has been shown in studies as the most effective treatment for BED. In fact, a study found that after 20 CBT sessions, 79% of participants have already stopped binge eating.
CBT empowers patients to change their cognition (i.e., thoughts) and behaviors (i.e., actions) in order to put an end to their need to overeat. CBT helps patients understand how their thoughts and feelings influence their resulting behaviors. Some CBT interventions include self-monitoring, goal setting, replacing dysfunctional thoughts about oneself and one’s weight, following set meal plans, and building good habits for sticking to a healthy weight.
Most patients suffering from BED can experience improvement in 12 to 16 sessions of CBT with a specialized therapist. In those sessions, therapists guide patients in developing better eating behaviors by teaching them to acknowledge their dysfunctional and irrational beliefs and actions related to their body image and food intake. A specialized kind of CBT has been developed for the treatment of eating disorders: the CBT-E.
Cognitive Behaviour Therapy – Guided Self Help (or CBT-GSH) is also useful in treating BED. In this CBT format, participants are typically provided with a manual that they will go through by themselves, while having the option to attend meetings with a therapist who will provide guidance and assist them in reaching their goals.
INTERPERSONAL PSYCHOTHERAPY
Shortened to IPT, this is a type of psychotherapy that focuses on a patient’s relationship issues. This therapy is founded on the idea that a patient’s social relationships significantly affect his or her psychological and emotional health. IPT’s long-term outcomes are comparable to CBT.
In IPT, binge eating is viewed as an unhealthy coping mechanism for dealing with unresolved personal issues like relationship conflicts, significant life changes, social problems, or grief. The objective of therapy is usually to recognize the specific triggers for the patient’s unhealthy eating behaviors, acknowledge them, and then make positive changes over a period of 12-16 weeks.
IPT is designed to build patients’ communication and problem-solving abilities, both of which are crucial in healing from BED. It can be effective in preventing overeating that’s triggered by toxic and dysfunctional relationships as well as poor interpersonal communication. It tackles present issues instead of past ones. IPT is frequently used in treating more severe cases of BED as well as patients with low self-esteem.
IPT is backed by research for producing both short- and long-term benefits on lessening binges. IPT sessions are either done on a one-to-one basis or in a group format, and may be given along with CBT sessions.
DIALECTICAL BEHAVIOR THERAPY
Shortened to DBT, this therapy aims to equip patients with the necessary skills to cope with stress and manage their unpleasant emotions, without having to resort to overeating.
Even though it’s less studied and used compared to CBT and IPT, DBT is often recommended for BED patients since this therapy was developed for people who have difficulty regulating their feelings, a characteristic that’s common among people who develop symptoms of BED.
The core areas of treatment in DBT are distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness. DBT teaches patients how to live in the present and appreciate it, as well as how to relay their needs to other people. It also teaches patients how to practice radical self-love and graciously embrace pain as a part of life, instead of repressing their distressing emotions through excessive food intake. DBT also teaches grounding techniques such as “5 senses.” All of these are beneficial in lessening the symptoms of BED and even of other disorders that normally co-occur with BED.
A study on the effectiveness of DBT in 44 women who have BED demonstrated that a whopping 89 percent of participants were no longer binge eating when the therapy ended. Nonetheless, studies on the long-term effectiveness of DBT are still ongoing.
SELF-HELP INTERVENTIONS
Self-help workbooks or manuals can be used even by people who are not yet formally diagnosed with BED. In “pure self-help format” (PSH), people do not receive direct feedback about their progress or any help in applying the lessons in the program.
On the other hand, “guided self-help” (GSH) refers to a group of self-help programs that include short visits of therapists to patients in order to provide guidance for implementing the program. An example of this format would be Light of the Moon Café, facilitated by Dr. Anita Johnston.
Guided self-help based on cognitive behavior therapy (CBTgsh) has led to short-term reduction of binges among obese patients with BED.
MOTIVATIONAL INTERVIEWING (MI)
MI interventions, which are usually used for treating addiction-related disorders, have resulted in higher eating disorder treatment retention. In MI, a therapist will help the patient face his or her resistance to change using gentle probing techniques. The therapist will guide patients in realizing that their present choices (particularly in relation to food) do not support their ultimate objectives in life.
Keep in mind that while this form of therapy shows promising results, more research is needed on the effectiveness of motivational interviewing in the treatment of BED.
MINDFULNESS-BASED APPROACHES
These newer modalities are quickly gaining popularity for lowering weight as well as treating a variety of eating disorders. Research has shown that mindfulness meditation successfully lessened episodes of overeating and emotional eating in people who previously did those.
SUPPORT GROUPS AND FAMILY THERAPY
Last but not the least, being a part of support groups as well as undergoing family therapy can both be helpful to patients with BED. These can help patients in coping with the negative results of their condition in terms of their negative self-image and impaired social relations.
ALTERNATIVE THERAPIES FOR BINGE EATING DISORDER
There are several complementary and alternative therapies that some patients with BED report as useful when it comes to relieving their stress and improving their symptoms. Some of these are yoga, acupuncture, meditation, massage, and gentle exercise. In fact, many of these interventions are considered integral components of newer therapies such as movement therapy, somatic therapy, and more.
In the coming years, more of the currently ongoing studies are expected to show which therapies produce good results, and more therapies may also be developed and recommended for use in treating BED as well as other eating disorders.
Get Successfully Treated for BED or Other Eating Disorders
With the right treatment program delivered by an experienced team, binge eating disorder can be treated. Patients who are struggling with BED must start treatment as soon as they can in order to reclaim control of their body and life while avoiding risks and complications.
‘Ai Pono Hawaii is a peaceful eating disorder rehab center in scenic Maui that has an amazing track record spanning more than 35 years. We offer effective, lasting, and holistic treatment for eating disorders to patients of all backgrounds.
‘Ai Pono’s caring and highly experienced team of specialists will perform a meticulous assessment of every patient before proceeding to design a personalized treatment program that includes the most suitable evidence-based treatment modalities for each patient.
