Symptoms and Remedies

By Abigail Natenshon, MA, LCSW, GCFP

What is Binge-Eating Disorder (BED) / Compulsive Overeating?

Binge-eating disorder (BED) or compulsive overeating is the lesser-known eating disorder, following anorexia nervosa and bulimia nervosa. It is characterized by eating when one is not hungry or by continual eating without regard to physiological cues. Binge eaters typically eat to the point of feeling extreme discomfort or even pain. I have worked with people whose bingeing behaviors are so severe as to be experienced as a form of self-mutilation; one 33 year old patient of mine describes eating so much food at a sitting that her skin hurts from being stretched. The patient will typically report frequent episodes of binge eating, with an inability to stop or to control the behavior. One in five young women today report this experience with food. Forty percent of binge-eating disorders occur in men and boys.

• Deprivation-sensitive binge eating arises out of excessive dieting or food restriction;
• Addictive or dissociative binge eating is the practice of self-medicating or self-soothing with behaviors that typically evoke feelings of emotional tranquility or numbness.

It is important to understand that not all people with binge-eating disorder are overweight, that not all overeaters are binge eaters, and that being overweight, even to the point of obesity, does not qualify a person as a binge eater.

The behaviors involved with binge eating are compulsive in nature, and typically signify a sense of inflexibility and excess, not only in the area of food consumption, but also in other life spheres as well. At times, and under certain circumstances, we all eat too much, too fast and too often. yet, we are not all binge eaters. Excessive behaviors do not qualify as binges unless their function is to reduce or contain anxiety (resolving emotional problems,) and they are experienced as frequent, unavoidable, and beyond the control of the person bingeing.

In some respects, binge eating disorder differs from anorexia and bulimia

Typically experiencing an obsessive preoccupation with body image, individuals with BED do not seek to avoid weight gain through purging or other drastic measures. They tend to exhibit less extensive levels of psychopathology and show strong motivation to desist from these behaviors, which can be tenacious and recurring. Because these aspects of BED differ from those of other eating disorders, this disease is mistakenly considered to be less serious and/or not as deserving of intensive treatment. In many instances, this disorder goes undiagnosed. A highly functional and thin BED patient of mine has complained that no one gives credence to the extent of her psychological suffering, depression and self-loathing after a binge. People say, "You're thin! You don't purge. What are you complaining about?!" "Nobody seems to care that the next day I am so depressed, I can't even get myself out of bed!"

It is significant to note that not all binges include large quantities of food. For an anorexic person, eating five grapes may be considered a binge. Remember what characterizes an eating disordered binge is the element of compulsion behind the eating behavior and the emotional outcome that occurs as a result of the eating behavior.

The Experience of the Binge Eater

Binge eaters report a total preoccupation with food. One of the problems that frequently occur with binge eaters is nighttime eating (Night Eating Syndrome).  Patients describe getting out of bed in the wee hours and walking in their sleep or in a trance-like state into the kitchen where the bingeing happens. Binge eaters sometimes do not know if their binge was a dream or a reality until the next morning when evidence of food wrappers and empty containers will appear in the kitchen.

Bingers often do their eating in secret, and typically feel most vulnerable to succumbing to these behaviors when they are alone. Patients describe eating in their car, sometimes en route to and from work or errands, where they feel compelled to drive into franchise restaurants, such as Dunkin Donuts, Taco Bell, or Wendy's and load up on food at each place. They describe having persuasive internal conversations with themselves in an effort to resist the temptation, but then report the all- powerful trance-like compulsion taking over.

In most instances, once the bingeing process has begun, patients report that it is virtually impossible for them to regain the upper hand, stopping or even slowing down the bingeing ritual. Because of the nature of this disease, blood sugar levels are highly volatile, spiking and dropping, a situation that adversely affects the brain and results in chronic and severe fatigue.

Treating Binge Eating Disorders

Because many of the underlying issues of the binge eater tend to be similar to those driving anorexia and bulimia, the same treatment techniques apply. Cognitive-behavioral, psychodynamic treatment with a family systems focus and in the context of a secure treatment relationship is most beneficial. Typically, the elements that drive these disorders include brain and body chemistry, physiology, unhealthy eating and other behavioral patterns, emotions, and sociability issues. All of these factors need to be addressed simultaneously in order to attain optimal treatment results. As with the other eating disorders, if victims of BED attempt to cease the dysfunctional eating behaviors without simultaneously attending to the emotional or relational issues underlying and driving them, their efforts will invariably result in failure.

In my own practice, I have observed that binge eaters benefit greatly from working together with others who share similar problems in the context of support/therapy groups. It is invaluable for people who tend to isolate themselves and hide their behaviors to share their feelings with others; in addition, group members are able to offer each other helpful and practical ideas and inspiration for making behavioral changes, increasing motivation and accountability. Developing internal self- regulation facility in other areas of life will contribute to healing eating dysregulation, and vice versa.

Some behavioral remedies for binge eating disorder

Along with psychotherapy, behavioral techniques that allow the individual to avoid temptations are generally effective. Behavioral techniques might include such changes as,

• If bingeing occurs in the car, taking a different route home where the patient will not be confronted with the temptation of fast food restaurant chains.
• Keeping a small cooler in one's car containing one's own nutritionally dense food, prepared and pre-packaged.
• Bringing a passenger along for the ride.
• Wearing an elastic band on one's wrist and snapping it hard to remind one not to begin the out of control bingeing process when the urges and temptations present themselves.
• A solution for home bingers might be not to bring unhealthy snack or trigger foods home, though for those who live with family members who like such snacks, eliminating snack foods from the pantry is an idea that is typically does not go over well. This may need to become a family decision made in the context of consensus, compromise, and an action plan.

Binge eaters who have a genetic propensity tendency towards addiction often report a craving and sensitivity to carbohydrates and sugar, so that the more they eat, the more they crave. There are some who claim that eliminating sugar from their diet can be an integral part of reducing binge eating episodes. This is a concept that is espoused by Overeaters Anonymous and is a treatment method that is very helpful for a great number of binge eaters. The problem that some people run into in using this alternative for healing is that restriction generally breeds greater obsessiveness and compulsions.

(Some of this information appeared in the first chapter of my book, When Your Child Has an Eating Disorder: A Step-by-Step Workbook for Parents and Other Caregivers, Jossey Bass Publishers, 1999.)

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