Binge Eating Disorder

*** Disclaimer: The following article includes information derived from our clinical team’s impressions as specialized professionals working directly with Eating Disorders in Windsor/Essex County.

Binge Eating Disorder (BED) is an eating disorder that is quite often overlooked and misunderstood. Interestingly, prior to the year 2013, BED was not distinguished as its own diagnosis in any diagnostic manuals – it was considered as a “feature” within the “Eating Disorder Not Otherwise Specified (EDNOS)” diagnostic category. Many did not consider it to be an eating disorder, specifically due to the misconceptions surrounding control. For example, we frequently hear from our clients about food-shaming comments that undermine the complexity of this disorder’s symptomology, such as “just stop eating”. At BANA, we often see clients who have received this diagnosis act in surprise, as they had “no idea” what they were experiencing was a mental health disorder, and have reportedly felt alone, ostracized, and full of self-blame. Many of these individuals’ symptoms have been historically misjudged, or attributed to laziness or “fatness”. Therefore, it comes as no shock that many individuals still do not know this diagnosis exits, or recognize it as legitimate and empirically supported. Receiving the diagnosis provided some of our clients with validation – their struggle was finally acknowledged, what they are going through is an actual condition, and they are not alone in these experiences.

In the 2018-2019 year, we collected data on our active clients to determine how frequent each eating disorder diagnosis is at BANA. Our findings demonstrate that BED is the second most commonly diagnosed eating disorder – we found that during this year, 30.8% of our clients were given this diagnosis.

The 5^th rendition of the Diagnostic Statistical Manual (DSM-5) is the current guideline used in North America to diagnose all mental health disorders. It outlines the requirements that must be met in order to receive any diagnosis within its pages.

DSM-5 CRITERIA FOR BINGE EATING DISORDER

a.The individual is experiencing recurring episodes of binge eating; binge eating is characterized by the following:

• Eating an amount of food that is definitely larger than what most individuals would eat in a similar period time under similar circumstances; this is done within a discrete period of time, typically within a 2-hour period
• There is a sense of lack of control over eating during the episode; feelings of being unable to stop or control how much one is eatin

b. The binge-episodes are associated with 3 or more of the following:

• Eating much more rapidly than usual
• Eating until uncomfortably full
• Eating large amounts even when not physically hungry
• Eating alone due to feeling embarrassed over how much one is eating
• Feeling guilty, depressed, or disgusted with oneself

c. Experiencing marked distress regarding binge eating being present

d. The binge eating occurs at least once a week (on average) for 3 months

e. The binge eating is not associated with recurrent use of inappropriate compensatory behaviours (as in Bulimia Nervosa), and does not occur during the course of Bulimia Nervosa or Anorexia Nervosa

Severity Ratings: based on the frequency of binge episodes

Mild = average of 1-3 binge eating episodes/week
Moderate = average of 4-7 binge eating episodes/week
Severe = average of 8-13 binge eating episodes/week
Extreme = average of 14 or more binge eating episodes/week

BINGING VS. OVEREATING

Often at BANA, we hear some confusion surrounding what constitutes a binge. For diagnosis, it is required that the portion size is objectively large, meaning most people would agree that is too much food to have within a given period of time. However, some people experience subjective binges, where not everyone agrees that the portion meets criteria but it is larger than what individual typically eats. In the case of subjective binges, the individual themselves feel out of control despite portions not being excessive. Beyond objective and subjective binges, there is overeating. Overeating may only be slightly more food than what is typical; however, the individual may not feel out of control. Overeating is a relatively normal behaviour, as most of us likely overeat from time-to-time.

Below is a small chart that can help outline these differences.

Type:                                     Portion:                                 Control:
Objective Binge                  Definitely large                    Out of control
Subjective Binge             Not agreeably large             Out of control
Over-Eating                        Not agreeably large             In control

THE CONTROL MYTH

“Just stop eating” or “just practice self-control” – some examples of comments we frequently hear directed towards those struggling with BED. The underlying implications behind comments like these is that control is easily accessible to individuals with BED. However, as clearly stated within the DSM-5, the sense of lack-of-control is a symptom of this disorder. Consider this: it would be silly to tell a diabetic “just produce more insulin”. Not having control over eating is within the nature of the disorder; therefore, it is not as simple as flicking “on” the control switch. It is much more complex.

The myths regarding control imply that recovery from BED is as “simple” as resolving problematic eating (we use quotations here, because resolving disordered eating can be challenging in and of itself). However, treatment for BED goes beyond regulating ones eating patterns – it also considers emotions and events that can trigger episodes of binge eating, as well as types of food-labelling that have been linked to the disorder and its symptoms. Research has demonstrated that using terms like “junk food” or “bad food” can actually make one more likely to overeat or binge on those same foods. Research has also shown that one of the most frequent causes of binge eating is undereating, due to the physiological and psychological deprivation that can come from restricting, fasting or dieting. We see this at BANA, as many of our clients with BED have a long history of attempting to control their chaotic eating with dieting and/or restrictive measures. If lack-of-control was truly the only factor responsible for binge eating, then we would not see individuals’ binge as a result of troublesome emotions /events, or undereating; however, we see this every day.

Comments that undermine control can be very damaging to individuals with BED. These individuals often find themselves in a tug-of-war between themselves and societal judgments. They subjectively experience this sense of loss of control, yet most people around them tend to assume that this condition is self-induced and easy to stop. Most of the time, these individuals know they are eating more than what is recommended, and do not need to be reminded of this regularly.  In other words, they likely know what the problem is but do not know how to solve it. These conflicting messages are often internalized, causing those with BED to believe there is something inherently “wrong” with them for not being able to “just stop”. This internal and external blame-game can be defeating, and cause feelings of depression and hopelessness. As mentioned above, these individuals may turn to food to cope with distress, thereby contributing to the cycle of the disorder.

One of the most important things to take away that we cannot repeat enough is: blame and comments about self-control do not solve the problem… they perpetuate it.

A NOTE ABOUT WEIGHT STIGMA  

One major misconception about BED is that those who have the diagnosis are all overweight or obese. This is not the case; individuals with BED are of all weights, shapes and sizes. This misconception about BED could be partly attributable to the possibility that those who meet criteria of the disorder but are not of above-average weight could be “missed” by professionals, or overlooked by the individual themselves. Being overweight is often seen as a “marker”, despite this not actually being a diagnostic criterion.

Individuals with BED who could be categorized as overweight or obese tend to face significant weight stigma. In a world full of stigma, a great deal of shame and embarrassment exists for these individuals; beyond individual and social-level stigma, a great deal of stigma is also systematic/institutional. For example, not being able to fit in airplane seats or wheelchairs, or not being able to find clothing that fits (or have a variety to choose from), are often seen as the individual’s problem, rather than something businesses/industries should solve. Although – of course – there are measures that the individuals can take themselves (such as attending specialized eating disorder treatment programs), there are also countless measures that could be taken on a grander scale so that these individuals do not face further ostracization and discrimination. *Recall: attempts to lose weight – particularly dieting/restricting, weight-loss programs, and sometimes even bariatric surgery – can actually reinforce the disorder, rather than resolve it.

One potential step that could be taken is the education and training of professionals in the medical field regarding BED, symptoms and their perspective causes, and weight-stigma. Many BANA clients disclose that every time they visit their doctors, they are faced with a lecture about the “need” for weight loss, and the effects of being overweight on health. Sometimes they even report that other concerns are not taken seriously because they have not lost weight yet – so long as they are still overweight, they will not be sent for further testing or considered for alternative treatments (other than those of weight-loss). Of course, we do not dispute that being overweight can present with health risks; however, we argue that not everyone who is overweight is facing or ever will face these health problems. More simply put: just because someone is above-average weight does not mean they are unhealthy. The assumption that weight equals health is in fact weight stigma; health may be correlated with weight, but they are not mutually inclusive.

OVERVIEW

BED is an eating disorder that receives a lot of criticism from the general public, and is often met with fat-shaming and pushing for weight-loss. We believe it is important for those who work in fields related to health and wellness to be educated on BED, as to minimize the risk of triggering or shaming this population. At BANA, we offer free educational presentations to any community groups, schools or organizations; if you are interested in learning more about how you can be eating disorder conscious in your work, please contact our health promotion team.

Because BANA was established in 1983, and due to the fact that BED was not officially considered its own diagnosis until 2013, our title “Bulimia Anorexia Nervosa Association” did not include this diagnosis. However, we still incorporate treatment of BED within our services and programs. If any of the criteria outlined in this article hit-home, but you’re not sure if they meet all the requirements for a diagnosis, do not hesitate to contact us through general intake. We can meet with you to discuss potential symptoms, and can support you through some of your concerns.

Our general intake number is: 1-855-969-5530

RESOURCES:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Marcin, A. (2015). Binge eating disorder: The history of BED. Retrieved from https://www.healthline.com/health/eating-disorders/binge-eating-disorder-history#1

Centre for Clinical Interventions. (2018). What are eating disorders. Retrieved from https://www.cci.health.wa.gov.au/

Craigen, K. (2017). 4 Common Misconception about Binge Eating Disorder. Retrieved from https://www.eatingdisorderhope.com/blog/4-misconceptions-bed

National Eating Disorders Association. (2019). Eating Disorder Myths. Retrieved from https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/eating-disorder-myths

Walden Behavioral Care. (2018). 8 Myths About Binge Eating Disorder. Retrieved from https://www.waldeneatingdisorders.com/blog/8-myths-about-binge-eating-disorder/