Melinda, a patient, says of her binge eating disorder, “I eat and eat and I know that I should stop, but I can’t. I eat so much that I want to throw up, my stomach hurts, and I have to lie down. Sometimes, I feel like if I don’t eat everything I can get my hands on, I’ll explode.” Her words highlight the anguish that many people feel when food controls their lives.
Both binge eating disorder (BED) and compulsive overeating (CO) are conditions in which food is typically used for unhealthy reasons. People with BED or CO tend to feel powerless, and often lose hope that their behavior can change.
What Is Binge Eating Disorder?
Binge eating disorder affects between 2 and 5 percent(Spitzer et al. 1993) of adults in the United States (more than four million Americans) and is the most common eating disorder. Up to 25 percentof overweight or obese individuals seeking treatment for obesity have binge eating disorder (Pull 2004). This percentage increases in those who are severely obese. Unlike other eating disorders, binge eating disorder appears to be almost as common in men as it is in women (Grucza, Przybeck, and Cloniger 2007); it affects African Americans as often as Caucasians (Mitchell and Mazzeo 2004).
If you have periods in which you eat large quantities of food in one sitting (the definition of a binge) you may have binge eating disorder. Other symptoms of BED include difficulty in controlling how much you eat and feeling powerless to stop eating, even though you may no longer be hungry or may feel too full. After a binge, you may suffer from emotions of disgust, shame, or embarrassment about your behavior.
For individuals with BED, weight problems are likely to begin earlier than for their peers; often they have a history of obesity, and may have started dieting at a young age (Johnsen et al. 2003). The BED obsession with body shape and size bears a greater similarity to thought patterns of individuals with bulimia nervosa than those of individuals with obesity who don’t binge. A hallmark of BED is a history of exposure to negative messages about shape, eating, and weight. While dieting may be associated with BED, in the majority of people, bingeing behavior begins before dieting (Stunkard 2004).
What Is Compulsive Overeating?
If you don’t fit the criteria for BED, but have struggled with your weight for most of your life, going on and off diets, you may be a compulsive overeater (CO). If so, this book can still help you.The main difference between BED and CO is that people with CO don’t experience discrete episodes of binge eating; they tend to eat past the point of fullness, but don’t necessarily binge while alone or hide their overeating.
How Are BED and CO Different?
The stories below describe two patients, one with BED, the other with CO:
David, the Compulsive Overeater
David’s parents fought constantly when he was growing up. After every fight, David’s mother would take him into the kitchen and cook their favorite comfort foods, encouraging David to eat with her. David was overweight as a child, but his mother insisted that he just had “big bones.” In college, he played sports and lost weight, but after college the weight came back. David overate when he was happy, sad, or lonely. Although he successfully lost weight on diets, the weight always came back. By the time he was an adult, married with two small children, David’s weight was in the obese range and affecting his health. David suffered from depression. He felt he was a failure because he could not control his overeating.
Jennifer, the Binge Eater
Jennifer’s mother died when Jennifer was eight. At the time, her father sent her to live with her grandmother, who was very strict and emotionally distant. Here she began to sneak food and binge eat. After gaining weight in middle school, she was put on a strict diet. She was ostracized by the “popular” girls, who often teased her and said mean things about her. At night, Jennifer would sneak downstairs to the kitchen to eat the leftovers. After every episode of bingeing, she felt ashamed and disgusted with herself. In high school, she was diagnosed with depression and put on medication, but couldn’t stop bingeing. She felt isolated and alone. She tried to make a fresh start in college, vowing not to binge anymore. But here she felt even more pressure to fit in, and began dieting to lose weight. When she felt fat her whole day was ruined. She knew she should stop but couldn’t, often eating to the point of abdominal pain. She felt caught up in a vicious cycle of bingeing and trying not to binge; it was ruining her life.
Both Jennifer and David use food to cope with their emotions; both feel embarrassed and upset with their inability to control their behaviors. Both also often eat when they are not hungry or overeat when they are full. However, Jennifer has specific periods of time when she binges, while David tends to overeat throughout the day. Jennifer’s bingeing causes emotional distress and leads to other behaviors to hide it. These behaviors—rooted in the shame, disgust, and guilt she feels about her actions—may create havoc in her life. Of the two, Jennifer is more likely to judge her worth as a person on how she looks or on how she feels about her body than David is.
In comparisons between obese patients who do not have BED and obese patients who do have BED, those with BED tend to have more fluctuation in their weight, experience higher levels of body dissatisfaction (Marcus et al. 1992), and are more likely to have been overweight as a child (Fairburn et al. 1998). Those with BED also have a higher incidence of depression and anxiety (Yanovski 1993). When asked to eat as much as they want in laboratory settings, people with BED will eat significantly more calories than those with CO (Walsh and Boudreau 2003).
Several risk factors for both BED and CO have been identified. These include genetics (which we’ll discuss further in chapter 2), low social support, pressure to be thin, emotional eating, depression, low self-esteem (Stice, Presnell, and Spangler 2002),bullying by peers, and some form of maltreatment in childhood (physical or sexual abuse) (Striegel-Moore et al. 2002).
BED currently falls into a diagnostic category called “Eating Disorders Not Otherwise Specified” (EDNOS) in the American Psychiatric Association’s Diagnostic and Statistical Manual (American Psychiatric Association 2000). EDNOS includes all eating disorders that don’t meet criteria for anorexia or bulimia. However, despite sharing many characteristics with other eating disorders, compulsive overeating has thus far not been considered part of the eating disorder spectrum.
What Causes Binge Eating Disorder and Compulsive Overeating?
There is no known cause for BED or CO. Also unclear is the relationship between dieting and BED, and whether depression causes BED or BED leads to depression. What is clear is that skipping meals, eating less than your body needs, and restricting categories of food that are thought to be fattening can lead to overeating or binge eating.
Many people with BED and CO have difficulty expressing their emotions, and may overeat or binge when happy, sad, bored, anxious, or stressed. Those with BED may also abuse alcohol, find it difficult to regulate their emotions (that is, they may feel that their emotions are in charge as opposed to the other way around), or act impulsively. In both BED and CO, social isolation or social withdrawal may occur. Strong genetic links exist for both BED and CO; these disorders may occur in several members of the same family.
Both binge eating disorder and compulsive overeatingcan serve as ways to cope with emotions, stressful situations, relationship problems, even issues from your childhood. It may be that when you find yourself home alone on a Friday night, food feels like your only reliable friend. Or you may have grown up in a family where dieting and talking about food and weight were part of the daily routine. If you were started on the diet treadmill as a child, you may no longer even know how to get off it. Or perhaps your disordered eating began after a traumatic event, when food soothed a chaos of emotions you didn’t know how to handle. No matter what your problems with eating may be, this book will help you develop a healthier relationship with both food and your body.
Recognizing that you have BED or CO is the first step on your road to recovery. Once you know you have a problem, you’ve gone a long way toward solving it.