Binge eating

Definition

Description

Demographics

Causes and symptoms

Diagnosis

Treatment

Nutrition/Dietetic concerns

Therapy

Prognosis

Prevention

Resources

Definition

Binge eating an abnormal eating pattern in which an individual eats significantly more food in a limited time than most people typically would eat. The time-frame for a binge is usually 1–2 hours.

Description

The eating disorders anorexia nervosa and bulimia nervosa are considered psychiatric disorders and have formal diagnostic criteria that are define in the

Possible health consequences of binge-eating

• Anxiety
• Depression
• Obesity
• Obesity-related diseases
• Poor self-esteem
• Sleep problems
• Stress
• Substance abuse
• Suicidal thoughts
• Weight gain
• Weight obsession

(Illustration by GGS Information Services/Thomson Gale.)

Diagnostic and Statistical Manual for Mental Disorders Fourth Edition-Text Revision (DSM-IV-TR)published by the American Psychiatric Association (APA). Binge eating is an acknowledged problem, but it has not risen to the level a separate psychiatric disorder as defined by the APA. Some experts believe binge eating is a subtype of bulimia, an eating disorder characterized by episodes of binge eating followed by purging the body of calories. Other experts believe that binge eating should be classified as an obesity-related behavior. Some healthcare providers place binge-eating disorder in the APA category of eating disorders not otherwise specified. Although the way a healthcare professional views binge eating does not change the behavior, it may influence the type of therapy recommended and affect the degree to which treatment is covered by heath insurance providers.

Everyone eats too much occasionally, but people with binge-eaters disorder have an abnormal eating pattern that occurs frequently. Many eating disorder specialists define binge-eating disorder as binge eating behavior that occurs at least twice a week for three months and has a negative effect on the individual’s relationships and daily activities.

Binge eaters exhibit many of the following behaviors.

• They eat abnormally large amounts of food at one sitting, often consuming 3,000-10,000 calories in a short period.
• They gobble their food, eating much faster than usual.
• During a binge, they feel out of control and unable to stop eating, even though they may want to.
• Despite feeling full or even painfully uncomfortable, they continue to eat.
• Binge eaters tend to diet constantly but never lose weight.

KEY TERMS

Electrolyte —ions in the body that participate in metabolic reactions. The major human electrolytes are sodium (Na+), potassium (K+), calcium (Ca 2+), magnesium (Mg2+), chloride (Cl-), phosphate (HPO₄ 2-), bicarbonate (HCO₃-), and sulfate (SO₄ 2-).

Neurotransmitter —One of a group of chemicals secreted by a nerve cell (neuron) to carry a chemical message to another nerve cell, often as a way of transmitting a nerve impulse. Examples of neuro-transmitters include acetylcholine, dopamine, serotonin, and norepinephrine.

Obese —more than 20% over the individual’s ideal weight for their height and age or having a body mass index (BMI) of 30 or greater.

Placebo —a pill or liquid given during the study of a drug or dietary supplement that contains no medication or active ingredient. Usually study participants do not know if they are receiving a pill containing the drug or an identical-appearing placebo.

Triglycerides —a type of fat found in the blood. High levels of triglycerides can increase the risk of coronary artery disease.

Type 2 diabetes —sometime called adult-onset diabetes, this disease prevents the body from properly using glucose (sugar).

• Then often eat alone and hide empty food containers to disguise from others how much they eat.
• They are ashamed and embarrassed about their bingeing.
• Food hoarding is common.
• After a binge, they feel guilty, upset, disgusted and/or depressed about how much they have eaten.
• They vow to themselves never to binge again, but cannot keep this promise.

Binge-eating disorder is different from bulimia. The two disorders are similar in their bingeing behavior, but people with bulimia follow a binge by purging the body of calories. They do this by some combination of self-induced vomiting, laxative, diuretic, or enema abuse, fasting, and compulsive exercising beyond reasonable levels. People with binge-eating disorder do nothing to purge the body of the extra calories they have eaten, although they often try to diet between binges. Many people who are bulimic also have anorexic behaviors. There is no overlap between binge-eating disorder and anorexia. Most people who have binge-eating disorder are obese, but not all obese people have binge eating behaviors.

Demographics

Estimates of the number of Americans who have binge-eating disorder range from less than 1% to 4%, with 2% being the most commonly cited figure. Although women with binge-eating disorder outnumber men 3:2, binge eating is the most common male eating disorder. The disorder affects blacks and whites equally; little research as been done on other racial or ethnic groups. Unlike the eating disorders anorexia nervosa or bulimia nervosa that start in the teenage or young adult years, binge eating disorder is more likely to occur in middle-aged adults between the ages of 46 and 55. Although binge eaters may be of normal weight, binge eating is a common disorder among people who are obese. Some estimates suggest that up to half the obese people in formal weight loss programs have problems with binge-eating.

People at higher risk of developing binge-eating disorder share certain characteristics. These include:

• frequent dieting. People who go on rigorous diets or who frequently gain and lose large amounts of weight (weight cycling) are more likely to become binge eaters.
• impulsiveness. Binge eaters, like bulimics, have problems with impulse control.
• low self-worth and negative self-talk. This occurs almost universally among people with all types of eating disorders.
• difficulty managing anger and appropriately expressing feelings.
• preoccupation with body image and weight.
• sexual abuse. Some, but by no means all, people with binge eating disorder report being sexually abused as children. This is an area of ongoing research.
• depression. It is not clear whether depression causes binge eating or if binge eating causes depression, but the two are often found together.

Causes and symptoms

Binge eating is a relatively new area of research. Like all eating disorders, binge eating appears to have multiple causes. Some people seem to be genetically predisposed to become binge eaters. Researchers think this may be related to abnormalities in neurotransmitters in the brain that help to regulate appetite. Research continues actively in this area.

For many binge eaters, stress is the factor that triggers a binge. Stress can be caused by very restrictive dieting, but it is often caused by social and cultural factors, such as family conflict, job-related stress, dysfunctional relationships, and the repeated message from the media that a thin body is a sign of success, while being obese results in failure to find a mate or succeed in life.

Symptoms of binge eating may be difficult to detect. Binge eating is different from continuously snacking, and it is often done in private. Obesity and obesity-related diseases such as hypertension (high blood pressure) Type II diabetes, and joint pain are signs that binge-eating disorder could be present, but not all obese people are binge-eaters. Behaviors such as secretive eating, constant dieting without losing weight, obsessive concern about weight, depression, anxiety, and substance abuse are all clues, but none of these signs are definitive. The individual may complain about symptoms related to obesity, such as fatigue and shortness of breath, or mention unsuccessful dieting, but again, these signs are not definitive.

Diagnosis

Binge eating can be hard for healthcare providers to diagnose. Binge eaters often go out of their way to hide how much they eat. They may, for example, buy snack food at the grocery store and eat it in the car before they go home, or they may buy food in secret and hoard it, so that people close to them will not know they are bingeing. Normally healthcare professionals begin diagnosis with a family and personal history. However, people with binge-eating disorder often lie about their eating habits.

A physician will begin with a physical examination and usually order standard laboratory tests such as a complete blood count (CBC), urinalysis, and blood tests to check the level of cholesterol, triglycerides, and electrolytes Additional tests, such as a thyroid function test, may be ordered to rule out other disorders. If the individual is obese, tests may be done check for obesity-related diseases such as diabetes, cardiovascular disease, and sleep apnea.

Several different evaluations can be used to examine a person’s mental state. A doctor or mental health professional will assess the individual’s thoughts and feelings about themselves, their body, their relationships with others, and their risk for self-harm.

Treatment

The medical community does not completely agree on the best treatment for binge eating. Medical specialists are more likely first to treat weight control issues with drugs, diet, and nutrition counseling in order to reduce the health risks of obesity-related diseases. Although there are no drugs specifically approved by the United States Food and Drug Administration for treating binge-eating disorder, the FDA has approved selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) for the treatment of bulimia. Bulimia also involves binge-eating behavior. These medications increase serotonin levels in the brain and are thought to affect the body’s sense of fullness. They are used whether or not the patient shows signs of depression. SSRIs are often prescribed for people with binge-eating disorder. Appetitive suppressants are also sometimes prescribed to help control binge eating. Treatment is most successful when group therapy occurs in conjunction with psychotherapy (see Therapies below).

Nutrition/Dietetic concerns

People with binge-eating disorder understand that their eating pattern is abnormal and unhealthy. Nutrition counseling and meal planning can help bring weight under control, but they do not address the inability to control the impulse to binge. Nutrition counseling needs to be part of a broader treatment program that includes psychotherapy and possibly drug therapy.

Therapy

Psychologists are more likely to approach the problem of binge eating by using therapy that helps the individual change his or her behavior and by treating emotional and psychological problems that cause it. For them, treating obesity is secondary to treating the behavior and the thought patterns that cause it. Psychologists tend to think that once the individual understands and can control bingeing behavior, obesity will be easier to treat.

Some types of psychotherapy that have been successful in treating people with binge-eating disorder are listed below.

• Cognitive behavior therapy (CBT) is designed to confront and then change the individual’s thoughts and feelings about his or her body and behaviors toward food, but it does not address why those thoughts or feelings exist. Strategies to maintain self-control may be explored. This therapy is relatively short-term.
• Interpersonal therapy is short-term therapy that helps the individual identify specific issues and problems in relationships. The individual may be asked to look at his or her family and personal history to try to recognize problem areas and to work toward resolving them.
• Dialectical behavior therapy consists of structured private and group sessions in which the therapist and patient(s) work at reducing behaviors that interfere with quality of live, finding alternate solutions to current problem situations, and learning to regulate emotions.
• Family therapy is helpful in treating children who are binge eaters. It teaches strategies to reduce conflict, disorder, and stress that may be factors in triggering binge eating.
• Some people with binge-eating disorder find self-help groups and structured weight-loss programs useful, while others do not.

Prognosis

There is no clear prognosis for binge eating disorder. Since stress often triggers bingeing, relapses are apt to occur in response to stressful life events. Some individuals find that simply seeking help improves their control over binge eating. For example, some studies have found that receiving a placebo is as effective as receiving medication. This is one reason why some parts of the medical community refuse to accept binge eating as a genuine disorder. Many studies are underway to test different approaches to treating binge eating. Individuals interested in participating in a clinical trial at no cost can find a list of studies currently enrolling volunteers at <http://www.clinicaltrials.gov>.

Prevention

Since binge eating is difficult to detect, it is also difficult to prevent. Some prevention strategies are listed below

• Parent should not obsess about their weight, appearance, and diet in front of their children.
• Do not tease people about their body shapes or compare them to others.
• Make it clear that family members are loved and accepted as they are.
• Try to eat meals together as a family whenever possible; avoid eating alone.
• Avoid using food for comfort in times of stress.
• Monitoring negative self-talk; practice positive self-talk.
• Spend time doing something enjoyable every day
• Stay busy, but not overly busy
• Become aware of the situations that make you want to binge and look for ways to avoid or defuse them. Do not go on extreme diets.
• Be alert to signs of low self-worth, anxiety, depression, and drug or alcohol abuse and seek help as soon as these signs appear.

Resources

BOOKS

Agras, W. Stewart. Overcoming Eating Disorders: A Cognitive-Behavioral Therapy Approach for Bulimia Nervosa and Binge-Eating Disorder2nd ed. New York: Oxford University Press, 2008.

Carleton, Pamela and Deborah Ashin. Take Charge of Your Child’s Eating Disorder: A Physician’s Step-By-Step Guide to Defeating Anorexia and BulimiaNew York: Marlowe & Co., 2007.

Heaton, Jeanne A. and Claudia J. Strauss. Talking to Eating Disorders: Simple Ways to Support Someone Who Has Anorexia, Bulimia, Binge Eating or Body Image IssuesNew York, NY: New American Library, 2005.

Kolodny, Nancy J. The Beginner’s Guide to Eating Disorders RecoveryCarlsbad, CA: Gurze Books, 2004.

Munsch, Simone and Christoph Beglinger, eds. Obesity and Binge Eating DisorderNew York: Karger, 2005.

Rubin, Jerome S., ed. Eating Disorders and Weight Loss ResearchHauppauge, NY: Nova Science Publishers, 2006.

Saxen, Ron. The Good Eater: The True Story of One Man’s Struggle With Binge Eating DisorderOakland, CA: New Harbinger Publications, 2007.

Walsh, B. Timothy. If Your Adolescent Has an Eating Disorder: An Essential Resource for ParentsNew York, NY: Oxford University Press, 2005.

Watson, Stephanie. Binge EatingNew York: Rosen Pub. Group, 2007.

PERIODICALS

DeAngelis, Tori. “Binge-eating Disorder: What’s the Best Treatment?” Monitor on Psychology.33, no. 3 (March 2002). <http://www,aoa.org/monitor/mar02/binge.html>.

ORGANIZATIONS

American Psychological Association. 750 First Street, NE, Washington, DC 20002-4242. Telephone: (800) 374-2721; (202) 336-5500. TDD/TTY: (202)336-6123. Website: <http://www.apa.org>

National Association of Anorexia Nervosa and Associated Disorders (ANAD). P.O. Box 7 Highland Park, IL 60035. Telephone: (847) 831-3438. Website: <http://www.anad.org>

National Eating Disorders Association. 603 Stewart Street, Suite 803, Seattle, WA 98101. Help and Referral Line: (800) 931-2237. Office Telephone: (206) 382-3587. Website: <http://www.edap.org>.

OTHER

Anorexia Nervosa and Related Eating Disorders. “The Better-Known Eating Disorders.” January 16, 2006.

<http://www.mentalhealth.com/book/p45-eat1.html> Anorexia Nervosa and Related Eating Disorders. “Males.

With Eating Disorders.” February 6, 2007. <http://www.anred.com/males.html> KidsHealth. “Binge Eating.” Nemours Foundation October 2004.

<http://www.kidshealth.org/parent/emotions/behavior/binge_eating.html> Mayo Clinic Staff.

“Binge Eating Disorder.” MayoClinic .com, March 20, 2006. <http://www.mayoclinic.com/health/binge-eating-disorder/DS00608> Medline Plus.

“Eating Disorders.” U. S. National Library of Medicine, April 2, 2007. <http://www.nlm.nih/gov/medlineplus/eatingdisorders.html>

National Association of Anorexia Nervosa and Associated Disorders “Facts About Eating Disorders.” undated; accessed April 3, 2007.<http://www.anad.org/>

Weight-control Informaton Network. “Binge Eating Disorder.” National Institute of Diabetes and Digestive and Kidney Diseases. September 2004. <http://www.niddk.nih.gov/publications/binge.html>

Tish Davidson, A.M.

Binge eating disorder

Definition

Binge eating disorder (BED) is characterized by a loss of control over eating behaviors. The binge eater consumes unnaturally large amounts of food in a short time period, but unlike a bulimic, doesn't regularly engage in any inappropriate weight-reducing behaviors (like excessive exercise, vomiting , taking laxatives) after the binge episodes.

Description

About three percent of women and one-tenth as many men have duffered from either bulimia or binge eating disorder at some time in their lives. BED typically strikes individuals between their adolescent years and their early 20s. Because of the nature of the disorder, most BED patients are overweight or obese. Studies of weight loss programs have shown that an average of 30% of individuals enrolling in these programs report binge eating behavior. Binge eating in milder forms is even more common, as are attempts to compensate for the binges.

Causes & symptoms

Binge eating episodes may act as a psychological release for excessive emotional stress . Other circumstances that may predispose an individual to BED include heredity and mood disorders, such as major depression . BED patients are also more likely to have an additional diagnosis of impulsive behaviors (for example, compulsive shopping), post-traumatic stress disorder (PTSD), panic disorder , or personality disorders. More than half also have a history of major depression. In 2002, the American Psychiatric Association was considering including BED as a psychiatric diagnosis.

Individuals who develop BED often come from families who put an unnatural emphasis on the importance of food. For example, these families may use food as a source of comfort in times of emotional distress. As children, BED patients may have been taught to clean their plates regardless of their appetite, or to be a good girl or boy and finish all of the meal. Cultural attitudes towards beauty and thinness may also be a factor in BED.

During binge episodes, BED patients experience a definite sense of lost control over their eating. They eat quickly and to the point of discomfort, even if they aren't hungry. They typically binge alone two or more times a week, and often feel depressed and guilty when the episode is over.

Diagnosis

BED is usually diagnosed and treated by a psychiatrist and/or a psychologist. In addition to an interview with the patient, personality and behavioral inventories, such as the Minnesota Multiphasic Personality Inventory (MMPI), may be administered as part of the assessment process. One of several clinical inventories, or scales, may also be used to assess depressive symptoms, including the Hamilton Depression Scale (HAM-D) or Beck Depression Inventory (BDI). These tests may be administered in an outpatient or hospital setting.

Treatment

Many BED individuals binge after long periods of excessive dieting; therapy helps normalize this pattern. The initial goal of BED treatment is to teach the patient to gain control over his or her eating behavior by focusing on eating regular meals and avoiding snacking. Cognitive behavioral therapy , group therapy, or interpersonal psychotherapy may be used to uncover the emotional motives, distorted thinking, and behavioral patterns behind the binge eating. The overweight BED patient may be placed on a moderate exercise program and a nutritionist may be consulted to educate the patient on healthy food choices and strategies for weight loss.

Initial treatment may focus on curbing the depression that is a characteristic feature of BED. Recommended herbal remedies to ease the symptoms of depression may include damiana (Turnera diffusa ), ginseng (Panax ginseng ), kola (Cola nitida ), lady's slipper (Cypripedium calceolus ), lavender (Lavandula angustifolia ), lime blossom (Tilia x vulgaris ), oats (Avena sativa ), rosemary (Rosmarinus officinalis ), skullcap (Scutellaria laterifolia ), St. John's wort (Hypericum perforatum ), valerian (Valeriana officinalis ), and vervain (Verbena officinalis ).

Binge-eating episodes that appear to be triggered by stress may be curbed by educating the patient in relaxation exercises and techniques, including aromatherapy , breathing exercises, biofeedback, music therapy, yoga , and massage. Herbs known as adaptogens may also be prescribed by an herbalist or holistic healthcare professional. These herbs are thought to promote adaptability to stress, and include Siberian ginseng (Eleutherococcus senticosus ), ginseng (Panax ginseng ), wild yam (Dioscorea villosa ), borage (Borago officinalis ), licorice (Glycyrrhiza glabra ), chamomile (Chamaemelum nobile ), and nettles (Urtica dioica ). Tonics of skullcap (Scutellaria lateriafolia ), and oats (Avena sativa ), may also be recommended to ease anxiety .

Allopathic treatment

Treatment with antidepressants may be prescribed for BED patients. Selective serotonin reuptake inhibitors (such as Prozac) are usually preferred because they offer fewer side effects. However, clinical studies don't show much effectiveness for use of antidepressants in treating BED. Psychotherapy shows better results. Once the binge eating behavior is curbed and depressive symptoms are controlled, the physical symptoms of the disorder can be addressed.

Expected results

The poor dietary habits and obesity that are symptomatic of BED can lead to serious health problems, such as high blood pressure, heart attacks, and diabetes, if left unchecked. BED is a chronic condition that requires ongoing medical and psychological management. To bring long-term relief to the BED patient, it is critical to address the underlying psychological causes behind binge eating behaviors. It appears that up to 50% of BED patients will stop bingeing with cognitive behavioral therapy.

Resources

BOOKS

Abraham, Suzanne and Derek Llewellyn-Jones. Eating Disorders: The Facts. 4th ed. Oxford: Oxford University Press, 1997.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.

Siegel, Michele, Judith Brisman, and Margot Weinshel. Surviving an Eating Disorder: Strategies for Family and Friends, 2nd ed. New York: Harper Perennial, 1997.

PERIODICALS

Brewerton, Timothy D. "Binge Eating Disorder: Recognition, Diagnosis, and Treatment." Medscape Mental Health 2, no. 5 (1997). http://www.medscape.com.

"Treatment of Bulimia and Binge Eating." Harvard Mental Health Letter (July 2002).

Tufts University. "Binge Eating Disorder Comes Out of the Closet: Experts Say Leading Obesity Factor Has Long Been Overlooked." Tufts University Diet & Nutrition Letter 14, no. 11 (January 1997): 4-5.

ORGANIZATIONS

American Psychiatric Association (APA). Office of Public Affairs. 1400 K Street NW, Washington, DC 20005. (202) 682-6119. http://www.psych.org/.

American Psychological Association (APA). Office of Public Affairs. 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700. http://www.apa.org/.

Eating Disorders Awareness and Prevention. 603 Stewart St., Suite 803, Seattle, WA 98101. (800) 931-2237. http://www.edap.org

National Eating Disorders Organization (NEDO). 6655 South Yale Ave., Tulsa, OK 74136. (918) 481-4044.

Overeaters Anonymous World Service Office. 6075 Zenith Ct. NE, Rio Rancho, NM 87124. (505) 891-2664. http://www.overeatersanonymous.org/.

Paula Ford-Martin

Teresa G. Odle

Binge eating disorder

Definition

Binge eating disorder (BED) is characterized by loss of control over eating behaviors. The binge eater consumes unnaturally large amounts of food in a short time period, but unlike a bulimic, does not regularly engage in any inappropriate weight-reducing behaviors such as excessive exercise , induced vomiting , or taking laxatives following the binge episodes.

Description

BED typically strikes individuals sometime between adolescence and the early twenties. Because of the nature of the disorder, most BED patients are overweight or obese. Studies of weight loss programs have shown that an average of 30 percent of individuals enrolling in these programs report binge eating behavior.

Demographics

Binge eating affects an equal numbers of females and males. Although there are no good statistics on how many children suffer from the condition, an estimated 1 to 2 million Americans of all ages are binge eaters. Many of them report that their condition started in childhood.

Causes and symptoms

Binge eating episodes may act as a psychological release for excessive emotional stress. Other circumstances that may make a child or adolescent more likely to engage in binge eating include heredity and certain psychological affective disorders such as major depression. BED patients are also more likely to have a comorbid (co-existing) diagnosis of impulsive behaviors such as compulsive buying, post-traumatic stress disorder (PTSD), panic disorder, or personality disorders .

Individuals who develop BED often come from families who put an extreme emphasis on the importance of food as a source of comfort in times of emotional distress. Children with BED may have been taught to clean their plates regardless of their satiety or that their finishing a meal makes them a "good" girl or boy. Cultural attitudes towards beauty and thinness may also be a factor in whether a person binges.

During binge episodes, BED patients experience a definite loss of control over their eating. They eat quickly and to the point of discomfort even if they are not hungry. They typically binge alone two or more times a week and often feel depressed and guilty when the episode concludes.

Diagnosis

Binge eating disorder is usually diagnosed and treated by a psychiatrist and/or a psychologist. In addition to an interview with the child, personality and behavioral inventories, such as the Minnesota Multiphasic Personality Inventory (MMPI), may be administered as part of the assessment process. One of several clinical inventories, or scales, may also be used to assess depressive symptoms, including the Hamilton Depression Scale (HAM-D) or Beck Depression Inventory (BDI). These tests may be administered in an outpatient or hospital setting.

Treatment

Many BED individuals binge after long intervals of excessive dietary restraint; therapy helps normalize this pattern. The initial goal of BED treatment is to teach the patient to gain control over the eating behavior by focusing on eating regular meals and avoiding snacking. Cognitive-behavioral therapy (learning new behavior), group therapy, or interpersonal psychotherapy may be employed to uncover the emotional motives, distorted thinking, and behavioral patterns behind the binge eating.

Because the prevalence of depression in BED patients is high, treatment with antidepressants may also be prescribed. Once the binge eating behavior is curbed and depressive symptoms are controlled, the physical symptoms of BED can be addressed. The overweight BED patient may be placed on a moderate exercise program and a nutritionist may be consulted to educate the patient on healthy food choices and strategies for weight loss.

Prognosis

If left unchecked, the poor dietary habits and obesity that are symptomatic of BED can lead to serious health problems, such as high blood pressure, heart attacks, and type 2 diabetes. BED is a chronic condition that requires ongoing medical and psychological management. Some of these conditions such as diabetes can occur in young people. To bring long-term relief to the BED patient, it is critical to address the underlying psychological causes for binge eating behaviors. It appears that up to 50 percent of BED patients stop bingeing with cognitive behavioral therapy.

Parental concerns

Binge eating can lead to excessive weight, a risk for serious current and future diseases including heart disease, type 2 diabetes, and cancer . Overweight children also suffer from psychological distress, particularly when teased or shunned by peers. Parents should be aware that antidepressant drugs used to treat BED as of 2004 contain a warning that recommends close observation of pediatric patients treated with the drugs. In some cases, worsening depression or emergence of suicidal tendencies may occur.

KEY TERMS

Bulimia nervosa —An eating disorder characterized by binge eating and inappropriate compensatory behavior, such as vomiting, misusing laxatives, or excessive exercise.

Cognitive-behavioral therapy —A type of psychotherapy in which people learn to recognize and change negative and self-defeating patterns of thinking and behavior.

See also Bulimia nervosa.

Resources

BOOKS

Gay, Kathlyn. Eating Disorders: Anorexia, Bulimia, and Binge Eating. Berkeley, NJ: Enslow Publishers, 2003.

Matthews, Dawn D. Eating Disorders Sourcebook: Basic Consumer Health Information about Eating Disorders . . . Detroit, MI: Omnigraphics, 2001.

Parker, James N., et al. The 2002 Official Parent's Sourcebook on Binge Eating Disorders. Boulder, CO: netLibrary, 2002.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. Web site: <www.psych.org>.

American Psychological Association (APA). 750 First St. NE, Washington, DC 20002–4242. Web site: <www.apa.org>.

Eating Disorders Awareness and Prevention. 603 Stewart St., Suite 803, Seattle, WA 98101. Web site: <www.edap.org>.

National Eating Disorders Association (NEDA). 603 Stewart St., Suite 803, Seattle, WA 98101. Web site: <www.nationaleatingdisorders.org>.

Overeaters Anonymous World Service Office. 6075 Zenith Ct. NE, Rio Rancho, NM 87124. Web site: <www.overeatersanonymous.org>.

Christine Kuehn Kelly

Binge Eating Disorder

Eating for Comfort

What Is Binge Eating Disorder?

What Causes Binge Eating Disorder?

How Is Binge Eating Disorder Diagnosed and Treated?

Can Binge Eating Disorder Be Prevented?

Resources

Binge eating is out-of-control eating. A person with binge eating disorder exhibits a repetitive pattern of bingeing that often results in overweight or obesity*, “yo-yo dieting,” and guilty or embarrassed feelings.

* obesity

(o-BEE-si-tee) is an excess of body fat. People are considered obese if they weigh more than 30 percent above what is healthy for their height.

Keywords

for searching the Internet and other reference sources

Binge and purge

Food and nutrition

Compulsive overeating

Overweight

Eating for Comfort

Rebecca’s parents sometimes got into fights that literally scared her out of the house. She often ended up at her neighbor’s house, where she was treated to hot chocolate, cookies, and other goodies. Eating in the comfort of her neighbor’s home always soothed Rebecca and lessened the pain she felt when her parents fought. Before long, Rebecca didn’t bother going to her neighbor’s house; she’d find a private place at home and eat whatever sweets she could find. She tried not to do it too often because it made her gain weight, but sometimes she felt she just couldn’t stop. She was ashamed of what she did, but it took her mind off her problems.

What Is Binge Eating Disorder?

People who binge on a regular basis have binge eating disorder. Bingeing means eating abnormally large quantities of food (sometimes thousands of calories) in one sitting. Binge eating is sometimes referred to as compulsive overeating because the person feels little control to resist or stop overeating. People who binge often eat when they are not hungry. Women and girls are more likely to have binge eating disorder, but it can affect boys as well. The number of people with this disorder is estimated at 1 to 2 percent of men and women. As many as 30 percent of all women who seek medical treatment to lose weight have binge eating disorder.

Binge eating disorder is similar to another eating disorder called bulimia (bu-LEE-me-a). A person with bulimia binges and then purges. Purging means using vomiting, laxatives, and enemas to rid the body of food. A person with binge eating disorder binges but does not purge.

What Causes Binge Eating Disorder?

The causes of binge eating disorder are hard to pinpoint, but a number of factors are thought to contribute to the problem. People who have binge eating disorder are usually overweight and/or are constantly dieting. Preoccupied with food, they are caught in a cycle of dieting excessively, becoming too hungry, and then overeating. People who have trouble dealing with stress or painful emotions may use binge eating as comfort. Those who have a family history of obesity may be more likely to binge eat. The cultural preoccupation with thinness and dieting also plays an important role in binge eating and in other eating disorders. People who binge are often torn between their feelings of comfort with food, their wish to be thin, and the confusing messages about food and about thinness in the media.

How Is Binge Eating Disorder Diagnosed and Treated?

People with binge eating disorder often seek help from a health care professional because they want to lose weight or because of concern about health problems related to obesity. A careful evaluation that involves questions about family and personal history, physical health, eating and dieting habits, psychological concerns, and personality issues may bring binge eating disorder to light.

Like other eating disorders, overcoming binge eating may take a long time, lots of commitment, and hard work. Treatment usually involves a number of professionals, such as a physician, a nutritionist, and/or a therapist. Treatments include counseling, change in eating and dieting habits, support groups, nutritional counseling, individual or group psychotherapy, and in some cases, medication.

Can Binge Eating Disorder Be Prevented?

According to Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED), prevention involves becoming more aware of what triggers a binge and making choices that help to avoid a binge. They provide the following guidelines that may help prevent binge eating disorder:

• eating regularly and avoiding getting too hungry
• not avoiding good tasting food
• eating small or moderate amounts of favorite foods
• having satisfying experiences that do not involve food
• keeping tabs on feelings so they will not lead to binge eating
• being wary of temptations, such as “all you can eat” buffets

See also

Bulimia

Eating Disorders

Emotions

Obesity

Resources

Organizations

Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED), P.O. Box 5102, Eugene, OR 97405-0102. Telephone 541-334-1144 http://www.anred.com

Eating Disorders Awareness and Prevention, Inc. (EDAP), 603 Stewart Street, Suite 803, Seattle, WA 98101. Telephone (800) 931-2237 for toll-free information and referral hotline http://www.edap.org

Overeaters Anonymous, 6075 Zenith Ct., N.E., Rio Rancho, NM 87124. Telephone 505-891-2664 http://www.overeatersanonymous.org

Binge eating

Description

Symptoms and treatments

Resources

Description

Binge eating is a form of overeating in which a person ingests a large amount of food during a discrete period of time (within one or two hours, for example) and experiences feelings of being out of control and unable to stop eating during the episode. In practice, the duration of a binge may vary greatly from one event to the next, making it difficult to define the number of binges occurring in a given day. Binge eating often occurs in the absence of hunger and is characterized by eating very rapidly; eating alone (due to embarrassment over the amount being eaten); and having strong negative feelings, such as guilt, shame and depression, following the binge. Typically, a binge episode ends only when all the desirable binge foods have been consumed or when the person feels too full to continue eating.

While binge eating is a symptom of bulimia nervosa, it differs from this disorder in that behaviors intended to get rid of the food (fasting, excessive exercise, or using laxatives or inducing vomiting to “purge” the food from the system) are present among those with bulimia, but are generally absent among binge eaters. Binge eating may also occur in anorexia nervosa.

The clinician’s diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revised, published in 2000) subsumes binge eating under the diagnosis of eating disorders not otherwise specified. Binge eating disorder is, however, under consideration as a separate diagnostic category, pending further study.

Symptoms and treatments

Binge eating episodes may occur in response to strong negative emotions, such as depression or anxiety, or to less defined feelings of distress or tension. The act of bingeing seems to alleviate these uncomfortable feelings temporarily and binge eaters typically describe themselves as “numb” or “spaced out” while engaged in these behaviors. Some people report that binges are related to the ingestion of certain “trigger foods,” usually carbohydrates, but regardless of the stimulus, the feeling of eating without being able to control one’s intake is a frightening experience for most people. The aftermath of a binge often includes an overwhelming sense of self-disgust, depression and anxiety.

While people who binge eat are clearly at high risk for becoming overweight, there are important differences between simple obesity and binge eating. People who binge eat are far more likely to report significant mood problems, especially depression, and to report greater dissatisfaction with their weight and shape than are comparably obese persons. They are also more likely to describe themselves as experiencing personal problems and work difficulties and to be hypersensitive to the thoughts and opinions of others. Like people with bulimia nervosa, they also have an increased likelihood of being diagnosed with major depression, substance-related disorders, and personality disorders, yet the overall rates of recovery for binge eating disorders are actually more favorable than those obtained in bulimia.

Binge eating is not common among the general public, but it is prevalent among persons attending weight loss clinics, where as many as half of the participants may fit this description. Both males and females develop binge-eating problems, but the rate of occurrence is 1.5 times greater among women. Age of onset is usually adolescence through young adulthood and the course of the disorder is often marked by a long history of on-again, off-again dieting.

As is the case with other forms of eating disorders, identification of specific causes for binge eating has been difficult. Since many people report relief from painful or uncomfortable mental states while bingeing, the behavior offers short-term emotional relief, making it likely to be repeated. Some investigators have considered genetic influences and personality variables. Still others have suggested that the “culture of thinness” in western societies contributes to the tendency toward harsh self-evaluation characterizing binge-eaters who then turn to food for solace.

At present, the most effective treatment approach to reducing the incidence of binge eating appears to be cognitive-behavioral therapy (CBT). The goal of this therapy is the development of skills for effectively coping with emotional distress rather than seeking to numb or disguise troubling feelings. This therapy focuses on helping the affected individual to decrease the binge eating behavior by recognizing the connection between thoughts and behavior, and to change behavior by changing negative thinking patterns. Follow-up research has been very encouraging, documenting both a decrease in depressive symptoms and a corresponding likelihood of healthy weight loss as the individual achieves better control of eating behaviors.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Bowers, Wayne A. “Eating Disorders.” In Cognitive-Behavioral Group Therapy, edited by John R. White and Arthur S. Freeman. Washington, D.C.: American Psychological Association, 2000.

Striegel-Moore, Ruth H., and Linda Smolak, eds. Eating Disorders: Innovative Directions in Research and Practice. Washington DC: American Psychological Association, 2001.

Thompson, J. Kevin, and others. Exacting Beauty: Theory, Assessment, and Treatment. Washington, DC: American Psychological Association, 1999.

Tobin, David L. Coping Strategies Therapy for Bulimia Nervosa. Washington, D.C.: American Psychological Association, 2000.

Jane A. Fitzgerald, Ph.D.