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

(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.

• 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.

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

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
• 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.