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Binge Eating Disorder

What constitutes "binge eating disorder?"

People with binge eating disorder lose control and binge, just like those suffering from bulimia do, but they don't regularly purge or compensate. They may periodically go on a diet, try to exercise, or undertake other means to try and compensate, but they don't persist at such efforts. Other terms used to describe this disorder include "compulsive overeating" and "emotional eating." Eating binges are often triggered by negative moods such as anxiety, depression, loneliness, or boredom, and eating serves to block out thinking and feeling. In some cases, the binge is an effort to feel good. As in all eating disorders, binge eaters are distressed about being unable to control their eating and are very dissatisfied with the appearance and exhibit a negative body image.

Binge eaters are usually overweight, often significantly, but some fall within the normal weight range defined as a BMI between 19 and 25. (Click here to determine your BMI.) An estimated 25% to 35% of those who seek treatment for obesity suffer from binge eating disorder or BED. It affects nearly 2% of the general population and some 8% of obese women in the community. Nearly as many men as women suffer from BED, with a ratio of 3:2, women to men.

What is a "binge?"

According to the American Psychiatric Association, a "binge" is characterized by losing control and eating-within a discrete period of time-an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. However, most ordinary people define a binge as just losing control over eating. A binge may involve a large amount of food or just a bite of something forbidden. For an anorexic, it may mean eating anything at all, while for the bulimic it may mean eating a forbidden food. For bulimics and bingeing anorexics, a binge has a definite beginning and end, and usually lasts several hours. For the person with binge eating disorder, it may mean grazing-eating more or less non-stop-on a variety of foods, usually those that are high in fat and simple sugar. For those with binge eating disorder, a binge may last all day or even several days. Feeling out of control is the hallmark of all binges, and binge eating refers to eating that results from the loosening of constraints that define, for the person, a desired way of eating.

How is binge eating different from compulsive overeating, emotional eating, or simple overeating?

The terms "compulsive overeating" and "emotional eating" are often used interchangeably with the term "binge eating." As with a binge, the hallmarks are feeling unable to control eating and eating more than you feel you should. Often compulsive overeating takes the form of "grazing"-a type of binge that involves eating more or less continuously for a long period of time. Emotional eating involves using food to cope with emotions.

Most people overeat from time to time, and many feel they often eat more than they should. Simple overeating may involve breaking self-imposed rules about what or how much to eat, but it is not accompanied by the experience of losing control. Some people who eat large amounts of food regularly but who do not experience emotional distress about their eating or their weight may gain weight from overeating, but they are simple overeaters. The diagnosis of an eating disorder or disordered eating requires feeling a loss of control and experiencing distress such as guilt and shame related to eating or appearance.

How do you treat binge eating disorder?

In most cases the person suffering from BED uses food and eating to cope with painful and overwhelming emotions. Unlike the bulimic, sticking to a sensible diet helps bring a sense of control to about half of binge eaters, at least for a while. However, "falling off the diet" can trigger more binge eating and more psychological distress.

The first step in overcoming BED is to identify your eating behavior pattern, including when, where, and how the disordered eating takes place, what the stressors are that trigger a binge, and what you are thinking and feeling at the time. Usually overeating is a way of avoiding or escaping from painful emotions or difficult problems. An important goal is to expand your coping skills, including your ability to problem solve, think positively, be assertive, manage conflict, and improve interpersonal functioning. "Normalizing" eating-eating three meals a day plus planned snacks-is often an early goal of treatment, as is learning to cope with cravings. Once we understand the problem, we can construct a solution tailored to your needs.

Dr. Joyce Nash, PhD    (650) 329-1000