Updated: Sep 23, 2020
[Listen to an audio version of this blog HERE.]
When we think of eating disorders, many of us probably think of Anorexia; extreme restriction resulting in the loss of a significant amount of body weight. Movies, television, and the media perpetuate the idea that someone needs to be very small or sickly in order to have an eating disorder, but that isn't true. Anorexia, Bulimia, Binge Eating Disorder, and Avoidant/Restrictive Food Intake Disorder are prevalent throughout all populations and in people who live in all body sizes. I'm going to quickly break down the most common types of eating disorders and explain how Binge Eating Disorder is different.
- Anorexia is characterized by an obsessive desire to lose weight by refusing to eat.
- Bulimia occurs when bouts of extreme overeating are followed by self-induced vomiting, purging, or fasting.
- Binge Eating Disorder is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and purging to counteract the binge.
- Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance that is characterized by a persistent failure to meet appropriate nutritional and/or energy needs.
Binge Eating Disorder (also called BED) is life-threatening but treatable. Binge Eating Disorder is more than three times more common than Anorexia and Bulimia combined. A 2007 study of more than 9,000 Americans and published in Biological Psychiatry, found that 3.5% of women and 2.0% of men had binge eating disorder during their life. Binge Eating Disorder has been formally recognized as its own eating disorder since 2013 when it was added to the DSM-5, the handbook used by health care professionals in the U.S. and much of the world as the authoritative guide to the diagnosis of mental disorders. Once BED was added to the DSM-5, it could be formally diagnosed and insurance companies are now required to treat BED. Without the DSM-5 diagnoses, insurance companies could deny provided treatment coverage, which brings up the important and under-addressed issue of insurance paying for mental health treatments, but I'll address that another day. I'll be succinct in saying that people normally have to reach a high level of sickness before insurance companies will grant them coverage, making it difficult to treat eating disorders before they become life threatening. It's sad, and stupid, and underscores how broken our healthcare system really is, but I digress.
It's also worth noting that each type of eating disorder does not exist in a vacuum. I restricted heavily for a long time (Anorexia), then began purging (Bulimia), then began binging (BED). My doctor told me that binging is fairly common for people who heavily restrict for a long time, because they become physically and psychologically depleted. Restriction can lead to obsessive thoughts about food and feelings of extreme hunger, which often leads to binging. Binging often leads to feelings of deep shame, which lead to purging, excessive exercise, or more restriction.
How is Binge Eating Disorder Diagnosed?
An episode of binge eating is characterized by the following:
- Eating in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time under similar conditions. Binging isn't just "eating too much," it's eating an entire box of cereal along with a pint of ice cream along with burger, etc.
- A feeling of lacking control during the binge. You might feel like you can't stop eating or like you have no control. You might feel full but continue to eat regardless.
Binging is usually done alone because the person binging is likely feeling shame, disgust, guilty, or depressed. You might eat very fast and past the point of uncomfortable fully. Binging has a "numbing" affect, causing some of our senses to shut down and making us feel sleepy. It's often a biologic response to restriction and/or a way to cope with anxiety or stress. To be formally diagnosed, a binge occurs about once a week for at least three months. It can occur concurrently with other eating disorders, like it did for me, or it can occur on its own. It is important to remember that binging is not an individual sign of weakness but a highly treatable disorder with both biologic and environmental underpinnings.
Health Consequences of Binge Eating Disorder
The health risks of binging are most commonly associated with clinical obesity, weight stigma, and weight cycling (i.e. yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder, however, up to two-thirds of individuals with Binge Eating Disorder are clinically obese. It is important to remember that BED can be diagnosed at any weight. Some significant health consequences of Binge Eating Disorder include: blocked intestines, bacterial infections, stomach pain/bloating, nausea/vomiting, stomach ruptures, difficulty sleeping, fatigue, abnormal blood sugar levels, insulin resistance, unbalanced hormones, reduced resting metabolic rate, anemia, depression, etc. For a full list of health consequences, visit the National Eating Disorders Association's web-page.
P.S. If you or someone you love is struggling with Binge Eating Disorder or any eating disorder, contact the NEDA helpline at 800-931-2237. Find at eating disorder treatment center near you HERE, find free or low-cost treatment options HERE, or find a free online support group HERE.