DSM 5

Binge eating disorder (BED) is finally becoming an official diagnosis in the diagnostic and statistical manual for mental health professionals (DSM 5). So this is a good time to highlight facts about the disorder, because, unfortunately, it’s still misunderstood (and not talked about much). 

For starters, you might be surprised to learn that BED is actually the most common eating disorder. It affects 3.5 percent of American women and 2 percent of American men.

Most importantly, BED is highly treatable. Effective treatments are available, and recovery is absolutely possible. You can have a healthy and peaceful relationship with food, weight and yourself.

Below, Karen Trevithick, PsyD, CEDS, clinical director for Eating Recovery Center’s Outpatient Services, reveals the biggest myths about BED, why it’s so misunderstood, why dieting doesn’t work and signs you can watch out for.

Tomorrow, I’ll be featuring another interview on BED, focusing on causes and effective treatments. Next week I’ll be publishing several older Weightless posts on BED for Binge Eating Disorder Week.

Q: Why is binge eating disorder so misunderstood in our society?

A: Binge eating is characterized by consuming large quantities of food in one setting, feeling numb or disconnected while doing so, and possibly losing track of time. Repeated episodes of binge eating may lead to weight gain – and over time, may contribute to one’s body mass index falling in the obese range.

In our society, there is a significant focus on the “thin ideal,” which leads to an emphasis on diet and exercise. Overall, there is a greater acceptance of restraint and control. Someone struggling with BED is likely to experience shame, not only for feeling out of control with his/her eating, but for behaving in a manner that is almost contrary to what is valued in our society. The combination of individual shame and cultural acceptance of the thin ideal provides little opportunity for an open dialogue about BED.

Q: What are the biggest misconceptions about this disorder?

A: Individuals who are within their weight range, or even under weight, could not possibly struggle with BED, only obese individuals struggle. While weight gain and obesity can be signifiers of BED, symptom severity (such as intensity and frequency of binge episodes, feeling numb or disconnected during binge episodes, and/or feeling a loss of control while eating) is a far better indicator.

All obese individuals must be struggling with BED. It is currently determined that BED has an estimated prevalence of 3.5 percent in adults. The hallmark trait of BED is the psychological distress caused by a relationship with food.

Additionally, there are typically psychiatric issues such as anxiety and/or depression that individuals with BED may also face. So although an individual may be slightly overweight or obese, that does not automatically mean he or she is struggling with BED.

Q: There is a common myth that people with BED simply need to go on a diet. But dieting can actually exacerbate the disorder. Can you talk about why this belief is so off base?

A: Many individuals subscribe to a dietary restraint model when attempting to lose weight. For example, determining that there are “good” or “bad” foods or foods that should no longer be consumed. There are two primary difficulties with this model, especially in individuals with eating disorders:

1. When a food is deprived, there is a tendency to focus more on that food (try not to think about a purple elephant). When there is finally an opportunity to consume that food, there is a greater likelihood that it will turn into a binge because either, a) an individual is finally allowing him or herself to consume it after thinking about it for so long; b) an individual does not allow him or herself to have a certain food ever again, therefore he or she feels he or she has to have as much as possible; or c) an individual feels he or she does not deserve to have a certain food or enjoy it, so he or she “punishes” him or herself by binge eating as opposed to simply consuming a certain food.

2. Along those lines, similar to anorexia nervosa and bulimia nervosa, BED is not just about the food. Eating disorders are psychological disorders. Individuals who struggle with BED utilize food as a coping mechanism—to numb out, to manage stress, to nurture and comfort themselves, to express emotions, etc. This is why dieting does not work; it does not address the psychological component. Depriving food and creating a rigid restraint approach to eating only reinforces negative self-evaluation, shame and self-judgment, which could ultimately lead an individual to needing to cope through binge eating.

Q: What are the symptoms individuals should watch out for (in themselves or loved ones)?

A: Binge eating tends to be more of a secretive behavior; some of the potential warning signs include:

  • Withdrawing from friends and loved ones and being less willing to share experiences and feelings.
  • Eating large quantities of food in a single setting.
  • Feeling numbed out or disconnected while eating.
  • Waking up at night to eat.
  • Losing track of time while eating.
  • Eating until the point of feeling sick.
  • Eating patterns that actually create distressing feelings and emotions.

Stay tuned tomorrow for another interview on binge eating disorder. And you can learn more about the disorder at the Binge Eating Disorder Association (BEDA).