Introduction – What is Binge Eating Disorder?
How to Know If You Have Binge Eating Disorder – The Diagnostic Criteria
Severity Levels of Binge Eating Disorder
Common Comorbidities of Binge Eating Disorder
10 Signs and Symptoms of Binge Eating Disorder
- Binge Eating and Other Abnormal Eating Habits
- Extreme Scrutiny Over Body Weight, Shape and Image
- Fear of Eating Around Others or In Public
- Feeling a Lack of Control
- Feeling a Sense of Disgust, Shame or Guilt For Oneself
- Social Withdrawal
- Frequent Dieting
- Difficulties in Concentrating
- Gastrointestinal Issues
- Fluctuation in Weight
How to Prevent Binge Eating Disorder
Know the Risk Factors
Tips on Prevention
How to Treat Binge Eating Disorder
Psychological Treatments
Medication
Nutritional Counselling
Combined Treatments
Conclusion
Introduction – What is Binge Eating Disorder?
Binge Eating Disorder (BED) is a detrimental psychiatric disorder involving recurrent periods of binge-eating, as characterised by trance-like episodes of eating and consuming abnormally excessive amounts of food. Amongst all the eating disorders described in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), BED is the most commonly diagnosed, affecting around 2 to 3% of the population.
While overeating may be considered normal from time-to-time, BED involves an excessive and recurring frequency of overeating, as well as other features like a deep sense of guilt or shame and feeling a lack of control over their behaviour during a binge-eating episode. For patients with BED, this can lead to high levels of psychological distress. Unlike other eating disorders, BED typically does not involve compensatory behaviours like purging or over-exercising.
How to Know If You Have Binge Eating Disorder – The Diagnostic Criteria
Binge Eating Disorder (BED) is typically diagnosed through a comprehensive evaluation by a licensed medical professional, based on the diagnostic guidelines provided by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
The DSM-V states that a diagnosis of BED would require that patient has recurrent binge-eating episodes involving eating excessive amounts of food that is abnormal for the average person within a discrete a period of time. These binge-eating episodes must occur at least one day a week, and have been occuring for at least a duration of 3 months.
The binge-eating episodes must also be associated with at least three of the following:
- Eating more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food, even when not feeling hungry
- Eating alone due to embarassment of how much food they are eating
- Feeling depressed, guilty or disgusted with oneself after overeating
Furthermore, the patient must not regularly perform any compensatory behaviours like purging (i.e. self-induced vomiting), inappropriate fasting or excessively exercising.
Severity Levels of Binge Eating Disorder
According to the DSM-V, there are four levels of severity of BED, depending on the frequency of binge-eating episodes.
- Mild: 1 to 3 episodes per week
- Moderate: 4 to 7 episodes per week
- Severe: 8 to 13 episodes per week
- Extreme: 14 or more episodes per week
Common Comorbidities of Binge Eating Disorder
A comorbidity, or comorbid condition, is the simultaneous occurrence of other medical conditions alongside a specific condition. BED can be accompanied by a range of physical and psychological comorbidities, which increases the complexity of the disorder and potentially makes it relatively difficult to overcome.
Studies have found that BED can be comorbid with physical conditions like obesity, hypertension, diabetes, menstrual dysfunction, gastrointestinal disorders (e.g., ulcers, irritable bowel syndrome, etc.) and more.
Moreover, BED typically involves deeper emotional or psychological issues and there is research evidence suggesting that majority of patients with BED will have had experienced a psychiatric disorder. Specifically, BED can be comorbid with psychiatric disorders like depression, anxiety, bipolar disorder and attention deficit hyperactivity disorder (ADHD).
10 Signs and Symptoms of Binge Eating Disorder
Defining Signs Versus Symptoms
- Detecting the signs and symptoms of BED plays a crucial role towards initiating the process of treatment and recovery.
- A sign involves an observable trait of the disorder that is perceived by another person, such as a general physician. Signs can include heart rate, blood pressure and body temperature.
- A symptom involves a subjective experience of the disorder that can only be experienced and described by the patient themselves, and not by another person. Symptoms can include headaches, stomach pains and fatigue.
- Signs can be indicative of symptoms. For example, if a doctor observes that a patient has an increased heart rate, it could be indicative that the patient is experiencing feelings of anxiety.
1. Binge Eating and Other Abnormal Eating Habits
As described by the DSM-V’s diagnostic guidelines for BED, binge eating episodes are typically associated with abnormal eating behaviours such as eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food even when not feeling hungry, eating alone due to feeling embrassed, and a feeling of guilt or disgust with oneself after binge-eating.
2. Extreme Scrutiny Over Body Weight, Shape and Image
Patients of BED typically have a very low self-esteem and are highly insecure of their own body. Because of their extremely distored body image, there is a tendency for BED patients to incessantly scrutinise their own body weight and shape. This manifests in behaviours like constantly looking at their reflection in the mirror and can further drive binge-eating habits.
3. Fear of Eating Around Others or In Public
BED patients tend to have a fear of eating in public, and especially eating in front of other people. They are afraid of others judging the amount of food they are consuming. This results in behaviours like secretly hiding or hoarding food in odd places and eating alone.
4. Feeling a Lack of Control
A characteristic of binge-eating episodes is the feeling of a lack of control of one’s own behaviour. People with BED tend to feel like they are unable to stop eating due to this lack of control with their own behaviour. This further spirals into extreme negative emotions regarding their inability to stop their binging.
5. Feeling a Sense of Disgust, Shame or Guilt For Oneself
People with BED not only have a low self-esteem, but also tend to feel disgusted and embarrassed with their ownselves. Stemming from feeling a lack of control over their own behaviour, patients will typically have binge-eating episodes in secret and then feel ashamed and guilty either during the episode or after.
6. Social Withdrawal
Rooted in their fear of eating in public or in front of others, as well as the sense of shame anf disgust for themelves, BED patients tend to withdraw socially and distance themselves from their family and friends. The fear of being judged on how much they eat further perpetuates this sign of BED.
7. Frequent Dieting
A common sign that someone could be struggling with BED is the act of abusing dietary regimens. This behaviour manifests in frequent and excessive dieting, which typically involves drastic dieting habits like fasting or completely cutting out major food groups all at once (e.g., no sugar, carbs, dairy, etc.).
8. Difficulties in Concentrating
For patients of BED, concentration could be something that they struggle with. Typically, someone with BED may be too occupied with the overwhelming thoughts of a negative self-image, body weight and shape, and binging. This is linked with the inability to focus and contentrate well, though the link may be a two-way phenomenon: bingeing is an attempt to resolve poor concentraiton and to keep focused, or preoccupation with bingeing/eating/not eating produces lack of concetration on other tasks.
9. Gastrointestinal Issues
A common comorbidity of BED, which is also an indicative symptom of BED, is gastrointestinal issues. The unhealthy nature of binge-eating behaviour can be harmful towards the gastrointestinal system, leading to symptoms like stomach cramping, acid reflux, constipation, etc.
10. Fluctuation in Weight
BED can lead to drastic changes in weight. While weight gain and obesity is commonly associated with BED, patients with BED can also drastically lose weight and become malnourished. Fluctuations in weight, both ways, is a classic sign of BED.
How to Prevent Binge Eating Disorder
Know the Risk Factors
In order to prevent BED, it is predominantly neccesary to understand the triggers of binge-eating behaviour and the risk factors of developing BED.
Genetics
BED can be inherited, which means if a parent suffers binge-eating behaviours, it is possible that their child would have BED, disorderd eating and/or other disorders linked to lack of concentration and poor impulse control.
Psychological Factors
Studies have found that BED has a strong predictive association to psychological traits like low self-esteem, negative self-evaluation and high body disatisfaction. People who have these traits are more likely to develop BED. It has also been shown that personality traits like high neuroticism and high impulsiveness are associated with the development of BED.
Environmental Factors
The environment in which a person is surrounded with also heavily influences the chances of developing BED. These environmental factors include:
- Family environment – Hostile familial environments like parental separation and high parental expectation, exposure to parents’ own eating problems or disorder
- Social pressures – Weight-related pressures like weight-teasing or body-shaming in a peer group
- Stressful life events – Trauma from stressful life events like death, bullying, any form of abuse, a breakup, etc.
Tips on Prevention
Knowing the possible symptoms and risks of BED is the best way to prevent any possible risk of developing BED – early detection means early intervention. Along with the knowledge of the risk factors, it would also be helpful to actively foster an encouraging environment where a healthy body image and positive self-esteem are nurtured.
How to Treat Binge Eating Disorder
There are two main types of treatment methods for BED: psychological treatments and pharmacological treatments (i.e., medication). Treatments for BED are typically aimed at reducing binge-eating episodes, as well as improve dietary habits and psychological wellbeing.
Psychological Treatments
Cognitive Behavioural Therapy (CBT)
Cognitive Behavioural Therapy is the main treatment method for BED, due to its high effectiveness rates. CBT as an intervention involves the reconstruction of a person’s cognitive beliefs, particularly negative or maladaptive thoughts that may lead to anxiety or distress. For BED specifically, this would mean reconstructing negative beliefs with regard to binging behaviour (i.e., negative self-esteem and feelings of shame or disgust towards the self).
Behavioural component of CBT can be efficiently administered by a dietician or nutritionist. This includes practising eating on time, meal planning and preparation, creating practical shopping lists and composing content of home-stored food, both for meals and snacks. See more under Nutritional Counselling.
Typically, CBT can be administered by a licensed mental health professional like a therapist or psychologist, and can occur either within a one-to-one or a group setting. The process of CBT involves active participation from the patient, as the mental health professional guides them through tasks like identifying negative beliefs, setting goals, establishing coping strategies and building skills like problem solving and interpersonal communication.
CBT also forms the basis of structured self-help treatments, which is applied CBT in the form of books, manuals or videos that can be practiced either with or without the guidance of a licenced professional.
Dialectical Behavioural Therapy (DBT)
Dialectical Behavioural Therapy can be viewed as the combination of CBT and mindfulness techniques, as well as re-structuring person’s interpersonal domain. It involves the standard structure of CBT combined with the core processes of mindfulness such as self-acceptance and compassion. While not as popular as CBT, DBT has still shown positive results in reducing binge-eating. It has been used to target emotional dysregulation and improve interpersonal relationships amongst patients who have undergone the treatment.
DBT is also carried out by a licensed mental health professional like a therapist or psychologist, either within a one-to-one or a group setting.
Medication
Lisdexamfetamine, also commercially known as Vyvanse, has been prescribed by providers to treat BED. With a prescription of 50-70 milligrams per day, Lisdexamfetamine is supported by evidence in being an effective and safe method of treatment for moderate to severe BED.
Common side effects of Lisdexamfetamine include nausea, dizziness, dry mouth and irritability.
Nutritional Counselling
Although often understated as a “not a direct treatment for BED”, patients of BED benefit from nutritional counselling sessions with a registered dietition or nutritionist. Nutritional counselling involves using specialised dietary techniques to maintain regular nutritional intake and foster a healthy relationship with food. With the guidance of a dietition or nutritionist, BED patients are able to create a healthy meal plan that is specifically tailored to their needs and effectively reduces their binging urges.
Combined Treatments
Ultimately, research evidence has shown that a combination of both psychological treatments and medication is the most effective method of treatment (e.g., CBT and Medication).
Conclusion
Binge Eating Disorder is a serious psychiatric condition involving abnormal eating habits, particularly binge-eating episodes where a patient consumes large amounts of food with a deep sense of guilt or shame and a lack of control over their behaviour whilst eating. Evidently, BED can be a devastating disorder as the patient can struggle with both physical (e.g., weight fluctuations, medical comorbidities) and psychological symptoms (e.g., extremely low self-esteem, social withdrawal, negative body image, poor cognitive performance). With a combination of adequate support from suitable healthcare professionals and an encouraging environment where a healthy body image and positive self-esteem are nurtured, most patients of BED are able to overcome the disorder and begin rehabilitation.
References
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https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed
