Eating disorders are a growing health concern. Eating disorders are characterised by unusual eating patterns.
The body is designed to eat adequate amounts at regular intervals and should stop eating when energy requirements are met. However eating disorders ‘hijack’ the body’s normal eating process.
However there is marked difference between disordered eating and eating disorders. Upto 50% of the population fail to have sound relations with food, body and exercise.
But that does not mean that each one of us is suffer from an eating disorder. The difference lies in severity.
An individual with disordered eating is often engaged in some of the same behaviour as those with eating disorders, but at a lesser frequency or lower level of severity.
Yet they are at a risk of developing a full blown eating disorder or psychological problems.
Among the three common eating disorders (anorexia nervosa, bulimia and binge eating disorder), we are going to focus on binge eating disorder (BED).
As per ‘The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)’, BED was included as a provisional diagnosis under the category Eating Disorder Not Otherwise Specified. But based on latest research, DSM-V has classified BED as a formal eating disorder.
BED is defined as consumption of excess food within a 2 hour time period with loss of control on intake and eating more than what a normal individual would eat within the same time span.
This disorder is differentiated from bulimia nervosa by lack of compensatory behaviour for overeating like purging, exercising etc.
What is a binge?
Earlier in the nineteenth century, the word ‘binge’ meant ‘a heavy drinking bout’.
However today it means to eat in excess.
For many people, a binge is not a serious matter- it might just mean an occasional indulgence but for some it is a loss of control and whirlpool of emotions.
Some individuals may have an occasional episode of overeating which may not have serious emotional consequences. This does not classify as binge eating disorder.
However for others there is a similar tune playing in their mind:
‘It starts with a memory of someone upsetting me. I am seized with an uncontrollable urge to eat. My mind has a war raging against this.
I give in and trash in everything I can possibly eat, gulping in rapidly to avoid thinking about what I am doing. I am restless and I can’t stop.
But I do stop when I physically can’t eat anymore. And then begins the cycle of guilt and disgust.’
Binge is typically characterised by an abnormal spike in consuming food and helplessness regarding intention or ability to control this spike.
The Structured Inventory for Anorexic and Bulimic Eating Disorders describes three types of binges:
- Objective binge eating: Eating a factually large proportion of food within a limited time period and lack of control on eating
- Subjective binge eating: Eating a proportion that is misperceived as a large amount within a limited time and lack of control on intake
- Atypical eating binge: Eating more or less continuously throughout the day or part of the day but amounts consumed is small and there is slight lack of control.
What does a ‘binge’ feel like?
Typically a binge constitutes 1,000 or 2,000 calories, however binges more than 6,000 calories have been reported.
Frequency of binges that constitute binge eating disorder is twice a week for a period of three to six months according to DSM-IV.
Dr. Christopher G Fairburn, in his book ‘Overcome Binge Eating’ describes the features of a binge very precisely:
- Feelings: The first moments of a binge are filled with pleasure but as the person keeps eating more they are replaced with feelings of disgust.
- Eating forbidden foods: Individuals who diet or are abstaining from a certain food type tend to crave and binge on the same.
- Speed of eating: Individuals eat very rapidly. They hardly chew, rather gulp down the food.
- Agitation: Due to the conflict between urge to eat and mind’s disapproval, people feel restless. They are compelled to eat (compulsive eating) to the extent that they may take food belonging to others.
- Feeling of altered consciousness: It feels you are in trance. People report watching TV or reading a magazine while binging to keep them distracted.
- Secretiveness: This is a hallmark of binge eating as these individuals are ashamed of their eating habits.
- Loss of control: This is a core feature of binge eating which some may feel even before eating while others develop it gradually.
What causes binge eating disorder?
There no single cause that individually contributes to BED, but a number of multiple factors at play.
Physical causes include improper functioning of hypothalamus, a person’s vulnerability to developing such disorders due to lack of secretion brain chemicals.
Even genetic factors or family history of eating disorders predisposes a person to develop BED.
Childhood maltreatment, sexual abuse, stress and depression are few of the psychological factors that contribute to BED.
Society’s expectations and norms regarding eating habits or body types also promote emotional eating. Dieting is another factor since it involves deprivation or restriction of certain food types which tend to crave.
Is there any criteria that can help in diagnosis of BED?
The DSM-V, published in 2013, lists the diagnostic criteria for binge eating disorder:
A) Recurrent episodes of binge eating: An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B.) The binge eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
C) Marked distress regarding binge eating is present.
D) The binge eating occurs, on average, at least once a week for 3 months.
E.) The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
What are the characteristics of individuals suffering from BED?
Although the above mentioned criteria is self sufficient in aiding in diagnosis of BED but here are a few characteristics that can help you ascertain the severity of the disorder and whether your loved one is in need of help.
- Evidence of binge eating such as disappearance of large amount of foods or presence of wrappers and containers
- Disruption in normal eating behaviour such as eating throughout the day with no planned mealtimes, eating sporadically and developing
- Controlled and impulsive eating till the extent of discomfort but not purging
- Eating normally when with others but gorging when alone
- Inability to stop or control intake of food
- Secretive about food such as eating alone in the car or stockpiling and stealing food
- Designing your lifestyle to make room for binges
- Emotional characteristics
- Initiating a binge to relieve stress or to numb negative emotions
- Feelings of anxiety, anger, shame or disgust after a binge
- Depression and social isolation, irritability
- Feeing disgust about one’s body type
- Never feeling satisfied about how much you eat and still a desire to improve eating habits
- Being a trance during a binge
- Certain personalities are linked with BED such as need to be in control, perfectionist tendencies, inflexible thinking etc.
- Body weight can range from mild to normal or even severe obesity
- Weight gain which may or may not be linked with BED
What goes on in the brain when you are seized with a binge episode?
Binge eating stimulates the same reward pathway that is activated in food addiction or substance abuse. (Read more: Is overeating an addiction?)
This pathway is known as mesolimbic system of the brain.
Food is necessary for our survival and whatever actions we take that supports our survival is rewarded by this system in other words it stimulates a pleasurable feeling.
Also this feeling is captured as a memory and reinforced in our mind so that we repeat these actions.
However in an eating disorder, this system is impaired to the extent that the part of the brain that is involved in controlling our food intake starts functioning abnormally and that is why individuals suffering from BED experience loss of control on food consumption.
The pleasurable feeling as well as repetition of behaviour is caused by the action of the following brain chemicals:
Opioids are addictive substances that are secreted by a brain in order to relieve pain and calm us down.
Animal models have shown that binge eating can alter endogenous opioid system
Research proves that opioid inhibitor, naloxone inhibits binge eating in rats while butorphanol, a painkiller similar to opioid stimulates overeating.
Similarly rats treated with opioid antagonist weakened bingeing in rats conditioned to eat chocolate flavoured, high sugar diet.
This is the feel good chemical released by the brain.
However repeated bingeing can also dull dopamine response and therefore motivate an individual to eat further to achieve the pleasurable state.
We are aware of the withdrawal symptoms drug abusers face.
Such aversive state has been described in individuals suffering from BED when in recovery, thus demonstrating the role of brain chemicals in manifestation of eating disorder.
BED as a gateway to other afflictions
Binge eating disorder is a distortion in the normal eating behaviour. Since it affects the brain the individual is likely to be affected by other psychological disorders. Also its a consumption of excess calorie of foods and there is no control over the nutritional quality of food, one is at a risk of developing other health problems.
Not all persons with BED are obese, but individuals suffering from BED are likely to suffer from obesity. Weight increases with growing severity of the disorder.
In a comparison between obese and normal weight individuals suffering from BED, it was observed that obese individuals had an increased concern about their weight gain and had a higher frequency of binges than normal weight individuals.
Prevalence reports of BED present that around 8.9 to 18.8% of the individuals seeking a treatment for obesity suffer from BED.
BED is consistently linked with psychiatric disorders like mood swings, anxiety, schizophrenia, substance abuse, depression etc.
It was observed that those who opted for bariatric surgery and were diagnosed with BED were likely to suffer from depression and anxiety.
A recent study of treatment-seeking BED patients revealed relatively high lifetime prevalence of psychopathology including mood disorders (54.2%), anxiety disorders (37.1%), and substance abuse disorders (24.8%).
Those that suffer from BED also have a poor life quality.
Other health problems
Apart from the preliminary hazards linked with BED as mentioned above, following conditions may also occur:
- Elevated cholesterol levels
- Cardiovascular diseases
- High blood pressure
- Gall bladder disease
- Joint pain
- Gastrointestinal problems
- Sleep apnea
What are the treatments available for BED?
BED treatment requires combined effort of family, friends, psychiatrist, psychologist and nutritionist.
An effective BED treatment would focus on releasing the stress and negative emotions linked with this behaviour. Pharmacotherapy involves administration of antidepressants and appetite suppressants.
Psychotherapy for BED including the following:
- Cognitive behavioural therapy: It focuses on abnormal thoughts and behaviours in binge eating.
- Interpersonal psychotherapy: It helps to remedy relationship problems and personal issues that lead to compulsive eating.
- Dialectical behaviour therapy: It makes use of cognitive behavioural therapy and mindfulness meditation to relieve stress and regulate emotions.
Binge eating afflicts approximately 5% of U.S. adults at some time in their life. Specific factors that can cause binge eating disorder have not been identified.
Mostly it is implied to occur as a result of underlying negative emotions, adverse experiences or as a result of heredity.
Binge eating is a complex behavioral phenomenon that closely mirrors substance abuse and addiction in its symptoms and mechanism.
Treatment of binge eating disorder should focus on reducing the stress behind such behavior as well as changing eating patterns.