Author: Paul Harper, PhD
Mary is 47, lonely, socially phobic about relationships, and weighs 525 lbs. She is constantly dieting, having tried numerous diet plans. She is obsessed with thoughts of food. She reports hearing a voice in the back of her mind that continually tells her to eat. When she is not dieting she feels compelled to eat large amounts of food daily, and has done so for as long as she can remember. She is never free of self-hate, shame, and remorse for her body and her behavior. She has lost the ability to feel hunger or satiety. As a youth and teenager Mary was beautiful. As an adolescent she was sexually abused by her older brother for five years.
Jenni is 18, beautiful, tall, slender, popular, a straight “A” student, a student body officer, and has been modeling for three years. Jenni binges most afternoons when she goes home and is by herself, eating around 10,000 calories at a time. She doesn’t purge. She is distressed over her eating habits and the impact it will have on her life. She has no control over her compulsions to eat or her eating behavior. Jenny recently broke up with her boyfriend. Her mother died when she was 11 and her father is aloof.
Tammy is a 32-year-old mother of two. Her weight has fluctuated over the years between 130 and 170 lbs. Tammy feels compelled to eat all the time. Her relationship with food is totally out of control. She is upset about her weight and her lack of ability to control her eating behavior. Tammy’s parents divorced when she was 10. Eventually her father remarried and severed all ties to his family. Tammy continues to try to reestablish a relationship to this day. She can’t understand how her father was not even interested in the birth of her two children.
Binge eaters come in all shapes and sizes and from all walks of life. Millions of people eat uncontrollably. The exact numbers of binge eaters is unknown but it would not be surprising to discover that there are more binge eaters than any other type of addiction population. This problem is experienced equally by men and women.
Despite the prevalence and magnitude of the problem, binge eating continues to exist and grow, often virtually unaddressed and unacknowledged by health care professionals. This is surprising because the impact of binge eating is as serious and harmful as any other form of an eating disorder. Additionally, the root causes of binge eating are the same as those in other eating disorders. The effects of binge eating on the economic, emotional and social health of our country are devastating and far reaching.
Although the reasons for the neglect of binge eating by health care professions are uncertain, a few of the reasons seem to be:
- The unwillingness of insurance companies to address the need to help those with the problem;
- The unhealthy and mostly inaccurate conception many people have about overweight people, which often result from the unreasonable expectations of beauty promoted in the mass media;
- The surprisingly large number of people who believe that obesity and large body size are simply a by product of laziness or lack of personal discipline;
- The reluctance of those who binge eat to talk about the problem with spouses, relatives, and friends; and,
- The lack of qualified individuals and institutions who can offer help.
Traditionally binge eating has been treated as an eating disorder NOS. However, there is a research category for binge-eating disorder in the DSM-IV (The complete set of criteria can be found there). The major characteristics of binge eating include:
- eating larger than normal amounts of food in a discrete period of time (2 hours);
- a lack of control over the binge episode (inability to stop);
- eating more rapidly than normal;
- eating when not feeling hungry;
- eating alone because of embarrassment;
- feeling disgusted, depressed or guilty; and,
- binging two days a week for 6 months.
DIAGNOSTIC QUESTIONS ABOUT BINGE EATING
The following questions are useful in determining if a client may need to get help with compulsive eating. If they answer yes to any one then they should talk to a professional for additional help.
- Do you turn to food when your are unhappy or under stress?
- Do you have cravings for certain types of food?
- Do you habitually eat at night or other non-meal times?
- Do you constantly think about food?
- Do you feel helpless about your overeating problem?
- Are you under more stress than normal?
- Are you fearful about anything?
- Do you worry that other people are disgusted with your eating?
- Do you eat by yourself?
- Do you eat large amounts of food in one setting?
- Do you eat when you are not physically hungry?
- Do you eat rapidly, sometimes without tasting your food?
- Do you diet?
- Do you feel disgusted, depressed, or guilty about overeating?
- Do you try to avoid certain kinds of foods?
Treating binge eating requires a multi-modal approach that includes psycho-education, cognitive behavioral therapy, behavior modification, nutrition training, and exercise awareness. Binge eating is a coping mechanism that can turn into an addiction. Much of the 12-Step and relapse prevention processes apply to the treatment of binge eating. The following list of Do’s and Don’ts have proven effective in the treatment of binge eating. Do’s
- Do shift client’s attention from any focus on dieting concerns, i.e., good or bad foods, calorie counting, strict use of the food pyramid, weighing yourself, etc.
- Do promote the utilization of medical and other forms of alternative treatment methods in order to help clients learn the complete picture about their bodies and their health.
- Do promote the acceptance of all sizes and shapes, and help clients think critically about the messages they encounter in the mass media and other social situations about weight and appearance.
- Do help clients recognize the value of a change process that relies upon natural and logical processes for change.
- Do give clients an opportunity to interact in a group setting that will build their social support system and network.
- Don’t focus on weight in any way, rather focus on healthy relationships with food. Help clients lose their anxiety about food.
- Don’t focus on change at first, rather focus on self-understanding. Dieting programs usually encourage short term quick changes, rather than focusing on long term life changes.
- Don’t have clients create eating plans and exercise plans that are based on current literature. If you do use plans, have clients create plans that predict what they will do, rather than what they should do.
- Don’t make promises you can’t keep. It does harm to promote weight loss for those who have a body type and genetic make up that won’t sustain being slender.
Most binge eaters are sensitive, intelligent, anxious, lonely, depressed, feel helpless and hopeless, and suffer with low self-esteem. Binge eaters have turned to the disorder as a coping mechanism for their inability to deal with inconsistencies and incongruence that they face in their lives. This population will respond to understanding about the following issues when they are incorporated appropriately into their treatment program.
- The faulty logic of dieting
- The nature and use of our cognitive systems in the development of negative and healthy beliefs
- Food use plans that promote healthy intuitive life styles
- The nature and impact of distorted beliefs
- The meaning of set weight and how it personally impacts one
- The nature of compulsive behaviors
- How food use becomes associated with the compulsive cycle
- The relationship between behavior, emotions, affect, and thoughts
- Family social systems, development, and related problems
- Relationships and marriage
- Body distortion
- Relapse prevention
So many people are suffering with binge eating and the problems associated with this disorder. The above information can help those who are working with individuals who suffer with binge eating and its related problems. If you have any additional questions or want clarification on anything discussed in this article, I would be happy to talk with you and share more of my experience in working with these wonderful clients.