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In the Media | The Most Common Eating Disorder You’ve Never Heard Of

Published by: Oprah Daily
Written By: Naomi Barr

Susie Denby says she remembers starting to binge-eat when she was around 10 years old. “There was one time when we had just gotten home from a pool party. As my mom was unloading the car, I kept grabbing handfuls of crackers that were on the counter and running up to my room to eat them. By the time she was done, I had finished the whole box. My mom was so angry with me,” she says. “I’ve always been a really anxious person, and looking back now, I see that food helped me regulate that fight-or-flight feeling.”

What began as occasional episodes got worse as she got older, Denby says. In her first year of college, she found it hard to connect with the other students at her large state university, plus she was diagnosed with polycystic ovary syndrome and put on a severely restrictive diet. “I would go home on the weekends and just start eating because it felt like a release from all of this pressure. Plus, it provided comfort, at least for a short while,” she says. After she graduated, her eating started to get unmanageable. The death of a loved one while she was still in school and another soon after mired her in grief; as a result, Denby found herself bingeing at least every week. “Whenever I felt that heightened feeling of grief and sadness, anxiety, or anger, I knew food could bring me down. I ended up turning to fast food because it was so easy to access, plus it was easy to eat in my car by myself. I’d go to the drive-through on my way home from work.” It wasn’t until she found herself purging one day after a binge that it occurred to her that she might have an actual eating disorder. That was in 2018, and when she sought treatment later that year at age 27, she was surprised to learn that she was dealing with a condition called binge-eating disorder.

Binge-eating disorder (BED) is the most common eating disorder in the  United States, yet remains the overlooked middle child compared to its better-known siblings, anorexia nervosa and bulimia. (This despite the fact that BED occurs at more than twice the rate in the general population: Estimates vary, but according to the National Institute of Mental Health, approximately 3 percent of the U.S. population will have dealt with the disorder at some point in their life, while only 1 percent … or less will have experienced bulimia or anorexia nervosa.) One reason it’s under-discussed is that the disorder only officially entered the Diagnostic and Statistical Manual of Mental Disorders (DSM), the tome clinicians use to classify mental health conditions, in 2013. (The DSM is also what health insurance companies look to when considering … and individuals alike—that people who binge simply lack the willpower or self-control that others have. Quite the contrary, says clinical psychologist Marney A. White, PhD, a professor of social and behavioral sciences in the Yale School of Public Health and a specialist in BED. “Individuals with binge-eating disorder are also often chronic dieters, so they can show high degrees of dietary restraint.” Unfortunately, that restraint often triggers more bingeing—and, with it, shame and guilt that can perpetuate the behavior, says Samantha DeCaro, director of clinical outreach and education at the Renfrew Center, an eating disorders treatment center with 21 locations around the country. “Many people who struggle with these episodes do end up attributing them to a problem with willpower. They think that if they could just be stronger, maybe they’d be able to fix it. But they don’t realize they’re actually dealing with a disorder. And once they learn what the disorder is, they realize that this is not their fault, that it has nothing to do with willpower, that it’s not a choice.”

So what is binge-eating disorder?

To be diagnosed with BED, a person must meet the following criteria:

They eat a much larger amount of food in a short amount of time (for example, within two hours) than what most other people would eat under similar circumstances.

They feel a lack of control over what or how much they eat during the episode.

The 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.

They feel significant distress and upset about their binge-eating.

The binge-eating occurs, on average, at least once a week for three months.

It isn’t associated with self-induced purging (vomiting or laxative use), excessive exercise or fasting to compensate for the binge, nor does it occur exclusively during the course of anorexia nervosa or bulimia

It’s also important to note that binge-eating is not a single occurrence of overeating, like Thanksgiving dinner or Super Bowl Sunday, where people intend to consume more food than usual.

What causes binge-eating disorder?

Researchers are still hammering out theories, from the behavioral to the genetic. On the behavioral end, a leading argument is that it’s a form of emotional regulation. Says White, “Eating provides short-term
pleasantness, and we learn this from day one. What do we do when a baby is crying? We give them a bottle. So we learn to soothe through food. What happens is that individuals who have difficulty processing certain emotional experiences, and who also lack adaptive coping strategies—like sitting with negative emotions and recognizing them as part of the human experience—turn to binge-eating to try to forget those feelings and make themselves feel better.”

Up to 30 percent of people with obesity also have binge-eating disorder.

Tami Weiser, 60, says that’s exactly what binge-eating did for her when she started having episodes around age 21. “I had started law school in a new state but, within pretty short order, figured out I didn’t really like it and didn’t think I wanted to become an attorney. After about three months of deep despair, I thought, Well, if I’m not going to quit, I’m at least going to eat whatever I want. So I started driving by the grocery store on the way back from school. I’d fill my cart with all the things I thought would make me feel better and then eat them in the car. I ate jars of Marshmallow Fluff—I mean, who eats that?— but it made sense to me,” says Weiser, who has been in recovery since her mid-50s.

Marshmallow Fluff actually makes perfect sense, since “the human brain is hardwired to like foods that are really tasty, meaning they’re dense in calories and have some component of sugar or fat, or both,” says eating disorders researcher J. Andrew Hardaway, PhD, an assistant professor of psychiatry and behavioral neurobiology at the University of Alabama at Birmingham. “So when people binge-eat, they’re usually not binge-eating on quinoa and kale salad. That’s because, evolutionarily speaking, sugary or fatty foods are meant to engage our brain more effectively than quinoa.” Those caloric-dense foods are not only good for stored energy; they also trigger parts of our brain connected to emotions and enjoyment, like the amygdala, and the release of hormones like dopamine, which is tied to our feeling of reward.

“When I ate, everything went blank—kind of like when you paint all the walls white in a room,” recalls Weiser. “It calmed me down and made all the worries go away, and I’d feel better, at least temporarily scientists have found that BED is heritable—meaning it runs in families—and shares some genetic factors with obesity and being overweight, says Cynthia Bulik, PhD, distinguished professor of eating disorders at the University of North Carolina at Chapel Hill School of Medicine and one of the leading researchers on the genetics of eating disorders. (While BED is more common in people who have overweight or obesity—up to 30 percent of people with obesity also have BED—and, on average, begins in one’s mid-20s, it can show up in people of all sizes, shapes, genders, and ages.) “We know that about 40 to 50 percent of the risk of developing a binge-eating disorder is due to genetic factors,” says Bulik. “You have risk genes, you have buffering genes, which are genes that can actually reduce the expression of whatever genetic risk you have, but then you also have environmental risk factors, like maybe your household happens to be one that has a lot of junk food available, and you have environmental buffering factors, like you come from a family that really encourages physical activity. Depending on which you have more or less all influence your risk for the development of binge-eating disorder.”

Bulik and other researchers hope that one day their research will lead to targeted drug therapies to prevent or treat BED. But in the meantime, Bulik says no one should think of it as a biological inevitability. “Yes, recovering from an eating disorder is an uphill battle against your biology, but that doesn’t mean you can’t get past it,” says Bulik. “There are skills you can learn from psychotherapy and other places that can help you get through it.”

What does treatment look like?

Cognitive behavioral therapy (CBT) is considered the gold standard, largely because several randomized controlled studies back up its success treating binge-eating disorder. Other therapies include interpersonal psychotherapy, a form of talk therapy that happens in individual and group formats, and dialectical behavior therapy, which, like CBT, helps patients create a toolbox of skills to manage their disorder.

Some treatment centers like The Renfrew Center, and individual therapists offer what experts call a “transdiagnostic” treatment model. “Our approach is rooted in CBT concepts, but there are a lot of other components, like mindfulness, where you learn to be present with your emotions in a nonjudgmental way. We also incorporate, yoga, art therapy, and exposure work, where you gradually reintroduce foods or experiences that you find scary or triggering to help conquer those fears,” says DeCaro. Denby, who is now 32 and in recovery, found that Renfrew’s day treatment program helped her tremendously. She also said she found help in online recovery spaces (the National Eating Disorders Association lists some) and connecting via TikTok or Instagram with experts promoting intuitive eating, like fitness coach Alex Joy Pucci.

As of now, only one drug has been approved by the Food and Drug Administration to help treat binge eating disorder: Vyvanse, which is often used for ADHD (both disorders involve low impulse control).
Certain antidepressants, anticonvulsants (which can help stabilize mood and also help reduce impulse control problems), and anti-obesity medications may also be prescribed to patients, though they don’t
work for everyone and, if they do, might only help in the short term.

The goal, says DeCaro, is finding a treatment that helps the patient not just stop bingeing but also feel better in general. “Even if we can pinpoint exactly what triggered the eating disorder, it’s not as powerful as identifying the things that are maintaining it. Once you do that, you can create an environment where it can’t thrive anymore.”

Both Denby and Weiser say therapy was the key to their recovery. As part of her treatment, Weiser and her therapist, Dr. White at Yale structured a regimented plan that included finding alternate activities, like crocheting, that could give her the sense of satisfaction and completion she once craved from food.

For Denby, working with experts led to a breakthrough. “At first, I was mad when a therapist wanted me to focus on the emotions I was having when I turned to food—I didn’t want to know! But it was a big
turning point for me,” she says, describing the shift like a physical release in her body. “Now I get what this disorder is. I’ve learned the skills for tolerating those emotions and recognizing that they don’t last
forever and that you don’t need to fight them as much as accept that they are there. Now I can stop myself and think about the ultimate consequence of my actions rather than the immediate gratification.”

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