Binge eating is the term used to describe a psychological eating disorder in which the sufferer eats large amounts of food in recurrent binge eating episodes (the English word binge means “binge”). While bulimia and anorexia primarily affect young girls, binge eating occurs regardless of age. About 30 percent of those affected are male. According to estimates, binge eating affects about two percent of the population in Germany.
What is binge eating?
People who are affected by binge eating suffer permanent and mermals weekly repeatedly ravenous appetite attacks, in the context of which they eat large amounts of food in a short time. The mostly high-calorie foods are devoured hastily. The patients do not eat with pleasure, but compulsively and far beyond the feeling of satiety until an unpleasant feeling of fullness sets in. In these situations, they no longer have any control over their eating behavior and cannot prevent the attacks from occurring or consciously stop them, so that binge eating can be classified as an eating disorder – comparable to anorexia nervosa or bulimia. In contrast to the latter, however, binge eaters do not try to compensate for the binge by vomiting, excessive exercise or periods of hunger – as a result, binge eaters are usually overweight. On the other hand, not every overweight person is also a binge eater: most patients suffering from obesity do not have binge eating episodes, but continuously eat too much food. The binge eating episodes are experienced by those affected as unpleasant and are accompanied by a high level of suffering.
Causes
The causes of binge eating are varied; as with most eating disorders, emotional difficulties often underlie the disturbed eating behavior. Thus, binge eating may serve to avoid and suppress unpleasant feelings. The excessive food intake then follows the purpose of covering up anger, disappointment or sadness. Accordingly, binge eating often occurs in the context of depression or anxiety disorders. In some cases, individuals with emotional life disorders are also unable to properly perceive negative feelings or emotional needs and mistake them for hunger. Self-esteem conflicts also often play a role in the development of binge eating disorder.
Symptoms, complaints, and signs
For it to be a diagnosable binge eating disorder, several symptoms must occur together. Single symptoms, such as occasional bouts of cravings, are not enough. Binge eating is defined by the fact that an uncontrolled eating attack occurs at least once a week. In addition, this triggers psychological suffering, which can take the person affected to the point of depression. Also – in contrast to other eating disorders such as bulimia – no compensatory mechanism (vomiting, extensive exercise) is set in motion on the part of the person affected. The eating attack as such cannot be controlled and involves a large amount of consumption in a short period of time. In addition, there are five other symptoms associated with binge eating. They include eating alone (out of shame), gorging, eating without feeling hungry, eating until an excessive feeling of fullness is reached, and feeling ashamed after eating or disgusted with oneself after eating. Binge eating disorder sufferers regularly experience at least three of these symptoms in relation to their binge eating episodes. Indirectly, binge eating can trigger symptoms associated with a diet too high in fat and sugar. Diabetes, poor blood counts, obesity, damaged teeth and other symptoms can follow years of binge eating. The cause is that the foods hastily eaten are often unhealthy foods with high physiological caloric value.
Course
On the one hand, binge eating brings with it the physical after-effects of obesity – these can range from cardiovascular disease and diabetes to serious diseases of the joints and the entire musculoskeletal system. In addition, however, binge eaters also suffer from the psychological consequences of their illness.The recurrent eating attacks, which are beyond the patient’s control, trigger strong feelings of guilt; the associated shame also often represents a major inhibition threshold to seeking professional help. The fear that other people will find out about the binge eating episodes can lead to social isolation and loneliness. Many binge eaters additionally suffer from depression.
Complications
Binge eating disorder has immediate physical and psychological consequences; severe physical, psychological, and financial problems often occur in the long term. Initially, binge eating leads to obesity with all its consequences, including severe disease and cardiovascular problems, osteoarthritis, stroke, or diabetes. If binge eating is combined with bulimia nervosa, severe stomach problems, bad breath and sore throat are often added to the mix. In the later course, pneumonia can develop from the overload of the throat. In addition, the usually rapid weight gain damages the bones, strains the gastrointestinal tract, and often leads to the formation of mental disorders. Sufferers often suffer from self-deprecation and depression after a binge eating episode, which can lead to social withdrawal and the development of psychological problems. Longer-term consequences of binge eating disorder include anxiety and self-loathing, as well as alcohol abuse and the formation of obsessive-compulsive disorders. If left untreated, sufferers quickly enter a negative spiral, the consequences of which cannot be foreseen. In addition, high food consumption often leads to financial problems, which increase with the frequency of binge eating. Affected individuals should confide their disorder to a doctor or family member because of the potential complications.
When should you see a doctor?
People who suffer from eating attacks should go to the doctor at the latest when increased stressful situations occur as a result. This may be incipient obesity or a general malaise. Action is also required if social life is affected – for example, if the person concerned begins to conceal his or her eating behavior by lying. Problematically, sufferers of this eating disorder tend to keep quiet about their problem. Accordingly, the impulse to seek medical advice often comes from relatives. Contact points can be psychologists, nutritionists and, of course, a family doctor with whom there is a relationship of trust. In most cases, it is not simply eating large quantities in a short period of time that makes it necessary to see a doctor. It is much more important to uncover possible causes and, together with a change in diet, to treat them. Often it is psychological problems that can be held responsible for binge eating. Since these are in any case worthy of treatment, going to the doctor is a necessity. Those who may be affected can also use the diagnostic criteria (established in the 1990s by the Psychiatric Association of the USA) to check whether their eating attacks are cravings or a serious disorder. Analyzing one’s situation can be done supportively with a trusted person.
Treatment and therapy
Through behavior therapy-oriented psychotherapy, binge eating patients can learn to correctly perceive their range of emotions, to better deal with these feelings, and to develop methods to emotionally regulate themselves even without binge eating. Normalization of eating behavior and weight is also an important therapy goal. By keeping a food diary, the patient and therapist can identify which situations and emotional states trigger binge eating and develop alternative behaviors for such stressful situations. Antidepressants may also be useful in supporting treatment. There are outpatient as well as inpatient and day-care treatment concepts; depending on the individual problem, supplementary family or group therapies can be used profitably. Art and music therapy, as well as animal-assisted therapies such as therapeutic horseback riding, can be helpful in developing emotional expression.
Outlook and prognosis
What the prognosis is for binge eating depends on the severity of the eating disorder as well as the presence of therapy. For example, it has been shown that graduates of therapy tailored to their needs may still be doing significantly better a year after therapy. Due to the sparse data available, the success rates vary between 30 and 75 percent.The disorder can be overcome by up to 70 percent of those affected after approximately twelve years (this refers to the number of years the disorder has existed, although therapy may not begin for several years), although a low risk of relapse remains – especially in stressful life situations. In addition, such eating disorders correlate with an increased risk of developing an anxiety disorder or substance abuse in the further course. Accordingly, a disturbed impulse control is still permanently preserved in many of those affected. Treatment must begin as early as possible to achieve good results. A pattern that has just been learned, which corresponds to the eating disorder, is easier to break than a loss of control over eating that has existed for years. If left untreated, however, binge eating progresses in phases: Periods of normal eating alternate with excessive eating; those affected experience a flare-up of their disorder primarily in stressful situations. It cannot be assumed that the eating disorder can be overcome on its own.
Prevention
As with all mental disorders, a balanced lifestyle and good mental hygiene are important protective factors for binge eating. Anyone who notices that personal problems or stressful situations affect eating behavior, or that feelings of boredom, emptiness, and sadness are compensated for by food intake, should seek psychological counseling early on to avoid the onset of a pathological eating disorder.
Follow-up
Binge eating disorders sometimes require lifelong follow-up care. It is possible that binge eating has resulted in a suicidal tendency, a lack of self-esteem, or obesity that requires treatment, with associated side effects and consequences of illness. During aftercare, medical professionals can address these sequelae. In some cases, psychological interventions are only necessary for life crises. The question is whether those affected seek help because they themselves see the risk of relapse. In other cases, healing can be spoken of after a long therapy. Relapse prophylaxis represents an important area in the therapy and aftercare of those affected. Aftercare is also important because binge eating – like any other eating disorder – has a specific function for the sufferer. Therefore, there is a risk of developing another disorder or an addiction as a substitute for this function after therapy. Sufferers must not only be examined for organic consequences during aftercare. Ongoing psychological care is also important. Whether it is always provided to a sufficient degree varies. It is problematic that binge-eating disorders have not yet been recognized as eating disorders for too long. Therefore, there are no uniform therapy concepts. Different views prevail about the duration and extent as well as the importance of aftercare.
What you can do yourself
Since binge eating primarily involves accessing sweet and high-fat foods, it makes sense for those affected to either banish these from their household or have them locked away by a partner, family or roommates. In this way, the binge eating episode can be prevented or at least directed to a healthy alternative (fruits or vegetables within reach). Since the causes of binge eating are mostly psychological and this eating disorder is primarily a form of avoidance behavior, it is important for those affected to deal with their negative feelings and stress. By exercising, using relaxation techniques and improving their personal situation through discussion and, if necessary, psychotherapeutic care, those affected can improve their quality of life. In many cases, this leads to less impulsivity with regard to eating. Since the absence of individual eating attacks also eliminates the feelings of guilt that many sufferers experience afterwards, the positive effect on their own psyche is additionally strengthened. In addition, it can help to spread the meals of the day over the entire day. Several small portions with a high nutritional value provide more energy, a more balanced blood sugar level and prevent the feeling of hunger – insofar as this is involved in binge eating. Preparing and eating food in a controlled manner also gives sufferers back their sense of control.
