Binge eating: description
Unlike bulimics (binge eaters), binge eaters do not try to make up for the calories they take in by vomiting, medication, or excessive exercise. This is why most binge eaters are overweight. However, people of normal weight can also have binge eating episodes on a regular basis.
Who does binge eating affect?
Binge-eating disorder typically occurs later than anorexia or bulimia. It predominantly affects young adults or people in midlife. However, even children can have binge eating episodes. However, the full-blown binge-eating disorder is very rare in childhood.
Women and men are affected by the eating disorder in roughly equal numbers. In contrast to bulimia and anorexia nervosa, the difference between the sexes is thus significantly smaller.
Binge eating: symptoms
For a diagnosis of binge eating, binge eating must occur at least once a week for a period of three months.
Diagnostic criteria of binge-eating disorder
A) Repeated episodes of binge eating.
B) Episodes of binge eating occur together with at least three of the following symptoms:
- Eating much faster than normal
- Eating to the point of an uncomfortable feeling of fullness
- Eating large amounts of food when one does not physically feel hungry
- Eating alone out of embarrassment about the amount one is consuming
- Feeling disgusted with oneself, depressed, or feeling great guilt after overeating
D) The binge eating episodes occur on average at least one day per week for three months.
E) The binge eating episodes are not accompanied by the regular use of inappropriate compensatory behaviors (e.g., intentional vomiting, fasting, or excessive exercise) they do not occur exclusively during the course of anorexia nervosa (anorexia) or bulimia nervosa (bulimia).
Repeated episodes of binge eating.
- Eating an amount of food in a definable period of time (e.g., two hours) that is definitely greater than most people would eat in a similar period of time under similar circumstances.
- A sense of loss of control over the food consumed during the episode (e.g., a feeling that one cannot stop eating or control what one eats).
Differentiation of binge eating from bulimia and obesity.
Unlike bulimia, binge eaters do not usually take counteractive measures to make up for the calories they have ingested. Accordingly, food is not regularly regurgitated, and laxatives or excessive exercise are not used to reduce weight. The body mass index (BMI) is therefore often higher than in people with bulimia.
Binge eaters are also more dissatisfied with their bodies and have lower self-esteem than people who are merely severely overweight. Other differences include the recurring binge eating episodes and more irregular and chaotic eating behavior than in pure obesity. People with binge eating are also more psychologically impaired and often suffer from other mental disorders at the same time, such as anxiety disorders.
The most common accompanying disease (comorbidity) of binge eating is due to concomitant obesity. 40 percent of binge-eating patients are severely overweight. People are considered obese if they have a body mass index of more than 30. BMI is calculated by dividing body weight by height squared. A woman with a height of 1.68 m and a weight of 85 kg would therefore have a BMI of 30.
The increased weight also damages joints and the spine. The knee and hip joints in particular, as well as the intervertebral discs, suffer under the strain. In cases of severe obesity, breathing and sleeping disorders also occur.
Psychological comorbidity and consequences of binge eating
The most common co-occurring mental disorders of binge eating are affective disorders (20 to 30 percent), which are disorders that affect mood and drive. These include depression, mania, and bipolar disorder. In addition, about 20 percent of people with binge-eating disorder suffer from an anxiety disorder. This includes phobias and panic disorders. Ten percent of binge eaters are addicted to substances, especially alcohol.
Why some people become addicted to eating is unclear. Presumably, several biological, social and psychological aspects together play a role in the development of binge eating.
Theories on the development of binge eating disorder
Research suggests that there are two main factors that work together to contribute to the development of binge-eating disorder.
- Childhood overweight and obesity.
Also at risk are people who do a lot of dieting because they are dissatisfied with their bodies. The slim ideal of beauty in our society leads many girls and women to devalue their own bodies. They try spasmodically to get closer to the ideal through restrained eating. However, abstaining from food, especially certain foods, increases cravings for food and promotes the development of binge eating.
Stress in particular plays an important role in the development of binge eating. In times of tension and negative mood, food has a brief relaxing effect on binge eaters. Since those affected have no other coping mechanisms to deal with stress, they stuff themselves with food. Afterwards, they develop feelings of shame and disgust that further damage their self-esteem. This in turn increases the risk of binge eating.
Another theory points to the connection between eating style and binge eating. Binge eaters often avoid high-fat and high-carbohydrate foods between binges. For one thing, the low-carbohydrate diet increases susceptibility to stress. For another, the calorie-induced eating deficit increases feelings of hunger and thus the risk of unrestrained eating.
Binge eating: examinations and diagnosis
The first point of contact can be the family doctor. In an initial consultation to take a medical history, the doctor will try to find out whether an eating addiction is actually present. The family doctor could ask you the following questions:
- Do you have binge eating episodes where you feel like you can’t stop eating?
- Do you eat faster than usual during binge eating episodes?
- When do you stop eating again?
- How do you feel during these binges and afterwards?
- Do you regurgitate the food you have ingested?
- Do you take laxatives to reduce your weight?
- Are you satisfied with yourself and with your body?
Physical examination
Further, the family doctor can determine whether there are any consequential damages due to the binge-eating disorder. He will calculate your BMI and examine your blood (e.g. measuring blood sugar, blood lipid levels and uric acid).
If you are overweight, a check of your cardiovascular system by electrocardiography (ECG) is also useful. If there is evidence of a disorder, a specialist may perform further tests.
Psychological examination
The Eating Disorder Examination (EDE) by Fairburn and Cooper is often used in clinics as a test for binge eating. This questionnaire is based on the criteria of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) and has proven to be a very reliable diagnostic instrument. It captures the following topics, among others:
- Restrained eating behavior
- Thought preoccupation with food
- Worries about weight
- Worries about the figure
Binge Eating: Treatment
Cognitive behavioral therapy and interpersonal therapy (see below) have been shown to be effective in treating binge-eating patients. In addition, behavioral therapy is necessary to reduce weight.
The therapeutic methods
For a long time, the same therapeutic methods were used to treat binge-eating as were used to treat bulimia. They are effective, but because binge-eating is a mental disorder in its own right, special treatment plans have been created in recent years. Doctors and psychologists hope that this will lead to even higher treatment success rates. The main areas of focus for binge eating therapy include:
- change eating habits
- to bring physical exercise into everyday life
- change negative thinking about one’s body and increase self-esteem
- learn strategies for relapse prevention at home
Cognitive behavioral therapy (CBT)
Interpersonal Therapy (IPT)
Drug treatment
If the patient also suffers from an affective disorder, for example depression, this is sometimes treated first. This is because a patient suffering from severe depression is not able to actively work on overcoming the eating disorder.
Binge-eating: course of the disease and prognosis
Binge-eating disorder often progresses in phases. Some binge eaters can eat almost normally for several weeks, after which the binge attacks return. In the long term, very few binge-eaters are able to cope with binge-eating on their own without professional support.
