Binge Eating Disorder

By Susan Parish-Walker, M.S., L.P.C.

After much deliberation, Samantha decided to confide in her best friend about how her food intake had become completely out of control. She used the metaphor that the food was in the driver’s seat and she was the passenger and that she had become a slave to binge eating. As she began to share with her friend she realized that she ate when she was depressed, sad, lonely, angry, and bored. She said that she often ate when she did not experience any type of hunger sensation and would not stop at satiety and this led to feelings of guilt and self-loathing. Moreover, she went to her internist and discovered that she had high blood pressure and high cholesterol and he referred her for treatment for a disorder commonly known as binge eating disorder.

Binge eating disorder (BED) is an eating disorder not otherwise specified (EDNOS) category in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. It is defined as follows: “Recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.” Compensatory behaviors may be described as purging, laxative abuse, restricting, over exercising, and fasting. Although compensatory behaviors do not appear to exist with patients who have “BED” a French study found that roughly one-third of these patients regularly use extreme weight-control practices. Furthermore, clinical experiences have shown that they often have the dieter’s mentality which is the attitude that they will overeat today and start their diet tomorrow.

More specifically, there are many clinical features that are unique to patients with “BED” such as their chaotic eating behavior that differ from that of patients with bulimia nervosa or with obesity who do not binge eat.  BED is also characterized by a higher level of body image dissatisfaction that can be measured on the Eating Disorder III Inventory Clinical Scale for body dissatisfaction. Unlike anorexia nervosa and bulimia nervosa, BED is not uncommon in men or minority groups and most patients are between 30 and 50 years old. Perhaps there is a correlation between the fact that the most likely time for men and women to gain weight is between the ages of 33-44.

BED is frequently associated with psychological problems such as low self-esteem or feelings of inadequacy which can also be measured on the EDI-III. Dr. April Fallon reported in her study that women correlate their body image with self-esteem more than men. For example, if a woman steps on the scales and her weight is up or her jeans are too tight, she has more feelings of inadequacy than men. Another psychological impairment is social isolation, body shame, and difficulty with interpersonal relationships or establishing an intimate relationship which often leads to loneliness and feelings of despair. Hence, this may trigger binge eating symptoms as a coping mechanism to deal with these emotions.

Psychological and physical factors play a significant role in “BED”. Depression is consistently found to be the common comorbid diagnosis which has a lifetime rate of generally 50-60% according to Christopher Fairburn, M.D. In addition, he reported that anxiety disorders are also elevated among this patient population and males had a higher rate of substance use disorders than females.  Physical complications may arise for these patients such as fatigue, joint pain, Type II diabetes, gallbladder disease, and heart disease according to the NIMH studies.
In summary, the treatment plan for “BED” at The Walker Wellness Clinic is very similar to that of Bulimia Nervosa. A comprehensive physical exam along with a blood work, a cardiac assessment, and a psychiatric consult is recommended.  A resting metabolic rate test is used to measure the patient’s metabolism and to establish the precise number of calories needed for a healthy weight range.  Enrolling in individual psychotherapy and perhaps group or family can be very clinically effective as well as nutrition counseling and meal therapy. Comprehensive psychological testing is often very useful in identifying the underlying causes of this disorder. In conclusion, Adjunct therapy is also very therapeutic for this patient population such as music, art, sand box therapy, or cooking classes.