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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Binge Eating Disorder

Allan N. Schwartz, LCSW, Ph.D. Updated: Jan 10th 2007

One of the great ironies of Anorexia Nervosa is that somewhere along the line a certain number of people with this disorder switch from starvation to binge eating and obesity. This is not true of everyone and the numbers and percentages are unclear but I have treated some of the people who, as adolescents are now binge eaters and over weight in their twenties. Binge Eating Disorder is a serious illness because of the dangerous impact that binge eating have on health.

The Different Eating Disorders Compared:

First, it is important to define and distinguish between some of the eating disorders already discussed on the log.

1. The first weblog of this series was on Bulimia Nervosa. Bulimia is characterized by self starvation followed by binge eating and purging or using laxatives. While bingeing the bulimic stuffs as much food into their mouths as they can fit and eat as fast as they can. Carbohydrates are the main aim of the binge and taste is amazingly unimportant. Soon after the binge there is alarm about the amount of food that was ingested. In an attempt to reverse the damage, the bulimic purges or uses laxatives, sometimes both, under the hope that they can get rid of the extra calories. Purging results in a feeling of calm and peacefulness not unlike that experienced by drug abusers. However, soon after the calm wears away there are intense feelings of disgust and self hate. This self hate does not prevent the cycle from beginning again either later the same day or the next day. Similar to those with Anorexia, the Bulimic spends a lot of time doing intense exercise. Bulimics lead a secret life about these activities due to the amount of shame they feel about their activities. Physically, binge eating and purging result in damage to the esophagus, teeth and heart, and digestive system. Bulimia can result in death.

2. In Anorexia Nervosa, which was discussed in the weblog just previous to this one, is characterized by rigid restriction of food intake, loss of weight equal to or more than 15% of total body weight considered normal for the height and age of the individual. What is important to note here is that there is a variety of Anorexia Nervosa that includes purging and using laxatives. These individuals might consider themselves to have bulimia as their diagnosis but in reality their low body weight and rigid food restriction places them squarely under the diagnosis of Anorexia. In some way, they convince themselves that Bulimia is less harmful than Anorexia. In point of fact, they are equally dangerous to health and threatening to life.

3. Binge Eating Disorder is somewhat similar to Bulimia Nervosa except that there is no purging. There are recurrent episodes of binge eating, even during a single day. The binge eating is rapid and has little to do with flavor. Rather, it is the rapid intake of food (stuffing) that seems to provide some type of hypnotic pleasure. The binge episode stops when the person feels discomfort or even pain due to the food intake. After the binge the individual feels self hatred and fear about having been out of control. They hate the weight gain they inevitably experience along with terrible shame about what they have done. The entire episode is characterized by a compulsive drive over which the individual feels no sense of control. Depression, guilt, self hate and disgust are the accompanying feelings after the binge. However, these negative emotions do not prevent a repeat binge later in the day or the next day.

There are dangerous physical symptoms that accompany binge eating and among these are:

1. Diabetes

2. GERD or Gastro Esophageal Reflux Disease

3. Obesity

4. High Blood Pressure

These are just a few of the types of physical problems resulting from Binge Eating.

In all cases that I have worked with, whether Anorexia, Bulimia or Binge Eating Disorder, people do not seem to know how to eat and to have disordered "eating lives." In other words, they did not grow up in homes in which the family met together at the table to jointly enjoy breakfast, lunch and dinner and at a set time each day. Often times, each member of the family fended for themselves for each meal and ate alone in their rooms and in front of the television.

In my experience, control is a major issue in all three eating disorders. As much as the binge eater wants to control their eating habits, they also resist counseling, whether it is from the therapist, nutritionist, medical doctor or anyone else. Work with those with the binge type of disorder often feels like a struggle between client and therapist over control of the dinner plate, with the therapist pulling the plate away from the client and the client pulling back.

Treatment for Binge Eating includes anti depressant medication including a particular medication named Topomax that seems to help some individuals gain control over their impulsiveness. In addition, individual psychotherapy and regular visits with a nutritionist who is expert in the field in order to educate about how to eat, have the client do a daily log of food intake and even do weigh-ins. In addition to this, attendance at self help groups such as Over-Eaters Anonymous (OA), that follows the twelve step addiction approach.

Many but not all people who were either bulimic or anorexic during their younger years experience binge eating disorder when they are older. However, there are many people who have this disorder without any history of the other eating disorders.

Why Do People Binge Eat?

This is a difficult question to answer. Some theories suggest that the binge eater is attempting to fill a deep void that they feel in their psyche. Perhaps this is one reason why bingeing occurs when the person is alone. However, there is evidence that binge eating is connected to other impulse disorders and may be due to some type of malfunction in the brain or in the digestive system. For some reason, the "switch" that tells the average person that they have eaten enough does not work in the binge eating resulting in the consumption of huge amounts of food until pain is felt.

Whatever causes this disorder, binge eaters are not deliberately engaging in and enjoying eating or dining. In fact, the concept of "fine dining" is alien to them because the binge has nothing to do with flavor or with gourmet cooking. One patient of mine had a major break through in her treatment when she was able to go out to dinner, sit at table with a table cloth and fine dinner ware, and enjoy the flavors connected with the excellent foods available at the restaurant. It had such a profound effect that, at least in her case, it helped her to move away from compulsive bingeing because she came to realize what she had always missed out on.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    dear concerned dancer - - Aug 5th 2008

    Dear concerned Dancer,

    I was anorexic for years, and am still recovering. in fact, I binged a few nights ago. I understand where you're coming from. Here is what keeps me from binging/starving (which I haven't been so good with lately):

    KEEP A JOURNAL. write down when, where, and how youre feeling when you have the compulsion to do an unhealthy food ritual.

    Let me know how it goes! 

    why i binge eat - cathy of SA - Oct 4th 2007

    ive lived a traumatic life and its now catching up with me since my mother died earlier this year, addtionally my twin sister died 5yrs ago also.

    i dont seem to be able to grasp life anymore, ive become destructive, more impulsive than ever before. i am currently seeing a psychologist whom is teaching me distraction techniques but they dont seem to relieve the extent of pain- no comparsion!

    yes i starve myself in between my binges, its also most for a sense of control, certainly not for the taste or a past time. at first taste might be there initially but then a switch is turned on and i cant stop, i just keep shovelling it in! then at the end i feel disgusted, guilty, totally beside myself thus i end in tears and brisk walking.

    i am in a contiunal spin cycle and psycotherapy alone isnt enough.

    - - Jun 17th 2007

    Thank you so much for this article! I often feel like a misfit for having gone straight from Anorexia to Binge Eating Disorder, and it is good to know that perhaps I am not the only one who has this problem. This switch is like going from one hell to the other, and the thin me now haunts the fat me, socially and personally. But when I try to diet, I end up bingeing in part becuase some biological function refuses to let me diet again. Thank you for letting those of us with this problem know we are not alone, becuase the switch from Anorexia to Binge Eating Disorder is one that is rarely addressed.

    Dancer and Bulimic - - Mar 3rd 2007

    I am a dancer at Carver and I've struggled with bulimia for almost 5 months to say. I haven't lost more than probably 15 pounds and it gets me so fusurated. I want to be thin, and look like the other dancers. I am not sure if i am addicted to purging, but if a day passes without me throwin up I can't sleep and I'll be very angry and disapointed at myself. I don't really get my menstrual and my chest and back hurt sometimes. I don't wan tot get sick, but I have to be thin so I get reconized by my dance instructor HAVE TO!!!!!!!!

    EDNOS, the OTHER eating disorder - Es - Feb 4th 2007

    I think it would be helpful to mention and give an adequate definition for "EDNOS"-Eating Disorder Not Otherwise Specified. It's another eating disorder that affects millions of us who don't fit quite so neatly into one of the other 3 categories. I'm glad it atleast has a name, even though it seems kind of vague.

    Editor's Note:  Eating Disorder Not Otherwise Specified (or NOS) is a catch-all category intended by the developers of the DSM for use describing conditions that seem clinically relevant to diagnosing clinicians, but which do not fit other recognized categories with in a family of diagnoses.  The NOS diagnosis is typically used to make provisional diagnoses (e.g., the kind that are made before the full history of a patient is apparent), and to handle cases which the DSM is not yet prepared to cope with.  Perhaps the bulk of ED-NOS diagnoses that are made today are actually Binge Eating Disorder diagnoses.  You can't actually make a diagnosis of Binge Eating Disorder yet, becuase the science on this subject is ahead of the DSM - the category Binge Eating Disorder doesn't yet exist formally.  It is likely that Binge Eating will be recognized in the next edition of the DSM. 

    What are my options? - YDiaz - Feb 3rd 2007

    I'm only 17 years old and already suffer from GERD. It at all started when I was 12, occasioanly purging after meals. I felt that I was bigger than all my friends and throwing up was the best way to look like them. This is by far the most difficult thing to over come. As i said, i'm only 17, the presure to be thin is over-whelming. One of my friends looks anorexic even through she "eats like a pig."  Another one is extremely thin and still thinks she's fat and the other one which i had most in common with was maybe 15 pounds over her ideal wieght, bulimic too, she lost that weight. Me, I'm still struggling. I diet constantly. I excercise like none of them do. Yet, after reading this article i realize that I do have an eating disorder, far worse than just bulimia. The worst part is that I've recently gone to the doctor, he says i have pre-ulsers, I don't want to get any heavier than what i am. I weigh 150 and this is the biggest i've ever been. I keep over eating, with out any self control because i feel so fat, which probably does not make much sense. I spend hours crying after i eat, because i know i can't throw up any more. Eating is painful, having an empty stomach burns and throwing up feels like knives going up my stomach.

    Even though I constantly binge, I have even stopped eating infront of my friends, the ones i could always trust. I would hate for them or any one to see how much i eat and how fast i do so. When i start eating, i never know when i'm "full" i just stop when it hurts or it becomes difficult to speak. I read here about Topomax, and i was wondering, with the problems i have in my stomach, can I still take it? Will it cause more damage to my stomach?Should i talk to my doctor about it? How do I STOP over eating?

    Thank you for all this helpful information.

    YDiaz

    Self-help - Dancer - Jan 25th 2007
    I know that treatment is suggested for those who have or believe they have a minor case of it, but I am looking for some tips that I can use in order to self-help my way through it. I feel I can do it. I am not far into the disorder, but I do not want to tell anybody and I don't want to get worse. I don't have strong mental issues, and I just want to be normal. However, I am also a very serious ballet dancer and am in an attempt to try and lose weight (only a bit) and keep it down. But, in that attempt, I binge binge binge. I just want to be able to have 3 well-balanced meals and 2 healthful, low calorie snacks. Would you mind offering self-help tips in order to accomplish this? Thank you, Concerned Dancer

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