Sherry-Lee Smith – Psychologist Perth WA
What is Binge Eating?
Binge eating is a relatively common phenomenon. Binge eating involves eating a large amount of food in a short period of time and feeling like you lack the control to stop. It may also involve;
- feeling embarrassed by the amount of food being eaten and therefore eating alone
- eating more quickly than normal
- eating large amounts of food when you aren’t actually hungry
- eating past the point of feeling full
- feeling guilty, disgusted or depressed afterwards
Binge eating can have a ‘dissociative quality’, whereby the person engaging in binge eating feels like they are in a trance or feels disconnected from themselves. People who binge eat, often feel ashamed of the behaviour, attempting to conceal the symptoms by eating in secret. The following behaviours may also occur in conjunction with binge eating;
- Eating other people’s food in secret
- Hoarding food
- Eating frozen, soiled, raw or spoilt food
- Hiding food
- Eating previously discarded food from the garbage
Studies show that rates of binge eating behaviour are high, with an estimate of 19% of female adolescents and up to 30% of university students having engaged in the behaviour at one point in time. Binge eating also occurs in a variety of eating disorders. It may be present in in Anorexia Nervosa (AN) (binge-eating/purging type), Bulimia Nervosa (BN), Binge Eating Disorder (BED) and other specified and unspecified eating disorders, as well as other disordered eating patterns.
Binge Eating Disorder
When an individual engages in binge eating regularly and is distressed by their behaviour they may have Binge Eating Disorder (BED). Unlike Bulimia Nervosa , people with BED rarely engage in what are known as ‘compensatory behaviours’. This behaviour may include excessive exercise, self-induced vomiting, misuse of laxatives and fasting.
Binge Eating Disorder is the most common eating disorder, with a lifetime prevalence of up to 4% of the population. It is associated with obesity and other mental health issues. It is common for individuals with BED to present for weight loss treatment. Twenty five to thirty percent of the people with obesity who seek weight loss treatment can be diagnosed with Binge Eating Disorder. Among people suffering from BED there is a higher rate of depression, anxiety, panic attacks, low self-esteem, substance abuse problems, alcoholism and other weight-related medical issues than found in the general population. In comparison to other eating disorders, there are a roughly equal number of men and women who suffer with BED.
Why do people engage in binge eating?
The most common reason that people engage in binge eating is to alleviate negative or uncomfortable emotions or psychological states. Research shows that triggers to binge eating include;
- Feeling an inner emptiness
- Interpersonal stress (i.e. problematic social interactions with friends, family, colleagues etc.) leading to negative emotional or psychological experiences
- Feelings of sadness, anger, guilt, hopelessness, loneliness, frustration or stress
- Negative thoughts and feelings about the body, shape or weight
- Feeling unlovable or unworthy
- Situations triggering negative thoughts or feeling about oneself
- Dietary restraint (i.e. calorie restriction or only eating certain foods etc.)
- Feelings of rejection or abandonment
- A desire to punish the self
- Feelings of anxiety or low mood
- There is also some evidence to suggest that biological factors such as neurotransmitters and hormones are involved in the onset of binge eating
Although the triggers to binge eating are commonly negative emotions or psychological states, binging doesn’t necessary alleviate these states completely. Often the lingering effect of binging is feelings of disgust, regret, shame, depression, guilt, decreases in self-esteem or self-hatred. In this manner a cycle of binge eating-negative affect-binge eating is created.
Studies show that individuals with Binge Eating Disorder a more likely than other people to have a history of;
- Weight related teasing
- Low peer support
- Parents who had difficulty nurturing them emotionally
- Physical abuse
- Sexual abuse or sexual assault
- Abuse and family problems
- Rejection sensitivity
- Dieting and calorie restriction
- Parental criticism
- Low parental affection
- Maternal overprotection
- Sensitivity to negative self-evaluations
Treatment of Binge Eating – How medical intervention and psychotherapy can help?
There is evidence to indicate that both medical intervention and psychotherapy can be effective at addressing binge eating behaviour. Medication can be used to reduce the frequency of binge eating episodes. These medications include; Serotonin Reuptake Inhibitors (SRI’s such as Fluoxetine, Fluvoxamine and Sertraline), tricyclic antidepressants, and Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s such as Sibutramine) and Topiramate. Medication options such as these should be discussed with your psychiatrist or GP. However, it is important to consider that relapse of binge eating is likely following the discontinuation of the medication.
It is also common for people with binge eating issues to seek weight loss treatment such as bariatric surgery. However patients with BED tend to have less successful surgical outcomes. This may be because surgery does not address the psychological function of the eating behaviour. It is usually recommended that cessation of binge eating is the first treatment goal, and once a person is able to abstain from binge eating, weight loss can be addressed.
Psychological treatment may address the issue directly (through addressing the symptoms) or may target the underlying causes of the binge eating (addressing relationship issues etc.).There are 3 main treatment options for binge eating including; Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT) and Dialectical Behaviour Therapy (DBT), although a variety of other approaches may be used depending on the unique circumstance of each individual.
Cognitive Behaviour Therapy for Binge Eating
Cognitive Behavioural therapy (CBT) for binge eating disorder focuses on addressing the interconnection of thoughts, feelings and behaviour that maintain a cycle of binge eating. The aim of CBT is to normalise eating behaviours and reduce binge eating behaviour using cognitive (thought, belief and expectations) and behavioural strategies. It also focuses on reducing negative emotional states that contribute to binge eating, developing problem-solving skills, and increasing skills in assertiveness, as well as improving self-esteem and body image.
Interpersonal Therapy for Binge Eating
Interpersonal Therapy (IPT) for eating disorders is focused on modifying the social environment that influences the development and maintenance of binge eating problems. Treatment is concentrated on social and interpersonal relationships and developing skills to effectively manage relationships and understanding their connection to binge eating behaviour. This may involve work around resolving grief and loss, addressing interpersonal difficulties, learning or enhancing interpersonal skills and managing the social role transitions inevitable in everyday life.
Dialectical Behaviour Therapy
Dialectical Behaviour Therapy (DBT) has been shown to be effective in reducing binge eating behaviour. DBT is largely focused on the balance between ‘accepting what is’ and ‘changing what can be changed’. DBT is collaborative in nature whereby the client and therapist work together to accept and validate the clients experience of themselves and their surroundings. At the same time there is an emphasis on raising awareness about how these experience came to be and problem-solving how to create alternative experiences by modifying the situations, thoughts and emotions that are related to binge eating. DBT can also help clients learn mindfulness skills, develop alternative coping strategies, understand and tolerate emotions and increase an individual’s skills in managing interpersonal relationships.
Other aspects of treatment for binge eating may include;
- Addressing underlying trauma including physical, sexual or emotional abuse
- Addressing dieting behaviours
- Developing a sense of community connection and addressing feelings of isolation
- Addressing underlying issues
- Increasing problem-solving skills
- Improving self-esteem and body image
- Changing the relationship you have with food
- Relapse prevention
If you are experiencing any difficulties with binge eating or other food, weight or body image issues please click here to find out more information or to book an appointment.
Sherry-Lee Smith – Registered Psychologist – Perth WA