The American Psychiatric Association (APA) took a big step in 2013 when they released the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. They included Binge Eating Disorder (BED) as a diagnosis for the first time. Thank goodness they did, as it is the most common eating disorder, more than three times more common than anorexia and bulimia combined. Since 2013, folks have been able to seek treatment for BED and have their treatment covered by insurance.
When I talk to folks about BED, however, I find that there are a lot of misunderstandings around what it is. BED is not overeating, although overeating can happen in the context of BED. Overeating is honestly a very normal part of eating in general, and we all do it from time to time. BED is also not a lack of willpower, and it is not gluttony. BED is a serious psychological disorder that requires good, evidenced based treatment.
What is Binge Eating Disorder, then? BED, as defined by the APA, is characterized by eating large amounts of food in a discrete period of time AND a sense of lack of control during an eating episode.
I think that most people view anorexia and BED as two opposite ends of the spectrum. I’d like to take a moment emphasize here that you cannot ever tell how or how much people are eating by looking at body size. People believe that folks with anorexia have too much control and folks with BED have too little. However, BED and anorexia actually share a lot of features. What the diagnosis in the DSM-5 fails to capture is that there is actually a restrictive component to BED. In fact, restriction, either mental or physical, is often what drives binge eating in the first place.
Many folks who come into my office with binge eating disorder describe their lack of control, their lack of willpower, their difficulty just “sticking to the plan.” They say they “know exactly what to do, so why can’t they just do it?” When I ask them what they know, they typically tell me about portion sizes, fruits and vegetables, “lifestyle changes,” exercise, and diets. In fact, they tell me that food and dieting are on their mind 50-90% of the time!
Almost everyone who comes into my office with BED has been on a diet. Or countless diets. Or they’ve attempted a “lifestyle change” (a diet in sheep’s clothing). Almost everyone feels extreme shame about their eating. In fact, my clients don’t lack willpower. It takes incredible willpower to continue to try another diet, go back to the gym and engage in boring or unbearable exercise, and deny themselves food they really like to eat. It takes incredible willpower to think about food for over half the day in an effort to stop bingeing.
Here’s why binge eating is directly correlated to restriction and so-called “willpower:”
Imagine you go on a diet. What do you feel first? Typically feelings of hope, euphoria. The first day goes really “well” (meaning that you’re being “good” at restricting). You imagine you can do this for awhile, it’s not that hard. A few days pass. You post a few things to social media about how you feel great. You get a week into your diet or lifestyle change, and you begin to feel hungry, tired, or deprived. You don’t get to enjoy Taco Tuesday with your friends because everyone else gets tacos and you get...boring food or no food at all or food that doesn’t actually taste good. You start to get cranky because you’re hungry. You start thinking about all the foods you actually want. And then all of a sudden, the pendulum swings and you find yourself in a binge, feeling out of control, wanting to eat everything. You believe that it is your own fault, your own willpower, or lack thereof, that is the problem.
And so most people say to me, why can’t I just STAY ON IT though??? When I want tacos on Taco Tuesday with my friends WHY CAN’T I SAY NO??
Listen to me: because your body does not know the difference between you going on a diet and going through a famine. Your body is carefully designed to make sure you do not starve (also, isn’t that wonderful?! Thanks body!) The fact that you salivate or start thinking about food as soon as you feel deprived is your brain and your body communicating together: Please please please don’t let her put us through starvation mode again.
There is literally no research that indicates diets work in the long term. To expect yourself to stay on something that pretty much everyone cannot stay on is a ridiculous standard. We keep pointing the finger at ourselves, when in reality we need to be pointing our fingers at the diet, the diet industry, and our cultural obsession with weight loss.
Healing from BED feels counter-intuitive because in order to end the restrict/binge cycle, one has to stop restricting. People feel terrified about this because they believe that if they stop restricting, take away their food rules, and allow themselves to eat what they want that they will only eat “bad” foods and never stop. In reality, ending restriction means actually trusting your body and it’s inherent cues to let you know what to eat, how much to eat, when to eat, and when to stop instead of following an arbitrary plan designed by someone else. It also means stopping the shame cycle when a binge does occur, and refusing to put yourself on another diet.
Binge Eating Disorder often develops out of deprivation and rules that are arbitrary. Your body and mind are complex and wonderful and designed to make sure that you nourish yourself. You can trust your body.