Binge Eating Disorder (Compulsive Overeating)
Symptoms and Remedies
By Abigail Natenshon, MA, LCSW, GCFP
What is Binge-Eating Disorder (BED) / Compulsive Overeating?
Binge-eating disorder (BED) or compulsive overeating is the lesser-known
eating disorder, following anorexia nervosa and bulimia nervosa. It is
characterized by eating when one is not hungry or by continual eating
without regard to physiological cues. Binge eaters typically eat to the
point of feeling extreme discomfort or even pain. I have worked with people
whose bingeing behaviors are so severe as to be experienced as a form of
self-mutilation; one 33 year old patient of mine describes eating so much
food at a sitting that her skin hurts from being stretched. The patient will
typically report frequent episodes of binge eating, with an inability to
stop or to control the behavior. One in five young women today report this
experience with food. Forty percent of binge-eating disorders occur in men
binge eating arises out of excessive dieting or food restriction;
or dissociative binge eating is the practice of self-medicating
or self-soothing with behaviors that typically evoke feelings of
emotional tranquility or numbness.
It is important to understand that not all people with binge-eating
disorder are overweight, that not all overeaters are binge eaters, and that
being overweight, even to the point of obesity, does not qualify a person as
a binge eater.
The behaviors involved with binge eating are compulsive in nature, and
typically signify a sense of inflexibility and excess, not only in the area
of food consumption, but also in other life spheres as well. At times, and
under certain circumstances, we all eat too much, too fast and too often.
yet, we are not all binge eaters. Excessive behaviors do not qualify as
binges unless their function is to reduce or contain anxiety (resolving
emotional problems,) and they are experienced as frequent, unavoidable, and
beyond the control of the person bingeing.
In some respects, binge eating disorder differs from anorexia and
Typically experiencing an obsessive preoccupation with body image,
individuals with BED do not seek to avoid weight gain through purging or
other drastic measures. They tend to exhibit less extensive levels of
psychopathology and show strong motivation to desist from these behaviors,
which can be tenacious and recurring. Because these aspects of BED differ
from those of other eating disorders, this disease is mistakenly considered
to be less serious and/or not as deserving of intensive treatment. In many
instances, this disorder goes undiagnosed. A highly functional and thin BED
patient of mine has complained that no one gives credence to the extent of
her psychological suffering, depression and self-loathing after a binge.
People say, "You're thin! You don't purge. What are you complaining about?!"
"Nobody seems to care that the next day I am so depressed, I can't even get
myself out of bed!"
It is significant to note that not all binges include large quantities of
food. For an anorexic person, eating five grapes may be considered a binge.
Remember what characterizes an eating disordered binge is the element of
compulsion behind the eating behavior and the emotional outcome that occurs
as a result of the eating behavior.
The Experience of the Binge Eater
Binge eaters report a total preoccupation with food. One of the problems
that frequently occur with binge eaters is nighttime eating (Night Eating
Patients describe getting out of bed
in the wee hours and walking in their sleep or in a trance-like state into
the kitchen where the bingeing happens. Binge eaters sometimes do not know
if their binge was a dream or a reality until the next morning when evidence
of food wrappers and empty containers will appear in the kitchen.
often do their eating in secret, and typically feel most vulnerable to
succumbing to these behaviors when they are alone. Patients describe eating
in their car, sometimes en route to and from work or errands, where they
feel compelled to drive into franchise restaurants, such as Dunkin Donuts,
Taco Bell, or Wendy's and load up on food at each place. They describe
having persuasive internal conversations with themselves in an effort to
resist the temptation, but then report the all- powerful trance-like
compulsion taking over.
In most instances, once the bingeing process has begun, patients report that
it is virtually impossible for them to regain the upper hand, stopping or
even slowing down the bingeing ritual. Because of the nature of this
disease, blood sugar levels are highly volatile, spiking and dropping, a
situation that adversely affects the brain and results in chronic and severe
Treating Binge Eating Disorders
Because many of the underlying issues of the binge eater tend to be similar
to those driving anorexia and bulimia, the same treatment techniques apply.
Cognitive-behavioral, psychodynamic treatment with a family systems focus
and in the context of a secure treatment relationship is most beneficial.
Typically, the elements that drive these disorders include brain and body
chemistry, physiology, unhealthy eating and other behavioral patterns,
emotions, and sociability issues. All of these factors need to be addressed
simultaneously in order to attain optimal treatment results. As with the
other eating disorders, if victims of BED attempt to cease the dysfunctional
eating behaviors without simultaneously attending to the emotional or
relational issues underlying and driving them, their efforts will invariably
result in failure.
In my own practice, I have observed that binge eaters benefit greatly from
working together with others who share similar problems in the context of
support/therapy groups. It is invaluable for people who tend to isolate
themselves and hide their behaviors to share their feelings with others; in
addition, group members are able to offer each other helpful and practical
ideas and inspiration for making behavioral changes, increasing motivation
and accountability. Developing internal self- regulation facility in other
areas of life will contribute to healing eating dysregulation, and vice
Some behavioral remedies for binge eating disorder
Along with psychotherapy, behavioral techniques that allow the individual to
avoid temptations are generally effective. Behavioral techniques might
include such changes as,
If bingeing occurs in the car, taking a different route home where the
patient will not be confronted with the temptation of fast food
Keeping a small cooler in one's car containing one's own nutritionally
dense food, prepared and pre-packaged.
Bringing a passenger along for the ride.
Wearing an elastic band on one's wrist and snapping it hard to remind
one not to begin the out of control bingeing process when the urges and
temptations present themselves.
A solution for home bingers might be not to bring unhealthy snack or
trigger foods home, though for those who live with family members who
like such snacks, eliminating snack foods from the pantry is an idea
that is typically does not go over well. This may need to become a
family decision made in the context of consensus, compromise, and an
Binge eaters who have a genetic propensity tendency towards
addiction often report a craving and sensitivity to carbohydrates and sugar,
so that the more they eat, the more they crave. There are some who claim
that eliminating sugar from their diet can be an integral part of reducing
binge eating episodes. This is a concept that is espoused by Overeaters
Anonymous and is a treatment method that is very helpful for a great number
of binge eaters. The problem that some people run into in using this
alternative for healing is that restriction generally breeds greater
obsessiveness and compulsions.
(Some of this information appeared in the first chapter of my
book, When Your Child Has an Eating Disorder: A Step-by-Step Workbook for
Parents and Other Caregivers, Jossey Bass Publishers, 1999.)
Click here to read about the