By Dr. Lucene Wisniewski
There are people who think that if you’re obese, then by definition you must have a pathological relationship with food. Just as everyone who has a low body weight does not have anorexia, the notion that all individuals who have a higher body weight have an abnormal relationship with food is false. Weight doesn’t tell you anything about whether or not a person has an eating disorder. So if you’re overweight you may or may not have an eating disorder. One of things we do know is that 1/3 of people who show up to weight loss clinics meet the diagnostic criteria for Binge Eating Disorder. The probability, therefore, is that an overweight individual does not meet criteria for an eating disorder, and their weight may instead be a consequence of an interaction between environment and genetics, or that the individual is eating past the point where they are full.
Binge Eating Disorder falls under the category of an unspecified eating disorder in the current DSM IV. Proposed changes to the
DSM V, however, qualify
Binge Eating Disorder as its own category based on the following diagnostic criteria:
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
- a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. The binge-eating episodes are associated with three (or more) of the following:
- eating much more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of being embarrassed by how much one is eating
- feeling disgusted with oneself, depressed, or very guilty after overeating
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for three months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (i.e., purging) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
When we define binge eating we’re talking about eating a large amount of food in a consolidated period of time. This isn’t to say that an individual with a healthy eating pattern doesn't eat past the point they are full once in a while. The differentiation is in the feeling that one has lost control over their eating. That is to say that the person who is binge eating couldn’t have stopped, even if they wanted to. Additionally, along with a loss of control, following a binge a person typically feels a high degree of guilt and shame. One indicator of a normalized eating pattern is eating when you're hungry and stopping when you're full. Its also normal to have variability in your hunger and fullness depending on things like activity, stress, and caloric intake.
Its important to note that while the majority of people who meet criteria for binge eating disorder are overweight, this is not true for all. For some people, their bodies are more efficient in metabolizing and storing caloric energy. If a person is binge eating then it requires different treatment than a person would receive if they were obese without the presence of binge eating. If you have binge eating disorder and you’re overweight, focusing just on the weight will probably not be adequate. There are many empirically founded treatments that are thought to be helpful for binge eating disorder. Cognitive behavioral therapy, Interpersonal Therapy, and Dialectical Behavioral Therapy have all shown to be helpful. CBT, however, should be the first line of treatment (Grilo & Masheb, 2005). While behavioral weight control and a restrictive diet may help decrease binging episodes temporarily, CBT will be a better long term intervention.
For more information on binge eating disorder visit:
Grilo, C. M. & Masheb, R. M. (2005). A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder. Behaviour Research and Therapy, 43, 1509-1525.
Contributions by Sarah Emerman