The eating disorder no one talks about

WH investigates binge eating disorder.

“What I call my first official binge happened when I was 14. My mother and father were arguing one night and I escaped outside so I wouldn’t have to listen to it. But before I scooted out the door, I grabbed a spoon and a can of frozen orange juice concentrate from the freezer. I sat on the porch and cried, scooping the syrupy stuff into my mouth until the can was almost empty. I was in so much crazy teenage pain – but the sweetness of the juice and the action of moving the spoon up to my mouth over and over again seemed to numb my feelings.

So the next time I was really hurting, after breaking up with a boyfriend, I binged again, ordering two pizzas and eating them all by myself. Then I hid the boxes deep in the rubbish bin and woke up the next morning with puffy eyes and heartburn, feeling guilty, fat and disgusting. As much as I hated what I was doing with food, I just could not stop. Soon I was sneaking into the kitchen almost every night and would stand at the bench and eat three, four, five pieces of bread with butter, or pour maple syrup into peanut butter and eat it straight out of the jar.”

You’ve heard of anorexia and bulimia. But not many people know binge eating can be classified as an eating disorder.

“Binge eating disorder (BED) isn’t something most people are familiar with, and there’s tremendous confusion about what constitutes an eating disorder,” says Sarah McMahon, a psychologist and director of the eating disorders treatment centre BodyMatters Australasia.

Unlike anorexia, people with BED feel an intense urge to eat too much, often to soothe difficult feelings – they typically eat a large amount of food quickly, in secret, and feel out of control during, as if they’re literally unable to stop. And unlike bulimia, sufferers do not (usually) purge afterwards.

The National Eating Disorders Collaboration estimates that up to 4.5 per cent of Aussie women have BED. Researchers at Harvard University, US, found it’s more than twice as common as anorexia or bulimia, but not talked about as much. Although BED has finally been listed as its own separate disorder in this year’s edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (also used by Australian clinicians).

“I drank meal-replacement shakes and tried to ‘be good’ to make up for it, but eventually my resolve would crumble and I’d binge again. I thought I was just a bad dieter and had no willpower. But an experience I had at 16 years old made me realise something was truly wrong. I was selling chocolate bars for a school fundraiser, and one day after school, I ate one. Then two. Then three. Then four. I couldn’t stop. I ate seven bars that afternoon, and then spent the evening trying to make myself throw them up until my eyes were red and I was drooling into the toilet. But it didn’t work. Over the course of the two-month fundraiser I ate 80 bars, and I knew I had a problem – when I asked my mother for the money to pay for the chocolate, she did too. Thank God she sent me to a therapist, who told me I wasn’t just a pig or a freak – and that what I was doing had an actual name, binge eating disorder.”

Pulling the trigger

People who suffer from binge eating often feel as if they have no morality or willpower, but willpower has nothing to do with it, says Dr Ovidio Bermudez, medical director of child and adolescent services at the Eating Recovery Center in Denver, Colorado, US.

“Would we expect someone who is anorexic and starving themselves to just be able to stop? It’s not a matter of willpower – eating disorders, including binge eating disorder, are true physical and mental health issues.” Aside from psychological effects, ingesting massive amounts of fat and kilojoules in regular hits places stress on the pancreas and can elevate cholesterol and triglyceride levels, meaning long-term BED can lead to medical complications like hypertension, high cholesterol, heart disease, obesity and diabetes.

So how, exactly, does someone “get” BED? Like any eating disorder, BED usually arises through a complex mashup of factors like genes, individual personality, upbringing and difficult life events. Researchers now believe that genetics play a huge role in BED, just like they affect a person’s risk of getting diabetes or certain types of cancer. One study published in the Archives of General Psychiatry found that a person is twice as likely to binge eat if she has a relative with BED. Personality may count, too: A 2010 study published in Comparative Psychiatry found that people with BED tended to be very cautious and concerned with avoiding danger or harm, while those with the binge-purge eating disorder, bulimia, tended to be more nervous.

Binge eating disorder – like other eating disorders – often starts out with a preoccupation with weight and shape. Food is no longer something that’s simply fun or nourishing; it becomes a value judgement on how good or strong or moral you are. Even as you desperately crave a “perfect”, thin body, you rebel against all the pressure and restriction and compulsively eat much more than your share.

“This strange cycle of weight obsession and binge eating was certainly true for me; I always felt fat and worried about my weight, long before I became even slightly heavy (at the peak of my binge eating disorder at 21 years old, I weighed about 100kg). And in between binges, I would count kilojoules or fast, trying to cure myself through diets.”

Many women with BED hope the structure of a diet can cure them. “I went down the weight loss route, trying to control my binge eating with diet and exercise, but it never worked,” says Rachael, a 24-year-old from Sydney, who has been diagnosed in the past with both BED and sort of a catch-all disease known as “eating disorders not otherwise specified”.

“I went to various personal trainers, commercial weight loss programs and countless body transformation challenges. But I would always gain an extra 5kg after these.”

For Rachael, like so many sufferers, the diets themselves would actually exacerbate the bingeing. “Eventually, the thoughts about dieting and controlling my body just get too restrictive and I think, ‘Screw eating carefully, I’m fat anyway so I might as well keep eating.’ This kind of binge will keep going until I can’t move and then the cycle begins again when I will start trying to be ‘perfect’ the next day.”

Part of this backfire reaction is psychological – we want what we “can’t” have – but part of it is pure biology. “Generally speaking, dieting is the biggest risk factor for the development of any eating disorder,” says McMahon. “It’s very common that a diet precedes an episode of binge eating. There’s a whole heap of neurological changes that take place when you restrict your food, and seeking food that is perceived as ‘forbidden’ is a survival instinct for us.”

So, what counts as a binge?

“This cycle of abusing food continued into my early 20s. I can remember being home alone one night feeling depressed, lonely and desperate for relief. So I walked down the street to a supermarket and bought a huge bag of miniature peanut-butter cups. By the next morning, only wrappers – and a thick sense of self-loathing and guilt – remained. I realised this wasn’t normal. For many years, my life had been a cycle of out-of-control eating, guilt, dieting and self-hate.”

When so many women are stuck in a cycle of dieting and falling off the wagon, it can be hard to distinguish disordered eating from the occasional binge or just being weird about food in a normal way like so many women.

“To young women, the word binge is part of normal vocabulary – they’re talking about ‘bingeing’ in the same way they’ll say a person is ‘so bipolar’,” says McMahon. “When girls go out to eat with friends, they might describe that as a binge. For some, it’s literally just two or three chips.”

For many women, it’s having a sudden compulsion to eat everything in the house – often full from dinner, they later find themselves finishing off leftovers, bags of chips, biscuits, raw cookie dough. Other women may overdo it on so-called “health” foods – but just because what you’re eating is gluten-free or made with raw cacao doesn’t mean you’re eating it for the right reasons. What counts most in terms of what qualifies as BED is how you feel during and after. In true eating disorder terms, a binge is when someone eats a large amount of food in a relatively short period of time, often when they’re not physically hungry, and feel a loss of control while doing it and intense shame after.

“Sometimes the need to binge comes on like a rush, a compulsive mix of anxiety and nervousness that needs to be quashed with food immediately,” says Rachael. “I feel like I have no control over my behaviour when I’m in that state and it’s a rush to buy the food and then eat the food fast and in secret. Once the binge is over I sort of ‘come to’ and realise what I’ve done – then I have to deal with the shame and guilt.”

Getting help

“It took nearly 15 years, but through self-help books, talk therapy and support groups, I fully recovered from binge eating disorder. When I walked into my first 12-step support group meeting for people with binge eating issues – I couldn’t believe that so many young, pretty, seemingly normal and successful women were dealing with the same out of control behaviour and pain that I was. With that help, I was able to find other ways to deal with difficult emotions, like meditating, moderate exercise and writing. To me, now, foods aren’t good or evil – they’re just food. I’m usually able to eat when I’m hungry and stop when I’m full. Once I recovered, I realised that there still wasn’t a lot of open discussion about binge eating disorder, so I started a support website, Healthy Girl, and eventually wrote a book, Food: The Good Girl’s Drug – How to Stop Using Food to Control Your Feelings.”

The good news is that, with help, it’s possible to recover from BED. These are the steps other recovered women have taken to get help:

Talk to your doctor “I used to go to the carpark at my local library and binge on McDonald’s and KFC,” recalls Kara, a 26-year-old from Queensland. When things got bad enough, she reached out to her doctor, with a good result: “I explained that I needed help because I felt I had no control over my eating; she was really understanding and referred me to see a psychologist.” Not every doctor is going to understand the specifics of binge eating disorder, but now that it’s officially listed in the DSM, people in the medical field are taking the illness more seriously. Chances are your doctor won’t be able to treat you herself, but she can refer you to a psychologist or physician who specialises in eating disorders.

See a psychologist “I’ve seen three psychologists, and they have all been very different in their ways and techniques,” says Kara. “I’ve learnt something different at each appointment. I no longer feel the need to be skinny and have accepted my body shape. I’m aware of my triggers and I know the urge to binge is about controlling my emotions – I’m learning that I need to talk about things instead of holding them in. I eat all foods and never starve myself anymore, I sometimes binge but it doesn’t go on for weeks like before.”

Her first 10 visits with a psychologist were covered by Medicare with a $10 out-of-pocket cost, and the second two programs were completely free. (Check with your psychologist first as these benefits vary depending on the length of a session or the fee charged by the psychologist.) In terms of the specific types of therapy that work best, research shows that cognitive behavioural therapy, which focuses on changing unhelpful or irrational thoughts and beliefs, and interpersonal psychotherapy, which focuses on how you relate to other people, are most effective.

Stop Dieting Rachael feels that dieting and the yearning to be thin worsened her binge eating disorder. “For years I tried cleanse programs, soup diets, etc. I over-exercised – twice a day, every day. But it backfired because then I felt so much guilt associated with food that I got to the point that I couldn’t even enjoy one biscuit. If I ate one, I would feel dirty and need to eat them all.” But her relationship with food is much healthier and more peaceful now that she’s stopped dieting. “Every day is a new opportunity to release old fears and restrictive rules I have about food,” she says. “I eat out at restaurants and cafes now, instead of ordering a green tea and then bingeing for several hours in secret when I get home. I’m learning to love my body as it is and I value its amazing resilience after 10 years with an eating disorder.”

One school of thought around how to eat wisely without focusing on kilojoules is called “intuitive eating”, and it focuses on tuning in to your body’s physical cues around hunger and cravings, and letting go of binge-inducing guilt (the great book that started the movement: Intuitive Eating by Evelyn Tribole and Elyse Resch).

Come clean about it Many people who struggle with BED are terribly embarrassed by it. But what happens when you share your struggles is you find out that way more people are suffering with food and body issues than you might think. It can be a relief to open up even to someone who doesn’t have the same issues, says Rachael. “My boyfriend has been my number-one supporter and I credit huge leaps and bounds in my recovery to his love and kindness. I’d tell him when I felt anxious or compulsive and after I had binged he would be the first to know. He would coach me to forgiveness when I couldn’t forgive myself and reminded me that I wasn’t a bad person.”

Reach out to The Butterfly Foundation Rachael tried a lot of strategies in her quest to recover from BED. “I tried neurolinguistic programming therapy [NLP], hypnotherapy and then Overeaters Anonymous.”

Finally, she found The Butterfly Foundation, a national non-profit organisation to support those with eating disorders and body image issues.

“I went to a weekly recovery group for eight weeks where I met more women in recovery, and then have had several months of one-on-one counselling with an eating disorder counsellor. I don’t binge on a daily basis anymore, only occasionally when something is particularly stressful and I don’t have access to other strategies in that moment. I’m still currently overeating, but I’m much more relaxed about that and going with the flow. I know that food will settle the more I take the focus off it. I’m trying to cultivate a happy and positive life for myself and with that will come peace.”

Could you have binge eating disorder?

Only a doctor or psychologist can diagnose you. But this quiz, from eating disorder specialist Dr Cynthia Bulik, can give you a good idea. If you answer yes to three or more of these, it’s a warning sign, says Bulik.1/ Do you frequently lie about the amount of food you eat? Y/N
2/ Do you often wait until you’re alone to eat? Y/N
3/ Once you start eating do you have difficulty stopping? Y/N
4/ Do you hide secret stashes of food around the house/in the car? Y/N
5/ Do you have feelings of shame, guilt, remorse or inadequacy after overeating? Y/N

6/ Do you often “zone out” during overeating, to the point where you barely remember, let alone taste, what you ate? Y/N

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Sunny Sea Gold is the author of self-help book Food: The Good Girl’s Drug – How to Stop Using Food to Control Your Feelings. Visit her website Healthy Girl