Binge eating is a form of overeating in which a person ingests a large amount of food during a discrete period of time (within one or two hours, for example) and experiences feelings of being out of control and unable to stop eating during the episode. In practice, the duration of a binge may vary greatly from one event to the next, making it difficult to define the number of binges occurring in a given day. Binge eating often occurs in the absence of hunger and is characterized by eating very rapidly; eating alone (due to embarrassment over the amount being eaten); and having strong negative feelings, such as guilt, shame and depression, following the binge. Typically, a binge episode ends only when all the desirable binge foods have been consumed or when the person feels too full to continue eating.
While binge eating is a symptom of bulimia nervosa, it differs from this disorder in that behaviors intended to get rid of the food (fasting, excessive exercise, or using laxatives or inducing vomiting to "purge" the food from the system) are present among those with bulimia, but are generally absent among binge eaters. Binge eating may also occur in anorexia nervosa.
The clinician's diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revised, published in 2000) subsumes binge eating under the diagnosis of eating disorders not otherwise specified. Binge eating disorder is, however, under consideration as a separate diagnostic category, pending further study.
Binge eating episodes may occur in response to strong negative emotions, such as depression or anxiety, or to less defined feelings of distress or tension. The act of bingeing seems to alleviate these uncomfortable feel ings temporarily and binge eaters typically describe themselves as "numb" or "spaced out" while engaged in these behaviors. Some people report that binges are related to the ingestion of certain "trigger foods," usually carbohydrates, but regardless of the stimulus, the feeling of eating without being able to control one's intake is a frightening experience for most people. The aftermath of a binge often includes an overwhelming sense of self-disgust, depression and anxiety.
While people who binge eat are clearly at high risk for becoming overweight, there are important differences between simple obesity and binge eating. People who binge eat are far more likely to report significant mood problems, especially depression, and to report greater dissatisfaction with their weight and shape than are comparably obese persons. They are also more likely to describe themselves as experiencing personal problems and work difficulties and to be hypersensitive to the thoughts and opinions of others. Like people with bulimia nervosa, they also have an increased likelihood of being diagnosed with major depression, substance-related disorders, and personality disorders, yet the overall rates of recovery for binge eating disorders are actually more favorable than those obtained in bulimia.
Binge eating is not common among the general public, but it is prevalent among persons attending weight loss clinics, where as many as half of the participants may fit this description. Both males and females develop binge-eating problems, but the rate of occurrence is 1.5 times greater among women. Age of onset is usually adolescence through young adulthood and the course of the disorder is often marked by a long history of on-again, off-again dieting.
As is the case with other forms of eating disorders, identification of specific causes for binge eating has been difficult. Since many people report relief from painful or uncomfortable mental states while bingeing, the behavior offers short-term emotional relief, making it likely to be repeated. Some investigators have considered genetic influences and personality variables. Still others have suggested that the "culture of thinness" in western societies contributes to the tendency toward harsh self-evaluation characterizing binge-eaters who then turn to food for solace.
At present, the most effective treatment approach to reducing the incidence of binge eating appears to be cognitive-behavioral therapy (CBT). The goal of this therapy is the development of skills for effectively coping with emotional distress rather than seeking to numb or disguise troubling feelings. This therapy focuses on helping the affected individual to decrease the binge eating behavior by recognizing the connection between thoughts and behavior, and to change behavior by changing negative thinking patterns. Follow-up research has been very encouraging, documenting both a decrease in depressive symptoms and a corresponding likelihood of healthy weight loss as the individual achieves better control of eating behaviors.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.
Bowers, Wayne A. "Eating Disorders." In Cognitive-
Behavioral Group Therapy, edited by John R. White and Arthur S. Freeman. Washington, DC: American Psychological Association, 2000. Striegel-Moore, Ruth H., and Linda Smolak, eds. Eating Disorders: Innovative Directions in Research and Practice. Washington DC: American Psychological Association, 2001. Thompson, J. Kevin, and others. Exacting Beauty: Theory, Assessment, and Treatment. Washington, DC: American Psychological Association, 1999. Tobin, David L. Coping Strategies Therapy for Bulimia Nervosa. Washington, DC: American Psychological Association, 2000.
Jane A. Fitzgerald, Ph.D.
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