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What's Wrong with Me?

It may be difficult to distinguish between binge eating and other disorders.

 Spotmatik Ltd/Shutterstock
Source: Spotmatik Ltd/Shutterstock

Melinda, a patient of mine, says: “I eat and eat and I know that I should stop, but I can’t. I eat so much that I want to throw up, my stomach hurts, and I have to lie down. Sometimes, I feel like if I don’t eat everything I can get my hands on, I’ll explode.” Her words highlight the anguish that many people feel when food controls their lives. Melinda often felt powerless, hopeless that her behavior can change. Her struggle is an example of binge eating disorder.

Binge Eating Disorder

Let’s consider some definitions and basic information about binge eating disorder (BED): Up to 25 percent of people in larger bodies seeking weight loss programs are estimated to have binge eating disorder. Unlike other eating disorders, binge eating disorder appears to be almost as common in men as it is in women; it affects African Americans as often as Caucasians.

If you have periods during which you eat large quantities of food in one sitting (the definition of a binge) you may have binge eating disorder. Other symptoms include difficulty controlling how much you eat and feeling powerless to stop eating, even though you may no longer be hungry or may feel too full. After a binge, you may suffer from emotions of disgust, shame, or embarrassment. You may eat in isolation because of embarrassment about how much you're eating. 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

For individuals with BED, struggles with food and body image are likely to begin earlier than for their peers; often there is a history of dieting at a young age. One may be obsessed with body shape and size which bears a greater similarity to thought patterns of individuals with bulimia nervosa than those of individuals living in larger bodies who don’t binge.

A hallmark of BED is a history of exposure to negative messages about shape, eating, and weight. While dieting may be associated with BED, in the majority of people, bingeing behavior begins before dieting.

BED affects both men and women. It is three times more common than anorexia nervosa and bulimia nervosa combined and is the most common ED in the U.S.

Now let’s talk about food obsessions.

When we discussed her relationship with food, Jenn became very animated. She reported being constantly obsessed with food. She talked about how her heart rate would increase and her mouth would water when she was in the chip aisle of the grocery store. She talked about trying to avoid going shopping because she knew she wouldn’t be able to resist buying the large bag of chips that was her “downfall.” But she also described her anticipation of getting the chips. She described the feeling as being like someone with substance use disorder going to score cocaine. She felt like a kid in a candy store—guilt-free and excited about her purchase. She sometimes felt the need to explain to the cashier why the bag was open: “I missed lunch today so I’m starving!” She would make promises, then bargains with herself to keep herself from buying the chips. Or if she gave in to her cravings, she would promise herself that she would eat just half the bag and then put them away. She also came up with punishments she would give herself if she slipped. Her eating felt completely out of control.

How do you know if you have food obsessions?

There are no criteria—and neither food obsession nor food addiction are clinically recognized diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)—but some researchers exploring the concept have used a measure known as the Yale Food Addiction Scale (YFAS). Using the same criteria used to identify people with substance use disorders, researchers using the YFAS have found that 5 to 10 percent of the general population test positive, including 7 percent of children tested. YFAS results also show that food obsession is 15 to 25 percent higher in those living in larger bodies. Even higher rates are found in those seeking bariatric surgery or in individuals in larger bodies with binge eating disorder (30 to 50 percent); 57 percent of people diagnosed with binge eating disorder also meet proposed criteria for food addiction or obsession. In both cases, people experience a lack of control over eating, continued overeating despite negative consequences, and an inability to change their behavior. People considered to have food obsessions also tend to experience higher levels of poor self-esteem, depression, and difficulty regulating their emotions.

Emotional Eating

Emotional eating can be defined as eating in response to emotional cues or eating to make yourself feel better or change your mood, as opposed to eating in response to being physically hungry. There are no approved diagnostic criteria for Emotional Eating so the use of this term is to describe the behavior described here:

Maryann just turned 60. She is married and has a successful career in nursing. Although she feels good about most things in her life, she continues to struggle with food and body image issues. When she feels happy, she overeats. When she’s sad or angry, she overeats. When her husband has to work late and she’s home alone, she overeats. She describes food as “my best friend.” Even though she has read many diet books and has been on numerous fad diets, she can’t seem to stop herself from having a “few more cookies.” A few more always leads to half a bag or a whole bag. Then the guilt comes, and she feels ashamed at having so little control. She really believes that if her life were just less stressful, she could stop overeating—or that if her husband was more affectionate, she wouldn’t turn to food for comfort.

Many people with food and weight issues may recognize that their emotions at times feel overwhelming, or they may shut down any access to their emotions and even have trouble identifying what they are feeling. The reactions represent two sides of the same coin—attempts to escape from emotions, or from the “emotional soup.” Stuck in the emotional soup, one may feel that their emotions are in charge. Emerging from the emotional soup requires emotional development—that is, being able to identify, express, understand, and very importantly, regulate emotions. It is not emotions themselves that cause problems; rather it is the attempt to suppress or avoid them. When emotions are not acknowledged, they may find expression in the foods we eat, in the size and shape of our bodies, or the need to eat foods that may be soothing momentarily but don’t quench the soul’s hunger for expression. Emotional regulation means being able to cope with emotions without resorting to unhealthy or self-defeating behaviors.

Learning to identify your emotions, and put a name to what you are feeling, are the first steps to being able to express emotions in a healthy and safe way. Emotional expression is important because it allows you to be the individual you are, with your own perceptions, emotions, and viewpoints. Emotional expression also is a necessary part of what it means to be human.

Does the label matter?

Binge eating disorder is the only disorder described here that is listed in the DSM-V, and therefore the only one whose treatment may be covered by insurance. Beyond insurance concerns, I think the labels can help you have a better understanding and give a name to what you’ve been feeling. This can make you feel like you’re not alone and offer you some sense that what you’re experiencing is real. The bottom line is that if you’ve been struggling for a while with either BED, food obsession, or emotional eating, there is help and support available—for example, my Food Addiction Recovery Workbook, which is available for free here.