GREEN MOUNTAIN
AT FOX RUN
BINGE EATING
Myths,
Truths and
Treatments
Marsha Hudnall, MS, RDN, CD
Kari B Anderson, DBH, LPC
Erin Risius, MA, LPC
What is Binge Eating Disorder (BED)?
Binge eating disorder involves a pattern of eating that is characterized by an irresistible urge to eat, and once
started, feeling compelled to eat until the food is gone, regardless of feeling full or stuffed. These binge
episodes are followed by strong feelings of self-loathing, which often prompt a cycle of self-destructive
behavior. The obsession of getting the food, eating the food, hiding the evidence, hating one’s self and
planning to get back into control (even while bingeing), occupies a person’s mind and life.
Although 2013 marks the official recognition of BED as an eating disorder within the Diagnostic and Statistical
Manual (used to aid clinicians in diagnosing mental health disorders), BED is actually the most common
eating disorder. (http://bedaonline.com/understanding-bed/characteristics)
Estimates are that:
• Almost 6 million women in the US (3.5%) suffer with the
problem.
• Approximately 2% of men do – about 3 million.
• Children and adolescents also suffer with BED.
• It’s very commonly seen among people who struggle with
weight. Approximately 30 to 40% of people who enter weight
loss treatment programs have BED.
At its core, BED is emotional eating gone awry.
Emotional eating can be part of normal, healthy eating. We all eat
occasionally when we’re not hungry — to celebrate, when we’re bored or
even just because something looks like it tastes good. But when eating is
the primary way we manage our emotions, it becomes problematic.
With BED, a person regularly uses food to escape, to reward herself, to
avoid stressful situations, to soothe anxiety, fear, shame, grief or loneliness,
or to express anger, frustration and the like. After eating, the person with
BED often then layers on additional emotions as she feels dismay over her
eating, which can spur additional eating. It becomes an unending cycle of
despair.
At its core, BED is
emotional eating
gone awry.
How Does Someone Develop BED?
It’s easy to see where the difficult emotions that arise from overeating come
from. In today’s society, most people believe healthy eating is defined by
diet rules – we should eat this, we shouldn’t eat that, we should only eat in
these situations, we shouldn’t eat in those situations. When we don’t follow
the rules, we believe we’re doing something wrong. Add in weight struggles
and you’ve got a recipe for binge eating out of guilt and defeat.
Successfully following diet rules can set us up for binge eating, too. One
of the most common triggers for binge eating is getting too
hungry. Overeating is a normal response to getting too hungry; feeling
guilty about the overeating is what turns it into a binge.
© 2014 Green Mountain at Fox Run, Ludlow, VT Fitwoman.com | 800-­‐448-­‐8106 While dieting is a
trigger for BED for
many people, others
can diet without
developing BED. Why
are they different?
2 While dieting is a trigger for BED for many people, others can diet
without developing BED. Why are they different?
For one, there are definite genetic contributors to the development of
BED. Meaning you often see several people within a family struggling
with the disorder. Other causes can include co-existing mood disorders,
anxiety disorders, and significant trauma or loss experiences. The
bingeing becomes a method of survival with strong reinforcing results.
There is no arguing that food, especially in large quantities, can alter our
physical and emotional state.
One of the most common contributors these days is thought to be weight
stigma, or discrimination or bullying based on a person’s size. Weight
stigma often leads to people trying to change their natural, healthy body
size through dieting, which sets in motion a struggle against fundamental
physiological mechanisms that are there to help ensure survival.
Weight stigma often
leads to people trying
to change their natural,
healthy body size
through dieting, which
sets in motion a
struggle against fundamental physiological
mechanisms that are
there to help ensure
survival.
That a person cannot win against basic survival mechanisms is almost
guaranteed; the failure that ensues can set up feelings that drive
emotional overeating. Weight stigma can also mean lower selfesteem. Food is commonly used to soothe the emotions that come from
feeling inadequate or unwanted.
Although the majority of people with BED live in larger bodies, those who
are smaller may also be triggered to develop BED because of weight
stigma. Essentially, the fear of weight gain is at the core of that
development. Binge eating disorder differs from bulimia in that there are
no compensatory behaviors following a binge such as vomiting or laxative
use.
People with smaller-sized bodies who suffer from BED may engage in
restricting behaviors between binges or have smaller binges that do not
result in weight gain. This does not mean they feel any less out of control
and hate themselves any less. In fact, they may feel their disorder is
minimized when in a group of women of size who also have BED.
Some people do develop BED without any history of dieting. Generally
these folks have experienced some early trauma or neglect. The food has
been used to soothe and create safety or is symbolic of love from
someone who did care for them, such as grandma. Another common
theme is having a history where food was unavailable or controlled in a
manner that brought up feelings of real deprivation.
“Whether due to economic reasons or an overly concerned caretaker’s
attempt to prevent weight gain, the feeling of scarcity becomes an
overarching belief,” says Dr. Kari Anderson, Binge Eating Specialist for
Green Mountain at Fox Run. “They carry the fear of ‘never getting
enough.’”
© 2014 Green Mountain at Fox Run, Ludlow, VT Fitwoman.com | 800-­‐448-­‐8106 “The feeling of scarcity
becomes an overarching
belief,” says Dr. Kari
Anderson, Binge Eating
Specialist for Green
Mountain at Fox Run.
“They carry the fear of
‘never getting enough.’”
3 How Do You Treat BED?
Professional help from specialists skilled in treating eating disorders is advised for anyone struggling with BED.
An effective treatment team generally includes, at a minimum, a psychologist or masters level therapist and a
registered dietitian. Psychiatric oversight might also be needed.
Key elements in effective treatment include:
• Compassion, caring and support. From those treating BED as
well as those who are being treated. The last part is very important;
people who struggle with BED and other eating disorders can
significantly benefit by becoming more compassionate towards
themselves and their struggle, opening the door to understanding
what is going on beneath the eating.
• Psychotherapy. Exploring the underlying issues driving the
behavior is key to understanding how to treat it effectively.
Developing the self-regulation skills necessary to create a feeling of
competence for those with BED is supported by evidence-based treatments using cognitive behavioral
therapy with mindfulness-based interventions. Internal Family Systems therapy and psychodynamic
psychotherapy, especially in a group format, can create a “safe haven” for insight and transformation.
The motivational dynamics of change are also an important factor in treatment delivery for successful
outcomes. As with any eating disorder, recognizing and responding skillfully to resistance is necessary
for those treating BED. Other modalities are available and may be effective but have not been researched
yet.
• Predictable eating. This means eating regularly and eating well-balanced meals and snacks. People
with BED may not be able to tell when they are hungry, so starting to eat every 3-5 hours or so can be a
good strategy to help prevent overeating that comes from getting too hungry. A balance of protein foods,
starchy foods, vegetables and/or fruit at meals helps provide the nutrients that support appetite
regulation. Whether real or perceived, feelings of deprivation trigger biological and emotional responses
of “survival”. Knowing that one can always have more helps calm the fear response and allows for a more
relaxed relationship with food. Ultimately, the goal is to develop a mindful response to body cues through
experimentation and developing trust in the ability to know when and how much to eat.
• Non-judgment about food. Giving up notions of “good” and “bad” foods helps a person decide how
much they really want of different foods. When we believe we shouldn’t or can’t have something, yet we
really like it, we set up a push-pull dynamic that often leads to overeating.
• Self-monitoring tools. Often, these are a form of food journaling. But they are not the diet diaries of old
that were used to control eating. Instead, they are used to gain awareness of patterns of thinking, feeling
and acting. A food journal that includes a hunger scale can help someone who binge eats get back in
touch with how they feel when they are hungry and when they are satisfied. An eating/emotions journal
in which someone records how she feels emotionally before, during and after eating can help raise
awareness of the emotions that drive eating.
• Physical activity. People who binge eat often say they live from the neck up. They’re disconnected
from their bodies. Physical activity helps reconnect the mind to the body, to aid people in better
recognizing what their body needs to feel well. Physical activity is also a great stress reducer. It’s
counter-productive to think of physical activity as a way to burn calories; that makes it something that is
done more as a punishment than as a way to feel better. The relationship with our body can ultimately
help heal our relationship with food, because we care for those things that we care about.
© 2014 Green Mountain at Fox Run, Ludlow, VT Fitwoman.com | 800-­‐448-­‐8106 4 Where Does Weight Loss Fit into the Treatment of BED?
When weight loss is a focus, it really doesn’t fit at all. Many larger-bodied
people with BED have a long history of dieting that has left them feeling
deprived and bad about their bodies. Effective treatment includes
stepping away from the judgment about body size; that generally doesn’t
happen when someone is actively focused on losing weight. Additionally,
a focus on weight loss can pull someone back into restrictive eating,
which exacerbates the eating disorder.
Even when a person has successfully dealt with BED, a focus on weight
loss is generally not advisable. An emphasis on healthy behaviors that
lead to healthy weights as a “side effect” can be a better approach for
anyone who has struggled with an eating disorder. That goes hand-inhand with a focus on developing a healthy relationship with food and the
body, to give a person their best chance at achieving and maintaining a
healthy weight. Research also supports that ending binge eating is a
treatment priority over weight loss, yet ironically those who stop bingeing
may ultimately end up losing more weight in the long run than those
focused on losing weight in the first place.*
Additionally, many people with BED may be significantly malnourished
due to the poor nutritional quality of the food they regularly eat. They may
benefit from work with a nutritionist to help heal their bodies as well as
their minds. It is important to work with a nutritionist who is skilled in
treating disordered eating so as not to trigger disordered eating attitudes
or behaviors.
Research also supports
that ending binge
eating is a treatment
priority over weight
loss, yet ironically
those who stop bingeing
may ultimately end up
losing more weight in
the long run than those
focused on losing
weight in the first
place.
Common Myths Associated with Binge Eating Disorder
How many of these myths have you heard before?
• Everyone who has BED is overweight. Although those with BED are more likely to be at a higher
weight, many people who struggle with the disorder are not. It’s estimated that 1 out of every 3 people
with BED are not at a higher weight.
• Most fat people have BED. To the contrary, many people who live in larger bodies are happy and
healthy. You cannot tell anything about a person’s health or behaviors based solely on what they look
like.
• BED is really just gluttony. Equating binge eating disorder with gluttony is like saying dyslexia is a
matter of intelligence. BED is a disorder with genetic, psychological, emotional, and social roots.
• Anyone can stop binge eating if they just use a little willpower. In the absence of understanding
what drives the binge eating, attempting to just stop it may actually make matters worse. That takes
away the purpose that bingeing serves in a person’s life without providing substitute strategies.
*Grilo, C.M., Masheb, R.M., Wilson, G.T., Gueorguieva, R., & White, M.A. (2011). Cognitive-Behavioral Therapy, Behavioral Weight
Loss, and Sequential Treatment for Obese patients with Binge-eating Disorder: A Randomized Controlled Trial. Journal of Consulting
and Clinical Psychology, 79, 675-685.
© 2014 Green Mountain at Fox Run, Ludlow, VT Fitwoman.com | 800-­‐448-­‐8106 5 How To Get Help with Binge Eating
If you frequently feel upset about your eating, whether it’s bingeing or not, it’s always a good signal that
professional help might be needed. Look for a professional who is experienced in treating BED, and ask
questions about their approach based on information in this article.
The Binge Eating Disorder Association (http://www.bedaonline.com/) lists a variety of resources for
treating binge eating disorder on their website. They also have a provider directory based on geographic
location.
Green Mountain at Fox Run has a Pathway℠ (http://www.fitwoman.com/pathway) to get you started on your
journey for change.
Marsha Hudnall, MS, RDN, CD
Kari B Anderson, DBH, LPC
Erin Risius, MA, LPC
President & Co-Owner
Chief Clinical Director
Program Director
Green Mountain at Fox Run
Green Mountain at Fox Run
Green Mountain at Fox Run
© 2014 Green Mountain at Fox Run, Ludlow, VT Fitwoman.com | 800-­‐448-­‐8106 6