Emotional Eating and Binge Eating Disorder
Athealth.com is pleased to welcome Ellen Shuman, Director of the Acoria Eating Disorders Treatment Center in Cincinnati, and Dr. Sandy Matthews, a licensed psychologist at the Acoria Eating Disorders Treatment Center, who answer questions about emotional overeating and binge eating disorder.
Athealth.com: Tell us about your professional background.
Ms. Shuman: I entered the eating disorders treatment field through a rather non-traditional route. I was a journalist who had researched and produced several documentaries and news series on obesity and eating disorders. My interest in these subjects was motivated by my own struggles with body image, emotional eating and weight, and the impact each of those issues had had on my life.
In 1992, I saw an article in the New York Times about something new called "Binge Eating Disorder." I'd done a fair amount of research on anorexia and bulimia and compulsive overeating, but I'd never heard of binge eating disorder (BED). As I read the proposed diagnostic criteria for the disorder, I knew that this is what I had struggled with for 30 years.
I was anxious to educate both professionals and consumers about BED and the differences between binge eating disorder and an obesity diagnosis. So, I produced a news series about it. Subsequently, I wound up on the Oprah Winfrey Show . The combined response to the news series and my appearances on the Oprah Show resulted in more calls, letters, and information requests than I'd ever gotten before, on any project I'd ever worked on.
So, I learned everything I could about the subject of emotional eating, and I started doing free information seminars. People still wanted more. I found several mental health professionals in my community who were also interested in this treatment area, and in 1993 we started the Acoria Center. Today, we operate with a multi-disciplinary treatment team consisting of 12 clinicians: a psychiatrist, psychotherapists, personal coaches, a dietitian, and a physical conditioning specialist. We treat the full range of problems associated with overeating.
Athealth.com: How are obesity and binge eating disorder related?
Ms. Shuman: Simply put, obesity is the excessive accumulation of body fat. A number of people who seek treatment for obesity also have problems with recurrent binge eating. The causes of these conditions are complex and may be environmental, familial, genetic, biochemical, cultural, and psychological.
Some people have medical or genetic factors that influence their metabolism and cause weight retention.
Some people have an "energy imbalance." That means they eat more calories than they expend in activity. Excess calories are then stored as fat, causing the person to gain weight. When significantly over a healthy weight, they qualify for a diagnosis of obesity.
Some people have "emotional" or "disordered" eating issues. These are people who eat to manage mood and stress. Emotional eating happens on a continuum. When someone does it occasionally, it's not a big problem. However, when a person's relationship with food and behaviors around food start to influence either mental or physical health, or the person's ability to live a normal, healthy life, then the person may be suffering from binge eating disorder.
Athealth.com: What are the signs or symptoms of binge eating disorder?
Eating large amounts of food when not physically hungry, rapid eating, hiding of food because the person feels embarrassed about how much he or she is eating, and eating until uncomfortably full are all examples of "emotional" and "disordered" eating patterns. People with BED report feeling a sense of impaired control during episodes of overeating. They report feeling great distress over these behaviors and about their weight. Yet, they can't seem to stop what they're doing. They have distorted attitudes about eating, shape, and weight. By the time they seek treatment, many report being "out of control" and feeling "desperate."
In the vast majority of cases, we find depression present. We also see anxiety, obsessive-compulsive and impulse control problems, substance abuse, and personality disorders. People with BED disparage their bodies and feel self-conscious about their body size and/or shape. However, not everyone who has binge eating disorder is overweight
In contrast to people who struggle with bulimia, people with binge eating disorder use no compensatory behaviors like vomiting, fasting, laxatives or use of excessive exercise to counteract the effects of the overeating episodes.
Most people with BED have a long history of trying restrictive diets in an effort to "regain control." However, weight is only a symptom, not the problem. That's why any intervention that involves dieting alone is destined to fail.
Athealth.com: Can you say more about that?
BED is a disorder of disconnection, disconnection from feelings and from self. Over involvement with food and 'food thoughts" are the ways people with BED self-regulate intense feeling states. Let me explain what I mean by that.
Most of our clients report having obsessive "food thoughts." Consciously or unconsciously, they use food thoughts to manage any and all intensity of feeling. For example…
Whenever Bill (not his real name) faces a difficult conversation with his mother, he disconnects from his anxiety by thinking about the ice cream in his freezer
People with BED use "food thoughts" in reaction to and as a defense against stressful life situations. Using food thoughts, they "disconnect" from intensity of feeling. This way of managing mood becomes a habit, a way of life. People develop this habit because it works!
When Susan is facing a deadline, or she's angry with her boss, she retreats to the break room. She waits until she's sure she is alone. Then she gets a Coke and 2 candy bars from the vending machines. She stuffs them in her purse and heads back up to her office to consume them in private. The moment Susan started to obsess about the food in the vending machines, she successfully disconnected from her stress over the deadline and from her anger. Susan will often hit the break room three or four times in a stressful workday.
Linda is single. Driving home from work on a Friday afternoon, facing a lonely weekend ahead, she flashes on the image of a McDonald's chocolate shake and before she realizes it, she's in the drive-through lane buying enough food to "numb" her Friday transition from work to home. She already knows she will overeat all weekend long.
Athealth.com: What is the prevalence of Binge Eating Disorder?
Early binge eating field trials suggest that as many as 30% of people who participate in weight control programs actually have binge eating disorder (BED). This same study suggests that binge eating disorder affects 3% of female college students and 5% of obese people in the general community (*Spitzer et al.1992.1993).
Other studies suggest that binge eating disorder is associated with a much broader demographic distribution than is the case with Bulimia Nervosa, in terms of gender, race and age.
Athealth.com: How is binge eating disorder diagnosed?
Authors of the DSM-IV have suggested that we need further study to determine the exact diagnostic criteria for BED. Today, someone with BED would receive a diagnosis of Eating Disorder Not Otherwise Specified.
However, the DSM-IV has proposed the following research criteria for Binge Eating Disorder.
The client reports during episodes of overeating both the subjective sense of impaired control and three of the following symptoms:
These behaviors must occur 2 times per week over the course of 6 months with no compensatory behaviors.
- Eating much more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food, even when not physically hungry
- Eating alone out of embarrassment at the quantity of food being eaten
- Feelings of disgust, depression, or guilt with overeating.
Anyone interested may read all of the research criteria for BED in the appendix of DSM-IV,
Athealth.com: Describe the treatment process for binge eating disorder.
Treatment begins with a preliminary screening. We use the Acoria BED questionnaire. This questionnaire contains questions about current eating and weighing habits. We ask if the person spends a fair amount of time thinking about food and the next opportunity to eat. We ask about compensatory behaviors to combat weight gain. Is there depression? Is the person having any suicidal thoughts?
If the client displays characteristics of BED, based on his/her responses to the questionnaire, he/she schedules a session with a licensed mental health professional for a diagnostic assessment. This assessment process starts with a 50-minute intensive interview and often continues over 2 to 3 clinical sessions.
Even though binge eating is the primary diagnosis, many clients typically have co-morbid conditions, such as depression, which may warrant pharmacological treatment. Anti-depressants that influence Serotonin levels (SSRIs) are often an important component of treatment.
In treatment, the client addresses his/her binge-eating disorder, any associated obesity, and any associated psychopathology through both individual therapy and group therapy. The therapist and client, together, determine treatment strategies and goals.
Primary goals of treatment are to:
As treatment continues, clients at Acoria are encouraged to use other services, such as psycho-educational programming, support groups, consultations with a dietitian, a physical conditioning specialist and/or a psychiatrist, and telephone coaching services. A dietitian works with the client to help normalize eating behaviors and patterns, while a physical conditioning specialist works with the client on exercise resistance and body movement issues.
- Reconnect with the body and with feelings
- Identify cognitive distortions
- Recognize perfectionism and "all or nothing" thinking
- Identify physical vs. emotional hunger
- Increase capacity to tolerate feeling states
- Learn how to communicate needs and set boundaries
- Improve body image
- Learn self-care
- Recognize recovery as a "process" filled with ups and downs
Change starts to occur when clients begin to understand that their original maladaptive coping strategy of using food is no longer working.
Once clients understand the process, they may choose to manage mood differently, through the learning and application of healthier coping strategies. The clients who do well are those who come to see change as a choice, a choice for which only they can take responsibility.
At Acoria, the length of treatment ranges from a few months to several years based on the severity of illness and the client's motivation and readiness to change.
Athealth.com: What happens to people with BED who do not receive treatment?
Ms. Shuman: They are caught in a vicious cycle of overeating, depression, more overeating, and more depression. Without help, their prognosis for a physically and emotionally healthy life is not good.
Athealth.com: What advice would you give to practitioners who see patients with binge eating disorder?
Ms. Shuman: When you see a patient who is over a healthy weight, don't make any assumptions about who is "obese" vs. who has BED. Don't offer the prescription of a reduced-calorie diet and more exercise until you have eliminated the possibility of disordered eating. Don't let image and degree of function stop you from screening for BED. Many of our clients are highly successful, high-functioning people in our community.
Be cautious about the word BINGE. Many people don't identify with it or don't want to identify with it, or don't know exactly what it means. Instead, we ask people if they "significantly overeat" or if they "eat small amounts of food all day long." Also, some people with BED feel they have "binged" anytime they eat any food at all. Often, a clinician learns a great deal from asking a client to define a "binge" in his or her own words.
Athealth.com: What should a person do if that person suspects that a friend or a family member might have a binge eating disorder? How can friends and family help in the recovery process?
Ms. Shuman: If you are concerned about a friend or loved one, approach with love, not criticism. Learn all you can about BED. Make a plan to discuss this in private. When you broach the subject, take the focus completely off weight.
Tell the person that you are concerned about his or her emotional well-being. Ask if he/she thinks it's possible he/she may be using thoughts about food to avoid thinking about other things or to manage mood. Share what you've learned about BED and ask if that person is interested in learning more.
This part is hard. Be prepared. Your concern may not be appreciated at the time you express it. Ultimately, only the person with the problem can take responsibility for making changes and for getting well. So, no matter what the reaction to your efforts, tell the person that you care and that you are available if they ever want to talk or want your help.
The Acoria Eating Disorders Treatment Center is located in Cincinnati, OH.
Spitzer, RL, Devlin, MJ; Walsh, BT: Hasin, D; Wing,RR; Marcus,MD; Stunkard, A;Wadden, TA;Agras, WS;Mitchell,J and, Nonas,C. (1992). Binge eating disorder: A multisite field trial for the diagnostic criteria. Int.J.Eat.Disord. 11, 191-203.
Spitzer, RL; Yanovski, S; Wadden,T; Wing,R; Marcus,MD; Stunkard,A; Devlin,M; Mitchell,J; and, Hasin, D. (1993). Binge eating disorder: Its further validation in a multisite study. Int.J.Eat.Disord. 13, 137-154.
"Why You can't stop eating". Interview with Dr. Judith Wurtman. November 1992, WCPO TV.
"Confession of a Binge eater" by Ellen Shuman. January 1994. Cincinnati Magazine
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Page last modified or reviewed on January 6, 2012