Binge Eating Disorder

An episode of binge eating can be defined as follows:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time in similar circumstances.

2. A sense of lack of control overeating during the episode, a feeling that one cannot stop eating or control what or how much one is eating.
    

Recently, there has been increased attention to binge eating disorder, where people engage in recurrent episodes of binge eating without the compensatory behaviours (vomiting, fasting, diuretic/laxative abuse, or excessive exercise) seen in bulimia. Many people who are overweight or obese have problems with binge eating. However, it is possible to be within the average weight range and have problems with binge eating.

Binge eating can have a devastating impact on people's lives, leading to weight gain, obesity, weight related health problems such as diabetes and high cholesterol, and psychological distress.

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Binge Characteristics

Fairburn (1993) discusses several common features of binge episodes:

• Feelings - initially, people can describe the first few seconds of a binge as highly pleasurable, particularly if the person is hungry. However, the positive feelings don't last and are soon replaced by feelings of disgust or desperation as the person eats more and more. A feeling of being totally out of control of eating is central to binge eating. People may feel powerless to stop or control their eating. Agitation and a sense of urgency around the food is commonly experienced.

• Eating Quickly - people often eat very quickly during a binge. People may tend to 'stuff' their food, taking little time to chew or swallow properly.

• Being on Autopilot - many people describe a binge episode as being like a trance-like state. The whole thing feels slightly 'detached' or automatic. Some people use distraction during a binge, such as watching TV, reading, or listening to music, to prevent them from analysing what they are doing.

• Secrecy - a lot of people conduct their binge eating in secrecy and may go to great lengths to conceal their habits from their family and friends.

• Aftermath - After people binge, there is likely to be a negative reaction. Feelings of disgust, shame, and guilt are often reported. After the binge cycle has established itself, every time the person binges, they feel very demoralised, and become more and more convinced that they have no control over the binges. This creates a vicious cycle, as they have set themselves up for another binge.
   

Why Does Bingeing Happen?

Binge eating doesn't come out of the blue - there are usually identifiable triggers that precede an episode. These triggers may include:

• Strong Feelings - emotional triggers are very common, hence the term 'emotional eating'. Very strong negative feelings, such as depression, anxiety, frustration, or insecurity, can act to trigger a binge episode. On the other side of the coin, positive feelings can also be associated with binge eating - feelings of happiness, joy, or celebration can trigger binges. Learning to eat in response to hunger, not emotions, is a key part of cognitive behaviour therapy for binge eating.

• Thinking and Feeling Fat - times when the person may be experiencing a strong sense of being overweight, or 'feeling fat', can be a common trigger. If the person has gained a little weight, this can exacerbate the 'feeling fat' state and increase the likelihood of a binge.

• Irregular Eating - Many people with disturbed eating have very irregular eating patterns. Often, they go for long periods of time (longer than 4 hours) without eating. Others may tend not to eat breakfast or some other important meal. Meals are often not planned, and snacking may not occur. Not eating enough causes physical and psychological distress, which can increase the likelihood of a binge. People are much more likely to overeat when they are extremely hungry.

• Boredom - for some people, not having enough structured time can trigger a binge. If you spend long periods of time alone, this can also increase the likelihood of a binge, as you are able to eat in secret.

• PMS - Some women report that the period of days leading up to menstruation can be particularly high risk for binges.

• Alcohol - drinking can increase vulnerability to binge eating. Alcohol can reduce inhibition against bingeing. It can also lower people's mood, and we know that strong negative feelings can act to trigger binges.

Everybody has different triggers for binge eating. Cognitive behaviour therapy helps people to identify each of their unique triggers, and teaches specific, effective strategies to combat them.

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Binge Thinking

 

As well as feelings and behaviour patterns, binge eating disorder is associated with thinking patterns which create and maintain the problem. We all have an internal dialogue, a conversation inside our heads, which operates in our daily life. This narrative has a major influence on our feelings and actions.

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But not all our thoughts, beliefs, or attitudes are helpful or useful to us. For example, if you believe that you can fly, you may end up with some broken bones. If you tend to believe that you are not a worthwhile person, this may lead you to become depressed. Overweight people may think that they cannot change, which leads them to feel helpless, and may lead them to eating more to "comfort" themselves.

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Thoughts which are unhelpful are known as 'negative thoughts'. Negative thoughts have the following characteristics:

• They are not realistic or logical

• They increase negative feelings such as anxiety, poor self-esteem, or stress

• They are self-defeating and lead to self-destructive behaviour

• They are entrenched and happen 'automatically' - without us noticing
   

Treatment for binge eating problems teaches you to identify what you’re thinking patterns are in relation to the eating problems, and in broader terms, how you think about yourself. You will then learn a range of cognitive techniques to challenge and change negative thinking. In addition to this, you will learn how to disengage from the thinking and develop a more compassionate and non-judgemental thinking style.

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How Does Treatment Help?

At Treat Yourself Well Sydney we combine a CBT approach with principles of Mindfulness and Acceptance and Commitment Therapy (ACT). ACT and Mindfulness are evidence based and serve to enhance the changes occurring with CBT. The word 'cognitive' means thinking, so CBT focuses upon how you are thinking about binge eating - in particular and food, eating, and yourself in general. CBT targets the particular "binge thinking” and gives you effective strategies to change your thinking to more realistic, healthy thinking. CBT also introduces you to simple behavioural changes which greatly reduce the risk of bingeing. ACT and mindfulness strategies focus on helping you to disengage from the thinking mind and increasing self-compassion.

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During treatment, you will learn the following skills:

• Learn to identify your own binge "cycle", and specific strategies to break it.

• Learn to eat from the body's signals of hunger and fullness rather than eating for other reasons ('mindful eating').

• Reduce attachment to negative, judgemental thinking patterns.

• Challenge negative thinking and implement reality-based thinking.

• Increase compassion for yourself.
   

Overall, treatment means that you end up with a toolbox of research based, effective strategies to intervene at each point in your binge cycle. On a broader level, you learn to look after yourself in a more meaningful way.