From Anorexia to Binge Eating

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One of the great ironies of Anorexia Nervosa is that somewhere along the line a certain number of people with this disorder switch from starvation to binge eating and obesity. This is not true of everyone and the numbers and percentages are unclear but I have treated some of the people who, as adolescents are now binge eaters and over weight in their twenties. Binge Eating Disorder is a serious illness because of the dangerous impact that binge eating have on health.

The Different Eating Disorders Compared:

First, it is important to define and distinguish between some of the eating disorders already discussed on the log.

1. Bulimia is characterized by self starvation followed by binge eating and purging or using laxatives. While bingeing the bulimic stuffs as much food into their mouths as they can fit and eat as fast as they can. Carbohydrates are the main aim of the binge and taste is amazingly unimportant. Soon after the binge there is alarm about the amount of food that was ingested. In an attempt to reverse the damage, the bulimic purges or uses laxatives, sometimes both, under the hope that they can get rid of the extra calories. Purging results in a feeling of calm and peacefulness not unlike that experienced by drug abusers. However, soon after the calm wears away there are intense feelings of disgust and self hate. This self hate does not prevent the cycle from beginning again either later the same day or the next day. Similar to those with Anorexia, the Bulimic spends a lot of time doing intense exercise. Bulimics lead a secret life about these activities due to the amount of shame they feel about their activities. Physically, binge eating and purging result in damage to the esophagus, teeth and heart, and digestive system. Bulimia can result in death.

2. In Anorexia Nervosa is characterized by rigid restriction of food intake, loss of weight equal to or more than 15% of total body weight considered normal for the height and age of the individual. What is important to note here is that there is a variety of Anorexia Nervosa that includes purging and using laxatives. These individuals might consider themselves to have bulimia as their diagnosis but in reality their low body weight and rigid food restriction places them squarely under the diagnosis of Anorexia. In some way, they convince themselves that Bulimia is less harmful than Anorexia. In point of fact, they are equally dangerous to health and threatening to life.

3. Binge Eating Disorder is somewhat similar to Bulimia Nervosa except that there is no purging. There are recurrent episodes of binge eating, even during a single day. The binge eating is rapid and has little to do with flavor. Rather, it is the rapid intake of food (stuffing) that seems to provide some type of hypnotic pleasure. The binge episode stops when the person feels discomfort or even pain due to the food intake. After the binge the individual feels self hatred and fear about having been out of control. They hate the weight gain they inevitably experience along with terrible shame about what they have done. The entire episode is characterized by a compulsive drive over which the individual feels no sense of control. Depression, guilt, self hate and disgust are the accompanying feelings after the binge. However, these negative emotions do not prevent a repeat binge later in the day or the next day.

There are dangerous physical symptoms that accompany binge eating and among these are:

1. Diabetes

2. GERD or Gastro Esophageal Reflux Disease

3. Obesity

4. High Blood Pressure

These are just a few of the types of physical problems resulting from Binge Eating.

In all cases that I have worked with, whether Anorexia, Bulimia or Binge Eating Disorder, people do not seem to know how to eat and to have disordered "eating lives." In other words, they did not grow up in homes in which the family met together at the table to jointly enjoy breakfast, lunch and dinner and at a set time each day. Often times, each member of the family fended for themselves for each meal and ate alone in their rooms and in front of the television.

In my experience, control is a major issue in all three eating disorders. As much as the binge eater wants to control their eating habits, they also resist counseling, whether it is from the therapist, nutritionist, medical doctor or anyone else. Work with those with the binge type of disorder often feels like a struggle between client and therapist over control of the dinner plate, with the therapist pulling the plate away from the client and the client pulling back.

Treatment for Binge Eating includes anti depressant medication including a particular medication named Topomax that seems to help some individuals gain control over their impulsiveness. In addition, individual psychotherapy and regular visits with a nutritionist who is expert in the field in order to educate about how to eat, have the client do a daily log of food intake and even do weigh-ins. In addition to this, attendance at self help groups such as Over-Eaters Anonymous (OA), that follows the twelve step addiction approach.

Many but not all people who were either bulimic or anorexic during their younger years experience binge eating disorder when they are older. However, there are many people who have this disorder without any history of the other eating disorders.

Why Do People Binge Eat?

This is a difficult question to answer. Some theories suggest that the binge eater is attempting to fill a deep void that they feel in their psyche. Perhaps this is one reason why bingeing occurs when the person is alone. However, there is evidence that binge eating is connected to other impulse disorders and may be due to some type of malfunction in the brain or in the digestive system. For some reason, the "switch" that tells the average person that they have eaten enough does not work in the binge eating resulting in the consumption of huge amounts of food until pain is felt.

Whatever causes this disorder, binge eaters are not deliberately engaging in and enjoying eating or dining. In fact, the concept of "fine dining" is alien to them because the binge has nothing to do with flavor or with gourmet cooking. One patient of mine had a major break through in her treatment when she was able to go out to dinner, sit at table with a table cloth and fine dinner ware, and enjoy the flavors connected with the excellent foods available at the restaurant. It had such a profound effect that, at least in her case, it helped her to move away from compulsive bingeing because she came to realize what she had always missed out on.
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Recognizing and Responding to Binge Eating in Children

Recognizing and Responding to Binge Eating in Children

Reprinted from Eating Disorders Today

By the age of two, many children have developed damaging eating habits that may persist throughout their lives. Like their parents, they are eating too few vegetables and fruits and too much highly processed food laden with sugar, fat, and salt. They have already learned to prefer, and sometimes even to demand, french fries, soda, pizza, hot dogs, sugary desserts, and candy.
Such early eating patterns, compounded by psychological and emotional challenges, may set the stage for the possible development of binge eating disorder (BED). So, how is BED diagnosed in children?
The first thing to consider is that the symptoms of eating disorders in children may be different from those experienced by adults. Thus, the criteria for diagnosing children may also differ. An article in a recent edition of Eating Disorders Review described a new set of research criteria for diagnosing binge eating disorders among children.
Marsha Marcus, Ph.D., and Melissa A. Kalarchian, Ph.D., of Western Psychiatric Institute and Clinic in Pittsburgh suggest that in children, loss of control over eating may be a more important factor than eating an objectively large amount of food. Also, as they speculated in the International Journal of Eating Disorders, dieting may not be consistently associated with binge eating in children.
The proposed criteria are described below. The researchers also point out the need for further research to clarify relationships among depression and eating and weight problems in children and adolescents. In addition, they stress that due to the alarming increase in obesity among ethnic minority children, a better understanding of binge eating in minority populations is critically important.
Proposed Binge Eating Disorder Criteria for Children
The first diagnostic criterion is a pattern of recurrent episodes of binge eating. (Criteria have not been established to specify how often such episodes occur.) An episode of binge eating is characterized by both of the following:
1. Food seeking in the absence of hunger (such as after a full meal)
2. A sense of lack of control over eating ("When I start to eat, I just can't stop.")
The second criterion is episodes of binge eating that are associated with one or more of the following:
1. Food seeking in response to negative emotions such as sadness, boredom, or restlessness
2. Food seeking as a reward
3. Sneaking or hiding food
The third criterion is that the symptoms persist over a period of at least 3 months.
Finally, for binge eating disorder to be distinguished from bulimia nervosa, there is an absence of behaviors such as purging (self-induced vomiting), fasting, or excessive exercise aimed at diminishing the effects of bingeing.
Signs and Symptoms
According to the KidsHealth.org website, the following are some of the signs and symptoms that may suggest the presence of an eating disorder in your child:
- Preoccupation with food and the next meal or snack
- Eating more than usual, while still saying she or he is hungry
- Eating very rapidly or Eating constantly
- Sneaking or hoarding food, even immediately after meals
- Feeling ashamed or fearful when confronted about this
- Excessive concern with weight and body shape
- Making negative comments about her/himself
- Feeling lonely, depressed, worried, preoccupied
- Spending a great deal of time alone
If You Suspect Your Child Has a Binge Eating Disorder
Make time to talk to your child. Explain that bingeing is a serious medical problem and that professional assistance may be necessary to help them understand how to take steps toward healthier eating and nutrition. If the situation warrants it, schedule a visit with a doctor or therapist who is familiar with childhood eating disorders.
In the meantime, avoid making comments about your child's appearance or weight. They are already hypersensitive about these issues, and the focus should be more on behaviors and feelings than their size. Provide a variety of nutritious food selections, but don't try to force food choices on your child or enforce drastic restrictions. Be sensitive to their unmet emotional needs and, if possible, help to constructively resolve any family issues that may be contributing factors. Help them find satisfying activities in which they can excel. Teach them that bodies are beautiful in all different shapes and sizes, and provide examples of what to say when other kids criticize or tease.
Above All, Seek Help
A child who may be developing an eating disorder should receive a thorough physical and psychological evaluation, followed by appropriate professional treatment. Early intervention is important to prevent long-term serious consequences. While binge eating disorder is a serious problem, it can be evaluated and treated successfully. Like any other challenge in life, moving in a new direction begins by taking one step at a time.