Waxing Existential: Binge Eating Disorder
According to the Binge Eating Disorder Association, “Binge eating disorder (BED) is the most common eating disorder in the United States. An estimated 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder. The disorder impacts people of all ages, including children and adolescents, races, and levels of education and income. Binge eating disorder is characterized by recurring episodes of binge eating, feeling out of control while binging, and feeling guilt and shame afterward.”
The DSM-5 now includes criteria for Binge Eating Disorder, as an Eating Disorder, whereas previously in the DSM-IV-R, it was listed in the appendix. Criteria include: frequent episodes of eating what others would consider an abnormally large amount of food and frequent feelings of being unable to control what or how much is being eaten. Several of these behaviors or feelings include:
• Eating much more rapidly than usual.
• 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 after overeating.
Maria W. Deibler’s recent article in Slate.com mentioned this as one of the changes in the DSM-5 that has been controversial. She quotes Allen Frances, professor emeritus at Duke University, who chaired the task force for the previous edition of the DSM as remarking that Binge Eating Disorder is one of the 10 changes in the new DSM to be ignored. According to Frances bingeing has now become a psychiatric illness, not just a manifestation of gluttony, and the availability of great tasting food.
My argument with all of this is not focused on a simple distaste with (no pun intended) and distrust for any iteration of the DSM, although use it sparingly I must. It is more focused on my own personal and professional experience with binge eating. I have been working in private practice, with a specialization in eating disorders for more than 20 years. Before that, I was studying eating disorders for my graduate degree, including doing an internship at an eating disorders treatment program. And before that I was living with an eating disorder, and even before that I was living with a mother with an eating disorder. I mention all the above to humbly say that I have experience in this area, and that my experience makes me question all easy categorizations, in my mind, in the way I approach binge eating disorder, or any eating disorder for that matter.
I will boldly go out on a limb now and say that I believe just about everyone has some sort of challenge in one’s relationship with food and body. That said, binge eating is very real, and manifests in the ways that the DSM-5 indicates, but is much broader. First of all, I don’t believe that binge eating is always characterized by eating large amounts of food at a rapid pace, or that bingeing leads to feeling uncomfortably full. I do agree with binge eating being primarily about eating when not physically hungry, and that feelings of guilt ensue.
I would define a binge as anytime one eats for reasons other than physiological, when there is another need that takes over. This could certainly mean that large amounts of food are eaten, but that could be grazing over a whole day, or it could be a smaller amount of food in a shorter time. I would say that the primary feeling that encompasses binge eating is shame. I would also say that, while binge eating can occur for many different reasons, anxiety seems to be at the core. Existential anxiety, to be more specific, in my personal and professional experience, is the underlay.
Sometimes a binge is planned. Sometimes it’s something that comes upon you, but always it is a change or movement, from one state of being to another. For example, there can be a sense of needing relief from anxiety, and food can offer a sensation that is different. There can be a need for nothingness, so the act of eating takes on a numbing effect. There can also be a need to be destructive or chaotic, and “out of control” eating may offer this. There may be a drive towards filling a void, and the systematic input of food, and the very act of eating can simulate this.
All of the above, when looked upon through an existential lens, make sense, don’t they? I will not attempt to go into the complexity and variation that is inherent in this statement because it varies by individual. I will oversimplify and say that if we want to truly understand what is going on with an individual who chooses binge eating as a way to work through the pain and agony of existential anxieties and dilemmas, please note the brilliance of the metaphor. Gluttony? “Let me attempt to feast on life because I am desperately trying to find meaning in any way I can.” Yes, food is available everywhere. Good? Bad? Who can be the judge, really? And who should when it comes to binge eating? Can you binge on broccoli? I say yes. The need is the need and the act is the act.
“When I’m at the precipice of terrifying thoughts of loneliness and abandonment, the thoughts are easily pushed away while a cupboard door is pulled open. Maybe later the meaning of my fear can be examined, but not when the chocolate cake is what I want to examine.”
Oh! And another thing: I’m not too hip on the belief that this behavior is curable. We have to live with some relationship with food. The hope is that the relationship can be amicable, respectful, enjoyable, and the like. But it’s also very complex and sometimes confusing. Just look around at the diet tips, tricks, do’s, don’ts that are readily available everywhere you might turn. What is healthy eating? This is a HUGE and ever-debated question. We pivot and transmute our relationship with food all the time, and that goes for almost everyone, right? If you have a history of binge eating, like I do, the relationship may be even more complex. Although I would say that I have come a long, long way, and bingeing is not my “go-to” anymore, there are days that I hear the sirens calling me to “solve it” with a pastry, and all bets are off when I’m cruising at 35,000 feet!
If we are to approach working with any eating disorder, disturbance, or challenge, it behooves us to take a look at what is beneath the “behavior” that manifests. It’s never really about the food.
-- Sibel Golden