Eating disorders are characterized by a derangement in eating behaviors that result in physiological and psychological impairment.
Roughly 90% of cases of Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are diagnosed in white females who live in Western societies. Of all of the eating disorders, Binge Eating Disorder (BED) has the highest incidence rate. Athletes have a higher risk of developing eating disorders than the general population, particularly in sports that require a weight class and/or are judged based on aesthetic (i.e. bodybuilding, wresting, gymnastics, etc.) with a 33% increased risk for males and 62% increased risk for females.
The psychopathology associated with eating disorders include body image disturbances such as an unhealthy obsession with weight, body composition, denial of the severity of the issue, and an increasing fear of gaining weight even if the individual in underweight. AN along with BN have been recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for decades, but it wasn’t until the release of the 5th edition, the DSM-5, in 2013 that BED was acknowledged as its own eating disorder instead of being classified under a generalized umbrella of Eating Disorder Not Otherwise Specified (EDNOS).
According to the DSM-5, BED is defined as “recurring episodes of eating significantly more food in a short period of time than most people would eat, with episodes marked by feelings of lack of control. A binging episode is characterized by the DSM-5 by both of the following criteria:
- “Eating in a discrete period of time (ex. within any two-hour period) an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances”.
- “A sense of lack of control over eating during the episode (ex. a feeling that one cannot stop eating or control what or how much one is eating”.
Other characteristics commonly associated with BED include eating at an accelerated pace, eating to the point of feeling physical discomfort, eating alone due to embarrassment, and eating even when not physically hunger. In order to be diagnosed with BED, a binging episode must occur at least 1x per week for 3 or more months or 2x per week for 6 months.
Individuals with BED may have low self-esteem, body image disturbances, inability to function appropriately in social settings, and/or reduced pleasure sensitivity. Additionally, obsessive-compulsive and anxiety disorders commonly accompany eating disorder. Many individuals with an eating disorder will fluctuate back and forth through the various eating disorders, so just because one is diagnosed with a particular ED does not mean they are confined to that diagnosis indefinitely. Because recovery from an eating disorder can take years and is a result of so many factors ranging from physical to mental issues, it is vital that outside help is elicited.
Treatment for each eating disorder will require assistance from an interdisciplinary team in order to provide medical, nutritional, and psychiatric/behavioral treatment. The priority for treatment will be to focus on normalizing eating and maintaining a healthy weight. For BED, much of the treatment can be achieved in an outpatient setting. The interventions will be adjusted per the individual’s specific abnormal eating behaviors but will likely include meal planning, re-learning hunger and fullness cues, body acceptance, and physical activity for pleasure vs. punishment. Cognitive behavioral therapy (CBT) has been proven to be an effective part of the treatment process as it has been proven to achieve remission from BED in > 50% of those diagnosed.
If you or anyone you know feels that this article is relatable, it is crucial to seek help from a team of professional healthcare providers. Eating disorders appear to have a low reported incidence rate not because they are not abundant in our society, (especially with the rise in social media) but because so few individuals decide to seek treatment. Just because not everyone is telling their story or making their struggles known does not mean they are not living it. It is scary to take the dive toward reversing behaviors and ways of thinking that have become so instilled, it can feel like you are losing control. The reality is that there is nothing braver than facing your inner critic head on and rewriting your story, and you have the power to do so whenever you decide.
To recover from an eating disorder is to get your life back. It is a long road full of ups and downs, but the reward of achieving food freedom is worth more than one can put into words.