Binge eating occurs in all eating disorders, and is particularly prominent in Bulimia Nervosa. A binge refers to an episode of eating in which an objectively large amount of food is eaten, more than would be ordinarily expected in the circumstances. A binge is accompanied by a sense of loss of control, such that it would be difficult to stop, or to control what or how much is eaten. A binge is therefore usually an extremely distressing experience for the sufferer. It is important in treatment for binge eating that the psychologist and the sufferer together identify events and experiences that prompt episodes of bingeing.
What leads to binge eating and what is the treatment?
Help for Binge Eating
Research and clinical experience indicate that binges usually occur as a result of one or more of four well-defined processes. These are as follows:
1. Being hungry. This is a very common trigger for binge eating. When people come to see a psychologist for help with binge eating, their eating patterns are often extremely erratic and irregular. There may be long periods of the day during which little or no food is eaten, and other periods where larger amounts or binges are consumed. Typically, a significant number of episodes of binge eating are a direct result of inadequate intake of food earlier in the day, creating high levels of hunger and a strong physiological urge to eat. A common scenario is someone spending the day attempting to minimise food intake, perhaps to compensate for a previous day’s binge, arriving home from work/school extremely hungry as a result, and therefore being highly susceptible to bingeing on exactly the kinds of food he or she has been trying to avoid all day.
As an initial intervention, the psychologist will address hunger-driven binges by instructing clients to adopt a regular eating pattern, with three meals and two or three snacks each day, and about three hours between meals or snacks (easily remembered as the 3+3+3 rule). This pattern of eating largely prevents hunger becoming severe, and binge frequency often drops dramatically and gratifyingly in a relatively short time frame.
2. Breaking a dietary rule. People with Bulimia usually have a very large number of dietary rules. These rules often concern what foods they may or may not eat, and in what amounts, issues associated with eating out, eating food of uncertain composition, and so on. Rule breaking is almost inevitable in the face of the large number of rules, and the consequence of breaking a dietary rule is often very familiar to people with bulimia.
The sequence runs as follows, using the example of chocolate. A young woman has a dietary rule about never eating chocolate, and attempts to strictly adhere to this rule. One afternoon she nibbles a square of chocolate from the fridge. Her response to this is what we can call “catastrophic”, in that she feels now that she has totally messed up the day and ruined all her prior attempts at dietary control. This catastrophic reaction leads the abandonment of any and all attempts to control dietary intake, which of course leads to a binge in which the young woman eats the entire bar of chocolate. This is followed by regret, often referred to by sufferers as “guilt”. The rule is thus reinforced, along the lines of “if only I had stuck to my rule, this would never have happened”, and chocolate remains a “feared food” because of its potential to initiate binges in this manner. The rule has become the “good guy”, and the young woman blames herself for lack of strength and self-control. In fact the reverse is true - the rule is the driver for this entire cycle of events, and the woman is merely responding to a strong physiological urge to eat when hungry, and a psychological consequence of continued attempts at self-denial.
In treatment, dietary rules are addressed, often by helping sufferers eat feared foods in controlled experiments, so that the potential of these foods for initiating binges is re-evaluated, leading to relaxation of rules prohibiting their consumption. Clients are encouraged to adopt dietary guidelines rather than rules, which by their very nature cannot be “broken”.
3. Drinking alcohol or using drugs. Alcohol and drugs can have a clear dis-inhibitory effect, and can result in someone bingeing on the kinds of foods she or he usually tries to avoid eating. Treatment for this kind of binge trigger involves developing other ways to manage stress, anxiety and aversive mood states which currently prompt substance use.
4. Upsetting events or unwanted moods. It is particularly clear that for many people upsetting events and their associated mood changes trigger binges. Often the mood or current emotion feels intolerable, and binge eating (and vomiting and over-exercising) helps the individual to cope with the mood or emotion, either by reducing awareness of it, or by “neutralising” it in some way. This type of bingeing is often colloquially called “Emotional Eating”.
A typical scenario might run as follows. Aaron, a second year university student, returns home tired after a long day of lectures and an exam which he feels went badly. His two flat mates have gone out without leaving him a note saying where they are, and the house is empty and messy. Thoughts like “my friends don’t care about me”, “I’m no good at uni”, and “I am always on my own” may show up, and Aaron may end up feeling lonely and dispirited, with a heavy sensation in his stomach and a tight feeling in his chest. Aaron hates feeling this way and sits down and eats two packets of biscuits. He “zones” out for a while, and the binge reduces his immediate awareness of his emotions. It is likely that Aaron will regret this binge soon after finishing the second packet of biscuits, and will experience further distress associated with feelings of shame, self-disgust or anxiety. However, in the short term the binge has had the effect of allowing him to avoid the painful emotions that arose when he got home.
Treatment for binges prompted in this way is covered in detail in the article Emotional Eating. Essentially treatment will involve learning new more adaptive ways to manage uncomfortable emotions and moods.
Often people who struggle with binge eating feel considerable shame and embarrassment about their eating behaviour, and this can be a significant barrier to seeking help. If you or someone close to you experiences difficulties with binge eating please consider making an appointment with me, in the knowledge that you will receive compassionate and experienced psychological help. While I understand that you may feel distress or anxiety coming to your initial appointment, I encourage you to try to keep in mind that I have worked with many people struggling with binge eating, and that most of those clients experienced very similar kinds of emotions, thoughts and behaviours.