Binge Eating Basics

What is Binge Eating Disorder

Binge Eating Disorder is a recurring pattern of eating large amounts of food with associated loss of control in a discrete amount of time.  While this sounds pretty straightforward, in practice this definition is pretty vague and leads to a lot of confusion for people who may be experiencing symptoms.  How long is “a discrete amount of time,” how much is a “large amount,” what is a “loss of control,” and how frequent is the “recurring pattern”?  Well, let’s dig in a bit and look at some of the typical language and definitions we use.  Before we do that, though, we need to be pretty clear that just because someone may binge eat, they may not meet criteria for the disorder itself.  In fact, binge eating happens for a lot of people who will not be diagnosed with this disorder!

To demystify this a bit, what does binge eating actually mean?  To meet criteria for a binge eating episode, we are typically looking for the entire amount of food eaten over a maximum of a two hour period.  Further, a binge eating episode needs to include an amount of food that a person would not otherwise typically eat in that two hour period.  This is a hard one to pin down, because not all binge episodes are clear-cut and easy to spot.  Not everyone will eat two frozen pizzas in a sitting, a half-dozen cheeseburgers, or a family size bag of chips!  Where do we draw the line?  Helpfully, the good researchers who work in this field have crafted formal definitions that most Psychologists will use to decide what is or is not considered a binge.  Some of these are more straightforward than others.  For example, eating one entire frozen pizza would be a large enough amount of food to be considered a binge.  Eating half of a large ordered pizza counts as well.  How about vegetables?  People don’t only binge on savory or sweet foods!  In the case of bell peppers, 4 will get someone across the binge episode line.  It’s important to understand that binging is not about calories or fat intake.  It’s about fullness, it’s about how we feel afterward, it’s about violation of eating norms.

You can see why determining whether something is or is not a binge can be quite difficult, and why people have such a tough time knowing that what they are doing would be considered binging!  Add in the fact that home-cooked meals most often include non-standard measurements of food, or when eating out people may eat only a portion of the food provided while also having no idea how it’s been prepared, and you’ll see where this gets even tougher.  How many plates of mashed potatoes, country fried steak, and green beans constitutes a binge?  You may need to discuss it in detail with a trained professional to know for sure.  We don’t mean to make things complicated.  Sometimes the nature of mental health and behavioral difficulties are just plain confusing and don’t have an easy, concrete line to cross.  As professionals, we also at times get stumped by the complexities of these assessments.

A binge eating episode also requires the individual to experience a “loss of control.”  While for some individuals this can be clear-cut and simple to describe, others may have difficulty identifying their internal experience.  Simply put, we are looking for someone who feels like they could not control their behavior, they were unable or unwilling to stop, had a desire to continue eating despite already feeling full, or they felt compelled to continue eating.  These are all internal experiences (thoughts, emotions, physical feelings), but we can also use observations to determine this component.  Things like food shards or crumbs being strewn about, leaving a large mess of food components, or eating in a way that doesn’t conform to social or personal standards are all indicators of loss of control.  Have you ever eaten slices of pizza after you’ve thrown them away?  Have you ever eaten lasagna or cake with your hands instead of utensils?  Maybe you’ve separated a large cooked meal out into smaller containers to prevent eating, but still ate the food in each container until they were all emptied.  These are more intense examples that many people will not experience, but these behaviors are not as uncommon as many would believe when we are dealing with binge eating.

Given the above, individuals who experience binge eating episodes also need to meet what we call “frequency criteria” to receive a full diagnosis of Binge Eating Disorder.  Currently, this sits at binge eating an average of once per week.  So, if you or someone you know is eating an objectively large amount of food that wouldn’t normally be eaten in similar circumstances, this person does so within a 2 hour period and experiences a loss of control, and they also do this on average at least once per week, you or this person would potentially meet criteria for Binge Eating Disorder.  It’s important to note too – therapy can help to treat binge eating concerns even if someone doesn’t meet all of the symptoms required for a diagnosis.  Binge eating episodes can be very difficult to experience, both physically and emotionally, and everyone deserves to get relief regardless of whether or not they have an official diagnosis.

Therapeutic Interventions for Binge Eating Disorder

Binge Eating Disorder is a relative newcomer to our diagnostic manuals, having only been included as a full diagnosis in the most recent version (DSM-V; Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).  That said, it was included in prior versions of the DSM as a “diagnosis for further study” and had been well documented in the research literature for literal decades before medical professionals agreed that it should be formally included.  This may seem esoteric, but it matters quite a bit for issues like insurance reimbursement.  This inclusion in the DSM also has an impact on researchers receiving more funding for treatment studies.  Now that it’s a formal diagnosis, we will have more opportunities as a field to dig in and investigate what treatments work the best for which disorders.

What does all of this mean for individuals who experience binge eating?  Well, it means that we have more research evidence to show us which therapies work the best for the most people.  It also means that insurance is much more likely to reimburse patients who receive those therapies, particularly when that treatment is provided by an out-of-network provider.

So, what therapies work the best for binge eating episodes and Binge Eating Disorder?  There are a few, but one of the therapies with the most research support is Cognitive Behavior Therapy – Enhanced (CBT-E).  CBT-E is a “modular therapy” that includes several different components to be added or removed as-needed to best help the patient.  It’s a very flexible treatment that is intended to be administered by well-trained clinicians who have experience in the field.  When we want to focus on binge eating concerns, CBT-E is the gold standard.

There are a few additional therapies that have been shown to be effective, but we won’t be going into them in this blog post.  We can save them for another time!