Do you turn to food to soothe uncomfortable feelings such as sadness, loneliness, anxiety, or anger?
Do you spend a lot of time thinking about your weight, calories, diets, and body image?
Do you go on eating binges, consuming an unusually large amount of food in a hour or two?
Do you feel shame, remorse, or guilt after such binges?
Do you severely restrict your food intake or exercise excessively after such binges?
Are you caught in a binge/diet cycle?
Have friends, family members, or health professionals expressed concern about your eating behavior or weight?
Do you rationalize that you can “get away” with compulsive overeating or under-eating because your weight falls into the normal range for your height, age, and gender – but you have a nagging feeling that your #1 relationship is with food rather than with other people?
Have other important areas of your life such as relationships, work, career, your physical and emotional health, and sense of purpose been put on a back burner as a result of your preoccupation with food, weight, and body image?
If so, you are not alone.
Most people have had the experience of eating until we’re stuffed (Thanksgiving being a common example). Also, we’ve probably all eaten for emotional reasons – let’s face it, from day one food is connected with love and nurturing (being breast-fed or bottle-fed by our mothers, while being held and cooed over, etc.). It’s natural that when we’re feeling uncomfortable, we might reach for a pint of Ben and Jerry’s for some solace.
However, in some cases people begin to turn to food more and more often, in attempts to manage or get rid of uncomfortable feelings. Gradually, it can get to the point where eating or focusing on food can end up being just about the only tool in one’s life-management toolbox.
In other instances, people meticulously control their food intake, drastically reduce, or obsess about calorie intake. Whether or not you’re aware of it, such preoccupation with food could be an attempt to control your life, when all other aspects of your existence feel out of control.
If your overeating or obsession with food and dieting becomes extreme, your emotional and spiritual development can be impaired or even grind to a halt.
Eating disorders come in various forms.
Binge Eating Disorder (BED) is defined as compulsively eating large quantities of food in a short amount of time (sometimes from a few minutes to a few hours) and feeling intense shame or guilt afterward. BED is the most common eating disorder in the United States. It may surprise you to learn that 40% of people who seek treatment for BED are male. Furthermore, 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with BED.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5, American Psychiatric Association, 2013) lists the following criteria for Binge Eating Disorder:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both:
- eating, in a discrete period of time (for example, within a two-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
- a sense of lack of control over eating during the episode
- Episodes include three (or more) behaviors:
- eating much more rapidly than usual
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of feeling embarrassed by how much one is eating
- feeling disgusted with oneself, depressed, or very guilty afterwards
- Marked distress regarding binge eating is present
- The binge eating occurs, on average, at least once a week for three months
- The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course of Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
Bulimia Nervosa is characterized by recurrent episodes of consuming excessive amounts of food in a brief period of time (from several minutes to several hours), after which the person engages in behavior to offset the binge (such as vomiting, exercising, or fasting). Bulimia can result in serious medical and psychological complications, such as severe depression, anxiety, cardiac issues, and even death.
The DSM-5 lists the following criteria for Bulimia Nervosa:
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within a two hour period), an amount of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances.
- Lack of control over eating during the episode (e.g., a feeling that you cannot stop eating, or control what or how much you are eating).
- Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- Binging or purging does not occur exclusively during episodes of behavior that would be common in those with anorexia nervosa.
Anorexia Nervosa is characterized by an abnormally low body weight, a deep fear of gaining weight, and a distorted perception of one’s weight and body shape. Severely restricted food intake may or may not be accompanied by purging behaviors such as vomiting, taking laxatives, or excessive exercise. Possible medical complications include irregular heart rhythms, absence of menstruation (in women), eroded teeth (if vomiting is induced), and death.
The DSM-5 lists the following criteria for Anorexia Nervosa:
- Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
- Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Other eating disorders with DSM-5 diagnoses include avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder.
ARFID is a general lack of interest in food or being repulsed by certain food smells, tastes, textures, temperatures, or colors.
Pica is characterized by the consumption of substances that aren’t considered food, such as dirt, soap, paint, chalk, pebbles, and cloth.
Rumination disorder involves the regurgitation of food one has recently chewed and swallowed, sometimes followed by the re-chewing, swallowing, or spitting out.
Other Specified Feeding or Eating Disorders (OSFED) refer to problems in eating behavior that do not meet the specific criteria for the above eating disorders. OSFED is actually the most common eating disorder diagnosis for adults as well as adolescents and affects up to 6 percent of the population. It is important to note that symptoms and associated medical or psychological components of OSFED are similar to and can be as severe as those for the other eating disorders.
According to the DSM-V, examples of OSFED include:
- Atypical anorexia nervosa: All of the criteria for anorexia nervosa are met, but despite significant weight loss the individual is within or above the normal weight range.
- Bulimia nervosa of low frequency and/or limited duration: All of the criteria for bulimia nervosa are met, but the binge eating and compensatory behavior (such as self-induced vomiting, laxative or diuretic misuse, etc.) occurs (on average) less than once a week and/or for less than three months.
- Binge-eating disorder of low frequency and/or limited duration: All of the criteria for binge-eating disorder are met, but the binge eating occurs (on average) less than once a week and/or for less than three months.
- Purging disorder: Recurrent purging behavior to influence weight or shape (such as self-induced vomiting, laxative or diuretic misuse, etc.), without binge eating.
- Night Eating Syndrome: Recurrent episodes of night eating, as characterized by eating after awakening from sleep or by excessive eating after the evening meal. The individual is aware of and recalls the eating. The night eating is not better explained by external influences such as local social norms or the individual’s sleep-wake cycle. The night eating causes significant distress and/or functional impairment. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication.
Orthorexia, a preoccupation with “clean” eating, would be another example of an OSFED.
What is the difference between eating disorders and disordered eating? It’s mainly a matter of degree. On a continuum, disordered eating falls between healthy eating and eating disorders in terms of the degree to which one is preoccupied with weight, body shape, food, and appearance (and the effect that this has on one’s life). Disordered eating can still cause distress or impairment in social, occupational, or other important areas of functioning and can in some instances morph into a diagnosable eating disorder if not adequately addressed and treated.
However powerless you may feel about your problems with food and eating, please keep in mind that recovery from eating disorders is possible. With tenacity and a commitment toward your well-being, you can develop a healthy relationship with food, your body, and yourself.
As a Certified Binge Eating and Chronic Dieting Professional (CBECDP), I help people heal their relationship with food, eating, and body image. I believe that we all have a wise, loving self that is capable of managing and thriving in life. It’s my job and privilege to help you get back in touch with this wisdom and strength within you.
Ultimately, eating disorders are about a lot more than the food. People overeat, obsess about food, or restrict food intake for many reasons, including:
- difficulty tolerating uncomfortable feelings, such as depression, anger, or anxiety
- a history of trauma
- a need to self-soothe (and not knowing or using other more helpful methods)
- a wish to “check out” of one’s life, for a number of reasons (including loneliness, relationship difficulties, a difficult day at work. being unhappy with one’s career, struggling with school, etc.)
- as a “reward” or to celebrate
- something to look forward to
- hypersensitivity to external and internal triggers – some people’s nervous systems are exquisitely highly tuned, which can be both a blessing and a curse
- a tendency toward perfectionism and black-and-white thinking (“I ate one cookie, so I might as well eat the whole bag”)
- a disconnect from one’s goals and sense of purpose, which can feel terrifying or deadening (or both)
People with disordered eating often find that learning how to manage their emotions and enhance their interpersonal communication skills can help pave the way to a healthy relationship with food, body, and weight. Fulfilling connections with other people can actually be both the sign and the way to recovery.
We can work together to help you learn what you are really hungry for (or are afraid to relinquish control over) and how to meet your true needs in constructive ways.
Due to recent advances in neuroscience, we know a lot more than we used to about what can cause our brain to go a bit awry, and how to retrain our brain (and mind, and soul) to attain (or return to) a balanced and optimal state.
Effective treatments have been undergoing rigorous research for the past few decades, with some specific treatment modalities demonstrating effectiveness for binge eating, compulsive eating, and other eating disorders, such as Cognitive Behavior Therapy CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Radically Open Dialectical Behavior Therapy (RO-DBT). Somatic (body-based) techniques can also be effective in balancing your nervous system and regulating your emotions. In my sessions with clients, we use a combination of these approaches, to help you heal not only your relationship with food but also with yourself, so you can live a happier and more fulfilling life.