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The Binge Pinch: Why eating takes a beating

The Binge Pinch: Why eating takes a beating

Genetics, gender, emotional trauma, poor body image and a history of obesity are among the risk factors associated with the disorder

binge eating disorder: when food takes over

Maria is 38, well-established in her career and has an active social life. But she had to approach clinical psychologists, seeking help for her binge-eating habits after experiencing back and knee pains due to excess weight. Maria, who had started having binge-eating episodes as a fresher in college, had also been treated for hypertension and high cholesterol over the last five years.

“I know what to do. I just can’t do it. I cannot control my eating,” she told psychologists.

Maria’s is just one among many case studies on binge eating disorder (BED) published by the American Society of Clinical Psychology.

What is binge eating disorder?

Dr Prerna Kohli, clinical psychologist and founder, MindTribe.in, says binge eating disorder is one of the impulse control disorders characterised by consumption of an amount of food within a period of two hours that is surely considered larger than how much most people would eat under similar circumstances. “Since it is an impulse control disorder, there is a sense of helplessness or lack of control over being able to stop eating or how much one eats,” Dr Kohli says.

Dr Paulomi M Sudhir, professor, consultant, behavioural medicine unit, Department of Clinical Psychology, NIMHANS (National Institute of Mental Health and Neurosciences), Bengaluru, says binge eating disorder is usually seen in young adults and middle-aged adults. “However, it is not limited to this age group. BED needs to be assessed carefully, else it might get missed, especially in persons with mood disorders like anxiety and depression,” Dr Sudhir says.

Signs and symptoms

Dr Kohli says an individual suffering from Binge eating disorder may notice three or more of the following symptoms. They may eat:

  • very fast
  • until they feel uncomfortably full
  • a large amount of food even when unhungry
  • alone because they feel embarrassed and experience hatred towards oneself after overeating

What causes BED?

Dr Kohli says BED generally develops as a maladaptive coping mechanism to emotional stress or distress, boredom, dieting or negative feelings about one’s own body.

“The act of eating large amounts of food gives the individual short-term relief from the uncomfortable feeling of anxiety and stress, but they experience guilt and shame afterward. The exact reasons are not well-understood at the moment and may differ from person to person. Some risk factors are genetics and gender (women are more likely to suffer from it). Others can include emotional trauma, poor body image, a history of obesity and binge-eating habits that can be traced back to childhood, and being diagnosed with other psychological disorders,” she says.

In Maria’s case, she reported attending counselling sessions during college after she was sexually assaulted. During these sessions, Maria’s concerns about her binge eating were brushed away by the counsellor who told her that they must stay focused on working through issues directly related to the sexual assault. This made her wait several years before she sought help for her binge-eating habits again.

Dr Sudhir says a family history of eating disorders, depression and substance-use disorders (such as alcohol dependence) is also likely to be present.

About what causes people to binge, Dr Sudhir says, “Some of the reasons are a disturbed body image, perfectionism (related to body/body weight) and mood disturbances (such as depression) — and eating may be used as a strategy to cope. Low mood, feelings of loneliness and boredom, adverse childhood experiences (including being bullied, sexual abuse) are sometimes noted as early predisposing or risk factors. However, these factors may not be specific to BED, and may be noted in other eating/psychological disorders.”

The pattern of binging and loss of control, says Dr Sudhir, is worsened by poor self-image and lack of confidence in being able to regulate one’s eating habits.

Speaking about the cases she has handled, Dr Sudhir says, “In one client, interpersonal conflicts with her partner led to episodes of binge eating, followed by guilt, and fear of rejection due to weight. In another client, however, binge eating was associated most often with feeling bored and not having any meaningful activities, and gradually she found food rewarding.”


Diagnosing BED

Dr Kohli says that since binge-eating is a common symptom of other disorders, expertise is required to ensure that the diagnosis is correct.

She says BED cannot be diagnosed in cases where the episodes of binging are followed by ‘compensatory behaviour’ such as purging (compulsion to purge, through self-induced vomiting or other methods, after consumption of food) or excessive exercise or fasting.

“Binge-eating episodes are required to occur at least once a week in a duration of three months, according to newest diagnostic criteria, and the person experiences marked distress regarding their eating habits. It is important to note that BED cannot be diagnosed if the binge-eating occurs with compensatory behaviour (excessive exercise, purging or fasting). It can only be diagnosed if symptoms are not better explained by anorexia nervosa or bulimia,” she says.

Dr Sudhir says as per the Diagnostic Statistical Manual of Mental Disorders Version 5 (DSM 5), the severity of BED is considered to be mild if the person has one to three binge episodes per week, moderate if the person has four to seven episodes per week, severe if the person has eight to 13 episodes per week and extreme in cases of 14 or more episodes per week.

“While there are self-report measures to screen and assess binge-eating disorders, it is best for the individual to be formally diagnosed by a trained mental health professional,” says Dr Sudhir.


Understanding the common triggers and patterns and high-risk behaviours and situations associated with binge eating is the key towards treatment, says Dr Sudhir.

“These will include emotions (an argument with a partner/parent), boredom, depression (eating may be a coping strategy to improve mood), situations that trigger urges (for instance, the sight of food arranged in a supermarket), restaurants and advertisements (hoardings),” says Dr Sudhir.

According to Dr Sudhir, it is also important to work on self-acceptance and developing a non-judgemental approach to oneself with respect to eating.

“This would also include setting realistic targets in therapy (which lead to mastering experiences and not failure), for example, one could be setting a target to reduce the number of binges and appreciating self in case of reaching targets. Guilt about frequent lapses and feeling futile and hopeless are also targeted in therapy. In some patients, seeing the entire family in therapy (family therapy) may be recommended when family conflicts are the key maintaining factor and can lead to relapse,” she says.

Watch out for a relapse

In binge eating, relapse is often a part of the recovery journey,” says Dr Kohli. She says several studies have showed that 20-50 per cent of the survivors of eating disorders have the chance of experiencing a relapse. “Two major factors that can trigger relapse are the duration of BED and the age of the individual. In such cases, it can be helpful to keep a lookout for the warning signs to prevent relapse and aim for long-term success,” says Dr Kohli.

Dr Kohli says the first step in the treatment plan for BED consists of guided support, which includes enabling the person who has been diagnosed to monitor their eating patterns and habits, understand the triggers that lead to a binge, create a realistic meal plan, enabling the person to come up with coping mechanisms and psychoeducation and enrolment of the person into a support group. The second step is cognitive behavioural therapy, which includes engaging the person in relaxation and stress-reduction techniques to manage triggers and cognitive restructuring to reframe the negative thought patterns into more productive ones.


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