Treating binge eating disorder with compassion

Studies have found that 22 per cent of people in the UK experience binge eating disorder. It’s a condition that can quickly develop into a set pattern of behaviours that require treatment from expert practitioners.

One such expert is leading chartered counselling psychologist Melanie Phelps. She talks to us in detail about binge eating disorder, highlighting how it manifests itself, the impact it has on people’s lives and how compassion and understanding is a key part in its treatment. 

What is binge eating disorder?

It’s a mental health condition that masquerades as a weight problem. When thinking about eating disorders, what automatically springs to mind for most people is anorexia nervosa. However, what people don’t realise is that binge eating is much more common than restrictive eating disorders like anorexia and it’s just as distressing.

Binge eating disorder is characterised by recurrent episodes of quickly consuming large amounts of food (a lot more than is typical for most people) in one sitting. Binge eating disorder has an addictive, compulsive, ritualistic quality to it and the food which is eaten during a binge is not particularly enjoyed beyond the first few mouthfuls, if at all. During a binge sufferers report how they feel completely out of control. Eating binges need to occur at least once a week in order to meet the diagnosis criteria. However, for many, binges are a daily occurrence.

Unlike bulimia, those suffering with binge eating disorder don’t follow their binge with any compensatory behaviours (e.g., self-induced vomiting, use of laxatives or over exercising) in attempts to rid the body of additional calories consumed. This results in feelings of shame and failure which leads to further distress.

Binge eating disorder can present as a mild, moderate, or severe condition. However, once binge eating starts, it can very quickly worsen and become entrenched.

Binge eating can provide a way to zone out and a temporary escape. They typically happen in a trance-like, disconnected state. Bingeing means that uncomfortable emotions can be suspended, but unfortunately, a downward spiral is inadvertently set up, because binge eating creates uncomfortable feelings of its own.

What are the health impacts of binge eating disorder, both mentally and psychologically?

Instead of being a pleasurable, sociable way of keeping alive and well, eating becomes a source of worry surrounded by guilt, shame, and secrecy. Increasing weight gain decreases confidence and esteem which can lead to self-disgust and self-neglect as well as increasing social isolation. It’s easy for the person to feel a complete lack of control over their relationship with food, leading to helplessness and hopelessness. These feelings are synonymous with depression, which is often a co-occurring diagnosis.

Additionally, worries, restlessness, and fear of judgement by others can lead to generalised anxiety and moreover, regular habitual binge eating cycles soon become the sufferers default coping strategy and as a result, alternative, healthier forms of coping are no longer employed and may not seem as effective. The sufferer therefore becomes trapped in a cycle of binge eating, where they feel bad about themselves, and engage in further binge eating episodes to cope with those feelings.

What are the reasons a person could develop binge eating disorder?

As with all eating disorders, there’s no one known cause, rather a mixture of elements which come together in a unique way for each individual. These could include:

• adverse childhood and adolescent experiences (e.g., such as bullying);
• genetic predisposition;
• strong personality traits such as perfectionism, for example;
• weight or looks- sensitive job roles;
• family food 'scripts' or templates (e.g., the old messages received about food and eating from the family).

However, perhaps the most common precursor to binge eating disorder is a history of dieting and food restriction.  The reason for this is because rule-based dieting (e.g., telling oneself “I must not have this or that”; “I should only eat salads”, etc.) is a common trap which leads to feelings of deprivation, and it is natural to crave more of what we disallow ourselves.

In addition, during food restriction, the body responds by sending out powerful signals to eat large quantities of whatever it is available, to guard against any future periods of 'famine' and the natural hunger – satiety and blood sugar mechanism is compromised producing further negative psychical and psychological consequences. 

So, although there can be many reasons why people develop binge eating disorder, a common factor is rule-driven dietary restriction.

What kind of symptoms and behaviour do people with binge eating disorder show and have?

While the sufferer feels like they’re out of control, binge eating becomes automatic and takes place on a regular basis.  Ritualised behaviour sequences for premeditated binges often develop. For example: choosing specifically-favoured binge foods from a regular supplier at a certain time of day, much like the same way a drug addict obtains their fix. The furtive nature of obtaining and hiding evidence of food consumption can make the sufferer seem cagey, restless and anxious. 

Nutritionally unbalanced, low quality and high-volume food that’s eaten rapidly during a binge may typically not be tasted, remembered, or even chewed. This type of eating is not in response to hunger signals (although it may have started that way), because it is an attempt to feed emotional (not physical) hunger. Therefore, whereas hunger can be satisfied by eating, emotional or psychological hunger cannot be satisfied by any amount of food, and so the food eaten serves simply as a temporary escape.

Binge eaters may feel very full but never feel emotionally or psychologically satisfied which leads to ongoing frustration. This can manifest outwardly in arguments with loved ones or work colleagues, or inwardly with self-criticism, self-harming and self-neglecting behaviours. The binge eater isn’t responding to the need to eat but the need to zone out.

After bingeing, the sufferer feels uncomfortably full and may rest or sleep, often waking with what is described as a ‘food hangover’, feeling ashamed, guilty, trapped, and disgusted about what happened. At this point more rules could be put in place such as deciding that “I will never do that again!”. However, when the same cycle of binging inevitably recurs the sufferer feels more distressed as they can no longer trust themselves, and breaking their own rules is evidence they are really out of control.  

Time taken for binges by obtaining and hiding food, recovering afterwards, for example, takes time away from everyday life, family and friend relationships, hobbies, interests, work productivity, and overall quality of life.

As there’s insufficient privacy for binge eating behaviours, getting involved in events such as work trips, holidays and days out might not be possible. When someone has binge eating disorder, their world and life as they know it begins to shrink. An unbalanced and restricted life can also precipitate depression.

How is binge eating disorder treated? How can they ensure they don’t relapse?

In the same way there is no one ‘cause’ for binge eating disorder, there is no one ‘cure’ either. Instead, what works best is a combination of therapeutic techniques and interventions tailored to suit each unique person. Sometimes nutritional support and medication prescribed by the GP can additionally help.

In therapy we identify and work with the impact of any traumas, adverse events or past experiences which may have contributed to the development of the problem. We also work together to understand the function and purpose of the eating disorder without judgement, so that we can identify what emotional, or other needs, remain unmet, and what can be done to calm and sooth these. Throughout, the aim is to allow a more compassionate relationship with the self and body to develop which weakens the hold the eating disorder has over the person.

In eating disorder treatment, relapse is seen as normal and expected part of the recovery process and is welcomed. We see this as an opportunity to learn and understand more about eating disorder behaviour. This could be in relation to identifying triggers, building skills, reducing stigma and shame, or strengthening the determination for recovery without self-judgment, rules or failure thinking.

To address any concerns that you may have regarding binge eating disorder, arrange a consultation with Melanie Phelps via her Top Doctors profile.