Binge-eating disorder

Overview
Binge-eating disorder involves repeated episodes of uncontrollable eating within a specific time frame. To be considered a binge, the amount of food must be larger than most people would eat in a similar period of time under similar circumstances. A binge may be planned with favorite foods prepared ahead of time, or it may be spontaneous. During a binge, a person has impaired control over certain behaviors, including eating very rapidly, eating when uncomfortably full, and consuming large amounts of food when not hungry. The person may eat alone, be embarrassed by how much is eaten, and feel disgusted, guilty or depressed after overeating. Binge-eating disorder does not involve habitual behaviors to compensate for the overeating, such as self-induced vomiting and laxative misuse.
Binge-eating disorder affects 2 to 5 percent of the general U.S. population. Prevalence varies from 10 to 30 percent in samples drawn from weight control programs, however. Binge-eating disorder usually begins in late adolescence to the early 20s. Like other types of eating disorders, binge-eating disorder occurs in all social classes and ethnic groups. Because eating disorders are more commonly associated with Caucasian females, they may be underdiagnosed in other ethnic groups. Binge-eating disorder affects females one and a half times more often than males.


Characteristics
Physically, you may develop high cholesterol, high blood pressure, adult-onset diabetes, abnormal weight or weight fluctuations, and sexual dysfunction. You may notice withdrawal symptoms after a binge, such as headaches, irritability and restlessness. You may also be at higher risk for gallbladder disease, heart disease and certain types of cancer.
Psychologically, you may have low self-esteem. You might eat to cope with your feelings or provide momentary comfort. You may feel disgusted and guilty about your behavior, yet obsessed about food or engaging in bingeing behavior. You may be preoccupied with your appearance and judge yourself harshly based on your weight and shape. A vicious cycle of overeating to cope with sadness about your weight and body image may develop.

Socially, you may behave compulsively. You may have frequent episodes of eating abnormally large amounts of food and eat rapidly until you're uncomfortably full or when you're not physically hungry. You may eat in secret or stop overeating while you're with other people. You may experience changes in social, occupational or recreational activities as a result of your eating or weight concerns. You may have unsuccessful attempts to stop the behavior and continue the problematic eating patterns despite negative consequences. You may have more difficulty losing or maintaining weight than others. You may be more inclined than others to eat while driving due to the privacy offered by a vehicle and the ease of getting food from fast-food outlets and convenience stores.

Symptoms such as sleep disturbances, decreased energy, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, see your medical health care provider to rule out a medical condition. If these or any other symptoms create continuing distress, seek additional help and support from a mental health care professional.


Coping
If you have a binge-eating disorder, recognize the cycle created by the disorder. For example, food and overeating are often used to cope with sadness about weight and body image. Yet after a binge, negative feelings about body image return and the binge cycle begins all over again. To identify your eating patterns and become aware of what feelings may trigger a binge, keep a daily chart of your feelings and caloric intake.
Learn about the potential family issues involved in eating disorders. For example, families of people with eating disorders are often overly close with rigid boundaries. Parents may send conflicting messages about independence. Fathers are more likely to be emotionally distant, while mothers are controlling. You may have learned to equate food with love or even held your family together by being the object of common concern.

It's also helpful to identify and challenge distorted thinking around weight, body image and food. Check out support groups and other community resources for education and support. Individual counseling may be necessary. Medications, particularly SSRI antidepressants such as Prozac or Luvox, may also be effective.

Tips for friends and family members
If you have a friend or family member who has binge-eating disorder, keep the following considerations in mind.

Do not focus on controlling the person's eating or weight. Remember that the person's behavior is an attempted solution to a problem, and, most often, one of the problems the person is attempting to solve is a perceived lack of control over his or her life. The person may resist your efforts to control what he or she considers the one thing in life that he or she actually has full control over.

Recognize your limitations. Assuming the person is an adult and he or she is not presenting an immediate danger to himself, herself or others, no one can force him or her to get help. However, you can express your concern in a loving way, find community resources and treatment programs, and encourage the person to seek help.

Recognize the normal feelings often experienced by friends or family members of people who have eating disorders. These include fear about the person's well-being or safety and anger that may be directed at the person who has the eating disorder, yourself for not being able to fix the problem, or doctors or other health care providers for not spotting the problem earlier or doing enough to help. Also understand the mistrust that may result from the person's attempts to deceive others and cover up his or her habit out of shame.

Confront the person assertively. Express your concerns about the person's behavior without violating his or her rights or boundaries. Use "I" statements to express your concern. For example, say, "I'm concerned because you seem preoccupied with your weight," instead of, "You're obsessed with your weight." Avoid generalizing the situation too much or placing blame. Be sensitive to the fact that the person may be ashamed or embarrassed about being confronted about his or her "secret." Do not add to the person's potential guilt or remorse with shaming lectures or exhortations.

Be prepared for denial. People who have eating disorders often experience a great deal of shame in connection with their behavior. Denial of the problem is a part of the illness. To prepare for the denial, have in mind specific examples of the behavior you consider problematic.

Offer unconditional support and love. Do not make your love and acceptance conditional on the person's weight, appearance or behavior. Many people who have recovered from eating disorders acknowledge the unconditional love and support of family and friends as a crucial factor in helping them recover.

Learn about eating disorders and seek support from others. You may want to join a support group or look to local organizations or other community resources.

Act immediately if the person's health appears to be compromised.


Summary
Binge-eating disorder is an often-overlooked condition and a potentially serious mental health issue. Binge eating can have a profound effect on your emotional, physical, behavioral and social health. Thankfully, a binge-eating disorder can be successfully overcome with proper identification, treatment and support.