UNC Healthy Heels

The following is a guest post from Dr. Cynthia Bulik, Distinguished Professor of Eating Disorders in the Department of Psychiatry in the School of Medicine, Professor of Nutrition in the Gillings School of Global Public Health, and director of the UNC Center of Excellence for Eating Disorders.

Borrowing from Patrick Swayze, “No one puts Binge Eating Disorder in the corner!”

Despite being the most prevalent eating disorder, binge eating disorder, or BED, has been referred to as the “red headed stepchild” or the “third wheel on the eating disorders wagon.” But this will all change in May 2013 when the American Psychiatric Association (APA) publishes the new edition of the Diagnostic and Statistical Manual,the DSM-5, the catalog of all psychiatric illnesses. Until this year, BED was included in the wastebasket category “eating disorders not otherwise specified.” It was placed there because the APA believed that further research was warranted before they could deem it a bona fide psychiatric disorder. Well, the research has flourished and BED will now have a home of its own in the DSM-5.

What is BED?

So pretty much everyone knows about anorexia nervosa (low body weight, fear of weight gain) and bulimia nervosa (binge eating and purging behavior), but BED often gets short shrift. The definition of binge eating is eating an unusually large amount of food in a discrete period of time and feeling out of control. It is the critical component of feeling out of control that differentiates a binge from just overeating. Moreover, people with BED feel distressed by their binge eating. Unlike those with bulimia nervosa, they do not engage in regular purging behaviors such as self-induced vomiting, laxative use, fasting or excessive exercise. For some, but not all, this can lead to energy imbalance and metabolic consequences of eating large amounts of typically unhealthy foods. Many people with BED have difficulty stabilizing their weight and are at increased risk for health consequences commonly associated with obesity, such as type 2 diabetes, high cholesterol, and high blood pressure.

Who gets BED?

BED does not discriminate. The official numbers in the United States suggest that 3.5% of women and 2% of men in the country suffer from BED. BED strikes all socioeconomic classes, races, and ethnicities, and affects people across the lifespan. Increasing reports of “loss of control” eating in children suggest that it may be a precursor to later BED. In the other direction, many adults with BED recall their binge eating starting at a very young age and recount stories about hiding and hoarding food, lying about what they ate, and feeling ashamed or fearful of being caught eating. BED can occur or continue well into middle and late adulthood with many women reporting that perimenopause can be a trigger for BED.

BED on college campuses.

BED tends to be under-recognized on college campuses, in part because anorexia and bulimia nervosa get so much attention. People fail to realize that BED can be just as distressing and damaging to health and wellbeing.  We hope that now, with official recognition in the DSM-5, we will be able to create greater awareness about BED and help people with the disorder get proper care.

Treatment for BED.

The good news is that BED is treatable. At this point in time, the treatment of choice for BED is cognitive behavioral therapy, which helps get a handle on unhealthy thoughts that might perpetuate binge eating. Here’s a classic example: after eating a small amount of a food that someone views as high risk or triggering they say, “Well, I already blew it. I may as well eat the whole package.” Helping people get a handle on these runaway thoughts can empower them to stop the binge in its tracks. Some people also find medication such as antidepressants or anticonvulsants to be of value; however, these medications do not provide long-term tools for managing urges to binge.

For more information on BED and eating disorders in general see Crave: Why You Binge and How to Stop and Midlife Eating Disorders: Your Journey to Recovery at http://www.cynthiabulik.com.