Binge Eating, Bulimia Nervosa and Anorexia Nervosa

It's clearly not an indulgence.

For the significance of binge eating varies from person to person. Some view it as an occasional indiscretion and it has little effect on them. For others, though it is a true problem, something that has negative impact on many aspects of their lives.

While no two personal accounts are identical, it turns out that true binges have two features in common:

• The amount of food eaten is large,
• There is a sense of loss of control at the time.

Indeed, there in now an agreed-on technical definition of the term binge:

An episode of binge-eating has both the following:

(1) Eating, in a discrete period of time (e.g. within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, and,

(2) A sense of lack of control over eating during the episode (e.g.) a feeling that one cannot stop eating or control what or how much one is eating). 

What is central to binge eating is the sense of loss of control. This feature above all distinguishes binge eating from everyday overeating and mere indulgence.

"I randomly grab whatever food I can and push it into my mouth, sometimes not even chewing it. But I then start to feel guilty and frightened as my stomach begins to ache and my temperature rises. It is only when I feel really ill that I stop eating."

                                                                                     Anonymous.

Here are some characteristics of a binge:

• A feeling of disgust as ore and more food is consumed
• Rapid eating (many stuff food into their mouth almost mechanically and also drink a lot to help wash the food down
• Agitation (some people pace up and down or wander around during their binges)
• The craving for food is a powerful force
• A feeling of being in a trance during a binge
• It occurs in secret (some people are so ashamed of their binge eating that they go to great lengths to hide it –and may succeed in doing so for many years).
• Loss of control (some people feel it long before they begin to eating. For others it evolves gradually as they start to eat. Or it may come on suddenly as they realise they have eaten too much)

It’s hard to say at what frequency binge eating becomes a problem, but if you are binge eating one a week or more you should defiantly consider getting help.
 
Many things trigger binges, but some of the most common are:

• Unpleasant feelings
• Feeling fat
• Gaining Weight
• Dieting and Associated Hunger
• Breaking a Dietary rule
• Unstructured time / Boredom
• Being alone
• Loneliness
• Premenstrual tension
• Drinking alcohol

Those who binge say they experience some immediate though temporary positive feelings. For example, they may feel a sense of relief. Feelings of hunger and deprivation will have disappeared. The binge may displace depression or anxiety. But these positive effects are short lived.

They are soon replaced by feelings of shame, disgust and guilt. Depression often sets in. Bingers often feel hopeless about ever being able to control their eating. Tiredness and stomach pains are common. Quite often, the fear of weight gain is so intense that it drives people to take compensatory measures.

Three things have to be present for a person to have bulimia nervosa:

1. The person must have frequent (objective) binges. This means that he or she must consume large amounts of food, taking into account the context in which the food is eaten. The person must also have a sense of loss of control at the time.
2. The person must regularly use any one of a variety of extreme measure for controlling shape or weight. These measures include self-induced vomiting, misusing laxatives or diuretics, over exercising, and intense dieting or fasting.
3. The person must be excessively concerned about his or her shape or weight or both and should have an intense fear of fatness and weight gain. This concern should go beyond just feeling fat or being unhappy with his or her physical appearance. Rather, the person’s whole life should be dominated by concern about body shape or weight.

Bulimia nervosa is largely confined to woman, most in their twenties. The problem usually starts in the late teen years with a period of strict dieting.

People with bulimia nervosa have chaotic eating habits. All have objective binges. Typically their binge eating occurs on the context of extreme dietary restriction. Many make themselves vomit after each binge in an attempt to get rid of the food they have eaten.

Once established, this pattern of eating tends to be self-perpetuating. People end up on a cycle of fearing weight gain, dieting, binge eating, drastic measure to control weight, leaning back to a fear of weight gain. This cycle means that binge eating can last for several years.

To receive a diagnosis of anorexia nervosa a person must meet two main conditions:

1. They should be significantly underweight, and this should be the result of his or her own efforts.
2. The person should be highly concerned about his or her shape or weight or both. However, rather than worrying about being underweight, the opposite occurs. The person should be terrified of gaining weight and becoming fat.

Indeed, many people with anorexia nervosa regard themselves as being “fat” despite their low weight. For this reason they are often said to have a “morbid fear of fatness” or a weight phobia.” Their dieting is often driven by a relentless pursuit of thinness. These attitudes toward shape and weight are similar to those found in bulimia nervosa.

Anorexia nervosa mainly affects teenage girls and young women. People with the disorder achieve their low weight by eating very little. Sometimes excessive exercising contributes also. They avoid eating foods they view as fattening, and they may occasionally fast. About a third have “binges”.

During these their attempts to restrict food intake break down, and they lose control over eating. These binges are often small in size, nevertheless, in other aspects they are typical. There is a sense of loss of control over eating, and the amount consumed is viewed as excessive.

For example, a binge may consist of only a few cookies. Even this quantity of food will seem large to most people with anorexia nervosa, however.

Binge eating disorder is the other eating disorder in which binge eating is a central feature. People with binge eating disorder have repeated binges. The difference with bulimia nervosa (and sometimes anorexia nervosa) is they do not take extreme weight control measures.

About half of people with binge eating disorder are overweight. This differs from those with bulimia nervosa who on average have normal weight. While those with anorexia nervosa are usually severely underweight. Binge eating disorder also effect much more men than does anorexia or bulimia. Moreover, the age range tends to be a little older too.

The most effective approach to date for the treatment of all eating disorders is a form of cognitive behaviour therapy. Dr. Christopher G. Fairburn in the 1980s developed it in the 1980s. The program is a short term form of therapy. Most patients see it as relevant and appropriate. The treatment erodes the problem progressively, using a carefully planned sequence of interventions.

• Recording in detail all eating at the time that it occurs, together with relevant thoughts and feelings
• Introducing a pattern of regular eating, thereby replacing many binges.
• Using alternative behaviour to help resist urges to binge
• Receiving education about food, eating, shape, and weight.

• Introducing avoided food into the diet and gradually eliminating other forms of strict dieting.
• Developing skills for dealing with difficulties that might otherwise trigger binges.
• Identifying and changing problematic ways of thinking
• Considering the origins of the binge eating problem and the role of family and social factors.

Planning for the future, including having realistic expectations and strategies to use should problems reoccur.

1. Vomiting is not an effective means of weight control. While vomiting obviously gets rid of some food that has been eaten, a study of seventeen women with bulimia nervosa showed that self-induced vomiting resulted in the retrieval of less than half the food consumed during the average binge. For this reason, when clients stop the binge eating and vomiting cycle they often actually lose weight.
2. It is a myth that people with binge eating disorder are prone to addictions or are just ‘impulsive’. Binge eating is a negative cycle that usually occurs in response to fears of weight gain and dieting.
3. Food voidance is especially prone to encourage binge eating. Any treatment plan should include a plan to introduce avoided or forbidden foods into your diet (these are usually things such as chocolate, ice cream etc.). A small amount of these things is beneficial and helps stop binge eating.
4. Most research evidence highlight the fact that diets as advertised do not work. Many diets are unnecessarily strict and are unsustainable in the long run. It is the impossibility of adhering to diets that often leads to binge eating.
5. If you are obese and you binge eat you have two problems and eating problem and a weight problem. Tackling both at once is difficult and the best step is to tackle your binge eating first. This is because, as mentioned above, eating problems often contribute to weight gain.
6. The weight loss plan we use at Mental Wellness Counselling follows NHS guidelines and also the LEARN programme devised by Dr. Kelley Brownell of Yale. Both are,  tried and tested and focus, and focus on healthy eating and exercise habits, and are unlikely to encourage binge eating.

For more information about how we can help you tackle you weight control problem or you eating problems, please reach out. We’re here to help.

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• ​NHS - Binge Eating​​​
• NHS - Bulimia Nervosa
• ​​​NHS - Anorexia​​​
• ​​Mind - Types of Eating Disorder​​​
• Beat Eating Disorders - UK Charity

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