Are you or is someone you know struggling with binge eating? Recovering from binge eating disorder can be an overwhelming endeavour, whether you attend an eating disorder clinic in Australia or attempt it on your own. Here is our dietitian’s guide to binge eating disorder recovery.
What is binge eating disorder?
Binge eating disorder (or BED) is a recognised mental illness that is characterised by regular episodes of binge eating accompanied by feelings of loss of control, distress, guilt, embarrassment and/or disgust.
During an episode of binge eating a person will eat excessive amounts of food past comfortable fullness. Often this period of eating will happen in a short period of time and in secret away from others (1).
How binge eating disorder is diagnosed
Binge eating is the most common disordered eating, affecting almost 50% of those with a diagnosed eating disorder.
To be diagnosed with this condition, you must meet strict criteria under the DSM-5. To meet the criteria (2), binge eating episodes must occur at least once a week for three months and not be followed by compensatory behaviours such as purging, over-exercising or laxatives.
Binge eating episodes must also be associated with three (or more) of the following:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty after binge eating.
Binge eating versus overeating
As humans, we all overeat from time to time. This is not the same as binge eating.
So, what’s the difference?
Overeating is when you unintentionally (or even by choice) eat a bit more food than you may have anticipated eating before the meal. This may have been because you were:
- Overly hungry by the time you were able to eat,
- Distracted and not in tune with your body’s hunger and fullness cues,
- Thoroughly enjoying the meal and wanted to have a bit more.
You may likely feel a bit uncomfortably full or tired/lethargic after the meal. Although you may also feel some guilt, these feelings aren’t usually overwhelmingly strong or distressing.
Binge eating, on the other hand, is always associated with strong feelings of loss of control, guilt, and/or shame. Often the drive to keep eating is overwhelming and intense despite physical fullness and even how pleasurable the food tastes.
Binge eating episodes are often highly distressing and can start to significantly impact both your mental and emotional health as well as your ability to engage in social activities, especially those surrounding food. Because food is so intertwined with socialising, this can lead to feelings of isolation and relationship breakdowns.
Some common signs that you are experiencing binge eating rather than overeating include (3,4):
- Experiencing an overwhelming sense of lack of control when eating or around food,
- Feeling numb or dissociated whilst eating,
- Eating more rapidly than normal,
- Chaotic, unpredictable eating patterns,
- Continuing to eat past comfortable fullness, regardless of how enjoyable the food is,
- Eating when not physically hungry,
- Eating excessive amounts of foods that you have deemed as ‘off limits’ or ‘bad’ or ‘unhealthy’,
- Overwhelming feelings of guilt and shame after eating,
- Eating in secret,
- Avoiding social situations, particularly those involving food because you are concerned you will lose control,
- Low self-esteem and embarrassment over your physical appearance.
Risk factors for developing binge eating disorder
Dieting is by far the strongest risk factor for developing binge eating disorder. This is because all dieting will involve some level of restriction, whether it be the amount or types of food. This restriction, which we will discuss more a bit later on, leads to something known as the binge-restrict cycle (1, 5).
2: Past experiences of food insecurity
Past experiences of food insecurity at any point in life (whether that be due to financial circumstances, food availability or living situations), can trigger an internal survival response to want to hoard or hide and then binge on food when it is readily available (1).
This may even present as your parents intentionally restricting your access to amounts or types of foods. These are usually ‘less nutritious’ foods such as chocolate, biscuits or lollies.
3: Placing a large emphasis on your body size and/or shape
Putting a large emphasis on how your body looks, especially its size or shape, is another common risk factor for developing binge eating disorder as it can start to affect your eating behaviours. For example, restricting the types or amount of food we are eating to lose weight (1).
4: Exposure to diet culture, weight discrimination and unrealistic body ideals
This may be from parents and other family members, friends and peers, through celebrity culture or social media.
5: Poor mental health – e.g. anxiety, depression, stress, burnout, trauma
People with a co-occurring diagnosis of a mental health condition are more at risk of binge eating. In fact, it is estimated that almost 80% of those with binge eating disorder also have a co-occurring mental health diagnosis. These include conditions such as clinical anxiety, depressive disorders and bipolar disorder as well as impulse control disorders and substance use disorders (6).
It is likely that the link between binge eating and anxiety/mood disorders is a result of using food as a method to cope with difficult emotions. However, on the opposite side, the strong feels of guilt, shame, and loss of control can also perpetuate anxiety and depressive thoughts (6).
Individuals who struggle with binge eating often also report a history of trauma at some point during their life. This link has been backed up by the research time and time again (7, 8, 9, 10).
There are a few potential reasons for this link. For some, binge eating acts as a distraction to shift focus away from thinking about or feeling the emotions brought up by past trauma. For others, binge eating may act as a form of self-harm to deal with pain (11). Those with past trauma are also more likely to experience body dissatisfaction which is another risk factor for binge eating disorder (10).
Why do we binge?
The reasons underpinning why you are binging are highly individualised from person to person. The process of recovering from a binge eating disorder will vary depending on these reasons. However, there are two main reasons that tend to come up.
1: To cope with low moods and/or avoid dealing with difficult emotions
Using food to try and cope with your emotions is one common reason you may be binge eating. Often these are negative or unpleasant emotions such as stress, loneliness, sadness, boredom or anger.
For example, have you ever found yourself ordering large amounts of takeaway when you’re lonely on a Saturday night? Or maybe when you’re stressed you feel the need to eat everything in the cupboard.
Binge eating can serve as a function to try and numb us from feeling these unpleasant emotions by providing some temporary relief. This is especially common if you don’t have any other strategies to help you cope with the emotions you are feeling.
However, it’s not always negative emotions that may be fuelling your binge eating. For example, you may use food as a reward when you achieve something.
Sometimes it can be difficult to establish what feelings may be contributing to a binge. In this case, working with a psychologist or attending an eating disorder clinic in Australia and using a tool such as a feelings and emotions wheel may be helpful.
2: Not eating enough food or restricting certain foods
Restricting food intake, whether it be the amount or types of food you are eating, is by far one of the biggest triggers for binge eating.
This may be intentional restriction such as dieting or cutting out foods for weight loss, or because you perceive them as ‘bad’ or ‘unhealthy’. However, not eating enough may also be unintentional. For instance, you may have long work shifts without a break, meaning you aren’t able to eat enough during the day.
The reason why not eating enough food (or even just restricting particular foods) can cause a binge is because it triggers something that we call the binge-restrict cycle.
Understanding the binge-restrict cycle
When we create any type of restriction in our diet, over time this creates a feeling of deprivation. The longer we deprive ourselves, the more our body will likely respond by increasing how much we think about and crave those foods we are depriving our bodies of.
The restrictions you have put in place may not be realistic, and inevitably something may happen that triggers us to break that restriction. As soon as you allow yourself to eat the food, you may then feel a loss of control leading to a binge.
After you have binged, you may then become overwhelmed with strong feelings of shame or guilt or disgust. This only then fuels you to restrict again, restarting the cycle.
Long-term effects of binge eating
Binge eating disorder affects people’s mental and physical health in multiple ways. The ways in which someone experiences it will vary significantly from person to person, but there are some common long-term effects that come up.
These include (1, 6):
- Increased risk of developing chronic conditions such as osteoarthritis and kidney failure as well as high blood pressure and/or high cholesterol leading to increased risk of stroke, diabetes and heart disease
- Preoccupation with food and weight, leading to low self-esteem, anxiety, depression and disrupted sleep
- Swollen jaws, bad breath, gum disease and tooth decay
- Digestive discomfort such as indigestion, heartburn/reflux, abdominal pain and bloating
- Irregular bowel habits such as constipation or diarrhoea
- Irregular or slow heartbeat, heart failure, low blood pressure, fainting, dizziness
- Disrupted hormonal balance leading to irregular or absent periods, loss of libido, and/or infertility
- Headaches, low energy and fatigue
- Weight fluctuations
Treatment approaches in recovering from binge eating disorder
The goal of binge eating disorder treatment is to help identify and then address the underlying reasons for your binge eating. For the best chance of recovering from binge eating disorder, it is recommended you work with a range of different health professionals including a GP, psychologist and dietitian.
Ideally, these professionals should all be trained in eating disorders. To help find suitable options, the Butterfly Foundation has compiled an easy searchable database you can access here.
Psychological treatment aims to understand and target the underlying thoughts, emotions, behaviours and habits that are triggering the binges.
This increases your awareness of why you are thinking, feeling and behaving the way that you are, to understand and reduce your triggers for binges and come up with alternative coping strategies.
There are a number of different therapies that your psychologist may trial, including:
- Cognitive Behavioural Therapy (CBT)
- Dialectical Behavioural Therapy (DBT)
- Interpersonal Therapy (IPT)
You might not find the right fit with your psychologist (or any health professional, for that matter) at the beginning, but that’s okay! It’s important to find someone that you feel safe and comfortable with.
Nutrition tips for tackling binge eating disorder
During your recovery, the help of a qualified dietitian is key alongside your psychological treatment. An online dietitian from The PNW Clinic can help you optimise your nutrition to reduce your risk of binges, break free from food rules and find freedom with food.
During sessions, you may work through a framework called the RAVES model developed by Shane Jeffrey (12). This includes:
- Regularity – establishing a regular eating pattern.
- Adequacy – ensuring adequate nutritional intake.
- Variety – increasing dietary variety and challenging diet rules and fear foods.
- Eating Socially – increasing confidence and reducing anxiety about eating out and in social situations.
- Spontaneity – encouraging flexibility in food thinking and eating behaviours.
There are three key nutrition strategies that will likely be involved:
Step 1: Establish regular and adequate eating
The first step to recovering from binge eating disorder is following a regular eating pattern. The ‘rule of 3s’ is a good place to start. This refers to:
3 meals & 3 snacks, eating every 3-4 hours
The reason for eating regularly is because this is the first step to reducing the restrict part of the binge-restrict cycle we discussed before. This teaches our bodies that food is always around the corner, and your body will not be deprived. We also know that leaving more than 4 hours between meals increases the risk of binge eating.
However, this can be easier said than done, especially if you have barriers such as busy work schedules or find you often forget to eat. If you find you have a lot of barriers to eating regularly, your dietitian can help you come up with some strategies to overcome these, such as setting phone alarms or keeping quick and satisfying snacks on hand.
We also acknowledge that the ‘rule of 3s’ may seem like a food rule in and of itself. However, it is an important part of breaking the cycle of restriction and it can help to rebuild trust with your body and re-establish normal hunger and fullness cues during recovery. In the future, you might work with your dietitian on intuitive eating and increased flexibility with eating.
Step 2: Keep a food and thoughts diary
Keeping a food and thoughts diary is a helpful tool to help make us more aware of our thoughts and feelings around certain meals and/or foods. Journaling before, during and/or after a binge can be especially helpful to help identify binge triggers.
If you are struggling to identify what emotions you are feeling, as discussed previously an emotions wheel can help. We recommend taking this with you to your psychologist and dietitian appointments to start to unpack and identify some alternative strategies to replace the binge eating.
Step 3: Challenge any food rules
Any form of restriction, including food rules, is one of the biggest risk factors for binge eating. You may have noticed that it is often the foods that you have been restricting or have negative thoughts around that you binge on.
For example, if you have created a food rule that you shouldn’t eat too much white bread because it is ‘bad for you’, then it is more likely that white bread will be a food that you feel less in control around. For example, needing to eat the whole loaf rather than 1-2 slices when you start eating it.
This is because restricting certain foods can create a scarcity mentality in which we may feel compelled to eat large amounts when we do have it as we don’t know when we’ll allow ourselves to eat it again.
The best way to overcome this is by giving yourself unconditional permission to eat all foods. And yes, this is a lot easier said than done.
Initially, you may feel like you are eating these foods quite frequently, but over time these foods will start to lose their power and you will notice you don’t feel the need to have them all the time.
Recovering from binge eating disorder
Recovering from binge eating disorder can seem like a daunting process, but with the help of a good support team including qualified health professionals or the help of an eating disorder clinic in Australia, recovery is possible and always 100% worth it.
If you are struggling with binge eating or think someone you know may be struggling, The Butterfly Foundation is a great place to start. You can access their website here.
We also recommend enlisting the support of a dietitian experienced in the area of binge eating such as one at the PNW clinic. To find out more or see if we are a good fit for you, you are welcome to book a free 15-minute discovery call.