Less understood than anorexia and bulimia, Binge Eating Disorder will soon receive an official diagnosis
May 13, 2013
By age 6, Chevese Turner had already begun binging. It started with a box of ice cream cones she snuck into her bedroom. She then proceeded to devour them all. “I was always sneaking food. I would hide it. I would store it,” says Turner, founder and CEO of the Binge Eating Disorder Association. “It wasn’t necessarily that I even ate more than most people, but I was preoccupied with food. I was essentially learning to use food to cope with life.”
Her eating pattern of binging, followed by restriction – the latter a form of compensation and punishment that actually set her up for more binging – continued into adulthood. Eventually, Turner, now 45, conquered the disorder by accepting herself and learning healthy coping skills to handle stress.
But it wasn’t until receiving the right diagnosis that she could begin to recover, a process that only fully began in 2010. And that’s why Turner and others are celebrating the fact that binge eating disorder will receive an official diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the standard reference book for mental health professionals, scheduled to be released later this month.
“It’s recognition that what we have experienced is an eating disorder,” Turner says. “What that means on a larger scale is that people with issues around food, and a lot of the feelings that go along with it, will finally have all of that validated, that this is something that they’re not alone in.”
The move also paves the way for more research, treatments and, potentially, insurance coverage. However, payment hinges on parity laws, which call for equal coverage of mental health disorders, but vary by state.
“In most states, parity law only encompasses anorexia and bulimia, so what that has meant is that these conditions typically receive more comprehensive coverage for treatment,” explains Jennifer Lombardi, a marriage and family therapist and executive director of Summit Eating Disorders and Outreach Program in Sacramento, Calif. The new classification of binge eating disorder could come under parity laws that offer people more treatment options, Lombardi says. “Hopefully this will begin a dialogue [and help health care officials] work with insurance companies to provide better care and more comprehensive care.”
Binge eating disorder was included in the current DSM, released in 1994, as an “eating disorder not otherwise specified” – a catch-all category – requiring further study. Since then, more than 1,000 articles have been published on the subject. The articlesreveal the “significant distress,” anxiety and mood disturbances associated with the disorder and the effictiveness of psychological treatments and medications, says Timothy Walsh, chair of the DSM-5 Eating Disorders Work Group of the American Psychiatric Association. “It was widely agreed that mentioning binge eating disorder only as an example of an eating disorder not otherwise specified was of limited help to individuals who suffered with the disorder and to the professionals attempting to assist them,” he says.
Diagnosis requires more than the occasional binge, but frequent excess consumption as well as distress and dysfunction, Walsh says.
These parameters are critical for treating a condition that has been less understood than anorexia and bulimia, even though it affects more people.
In 2007, researchers at McLean Hospital in Belmont, Ma., an affiliate of Harvard University, found that 0.9 percent of women and 0.3 percent of men experience anorexia during their lives, and 1.5 percent of women and 0.5 percent of men experience bulimia. Binge eating disorder, meanwhile, affects 3.5 percent of women and 2 percent of men.
“Everybody knows about anorexia and bulimia. However, binge eating disorder affects more people, is often associated with severe obesity and tends to persist longer,” stated lead author James Hudson. “The consequences of binge eating disorder can be serious, including obesity, diabetes, heart disease, high blood pressure and stroke. It is imperative that health experts take notice of these findings.”
Lack of control and stress are the hallmarks of binge eating disorder, which drives sufferers to eat past the point of satiety and comfort and feel shame and guilt as a result, explains Russell Marx, chief science officer of the National Eating Disorders Association.
“This is not a failure of willpower,” says Susan Albers, a psychologist at the Cleveland Clinic Family Health Center and author of “Eating Mindfully: How to End Mindless Eating & Enjoy a Balanced Relationship with Food.” Binging is also more than emotional eating, although in both cases, someone is resorting to food to manage a need beyond hunger. “Unfortunately, a lot of these patients are sent to weight-loss programs, and that often doesn’t help, and also sometimes makes it worse because you really have to understand how the emotions tie in with the symptoms that they’re experiencing,” Albers says.
She uses an approach to treatment based on mindfulness – helping the patient become aware of his or her emotions to ultimately accept them. Mindful eating thwarts binging because it takes the opposite behavior. “Binging is very disconnected eating … A lot of times you’re not even tasting the food,” Albers says, adding that binging is a form of emotional escapism that comes in a flurry of consumption in which the patient may not even notice the stressor that started it.
Like other eating disorders, binge eating disorder has its roots in biology and temperament, Lombardi says, explaining that a family history of anxiety or depression, and a personality that is prone to perfectionism, pleasing others and high sensitivity to change and conflict, can set someone up for the disorder. It can also set into motion as a result of trauma or loss, relationships and culture. “We live in a culture that places a tremendous amount of emphasis on weight and appearance,” and that can lead to “feeling pressured to look a certain way,” Lombardi says.
For Turner, a big part of her healing came from making peace with a body that didn’t conform to a particular stereotype of beauty. “I needed to accept that I wasn’t a bad person, that there was nothing bad about me because of my size,” she says. Similarly, she would learn ways to soothe herself – meditation or a trip to the spa, for example, instead of food. To do that, she had to learn to pay attention to herself and her environment and to recognize her emotions and live with them. Eventually, Albers says, the emotions always pass.