In 2013 Binge Eating Disorder (BED) was finally added to the DSM-5
as its own diagnosis. Prior to that, those patients were lumped into the diagnostic category called “Eating Disorder Not Otherwise Specified” (EDNOS), which was really just intended to be the category for people whose symptoms were so varied that they didn’t fit specifically for Anorexia Nervosa or Bulimia Nervosa. But what EDNOS ended up capturing was those with BED along with the people it was actually intended for.
Today it is the most common eating disorder diagnosis
in adults, even more common than the better-known Anorexia and Bulimia. Truth be told, a lot of patients don’t fit squarely into any of these categories because eating disorders are vast in their symptoms and nuanced. But it helps to have categories to make some generalizations for the purpose of research and advancing our field in training professionals so we can have better and more widely available treatment options for people who suffer from this illness.
With BED being so common, why haven’t people heard of it? Even patients who are diagnosed will sometimes say they’d never heard of it before their diagnosis. And certainly their family and friends don’t usually know about it or understand it. They’ll say things like, “If you just follow X diet and cut out XYZ foods, you’ll be fine.” Or, “Why don’t you try working with a personal trainer?” (As if exercise is the solution to their eating problems?!)
Even doctors will miss the BED diagnosis, and give people win BED terrible advice – usually to diet and lose weight, recommendations which actually exacerbate the BED
Many people with BED have a long history of dieting, even dating back to childhood. The typical pattern is that some weight (potentially even a large amount of weight) is lost with each diet, only to be regained – often plus some. The end result is a weight equal to or higher than before the diet.
This wreaks havoc on the person’s self-esteem. They feel as if they failed by “falling off the wagon.” The truth is that the diet was never going to work long-term anyway, but nobody told them that.
Think about it – people will go on diet after diet, despite the ineffectiveness at long-term results. They’ll even go back to the same diet program time after time, even when it has failed them! Pretty genius marketing by the diet companies if you ask me.
These people blame themselves. They should be blaming the diets.
With each diet-regain cycle, a person’s set-point weight can increase
, meaning that over time their body’s natural preferred weight range will become higher and higher, which is part of the reason it becomes harder to lose weight over time. We also have to factor in the psychological damage being done along the way.
How many of these people who are perpetually dieting actually suffer from BED and don’t realize it?
With the weight increases from repeated dieting, it becomes more likely that the person will be referred for bariatric surgery.
But is bariatric surgery an effective treatment for BED? Nope.
There is a high prevalence of people with BED seeking bariatric surgery
, because their eating disorder often results in weight gain, and they hope that changing the size of their stomach will control their eating issues. Luckily, many bariatric surgeons are screening for this, but it’s hard to catch an eating disorder ahead of time because it would be based on the individual’s self reporting their own eating issues, and they often don’t want to say anything that would jeopardize this surgery they so desperately want to have.
Professionals who treat eating disorders are then here to pick up the pieces when someone has bariatric surgery and it doesn’t work. These people continue to struggle with psychological, emotional and behavioral eating issues. I personally really enjoy working with this patient population because they’ve been through SO much and deserve authentic human compassion and healing.
None of this makes bariatric surgery bad or wrong. That’s a complex decision for a patient and their doctors to make together. They way I explain it to clients is that stomach surgery is not brain surgery. Both can be addressed.
The most effective treatment for BED
is what we call a “multidisciplinary” treatment approach – meaning the person sees a team of professionals including a therapist, dietitian and medical doctor.
It’s absolutely crucial for these treatment team members to be specialized in eating disorders, ideally with BED specific training because of the nuanced ways BED differs from other eating disorders.
Professionals who aren’t specialized in eating disorders will often (unintentionally) do more harm than good. They’ll often give recommendations that are completely contraindicated – such as dieting, attending Overeaters Anonymous, restricting certain foods, focusing on weight loss, etc. These things backfire.
Instead, the person needs to make peace with food and melt the shame they have experienced all these years. This is hard to do.
We start by stabilizing their eating patterns and making sure they are eating enough throughout the day. Yes, you heard that correctly. People with BED often need to eat more during the day, not less. This helps reduce urges for binge eating, especially later in the day and evening/nighttime.
Along with stabilizing eating patterns, we help them start to identify triggers for bingeing. These can include environmental triggers and emotional triggers. Helping the person recognize these things allows them to start using other coping mechanisms.
Sometimes medication can be helpful in BED treatment. This can be prescribed by a person’s medical doctor or a psychiatrist. Common medications include those for anxiety and depression (which often co-occur with BED), and the only FDA-approved drug for BED, Vyvanse
. There is a lot of controversy around the use of Vyvanse in BED treatment, but I can attest that I’ve seen it help many patients.
Additional components of treatment can include group therapy, family therapy and other medical specialists as needed on an individual basis. They key is to tailor treatment to each person’s situation.