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What is a binge?

A binge is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
as "Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is
definitely larger than what most people would eat in a similar period of time under similar
circumstances," and "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)." Both elements need to be
present in order for the eating episode to fit the definition of a binge.

Eating too much at a holiday dinner, or ordering dessert when you are already full after a dinner out
with friends, are examples of overeating that do not meet the definition of a binge. Those
circumstances are fairly typical or "normal," and therefore do not meet the first part of the definition
above of a binge.

Similarly, eating too much, but spacing the eating throughout the day rather than within a discrete
(two hours or less) period of time, does not constitute a binge. Such eating behavior may, however,
be an example of compulsive overeating or emotional eating, which can also be distressing and
result in feeling out of control.

What is Binge-Eating Disorder?

The DSM-5 contains the diagnostic criteria for Binge-Eating Disorder (BED). It requires that the
binges occur on average at least once a week and have continued over the course of at least three
months. Additionally, the person must be experiencing marked distress as a result of the bingeing
and the binge must be characterized by at least three of the following:

- Eating much more 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 afterward

All of these criteria must be present for a diagnosis of BED. If the eating behavior does not meet the
criteria for BED but causes marked distress and interferes with normal functioning, the symptoms
may reflect an Unspecified Feeding or Eating Disorder or Other Specified Feeding or Eating
disorder, two new classifications of eating disordered behavior in the DSM-5.

Why do I binge?

Food for humans is meant to be both for nourishment and for enjoyment. For people with an eating
disorder, food has taken on a greatly expanded role. Food may be used to quell boredom, as a
means of putting off something we would prefer to avoid doing, or to help us forget unpleasant
feelings or thoughts. Sometimes we might eat because we misinterpret our body's needs. For
example we may be fatigued and believe we need a snack to give us energy, whereas what the body
really needs is a nap. People may also reach for food when they are thirsty instead of hungry, again
misinterpreting the body's signals.

Many people who have BED and other eating disorders suffer from depression, bipolar disorder,
anxiety, and obsessive-compulsive disorders. They may be experiencing a life transition or a
relationship conflict. Food may then used to help the individual manage distressing emotions or to
temporarily block out distressing thoughts.

Many of those with binge- or compulsive-eating behaviors have not learned healthy ways of
managing emotions. We have learned it is not okay to show our anger, or it is not okay to cry when
we are feeling sad. We may have been taught to "keep a stiff upper lip" or "if you don't have
something nice to say, don't not say anything at all." Along with the resultant "stuffing" of emotions
may come stuffing with food, an unhealthy alternative to expression of that which we feel.

Over time, unhealthy use of food can become a habit. The more we use food as a means of coping
when we feel distressed, the more ingrained the habit becomes. Soon we may find ourselves
automatically heading for the refrigerator or pantry every time we experience distress.

Is bingeing an addiction to food?

Bingeing is similar in some ways to habitual use of other substances, such as alcohol, nicotine, and
marijuana. In fact, there is some evidence that sugar may be "addictive" for some people. Just as
some people cannot drink alcohol without continuing to crave it, some of us experience similar
reactions to eating processed food, particularly foods containing sugar. For these individuals, sugar
can trigger reactions in the brain that are similar to those triggered by hard core drugs. It feels as
though the only relief to the discomfort caused by withdrawal is to infuse the body and brain with
more of the substance, in this case sugar or other carbohydrates.

Even for those of us who do not have a bona fide "addiction" to sugar, repetitively using food as a
means for managing difficult emotions can lead to a habit that becomes deeply ingrained over time.
As with all habits, it takes a great deal of effort to unlearn and to substitute a healthier way of coping.

What causes BED?

The role of dieting.

Theories abound about why some people binge. Eating disorders often begin in early puberty, a time
when bodies mature and noticeable changes in body shape occur. Young people, particularly young
girls, become increasingly focused on their bodies. Our society emphasizes body shape and size in
evaluating attractiveness. Although the ideal feminine body shape and size has varied rather
dramatically over the decades, most modern publications today feature slender, often unrealistically
thin, models. Thin today, then, has become an attribute of attractiveness. This becomes a
paramount issue for young girls (and boys), who perceive attractiveness as a prerequisite for
acceptance.

Dieting creates physiological deprivation, which the dieter tries to ignore for as long as possible. Most
of us, however, cannot deprive ourselves for long periods of time without giving in to cravings. This
lays the groundwork for the first binge. After a period of deprivation, bingeing relieves the real
physiological distress created by hunger and provides comfort in the moment. However, a binge that
occurs when an individual has been trying to diet to lose weight also causes strong feelings of guilt.

Breaking a period of dieting or food restriction not only leads to guilt but also very likely to additional
bingeing. This is known as the "abstinence violation effect," a term first coined in research related to
alcohol addiction. The phrase describes the effect of breaking one's vow of sobriety, which often is to
continue to drink once that first sip of the forbidden substance has been taken. An individual may
think to him- or herself: "Well, I've done it now. I've ruined my perfect record. I might as well throw in
the towel." This is a common occurrence with individuals who binge as well.

Dieting often precedes the onset of bingeing. However, many people diet and do not develop binge
eating behaviors. Why?

The role of emotion regulation.

Research suggests that many people who binge-eat are experiencing psychological distress such as
depression, anxiety, low self-esteem, and other mood disorders. Additionally, many individuals who
have BED have "anxious attachment" issues.

Attachment styles, including anxious attachment, are formed early in life as a result of our experience
in relationship with our primary caregivers. These styles become fairly stable at an early age and
influence how we see ourselves and others in relationship. Such questions as "Can I trust others to
be there for me?," and "Am I lovable in the eyes of others?" are related to how we experience our
early caregiver relationships. Individuals with anxious attachment have experienced caregiver
relationships that may have been unstable or unpredictable.

Healthy relationships create a safe harbor in which one may be oneself, including expressing
emotions genuinely without fear of reprisal or ridicule. Individuals who have anxious attachment are
less likely to have healthy relationships in which expressing emotions is possible. Consequently, they
must find another way to manage and tolerate difficult emotions. Alcohol, other non-prescription
drugs, and yes, food, may then be used for these purposes. Indeed individuals who use food and
other substances as a substitute for healthy emotion regulation sometimes speak of their
"relationship" with their substance of choice.

To summarize, individuals who binge tend both to have difficult mood issues, such as anxiety and
depression, and at the same time be deprived of the ability to express those emotions within the
context of a healthy relationship. Yet not all individuals who are both depressed or anxious and have
anxious attachment styles become binge-eaters. The missing puzzle piece relates to unhealthy body
image.

The role of body image disturbance.

My own doctoral research, replicated in the findings of other researchers, suggests that individuals
who have eating disorders, including those who binge-eat but who do not meet all of the diagnostic
criteria of BED as set forth in the DSM-5, have body image issues on top of, or in addition to,
negative mood and anxious attachment.

Body image is our idea or mental picture of what our body looks like. It is the collection of thoughts
and feelings we have about our bodies, and it often is unrelated to how we actually appear to others.
Individuals who have eating disordered behaviors often have an unrealistic belief about their weight,
believing their bodies are larger than in fact they are.

Body image disturbance is more than "mere" body dissatisfaction, which the majority of women in
Western cultures experience to some degree. Body image disturbance reflects an exaggerated and
undue importance and influence of self-perceived body shape and/or weight on one's self esteem.
Having body image disturbance means that the individual attributes low self esteem to his or her
body's unacceptable (in the individual's eyes) shape and/or weight.

In a way, attributing the cause of low self esteem or negative mood to one's body shape or size
makes good sense. It allows one to exchange the amorphous and unmanageable issues of dysphoric
mood and poor self esteem to something concrete and specific. If binge eating becomes the crux of
the problem, at least it is something an individual knows s/he can do something about! So having a
binge eating problem allows one to invest emotional energy into fixing eating and weight issues
rather than the real issues of low self esteem and negative mood they feel helpless to begin to
address.

How can I stop bingeing?

You deserve to have a partner in your journey to health! You should not have to do this alone! Nor
are you likely to experience the same success in stopping binge-eating behaviors on your own as
you would with the help of an experienced therapist. Healing requires, first, acquiring new emotion
regulation and emotion tolerance skills, relationship skills, and mindfulness skills that allow you to
become aware of your eating behaviors in the moment. I urge you to seek a therapist experienced in
treating binge-eating to help you acquire these skills.

It may seem impossible to you now to give up bingeing as a means of coping with life. With the
acquisition of new skills, you will be ready to decide if and when you are ready to give up
binge-eating and replace it with new, healthier emotion regulation skills.

Where can I get help?

Please go to the Resource Page to get ideas about where to find help.

Ask The Expert