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Is bingeing the same thing as Binge Eating Disorder? (No, not exactly.)

Does Binge Eating Disorder require restriction to treat? (NO.)

Is bingeing a response to physical and/or mental restriction? (YES.)

Can trauma/emotions/anxiety cause Binge Eating Disorder without the presence of restriction?? (Yes! However it is extremely rare in our culture for restriction/guilt to not ALSO enter the picture after the fact, and therein lies the importance of addressing restriction, even if and when it isn’t the cause.)

The line between disordered eating (bingeing) and Binge Eating Disorder is blurred, just like it is for all disordered eating/eating disorders.

People binge in response to restriction, and they binge in response to trauma, anxiety, or difficult emotions. The important thing to remember though, is even if restriction isn’t the main cause of your bingeing, it is probably a big piece of it, just because of the culture we live in. Addressing restriction is extremely important, along with any other emotional/trauma-based treatment.

Anyone with an active eating disorder should be getting treatment, and The F*ck It Diet is just a supplement.

(Note: This particle post is associated with an episode that I recorded on August 1st, 2020, responding to a disgruntled instagram follower who was angry that I was “ignoring binge eating disorder” in my instagram posts, and saying that I imply that all binge eating disorder is a response to restriction. To get the full drama, (anonymous) angry comments and DMs, the accusations of being unethical and predatory, and my full response, listen to the episode above. For the purposes of this post, I am going to distill it down to discussing the nuance of bingeing vs. BED.)

The first and most important thing I want people to know about bingeing, is that when it is in response to calorie restriction, it is the body’s attempt to protect you against past and future famine. In a very basic sense: it is protective. And if you’ve tried to diet a lot, whether you were “successful” or not it is also going to be a response to diet thoughts. That’s an example of what people mean when they say: “mental” restriction. Restriction doesn’t have to be literal and physical (ie, less calories), it can just be mental guilt, rules, or diet ideation.

A LOT of our collective bingeing is because of our collective dieting, and out collective diet culture. The question then becomes, is that all? Do we binge for other reasons?

To make sure I’ve covered my bases, I consulted Casey Bonano, CEDRD-S to weigh in on bingeing vs Binge Eating Disorder (BED). She is a Dietitian specializing in Eating Disorders, an anti-diet approach, HAES, & Intuitive Eating. You can follow her on instagram here, and find her Food Freedom Guide here.

Here is Casey’s breakdown of the difference between bingeing and Binge Eating Disorder:

“Bingeing is usually based on restriction, and with incorporating all foods, some self reflection, and general coping skills it can be resolved. BED is more complex and will take a deeper dive into the psychological or emotional components, usually requiring mental health professions such as a therapist and a dietitian, but restriction (whether physical or mental) is often a component of BED as well and must first be addressed or ruled out before the emotional work can be done.”

There are people who believe that avoiding binge trigger foods is the way to treat Binge Eating Disorder, along with addressing the emotional/mental components of BED. I do not consider this a full recovery, as it uses restriction as a treatment. This is treating one eating disorder with another eating disorder. This will tend to backfire longer term, or just be manifested as restrictive disordered eating. When people claim that avoiding binge foods is how they “recovered” – I would never tell them that their lived experience isn’t valid, people should do what they feel is working for them, but I would also never recommend that method, or consider that true recovery.

For instance, if someone is in horrible pain from their bingeing, and can’t access or figure out how to remove restriction without living in constant pain from their bingeing during the process, trying to apply restriction and avoiding “binge foods” might feel like the only way to live without constant pain. That is a way of trying to mitigate the symptom. I understand and empathize with being in this position, but I still wouldn’t call it eating disorder recovery. And I would give a fair warning that it may eventually backfire and your body may override your attempts at willpower anyway and lead to more bingeing.

My strong opinion is this: ED treatment that doesn’t address fat-phobia or restriction, (yes, even BED), is unethical.

Here is another tricky part, all of the diagnostic markers of Binge Eating Disorder, are also things that people who binge just in response to restriction or diet culture experience. My own personal binge eating included alllll of the markers of Binge Eating Disorder, but the root cause was restriction.

 

DIAGNOSTIC CRITERIA FOR BED (from nationaleatingdisorders.org )

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  • 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).
• The binge eating episodes are 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 afterward.
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for 3 months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

WARNING SIGNS & SYMPTOMS OF BINGE EATING DISORDER

Emotional and behavioral 

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
• Appears uncomfortable eating around others
• Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Fear of eating in public or with others
• Steals or hoards food in strange places
• Creates lifestyle schedules or rituals to make time for binge sessions
• Withdraws from usual friends and activities
• Frequently diets
• Shows extreme concern with body weight and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
• Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
• Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).
• Eating alone out of embarrassment at the quantity of food being eaten
• Feelings of disgust, depression, or guilt after overeating
• Fluctuations in weight
• Feelings of low self-esteem

(End of the excerpt from nationaleatingdisorders.org)

All of those markers of BED above, were things I experienced as a chronic dieter/binger.

People with binge eating OR binge eating disorder need therapy to address emotional components, but also need to eliminate restriction of all kinds, both physical and mental restriction (mental restriction includes guilt or stress over food, as well as food rules and all manifestations of diet culture).

EVEN IF restriction is not the root cause or start of someone’s bingeing or BED, (for instance, when it is trauma or anxiety that spurred bingeing as a coping mechanism) restriction still usually becomes a piece of the bigger puzzle that will make healing difficult, and must be addressed.

Pathologizing food, weight, or eating is never the answer if what you’re looking for is full recovery. The answer is removing all restriction, and addressing emotion/psychological components. You can’t treat bingeing or binge eating with restriction.

Casey Bonano also shared: “In all my years of working in this profession I have NEVER worked with someone who didn’t restrict in some capacity (physical or mental) that then lead to their bingeing. I’ve had people swear up and down they don’t restrict and I’ve also been able to find some kind of restriction. This is likely the lack of awareness around what restriction is and how our culture promotes a lot of restrictive behaviors, and then passes them off as normal.

People can address the restriction and still end up bingeing for emotional purposes. Often I let people know that there are biological and psychological reasons we binge. We first address the biology (ie. don’t restrict, eat all foods, unconditional permission to eat) so that then we can address/pinpoint the emotional.

Often resolving your restriction will decrease your bingeing. Of course bingeing/emotional eating is a coping skill but you can’t really address that until you eliminate the restriction.

For example if you binge because you have trauma, perhaps “eating all the things” isn’t going to solve the core issue, BUT it would still be the first step I would do as a dietitian with that patient.” (- Casey Bonano)

Most people who binge eat, even people diagnosed with Binge Eating Disorder, don’t realize how much of it is caused and perpetuated by restriction.

I don’t often make the distinction between chronic bingeing and BED, because it draws an arbitrary line that implies that people with Binge Eating Disorder need a different approach altogether, and I think that makes the message triggering and confusing. People with BED will most likely require more care and more mental health support to unpack the complexities, but the bigger picture issues are the same: address restriction, and address trauma/emotion/psychological factors. Restriction is the not the answer.

I encourage every single person who is embarking on healing, healing from dieting or disordered eating, to get treatment and therapy, and in the case of active eating disorders, treatment is a non-negotiable.

If you have personal experience with Binge Eating Disorder and the role restriction plays, please reach out with your experience at podcast@carolinedooner.com

Love you all, stay safe and sane, and ….fuck it.

Caroline