Eating disorders (EDs) are complex mental health disorders that impact the lives of over a million Canadians (1). In the first two parts of this series, we explored some of the medical consequences of anorexia nervosa and bulimia nervosa. In this part 3, we will do the same with binge eating disorder.
Binge eating disorder (BED) has almost twice the lifetime prevalence of anorexia and bulimia, making it one of the most commonly experienced EDs (2). Similar to bulimia nervosa, BED is characterized by recurrent episodes of binge eating; however, there is no engagement in compensatory/purging behaviours afterwards (3).
Binge eating and overeating are sometimes used interchangeably; however, there are big differences between the two. Overeating is the experience of eating past the point of comfortable fullness that can happen from time to time around normal, non-disordered eating. For example, say you’re at a big potluck dinner, where everyone has brought a dish or two to share. You may feel that you’ve overeaten by filling your plate for seconds or thirds of everything, when you usually stop eating after feeling comfortably full.
Binge eating is the experience of regularly overeating, with the added factor of feeling out of control around the speed, amount, and type of food eaten. Binge eating (by definition) happens at least once a week over at least three months and leads to feelings of mild to extreme distress.
Someone can be more vulnerable to binge eating for a multitude of reasons, including strong hunger (especially if preceded by restriction), emotional distress, social situations involving food (especially foods that one typically does not allow themselves to eat), “screw-it” eating (where someone may continue eating because they’ve already “messed up” – like eating multiple slices of pizza because one already feels excessive), and much more.
In practice, there are two main types of binges that can occur, regardless of the type of ED (like, binge-purge type anorexia, bulimia, or BED). The first one is the objective binge, which is the “textbook” definition of a binge: feeling out of control around what and how much is eaten, while consuming an unusually large amount of food in a short period of time (3). An objective binge also includes three or more of the following (3):
There is also the subjective binge, that can feel exactly like an objective binge to the person experiencing it, but doesn’t fit the “qualification” of eating a large amount of food in little time (2,4). Subjective binges often feel “bingey” because the types of food being eaten feel forbidden to the person.
As an example, let’s say three people, Karl, Antoine and Tina serve themselves cookies. Karl may feel uncomfortable eating cookies and feel like they’re losing control and bingeing while eating three of them, when Antoine might eat that as his normal serving. Tina may feel triggered to binge and eat a whole box of cookies and a medium pizza in 15 minutes, which may be a smaller binge for her. Karl’s and Tina’s experiences around binge eating are completely valid, and also show the difference between a subjective and objective binge. Around the subjective binge, it can also show how forbidden foods and food rules can play a larger role in the experience and personal vulnerabilities to binge eating.
What feels important to note is that subjective and objective binge eating are treated the same as they both represent disordered thoughts, patterns and behaviours around eating.
Every person’s experience with BED is unique to them, and these behaviours can feel very protective in the moment. At the same time, binge eating can often be a way to regain control when someone feels out of control, or to escape discomfort (2). Binge eating can lead to a variety of physical and psychological consequences that can be incredibly impactful in day-to-day and long-term ways.
Binge eating can lead to some uncomfortable gastrointestinal symptoms, such as stomach distress, abdominal pain, heartburn, bloating, nausea, constipation or diarrhea (2). It can also impact one’s ability to recognize and/or respond to their hunger and fullness cues (2).
More significantly, frequent binge-eating episodes can overstimulate nerve fibres in the stomach, which can cause the stomach to work differently and expand, increasing the risk of one’s stomach becoming extremely enlarged, and tearing (2). This can lead to the stomach leaking food or digestive juices into the abdomen, as well as symptoms like severe, sharp pain and bloating around the abdomen, nausea and spontaneous vomiting, and more (2).
Those with BED may also be at increased risk of developing conditions such as type 2 diabetes, high blood pressure, dyslipidemia, and gastrointestinal disorders, like heartburn and dysphagia (a.k.a difficulty swallowing) (5).
Lastly, despite it being normal for our bodies and weights to change over our lives, those with BED often experience more regular weight fluctuations, especially if restricting intake is involved (2). This can be incredibly distressing, and lead to some of the more psychological and behavioural impacts of BED, as outlined below.
As with other EDs, those with BED often report higher levels of comorbid mental health disorders, such as anxiety and depression (5). Binge eating can temporarily improve one’s mood or serve as an “escape” from challenges being faced (2). At the same time, binges can also lead to a variety of negative feelings of shame, guilt, and body image preoccupations (2).
As a result of some of these feelings, one may be very secretive about food and only binge in complete privacy (2). For many people, binge eating happens at night, which can also cause sleep disturbances, from waking up to binge late at night to trying to fall asleep when extremely full (2).
Those with BED often experience great challenges with self-esteem and self-acceptance, which can present as self-loathing and self-disgust (2). As with other EDs, those with BED place a great focus on their weight and appearance, which can be agonizing if their weight fluctuates (2). One’s perceived lack of control around eating does not help with this, as distress from body image preoccupation can also lead to more binge eating as a way to cope.
Binge eating disorder is a complex eating disorder that can have distressing impacts on physical and mental health. Whether it be engaging in objective or subjective binges, the perceived lack of control around eating can be an incredibly difficult experience to navigate. Working toward recovery can help those with BED understand and explore their personal triggers and vulnerabilities to binge eating, reduce and stop binge eating, and improve their relationship with food and their body.
Stay tuned for the fourth and final part of this series where we will explore the impacts of ED recovery on restoring one’s health. If you or someone you know are impacted by BED, or another eating disorder, do not hesitate to reach out to the Sööma team for support, at (514) 437-4260 or by email at info@sooma.ca. You can also book an appointment with one of our professionals directly by clicking this link.
Written by
Registered Dietitian
