The word "binge" is ubiquitous. We hear people referring to binges in a variety of contexts with respect to a multitude of behaviors and yet, generally speaking, the precise definition of "binge" remains vague. Certainly, everyone who uses this term is referencing something large, but that does not leave much room for differentiating between a clinically relevant behavior (e.g., binge eating) and a normative behavior (e.g., Thanksgiving dinner). The purpose of today's article is to provide some clarity on this topic, with a particular focus on the definition and nature of binge eating.
According to the DSM-IV-TR, a binge eating episode has two defining characteristics. The first is that more food is consumed in a discrete period of time than would typically be consumed by others in that same period within the same context. A discrete period of time is, admittedly, a fairly broad term, although the DSM further specifies that a single episode should last less than two hours. The second defining characteristic is that the individual experiences a perceived loss of control during the episode. Having spent a significant amount of time discussing the nature of binge eating with both clients and students, I have found that a fairly distinct pattern of questions almost invariably emerges. As such, I would like to address several of these questions here.
The perceived loss of control is important to consider when attempting to distinguish between clinically relevant binge eating and normative eating experiences. When I go to Cheeburger Cheeburger on Sanibel Island, Florida, I often decide to order the one pound burger so as to get my picture placed on the wall. This behavior is thus planned ahead of time and represents a careful decision on my part. The premeditated nature of the behavior, in part, serves to disqualify this meal as a binge. Even more so, however, my ability to stop when I feel full is what makes this particular meal not fit the category of binge eating. When the burger is too much - which happens from time to time - I simply stop. I do not feel compelled to continue. When an individual binge eats, she often feels as though the behavior is simply happening, almost as though she is a spectator with no control over the outcome.
For individuals who binge eat, dissociation is a common experience. As such, they do not savor the food they are eating, enjoy the experience as it is happening, or feel capable of enacting any degree of control over the behavior. In earlier posts discussing dialectical behavior therapy (DBT), we mentioned that there is compelling empirical evidence that DBT is an effective treatment for bulimia nervosa (BN) and binge eating disorder (BED), both of which are characterized by frequent binge eating. One explanation for this might be the emphasis on mindfulness, which teaches individuals skills for remaining focused on neutral present stimuli and can help prevent or diminish dissociative experiences.
Importantly, although eating disorders are significantly more common in women than in men, there is evidence that there are no sex differences in rates of binge eating behaviors (Striegel-Moore & Franko, 2003).
Is there really any difference between obese individuals without an eating disorder and obese individuals with binge eating disorder?
There are many other questions that come up when I talk about binge eating with clients and students. Can you think of others? Are there answers to these questions that you think I may have overlooked in this article? I encourage you to share your thoughts with other readers through the comment section. Ideally, I would love for this to be a conversation involving a variety of perspectives and experiences. I can think of no better way to encourage a broad, thorough education on this important topic.
If you would like to learn more about binge eating, we encourage you to explore the following resources, all of which are available through the Psychotherapy Brown Bag online store:
- Overcoming Your Eating Disorder: A Cognitive-Behavioral Therapy Approach for Bulimia Nervosa and Binge-Eating Disorder, Guided Self Help Workbook (Treatments That Work)
- Overcoming Eating Disorders: A Cognitive-Behavioral Therapy Approach for Bulimia Nervosa and Binge-Eating Disorder Therapist Guide (Treatments That Work)
- Overcoming Your Eating Disorder: A Cognitive-Behavioral Therapy Approach for Bulimia Nervosa and Binge-Eating Disorder, Guided Self Help Workbook