Can You Have a “Little” Binge Eating Disorder?

I have battled with my weight my entire life and was thin until I became pregnant with my first daughter. I followed the example of others around me at the time, twenty-seven years ago and I gained 70–yes 70 pounds when I was pregnant. The good news was that I lost it all minus 20 pounds, but then I became pregnant with my son and gained 50 more pounds and lost all of that minus 20 pounds. If you are dong the math, I am 40 pounds heavier. That is not that bad and I can work on it, but then it started. Mental illness struck very hard and I began taking more psychotropic medications–anti-psychotic medications which were the absolute worst for me.

Psychotropic medications caused me to gain weight from breathing it seemed like.

Today, once again I am presently attempting to lose weight. This is day #4 on my diet of eating little to no carbs. I am proud of myself. One day at a time. I must lose weight. This is the next big step in my continued recovery and mental health journey. Improving and maintaining good physical health must be part of my journey.

My life is improving in so many ways. It is time for me to conquer my weight battle. It is my next step in my recovery of mental illness. Carbs are my nemesis–my unfriendly frenemy. I love anything and everything with carbs, especially bread. The more bread or carbs I eat the more I want, want, want. This must end.

I have overcome so much, so why can’t I defeat my weight problem–the monster of a beast it is? Well, the answer is, I can and I will. It is time–the next step in my recovery journey. On our recovery journeys, sometimes we have to break down our obstacles one at at time-little by little, step by step, piece by piece. Keep focused on small parts and goals to get to the finish line of recovery. I am on a mission to lose weight, again.

Remember there is no real finish line of recovery. When you get better and reach your best, define a new best. Become the best you you can be and do it over and over again.

At times, I believe I have a little of this “Binge Eating Disorder” if it is possible to have it a little. I like to eat and have always been an emotional eater. If I was one of those people who could or would not eat when I was depressed or upset over the years, I would be so beautifully thin. However, it is the opposite for me and food has always been my comfort in times of distress.

New (back in May 2013) in the DSM-5: Binge Eating Disorder

It’s official!  Binge Eating Disorder (BED) is now an actual eating disorder diagnosis in the DSM-5 which was released by the American Psychiatric Association in May 2013. DSM stands for Diagnostic and Statistical Manual of Mental Disorders. This is the official “rule-book” of mental health diagnosis and is important so that everybody is using a common language when talking about a specific disorder.  The previous DSM-IV was released in 1994 and binge eating was only listed in Appendix B and had to be diagnosed with the non-specific “EDNOS” (Eating Disorder Not Otherwise Specified).  In the past 20 years there have been over 1,000 research papers published that support the idea that BED is a specific diagnosis that has validity and consistency.

The key diagnostic features of BED are:

1. Recurrent and persistent episodes of binge eating
2. 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 being embarrassed by how much one is eating
   • Feeling disgusted with oneself, depressed, or very guilty after overeating
3. Marked distress regarding binge eating
4. Absence of regular compensatory behaviors (such as purging).

BED is the most common eating disorder in the United States. In adults it affects:

• 3.5% of women
• 2% of men
• and up to 1.6% of adolescents [1].
• In women it is most common in early adulthood but more common in men at midlife.
• BED seems to affect blacks and whites equally.

Comorbid problems are both physical and psychiatric.  Although most people with obesity don’t have BED, up to 2/3 of people with BED are obese and can have the medical difficulties associated with this condition. Compared with normal weight or obese control groups, people with BED have higher levels of anxiety and both current and lifetime major depression.

Effective evidence-based treatments are available for BED. These include specific forms of cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Some types of medication can be helpful in reducing binge eating. These include certain antidepressants (such as SSRIs) and certain anticonvulsants (such as topiramate, which can also reduce body weight). All treatments should be evaluated in the matrix of risks / benefits / alternatives.

For more information on the specific changes to the DSM-5, please see the recent webinar entitled, “Eating Disorders in the DSM-5: Implications of Changes in the Diagnostics Categories and Criteria.” This webinar was moderated by B. Timothy Walsh, M.D. who headed the DSM-5 Eating Disorders Work Group, joined by Evelyn Attia, M.D. and Stephen Wonderlich, Ph. D., who were on the work group and currently serve as members of the NEDA Research Advisory Council.

[1] Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry. 2011;68(7):714–723.

© Copyright 2018 National Eating Disorders Association

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