Eating Concerns and Body Image

Binge Eating Disorder

What is Binge Eating Disorder?

Binge Eating Disorder (BED) is the newest eating disorder diagnosis recently added to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). It affects about 3% of all adults in the United States, and is a little more common in women than men; 3 women for every 2 men have it. BED involves a) consuming an abnormal amount of food at one sitting, b) feeling out of control while doing so, and c) the episodes occuring on average at least once a week for 3 months or more. People with BED may also:

  • Eat much more quickly than usual during bingeing

  • Eat when they are not hungry

  • Eat until they are uncomfortably full

  • Eat secretively

  • Feel ashamed or disgusted by the bingeing behavior

  • Feel anxious and preoccupied about weight and/or shape

Binge eating also occurs in another eating disorder, called bulimia nervosa. People with bulimia, however, usually purge afterwards using self-induced vomiting, laxatives, diuretics, or strenuous exercise.

Similarly, some people suffer from a form of disordered eating known as compulsive eating. Compulsive eaters tend to consume smaller amounts of food than individuals who binge, and usually feel that they have at least some measure of control over the eating experience. The distress that results from compulsive eating can be significant, however, even if the behaviors associated with it are not as intense as those in BED. 

What are the complications of Binge Eating Disorder?

BED is exhausting, disruptive, and demoralizing. It can produce unhealthy weight gain and can increase the risk for chronic illnesses like heart disease and high blood pressure. 

What are the causes?

According to the United States Department of Health and Human Services, the causes of binge eating disorder are not fully known. Although as many as half of all people with BED are depressed or have been depressed in the past, it isn't certain whether depression causes BED or vice versa. Some studies have found that people with BED have trouble handling emotions, and report bingeing when angry, sad, bored, or stressed. Research into brain chemistry and metabolism in people with BED is ongoing, and the role of genetics is being evaluated, since the disorder is often present in several members of the same family.

The Mayo Clinic suggests that dieting, sexual abuse, and culturally-driven pressures focused on weight, shape and appearance, may, as with other eating disorders, also be risk factors for BED. 

What is the role of genetics and biology?

It is now becoming clear that genetics and biological predisposition play a critical, though not exclusive role in the development of an eating disorder. Studies of people with anorexia and bulimia have found links to specific chromosomes, and a 2006 study led by the University of North Carolina, Chapel Hill, estimated that 56% of the responsibility for developing anorexia nervosa is determined genetically. Other studies have examined variations in serotonin and dopamine receptors in patients with anorexia and bulimia which could serve to reinforce eating disorder symptoms like food restriction. 

What is the significance of biological predisposition for people with eating disorders?

Firstly, it can lessen some of the shame and blaming that goes on when someone develops an eating disorder. Too often, people with eating disorders blame themselves for becoming preoccupied with food and their bodies, not realizing the extent to which these obsessions can be driven by biological susceptibilities. People can be much more compassionate with themselves when they understand that-even though there may have been times when they've consciously chosen to use a disordered behavior in order to cope-they didn't choose the disorder itself. Understanding the biological contribution may also allow some people to feel less shame about utilizing psychiatric medications like antidepressants or anti-anxiety drugs as part of their recovery. 

Does this mean that socio-cultural factors aren't important in the development of an eating disorder?

Not at all. Plenty of people have variable neurotransmitter levels and do not struggle with eating or body image, and many other people with eating disorders have no corresponding predisposition. Even for people with a predisposition, it is the environment in which they live that can mitigate or promote the expression of their genetic tendencies. This is one of the reasons that it remains critical to address the "thinness culture." Another is that dieting-with its potential for malnourishment and disruption of brain chemistry-can contribute to an existing problem in susceptible individuals, or create a completely new one to deal with. In fact, dieting has been called " a necessary, but not sufficient condition for the development of an eating disorder." When it comes to understanding and treating eating disorders, it's important to think in terms of both nature AND nurture. 

Why would anyone DO this to themselves OR Why can't people with eating disorders just STOP?

It can be difficult to understand why anyone would repeatedly engage in a behavior that is ultimately harmful, but it's important to remember that eating and exercise disorders are, first and foremost, an attempt at a solution.

For people with BED, the bingeing may have developed as a means of experiencing pleasure, soothing difficult emotions, expressing difficult emotions, numbing emotions altogether, or converting psychic pain to physical pain-something many people find easier to cope with. These dynamics with food are further complicated and exacerbated when dieting is added to the mix. Restrictive eating has been shown to increase the risk for bingeing, probably because of how it promotes the experience of both psychological and physiological deprivation; and the more often the cycle is repeated, the more entrenched it can become. That eating disorders take on a life of their own psychologically, is strongly reinforced by genetic susceptibilities that can heighten an individual's response in terms of brain chemistry, metabolism, and other important physiological processes. People with BED tend to feel tremendous shame about their behaviors because they are so often looked upon as "gluttony," "lack of control," and "self-indulgence," with no appreciation for the very real psychological and physiological drivers involved.

Dan Reiff, MPH RD, and co-author of Eating Disorders: Nutrition Therapy in the Recovery Process, uses an analogy he calls "The Helicopter Story." In it, he likens the ambivalence of someone considering eating disorder recovery to a person, unable to swim, who has been stranded in the middle of the ocean with only a life-jacket to keep them afloat. Rescue by helicopter will prevent them from ultimately drowning or dying of hypothermia, but the helicopter team tells the swimmer that he or she will need to give up their life-jacket in order to be pulled on board. It's a daunting prospect, and it's also the reason why people with eating disorders need time and lots of expert support in order to give up their behaviors and recover completely. 

How do I help a friend who has an eating disorder?

If you are worried that a friend is a compulsive overeater, click here for information and resources. 

Is recovery possible?

When medical support, nutrition work, and psychotherapy are utilized, recovery is completely possible for individuals with anorexia. Chances for complete recovery are highest when people receive early, expert treatment at the right level of intensity.

To get the support that you need at Brown University, follow the links below. 

On-Campus Resources

BWell Health Promotion 401.863-2794
Located on the third floor of Health Services.
Confidential information or care is available through individual appointments with a Nutritionist.  Students can discuss personal eating concerns, as well as any concerns they may have regarding a friend, a roommate, or a teammate. Health Promotion also offers workshops, pamphlets, and reading materials covering these and related issues. There are no fees for Health Promotion services.

University Health Services 401.863-3953
Located at the corner of Brown and Charlesfield streets.
Confidential information and care is available on a walk-in, or by scheduled appointment basis. Care is available for initial, current or past disordered eating patients. There are no fees for medical care at Health Services. However, there may be fees incurred if laboratory tests, medications, specialist or emergency hospital care is needed.

Counseling and Psychological Services 401.863-3476 
Located on the fifth floor of J. Walter Wilson.
Confidential appointments are available at Counseling and Psychological Services for students concerned about their eating issues. Guidance is also available for those who are concerned about a friend, roommate, or teammates' eating. Services include crisis intervention, short-term psychotherapy and referrals. There are no fees for appointments at Counseling and Psychological Services.

Related Links

Body Positive 
This site looks at ways we can feel good in the bodies we have. One of their slogans: "Remember, your body hears everything you think." Other topics on the web site: Size Acceptance; What do you say when everyone around you is dieting? 200 Ways to Love the Body You Have; Dieting Detox; Evaluating Weight Loss Programs: What are the Red Flags? Free subscription to email newsletter "Body Positive Pages."

Something Fishy
This site provides signs of eating disorders, motivational support talks, information on cultural issues and how to help loved ones.

National Association of Anorexia Nervosa and Associated Disorders

National Eating Disorders Association
This site provides general information about eating disorders and body image concerns, tips for helping a friend and referral sources.

Eating Disorders Referral and Information Center
Provides information and treatment resources for all forms of eating disorders.

The Academy of Nutrition and Dietetics
Articles from the AND on eating disorders, including The Female Athlete, Compulsive Eating and Anorexia.

Health At Every Size (HAES) 
HAES is a paradigm that says you don’t have to change your weight or size in order to improve your health. It isn’t a health promotion model that we hear much about, but it’s an approach that has been shown to have tremendous psychological and physiological benefits – without the pitfalls associated with traditional weight-focused interventions.

  • Click here to read about a study that compared HAES with a weight-centered program.

  • Jon Robison, PhD, is a health educator and HAES specialist who has written some great articles about this new paradigm.

  • Karin Kratina, PhD, RD, is a nutritionist who has been at the forefront of HAES since the beginning. Her website is a wonderful resource for people interested in research resources and the daily practice of HAES.

  • Ellyn Satter, RD, specializes in promoting eating competence in children and adults, and helping adults to recover from experiences with dieting.

  • 401.863-2794
    Health Promotion
  • 401.863-3953
    Health Services
  • 401.863-6000
    Sexual Assault Response Line
  • 401.863-4111
  • 401.863-3476
    Counseling & Psychological Services
  • 401.863-4111