By Makayla B, Lagniappe Wellness Dietetic Intern
Binge eating disorder is the most common eating disorder in the United States.1 This disorder will be experienced by 2.8% of the US population at some point in their lives. To put that into perspective, it is 1.75x more prevalent than the two most well-known eating disorders combined, Anorexia (0.6%) and Bulimia (1%). According to the DSM-5-TR2, Binge Eating Disorder is diagnosed by episodes of Binge Eating with some additional criteria:
- At least 3 are met during a binge episode:
- 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
- The feeling of disgust, depression, or guilty after overeating
- Is not associated with any regular use of EXCESSIVE compensatory behavior (purging, fasting, excessive exercise).
- Occurs over the course of at least 3 months.
The Binge Restrict Cycle
Binge Eating often appears in a cyclic form often referred to as the Binge-Restrict cycle [pictured below]. It usually starts off with some sort of food restriction (often in the form of dieting). Although this is usually less severe than compensatory behaviors associated with Anorexia or Bulimia. Dieting is a form of restriction that decreases caloric intake and/or eliminates entire food groups as a way to control eating patterns. This very quickly leads to intense cravings and combined with a triggering event leads to a binge. Triggering events often tie into an internal stressor such as negative self-talk, negative emotions or an external stressor such as a tight work deadline or family stressors. Shame and guilt occur after a binge which leads to restriction, starting the cycle anew. The cycle continues over and over again until the cycle is broken. Intuitive eating aims to end the cycle by eliminating restrictions with ten major principles which will be discussed further in a minute.
What Started the Cycle?
As with any cycle there was always a beginning. It is important to note the potential root causes of the binge-restrict cycle as a way to understand it more in depth. Factors affecting Binge eating are often an interplay of many factors that have occurred over the course of a lifetime. They are complex in nature and cannot all be covered here. Three predominant ones include emotional overeating, internalization of diet culture and traumatic life events.
Emotional Eating
An individual partakes in emotional eating when food is used to relieve stress to cope with often difficult emotions. Research has shown that individuals who eat emotionally are at risk for binging behavior.3 These patterns of behavior usually develop in childhood and express themselves throughout the lifetime if untreated. If a child grows up in a family that did not express emotions, a child may learn that it is not safe to express emotions and therefore turn to food as a way to distract. Secondarily, the parent may have expressed their love for their child through food. This may lead the child to seek food as a coping mechanism when uncomfortable emotions arise.
Diet Culture
The urge to restrict after a binge is perpetuated by diet culture. Diet culture is harmful to people of all weights and all sizes encouraging a particular appearance as the ideal standard. It perpetuates the notion that a person should do anything to attain this unrealistic standard of beauty and that self-worth is based on it. Some children may have grown up in a household that assigned worth based on physical appearance. If a child grows up in an environment where bodies were commonly critiqued and criticized, value and worth might now be linked to appearance. Diet culture then enforces this notion that appearance is based on self-worth. The connection between appearance and self-worth influences increases feelings of guilt and shame after a binge and the desire to then restrict.
Trauma
People who have PTSD or have a history or experiencing traumatic events typically are at greater risk for all types of eating disorders.4 People who have experienced significant trauma in their life tend to struggle with emotional regulation and have high rates of dissociation5. Dissociation is defined by the American Psychological Association as, “a defense mechanism in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche”.6 This essentially means that one separates themselves from their psyche and memory as a form of self-protection to distance oneself from the trauma. In trauma survivors, the binge episode may be a form of dissociation. The triggering events (often strong negative emotions or thoughts regarding the trauma) lead to a binge. This intake of food feels uncontrollable, almost an out of body experience. It is easy to see the psychological symbolism of the food as a way to fill the void at that moment.
What is Intuitive Eating and Why Does it Work?
Intuitive Eating is a term coined by two registered dietician nutritionists, Evelyn Tribole, MS, RDN, CEDRD-S and Elyse Resch, MS, RDN, CEDS-S, Fiaedp, FADA, FAND. It is the name for a framework of eating centered around a mind-body approach to health. Through the ten principles, it aims to reduce obstacles to body awareness and guides the individual in how to make choices that will support the physical and psychological needs of the body.
10 Principles of Intuitive Eating7
Reject the Diet Mentality
It is important to realize how diets often do not work and leave the dieter often worse off than at the start. They often result in weight cycling and a feeling of failure and disappointment. Rejecting the notion that you need to change your body and focusing on choices that lead to well-being is a cornerstone of intuitive eating.
Honor your Hunger
Nourishing your body to keep it fed with adequate calories and nutrients is key. It is important to respond appropriately when hunger is present and not to get overly hungry as this can trigger a primal drive to overeat.
Make Peace with Food
Categorizing foods into ones that are “good” and “bad” naturally leads us to crave the ones that are off limits. Unconditional permission to eat any foods and removing labels from them gives us food freedom to listen to what foods our body actually wants.
Challenge the Food Police
The food police is an internal dialogue governing what you think you can and cannot eat. It is formed through social conditioning and diet culture.
Discover Satisfaction
When we only focus on choosing foods based on nutrition, we often forget about pleasure. When making food choices, remember to select foods you really want to eat. This will maximize satisfaction.
Feel Your Fullness
Check in with your hunger cues before, midway and at the end of the meal. It is often helpful to use a rating scale to numericize your feeling of fullness as a strategy to help get in touch with your body.
Coping with Emotions
Discover ways to cope with difficult emotions other than through food. Food may offer short-term comfort but in the long term may cause more harm than good. Instead, look for alternatives rooted in self-compassion such as meditation or dealing with the root cause of these emotions. A licensed therapist may be helpful in offering guidance through this journey.
Respect Your Body
Respect your body and its differences from others. Each body is genetically different and will never look the same as someone else’s. Accept and even celebrate your unique differences.
Enjoyable Movement
Exercise should not be a punishment or something that is obligatory. Focus on how you feel after exercise and focus on movement that makes you feel good.
Gentle Nutrition
Everybody needs different foods. There is no single eating pattern or lifestyle that is suitable for everyone. Focus on making food choices suitable for your overall physical and mental wellbeing.
Conclusion
In summary, intuitive eating is a great tool for those struggling with binge eating disorder or the binge restrict cycle. It is a strategy to end the cycle of binging, guilt and restriction and lets the user tune into what is best for their overall wellbeing in a holistic way. Practicing intuitive eating takes time and is a skill to be developed. It counteracts years or even decades worth of behavior patterns and is often very difficult to practice. Working with an eating disorder dietitian and therapist within a team of qualified medical professionals is suggested to assist you along your healing journey. Healing your relationship with food takes time, be kind to yourself.
Resources:
Search for qualified dietitians: https://iaedp.site-ym.com/search
NEDA helpline: https://www.nationaleatingdisorders.org/help-support/contact-helpline
EAT 26: https://psychology-tools.com/test/eat-26
References
- Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. [Published correction appears in Biol Psychiatry. 2012;72(2):164.] Biol Psychiatry. 2007;61(3):348-358.
- Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. American Psychiatric Association, 2022.
- Černelič-Bizjak, M. and Guiné, R.P.F. (2022), “Predictors of binge eating: relevance of BMI, emotional eating and sensivity to environmental food cues”, Nutrition & Food Science, Vol. 52 No. 1, pp. 171-180. https://doi.org/10.1108/NFS-02-2021-0062
- Brewerton, Timothy D. “Eating disorders, trauma, and comorbidity; Focus on PTSD.” Eating disorders 15.4 (2007): 285-304
- Ehring T, Quack D. Emotion regulation difficulties in trauma survivors: the role of trauma type and PTSD symptom severity. Behav Ther. 2010 Dec;41(4):587-98. doi: 10.1016/j.beth.2010.04.004. Epub 2010 Jun 30. PMID: 21035621.
- “Apa Dictionary of Psychology.” American Psychological Association, American Psychological Association, https://dictionary.apa.org/dissociation.
- Tribole, Evelyn, and Elyse Resch. “10 Principles of Intuitive Eating.” Intuitive Eating, 19 Dec. 2019, https://www.intuitiveeating.org/10-principles-of-intuitive-eating/.
