Written by Cherie Massmann, LPC, NCC
It is normal to overeat! In a culture filled with wonderfully delicious food, it is not uncommon to overindulge at times. Having a wonderful entrée or dessert at a favorite restaurant and having a hard time stopping when we know that we are full is quite normal.
As a child I remember a regular joke that my dad would say to our server when he would eat a little too much at a restaurant. He would say, “Do you have carry out service? Will you carry me to my car?”
Understanding the Difference Between Overeating and Binge Eating
Given that overeating from time to time is normal behavior and binge eating is not, it can be hard to understand the difference. I hope to illustrate the differences and to dispel the myth that people with Binge Eating disorder “just need more self-control” or “just does not care about themselves enough”.
The motivation to binge eat is deeper and more devastating than some would guess. People who suffer with binge eating will tell you that it is rarely about the taste of the food that they are eating. Enjoyment of food, if any, is fleeing.
Who Is Affected By BED?
Binge Eating Disorder (BED) is a disorder that affects children and adults, males and females. In the new revised DSM-5, Binge Eating Disorder is defined as: 1) Eating in a discrete period of time (such as 2 hours) in which the individual consumes an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances with 2) a sense of lack of control over eating during the episode or a sense that one cannot stop eating or control what or how much one is eating.
Think of a ball rolling down a hill and not being able to stop it.
These binge eating episodes must be associated with three or more of the following to meet full diagnosis:
- Eating much more rapidly than normal
- Eating until feeling uncomfortable full
- Eating large amounts of food when not feeling physical hunger
- Eating alone because one feels embarrassed by how much one is eating or feeling disgusted with oneself
- Depressed or very guilty afterwards
BED can have an early onset in childhood or early teen years, or it can also occur later in life as a result of some significant change in the life of the patient. It is usually associated with lower mood, instability or conflict in interpersonal relationships and an over focus on one’s body and weight.
Treating Binge Eating Disorder
At Webster Wellness Professionals, we see many patients suffering with BED. Most, prior to coming in for treatment are unfamiliar with the criteria of a binge eating diagnosis. They just know that they are “out of control” and they feel helpless to change.
It is common for patients to say that they feel unworthy of my time and attention because they know that they are harming themselves. They feel ashamed and all alone. It is not that they haven’t tried. Most patients are very familiar with the how-to’s of losing weight and have attempted to control their eating with multiple diets before seeking treatment.
Some have even experienced significant weight loss via extreme diets for some period of time before they return to a regular binge eating pattern. It is not that they are not trying. What they are doing will not work! Any attempts to control binge behaviors and lose weight with an extreme or rigid diet increase the odds of periods of binging and unrestrained eating.
Seven Lies Patients May Tell About Themselves
In my work, I have stumbled upon Seven Common Lies that patients with BED tell themselves:
- I have to be a certain weight or shape to be loved, valued or worthy.
- My body is not normal – I have to eat much less than other people to lose weight.
- Other people are judging me as a person based on my weight.
- It is not fair, thin people get to eat whatever they want, whenever they want.
- I can’t be trusted around food.
- If I can’t do it perfectly then it is not worth doing at all.
- It is my fault, I did this to myself and I don’t deserve care from others.
Patients suffering from BED have an ever present internal voice that pushes, scolds, and humiliates them, which can be very difficult to ignore. When a patient gives in and listens to that critical voice to continue eating and binge, it eases the voice temporarily giving the patient a moment or two of rest, quiet.
Our patients tell us that the pleasure of that moment comes not in the food but in the relief from the ever critical voice in their head. The relief is temporary however, often only lasting minutes at a time.
Learning to Push Back Against the Disease
Learning to fight back, learning to separate, disagree and disobey the voice that calls them fat, worthless and unlovable is very hard work. Effective BED treatment requires that the patient feel safe and cared for by the treatment provider. Patients can only face the shame that they feel in an environment that allows them and even encourages them to make mistakes.
Therapists must be willing to meet the patient where they are and help them build both meal regularity and self-acceptance over time. When a therapist is able to model problem solving and overcoming barriers the patient can begin to open themselves up to new information.
As they become more aware of their own biological, environment and emotions triggers of binge eating, they can begin to make a different choice. When they begin to see the lies for what they are, distortions that keep them sick and view themselves with more gentle and caring eyes they continue to make those better choices. Over time they can begin to trust themselves in big and small ways and that makes all the difference.
Cherie Massmann, M.A, LPC, NCC earned her Master’s degree in Counseling from Webster University in St. Louis, Missouri in 1999. Ms. Massmann is a member of the Webster Wellness Professionals outpatient multidisciplinary team. She provides individual, family and group therapy for all aspects of eating disorders.
Ms. Massmann is a cognitive-behaviorally trained therapist with over 13 years of experience treating binge eating disorder, anorexia nervosa, and obesity in adults and adolescents. She specializes in treating Binge Eating Disorder and runs the Behavioral Weight Loss Program for Webster Wellness Professionals.
Prior to joining the Webster Wellness Professionals team she worked as a staff therapist in the Departments of Psychiatry and Internal Medicine at Washington University School of Medicine.
She has been the clinician of several multi-center National Institute of Health grants including: the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY study), the Comprehensive Maintenance Program to Achieve Sustained Success (COMPASS), a treatment of childhood obesity and the Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE study).