Understanding—and Healing—Binge Eating Disorder
The most pervasive eating disorder in the United States is the one we rarely talk about: binge eating. A binge is different from an occasional overindulgence (perhaps, with the rise of “binge watching,” we’ve started throwing around the word too casually) because these events are frequent and overpowering. For more than 3 million Americans, life with binge eating disorder (BED) is burdened by episodes of compulsive overeating, followed by overwhelming feelings of distress, shame, disgust, or guilt. It can be crippling, often impairing people who have it from carrying out routine activities.
What’s worse, BED is frequently trivialized. The idea that it can be cured with willpower or a good diet plan—or, worse, that it’s not a mental health disorder at all, but a poor lifestyle choice—is a gross misjudgment. In reality, BED is just as threatening to mental, physical, and emotional health as other eating disorders. And it can be near-impossible to heal without clinical help.
The American Psychiatric Association first formally recognized BED as a psychiatric disorder in 2013, outlining a path to diagnosis and treatment for millions of Americans. Decades of research inform current treatment models, which include medication as well as cognitive behavioral and dialectical behavioral therapies. But perhaps the most comprehensive approach is also the most promising. Therapist Dushyanthi Satchi, L.M.S.W., specializes in holistic eating disorder treatment at Spectrum Neuroscience and Treatment Institute in New York City. Satchi integrates evidence-based best practices with depth psychology and complementary modalities, such as mindfulness, meditation, and gratitude training. As Satchi explains, BED recovery is so much more than cracking an overeating habit—it’s about detangling the disorder’s psychological underpinnings, cultivating self-love, and learning the coping skills you need to feel comfortable with your relationship to food going forward.
A Q&A with Dushyanthi Satchi, L.M.S.W.
Can you put binge eating into context? How many people are affected and why is it less talked about than other eating disorders, like anorexia and bulimia?
There are an estimated 3 million Americans who suffer from binge eating disorder—three times the number of cases of anorexia and bulimia combined. BED affects about one in thirty-five adults in the US, according to a 2007 Harvard study. Unlike other eating disorders, it affects almost as many men as women and is seen across all ethnic groups. About 20 percent of people with BED are of normal weight, and about 65 percent are obese.
Fat-shaming contributes to the lack of recognition of BED. We all know that overweight kids are bullied in school, but people also report weight bias, comparable to racial and sex biases, as a prejudice in securing jobs. Binge eating is often viewed as a lack of willpower, and sufferers are often blamed for their condition and told to diet. There is a general lack in understanding that BED is a true psychological/emotional disorder that requires treatment.
BED was first recognized as an eating disorder in the DSM-5 (the diagnostic manual of the American Psychiatric Association), in 2013, which means doctors did not give official BED diagnoses until recently. Within eating disorder research however, BED has been discussed at least since the 1950s.
How do you distinguish between binge eating and overeating?
Most of us know what it’s like to overeat if we’ve ever had Thanksgiving dinner. However, binge eating also involves severe emotional distress and a frequency of at least once weekly over a three-month period, although this can lessen during recovery.
Emotion—not hunger—drives the binge. The binge can last about two hours. Binge eaters feel out of control about how much and what they eat. Binge eaters eat food when they are not hungry, eat faster than normal, and past the point of fullness. They often hide food and consume food alone due to shame and embarrassment. After a binge, they feel disgusted, depressed, and ashamed. One patient told me, “I don’t even like the foods I binge on. I just feel this overpowering urge to eat.”
One in three Americans is overweight, but not all have BED. Overeaters may feel uncomfortably full and slightly guilty after consumption, but they enjoy eating and feel content with the taste of the food.
Overeaters Anonymous uses the terms “binge eating” and “overeating” interchangeably, but I find value in differentiating between the two because the treatments are different. There is always a spectrum with eating disorders, and overeating may require counseling depending on the frequency and nature of the issue.
What typically is, or can be, at the root of binge eating behavior?
BED is caused by a combination of factors, including cultural and media influences, biology, personality, and early childhood experiences.
At its root, BED—similar to other addictions—is about using food to numb pain. Food becomes a drug, which is why binge eaters are compared to alcoholics and drug addicts more often than anorexics. Like other addicts, binge eaters can’t cope with emotional distress in a healthy way. This distress is a combination of current stress, previous childhood experience, and a learned dysfunctional emotional pattern of suppressing feelings.
The mechanism of using food to cope typically happens at a subconscious level. A binge eater doesn’t often come into my office and say, “I’m really hurt because my father neglected me so I binge.” Instead, they talk about wanting to lose weight and getting angry with themselves for not having willpower.
“Food becomes a drug, which is why binge eaters are compared to alcoholics and drug addicts more often than anorexics.”
I often ask, “What percentage of the day do you think about food?” For people with BED, that number is usually around 80 to 90 percent, which is a signal that there’s deeper pain to unearth.
Underneath this pain there is often a deep-seated self-hatred. Clinicians see eating disorders as a slow form of suicide. The health risks of BED include heart disease, gallstones, osteoarthritis, and obesity. Healing involves transforming this self-hatred to love.
For instance, I treated a BED patient who also had severe ADHD, and he suffered from self-esteem issues. He was angry that he couldn’t perform well at school and work. As a young boy, he had always felt that he was a disappointment to his single mom, who often lost patience with him. He never felt that he fit in socially in his conservative Connecticut town. As a part of his treatment, we worked on his seeing himself through a more compassionate lens, developing his social skills, and finding purpose in his work. Eventually he grew to love himself, and this transformation helped him stop bingeing.
What is the biological component of BED? Is there one?
Understanding that BED has a biological component helps patients reduce the heavy self-blame they often carry. BED tends to run in families, and research suggests that people with BED have a blunted response to dopamine in the brain. Dopamine is the neurotransmitter involved in many cognitive and behavioral effects, including the feelings of pleasure we get from food.
According to neurologist Jay Lombard, “Similar to drug addicts, binge behavior resembles addictive behavior linked to the reduced dopamine activity, which affects food intake amounts, satiety, and food choices.” This means that binge eaters may have difficulty with impulse control, including controlling food cravings; may experience increased pleasure with food; and may not receive correct messages of hunger and fullness from the brain.
Evidence indicates that BED is due to a combination of learned behaviors and biological factors, but as we know through the emerging field of epigenetics, our biology does not necessarily determine our destiny. BED can be overcome with psychological intervention and medication if necessary.
Do you see any overlap between binge eating and bulimia?
Absolutely. Both use food binges to cope with emotional pain. But bulimics purge and binge eaters do not. The purge gives bulimics a temporary high or feeling of control, followed by emotional distress.
What can help binge eaters heal and change eating habits?
Binge eaters should seek treatment from a specialized therapist, psychiatrist, and nutritionist, sometimes within an organized clinical program. There are steps that are proven to work:
Radical Acceptance
The first step in healing is understanding that they are using food as a drug and making a commitment to change. With my patients, I introduce the Zen Buddhist concept of radical acceptance—compassionately accepting the situation for what it is without resistance or judgment. It’s the balance between acceptance and change—accepting that they have an addiction and making a commitment to change and recover. This is similar to the Serenity Prayer popular in most addiction-recovery programs. Spirituality or a sense of surrender is very helpful in recovery.
Coping Mechanisms
When they feel the urge to binge, we find other coping mechanisms to quell that urge. This might include mindful breathing, taking a walk, or even throwing rolled-up socks against the wall. Exercise is often a highly effective antidepressant.
Mindfulness
I encourage them to become mindful of their thoughts, which may have been buried by years of bingeing. So often, we do not notice the constant stream of negative thoughts going through our minds. Understanding how thoughts, emotions, and behaviors are interconnected is critical. For instance, “I hate my life” leads to feelings of sadness, which lead to bingeing. Changing thoughts creates behavioral change. Our inner world can dramatically shift our outer lives.
Relationship with Food
With the help of a nutritionist, we work on food education, changing eating habits, mindful eating, and redeveloping a relationship with food.
Therapy and Life Coaching
In addition to processing any current and childhood pain, we work on life goals that range from developing better communication skills to a career change—anything and everything to bring them into the vision of the life they want.
What’s important for maintaining a healthy relationship with food?
Maintaining a healthy relationship with food involves maintaining a healthy emotional relationship with yourself and your world. Food cannot be used as a substitute for feelings.
There should not be any foods on the “no” list: Restricting leads to obsessing. Even functional medicine expert Dr. Mark Hyman believes in the 90-10 rule, which means 10 percent of the time he leaves room for unexpected food choices.
Individualized nutritional education is important as well. There is an excess of diet and nutrition information on the internet, and it’s helpful to have guidance from a nutritionist for each individual’s unique needs.
Unlike some therapists, I personally believe it’s a positive tradition to use food to celebrate a birthday or a happy event. It’s part of our culture. It’s about moderation, not going to extremes.
Are there any common misconceptions about binge eating or treatment that should be dispelled?
I don’t believe in the adage “Once an addict, always an addict.” I’ve seen people experience full and complete healing, and it is beautiful to watch them find happiness and freedom. People can and do recover.
Any advice on encouraging healthy body image?
A daily scroll through Instagram could give any one of us a negative body image. If you find yourself looking at someone’s page and it makes you feel insecure, stop looking. Limiting these and other messages from the media helps take the pressure off of what is the so-called “perfect” body. Changing the goal from weight to wellness is also an important and liberating shift.
There are also beautiful exercises involving looking in the mirror and truly accepting, without judgment, all that we see—learning to be at peace with what is instead of being anxious about change. It’s a variation on exposure therapy, where a patient faces or imagines their fears, which has been used to treat anxiety for decades. This exercise involves looking in a mirror and confronting judgmental or distorted beliefs about the body, replacing these thoughts with more accurate and compassionate ones, and being mindfully aware of thoughts, sensations, and emotions that arise. Scientific studies, including a study at Mount Sinai in 2012, support that just five to six sessions of mirror exercises in therapy increase a patient’s body satisfaction and decrease discomfort when looking at their reflection.
We can still have health goals but lose the anxiety.
How can people access support resources or get involved in public advocacy?
The National Eating Disorders Association is the largest nonprofit dedicated to supporting people affected by eating disorders. It has a help line to call, text, or chat for support. It also offers an abundance of resources on where to get help in your area, as well as access to educational material, legislative advocacy, and charitable organizations.
There are similar resources available through Academy for Eating Disorders, Binge Eating Disorder Association (BEDA) , and ANAD, the National Association of Anorexia Nervosa and Associated Disorders. Also, Eating Disorders Anonymous offers online, phone, and in-person group sessions.
Dushyanthi Satchi, LCSW, is a therapist and trauma counselor at Spectrum Neuroscience and Treatment Institute in New York City, specializing in cognitive behavioral therapy, dialectical behavioral therapy, and mindfulness for trauma, anxiety, depression, ADHD, and eating disorders. Satchi has also worked with rape and abuse victims for over fifteen years, and she has consulted for the United Nations on policy and media to fight gender-based violence.
The views expressed in this article intend to highlight alternative studies. They are the views of the expert and do not necessarily represent the views of goop. This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.
