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How Is Binge Eating Disorder Underrepresented Compared to Other Eating Disorders?

Since its addition to the DSM – V (the official list of mental health and behavioral disorders) in 2013, binge eating disorder has received more attention than it has in the past. However, it’s not widely known outside clinical experts that binge eating disorder is actually the most common eating disorder in the United States. The total number of people in the country who need binge eating disorder treatment may be as many as 2.8 million, including men, women, and adolescents of all races and genders.

Despite more people dealing with binge eating disorder than all other eating disorders combined, some data indicate that the numbers are still too low. Some people who need treatment still go underrepresented. Certain demographics that fall outside the stereotypical groups that suffer from eating disorders may have much higher incidences of binge eating disorder. That being said, the important question considering that the disorder was only recently officially recognized is:

Are people paying enough attention to the need for binge eating treatment?

Other Kinds of Eating Disorders Are Still More Well-Known

When eating disorders are portrayed in the movies and TV, binge eating disorder is nowhere to be seen most of the time. Even documentaries and news shows, when doing a story on eating disorders, normally don’t mention binge eating disorder. Instead, the conversation goes to more dramatic eating disorders. Anorexia nervosa, with the extreme weight loss it can come with, and bulimia nervosa, with the self-induced vomiting that accompanies that disorder, are normally given a larger share of the spotlight. Binge eating episodes are sometimes even dismissed as simply occasional overeating.

Of course, those disorders are serious mental health conditions and should not be ignored. However, because its symptoms are less well understood and it doesn’t involve weight loss, people with binge eating disorder can often go underserved. Even medical professionals can be underinformed about the commonality and severity of binge eating disorder. This means millions of people potentially are not getting the critical mental and physical healthcare that they need.

Defining Binge Eating Disorder

Binge eating disorder is a behavioral disorder in which an individual had episodes of eating large amounts of food in a short period. This is usually done alone or in private, and normally away from regular mealtimes. While people without the disorder will overeat from time to time (such as at Thanksgiving dinner), BED causes these binge eating sessions to be both regular and compulsive. Over time, the brain becomes dependent on the releases of dopamine and serotonin (“feel-good” chemicals that the brain creates as pleasure rewards) and the binges become involuntary.

The DSM-V defines it as the following:

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    2. The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  1. Binge-eating episodes are associated with three (or more) of the following:
    1. Eating much more rapidly than normal
    2. Eating until feeling uncomfortably full
    3. Eating large amounts of food when not feeling physically hungry
    4. Eating alone because of being embarrassed by how much one is eating
    5. Feeling disgusted with oneself, depressed, or very guilty after overeating

The binge eating episodes must be frequent and repeated to warrant a professional diagnosis; in the DSM-V the requirement is engaging in a binge eating episode one day a week for at least three months. Dieting is also associated with this disorder. Most people with binge eating disorder will publicly “be on a diet” and express displeasure with their body and/or weight.

Because the amounts of food eaten tend to be large and there are no compensatory purging efforts, binge eating disorder recovery must take into account the health needs associated with BED.

Physical Symptoms Requiring Binge Eating Treatment

For many people, eating disorders are associated with a refusal to eat, purging behaviors like vomiting or laxative abuse, and extreme thinness. Because of this perception, it might be confusing for some that the medical aspects of binge eating disorder treatment normally focuses on (aside from the behavioral therapy) addressing the medical needs of the client.

It’s important to note that not every overweight person has an eating disorder, and not every person with binge eating disorder is overweight; the behavioral characteristics are what make a diagnosis.

Some of the physical health risks associated with binge eating disorder include:

  • Heart disease
  • Hardened arteries
  • Sleep apnea
  • Gastrointestinal discomfort ranging from IBS to constipation
  • High cholesterol
  • Liver disease
  • Anemia
  • Diabetes type II

Residential treatment is better suited to address these complications (if they are severe) than day treatment. On the other hand, most general practitioners are capable of treating them, and day treatment can be used to address the behavioral and psychological aspects of binge eating disorder. Each individual will need a specialized treatment plan that helps with their specific needs.

Psychological and Psychiatric Symptoms of Binge Eating Disorder

The psychological aspects of binge eating disorder are the main focus of treatment. Therapists work with clients to understand the root causes of the disorder, an essential step toward correcting their behavior. Connected issues with body image, self-esteem, and interpersonal relationships are central points of binge eating therapy; they each factor in as causes of the disorder and triggers for episodes.

There is also a higher percentage of co-occurring psychiatric diseases such as:

  • Depression
  • PTSD
  • Anxiety
  • Bipolar Disorder
  • Obsessive-compulsive Disorder

While all these physical symptoms are commonly treatable, the continuation of binge eating episodes without specialized binge eating disorder treatment can slow the recovery down. It’s important to coordinate binge eating disorder recovery between a specialized facility and your doctor. In some cases, a family practitioner may not be aware of the acute symptoms of BED so, it’s best to contact specialized treatment experts as well.

Men May Be Underrepresented in Binge Eating Disorder Treatment

Most eating disorders are known to affect women more often than men, although men may not report their symptoms as often as women do because of societal stigmas. Binge eating disorder is different. It affects men almost as often as women. A study published in the International Journal of Eating Disorders in 2011 found that “out the 46351 people questioned 1630 men and 2754 women were found to binge eat, defined as experiencing at last one binge episode in the past month.”

These proportions show that unlike anorexia nervosa or bulimia nervosa, men have binge eating disorder at almost the same rate as women. This might lead to the underrepresentation of males in the treatment of binge eating disorder. The study concluded that “the disorder is just as damaging to men as it is to women, yet research has shown that the number of men seeking treatment is far lower than the estimated number of sufferers.”

Age of Onset Is Slightly Later

The more well-known disorders anorexia nervosa and bulimia nervosa begin, on average, at age 18. Cases in the early tweens are not unusual, and some cases have been seen in children as young as 7. Because of this, eating disorders are often seen as a teenager’s affliction. Binge eating disorder has an average age of onset of 21, and although three years might not seem like a huge difference, it can affect the likelihood of a person reaching out for help. If a person thinks, “eating disorders only affect adolescents,” they’re much less likely to admit to themselves there is a problem when binge eating gets out of hand. Adults have sometimes expressed feeling out of place at eating disorder treatment facilities because most of their fellow clients are much younger than them.

Eating Disorders Don’t Discriminate

Although binge eating disorders, like all eating disorders, affect people of all ages, genders, and ethnicities, they are still disproportionately diagnosed in white women. Awareness of this disparity is increasing, however. In another 2011 study, researchers found that “Hispanics were significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers. The researchers also reported a trend towards a higher prevalence of binge eating disorder in all minority groups. (Swanson, 2011).”There are similar trends observed in African-Americans, Asian Americans, and Pacific Islander populations. Although eating disorder treatment facilities don’t discriminate about who they admit for treatment, societal barriers still hold many people back from getting diagnosed with binge eating disorder or another eating disorder. Thankfully, in recent years online advocacy groups and cooperating treatment facilities are making inroads.

Binge Eating Disorder Is Serious But Doesn’t Get the Attention It Requires

Even though it’s the most common eating disorder, binge eating disorder wasn’t recognized formally by the psychological community until 2013. It will take time for the rest of the world to catch up to the DSM-5, as currently, this widespread disorder is dismissed as “overeating,” leading to an underserved population that numbers in the millions. If you or a loved one suspects the binge eating disorder is a problem, don’t wait. Reach out to your doctor or a qualified specialist to get on the road to binge eating recovery.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.