Starving and Binging: Types of Eating Disorders (Bulimia, Anorexia, Bingeing)

Nearly everyone has seen the images: an impossibly thin young girl, obsessively toying with food but never eating it, the details of her skeleton clearly visible through her dry flesh; or the young woman with bulimia, compulsively stuffing herself with thousands of junk-food calories, then vomiting back everything she has eaten and doing it all over again, sometimes many times a day.

Rooted in deep psychological, cultural, and physical dysfunctions, an eating disorder is one of the most stubborn problems a person can face. In recent years, these mysterious illnesses have received a torrent of media attention—as the subject of television movies and talk shows, and as grist for the tabloids. One celebrity after another (usually female) has revealed her personal battle with these disorders. Some, like the late Princess Diana and actress Jane Fonda were bulimics. Others, such as TV actress Tracy Gold, were anorexic. Perhaps the most dramatic and horrifying stories are those of anorexic women who have starved themselves to death: rock and roll star Karen Carpenter, only 32 when she died in 1983; or more recently, gymnast Christy Henrich, 22, who weighed just 43 pounds at the time of her death, which was attributed to multiple organ failure.

Anorexia nervosa and bulimia nervosa have long been classified as psychiatric illnesses. A third eating disorder, binge-eating syndrome, was recently added to the basic psychiatric guidelines. Together, they can be viewed as variations on a theme of extreme eating behavior—from not eating at all (anorexia), to bingeing-and-purging (bulimia), to eating nearly all the time (binge-eating syndrome). It takes a combination of medical, psychological, and nutritional therapy to overcome any of these disorders. Treatment usually involves the patient’s family as well, especially in the case of anorexics, who are frequently adolescent girls.

Eating disorders can be found around the world, but they are most common in industrialized western nations where food is abundant. In the United States, there are many strong cultural influences at work that most experts agree contribute to the development of eating disorders. Women in particular are the target of a constant barrage of subtle and not-so-subtle “thinner-is-better” messages, and by most counts, they account for about 90 percent of those with eating disorders.

(The male version of the problem has been dubbed the “Adonis complex.” Known medically as muscle dysmorphia, its hallmark is a quest for extreme muscularity that can lead not only to eating disorders but also to abuse of drugs such as anabolic steroids. Its victims are less likely to seek help than their female counterparts.)

Estimates of the number of people with eating disorders vary, in part because the disorders are often characterized by secretive behavior and can remain undetected until serious health problems develop. Some studies estimate that one to four percent of adolescent and young adult women in this country have an eating disorder, with concentrations in some subgroups such as college students and athletes. Among college-aged women, as many as 25 percent develop an eating disorder (in four out of five cases, bulimia). And one national study of adolescents found that nearly 9 percent of the girls and more than 4 percent of the boys were involved in binge/purge activities at least once a day. The National Association of Anorexia Nervosa and Associated Disorders (ANAD), an educational and self-help organization, estimates that seven million women and one million men in this country have eating disorders.

Eating disorders usually begin early in life. The period between 14 and 18 years old is the riskiest; and by age 20, fully 86 percent of people with eating disorders have already experienced symptoms, according to ANAD. These symptoms, which vary by disorder, can continue for years, or even decades. And it is important to remember that the statistics show only the tip of the iceberg. Individuals with problems serious enough to be diagnosed as eating disorders represent only a fraction of those people who have fasted or binged or purged at some point in their lives.

Some 44 percent of adult women and adolescent girls, 29 percent of adult men, and 15 percent of adolescent boys say they are trying to lose weight. One study of college-aged women found that 91 percent wanted to lose weight—a percentage the investigator called “astonishing.” A survey of high school girls around the country determined that 39 percent thought they were overweight, 58 percent had dieted at some time, and 20 percent had binged and purged. Lately the statistics have been boosted by the sobering fact that childhood obesity has become a national epidemic—today nearly 25 percent of all children are overweight, with the rates among minority children even higher.

Serious problems may begin as diets that go out of control, or as an obsession with food that grows out of a seemingly healthy interest in good nutrition. Studies have found that from 3 to 5 percent of adolescent girls have subclinical eating disorders—not serious enough to merit a full-blown diagnosis, but serious enough to cause health and life problems.

Children with chronic diseases such as asthma and diabetes are particularly at risk for developing an eating disorder. Diabetes patients, for instance, are counseled to count and keep track of everything they eat, a habit that can quickly lead to compulsive behavior. Eating disorders strike almost twice as often among teenage girls with type 1 diabetes as in girls without the disease. To shed pounds, many of these girls simply skip taking their insulin or cut back on the dose—a strategy that leads to weight loss, but also invites the serious and even fatal complications of diabetes.

Also, paralleling the upsurge of obesity in young people is a corresponding epidemic of type 2 diabetes in children. Previously, type 2 was diagnosed almost exclusively in adults (typically, those with weight problems). Now it’s showing up in more and more children, particularly among minorities. Children with type 2 don’t need to take insulin, since their body continues to produce it, but they still need to monitor their food, putting them at risk of compulsive eating disorders.

In the past two decades there has been a growing interest in eating disorders in the medical and psychiatric communities. Many programs now exist to treat them, and family physicians and other health professionals are becoming increasingly sophisticated in recognizing symptoms. Experts now favor a multidisciplinary approach to treatment, with help from psychiatrists, pediatricians or family doctors, psychologists, dietitians, and social workers. Prevention is also receiving increasing attention, through both school and community-based programs. Nutritional education at an early age, especially for young athletes and others who are considered high-risk, can sometimes prevent eating disorders from developing or from going out of control.

Anorexia, bulimia, and binge-eating have much in common. All are centered on food, and all involve extreme control or lack of control in eating behavior. They are often accompanied by low self-esteem, depression, thoughts of suicide, and high levels of stress. Increasingly, doctors are also noting a link with substance abuse. All three disorders can overlap or alternate in the same person, with anorexics sometimes developing binge/purge behavior and bulimics going through periods of fasting. Despite these similarities each is a distinct disorder with its own symptoms, patterns, and treatment.

Anorexia Nervosa

Anorexics don’t eat; but that doesn’t mean they lack an appetite. Indeed, anorexics often display an obsessive interest in food. A typical anorexic will read about food, shop for, cook, and constantly think about food, in fact, will do everything with food except eat it.

According to the American Psychiatric Association, from one-half to one percent of women between ages 15 and 30 suffer from anorexia. The number of cases appears to have increased in recent decades, although it is not clear whether this is due to an actual increase or better reporting. More deaths are attributed to anorexia than any other psychiatric disorder.

Anorexics have usually been described as high-achieving, perfectionist, and compliant white adolescents from comfortable or affluent families. The stereotype has its limits, however. Increasingly, cases are being reported among African Americans and Hispanics. Those studying the spread of anorexia and other eating disorders have found that while age and gender are closely related to development of eating disorders, ethnic background and economic status are not.

 

Warning Signs of Anorexia

Anorexia nervosa does not develop overnight, and early treatment can head off severe illness and even save lives. Some warning signs are clear; others more subtle.

Unnatural or obsessive preoccupation with food, dieting, and weight
Distorted body image and intense fear of gaining weight
Denial of hunger
Avoidance of social situations with food
Poor eating habits and decreasing daily intake of food
Cessation of menstrual periods
Lack of energy, weakness, fatigue, and depression
Abdominal cramps and other aches and pains
Excessive exercising
Decreased coordination
Inability to concentrate
Indecisiveness

 

Hallmarks of Anorexia

According to current diagnostic guidelines, you are anorexic if you:

Refuse to maintain a minimally normal body weight. This is estimated at 85 percent of what is considered normal weight for your height.
Have an intense fear of gaining weight or getting fat.
Have a distorted perception of what your body actually looks like. If you are an anorexic, you will look in the mirror at what may be an emaciated image and honestly believe that you are overweight and need to lose weight.
Stop having your menstrual periods. Depriving the body of nutrition interferes with the hormonal cycles that regulate menstruation, bringing it to a halt. (If you are male, this obviously does not apply, although hormonal abnormalities are also seen in male anorexics.)

Anorexia typically begins to develop between ages 12 to 14, or later in adolescence, at about age 17. Some cases have appeared before puberty and some as late as the early 30s. The cause is unknown, although a variety of cultural and psychological factors are probably involved. Eating disorders seem to run in families, and a girl has a 10 to 20 times greater risk of developing anorexia if she has a sibling with the disease.

There also appears to be a link between overprotective parenting and anorexia. Many anorexics come from close-knit families that allow their members little room for individuality. Rebellion against this restrictive environment often takes the form of refusing to eat.

There are two types of anorexia. With the restricting type, you lose weight primarily through dieting, fasting, and excessive exercise. The binge-eating/purging type is more complicated because it can be confused with bulimia. This type of anorexic may binge-eat, then purge by vomiting and misusing laxatives, diuretics, or enemas, or even purge regularly after eating only small amounts of food.

 

Ravages of Anorexia

09A Fatal in up to 10 percent of cases, anorexia can cause irreversible damage in those who survive. The severe malnutrition that accompanies the disorder can bring on osteoporosis, the brittle-bone disease underlying many of the fractures suffered by the elderly. Dry, scaly, yellowish skin and noticeable hair loss are other unpleasant signs of this insidious disorder that, ironically, begins with the pursuit of perfection.

 

What Happens to Your Mind and Body

Many anorexics describe the beginning of their disorder as a reaction to a comment such as “you really need to lose some weight.” They begin to diet and enjoy the positive feedback that comes with weight loss and the sense of control that they feel over their bodies. But then they somehow lose perspective on what a healthy or attractive body image really is, and want only to continue losing weight. While they feel they are controlling their diet, the diet ends up controlling them.

“I controlled everything through my food,” said Tracy Gold, a young TV actress whose battle against anorexia was well-publicized in gossip columns and fan magazines. She described this control as turning into a tremendous fear of food that became nearly impossible for her to overcome. “To me it was like an evil force inside of me,” she said. “You want to live; you want to get better; but you literally don’t know how.”

Christy Henrich, the 22-year-old gymnast who died in July 1994 weighing 43 pounds, used similar words to describe what her life had become. “My life is a horrifying nightmare,” she said when she went public with her illness a year before her death. “It feels like there’s a beast inside of me, like a monster. It feels evil.”

Psychologically, in addition to these feelings of fear and evil, anorexics often suffer from other psychological problems, such as obsessive-compulsive behavior, social isolation, anxiety, a revulsion toward fat and self-indulgence, and compulsive and excessive exercising. Often, a hidden depression lies at the core. Like people suffering from involuntary malnutrition, anorexics may also exhibit any of the following additional symptoms:

  • Insomnia
  • Lack of concentration
  • Indecisiveness
  • Preoccupation with food
  • Mood swings
  • Irritability
  • Fatigue and lethargy

In the most extreme cases, mental functioning becomes severely impaired.

A number of medical conditions characterize anorexia, some stemming from what are believed to be underlying psychological issues. For example, teenage anorexics are often described as fearful of growing up and attempting to thwart their emerging sexuality. By fasting, these girls drastically reduce the amount of female hormones being produced, which not only keeps their breasts and hips from developing, but also blocks the process of menstruation.

Emaciation is a second, more obvious condition that develops, but more important is the body’s protective response to the effects of starvation. Vital organ function begins to decline, as if shifting into a lower gear of operation. Breathing and heart rates decline. Heartbeat becomes irregular. Blood pressure drops. Thyroid function slows. Body temperature goes down. Most anorexics cannot tolerate cool temperatures and always feel cold, particularly in their hands and feet.

They may develop constipation due to water imbalance. Deprived of protein, their nails and hair may become brittle and their hair may fall out. Vitamin deficiencies will eventually cause their skin to become dry and scaly, often with a yellow or gray cast to it. As anorexia progresses, a type of fine body hair called lanugo will grow. This downy covering is probably an attempt by the body to compensate for the loss of muscle and fat tissue.

The breakdown that anorexia causes in hormone production also often results in osteoporosis, the loss of bone mass that leads to brittle bones. It is comparable to the condition that develops in postmenopausal women whose bodies have almost stopped producing estrogen. To halt bone loss, most doctors (more than three-quarters according to one report) prescribe hormone replacement therapy for teenage anorexics. There’s no proof, however, that this does any good. On the contrary, recent studies have found that it has no effect on bone mass in adolescent girls.

Researchers are beginning to find other hormonal and chemical changes related to anorexia. Levels of serotonin, neuropeptides, and leptin, the chemical messengers that regulate appetite, are abnormal in people with anorexia, although it’s not known whether this is a cause or an effect of the disorder. In addition, nutritional deprivation renders anorexics resistant to growth hormone and retards production of the insulin-like growth factor I, another hormone related to growth. Administration of these hormones may someday become a treatment for anorexia, but work in this area is still new and is not yet being applied to patients. Other researchers are investigating the role of enkephalins and endorphins, opiate-like chemicals produced in the brain.

The course of anorexia varies considerably, depending on when the condition is detected, what supports are in place, and how it is treated. Up to ten percent of those with anorexia nervosa eventually die of the disease. Most others go on to lead healthy and productive lives.

Treatment for Anorexia: What to Expect

There are two important points about treating anorexia. First, denial is one of the most consistent features of the disorder, and most anorexics resist treatment. It is usually up to a family member or close friend to recognize the problem and get the patient into treatment.

Second, continued treatment and monitoring is crucial because anorexia is often a chronic and recurring condition. This means that one successful course of treatment does not necessarily cure the disease and that even “cured” patients may suffer setbacks. In fact, some studies have found that as many as half of anorexics who have been hospitalized for treatment will relapse after what has been considered a successful course of treatment. So, for most patients, treatment will be a long-term process.

Most patients undergo a combination of psychological and medical treatment. In many cases, this means hospitalization to begin dealing with the physical effects of starvation. Hospitalization is usually advised if you weigh less than 70 percent of your recommended body weight, have rapidly progressing weight loss, and have symptoms such as irregular heartbeat, dizziness or fainting, and low potassium levels. Anorexia is probably the only psychiatric illness for which the most effective initial treatment is often a long stay in the hospital.

The first step is called “refeeding,” which can be done on an in- or outpatient basis, depending on the severity of your condition and whether or not you’re ready to cooperate. Some patients have to be force-fed through nasogastric or intravenous tubes; there are even cases in which courts have ordered such treatment in order to keep the victim alive.

While refeeding goes on, you’ll begin to receive behavioral therapy, psychotherapy, and nutritional counseling. You’ll be encouraged to develop your eating plans, which will start with small amounts of food that you can feel safe with, gradually increasing the number of calories you consume and broadening your selection of foods. Your doctor will keep a close watch to avoid potential physical problems that can develop with refeeding such as abdominal bloating, constipation, and swelling. If a slow and gradual approach is taken, these can usually be avoided or lessened.

Therapy is typically a lengthy process. A variety of different approaches are used, alone or in combination. These include cognitive behavioral therapy and individual or group psychotherapy. Cognitive therapy focuses on correcting a person’s distorted notions about food, body image, and self-worth. Recently, as doctors began to realize the role the family plays in development of anorexia, family therapy has become increasingly common. Self-help groups such as Overeaters Anonymous are also a major source of supportive therapy. Nutritional counseling remains an absolutely crucial part of treatment.

A number of different medications have been used for anorexia. Some have helped, although no single medication stands out. Anti-anxiety drugs may work in some cases, while antidepressants are frequently prescribed for those with symptoms of depression.

The prognosis for anorexia varies, depending on the severity of the disease and your ability to cooperate with treatment. If you are able to acknowledge the severity of the problem, get help, and successfully rebuild your self-esteem, you have every right to be confident of recovery.

Bulimia Nervosa

Though still uncommon, bulimia is not as rare as anorexia. Doctors estimate that it occurs in as many as five percent of adolescent and young adult women. Only 10 to 15 percent of bulimics are male. Of the three eating disorders, it is the one most easily kept hidden, since many bulimics maintain a normal body weight, even while they engage in the extreme and destructive bingeing and purging that characterizes the disease. As a result, the actual number of bulimics may be twice as high as the estimates.

 

Warning Signs of Bulimia

Although some of the warning signs of bulimia are similar to those of anorexia, most are associated with purging. Bulimic behavior can accelerate quickly. To stave off potentially serious physical consequences, early recognition is a must.

Avoidance of social eating situations
Disappearance after meals; long visits to the bathroom after eating
Secretive eating
Denial of hunger
Hidden stashes of food, particularly high calorie foods such as candy, chips, etc.
Intake of potassium pills
Use of laxatives, diet pills, diuretics, emetics
Bloodshot eyes (from vomiting)
Abrasions on the back of the hand (from inducing vomiting)
Compulsive exercising
Swollen salivary glands

 

In the past couple of decades, some of the secrecy cloaking bulimia has been brushed aside as celebrity confessions and widespread media reports about the disorder have multiplied. Many colleges now have programs through their student health centers to deal specifically with bulimia, since it is so widespread on campuses. Some studies claim that 10 to 20 percent of female college students have practiced bulimic behavior at some time in their lives. Like anorexia, bulimia is also associated with certain athletic and artistic pursuits, such as running, gymnastics, competitive swimming, and dancing.

The causes of bulimia are not well understood. A history of anorexia may be a risk factor. Early warning signs include abnormal concerns related to weight, withdrawal and social isolation, negative changes in body image and self- image, and changes in relationships with family and peers. When bulimics review their early years, they report more intrusive parental behavior than people without eating disorders. And a study of European adolescents found that bulimic behavior is associated with early onset of menstruation and early sexual experiences.

Cultural and psychological factors also play a role, and there may be a chemical imbalance at work as well. A recent study found an association between bulimic behavior and a deficiency of tryptophan in the body. Tryptophan, a naturally occurring amino acid found in many foods, is used to make serotonin, which has a role in regulating appetite. Bulimics have also been found to have lower than normal levels of leptin, a protein that inhibits food intake. Genetics may also be a culprit. A study of 1900 fraternal and identical twins concluded that bulimia is often inherited. Work is ongoing to locate the genes at fault.

Bulimics may consume astounding quantities of food in the binge phase of their cycle. A typical binge lasts about two hours. The following description from “My Name is Caroline” (Doubleday, 1988), a book by recovering bulimic Caroline Miller, vividly illustrates what was a characteristic binge for the author, and many other bulimics:

…I give my order for a double-thick vanilla frappe…. Colorful jimmies, peanuts, chocolate chips, coconut and other ice cream accouterments beckoned. I wanted to ask the woman to toss some jimmies and chocolate chips into my shake, but I knew that normal people didn’t do that kind of thing….[At] my next destination, David’s Cookies,…I quickly picked out two pounds of cookies. I crammed a few cookies in my mouth while I paid….Baskin Robbins was next….I ordered a mixture of pralines ‘n cream and jamoca almond fudge….With the cookies in my pocket I was going to make a huge crunchy mess and finish it all myself.

Ms. Miller then describes her purge, a graphic, unpleasant, but accurate portrayal of what a bulimic goes through:

I jammed two fingers down my throat and felt the familiar bile rising. Harder and harder I thrust, gouging the back of my throat in the process….All of a sudden the food came up in gushes, splattering all over the toilet seat, the floor and my clothes. Disgusted yet elated at my success, I kept probing, trying to make sure I was getting everything up….

 

The High Cost of Bulimia

09A Although it’s not as lethal as anorexia, bulimia can cause severe and permanent disfigurement. As stomach acids erode the gums and etch the teeth, a bulimic’s smile may become ragged. In the end, all teeth may need extraction. Constant trauma to the digestive system can lead to ulcers, hemorrhage, and rectal bleeding. As in anorexia, irreversible osteoporosis may result.

 

What Qualifies as True Bulimia

To be diagnosed as a bulimic, you must meet the following diagnostic criteria:

  • You engage in recurrent episodes of binge-eating. This is defined as consuming larger than normal amounts of food within a two-hour period, and feeling a lack of control over eating during the episode.
  • You repeatedly compensate for the binge-eating with purging behavior to prevent weight gain. Purging behavior can include self-induced vomiting; misuse of laxatives, diuretics, enemas, over-the-counter diet pills, or other medications; fasting; or excessive exercise.
  • You binge and purge at least twice a week for three months.
  • Your self-evaluation is unreasonably influenced by body shape and weight.

It is important to remember that while these precise standards must be met for a medical diagnosis, you may be one of many people who does not meet the strict criteria but is still moderately to severely impaired by bulimic behavior.

What Happens to Your Mind and Body

Bulimia, too, has both psychological and physical components, including its own set of personality characteristics. Researchers have suggested that many bulimics suffer low self-esteem, intolerance of frustration, and an inability to appropriately recognize and express their feelings. Some have even theorized that childhood sexual abuse may be a factor in later development of bulimia, but this link has never been proved, and is certainly not the case for all bulimics.

Like anorexics, bulimics are likely to be preoccupied with food, at the expense of other, healthier pursuits. Their obsessiveness and secretiveness is comparable to the behavior of many substance abusers. In fact, bulimia has been linked to substance abuse, and other impulsive actions such as overspending, shoplifting, and promiscuity. The hidden nature of a bulimic’s bingeing and purging activities can lead to social isolation, although many bulimics manage to function appropriately and keep their behavior secret.

Depression has also been associated with bulimia, and some studies have found that more than half of all bulimics have experienced clinical depression. However, it is unclear whether depression causes the eating disorder, or vice versa.

Some research has also found irregularities in the brain chemistry of bulimics, particularly in the release and processing of the chemicals that regulate the feeling of being full. While most people eat only when hungry, bulimics respond to the mere presence of food.

Bulimia can remain hidden for years, while the bulimic persists in her unhealthy eating habits. Eventually, however, physical signs of the disease are likely to become difficult to conceal. Extreme purging can cause dehydration and imbalances in the body’s level of potassium, sodium, and other chemicals, which in turn can lead to fatigue, seizures, irregular heartbeat, and brittle bones.

Vomiting, the most commonly used method of purging, can also lead to tell-tale signs—and even serious injury:

It can damage the stomach and the esophagus, sometimes resulting in bleeding, ulcers, loss of the gag reflex, and chronic heartburn.
Stomach acids can have very damaging effects on the mouth. They cause gums to recede and tooth enamel to erode, leading to ragged teeth. Tooth enamel is not replaceable, and some bulimics finally need to have all their teeth extracted.
Repeated vomiting also causes salivary glands to swell, resulting in a chipmunk-like appearance.
Many bulimics have abrasions and scarring on the back of the hands, caused when they stick their fingers down their throats to induce vomiting.

Overusing laxatives results in a different set of problems. Constipation and bloating are common, and laxative abuse may also lead to bowel abnormalities and rectal bleeding.

Getting Treatment for Bulimia

Bulimics are usually more willing than anorexics to admit their problem and accept help. The disorder is generally considered less complicated to treat than anorexia, and bulimics rarely need hospitalization. Exceptions are cases of extreme chemical imbalances, serious gastrointestinal complications, or severe depression.

Cognitive behavioral therapy that helps you reevaluate unrealistic expectations and demands on yourself is usually regarded as most effective in treating bulimia, with quicker and more dependable results than psychotherapy. One technique is to keep a diary of food consumption and eating behavior. For example, your therapist may have you write down everything you eat over a certain time period—a chore that can very effectively interrupt a pattern of bingeing.

Cognitive therapy also helps you recognize what triggers your binge/purge behavior and helps you come up with other ways to deal with those triggers. It also helps you deal with the unrealistic messages about body image that permeate our culture. Therapy should be combined with nutritional counseling, to help you learn how to plan regular, balanced meals.

Group therapy can also work well, particularly for those in college. Family therapy is often helpful if you live at home. Even light therapy can help, according to one recent study of bulimics with seasonal affective disorder, a condition that often accompanies the problem.

Antidepressant medication can be very beneficial if you are one of the many bulimics who suffer from a depressive disorder. A variety of these drugs have been used with bulimics and doctors are currently enthusiastic about fluoxetine (Prozac), which boosts levels of serotonin, one of the brain chemicals that controls feelings of being full. Studies have shown fluoxetine to be effective in patients who have failed to respond to or have relapsed after cognitive behavioral therapy or psychotherapy. In 1997, the drug became the first to be specifically approved for the treatment of bulimia. Other drugs that have been used successfully include desipramine (Norpramin), imipramine (Tofranil), and trazodone (Desyrel).

Regular dental care is also an important part of treatment for bulimics.

Like anorexics, bulimics are prone to relapse. The episodes can be caused by stressful life events, anything from final exams to career change to divorce. Some kind of continuing therapy or access to a support or self-help group can often prevent relapse, or make it easier to quickly move through the relapse back to healthy eating patterns. Forty percent of binge-eaters are male.

Binge-Eating Disorder

Now regarded as a psychiatric problem unto itself, binge-eating disorder is, essentially, bulimia without the purging. Binge-eaters do not force themselves to vomit, take laxatives, or otherwise rid themselves of their food, and hence, are almost always extremely overweight. They are also referred to as compulsive overeaters.

Some degree of binge-eating takes place in a substantial percentage of people in weight-control programs—anywhere from 15 to 50 percent, according to various studies. General surveys have found that as many as four percent of Americans may engage in binge-eating, often after completing a weight-control program or attaining weight goals. Dieting itself does not seem to cause binge eating in someone who is not already predisposed to the problem. However, with nearly one-quarter of Americans now meeting criteria for obesity (body mass index greater than 30), the chance of developing the disorder is clearly on the increase. Forty percent of binge-eaters are male.

When Does Binge-Eating Become a Disorder?

Because binge-eating disorder has only recently been recognized as a true illness, it has not been studied to the same extent as anorexia and bulimia. The official diagnostic criteria are still viewed as general guidelines, and shouldn’t be considered definitive.

Binge-eaters eat large amounts of food, sometimes when they are not even hungry. They usually eat alone, feeling embarrassed about the amount they consume. After a binge, they often have feelings of self-disgust, guilt, or depression.

For those with a true disorder, the episodes occur, on average, at least twice a week for at least six months. Like bulimics, people with binge-eating disorder are likely to eat very quickly, continuing even after they feel uncomfortably full. While bingeing, compulsive overeaters feel they are unable to stop.

What Happens to Your Mind and Body

Studies have found that people with binge-eating disorder are more prone to major depression, anxiety disorder, and other psychiatric conditions. They are also more likely to have a family history of substance abuse. However, doctors are not sure whether binge-eating causes the psychiatric problems or vice versa—or even if there is any relation at all.

Binge-eaters often suffer from frustration and low self-esteem, and may connect other difficulties, for example, problems with relationships or employment, to their eating habits. The secretive nature of their disorder may cause social isolation, as it does for bulimics.

The most common physical consequence of binge-eating is weight gain, and often obesity. Along with this comes increased risk of a number of diseases associated with being overweight: high blood pressure, clogged blood vessels, heart attack, stroke, diabetes, and sometimes bone and joint problems.

Treating Binge-Eating

For a binge-eater, food is an addiction—in some ways harder to treat than an addiction to drugs or alcohol. If you have a substance abuse problem you can learn to completely avoid drugs or alcohol. But it’s impossible to totally give up food. Moreover, certain foods that are likely to cause eating problems—such as sweets or high-fat foods like potato chips—are often part of everyday social activities. If you are a binge-eater, it can be very difficult indeed to successfully negotiate these potential pitfalls. Learning what triggers a binge and substituting a healthier reaction when you encounter a trigger can be a major help.

Like other eating disorders, binge-eating can be treated with behavioral therapy and psychotherapy. A number of medications have also been found to help, including fluvoxamine (Luvox), desipramine (Norpramin), sertraline (Zoloft), and topiramate (Topamax). In addition, a prescribed exercise regimen can be a valuable part of treatment. However, support and self-help groups are especially important. Overeaters Anonymous, for instance, is a 12-step program that is often helpful for those with binge-eating disorder. Remember, though, that the habits that mark this disorder have often developed over a long period of time, and quick fixes are unlikely.

The most extreme treatment for intractable obesity is surgery, either stomach stapling or some variation that makes it virtually impossible to ingest large amounts of food. The latest innovation is an adjustable band that can be implanted around the stomach through a very small incision. Surgery, however, is recommended for only the most highly motivated patients.

Therapy is often a long-term process, punctuated with relapses. Still, just as with alcohol or drugs, it is possible to control this most insidious of all addictions.

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