By David Joel Miller
Out of control eating is officially a mental illness
With the advent of the DSM-5, Binge Eating Disorder (307.51 F50.8), is officially a recognized mental illness. Reading through the description of this newly recognized disorder it occurs to me that this is not what most non-professionals have been thinking of when they talk about people who overeat. What follows is my oversimplified explanation of how I understand this and how it might affect clients I see. For the full official description you would need to read the APA’s DSM-5 text.
Why does Binge Eating Disorder matter?
Given the APA’s estimates, the number of people in the U. S. who currently have or meet criteria for Binge Eating Disorder would run from 2 ½ to 5 MILLION people. A look at the criteria also indicates this is a lot more serious condition than we might first think. A lot of the criteria remind me of the features we see in alcoholism. This is more than just liking to eat. Binge Eating Disorder goes all the way to losing control.
First some things that do not appear to be included in the definition of Binge Eating Disorder and then the things that might define the disorder.
What Binge Eating Disorder is not:
Binge Eating disorder is not being overweight or obese.
We think that excess weight is a medical problem. There are a lot of reasons someone could be overweight or even obese that have nothing to do with binge eating. Mental Health and obesity have a lot of connections but Binge Eating Disorder is not the only one. (More on how mental illness may be making you overweight in an upcoming post.)
Binge Eating Disorder is not Holliday Eating
That Thanksgiving dinner is a good reason to gorge yourself. It is almost un-American to eat lightly on that holiday. Lots of family’s have other traditional family or holiday celebrations and food is a major part of that celebration. We do not count social eating events as Binge Eating Disorder even if after the holidays you find you have packed on some pounds.
Snacking all day is not Binge Eating Disorder
Some people have told me that eating small amounts of food at many small meals a day is healthier than a few huge ones. I am also told that eating lots of food is healthy if you can do it all day long. (I am skeptical of that argument.) There was a time when low weight people died every winter and a fat baby was considered a healthy baby. Modern health care has severed that connection, but I know new parents often worry if their child is not gaining weight as rapidly as they expected.
Eating because you are chronically hungry is about poverty, famine or bad nutrition.
If someone is low in body weight and eats a lot that is probably not Binge eating disorder. If they are staying low body weight because they do other “compensating” behaviors that is a different kind of eating disorder most likely Bulimia Nervosa.
Eating frequently because you are growing, expending energy or just plain hungry is not Binge Eating Disorder. Binging is sneakier than that.
What factors do make it Binge Eating Disorder?
The Binge eater feels badly when they do it
People with Binge eating Disorder may eat alone so others do not see how much they eat. This behavior reminds me of the alcoholic sneaking drinks. The Binge Eater does not want others to see them binging. The may eat in solitary, hide the evidence and they feel guilty or ashamed of what they do.
Eventually that shame and or guilt become a separate problem that needs treatment and may be the thing that keeps the binging behavior going even if they want to stop.
Binge eaters lose control of their eating
This loss of control takes many forms. The binge eater eats fast, very fast. They eat more than they want. They can’t stop eating even when they are over full. They may keep on eating to the point of feeling sick to their stomach.
One of the defining features of this disorder is the tendency to eat huge amounts of food in a short period of time. A binge eater will eat enough food for two or three people and do it in 2 hours of meal time or less.
Binge Eaters do these behaviors a lot.
This is not something that the binge eater does occasionally. To get this new diagnosis a person would need to binge at least 13 times over a three-month period.
The Binge Eating Disorder diagnosis allows for a range of severity.
The minimum is the 13 times in three months. Extreme Binge Eating Disorder is binging two times a day all 7 days a week. To meet the 3 month rule and have extreme Binge Eating Disorder would require over 180 episodes of binging with no compensating efforts to lose the calories.
Emotional Eating does not automatically count as a Binge
Most counselors have heard clients describe times they “emotionally eat.” You have a fight with your partner and there goes the whole two gallons of ice cream. Those uses of food to make yourself feel better are more likely a part of depression, anxiety or that often overlooked but sometimes fatal Adjustment Disorder.
The Binge Eating conclusion?
If you are overweight or obese see your doctor and work on your physical health. If you occasionally use food like a drug to treat your emotional problems work on those problems. But if you find that you or someone you know is repeatedly binging on food, feels shame and guilt about this behavior or has lost control of how much they eat, it is time for some professional help.
For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at http://www.counselorfresno.com/recommended-books/