Binge Eating Disorder & Processing Emotion

Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder. BED is the most common eating disorder in the United States. In fact, it is three times more common than anorexia and bulimia combined.

BED is defined as recurrent episodes of binge eating, where an individual objectively eats large amounts of food with a sense of loss of control. The binge eating episodes are associated with three or more of the following:

• Eating much more rapidly than normal
• Eating until uncomfortably full
• Eating large amounts even when not hungry
• Eating alone due to feelings of embarrassment
• Feeling disgusted, depressed, or ashamed after an episode

With BED, binge eating occurs at least once per month for three months, and the person does not engage in any compensatory behaviors (for example, purging), as seen in other eating disorders, such as bulimia.

Binge Eating Disorder & Processing Emotion

One symptom associated with BED is difficulty processing emotions — that is having:

• Difficulty acknowledging, recognizing, accepting, and understanding one’s own emotions
• Acting on impulse
• Difficulty tolerating negative emotions (such as sadness, loneliness, anxiety, guilt, and shame)
• Difficulty modulating one’s own emotions

In a recent study by Monell, Clinton, & Birgegård (2020), they found that in individuals struggling with binge eating as experienced in BED, those with more difficulty focusing on and understanding emotions had lower self-affirmation. In other words, they had difficulty taking a friendly, accepting, and curious stance toward themselves.

They were also more likely to have a harsh and hostile style of self-regulation that strongly resembled self-criticism and maladaptive perfectionism. These difficulties are common traits found in those struggling with an eating disorder and often are a part of the “binge-diet cycle” (see below) that perpetuates BED.

In addition, these researchers found that, overall, difficulties with processing emotion were associated with greater body, shape, and weight concerns — which are common concerns amongst those with eating disorders.

How difficulties processing emotion may contribute to the development and maintenance of BED

Often, individuals who struggle with BED get caught up in the binge-diet cycle (see image at right) that perpetuates the disorder. As part of this cycle, a person might experience difficult emotions such as anxiety, guilt, or shame.

It is thought that because an individual is struggling to process these difficult emotions, they turn to binge eating. Binge eating may act as a way to soothe, distract from, or down-regulate one’s emotions— in other words, it helps regulate the negative emotions that occur in this cycle.

Taking a closer look at the binge-diet cycle, it often begins with dieting (or restricting consumption of perceived “bad” foods). While this restriction may result in initial feelings of accomplishment, individuals are bound to experience food preoccupation and craving as their bodies fight to maintain homeostasis.

Our bodies do not want to be deprived, so they let us know that we need a variety of food by sending us hunger cues — feeling an empty stomach, stomach growling, headache, light-headed, grumpy, or “hangry,” lack of energy, shakiness/weakness. We begin to have overwhelming food cravings and can’t seem to think about anything else other than food.

While this food preoccupation and craving is simply our body doing its job, it results in overwhelming anxiety as one fights to maintain a restrictive diet. Ultimately, as a way to “get rid of” or modulate this anxiety, a binge episode occurs, which then results in difficult emotions like guilt, shame, frustration, or sadness.

As an attempt to “correct” these emotions, the individual returns to dieting or limiting “bad” foods. In doing so, this only continues the binge-diet cycle.

Let’s pause here for a moment to acknowledge the complexity of this cycle. The development and maintenance of BED are not due simply to a problem with processing emotions. There are many factors at play, including biological, psychological, and socioenvironmental factors.

Biological factors include things like the hormones involved in regulating hunger and fullness in an attempt to maintain homeostasis. It includes hunger cues and physiological deprivation due to restricting or dieting.

Psychological factors include things like the characteristics highlighted by the research of Monell, Clinton, & Birgegård (2020) — tendencies towards harsh self-criticism and maladaptive perfectionism. It includes judging foods as “good” or “bad” and criticizing oneself for eating “bad” foods. It includes mentally feeling deprived of certain foods.

Socioenvironmental factors include things like growing up in diet culture, being subjected to weight-bias and limited to access to a variety of foods.

While this cycle may look different for everyone (everyone’s biological, psychological, and social environmental factors are unique to them), this binge-diet cycle and difficulty with processing emotion are commonly recognizable amongst those struggling with BED.

Addressing difficulty with processing emotion with BED treatment

One way to exit the binge-diet cycle is to learn how to effectively process emotions. Empirically-backed treatment approaches like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) focus on identifying how thoughts, emotions, and behaviors are connected.

They also help build skills to help individuals learn how to decrease disordered eating behaviors while tolerating difficult emotions (like anxiety and guilt), getting disentangled from distressing events, and increasing the curiosity towards one’s own mental states.

Other approaches, such as psychodynamic and interpersonal therapy, can help individuals explore associations between emotions and eating behaviors, while also helping individuals understand how relationships inside and outside therapy impact BED symptoms.

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Sources:

1. National Eating Disorders Association. Learn: Binge Eating Disorder. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed on May 11, 2020.

2. National Eating Disorders Association. Learn: Statistics and research on eating disorders. Retrieved from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders on May 11, 2020.

3. Hudson, J. I., Hiripi, E., Pope, H. G., Jr, & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348–358. doi:10.1016/j.biopsych.2006.03.040

4. Fielder-Jenks, C. Development & Maintenance Causes of Binge Eating Disorder. Retrieved from https://www.eatingdisorderhope.com/blog/causes-binge-eating-disorder-development-maintenance on May 11, 2020.

5. Monell, E., Clinton, D. & Birgegård, A. Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating. J Eat Disord 8, 17 (2020). https://doi.org/10.1186/s40337-020-00294-4

6. Polivy J., Herman C.P. Etiology of binge eating: Psychological mechanisms. In: Fairburn C.G., Wilson G.T., editors. Binge Eating: Nature, Assessment, and Treatment. The Guilford Press; New York, NY, USA: 1993. pp. 173–205.

7. Dingemans, A., Danner, U., & Parks, M. (2017). Emotion Regulation in Binge Eating Disorder: A Review. Nutrients, 9(11), 1274. https://doi.org/10.3390/nu9111274

8. Wallace, L.M., Masson, P.C., Safer, D.L. et al. Change in emotion regulation during the course of treatment predicts binge abstinence in guided self-help dialectical behavior therapy for binge eating disorder. J Eat Disord 2, 35 (2014). https://doi.org/10.1186/s40337-014-0035-x

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About the Author:

Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.

She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.

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The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published May 14, 2020, on EatingDisorderHope.com
Reviewed & Approved on May 14, 2020, by Jacquelyn Ekern MS, LPC