Erase All Stereotypes: The Most Common Eating Disorder is BED

Spotlight Article by Cynthia Bulik, PhD, FAED Director UNC Center of Excellence for Eating Disorders

Erase All Stereotypes: The Most Common Eating Disorder is BED

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Dr. Cynthia Bulik, Ph.D.

Cynthia M. Bulik, PhD, FAED, (BA, University of Notre Dame; MA, PhD, University of California, Berkeley) is Distinguished Professor of Eating Disorders in the Department of Psychiatry in the School of Medicine at the University of North Carolina at Chapel Hill, where she is also Professor of Nutrition in the Gillings School of Global Public Health, and director of the UNC Center of Excellence for Eating Disorders.

She developed treatment services for eating disorders both in New Zealand and in the United States. Her research includes treatment, laboratory, epidemiological, twin, and molecular genetic studies of eating disorders.

She is a recipient of several awards including the Eating Disorders Coalition Research Award, the Academy for Eating Disorders Leadership Award for Research, the Price Family National Eating Disorders Association Research Award, IAEDP Honorary Certified Eating Disorders Specialist Award, and the AED Meehan/Hartley Award for Advocacy.

Dr. Bulik is past president of the Academy for Eating Disorders, past Vice-President of the Eating Disorders Coalition, past Associate Editor of the International Journal of Eating Disorders, and Chair of the Scientific Advisory Council of BEDA.

She is passionate about translating science for the public and has appeared on many national shows including the Today Show, Good Morning America, CBS This Morning, Katie, Dr. Oz, and Dr. Phil. Her works has been featured in the New York Times, the Washington Post, USA Today, Newsweek and Time. Dr. Bulik holds the first endowed professorship in eating disorders in the United States. Read more at www.cynthiabulik.com.

Binge Eating Disorder

When someone says “eating disorder,” what image do you conjure up in your mind? Chances are if you are like most people, you imagine a thin, white, upper-middle class teenage girl. Surprisingly, you couldn’t be more wrong. If we look at the numbers, the most common profile of someone with an eating disorder is probably a woman in her thirties or forties who struggles with weight control and suffers from BED. Countless women and men in midlife and beyond from all racial, ethnic, and socioeconomic backgrounds wake up each morning with BED and until now, they did not even have a diagnostic category of their own. BED is the most common eating disorder, afflicting 3.5% of women and 2.0% of men in the U.S.  This translates to 4.2 million women and 2.3 million men in the U.S with BED. IN 2013, BED will finally find a home in the American Psychiatric Associations compilation of mental disorders the DSM-5.

The proposed DSM-5 criteria for BED include:

  • Recurrent episodes of binge eating defined fundamentally in the same manner as bulimia nervosa, but augmented by descriptors that characterize the experience of the binge as eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone because of embarrassment, and feelings of disgust, depression, or guilt after a binge.
  • The individual must experience distress over the binge eating.
  • The frequency and duration is on average once a week for three months.
  • To be distinguished from bulimia nervosa, an individual must not engage in regular compensatory behaviors and the behaviors cannot occur in the context of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder.

But these are just the diagnostic criteria. They cannot convey the pain associated with BED.

What does BED feel like? Listen to Donna’s story:

“I remember as a child listening to my parents talk about missing food and my mom walking in on me after I baked cookies, asking me where they all went. I told her that I had burned them and had to put them down the garbage disposal. Thus started a life of lies. I was teased about my weight during school and buried my pain in food. I have been binge eating since I was six, but I never knew what it was or that other people did it. As an adult, I would do the weekly grocery shopping for the family and not be able to wait to get into the car with the bags—I would eat cookies all the way home. I remember with shame having eaten my son’s entire sixth birthday cake, all decked out in a Lego theme, before he and his friends got home from school for the party. I had to run to the store and buy a generic undecorated sheet cake just so they would have cake. I have never felt so ashamed. When the urges would come over me, nothing, not even disappointing my son, could stop me.”

Donna illustrates vividly the shame that can accompany BED. Many people with BED don’t even know they have a disorder. They are too ashamed to tell others for fear of just being labeled as being a glutton or being accused of having no self-control. We hope that recognition in the DSM-5 will liberate people from the shadows of shame and allow them to reach out for the care that they deserve.

The most important message is that BED is treatable. It does not have to be a life sentence. At this point in time, the treatment of choice for BED is cognitive behavioral therapy, which helps get a handle on unhealthy thoughts that might perpetuate binge eating. Here’s a classic example: after eating a small amount of a food that someone views as high risk or triggering he says, “Well, I already blew it. I may as well eat the whole package.” Helping someone get a handle on these runaway thoughts can empower him to stop the binge in its tracks. Some people also find medication such as antidepressants or anticonvulsants to be of value; however, these medications do not provide long-term tools for managing urges to binge.

The single most important step for anyone who suspects she might have BED is to get an evaluation. Whether it be by a primary care physician, a psychologist, or a dietitian—it is a critical first step. Many people are afraid that if they go in for an evaluation that means they are committing to years and years of psychotherapy. That is not the case! People vary widely in how long and what type of treatment they need. For some, a good self-help book or program might be all it takes. For others, a good relationship with a dietitian can go miles toward normalizing eating and reducing the urge to binge. For others, brief courses of psychotherapy help get the urges under control. You will never know what your recovery path will look like until you take that first step.

 

For more information on BED and eating disorders in general see Crave: Why You Binge Eat and How to Stop and Midlife Eating Disorders: Your Journey to Recovery at http://www.cynthiabulik.com.

 

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