April 29, 2022 • 18 mins
Binge eating—eating too much, too often and feeling miserable afterward—is the most common of eating disorders. A mother who worries about her teen daughter’s secret cookie habit gets advice from Dr. Saltz.
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Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how Can I Help? I'm Dr
Gale Salts. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Eating disorders in general
can be severe, even life threatening, and certainly do require treatment.
Most people think that to have an eating disorder, you
have to be too thin, or be throwing up, or
(00:47):
using some method to either restrict what you eat or
get rid of calories you have consumed. But this is
not true for all types of eating disorders. So today
I'm answering a question about binge eating. Binge eating is
a type of eating disorder, the most recently recognized one
in the Psychiatric Diagnostic Manual. It is actually also the
(01:12):
most common of the eating disorders. The lifetime prevalence is
two point eight percent of the population, with twice as
many females affected as males. Binge eating disorder is characterized
by recurrent binge eating episodes, during which the person feels
(01:32):
a loss of control and marked distress over his or
her eating. But unlike bolimia nervosa, binge eating episodes are
not followed by purging, by excess exercise, or by fasting.
As a result, people with binge eating disorder often are
(01:53):
overweight or even obese. Specifically, the diagnostic criteria to meet
the criteria for binge eating disorder is for current episodes
of beinge eating. An episode of bidge eating is characterized
by both of the following eating in a discreete period
of time, like within any two hour period, any amount
(02:16):
of food that is definitely larger than what most people
would eat in a similar period of time under similar circumstances,
and a sense of lack of control over eating during
the episode, like feeling that one cannot stop eating or
control what or how much one is eating. Then also,
(02:37):
the binge eating episodes are associated with three or more
of these following things. Eating much more rapidly than normal,
like really fast eating until feeling uncomfortably full, eating large
amounts of food when not feeling physically hungry, to start
eating alone, because of feeling embarrassed by how much one
(03:00):
is eating, and feeling disgusted with oneself depressed or very
guilty afterwards. It's also a hallmark to have marked distress
regarding the binge eating being present as a phenomenon in
your life at all, and the binge eating must occur
on average at least once a week for three months.
(03:25):
You also want to make sure that it is not
part of actually bulimia nervosa where there would be purging,
and does not occur during anorexia nervosa, which is really
characterized more by restricting calories. So generally speaking, the difficulty
in being able to treat an eating disorder of any
(03:47):
kind is that the person with the disorder may have
difficulty realizing they do, and because they tend to be
secretive about their eating, others around them they also not
realize what is going on. There are, however, red flags
and warning signs that might alert you that you or
(04:07):
someone close to you is really struggling with binge eating.
So let me tell you the list of red flags.
Disappearance of large amounts of food in short periods of
time or lots of empty wrappers and containers, indicating there
has been a consumption of a large amount of food.
(04:28):
The person appears uncomfortable eating around other people, any new
practice that you see with food or with bad diets,
like cutting out entire food groups like I don't eat
sugar or carbs or dairy, or I'm suddenly going to
be a vegan, the fear of eating in public or
with other people, stealing or hoarding food in strange places,
(04:55):
creating a lifestyle schedule or a ritual to make time
for being sessions withdrawal from your usual friends and activities,
frequently dieting, showing extreme concern with body weight and shape,
and frequently checking the mirror for perceived flaws in how
(05:17):
you look. Having secret recurring episodes of binge eating, of course,
which is the eating in a discreet period of time
and amount of food that is much larger than most
individuals we'd eat under the similar circumstances, and feeling a
lack of control over your ability to stop eating, a
(05:38):
disruption in normal eating behaviors, including eating throughout the day
with no planned meal times, skipping meals, were taking small
portions of food at regular meals, and engaging in sporadic
fasting or repetitive dieting. The point here is that people
with binge cheating may avoid food at other times to
(06:01):
try to compensate for when they're binging. They may develop
food rituals, so just only eating a particular food group,
or you might find their excessively chewing their food and
trying to make it last a long time. We're not
allowing their foods to touch each other. People with binge
(06:21):
eating disorder can have other strange rituals about food. They
may be eating alone out of embarrassment at the quantity
of food that they are eating, feeling discussed or depression
or guilt about overeating. And you may know fluctuations in
weight because they're binging it sometimes and then they're not
(06:43):
eating at other times, and there may be feelings of
low self esteem across the board. People with bene eating
may also have some physical problems like stomach cramps or
other gastro intestinal complaints like constant patient or asset reflux
because the body is not meant to binge food and
(07:04):
it can cause some g I upset. And they may
also note that they have difficulty concentrating on things, and
this is probably because they're pretty preoccupied with when and
how they are going to binge food overall, experiencing shame
about what one eight or one's body is a major
(07:25):
feature as well of binge eating disorder. So with that,
right after the break, we'll get to my listeners question.
(07:47):
Welcome back. Let's get to my listeners question and see
how can I help, dear doctor Selts. I was cleaning
my teenage daughter's room when I found multiple wraps of
cookie bags under her bed, and I found potato chips
in a drawer. This seems odd to me because they
(08:09):
are not things I have bought for the house, and
I was unaware that she bought them, let alone ate
them all. She is a little overweight, but not a lot,
and she seems unconcerned about her body weight, and actually
neither am I. I asked her about the cookies and
she got really upset, like so upset and saying she
(08:32):
didn't want to talk about it that now I'm concerned
that there is more to this than just I felt
like some cookies. I don't limit what she can eat,
so I don't know why she would need to sneak
food into her room or why it would upset her
to tell me. Can you help me figure out what
is going on and why? When a mom gets a
(08:57):
feeling something is up with her child, I inclined to
put a lot of stock into that feeling. You have
concerns that she is sneaking junk food into her room,
eating it secretly, and trying to then hide the evidence
she has eaten it. Kids might sneak food because there
are limits on what they are allowed to eat at home,
(09:18):
and so they know they're breaking the rules and they
hide it. You, however, know that you don't really have
those rules, and so she doesn't need to sneak it.
It does seem she is hiding the eating of the
food without a need to, and that she is openly
(09:39):
upset at mentioning you saw it and asking her why
she did that. All of this raises the suspicion of
compulsive eating, that she feels the need to eat in secret,
something that she feels ashamed about and doesn't want anyone
to know, including you. Compulsive eating, the feeling of needing
(10:03):
to eat food and feeling you don't have control over
this eating and then feeling bad about it, often comes
in the form of binge eating. Binge eating, in particular,
is eating large quantities, like an entire package of cookies,
rather than a few cookies in a short period of time,
like one sitting and often eating them very fast. If
(10:27):
her cookie eating is spread out over the course of days,
well that isn't binge eating. It's sneaking junk food that
she feels she shouldn't really have and therefore is keeping secret,
and it could become a harbinger of a future eating disorder,
but it honestly might not. But if rather she's eating
(10:47):
a package of cookies in a two hour period and
hiding it and feeling ashamed and guilty about what she
is doing, and she's doing it even every few weeks,
then this is a binge eat eating disorder and it
needs treatment. A one time binge because it's a holiday
or she has friends over and they go overboard does
(11:11):
not make for an eating disorder. But if you keep
finding packages and rappers in her room, then this is
not a once in a blue moon situation. You can
sit down with your daughter and explain what binge eating
is because she might not know and why it's a problem.
Though not her fault and likely not something she can
(11:34):
control on her own without some therapeutic help, it's that
it is unhealthy and can have long term unhealthy consequences
for both her body and her mind that it's important
you explain that to her. Encourage her to speak to
a therapist who specializes in adolescent eating disorders to learn
(11:58):
ways that she can manage these impulse and reverse or symptoms.
The earlier you help her get intervention, the easier it
will be for her to undo this issue. People with
binge eating disorder also often have another mental health issue,
especially an anxiety disorder, a depression, or even a substance
(12:22):
used disorder. This is again another reason to have her
see someone who can evaluate for those and treat or
to treat the eating disorder and decrease the likelihood of
developing one of these other mental health disorders. Should you
definitely get her to a therapist, try asking her these questions,
(12:45):
which are likely to give you more information. Sit down
with her and say, hey, honey, do you eat unusually
large amounts of food or until you're actually uncomfortably full?
Do you feel you're eating is out of control? Have
you tried to lose weight, and if so, how are
you doing that? Do you think about food often? Do
(13:11):
you eat even when you're full or not hungry? Do
you eat in secret? Are you feeling depressed, ashamed or guilty?
About your eating. Do you make yourself vomit to get
rid of calories? Are you concerned about your weight? Do
you exercise how often? Because too often is an indicator
(13:36):
of actually some sort of eating disorder. These are the
kinds of questions that can point to a growing eating
disorder and help both of you to be aware if
she needs some help. If she's answering affirmative to even
a few of these, I would definitely get her a therapist.
(13:58):
I hope that was helpful. The goals for treatment of
binge eating disorder are to reduce eating binges and achieve
healthy eating habits. Because bene eating can be so intertwined
with shame, with poor self esteem, and other negative emotions,
treatment may also address these and other mental health issues
(14:20):
like depression. By getting help for being cheating, you can
learn how to feel more in control of your eating.
Whether an individual or in group sessions, some sort of
psychotherapy can help teach you how to exchange unhealthy habits
for healthy ones and reduce the episodes. There are different
(14:40):
forms of psychotherapy that can be helpful, but most of
them fall into the realm of cognitive behavioral therapy, which
helps you cope better with issues that trigger binge eating episodes,
such as negative feelings about your body or a depressed mood.
It can also give you a better sense of con
troll over your behavior and help you regulate your eating patterns.
(15:05):
Weight loss programs, which might be needed if you've developed obesity,
are generally done under medical supervision for people with binge
eating to ensure that your nutritional requirements are met and
that you're not triggering further binge eating, which is why
it's important to treat the binge eating first. Typically, treating
(15:30):
binge eating disorder on your own isn't effective, but you
can try these things to help reinforce what the therapist
is doing. Don't skip sessions with a therapist, have a
meal plan and do your best to stick to it.
Avoid dieting unless it's supervised dieting because dieting can put
(15:52):
you into the vicious cycle of more binging, so doing
it with your therapist help and sometimes even with a
doctor's help, is the best way to go. If you
have this disorder, do eat breakfast. Many people with binge
eating disorder skip breakfast, but if you eat breakfast, you're
actually less prone to eating higher calorie meals. Later in
(16:15):
the day, arrange your environment in a way that doesn't
trigger your binges. So most people with being cheating disorder
are very tempted by particular types of food to binge,
so keeping those foods out of your home and limiting
your exposure to them can be helpful. You do want
to make sure you're getting the right kind of nutrition.
(16:39):
People who binge can eat junk food and then not
eat other food and actually be nutritionally depleted, which actually
makes you feel worse. And it's important that you share
somewhat with caring family members or friends who want to
see you get healthy and who you can connect with
and who can be x scepting and understanding, because that
(17:02):
kind of support will help you. And of course exercise
is helpful because it's really helpful for your mood. It's
just a matter of not overdoing it. Living with an
eating disorder is really difficult because you have to deal
with food on a daily basis, so it's not something
like a drug or alcohol that you can just avoid altogether.
(17:26):
So remember these things. If you're struggling with an eating disorder,
don't buy into your own self criticism. You are doing
the best you can identify situations that can trigger destructive
eating behaviors so you can develop a plan to deal
with them. Look for positive role models who can help
lift your self esteem and remind yourself that ultra thin
(17:49):
models or celebrities actresses showcased in women's magazines often don't
represent healthy or realistic bodies. Try to have a trusted
relative or friend who you can talk to about what's
going on, and try to find someone who maybe even
can be your partner in the battle against binge eating,
(18:11):
somebody you can call for support instead of binging. Make
sure to nurture yourself by doing something just for fun
or to relax, something like taking a walk, doing some meditation,
practicing some yoga, and sometimes journaling about your feelings and
behaviors can really be helpful. You can look back and
(18:33):
reflect on where you've been and where you've come, and
it can help you be more aware of your feelings
and your actions and how they're related. Do you have
a problem I can help with? If so, email me
yet how can I help? At Seneca women dot Com,
all centers remain anonymous and listen every Friday too. How
(18:54):
can I help with me? Doctor Gale's Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how Can I Help? I'm Dr
Gale Salts. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Eating disorders in general
can be severe, even life threatening, and certainly do require treatment.
Most people think that to have an eating disorder, you
have to be too thin, or be throwing up, or
(00:47):
using some method to either restrict what you eat or
get rid of calories you have consumed. But this is
not true for all types of eating disorders. So today
I'm answering a question about binge eating. Binge eating is
a type of eating disorder, the most recently recognized one
in the Psychiatric Diagnostic Manual. It is actually also the
(01:12):
most common of the eating disorders. The lifetime prevalence is
two point eight percent of the population, with twice as
many females affected as males. Binge eating disorder is characterized
by recurrent binge eating episodes, during which the person feels
(01:32):
a loss of control and marked distress over his or
her eating. But unlike bolimia nervosa, binge eating episodes are
not followed by purging, by excess exercise, or by fasting.
As a result, people with binge eating disorder often are
(01:53):
overweight or even obese. Specifically, the diagnostic criteria to meet
the criteria for binge eating disorder is for current episodes
of beinge eating. An episode of bidge eating is characterized
by both of the following eating in a discreete period
of time, like within any two hour period, any amount
(02:16):
of food that is definitely larger than what most people
would eat in a similar period of time under similar circumstances,
and a sense of lack of control over eating during
the episode, like feeling that one cannot stop eating or
control what or how much one is eating. Then also,
(02:37):
the binge eating episodes are associated with three or more
of these following things. Eating much more rapidly than normal,
like really fast eating until feeling uncomfortably full, eating large
amounts of food when not feeling physically hungry, to start
eating alone, because of feeling embarrassed by how much one
(03:00):
is eating, and feeling disgusted with oneself depressed or very
guilty afterwards. It's also a hallmark to have marked distress
regarding the binge eating being present as a phenomenon in
your life at all, and the binge eating must occur
on average at least once a week for three months.
(03:25):
You also want to make sure that it is not
part of actually bulimia nervosa where there would be purging,
and does not occur during anorexia nervosa, which is really
characterized more by restricting calories. So generally speaking, the difficulty
in being able to treat an eating disorder of any
(03:47):
kind is that the person with the disorder may have
difficulty realizing they do, and because they tend to be
secretive about their eating, others around them they also not
realize what is going on. There are, however, red flags
and warning signs that might alert you that you or
(04:07):
someone close to you is really struggling with binge eating.
So let me tell you the list of red flags.
Disappearance of large amounts of food in short periods of
time or lots of empty wrappers and containers, indicating there
has been a consumption of a large amount of food.
(04:28):
The person appears uncomfortable eating around other people, any new
practice that you see with food or with bad diets,
like cutting out entire food groups like I don't eat
sugar or carbs or dairy, or I'm suddenly going to
be a vegan, the fear of eating in public or
with other people, stealing or hoarding food in strange places,
(04:55):
creating a lifestyle schedule or a ritual to make time
for being sessions withdrawal from your usual friends and activities,
frequently dieting, showing extreme concern with body weight and shape,
and frequently checking the mirror for perceived flaws in how
(05:17):
you look. Having secret recurring episodes of binge eating, of course,
which is the eating in a discreet period of time
and amount of food that is much larger than most
individuals we'd eat under the similar circumstances, and feeling a
lack of control over your ability to stop eating, a
(05:38):
disruption in normal eating behaviors, including eating throughout the day
with no planned meal times, skipping meals, were taking small
portions of food at regular meals, and engaging in sporadic
fasting or repetitive dieting. The point here is that people
with binge cheating may avoid food at other times to
(06:01):
try to compensate for when they're binging. They may develop
food rituals, so just only eating a particular food group,
or you might find their excessively chewing their food and
trying to make it last a long time. We're not
allowing their foods to touch each other. People with binge
(06:21):
eating disorder can have other strange rituals about food. They
may be eating alone out of embarrassment at the quantity
of food that they are eating, feeling discussed or depression
or guilt about overeating. And you may know fluctuations in
weight because they're binging it sometimes and then they're not
(06:43):
eating at other times, and there may be feelings of
low self esteem across the board. People with bene eating
may also have some physical problems like stomach cramps or
other gastro intestinal complaints like constant patient or asset reflux
because the body is not meant to binge food and
(07:04):
it can cause some g I upset. And they may
also note that they have difficulty concentrating on things, and
this is probably because they're pretty preoccupied with when and
how they are going to binge food overall, experiencing shame
about what one eight or one's body is a major
(07:25):
feature as well of binge eating disorder. So with that,
right after the break, we'll get to my listeners question.
(07:47):
Welcome back. Let's get to my listeners question and see
how can I help, dear doctor Selts. I was cleaning
my teenage daughter's room when I found multiple wraps of
cookie bags under her bed, and I found potato chips
in a drawer. This seems odd to me because they
(08:09):
are not things I have bought for the house, and
I was unaware that she bought them, let alone ate
them all. She is a little overweight, but not a lot,
and she seems unconcerned about her body weight, and actually
neither am I. I asked her about the cookies and
she got really upset, like so upset and saying she
(08:32):
didn't want to talk about it that now I'm concerned
that there is more to this than just I felt
like some cookies. I don't limit what she can eat,
so I don't know why she would need to sneak
food into her room or why it would upset her
to tell me. Can you help me figure out what
is going on and why? When a mom gets a
(08:57):
feeling something is up with her child, I inclined to
put a lot of stock into that feeling. You have
concerns that she is sneaking junk food into her room,
eating it secretly, and trying to then hide the evidence
she has eaten it. Kids might sneak food because there
are limits on what they are allowed to eat at home,
(09:18):
and so they know they're breaking the rules and they
hide it. You, however, know that you don't really have
those rules, and so she doesn't need to sneak it.
It does seem she is hiding the eating of the
food without a need to, and that she is openly
(09:39):
upset at mentioning you saw it and asking her why
she did that. All of this raises the suspicion of
compulsive eating, that she feels the need to eat in secret,
something that she feels ashamed about and doesn't want anyone
to know, including you. Compulsive eating, the feeling of needing
(10:03):
to eat food and feeling you don't have control over
this eating and then feeling bad about it, often comes
in the form of binge eating. Binge eating, in particular,
is eating large quantities, like an entire package of cookies,
rather than a few cookies in a short period of time,
like one sitting and often eating them very fast. If
(10:27):
her cookie eating is spread out over the course of days,
well that isn't binge eating. It's sneaking junk food that
she feels she shouldn't really have and therefore is keeping secret,
and it could become a harbinger of a future eating disorder,
but it honestly might not. But if rather she's eating
(10:47):
a package of cookies in a two hour period and
hiding it and feeling ashamed and guilty about what she
is doing, and she's doing it even every few weeks,
then this is a binge eat eating disorder and it
needs treatment. A one time binge because it's a holiday
or she has friends over and they go overboard does
(11:11):
not make for an eating disorder. But if you keep
finding packages and rappers in her room, then this is
not a once in a blue moon situation. You can
sit down with your daughter and explain what binge eating
is because she might not know and why it's a problem.
Though not her fault and likely not something she can
(11:34):
control on her own without some therapeutic help, it's that
it is unhealthy and can have long term unhealthy consequences
for both her body and her mind that it's important
you explain that to her. Encourage her to speak to
a therapist who specializes in adolescent eating disorders to learn
(11:58):
ways that she can manage these impulse and reverse or symptoms.
The earlier you help her get intervention, the easier it
will be for her to undo this issue. People with
binge eating disorder also often have another mental health issue,
especially an anxiety disorder, a depression, or even a substance
(12:22):
used disorder. This is again another reason to have her
see someone who can evaluate for those and treat or
to treat the eating disorder and decrease the likelihood of
developing one of these other mental health disorders. Should you
definitely get her to a therapist, try asking her these questions,
(12:45):
which are likely to give you more information. Sit down
with her and say, hey, honey, do you eat unusually
large amounts of food or until you're actually uncomfortably full?
Do you feel you're eating is out of control? Have
you tried to lose weight, and if so, how are
you doing that? Do you think about food often? Do
(13:11):
you eat even when you're full or not hungry? Do
you eat in secret? Are you feeling depressed, ashamed or guilty?
About your eating. Do you make yourself vomit to get
rid of calories? Are you concerned about your weight? Do
you exercise how often? Because too often is an indicator
(13:36):
of actually some sort of eating disorder. These are the
kinds of questions that can point to a growing eating
disorder and help both of you to be aware if
she needs some help. If she's answering affirmative to even
a few of these, I would definitely get her a therapist.
(13:58):
I hope that was helpful. The goals for treatment of
binge eating disorder are to reduce eating binges and achieve
healthy eating habits. Because bene eating can be so intertwined
with shame, with poor self esteem, and other negative emotions,
treatment may also address these and other mental health issues
(14:20):
like depression. By getting help for being cheating, you can
learn how to feel more in control of your eating.
Whether an individual or in group sessions, some sort of
psychotherapy can help teach you how to exchange unhealthy habits
for healthy ones and reduce the episodes. There are different
(14:40):
forms of psychotherapy that can be helpful, but most of
them fall into the realm of cognitive behavioral therapy, which
helps you cope better with issues that trigger binge eating episodes,
such as negative feelings about your body or a depressed mood.
It can also give you a better sense of con
troll over your behavior and help you regulate your eating patterns.
(15:05):
Weight loss programs, which might be needed if you've developed obesity,
are generally done under medical supervision for people with binge
eating to ensure that your nutritional requirements are met and
that you're not triggering further binge eating, which is why
it's important to treat the binge eating first. Typically, treating
(15:30):
binge eating disorder on your own isn't effective, but you
can try these things to help reinforce what the therapist
is doing. Don't skip sessions with a therapist, have a
meal plan and do your best to stick to it.
Avoid dieting unless it's supervised dieting because dieting can put
(15:52):
you into the vicious cycle of more binging, so doing
it with your therapist help and sometimes even with a
doctor's help, is the best way to go. If you
have this disorder, do eat breakfast. Many people with binge
eating disorder skip breakfast, but if you eat breakfast, you're
actually less prone to eating higher calorie meals. Later in
(16:15):
the day, arrange your environment in a way that doesn't
trigger your binges. So most people with being cheating disorder
are very tempted by particular types of food to binge,
so keeping those foods out of your home and limiting
your exposure to them can be helpful. You do want
to make sure you're getting the right kind of nutrition.
(16:39):
People who binge can eat junk food and then not
eat other food and actually be nutritionally depleted, which actually
makes you feel worse. And it's important that you share
somewhat with caring family members or friends who want to
see you get healthy and who you can connect with
and who can be x scepting and understanding, because that
(17:02):
kind of support will help you. And of course exercise
is helpful because it's really helpful for your mood. It's
just a matter of not overdoing it. Living with an
eating disorder is really difficult because you have to deal
with food on a daily basis, so it's not something
like a drug or alcohol that you can just avoid altogether.
(17:26):
So remember these things. If you're struggling with an eating disorder,
don't buy into your own self criticism. You are doing
the best you can identify situations that can trigger destructive
eating behaviors so you can develop a plan to deal
with them. Look for positive role models who can help
lift your self esteem and remind yourself that ultra thin
(17:49):
models or celebrities actresses showcased in women's magazines often don't
represent healthy or realistic bodies. Try to have a trusted
relative or friend who you can talk to about what's
going on, and try to find someone who maybe even
can be your partner in the battle against binge eating,
(18:11):
somebody you can call for support instead of binging. Make
sure to nurture yourself by doing something just for fun
or to relax, something like taking a walk, doing some meditation,
practicing some yoga, and sometimes journaling about your feelings and
behaviors can really be helpful. You can look back and
(18:33):
reflect on where you've been and where you've come, and
it can help you be more aware of your feelings
and your actions and how they're related. Do you have
a problem I can help with? If so, email me
yet how can I help? At Seneca women dot Com,
all centers remain anonymous and listen every Friday too. How
(18:54):
can I help with me? Doctor Gale's Salts
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Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.