Binge Eating Disorder

The DSM-5 may include binge eating disorder, which may have best described my symptoms from ages 13-21. At present, binge eating disorder is listed in the DSM-IV in the appendix, and the closest diagnosis would be 307.50 Eating Disorder NOS.

DSM-5 Proposed Diagnostic Criteria for Binge Eating Disorder:

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. The binge-eating episodes are associated with three (or more) of the following:

1. eating much more rapidly than normal
2. eating until feeling uncomfortably full
3. eating large amounts of food when not feeling physically hungry
4. eating alone because of being embarrassed by how much one is eating
5. feeling disgusted with oneself, depressed, or very guilty after overeating

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for three months.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (i.e., purging) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

At age 13, not long after I moved in with my father and his girlfriend, I fit the criteria for Binge Eating Disorder. I binged usually after school when I was alone in the house, but eventually began to binge before school as well, also when I was alone in the house. I would also eat junk food on weekend evenings while my father drank alcohol. I would wake up feeling full to the extent that it would put a damper on my weekend, but I couldn't seem to control it. The afterschool binges were the worst, and compounded by the fact that I was expected to eat dinner when my father and his girlfriend came home, even if I was already full.

I ate large amounts of food (eg: at once I could eat an entire box of cookies and an entire box of crackers, with cheese, or if I sat down to eat one bowl of cereal I would eat a whole box.) I felt out of control and could not stop once I started, uncomfortably full (which would make it difficult to concentrate at school, but would also contribute to digestion issues which would make it difficult to concentrate as well - on a regular basis), I would feel an enormous amount of guilt regarding the waste, the excess, and how much expense I was causing, I would not want to have been observed binging, I ate rapidly, and with marked distress.

I did not seek help until age 15, but when I tried to explain to various professionals, it was often assumed that the problem with food was relatively minor, whereas I felt that it was controlling every aspect of my life. I probably looked a healthy, normal weight, and as teenagers may exaggerate, it may have been assumed that I was feeling excessive guilt for relatively minor reasons. However, my weight constantly fluctuated, and I never had the feeling that I was in control of my eating. I knew there was something different about my relationship with food that I did not see in other kids I knew. Other kids had weight concerns, but I don't think their eating patterns were like mine.

Pretty much every weekend when I came home from school (age 13 onward), I would tell myself that over the weekend I would get my eating under control, but when Monday morning would come, I would not feel in control.

When I spent the summer with my mother (at age 14, after living away from her for the schoolyear), my eating was 'normal' again, for the entire summer. A year away from the structure she had provided did not totally erase its effects, and I was able to fall back on it. My weight was a constant 113-4 lbs all summer, and that might have been the 'natural' weight for my body at that time.

After I left to go back to my father's, I was again out of control with food, my weight fluctuated constantly throughout the schoolyear, and when I went back to visit my mother the next summer I couldn't get back into the old routine. After a week of extreme dieting and exercising, and a resulting backlash binge, I knew that something was wrong and that I couldn't handle the pressure, and it was at this time that I asked to see someone professionally.

The next year of high school was the worst yet as far as food and fluctuating weight, and by summer there was no way I could manage to spend an entire summer with my mother. My visit was again short, and not long after I left, she died suddenly.

On a few occasions, I made attempts to purge that were unsuccessful. On a few occasions over a period of 7 years, I fasted. It was not until the age of 21 that I began fasting regularly. I was very frequently trying to diet, but with the exception of only a couple of occasions, I kept the calorie count reasonable (1200 per day) and the amount of exercise was probably not excessive most of the time considering my level of fitness. However, I may have been more fit than I realized or when doing farmwork which I didn't count as exercise may have compensated for some of my binges.

I was not technically bulimic until age 21. At that age, I had first embarked on a fitness and weightloss plan, and managed to lose a significant amount of weight in a 'healthy' way. I didn't go below 1200 calories per day, and although I exercised a lot, I have a body type that can/could handle a lot of exercise without injury. When I lost control again and started to gain weight back, I became desperate enough to try an alternative appproach, partly because I had been living away from home, and was scared that I'd end up back there. I first began trying to control my weight with regular fasting, and later I began to self-induce vomiting.

The regular fasting that began at the age of 21 was a desperation measure. I had worked hard to lose weight and get fit before leaving the family home, and once away from home I was afraid of falling back into old habits that I associated with being trapped in the home. I would have preferred to keep weight off in a healthy way, but at that time I began to see that fasting, which I did not consider healthy, was better than moving back home.

When I found I was more and more out of control and unable to control things by fasting, I went back home, and almost immediately I began to self-induce vomiting. It didn't really help with my weight so much - I gained weight back rapidly in spite of doing it - but at that point I began to question how smart it really was to suffer through the hours of painful digestion if you didn't have to.

From age 21 onward, Binge Eating Disorder had become Bulimia Nervosa.

I realize that it is difficult for most people to accept that Binge Eating Disorder is not just a silly diagnosis made up to accommodate those with no self-control. Perhaps it has an evolutionary basis - in times of plenty, we get cues to eat as much as possible, and if there are never times of dearth, we just keep eating, or learn to create the periods of dearth ourselves?

From the DSM-5 draft:

In terms of antecedent validators, there is evidence from family history studies that BED tends to run in families and is not a simple familial variation of obesity. Furthermore, in comparison to other eating disorders, BED shows a relatively distinct demographic profile with a greater likelihood of male cases, older age, and a later age of onset.

Regarding studies of concurrent validators, BED is also differentiated from obesity in terms of greater concerns about shape and weight, more personality disturbance, and a higher likelihood of psychiatric comorbidity in the form of mood disorders and anxiety disorders. Also, BED is associated with lower quality of life than obesity.

I have mentioned that my father used alcohol, cigarettes and coffee to help him with anxiety and depression, and perhaps glossed over the food aspect. It may have been something not recognized as a problem, since he was a tall and very muscular/athletic man who could perhaps eat significantly more than most people. When young he was considered skinny, and for the purpose of sports at one point he was required to gain a significant amount of weight. When your activity level drops, you cannot continue to eat as much, although if you have a genetic predisposition for obesity or binge eating, the habit once acquired might be difficult to drop again.

It could be that not only my mother and my father's girlfriend had food and body image issues, but that also my father had significant issues in these areas.

On my mother's side of the family, binge behaviour was encouraged (and even rewarded) during special occasions, like Christmas and Easter. I associated visits to my mother's family with pleasure, fun, happiness. One of the major issues in my parents' relationship that contributed to its demise might have revolved around my mother's attempts to separate special occasions from the everyday, whereas my father wanted to have special things every day, or could see no reason for restraint. However, it may be that as a result of feeling out of control with food, he adopted this philosophy.

When my mother was 37 years old, she confided in me that her doctor had told her she had heart problems. I was stunned - it didn't make sense to me, and I didn't know how to absorb the information. She was slim, and looked young for her age. It is possible that she engaged in binge behaviour which I was not aware of, and that she controlled her weight through fasting, or periods of extreme caloric restriction.