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
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
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
B. The binge-eating episodes are associated with three (or more) of
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
5. feeling disgusted with oneself, depressed, or very guilty after
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for
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
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
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
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