Therapy for Binge Eating and Bulimia
Binge Eating at a Glance
Do you feel like you’re on a rollercoaster when it comes to your relationship with food? Do you often eat larger quantities of food than most people would eat in a similar time period? If so, you may suspect that you have binge eating disorder or bulimia nervosa, two similar but distinct forms of disordered eating. Maybe you’re not sure if you have an eating disorder, but you feel like you’re stuck in a cycle of emotional or compulsive eating.
Perhaps you eat out of habit or to cope with feelings of stress, anxiety, sadness, and boredom.
Throughout the day, you might be preoccupied with thoughts about food. If so, somedays this may sound like battling your urge to binge eat, and other days it may seem like the only thing you can think about is planning your next binge. You might arrange your days and evenings around binge eating, preferring to keep all of this hidden from others. Perhaps you decline social invitations because part of you would rather stay home and eat alone. You might delay going to sleep so you can secretly binge at night. Perhaps you even try to hide your binges from store clerks by buying food at various locations. Your preoccupation with food is exhausting, and it distracts you from important areas of your life.
Once you start binge eating, it’s often hard to stop. It may feel like you’re on autopilot. Sometimes binge eating feels pleasurable, other times it feels robotic. You tend to eat to the point of physical discomfort, and you experience feelings of regret and shame following a binge. Perhaps you vomit or engage in other unhealthy behaviors in an attempt to feel better. If so, you’ve likely learned that these behaviors have consequences, and any relief they bring is short-lived.
You realize your relationship with food is taking a serious toll on your health, relationships, and overall wellbeing. You’ve made commitments to stop binging in the past, but you inevitably find yourself back on the rollercoaster of emotional eating. At this point, you’re not sure if change is possible, but change is what you desperately want. If you relate to this experience, we encourage you to keep reading. This page covers reasons to be hopeful about the treatment of eating disorders, what you can expect as you begin to feel better, our experience in this area, and some of the most common questions clients have about the process.
A Healthier Relationship with Food
Imagine waking in the morning and feeling good about yourself. Imagine feeling at ease in your body. Imagine your first thoughts of the day being about what you want to accomplish, experience, or enjoy as opposed to what you ate yesterday, what you tell yourself you can’t eat today, and how terribly you feel about your relationship with food.
As you go about your day, imagine trusting your body to reach a healthy state when it’s given balanced meals that nourish and energize. With compulsive eating no longer occupying your mind, you’re free to spend time with loved ones and develop new hobbies and interests. Your life feels richer; you feel connected with others, and you experience moments of joy.
Imagine winding down your day knowing you’ve given your body what it needs. Imagine feeling grateful for all you were able to do and experience throughout the day. Finally, imagine feeling ready for a good night’s sleep and doing just that - sleeping comfortably throughout the night, preparing yourself for the dawn of a new day.
Reasons to be Hopeful
You're Not Alone
Binge Eating Disorder (BED) is the most common eating disorder in the United States, impacting approximately 3% of women and 2% of men at any given point in time. Bulimia nervosa (BN) impacts 1-3 % of young adult women and one tenth that number of men. While it’s not good news that so many adults are impacted by eating disorders, it may understandably ease your mind to know you’re not alone. Since so many individuals are impacted by BED and BN, there’s considerable research about treatments that help.
Therapy is effective for BED and BN. While the treatment approach for each disorder varies slightly, research consistently shows that therapy significantly reduces symptoms for patients with either disorder. For example, following a course of CBT, it’s estimated that 50-55% of patients fully recover and another 25% of patients experience significant gains. Other studies have found CBT to be effective for 95% of patients with binge eating disorder. Importantly, follow up studies show that these gains are maintained over time.
Drs. Casey and Christopher received specialized training in the assessment and treatment of eating disorders. They have worked with patients in individual and group therapy to address symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. Dr. Casey has facilitated ANAD groups in the community, which are free support groups for clients with eating disorders. Drs. Casey and Christopher limit their current practice to the assessment and treatment of binge eating disorder and bulimia nervosa given that patients with anorexia nervosa often require greater medical oversight. Clients seeking therapy for disordered eating often have overlapping mood or substance use disorders, and Drs. Casey and Christopher have experience with those concerns as well.
Ketisch, T., Jones, R., Mirsalimi, H., Casey, R., & Milton, T (2014). Boundary disturbances and eating disorder symptoms. The American Journal of Family Therapy, 42(5), 438-451.
Frequently Asked Questions
What about HAES (Health at Every Size) - Is weight even important?
This is a complex question. On one hand, we know that weight does beautiful things for us. Weight supports our bodies and minds, and it allows us to accomplish meaningful things in life. If we want to learn and stretch our minds, we need food and we need weight. If we want to be athletic and strong or experience growth as an athletic person, we need food and we need weight. If we want to be present with others and have meaningful relationships, we need food and we need weight. When it comes to weight, we quite literally can’t live without it.
On the other hand, there are costs associated with carrying weight around all day. Weight impacts internal systems within the body and can become a hindrance to those systems at times. For example, as weight increases we might experience increased blood pressure and risk of type 2 diabetes along with diminished mobility and immune functioning. Just for a moment, we’re going to complicate this side of the equation. While research supports this argument, there are also studies suggesting that the stigma of weight gain may moderate (or essentially be responsible for) the tax weight takes on our bodies. We’re not in favor of one side or the other, because “all or nothing” thinking tends to be overly simplistic. However, we do believe it’s important to acknowledge and address the social context of weight, food, and body image concerns. In the meantime we know that, for whatever reason (biology and/or culture) weight can reach a point at which it becomes harmful for a person’s vitality.
In viewing weight as a balance of pros and cons, it’s easy to get caught up on where exactly a problem begins. This struggle sounds something like this: “When does a person not weigh enough?! When does a person weigh too much?! Is my weight a problem?!” We understand the feelings beneath these questions and why these questions are asked. But from a psychological perspective, we’re not fans of them. Here’s why:
First, asking “Do I weigh too much?” or “Do I weigh enough?” is frustrating and exhausting. Most of us have experienced this struggle internally or had it imposed upon us by friends, family members, medical professionals, and even strangers. The answer inevitably depends on who you ask. Everyone has an opinion, and women often receive mixed messages anyway.
Second, when we ask questions about weight, it’s easy to forget that we're really trying to ask questions about health. We can’t make assumptions about our health or the health of others based on weight or body size alone. Weight can absolutely be one measure of health, but if you have weight loss goals in mind it’s important to work with a physician who specializes in this area. This type of medical doctor will have the knowledge, skills, and bandwidth to help you learn more about your overall measures of health.
Instead of having you ask, “Is my weight a problem?” We’d love to help you ask: “Do I feel healthy? Do I have energy and stamina? Do I nurture myself with nutritious foods? Do I know how to listen to my body so I eat when hungry and stop when full? Do I even know when I’m hungry? Do I allow myself to experience the joy and pleasure of food? If not, how come? Do I have interests outside of food? Do intrusive thoughts about food negatively impact my life? Does my environment help me make healthy choices or does it get in the way? Do I use food as a way to walk toward a healthy life or do I use food as a way to avoid life? These are powerful questions. If you’d like to explore them, we’d love to help.
What causes binge eating disorder?
Several variables underlie and coincide with the development of binge eating disorder. First, genetics and hormones play a powerful role in our health, including hunger cues and cravings. Research shows us that you are more likely to binge eat if you have a family member who binge eats, and this similarity has more to do with genetics than it does with environmental cues. Dietary restrictions are another, albeit somewhat surprising, risk factor for binge eating disorder. Clients who eat regularly and don’t skip meals have fewer episodes of binge eating. Third, binge eating creates changes in the brain that make cravings powerful and difficult to resist with willpower alone.
Painful emotions and unhelpful thoughts also play a role in the development and maintenance of binge eating disorder. Many clients with binge eating disorder report higher levels of difficult emotions along with limited coping skills. Clients with binge eating disorder also tend to hold negative and unhelpful thoughts about certain foods and their bodies. These thoughts are often so ingrained and automatic that client’s need help recognizing and challenging them in therapy.
Relationships play a role in binge eating as well. Relationship concerns might include feelings of loneliness, frequent conflict within important relationships, and difficulty setting and maintaining boundaries. Relationships can also contribute to binge eating disorder when well-meaning loved ones comment on bodies (theirs or yours) or when they openly hold rigid thoughts about food and weight.
Lastly, our physical environment and habits can contribute to the development of binge eating disorder. In terms of physical environment, we’re bombarded with foods in advertisements, grocery stores, and restaurants that are typically high in sugar, fat, and salt. From an evolutionary perspective, these foods are desirable, but eating them often can change the reward circuitry of the brain. In terms of habit, our behavior is often influenced by cues. For example, you may have noticed that you associate certain places with binge eating. If so, simply being in those places can increase the likelihood of a binge. Another way our environment impacts behavior is through barriers or lack thereof. We tend to make the easiest choice. If foods high in sugar, fat, and salt are readily available whereas more nutritious options are out of reach, it’s nearly impossible to make changes that support our long-term health. Of course, it’s not about having “good” foods available and “bad” foods out of reach, the long-term goal is balance. If you’re interested in reaching out for support, we’d love to help.