At 2 or 3 a.m., David Tedrow would hide the empty cardboard cereal box, shoving it into the bottom of the trash can or the back of the cupboard, where his wife wouldn’t notice it. Mr. Tedrow was in his 60s and retired, and he often slept until the afternoon so he could stay up late, after everyone else had gone to bed.
During frantic late-night bursts, he would eat an entire box of cereal — Oatmeal Squares, Frosted Mini-Wheats, whatever was around — and then dispose of the evidence. He had eaten compulsively throughout his life, he said, but after months of going through a box of cereal each night, he decided to try to get help.
In 2016, he left his home in North Carolina to seek treatment for what he thought was food addiction at a hospital in Wisconsin that specialized in eating issues. He was diagnosed with binge eating disorder.
“I had no earthly idea that it even existed,” he said. But the diagnosis gave him a sense of relief. “There was an explanation for this.”
Binge eating disorder is the most common eating disorder in the United States. Exact numbers vary, but according to the National Institute of Mental Health, nearly 3 percent of the U.S. population has had binge eating disorder at some point in their lives, more than double the reported numbers for bulimia nervosa and anorexia. Yet, the disorder is under-discussed and underrecognized by both the general public and those in the medical field, partly because many don’t know about the diagnosis or its potential severity.
Often, people will exhibit symptoms for decades before receiving a diagnosis, said Cynthia Bulik, the founding director of the University of North Carolina’s Center of Excellence for Eating Disorders. “For so long, they’ve been told things like ‘Oh, this is just emotional eating’ or ‘You’re out of control’ or ‘It’s because you have no willpower’ or ‘Gluttony’s a sin,’ or whatever these things are that people explain it away, without realizing that they have a treatable condition,” she said.
What is binge eating disorder?
Binge eating disorder is a relative newcomer in the world of diagnosable mental health conditions; it entered the Diagnostic and Statistical Manual of Mental Disorders, which clinicians and researchers use to classify mental health conditions, 10 years ago this month. At the time, the diagnosis was fairly controversial, said Dr. B. Timothy Walsh, who led a group that recommended changes to existing criteria for eating disorders and proposed adding new ones to that edition of the D.S.M. Some thought that it was “pathologizing normality,” he said, and did not understand how it was different from ordinary overeating.
But the behaviors of binge eating disorder are distinct, he said. A person with the condition has, on average, at least one binge episode per week for three months or longer, during which the person eats an objectively large amount of food in a short period of time — three or more main courses in one sitting, for example — and, crucially, feels a loss of control and struggles to stop eating. “This isn’t like, ‘I had an extra piece of pizza that I wish I didn’t eat.’ This is, ‘I ate several pieces, several pizzas, in this discrete amount of time,’” said Dr. Holly Peek, the assistant medical director of the Klarman Eating Disorders Center at McLean Hospital in Massachusetts.
People with binge eating disorder also tend to eat more quickly than usual during an episode; many also eat in secret and grapple with guilt, said Kelly Allison, the director of the Center for Weight and Eating Disorders at the University of Pennsylvania.
People who have the disorder sometimes go on to develop bulimia, and vice versa, said Andrea Vazzana, a clinical psychologist at NYU Langone Medical Center who specializes in eating disorders. Those with bulimia experience bingeing episodes as well, but they also regularly engage in recurrent purging behaviors, like induced vomiting or overexercising, in order to “compensate” for eating. Binge eating disorder itself is not linked with recurrent purging behaviors.
And, critically, binge eating disorder interferes with people’s day-to-day lives. Some of Dr. Bulik’s patients have missed work because they stayed up bingeing and then felt sick, she said; other patients have woken up with crinkled wrappers in their bedsheets, and unchewed food still in their mouths. One of her patients ordered a cake for her child’s birthday party and, on the drive home from the supermarket, ate the whole thing with her hands.
During a binge, Kaitlin Schaefer, 36, who manages corporate sustainability efforts for a clothing brand in Toronto, often felt like she was hovering outside of her body — time would dissolve in the minutes between opening a pint of Ben and Jerry’s and the spoon scraping the bottom of the carton.
“It’s almost like you become a robot,” said Kelsey Grennan, 25, a content creator who has posted videos on TikTok about her experiences with binge eating disorder, which she was diagnosed with at age 18. At the height of her disorder, food was a refuge, a shortcut to numb her stress, she said, adding, “You go into this state of wanting to escape.” Online, Ms. Grennan has found a vocal, and growing, community of people who are recovering from the disorder. Videos with the hashtag #BingeEatingRecovery have been viewed more than seven million times on TikTok, and myriad users share intimate details about their binge episodes and paths to treatment — helping to reduce stigma around a disorder that is so often marked by shame.
What causes binge eating disorder?
Researchers are working to identify the role that genetics play; trauma, particularly a history of sexual abuse, can also predispose someone to the disorder, Dr. Vazzana said.
Restrictive dieting can lead people to develop the disorder in some cases, in what Rachel Goode, an assistant professor at U.N.C. School of Social Work, calls the “boomerang effect,” as people ricochet between not eating and bingeing. The longer people deprive themselves of food, the more likely they may be to binge because they are hungry.
In high school, Chris Garcia, now a 30-year-old nurse who lives outside of Washington, D.C., would challenge himself to go all day without eating, thinking that if he lost weight, he might face less bullying. But at night, sometimes after working a shift at McDonald’s, he would go from drive-through to drive-through, buying fries or tacos, feeling ravenous and trapped. “Being focused on dieting and trying to be ‘good’ — really unrealistic things — when you restrict yourself from so many foods, I think it’s impossible, really,” he said.
What treatment options are available for binge eating?
Cognitive behavioral therapy is the standard treatment for binge eating disorder. Sometimes, clinicians will use another type of talk therapy, known as interpersonal psychotherapy, but that is less common. Support groups can also be helpful, and the National Eating Disorders Association lists resources and low-cost support options on its website. The Multi-Service Eating Disorders Association also provides resources.
The Food and Drug Administration has approved only one medication to treat binge eating disorder: Vyvanse, a drug often used to treat attention deficit hyperactivity disorder. Some clinicians prescribe antidepressants, though it’s unclear whether those medications target binge eating behaviors themselves, or whether addressing an underlying depression can help alleviate symptoms, Dr. Peek said.
Inpatient treatment, while costly, can also be transformative. At the hospital in Wisconsin, Mr. Tedrow spent three weeks focused on getting better. He started cognitive behavioral therapy and medication, and he went to support groups and traded stories with others who were also in treatment.
Binge eating disorder is still “a constant battle,” he said. “But we can get over it.”
“I’ve done it,” he added. “You’re not doomed.”
What Is Binge Eating Disorder? What to Know About Causes and Treatment - The New York Times
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