Binge Eating Disorder

It’s been more than four years since Dave Vrablik had a binge eating episode, but he remembers them all too well. Two to three times a week, he would go to a fast-food restaurant or chain steakhouse alone and eat supersized meals.

“All my life, I dealt with trauma or adversity or any kind of issue by going to food,” he recalls. “It was the one thing I could rely on.” The food made him feel better, temporarily. Relief was followed by extreme physical discomfort and a vow to never do it again. Hours or days later, the cycle would begin anew.

The devastating sudden death of a beloved older brother exacerbated his binge eating behaviors. It took a tearful plea from his wife and an intervention by his father and a good friend to send Vrablik to an eating disorders treatment program for the help he needed.

“I can remember walking through those doors and not knowing what I was walking into,” he recalls. “I had never even heard of binge eating disorder.” He was in ERC’s partial hospitalization program seven days a week for seven weeks. “My treatment at ERC saved my life,” he says.

A Hidden Disorder

Binge eating disorder (BED) is the most common eating disorder—as many as 7 million people in the U.S. will struggle with it over the course of their lifetime1— but also one of the most underdiagnosed. “Many clinicians aren’t familiar with BED, perhaps because it has only been in the DSM since 2013,”2 says Kate Barse, PsyD (she/her/hers), Clinical Leadership at ERC.

Clinicians often miss BED diagnoses because of assumptions they make based on a person’s body size. A clinician may not think to ask a person living in a smaller body about the behaviors that characterize BED. Conversely, we know that eating disorders are more often missed in people living in marginalized bodies due to cultural and weight stigma as well as implicit or explicit bias. “For patients in larger bodies, the focus too often shifts to weight loss and starting a diet, rather than assessing whether there’s an eating disorder,” explains Dr. Barse.

There also can be patient-related barriers to identifying BED, such as feelings of shame or a lack of understanding that they have an illness that is treatable.

Assessing for BED

Clinicians should actively invite conversation around food and behavior, Dr. Barse advises. “We can take a nonjudgmental stance and invite folks into a low-risk conversation,” she says. “Some questions you can ask are, ‘How is your relationship with your body? How much time do you find yourself spending thinking about food, planning around it, focusing on eating it? Is it distressing to you?’” Phrases that should raise red flags are those alluding to compulsive eating, such as “I can’t help it” or “I feel like I have to,” Dr. Barse says.

In addition, regular extended periods of restriction, such as regularly skipping breakfast and being “too busy” for lunch, can be a sign that a person is trying to make up for binge eating episodes.

“There are numerous biological and psychosocial risk factors for BED including a history of trauma, dieting, a family member with an eating disorder and heritability, among others. Mood and anxiety disorders are highly correlated with BED as well,” says Dr. Barse.

ERC’s Unique Approach

With the appropriate information, a clinician can proceed to diagnosis and the creation of a holistic treatment plan. “We recommend that BED be treated by an eating disorders specialist and a registered dietitian,” Dr. Barse says. “At ERC, we’ve found that evidence-based therapies such as cognitive behavioral therapy, dialectical behavioral therapy and acceptance and commitment therapy can all be effective modalities for treating BED.”

ERC has treated thousands of patients with BED for more than 10 years, becoming one of the largest, leading BED treatment providers in the U.S., including both in-person and virtual treatment.

A unique feature of our virtual binge eating disorders program at Eating Recovery At Home is that it takes place in a separate milieu, that is, not in a mixed group that includes patients with restrictive eating disorders. Patients report that they feel more comfortable in a separate milieu and are better able to share their experiences with others who have similar food behaviors and body image concerns. Through this specialized programming, patients learn inclusive and mindful eating, dismantle diet culture expectations, gain confidence in preparing and cooking meals and, most importantly, find freedom from shame and guilt.

The nutrition approach to BED treatment is more flexible than the approach for people with restrictive eating disorders. “We have guidelines, but not rigid rules around eating, and we don’t exclude specific foods. We plan, prepare and eat meals together,” explains Hannah Gruenewald, MS, RD, LD (she/her/hers), Clinical Nutrition Manager at ERC.

Vrablik can vouch for the effectiveness of ERC treatment. “Community was one of the most important elements of getting treatment for my binge eating disorder and continues to be throughout my recovery journey,” he says.

Vrablik now has his own company as a motivational speaker. “I actually came up with the idea for my business while I was sitting in a room at ERC,” he recalls. “They helped me recapture my authentic life. Now I want to help others have a chance at a new beginning.”

Learn more about Eating Recovery At Home and Pathlight At Home, our virtual intensive outpatient programs for eating disorders and mood and anxiety disorders. Available and accessible across the nation, these programs are covered in-network by most commercial insurance plans.

FREE ONLINE SUPPORT FOR BED

Click here to learn more about our virtual support groups for binge eating, which are open to anyone. Prior treatment at ERC Pathlight is not required.  

Citations:

1. Deloitte Access Economics. (2020). The social and economic cost of eating disorders in the United States of America: A report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020.
2. Marx, R. (2022). New in the DSM-5: Binge eating disorder. National Eating Disorders Association.