Sarah is typical of most of the patients seen by Elena Ramirez, Ph.D. (co-founder of VCCBT) in that her eating patterns frequently spiraled out of control, but not nearly enough to qualify as having a classic eating disorder like bulimia or anorexia. Nor does she fit the profile of a more recently recognized problem, binge eating disorder, or BED—which features regular bulimia-like binges but without its “purging” behaviors (like vomiting and laxative abuse). “I see a lot of people with subclinical eating problems who fall between the cracks,” Ramirez explains. Many, like Sarah, “use food to distract themselves from negative emotions like anxiety, fear or anger.” Some, she adds, are serial dieters who have been so restrictive about what they can or can’t eat that when they finally do give in to that forbidden bite of pizza or chocolate, “they think they don’t have any control at all, and just eat everything in sight.”
This kind of eating behavior can evolve into a full-fledged eating disorder, but more often the overeater waxes and wanes on the edges of an “almost eating disorder,” says Ramirez. “Over time, their eating tends to get more and more out of control, and they start to gain weight. That’s when they seek help.”
Whether binge-eating problems are diagnosed or fly under the diagnostic radar, researchers are just beginning to understand their impact on the population. Last year, researchers at Harvard’s McLean Hospital in Belmont, Massachusetts, polled 2,980 Americans in the first national survey of eating disorders. They found that BED is the most common eating disorder, affecting some 3.5 percent of women and 2 percent of men—making it more than twice as common as bulimia and more than four times as prevalent as anorexia. While BED and other binging behaviors aren’t as well recognized as anorexia and bulimia, “some of the driving forces behind them are the same,” notes Cynthia Bulik, Ph.D., director of the eating disorders program at the University of North Carolina at Chapel Hill and co-author of Runaway Eating: The 8-Point Plan to Conquer Adult Food and Weight Obsessions (Rodale, 2005). All involve “the consistent use of food or food-related behaviors (such as purging or exercising excessively) to deal with unpleasant feelings,” she notes, coupled with “the feeling that these behaviors are out of control.”
Most experts believe binge eating is much more prevalent than any survey can measure. “Our findings only document people whose eating problems are clinically significant and causing marked distress—and that’s probably just the tip of the iceberg,” says James Hudson, M.D., Sc.D., director of the psychiatric epidemiology research program at McLean Hospital and lead author of the national eating disorders survey. “Because there’s so much shame associated with eating disorders, a lot of people aren’t willing to admit they have a problem.
“We suspect there’s a much larger group of people who aren’t binging as often or as intensely, but nevertheless have tendencies toward out-of-control eating,” Hudson continues. “That’s hard to quantify in a survey, but it’s out there.”
Most of us have done our share of out-of-control eating, whether it’s polishing off a family-size bag of potato chips without noticing or eating all the chocolates in the Valentine’s sampler—and we’ve probably felt at least a little guilty for overindulging. But if you find yourself having those “slip-ups” fairly regularly—or if your eating causes you so much shame that you have to do it in secret—your eating issues might be cause for concern.