Understanding Binge Eating Disorders
By Lindsey Getz
Treating trauma and treating binge eating disorders may seem like two entirely separate entities, but often a disorder such as binge eating is a coping mechanism. Research shows that many individuals with eating disorders have had a prior history of sexual abuse. Since binge eating is centered on consuming food, it would appear that food is the problem. Not the case at all, says Lisa Ferentz, LCSW-C, DAPA, founder and president of Advanced Psychotherapy Training and Education, Inc. in the Baltimore area.
“One of the key elements I want clinicians to know when treating clients with binge eating disorder is that food is just the symptom,” says Ferentz. “If someone is bingeing, there is probably a deeper pain narrative underneath that is trying to be managed with food.”
While certainly not all cases of eating disorders are linked to a past history of trauma, Ferentz says that the literature reveals many are—and that can’t be ignored. In fact, in many cases that trauma history is at the core of why the binge eating is happening in the first place.
“Binge eating may be the client re-enacting a painful experience from the past,” Ferentz says. “Or it may be their way of exerting control. If you’re dealing with a client who has been physically abused and feels an intense loss of control about their body, eating disorders are often a way that they feel they are regaining that control. In these cases the client may binge, feel out of control, and then starve to regain control. It becomes a cyclical event as the starvation often leads to more bingeing. In some cases, the shame associated with bingeing can also lead to purging.”
Out of Control
Binge eating is essentially defined as “uncontrolled eating.” Ferentz says that during a binge the individual may consume as much as 2,000 to 3,000 calories—or more—in a single sitting. Food is hoarded; bingeing is often done late at night when no one is around.
“You wouldn’t see this client binge eating in the mall food court,” Ferentz says. “In fact, a binge eater would probably have a salad in the food court. It’s all about secrecy and there is often a lot of shame and guilt associated with it. There may also be a component of lying. If confronted about bingeing, it’s not uncommon for a binge eater to lie. But this only leads to more guilt and shame, which in turn can lead to more binge eating.”
During a binge, Ferentz says there is typically a detachment from the eating experience. The client may not even taste what they’re eating. This detachment typically occurs shortly into the binge process. It becomes so depersonalized that there is no sense of enjoyment or pleasure about the food.
“My clients have described it as standing outside their body, watching themselves eat,” Ferentz explains. “They’re often so detached that they don’t even know how to stop. That feeling of being out of control is a huge part of this.”
“When clients binge, they are doing so to self-soothe or self-medicate,” Ferentz says. “It’s a way to make themselves feel numb. But obviously there’s a trigger that’s setting all this into motion and that’s the first thing for clinicians to figure out. Secondly, they need to have better ways to manage these triggers. Clinicians need to help their clients find better ways to cope.”
Ferentz, who authored the book Treating Self Destructive Behaviors in Trauma Survivors: A Clinician’s Guide, says she would encourage clinicians to first take a close look at how they view obesity. There is no doubt that a stigma is attached to individuals who are obese and Ferentz would encourage clinicians to do a thorough self-assessment and ensure they are truly bringing compassion into the room.
“Binge eaters have a tremendous amount of shame,” Ferentz emphasizes. “The antidote to shame is compassion. The clinician needs to be aware that there are stereotypes and prejudices linked to those who are large and it’s incredibly important that they are mindful of their own attitude about body image and weight. A clinician needs to have a nonjudgmental and compassionate approach to treatment—that’s really important in order for this to work.”
Since it’s common for binge eaters to tell their clinician that they literally “don’t know how to stop,” this is where helpful coping tools are so critical. But first it needs to be understood what’s causing the pain that leads to bingeing.
“We want to help clients gain insight about what’s going on underneath the eating disorder,” Ferentz says. “What trauma they’re trying to re-enact or cope with. This is an area where social workers who are trained in trauma can really help get to the heart of the matter.”
Ferentz says that in many cases the food being forced into the body is directly linked to a sexual abuse narrative in which force was also used on the body.
“Obviously we can’t say that all eating disorders are linked to sexual abuse and it’s important to remember that there are lots of cases where there is no history of abuse,” Ferentz adds. “But there is indisputably a strong tie. I definitely encourage clinicians to consider that an eating disorder may be the clients way of re-enacting or re-storying their trauma.”
And, of course, new tools should be provided to replace the food.
“As we provide these new tools for coping, the hope is that the client no longer needs to turn to food as a way to self-medicate,” Ferentz says.
In her workbook for clients, Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing, Ferentz uses tools such as journaling exercises and a lot of art therapy to help clients “work with their body, go deeper, and gain that mindfulness that is really critical to overcoming the urge to participate in uncontrollable eating.”
“Clinicians just need to remember that they cannot expect their client to give up any sort of self-destructive behavior until they have new ways to cope available to them,” Ferentz adds. “If social workers can help their clients fill their tool box with new coping mechanisms and new ways to communicating their pain narrative, they can help them stop the cycle of binge eating.”
— Lindsey Getz is a freelance writer based in Royersford, PA, and a frequent contributor to Social Work Today.