Spring 2025 Issue

Mental Health: Binge Eating Disorder
By Jennifer Rollin, LCSW-C
Social Work Today
Vol. 25 No. 2 P. 10

How to Tell if Your Client Is Struggling in Silence

She’s just finished dinner when the urges begin. “Just have one other snack,” her brain tells her. However, before she knows it, she’s eating rapidly. She washes down Oreos with glasses of milk, makes peanut butter sandwich after sandwich, and then eats more cookies. She feels like something has taken over her body. She watches herself go through the motions of eating and drinking as if she were someone else. After the binge, she feels guilt, shame, and physical pain. Each time, she tells herself it won’t happen again, but it keeps happening. She feels trapped, alone, and isolated in this struggle—which feels exhausting. She is grappling with binge eating disorder.

Binge Eating Disorder
Binge eating disorder involves recurring episodes of binge eating. According to the DSM, binges occur once a week for three months or more. Binge eating episodes include at least three of the following: eating in isolation, rapid eating, eating large amounts of food in the absence of physical hunger, eating to the point of physical discomfort, and guilt after the episode.1

The Prevalence of Binge Eating Disorder
Binge eating disorder affects people of all sizes, races, ethnicities, socioeconomic backgrounds, genders, and abilities. Eating disorders do not discriminate.

Binge eating disorder is estimated to affect roughly 4.4% of people. However,
this disorder wasn’t added to the DSM until 2013.2

Many clients with binge eating disorder struggle in silence, due to guilt and shame over their relationships with food and body image. Therefore, it’s important to know the warning signs that someone may be experiencing binge eating disorder.

Warning Signs of Binge Eating Disorder
Learning to recognize binge eating disorder can help us improve prevention, diagnosis, and treatment. By identifying its signs, we can support clients who may be challenged by binge eating disorder behaviors. We can provide clients with psychoeducation and treatment referrals, while also encouraging them to practice self-compassion concerning their struggles.

Episodes of Binge Eating
To be diagnosed with binge eating disorder, a person must experience episodes of binge eating. However, what qualifies as a binge can be confusing. A binge is defined as eating much more food than is typical during a short period of time, for example within two hours. Typically, while those affected are eating, there’s a feeling of a lack of control, rapid eating, and feelings of guilt follow.3

Kate Dansie, LCSW-C, an eating disorder and OCD therapist, and clinical director at The Eating Disorder Center in Rockville, Maryland, says, “Often there’s a feeling that a person can’t stop eating even if they want to.”

Eating in Secrecy and With Shame Attached
Eating alone can be a warning sign of binge eating, as people often binge in secret when others are not around.3 Avoiding food in social settings can also be a sign of struggling with binge eating disorder. Often, individuals who struggle with binge eating feel ashamed about their struggles. This may be partly due to the stigma and myths in society about binge eating disorder.

Frequent Dieting or Food Restriction
Clients who often diet and restrict their food intake could secretly struggle with binge eating disorder.3 There’s a well-documented binge/restrict cycle in binge eating disorder. For example, sometimes people restrict food after a binge, which fuels more binge eating.3

Restriction (physical or emotional) is a significant trigger for binge eating episodes. Physical restriction involves avoiding certain foods or not eating enough for one’s energy needs. Emotional restriction involves eating and also telling oneself things like. “My diet starts tomorrow.” or “I’ve been so bad by having this food.”4

Dissociation During Binge Episodes
Clients may report feeling “outside of their bodies” or watching themselves go through the motions of eating during binges. Feeling dissociated or disconnected from the experience of binge eating is common. While dissociation is a spectrum and everyone experiences it to some degree, higher levels of dissociation are a common experience for survivors of trauma.

There are strong associations between eating disorders and trauma. One study found that 75% of individuals with binge eating disorder had experienced a noninterpersonal trauma.5

Laura Jones, LPC, agrees that there’s often “a level of dissociation and not being aware of what they’re consuming and how they’re feeling,” during binge episodes.

Megan Samuels, LCSW-C, eating disorder and trauma therapist at The Eating Disorder Center in Rockville, Maryland, says, “When we look at how binge eating disorder can be a dissociative episode—sometimes I have clients who say, ‘I don’t even remember eating that large quantity of food.’ And when there is amnesia, that is usually a clue into dissociation.”

Causes of Binge Eating Disorder
As with other eating disorders, binge eating disorder is thought to be caused by a combination of genetic and other factors, which can include life stressors and difficulty coping with emotions. Research supports the role of genetics in the development of eating disorders.6 Furthermore, environmental stressors may bring out the underlying genes in individuals who develop eating disorders.7

Treatment
When treating binge eating disorder, it’s important to address both the relationship to food and body image, as well as underlying issues such as trauma, depression, anxiety, and difficulty coping with emotions.

Through psychoeducation on the causes of binge eating disorder, we can help lessen some of the shame and stigma individuals experience. Unfortunately, in the media, binge eating disorder may be stereotyped and stigmatized as a condition related to “willpower,” which is far from the truth. Binge eating disorder is a serious mental illness. Individuals struggling with this disorder deserve compassionate therapy and treatment.

Therapeutic modalities for binge eating disorder include the following.

Dialectical Behavioral Therapy (DBT)
DBT is based on cognitive behavioral therapy; however, it utilizes a specific set of skills for helping those who experience emotions intensely.8

Dialectical means that two opposing ideas can be true at the same time. This therapy helps clients balance acceptance and change strategies.8

For some, binge eating is a way (in part) to cope with difficult emotions. The skills learned through DBT can provide alternative coping tools.

“I think one of the big things is helping clients tolerate distress relating to urges to binge eat and restrict,” Samuel says. “That might look like helping clients to increase capacity for mindfulness skills around eating. Another thing I like to use with clients is a DBT behavior chain analysis to help them identify triggers for binge eating episodes.”

Acceptance and Commitment Therapy (ACT)
ACT works to help clients increase psychological flexibility. We may desire to escape painful feelings, yet ACT can help us accept our full range of emotions while we pursue our true-life values.9 This modality can be helpful for binge eating disorder.10 Binge eating can be an attempt to cope with uncomfortable emotions. However, eating disorders often lead individuals away from what they value in life.

“Looking at your values around food is an important part of eating disorder treatment. So, for example someone might value food being shared with friends, family, or other people in the community; however, with binge eating disorder, people are often eating in isolation or eating in a way that makes them feel ashamed,” Dansie explains.

Internal Family Systems (IFS)
IFS posits that every person is a system of wounded and protective parts led by the “core self.” Much like members of a family system, these parts may take on extreme roles within us.11 IFS can help clients recognize the roles different parts play in their unique system. It also can help address internalized stigma that individuals with binge eating often experience.

“When I’m thinking of a client coming to me with binge eating, the bingeing is a part of them trying to do something. It’s not good or bad; it is trying to help. I have found that seeing [the bingeing] as a part of them, not all of them, is helpful for working with bingeing and with shame, which is a core component of binge eating,” Jones says.

Unpack Weight Stigma
It’s important to note that people in all body sizes can struggle with binge eating disorder. It’s also crucial that we recognize weight stigma. Weight stigma is a form of oppression that clients in larger bodies face.

As Jones explains, “The world privileges certain bodies over others in many ways, whether it’s race, sexuality, gender, or body size. When you do have some of these marginalized identities, it makes moving through this world harder. There are beliefs that are thrown on you, obstacles, and there’s discrimination. I really think that you can’t do therapy and truly heal from an eating disorder without recognizing how someone moves through the world and what they may be trying to cope with.”

Experiencing oppression is a form of trauma that can underlie an eating disorder. 12 It’s critical to acknowledge the myriad forms of oppression that clients with marginalized identities experience, including weight stigma, and the ways they intersect.

In treatment, it’s important to help individuals in larger bodies to unpack weight stigma. When working with these clients, Dansie says, “It’s important for people to ask questions like: ‘Is my body the bad guy here, or is it what I’ve been told about my body my entire life?’ People can come in with a core belief that ‘OK, my body is this size. It must mean I’m doing something wrong.’ And so, unpacking that and starting to label weight stigma as weight stigma is an important step.”

Work With Clients to Decrease Food Restriction
Clinically, it’s important to work as part of a treatment team, as eating disorders are complex illnesses.13 Alongside therapy, clients often meet with an RD. All providers must help clients identify and eventually eliminate food restriction.

“Food restriction both causes and maintains binge eating. It creates this evil feedback loop. Decreasing restriction is one very important part of treatment,” Dansie says.

The Bottom Line
Eating disorders, such as binge eating disorder, are complex illnesses. When left untreated, there can be dire outcomes. It’s critical that clients see a specialist with the training and experience to treat eating disorders as opposed to a generalist therapist. With specialized care, binge eating disorder is highly treatable and recovery is possible.

Anyone who has a difficult relationship with food deserves treatment and support. Still, far too many clients suffer in silence. By identifying signs of binge eating disorder, social workers can help those who struggle with this disorder to receive effective treatment.

— Jennifer Rollin, LCSW-C, is an eating disorder therapist and founder of The Eating Disorder Center, an outpatient eating disorder therapy practice based in Rockville, Maryland, that also serves clients in D.C., Virginia, Florida, Pennsylvania, and New York.

References
1. Management and outcomes of binge-eating disorder. National Library of Medicine website. https://www.ncbi.nlm.nih.gov/books/NBK338301/table/introduction.t1/. Published December 2015. Accessed October 10, 2024.

2. Binge eating disorder. National Eating Disorder Association. https://www.nationaleatingdisorders.org/binge-eating-disorder/. Accessed October 10, 2024.

3. Binge eating disorder. Cleveland Clinic website. https://my.clevelandclinic.org/health/diseases/17652-binge-eating-disorder. Updated April 17, 2023. Accessed October 10, 2024.

4. Binge-eating disorder. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/
binge-eating-disorder/symptoms-causes/syc-20353627#:~:text=If%20you%20have%20binge%20eating%20disorder%2C%20you%20may
%20try%20to,the%20condition%20is%20for%20you. Updated February 23, 2024. Accessed October 10, 2024.

5. Convertino AD, Morland LA, Blashill AJ. Trauma exposure and eating disorders: results from a United States nationally representative sample. Int J Eat Disord. 2022;55(8):1079-1089.

6. Donato K, Ceccarini MR, Dhuli K, et al. Gene variants in eating disorders. Focus on anorexia nervosa, bulimia nervosa, and binge-eating disorder. J Prev Med Hyg. 2022;17;63(2 Suppl 3):E297-E305.

7. Mazzeo SE, Bulik CM. Environmental and genetic risk factors for eating disorders: what the clinician needs to know. Child Adolesc Psychiatr Clin N Am. 2009;18(1):67-82.

8. Dialectical behavior therapy. Cleveland Clinic website. https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt. Updated April 19, 2022. Accessed October 10, 2024.

9. Dindo L, Van Liew JR, Arch JJ. Acceptance and commitment therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics. 2017;14(3):546-553.

10. Acceptance and commitment therapy for eating disorders. Eating Disorder Hope website. https://www.eatingdisorderhope.com/treatment-for-eating-disorders/therapies/acceptance-commitment-therapy-act. Updated March 11, 2025. Accessed October 10, 2024.

11. What is internal family systems? IFS Institute website. https://ifs-institute.com. Accessed October 10, 2024.

12. Boswell RG, Launius KN, Lydecker JA. Multiple marginalization, discrimination, and disordered eating among youth aged 10-11. Int J Eat Disord. 2024;57(8):1783-1790.

13. Members of treatment team. National Alliance for Eating Disorders website. https://www.allianceforeatingdisorders.com/members-of-treatment-team/. Accessed October 10, 2024.