Tuesday, July 25, 2006

What Constitutes a Binge? (Part I)

According to the American Psychiatric Association’s Diagnostic and Statistical Manual (IV-TR), a binge is characterized by the following:
1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.
2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

Binges may occur in isolation (and without any correlated behaviors) or may be a feature of Bulimia Nervosa, Eating Disorder Not Otherwise Specified, or Binge Eating Disorder (not yet a clinical disorder, but likely will become one.) They may occur at lightning speed or be longer-lasting, may include eating one food, or many. And, clearly, even the clinical criteria are quite ambiguous: What exactly is an amount of food “larger than most people would eat”? Who are these “most people?” Are they of our same gender, size, culture, and eating-disorder status? What are “similar circumstances”? Moreover, can you always detect when you’re feeling a “lack of control” and is there even any way to quantify control? You’d think that as a science and a practice, we’d be able to do better than this. . . .

With such ambiguity (and diversity) in a clinical presentation, how do you really know if it’s a binge? Justice Stewart’s definition of pornography comes to mind (“You know it when you see it”), yet introspective awareness may be somewhat limited during a binge (though possibly enhanced after one). I think the control factor is a big one—if you feel like the eating behavior is controlling you (rather than you, it), then that could be a binge, but of course, the quantity consumed cannot be ignored (uncontrollably stuffing back a bag of airline peanuts, for example, can’t really be labeled a binge). Just because you’ve eaten more than you wanted, eaten past the point of fullness, or eaten when you weren’t even hungry doesn’t make it a binge.

I return to my old-standby, the continuum, when confronted with ambiguous topics like this. It seems it’s clear when it’s not a binge, and even pretty clear when it is a binge, but for all the shades of grey in between (particularly the darker greys, toward the binge-end of the continuum), I’d say this is a highly idiographic enterprise—I’d want to know from you as an individual—did it feel like you wanted/needed to binge? Did it feel like a binge during the binge? How about after? Because, especially when the science is so vague, the person is expert and the subjective experience quite diagnostic.

What makes it a binge for you?

12 comments:

Flowerchild said...

When I was really psycho surrounding food, a binge was anything that went beyond what I had planned to eat. If I ate one bite more, I had to throw it all up. It started me on a downward spiral that lead to more bingeing (sp?) and purging and shame and etc., and so on and so on and so forth.....After over 25 years dealing with an ED (and tens of thousands of dollars of TX), I came to the realization that the crazy rules I made about food were crazy and that really, it wasn't about the food. duh.
I am now usually nicer to myself when I have eaten more than I planned. When I start down The Slippery Slope and run around my kitchen banging the cupboards in search of massive amounts of carbs, I can usually ask myself, "what is this all about? really? what am I freaking out about? really?" thank God for God and insight and healing....

Beth said...

Don't most of us binge at Thanksgiving? Eating past the point of physical comfort or being unaware of satiety and eating till you feel ill would constitute a binge. The people with disorders are ones who binge on a frequent basis or focus greatly on an accidental binge. I know that bingeing was not a problem in my life until I attempted, at age 15, to diet. After the weight loss was achieved, food took on a superior role and slowly affected my actions and mind. At first, binges were a pint of ice cream perhaps. Then a box of cookies. Now it could be a gallon and cookies. Somewhere along the way, the binges became less about my body craving the food, and more about my mind. In the midst of everything, I began purging, which only makes the binges more addictive. Perhaps there is a continuum from a snack to a 20,000 calorie binge. This can't ever be exactly defined, as a binge is subjective to each individual based on their physiology, lifestyle, nutritional beliefs, environment, etc.

Anonymous said...

For me the binge was eating in secret or eating rapidly. I like how Geneen Roth explained it in "Breaking Free"....eating with urgency(something like that). She said she could binge on a gallon of ice cream or 2 cookies. That was me.... I can overeat in a calm state of mind or I can eat the same foods but define them as a binge if I am not "present". It will all depend on my frame of mind. Was I "present" while eating or thinking ahead of what I would eat next and how quickly I could get to it before i "snapped" out of this trance. Was I being drawn to the kitchen by my emotions? I believe binges are different for each person.

PalmTreeChick said...

Anytime I eat more than I think I should.

Obviously everyone's food requirements are diffent, as are out perceptions of what we feel we should or need to eat, so if I eat "too much" on a holiday or something, it's probably not even a "normal" amount of food for someone else, never mind being considered overeating. But to me, it's overeating, or a binge.

I guess when I feel uncomfortable with what I've eaten, it's a binge.

Haley-O said...

Beth said it all....Ditto!

Bex said...

I agree with anon. It's all about the manic feeling of stuffing down food regardless of the amount - I could feel manic about secretly stuffing two cookies or manic about eating everything in my cupboards. I know its a binge when I can hear a little voice screaming inside me and my heart is racing and I have the high of the risk at being caught (although some binges have occured in full view of others).
I know the little voice is the feeling and emotions wanting to be heard over the roar of the chewing and cramming down of the food. Sometimes it can be silenced with one freddo frog sometimes it takes the whole packet but the fact that I am trying to silence it, for me, means I am bingeing. I guess for everyone its different and putting limits on what is or isn't a binge is where many women fall through the gaps and never get the help they need.

psychbaby said...

Like flowerchild and palmtree, for me it's anything that I did NOT want to eat. It's eating against my own will, breaking the promise to myself that I wasn't going to eat a piece of bread tonite.

The binge is eating it and then going back for 2 more slices, then feeling like crap and hating myself for it.

So ya, breaking promises to myself, no matter even if it's a bite of something.

wading through recovery said...

There definitely have been times where I know I've binged. At those times, it was usually in secret and I too felt afraid of being caught. Usually, I binged with the full intent of purging afterwards. In fact, I don't believe I've ever binged without purging.

Despite knowing those times that I definitely did binge (early on in my ed career), bingeing was never what I perceived the problem to be for me. The problem seemed to be the purging. Sometimes, I binged just so I could purge.

And the purging has lasted much longer than the bingeing did. I knew at times that I wasn't bingeing either because I had eaten a 'normal' amount of food or even though I felt guilty, I knew that what I had eaten wasn't a binge-it was just off limits to me in my mind. Towards the end, the eating just seemed like a neccessary precursor to the purge.

I know I'm going off a little on a tangent here (with the talk of purging), but I relate to frustrations with DSM definitions. I always felt frustrated that it was assumed that I binged because I purged. I knew that a lot of times I wasn't 'bingeing' because it didn't feel out of control and the quantity was pretty normal. I guess what I always 'got' out of the cycle was the release from the purge.

neca said...

To me, a binge is more about my perception than a specific quantity of food. If I feel out of control, helpless when confronted by food, or like I have to fill some void with food, then does it really matter if I ate 6 cookies or the whole bag? In the end, aren't the feelings of greater importance than the food?

drstaceyny said...

fc--excellent questions to ask yourself (at the end of your 2nd paragraph). And the fact that you CAN ask them seems to show you've done a lot of work. . . .

Beth--re: your Thanksgiving question, I'd probably agree with you. Most of us probably do eat too much (and with too little control) on such occasions, but according to strict criteria, both of those features have to be present. Your story is a good example of why I continue (at least, partially) to blame dieting for the development of eating-disordered symptoms. As you probably know, I LOOOOVE the continuum way of thinking, so it makes perfect sense what you're saying--and I agree with the subjective nature of a binge. Unfortunately, all we have to go on for diagnostic and descriptive purposes is the DSM-IV criteria--which groups classes of symptoms (and people), while potentially losing uniquely individual information. That's exactly why I put the question out to all of you.

anon--I, too, think it differs for each person, though there are some commonalities (such as one that you point out--there's more to it than what you're eating).

ptc--you raise an interesting question--for someone who typically restricts, can we define a "normal meal" as a binge? You've got me thinking. . . .

Haley--thanks for chiming in. And I like your new site!

Bex--excellent point. I think, as I indicated above, it's important to take an individual approach and, as we're realizing, expand the definition, particularly with regard to the feeling surrounding a binge.

pb--I'm curious about these promises that we all seem to make, from time to time. It seems like have the potential to set us up for failure. . . .

wtr--again, thanks, for another individual perspective. According to the DSM, if you weren't bingeing (but really, just purging), you'd probably be classified as EDNOS. But, does this really matter? I think it would be more important for you to understand the allure of the purge. (I'm thinking of another post.)

neca--absolutely. Thanks for clarifying what I've been thinking. . . .

And, to everyone, thank you so much for your personal, introspective, and illustrative comments. I'm lucky to have you as readers. : )

chrissie said...

A binge, for me, is eating despite knowing full well that I'm not hungry. A binge occurs, typically, when I'm depressed and for what ever reason have an "empty" feel which is quickly filled with food - it doesn't matter what the food is. I don't taste it I just eat it, and eat it and eat it. And if the emptiness isn't filled then I'll find something else to eat.

The saddest part of my binging (and I would say that this happens, once, maybe twice a month if it's been a horrible emotional month for me) is that the empty feeling eventually does get filled and I've come to identify the pain of a too full stomach with relief. It doesn't hurt to be uncomfortably full. It's not empty so despite having just eaten two sleeves of crackers with peanut butter or a pint of ice cream and cookies or a block of cheese and a whole lot of lunch meat - I'm not empty anymore. That is what matters.

These are things that I can only consider in retrospect. I can't even remember thinking while in the middle of a binge so I can't say what's been on my mind. It really doesn't matter that I know it now either. The next time I feel empty I will likely binge again. Not because I want to, but because I don't think. Open mouth - insert food - fill the need. What ever that need may be.

drstaceyny said...

Chrissie--why is it sad that the binge is filling you up/causing relief? I think that it's for exactly those reasons that we binge at all. Even though it's not something we ever WANT to do, we do it b/c on some level, it works (and pretty well, at that). I go back to basic behavioral psychology--we're not going to continue to do something (especially that we might regret after) unless it feels good/serves some purpose/etc.

It makes perfect sense that thinking abt these things are difficult during a binge--if we could think abt them, we'd probably stop eating, and then the binge would be "unsuccessful" (see goals above). I think it's inordinately helpful to continue to think abt after--not in a punitive way, but in a, "Hmm. . .I must have been feeling pretty empty. What could have made me feel this way?"