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Summertime Scaries

The summer season produces many unique challenges for those recovering from an eating disorder, disordered eating, or body image concerns.  From family cookouts to bathing suits, the summer months can feel like one huge exposure assignment!  We’ve compiled some great reads that address many of the “summertime scaries” in recovery.  Check them out below!

 

The grittiness of growth.

 

It’s summertime, and the living is…well, a mixed bag of emotions.

Growth is hard. Healing is raw. This month, we chose to feature the blog of a local Asheville clinician – Elizabeth Gillette, LCSW of Heirloom Counseling – to celebrate the “realness” of getting in touch with our true selves. See her recent blog post below about being gentle with yourself as you walk your own path of growth and healing.

Being Gentle with Yourself as You Grow

Hi!
There is something many of my clients realize once we start really digging into relationship and self-work: it doesn’t feel very good.
On one hand, I don’t enjoy seeing people experiencing discomfort or big emotions (I have had to learn to hold space for this and allow it instead of rescuing or fixing). But on the other hand, I have realized that the place where emotions are flowing and discomfort is welcomed and old hurts are received instead of pushed away is where the healing happens. Healing is feeling it all and changing your relationship with your feelings. When the emotions are unearthed, I take that as a good sign. You are a living, breathing, deeply feeling person and I want you to know I respect that—so I let you feel it. We feel it together.
Whether you’re actively shifting your attachment style toward security or it seems like your life as you know it is crumbling all around you or you are growing so quickly that it’s hard to keep up with yourself, please know you are still loved and worthy and whole. None of this work is easy. I’ve come to believe that if you are awake and aware and showing up in any conscious way in this world then you are exposed to the pain of all of it. So many of us are hurting. I know that.
But here’s what I want you to remember. The work you do reverberates out into the collective. Your healing is my healing, and mine is yours. We all deserve to heal. Every one of us. We can help each other do that—by offering support, by being in relationship in a conscious way, and by being accountable for our own stuff. Healing is unlearning just as much as it is acquiring new skills and practicing new responses. We must take inventory of our values and beliefs, gain an understanding of how we came to those beliefs (and whether they still make sense), and move into alignment with who we are now.
Your personal work is incredibly powerful because we are all part of something much bigger than ourselves.
Healing doesn’t happen overnight. And attachment and relationship work? We are in it for the long-game. This work takes practice, time, energy, dedication, and awareness. We must be gentle with ourselves to maintain our commitment. Humans don’t learn well when they are shamed or afraid or experience harshness. How can you create compassion for the parts of you that are learning right now? The fact that you are engaged with the work on a daily basis and healing at your own pace is good enough. Let it be good enough for this moment. Rushing this type of healing doesn’t allow us to dive deep, to fully embrace our experiences, to feel everything we need to feel to move forward.
We all have our own stories and experiences of healing and I believe it’s very important for us to hold space to hear those experiences and learn from one another. I am so thrilled to launch the here to heal podcast on June 11! It’s coming up soon and I’ve done some amazing interviews with incredible folks in my community as well as solo shows where I share more about my own experiences with healing. I’m looking for folks who would be willing to be part of my Podcast Launch Team—people who will listen to a few episodes and then rate and review them on iTunes and get the word out to others who might be interested. If that’s you, will you hit reply to this email and let me know? I will send you instructions and a reminder when the podcast launches! THANK YOU!
I also want to share an opportunity for an in-person healing experience that I am offering on June 22, 2019, with Liz Gunn and Monica Leblanc in the mountains of Western North Carolina. We are hosting an afternoon gathering to support your relationship to yourself utilizing attachment theory, astrology, and the Enneagram (a combination that I have found to be extremely powerful in my own healing work). This experience will provide grounded and practical tools for increasing consciousness and self-awareness with a healthy dose of fun, pleasure, and play. This gathering will be nourishing on many levels and is the perfect way to celebrate the summer solstice! Space is limited so the gathering feels intimate—please register as soon as you can to secure your spot!
Thank you so much, always.
Warmly,
Elizabeth

 

FYI! Elizabeth is launching a podcast THIS MONTH that we are seriously stoked for. Check out the details here: here to heal Podcast

Happy [and sad and frustrated and whatever else you may feel] Growing!

‘Clean’ Eating: Magic or Mayhem?

This month, we feature an article published by Outside Magazine that discusses the clean eating trend in depth.

Bonus: the article includes perspective from one of our own here at Nutritious Thoughts – Margaret Ruch, MS, RD, LDN!

Is ‘Clean Eating’ Good for You? Not Really.

Trying to eat perfectly all the time is a losing battle

The clean-eating trend isn’t new, but it is ever present. It’s a hashtag on Instagram, a hot topic on Twitter and Reddit, and a whole category of food blogs, cookbooks, and magazines. While this approach to eating looks a little different for everyone, it always promotes whole foods and warns against processed options and added sugars. Some clean-eating plans even eschew whole-food staples like dairy, grains, and naturally occurring sugars. Despite the trend’s prevalence—and the fact that “eating clean” as a term sounds benign enough—health experts are wary of the approach for a handful of reasons. Here’s an overview of why athletes should steer clear of the trend.

“Clean Eating” Is an Ambiguous Term

There’s no agreed-upon definition of clean eating. “Generally, it’s about eating foods that are less or not at all processed. It’s always a form of restrictive eating, and for some people, it leads to avoiding whole food groups,” says Margaret Ruch, a registered dietitian who specializes in sports nutrition and disordered eating. The paleo version of clean eating, for example, emphasizes protein, vegetables, nuts, seeds, and some fruit, but it cuts out dairy, grains, legumes, added sugars, and processed foods.

The flexibility of what constitutes clean eating can lead adherents down a path of increasing restriction. The diet promises to be the cure for all kinds of ailments: fatigue, bloating, acne, weight gain, and even some chronic illnesses. If someone adopts of a couple of rules (like cutting out sugar and processed carbs) and doesn’t see benefits, it’s likely they’ll keep adding rules and cutting out foods until they do. “It’s a slippery slope—you want to eat healthier, but there’s really no end goal for clean eating, no way to know you’re doing a good job with it,” says Heather Caplan, a registered dietitian, distance runner, and former running coach.

Plus, while diet certainly impacts health, it’s unrealistic to give it so much power. Factors that are totally out of our control (genetics, for one) play a huge part in our health outcomes, as do things like our relationships, location, and socioeconomic status. “I say that to comfort people, but it’s often jarring. Just because you eat ‘perfectly’ doesn’t mean you’re definitely going to be healthy,” says Caplan.

You Need More Calories Than Veggies Can Provide

“Proper nutrition can play a big role in sports performance, but proper fueling has more to do with getting enough—enough energy, enough carbs, enough protein, enough fat, and enough fluid,” Ruch says. In other words: prioritizing nutrient-dense food is good, but the most important thing is to make sure you’re giving your body the calories it needs to perform and recover properly.

“No matter how you define clean eating, it’s about cutting out certain foods, which makes it much harder to get enough food overall,” Ruch says. “If you’re not consuming as much energy as you need, that really can damage your body in the short and the long term.”

It’s Tough to Get Enough Carbs from Whole Foods 

Exactly how many carbs a person needs depends on several factors—age, gender, weight, activity level, genetics—but “for endurance athletes, carbs should generally be about 50 to 60 percent of your total food intake,” Caplan says.

“If you define clean eating as no processed carbs, it’s going to be really tough to reach your carb needs because of all the fiber that comes with unprocessed carbs,” she says. Fiber increases a food’s volume without increasing its energy, so it makes you feel full more quickly. If you’re also cutting out whole grains and legumes, it’ll be even tougher to fulfill your carbohydrate needs.

Processed Carbs and Sugar Are Great Workout Fuel

Complex carbohydrates from whole foods are great choices most of the time. They’re more nutrient dense than processed carbs, and they digest slowly for steady energy. They’re not a good source of quick energy, though. “I wouldn’t recommend that someone eat a sweet potato or a slice of Ezekiel bread right before working out—they will be slow to enter your bloodstream,” Ruch says.

“So many athletes aren’t getting adequate carbs, usually because they’re afraid of sugar,” she says. “Processed carbs and sugars are great when you need blood sugar quickly, like when you’re about to go on a run or do any kind of intense or long workout.”

Plus, whole carbs preworkout can cause an upset stomach. Fiber is resistant to digestion, which means you’ll likely deal with some bloating and a sensitive stomach while your body breaks down fiber-rich foods—inconvenient during, say, a long training run. “Some people need a low-fiber preworkout snack, like white bread or cereal,” Caplan says. “Other people, like me, can tolerate more fiber and be fine.” If your gut isn’t having it, don’t hesitate to switch to a processed-carb snack or sugar (like a honey stick) that’s easier for your body to break down.

Restrictive Eating Creates Nutrient Deficiencies

Nobody wants to get sidelined by a stress fracture, and diet plays a big role in bone health. Eliminating dairy affects your calcium and vitamin D intake. “If you’re not replacing that dairy with something else, you’re likely going to be deficient,” says Ruch. And relying on supplements won’t cut it; studies have consistently shown that these supplements don’t reduce the risk of osteopenia, osteoporosis, or fractures, and that your best bet for good bone health is getting adequate calcium through your diet. (If you have a dairy allergy, you can get calcium and vitamin D from fortified products, like nondairy milks.)

Whole grains also provide important micronutrients, including vitamin E and various B vitamins such as riboflavin, thiamine, niacin, and folate, that offer critical support to digestion, the nervous system, and more, Caplan says. “Most whole grains are fortified with folate or folic acid, and sometimes iron.” All of these nutrients are essential for good health, and while it’s possible to get them elsewhere, grains are an easy and inexpensive source.

Diet Can Cause Mental and Emotional Stress, Too

“When we talk about health, we have to take into account not only the nutritional value of what we’re eating but also emotionally how we feel when we’re eating a certain way,” says Breese Annable, a psychologist who specializes in disordered eating, chronic dieting, and body image. Although a less rigid style of clean eating might be fine for some people, too many food rules can have a big negative impact on overall health, Annable says. For example, if you avoid social gatherings for fear of not being able to eat “clean,” you’re isolating yourself, which can have its own negative consequences. Plus, chronic stress has been shown to impair sports recovery.

Stressors of rigid clean eating might include spending more money on food (whole foods are generally more expensive) and constantly denying yourself the foods you’re craving. “There’s a trade-off between any potential benefits of following a certain diet and the stress you put on yourself when you’re so rigid and inflexible,” Ruch says. “This is true even if you do manage to get enough energy and nutrition from a diet.”

The Bottom Line

Clean eating essentially paints foods as being good or bad. “It creates this sense of morality around food,” Annable says. But health isn’t black and white, and thinking of food that way won’t do you any favors. If anything, it sets you up for feelings of guilt and failure when you inevitably break whatever diet rules you’ve set for yourself.

“It’s harmful to put labels on your diet and yourself, instead of just saying you eat a flexible diet and you’re mindful about your food intake,” Ruch says. There’s nothing wrong with wanting to eat healthfully, but the best approach is to focus on eating mostly nutritious foods while thinking of the occasional less nutritious treats as just part of an overall healthy balance. In other words: ditch the idea of clean eating, and embrace the fact that no one meal or food choice will make or break your health.

Direct article link here: https://www.outsideonline.com/2391283/is-clean-eating-good

Spring Time Blues

The weather is warming, daylight lasts longer, and the world seems to be blooming…and it expects you to be doing the same.

This month, we feature a very important blog post by Carolina Partners in Mental HealthCare, PLLC that highlights the pressure we may feel to present ourselves to the world as happy, energetic, and carefree this time of year and how it is perfectly alright (and actually makes sense) if “happy-go-lucky” is not everyone’s reality during the Spring season.

Check the post out below!

IT’S SPRING! WHY YOU DON’T HAVE TO FEEL HAPPY

Spring is finally here. People are wearing shorts, the birds are infectiously happy, flowers are blooming everywhere. In the grocery store today, a man told me, “You look so sad. Be happy! The weather is beautiful.” While there’s always room for gratitude in our days, and nice weather certainly can be something to be grateful for, I’m here to tell you why you don’t have to be happy.

There are admittedly many proven mental health benefits to Springtime. The increase in daylight provides a boost in one’s serotonin levels (serotonin is a crucial ingredient for feelings of happiness). And during the new season, people don’t need to expend as much energy to fight off the drowsiness that occurs when it’s darker outside. Also, people tend to socialize in the Springtime more, which comes with other mood-enhancing benefits; for example, laughing with friends or hugging loved ones, both of which release important endorphins.

With all of this bright light, social bustle, and beautiful, blooming nature, there can be an unspoken expectation to be as happy as possible all the time. But, for a number of reasons, many of us don’t feel happy during Spring … or we don’t feel as happy as other folks seem to think we should. And I would like to detail a number of reasons for why we may not feel happy, despite the beautiful weather and chipper social milieu:

  • The expectation to be happy itself can be stressful, and can, perversely, end up making us feel less happy. It is very alienating to be pressured to feel a certain way when you don’t already feel that way to begin with, and this social pressure is severely heightened in Springtime.

 

  • The warmer weather can make it more difficult to think clearly on a physical level. Ideally, Spring is a time of moderate levels of warmth that help us adjust to the oncoming heatwave of the Summer. But in reality, Spring is often dramatically warmer than we expect or want it to be, and those changes usually happen without warning.

 

  • A third reason is that many of us need to spend our days indoors during these lovely Spring days. Students are busy studying for exams. Office workers continue to spend eight hours a day inside, regardless of the season. That disconnect between desire and reality can be very demoralizing.

 

  • Some people experience a problem with sinuses during this time, which can make simple things like going on a walk in your neighborhood very unenjoyable.

 

  • Perhaps most importantly, it is important to remember that the regular ups and downs of life continue to happen in Spring, despite the shifting climate. For some folks, Spring is the anniversary of a loved one’s passing. Other people are experiencing terrible illness. There are folks who lose their job in Spring, or get into a car accident. The mere existence of warm weather and budding cherry blossoms does not erase the usual tribulations of life.

While there are likewise many reasons to enjoy the season, it’s important that we be aware of our own impulse to assume that everyone else is happy, or that everyone else should be happy, or that we should be happy. Spring is a time of should-ing. We “should” all over each other during this season, a practice that often makes even the enjoyable aspects less enjoyable.

As you move about in the world during this season of opening and renewal, remember to hold yourselves and others in a place of understanding and compassion. If you find yourself feeling sad, angry, frustrated, hopeless, etc., remind yourself that those emotions are a part of life, no matter the season. The same goes with other people whom you interact with. Every season is the right season to treat yourself and others with compassion, and to reach out for the help that you need.

To access other posts from the Carolina Partners in Mental HealthCare, PLLC blog, follow this link: Be Well Blog

Is ‘National Nutrition Month’ a Recovery-Positive Campaign?

As registered dietitians dedicated to the prevention and evidence-based treatment of eating disorders and disordered eating, we found ourselves asking the following questions leading into National Nutrition Month®:

  • Does National Nutrition Month® (NNM) align with Eating Disorder/Disordered Eating (ED/DE) recovery?
  • As Health At Every Size® (HAES) informed professionals, to what extent might we ethically support participation in this month-long campaign focusing on nutrition and physical activity to our clients, our peers, friends, loved ones…ourselves?

The quick answers?

  • A little bit, kind of, sorta…
  • Proceed with caution

Here’s a more in-depth look at our perspective:

Let’s begin by explaining a little bit more about NNM!  NNM was created by the Academy of Nutrition and Dietetics (AND), the largest organization of food and nutrition professionals in the United States. AND defines NNM as follows:

What is National Nutrition Month®?

National Nutrition Month® is an annual nutrition education and information campaign created by the Academy of Nutrition and Dietetics. The campaign, celebrated each year during the month of March, focuses on the importance of making informed food choices and developing sound eating and physical activity habits.

– Academy of Nutrition and Dietetics (AND)

We’ve done a thorough review of the National Nutrition Month website for 2019 and wanted to share some thoughts with you.

What we appreciated about this year’s theme:

  1. The 2019 NNM theme is self-titled (“National Nutrition Month®”) which makes it more inclusive of many different topics of discussion – including eating disorders and disordered eating! Win!
  2. Many of the educational materials encouraged making sustainable changes towards achieving balanced food and movement routines that are individualized. We love this approach!
  3. Mental health and motivation for change (which are totally intertwined with eating and moving our bodies) were not excluded from the conversation!

What we could have done without:

  1. The language! Reviewing the NNM website brought up a much larger conundrum – the way we speak about nourishment in our society. The language we use to address nutrition and movement is morally charged. The “good/bad” or “right/wrong” polarization is not recovery-positive and continues to drive us farther away from seeing food as just food and moving our bodies as joyful and drives the shame wagon. Shame does not motivate people to adopt health-promoting behaviors.
  2. Weight management. Encouraging weight management through portion control and calorie tracking is not an approach that is respectful and accepting of all body shapes and sizes and promotes the message that larger bodies are inherently in need of “fixing” or must be controlled in some manner. Nah, nah, nah. Not buying it. Weight management is not weight neutral. It’s not HAES-informed. It’s not recovery-positive. It’s oppressive and unethical to prescribe disordered eating behaviors to people living in larger bodies. Also, there is a body of evidence against it.

*Caveat: National Nutrition Month was not created specifically for those in recovery from ED/DE, but for the general United States public.  However, even so, language equating terms such as “weight management” and “portion control” as being “right” can be harmful for at-risk populations and creates unnecessary vulnerability to developing ED/DE behaviors.

Suggestions for observing NNM in ED/DE recovery:

  1. Celebrate how far you’ve come! Take this opportunity to reflect on how eating and movement patterns have become more sustainable and balanced.
  2. Set goals. How might you propel your recovery forward this month? What would it look like to take steps to strengthen our relationships with ourselves and with food, movement, and recovery?
  3. Increase your food variety – try some new foods this month!
  4. Take up space and use your voice. Be in a larger body. Be fat. Exist as you are.

We love our field, our colleagues, and the wealth of valuable knowledge provided by AND, and we hope to continue to shift the way nutrition and wellness are presented to the general public to be more inclusive and less stigmatizing!

Check out what other ED/DE clinicians have said about NNM over the years:

https://marcird.com/my-take-on-national-nutrition-month/

https://veritascollaborative.com/blog/blog-national-nutrition-month/

https://www.sovcal.com/recovery/having-an-eating-disorder-during-national-nutrition-month/

 

 

 

What is “Health At Every Size”?

THE HEALTH AT EVERY SIZE® APPROACH:

Weight does NOT define Health.

The framing for a Health At Every Size (HAES®) approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES® model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being. The HAES® approach honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework.

The Health At Every Size® Principles are:

Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.

Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.

Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.

Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

What’s Love Got to Do with It?

En lieu of Valentine’s Day and with love on the mind, we thought to follow suite with February’s blog theme in a post about self love.

Except, we won’t be talking about self love.

Instead, we’re going to re-frame “self love” as “self acceptance.” Why? Hopefully the answer will be evident by the end of this blog post. In short: we don’t need to love every single thing about ourselves. That’d be unrealistic. A losing battle. Instead, making peace with our bodies through acceptance not only lifts a weight off our shoulders, but brings power through embracing uniqueness and diversity.

Merima Dervović is a public speaker and wheelchair user born with spina bifida. In her 2018 Ted Talk, Merima explains her body image difficulties and struggles with acceptance. She also shares her realization that while she doesn’t choose to love her condition, she chooses to embody her sexuality, her identity, her personality, etc. Merima identifies three steps in her path toward self acceptance. In this blog, we highlight, describe and expand on these steps.

Step 1: Acceptance means truth. And that’s a truth that society now needs more than ever. The majority of you are not in my position, but you don’t have to be in a wheelchair to inspire change in the world. You just have to get comfortable with your imperfections, wherever those imperfections may be.” In other words, acknowledgement. Acknowledge YOU, all parts that make you, YOU. This includes parts you may believe to be flawed, less-than, imperfect to a societal-imposed standard. This blog frames self acceptance from a body image perspective, but the message is also applicable with respect to mental and emotional parts of our character as well. The first step to awareness is to acknowledge your truths.

Step 2: Become shameless. This step involves taking your power back. Now that we’ve identified our ‘flaws’ in step 1, let’s own them. Being shameless means speaking your mind and allowing yourself to be [and feel] who you truly are – completely and fully. You have all the right in the world to not fit in and still feel good about yourself.

Be more shameless by using the art of ignoring things. Merima challenges us to: “Take all the shame imposed by others, look at it, and just let it go. What has helped me navigate the world is the art of ignoring things – glances and comments from others, etc. The truth is, people will hardly ever change. You will always encounter people that will judge you, stare at you, and make you feel like you won’t fit in. The good thing is that we can change the perceptions that we have about ourselves.

Step 3: Detach yourself with compassion. The key to this step is to switch the perspective that you have about yourself, focusing less about the things that you DON’T like about yourself, and instead emphasizing the things that you DO like.

“Acceptance is a process. You have to get comfortable with being uncomfortable. Every change is uneasy. But once you follow through with the process, you will find that most of your fears are inside of your head. They are not real. Commit to compassion day by day. Energy is put into compassion just as energy is put into self-loathing – choosing one over the other is the challenge.


Imperfection is the key to self-acceptance. You have to own your body from the roots of your hair to the toenails in your feet. You may not particularly like those hair roots or toenails (or other bodily feature in-between), but they are yours. Every flaw carries its own story, own uniqueness. They truly are what makes you, YOU! We don’t have to love our flaws, but simply acknowledging and accepting them allows our mind to feel content – and dare I say, empowered?

*This month’s blog post was developed and written by: Emma McVey, Dietetic Intern with University of Northern Colorado

OSFED & Additional Eating or Feeding Disorders: The Signs, Symptoms, & Impact

Other Specified Feeding or Eating Disorder

According to the National Eating Disorder Association

Formerly described at Eating Disorders Not Otherwise Specified (EDNOS) in the DSM-IV, Other Specified Feeding or Eating Disorder (OSFED), is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

Examples of OSFED Include:

  • Atypical anorexia nervosa (weight is not below normal)
  • Bulimia nervosa (with less frequent behaviors)
  • Binge-eating disorder (with less frequent occurrences)
  • Purging disorder (purging without binge eating)
  • Night eating syndrome (excessive nighttime food consumption)

The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. If something does not seem right, but your experience does not fall into a clear category, you still deserve attention. If you are concerned about your eating and exercise habits and your thoughts and emotions concerning food, activity and body image, we urge you to consult an ED expert.

Symptoms associated with anorexia nervosa include:

  • Inadequate food intake leading to a weight that is clearly too low.
  • Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.
    • Self-esteem overly related to body image.
    • Inability to appreciate the severity of the situation.
    • Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.

Restricting Type does not involve binge eating or purging.

Symptoms associated with bulimia nervosa include:

  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge-eatingepisodes.
  • Self-esteem overly related to body image.

Symptoms associated with binge eating disorder include:

  • Frequent episodes of consuming very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge eating episodes.
  • Feelings of strong shame or guilt regarding the binge eating.
  • Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior.

 

Additional Eating or Feeding Disorders

Avoidant/Restrictive Food Intake Disorder

  • Failure to consume adequate amounts of food, with serious nutritional consequences, but without the psychological features of Anorexia Nervosa.
  • Reasons for the avoidance of food include fear of vomiting or dislike of the textures of the food.

Pica

  • The persistent eating of non-food items when it is not a part of cultural or social norms.

Rumination Disorder

  • Regurgitation of food that has already been swallowed. The regurgitated food is often re-swallowed or spit out.

Unspecified Feeding or Eating Disorder

  • When behaviors do not meet full criteria for any of the other feeding and eating disorders, but still cause clinically significant problems.
  • Alternatively, when clinician is unable to assess whether an individual meets criterion for another disorder, for example, when there is a lack of information in an emergency situation.

Binge Eating Disorder: The Signs, Symptoms, & Impact

Binge Eating Disorder

According to the National Eating Disorder Association...

Binge eating disorder (BED) is an eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. Binge eating disorder is a severe, life-threatening and treatable eating disorder. Common aspects of BED include functional impairment, suicide risk and a high frequency of co-occurring psychiatric disorders.

Binge eating disorder is the most common eating disorder in the United States, affecting 3.5% of women, 2% of men,1 and up to 1.6% of adolescents.2

The DSM-5, released in May 2013, lists binge eating disorder as a diagnosable eating disorder. Binge eating disorder had previously been listed as a subcategory of Eating Disorder Not Otherwise Specified (EDNOS) in the DSM-IV, released in 1994. Full recognition of BED as an eating disorder diagnosis is significant, as some insurance companies will not cover an individual’s eating disorder treatment without a DSM diagnosis.

BED Symptoms and Diagnostic Criteria
The DSM-5, published in 2013, lists the diagnostic criteria for binge eating disorder:

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
    • 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).
  2. The binge eating episodes are associated with three (or more) of the following:
    • Eating much more rapidly than normal.
    • Eating until feeling uncomfortably full.
    • Eating large amounts of food when not feeling physically hungry.
    • Eating alone because of feeling embarrassed by how much one is eating.
    • Feeling disgusted with oneself, depressed, or very guilty afterward.
  3. Marked distress regarding binge eating is present.
  4. The binge eating occurs, on average, at least once a week for 3 months.
  5. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Characteristics of BED
In addition to the diagnostic criteria for binge eating disorder, individuals with BED may display some of the behavioral, emotional and physical characteristics below. Not every person suffering from BED will display all of the associated characteristics, and not every person displaying these characteristics is suffering from BED, but these can be used as a reference point to understand BED predispositions and behaviors.

Behavioral Characteristics

  • Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
  • Secretive food behaviors, including eating secretly (e.g., eating alone or in the car, hiding wrappers) and stealing, hiding, or hoarding food.
  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting; and developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, not allowing foods to touch).
  • Can involve extreme restriction and rigidity with food and periodic dieting and/or fasting.
  • Has periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling uncomfortably full, but does not purge.
  • Creating lifestyle schedules or rituals to make time for binge sessions.

Emotional and Mental Characteristics

  • Experiencing feelings of anger, anxiety, worthlessness, or shame preceding binges. Initiating the binge is a means of relieving tension or numbing negative feelings.
  • Co-occurring conditions such as depression may be present. Those with BED may also experience social isolation, moodiness, and irritability.
  • Feeling disgust about one’s body size. Those with BED may have been teased about their body while growing up.
  • Avoiding conflict; trying to “keep the peace.”
  • Certain thought patterns and personality types are associated with binge eating disorder. These include:
    • Rigid and inflexible “all or nothing” thinking
    • A strong need to be in control
    • Difficulty expressing feelings and needs
    • Perfectionistic tendencies
    • Working hard to please others

Physical Characteristics

  • Body weight varies from normal to mild, moderate, or severe obesity.
  • Weight gain may or may not be associated with BED. It is important to note that while there is a correlation between BED and weight gain, not everyone who is overweight binges or has BED.

BED Population and Demographics
Binge eating disorder is the most common eating disorder in the United States; it is estimated to affect 1-5% of the general population.1 BED affects 3.5% of women, 2% of men,1 and up to 1.6% of adolescents.2

Demographic Information

  • Binge eating disorder affects women slightly more often than men—estimates indicate that about 60% of people struggling with binge eating disorder are female and 40% are male.
  • In women, binge eating disorder is most common in early adulthood. In men, binge eating disorder is more common in midlife.
  • Binge eating disorder affects people of all demographics across cultures.

Physical and Psychological Effects of BED
Binge eating disorder has strong associations with depression, anxiety, guilt and shame. Those suffering from BED may also experience comorbid conditions, either due to the effects of the disorder or due to another root cause. Comorbid conditions can be both physical and/or psychological.

Physical Effects

  • Most obese people do not have binge eating disorder. However, of individuals with BED, up to two-thirds are obese; people who struggle with binge eating disorder tend to be of normal or heavier-than-average weight.
  • The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:
    • High blood pressure
    • High cholesterol levels
    • Heart disease
    • Type II diabetes
    • Gallbladder disease
    • Fatigue
    • Joint pain
    • Sleep apnea

Psychological Effects

  • People struggling with binge eating disorder often express distress, shame and guilt over their eating behaviors.
  • People with binge eating disorder report a lower quality of life than those without binge eating disorder.
  • Binge eating disorder is often associated with symptoms of depression.
  • Compared with normal weight or obese control groups, people with BED have higher levels of anxiety and both current and lifetime major depression.

BED Treatment
Effective evidence-based treatments are available for binge eating disorder, including specific forms of cognitive behavioral therapy (CBT), interpersonal therapy (IPT), dialectical behavioral therapy (DBT), and pharmacotherapy.

All treatments should be evaluated in the matrix of risks, benefits, and alternatives. Decisions regarding treatments should be made after consulting with a trained medical professional and eating disorder specialist.

To find a treatment provider who specializes in binge eating disorder, please visit NEDA’s Treatment Referral database.

Social Stigma of BED
Many people suffering from binge eating disorder report that it is a stigmatized and frequently misunderstood disease. Greater public awareness that BED is a real diagnosis—and should not be conflated with occasional overeating—is needed in order to ensure that every person suffering from BED has the opportunity to access resources, treatment, and support for recovery.

NEDA’s shareable binge eating disorder infographic offers an easy way to spread the word about BED. It is important to underscore that BED is not a choice; it’s an illness that requires recognition and treatment.

Sources
1. Hudson, J.I., Hiripi, E., Pope, H.G. et al. (2007)The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol.Psychiatry, 61, 348–358.
2. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry. 2011;68(7):714–723