Binge Eating Disorder: the Neglected Stepchild of Eating Disorders

Binge eating disorder (BED) finally received the recognition as a true eating disorder diagnosis in the DSM in 2014 yet still seems to be the neglected stepchild of the eating disorder treatment world.

The clinical community remains transfixed by the immovable fortress that Anorexia Nervosa presents in so many patients. And the relative success of cognitive behavioral therapy for Bulimia Nervosa makes for some positive affirmation in treating these difficult illnesses.

However, BED taps into several prejudices both in the medical establishment and in our culture that sideline interest in the disorder and undermine any movement towards improved care.

First, both overeating and larger people immediately trigger the fatphobia ingrained in our culture. Eating more and being larger invoke an automatic response of weakness, inferiority and worthlessness. The kindness, compassion and understanding that are the cornerstones of eating disorder treatment often don’t break through the raw prejudices in our society.

In addition, the eating disorder treatment protocols and insurance company standards for care all revolve around weight gain. Eating a nutritious meal plan and maintaining supposedly adequate body weight are erroneously deemed the overall goal of treatment. However, this entire philosophy is not relevant for someone with BED, and there is no similar approach to helping people with this disorder.

Time and again, people with BED who enter treatment programs note that they don’t belong, aren’t truly accepted and don’t see any value in treatment not geared towards their illness.

These patients frequently remark that they cannot find an outpatient program or group designed to help them and populated with people like them. However, these patients with BED are a significant and prevalent part of the population who have eating disorders. Just in my practice alone, easily one third of my patients with eating disorders have BED.

The next post will outline the goals of treatment and what adjustments in clinical goals can help people specifically struggling with BED.