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Princess Diana in 1982, left, and in 1997. In a 1995 BBC interview, she disclosed she had battled bulimia. Photos/Getty Images

How to overcome binge-eating urges

The good news for people with extreme eating urges is that the disorder responds well to treatment, writes Ruth Nichol.

Binge-eating disorder wasn’t recognised as a distinct eating disorder by the American Psychiatric Association until 2013. That means it has been studied less extensively than other eating disorders such as anorexia and bulimia, and there are fewer statistics available about it.

Most existing data comes from the US, where binge-eating disorder is estimated to affect three times as many people as anorexia and bulimia combined – about 3.5% of women and 2% of men. However, although eating disorders have typically been more common in women, it’s now thought men may be equally affected by binge-eating disorder.

A diagnosis of binge-eating disorder is made if someone has at least one episode of extreme eating a week for at least three months. “Bingeing is not over-eating,” says Auckland eating-disorders specialist Jan Geary. ”It’s eating a large amount of food in a very short period of time and it’s always accompanied by a sense of being out of control.”

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Most people feel ashamed and embarrassed by their behaviour and do it in secret. However, unlike bulimia, they do not try to vomit afterwards. Bulimia affects about 1.5% of women, including Princess Diana, who in her explosive 1995 BBC Panorama interview with Martin Bashir said she developed “rampant bulimia” after finding out Prince Charles was having an affair with Camilla Parker Bowles.

Geary says that no one knows exactly what causes binge-eating disorder. Eating disorders of all kinds tend to run in families, but it’s hard to know whether that’s because of genetic factors or shared attitudes towards food. She says having a larger body during childhood can be a predisposing factor, possibly because it leads to dieting, which then tips over into binge eating. Other possible contributing factors include coming from a family where food is used as a reward, and the generally greater availability of energy-dense food.

Jan Geary. Photo/Supplied

The good news is that binge-eating disorder responds well to treatment. Geary uses an approach developed by British eating-disorders specialist Christopher Fairburn called enhanced cognitive behaviour therapy (CBT-E).

Treatment starts with the affected person keeping a real-time record of everything they eat, as well as any relevant thoughts and feelings associated with eating. “This often reveals how frequently they are bingeing – they may think they are doing it once a week but it’s actually four times a week.”

At the same time, they are encouraged to establish a regular pattern of eating, with three planned meals a day and snacks in between. Geary says many binge eaters have chaotic eating patterns, and it’s important to introduce a more normal regime to help prevent bingeing.

Other elements of treatment include finding alternative activities as distractions from the bingeing urge, such as going for a walk or having a shower or a bath.

It’s also important to eliminate dieting of any kind and to stop thinking in terms of “forbidden foods”. “Often people with binge-eating disorder avoid more energy-dense food, then they eat it in a binge,” says Geary. “It’s about learning how to have some pizza or caramel slice and then stop, rather than carrying on.”

Fairburn recommends having about 20 treatment sessions in as many weeks. However, Geary says although this is usually successful for people with bulimia, it can take longer than 20 weeks to rein in binge eating.

“They might be in their thirties or forties or fifties and they have been eating in a chaotic way for most of their lives. For some people, committing to normal eating is a huge undertaking and they really have to put the hours in.”

This article was first published in the November 16, 2019 issue of the New Zealand Listener.