Saturday, October 13, 2012

Binge eating disorder: the overlooked eating disorder

I was thinking about what to post, and realized I think my own blog represents the ways in which binge eating disorder is overlooked. Sure, so it's not an "official" eating disorder yet. It will be, and regardless, it is something with which many of our patients struggle. It reminds me of the post on competition between the eating disorders. I guess I don't often hear someone with binge eating disorder say they wish they had anorexia, but it wouldn't surprise me if the thought process is there.

I think the vast majority of our binge eating disorder patients don't even recognize their disorder is also fraught with restriction. The typical pattern for binge eating that I see is restriction in two different ways. One, there's the long-term restriction of multiple diets throughout their lives. Then, there's the day-to-day restriction, where they do not eat enough during the day, and then binge at night. But, in my experience, binge eaters look at their own body size and think both that they don't "deserve" the label of an eating disorder (because only the emaciated REALLY have eating disorders), and they cannot possibly restrict. So, at the beginning, it is often a bit of a battle on our parts to help those with BED recognize they are restricting.  But they must recognize this as they likely will not stop bingeing if they do not stop restricting.

A couple of themes that have come up with those who binge eat and/or compulsively overeat and, as a result, are at a higher weight. First, they often refuse to go to doctors anymore because, as they say, "I don't need anyone else to tell me I need to lose weight. It's like they think I'm not aware I weigh what I do." Second, almost without fail, these patients have a very limited ability to show any emotion. A few recently have talked about this concept in being "the funny, fat friend." They report feeling pressure to show everyone how funny they can be, seemingly to compensate for their weight.

We have struggled and struggled to start a binge eating group. I may have commented before on the difficult nature of trying to run any type of eating disorder group, given all the comparing and social anxiety. But, my guess is that the shame has been so strongly instilled in those with binge eating disorder, especially those at higher weights, that they just suffer in silence, not wanting to subject themselves to more judgement; even from those who suffer from the same behaviors. I remain optimistic that we will get a binge eating group started. I think it is greatly needed; especially so there can be a place where nobody needs to be the "funny, fat friend."

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