With candor, humor, and remarkable courage, former New York Times restaurant critic Frank Bruni recounted his past struggles with his weight, binge eating, and bulimia nervosa, as this year’s keynote speaker of the International Conference for Eating Disorders in New York City. Bruni described many nights where, resolved to begin dieting tomorrow, he would eat a full dinner and then binge on take-out and ice cream. Ashamed of his behavior and increasing weight, Bruni avoided getting together with friends or pursuing romantic relationships.
Like Bruni, many people report that they have problems with binge eating, but what does the mental health community mean when we called something a “binge?” Binge eating is not just feeling like you’ve overeaten, it’s eating a large amount of food while feeling out of control, or like you cannot stop. For most people, Thanksgiving dinner or a fourth of July barbeque isn’t a binge even though you’re likely eating more than you normally would. However, if you felt like you couldn’t stop yourself from going back for more stuffing, or if you ate five strawberry shortcakes after promising yourself you’d only have one, you might be crossing over into binge territory. Countless men and women find their lives negatively affected by binge eating. The mental health community is taking steps towards recognizing these individuals’ struggles and developing treatments to better help them.
In fact, in 2013 binge eating disorder (BED) became an official diagnosis in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). As a result of the efforts of patients, clinicians, and researchers, we now know that BED is almost as common in men as it is in women, and that there are more people suffering from BED than anorexia nervosa and bulimia nervosa combined. We also know that among individuals with BED, those who judge themselves primarily by their shape or the number on the scale tend to be more depressed, struggle with more problematic thoughts and behaviors, and have lower self-esteem than those who find other ways to define or evaluate themselves.
But, there is some good news. There are several effective psychological treatments for BED- namely cognitive behavioral therapy and interpersonal psychotherapy. In cognitive behavioral therapy, clients work individually or in a group therapy setting to break the cycle of dieting and binging by implementing a very structured schedule for eating. Taking a different tack, interpersonal psychotherapy focuses on helping clients more effectively deal with interpersonal difficulties that are thought to perpetuate the problem eating behaviors and related distress. These treatments appear to be equally useful in reducing binge eating, though the time course for expected change in symptoms might be slightly different. In addition to psychotherapies, there are also medications that can help people reduce their binge eating.
While Frank Bruni did not have formal treatment for his disordered eating, he noted that, consistent with the main principle of the cognitive behavioral approach, the routine of eating on a fairly strict schedule while reviewing restaurants for the New York Times largely kept him from binge eating. He emphasized that regardless of whether you rely on self-help or formal treatment, being utterly honest about your eating problems and addressing them head on turns out to be easier than dealing with them alone, holding on to secrecy and shame.
To learn more about Frank Bruni’s experience with food, his body, and his appetite, check out his memoir Born Round: The Secret History of a Full-Time Eater. For more information about binge eating disorder, please check out the Binge Eating Disorder Association’s website. If you or someone you know is struggling with an eating disorder, we encourage you to contact the National Eating Disorder Association or our program for referrals.