Understanding Binge Eating Disorder in Men
Binge eating disorder (BED) has become an emotional and health concern for men across the United States. This eating disorder, which affects more than one million men in America, is recognized by the American Psychiatric Association as a disorder of its own that needs further study.
What is BED?
About 95% of the US population have cravings for "pleasure" or "comfort" foods. The other 5% crave alcohol, cigarettes, or some other addictive substance. Having cravings and fulfilling them is a natural human instinct.
But BED is more than an occasional craving for a sweet snack. At first, eating may satisfy cravings. But eventually, the eating becomes more and more frequent and higher in calories and fat. This overeating leads to feelings of self-disgust and guilt, which may cause a person to eat even more.
A typical binge may include eating anywhere from 1,000 to 15,000 calories at a time. In fact, it is not uncommon to have a "food hangover" the day following an especially large binge. The foods consumed are usually high in fat and are eaten in a relatively short period of time, putting an enormous amount of stress on the digestive and endocrine systems. BED is different from two other characteristic eating disorders, anorexia and bulimia . Anorexia is a condition of slow, self starvation, while bulimia is a binging and vomiting syndrome.
BED is formally characterized by the American Psychiatric Association in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) according to the following five criteria:
1. Recurring binge eating episodes – An episode of binge eating is characterized by both of the following:
- Eating an amount of food that is definitely larger than most people would eat in a similar amount of time under similar circumstances
- A sense of lack of control over eating during the episode
2. The binge eating episodes are associated with three or more of the following:
- Eating much more rapidly than you usually would
- Eating until you feel uncomfortably full
- Eating large amounts of food when you don't physically feel hungry
- Eating alone because of embarrassment at how much you are eating
- Feeling disgusted with yourself, depressed, or very guilty after overeating
3. Binge eating causes emotional and physical stress or remorse.
4. The binge eating occurs, on average, at least two days a week for six months or more.
5. The binge eating is not followed by other inappropriate behaviors such as purging, fasting, or excessive exercise, and does not occur exclusively during episodes of other eating disorders, such as anorexia nervosa or bulimia nervosa.
Who is Affected by BED?
While only 5% to 10% of people with anorexia and bulimia nervosa are male, it is estimated that BED affects a much greater proportion of men. It is estimated that about 40% of people with BED are men.
What Are the Common Characteristics of BED?
There are some underlying common characteristics of men who have BED. Most are overweight and sedentary with a history of depression , low assertiveness, and poor self-esteem. Similar to people with other eating disorders, men with BED view themselves in a negative light and allow food to control their lives in order to compensate for their lack of control in other areas such as work or family matters.
Another common characteristic of men with BED is that they fail to address their own personal needs and turn to food instead. For these men, food can be a great sedative and a means of suppressing feelings of anger, guilt, despondency, and sadness. Men with eating disorders tend to eat in private, not wanting to alert others to their habit. This increases the feelings of isolation and sadness, creating another vicious cycle.
The pathophysiological mechanism of binge eating is poorly understood. Many patients report stress to be a major trigger for binge eating. From other studies, we know that stress, in turn, causes increased levels of cortisone, the so called “stress hormone”. Cortisone administered to patients significantly increases appetite, which might explain the biological mechanism of binge eating. More studies are needed in this area.
What Are the Effects of BED?
Unlike bulimia, where people eat and then purge, there is no counteraction to binging. Therefore, weight gain is a likely effect. As noted above, men with BED are often overweight to begin with. The effects of BED on health include all the possible consequences of overweight or obesity— diabetes , hypertension , and heart disease .
An ever more serious consequence is death. According to Dr. Ken Stephenson, a psychotherapist who specializes in treating males with eating disorders, "People with eating disorders have the highest mortality rate of all psychiatric patients." Isn't that a good enough reason to seek help now?
Where Can I Get Help?
Men with symptoms of BED need to seek treatment as soon as possible. The longer a person waits, the greater the risk to their health. Treatment of the disorder generally includes cognitive-behavioral or interpersonal therapy performed by a licensed clinician. Cognitive-behavioral therapy teaches patients techniques to monitor and change their eating habits as well as to change the way they respond to difficult situations. Interpersonal psychotherapy helps people examine their relationships with friends and family and to make changes in problem areas.
Treatment with medications, such as antidepressants, may be helpful for some individuals. Self-help groups also may be a source of support. Researchers are still trying to determine which method or combination of methods is the most effective in controlling binge eating disorder. It appears that multimodal therapy that combines both medications and intensive cognitive behavioral therapy (a type of psychotherapy) works the best. However, the type of treatment that is best for an individual is a matter for discussion between the patient and his or her healthcare provider.
National Eating Disorders Organization
Reas DL, Grilo CM. Timing and sequence of the onset of overweight, dieting, and binge eating in overweight patients with binge eating disorder. (published electronically ahead of print) Int J Eat Disord. Nov 6, 2006.
Molinari E, Baruffi M, Croci M, Marchi S, Petroni ML. Binge eating disorder in obesity: comparison of different therapeutic strategies. Eat Weight Disord. 2005;10(3):154-161
Gluck ME. Stress response and binge eating disorder. (published electronically ahead of print) Appetite. Jan 2006;46(1):26-30.
Last reviewed January 2007 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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