What Is Binge Eating?

Excerpted from
Binge Breaker! Stop Out-of-Control Eating and Lose Weight
By Dr. Peter M. Miller

While the term "binge eating" is of recent origin, the symptoms of this behavior have been recognized in medical writings for over two thousand years. In ancient works, excessive eating was referred to by the Latin bulimus or bolismus. Derived from the Greek bous, "ox," and limos, "hunger," the words referred to a ravenous or animal-like appetite. It was only later that distinctions were made between overeating with and without purging (vomiting).

Hippocrates wrote of binge eating as "sick hunger" as distinguished from ordinary hunger. In 1743, A Medical Dictionary, compiled by James in England, described a condition labeled "true boulimus" characterized by intense preoccupation with food and overeating within a very short interval.

Prior to the eighteenth century, binge eating was thought to be caused by any one or a combination of digestive dysfunction, stomach acidity, gastritis, defective gastric secretions, congenital structural abnormalities, brain disease, and head injury. It was only in the nineteenth century that theories regarding the possible psychological nature of this behavior emerged.

Early treatments focused on warming and comforting the stomach both internally and externally. Medieval medical prescriptions for this problem included the consumption of red wine, hot spices, and fatty, greasy foods. Apparently, fatty foods were prescribed to cause intestinal discomfort to discourage further eating. Other early remedies required all food to be boiled to "jelly" prior to eating. Fortunately, our current treatments are less traumatic, more palatable, and certainly more effective.

It was not until the 1950s that Dr. Albert Stunkard, a renowned obesity expert at the University of Pennsylvania School of Medicine, published the first case report of what he labeled "binge-eating syndrome" in Psychiatric Quarterly. Actually Dr. Stunkard's patient was responsible for naming the disorder when he compared his episodes of excessive overeating to an alcoholic's binge drinking. The patient was a 37-year-old high school teacher who was 5 feet 9 inches tall and weighed 272 pounds. He had been overweight since childhood. He sought treatment because he was being considered for a position as principal and could not pass the required physical exam because of his weight.

He told Dr. Stunkard that eating had become an obsession with him. He thought about food almost all the time. He spoke of his eating in terms of victories and defeats or instances of "I was good" or "I was bad." Being "bad" meant succumbing to temptation, breaking his diet, or going to great lengths to prevent anyone from witnessing his "shameful" acts of eating. His eating pattern was very erratic with few regularly scheduled meals. lie often ate out of frustration with day-to-day stresses.

During one binge, he stopped off at a grocery store on the way home from work and proceeded to buy a cake, several pieces of pie, and cookies. He remembers driving through town with one hand on the steering wheel and the other hand stuffing food in his mouth. He ate rapidly, paying little attention to what or how much he was eating. Afterward, he was totally stuffed and uncomfortable. He felt extremely guilty and upset over his behavior.

Unfortunately, little attention was paid to the binge-eating problems described in this case study for the next two decades. Then, in the 1980s, interest in this problem was renewed with the publication of several important studies. (I am pleased to say that the first of these research papers was published in the international journal Addictive Behaviors, of which I am editor in chief) Throughout the 1990s several major universities and medical schools have launched a concerted effort to find out more about binge eating and its treatment. Based on these studies we now can better define binge eating and the important clinical features associated with it.

The Definition of a Binge

Clinically, a binge is defined as eating—within a time period of two hours or less—an amount of food that is definitely larger than most people would eat under similar circumstances. People diagnosed with binge-eating disorder binge two or more times a week.

In defining a binge, the context in which the eating occurs is important. What would be considered excessive consumption at a typical meal might be normal or average during a holiday meal or a special celebration On the other hand, eating a meal-size portion of food as an in-between-meal snack would be considered excessive.

A single episode of binge eating does not have to be restricted to one setting. Consider the case of Joan. As a veteran dieter who never had been successful at losing weight because of her binge eating, Joan read a magazine article on binge eating and came to me for help. One of her recent episodes of binge eating illustrates the point that this behavior need not be confined to one location.

It was a Saturday and Joan and her husband were scheduled to go to a dinner party that evening. She had gained 30 pounds over the past six months and had been avoiding social engagements out of embarrassment.

At four o'clock in the afternoon she tried on the one dress she knew would still fit her and would also help to hide her extra pounds. Disaster! The dress wouldn't fit! Not even close. She couldn't even zip it up. She felt devastated. "What's the use?" she thought. She was alone in the house since her husband was out playing golf so she went straight for the refrigerator. She took out the ice cream, put a large portion in a bowl, covered it with chocolate sauce, and proceeded to cat it all. After finishing off another large bowl, she felt depressed, guilty, and angry with herself. She not only had "broken" her diet but she would have to go to the party in one of her larger-sized outfits, one that she felt made her look like a "tank."

Once at the party, she overate hors d'oeuvres and even had dessert. She felt self-conscious the entire evening and couldn't relax. Upon returning home, she stayed up later than her husband to watch television. She felt so miserable and embarrassed that she ended up eating a whole bag of chocolate chips that she had bought a few weeks earlier to make cookies.

Joan's overeating had begun in the afternoon, continued at the party, and kept going upon her return home. While this pattern is considered binge eating, frequent snacking on small amounts of food throughout the day would not be called bingeing.