Warning: This post contains specific details of my experience of my eating disorder. Some parts of it could potentially be triggering to others with eating disorders.
The DSM V says:
Binge Eating Disorder: 307.51 (F50.8)
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge-eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Specify if:
In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than on episode per week for a sustained period of time.
In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity: The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Mild: 1-3 binge-eating episodes per week
Moderate: 4-7 binge-eating episodes per week
Severe: 8-13 binge-eating episodes per week
Extreme: 14 or more binge-eating episodes per week
https://www.psychiatry.org/psychiatrists/practice/dsm
Binge Eating Diagnosis
Binge Eating Disorder. They say I have this. I feel like I drifted around and through this diagnosis for many years, not having a clear idea of what was happening or that it could be thought of as an eating disorder. Providers would ask me if I binged, or purged, and I would say “No, I just eat too much.” They almost never asked a second question, so I got away with my ellipses.
My last two serious diet attempts were more medicalized than the previous ones. One was an inpatient weight loss clinic and one was an outpatient program through a local hospital. Providers at both of those programs were more persistent about questioning my bingeing. Honestly, I think they were trying to cover their butts–if I had a real “disorder,” then it couldn’t be their fault when their diets failed. They simply weren’t equipped to handle someone as ill as I. Both programs diverted me from their main weight loss groups into more binge-eating-oriented sessions.
Ironically. I believe that was the seed that finally got me free of the whole diet industry. Because even these diet industry programs had to admit that their stupid fasting and limiting and protein drinks–one of these was a diet so parsimonious that I became sodium deficient, something I had had no idea was even possible*–could be triggers for binges. So even they had to start letting me think through how often and how much I needed to eat to stay “under control.”
*The solution to sodium deficiency, apparently, is permission to eat 1-2 zero-calorie cups of bouillon per day. Not more. We don’t want to trigger water retention.
Some combination of them having to be honest about a few things, which actually got me some proto-information about this disorder, and the mere fact of the increasingly absurd bullshit I was being fed (instead of food), broke through. I started questioning whether it actually made sense to force myself, when already in pain from hunger, to postpone eating for at least 15 minutes by drawing in an adult coloring book.
The whole thing is still pretty amorphous. I don’t, so far as I am aware, have a written diagnosis by a doctor of binge eating disorder. I’m not aware of there being any particular prescribed or organized course of treatment. I’m not even sure, some days, that I have it. It’s not something that has worked its way into my “identity.”
In the book The Care and Feeding of Ravenously Hungry Girls, by Anissa Gray, there is a vivid description of the experience of a binge episode. It rings true to me, but doesn’t feel like me. I don’t feel like bingeing caused a blissed out or numbing feeling for me. I don’t feel like the compulsion to binge was ever consciously associated with particular emotions. It always really truly felt like just a rebound from the restriction and like a failure of control, like not being at the helm of my own ship.
Diagnostic Criteria
Some parts of the DSM V description feel very, very true for me. A2, B2-4. A2–a sense of lack of control in your eating–is the hallmark of how I have felt about eating for 42 years. No control, and, truly, no belief that I could ever be in control. Of course it turns out that the right way to not lose control is not to try to over-control things in the first place. Trite but true.
These days, by the way, a common occurrence in my half-recovered state is for me to get too hungry (more on that in another post), gather a huge pile of food, and begin to eat. A few minutes later, I will think something like “This is great, I’m really going to finish this, I am going to binge! I am never going to stop.” And then not long after, sometimes just a couple of bites after, full stop. Lots of food gets wasted and, unfortunately, food finds itself abandoned all over my house, office, and car. (Other aspects of my self care also need work, apparently.) But not only do I no longer feel out of control of my eating, I no longer even feel able to be out of control of my eating. I kind of miss that sometimes.
B2, B3–pretty well the definition of a binge. B4–this is huge. I’ve eaten secretly for years. Even my husband rarely saw my worst binges. I would wait until he went out to work or see his friends on my day off, and then order and eat an entire pizza or a huge pile of takeout chinese. One of the first hints, in retrospect, that I was starting to win free, was the willingness for him to know that I was eating these things and how much I was eating. Because the shame and the hiding is also the joy and the glory of having a secret, a special thing all your own.
B5 and C are a bit iffy–I didn’t really have consciousness of bingeing so much as categorically overeating, so it’s hard to recall feeling marked distress about the binges in particular. Plus I was hideously depressed the whole time, not just about eating. I felt disgusted with myself pretty much 24-7, so I don’t know where one disorder ended and the next began. I do recall marked distress over the occasional periods when I would also purge. I had strong awareness of the health risks of excessive vomiting and wished I could resist purging, although at the same time that was mixed with pride that I had “cleared my system” of the results of the binge. And a relief of the physical pain of overfullness, of course.
D–I never tracked my binges carefully, or even my eating in general, until things were already starting to get better, so this is hard to say.
But Wait, Really?
But what I really want to talk about is the rest of the description. A1 and E in particular.
It frustrates me that in A1 this disorder is characterized in opposition to, or comparison with, “normal” eating. I’m pretty goddamned sure that even when I don’t binge I eat more than “normal.” I know this because first, I’ve had my resting metabolism tested (by one of those “medical” diet facilities) and it’s quite high, so if I ate a “normal” diet of 2000 calories a day, I would be rapidly shrinking. Second, I’ve watched normal people eat. They don’t eat shit. I’ve seen them, in all seriousness, be defeated by a tiny container of Teddy Grahams after their lunch, and I’m not talking about dieters. In fact, whenever I have lunch with my coworkers in a group, I always end up undereating because I am unconsciously keeping pace with them. Then I’m ravenous two hours later. (Probably also a good topic for a future post.)
This kind of vague, moralization-tinged definition of the disordered eating process is, in my opinion, symptomatic of the bullshit fatphobia with which the medical profession is rife. And I bet it makes it hard to diagnose fat people properly, because where does eating an appropriate amount to nourish your larger body end and disordered eating begin? If you only had the DSM V to go off of, I think you would have a lot of trouble answering that question.
Warning: The next bit is the part I am most concerned could be triggering, particularly for those in recovery from a restrictive eating disorder. Proceed with caution.
Worst of all badness, though, is E. Reminder:
The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
You know what this sounds like to me? It sounds a hell of a lot like binge eating disorder is what you have if you aren’t cool enough to qualify for anorexia or bulimia. You aren’t clever enough to realize that you are supposed to engage in “compensatory” behavior to balance your bingeing. Yeah, they covered their asses with the word “inappropriate,” but “compensatory” is pretty strong. You also haven’t quite managed to qualify for a restrictive eating disorder–which is always checked for first–so congrats, you get the consolation diagnosis.
Admittedly, I’m sure some of that is me reading things into it, because that’s what I’ve always believed. Do you know how many times I have prayed–literally prayed–to get anorexia instead? If I were going to be sick with an E.D., the reasoning went, then couldn’t I at least lose some weight while I was at it? Why, oh why, did I have to have an imbalance in the direction of bingeing over purging? I’ve actually tried, on multiple occasions, to “flip the switch”–trick my brain into addicting to the feeling of emptiness instead of the feeling of fullness–as a weight-loss technique. Go American social pressures! Go!
So thanks a fucking lot, Mr. DSM V (and I feel confident you are a Mr., although I realize I shouldn’t project that genderization onto you without your permission) for making me feel, even in the moment of my diagnosis, like a failure with the wrong, less cool disease. That was really a value added to the whole journey.
Remission
Raise your hand if you had any idea that eating disorders, like cancers, could go into remission. Anyone? Anyone?
By the definition in this manual, I am now in full remission. I haven’t had a real binge in months. Some of the emotional distress still happens, and I still have bad eating habits and eat too much too infrequently, but I no longer lose control or awareness of my eating. I no longer finish entire containers of food in one sitting. I no longer hide my eating.
Do I feel like I am in remission? I do not. I actually find this possibility terrifying because if I am getting better than why can I still not feed myself successfully? I can barely get through a single day without a food-choice-related disaster and I have regular panic attacks about how to nourish myself. I can’t handle the grocery store and even Instacart is often a big fail. Our oven has been broken for 16 months and it only impinges on my consciousness once every couple of weeks, because I don’t cook.
Also, why am I not losing weight? — argh, so much work still to be done on the body liberation/ fat acceptance side of the aisle!!!!
And finally, what the fuck do I do with my Saturdays now?
Fat, Fab, and Forty 