Two Pathways to Over-Eating or Binge-Eating: Change Your Course
As I field inquiries from individuals seeking treatment for conditions like binge eating disorder and bulimia, I almost always provide some basic education in that very first call about the two most two most common “pathways” to over-eating or binge-eating (and ultimately purging cases of bulimia). Almost every caller will identify with at least one of the common pathways or patterns:
- Chronic restriction, restraint or long-term weight control efforts
Many who struggle with over-eating report varying degrees of effort to limit or restrict eating with the objective of controlling or losing weight. Or alternatively, there can be restricted or controlled eating with the goal of eating “clean,” being “healthy.” I hear a lot of people talk about ongoing efforts to “be good” or stick to some kind of eating rule[s] and then the experience of guilt and self-condemnation should they break that rule. Invariably, judgments about good/bad, ok/not ok, lead to preoccupation and tremendous investment of time thinking and worrying about food.
Whether restrictive behaviors leave you so ravenous that you can’t help but over-eat or alternatively, they just leave you frustrated, conflicted, deprived --- the result is over-eating or bingeing, feeling lousy and then trying to “get back on track” by jumping right back into a restrictive pattern.
- Mood or event-related eating
Feelings. We all have them but don’t always manage them effectively. Food is a means of escape, numbing, relaxing, pleasure, relief… Unfortunately, these are short-term “benefits” but long-term, using food to cope leads to all sorts of problems. Some people find that certain settings or events can be triggering and can lead to over-eating or binge eating episodes. Again, the food can act as a means of self-soothing, which can feel helpful, calming in the short-term – but clearly not beneficial in the bigger picture.
Effective Treatment for Over-Eating
Effective treatment for binge eating or over-eating (and purging) needs to address the aforementioned patterns head on. Enhance Cognitive Behavioral Therapy in many cases, is the ideal intervention. A benefit of course, is that it is relatively short-term (20 weeks) and thus, extremely efficient and cost effective. We expect to see at least a 50% reduction in symptoms in the first 6-8 weeks. If we do not, then we will be serious about figuring out what is getting in the way of change. The vast majority of patients (at least two thirds) do respond with this kind of symptom reduction in the first stage of treatment. So that’s some potentially very serious change, which comes as a tremendous relief to anyone suffering from binge eating/over-eating.
CBT-E provides strategies to support a stable, pattern of flexible eating. You will identify the emotions that get you in trouble and learn alternative skills for coping. You will be given strategies for increasing your awareness of what’s happening with your food and alternatives (skills) when tempted to eat when you’re not actually hungry.
More standard talk therapies or open-ended exploratory, insight-oriented therapies are very helpful for many, but they tend not to be highly impactful if you are trying to change your eating. We require behavioral interventions for behavioral struggles. So CBT-E - proven through research as the most effective course for binge eating disorder and bulimia – is in most cases, the way to go.
When seeking treatment, be sure to ask about therapist training and treatment orientation. Standard CBT is different from CBT-E, which was designed specifically for eating disorders, so be sure that the provider knows and practices the Enhanced CBT version of CBT. And make sure that the therapist plans to adhere fully to the CBT-E treatment. “Using techniques” from CBT-E is not enough. For more information on Enhanced CBT click here.
About the Author:
Melissa Gerson, LCSW is the Founder and Clinical Director of Colombus Park, the leading outpatient eating disorder treatment center in New York City.
Melissa is a native New Yorker whose original career path landed her as a professional ballet dancer with the Miami City Ballet Company in Florida. But after seven years on her toes, Melissa retired and returned to her NYC roots to attend Columbia University as a Psychology major. She went on to earn a master's degree in social work at New York University. Melissa has fifteen plus years of experience both on the front line of eating disorder treatment as a therapist, but also behind the scenes in program development and clinical supervision. Melissa completed post-graduate training at some of the most reputable NYC institutions like NYU’s Psychoanalytic Institute, the William Alanson White Institute and NY State Psychiatric Institute. Having completed years of intensive training through the Training Institute for Childhood and Adolescent Eating Disorders, Melissa is a Certified Family-Based Treatment Therapist; thus she is one of a handful of providers in NY State, fully certified to provide Family-Based Treatment (Maudsley) for children and teens.
Melissa is a true leader in the eating disorder treatment community with a particular focus on using the most current and efficient evidence-based treatments like CBT-E, DBT and Family-Based Treatment for Children and Adolescents.