Binge Eating Disorder Is Not About Willpower

Binge eating disorder (BED) affects people of all ages, genders and ethnicities, and is the most common eating disorder in the United States. Individuals with BED repeatedly engage in excessive food consumption over a short period of time, accompanied by a sense of loss of control and feelings of shame and guilt. They frequently have an overvaluation of shape and weight. Often individuals with BED don’t realize they have an eating disorder and don’t seek treatment. At the same time, there is a group who have sought treatment, relapsed, but are hesitant to seek treatment again because it wasn’t successful the first time.

Angie woke up at her routine time determined that she wouldn’t binge today. She recently relapsed after being successful in treatment for BED last year. Usually when she was determined she accomplished her goals. She was tired of feeling lonely and blamed the bingeing for her loneliness—how could she date or have close friends when she had this secret? No one knew how lonely she was either. She was around people most of the time, yet she kept her emotions hidden. No one really knew her. She described herself this way.:

It’s like I’m not in control, the binging is. It’s like stress just sends me right back to using food for comfort. I hate how weak I am and I can’t let anyone see that. I don’t know which came first, the depression or the binging but I’m miserable, have been for some time. The binging controls me. I’m trapped and I don’t know how to end this cycle.

In the afternoon, Angie’s daughter called, upset because her boyfriend had broken up with her. Angie comforted her but was also distressed—she hated that her daughter was so sad. She noticed urges to eat ice cream. Then her boss told he she was not getting the promotion she wanted, that she needed to improve her skills in working with a team rather than doing all her projects independently. She felt disappointed and resentful. No one worked as hard as she did, and no one recognized that. After the meeting with her boss, she felt fatalistic and began planning a binge. What did it matter? Nothing would ever work out for her.

Angie is part of a subgroup of individuals with binge eating disorder who also have a personality disorder. Temperament and personality styles have long been recognized by researchers in the eating disorders field as contributing to the onset, symptom expression and maintenance of eating disorders (Cassin and von Rassin, 2005). Given that 22 to 55% of individuals with eating disorder also have a personality disorder diagnosis, considering the personality disorder of the client is an important part of assessment for treatment and likely critical for effective treatment.

While research has identified primary personality disorders typically found with those who suffer from anorexia nervosa and bulimia nervosa, there is limited research concerning personality and BED. What research is available suggests that Avoidant Personality Disorder and Obsessive Compulsive Personality Disorder are most commonly associated with BED (Becker and Grilo, 2015).

In addition to a personality disorder diagnosis, Individuals who are diagnosed with eating disorders, including those suffering with binge eating disorder, typically have a mood disorder, such as anxiety or depression or both. Plus, over the course of time individuals with eating disorders tend to have various eating disorder diagnoses. The multiple diagnoses that an individual with an eating disorder is often given reflect the complexity of treatment. Yet certain core issues are believed to underlie various eating disorders. Treating the core underlying issues with a transdiagnostic treatment is often recommended.

Dr. Thomas Lynch, (2018) proposes that there are two underlying personality styles, under controlled (UC) and over controlled (OC). The under controlled personality style has low inhibitory control, high reward sensitivity, high threat sensitivity and global processing. The overcontrolled personality has high inhibitory control, low reward sensitivity, detail-oriented processing, and high threat sensitivity. The person with an under controlled personality style is driven by their emotions and struggle with emotion regulation. They act impulsively. The overcontrolled individual is not impulsive, and inhibits their emotions. They don’t need more self-control, they need to decrease perfectionism, rule oriented behavior, and learn to relax and connect with others.

Each personalitystyle would indicate a different treatment for the individual with binge eating disorder.. For those individuals assessed as under controlled, the DBT could be the indicated treatment For those who are assessed as under controlled, then RO DBT would be indicated. If you are seeking treatment for binge eating disorder, consider asking your therapist about the possibility of a transdiagnostic treatment.

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