The following is not independent thought and derives from chapter 7 of Christopher Fairburn's "Overcoming Binge Eating".
This post is a follow-up to a previous one entitled "What Causes Binge Eating?":
https://www.johnrapplcsw.com/post/what-causes-binge-eating
A "binge" in the context of binge eating disorder is defined as involving three or more of the following, according to DSM-5:
Rapid eating
Eating to past the point of fullness and to discomfort
Eating objectively large amounts of food when not physically hungry
Eating alone due to emabarrasment over quantity
Disgust, depression, or guilt following a binge
Binge eating must also cause "marked distress" for the individual.
Binge eating disorder and 'classic' addictions do have phenomenological similarities:
Cravings or urges
Loss of control
Preoccupation with the behavior
Use of the behavior to alleviate tension, negative emotions
Denial of the severity of the problem
Attempts to keep the problem a secret
Persistence in the behavior despite negative consequences
Repeated and unsuccessful attempts to stop or cut back
The 'addiction model' of binge eating suggests that people who binge are biologically vulnerable to certain foods, typically sugar and starches. These foods are viewed as toxic to the individual and thus permanent abstinence is recommended.
However, there are important differences between binge eating disorder and classic addictions:
Binge eating does not involve the consumption of only sugar, starches, etc. It is the amount of the food consumed that is the central problem, not which foods are eaten. I have never encountered anyone who binges only on pure sugar.
Those who binge have a strong drive to avoid the behavior and compensate for it by way of returning to dieting. Much of the distress related to binge eating is that it represents a 'dieting failure'. Binge eating as a reaction to and breakdown of strict dieting has no equivalent in classic addictions.
Those who binge fear the behavior. In most cases, the underlying drive to diet, self-worth associated with thinness, and body image distress create a strong disincentive. Those addicted to alcohol or other drugs are not vulnerable to (over)using substances as a result of a wish and effort to avoid them.
As discussed in a previous post, the "restraint model of binge eating" does not account for all binge eating problems. When it is absent or present to a lesser degree, binge eating often serves as a method of regulating emotion. This is also true of self-injury, which typically is not considered an addiction.
Binge eating disorder and substance abuse problems can and do co-occur, but not at higher rates than in other mental health disorders, suggesting there is no shared etiology or underlying process.
CBT-E is thus critical of applying an abstinence-only or 12-step approach to treating binge eating disorder, especially when the total and permanent avoidance of specific foods or food components in prescribed. Major differences between the approaches include:
12-step programs may view binge eating as an illness for which there is no cure and suggest that abstinence is required for management of the illness. CBT-E suggests that recovery is possible for most people and that former binge foods can be reintegrated safely into one's diet. Food avoidance is viewed as a significant driver of binge eating, not a solution.
12-step approaches may strive for the immediate cessation of binge eating. CBT-E suggests that it may require weeks or months for a pattern of regular eating, exposure to feared foods, addressing body image problems, etc. to greatly reduce the frequency of binges.
12-step programs may encourage a black-and-white stance toward whether one is in/out of control of eating, abstinent or not, and whether foods are toxic or not. CBT-E suggests that all-or-nothing thinking (the ricochet effect discussed in my previous post) is a significant driver of binge eating and must be attenuated.
CBT-E's concern, I infer, is that an abstinence-based approach will either worsen binge eating, by strengthening the restraint model, or train the individual to be 'better' at restrictive dieting - perhaps shifting their symptoms toward those of another eating disorder.
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