Easier to be Treated for Anxiety than Binge Eating

Why is it so much easier to tell my doctor about my anxiety than about my eating habits?

And why doesn’t my doctor ask me about my eating habits? 

It seems that the stigma and shame felt around our binge eating might also be experienced by the health professionals we consult with.  And the consequence of this is that people are not receiving the specialist help they need and deserve.  People try every diet available, and often have considerable success – in the short term.  They are genuinely committed to, and focused on, curbing excessive eating that they probably already realise happens when they are distressed or anxious.  But the anticipation of judgement from a health professional means that often their anxiety is discussed but not their binge eating.  So when a person is referred for ‘talking therapy’, they are perhaps offered a course to learn anxiety management skills – and still the problems underlying the binge eating are not addressed.

So we talk about our anxiety, which feels much more acceptable, and our doctor can be empathic towards us and they feel confident in providing treatment.  But if the binge eating never gets mentioned, it never gets treated.  Of course, it is really important to  address social anxiety, self-consciousness and other forms of anxiety but doing this alone may not be sufficient to help us feel restored and in charge of our lives….and our eating.

Self criticism leads to further binge-eating

A research paper from 2021 tells us about a university student treated for anxiety – specifically excessive shyness, fear of social situations and fear of contributing in class.  She was also anxious about being judged negatively about her body weight although she was not visibly obese.  With a very  specific medication routine, most of her anxiety symptoms greatly improved and remained stable for a period of five years.  However she remained concerned about her weight and, despite trying different weight loss programmes, had not reduced her weight.  Only after being reviewed following five years of anxiety treatment did she disclose that she was regularly binge eating.  And these bouts of excess eating were followed by self-criticism, guilt and stress which preceded the next binge eating episode.  The reason she gave for not reporting the binges was her fear of being judged negatively.  And the mental health team caring for her, had not asked about her eating.

Research tells us that as many as 70% of people with binge eating disorder also experience diagnosable anxiety.  So why is it so hard for everyone to talk about binge eating?

So maybe we can start by thinking about why it is easier to talk about anxiety.  One reason would seem to be that talking about our mental health has just become more mainstream over the years since the Covid 19 Pandemic.  The pandemic was shown to have a widespread, negative impact on mental health including anxiety.   Sadly, many people continue to suffer long-term effects on their physical and mental health.  But the ‘up-side’, if you can call it that, is that the stigma surrounding mental health has reduced.  So, as we hear friends, relatives, and even celebrities, talking about their post-pandemic anxiety, we see that we are not alone.  Our experience is normalized, we feel more confident to talk about it and consequently we are more likely to get help.

So why isn’t it the same for binge eating?  Firstly, we just don’t hear so many people talking about it – although, thankfully, a few celebrities, such as Ed Sheeran, are starting to disclose their own difficulties.

For some people, a significant element of binge eating is secret eating.  They hide, hoard or just eat when others are not around to witness what they’re doing.  The secret eating is sometimes, but not always, part of an episode of excessive eating. So secrecy and anxiety about being seen can be an integral part of the problem.

Secret eating, along with binge eating, is understood to be associated with shame.  So it is really no wonder that we find talking about it so difficult.  Shame is the emotion that makes us withdraw and hide from others.  As Brene Brown would say, ‘shame is shaming’.  It undermines our sense of self-worth and can make us highly sensitive to how we believe others perceive us.  We strive hard to avoid feelings of shame so the behaviour that shames us is rarely disclosed.  And health professionals are not immune to this either.  Because of the way we have evolved to ‘mirror’ the emotions we witness in others our GP, for example,  will be also trying to avoid experiencing the discomfort of shame that he anticipates from asking a potentially shaming question of his patient. 

So why do we find binge eating such a shameful thing?  This is perhaps related to our present day culture and society’s expectations.  Eating excessively hasn’t always been frowned upon.  In past times, having the finances to eat more than needed was often aspired to.  But our 21st century ‘Western’ society places a very high value on ‘self-control’.  And if we binge eat, we would appear to have no regard for our self-control.   It may be that valuing a person’s ability for self-control started to gain popularity with the Victorians .  We might even have been encouraged to believe it was ‘good for our soul’ to be self-disciplined!  So I think the shame we feel in relation to excessive eating has quite deep cultural roots. 

These ideas, although expressed more subtly, seem to survive just as strongly in some parts of our society today.  This is alongside the false belief that we all have equal opportunities and therefore equivalent resources, finances, living situations etc. 

Being stressed by our current living circumstances will often lead to a more generalized anxiety.  If we are not in a position to change these circumstances, what could be more intuitive that to seek relief from anxiety in whatever way we can - this could well be through food.  And if these stressful circumstances are prolonged, or we have unresolved trauma in our history, our susceptibility to anxiety will remain and we will continue to seek comfort.  Very often, we then feel shame from our ‘comfort behaviour’ which makes us feel even more anxious and we repeat the same cycle again. 

But this leaves us in a predicament.  We want to bring our binge eating to an end and restore our self-esteem and confidence.  But as we stop the behaviour that brings us comfort, the difficult feelings and anxiety are more noticeable and feel more distressing. 

Changing compulsive eating behaviours is additionally tricky because, unlike alcohol or drugs which we can completely abstain from, we need to eat.

But despite these challenges, there are definitely things we can do to increase our chances of making sustained changes to our binge eating patterns.

·       We can start by getting clear about our motivation by listing the pros and cons of stopping bingeing.

·       We know that we will need new behaviours to replace bingeing, so now is a good time to think about what else will be soothing, healthy and supportive for us.

·       We can examine what happens around our binge episodes to identify our patterns; start to know our triggers and put in place ways to avoid them.

·       Find alternatives to food as a reward when you are having success.

·       Eat nourishing meals with healthy snacks in between so that you don’t get too hungry and so that your mood is not negatively affected.

·       We might have developed unhelpful thinking styles such as ‘black and white thinking’.  This would lead us to abandon our goals when we just have a slip up.  If you realise that this is what you do, practice challenging these thoughts when they arise.

·       Try to make sure that life isn’t just filled with chores.  Try to make time for yourself and increase the time you spend doing things that you enjoy.

·       Look at what is adding stress to your life.  Make sure you are not putting off dealing with problems, or you are likely to be thinking and worrying about them, which becomes an ongoing stressor from inside you. 

·       If you are trying to lose weight, aim for a healthy, enjoyable range of foods.  Look for the type of meals that you can imagine eating into the future.  Make it a ‘way of life’ not a ‘diet’.

·       Practice mindful, slow eating on maybe one meal each day so that you start to notice the tastes, textures and appearance of your food.  This can make it more satisfying and enjoyable.  With mindful awareness you can start to distinguish between when you are actually hungry and when you want to eat for different reasons.

·       Try to include some additional exercise.  This will aid weight management and will also release ‘feel good’ chemicals in your brain and help with your mood, which should also give you less reason to ‘comfort eat’.

·       Make a plan for how you are going to get back on track if you have a slip up.

So while you might feel that you are stuck in a compulsive cycle of binge eating, there are definitely things you can do to make a start on change.  Planning ahead will be hugely helpful.

You can also access a workbook here:  https://www.naadac.org/assets/2416/mitchell-cbt-for-bed-self-help-manual.pdf which elaborates on the ideas above.

For many people, addressing the underlying emotional drivers behind their binge eating will be a crucial element of overcoming the bingeing behaviour and the anxiety that could be maintaining it.  This will probably be through personal counselling or psychology input.

So even though your GP might not ask you about your eating behaviour, maybe with increased assertiveness and confidence in knowing what you need, you will feel able to broach the topic and begin the conversation. 

Reading

Patterson B, Pipe A, Van Ameringen M.  (2021) Binge eating disorder hidden behind a wall of anxiety disorders.  J Psychiatry Neurosci.  Mar; 46(2): E208–E209

Carlos M. Grilo and Janet A. Lydecker.   I Didn’t Want Them to See: Secretive Eating among Adults with Binge-Eating Disorder.  Int J Eat Disord. 2019 Feb; 52(2): 153–158.

Published online 2019 Jan 9. doi: 10.1002/eat.23002