Anorexia to Binge Eating: What Eating Disorders Tend to Have in Common

NOTE: This blog post focuses on body image related eating disorders and does not speak to the clinical characteristics unique to ARFID (Avoidant Restrictive Food Intake Disorder).

Eating disorders have always interested me. As a child and adolescent, I had my own experiences with disordered eating and body image issues. Being exposed to the epitome of diet culture in the 90’s alongside being immersed in the dance world probably didn’t help my case. Naturally given my experiences, I wanted to better understand eating disorders and how to treat such challenging (and socially reinforced) disorders. I started to work with eating disorders professionally when I started a placement within a hospital-based eating disorders program many years ago during my undergraduate degree in social work. The learning I did personally and professionally during this placement was life changing.

I learned a lot about eating disorders and how to formally treat EDs including “Family Based Treatment”, “Cognitive Behaviour Therapy” for EDs and DBT was just starting to make it’s way into treatment, as well. I also learned about family systems in which they thrive, how systems can be major barriers to meaningful recovery (including the very system I was working in at the hospital) and just how enduring eating disorders can be. Eating disorders are one of the highest risk mental health issues someone can have. For example, with Anorexia Nervosa specifically, the two primary causes of death are suicide and bradycardia (among other medical issues). Binge/purge types of EDs carry risk of esophagus rupture, stomach issues, heart issues due to depletion and imbalances in blood work, and dental issues. Eating disorders are so unique due to the suffering that comes from both the mental and physical aspects.

I learned quickly during my placement all those years ago, that eating disorders did not have one “look”, despite stereotypes we are shown. Yes, I did witness patients that were emaciated and very thin. I also witnessed patients of average or higher body weights who also required significant support, including medical stabilization and inpatient treatment. It was interesting to have patients that were experiencing restrictive eating disorders and those with binge and/or purge symptoms in the same space, doing a lot of group therapy together with the same content.

What I noticed through this is that there are so many commonalities trans-diagnostically between eating disorders. Much of the time, the suffering felt internally is similar. The emotions of hurt, guilt, shame is similar. The yearning for control or perfection but never feeling quite like it has been achieved can be similar. The belief of being undeserving, deserving of pain, that there was a “good” and “bad” way to eat, and such thing as “good” and “bad” bodies is similar.

The behaviours (or patterns of behaviour) are what set one eating disorder apart from another. But one behavioural symptom seemed to come up repeatedly, even with non restrictive EDs. Restriction. Believe it or not, restriction has a role in most body image based eating disorders. Restriction comes from having particular “food rules” and fears around certain foods and/or weight gain. Restriction can look like complete refusal of food or it can be a rigidity and particularness about what foods someone will eat, essentially “restricting” certain foods for no medical reason (such as allergies, diabetic management, etc). Restriction tends to signal scarcity to the brain and body, making awareness around food more heightened and making “forbidden” foods more tempting.

Someone with Anorexia that is engaging in restrictive might dig their heels in, and continue with the restriction despite the yearning for food. When they move through this initial phase, there is sometimes a euphoria that accompanies hunger. The brain-gut connection begins to start to be interrupted, potentially causing a disconnect if restrictive patterns continue. This makes hunger cues harder to recognize, which makes restriction more functional.

Someone with more of Bulimia (binge/purge) or Binge Eating presentation to their eating disorder, tend to inevitably deviate from their restrictive food rules and after such hunger and distress, are much more likely to engage in over-eating or binge eating behaviour as a result. Binge eating involves eating a very large amount of food in one sitting and is often described as being done in an “auto pilot” or dissociative sort of state. It is hard to put the breaks on. Someone is unlikely to feel connected to their satiety cues enough to understand how their body is reacting to consuming the food. There is a difference between what an ED professional would consider a binge and something we call a “subjective binge” which is maybe not a ton of food objectively, but to the person, it feels like a lot of food.

Binge eating tends to result in feelings of guilt and shame. People who engage in purging (vomiting, laxative use, over-exercising), are likely to engage in their purge of choice after a binge, with a sense of urgency around “getting rid of” the food or calories. Someone with binge eating solely, will suffer internally with feelings of guilt and shame, sometimes resulting in further unhealthy coping behaviours (i.e. self harm). Normally, there is some sort of renewed interest in a “diet”, “eating good”, or food rules that they vow they will “stick to” this time.

This typical cycle reinforces and maintains the eating disorder. Regardless of the diagnosis, restriction is almost always present in people with body image focused EDs. I tend to focus on interrupting restrictive symptoms to start, which often comes to the surprise of clients who experience binge eating. They expect to be given a meal plan, hold on to the restrictive aspects and somehow let go of what they deem to be the “bad symptoms” or the binge eating and purging behaviours. It is important to understand that the voice holding this ideology of good/bad symptoms, is in fact the eating disorder.

The eating disorder “part” of my clients tends to get activated when I have to truthfully share with them that letting go of food rules/forbidden foods/dieting will be essential to their ED recovery, regardless of diagnostic presentation or weight. From here, we usually end up addressing fears of gaining weight, how much their weight and shape make up their self esteem and where these beliefs originated in their life. We start to look at automatic thoughts and labels they associate with higher weight or less restrictive food intake. We start to re-assess how we think about food and what needs to happen to start to challenge anxiety around food and body image.

Eating disorders are complex, specialized and layered. They tend to have a long lifespan in comparison to other mental health issues and are more likely to evolve over time (i.e. from restrictive to binge/purge types). Peace with food and our bodies does not come from achieving the body we think we want. It does not come from a “clean eating” or diet plan. It cannot occur by being rid of some symptoms while keeping the socially acceptable symptoms. Healing is truly an inside job and involves commitment to self-reflection and discovery. It will force you to make friends with the ED part that has been sabotaging your joy in hopes that we can let it know it is safe to let go and be without these protective but unhealthy patterns. It includes giving yourself permission to eat, permission to enjoy food again, and permission to be in your unique body as it is. Interrupting restriction is not only clinically relevant but also a practice of resistance to a society that encourages restriction and self starvation as something to aspire to.

This is not medical advice and is for educational and entertainment purposes only. Please consult your healthcare team if you have concerns about your mental or physical health.