Binge eating: the trap of fasting

Clinical classification of a disorder that is difficult to recognize

Binge eating , according to traditional psychiatric nosography, is an eating disorder characterized by recurrent episodes of binge eating. Upon closer inspection, however, what actually happens is that those suffering from this disorder spend days eating too little or not at all, then, exhausted, lose control and binge. The binge, therefore, is only half the problem. The other half is the fasting that precedes it.

However, when the patient emphatically describes their voracious eating, the professional listening (be it a doctor, nutritionist, or psychotherapist) can be misled and end up focusing on the binges and losing sight of the fasts. The risk becomes that they try to solve the problem by proposing a new "diet" or "nutritional program." However, if we observe the facts over time, we realize that diets not only fail, but exacerbate the problem. The vicious cycle that fuels binge eating , in fact, is not a lack of control, but an excess of control that sooner or later leads to a loss of control.

Binge Eating : alternating between restriction and binges

The results of the intervention research conducted by Giorgio Nardone at the Strategic Therapy Centre in Arezzo (Nardone et al., 1999; Nardone, 2003), carried out on overweight patients and/or patients suffering from eating disorders, led to the identification of a peculiar clinical picture characterised by the alternation of prolonged periods of abstinence from food and adherence to a dramatically low-calorie diet with moments of excessive food consumption, similar to real binges with very high caloric intake (Nardone et al., 2014).

When one observes the problem as it functions in its entirety (as is characteristic of Brief Strategic Therapy), it becomes clear that the characterising element of the disorder is not the binge eating, but the fasting or semi-fasting that favours it.

A clinical case

F. was a well-groomed, smiling, self-confident and seemingly relaxed woman who lived a normal life. She has been married for years, with a son and a regular job.

Unable to diet

He had been struggling with weight for years. He had followed numerous dietary paths without ever being able to complete them.

What prevented her from dieting?

The script was always the same: it began with some small transgressions to the prescribed diet, which quickly became real binges. She was too swollen and numb to move, she let herself go on the bed and lay there, motionless, until the next morning.

How did he react to what she perceived as an inability to diet?

Upon awakening, still full and frustrated by the sense of inadequacy at having been unable to control herself, she would skip breakfast and go to work. During her lunch break, she ate nothing. She would start eating again in the evening. For a few days, she would precisely calculate the calories she would consume (no more than 500 kcal per day) and choose the least flavorful foods, to ensure she didn't lose control and give in to gluttony.

Then, exhausted, she collapsed. She devoured everything, until she felt so full she had to collapse on the bed again. And so the vicious circle began again.

A continuous search for new strategies not to collapse

Those who suffer from binge eating are always looking for new strategies to allow themselves only what's necessary to stay on their feet. F. had also consulted numerous dieticians and nutritionists, who had inadvertently become teachers from whom she learned the art of control (calorie counting, using tasteless meal replacements, techniques for not feeling hungry and not giving in to pleasure).

Binge Eating Is Not Bulimia: Two Disorders, Two Logics, Two Solutions

People who suffer from binge eating often describe themselves as bulimics. When they describe their colossal binges, many professionals might even be tempted to call them bulimics. Bulimia, in fact, means being ravenously hungry (Nardone, 2013).

However, there is a substantial difference between Binge Eating and Bulimia:

– in binge eating, binges always occur after periods of fasting or semi-fasting.

- in Bulimia binges are not preceded by fasting or semi-fasting. People report that they are always on a diet, but they never manage to stay on it.

This is an important difference. In fact, in the first case it is essential to break the vicious circle of "fasting-binge", in the second it is necessary to create a self-regulatory capacity.

Studying well how the problem works in the individual is the first thing to do. A correct operative diagnosis is an essential premise for implementing an effective and efficient therapy (Nardone, Portelli, 2015).

The therapy

Based on the clinical framework developed thus far, it follows that, to be effective , binge eating therapy must not be a treatment of binge eating, but rather of the very thing that creates the conditions for binge eating: fasting or semi-fasting. As ancient Chinese clinical thought suggests, those who focus on treating binge eating and neglect fasting are like those who focus on caring for the leaves and neglect the roots.

The clinician who aspires to an effective and efficient therapy, precisely because he wants to eliminate binges, should concentrate on correcting fasts. If one proceeds in this way, in fact, the breakdown of the dysfunctional contradictory logic that feeds the problem is produced (Nardone and Balbi, 2008). Once the vicious circle is broken, the symptom (the binge) will spontaneously disappear.

Conclusion

The careful study of Binge Eating reminds us that when a person binges, he does not always do it for "gluttony". Sometimes, what creates the binges is its very opposite: "the excess of restriction".

Anyone who wants to effectively and efficiently treat an eating disorder such as binge eating must have the patience to step back and investigate how the disorder works in the individual person. Nothing should be taken for granted, since, as Napoleon Bonaparte said: "Just because I am in a hurry, I go very slowly".

dr. Gabriele Bovina
Psychotherapist and official researcher of the Strategic Therapy Center

BIBLIOGRAPHY:

• Nardone, G., Verbitz, T. & Milanese, R. (1999). The food prisons. Milan: Ponte alle Grazie.
• Nardone, G. (2003). Beyond the love and hatred of food. Milan: BUR.
• Nardone, G. & Balbi, E. (2008). Sail the sea without the knowledge of the sky. Milan: Ponte alle Grazie.
• Nardone, G. & Portelli, C. (2015). Change to know. Milan: TEA.
• Nardone, G. (2013). Psychotrap. Milan: Ponte alle Grazie.
• Nardone G. & Valteroni, E. (edited by) (2014). Diet or no diet. Milan: Ponte alle Grazie.