Clinical classification of a disorder that is difficult to recognize
Il Binge Eating, according to traditional psychiatric nosography, it is an eating disorder characterized by recurrent episodes of binge eating. On closer inspection, however, what actually happens is that those who suffer from this disorder spend days eating too little or not eating at all and then, exhausted, lose control and overeat. The binge, therefore, is only half the problem. The other half is the fast that precedes it.
However, when the patient emphatically describes his voracious eating, the professional who listens (doctor, nutritionist, or psychotherapist) may be misled, concentrate on binges and lose sight of fasting. The risk becomes that of trying to solve the problem by proposing a new "diet" or "nutritional path". However, if we look at the facts over time, we realize that diets not only fail, but exacerbate the problem. The vicious circle that fuels the Binge Eatingin fact, it is not the lack of control, but the excess of control that sooner or later causes you to lose control.
Il Binge Eating: alternation of restrictions and binges
The results of the intervention research conducted by Giorgio Nardone at the Strategic Therapy Center of 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 characterized byalternation of prolonged periods of abstinence from food and adherence to a dramatically low-calorie diet with moments of excessive consumption of food, comparable to real binges with a very high caloric intake (Nardone et al., 2014).
When the problem is observed for how it works in its entirety (as characteristic of Brief Strategic Therapy), it is evident that the characterizing element of the disorder is not the binge, but fasting or semi-fasting that favors 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, frustrated by the sense of incapacity for not being able to control herself, she skipped breakfast and went to work. During her lunch break she ate nothing. She started eating again in the evening. For a few days, he calculated exactly the calories he would introduce (no more than 500 Kcal per day) and chose the less tasty foods, to make sure he didn't lose control and succumb 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
Sufferers Binge Eating he is always looking for new strategies to be able to allow himself only what is necessary to stand up. F. had also consulted numerous dieticians and nutritionists who had involuntarily become masters from which to learn the art of control (calorie calculation, use of flavorless meal replacements, techniques for not feeling hungry and not giving in to pleasure).
Il Binge Eating it is not bulimia: two disorders, two logics, two solutions
People with binge eating often refer to themselves as bulimic. Faced with the description of their colossal binges, it may come naturally to many professionals to define them as such. Bulimia, in fact, means to be hungry like a bull (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).
Thanks to the clinical framework made up to this point, it follows that the therapy of Binge Eating in order to work, it must not be the therapy of binges, but of what creates the conditions for binges, that is fasting or semi-fasting. As ancient Chinese clinical thinking suggests, those who focus on binge therapy and neglect fasts are like those who focus on caring for the leaves and not caring for 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.
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
- 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.