Thursday, March 23, 2023

“What do you guys think of when I say eating disorders?” is a question I generally raise when I speak in schools and various institutions. The response? Anorexia. Thin. Skeletons.

More often than not the answers I receive relate in some way to anorexia, the “better known” eating disorder. When I ask the audience about the other eating disorders, their answers are rampant with misconceptions. There are constant references to bulimia on television—mostly in sitcoms—that revolve around the individual making him/herself throw up after eating. In reality, this is not the definition of bulimia.

When I began treatment for anorexia I was just as unaware of the nature of bulimia and binge eating disorder. As a community—and one that jokes about “overeating”—we must understand the nature of these disorders to create awareness and support those who are suffering.

Anorexia may be the most commonly known eating disorder, but it is not the most common eating disorder. In fact, of the three major eating disorders it is the least rampant. Binge eating disorder is most common, followed by bulimia. Bulimia nervosa is when an individual binges on food and then uses compensatory behaviors to “get rid” of this food. “Okay, but what’s a binge?”

This question is often met with smirks and laughter as individuals think of binge-watching television or eating a pint of ice cream. In reality, a binge is when an individual consumes a large amount of food in a short amount of time. For example, one who binges may eat around 3,000 calories in one hour. What does this mean? S/he may eat an entire tub of ice cream, 4 slices of pizza, cake, a bag of chips, and a pack of cookies. The binges can take place over longer periods of time—even hours in some instances. A binge feels compulsory and is usually done secretly or even at night.

When I mentioned bingeing to my mother recently she said, “Well, I binge sometimes!” When challenged about what this means she said, “I’ll eat a bowl of ice cream, and some chips and maybe a few pieces of licorice if I’m still hungry.” This may constitute overeating, but this is not a binge. While for some this may seem like a binge, it is missing a key element: the compulsive nature of eating as if the individual is being forced, and only stopping when the person feels full or vomits. Of course, some individuals who binge may not do so in this manner; a binge does not need to technically involve a superfluous amount of food. But binges by nature are not comfortable and the person may not even be emotionally present while s/he is bingeing.

The person will then use a behavior to purge the food just consumed during the binge. This may involve vomiting, laxatives, or exercise. If an individual simply purges without bingeing first, this is classified as anorexia with purging. When a person suffers from bulimia, s/he generally binges and purges at least once a week for three months.

Those who suffer from binge eating disorder have binge episodes but do not use compensatory behaviors. Until last year binge eating disorder was not recognized by the Diagnostic and Statistical Manual as its own eating disorder. Instead, it was listed under EDNOS (Eating Disorder Not Otherwise Specific, now called OSFED—Other Specific Feeding and Eating Disorders). Those who suffer from both bulimia and binge eating disorder will often restrict as well. In fact, many times when individuals suffer from anorexia they end up switching to bulimia as they completely restrict and their bodies are so desperately craving nutrients. They may binge and then purge as they feel guilty. Though I never binged, many of my peers in treatment had fluctuated between the various disorders.

Bingeing is somewhat different from emotional eating, though there are many similar qualities. Emotional eating may not feel as compulsive; rather, the person is eating not because s/he is hungry but because of a deeper emotional reasoning.

I’m often met with the question: Why are all these eating disorders treated in the same facilities? Shouldn’t those who suffer from bulimia be separated from those who suffer from anorexia or binge eating disorders? All individuals who suffer from an eating disorder—and there are many others that are listed under OSFED—are in pain and the symptom of this pain is an unhealthy attitude toward eating. The person often loses their sense of hunger and fullness and also feels discomfort in their body. This definition is somewhat limiting but it is important to keep in mind the fundamental idea that it is not truly about the food, but about what is troubling the individual.

While I’ve stated some of these ideas in the past, I believe that once in a while some psycho-education is important. There’s such a lack of understanding in the general community on eating disorders, and even more so within the Jewish community, and I feel it is one of my duties to not only write about confidence, body image, and life lessons but to bring it back to eating disorder awareness in the basic form.

For more information on the various eating disorders, visit NationalEatingDisorder.org or the DSM-5. To learn more about Temimah and her work, visit www.tvcsupport.org.

By Temimah Zucker

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