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What is the most common eating disorder? The answer may surprise you

By Francie Williamson, Communications Coordinator, Department of Psychiatry

The word “gorge” has more than one meaning for Kara Richardson-Whiting.

It represents her lowest point in life, when she weighed 300 pounds. It also represents how she got to 300 pounds: a binge eating disorder that she traces back to when her parents were about to divorce, as well as a sexual assault during adolescence.

Richardson-Whiting writes about her journey in the memoirs Gorge: My Journey up Kilimanjaro at 300 pounds, and The Weight of Being: How I Satisfied My Hunger for Happiness. She will be telling her story during a series of presentations on Monday, Feb. 24 at the University of Iowa, as part of Eating Disorder Awareness Week.

Eva Schoen

Eva Schoen, PhD, assistant professor of psychiatry and clinical director of eating disorders services at University of Iowa Hospitals & Clinics, says binge eating disorder, or BED, is the most common eating disorder, even though it’s not talked about as much as other eating disorders, such as anorexia or bulimia.

“It is often underrecognized and undertreated,” Schoen says. The disorder wasn’t even recognized in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which mental health professionals use to make a diagnosis, until the fifth edition came out in 2013.

In BED, “patients will eat a considerably larger amount of food in a short period of time and then have reactions of guilt and shame afterwards,” Schoen says.

Patients also may or may not struggle with higher weight. “Weight is not actually a criterion for this disorder,” Schoen says, adding that causal factors for the disorder have a wide range.

“There have been patients with long histories of emotional overeating, or stress related eating that can develop into BED,” she says. “An underlying anxiety or depressive disorder puts somebody at risk, or history of childhood trauma, just like any other mental health issue, or stressful life circumstances.”

Schoen says a history of dieting is not necessarily a causal factor but can “lead someone to potentially experience binge episodes, which can then move into a binge eating disorder.”

About 10 to 15 percent of the patients she sees at UI Hospitals & Clinics are people diagnosed with binge eating disorder, Schoen says.

Treatment for BED varies. Schoen says a lot of patients often participate in cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT).

“If we assume there’s an emotional dysregulation problem in BED then emotional regulation treatment could be helpful,” Schoen says.

Part of the challenge, however, is just getting someone into treatment in the first place.

“I think it’s even more acceptable to say I have problem with binge drinking than it would be to say I have trouble with binge eating,” Schoen said. “I think the emotional regulation issues, the control issues with that are stigmatizing, and I think it’s certainly difficult to deal with weight issues in this diet obsessed culture.”

While eating disorders such as anorexia and bulimia are more common in women, BED is seen more evenly across genders, although it is still more common in women by a ratio of about 2 to 1.

“With males, oftentimes, eating a lot and being able to basically binge is sometimes even seen as something that is an accomplishment,” Schoen says, “Like I ate two entire pizzas or whatever it might be, so (BED) gets reinforced there as well."

Often, Schoen says, people don’t recognize that they meet the diagnostic criteria for BED until they talk with a health professional.

“For bulimia, people are aware purging after meals isn’t a normative thing. With the binging, it’s hard to tell where overeating ends and a binge begins, so people often don’t self-identify,” Schoen says.

In her memoir, The Weight of Being, Richardson-Whitely says that she wasn’t diagnosed with binge eating disorder until she decided to have bariatric surgery.

She notes that she used to view people with eating disorders as having either anorexia or bulimia and that having a name for her particular challenge “was a huge relief.”



Author Kara Richardson-Whitely will be at the University of Iowa on Monday, Feb. 24.

  • 8 to 9 am Kelch Conference Room, 1289 Carver Biomedical Research Building– “Binge Eating Disorder and Fitness at Any Size.” For health professionals.
  • 12:30 to 1:30 pm W256 GH/HP Smith Conference Room (Elevator BW, Level 2) – “Moving Mountains: A Journey from the Depths of Binge Eating Disorder to the Top of the World.” Presentation for dietitians, dietetic students and other interested health professionals.
  • 7 pm, Pappajohn Business Building (PBB) W10 (auditorium) – “Moving Mountains: A Journey from the Depths of Binge Eating Disorder to the Top of the World.” Program for students and community.
Thursday, February 13, 2020