SSince Sam Ikin was a child, his urge to devour food was beyond his control. He didn’t want to be fat. “I wanted to look good. But the more I deprived myself of something, the more I wanted it,” he says.
In one go, he might end up eating a few packets of cookies or a whole big bag of crisps. “You’re not aware of how much you’re eating, you just want to keep eating. And then once you finish what’s in front of you, you start thinking about what else is there,” he says. He “went out” when he ran out of food, was interrupted, or had gotten to the point where he just couldn’t eat.
“It’s something you would only do when no one is around, or in secret when you think no one can tell it’s happening.”
Throughout his life, says Ikin, he heard different versions of the same question: “Why don’t you stop?” »
And yet, he didn’t think he had a problem with food. “I knew I had some sort of psychological problem, but I never imagined that I might have an eating disorder.”
It wasn’t until his early thirties that Sam was diagnosed with binge eating disorder (BED), the most common and perhaps least understood eating disorder.
BED is a disease that causes people to consume unusually large amounts of food all at once, frequently, and regularly over a period of time. Similar to those with bulimia nervosa, people with BED feel like they can’t stop eating. But unlike bulimia nervosa, BED is not associated with compensatory behavior such as excessive exercise, vomiting, or taking laxatives. It is not limited to overweight or obese people, but is more common in this group.
Ikin says BED is often mistaken for a fun ride, an indulgence. It is associated with laziness, he says, and lack of self-discipline.
“A binge is not a pleasant experience,” he said. “It’s a crazy experience where your hand moves back and forth from your mouth and back to the food. In the end, you feel bad. You look at all the empty packets, all the evidence, and the first thing that shame sets in. The share of shame is enormous.
He was trying to hide it, secretly binge where he could, “trying to binge shopping or things like that.” With kids at home, he would want to eat all the junk food and hide it from them too.
“Bulimia is awful,” he says.
The disorder permeated his entire life, from the daily inconveniences of being overweight to confronting societal expectations and judgment. “You can’t comfortably fly on airplanes, you can’t buy a suit off the shelf, you can’t even walk into some stores without being looked at as if you were a leper,” he says.
In Australia, 47% of all people with an eating disorder have BED, compared to 3% with anorexia nervosa, 12% with bulimia nervosa and 38% with other eating disorders. It is equally common in men and women. In total, eating disorders affect around one million Australians.
Binge eating disorder was not officially recognized as a disorder by the American Psychiatric Association until 2013 and remains less well understood than other eating disorders and underdiagnosed by medical professionals. In Australia, fewer than two in five people with BED have access to medical care, and the pandemic may have made matters worse.
A difficult diagnosis
“Bulimia attacks often go unrecognized because we can’t tell what people might look like,” says Dr Jane Miskovic-Wheatley, head of the research arm at the University of Sydney’s InsideOut Institute.
She says most people with BED could be in their normal weight range or overweight, like the majority of the Australian population.
Historically, the first medical reports of eating disorders described young, white, thin women. This image has remained etched in the collective consciousness, leading to skewed medical research and diagnostic criteria.
“It’s ubiquitous, even among academics and medical professionals,” says Dr Deborah Mitchison, an NHMRC researcher at Western Sydney University’s Translational Health Research Institute. These “historical blind spots” have prevented researchers from knowing what an eating disorder looks like in a man or someone with a larger body, she says.
A diagnosis of BED can take years or even decades, and all too often, all medical professionals have to offer their patients a message to “eat less, exercise more,” says Mitchison. “It’s too simplistic. They actually have a psychological disorder, and it goes undetected.
As with other eating disorders, a variety of factors can cause a person to develop binge eating, ranging from environmental, social, and cultural issues to genetics and an individual’s own thoughts and feelings. Links to depression and anxiety have also been reported. A recent study from the Florey Institute and the University of Melbourne found that there are a range of biological differences between men and women that trigger binge eating, including hormones, stress and neural circuitry.
For Ikin, an episode could be triggered by a desire to go to extremes. “If I’m having a shitty day, if I’m really upset, it could trigger a frenzy. But it also happens sometimes when I feel good, and I can’t explain it,” he says. “You want to heighten the emotions you feel – whether positive or negative, you want to take them to the extreme.”
Covid made things worse
The World Health Organization predicted a post-Covid mental health pandemic, and research is increasingly supporting that prediction.
An InsideOut Institute survey published last month found an escalation in eating disorder symptoms during Australia’s first major Covid wave and widespread failure to access treatment.
Sixty-six percent of respondents reported an increase in binge eating compared to before the pandemic. Other disordered eating behaviors also increased sharply, with 74% of participants reporting increased food restriction.
“The biggest element of the pandemic that negatively impacted people who experienced eating disorders was a change in daily routine,” says Miskovic-Wheatley, who led the study. This included the inability to engage with family and friends, maintain a balanced lifestyle, and access medical care.
The survey revealed alarming rates of diagnosis and treatment, says Miskovic-Wheatley. Although almost all respondents (96%) reported experiencing symptoms of active eating disorders, only half had received treatment.
Over the past two years, psychotherapists have been inundated with inquiries from old and new patients. Waiting times for an appointment have lengthened to 12 months. “Long lists like this can be quite off-putting to a lot of people,” says Sarah Barakat, a psychologist and doctoral student at the InsideOut Institute.
Barriers to treatment
Barakat says there are three main barriers people with BED face in accessing treatment.
The most important is the cost. From November 2019, people with eating disorders can access up to 40 psychological sessions with a mental health provider and up to 20 sessions with a dietitian each calendar year on the recommendation of their GP.
But rates for eating disorder specialists can be high, and out-of-pocket costs after Medicare reimbursement remain unaffordable for most, Barakat says.
Then there is a geographical barrier. The vast majority of specialized services for eating disorders are concentrated in large metropolitan areas. Access to care in outlying, rural and remote areas can be inadequate and, in many cases, non-existent.
The third obstacle is the shame associated with the disorder. “There is still a high level of stigma and embarrassment around eating behaviors,” Barakat says. “People with binge eating are much less likely to seek care.”
She says less than 40% of people with BED have access to professional help. She is currently conducting a randomized controlled trial to assess the effectiveness of a self-help treatment program based on cognitive behavioral therapy and delivered entirely via a digital platform.
She hopes e-therapy will overcome these barriers, making treatments more affordable and accessible for those who don’t live in cities. “It also provides a step into the world of treatment that is not overwhelming or confrontational for the patient, who is given the opportunity for more privacy and anonymity.”
There’s a huge need to talk about binge eating to break the stigma still attached to it, Ikin says. Now in his 40s, he has learned to cope with his illness by carefully planning his meals and separating food from his emotions with the help of his therapist. “I think I’m on the right track now,” he said.
“People are starting to understand and destigmatize mental illnesses like depression, anxiety and even OCD, while there is still a lot of stigma and lack of understanding around eating disorders.
“I used to lie about it all the time,” he says.
Now that he has opened up about his illness, he feels more free to be himself and can benefit from the support of his family and friends. “It’s good not to hide anymore.”