BINGE EATING DISORDER

Kids are always rooting around in the kitchen, especially during the teen years. They grab a handful of cookies here, a bag of chips there. They're growing like weeds, of course, so you figure all that eating is OK. Most of the time it is.

But sometimes heavy snacking isn't what it seems to be. If a child eats unusually large amounts of food - and feels guilty or secretive about it - she could be struggling with the most recently recognized eating disorder, a condition called binge eating disorder.

What is Binge Eating?

Lots of people find comfort in food. After all, it's often at the heart of our happiest celebrations. Birthdays mean birthday cake with friends, and Thanksgiving means turkey and stuffing with family.

But people with binge eating disorder have a different relationship with food. At first it may provide sustenance or comfort, but later it is the focus of incredible guilt and distress. They eat unusually large amounts of food quickly and feel completely out of control as they do it, and they binge not just from time to time, but fairly regularly. These behaviors become a pattern of eating and can alternate with dieting.

Children and teens who sometimes eat a lot don't necessarily have binge eating disorder. Kids can have huge appetites, especially during growth spurts, when they need more nutrients to fuel their growing bodies.

Most people will occasionally eat much more than they normally do, often on holidays. "If you ate a lot on Thanksgiving, that wouldn't be a binge - almost everyone eats a lot in those circumstances," explains Marsha D. Marcus, PhD, chief of the Behavioral Medicine and Eating Disorders Program at the Western Psychiatric Institute and Clinic in Pittsburgh, Pennsylvania.

But binge eating is different. "It's the sense of loss of control over eating, a feeling that one can't stop eating or control how much one is eating," Dr. Marcus says.

It's also important to distinguish binge eating disorder from other eating disorders, such as bulimia nervosa and anorexia nervosa. People with bulimia nervosa (sometimes called binge-purge syndrome) binge on food and then vomit or use laxatives to avoid weight gain. They may also fast or compulsively exercise after an eating binge. Like people who suffer from binge eating disorder, those with bulimia nervosa repeatedly eat excessive amounts of food and feel guilty or ashamed about it.

Anorexia nervosa, another eating disorder, also involves feelings of guilt about eating. Whereas people with binge eating disorder consistently overeat, anorexics starve themselves, causing potentially life-threatening damage to their bodies. They may also compulsively exercise to achieve weight loss, a condition known as anorexia athletica.

It is difficult to know exactly how many people suffer from binge eating disorder because the condition has only recently been recognized and many people may be too embarrassed to seek help for it. Still, it is believed that 2% of adult Americans - roughly 1 million to 2 million people - have the disorder.

There is little information on how many children and teens are affected by the disorder, but adults in treatment often say their problems started in childhood or adolescence, Dr. Marcus says. And unlike most other eating disorders, where the vast majority of sufferers are female, binge eating disorder is only slightly more common in females than in males, so boys are almost as likely as girls to have the condition.

Risks and Complications

Because many people with binge eating disorder are overweight, the most common health risks are the same ones that accompany obesity, including: diabetes, high blood pressure, high cholesterol levels, gallbladder disease, heart disease, and some kinds of cancer. (Although this disorder is more common in people who are obese, it also affects people with healthy weights.)

In addition to physical complications, people who binge eat may experience feelings that are common to many eating disorders, such as depression, anxiety, guilt, or shame. They may avoid school, work, or socializing with friends because they are ashamed of the problem.

Signs and Symptoms

It can be difficult to determine whether a child has binge eating disorder, particularly if your teen is going through a growth spurt and seems to be eating everything in the house. But several signs distinguish a child who binge eats from one with a "healthy appetite." Parents may first suspect a problem when they discover large amounts of food are missing from the pantry or the refrigerator, though it is hard to imagine one child could have eaten so much.

Other signs of a problem include:

• a child eating a lot of food quickly
• a pattern of eating in response to emotional stress, such as family conflict, peer rejection, and poor academic performance
• a child feeling ashamed or disgusted by the amount she eats
• finding food containers hidden in a child's room
• an increasingly irregular eating pattern, such as skipping meals, eating lots of junk food, eating at unusual times (like late at night)

What Causes Binge Eating Disorder?

The cause of this disorder is unknown, although the National Institutes of Health reports that up to half of all people who have it also have a history of depression. It remains unclear, however, whether binge eating brings on depression or whether people with depression are prone to the disorder. Many people who binge eat say that episodes can be triggered by feelings of anger, sadness, boredom, or anxiety.

Scientists are also examining how brain function and body metabolism (the way the body uses energy) may affect binge eating.

Diagnosing Binge Eating Disorder

Physicians and mental health professionals use the criteria in the Diagnostic and Statistical Manual IV (DSM-IV) when they identify binge eating disorder. These include:

• binge eating more food than most people could consume in short periods of time
• feelings of distress about eating behaviors
• binge episodes associated with eating more rapidly than usual, eating until uncomfortably full, eating when not hungry, eating alone because of embarrassment about how much food is consumed, and feelings of disgust, depression, or guilt
• binge eating that occurs, on average, at least 2 days a week for 6 months
• binge eating that isn't associated with regular purging with laxatives or by vomiting

"The diagnosis is made if they are eating a large amount of food, even more than most kids eat. Also, a binge has to be accompanied - in order to be determined a 'binge' - with a loss of control over eating," Dr. Marcus explains.

That diagnosis will only come after the doctor discusses family dynamics, patterns of eating, and emotional issues with your child. The physician will also perform a complete physical and may order lab tests to assess some complications of obesity and nutritional adequacy.

Treatment

Different types of therapy can help treat this disorder. For example, family therapy and cognitive behavioral therapy teach people techniques to monitor and change their eating habits and the way they respond to stress. Counseling also helps patients look at relationships they have with others and work on areas that cause them anxiety. In some cases, doctors may prescribe antidepressant medication to be used in conjunction with therapy.

As with any eating disorder, there is no quick fix for binge eating. Treatment can take several months or longer while the person learns how to have a healthier approach to food.

Helping Your Child

If you suspect your child has a problem with binge eating, call her doctor or health care provider for advice. When seeking treatment, look for a mental health professional who has experience treating eating disorders in children.

Be sure to talk to your child, too, and let her know you're there to help or just to listen if she needs to talk. Having an eating disorder can be difficult to admit, and your child may not be ready to acknowledge that she has a problem. You can show her how to develop healthier eating habits by modeling a positive relationship with food and exercise and by not using food to reward her or yourself.

Although weight-control programs are helpful for some people affected by binge eating disorder, children should not begin a diet or weight-control program without the advice and supervision of a doctor.

With the help of her family and a physician, your child can begin the trip back to healthy eating.