Managing recovery for binge eating disorder in the long-term

At least 70% of those treated for binge eating disorder successfully gain control of their condition and maintain a healthier relationship with food in the long-term. Treatment is a team effort, with everyone involved doing their share to achieve the same goals, including the individual requiring help.

Learning to cope with an eating disorder and take back control in life may initially feel like a dramatic shift for a person. Eating disorders, such as binge eating disorder are an all-consuming, out-of-control existence which cannot be rectified independently. Human beings need food for sustenance, on a daily basis. A recovering binge eater cannot run from food. A person must learn how to have a healthier relationship with food, daily, for the rest of their lives.

Before treatment, binge eaters lose the ability to even enjoy what they are consuming en masse. It’s not just unhealthy snacks in bulk that are consumed. Some have been known to wolf down large quantities of raw cake batter, boxes of frozen fish sticks or combinations of flavoured foodstuffs in one sitting that would normally not be paired together (like peanuts, liquorice, bread, pastries and sandwich spread). In the end, binge eating is not about enjoying food or the process of eating. Binges may not only lack in nutritional quality, but also taste. Taste and sense of enjoyment may not even be of primary concern. For many, it’s just about compulsively filling a void.

A dramatic shift in this way of eating, combined with intense changes relating to emotional, behavioural and psychological influences and triggers will take quite a toll on a person during their treatment. Medical measures to correct wrongdoings and behaviours are designed to be intense so as to ensure the most effective long-term recovery results. A person need not feel they are required to cope with binge eating disorder on their own. Treating professionals will continuously work alongside a person, every step of the way.

Whether being treated in an outpatient or inpatient capacity, at some point, a person will need to use the tools acquired during professionally guided treatment sessions to implement self-care steps on their own. It’s important that a person feels confident to ‘take the reins’ and continue managing treatment guidelines outside of their sessions in order to achieve stability and a healthier way of life, for life.

Self-care will help to reinforce the effectiveness of a treatment plan for binge eating, and by developing and maintaining healthier habits, ensures long-term recovery.

1. Things a recovering binge eater can do to help themselves include:

• Treatment maintenance: Recovery is a day-to-day process. Meal plans, exercise routines, therapy sessions, medication doses, regular check-ups with the GP etc. are likely to be set by the treating healthcare team, and for good reason. Skipping meals, missing medication doses or therapy sessions can make way for binge setbacks and compromise treatment efforts. A person with binge eating disorder will fare better by sticking to the structured plan and also ensuring overall good physical health. A treating GP will also likely wish to keep a close eye on physical improvements and monitor problems which may have been caused by binge eating, such as blood pressure changes, heart related or digestive problems. Appointments to monitor physical condition must also be kept.
• Cleaning out the home: The habit of hoarding and stockpiling food can be corrected by cleaning out all the hiding places where binge foodstuffs were kept. Without temptations on hand, triggering behaviours cannot be easily fulfilled. A recovering binge eater will also fare better by avoiding or limiting exposure to places where triggers can threaten to derail recovery, such as dining at a fast food outlet. A treating doctor may also advise a recovering binge eater to make a concerted effort to shop only for the amount of food that is actually needed at any point in time. Even keeping excess quantities of healthier food options available can trigger binges. Unhealthier choices may have previously been preferred binge foodstuffs, but anything will generally do for someone with an eating disorder.
• Avoid participating in diet plans independently: For many, losing weight is high on the priority list. A doctor will likely discourage a patient from participation in fad diets or trying to diet on their own, especially avoiding those which are restrictive. Normally, weight loss programmes will be medically supervised once binge urges are under control and a person is effectively managing emotional and psychological triggers with their treatment team. Dieting is likely to trigger unhealthy habits and urges once again, and is best avoided. If weight loss is necessary, the treating doctor can recommend appropriate and safe management strategies or a supervised programme that can help to achieve weight loss in the short term, and also maintain a healthy weight in the long-term. For treating professionals, the main goal is not to achieve attractive perceptions of skinny. Weight loss also does not equal recovery. Nutritious eating is aimed at getting the affected individual into a healthier state and the goal is to help them build an improved relationship with food.
• Developing healthy eating habits: Binge eaters typically skip the most important meal of the day – breakfast. A recovering binge eater should ensure that they eat a nutritious breakfast every day which discourages the urge to consume higher calorie meals later in the day. Working with a nutritionist, a recovering binge eater must stick to consuming recommended meals and foods which provide the body with essential nutrients, and also help to rectify damage, like high cholesterol, caused by poor eating. Nutritional supplements may be incorporated into a diet plan if deemed safe and healthy by the treating team.
• Getting physically active: The time is now. Living on the side-lines, ‘waiting’ to reach the ultimate healthy state is not likely to be encouraged by a treating doctor. Part of the ‘getting healthier process’ is stepping out of the shadows and adopting a much-improved overall lifestyle. The number of associated health problems that develop as a result of binge eating can be alleviated with regular exercise. A treating doctor can advise exercise activities that will most benefit the body (depending on a person’s overall physical state and list of complications where relevant), and aid in achieving an improved state of health and fitness.
• Connecting with others: When food no longer needs to be a binge eater’s companion, other people can be. Social isolation behaviours are another adjustment requiring change for a recovering binge eater. Close family and friends can be a huge source of support during recovery. A treating doctor will encourage a recovering binge eater to stay connected while working through interpersonal relationship issues in therapy.

2. Tips for dealing with negative feelings and behaviours

During therapy, a recovering binge eater will learn to cope with the negative emotions and psychological factors that spur on binge impulses. Coping mechanisms will need to be implemented beyond the walls of a therapy facility.

Some tips a recovering binge eater can keep in mind for their own emotional benefit include:

• Learning to be patient and recognise old ‘blame game’ patterns – sometimes relapses occur (there is no shame in a setback), but mostly it takes time for binge urges to cease altogether (therapy and medications may not dispel urges immediately). Recovery is not an instant process. Urges to binge will gradually reduce during the treatment process. In the meantime, patience, compassion and a little self-love can go a long way.
• Recognising that food is part of the behavioural effect (i.e. a behavioural addiction, not a food or weight-related addiction). Weight problems and willpower also have little to do with the source of the problem. The source/s of binge eating disorder are influenced more by emotional and psychological problems and issues. Appropriately dealing with this effectively treats the root of the problem causing an unhealthy relationship with food.
• Being aware of situations which may trigger binge urges and find healthy ways to deal with, limit or avoid them.
• Recognising self-criticism and implementing kinder coping mechanisms for negative thoughts and feelings, such as participating in activities like walking, yoga or meditation techniques.
• Making use of journaling techniques to create better awareness of one’s feelings and emotions, and also to draw parallels between them and resulting behaviours. Journaling is not to be used as a calorie tracker, but more as a way to understand how the food eaten correlates with emotions (before and after eating it), potentially providing insight into triggers.
• Looking for positive, healthy and realistic role models who can help to elevate self-esteem.
• Broadening circles of trust and including loved ones in the process of healing so that they may understand and provide healthy support.
• Trusting in and relying on loved ones willing to be a source of stability and support when it is needed, especially if the urge to binge resurfaces.
• Getting in touch with life and setting goals or learning new things that improve quality of life, now and in the future.

3. Tips for dealing with body image

For a binge eater, time in front of the mirror may also be just as central to their daily habits as unhealthy eating habits. Improving poor body image is a critical part treatment and recovery.

No one is born filled with absolute disgust for their own body. Negativity around body image is learned from the way perceptions are drilled into us, as human beings, and how differences in individuals are talked about. Effects of this can be long-lasting and affect people on a ranging scale between good and bad. Body image is about how others view us, and how we see ourselves. A binge eater feels negativity on both sides – they dislike their body and perceive that others do too.

A binge eater with a body image complex will constantly compare their body to those of others, criticise and speak negatively about themselves. Often, a person with a binge eating problem will refrain from dating, purchasing new clothes or updating their wardrobe, or treat themselves to a summer vacation for fear of “showing off their body”. Some create rules and may sometimes utter the words, “only when I lose enough weight”, which does not ever come to be due to frequent weight fluctuations, this can lead to feelings of disappointment, self-loathing and depression.

When a person has a healthy body image:

• Appearance is not something to obsess over
• Activities and people are not avoided
• Value as a person is not confused with feelings about appearance

To achieve and maintain a healthier body image, a person can:

• Remove the scale from the equation: The scale and its use is part of the body image problem which triggers emotional responses and subsequent overeating behaviours. A binge eater who frequently weighs themselves only really achieves a confirmed emphasis regarding their body size and weight. Part of the treatment process may encourage physical movement as a focus, like practicing yoga or Pilates, instead.
• Learn how not to internalise feelings: Negative feelings and emotions which are internalised can spark a binge, followed by intense guilt and disgust. Negative emotions may sometimes also be vocalised and come out as exaggerations about perceived body image (i.e. “I’m the fattest person in the entire world.”). A therapist can help a recovering binge eater to better control negative emotions (by helping them to ‘get out of their own head’) and work through the source of the body image problem/s.
• Recognise the good: By changing focus around, a person can start to recognise their good traits and strengths as a person (physical and non-physical). Instead of dwelling on the negative aspects that trigger unhappy emotions, learning to recognise good traits can help a person to develop a healthier perception of who they really are while working to correct the damage caused by binge eating behaviours. Loved ones can help with reinforcing a healthy body image, especially in teenagers and young adults. Learning acceptance and how to implement positive changes for the better can do wonders for a healthier perception of body image.
• Avoid media triggers: Magazines, television, the film or music industry and social media platforms may aggravate unrealistic ideals and perceptions regarding body image. For many, these sources spark triggering emotions which result in binging and other negative behaviours. Critical comparison can be alleviated by avoiding media sources, particularly during the initial phases of treatment, when a recovering binge eater is feeling at their most vulnerable. A treating therapist will help the person to recognise and realistically understand the differences between a perceived ‘perfect body image’ and a healthy state of physical wellbeing during scheduled sessions.