The Most Common Eating Disorder in the United States Is Also the Most Misunderstood

'Genetics loads the gun, environment pulls the trigger.'

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Chelsea Kronengold has struggled with food issues ever since she was a little girl hiding candy wrappers under her bed. "I was awkward, insecure, and embarrassed with my body and my weight," admits the 23-year-old. "But it wasn't registering that was probably the start of an eating disorder."

As a teenager, she turned to food for comfort. "More stressful scenarios would result in more of these high-caloric binges," Kronengold says. "It went with the emotional ebbs and flows of my life."

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Bingeing and yo-yo dieting became her norm. But it all started to spiral out of control during her junior year of college when she transferred to a different university and was placed in a freshman dorm.

"I was living with freshman girls who got their first taste of freedom and all they wanted to do was go out and party," she explains. "I didn't feel like I fit in, so I pretty much isolated myself and camped out in my room… Food became my friend — and my enemy."

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In private, she'd mindlessly eat heaps of carb-filled junk food. "I would just eat until everything was gone," she says. "I'd eat until I was basically numb, to the point where I was blacking out. There was this sedative effect. In hindsight, I can't even remember how much I ate."

Her binges were always followed by extreme guilt and self-hatred that chipped away at her already weak self-esteem. "I wasn't eating all of this junk food because I liked it — I was eating to hide behind it," Kronengold says. "And I was always left with such shame about what I'd done."

Hitting Bottom

Kronengold didn't recognize the severity of her situation until she returned home for the first time in a couple months. Her mom commented on how much weight she had gained in such a short period of time.

"After getting a rude awakening from her, I realized it was time to get help," Kronengold says. "I knew I've always had these food issues, but this was definitely the straw that broke the camel's back."

Food became my friend — and my enemy.

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A therapist at her university's counseling center who specialized in eating disorders confirmed that she was suffering from binge eating disorder (BED), which is defined by the National Eating Disorders Association (NEDA) as recurrent episodes of eating large quantities of food (often to the point of discomfort), experiencing shame, distress, or guilt afterwards, and not regularly using unhealthy compensatory measures (i.e. purging) to counter the binge eating."I learned that it isn't about the eating, it's about the psychological aspect of it," Kronengold explains. "For me, it was more of a coping mechanism."

During therapy, she realized that her love/hate relationship with food stemmed back to childhood.

"Growing up, my mom was always dieting and watching her weight, so we never had a variety of food in our home," she says. "The most 'unhealthy' food in my house was pretzels, so it was something I always felt deprived of. So when I got a chance to have junk food, I didn't know how to regulate myself. I don't blame her for my eating disorder — it was just how I was raised."

Feeding Instead of Feeling

If up until this point you've been thinking to yourself that Kronengold's story isn't dramatic enough to be an actual eating disorder ("she just ate a lot, so what?"), that's exactly the problem: BED is the most common eating disorder in the United States, but it doesn't feature the shocking elements we've come to expect of eating disorder stories – like long-term starvation and vomiting – so it's often misunderstood as a case of "pigging out" rather than having a legitimate illness. But that couldn't be further from the truth.

"The piece that I think gets lost every single time about BED is that people focus on the behavior, but this is a mental health disease," says Andrew Walen, LCSW-C, LICSW, founder and executive director of The Body Image Therapy Center, an outpatient center for adults that specializes in the treatment of BED, as well as bulimia and anorexia. "It's the shame and the guilt that is felt after doing it that is the key component. Because when someone is struggling with that shame and guilt, they're likely to continue to want to self-medicate."

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There are numerous misconceptions about this disease, continues Walen, who is 13 years recovered from several forms of eating disorder behavior himself, including BED. "Most people think someone who is a binge eater is eating all the time, and they're not," he says. "More often than not, this person is skipping meals, trying to undo the binge they've had."

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Also, you can't spot someone with BED based on body size. "We'll see people at a normal weight with full-blown BED, we'll see very large people who have normal relationships with food," Walen says. "The key thing to remember is that this is a disease of the brain, not the body."

Someone suffering from BED may not always go for junk food, either. "I've had clients who would graze on everything they had in their refrigerator — even the fruits and vegetables — just to avoid going to bed and having to be intimate with their partner," he explains. "They were stalling from having to get undressed because there is so much body shame. This one person, her skin was turning orange from all the carrots she was eating."

And by no means is disease restricted to women. In a July 2014 study, researchers found that more than 45 percent of male veterans, as well as 65 percent of female veterans, showed signs of BED and/or bulimia after returning from their military duties in the Middle East.

"Men and women who develop BED in near equal numbers do so because of the genetic predisposition." Walen says. "They do it to numb out, space out, feel more relaxed, to find more heightened joy in food that is somewhat different from the rest of the population. It's no different than the fact that many people drink alcohol, but only a small number will become alcoholics because they process the experience differently."

Identifying BED vs. Occasional Overindulgence

So what's the difference between people who have BED and people who say they've been "so bad" for "pigging out" too much lately?

"What you're hearing is the development of an environment that shames our food behaviors," Walen explains. "The fear is becoming fat. There are plenty of people who will do some disordered behaviors from time to time, but someone is either genetically predisposed to having an eating disorder or they're not. We need to remember genetics loads the gun, environment pulls the trigger."

The key thing to remember is that this is a disease of the brain, not the body.

When it comes to warning signs of BED, are several emotional, mental, and behavioral characteristics to consider. Eating in secrecy to the point of being painfully full and then feeling shameful or guilty at least once a week, every week, for three months could indicate a problem. "For an easy screening tool, the BEDS-7 questionnaire is a good starting point," Walen suggests.

Recovery from BED involves working with specialized therapists who can help patients face their anxiety around food and figure out where they are struggling emotionally.

"Anecdotally, most binge eaters who are asked in treatment when they think their behaviors with food started, most will point to early childhood, as young as 5," Walen says.

Most importantly, recovery is not about weight loss. "It's a psychological recovery," he adds. "It's about making peace with your relationship with food and to find health and happiness within the body you currently have."

From Patient to Professional

With the help of her therapist, Kronengold has learned coping skills for her emotions, which include meditation, listening to music, and pausing before indulging in unhealthy behaviors.

"If I have an urge to binge, I'll think, 'What is this food going to do for me? What is this going to solve?'" she says. "It's about talking myself through it."

When she felt she was in a good place with her recovery, Kronengold coordinated a NEDA Walk on her college campus. "I kind of created my own support group," she says. "I channeled my eating disorder into activism."

Today she is a program coordinator for NEDA, having earned her master's degree in clinical psychology. Kronengold — who adds that being in recovery is an ongoing process — strongly urges anyone who may be suffering from BED to contact the helpline.

"We can provide information about eating disorders and find treatment providers, but sometimes people just need someone to talk to about their concerns," she says. "I want others to know they're not alone."

To contact a volunteer at the NEDA Helpline, call 1-800-931-2237.

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