Binge eating and bulimia

This guide is psychoeducational content. It does not replace a consultation. Certain signs call for prompt medical advice: repeated vomiting, feeling faint, palpitations, dizziness, muscle weakness, regular use of products intended to get rid of what has been eaten, binges during pregnancy or in a person with diabetes. See section 21. If you are thinking about dying, call your doctor the same day or, in immediate danger, the emergency services. Allow fifty-five minutes to read.

1. Before you begin

It is ten in the evening. The day has gone well: a coffee in the morning, almost nothing at midday, willpower all day long. And then you open a cupboard, without really thinking about it, and an hour later you are sitting on the kitchen floor, surrounded by wrappers, your stomach hurting, with a single thought: how could I have done that again. The next day starts with a promise: today, nothing. And the circle starts again.

Three things, straight away.

A binge is not a lack of willpower. It is the predictable result of a well-described biological and psychological mechanism. People who are highly determined in every other area of their lives have binges, precisely because they are determined to restrict themselves.

Restriction is the main fuel of binges. This is the most counter-intuitive point in this guide, and the most solidly established: the less you eat during the day, the more likely the evening binge becomes. Treatment therefore does not begin by eating less, but by eating regularly.

It can be treated, and treated rather well. Eating binges are among those psychological difficulties for which precise, evaluated methods exist, part of which can be carried out through guided self-help. Many people are markedly better within a few months.

Who this guide is for

For you if you eat in binges, with the feeling that you cannot stop, whether or not you make yourself vomit afterwards.

For you if for years you have alternated between periods of strict control and periods when everything gives way.

For you if you eat too much in the evening, alone, in secret, and the shame that follows occupies a large place in your life.

For you if someone close to you is living through this and you want to understand what is really happening.

2. What a binge is

Three elements, not one

Many people say 'I had a binge' thinking mainly of the quantity. In reality, three things define an eating binge, and quantity is neither the first nor the most important.

• The loss of control. This is the central element. The feeling that something has been set off and that you can no longer stop it, that you are watching your own hand reach towards the cupboard. Some people describe an altered state, an acceleration, a fog.
• The quantity, in relation to the circumstances. Eating, within a limited period, markedly more than most people would eat in the same situation. It is relative: three helpings at a celebration meal are not a binge; the same thing alone, at eleven at night, after a day of restriction, often is.
• The distress that follows. The shame, the disgust, the guilt, the panic, sometimes a heavy torpor. That is what turns an eating episode into a psychological problem.

What it is like from the inside

The descriptions resemble one another from person to person. It often starts with an innocuous thought, 'just one square', or with a tiny transgression of a rule one had set oneself. Then a tipping point: since it is spoilt anyway, one may as well go all the way. The speed increases. Taste disappears fairly quickly; most people report that they no longer really taste what they are eating. The body becomes uncomfortable, then painful. And the binge stops, not through fullness, but through exhaustion, through pain, through supplies running out, or because someone comes home.

What comes afterwards

This is often the worst moment: the taut stomach, the shame, the fear of the next day, the tiredness. Many people describe an inner sense of dirtiness that is hard to put into words, and the conviction that they are the only one who does this. They are not: eating binges are one of the most frequent and least admitted psychological difficulties.

Objective binges and subjective binges

Some people feel every element of a binge — loss of control, shame, collapse — over a quantity that, seen from the outside, remains ordinary: a few biscuits, a piece of bread. This is called a subjective binge. The suffering is just as real, the mechanism is the same, and this guide applies in the same way. What is at stake is not the quantity but the breaking of a rule.

What a binge is not

It is not greed. Greed is savoured; a binge is not savoured.

It is not a problem of nutritional knowledge. Most people who have binges know far more about food than the average.

It is not a choice. No one chooses to spend their evenings, their money and their self-esteem on it.

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