Three of the most common and most powerful triggers for binge eaters -- family, food and feelings -- converge at this time of year, making the holidays an especially challenging time.
For some people, the loneliness of separation from family prompts a bubbling up of conflicts, guilt and painful childhood memories; for others, the family reunions themselves are the stressors. The resulting feelings of anger, frustration, sadness and isolation can lead many binge eaters to reach for the closest form of solace, or self-punishment, at hand: the food that is a central feature of holiday gatherings.
Binge eaters "are trying to cope and comfort themselves in some way," says Nina Savelle-Rocklin, a therapist who specializes in eating disorders. "And that way is hurting them."
Reflecting her psychoanalytic approach to treatment, Savelle-Rocklin observed that "an infant's first experience of love and nurturing is the feeding process." Many with problematic eating patterns, she added, overeat when they "feel empty, disconnected from people, unloved." They use food, she said, to "fill the emptiness."
Studies show that most patients can learn to control binge eating with cognitive behavioral therapy -- a short series of counseling sessions focused narrowly on the behavior and its management. Other patients, particularly those with accompanying depression and anxiety, may have a more lasting response if they explore the underlying motivations for their behavior, some experts believe. (This is the kind of therapy that Savelle-Rocklin practices.)
In cognitive behavioral therapy, says Rutgers clinical psychologist Terry Wilson, "the goal is to help this person return to -- or develop -- regular, moderate eating patterns." That means the patient is regularly eating breakfast, lunch and dinner, along with two to three planned snacks. One such snack may even be after dinner, when many binge eaters are at their most vulnerable.
"We know that a pattern of regular eating is important" for binge eaters, who tend, between binges, to eat too little, skip meals (especially breakfast) and avoid particular classes of food, which are thought of as "forbidden foods," says Wilson.
What some experts call the "dichotomization" of foods -- their division into "good" and "bad" foods -- is a particular problem for many binge eaters, he adds.
"The notion is, if I'm going around in life thinking I can never, never eat chocolate, that's a relapse waiting to happen," Wilson says. "If I transgress that rule, I'm likely to lose control. That's been well established."
By contrast, the most successful treatments for binge eaters focus on fostering moderation, regularity and flexibility, placing nothing off limits.