Portrait of a Binge Eater

Offers a look at eating disorders and how they have changed. Anorexia nervosa and binge eating; Why it is due for an overhaul; Why people binge eat; Following binges with purges; No way to tell a binge eater by body weight.

By PT Staff, published March 1, 1992 - last reviewed on June 9, 2016

Shifting Symptom

Pathology marches on. The disturbance in body image that characterizes anorexia nervosa is changing shape. Where once patients' claims of feeling fat even when emaciated were typical, patients today are more apt to deny the seriousness of their low body weight or to put "undue influence" on body shape and weight in evaluating themselves.

What's more, the disorder has evolved into two distinct subtypes. There are those anorexics whose pursuit of thinness is so singular can restrict food intake all the way. And there are now those who break out in recurrent episodes of binge eating.

Such is the lot of America's psychologists and psychiatrists that every few years they must round up the latest manifestations of disorder and update the details of dysfunction. With any luck, the diagnostic bible of the mental health professions, Diagnostic and Statistical Manual (DSM III), now in a revised third edition, will reflect the shifting symptoms of eating disorders in a fourth edition due out later next year.

The topic of binge eating, too, is due for an overhaul. If today's observers have anything to say about it, they will restrict the definition of bulimia nervosa to only those who follow their binges with purges, either by vomiting or laxative use. It's getting harder and harder to find anyone who compensates for bingeing solely by restricting food intake. But whether in anorexia or bulimia, purgers have more pathology, the DSM's Eating Disorders Work Group reports in the Journal of Abnormal Psychology.

And there's no way to tell a binge eater simply by looking at their body weight. Bingers, it now appears, come in all shapes and sizes; some purge and some don't. Obese bingers, says the Work Group, are the hardest of all eating-disorder patients to treat.

But all are alike in one highly unhappy way. They are all most likely to evaluate themselves by a single dimension only: Body shape equals all of self-esteem.

Photo: Woman bingeing ((c) Comstock)