Binge Eating Disorder: A Literature Review
If you feel like any of these issues effect you then you should contact your GP or an appropriate healthcare professional that specialises in the treatment of mental health conditions. This text is for educational purposes only. It is not meant to diagnose or outline a course of treatment for any particular individual or any particular condition. It is also not meant to contradict any existing diagnosis or treatment for any individual or condition.
Contents
What is Binge Eating Disorder (BED)?
What influences emotional eating:
o Traditional dieting and emotional eating
o Non-dietary influences that predispose to emotional eating
Regulating emotions in Binge Eating Disorder
Personality types in Binge Eating Disorder
o Impulsive personality type
o Non-accepting personality type
Stress responses and appetite: “We must have a pie. Stress cannot exist in the presence of a pie” (David Marnet,1999 ‘Boston Marriage’)
o Chronic early life stress: the cause of a dampened down stress response
Motivating change: motivation, stress and self-confidence
o Two types of stress response: “Can I do it – yes or no?”
o Attributions: “Why can I do it (or not do it)?”
o The changeable and unchangeable: hope and motivation versus hopelessness and no motivation
“I’m constantly evolving”. Hope and motivation
“I can’t change”. Hopelessness and no motivation
What is Binge Eating Disorder (BED)?
BED is the most common eating disorder (Citrome 2017). It involves recurrent episodes of binge eating, on average, at least once per week that is characterised by distress (Juarascio et al 2017) and feelings of a loss of control (Dingemans et al 2017).
Many sufferers eat alone due to shame being tormented by feelings of disgust, guilt or sadness after a binge eating episode (Dingemans et al 2017).
A majority of individuals have at least one other mental health disorder, most commonly anxiety and mood disorders (Dingemans et al 2017). 63% of suffers have some sort of impairment in their work, home, social or personal life (Citrome 2017).
Emotions are heightened in individuals that are prone to feeling their distress is inevitable and is destined to keep happening, feel personally to blame and don’t contain their distress to key areas of their life but have it spill over to affect everything (Rubenstein et al 2016).
As with most mental health disorders these emotions can be complicated by a social or personal stigma. Obese patients with BED (less than 50% of people with BED are obese) can feel judged by unfair social stereotypes related to obesity (Citrome 2017).
The perceived shame of mental health stigma, as well as that of the individual’s negative interpretation of their body image and eating behaviours, can give the feeling of being judged by others as defective, inferior, inadequate and unattractive (Duarte et al 2017).
Healthy individuals can experience these same shameful judgements whilst, at the same time, standing back from them. They are seen as mere thoughts that are a useful learning experience to help challenge and transform their personal perspectives (Babic et al 2020).
However, when individuals can’t stand back from these shameful judgments they take them to heart and become overwhelmed by them. They change from being mere thoughts with no consequence to forming a true representation of an individual’s abilities and perceived self-worth. This can result in concealment, avoidance, control and excessive self-monitoring (Duarte et al 2017) as individuals become imprisoned by these emotions and disconnected from the outside world.
Emotional eating can therefore be seen as a way to help cope with distressing emotions (Lattimore 2020), such as the perceived shame from feeling inferior, ostracized or rejected by others over body image and eating (Duarte et al 2017). The lure of eating, in response to these distressing emotions, is in how it removes individuals from these emotions by drawing their immediate attention, temporarily, to the positive associations they have with eating (Dingemans et al 2017) e.g. self-nurturing (Sanftner & Crowther 1998) or filling a void.
Embracing a healthier way of dealing with these emotions can make the need for binge eating redundant. By no longer feeling as though drowning in overwhelming emotions associated with inferiority and shame a new resilient identity can float to the surface that reflects the individual’s own personality and values (Babic et al 2020).
Questions that may suggest a binge eating tendency are (Citmore 2017):
"Have you felt like some of your eating has seemed out of control?"
"Have you had any concerns about your eating behaviours or your relationship with food?"
"Are there times when you eat more rapidly than usual or eat alone because of embarrassment about others seeing how much or how you eat?"
"Are there times when you eat in secret?"
"Does your weight fluctuate?"
"Do you eat more when you are stressed or anxious?"
What influences emotional eating
Traditional dieting and emotional eating
Diets that restrict food intake are notoriously ineffective as the body cannot distinguish between a diet related food restriction and an actual food shortage from famine. Thinking it’s starving the body slows down its metabolism and increases appetite and hunger in a desperate attempt to get us to eat. This produces intense feelings of deprivation, especially when stressed predisposing to emotional eating tendencies (Strien 2018).
Dieters attempt to suppress, or avoid, thoughts related to food, eating, weight or eating disorders (Barnes et al 2013). However, suppressing thoughts and emotions requires self-control, and self-control is a resource that can be depleted. Draining our levels of self-control, means (i) we can’t suppress these emotions anymore and become fixated on them; (ii) perform badly in other tasks that require us to dip into our depleted stocks of self-control (Litvin et al 2012).
Non-dietary influences that predispose to emotional eating
Non-dietary influences that predispose to emotional eating include:
Poor awareness of whether feeling hungry or full after a meal (Strien 2018).
Poor ability to identify, describe and clarify emotions (Strien 2018) including the emotions that trigger eating (Lattimore 2020). The distinction can be lost between eating when hungry and eating in response to distressing emotions (Lattimore 2020).
Rash, impulsive behaviours in response to distressing emotions trigger a reckless need for immediate satisfaction in the form of eating (Lattimore 2020). Attention has to be drawn to the positive associations with eating (Dingemans et al 2017) such as self-nurturing (Sanftner & Crowther 1998) in an attempt to remove themselves from negative emotions such as self-blame, blaming others, feeling defeated or a perceived inability to make a change. Consequently, the thought of not being able to eat in order to deal with these emotions triggers feelings of distress (Lattimore 2020).
Susceptibility to depression, anxiety, anger/frustration, disappointment and feelings of being hurt or lonely (Dingemans et al 2017), especially when interacting with others (Strien 2018).
Response to stress with a dampened down stress response. Refer to ‘Stress responses and appetite: “We must have a pie. Stress cannot exist in the presence of a pie” (David Marnet,1999 ‘Boston Marriage’)’.
Regulating emotions in Binge Eating Disorder
Day-to-day individuals unconsciously use different ways to regulate their emotions when positively adapting to everyday stresses. When these coping mechanisms are used correctly in response to adversity they develop self-confidence and resilience (Babic et al 2020).
Some individuals though, negatively adapt to day-to-day stresses by using binge eating to manage their emotions. Being overwhelmed by distressing emotions makes them difficult to cope with. Binge eating allows individuals to, temporarily, remove themselves from these overwhelming emotions by drawing their immediate attention away from them and to the positive associations they have with eating (Dingemans et al 2017) e.g. self-nurturing (Sanftner & Crowther 1998) or filling a void.
Therefore, binge eating can be used to escape or distract from intense moods. This might be intense negative moods such as depression, anger or anxiety (Dingemans et al 2017) giving rise to the threat of feeling inferior, ostracized or rejected by others over body image and eating (Duarte et al 2017). Or intense positive moods e.g. uncontrollably eating, in response to excitement and celebration (Dingemans et al 2017).
The coping mechanisms people use correctly, or incorrectly in BED, to deal with day-to-day stresses are (Dingemans et al 2017):
Reappraisal. Distancing yourself from a situation can generate a new perspective to lessen its emotional impact e.g. stepping back and seeing things from another person’s perspective. This is especially true when an entire self-identity is based on perceived, or actual, shortcomings.
Being aware of, and being able to clearly categorise how our body is feeling and what emotions are being experienced makes them easier to appraise (Brewer et al 2021). Reappraising, or changing these perspectives, enables one to acknowledge and validate perceptions but without labelling them; this generates new perspectives e.g. with shameful acts altering phrases like “I’m dumb” to “I’m having familiar thoughts that I’m dumb”. Reappraising distressing situations can make them less overwhelming and a learning opportunity to develop self-confidence (Cook & Artino 2016) and resilience (Babic et al 2020) “making a mistake is not horrible, it helps me to learn”.
Problem-solving. Getting out of a rut using a flexible, fluid change in thinking alters behaviour as to adapt to situations. This creates enjoyment by thriving on challenges that involve learning opportunities be it from success or failure. Being weighed down by over-reflecting on past experiences and anxiously anticipating the future impairs the flexible thinking needed for effective problem-solving (Zhang et al 2018). An example of a problem-solving tool is worry.
When grounded by literal and pragmatic thinking worry is part of a healthy and productive problem-solving tool. In truly worrying situations that pose a literal, not perceived threat, from uncertainty and danger worry uses a “what if ... happens" style of thinking to openly confront the situation, whilst at the same time, creating a little bit of drama that beneficially stresses the importance of an upcoming threatening situation; this motivates the individual to find a solution to the situation; and then monitors the progress of the individual in implementing this solution to successfully make sense of, and navigate, the uncertainty and danger (Meeten et al 2016).
However, when worry spirals out of control, and isn’t grounded by literal and pragmatic thinking, it becomes overly dramatic by developing a disproportionate desire to avoid, what is perceived to be, uncertain and dangerous threatening situations. Uncontrollable worry shifts the emphasis away from using grounded, concrete, pragmatic thinking that is open to directly confronting and processing complexity to using an anxiety-driven desire to misshape and overgeneralize in order to protect against confronting the enormity of a problem and its solution.
Therefore, being anxiety driven, the individual becomes reliant on uncontrollable worry to provide a convenient, understandable, overgeneralized perception of the problem and its solution. It muddies any clear visual images of the problem or its solution by thinking verbally (Ehring et al 2008) to predict ‘impending doom’ as to feel secure of no surprises and cling on to inflexible, generic beliefs that avoid any conflicting points of view. By avoiding using grounded, concrete, pragmatic thinking to entertain these conflicting points of view they fail to embody a clear vision of the true complexity, and conveniently, blur their perspective narrowing their emotional engagement (Hochli et al 2018). This enables them to feel distant from the problem and shift blame (Kyung et al 2010) and responsibility, either on to themselves or others, which makes it an ineffective problem-solving tool.
When an individual is consumed by worry, so their emotions, prejudices and biases misshape their perception, worry impedes the problem-solving process further by swallowing an individual up with repetitive negative thoughts about (McEvoy et al 2014):
· Personal shortcomings, failings, faults and mistakes.
· Unwanted intrusive images and thoughts.
· Uncontrollable obsessive thoughts.
· Thoughts about a situation and wishing it would go better.
Acceptance. Involves standing back from distressing emotions and not taking them to heart. Acceptance isn’t about changing bad emotions to good emotions but deliberately experiencing and accepting bad emotions with a dispassionate curiosity.
Grounded, concrete, logical thinking that ascertains how situations unfold ‘talks to the individual’ bringing things closer whilst openly accepting complexity; by slowing us down it provokes less reflex, abstract, blinkered emotional responses that skewer memory and cast unjust moral judgements e.g. shame (Kyung et al 2010). An example is optimistic individuals, who not only accept, but elaborate on, negative health information (Aspinwall & Brunhart 2000). Despite ‘ramping-up’ this negativity it fails to make a dent on the optimist due to their ability to openly reframe and reappraise pessimism to remain confident and persistent in pursuing their goals (Pacheco & Kamble 2016).
Shame is a key emotion that prevents an individual from standing back from the distressing emotions of disgust, guilt or sadness making them difficult to reflect on, and relate to, in a healthy way (Duarte et al 2017). In BED emotional acceptance can be used to confront and release our grip on those thoughts that trigger binge eating (e.g. depressions or anxiety); those that relate to ourselves (e.g. our worth in society as an individual); and those that use binge eating as a coping mechanism (Dingemans et a 2017).
Avoidance. Examples of how individuals avoid distressing emotions include the rigid, inflexible styles of thinking associated with:
(i) Maladaptive perfectionism (Santanello & Gardner 2007). Maladaptive perfectionists exhibit an “all or nothing” thinking, making them feel as though their failures are catastrophic and humiliating (Pia et al 2020). Measuring their self-worth against achieving ‘perfection’ (Ferrari et al 2018) maladaptive perfectionists are destructively self-critical (Woodfin et al 2021) in order to meet, what is perceived to be, their own, or other people’s impossibly high standards as to ensure their approval. They don’t embrace mistakes in order to learn, but avoid them, as to feel guaranteed they can avoid experiencing rejection, criticism or being overlooked (To et al 2021); they experience greater relief they did not fail, and less so the delight of accomplishment; and experience fear and caution that prevents them from connecting with personal creativity, inspiration, passion, joy and productivity (Kelly 2015). By being ‘perfect’ they must meet, what they perceive to be, other people’s impossibly high standards. However, by measuring their self-worth against achieving the impossible, perfection, and inevitably falling short of these unrealistic standards, makes them feel they don’t have the approval of others which perpetuates a self-image of worthlessness (Ferrari et al 2018) and of being undeserving of love or wellbeing (Pia et al 2020). Unable to accept their perceived imperfections means they avoid these distressing thoughts by burying them in the positive associations with binge eating (Cooper & Fairburn 2011).
(ii). Catastrophising behaviour. In unpredictable and uncertain situations predicting ‘impending doom’ provides a comforting certainty whilst anxiously narrowing one’s gaze to a predicted worst possible outcome. A preoccupation with catastrophic behaviour avoids widening one’s gaze to confront a bigger, more daunting picture, where success hinges on a less dramatic and more challenging, broader, flexible style of thinking (Flick et al 2013).
In BED distressing emotions are avoided, temporarily, by drawing their immediate attention away from these emotions and to the positive associations with eating (Dingemans et al 2017) e.g. self-nurture (Sanftner & Crowther 1998) or filling a void. This can temporarily distract from emotions, such as anxiety, depression or guilt but after eating other negative emotions such as depression (Rosenbaum & White 2013) can come flooding back.
Rumination. Brooding or dwelling on past events or negative personality traits makes you fixate on problems and feelings so they swallow you up; this prevents effective problem solving and makes you idle and inactive. Individuals dwell on things (ruminate) by using:
(i) Abstract rumination: getting stuck in a rut with repeatedly having the same few negative thoughts. These thoughts are characterised as unconstructive, unclear and broad/ill defined (Paucsik et al 2021). Abstract rumination tries to be creative but is distorted by prejudice or bias; this creates a blindspot in our imagination making it hard for us to see how the world could be different from how we assume it to be; this influences our assumptions on the hypothetical interpretation of things, their meaning, why something’s being done, the cause, the purpose, the overall goal and the implications and consequences. Example: “why did I fail? what does this say about me? why couldn’t I have handled things better? what’s going to happen now?”
(ii) Concrete rumination: repeated thoughts that focus on the experiences in the present moment e.g. sights, smells, sounds, etc. These thoughts aim to grasp and respond to situations and how to keep pace with how these situations change. These thoughts aren’t elaborate or hypothetical but distinct, clear and asks specific questions to get specific answers that leave no doubt (Paucsik et al 2021). Example: “how did I fail? How did all this unfold? How can I get round this? How can I change the outcome? How can I break things down into smaller steps and move forwards?” Concrete rumination typically results in a less depressed mood (Watkins et al 2012) and less regret once a decision has been made (Deya et al 2018).
Unhealthily dwelling on things in either style of rumination constitutes an unhealthy coping mechanism. However, abstract rumination, (i) draws elaborate conclusions from one situation forming a sweeping rule of thumb for all situations (Watkins et al 2012), this overgeneralization predicts never-ending patterns of defeat (ii) proposes an imaginative ‘reality’, distorted by prejudice, encouraging a measure of self-worth against ‘perfection’ leading to stress, depression, anxiety and lower levels of self-compassion (Paucsik et al 2021); (iii) ponders on things using vague, ill-defined imaginative thoughts that lack the clarity of vision to focus on confronting problems and the issues around their solution. In contrast, ruminating on past events being focused on more concrete details e.g. where you were, sights, sounds, how what you felt related to what you done, forms a clear vision in the minds eye that openly confronts problems and their solution (Stober 1998); (iv) results in a depressed mood (Watkins et al 2012) as individuals feel hopeless by becoming exhausted and loosing a sense of control over the overwhelming enormity of their emotions; (v) experience regret once a decision has been made (Deya et al 2018).
Binge eating temporarily disconnects the individual from these overwhelming emotions so they can briefly escape from, and regain a sense of control over them; it does this by consuming the individual’s immediate attention with the distinct, clear, specific, actions and emotions associated with eating; however, this only temporarily blocks out, or ‘numbs’ the individual to distressing emotions, including the upcoming consequences after the binge eating episode (Rosenbaum & White 2013). Standing back from, and reappraising overwhelming emotions to get a fresh outlook is a more healthy way to reduce the tendency to ruminate (Kirishnamoorthy et al 2021).
Suppression. Not being aware of, and not being able to clearly categorise how our body is feeling and what emotions are being experienced makes them easier to suppress. However, when these feelings and emotions escalate to the point where we do feel them it makes them harder to manage and learn from and can promote genuine self-denial “I never realised I had a problem” (Brewer et al 2021). Conversely, a more conscious attempt to deliberately bottle up emotions by not experiencing or expressing them how you want (e.g. put a brave face on) involves distracting oneself from them and constantly checking that these emotions don’t surface. This drains self-control so (i) these emotions fail to be suppressed and become fixated on; (ii) there is less self-control for other tasks (Litvin et al 2012).
Using suppression to deplete stocks of self-control facilitates our natural desire to, on a whim, indulge in short-term, fleeting pleasures; self-control curtails the temptation of these immediate short-term pleasures (e.g. binge eating) that can draw our attention away from working towards a deeper sense of satisfaction by achieving our longer-term goals (e.g. having control over eating behaviours) (Duckworth et al 2017).
When suppression, by brute force, attempts to suffocate short-term instantaneous desires, for example when trying not to eat doughnuts, it asks ‘how’ this can be achieved “how can I suppress the desire for doughnuts? Just walk away from them, just don’t think about them”. Whilst this may work temporarily it ultimately drains self-control resulting in an uncontrolled, exhausted desire for indulgence (Duckworth et al 2017). Binge eaters, especially those dieting, are more likely to attempt to suppress thoughts and emotions related to food, eating, eating concerns and weight (Barnes et al 2013).
Not suppressing emotions and not exhausting stocks of self-control, illuminates a path beyond this natural desire for instantaneous pleasure, that leads to our longer-term goals.
“I’m having familiar thoughts of doughnuts as a delicious treat. Even though this desire is motivated predominately by the thought of doughnuts, rather than how they literally taste, they are none the less still very tasty!”
However, as not to stumble at the first hurdle, succumbing to every passing desire for instantaneous pleasure, we must, simultaneously, widen our gaze to the clear values and principles that motivates us to pursue our longer-term goals. This is achieved by asking ‘why’ (Duckworth et al 2017). For example:
Question: “Why am I forgoing the immediate satisfaction from eating the doughnuts? Why do I want the opportunities this will afford me?”
Answer:”I like the fact that I can choose not to succumb to every passing whim; that I can experience a deeper sense of satisfaction from making myself happier, healthier and in control of myself and my life. I like that I feel self-confident in knowing I can act in away that reflects my personal values”
These example statements aim to establish a clear concrete vision that ‘talks to the individual’ in order to fully processes what they want to achieve, why they want to achieve it and how to achieve it. When this clarity of vision is talked over in an attempt to suppress it with more ill-defined, overgeneralized, elaborate, abstract thoughts then there is a failure to openly visualise and process the complexities of the problem and its solution (Stober 1998).
Acknowledging the fleeting whim of immediate pleasure whilst keeping in mind the longer-term bigger picture, can, however, risk imposing an intolerant mindset associated with ‘perfectionism’. A healthy flexible mindset acknowledges the place for savouring immediate satisfactory hedonic pleasures and accepts failure as essential to the learning process.
Personality types in Binge Eating Disorder
Impulsive personality type
Impulsivity is characterised by distressing emotions driving rash actions. By persistently and desperately seeking out rewards the impulsive individual is blinkered to any consequences of their actions (Giel et al 2017).
With BED a difficulty coping with distressing emotions generates an immediate need for the individual to remove themselves from these emotions by narrowing their gaze on food (Dingemans et al 2017) as a form of self-nurture (Sanftner & Crowther 1998). However, this blinkered need for food as a form of immediate satisfaction is only temporary as it ignores the longer-term consequences that occurs after binging (Dingemans et al 2017) e.g. depression (Rosenbaum & White 2013).
This creates a binge eating cycle. After binging and the longer-term consequences e.g. depression are experienced there is an immediate impulsive need for further instantaneous satisfaction from, once again, eating (Dingemans et al 2017).
Non-accepting personality type
Acceptance involves standing back from thoughts and emotions so we can decide what to do based on the direction we want our life to take. This stops distressing thoughts and emotions being taken to heart and weighing us down as they overwhelm, consume and govern us.
Purposively experiencing and accepting distressing emotions, such as shame, makes the individual feel less threatened and self-conscious by them (Zhang et al 2018). By removing the threat of being overwhelmed by distress and vulnerability (Chen & Jackson 2019) individuals become motivated to challenge themselves by working towards a goal (Cook & Artino 2016) as an opportunity to promote growth and resilience (Babic et al 2020).
Purposively experiencing and accepting, without over-identifying with, distress so you relate to it, and yourself, in a healthy way is fundamental to developing self-compassion, a form of self-care that directs ‘forgiving loving acceptance’ inwards towards the self. It’s not until we broaden our horizons, using more flexible thinking, as to fully experience, accept, reappraise and reframe distressing emotions in a more productive light, that we can learn how to stop over-identifying with, and getting swallowed up by, distressing emotions resulting in externalised behaviours such as getting upset, yelling or freaking out, and internalised emotions such as stress (Berardini et al 2021) and start ‘flipping the script’ so we can begin utilising our flaws in order to promote growth and development (Al-Refae et al 2021). By not being so cold-hearted towards ourself, suffering the burden and stress of ‘compassion fatigue’ from showing outward compassion, rather than directing it inward, we can take time to learn self-care, helping ourselves, in the same way that we would another, by being kind, caring, understanding and non-judgmental towards ourselves. Accepting and experiencing distressing emotions in this way, embracing them as a shared experience, something that ‘we all go through’ e.g. you can’t measure your self-worth against perfection, none of us are perfect, everyone make mistakes, feels shame and experiences inadequacies (Cȃndea & Szentágotai-Tătar 2018) creates a sense of belonging, of not being isolated (Berardini et al 2021) but connected and grounded with other people and secure places, ‘being at home within’ (Wang et al 2021) “I know how you feel you’re not good enough. Other people sometimes feel they are not good enough too, but it’s just a thought in your head. Don’t let it destroy you. Everybody makes mistakes”
Therefore, being destructively self-critical, harsh, and judgmental so you over-identify with, and get carried away with emotions, hinders self-compassion with the need to develop it misconstrued as being ’selfish’ with associated feelings of guilt (Berardini et al 2021). But by developing self-compassion, fostering resilience and the realisation that ‘we are all in the same boat’, reduces the fear and shame from being looked upon unfavourably by others (Zhang et al 2019) which avoids the need to compensate for negative social comparisons by obtaining a ‘higher social rank’ (Ferrari et al 2018). Regaining control over obsessive thoughts on negative emotions and self-criticism promotes resilience, wisdom (Al-Refae et al 2021), social connectedness, optimism, overall happiness and satisfaction (Berardini et al 2021) and an authenticity whereby one’s outer expressions reflect a non-egotistical true inner self characterised by an open, self-compassionate mindset (Zhang et al 2019)
In contrast, non-acceptance is when an individual does get carried away with distressing emotions, taking them to heart and becomes weighed down by them. An example is pursuing perfection to meet, what is perceived to be, other people’s impossibly high standards. Measuring your self-worth by being ‘perfect’ in order to secure approval from others involves being destructively self-critical as to avoid mistakes (Ferrari et al 2018) and assure not having to experience rejection, criticism or being overlooked (To et al 2021). However, using self-compassion to accept the reasons for wanting this approval, namely the concealment of perceived failures and the need for achievements to prove self-worth, makes them easier to stand back from and less overwhelming. By making the need to be perfect less overwhelming, this in turn, prevents a self-image of worthlessness when these impossibly high standards can’t been met (Ferrari et al 2018).
Being overwhelmed by emotions makes them unable to step back from, and reappraise, from a fresh perspective. These emotions are heightened in individuals that predict their distress is inevitable and will always happen, feel personally to blame and don’t contain their distress to key areas of their life but have it spill over to affect everything (Rubenstein et al 2016).
Loosing control and becoming consumed by thoughts and emotions means they transform from being a mere thought with no consequence to forming a true representation of the self that dictates the individual’s actions (Zhang et al 2018).
This can be seen when an individual says “this is too difficult I can’t do it”. When said flippantly, this should reflect no more than a brief emotional state of mind. However, when an individual is flooded by emotions that dictates their actions, this off the cuff remark, turns into a literal description of how someone sees their true inability to cope (Zhang et al 2018). This leads to hopelessness, resignation and a lack of motivation (Cook & Artino 2016) further reinforcing the individual’s negative self-image of themselves.
When individuals feel inferior, hopeless and helpless they desire to hide these flaws (Velotti et al 2017) by either escaping or disappearing (Cȃndea & Aurora 2018) or pursuing perfectionism (Ferrari et al 2018). This can lead to low self-esteem and a vulnerability to other negative emotions such as shame (Velotti et al 2017).
This is how, by not accepting, and being overwhelmed by the threat of negative emotions, including shame, low self-esteem and guilt (Sanftner & Crowther 1998) can dictate an individual’s binge eating. Obese patients with BED (less than 50% of people with BED are obese) can feel judged by unfair social stereotypes related to obesity (Citrome 2017) as can BED patients with other mental health conditions.
Shame is a key emotion that prevents an individual from standing back so they can accept and engage with distressing emotions. Shame arises from an individual perceiving themselves as inferior with regards to the kind of person they are, their abilities and their appearance (Velotti et al 2017).
By leaving the individual feeling they are judged as being defective, inferior, inadequate and unattractive shame can act as a catalyst. It can transform distressing emotions from being a mere thought with no consequence, to being taken to heart so it forms a true representation of their self-image that dictates their actions (Duarte et al 2017).
An individual overwhelmed by shame looses a sense of control over how to steer themselves out of distress resulting in hopelessness and resignation. When this feels like a permanent state it can lead to pity, or anger if we deem that ourselves or others have some type of control over how to improve things but aren’t (Cook & Artino 2016).
When behavioural shame arises from a feeling of ‘falling short’ of a moral standard a fear of losing control over eating ensues, as well as a need to conceal eating due to feelings of guilt (Duarte et al 2017).
In BED these high moral standards maybe from feeling overwhelmed by the pressure to be a healthy role model for one’s children; being a devoted, honest, engaged friend; or being a loving, supportive partner (Juarascio et al 2017).
Therefore, by not being able to stand back from and accept overwhelming emotions such as shame and feeling inferior, ostracized or rejected by others over body image and eating (Duarte et al 2017) binge eating, temporarily, allows the individual to remove themselves from these emotions by drawing their attention to the positive associations they have with eating (Dingemans et al 2017) e.g. self-nurturing (Sanftner & Crowther 1998). It can also be used as a self-sabotaging behaviour to obtain comfort by re-gaining control and steering away from the threat of the unknown back to the familiar territory of controlled failure.
Stress responses and appetite: “We must have a pie. Stress cannot exist in the presence of a pie” (David Marnet,1999 ‘Boston Marriage’)
A normal stress response involves our body releasing a stress hormone called Cortisol. There’s an optimal amount of Cortisol our body needs, too much or too little Cortisol can have negative effects on our health.
When exposed to chronic childhood stress this normal stress response dampens down so that in response to stress in adolescence and adulthood the body doesn’t release enough Cortisol. This has been associated with BED but can be remedied by the use of Mindfulness (Strien 2018), including the Mindfulness concepts outlined in this article.
The relationship between stress and Cortisol is intimately linked with appetite “We must have a pie. Stress cannot exist in the presence of a pie” (David Marnet,1999 ‘Boston Marriage’)
Other symptoms of a dampened down stress response, when the body doesn’t release enough Cortisol in response to stress, includes tiredness, pain and always thinking the worst will happen (catastrophising) (Hannibal & Bishop 2014).
In pubescent females oestrogen activation compounds this dampened down stress response (Strien 2018).
Chronic early life stress: the cause of a dampened down stress response
There are two types of stress response (i) feeling threatened or intimidated or (ii) believing in yourself and feeling excited by the thought of rising to a challenge (Jamieson et al 2012).
It’s not either or, everyone will experience different levels of threat and intimidation or excitement and challenge in anyone given situation.
Chronic stress in early life can cause a dampened down stress response (less Cortisol released in response to stress). Less Cortisol makes day-to-day stresses seem more fearful (Miller et al 2011) making individuals passive and withdrawn (Loeb et al 2021). Alternatively, our body can attempt to ‘fire back up’ its Cortisol levels in response to stress resulting in aggression (Oberle 2018) and fearlessness (Miller et al 2011).
Positively exposing children to adversity builds resilience (Richter-Levin & Sandi 2021). For instance, supporting a child to take personal responsibility for their mistakes (Palominos 2019) by giving them the tools to learn from their own success and failures (Lam et al 2019) allows them to flourish and develop resilience (Babec et al 2020). This sense of personal growth, is why learning, be it from success or failure, becomes exciting and intrinsically motivates a child without the need to seek approval or desperately avoid disapproval. They learn to embrace the motto “fail often in order to succeed sooner”. Such children are not stressed in the face of repeated adversity but learn to embrace it.
Conversely, repeatedly exposing children to distressing situations in a negative way creates chronic stress. Not learning how to cope with distressing situations can make them feel vulnerable and easily overwhelmed by adversity. This vulnerability creates pessimism, a sense that things will never get better, and that they have no control and are automatically to blame when things go wrong (Rubenstein et al 2016). Without a sense of ability to control, or steer, a distressing situation to a favourable outcome, adversity can feel unpredictable and traumatic (Richter-Levin & Sandi 2021).
Repeated negative exposure of a child to adversity produces chronic stress and dampens down their stress response and undermines their autonomy. It can be from abuse, bullying or manipulative parenting (Loeb et al 2021) from authoritative figures e.g. parents, coaches, teachers, etc.
Manipulative parenting isn’t the same as parenting that positively uses clear boundaries. Manipulative parenting attempts to suffocate individuality repeatedly using guilt as a form of control; it makes a child subservient to the expectations of authoritative figures with no regard for their own feelings and values (Loeb et al 2021).
As this type of learning uses coercement to suffocate individuality and secure unquestioning obedience and conformity the child is not intrinsically motivated by the exciting learning opportunities that comes from success and failure in order to achieve personal growth; it is extrinsically motivated to learn in order to avoid disapproval or to seek perfectionism by desperately seeking approval from others by striving for excellence (Kelly 2015).
Therefore, due to a lack of self-confidence, embracing individuality and responsibility in order to forge their own path in life can leave them feeling intimidated and vulnerable as they anxiously anticipate danger, seeing every challenge as an intimidating threat.
Feeling intimidated and nervously anticipating danger can negatively affect motivation causing:
Low motivation. Individuals with low motivation and a dampened down stress response (low Cortisol) can become passive and withdrawn disengaging from problems denying they exist (Loeb et al 2021). Defensive behaviour such as aggression or antisocial behaviour may compensate for this to ‘fire back’ up their stress hormones (Cortisol) making them feel fearless (Oberle 2018 & Miller et al 2011).
High motivation. Here the individual’s ‘drive to strive’ and excel in order to achieve acceptance is highly motivated by avoiding the threat of rejection, criticism or being overlooked (To et al 2021). In BED this can include feeling overwhelmed by putting too much pressure on oneself to be a healthy role model for one’s children; being a devoted, honest, engaged friend; or being a loving, supportive partner (Juarascio et al 2017).
This dampened down stress response, when our body doesn’t produce enough Cortisol, from chronic childhood stress, that accounts for these behavioural changes can be helped by Mindfulness to ‘fire back up’ Cortisol to a healthy level (Strien 2018).
Motivating change: motivation, stress and self-confidence
Being motivated to change behaviour promotes growth and creative thinking. An internally motivated individual envisions themselves growing as they tread a path that embraces challenges, learning from success and failure, as they stride towards a goal. They embrace the motto “fail often in order to succeed sooner”.
Self-confidence and how an individual responds to stress are personal influences that can help shape a vision. It helps shape a vision of the path towards a goal that has obstacles and the vision of how an individual responds to these obstacles. This vision of a journey with rewards, success, failures, exciting challenges and intimidating threats determines how motivated an individual is to tread this path.
Central to this vision is to accept, but not be overwhelmed by, the threat of distress and vulnerability (Chen & Jackson 2019) so individuals become motivated to challenge themselves by working towards a goal (Cook & Artino 2016) as an opportunity to promote growth and resilience (Babic et al 2020). Becoming overwhelmed by distress and vulnerability, so you talk yourself out of any meaningful attempt to tread this path towards your goals, is a strategy used to avoid these emotions (Rubenstein et al 2016).
Two types of stress response: “Can I do it – yes or no?”
There are two types of stress response (Jamieson et al 2012). It is important to remember it’s not black and white everyone will experience both types to different degrees:
Threat or intimidation stress response: “can I do it?” “No”. A lack of self-confidence in your ability to rise to a challenge creates a perceived loss of control and unpredictability. This drives anxiety-fuelled expectations highly anticipative of threat and danger. Whilst useful when we truly are ‘out of our depth’, it can spiral out of control alerting to potential danger when none actually exists (Kiversteine et al 2019).
Challenge stress response: “can I do it?” “Yes”. Having self-confidence you can rise to a challenge gives a sense of control so you can predict, good or bad what is going to happen.
Attributions: “Why can I do it (or not do it)?”
Answering, “can I do it?” largely determines whether you’re motivated to take on a challenge or overwhelmed and unmotivated by seeing something as a threat (Cook & Artino 2016).
The answer to “can I do it?” largely comes from weighing up past experiences and observing that of others. But answering ‘“can I do it?” with “yes” or “no” is only one side of the coin; how we explain to ourselves the reasons for our past success and failures is the other side (Cook & Artino 2016). Our personal thoughts and ideas that explain our past success and failures defines how we see ourselves and our place in society. Past success or failure can be attributed to (Cook & Artino 2016):
Personal ability.
Innate ability.
Other people.
Luck (e.g. “It was just a fluke” or “I had my lucky socks on!”).
“I’m getting to grips with this, I can see it coming right”. If past success or failure is seen as being due to things we can work with and control, especially when we can predict, good or bad, what will happen (Richter-Levin & Sandi 2021) then the sky’s the limit and we are motivated by the challenge (Cook & Artino 2016). For example, developing our personal ability develops pride and self‐esteem (Cook & Artino 2016).
Such individuals don’t always see distress as a given but when they see it coming they’re not overwhelmed by it; they don’t always see themselves to blame but when they do they accept a healthy degree of personal responsibility; and they isolate negativity not allowing it to spill over onto other aspects of their life. They embrace the motto “fail often in order to succeed sooner”.
“I don’t know what will happen. I can’t do anything about it” If we are at the ‘mercy of the elements’ and past success or failure is seen as being due to things we can’t work with and control (Cook & Artino 2016), especially when we can’t predict, good or bad, what will happen (Richter-Levin & Sandi 2021) we are unmotivated and intimidated seeing things as more of a threat. This is when we feel more hopelessness, resignation, shame (Cook & Artino 2016) and pity (Weiner 1985). For example, when we think we’ve failed because of our innate ability “I can’t do anything about it, it’s just who I am”.
Such individuals can predict their distress is inevitable and will always happen; feel personally to blame; and don’t contain their distress to key areas of their life but have it spill over to affect everything (Rubenstein et al 2016).
In reality people attribute past success or failure to a combination of different causes rather than just one thing.
The changeable and unchangeable: hope and motivation versus hopelessness and no motivation
In reality things are rarely black‐and‐white as everyone shifts, to varying degrees, between different mindsets.
“I’m constantly evolving”. Hope and motivation
Individuals may feel they have failed previously from a lack of personal ability. Ability isn’t a fixed quantity, the sky’s the limit, “if I can just work on that I know I can do it next time”. Being motivated to build on their ability, to take on challenges without fear or intimidation, but still aware of their problems and emotions, these individuals feel less hopelessness, resignation, shame (Cook & Artino 2016) and pity (Weiner 1985). As failure is not seen as distressing, but just another learning tool for growth and change, they are motivated to feel smarter by seeking out learning opportunities that fully engage and challenge their abilities (Cook & Artino 2016) in order to build resilience (Babic et al 2020).
“I can’t change”. Hopelessness and no motivation
“Can I do it? No. I’ve never been any good at it. It’s just who I am. I can’t change”. An individual with permanently low expectations of their innate ability to control and change things shuts down and withdraws (Loeb et al 2021). This is especially so when individuals can’t predict, good or bad, what will happen (Richter-Levin & Sandi 2021)
The heightened sense of hopelessness, resignation, shame (Cook & Artino 2016) and pity (Weiner 1985) from believing that their personal capacity to adapt and grow is stunted and unchangeable makes failure a highly distressing emotion and one to be avoided.
Being desperate to avoid the distressing emotions of failure, especially unpredictable failure, can lead them to talk themselves out of any meaningful attempt to achieve their goals (Rubenstein et al 2016) “people with low expectations are rarely disappointed”. They may complete easy tasks to gain recognition and one upmanship (Cook & Artino 2016). Their sense of vulnerability can create pessimism, that things will never get better, and a sense that they are to blame when things go wrong (Rubenstein et al 2016). This can lead to self-sabotage (Cook & Artino 2016) to shift blame, avoid any real action (Taghizadeh & Cherati 2015) and set themselves up for a less distressing ‘predictable failure’ as opposed to putting it on the line and risk a far more distressing ‘unpredictable failure’. To the other extreme it may create a need to excel in order to be accepted and avoid rejection, criticism and from being overlooked (To et al 2021).
Interestingly mindsets change with age: young children who typically have the ‘invincibility of youth’ believe they have potential and their abilities are changeable and endless; as we get older people become more brittle believing their abilities are more fixed and unchangeable ‘you can’t teach an old dog new tricks’ (Cook & Artino 2016). Could this contribute to the decrease in resilience with age? (Babic et al 2020).
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