I'm finished preparing and are taking the jump tomorrow.

My goal now is body healing and reaching it's set point weight. That means I'm ditching the other plan I had.  Tomorrow I jump up 180 calories to 1700 calories from 1520 this week. After three or so days I'll jump further to 1900 calories, after another 3 days if I'm hungry for more I'll jump to 2100 and after another three days I'll jump to 2300. I'm thinking I may need more time than three days to be hungry for more, but the opposite can happen as well, and my body may be ready to jump after only two days. I will find the best solution for my body, and will not force it to eat like I forced it to starve.

One motivating factor is reading recipes and thinking I can allow myself to eat all that. That gives me joy and a feeling of freedom. I have solved my clothing problem so that is no longer holding me back from jumping to reach my goal, or my body's goal, more precisely. See, I refuse to dress womanly and with curves I see that as a threat to my body image. I like teen boys wear and mens wear. I started dressing with ties and mens jackets when I was 16, and I have never liked much of womens wear. I do like some, though, but it can easily be combined with mens wear.

Only thing I'm not sure about yet is if I am going to follow a meal plan or let my self give in to extreme hunger if that arrives. I have been wondering what the result of giving in to EH compared to not giving into it will be. I haven't found so much info about it. Just that some who doesn't give into it may think they are recovered before they really are. I don't want that of course. I want full recovery and stay there. I am not afraid of EH, because I have experienced it many years ago, but I would prefer avoiding it because I don't think I can afford to buy a huge amount of food at the moment.

So I wonder if it is possible to get a healthy recovery without giving in to it. I would rather eat a few hundred calories more than minimum daily than eating a lot the first days of the month and end up with no money for food at the end of the month. Will I overshoot more if I don't give into it and use very much more time to get well without extreme eating? I do not want to worry about not having enough money for food either. That is stressful.

So untill more money is coming in I think eating according to a meal plan and counting calories to make sure I eat enough will be the best for me. If I get extreme hunger I don't have to count, but I will try to have some control so i don't eat what ever and extreme amounts. I have read about peoples experiences with extreme hunger today. Two said that the extreme hunger disappeared after a few weeks because the body understood it got enough food every day. I find that reasonable. I mean, it's ok and understandable that the body are telling me it is very hungry, but as long as I feed it food for healing purposes it is not restricting when I don't give into it and let my body take over completely. I don't say there is wrong eating according to the extreme hunger, but I think maybe it is okey not to do it as well as long as I give the body above minimum amounts.

I will get more money when a guy moves into the apartment in june, july or august. This person can be a challange for me, and that's ok. This recovery will test our friendship because he likes me skinnier the better and have to watch me eat a lot and be huge. It will certainly be interesting to see if he can be supportive or not.Perhaps he wants to move out or never move in, ha ha. At first I thought I needed to be sure he could support me before I could take the jump into full recovery, but as my motivation increased I don't feel I need his approval. This is my thing, if he likes it or not. I can handle a rejection if it's based on such a superficial thing as body size. 

Are you afraid you have gone from anorexia / bulimia to a binge eating disorder?

I just had to copy this very interesting - and hard to find anywhere else- information about binge eating from youreatopia.com. Link to the whole page is found at the bottom.

Bingeing in the true clinical sense only occurs for the tiny group suffering what appear to be rare circadian rhythm and endocrine disorders that result in binge eating disorder or night eating syndrome.
Critically, those with BED are not able to apply any restrictive responses to their overeating. The condition appears in pre-pubescent childhood and usually involves being classified as ‘obese’ by age 11.
I’m going to repeat that:
Binge eating as a clinical disorder involves an inability to apply any restriction.
That means, if you are on the restriction eating disorder spectrum, you are unable to develop BED. Your bingeing experience is an expression of required energy needs in reaction to restrictive eating behaviors. It is why I call this behavior reactive eating and not bingeing.

Will I Become A Binge-Eater?

Does someone who recovers from the restrictive eating disorder, no matter the restrictive facets they experience, develop a binge eating disorder?
The answer is “no”. However, it is important to note that the process of recovery from an energy deficient state most certainly involves a period of extreme hunger and eating. It is a transient condition that disappears once energy balance is restored.
Here are the likely reasons why those who reach a complete remission from a restrictive eating disorder do not develop binge eating disorder:

1. The candidate genes associated with inflammatory obesity, cholesterol, insulin and glucose levels are unrelated to the genes identified thus far for restrictive eating disorders [R Stöger, 2012; AW Drong et al., 2012; CJ Nolan et al., 2011; A. Hinney et al., 1999 and 2000].
2. Patients fully recovered from the restrictive eating disorder rarely reach final restored weights above BMI 25. 2% of the recovered population does go above BMI 25, however ALL return to weights at or below BMI 25 after one full year beyond recovery (with no relapse of restriction involved) [CM Bulik et al., 2006].
3. Leptin resistance is not a factor in either the activation or resolution of a restrictive eating disorder. Yet, leptin resistance is often present in patients with inflammatory obesity. [P. Dandona et al., 2004; JF Caro et al., 1996; S Herpertz et al., 1998 and 2000]

Restriction is the enemy. Be vigilant against restriction and put your trust in your body’s ability to find it’s optimal weight set point if you just give it the energy it is demanding (no matter your current weight).
No one keeps gaining and gaining. We each have an optimal weight set point [RE Keesey et al., 1997; RE Keesey, 1988]. On average 70% of adult females reside between BMI 21-27 [Statistics Canada, 1978] but our heights and weights exist on a bell curve and you are only going to be healthy at your particular optimal weight set point.

Non-ED men and women ‘overeat’ regularly and it is not bingeing in any clinical sense nor does it impact optimal weight stability.
Between the ages of 10-16 it is common for the body to store extra energy in anticipation of physical growth requirements. It is difficult for anyone in our obese-fearing and weight-obsessed culture to not react to these phases of extra weight with immediate restriction. Sadly, for those with the restrictive eating disorder genotype, it is usually this very circumstance that catapults them into years of cycling through restrictions and quasi-recoveries.
Between the ages of 16-25, the body will occasionally store extra energy, but usually it is using the extra energy coming in (through natural overeating sessions) as it happens. However, if a restrictive eating disorder patient hijacked his or her normal development as a child with self-administered starvation and/or excessive exercise, then the recovery process may mimic the energy storage/growth spurt that was supposed to happen but was stalled by the onset of the eating disorder. Give it time and it works itself out.

The answer to getting out of this quasi-recovered state and reaching full recovery is to eat to the recovery guideline amounts (and more) every single day. Responding to any extreme hunger is as critical now as it is all throughout the recovery process.
Despite restrictive eating disorder-based fears that there is no way to eat this much and not become obese when you are already ‘weight restored’, no clinical evidence supports those fears.

Your metabolism will ensure that your body adjusts to its optimal weight set point and the excess energy is necessarily needed to complete the lingering repair and to finally push the metabolism back to its optimal functioning rate. And no, your metabolism is not broken and your brain responds accurately to leptin levels.

As for whether the temporary overshoot is necessary, there is some evidence that it may indeed have value in ensuring the return of an optimal fat-mass to fat-free-mass ratio. In fact, Abdul Dulloo and colleagues re-examined the Minnesota trial data and discovered that the depletion of fat-free mass and fat mass (occurring during starvation) separately trigger hyperphagia (excessive eating) in post-starvation subjects and that the hyperphagia will persist until both fat and fat-free mass are restored [A Dulloo et al., 1997].
We also know from numerous other studies that anorexics often maintain a higher proportion of fat mass post-re-feeding [CI Orphanidou et al., 1997; M Probst et al., 2001; C Mantzoros et al., 1997] and this is likely due to the prevailing attitudes that hyperphagia must be avoided during recovery at all costs as it is considered a marker of “bingeing”. Instead, what these post-recovery data may show is that the prohibition of hyperphagia in recovery from restrictive eating disorders serves to halt the body’s ability to return to an optimal fat mass to fat-free mass ratio.

http://www.youreatopia.com/blog/2012/10/31/bingeing-is-not-bingeing.html

also take a look at http://www.youreatopia.com/blog/2011/11/3/binge-eating-disorder-and-night-eating-syndrome.html

Fat is not to blame. Fat is not a shame.

It was never the fat that was the enemy. It was the dirty men crossing the line, it was the materialistic people who saw you as a body only, it was the ballett class that just accepted skinny girls and women, it was the overcontrolling parents that gave you no control over your life and no freedom to be you.

You don't want a man who only likes skinny girls and women do you? But a man who find beauty in every living body. A tolerate human being. That is what you want to be as well, isn't it? Now we go around as living dead. You never wanted that, did you?

You needed to put up a boundery around yourself, because clearly the fat wasn't rough enough to work as that. Edgy bones would do the trick. The dirty hands would get hurt by your bones. No fat to grab on to.

Fat is feminine mostly. This part of the feminine is still not respected. Many men still fear us: our special strength, our nature, our sexuality and connection to the unconcious and the divine. Can you imagine a goddess with unhealthy low fat percentage? It is a part of our strength. Without it we can't be fertile.

I'm trying to accept being heavier. To be used to the idea of being heavier. I have to be sure I can hold a bigger body. Wear a bigger body without shame before I gain. I must stop fooling myself to think I can have energy for exercise just by gaining a few kilos. It doesn't work like that. The body are deficient, that means I need to go all the way till the body says it is ok.

I can throw away the idea of counting calories in recovery. I can binge and go crazy because it is the body that needs healing and that takes a lot of energy, time and rest. It's all in or no change at all. I will eat healthy, though. Add fat, not sugar. Eat healthy and supplement with chocolates sweetened with stevia and home made ice cream and almond buns. I'm just not ready to face me with a fuller body yet. I am motivated though. I must talk to someone special and see if he can support me first. A very good friend of mine who likes skinny, child-like women only. Sigh!

If the set-point theory is true why do people get over and under it?

1 Because body fat isn’t your only set point.

You have a body fat “set point.” But Paul Jaminet also hypothesizes that your body has an even more important set point for maintaining the health of your lean tissue. If your body isn’t getting the micronutrients it needs, it will try to get more nutrients using the same mechanisms that it uses when you fall too far below your body fat set point: increasing your appetite and extracting more energy from your food. If you’re eating nutrient-poor processed foods all the time, you’ll just stay hungry, because your body is desperately looking for nutrients by driving you to eat more food.

2 Because you eat more than your body needs. Pleasurable food overwhelms your body’s natural message of “OK, I’ve had enough now,” so if you don't control your self it is very easy to eat more than the body needs. Stimulating food is also easy to be addicted to. 

3 Sometimes insulin stays elevated all the time. This prevents you from running off your stored energy reserves, because you’re constantly in “storage mode” and never switch over to burning those stored calories. In this situation, you’re eating enough calories, but they’re not available for energy, so your body is starving (and you still feel hungry) even though you’re gaining fat. It’s the worst of both worlds. 

All kinds of things affect insulin levels. Just to name a few: sleep deprivation, chronic stress, exposure to environmental toxins, menopause, genetic factors, vitamin deficiencies, and the composition of your gut flora. It’s true that eating more carbs than your body can handle is one factor affecting insulin levels, but it’s far from the only problem! 

Regardless of how it starts, though, chronically high insulin can overwhelm the body’s “set point” and cause weight gain. Problems with insulin also affect another hormone called leptin, which regulates appetite and metabolism. The ultimate result is that your body is now “defending” a higher weight, making it very difficult to get (or stay) lean. 

What to do to maintain a healthy weight:

Eat nutrient-dense food.

1 Avoid food that is hard to stop eating or drinking. (Things with honey, syrup, sugar, chips, beer, wine etc.)

2 Avoid sweeteners that make you hungry. (I get hungry from Pepsi max (aspartam).

3 Make sure you have healthy levels of hormones like insulin and leptin so the calories gets burned for energy, not stored as fat by eating low-carb or carbs in moderation. (Read details in the article below.)

4 Avoid chronic inflammation because it elevates hunger and impairs carbohydrate metabolism. ( A recipe for overeating and storing those calories as fats.) Reduce inflammation by getting enough sleep, managing your stress, avoid extreme and punishing exercise, make sure you recover properly from your workouts, limit nuts and seeds, and eat plenty of fish (omega 3).

5 Intermittent fasting.  Intermittent fasting mimics the benefits of carbohydrate restriction: it lowers insulin and raises the levels of several other fat-burning hormones like growth hormone and adrenalin, prompting your metabolism to use stored body fat for fuel and lowers you calorie intake.

6 Exercise

7 Be careful with the consumtion of nuts, seed butters, dried fruits and fruit juices. 

All except the mentioning of alcohol is taken from the article below.

http://paleoleap.com/weight-loss-on-paleo-diet/
I continue adding more interesting stuff about addiction to stimulating food.
Our brains are wired to respond to the stimuli with which they evolved. For example, our natural taste preferences tell us that fruit is good. But what happens when we concentrate that sugar tenfold? We get a superstimulus. Our brains are not designed to process that amount of stimulation constructively, and it often leads to a loss of control over the will, or addiction. 

It's a very similar process to drug addiction. Addictive drugs are able to plug directly into the brain's pleasure centers, stimulating them beyond their usual bounds. Food superstimuli do this less directly, by working through the body's taste reward pathways. In fact, sweet liquids are so addictive, rats prefer them to intravenous cocaine. You can't take just one hit of crack, and you can't have just one Hershey's kiss.

This chapter was taken from the article below.
http://wholehealthsource.blogspot.no/2008/03/superstimuli.html#uds-search-results

A Curious Finding

It all started with one little sentence buried in a paper about obese rats. I was reading about how rats become obese when they're given chocolate Ensure, the "meal replacement drink", when I came across this:

...neither [obesity-prone] nor [obesity-resistant] rats will overeat on either vanilla- or strawberry-flavored Ensure.

The only meaningful difference between chocolate, vanilla and strawberry Ensure is the flavor, yet rats eating the chocolate variety overate, rapidly gained fat and became metabolically ill, while rats eating the other flavors didn't (1). 

Experiments in rats and humans have outlined some of the qualities of food that are inherently rewarding:

• Fat
• Starch
• Sugar
• Salt
• Meatiness (glutamate)
• The absence of bitterness
• Certain textures (e.g., soft or liquid calories, crunchy foods)
• Certain aromas (e.g., esters found in many fruits)
• Calorie density ("heavy" food)

We are generally born liking the qualities listed above, and aromas and flavors that are associated with these qualities become rewarding over time. For example, beer tastes terrible the first time you drink it because it's bitter, but after you drink it a few times and your brain catches wind that there are calories and a drug in there, it often begins tasting good. The same applies to many vegetables. Children are generally not fond of vegetables, but if you serve them spinach smothered in butter enough times, they'll learn to like it by the time they're adults.

Industrially processed food, which has been professionally crafted to maximize its rewarding properties, is a superstimulus that exceeds the brain's normal operating parameters, leading to an increase in body fatness and other negative consequences.

http://wholehealthsource.blogspot.no/2011/04/food-reward-dominant-factor-in-obesity.html
Here is a link to a article about leptin:http://paleoleap.com/managing-leptin-levels/

Eat more, but still low carb.

My goal is to eat more than then minimum amount for recovery (for my age: 2500) when my body want me to, cause I am not gaining fast at all. That means not skipping the last meal at the end of the day like I am sooo used to. Before my first diet at 16 my weight was 70 kilos, 27 kilos more than my lowest weight. I had eaten too much, junk and sweets, so I was above my set point. The 2nd time I ate unrestricted amounts and food choices for a long time, after long periods of almost no food, I overshot that weight! Probabably because I ate junk. 

The first time i overshot my startweight with 4 kilos, before I felt ready to stop "eating sugar" and rest and have a life again (as if I was releasing my self from a hospital). But I started restricting again for months without being aware of it while trying to eat very healthy and normal amounts, and ended up binging daily again and gained so much I ended up even 5 kilos more than last time. Why don't Gwen warn the girls at eatopia that if they addictive food they will gain too much?

For almost 2 years after that i restricted and came down to 54 kilos. Again I tried to recover and eat without counting calories, fear fat etc and gained again, but not as much as the first time when I recovered unwillingly and lived on junk. This second time I tried to learn to cook and had people over for dinner and stuff. I don't remember weighing myself so I can only guess my weight. I can say 60 kilos. I then moved to a school I got all my meals at and gained because the food was very far from low carb and full of oil, and I drank a lot of tea with honey, so I gained a few kilos. After a while I felt uncomfortable with the bigger body and started restricting again for real when the school year was over. I did so till the recovery I am in now.

I have no idea where I will end up because I did not eat normally from the age 12 when I was skinny. It is normal to overshoot 10% of the set point weight and by the following year get rid of it, but I know that those who don't break the addiction to food (chocolate, chips etc) can gain and gain like every anorectic person fear.

Right before I started eating sweets daily, because I started restricting food a little because I was ashamed that I ate more than the skinnier girls (3 slices of bread compared to their 1 slice) (but ended of course up heavier because of the sugar) my weight was perhaps 65 kilos. If I end up on 65 kilos I am happy. I mean, I am 42 years old, and some day I have to accept my body and give my self freedom and a life. I will not touch sugar and eat low carb, so there is a chance my set point weight is below 65 kilos.

I am totally into eatopia, but I have not seen Gwen say an overshot is based on binging on sugar-loaded junk. It is just my guess based on a little experience. I think sugar make us gain over the set point weight. My experience is that the body don't have the time to regulate the weight when you start to eat a lot of sugar. Then I just gained. You don't feel full when you eat sweets. If you replace that with food, you just eat and eat and just gain and gain. Never replace food with sweets and junk like potatoe chips! I am excited to see if my theory is a fact.

Now i don't have the same fear and rejection to fat bodies. I know that those who are slightly overweight or almost overweight live the longest. It is a myth in society that thin is the same as healthy and that eating a bit too little will make your life longer. A body is beautiful no matter how much fat it has on the muscles as long as she is healthy, I think. Attitude is more important.

EDIT: After reading the articles I have linked to in the next blog post I can guess my weight will be close to 63 kilos. Why do i say that suddenly? Because now i read that my theory is correct: when eating junk and sweets in recovery or at set point weight you will gain above set point because you eat more than your body needs. Simple as that.

Have you restricted eating, trying to recover and just had a binge?

 You did it because your body needed it. Don't worry. You did the right thing. Binge or not, doesn't matter. It's natural. You just have to keep on avoiding restriction or you are going face down to your own grave again. There is no reason to fear what you have done. Your body needed something extra (happens before the period for many, but can happen when ever), and you were kind enough to support that need. You were kind. A study shows that when girls are eating extra amounts of food and calories before their period noone gain that as fat. All the extra calories are used for hormones and stuff! So just give in and give the body the extra when it needs it.

A conversation about BED (binge eating disorder).

Me: I think many people are afraid of this illness, and some of those who has it are treated badly. Because people don't understand it, fear it and some think it is to be ashamed of. I think that is a tragedy and a huge burdon for the people who has this illness to carry. I think many have found comfort in food, so the fear is perhaps based on that, but I wonder if it is biological reasons to why they start as kids to eat extra amounts. I wonder if it in fact is first of all a physical reason for the need for more food than normal. Is it an unbalance or do these people really need extra food and have a higher BMI than avarage? May the unbalance of hormones, or is it inflammation?, be caused by emotions? I would like to know these things so the misunderstanding can be treated by knowledge.

I understand that the whole picture will never be finished, but how much is understood till now?
Can emotions effect hormones and hormones effect emotion?

Gwyneth: 

Yes people don't understand it. Primarily they are unaware that it is not an eating disorder at all and that its inclusion in the DSM-5 was not based on any science that it is an eating disorder either.

Many of the questions you have surrounding binge eating disorder are covered off in the blog post Binge Eating Disorder and Night Eating Syndrome

There is no single cause for these symptoms appearing, but the they are very rare and involve a lot of other psychological distress and symptoms.

BED is essentially non-purging 'bulimia' in its current iteration within the DSM-5. In its definition prior to DSM-5 it was not a standalone eating disorder. It was rather a set of symptoms that could arise for those with serious Axis II disorders (psychosis, schizophrenia, and several personality disorders) and that was based on 30 years' worth of work done by Albert Stunkard and his colleagues. It was also very rare.

And whenever this question is asked on these forums it's usually because yet another new member is anxious and concerned that he or she has binge eating disorder.

Binge eating disorder is not associated with restrictive eating disorders at all. If you restrict, then you cannot have binge eating disorder. At all.

It's not about eating extra amounts as a kid. It's about serious mental illness. These individuals are often not able to reside in the community and if they do they have many points when they need 24/7 psychiatric care.

It's not about comfort in food, imbalanced hormones, emotions or inflammation. And frankly, their eating behaviours are usually the least worrisome of their symptoms associated with their overall serious mental illness.

It's commendable that you have empathy and consideration for their plight, but these forums are designed for those dealing with the restrictive eating disorder spectrum. Restrictive eating disorders are standalone eating disorders and they are all treated with rest, unrestricted re-feeding and brain retraining.

Those with binge eating symptoms have nothing in common with those with restrictive eating disorders and they usually require much higher levels of psychiatric support and intervention than most with restrictive eating disorders will ever require.

We would want anyone who has binge eating disorder to be free from shame and abuse however there are no binge eating disorder patients on these forums. Of more immediate concern to me is that those with restrictive eating disorders who are active on these forums do not end up anxious about a condition that they have no chance of developing.

Me: I was hoping you would answer. Thank you very much. The link: "more details found here" is not working. I come to "page not found". Hope to be able to read it.

I am surprised to read in the article about BED and NES that BED maybe should not be called an eating disorder. Is that because those with BED don't have much in common, have different body size and different mental conditions?

I am very greatful that I read years ago that you think one can not go from anorexia to a binge eating disorder, because I got very disappointed and scared thinking that I had become a binge eater when eating much after a long time with no or almost no food. I felt I could trust my body even less when it was possible ( as I thought) that I was changed so much in a sudden. I don't think it is too bad or very wrong to say we can go from anorexia to a binge eating disorder, but it is important to know it is not permanent, that we in recovery will not feel the need to eat a lot forever. I remember I found it extremely difficult to throw up when I was in a period of eating a lot after restriction contrary to before. It was like my body was holding on to the food so hard in hunger.

This says a lot: The bulimia nervosa group scored high on the features of binge eating and fear of fatness/compensatory behaviors but not on drive for thinness. The binge eating disorder group scored high on binge eating but not on the other two features. And:
Fear of fat/compensatory behaviors and drive for thinness are not present for those with clinical BED.

What i don't know is why the BED's don't try to be thin when they hate their body. Do they feel helpless, thinking they can not do it? Is that it? Or are they destructive and feel they deserve to be "big and bullied"? I know some use their big body as a shield towards the world and therefor don't want to be thin.

Gwen: Fixed the link -- sorry about that.

No, it is important to be accurate. You do not go from anorexia to binge eating disorder.

In recovery, you experience hyperphagia (extreme eating) and that is to rectify the huge energy deficit in your body.

Binge eating disorder facets must necessarily involve no energy deficit within your body. It must involve consumption of food in excess of your energy requirements. And that is not happening in recovery.

Eda -- you likely don't know anyone personally who has binge eating disorder. It is an extremely rare condition.

It might be better to analyze why you are worried about how those with BED may think and feel. Your more immediate concern is presumably taking care of your own recovery needs right now.

BED has about as much in common with a restrictive eating disorder as Alzheimer's does. That's not to say that BED is related to Alzheimer's (it's not) but I think you may want to disengage yourself from the topic -- it has no bearing on your recovery efforts and it has no bearing on anyone you likely know in your own life either.

G.

Me: "Binge eating disorder facets must necessarily involve no energy deficit within your body. It must involve consumption of food in excess of your energy requirements. And that is not happening in recovery." Interesting. 

Ok, it was just that I read about a girl being called a whale and I felt sorry for her and thought that it is so unnecessary , and i thought about the lack of knowledge and misconseption underneth the behaviour. We either try to find the truth or think and act like a fool. But it's really hate that causes namecalling like that so I rest my case. We need wisdom, but also love to be nice to each other.

:http://www.youreatopia.com/blog/2011/11/3/binge-eating-disorder-and-night-eating-syndrome.html

More i found on the forum about the subject written by Gwen:

I got the following by e-mail:

I was wondering if you have any scientific evidence to back up your claims that REDs and BED cannot occur in the same person (or very rarely occur in the same person) due to the genes being completely different? I've gone through YE but haven't been able to find anything. Thank you!

Here's the response I gave:

Thank you for your inquiry. Perhaps you would like to provide the direct reference to the claims you say I have made? Given that the genotype associated with restrictive eating disorders has not been fully identified and we only have some likely gene candidates that may be implicated in the onset of restrictive eating disorders, I doubt that I made the claim that restrictive eating disorders are unrelated to binge eating disorders due to genetic variation. If I have done so, then I would like to know where because I will need to correct such an assertion!

However, I do provide the clinical data that identify BED as an extremely rare condition wherein absolutely no compensatory behaviours are applied (they don’t try to get back on a diet etc.). An individual with BED is not suffering from a distinct eating disorder, but rather symptoms of bingeing that are actually indicative of a serious psychopathology. Albert Stunkard and his colleagues provide heaps of solid clinical data on the topic — the condition does not arise from restrictive eating disorders. The condition is rather a sign of Axis II psychological disorders [Wilfley DE, Friedman MA, Dounchis JZ, et al. Comorbid psychopathology in binge eating disorder: relation to eating disorder severity at baseline following treatment. J Consult Clin Psychol 2000; 68:641-649]. Axis II disorders are where a patient can lose touch with consensus based reality — things like borderline personality disorder, bipolar disorder, schizophrenia and the like. Restrictive eating disorders are Axis I disorders — like anxiety and depression where the patient is still grounded in reality even as behaviours and thoughts might be causing distress or even denial for the patient.

For a patient to develop an Axis I disorder first and then progress into an Axis II disorder is certainly feasible, but will be extremely rare. Axis II disorders tend to have quite an early onset in childhood development.

As for evidence that binge eating disorder cannot occur in someone with a restrictive eating disorder, you simply have to look at the criteria for diagnosing binge eating disorder: namely, that anorexia nervosa and bulimia nervosa have been excluded as a possible alternate diagnosis. As per the direct language from the Diagnostic and Statistical Manual (V5): "recurrent binge eating [disorder] is much less common, far more severe, and is associated with significant physical and psychological problems” [emphasis mine].

Binge eating disorder is rare and cannot involve any compensatory behaviours. Compensatory means any attempt to try to restrict in response to having “binged”.

Having had the opportunity recently to discuss the current inclusion of BED in the DSM V with one of the psychiatrists who formed part of the ED committee drawing up the DSM V [Dr. Steven Wonderlich], I can also confirm from the recent trial data he and his colleagues have published show individuals with BED are actually most commonly under-eating but will self-identify as having a bingeing problem. In essence, the inclusion of BED in the DSM V was applied because the psychiatric community identified that a portion of the community actually need help to eat enough food to support their energy needs, but they believe their issue is actually one of over-eating.

The inclusion of BED in the DSM V is not actually being applied in the community as the same BED that Stunkard and his colleagues studied for some 30 years to make the following conclusion on its existence in the population: BED is a marker for underlying psychopathology and not a standalone eating disorder. [Stunkard, Albert J., and Kelly C. Allison. "Binge eating disorder: disorder or marker?." International Journal of Eating Disorders 34.S1 (2003): S107-S116l; Stunkard, Albert J., and Kelly Costello Allison. "Two forms of disordered eating in obesity: binge eating and night eating." International journal of obesity 27.1 (2003): 1-12].

The BED classified within the DSM V is actually being used out in the community (for treatment purposes) as indistinguishable from non-purging bulimia nervosa — attempts to constantly under eat followed by cycles of reactive eating as the body attempts to redress the energy deficit.

And finally, I would encourage you to look out any clinical data that would confirm patients with a remitted restrictive eating disorder history subsequently develop confirmed cases of binge eating disorder as it is defined within the DSM (not as it is applied within treatment). So far, I have yet to even find a single case study in the literature, let alone any kind of broad prospective or retrospective review of patients with restrictive eating disorders who develop binge eating disorder. And as I said, I am speaking of binge eating disorder in its original classification — where the patient does not attempt to compensate for a binge with either going back on her diet or exercising or swearing off of “bad” foods again.

There is of course more than enough clinical data to confirm that approximately 62% of patients with anorexia nervosa will develop bulimia nervosa within 8 years of the onset of the anorexia (if untreated) [Eddy, Kamryn T., et al. "Longitudinal comparison of anorexia nervosa subtypes." International Journal of Eating Disorders 31.2 (2002): 191-201]. As the body is depleted of energy progressively through years of restrictive eating behaviours, eventually there is an increased drive to rectify the energy deficit with reactive eating sessions (bingeing). In the absence of the patient developing subsequent purging behaviours, then she will have moved from anorexia nervosa to non-purging bulimia nervosa now also indistinguishable from binge eating disorder within the treatment community.

The treatment for the BED is the same as for bulimia nervosa — the patient is encouraged to begin eating enough to support her actual energy requirements in a constant daily process which subsequently lowers the instances of reactive eating (often called “bingeing”).

I will be discussing all these recent clinical findings (delivered at the UCSD Eating Disorders Conference 2014) in an upcoming blog post.

Essentially (and the involved psychiatrists are still in hot debate on the topic) the inclusion of BED in the DSM V appears to be driven by an attitude of “if you can’t beat them join them”. The treatment community recognized that a portion of predominantly average or above-average weighted men and women would remain utterly untreated if they have self-identified as having a problem with over-eating and therefore believe that classifications of restrictive eating disorders do not apply to them at all. The inclusion of BED allows for these patients to be treated for actual under-eating issues but they will readily seek treatment because the condition is identified as one of “bingeing”—which they can relate to. I am not entirely sure if I agree with this “ends justify the means” approach to clinical care, but it is nonetheless what is happening.

Best wishes, Gwyneth.

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