Experiential Avoidance in Binge Eating Disorder Treatment

At the start of the COVID-19 pandemic, one-third of individuals in Australia with a history of eating disorders reported an increase in binge eating. Study respondents in the U.S and the Netherlands^[1] with a history of bulimia nervosa or binge eating disorder (BED) also reported increased binge urges and an increase in binge episodes.

As the pandemic raged on, people looked for ways to feel connected despite being physically isolated. They turned to food, drugs, alcohol, sex, and other behaviors to comfort or even numb themselves from their new, painful reality. But those who suffered from BED during the pandemic were dealing with issues far more complex than just turning to specific foods for comfort.

The continued assault of diet culture messages combined with a desire to avoid unpleasant emotions left people with BED at high risk during the pandemic. Eating disorder treatment professionals now have a responsibility to identify and apply the most effective, evidence-based interventions to help people fully recover from BED. One way to do that is to help patients understand their tendency to use binge eating as a tool for experiential avoidance.

What Is Binge Eating Disorder?

Binge eating disorder is the most common eating disorder in the United States, affecting millions of Americans. Symptoms of BED include:

• Recurrent and persistent episodes of binge eating
• Eating more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts of food even when not hungry
• Eating alone, often due to embarrassment

While many people may overeat on occasion, BED is accompanied by a feeling of distress, guilt, shame, or embarrassment over the amount of food that one consumes. In fact, people with BED are more likely to experience a number of mental health challenges including mood disorders, anxiety disorders, post-traumatic stress disorder, and personality disorders.

What Is Experiential Avoidance?

Experiential avoidance is a tendency to want to get rid of, fix, control, or avoid unpleasant internal experiences. These can be distressing thoughts, painful emotions, upsetting memories, or undesirable urges.

With experiential avoidance, when people feel hurt, upset, triggered, stressed, or anxious, they turn to specific behaviors as a way of suppressing or reducing these unpleasant emotions. For instance, many of us turn to our phones or TVs when we are stressed or unhappy and desire an effective distraction. The screens make us forget about our negative emotions.

The problem is this: When we attempt to control or avoid unpleasant thoughts and emotions, it backfires. Those thoughts and feelings that we are trying so hard to avoid will come roaring right back at us later, often more stubbornly than before.

How Is Experiential Avoidance Related to Binge Eating Disorder?

Binge eating can be a form of experiential avoidance. Eating large amounts of food can successfully help people “feel better” in the short term. But, while short-term emotional suffering may be relieved, recurrent binge eating episodes actually result in more emotional distress and an increase in physical health problems. Binge eating feels like it is comforting or numbing us. But over time we feel worse.

The longer we avoid the “thing” we are avoiding, the more it gains in intensity and frequency. Not only do people who rely on experiential avoidance underestimate their ability to cope with these problems as they come up in life, they may also overestimate how bad things are going to turn out. In essence, experiential avoidance is a form of self-sabotage.

Additionally, higher levels of experiential avoidance distance us from living a life based on our true values, moving us away from experiencing meaning and fulfillment in our day-to-day existence.

How Diet Culture Fosters Binge Eating Disorder

Before we discuss BED treatment tools, we want to touch on the impact of diet culture on people who binge-eat. (No, you don’t have to be on a diet to be impacted by diet culture.) In our society, thinness has traditionally been idealized. People commonly associate thinness with good health and even good or desirable morals. In our society, certain ways of eating are demonized and certain types of bodies are idolized. These messages permeate almost all media.

Diet culture fosters fat phobia and it fosters internalized weight biases. This can prevent people from admitting they have a problem or reaching out for help, and they will continue to suffer. Think about it. Have you heard these types of diet culture messages from others, or even believed them yourself?

• I should have more willpower.
• I should be able to control my eating.
• I'll start that adventure (get a new job, fall in love) once I lose weight.
• I am a failure because I am in a larger body.
• I will be perfect “if” I can just lose the weight.

Diet culture tells us that our “body” is the problem, not the eating disorder. Even worse, doctors continue to encourage people in large bodies to lose weight — often without assessing them for eating disorders. In patients with BED, this intensifies internal diet culture messages and the urge to binge grows.

Our Binge Eating Disorder Treatment Approach

When it comes to addressing BED and experiential avoidance, we can teach our patients a variety of techniques and show them resources that will help them tolerate difficult emotions as they learn to live in the present moment. We can teach patients how to

• Emotionally self-regulate
• Develop coping skills to manage urges
• Practice self-care
• Instill regular nutritious eating with an “all foods fit” anti-diet approach
• Create healthy relationships with food and their body

Difficult emotions are a normal part of the human experience. Reclaiming positive experiences can teach our patients how to cope. Here at Eating Recovery Center, we commonly integrate the following therapies in BED treatment to teach emotion regulation.

• Cognitive Behavioral Therapy (CBT) for BED helps us change how we think and act so that we can cope with difficult emotions as they arise.
• Dialectical Behavior Therapy (DBT) for BED teaches emotion regulation to reduce problem behaviors and create a life worth living.
• Acceptance and Commitment Therapy (ACT) for BED helps us change our relationship with our thoughts and emotions through mindfulness so that we can connect with our values and move toward them.

Through a combination of medical, therapeutic, dietary, and psychiatric interventions, we can help individuals recover from binge eating disorder.

This blog was based on our continuing education course, Journey of Joy: Binge Eating Disorder Recovery and Freedom from Diet Culture, presented by Dr. Catherine Ruscitti, PsyD, CEDS, and Kara Richardson Whitely.

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