The Difference Between Extreme Hunger and Binge Eating Disorder

After posting The Biological Importance of Honoring your Extreme Hunger last week, I received the following email:

Hi Livia,

I have been eating SO much food recently after deciding I was going to commit to full recovery from anorexia. I can eat the entire kitchen and feel like nothing satisfies me, and I am only craving unhealthy junk food! I feel so disgusting and have been gaining weight so quickly and I am afraid I am now developing Binge Eating Disorder. Even when I am SO full, I cannot stop thinking about food so I keep eating until I feel super nauseous…surely, this cannot be normal? I am not sure if you will read this, but I am just in need of some guidance and hope you can give me advice on what I should do!

If you resonate with this email, you're right to be worried! I mean, stuffing food in your face without even tasting it, downing sugary, high-fat foods until you feel nauseous, and consuming thousands upon thousands of calories in one sitting is practically the definition of binge eating disorder, right? Why don't we have a look at the definition of binge eating disorder in the DSM-5 (Diagnostic and Statistical Manual for Mental Disorders) together.

Binge Eating Disorder Diagnostic Criteria

There are 5 specific criteria that one has to meet to be diagnosed with binge eating disorder (BED).

Criterion 1

An episode of binge eating must be characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.

2. The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

Criterion 2

Binge-eating episodes are associated with three (or more) of the following:

• Eating much more rapidly than normal

• Eating until feeling uncomfortably full

• Eating large amounts of food when not feeling physically hungry

• Eating alone because of being embarrassed by how much one is eating

• Feeling disgusted with oneself, depressed, or very guilty after overeating

Criterion 3

One presents with distress regarding binge eating.

Criterion 4

The binge eating occurs, on average, at least 1 day a week for 3 months (DSM-5 frequency and duration criteria)

Criterion 5

The binge eating is not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

Binge Eating Disorder vs Extreme Hunger

There’s a lot to unpack here, but the 5th criteria is actually the only one you need to differentiate extreme hunger from binge eating disorder. It states that if there is any form of restriction or compensation involved (this also means leading up to the “overeating”), the overeating does not qualify as binge eating disorder.

To elaborate, someone who truly has diagnosable binge eating disorder does NOT need to come out of energy deficit like you do. You may be wondering about the remaining 4 criteria that specify "eating more than what is considered a normal amount of food, feeling a lack of control around food, eating really fast, eating when not physically hungry, feeling guilty after eating," and all the other symptoms and emotions that are mentioned in the first 4 criteria.

You may be thinking: "Well, I match the first 4 criteria, so Livia, you haven’t convinced me yet!" Like I said, I don’t need to convince you...that’s exactly what the 5th criterion is for! It was actually added to the DSM because there was a very blurry line between real binge eating disorder vs extreme hunger that's experienced by someone who displays symptoms of BED after anorexia, orthorexia, bulimia, or another form of restrictive eating.

I know I said I didn't need to convince you, but before we move on, I want to stress that whatever is considered a "normal" amount of food, someone with extreme hunger will need to eat WAY more than that. The only way you can get out of energy deficit, pay off energy debt, and get rid of mental hunger in eating disorder recovery is by eating an abundance of food. Feel like you're eating too fast or too much junk food? Be sure to enroll in my course Extremely Hungry to Completely Satisfied that guides you step-by-step through the terrifying process of weight gain, digestive issues, hormonal changes, and all the other unpredictable symptoms that accompany nutritional rehabilitation.

The reason you want to eat large amounts of high-calorie foods in anorexia recovery (and perhaps, eat said foods really fast) is because your body is trying to acquire calories as quickly and efficiently as possible. To give a tangible example of this...

Imagine a child named Jonny who has been kidnapped and locked in a room. Jonny is only given a couple slices of bread to eat per day. This goes on for [fill in the time you have been restricting]. The result of this deprivation is that Jonny is now starving. Because his environment is clearly lacking resources, Jonny's brain perceives a famine.

But one day, Jonny is able to escape through the window of the room he has been locked up in! He runs away as fast as his little legs can carry him to a house made of gingerbread and every type of candy imaginable. As soon as Jonny gets to the house, what do you think he'll do? You guessed it: Jonny will eat a SHIT TON OF FOOD until he's so nauseous and stuffed that he can barely move.

Even though Jonny is very full, he continues eating because his reptilian brain (as described in this post) has no idea that he’s actually safe now. It will take a while for Jonny to feel safe enough before his entire body trusts that he won’t be deprived of food again. Now that he is literally living in a house made of endless food, he continues eating whatever rains down on him, very fast and with incredibly urgency. Why? Because for his body, getting out of energy deficit is very urgent! All the body wants – all the body is primed to do – is to ensure proper functioning. And to ensure proper functioning, one must have adequate fuel.

You Can't Have Binge Eating Disorder If You're Just Hungry

Now, I have a question for you after hearing this story: would you tell Jonny he was developing binge eating disorder while he was stuffing his face with food? ... So why would YOU be developing binge eating disorder after your restrictive eating disorder? Just like Jonny, you are hungry. Even if you are physically full, you have every right to still be hungry in the form of mental hunger. Just like Jonny, it's time for you to make up for all of the restriction, which naturally will resemble binge eating disorder.

It’s not your fault that you fell into disordered eating or developed an eating disorder, but it is your responsibility to nourish yourself back to health. As I write in How to Beat Extreme Hunger, it’s much easier to take on a victim role instead of taking responsibility for your eating disorder recovery journey. No one can do this for you. No one can signal to your body that food is abundant, not even your own eyes! Your survival brain has to trust that food is abundant, and it can only trust if you prove that food is abundant. So, now go prove to your body there is no famine! Go prove to your body that all the food it is asking for, whether this be through physical extreme hunger or mental extreme hunger, that you’ll feed it. Your body is nothing more than the encapsulation of your unique being, a being that can only contribute your special gifts when your body is well fed.

All that being said, I'm cheering you on my friend. If you're ready to take the next step on your journey to finding full freedom, be sure to grab a copy of my books and enroll in my Extreme Hunger Course.

See the DSM-5 Criteria for Binge Eating Disorder here.