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Chapter 2


word “binge” has many personal meanings for those who use it. Patients who tend to restrict their intake may con- sider any unplanned eating or even “normal” portions to be “bingeing.” Clarify what constitutes a binge episode for each individual and avoid using the word binge when ask- ing questions about food intake until you have confirmed that you understand each patient’s personal definition.


Other Factors Associated with Excess Intake


Binge eating Patterns: Finding out the times of day, types of food, and triggering situations related to an individual’s binge eating will help you problem-solve and eventually provide advice to help change or stop the behavior. Keep in mind that patients with anorexia may struggle with or fear binge eating as much as patients with bulimia or binge eat- ing disorder.


Change in Way Clothes Fit: Eating disorders are related to a disrupted sense of body size and shape, referred to as “body image distortion.” For some individuals, changes (or lack of change) in the fit of clothes is the only way they can identify a change (or lack of change) in body size or weight. Patients may have clothing rules or routines, such as try- ing on a certain pair of jeans to see if they fit or refusing to try on certain sizes of clothing when shopping. Attempt- ing to convince individuals that they are not the size that they imagine they are is rarely helpful in these situations. Body image can be so distorted that patients may insist that clothing they are wearing must be mismarked because it is impossible for them to fit in that size.


Highly Variable Calorie Intake: Many individuals with eating disorders will describe drastically varying eating patterns, often described as “good days” and “bad days.” It is helpful to find out what constitutes the difference in intake and what triggers each type of day.


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