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CHAPTER TWO: LITERATURE REVIEW
Overview
Bingeing is a central feature of the presentations regarding eating disorders common to binge eating disorders, Bulimia Nervosa, Anorexia Nervosa, and other eating disorders (Richman, 2017). Binge eating is linked to significant physical and psychological health problems and impaired societal functioning and life quality. It is also connected to other psychological illnesses like substance abuse, trauma, anxiety, temperament illnesses, and depression. Initially, binge eating syndrome appeared as an authorized diagnosis in the fifth Diagnostic and Statistical Manual of Mental Disorders, becoming an essential recognition in history (Hillbert et al., 2018). Despite the solid theoretical literature review devoted to the conceptualization of eating disorders, particularly bulimia and anorexia, there is scarce research on the topic of theoretical approaches relating to binge eating disorders. As per Munn-Chernoff et al. (2015), the present exploration intends to contribute to the literature by discussing the theoretical review of binge eating disorder through models like dietary restraint theory, feminist theory, systemic theory, emotional regulation theory, addiction model, affect regulation theory, cognitive behavioral model, and schema theory binge eating. Besides, the related literature review on the topic and the summary of the research findings will be provided in the current study. Theoretical Framework
The evaluation of the theoretical framework of binge eating disorder is essential when considering the question of trauma and binge eating disorder. The etiological guidance on the advancement and preservation of binge eating disorders has raised considerable discussion and
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limited agreement. Even though substantial literature has been devoted to conceptualizing other disordered eating like bulimia nervosa and anorexia nervosa, research assessments on the theoretical framework, particularly for comprehending the binge eating disorder processes, are limited (Munn-Chernoff et al,. 2015). Besides, the literature questioning the function of binge eating is mainly centered on comprehending bingeing in the context of bulimia nervosa. However, bulimia nervosa is related to the bingeing cycle and compensatory or restraint behaviors, but the cycles are not present in binge eating disorder. Bingeing or purging is a multifaceted pattern of behavior and using one theoretical framework to appreciate its etiology as
well as accounting for the disorder by a sole cause is most probable to be unsuccessful and ambiguous. Therefore, this section in the current study seeks to explain binge eating disorder theories to show that the disorder should not be generalized with other disordered eating behaviors.
Dietary Restraint Theory
The influential dietary restraint theory is partially a genetic clarification for binge eating patterns between obese and normal-weight individuals, focusing on the function of dieting as a causing factor in binge eating maintenance, signifying that the limiting food consumption to the point of becoming chronically starved made individuals more vulnerable to binging (Richman, 2017). Dieting or food restraint is preceded in the first episode of binge eating, and thus, restraining dieting triggers individuals to begin and endure binge eating. Dietary restraint theory holds that individuals engaged in binge eating are stuck in a pattern of restraining and then binge eating and restraining, continuing the cycle. Such individuals involved in constrained consumption of food are then cognitively adapting to their binge eating behavior (Keel & Forney, 2013). They no longer depend on biological signals to eat. Besides, their thinking is
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constrained in the black and white style in association with the consumption of food and the eating habit where stringent rules were set in place to dictate the kind of food to be eaten, at what
time, and when. The rules were believed to make people susceptible to disinhibition, particularly when a single rule was broken, which undoubtedly contributed to the episodes of bingeing because of their rigid or uncompromising cognitive style.
According to Hillbert et al. (2018), research findings supporting dietary restraint theory originates from various laboratory-based experiments investigating the counter-regulation phenomenon among restrained eaters. Dietary restraint theory hypothesizes that dieting causes hunger, making a person develop binge eating behaviors. Other contributing factors include negative mood and persistent attempts to control the intake of food and calories. Studies indicate that self-reported starving could potentially predict the imminent beginning of bingeing in both samples of eating disorder patients and non-clinical samples (Slane et al., 2016). Additionally, evidence regarding the dietary restraint theory originates from numerous lab-based experiments that investigate the counter-regulation phenomenon, that is, consuming more food after eating food or meal rich in calories among the restricted eaters. Inhibited the researchers measured eating through the calculation of the food amount consumed in a taste testing experimentation among randomly allocated respondents to eat a preload before the actual taste test. Generally, the
study results indicated that non-dieters appear to regulate their food intake and eat less food after a high preload of calories. However, dieters were found to consume more after consumption of the preload in relation to no preload consumption, showing a response to counter-regulation.
Various scholars have associated the impact of food reminders on cravings for food or people's desire to eat among the restricted eaters versus the unrestricted eaters. The study outcomes indicated that the restricted consumers were more reactive to food cues compared to
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the unrestricted eaters. Empirical support for the restraint theory is mixed (Noguchi, 2020). The support for restraint theory in bingeing among research respondents whose dietary behavior preceded binge eating has been recorded by some researchers. However, the results failed to support the theory for individuals for whom binge eating preceded dieting. Besides, independence from binge eating and dietary restraint has also been recorded. Some studies have suggested that the influence of restraint on binge eating disorders might depend on the order in which binge eating and dieting occurred (Keel & Forney, 2013). However, due to one criticism of dietary restraint theory for binge eating disorder incorporate the dieting role particularly, people with binge eating disorder seem to significantly exhibit lower dieting behavior than those with other eating disorders hence making the resolution unproblematic. People with binge eating habits tend to follow more variable patterns.
Most research evidence regarding dietary restraint theory for binge eating disorder has been criticized for not being convincing and too narrow to explain binge eating pathology. Although most studies suggest that dietary restraint does not play an indispensable role in the trigger and preservation of bingeing behaviors, they do not explain the episodes of binge eating experienced by individuals who have never been involved in the restriction of their diet. It is important to establish a more wide-ranging theory or model of disordered behavior that considers
the behavioral or environmental, and psychological factors to understand and efficiently treat binge eating disorders.
Escape Theory of Binge Eating
Heatherton and Baumeister came up with the escape theory of bingeing in 1991 to act as a substitute to dietary restraint theory. The theory suggests that people involved in binge eating are result of trying to evade from self-consciousness (Noguchi, 2020). They hold high individual
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expectations regarding their body image like shape and weight, wishing to be viewed favorably. They are uncomfortable and assume that they are being judged by others. Therefore, they seem to develop a cycle of increased self-criticism, self-awareness, and adverse self-assessment. The negative self-perceptions cause emotional distress, including low mood and anxiety, thus making
them attempt to escape such severe cognitive experiences by resolving binge eating behaviors (Keel & Forney, 2013). Binge eating escape theory holds that the episodes of bingeing offer reprieve from the negative internal experiences by concentrating the affected person's devotion on meek sensations and actions. Thus, the escape theory proposes that the central point to overwhelming binge eating is learning other coping techniques with adverse practices. Due to high self-esteem and body image expectations, irrational thoughts and adverse effects tend to emerge when the binge eaters fail to live up to their extremely high standards (Harris & Kuba, 2017). The unpleasant emotions more generally foster distress, prompting the person to attempt removing the troubling thoughts through cognitive narrowing, which focuses an individual's attention on the current or immediate environmental stimulus. This is done to avoid meaningful thoughts and maintain self-esteem at a quite low level. The binge eating evading coping approach occurs as a result of escaping from the negatively emerging emotions (Keel & Forney, 2013). Besides, the escape theory suggests that people may associate their undesirable emotions to the binge eating episodes rather than the primary source of their agony, thus maintaining the longer-term cycle of binge eating.
Escape theory application to the behaviors of bingeing through the use of structural equation modeling was assessed in a non-clinical sample. The study outcomes indicated that the escape theory was appropriate to the data used in the study as it supports the model (Crowther et al., 2016). It was found that perfectionism solidly predicted the pervasive self-consciousness,
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which solidly predicted adverse affect, that suggestively projected avoidant managing tactics, that in turn was found to predict the occurring episodes of binge eating. Additionally, studies examined the association between binge eating, dissociative experiences, and negative affect among African American females who met the standards for eating disorders that repeatedly engaged in purging or binge eating. The research findings supported the escape theory of binge eating. They indicated that dissociation and the stages of harmful affect were expressively higher
prior to the episodes of binge eating than a snack or a meal.
There is limited empirical evidence on escape theory. Brownley et al. (2016), found that cognitive narrowing, negative affect, negative self-awareness, and perfectionism led to binge eating that, even though maladaptive, episodes of binge eating offer individuals’ imperative functions. Besides, some researchers show that binge eating disorder is linked to dissociation experiences showing that bingeing offers escape from negative feelings or mood. Although research findings supporting the escape theory as an impartial description relative to binge eating
etiology is to a certain degree inadequate, there are numerous likenesses with other theories associated with binge eating as an emotional regulation and distress tolerance mechanism. Cognitive-Behavioral theory of Binge Eating Cognitive theory focuses its prominence on individuals having distorted perceptions like the belief that "I should become thin." The theory describes influencing factors of individuals with binge eating as introverts, perfectionist standard holders, high achievers, and emotionally sensitive individuals (Slane et al., 2016). Such people become depressed and withdrawn, most likely contributed by an external situation. Their belief is developed through the society or family
members as well as the media that losing their weight minimizes distress and thus prompts them to engage in behaviors like exercise or dietary restrictions to achieve their desire. The cognitive-
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behavioral theory emphasizes the significance of body weight and shape as the primary maintaining factors and judgements concerning food consumption as subordinate. The belief and values regarding shape and weight cause the observed behaviors of limiting caloric consumption as either amplified rate of recurrence or evasion of weighing.
A pervasive fatness fear, a dichotomous or rigid thinking style, and over-valuation of self-
control and thinness were presented in the cognitive processes (Brownley et al., 2016). The cognitive-behavioral theory emphasizes the propensity for people to judge their self-esteem based on their body image, weight, eating behaviors, and control over these aspects. The self-
assessment style was believed to be associated with reduced self-worth, perfectionism, and aversive self-evaluations. The theory accounts for the episodes of binge eating that arise among people with other eating disorders like bulimia nervosa as a result of their dichotomous, rigid intellectual with respect to their food consumption behavior (Cronce et al., 2017). The extreme anxiety regarding their shape and weight makes them assume strict and most impracticable regulations about food consumption. Besides, researchers show that when such persons diverge from their self-induced regulations, they develop a feeling of failure, weakness, and lack of self-
control. They thus unrestraint all control over their food consumption habits and begin an episode of binge eating. The central cognitive disturbance is said to be maintained by binge eating episodes by working to amplify an individual's concern regarding their capacity to control their weight, shape, and eating pattern.
As a result, Clark and Winterowd, (2012) state that binge-eating episodes are believed to strengthen individuals' engagement in the restraint of their diet, thus increasing the chances of bingeing episodes in the future. The dietary restraint theory and the cognitive-behavioral model present a brutal pattern whereby dietary restraint and binge eating episodes trigger the disordered
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eating behaviors and the associated compensatory habits among people with disordered eating, mediated by the beliefs concerning their control body image and weight, and eating. Besides, the cognitive-behavioral theory suggests that bingeing episodes are more likely to happen when individuals have low moods, with the state of emotion believed to undermine the ability of a person to maintain their strict control over their food consumption. Individuals use binge eating as an arrangement of attitude regulation while engaging in binge eating to neutralize the negative
state of mood (Pike et al., 2016). Studies have also emphasized the function of compensatory behavior like misuse of diuretics or laxatives, self-induced vomiting, intense exercise after bingeing, proposing that people with binge eating disorders utilize compensatory behavior to reduce the dangers of weight gain after bingeing. Therefore, the main barriers against overeating are eliminated. People become trapped in a vicious cycle of purging and bingeing that later minimizes self-worth ad strengthens the binge-purge cycle.
A cognitive-behavioral treatment program was developed based on binge eating theory. The program was recommended as the initial-line treatment for individuals with binge eating syndromes and was found to have a remission rate in 50% of the cases (Thein-Nissenbaum et al.,
2011). Cognitive-behavioral treatment was then compared with interpersonal psychotherapy, which was developed originally for depression treatment. A randomized control trial of patients with disordered eating who had received the treatment was followed up for one year then given a
post-treatment. The study results indicated that cognitive-behavioral treatment is superior to interpersonal psychotherapy treatment at eradicating binge eating (Franko et al., 2007). Yet, despite the observed reduced occurrence of binge eating, the core psychopathology of binge eating, like the worry concerning shape and weight, was reported to have not been significantly eliminated.
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The investigation on the effectiveness of cognitive-behavioral treatment found that reduced dietary restriction arbitrated the decrease in binge eating. The measures of mid-treatment
of self-worth relative to binge eating behavior, body shape, weight, and negative affect were linked to post-treatment results (Salas-Wright et al., 2019). Although cognitive-behavioral treatment for individuals with disordered eating demonstrated encouragingly good results, with most patients ceasing to involve in binge eating, a significant proportion of the population remained symptomatic after the treatment. When modified to treat binge eating disorders, the approach has effectively demonstrated binge eating abstinence rates. However, studies have indicated no difference between cognitive-behavioral treatment and interpersonal psychotherapy treatment in long-term change maintenance. According to McElroy et al. (2016), about 40% of the participants were found to continue engaging in binge eating. This shows that cognitive-
behavioral treatment and the theory based on cognitive-behavioral theory require additional development to appropriately understand and address the factors that persist in maintaining binge
eating etiology in almost half of the cases in the experimental samples.
Emotional Regulation Theory
The escape theory and affect regulation theories theorize that bingeing in binge eating disorder can be triggered by negative moods. However, the majority of research explorations regarding the theories are not specific to binge eating disorders. Additionally, the theories fail to address why patients with binge eating disorders seem to experience relief from adverse effects after bingeing. As stated by Cronce et al. (2017), the increased focus is centered on emotion regulations across all eating illnesses. Researchers have shown that severe emotions play a primary role across all eating disorders proposing that disordered eating constrains the experiences of adverse feelings among individuals.
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In their study, Thein-Nissenbaum et al. (2011) stated that emotional regulation theory postulates that people with binge eating disorder develop extensive difficulties regulating their emotions, including poor emotional consciousness and intelligibility, limited impulse control, and lack of emotional control mechanisms. Binge eating has been viewed as serving the functions of minimizing awareness of negative states of emotion but can also provide a mechanism to cope with stressors. The predisposing factors include eating problems, adverse family history of weight, negative family circumstances emphasis on physical appearance in the society, and the dependence on external ideals to critic self-confidence. Such predisposing factors contribute to diminishing interpersonal effectiveness of a person and the sense of character leading to loss of control and a sense of ineffectiveness over their body.
Binge eating disorder is stimulated by significant life events related to loss, significant life changes that make people experience negative affect or be self-critical, sexual conflict, and other adverse life events experienced by a person. Patients with binge eating disorder lack alternative coping skills when faced with distress, thus turning to restrictive food intake or bingeing to regulate their emotional state, including anger or distraction from loneliness or boredom (Meany eat al., 2014). Therefore, binge eating disorder is sustained by the consequence of adverse affect
effect reduction. In eating disorders, symptom clusters are a more clinically useful technique to comprehend the eating disorder process because of the increased inconsistency between individual cases presenting with similar diagnoses. Thus, bingeing should be understood based on symptoms. Binge eating is triggered by dieting or food cravings, but it does not seem to be the case for all people with binge eating disorders. Restraint theory does not offer sufficient explanation regarding the binge eating phenomenon since it fails to consider bingeing episodes experienced by individuals who did not constrain.
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Numerous research explorations have presented a considerable amount of investigational findings in support of the emotional regulation theory (Jennings et al., 2015). For instance, the laboratory-based assessment showed that inducing negative moods in women identified to have developed binge eating disorder contributed to bingeing episodes, and reducing negative affect resulted in binge episodes. Besides, a systematic review in investigational studies examining the emotional regulation theory in binge eating disorder and obesity held that the study results from the reviewed studies sported the theory that undesirable feeling was a precursor to binge eating for patients with binge eating disorder. Richson et al. (2020) show that temporary mood enhancement was experienced among the research respondents after food intake in obesity and disordered binge eating groups. The observational and naturalistic studies with the experimental samples showed backing for the emotional regulation theory.
In other studies, researchers have shown that binge eating disorder among patients is generated by a failure in the attempts for the regulation of emotion. A clear discrepancy in the emotional regulation approaches in patients with binge eating syndrome than healthy controls has also been identified (Braun et al., 2019). Although a deficiency in the ability of emotional regulation has been experienced across various eating disorder diagnostic groups like anorexia nervosa, bulimia nervosa, and binge eating disorder, as well as other psychological conditions like major depressive syndrome and borderline temperament disorder, studies have demonstrated
that the profile of emotional regulation varies across diverse eating syndrome diagnostic groups. It is vital to note that some researchers have doubted the objectivity of emotional regulation impact of binge eating. increased rates of adverse affect that preceded bingeing episodes have been recorded, but there is a lack of evidence to show that bingeing efficiently alleviated pervasive affect (Grilo et al., 2005). The inefficiency of the studies is due to the failure to assess
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the changes in affect during the episodes of binge eating. It is likely that binge eating offers an instant emotional regulation outcome that is time-limited.
Brody (2015), acknowledges that dialectical behavior therapy has been utilized in treating
binge eating based on the emotional regulation theory due to its function in promoting emotional regulation. Its efficacy in its potential to lessen binge eating regularity among people with binge eating syndrome provides evidence for the emotional regulation model validity for binge eating. Researchers show that people who binge eat have faced certain influencing factors including low
self-worth, a sense of ineffectiveness, life dissatisfaction, desire for control, and a history of trauma that makes them more susceptible to experience psychological challenges (Jennings et al.,
2015). Food craving as a trigger for binge eating is largely related with the predisposing factors of social pressure to be thin and the need for control. The need to escape from adverse effects and aversive self-awareness as a binge eating trigger is linked to numerous predisposing factors like poor coping skills and low self-esteem (Keel & Forney, 2013). The outcomes of binge eating
include an immediate decrease in adverse affect and hunger accompanied by lasting consequences of experiencing a deficiency of control and unease regarding weight gain, strengthening low self-worth, and increasing determination to control weight and eating.
Researchers found that women with binge eating disorders show an increased negative pattern of daily emotions. Besides, emotions linked to association with others appeared to be more relevant, for instance, the feelings of loneliness, hurt, and disappointment, and the feelings of being bored proposing dissatisfaction in association with others and life or selective processing of daily events. Compared to men, women are more probable to engage in binge eating in response to aversive emotions (Munn-Chernoff, et al., 2015). The commonly identified negative emotions include sadness, disappointment, guilt, hurt, and anger. The emotional
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regulation theory does not provide a definitive explanation for bingeing. However, it can be appropriate in trying to shed light on the emotional process of people with binge eating disorders.
The wide-ranging studies show that binge eating incidents are activated by unbearable states of emotion or the cues of hunger. Bingeing is upheld by the instantaneous impacts of involving in episodes like food cravings and reducing negative affect. Longer-term impacts are believed to aggravate some of the primary generators that strengthen and maintain the sequence of behaviors.
Addiction Model
The addiction model is another influential binge eating disorder theoretical model. Many researchers suggest that bingeing can be better considered as an addiction, thus drawing parallels
between binge eating and addiction. Numerous patients with binge eating disorders are believed to share resemblances with those having addictive illnesses (Brody, 2015). Popular factors described by binge eaters and individuals addicted to alcohol and drugs include preoccupation with food or substances, loss of control, secrecy from others as a way to regulate affect. Quite commonly, cravings and lack of feeling in control resulting in food preoccupation causing futile attempts to control or stop the behavior have been reported among binge eaters (Adamus-Leach et al., 2013). Similar to substance addicts, guilt, shame, anger, and other adverse social and psychological consequences can happen due to their actions
Some studies have indicated that some people may experience bingeing as a form of addiction, while others suggest that for individuals who meet the criteria for binge eating disorder, their bingeing behavior fulfils the DSM-5 standards for addiction (Lee-Winn et al., 2014). Perhaps, the growing interest in a novel diagnosis of food obsession is the convincing argument in favor of the perspective of the addiction model of binge eating disorder. However,
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the food addiction putative diagnosis remains controversial, and correspondingly, addiction model value for binge eating disorder remains unclear.
Shema Theory of Binge Eating
A schema model of binge eating extends the emotional regulation theory of binge eating by examining the functions of binge eating in the alleviation of adverse effects that occur after an
aversive core belief is generated (Witte et al., 2018). Schema level cognitions or the core beliefs are defined as dichotomous, unrestricted, and absolute aversive cognitions regarding oneself, others, and the world and are thought to occur early in one's lifespan as a moderately adaptive response the environmental conditions of a child. However, the overtime change in situations makes them maladaptive (Dubosc et al., 2012). For instance, schemas or unconditional beliefs comprise failure, unlovable, beliefs related to being inadequate, fear of abandonment, and defective. An individual's self-esteem becomes threatened when one or more of the adverse core beliefs is activated. This makes a person start experiencing adverse affect
like anxiety and reduced mood as a direct consequence.
Numerous scholars have assessed the core beliefs of people detected with disordered eating. They have shown that persons with binge eating syndrome significantly experience more pathological core beliefs compared to participants in the controlled experiment. Particular schemas have been recorded to be associated with certain symptoms of eating disorders (Moerdijk et al. 2017). In an investigation on the availability of early maladaptive core beliefs in persons identified with eating illnesses, it was found that particular schemas like enmeshment, abandonment, emotional deficiency, emotion inhibition, and subjugation are linked to behaviors related to binge eating syndrome. Besides, differences in schema profiles across patients diagnosed with various eating disorders have been reported (Dohm, 2012). Binge eating has been
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found to be linked to numerous early maladaptive schemas like susceptibility to maltreatment abandonment, emotional inhibition, failure to attain, shame or defectiveness, emotional deficiency, inadequate self-control, social seclusion, social undesirability, and abuse or mistrust.
Particularly, emotional inhibition schema has been reported to be a good predictor of binge eating rate of recurrence in numerous eating disorders, including bulimia nervosa and binge eating. This core belief is linked to the belief that feelings should not be expressed or experienced for fear of rejection, shame, ridicule, or feeling out of control (Lee-Winn et al., 2014). The hypothesis of this schema holds that when a person experiences strong feeling, they tend to inhibit their emotional response by avoiding their feelings or neutralizing them. Schema theory falls in a similar line to the emotional regulation theory of binge eating. They both state that the functioning of binge eating is like a coping mechanism to deal with what is viewed to overwhelm aversive affect. The investigation regarding the type and strength of core beliefs held by people with binge eating disorder compared to other eating disorders or non-clinical controls, and then assessed in the relationship between the strength of a particular schema and binge eating frequency showed that participants with other eating disorders or binge eating disorders demonstrated increased levels of pathological core beliefs than controls, but with the same level to each other (Warren et al., 2009). Therefore, this shows that participants in the clinical setting experienced heightened levels of adverse core beliefs about self-regulation of their weight.
Longmire-Avital and Finkelstein, (2021) state that the occurrence of binge eating incidents is linked to the strength of the schemas held. Individuals who recorded more binge-
eating episodes displayed higher levels of aversive core beliefs. In the argument, Ogden et al. (2013) held that the finding is unique to particular groups with binge eating disorders since those with other types of eating disorders had increased levels of negative cognition irrespective of the
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frequency of their purging episodes. Therefore, this shows that there exist vital differences between binge eating illnesses and other types of eating syndromes. Besides, not just the absence
or presence of compensatory behaviors that isolated the diagnostic groups.
Research findings on schema therapy in binge eating treatment is moderately scarce, with
limited studies exploring the efficacy of schema-based therapy (Kuba & Harris 2011). A randomized controlled trial to assess different psychotherapies for binge eating treatment comparing schema therapy to cognitive-behavioral treatment and appetite-centered cognitive-
behavioral treatment showed promising results for schema therapy in binge eating treatment with
a significant decrease in the frequency of bingeing after the treatment. However, there lacked significant differences in the results between the modalities of treatment. Appetite-focused cognitive-behavioral treatment and schema therapy were found to offer reliable alternatives to cognitive-behavioral treatment in binge eating treatment (Boisvert & Harrell, 2009). However, schema therapy provides evidence with promising outcomes. Therefore, further investigation is required in this area to identify the enduring effectiveness of binge eating illness treatment grounded on schema therapy.
Psychodynamic Theory
Psychodynamic theory is relevant since it provides a relational explanation model centered on historical impacts on binge eating (Moerdijk et al. 2017). Besides, it views binge eating behavior and the food itself as accomplishing an intrapsychic objective as well as expressing or communicating the underlying issues. In general, this theory holds the perspective that when the needs are unmet in the development of human beings, they result in maladaptive functions as a consequence. According to Napolitano and Himes (2011), the occurrence of maladaptive functions is due to serving as a developmental deficits substitute and protection
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against the resulting frustration, anger, and pain. However, they do not resolve the underlying deficits, and thus a person who did not learn how to self-soothe can turn to food as a way of comfort, leading to binge eating when faced with a frustrating situation. However, this might perpetuate a situation where they cannot learn how to comfort themselves.
Also known as psychoanalytic psychotherapy, psychodynamic theory helps people understand their unconscious behavior patterns and emotions. Psychodynamics influences individuals' feelings, thoughts, and behaviors affected by eating disorders (Striegel-Moore et al., 2011). The psychodynamic domain of influence is considered resting within a biopsychosocial context for binge eaters. Psychodynamic theories posit that the occurrence of binge eating is triggered in response to a particular relation deficiency, particularly among individuals associated
with providing care to young children. Therefore, psychodynamic theories of binge eating disorders differ from other theories that consider the role of distal influences, particularly in problematic associations with providing care during childhood. Although this idea is essential, researchers have not empirically tested it to determine whether it is the predictor of binge eating disorders among individuals.
Transdiagnostic Cognitive Behavioral Model
The transdiagnostic theory of binge eating posits that all eating disorders share similar core psychopathological procedures, particularly cognitive. The theory encounters the need to isolate disordered eating into diagnostic or distinct clinical presentations that call for specific treatment (Dubosc et al., 2012). However, the transdiagnostic model is fixated on common psychopathology processes to maintain all eating disorders. This transdiagnostic model embraces
a wide-ranging maintenance mechanism and can be utilized in the formulation of all eating disorders. Compared to other models, the model accounts for increased binge eating and dietary
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restraint variation. Besides, a structural equation modeling in large clinical binge eating samples showed that different models of eating disorders provide an excellent fit to the data (Garrusi & Baneshi, 2012). Still, the transdiagnostic model provided greater explanatory power, which accounts for more significant variations in disordered eating symptoms than the primary cognitive-behavioral model.
An enhanced cognitive-behavioral transdiagnostic treatment program was established based on the transdiagnostic model. Mandl (2019) states that numerous clinical trials assessed the efficiency of cognitive-behavioral transdiagnostic treatment across various diagnostic groups.
Significant differences were recorded between pre and post-scores across different outcome measures, incorporating stress and anxiety scores, reduced depression, improved life quality and self-esteem, and the significant decrease in the psychopathology of eating disorders and symptoms. This comprised a significant decrease of patients involved in the episodes of binge eating between pre-and post-treatment.
The transdiagnostic cognitive-behavioral model vies the core psychopathology of a person's propensity to judge their self-esteem based on weight, shape, and ineffectiveness to control as the central significance in maintaining any eating disorder. The extreme evaluation of alleged lack of control, shape, and weight has also been presented among patients with bulimia and anorexia. Besides, the model proposes the existence of sub-groups of patients across all eating illnesses who share specific symptoms like interpersonal difficulties, low self-esteem, clinical perfectionism, and low mood (Longmire-Avital & Finkelstein, 2021). According to the model, binge eating behavior is considered a response to food restriction. It held that bingeing behavior occurs when a person finds it difficult to adhere to restrictive food regimes or strict
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diets. Therefore, purging behavior maintains the core psychopathology of the excessive worries of a person concerning their weight, control, and shape.
Due to the quite diminished lasting efficiency of the greatest accessible treatment for binge eating, various studies have examined potential predictors of outcomes of cognitive-
behavioral treatment for binge eating illness, including the presence of comorbid psychological disorders, the severity of the eating disorder symptoms, duration of the disorder, and the higher frequency of binge eating during pretreatment. They have been displayed to predict worse outcomes for cognitive behavioral transdiagnostic treatment. As argued by Afari et al. (2021), numerous research studies have supported transdiagnostic theory holding that it is common for people with eating disorders to move between various diagnoses of eating order. However, others
argue against the transdiagnostic model that all eating disorders are variants of a single disorder with common maintaining factors and casualty. Although some researchers have criticized the model, it is still considered the dominant model in treating eating disorders.
Feminist Theory
Conceptualizing disordered eating as a personal medical issue depresses the examination of socio-cultural impacts on eating illnesses and obscures the association between the eating experiences of women and their living conditions. The feminist theory posits that eating illnesses
are a pathology of the contemporary cultures where some obsessions do not preoccupy fewer women with the food consumed or their body (Hall et al., 2015). It offers a social-cultural explanation concerning eating disorders. Feminist theorists argue that the obsession with shape and body weight and the consequent disordered eating face a normative discontent about weight and shape for most women, stating that it does not affect a small number of women as suggested by the DSM classification system (Thompson-Brenner et al., 2013). Besides, the addition of
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disordered eating conditions in the DSM classification system offers validity to the widespread beliefs regarding the significance of body shape and weight for women, the frames of women's bodies, and experiences as pathological.
Studies and research explorations regarding fat studies perspectives assume a fundamental stance on the obesity epidemic, suggesting that weight is increasingly regarded as a straightforward proxy for both mental and physical health in a move that is pathologizing to fat people, particularly women for cultural reasons (Maguen et al., 2012). The explanation of feminists for disordered eating prioritizes factors such as media influences, inequality in the distribution of power, identity and role conflict problem, being female, a patriarchal society, and the role of societal pressure concerning body shape and weight. In contrast, feminist theorists focus on political, social, familial aspects of women's lives concerning the medical models of eating disorders.
The role of internalized weight bias for individuals with binge eating disorders includes predisposing individuals to bingeing (Mama et al., 2015). Therefore, the feminist theory also suggests that positioning an eating disorder as a possible cultural artifact is a socio-cultural explanation for binge eating disorder with binge eating, which is the characterized definition of binge eating disorder positioned as pathological because of the cultural emphasis placed on appropriate weight and food control. The critiques of feminist theory and fat studies emphasize the failure of other models to consider socio-cultural factors. The factors are likely to be essential
provided that binge eating disorder is influenced by cultural factors and is normative for some populations.
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Systemic Theories
According to systemic theories, individual mental phenomena should be understood systemically. It should be regarded as essentially originating from and best comprehended based on societal systems in which people live (Kupemba, 2021). Occasionally, the family setting has been considered a fundamental causative factor for different eating illnesses, incorporating binge eating disorders. Historically, restricted parental contact during anorexia nervosa treatment was important to avert the parent from triggering an eating disorder (Maguen et al., 2012). The family
role was later reframed and referred to as psychosomatic family placing emphasis on the pathological familial procedures in the development of eating disorders. However, most researchers criticized the model. The effective way of treating anorexia nervosa was suggested as
altering the family structure through family therapy. However, the efficacy of the psychological family model had no identifiable type of familial pattern associated with eating disorders. Studies
recorded limited supportive evidence that families cause eating disorders.
Although the family's perspective regarding the causation of eating disorders has been challenged, various scholars have persistently studied familial factors linked to eating disorders (Moerdijk et al. 2017). Families with binge eating disorders are more conflictual, disorganized, less honest with their feelings, and less cohesive. The family environment was considered a significant contributing factor for the onset and maintenance of binge eating disorder, with suggestions stating the worth of systemic approaches and family-based treatments. Obese women
with binge eating disorders faced parental rejection, particularly paternal, and needed nurturance and affection during child-parent association (Goode etal., 2020). Emotional unresponsiveness from parents and weight-related teasing was also linked to binge eating among children aged 12 years.
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The current family or systemic treatments were started in London at the Maudsley Hospital and are built on the inclusion attitude with family regarded as the possible resource in therapy to lessen parental guilt (Marques et al., 2011). Therefore, the focus of family systems theory was to help a family develop skills that can help in facilitating communication and emotional literacy, navigate attitude differences and opinions, and recognize how behavior rigidity and emotionality can be linked to disordered eating. Family models of disordered eating also suggest that family members are systemically interconnected, with every member influencing the entire family, developing interaction patterns that can be less or more useful. The approach acknowledges that every family member might differently experience the associations and their attached meanings.
There is still limited research on systemic theories notwithstanding the extensive history of systemic techniques on eating syndromes and the impact of family-based treatments. Little evidence suggests that the Maudsley approach and family-based treatment for treating eating illnesses are extensively effective on other eating disorders (Rostami, 2020).. However, there is a
lack of extensive research on their effectiveness in treating binge eating disorders. Binge eating disorder is usefully conceptualized as a relational issue whereby feelings of rejection because of weight are linked to having an identity dictated by an individual's body weight and image. Theories and studies on eating syndromes broadly posit that families play a crucial role in the etiology and maintenance of eating illnesses. Although there is scarce research on family-based and systemic models of binge eating disorder, there is ground that systemic theories can be perfectly applied for the case of binge eating disorder.
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Related Literature
Binge eating disorder is the most prevalent disorder in the United States, affecting about three percent of American adults, thus becoming more prevalent than other eating disorders. The American Psychological Association announced the inclusion of binge eating disorder as a formal eating disorder in its Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) (Clark & Winterowd, 2012). This changed the previous status of binge eating disorder from being a provisional diagnosis which necessitated additional research (Hall et al., 2015). In DSM-5, the diagnosis for binge eating disorder outlined by APA included a person having repeated binge eating episodes where the food amount consumed s larger than what most people eat in a similar situation. An individual experience marked distress and loss of control from the binge eating episodes. Similar prevalence rates of the symptoms associated with eating etiology have been recorded in the diverse population. In the study by Harrington et al. (2010), the research on eating disorders among African American women has remained extremely low despite the findings showing that they are equally impacted like European American women. Increasing research findings have challenged the beliefs that eating disorders mostly affect European American women, thus emphasizing the significance of empirical research among diverse populations.
Eating Disorders
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders includes various eating and feeding disorders and their respective subtypes. According to Marques et al. (2011), the prevalence rates for common eating and feeding disorders range from 0.4 to 1.6 percent and are reported to affect more than 30 million Americans. However, the overall prevalence rate of Otherwise Specified Feeding and Eating Disorder remains unknown, making
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many cases go unreported and undiagnosed. Different eating disorders include Binge eating disorder, Bulimia nervosa, anorexia nervosa, and other specified or Unspecified eating disorders. As per Fichter and Quadflieg (2016), the lifetime prevalence rate for Anorexia is 0.9%, 1.5% for bulimia, and the large prevalence rate is recorded for binge eating disorder at the rate of 3.5%. The greatest contributor to Bulimia nervosa and Anorexia is dissatisfaction with one's body image.
Anorexia nervosa is an eating disorder characterized by the restriction of food intake to attain reduced body weight due to the strong fear of gaining body weight or becoming fat and how one perceives their body shape or weight. The dissatisfaction experienced by individuals regarding their body image is because of self-evaluation leading to reduced self-worth (Sala et al., 2015). American Psychiatric Association further distinguishes Anorexia into two subtypes. The two subtypes of Anorexia nervosa include binge eating or purging type and restricting type. In purging or binge eating type, a person engages in binge eating then purges to compensate for the consumed calories through induced vomiting or misuse of laxatives (Echeverri-Alvarado et al., 2020). In the restrictive subtype, a person achieves weight reduction through the restriction of
food intake but does not experience purging or bingeing episodes. The point prevalence or the new cases of Anorexia occur during young adulthood or adolescence at a higher rate. The condition also affects more females than males.
Bulimia nervosa consists of recurrent binge eating, inappropriate compensatory behaviors
at least once a week to avoid weight gain and undue influence on body image and self-esteem. The episodes of binge eating are similar to a binge eating disorder where an individual consumes
a large amount of food in a given period (Braun et al., 2019). Individuals affected by bulimia nervosa might feel out of control over their eating, making it impossible to stop the behavior. The
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main difference between this type of disordered eating with other eating disorders is that an individual fears weight gain and feels guilt due to binge eating behavior. The person compensates
for binge eating behavior, and a condition referred to as purging (Ross, 2019). Some purging behaviors include excessive exercising, diuretics, fasting or extreme dieting, laxatives, and vomiting. The highest bulimia nervosa prevalence rates occur in young adulthood or late adolescence, affecting females 10 times more than males.
Assari, (2018) shows that Bulimia nervosa is further distinguished by two sets of specifiers that include current severity level and status of remission based on the number of episodes every week that the affected individuals are involved in inappropriate compensatory behaviors. The diagnosis of bulimia nervosa was initially distinguished based on purging and non-purging subtypes. However, some scholars are not sure whether the non-purging subtype of bulimia nervosa better aligns with binge eating disorder than the bulimia nervosa diagnosis because of similar characteristics and eating disorder symptomatology. Binge eating disorder incorporates episodes of recurrent bingeing at least once a week. The episodes of binge eating are characterized by a large amount of food intake more than an average person can consume in a similar circumstance and within a specified period (Sala et al., 2015). In a given episode, individuals binge eating feel out of control concerning their eating period. The person typically gets traumatized while bingeing but does not engage in inappropriate compensatory behaviors to avoid weight gain as those involved in bulimia nervosa would. The attributes considered to categorize individuals as having binge eating disorder include having a more rapid eating behavior than usual, one eats until feels full, one consumes large food quantities when not physically hungry, experiencing shame or guilt about oneself after
engaging in episodes of recurrent eating, and eating in private because one feels embarrassed for
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consuming large quantities of food than a normal person would consume (Santomauro et al., 2021). Like bulimia nervosa, binge eating disorder is distinguished by two sets of specifiers that include a current severity level and status of remission, which is grounded on the episodes of binge eating the affected person engages in. The limited research concerning binge eating disorder specifiers is due to its recent inclusion in the DSM-5.
Otherwise Specified Feeding and Eating Disorders (OFSED) are characterized as eating disorders that an individual does not fully meet the criteria for the outlined disorders when diagnosed but experiences symptoms that can contribute to significant distress or impairment in their life (Moerdijk et al. 2017). These disorders affect an unspecified or unknown percentage of the population due to their numerous presentations. Due to the historical ambiguity related to the diagnosis, Otherwise Specified Feeding and Eating Disorders was shifted from the former Eating
Disorders Not Otherwise Specified. According to Duarte and Pinto-Gouveia (2017), there is limited literature assessing its treatment and prevalence. Healthcare providers must note why patients' symptoms fail to fit into any eating disorders. This might include purging to reduce weight without engaging in binge eating, being of normal body weight in Anorexia, and lower purging or binge eating frequency.
History of Binge Eating Disorder
The symptoms of binge eating disorder were initially described in 1959 by Stunkard, who
described the episodes of binge eating as an orgiastic experience where large food quantities are consumed by individuals at irregular intervals in a short period, particularly when a person is stressed (Braun et al., 2019). Stunkard believed that binge eating frequently appeared to have a personal and symbolic meaning inducing negative feelings like severe discomfort, self-
condemnation, distress, and guilt, that individuals encountered after bingeing (Ambwani, 2015).
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Until the 1980s and 1990s, various researchers proposed its inclusion in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders since its diagnostic criteria offered distinct disorders (Fichter & Quadflieg, 2016). In 1994, American Psychiatric Association included binge eating disorder in Appendix B of the DSM-IV as a provisional eating disorder., Eating Disorder Not Other Specified (EDNOS), which required additional definition.
Binge eating disorder was formally recognized in the DSM-5 in 2013, the first time it was
acknowledged as a separate disorder from other types of eating disorders (Trottier et al., 2016). Due to the empirical evidence, the DSM-IV diagnostic criteria implemented two main changes in
the DSM-5, changing the frequency of binge eating from two days a week to once a week. The severity criteria were also applied associated with episodes of binge eating frequency. Currently, binge eating disorder is defined as excessive and abnormal food consumption patterns linked to recurrent, uncontrolled, and persistent bingeing without weight control behaviors. Researchers argue that binge eating disorders have numerous parallels with conventional addiction disorders (Lee-Winn et al., 2014). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines binge eating disorder by two properties: eating in a short period and consuming a considerable amount of food that is considerably greater than what most individuals
would consume in the same period under the same period situations. Compared with non-binge eating disorder counterparts, laboratory-based studies have shown that individuals diagnosed with binge eating disorder seem to have higher caloric intake and a large amount of food consumption, even in non-binge eating episodes.
Food and Drug Administration approved a new drug to treat binge eating disorders in 2015 (Badrasawi & Zidan, 2019). The drug known as lisdexamfetamine dimesylate was sold under Vyvanse prescribed to treat moderate to severe binge eating. It helps individuals control
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bingeing by maintaining a steady supply of the neurotransmitter dopamine in the brain because bingeing and overeating are associated with the reward centers in the brain. This was a huge step in treating binge eating disorder because it was the first drug prescribed explicitly for binge eating disorder. A significant milestone has been achieved, and the treatment is psychologically gentle and offers the highest level of care outside the hospital setting (Badrasawi & Zidan, 2019).
Effective medication developed by the researchers has been due to the prior developments that have enabled professionals to differentiate between obesity and binge eating disorder. However, as Saltzman and Liechty, 2016) point out, Vyvanse might not be an effective treatment for individuals with recurrent substance abuse behavior due to the possibility of addiction when taking Vyvanse. Researchers and medical professionals are currently investigating how binge eating disorder affects different people to develop effective treatment options for every individual.
The Role of Trauma in Binge Eating Disorder
The study by Dingemans et al. (2017) states that traumatic stress refers to psychological and physical reactions occurring in different degrees after a traumatic experience, categorized by symptoms that include numbness, avoidance, nightmares, the acute burst of panic or fear, anhedonia, and emotional blunting that lead to changes in the eating behaviors. Researchers focused on addressing eating behavior among individuals affected by past traumatic events posit that symptoms of post-traumatic stress disorder are linked to consumption of fast food, soft drinks, and unhealthy eating behaviors (Lee-Winn et al., 2014). Eating habits is an extensive term that comprises feeding practices, eating-related problems, dieting, and food choice and motives representing an essential element for the promotion and maintenance of good health in the entire life of individuals. Traumatic experiences can be the risk factors for developing eating
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disorders. The history of trauma and childhood trauma is associated with increased symptoms of eating disorders. Patients with post-traumatic stress disorder report increased symptoms of eating
disorders compared to those without any history of traumatic experiences.
Emotion eating and regulation difficulties are proposed as mediators in the relationship between post-traumatic stress symptoms and binge eating symptoms. Emotional dissociation and
dysregulation have been suggested as the mediators between eating psychopathology and childhood trauma. Many individuals have been reported using disordered eating like binge eating
as a short-term means to relieve adverse affect associated with trauma (Kathryn & MacDonald, 2017). Stress has been found to minimize behavioral and emotional control and increase impulsivity, thus contributing to overeating. Emotionally conditioned eating is also a perceived stress regulator. The brain expresses a strong desire to eat and minimal capacity to inhibit eating when stressed. Sweets and food can be easily accessed and make a person feel more comforted or relaxed, leading to less stress and creating a better mood. However, while chronic stress strengthens the desire for sweet and tasty foods with high-fat content, acute stress can, in turn, minimize appetite.
Differentiation between and possible overlap with eating disorders and food addiction has
received considerable attention from various researchers. Studies have shown that increased levels of post-traumatic stress disorder symptoms are related to increased levels of food addiction (Trottier et al., 2016). Childhood trauma is associated with addiction to food and binge eating behaviors. Besides, the higher prevalence rate of food addiction is recorded among individuals with disordered eating habits. From various studies, the main themes originating from individuals who expressed their experience with traumatic stress and its impact on their eating habits included experiencing lack of appetite and reduced ability to plan and prepare
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meals, experiencing stressful and emotionally controlled eating behaviors, experiencing addiction to sweets and food, and experiencing eating habits as their coping mechanism (Auxéméry, 2012). Binge eating increases the intake of salty snacks, sweets, fast food, restrictive
eating, and controlled eating due to fear and a strong urge to avoid or regulate discomfort associated with emotions and stress.
Besides, eating situations or specific food types triggered traumatic memories and provided feelings of bad conscience, leading to increased anxiety. Post-traumatic stress disorder has been found to create difficulties in the sustainability of varied diets, causing increased food intake (Lee-Winn et al., 2014). Individuals develop eating behaviors as a way to avoid panic, fear, anxiety, or negative conscience. Restrictive and controlled eating behavior can be described as a situation in which a person avoids eating some food types, eats unprocessed food, or engages in unhealthy overeating. A person might be scared of eating more than an average amount. In contrast, others hold that unhealthy eating or overeating negatively affects their body image or can cause the hypo-arousal feeling that triggers traumatic experiences. The motive to suppress emotions surpasses the urge to consume average food (Kathryn & MacDonald, 2017). Although it is considered a medication for negative thoughts or unfavorable feelings, it is not viable.
Ramirez et al. (2017 found that most people turn to disordered eating as a coping mechanism for their painful experiences. Both eating disorders and post-traumatic stress disorder
have high dissociation rates; a person feels disconnected from oneself. People suffering from both disorders potentially attempt to use their eating habits to disconnect from traumatic emotions and memories. People might severely restrict their food consumption or restructure
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their exercising routine to regain a sense of control in their lives (Lee-Winn et al., 2014). Trauma
often leaves individuals with a feeling of powerlessness, while disordered eating behavior provides a false sense of achieving power over an incidence that can be controlled. However, these disorders become uncontrollable, thus overpowering the initial intention of making a person's life dominated by weight and food. Any form of trauma or abuse can trigger eating disorders (Ashley Acle, 2021). They include bullying, sexual abuse, emotional abuse, and physical abuse. Although it might not be possible to state that trauma causes eating disorders directly, it is a stronger risk factor contributing to individuals' disordered eating.
The relationship between the psychopathology of eating disorders and sexual assault has
been extensively explored, but the subject remains of debate. Studies show that approximately 30% of eating disorders have experienced childhood sexual abuse or sexual trauma (Braun et al., 2019). However, there is a complex relationship between the inherent issues in self-regulation, the type of trauma, and other risk factors that contribute to challenges in pinpointing the accurate
effect of sexual assault on the risk of eating disorders in the future. Individuals who experienced sexual assault are slightly more likely to develop bulimia nervosa than binge eating or other types of eating disorders. Some research studies theorize that being abused sexually can contribute to disordered eating behavior. Therefore, an individual can control their lives but find the turmoil of sexual trauma and the outlet of emotional pain. In the case of binge eating, the inherent symbolism in the etiology of the disorder is its ability to help an individual purge the adverse feelings linked to traumatic stress, while food consumption helps to occupy an emotional
void.
Although not similar to conventional eating disorders, researchers have found interesting facts about trauma and eating behaviors and how they can develop during childhood (Badrasawi
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& Zidan, 2019). Some children consider eating snacks when confronted with stress, while others lose their appetite. The parents recognized the actions and monitored their children's responses after being anxious or upset. Emotional overeating or undereating among children can potentially
contribute to disordered eating. Ethnic Minorities
In the growing literature, researchers acknowledge that females identifying as sexual minorities across different racial groups are at an increased risk of developing binge eating habits. There are increased bulimia, Anorexia, and Other Specified Eating Disorders among people who self-identify as African Americans, Hispanic, Caucasian, and Asian Americans (Garrusi & Baneshi, 2012). Binge eating is believed to be common in marginalized groups, particularly the African American community. The inadequacy of the research exploration on the topic has made it difficult to acknowledge the actual status of the health professionals. Race has been posited as the potential stressor contributing to the development of eating disorders among African American women because they lack inherits opportunities associated with European American women (Fichter & Quadflieg, 2016). African American women are more likely to suffer from eating disorders than women from other minority groups. The prevalence rates of binge eating habits are more frequent among African American women than Caucasian women. Greater frequency of binge eating, diuretic use, induced vomiting, laxative use, and fasting is more common among African American women than Caucasian origins (Kathryn & MacDonald, 2017). However, the cultural norms can protect African American women from disordered eating habits since they report lower diet pills and purging rates. Besides, lower cases of caloric restriction and reduced anorexia rates have been reported among African American women than other ethnic minority groups. Researchers have
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demonstrated that females from the Asian American group are less likely to engage in binge eating than African American and Caucasian women. This supports the held belief that Asian American women record a lower risk of disordered eating than other marginalized communities. Race-Related Stress and Eating Disorders
Some scholars have noted that African Americans report increased racism experiences than other marginalized communities in the United States. Thein-Nissenbaum et al. (2011) state that African Americans have been found to experience increased discrimination rates across the socioeconomic status level, age, and gender than European Americans. The main pathway through which discrimination based on race adversely affects poor physical and mental health outcomes for African Americans is through coping behaviors. According to empirical and conceptual research, some people might try to dampen stress reactions by using helpful and unhelpful coping mechanisms when faced with racially discriminative experiences (Polychronopoulos, 2017). Stress coping mechanisms might incorporate seeking social support, praying, developing poor eating behaviors, taking substances or drugs, and embracing racial identity or pride. However, chronic exposure to stress from ethnic discrimination may deplete the
adaptive psychological resources of individuals equipped with effective psychological tools, thus
increasing the health problems through insidious processes that contribute to poor health behaviors.
Maladaptive eating like excessive dietary restrictions and significant overeating may happen due to exposure to racial discrimination and a way of coping with racial-related stress using unhealthy behaviors (Moore, 2021). Obesity and disordered eating behaviors can occur due
to poor eating habits like increased consumption of calories in response to stress. African American women have disproportionately experienced increased obesity rates than other racially
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marginalized groups in the United States. Stressed and bad eating habits can heighten the risk of obesity. It is vital to assess how racial-related stress is associated with eating disorders within African American population, particularly women.
Race-related influence on eating pathology can be well understood through a transactional model of stress and coping. The model focuses on psychological stressors like discrimination based on race and can contribute to stress coping responses and appraisals that can harm an individual's health condition. The coping mechanism associated with eating disorders is bidirectional and can cause some people to reduce food consumption during stress (Lee-Winn et al., 2014). Besides, the meaning and value assigned to stressful stimuli such as racial discrimination can be discussed through the transactional model of stress appraisal, determining how detrimental a stressor can be and how much it can impact a person's behavioral health. The stress appraisal process is also consistent with the risk factor model. The socio-
cultural values are associated with eating disorders in European American women alongside discriminatory stressors experienced among African American women (Badrasawi & Zidan, 2019). Such values and stressful events impact emotional and cognitive appraisal processes that make individuals develop eating disorders.
The standards of beauty and media messages are the fastest contributors of stress among women since they contribute to body dissatisfaction experiences and involvement in poor eating behaviors to reduce weight and attain discrepant ideals of the body. Besides, the transactional model of stress and coping also proposes that an individual's appraisal of stressful events plays an essential role in the degree to which adverse states are experienced in response to the events. Studies have shown that appraised stress temporarily preceded purging and binge eating behaviors (Kathryn & MacDonald, 2017). The pessimistic view and interpretation of traumatic
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events can also lead to aversive emotional responses that enhance maladaptive coping behaviors. Negative affective states like hostility, anxiety and depression are viewed as mechanisms between unhealthy coping behaviors and racial discrimination. Substance abuse or use is considered the primary harmful coping behavior many individuals use in response to stress. There are limited studies on which adverse affective states like depressive symptomatology can link eating pathology and stress due to racial or ethnic discrimination. Trauma and Binge Eating Among African American Women
Trauma is defined as a situation where a person experiences severe bodily threat or injury
followed by intense helplessness, fear, or horror (Garrusi & Baneshi, 2012). An individual might experience numerous challenges like depression symptoms, eating problems, substance abuse, anxiety, and post-traumatic stress disorder after getting exposed to trauma. Binge eating is one of
the most common problems for individuals affected by trauma. Although the rates of binge eating are not well known among the African American women survivors, binge eating disorder seems to be a widespread issue among the marginalized communities in the United States. Recurrent binge eating is linked to a host of aversive consequences that include increased risk of obesity and its medication sequelae, impaired interoceptive awareness, and comorbid psychological issues (Lee-Winn et al., 2014). It is essential to understand the problem of trauma and binge eating among the diverse American population, given the increased rates of exposure and bingeing among African American women.
The literature review conducted by Rosenberger and Dorflinger, (2013) show that the recent studies have indicated that trauma and binge eating among African American women are greatly related. Exposure to trauma or distress is a significant predictor of binge eating severity among African American women and other marginalized groups. However, trauma has not been
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found to predict the psychological function of eating significantly. Historically, the strong black women ideology is a salient cultural symbol relevant to African American women's trauma recovery and binge eating (Linardon et al., 2016). The symbol began as a justification or rationalization for slavery since African American women were flaunted as psychologically and physically stronger and more resilient than European American women. The image was later appropriated within the African American community in response to derogatory images of African womanhood. The image incorporates numerous positive attributes, engenders self-
efficacy for confronting the challenges, imbues pride steeped in a historical legacy and rich culture, and offers encouragement in misfortune situations. The belief that African American women are inherently resilient and strong is one of the strong black women ideology tenets. Due to the pressures of living up to the ideal of superwomen, low self-esteem, guilt, shame, and depression easily preoccupy the African American women when they perceive themselves as failing to attain such a goal (Lipson & Sonneville, 2019). The ideal form of the image does not permit African American women to express or experience distress or vulnerability and may deny or reduce the struggles they experience, thus depriving them the permission to break down, feel the stressed struggle or pain. The circumstance can be salient for the survivors of trauma because the extreme form of the symbol gives them a narrow range of responses to harsh conditions. This makes them avoid admitting the experience of a particular emotion or vulnerability to distress. The African American women who have strongly internalized the symbol of the strong black women ideology might cling to it more firmly as they
struggle to find culturally sanctioned ways of dealing with traumatic situations.
The excessive or ideal form of a strong black women ideology can be problematic for women prone to using eating as their coping mechanism to distress. The cultural pressures to
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embody control and strength and consequential prohibitions against vulnerability and weaknesses contribute to denial and erasure of pain, leaving many African American women inclined to self-medication with compulsive overconsumption of food. The notion that strong African women ideology might be linked to binge eating and the recovery of trauma among African American women can be intriguingly possible, but it requires additional examination.
The study by Vanzhula et al. (2018), shows that recurrent binge eating is the main behavior of binge eating disorder that is concurrently accompanied with the experience of loss of
control and marked distress without inappropriate regular compensatory behavior for weight loss. Binge eating disorder is the most common eating disorder across all ethnic and racial groups in the United States, affecting between 0.8% to 2.6% of America's population (Polychronopoulos, 2017). Besides, binge eating disorder is always comorbid with numerous psychiatric and somatic conditions, including substance use disorder, metabolic syndrome, mood
disorder, and obesity. Recent research explorations report similar or higher rates of Binge eating disorder among African American population compared to European American Women. In various studies, the prevalence of binge eating disorders among African American women was approximately 5% compared to about 2.5% of non-Hispanic white women (Vanzhula et al., 2018). Besides, the prevalence of binge eating among women with obesity is estimated at a higher rate of about more than 30% for African American women than European American women.
According to Lipson and Sonneville, (2019), although there are multiple efficient behavioral treatments for binge eating disorders, for instance, behavioral weight loss, cognitive behavioral therapy, and interpersonal psychotherapy, African American women and other marginalized groups have lower access rates to the care of binge eating disorders than European
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American women. Binge eating and binge eating disorder can be more aversive among African American women who fail to access treatment. Early detection and intervention of binge ting episodes among this population can be the initial essential step towards preventing and improving access to care (Trottier, 2020). The current study systematically reviews the empirical research investigations regarding African American women. It addresses the racial or ethnic differences, prevalence rates, the course of binge eating pathology, evidence-based treatments, and factors leading to the development of binge eating disorder.
Diagnosis and Severity Assessment of Binge Eating Disorder
The diagnosis of binge eating disorder involves clinical interviews by healthcare professionals, including clinical psychologists and physicians, to determine if the affected individuals meet the criteria laid by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Additionally, the severity assessment of the disorder can be done using different instruments. The instruments used in assessing binge eating disorder severity need to be
examined to make appropriate changes since its inclusion in the DSM-5 (Zelkowitz et al., 2021). This will enable the severity assessment to reflect the new criteria and cause formidable reliability and validity on the instruments' performed tests. Patients can also record daily binge eating diaries to determine the frequency of binge eating. This can provide reliable information since patients write detailed accounts of their food intake and indicate the type of food that is believed to consist of a binge. The clinicians can examine subjective episodes of binge eating recorded in the diaries to determine whether to classify them as objective binge episodes (Kathryn & MacDonald, 2017). The results are used to determine whether a person qualifies to have a binge eating disorder.
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Risk factors of Binge Eating Disorder
Binge eating disorder can affect both men and women irrespective of race or ethnicity. Commonly, it affects individuals in their late adolescents and early adulthood and is strongly associated with low self-worth (Trim, 2021). The exact cause of binge eating disorder is not well known. However, environmental influences like body shaming, personality traits, and biological factors can trigger binge eating disorders. Numerous risk factors have been implicated in different eating disorders. However, little is known about the actual risk factors associated with binge eating disorders. In a community-based controlled study design, the primary risk factors were identified from comparing subjects with binge eating disorder with those without binge eating disorder as the controlled cases were diverse. Molendijk et al. (2017) included vulnerability to obesity, parental depression, adverse childhood experiences, recurrent exposure to negative views about eating behavior, shape, and weight. Vanzhula et al. (2018) found that pronounced susceptibility to obesity and certain childhood traits distinguished individuals with binge eating disorders from other eating disorders. Individuals with binge eating disorders are reported to have more exposure to adverse comments about their body image and early childhood exposure when equated to other eating illnesses.
The study by Hoerster et al. (2015) show that people with binge eating disorders come in all shapes and sizes since one can be a healthy weight, obese, or overweight and still have the condition. Binge eating disorder seems to be linked to obesity and psychiatric disorder exposure risk factors. The risk factors of binge eating are weaker and more circumscribed when compared with extensive risk factors for other eating disorders like bulimia nervosa (Jordan et al., 2015). Negative self-evaluation, pre-morbid perfectionism, and susceptibility to obesity appear to be categorized in other eating disorders. Besides, family history and genetics are other main risk
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factors. They can consist of a family history of mood disorder or depression, growing up with family members who display unhealthy and disordered eating habits, physical or sexual trauma in the home, negative situations involving trauma or loss of a family member, and emotional abuse and neglect.
Theoretical models suggest the inadequacy of clear empirical support in providing a pathway to understanding binge eating disorder risk factors. As per Baek et al. (2018), the literature has discussed numerous risk factors regarding binge eating. However, there is slight agreement over their implication. Different risk factors incorporate socio-cultural risk factors, particularly ideal body internalization, body mass, body dissatisfaction, the urge to be thin, negative affect, familial factors, and dietary restraint. An extensive literature is centered on how the cultural pressure to be thin affects eating disorder prevalence. Pressure to be thin has been considered the aversive factor linked to eating pathology by increasing body dissatisfaction among women. Researchers like Iacovino et al. (2012), noted that pressure to be thin from the media, romantic partners, peers, and family can contribute to binge eating by increasing dieting chances. Generally, societal pressure of thinness appears to be the predisposing factor that can ultimately cause binge eating, an issue of a particular weight. It is a burden faced by numerous people and is possibly socially accepted or embedded.
Studies have also shown that ideal body internalization is critical in developing binge eating disorders. For instance, experimental reduction of an ideal body internalization contributed to decreased binge eating symptoms, negative affect, dieting, and body dissatisfaction (Vanzhula et al., 2018). Therefore, ideal body internalization seems to place people at risk for the onset of binge eating and can cause the advancement of binge eating disorder. Besides, dieting is a socio-cultural risk factor that predicts binge eating, as shown by
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the dietary restrain theory. According to systemic theory, the family environment has been a substantial causative factor for different eating illnesses such as binge eating. Depression, stress, and anxiety are the negative emotional risk factors contributing to binge eating. Wilson and Sysko, (2009) indicated that low self-esteem has been reported to be frequently associated with the onset of binge eating disorder and is conceptualized as a global negative perception of oneself. The studies on the risk factors of binge eating disorder are primarily associated with the history of dieting, factors associated with the feelings of a person's body image, and challenging family situations (Donofry et al., 2014). However, the research concerning such risk factors is still scarce.
Treatment of Binge Eating Disorder
The most researched psychotherapy for binge eating illness is cognitive behavioral therapy, supported as the best treatment option for the condition. However, Araujo et al. (2010) noted that the first-line treatments are individual psychological therapy proposed for adults with binge eating disorders. Numerous approaches have been recommended to treat binge eating disorders based on individual situations. According to Guerdjikova et al. (2011), cognitive-
behavioral therapy is a time-limited approach that centers on the interaction between behaviors, feelings, and thoughts. Its key treatment components comprise mindfulness, cognitive restructuring, self-monitoring of essential behaviors, developing regular eating patterns, and psychoeducation. Cognitive-behavioral therapy on binge eating disorders incorporates feared foods and dietary restriction (Lydecker & Grilo, 2018). It addresses body image and weight issues and provides alternative skills to cope with and tolerate traumatic events. Besides, cognitive behavioral therapy teaches individuals different strategies of preventing relapse from achieving behavior change but not focusing on weight loss. Cognitive-behavioral therapy does
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not necessarily contribute to weight loss when treating binge eating disorders. Studies show that cognitive-behavioral therapy can be helpful for individuals wanting to recover or abstain from binge eating. There is also a short-term treatment of binge eating disorder, referred to as interpersonal therapy, which focuses on interpersonal issues. Another newer form of cognitive-behavioral therapy is dialectical behavior therapy, designed to deal with impulsive behaviors. As Guerdjikova et al. (2017) highlights, scholars argue that persons with binge eating illness tend to face more interpersonal problems that can cause psychological distress in their feelings, thus triggering the onset of binge eating disorder. According to Pawaskar et al., (2016), although interpersonal therapy shows a positive response in treating binge eating disorders, studies have indicated that it is less effective than cognitive-behavioral treatment. Although there are too few studies to conclude the effectiveness of other psychotherapies like mindfulness, group therapy, and family therapy for the treatment of binge eating disorders, they have been shown to promise favorable results (Reas & Grilo, (2014). Mindful eating blended with mindfulness-based eating awareness training with mindfulness strategies helps people become more informed of hunger cues and alter their eating behaviors to avoid binge eating. The potential efficacy of group therapy and family therapy treatment modalities has not been extensively evaluated.
The first Food and Drug Administration-approved medication for treating modest to serious binge eating illnesses among adults is Lisdexamfetamine dimesylate or Vyvanse, the medication for attention deficit hyperactivity syndrome (Guarda, 2021). Vyvanse is a stimulant that can be abused or habit-forming. It is believed to cause more severe side effects, but the common side effects include insomnia and a dry mouth. Other types of medication that are vital in treating binge eating disorder include antidepressants and topiramate. Antidepressants can
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minimize binge eating, but it is not clear how they achieve it (Schreiber-Gregory et al., 2013). However, they are associated with how they affect particular brain chemicals related to mood. Also known as Topamax, topiramate is an anticonvulsant utilized in controlling seizures but has been reported to decrease episodes of binge eating. The side effects of topiramate have been recorded as nervousness, dizziness, concentration trouble, and sleepiness.
Besides, lifestyle and home remedies can effectively reduce binge-eating episodes. Typically, treating binge eating disorders is ineffective without seeking guidance from a healthcare professional (Guarda, 2021). However, individuals can reinforce self-care steps in their treatment plan for binge eating disorders. Individuals should stick to their treatment and never skip any therapy session. Unless supervised, dieting should be avoided at all costs. According to Scott et al., (2019), any dieting attempts can trigger more binge-eating episodes enhancing a vicious cycle that can be difficult to break. Researchers have shown that individuals engaged in binge-eating episodes skip breakfast. However, it is advisable to eat breakfast because it helps minimize the likelihood of consuming meals with higher calories later in the day. Besides, patients with binge eating disorders should strive for the proper nutrients since consuming many during binges does not imply consuming foods with the appropriate nutrients. Availability of certain foods can trigger bingeing, and thus, their environment should be arranged
to keep tempting foods out of reach by limiting their exposure (Towner, 2020). Living with disordered eating conditions is difficult since one has to deal with food daily. The potential risk of medical care should be discussed with the medical care professional to discuss suitable dietary
supplements.
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Summary
Zelkowitz et al. (2021) states that the consequences of post-traumatic stress disorder can be severe, affecting individuals in behavioral, physiological, and psychological ways. Traumatic experiences affect individuals with disordered eating behaviors in numerous complex ways. Understanding the changes in individuals' eating behaviors with eating disorders can be useful for health professionals dealing with eating disorder patients. Binge eating is associated with a wide variety of severe psychiatric and physical health conditions (Turton et al., 2017). This literature review has discussed numerous aspects concerning trauma and binge eating disorders. The current study has shown that binge eating is solidly linked to obesity. However, numerous health care providers fail to recognize disordered eating in their obese patients. Individuals with obesity and with or without binge eating disorders experience numerous forms of anti-obesity stigma. Such adverse experiences might negatively influence compliance to treatment, patient-
doctor relationship, and treatment-seeking. In their view, Salami et al. (2019) hold that there is a greater need to create awareness about binge eating disorders. The potential challenging issue is that whereas overweightness is commonly documented as a chronic physical problem that calls for continuous interventions, the increasing literature about pharmacotherapy for binge eating disorder comprises entirely short-term trials testing acute treatment effects.
Binge eating disorder seems to be related to exposure to risk factors for obesity and psychiatric disorder. In their studies, Reichenberger et al. (2021) showed that the risk factors for binge eating are weaker when compared to those of bulimia nervosa. This literature review describes the most prominent binge eating disorder theories and provides a conceptualization of the disorder in its various presentation forms. Numerous theories focused on poor emotional regulation skills and the availability of adverse effects in the precipitation of binge eating (Lee-
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Winn et al., 2014). Similarly, the common ideas about most of the theoretical models discussed consist of the aversive core beliefs about self and reduced self-worth. Generally, it should be noted that cognitive-behavioral theory models have the most empirical evidence conducted by a huge body of researchers. This is because of the existing of different research published examining the related theories and the treatments of eating disorders based on the models.
Bingeing is a common aspect of eating illnesses and is linked with significant costs like comorbid physical and mental welfare complications, poor social functioning, and reduced life quality. An extensive research exploration concerning cognitive models of binge eating disorder has emphasized the role of dieting or restricting behavior, low self-esteem, emotional regulation, severe affect, and preoccupations with body weight and shape, with much focus on compensatory behavior (Jordan et al., 2015). It is essential to understand explanations at social, relational, and interpersonal levels to comprehend the experience and purpose of bingeing. Little attention has been experienced to the impact of societal factors like body shape and weight on binge eating disorders. Therefore, this qualitative study has contributed essential efforts by analyzing the cultural and social context that potentially influences individuals affected by binge eating.
According to Lawless et al. (2020), binge eating illness is maintained due to its form of coping response to the history of food control and negative affect. While binge eating behavior might offer temporary relief, it promotes a sense of binge out of control and negative mood around the food. Therefore, the triggers of bingeing become implicated as the maintenance aspects in binge eating disorders. Individuals can easily beak from the cycle of bingeing if they get informed about the complex pattern of binge eating disorder. There is a need to support different theories of binge eating disorders to help understand how women experience their
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bingeing behavior. A holistic approach in dealing with or addressing the situation should help the
target population succeed in dealing with binge eating or purging syndrome. Cognitive-behavioral treatment for binge eating illness has been shown to promise short-
term success, indicating that researchers have not explored the maintaining factors in this treatment (Kathryn & MacDonald, 2017). Researchers like Ambwani et al. (2015) call for intensified examination to improve the understanding of cognitive factors that maintain binge eating behavior. The initial step is to improve evidence-based treatments for binge eating. Research should be fixated on the maintaining belief or schemas that might be causative to the regularity of post-treatment decline experienced among patients with binge eating. Theories concerning binge eating disorders have indicated promising preliminary evidence of their efficiency. Legenbauer et al. (2018) highlighted that long-term treatments effective for binge eating disorders should be investigated to enhance the effectiveness of the current treatments. Due to the increased prevalence of binge eating in the general community, mostly among the eating-disordered individuals, and the related costs of the condition experienced in society, attempts must be made to recognize the widespread issue and advance the treatment results. Researchers should consider paying equal attention to all ethnic groups without any assumptions to provide a clear picture about the prevalence rates of binge eating in the entire United States population.
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CHAPTER THREE: METHODS
Overview
The study aims to explore the lived experiences of African American women affected by trauma and binge eating disorder and the challenges faced when accessing treatment. This study will employ hermeneutic phenomenology to investigate and describe the lived experiences of African American women in the State of Virginia regarding trauma and binge eating disorder. The literature review for this study demonstrated that post-traumatic stress disorder and other negative mood triggers contribute to binge eating disorder among women. The emergent nature of phenomenology and the experience between the researcher and the participants is fundamental
in exploring the phenomena of trauma and binge eating disorder among marginalized communities. The section serves as an outline of the research design and strategies for collecting and analyzing data. The descriptive information regarding the research participants is explained. It presents the research design, research questions, hypotheses, research respondents, instrumentations used to collect data, data collection and analysis procedure, and the chapter summary.
Design
The study will employ a hermeneutic phenomenology research design. A purposive sampling research design was used in the sample selection. The researcher employed semi-
structured interviews that were audio-recorded and analyzed. A phenomenology originated from "phenomenon," a Greek word that means something that shows itself and manifests that it can become visible by itself (Fricke & Føllesda, 2016). It is an umbrella that includes a range of research approaches and philosophical movements. As the literature review demonstrated, binge
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eating disorder is triggered by adverse life events. It is reasonable to consider post-traumatic stress disorder on the responses of the research participants for the binge eating disorder. Phenomenology offers the exploration of the recovery journey for such responses and the impact of trauma on the patients with eating disorders; thus, this qualitative method is well suited for the
study. Besides, a holistic approach towards treating binge eating disorders includes finding a suitable way of dealing with traumatic events. This can help promote a deeper understanding of the recovery experience and help design patient-centered interventions that promote positive outcomes recovery from binge eating disorder.
Qualitative Research
There has been an extensive amount of qualitative research studies exploring the efficacy of various treatments of different eating disorders. Most of the studies explored constructs like adverse behavior related to body image, dissatisfaction with one's body weight, and anxiety. However, limited research studies qualitatively explored the lived experiences of African American women exposed to binge eating due to trauma resulting from adverse life experiences. In this research, the phenomenological study will be used to examine trauma and binge eating among African American women in the State of Virginia in relation to European American women. A qualitative research design is appropriate for this study since the main focus is centered on the participant's narration of the lived experiences to help understand and identify the
emerging themes to help in the interpretation of the situation and how to control it. The value of qualitative research in disordered eating is described by various researchers who hold that the lack of such research at the time was a challenge in developing the clinical practice and theoretical approaches.
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Based on the rate of individuals from the marginalized community diagnosed with binge eating disorder, it is essential to strive towards an in-depth level of understanding of individual experiences, which is difficult to achieve through quantitative research techniques alone. Although various studies have shown an improvement in various treatments, the appropriateness of such treatment options to dealing with individual experiences has not been extensively explored. Such in-depth understanding and discovery cannot be inherent in quantitative research design. Thus, the current study strives to towards this level of rigor and the depth to understand the lived experiences of African American women with binge eating disorder by using a qualitative research approach, particularly the hermeneutic phenomenology. The aspects of interest include racial discrimination and body image dissatisfaction that have not been qualitatively explored in a meaningful manner. Thus, it is essential to examine how the respondents from the African American women described their lived experiences to help understand how the recovery process of binge eating disorder can be achieved. Phenomenology
According to Fricke and Føllesda (2016), phenomenology originated from "phainomenon," a Greek word that designates what appears to us. It is thus a qualitative research approach rooted in philosophy and psychology. It explores the experiences of individuals living a
particular phenomenon, enabling the researcher to achieve a complete and deep understanding of
the first-hand experiences narrated by an individual. However, phenomenology describes the lived experiences of numerous individuals; hence it differs from a narrative study that focuses on
a single individual. It assumes that lived experiences of people can help make sense and implies that practical experiential and intuitive understanding is more meaningful than abstract, theoretical knowledge. The principal goal of phenomenological research is to obtain complex,
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vivid descriptions of the lived experiences encountered by an individual as it was lived in the context of space, time, and the association with others in the society.
Through careful exploration, a phenomenological qualitative research design helps in gaining a vivid understanding of the events through the lens of the affected participants. The resulting research data from phenomenological research is detailed since the participants provide narratives of the account based on their knowledge and experiences concerning the study subject.
Phenomenology does not generate theoretical or empirical observations but offers accounts of experiences as we live them. According to Nowell et al. (2017), phenomenology in research is the study of phenomena, their nature, and their meanings. Its focus is on how things appear to us in our consciousness or experiences, where phenomenological researchers aim to offer detailed textured descriptions of lived experiences. Some researchers define phenomenology as a discipline that focuses on individuals' perceptions of the world and what it implies. A qualitative research method is concerned with the meanings and how they arise in the experiences.
The conceptualization of phenomenology as a philosophy is an overarching perspective and a research method from which all the qualitative research is sourced. The phenomenology of perception has prominent themes: essence, reduction, description, and intentionality. Description of the phenomena is considered as the aim of phenomenology. Reduction involves bracketing or suspending the phenomena so that the incidences themselves can be returned to. Essence is the core meaning of a person's experiences that accurately depict it. Intentionality is consciousness because people are always conscious of an event. Therefore, intentionality is the actual meaning of the idea or object that is always more than what is provided in the perception of a single viewpoint.
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Hermeneutical Phenomenology
The standard definition of hermeneutics is that it is the art of interpretation. Hermeneutic phenomenology is a qualitative research method that enables the educational agents to reflect on personal experiences and the professional work to analyze important aspects of such lived experiences, providing them with the needed sense and the essential of the phenomenon (Sloan & Bowe, 2014). The relationship between education and phenomenology is established based on the perspective of sense, considering that education is the transmission from the society to its members based on the sense that the culture has offered to its relationship in the world. It is feasible to find the compilation of reality acquired by society as perceived by the sense transferred by education. Education is essential in the phenomenological method since it helps interpret, understand, and make sense. In phenomenology, the experience from the achievement of the subject-object dualism of modernity is the foundation of all knowledge. For modernity, the
world consists of facts, where a person is a fact among others, and reality is recognized as the aspect outside the consciousness of human beings.
The hermeneutical phenomenology research method is oriented in the description and interpretation of significant structures of the lived experiences and to the recognition of what the pedagogical value of the experiences means. In this study, the phenomenon will be the prevalence of binge eating disorders among African American women. The target population will
be African American women who have experienced binge eating disorders due to traumatic events. The researcher will then select the desired sample based on the number of the required participants to be recruited in the study. The phenomenon is shown in an individual's consciousness and gives significance to the lived world. Phonology does not discard anything
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represented in the consciousness but prioritizes what is presented because people can only speak what they experience. Therefore, human behavior is defined from their experiences.
Phenomenology is a human science delimited as a natural science since lived experiences
are the objects studied. Human science is essential because it allows people to internalize and comprehend the real situations of others and explain their daily life. Besides, it describes the characteristics of the approach giving the explanation to a phenomenon represented in the consciousness of a person. This enables revealing the nature and structure regarding the experience without making generalizations (Sloan & Bowe, 2014). Hermeneutical phenomenology prevents conceptualizing or categorizing how we experience the world by giving reflective character to daily activity. This makes an individual understand the meaning of uniqueness and knowing oneself. Phenomenology will explore the experiential realities concerning binge eating that are little communicable among African American women. Therefore, it is vital to have a systematic and detailed description reflecting all the factors contributing to binge eating among the affected participants. Interpretive understanding can be used to access the non-observable realities displayed by the research participants to reveal the underlying structure that gives meaning to the phenomenon being studied.
Hermeneutic phenomenology rejects the idea of suspending personal opinions and the turn for interpretive narration to the descriptions. It puts the effort to determine the subjective experience and find the genuine objective nature of perspectives realized by a person based on the premise of impossible reduction and acceptance of endless interpretation. Hermeneutic phenomenology is centered on a person's subjective experience and the groups. It attempts to unveil the world experienced by individuals or groups through their life-world stories. It holds
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that interpretation is what is present, and description is an interpretive process. This study design proposes using the hermeneutic cycle to generate the best interpretation of the phenomena.
Strategies in Phenomenology
According to Elida and Guillen (2018), phenomenological description entails four strategies: intuiting, bracketing, analyzing, and describing. These strategies will be employed in this study to achieve the researcher's desired goal in the appropriate manner. The special strategies in phenomenology are described below;
Intuiting
Intuition is a phenomenological research process that involves thinking through the data to develop an accurate interpretation, or a true comprehension of what is meant in a given description is achieved. In this strategy, the researcher gets absorbed in the phenomenon, looking
at it from a newer perspective without layering it with what had been bracketed out. The process of intuiting requires maximum concentration since it requires intense researcher involvement. Intuiting leads to the common understanding of a particular phenomenon being explored (Elida & Guillen, 2018). This enables the researcher to understand the phenomenon of trauma and binge eating as described by African American women. The researcher can encourage knowledge
generation during the collection of data through facilitative techniques like refraining from leading questions but focusing on asking open-ended clarifying questions. Bracketing
Bracketing is the process of holding assumptions and preconceptions in suspension to improve the research rigor (Sloan & Bowe, 2014). This implies that the researcher will examine the assumptions and presuppositions to keep them in suspension or set them aside but not to conceal them to avoid causing interferences with the respondents provided information.
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Throughout the study, the bracketing strategy or process is essential, particularly during the analysis of the collected data. It requires the researcher to avoid bias and remain neutral regarding the belief or disbelief in the presence of the phenomenon being studied. In this study, the researcher will have to identify any preconceived ideas about African American women who have been affected by disordered eating, particularly binge eating disorder. Besides, the history of participants concerning trauma will be given consideration. The process will help prevent the information from interfering with the recovery of pure phenomenological description. It will allow trustworthiness and accuracy to prevail and determine the validity of the research outcomes. Analyzing
In phenomenological analysis, the essence of the phenomenon being explored is identified according to the collected data and presented. During the analysis process, the researcher pays close attention while listening to the participants' descriptions (Nowell et al., 2017). Comparisons and contrasts of the description regarding the phenomenon being studied are
also conducted. Close attention is necessary to help identify the repeating themes and interrelationships at this stage. Common essence or themes begin to emerge in this process when the researcher starts to listen to the descriptions and experiences of African American women affected by trauma and binge eating disorder. Describing
The aim of describing is to communicate and distinctly describe verbally or in writing. Describing is the final critical element of the phenomenon since it communicates or delivers the information to others about the researcher's findings. Premature description of the phenomenon by the researcher should is not encouraged. Therefore, premature descriptions should be avoided
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since it is a common methodological error linked to the research type. Phenomenological description in this study will involve classifying the essences or all the crucial elements common to the lived experiences of binge eating disorders and describing the essences in detail. Research Questions
RQ1: What is the relationship between trauma and binge eating disorder?
RQ2: How does the ethnic disparity in Virginia State affect African American young women from seeking treatment for trauma and binge eating disorders?
RQ3: What is the prevalence rate of binge eating disorder among African American women compared to the European American women in Virginia State?
Participants and Setting
Setting
The study interviews will be conducted online. Online focus groups will be scheduled to conduct live sessions as planned by the researcher. The participants will be recruited by the in the
teams and invited to log on to live online session at a scheduled time. The interview duration will
be communicated to the participants during the recruitment. The discussions will be recorded and
stored to be used during the analysis process. Participants
The sample population comprised of young women from the State of Virginia. The population is the entire set of people with some common characteristics as defined by the sampling criteria designed for the study (Uriegas et al., 2021). The population for this study comprised women from the State of Virginia, from which a sample was selected. Certain inclusion and exclusion criteria will be set in place. Only individuals identified as African American young women will be recruited from churches, healthcare centers, and higher learning
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institutions were included in the study. The selection criteria for the participants will be to self-
identify as African American. Participation will be voluntary, and there will be no incentive provided. Male and other races will be excluded since the main focus will be to determine the rate at which binge eating disorders are experienced among African American women. The study
respondents are considered representative of the State of Virginia population. Identification and selection of research participants will be conducted through purposive sampling. This technique is vital as it enables the researcher to use own discretion to select suitable participants for the study based on their knowledge. Besides, snowball sampling will be employed in the recruitment
of the participants. The recruited participants will help the researcher identify other potential subjects that can provide a first-hand experience of the phenomenon under study.
The study will comprise a sample size of 18 participants. Besides, the development of a detailed and dense description of disordered eating experiences will also contribute to the number of participants to be recruited in the study. In the inclusion criteria, the factors considered will include being a woman self-identified as African American, aged between 19 to 25 years, and having a history of post-traumatic stress disorder. The sample used in the study will
comprise of African American young female students from Liberty University, willing to participate in the study. Snowball sampling will be employed to easily identify possible respondents. Since the study will involve human subjects, the researcher will seek IRB approval from the relevant authorities. The participants included in the sample are believed to have a history of binge eating disorder due to post-stress traumatic disorder caused by racial discrimination, sexual assault, dissatisfaction with their body image, and other life-threatening events like road accidents. Besides, proper consent will be sought from the participants before being recruited in the study.
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Procedures
The research participants will be approached in the field where the informed consent will be provided to them prior to the actual data collection process. They will be detailed how the online session will be conducted. The participants will also receive a complete outline of the exploration endeavor for them to be as unbiased as possible. However, there will be no particular
method for objective control. The informed consent will document the procedure, including risks
and benefits of the study, time commitment of the respondents, and the information confidentiality that will be gathered. Besides, participants will be informed about the aim of the investigation, the right to respond to the research, and the free will to withdraw from the participation without any hindrances. The interview date will be informed to the participants through telephone calls and data. Data will be collected through voice recording and note-taking.
Initials will be used to conceal the names of the participants.
The research participants will be required to sign an informed consent form before the interview. This will provide complete assurance of the confidentiality of their responses, and it will only apply to the respondents willing to provide their views and insights about the research topic (Nowell et al., 2017). After each interview, the data will be reviewed, analyzed, and interpreted into themes and meaningful concepts.
Researcher's Role
The role of the researcher in this study will be to attempt to access the feelings and thoughts of African American women experiencing trauma and binge eating disorder. In phenomenological research, the researcher focuses on gaining insights into the feelings and opinions of individuals to provide the basis for future stand-alone qualitative studies. This is a tiresome task since it involves conducting interviews and asking people about things that might
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be very personal to them. Besides, the experiences under examination might be new to the mind of the participants, and it cannot be easy to relive the past experiences. However, the researcher is primarily responsible for safeguarding the research respondents and their data. Besides, the mechanism for such safeguarding will be articulated to the participants before that study begins. Data Collection
The pilot study will be conducted before the actual data gathering process by distributing the survey questionnaires to two respondents through email and getting their feedback. Potential participants that will comprise of students will approached in the field and asked their willingness to participate in the study. They will also be required to provide their contact details that will be used to invite them in the online session. The data collected through the pilot study will make available the difficulties and the factors that might influence African American women
with binge eating disorders. The selected sample will collect the target samples' expectations, perceptions, and beliefs.
The primary criterion variable will be binge eating symptomatology, while the estimation
of weight status will be the primary predictor variable. Based on these variables, binge eating behavior will be determined from the eating attitude test. Besides, the response regarding weight perception will be collected with the purpose of assessing weight status estimation. The researcher will use a questionnaire to acquire basic personal, previous history, and demographic data. The information gathered includes age, ethnicity, sex, history of the post-stress traumatic disorder, lowest and highest weight, height, mental weight, and ideal weight. As per Uriegas et al. (2021), mental weight is the perceived weight of a person if they do not consciously attempt to control their weight. For instance, people may tend to think that if they do not eat healthily or
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exercise to control weight, they might weigh more. The elimination of behaviors like exercising and healthy eating can contribute to the feelings like gaining an unrealistic amount of weight.
The Eating Attitude Test will be administered to screen for the symptoms and behaviors of eating disorders. According to Pacheco (2012), healthcare professionals use the tool to identify people at risk for eating disorders and start an appropriate treatment plan. The eating attitude test symptom checklist is a self-reported measure that provides information concerning pathogenic behaviors or the frequency of the symptoms. This tool is the most widely used screening measure for eating disorders. In this study, the research participants will be directed to respond to various items based on a 6-point Likert scale based on the self-report instructions. The
response options will range from "never" represented by the numerical value of 1 to "always" represented by a numerical value of 6. The eating attitude test is an instrument that has been found to have good reliability and validity.
The data collected on the predictor variable will be the estimation of weight. The response will comprise five response weights: very overweight, slightly overweight, about the right weight, slightly underweight, and very underweight. In various studies, researchers have measured weight perception with similar or identical response scales with every answer associated with the categories that include overestimation of weight status, accurate estimation of
weight status, and underestimation of weight status. The relationship between the response and perceived weight status will be based on the body mass index (Pacheco, 2012).
Interviews
This study will use semi-structured interviews since they are designed to exchange information with informal characters, conversing for a goal. Semi-structured interviews are characterized by open-ended questions with an interview guide that defines broad areas of
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interest. The predefined topics for this study will be derived from the literature review. At the start of the data collection, the researcher will adapt and improve the process after gaining more insight into the participants. Surveys/Questionnaires
The questionnaire will be administered to the study participants with a sample of questions designed by the researcher. The sample questions include;
1.
Please introduce yourself.
2.
What is your experience with trauma and binge eating disorder?
3.
What is your perception of eating disorders for the African American community?
4.
How would you describe your experience with the healthcare professionals while seeking
binge eating treatment? 5.
What does an eating disorder mean to you?
Document Analysis
Thematic analysis is appropriate for this study since it involves reading through the dataset like interview transcripts and identifying the patterns in meaning across the collected data
to derive the themes (Kiger & Varpio, 2020). It involves an active reflection process where the researcher. Thematic analysis will be used in this study to identify the patterns in the data provided by the research respondents. Besides, this approach is flexible as it allows the researcher to generate new concepts and insights derived from the gathered data. The researcher reviews the data to ensure each theme is distinct and has enough data to support them (Lester, 2012). Similar themes are merged, and those without enough data to back them up are eliminated. After wholly thought out the themes, the researcher can then communicate to the readers about the analysis or the validity.
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In this phenomenologically based research, conversations and analysis of personal texts will also be employed. Since the conversation is constrained with time and the opportunity to balance focusing on the research goal and avoiding undue interference by the researcher, various instruments will be used to record and store the provided information for future reference. Interview notes and voice recording techniques will ensure accuracy during data analysis. Establishing a good level of rapport and understanding will be vital while interacting with the participants to help the research gain in-depth information.
Focus Group
Focus group as a research method is dominant for phenomenology study. This research method brings individuals from the study population together in a specific setting to discuss an issue and generate the research data. They will be used as group interviews to examine the experiences of African American women concerning trauma and binge eating. The study will employ a focus group consisting of six African American women to seek essential characteristics
of the experiences with binge eating disorder. The focus group will be required to preserve the individual lived experiences within the group context. The focus group is appropriate for this study as the group interviews can be beneficial because they stimulate discussions and open up new opinions from the participants. Therefore, the group context will allow for better exploration
of the perspectives, values, attitudes, ideas, knowledge, and beliefs since it empowers the research participants.
This study will use focus groups since they are inexpensive, fast, and relatively easy to access information while interacting with the research participants. Although the technique can be less appropriate for discussing sensitive topics, the research respondents will be informed prior to the actual data collection to express their willingness to take part in the discussion. This
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will enable them to decide if they are willing to disclose sensitive matters in the group setting. Besides, the research will pay attention to the emergence of groupthink and possible dynamics experienced within the group. Observation guides will be essential while the observer or the researcher takes non-verbal aspects of the circumstances. The participants will comprise of African American female students from Liberty University. A focus group will consist of six participants where interview questions developed by the researcher will be asked.
Observations
Observation is a way to collect data by watching the research participants' events or paying attention to physical characteristics in their natural setting. Mainly, observation is useful in gaining insight into the actual behavior and a particular setting (Busetto et al., 2020). In this study, the researcher will be the observer and attempt not to influence the setting. The approach will involve collecting data using the observer's senses by listening and looking systematically and meaningfully. During the observation, the researcher will take notes on every event and various pre-determined parts taking place around them. For instance, the observations will focus on taking notes on interactions with the research participants. Participants will be observed during online video conferencing sessions. The observations will occur randomly during the entire online session with the participants. After the interaction with the research respondents, the
notes will be transcribed into the observation protocol.
Data Analysis
The data analysis process is discovering meaningful categories, patterns, coherent themes, and new ideas to understand the phenomenon better (Kiger & Varpio, 2020). In this study, the thematic analysis will be employed. After the collection of data, the information will be categorized with the objective to recognize any patterns representing the perceptions
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presented by the participants during the collection of data. Data will be organized into logical categories, summarizing and making sense of the notes' manuscript. While identifying the emergent themes, the researcher will develop specific codes to help in identifying the concepts into meaningful themes. This will help identify the sub-categories not recognized in the initial advancement of the study.
The purpose of conducting interviews is to find out what others think. This helps the researcher to find out what cannot be observed. After the interviews, data is reviewed, analyzed, and interpreted into themes and meanings. The thematic analysis involves categorizing, synthesizing, and analyzing the qualitative text data through describing (Nowell et al., 2017). The data analysis process is described as looking for patterns to explain the goal of a phenomenon being studied. Data analysis will use the responses from the interviews and the administered questionnaires. The emerging themes from the sources will be categorized according to the indicators from the literature.
Trustworthiness
Trustworthiness in qualitative research concerns establishing credibility, dependability, conformability, and transferability. Since the qualitative nature of this research does not use instruments with established metrics regarding validity and reliability, it is vital to address how the researcher will develop credible, confirmable, transferable, and dependable study findings (Sanjari et al., 2014). Trustworthiness, or the study rigor, is the degree of confidence in the research method, data, and interpretation of findings to ensure quality is achieved. Procedures necessary to make this study worthy of the readers' consideration will be established. Trustworthiness is about establishing these four concepts, the criteria established for qualitative researchers as described below;
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Credibility
Credibility is how confident the researcher is in the truth of the research findings (Connelly, 2021). The researcher will ensure that the results are true and accurate in this study by
employing the triangulation technique. This will involve analyzing every participant's views independently concerning their experience with trauma and binge eating disorder. Besides, multiple data collection methods like observations, note-taking, and recording of the occurrences
during the discussion will be employed. Dependability and Confirmability
Dependability is the extent that when other researchers repeat the study, the generated findings will be consistent (Busetto et al., 2020). The researcher will ensure that enough information is generated during the study. This will be useful in helping other researchers who want to replicate the study obtain similar findings. Dependability can be achieved through conducting an inquiry audit. Confirmability is the degree of neutrality in the researcher's conclusions. The researcher will ensure confirmability by providing an audit trail highlighting the data analysis steps used in this study to justify the decisions. Confirmability is vital in this study since the findings will be based on the responses of the participants. Therefore, this will minimize any potential bias due to the researcher. Transferability
Transferability is how confident the researcher demonstrates the applicability of the study
findings to other concepts (Connelly, 2021). Other contexts can imply similar situations, similar phenomena, or similar populations. For instance, the study on binge eating among African American women should be confidently be applied to other minority communities. The
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researcher can use descriptions to show the research findings' applicability to other contexts in this study. Ethical Considerations
The in-depth nature of the study process in qualitative research makes the ethical considerations have a particular resonance. Protecting human subjects by applying appropriate ethical principles is crucial in research studies (Sanjari et al., 2014). Ethical issues will be more salient in this study when conducting one-to-one interviews with participants vulnerable to trauma and binge eating disorder. Various ethical issues will be considered when the researcher interacts with the research participants, and they include;
Anonymity and Confidentiality
The participant anonymity and confidentiality will be preserved by hiding the identity and names during data collection, analysis, and reporting of the research findings. The researcher
will ensure that the privacy and confidentiality of the research respondents are well managed during the interview and discussion sessions. This will enable participants to provide the needed information to the researcher freely.
Informed Consent and Voluntary Participation
Informed consent involves the free provision of the consent and the subjects to understand what the researcher requires. This implies that the participants should be adequately informed about the research, understand the information, and have the freedom to decide whether or not to participate in the study voluntarily (Sanjari et al., 2014). The agreement with the participants to take part in the study will be obtained only after a thorough explanation of the research process. The potential participants will be privately approached and provided a description of the aim of the study and the data collection procedure. The voluntary nature of the
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research will allow them to withdraw from the study as it will not affect the process. An explanation will be provided to potential participants to withdraw from the study at their convenient time after signing the consent form.
Ethical Approval
Before starting the research exploration, ethical approval will be sought from the respectful authorities. Some modifications along the study period will be done when necessary since obtaining ethical approval is not a straightforward process.
Data Protection
The study will ensure the participant data is well protected. The collected information will be stored in protected data storage devices. The interview transcriptions, including the signed consent form and the responses from the research participants, will be stored in a sealed wrapping and stored in a locked cabinet. The first point of contact will be through a phone call to
confirm their availability for participation. The study will be conducted with the selected participants for confidentiality. The identity of the research respondents will remain confidential, and their names will not be directly associated with any data. All the anonymized data will be stored in safe and secure storage for a specified period. According to the data protection procedures, a safe and secure disposal method will be used. Identifiable data will be destroyed as
soon as the researcher considers them unnecessary. Summary
Literary, phenomenology is commonly understood as an exploration of phenomena, the experiences of things as they seem in our experience. It examines the conscious experiences as experienced from the first-hand perspective (Fricke & Føllesda, 2016). This study aims to determine the prevalence rate of trauma and binge eating disorder among African American
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women compared to European American women. In this chapter, the research methodology that will be employed in the study, that is, the hermeneutic phenomenological study, has been discussed. The described method will be used to determine the relationship between trauma and binge eating disorder, show whether there is a relationship between ethnic disparity and the search for treatment for trauma and binge eating disorder among African American women and whether binge eating disorder is more common among African American women than European American women. Utilizing the thematic analysis in the hermeneutic phenomenology study will provide an overview concerning the experiences of African American women with binge eating disorders.
Besides, this section provided a discussion concerning the participants and the recruitment setting grounded on the researcher's inclusion and exclusion criterion. The discussion
includes the research instrumentations and procedures. Thematic analysis is the proposed data analysis approach in this phenomenological study. The information for the data analysis that consists of identifying themes from the responses about the experiences of trauma and binge eating disorders provided by the African American women incorporated in the study are also discussed. Data confidentiality and informed consent for the study participants are also presented
in this chapter.
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Directions
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