On the morning of St. Patrick’s Day 2009, Monaco got a call. Her roommate had been killed in an accident after hanging out with friends the night before.

“It broke me,” she said, refusing to talk about the death even now.

For days, Monaco couldn’t eat. Then one afternoon she asked her boyfriend to pick up some Golden Oreos and a box of Toaster Strudels. The carbs comforted her. “I thought, ‘This helped. This feels good. I don’t have to think right now about what happened,’ ” she said.

She started using food to cope with her pain and then blaming herself for using food to cope — although it’s unlikely she knew she was doing so at the time. She felt depressed and guilty, and food simply made her feel better.

When her boyfriend of a year and half broke up with her shortly after her roommate’s death, she went to the grocery store and bought bags of chips and several boxes of crackers. In the months that followed, she forgot all about the lean proteins and vegetables that used to make up her diet.

Monaco’s mom and dad were concerned about her but didn’t realize food was becoming an issue, she says. Before her junior year, they moved her into a new apartment because she was nervous about sharing space with someone again. But living alone just enabled Monaco to binge without worrying about people looking over her shoulder. She started to ignore calls from friends and threw herself into her schoolwork.

The day after she graduated college in May 2011, Monaco stepped on the scale for the first time in years.

Her legs trembled when she saw the number: 240. She had gained more than 100 pounds in two years. She sat down at the kitchen table with her mom, and together they cried.

A new balance

Until DSM-5 — the latest version of the psychiatric diagnostic manual — was released this month, binge eating wasn’t an official eating disorder. Many who have it simply think they are gluttons who lack self-control, says Marsha Hudnall, a registered dietitian and co-owner of the Green Mountain weight loss retreat in Vermont.

The disorder is characterized by frequent episodes of overeating in a short periods of time. People with the disorder feel out of control during binges and are often disgusted with themselves afterward. The usually eat alone because they’re uncomfortable consuming so much in front of others.

It’s estimated that 3.5% of women and 2% of men in the United States have the disorder, but Hudnall says experts believe it’s “extremely underdiagnosed.”

Doctors used treat the disorder by putting patients on a diet. They now know “that is absolutely the wrong thing to do,” Hudnall said.

“Many people who have binge-eating disorder, they’re eating food to cope with their feelings. If you try to take away food without giving them something else to cope, you’re stranding that person. And you make them feel guilty when they go back to the one strategy they know.”

Monaco went to Green Mountain in the summer of 2011. She chose the retreat because it focused on helping women have a healthy relationship with food rather than focusing solely on losing weight.

The first priority at the retreat, Hudnall says, is to get patients to eat regular, small meals that are based on the government’s MyPlate guidelines. Many people who binge go long periods of time in between without eating to try to save calories, which can lead to more binge eating later on.

The next step is therapy, where the patients learn other strategies for coping with their emotions.

For Monaco, that meant writing. She purged her emotions into a journal and tried to forgive herself for using food to cope. She bonded with other women at the retreat who were all just “trying to get to a happy place.”

“For the first time, I was not alone,” she remembered. “I was not sitting alone in my car or in room somewhere or in a bathroom stall, eating. … This place really acknowledged that we’re all real people with real problems.”

Four weeks later, Monaco left with a better understanding of her disorder. She knew that she couldn’t go back to the same environment that had led her to this pain, so she packed up and moved cross-country to live near her brother in California.

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