What is binge eating disorder?

Binge eating disorder (BED) is a behavioral disorder characterized by chronic, compulsive overeating. While occasional overeating is normal, an eating disorder is a condition that you live with every day. It feels like it controls you and interferes with your mental, emotional and physical well-being. Binge eating means consuming large quantities of food in a short period and feeling like you can’t stop.

What is considered binge eating?

Criteria to diagnose binge eating disorder include:

• Eating a greater amount of food than most people would within a limited period (one to two hours).
• Feeling a sense of compulsion or lack of control associated with eating.
• Binge eating episodes occur at least once a week and have been going on for several months.
• Feelings of distress and/or self-loathing about binge eating.

What is the difference between bulimia nervosa vs. binge eating disorder?

Unlike bulimia nervosa, binge eating disorder doesn’t involve purging calories, such as forced vomiting, abusing laxatives or exercising excessively after eating. A binge eating episode ends with eating. On the other hand, some people with binge eating disorder are chronic dieters. They may attempt to restrict calories before lapsing into binge eating, or they may attempt to diet after a binge to make up for it.

How common is binge eating disorder?

Binge eating disorder is the most common of all eating disorders, accounting for almost half of all diagnoses. In the U.S., it affects almost 3% of the population, including all racial and ethnic groups. It’s more commonly diagnosed in women and people assigned female at birth than in men and people assigned male at birth, by a ratio of about 3:2. It’s also more commonly diagnosed in teenagers than adults, by a ratio of about 4:3.

What are the signs and symptoms of binge eating disorder?

Signs and symptoms of binge eating disorder may include:

• Eating past the point of satisfaction and to the point of discomfort.
• Eating too fast to notice how much you’re eating or how it feels.
• Eating large amounts of food when you’re not hungry or after recently finishing a meal.
• Eating in response to emotional stress (emotional eating).
• Eating alone and in secret and avoiding social eating.
• Organizing your schedule around binge eating sessions.
• Hoarding and stashing food in hidden places to access later.
• Hiding eating from others because you’re embarrassed about how much you’re eating.
• Obsessive thinking about food and specific food cravings.
• Frequent dieting, which may cause weight fluctuations or no weight loss.
• Guilt, remorse, shame and self-esteem issues related to binge eating.

Many people may exhibit signs or symptoms of binge eating occasionally. When they begin to recur regularly (once a week or more), you may have a disorder. Environmental conditions such as stress and relationships can influence your behavior and affect your mental health. These conditions may combine with other causes to push you over the edge from occasional disordered behavior to meeting the criteria for BED.

What causes the urge to binge eat?

Many factors influence eating behavior, including psychology, biology and learned habits. What triggers you to binge eat might be different from what triggers the next person. Eating can release pleasure hormones in your brain (serotonin and dopamine,) which might encourage addictive tendencies. Eating can also be a way of escaping or numbing uncomfortable feelings or compensating for unmet needs.

What risk factors are associated with binge eating disorder?

You may be more likely to develop binge eating disorder if you have:

• A family pattern of disordered eating.
• A family pattern of dysfunctional emotional coping.
• A personal history of trauma or abuse.
• A personal history of food insecurity.
• A mood disorder such as depression.
• An anxiety disorder (general or specific).
• Attention deficit/hyperactivity disorder (ADHD).
• Substance use disorder (SUD).
• Body dysmorphic disorder (BDD).
• Executive dysfunction.

What are the possible complications of binge eating disorder?

Any mental health disorder can escalate to cause increasingly destructive thoughts, feelings and behaviors. Binge eating disorder can also bring with it the health complications associated with obesity. While not everyone with BED has obesity, the combination of these two disorders can be especially harmful. The cycle of binge eating and weight gain can compound your mental and physical distress.

Complications of untreated mental illness can include:

• Increasingly antisocial behavior, such as secrecy, avoidance and lying.
• Increasingly erratic behavior, such as stealing and hoarding food.
• Increasing depression, anxiety and body dysmorphia.
• Increasing distress, self-loathing and risk of self-harm.

Complications of obesity can include:

• Type 2 diabetes.
• Cardiovascular disease.
• Gallstones.
• Fatty liver disease.
• Kidney disease.
• Osteoarthritis.

How is binge eating disorder diagnosed?

Healthcare providers diagnose eating disorders by asking detailed questions about your behaviors, thoughts and feelings. You might be reluctant to open up about these details, but honesty is important to getting the right diagnosis and the right treatment. You can start by talking to your primary care practitioner or seek out a mental health care practitioner. Either one can make the diagnosis.

Is there a test for binge eating disorder?

There’s no test, though the questions you’ll answer might take the form of a quiz. Your healthcare provider will analyze your answers according to the diagnostic criteria listed in the DSM-5. They may also ask follow-up questions not listed in the manual. If they think you meet the diagnostic criteria, they’ll diagnose binge eating disorder.

Do I need a diagnosis?

You don’t necessarily need a diagnosis to begin treatment. In fact, you may benefit from treatment even if your symptoms are “subclinical” (meaning, they don’t quite meet the criteria for diagnosis). Going through the interview process with a healthcare provider will help you and them to learn more about what type of support may benefit you. Some people feel relieved or validated by receiving a diagnosis and more empowered to seek help. This can be especially important for parents trying to help their children.

How do you recover from binge eating disorder?

There’s no quick fix, but with a consistent, long-term treatment plan, you can recover. Psychotherapy is usually the foundation of this treatment plan, and it’s proved effective for most people. Depending on the individual, your plan may also include medications or nutrition advice. You may interact with a variety of healthcare specialists, such as a psychologist, a psychiatrist or registered dietician.

What’s in the treatment plan for binge eating disorder?

Psychotherapy (talk therapy) is the most important part of the treatment plan. You can choose from several different methodologies or approaches. Medications or diet may play supportive roles in your treatment plan. Medications and diet don’t address binge eating disorder directly, but they can help you manage some of the factors that may contribute to your disorder.

Therapy

There are many types of psychotherapy. The most studied and proven methods for treating BED are:

• Cognitive behavioral therapy (CBT): CBT helps you examine your behaviors and the thoughts and feelings behind them. Your therapist then works with you in a structured way to break those patterns and find more constructive ways of responding to those thoughts and feelings.
• Interpersonal therapy (IPT): IPT is a short-term, focused type of individual therapy that addresses the current conflicts and stress factors affecting your life. Rather than dig into childhood issues, your therapist focuses on problem-solving to relieve your most pressing pain points.

Other options include:

• Dialectical behavior therapy.
• Psychodynamic therapy.
• Individual psychotherapy.
• Group therapy.

Medication

Lisdexamfetamine (Vyvanse®), an ADHD medication, has recently become the first U.S. Food and Drug Administration (FDA)-approved drug to treat binge eating disorder. Research has shown it can help with impulse control in both conditions. It shouldn’t be your only treatment, as impulse control is only one factor involved in BED. It can help suppress BED and keep you from relapsing longer, but it doesn’t address the root of the disorder.

You may also need medication to treat another condition related to your eating disorder, such as antidepressants or anxiety medications. Treating your underlying mental health conditions can help take the edge off your eating disorder. In addition, some providers may prescribe appetite suppressants for some people. These medications have shown short-term benefits for people in treatment for BED.

Diet and nutrition

People of all shapes and sizes can have BED, and they can also have various types of malnutrition. They may be deficient in micronutrients (vitamins and minerals) even if they have an excess of macronutrients (sugar and fat). Nutrient deficiencies can motivate binge eating by producing cravings and a vague sense of not getting enough. Nutritional supplements and nutrition education can help.

Some people find that a structured, nutritionally balanced meal plan can simply reduce some of the decision-making stress related to eating. It can satisfy your physical needs while leaving less room to act impulsively or emotionally. Although weight loss isn’t the main goal of treatment, it can be a side effect, and this can help relieve stress for some people. However, diet may be triggering for others with BED.

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