Binge Eating Disorder

What is binge eating disorder?

Binge eating disorder (BED) is a behavioral disorder characterized by chronic, compulsive overeating. While everyone overeats occasionally, 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.

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

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. It’s more common in women than in men, by a ratio of about 3:2. It’s also more common in teenagers than in adults, by a ratio of about 4:3.

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).
• Experiencing guilt, remorse, shame and self-esteem issues related to binge eating.
• Eating alone and in secret and avoiding social eating.
• Having obsessive thoughts about food and specific food cravings.
• Hoarding and stashing food in hidden places to access later
• Frequently dieting, which may cause weight fluctuations or no weight loss.

Unlike bulimia nervosa, binge eating disorder doesn’t involve purging calories, such as forced vomiting, misusing 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.

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 mental health condition, such as depression or anxiety
• 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 and cause increasingly destructive thoughts, feelings and behaviors. Binge eating disorder can also bring with it the health complications that come with having obesity. While not everyone with BED has obesity, the combination of these two disorders can be especially harmful. Binge eating and weight gain can play into each other, adding to 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

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.

Your provider will analyze your answers according to the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria to diagnose BED 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.
• Eating to the point of physical discomfort and/or emotional distress and self-loathing.

Either a mental healthcare practitioner or your primary care practitioner can make the diagnosis.

Do I need a diagnosis?

You don’t necessarily need a diagnosis to begin treatment for binge eating disorder. In fact, you may benefit from treatment even if your symptoms are “subclinical” (they don’t quite meet the criteria for BED). But you may feel relieved or validated by receiving an official diagnosis and may feel more empowered to seek help. This can be especially important for parents trying to help their children.

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

There’s no quick fix, but with a consistent, long-term treatment plan, you can heal from BED. Psychotherapy is usually the foundation of this treatment plan, and it’s proven effective for most people. In some cases, your plan may also include medications or nutrition advice. You may work with a variety of healthcare specialists, such as a psychologist, psychiatrist or registered dietitian.

Therapy

Psychotherapy (talk therapy) is the most important part of the treatment plan for binge eating disorder. There are many different approaches to therapy. The most 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 will work with you to break unhealthy behavior patterns and find healthier ways to cope with the thoughts and feelings that oppress you.
• Dialectical behavior therapy (DBT). This method is based on cognitive behavioral therapy, but it’s specially adapted for people who experience emotions very intensely. It focuses on first accepting those feelings and learning to live with them, and then working to change your behaviors.
• Interpersonal psychotherapy (IPT). IPT is a short-term, focused type of therapy that addresses the current relationship conflicts and stress factors affecting your life. Rather than dig into childhood issues, your therapist will focus on problem-solving your most immediate pain points.

Medication

Medications may play a supporting role in your treatment. They don’t address binge eating disorder directly, but they can help you manage some of the factors contributing to it. Medications may include:

• Lisdexamfetamine (Vyvanse^®). This 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 doesn’t address the root of the disorder, but it can help suppress it.
• Medications for other mental health conditions. You may need medications to treat another condition related to your eating disorder, like antidepressants or anxiety medications. Treating underlying mental health conditions can help take the edge off your eating disorder.
• Appetite suppressants. Some healthcare providers may prescribe appetite suppressants for some people. These medications have shown short-term benefits for people in treatment for BED. They can help to break the cycle of binge eating and introduce a new eating pattern.

Diet and nutrition

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

Some people find that a structured, nutritionally balanced meal plan can help 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 focus of BED 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.

Will I always have binge eating disorder?

Most mental health conditions are chronic, which means that there’s always a risk of relapse. But your disorder can go into remission, and that remission can be lasting. This is what recovery means for binge eating disorder. The road to recovery may not be short or straight, but most people do get better with treatment. Remember, it’s not a matter of willpower. It’s about recognition, support, skills and healing.

What are some tips for living with binge eating disorder?

If you’re trying to get a handle on your binge eating, it can help to become more mindful of the urges that motivate your eating habits. By paying attention to your urges, you can learn to distinguish true hunger from the urge to binge eat. You can also learn to recognize when your hunger is satisfied. And you can become more conscious of what triggers your urge to binge eat. Here are some tips:

• Practice mindful eating. When you’re thinking about eating, or you find yourself preparing to eat, slow down. Take a deep, slow breath. Then, just notice, without judgment, what’s happening in your mind and body. You can also stop and do this while you’re eating.
• Learn to recognize hunger. Physical hunger symptoms include stomach pangs or grumbles, light-headedness and hunger headaches. You may feel slightly tired or weak from low blood sugar. One self-test is to ask yourself if you’re hungry enough to eat something healthy, like salad.
• Eat when you’re hungry. This is just as important as learning to stop eating when you’re not hungry. If you really are hungry, now is the time to eat. Don’t wait until you’re starving, or you’ll be more likely to lose control and binge eat.
• Stop before you’re full. It takes time for your stomach to receive and digest the food you’ve just eaten. Eating too fast can lead to eating too much, simply because you haven’t had time to notice that you’re full. One technique is to stop when you feel almost full — like 80%.
• Keep a journal. Journaling is one of the most tried-and-true methods for becoming more conscious of your thoughts, feelings and behaviors. Take note of what you eat each day and what you’re thinking and feeling. You’ll start to recognize patterns, and maybe triggers.
• Tackle your triggers. If you’ve noticed that certain foods or situations tend to lead to binge eating, look for ways to remove them from your life. Clear your home of your favorite binge foods and plan alternative meals in advance. Avoid social settings that encourage binge eating.

When should I contact a healthcare provider about BED?

If you think you or someone you care for has an eating disorder, it’s always better to contact a healthcare provider sooner rather than later. People who have eating disorders often don’t recognize that anything is wrong, so others who care for them can play an important role in bringing attention to the matter. A healthcare provider can advise you on what to do next to help yourself or your loved one.