Binge Eating Disorder

Binge eating disorder is the most common eating disorder in the United States, affecting nearly 30 million Americans in their lifetimes, yet many people don’t realize it’s a serious medical condition that requires professional treatment.

Table of contents

• What is binge eating disorder?
• How common is binge eating disorder?
• Signs and symptoms
• How is binge eating disorder diagnosed?
• What causes binge eating disorder?
• Health consequences
• Related mental health conditions
• Treatment options
• Getting help

What is binge eating disorder?

Binge eating disorder is a serious mental health condition that causes frequent episodes of eating unusually large amounts of food in a short period of time while feeling unable to stop^[2]. Binge eating means consuming large quantities of food in a short period and feeling like you can’t stop^[4].

Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But binge eating disorder is different from occasional overeating^[2]. People with binge eating disorder eat very large quantities of food without feeling like they’re in control of what they’re doing^[3]. Unlike people with bulimia nervosa, those with binge eating disorder do not try to get rid of the food through behaviors such as vomiting, though they may sometimes fast between binges^[3].

A binge eating episode is characterized by eating an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances, coupled with a sense of lack of control over eating during the episode^[7]. Binges are sometimes planned in advance, but can be spontaneous. They are usually done alone, and may include special binge foods^[5].

How common is binge eating disorder?

Binge eating disorder is the most common eating disorder that healthcare providers diagnose, accounting for almost half of all eating disorder diagnoses^[4]. In the United States, it affects almost 3% of the population^[4]. Approximately 2.7% of women, 1.7% of men and 1.8% of adolescents suffer from binge eating disorder^[7].

The disorder is 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^[4]. This disorder is seen in all age groups, races, ethnic backgrounds, and socioeconomic income levels^[7].

Signs and symptoms

People with binge eating disorder may be at a healthy weight, overweight, or obese^[2]. Most people with binge eating disorder feel upset about their body size or shape no matter what the number on the scale is^[2].

The main symptom of binge eating disorder is eating a lot of food in a short time and not being able to stop when full^[5]. Other behavioral and emotional signs include:

• Feeling that you don’t have control over your eating behavior, for example, you can’t stop once you start^[2]
• Often eating much larger than usual amounts of food in a specific amount of time, such as over a two-hour period^[2]
• Eating even when you’re full or not hungry^[2]
• Eating very fast during eating binges^[2]
• Eating until you’re uncomfortably full^[2]
• Often eating alone or in secret^[2]
• Feeling depressed, disgusted, ashamed, guilty or upset about your eating^[2]
• Eating when not hungry^[5]
• Having obsessive thoughts about food and specific food cravings^[4]
• Hoarding and stashing food in hidden places to access later^[4]
• Frequently dieting, which may cause weight fluctuations or no weight loss^[4]

People who regularly eat in this way may have binge eating disorder^[5]. People with binge eating disorder often feel embarrassed or ashamed about eating binges. People with the disorder often go through periods of trying to restrict or severely cut back on their eating as a result. But this instead may increase urges to eat and lead to a cycle of ongoing binge eating^[2].

How is binge eating disorder diagnosed?

To be diagnosed with binge eating disorder, specific criteria must be met. The diagnosis involves recurrent episodes of binge eating, where an episode is characterized by eating an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances, along with a sense of lack of control over eating^[7].

The binge eating episodes must be associated with three or more of the following behaviors:

• Eating much more rapidly than normal^[7]
• Eating until feeling uncomfortably full^[7]
• Eating large amounts of food when not feeling physically hungry^[7]
• Eating alone because of feeling embarrassed by how much one is eating^[7]
• Feeling disgusted with oneself, depressed, or very guilty afterward^[7]

Additionally, marked distress regarding binge eating must be present, and the binge eating must occur, on average, at least once a week for 3 months^[7]. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors such as purging, and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa^[7].

If you think you may have binge eating disorder, see a doctor as soon as you can. They’ll ask you about your eating habits and how you’re feeling, and check your weight and overall health^[5]. A healthcare professional may recommend a mental health evaluation, which includes talking about your feelings and eating habits with a mental health professional^[10].

Your healthcare professional also may want you to have other tests to check for health problems that can be caused by binge-eating disorder. These may include high cholesterol, high blood pressure, heart problems, diabetes, poor nutrition, and other conditions. Tests may include a physical exam, blood and urine tests, or other specialized evaluations^[10].

What causes binge eating disorder?

The exact causes of binge eating disorder are not known, but it’s likely a combination of things, including genetics, family eating habits, emotions, and eating behavior^[4]. 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^[4].

Eating can release pleasure hormones in your brain, which might encourage addictive tendencies. Eating can also be a way of escaping or numbing uncomfortable feelings or compensating for unmet needs^[4]. Some people use food as a way to soothe themselves or to cope with difficult feelings^[4].

You may be more likely to develop binge eating disorder if you have certain risk factors, including:

• A family pattern of disordered eating^[4]
• A family pattern of dysfunctional emotional coping^[4]
• A personal history of trauma or abuse^[4]
• A personal history of food insecurity^[4]
• A mental health condition, such as depression or anxiety^[4]
• Attention-deficit/hyperactivity disorder (ADHD)^[4]
• Substance use disorder^[4]
• Body dysmorphic disorder^[4]

You are more likely to have an eating disorder if you or a member of your family has a history of eating disorders, depression, or alcohol or drug misuse, if you’re too worried about being slim, if you have anxiety, low self-esteem, an obsessive personality or are a perfectionist, or if you’ve experienced a stressful event or trauma^[5].

Health consequences

Any mental health disorder can escalate and cause increasingly destructive thoughts, feelings and behaviors^[4]. Binge eating disorder can bring with it the health complications that come with having obesity, though not everyone with binge eating disorder has obesity^[4].

Research shows that individuals with binge eating disorder are at a higher risk for developing the following health conditions:

• Type 2 Diabetes^[7]
• Metabolic syndrome, which includes a higher waist circumference and increased triglyceride levels^[7]
• High cholesterol^[10]
• High blood pressure^[10]
• Heart problems^[10]
• Poor nutrition^[10]
• Stomach cramps and other non-specific gastrointestinal complaints such as constipation and acid reflux^[7]
• Sleep-related breathing disorders^[10]

People with binge eating disorder may also experience noticeable fluctuations in weight and difficulties concentrating^[7].

Related mental health conditions

People with binge eating disorder are more likely to have other mental health problems. The following are some conditions that frequently co-occur with binge eating disorder:

• Anxiety disorders including generalized anxiety disorder, social anxiety, phobias, panic disorder and post-traumatic stress disorder^[7]
• Attention-Deficit/Hyperactivity Disorder (ADHD)^[7]
• Bipolar Disorder^[7]
• Depression and other mood disorders^[7]
• Substance use disorders^[7]
• Suicidality^[7]

Many people who binge eat are unhappy about their weight and may feel depressed^[4]. They may have feelings such as depression, anxiety, guilt, or shame^[4]. They may avoid school, work, or socializing with friends because they’re ashamed of their binge eating problem or changes in their body shape and weight^[4].

Treatment options

Most people recover from binge eating disorder with the right support and treatment, but it may take time^[5]. The goal for treatment of binge-eating disorder is to have healthy, regular eating habits. Because binge eating often involves shame, poor body self-image and other negative emotions, treatment also addresses these and related mental health conditions, such as depression^[10].

Treatment of binge-eating disorder may be done by a team of specialists. The team can include doctors and other healthcare professionals, mental health professionals, and dietitians, all with experience in eating disorders^[10]. People with binge eating disorder are best treated by a team that includes a doctor, dietitian, and therapist^[4].

The main treatments include:

Guided self-help programmes: You’ll probably be offered a guided self-help programme as a first step in treating binge eating disorder. This often involves working through a self-help book or self-help guide online, combined with sessions with a healthcare professional, such as a therapist^[13]. Joining a self-help support group may also be helpful^[13].

Talk therapy: Psychotherapy, also called talk therapy, can help you learn how to exchange unhealthy habits for healthy ones and reduce binge eating. Talk therapy may be in individual or group sessions^[10]. Treatment includes nutrition counseling, medical care, and talk therapy including individual, group, and family therapy^[4].

Cognitive behavioral therapy (CBT): If you’re offered CBT, it will usually be in group sessions with other people, but it may also be offered as one-on-one sessions with a therapist. You should be offered about 20 sessions across 20 weeks^[13]. CBT may help you cope better with issues that can trigger binge eating and involves talking to a therapist who will help you explore patterns of thoughts, feelings and behaviors that could be contributing to your eating disorder^[10].

Medicine: The doctor might prescribe medicine to treat binge eating, anxiety, depression, or other mental health concerns^[4]. Antidepressants should not be offered as the only treatment for binge eating disorder, but you may be offered an antidepressant in combination with therapy or self-help treatment to help you manage other conditions^[13].

By getting help for binge eating, you can learn how to feel more in control of your eating^[10]. Treatment for binge-eating disorder can help people feel more in control and balanced with their eating^[2].

Getting help

Because people often feel guilty or embarrassed about out-of-control eating, many don’t talk about it or get help^[4]. It can be hard to admit you need help with an eating disorder, so bringing a friend or loved one with you to your appointment may help^[5].

If you think you may have binge eating disorder, see a doctor as soon as you can^[5]. The doctor should refer you to an eating disorder specialist or team of specialists if they think you have binge eating disorder or another eating disorder^[5]. Look for a mental health professional with expertise in treating eating disorders^[10].

Getting help early makes it more likely that a person can get better before it causes health problems related to weight gain^[4]. If you’re concerned that a family member or friend may have binge eating disorder, let them know you’re worried about them and encourage them to see a doctor. You could offer to go along with them^[5].