What Is Binge Eating Disorder?

Binge eating disorder (BED) is the most common eating disorder (ED). People with BED repeatedly eat a large amount of food in one sitting (called a binge) and feel they don’t have control over their eating behavior. During binges, they usually eat faster than normal, eat until they are uncomfortable, eat when they are not physically hungry, and feel embarrassed, disgusted, or depressed because of their binges. 

Unlike other eating disorders, those with BED do not engage in purging behavior like self-induced vomiting and extreme exercising. People with BED are often overweight, but not all of them are, and being overweight does not always mean someone has binge eating disorder.

Some estimates are that about 3.5% of adult women and 2% of adult men have binge eating disorder, and for men, binge eating disorder is most common between the ages of 45 and 59.

Signs and Symptoms

People with BED feel out of control and binge eat at least once a week for at least three months, according to the American Psychiatric Association. It is not always obvious when someone is struggling with BED because people with this eating disorder tend to hide their behavior from others out of shame or embarrassment.

Binge eating episodes are associated with at least three of the following symptoms:

• Eating faster than normal
• Eating until uncomfortably full
• Eating large amounts of food when not hungry
• Eating alone because of embarrassment
• Feeling disgusted, depressed, or guilty afterward

Disruptions to regular eating behaviors, efforts to avoid eating in public, and large amounts of food going missing or empty wrappers and containers around the house are also signs of BED.

Physical

Physical symptoms of BED include: 

• Weight fluctuations 
• Gastrointestinal issues (such as acid reflux, stomach pain, and non-specific complaints)
• Difficulty concentrating

BED can also lead to metabolic syndrome, a cluster of diseases that can increase the risk of heart disease, stroke, and type 2 diabetes.

Psychological

Psychological symptoms of BED include:

• Anxiety
• Body shape dissatisfaction
• Depression 
• Fear of weight gain
• Low self-esteem 
• Overvaluation of body shape and weight
• Polarized thoughts about dieting and binge avoidance 

Causes

The exact cause of BED is not known, but researchers believe a range of biological, environmental, and sociocultural factors contribute to their development. Studies have suggested that people with BED may use overeating as a way to deal with anger, sadness, boredom, anxiety, or stress.

Other factors that contribute to BED include:

• Body image issues: Depending heavily on weight and appearance for self-esteem has been noted as a contributing factor of BED. Negative body image is also associated with BED.
• Obesity: Although BED can occur in people of any size, it is strongly associated with obesity. Those with BED are about three to six times more likely to be obese than those without an eating disorder.
• Genetics: BED runs in families. One study suggested that a heightened sensitivity to reward, which could manifest as a strong dopamine signal in the brain, could be a contributing factor to BED.
• Other psychological conditions: People with BED often have other psychological conditions as well, including depression, anxiety, PTSD, bipolar disorder, and substance use disorder.
• Trauma: Stressful life events, particularly the death of a loved one, separation from a family member, and accidents, have been associated with the development of BED.

Diagnosis

Binge eating disorder has been added to the Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5) as an official diagnosis. Previously, it was considered a subtype of eating disorder not otherwise specified (EDNOS).

A diagnosis of BED is made based on the following criteria:

• Recurrent episodes of binge eating (consuming a large amount of food and feeling a lack of control over eating) occurring at least once a week for three months
• Marked distress regarding binge eating behavior
• The binge eating is not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

Furthermore, the binge eating that takes place has to be associated with three or more of the following:

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

BED severity is graded as follows:

• Mild: One to three episodes per week
• Moderate: Four to seven episodes per week
• Severe: Eight to 13 episodes per week
• Extreme: Fourteen or more episodes per week

Your healthcare provider will also conduct blood, urine, or other tests to rule out physical conditions that could be related to your symptoms of BED.

Treatment 

BED treatment can help people interrupt and stop binge eating, and form a healthy relationship with food. Treatment usually includes psychotherapy, medications, and nutritional counseling. A combination approach can help people with BED begin to rebuild physical well-being and healthy eating practices.

Psychotherapy

Therapy used to treat BED includes:

• Cognitive behavioral therapy (CBT) is the most evidence-based form of treatment for BED, helping people with this eating disorder reduce or abstain from binging. It works by addressing and transforming underlying thoughts and beliefs related to the person's eating behaviors, body shape, and weight that contribute to binge eating.
• Interpersonal psychotherapy (IT) is a form of short-term talk therapy that helps people reduce binge eating in the short and long term. It focuses on relieving the underlying triggering interpersonal issues that contribute to a person's urge to use binge eating as a method of coping. For example, a session may focus on addressing and remedying feelings of grief that the person tries to binge eat away as a form of maladaptive coping.
• Dialectical behavior therapy (DBT) may help people abstain from binging by teaching them healthier coping mechanisms and encouraging them to develop new ways to deal with negative emotions and triggers that do not involve food. These tools may include mindfulness training and distress tolerance. The goal is not to avoid negative life stressors, but to cope with them without engaging in binging.

People who complete CBT or IT treatment have remission rates greater than 60%, and improvement is usually well maintained over the long term.

Medications

Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that work on brain chemicals responsible for regulating mood, anxiety, appetite, and other functions. By preventing the reuptake (absorption) of serotonin, they increase the level of this neurotransmitter in the brain. SSRIs have shown short-term effectiveness in reducing binging frequency and increasing binge eating abstinence.

Vyvanse (lisdexamfetamine dimesylate) is a prescription stimulant medication approved for the treatment of moderate to severe BED. Clinical trials have shown that it is effective at reducing the number of binges per week. It may work by impacting dopamine in the brain.

Nutritional Counseling

People with binge eating disorder can also benefit from nutritional counseling with a registered dietitian. Nutritional rehabilitation, or medical nutrition therapy, is a therapeutic approach that utilizes specific dietary recommendations for healing and incorporates diet therapy counseling.

Dietitians who are specialized in eating disorder recovery will guide you toward making peace with food and your body by making recommendations that can help you overcome challenges with food and normalize eating habits and behaviors. For example, if there are certain foods that you feel trigger you to binge, a dietitian can help you begin to "legalize" these foods by gradually incorporating them into your diet.

A dietitian will also help you regulate your intake by recommending a meal plan that is tailored to your individual needs.

Coping

Along with professional treatment, coping strategies help people with BED sustain remission and improve overall quality of life. 

These strategies include:

• Practicing intuitive eating (i.e., eating when you are hungry rather than for emotional reasons)
• Practicing mindfulness in eating (maintaining awareness while eating), which has been inversely associated with binge eating and is a negative predictor for developing BED
• Respecting your body (i.e., treat it well by getting adequate rest, exercising, and avoiding harmful substances, especially those that further reduce feelings of control)
• Trying distraction techniques to delay or prevent binging, including reading books, playing sports or board games, or listening to music
• Spending time in nature to reconnect with the external environment and get out of your head
• Talking with someone, or journaling or drawing your feelings

A Word From Verywell

There are many avenues for treating binge eating disorder, and they all begin with a single step. Please know that the earlier you receive support, the better the outcome. There is nothing to be ashamed of. You do not have to live with binge eating forever.

While not every option will be right for you, one or more of the treatment methods discussed in this article can help you reduce binging behaviors and take back control of your life. Talk to your healthcare provider about which method or methods they recommend.