Binge Eating Disorder

What is binge eating disorder?

Binge eating disorder is a mental health condition characterized by episodes of consuming large amounts of food, followed by feelings of guilt and shame. People with the condition will regularly engage in binge episodes, during which they will feel out of control when eating large quantities of food in a short period of time and may continue eating beyond feeling full ^[1].

Unlike other psychiatric disorders and eating disorders, such as anorexia nervosa and bulimia nervosa, people with binge eating disorder do not engage in compensatory behaviors, such as vomiting, using laxatives, excessive exercise, or fasting, to prevent weight gain. These behaviors can be present on occasion but do not form part of regular eating habits ^[2].

Episodes of binge eating disorder can cause intense feelings of shame, guilt, and physical discomfort, and often contributes to weight gain, sometimes resulting in obesity ^[3].

Symptoms of binge eating disorder

Symptoms of binge eating disorder may vary from person to person, but typically include ^[2][4]:

• Eating a large quantity of food in a short period of time, usually within two hours
• Loss of control regarding eating habits, such as feeling unable to reduce or stop binge episodes or food hoarding
• Eating very fast
• Eating when full or not hungry, even despite physical discomfort
• Eating in secret or alone due to feelings of embarrassment around eating habits
• Eating throughout the day, not just mealtimes, including regular snacking even when not hungry, or alternatively, skipping mealtimes with a view to binge later in the day
• Negative feelings after eating, such as shame, guilt, and depression
• Gathering and storing food for a binge episode, including planning for a binge episode, hiding food in preparation, and buying large quantities of junk food
• Regular unsuccessful dieting, with attempts to lose weight but regaining any weight lost shortly after, leading to regular weight fluctuations
• Low self-esteem and negative views of self, especially regarding appearance and weight
• Creating rituals or specific ways of eating, such as avoiding certain types of food, only eating from a specific bowl or plate, or not letting different foods touch
• Social withdrawal and isolation, often in an attempt to avoid embarrassment around eating
• Difficulty concentrating, typically due to poor nutritional intake
• Stomach pain or upset, such as constipation and acid reflux
• Oily and spotty, or very dry skin
• Increased blood pressure
• Medical conditions such as heart disease and gallbladder disease

Causes of binge eating disorder

The cause of binge eating disorder is not known, but research suggests that are various contributing factors to the development of the disorder.

• Genetics: research suggests that there is an increased chance of developing binge eating disorder if you have a relative with the condition ^[5].
• Childhood experiences: childhood obesity, restricted or controlled meals during childhood, and childhood trauma and abuse, particularly bullying and sexual abuse, can all significantly increase the likelihood of developing binge eating disorder ^[3][6][7].
• Mental health conditions: it is common for people with binge eating disorder to have coexisting conditions, such as depression, anxiety, and other emotional dysregulation, which may be the cause of, or contribute to, binge eating as a way of managing distress ^[1][8].
• Personality traits: studies show that people with binge eating disorder are more likely to have anxious, obsessive, or perfectionist personality traits, suggesting that these traits contribute to the development of the condition ^[5][7].
• Brain functioning: research suggests that binge eating behaviors may be similar to substance addiction, as they are both related to changes in reward pathways and inhibitory control in parts of the brain ^[9]. There may also be differences in brain activity in those with binge eating disorder compared to the general population, in the parts of the brain that process information about food and respond to food consumption ^[3].

Diagnosing binge eating disorder

When making a diagnosis of binge eating disorder, your doctor or therapist will ask you several questions to gather information, and may use a medical questionnaire, such as the Binge Eating Scale and Eating Disorders Examination ^[3].

They will ask about the symptoms that you are experiencing, when they started, how often they occur, and how long an episode typically lasts. They may also ask about any exercises or diets that you have previously or are currently engaged in.

They will ask you how you feel about your weight and appearance and if you have any worries about these aspects, as well as any other emotional difficulties or concerns you may be experiencing. They will also ask how you feel about your eating habits, including if you are happy about the types of food you eat and how much you eat ^[7][10].

Your doctor will also want to ascertain your family history including whether anyone in your family has had an eating disorder, as well as gathering information about your childhood, such as whether you were overweight as a child, if you had access to regular meals, or if you experienced any trauma or abuse during your childhood ^[3].

After gathering this information, your doctor will be able to compare your details with diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ^[11], to ascertain whether you meet the criteria for this diagnosis, which includes:

• Eating more than is normal in a 2-hour period
• Lacking control around eating habits, eating very fast, and eating past feeling full
• No compensatory behaviors following binge eating, such as vomiting or excessive exercise
• Experiencing a binge eating episode at least once per week for three months
• Feelings of shame and guilt following an episode

Prevention of binge eating disorder

If you or someone you know is experiencing the early warning signs of binge eating disorder, such as eating in secret, consuming large quantities of food, and regularly feeling concerned about weight gain, it is important to seek professional help. By speaking with a professional about your symptoms, you can receive an appropriate diagnosis and proper treatment for your condition.

Many people feel afraid about asking for help with an eating disorder, because of stigmatization and feelings of shame, but it is important to ask for help to prevent the condition from becoming more severe. Finding an eating disorder specialist will usually make the process easier as they will have a wealth of knowledge on how to support you.

Treating binge eating disorder early can help to prevent negative consequences, such as worsening physical and mental health. Research also shows that early intervention reduces recovery time and improves maintenance of healthy eating habits ^[9].

Treatment of binge eating disorder

Treatment for binge eating disorder may vary from person to person, depending on the severity of their condition and their symptoms. ^[3].

Weight loss

For people with binge eating disorder who are overweight, treatment will likely involve a multidisciplinary team, including a registered dietician, with a goal to lose weight as well as managing eating habits. This professional team will educate and advise on appropriate meal plans, how to monitor calorie intake, and devise an exercise program ^[9].

Therapy

Various types of therapy have found to be helpful in reducing the symptoms of binge eating disorder, including:

• Cognitive behavioral therapy (CBT): CBT can help with recognizing triggers, reducing harmful behaviors, increasing feelings of control around eating, and providing coping and problem-solving techniques, all of which can help to reduce the negative emotions and behaviors associated with binge eating disorder ^[10].
• Interpersonal psychotherapy: Interpersonal psychotherapy can be useful in recognizing underlying causes of the condition, providing support with distress management, reducing negative feelings, and increasing self-esteem, which may in turn reduce symptoms of binge eating disorder ^[3].
• Dialectical behavior therapy (DBT): DBT helps to provide useful skills that can be put in place around eating habits, such as mindful eating, emotion regulation, and distress tolerance, and in forming a relapse prevention plan, so can help increase control around eating habits and improve management of the condition ^[9].

Medications

There are no available medications that can cure binge eating disorder, but doctors may prescribe antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and citalopram, to aid in emotion regulation and reducing negative feelings associated with the condition ^[9][10].

If you are prescribed a medication to help treat your condition, it is important to take it exactly as prescribed by your doctor, as taking too much or too little, skipping doses, or suddenly stopping or starting a medication can cause serious adverse effects and can worsen your physical and mental health.

Self-care for binge eating disorder

If you have binge eating disorder, you can manage your condition by ^[3][7]:

• Learning personal triggers: gaining an understanding of personal triggers can help with managing the condition, allowing an opportunity to avoid or limit challenging situations that may cause harmful eating behaviors.
• Learning the underlying cause: understanding what may have caused the condition can help with developing useful coping strategies and engaging in therapeutic support.
• Limiting weight checking: people with binge eating disorder may compulsively check their weight regularly, or may avoid checking their weight entirely. Unless recommended by a healthcare professional, someone with BED should stop checking their weight entirely.
• Creating a routine: binge eating disorder can cause people to skip meals prior to binge episodes, or to eat consistently throughout the day, so setting a routine for specific mealtimes can be useful in preventing these unhelpful habits and creating a better quality of life.
• Learning more about healthy eating and cooking: because binge episodes tend to consist of high-fat or high-sugar foods, people with binge eating disorder often do not receive appropriate nutrition, so it can be useful to learn about healthy and nutritious meals that are enjoyable and can help to prevent cravings. You can speak to your local GP about medically viable weight loss treatments.
• Speaking with family and friends: speaking with close friends or family about your condition can help to reduce feelings of shame and guilt and allow you to receive support from others.
• Attending a support group: attending a support group with others with binge eating disorder can be helpful in developing further understanding and acceptance of the condition, sharing and discussing experiences, and learning new ways to manage your symptoms.
• Relaxation exercises: it can be useful to engage in relaxation exercises, such as mindfulness, breathing exercises, yoga, and meditation, as these practices can reduce negative feelings that may be associated with the condition, such as anxiety and depression.

Helping someone with binge eating disorder

If you know someone with binge eating disorder, you can help them by:

• Being mindful of the language you use: people with binge eating disorder often experience feelings of shame and guilt around eating and body image, so it can be unhelpful to make comments about your, their, or someone else’s weight or eating habits.
• Giving encouragement and praise: making positive comments about their progress with recovery and about achievements unrelated to the condition can help to increase self-esteem and motivation.
• Talking and listening to them: talking to them about their condition, listening to their concerns, and acknowledging their feelings can help to reduce feelings of shame and validate their experiences.
• Learning their triggers: understanding what can trigger or worsen their condition can help you to avoid or manage challenging situations.
• Cooking and eating together: if they are comfortable with this, it may be helpful to cook and eat with your loved one, to help increase their motivation with balanced eating and sticking to a meal plan.
• Avoiding unhelpful suggestions: while it is important to continue to include your loved one in your plans, ensure you are mindful of avoiding suggestions that may present challenges or triggers for them.

FAQs about binge eating disorder

What are the complications of binge eating disorder?

Binge eating disorder can also result in worsening mental health, potentially leading to depression, anxiety disorders, substance abuse, and suicide attempts ^[1][10]. It can lead to diabetes, heart problems, muscular pain, breathing difficulties, hormonal imbalances, and cancers ^[1][4].

Sometimes, people with untreated binge eating disorder may go on to develop another eating disorder, such as bulimia or anorexia, which can contribute to increasingly worsening physical and mental health ^[3].

How common is binge eating disorder?

Various studies suggest that binge eating disorder affects between 1.4% and 3% of the population and it is believed to be more common in females than males ^[1][5][12].