Binge Eating Disorder

When food becomes both comfort and enemy, a binge eating disorder (BED) may be at play. This complex eating disorder drives people to consume significant quantities of food in short periods, often leaving them feeling ashamed, out of control, and emotionally devastated. However, BED isn’t about lacking willpower or making poor choices. Instead, it’s a legitimate mental health condition that creates intense emotional suffering and requires comprehensive, compassionate care.

Understanding Binge Eating Disorders

BED is characterized by a perceived loss of control over eating and by regular bingeing episodes, where a person ingests large amounts of food in a relatively short period of time ^[1]. Extending far beyond occasional overeating, the condition often involves eating very rapidly, consuming food until uncomfortably full, and continuing to eat even when not physically hungry ^[2].

Along with disordered and secretive eating, BED includes mental distress about the behavior, such as depression and feelings of guilt or disgust. Additionally, employment and relationships can be disrupted by the related secrecy and emotional strain. Thus, in addition to causing physical effects, BED can profoundly impact mental health and well-being ^[3].

When it comes to prevalence, BED is the most common type of eating disorder in the United States ^[1]. However, the American Psychiatric Association didn’t add BED to its diagnostic manual (the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-5-TR) until 2013 ^[1][3]. As such, historical statistics are somewhat limited. Nevertheless, recent estimates indicated that lifetime prevalence of BED averages 1.9% in international surveys and 2.6% in U.S. reports ^[4].

Despite BED’s many challenges, effective treatment options are available. With appropriate support, including therapy and medication (if needed), people can work toward managing their symptoms and improving their quality of life.

Signs and Symptoms of BED

While no two experiences with BED are identical, signs and symptoms of BED include ^[5]:

• Turning to food as a way to cope with emotional stress or difficult feelings.
• Feeling intense guilt, shame, or low self-worth after binge episodes.
• Continuing to eat well beyond the point of fullness, sometimes to the extent of physical discomfort.
• Eating so quickly that it’s hard to recognize how much food was consumed or to savor the experience.
• Frequently trying diets, which may lead to fluctuating weight or frustration due to a lack of lasting results.
• Consuming large quantities of food even when not hungry or shortly after finishing a meal.
• Choosing to eat alone or in secret, and hiding or stashing food in secret places to binge later.
• Having persistent, intrusive thoughts about food and intense cravings for specific items.

It’s important to note that only a mental health professional can diagnose BED using specific criteria outlined in the DSM-5-TR. However, recognizing these signs and seeking help is a crucial first step on the path to recovery. 

Binge Eating vs. Bulimia

BED and bulimia nervosa share several similarities. Both eating disorders can involve episodes of consuming large amounts of food within short periods, accompanied by significant emotional distress. However, they’re unique disorders with important differences. Specifically, the key distinction lies in what happens after the binge.

Bulimia nervosa involves regular post-binge behaviors, e.g., self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise, that try to compensate for the abundance of food consumed. An intense fear of weight gain drives these behaviors and attempts to “undo” the calories consumed during binges. Additionally, diagnostic criteria for bulimia nervosa include body image distortions, such as overestimating weight and size ^[3].

In contrast, those with BED don’t have consistently distorted body images, and they don’t regularly engage in compensatory behaviors. Instead, they experience the same distressing binge episodes but without the purging component, which often leads to weight gain and additional shame about their body size ^[3].

Indeed, both conditions require compassionate, evidence-based care. But BED treatment often focuses on breaking the binge cycle rather than managing purging behaviors.

BED Causes and Risk Factors

BED doesn’t have a single cause. Rather, a complex interplay of biological and environmental factors leads to its development. Among them, a family history of eating disorders, as well as stress and poor self-image, are risk factors for BED. Additionally, consistent dieting or regularly limiting calories may trigger the urge to binge ^[2]. What’s more, difficult life circumstances such as poverty, trauma, violence, food insecurity, or mental health challenges can also increase BED risk ^[3].

Biology is another critical factor, as the following may be associated with the development of BED ^[3]:

• Problems with Food Intake Regulation: Disruptions in hunger and fullness hormones may weaken the body’s satiety signals, making it harder to regulate appetite.
• Brain Region Alterations: Individuals with BED often exhibit reduced activity in brain areas responsible for self-control and increased activity in reward-related regions. This combination can drive food cravings.
• Cognitive Impairments: People with BED tend to have weaker decision-making and impulse control, along with difficulties in cognitive flexibility and attention regulation. Thus, they’re more likely to choose immediate, smaller rewards over larger, delayed options.
• Genetics: BED runs in families, and specific genetic variants can increase BED risk.
• Gut Microbiota: Imbalances in gut bacteria may influence food cravings, digestion, and appetite regulation. Some studies suggest that people with BED have different microbial compositions compared with those without the disorder.

Health Consequences of BED 

BED can affect the body in multiple ways. Often, it’s associated with obesity and extreme obesity, and compared to the general population, those with BED are more likely to have a body mass index (BMI) of 25 or higher ^[3][4]. As such, the following conditions commonly occur alongside BED ^[3]:

• Hypertension
• Various heart conditions
• Arthritis 
• Elevated cholesterol and triglycerides
• Diabetes mellitus
• Sleep problems 

Beyond weight-related issues, BED can disrupt everyday bodily functions. Digestive problems are common, including bloating, acid reflux, constipation, diarrhea, and stomach pain. Plus, respiratory challenges and musculoskeletal discomfort are also more frequent in those with BED. Additional health concerns, such as urinary difficulties, increased cancer risk, and polycystic ovarian syndrome, are also associated with BED ^[3].

The wide range of physical health challenges associated with BED underscores the importance of early recognition and comprehensive care. Addressing both the eating disorder and its related medical conditions can significantly improve overall quality of life.

Mental Health and Binge Eating

Along with negatively impacting physical health, BED can take a significant toll on emotional and mental well-being. The disorder’s intense feelings of guilt, shame, and distress following episodes of uncontrolled eating can affect daily life, making social interactions, work, and personal relationships more challenging. Over time, the emotional weight of the disorder can also erode self-esteem and increase stress, creating a cycle that reinforces binge-eating behaviors ^[3].

This emotional burden can be compounded by the stigma surrounding eating disorders and being overweight. In turn, this can lead to further efforts to conceal bingeing behavior, often preventing people from seeking help. In fact, only about 50% of those with BED ever seek treatment for the disorder. What’s more, many people aren’t even aware that they have a disorder, and as such, they seek help solely for weight loss ^[3]. In doing so, they often fail to get the mental health care they need to make optimal progress.

BED and Co-Occurring Disorders

Like many mental illnesses, BED often occurs alongside other mental health conditions. In fact, roughly 79% of those with a history of BED have at least one other psychiatric condition, while nearly half experience three or more overlapping conditions ^[4]. Among the most common co-occurring issues are anxiety disorders, which impact more than half of this population. Mood disorders such as depression and bipolar disorder are also prevalent, as are impulse-control and substance use disorders ^[3].

The presence of co-occurring disorders is also closely linked to BED severity. People with BED and mood or anxiety disorders often experience more intense binge episodes and greater emotional distress ^[3]. Perhaps most concerning, approximately 25% of those with BED experience suicidal ideation ^[6].

These statistics reveal the profound emotional burden that BED can carry and the urgent need for compassionate, comprehensive care that addresses both the disorder and the mental health challenges that often accompany it.

If you or someone you know is experiencing thoughts of suicide, reach out for help immediately. Dial 911 for emergency services, or call or text 988 to reach the 988 Suicide and Crisis Lifeline, which provides free, confidential support 24 hours a day, seven days a week. Counselors can provide immediate assistance, emotional support, and connections to local resources. 

Treatment for Binge Eating Disorder

Treatment goals for BED typically include a reduction in binge episodes, co-occurring conditions, and potentially body weight. Achieving these goals generally requires a comprehensive approach that addresses the psychological, behavioral, nutritional, and physical health aspects of the condition.

Psychotherapy, including individual, group, and family therapy, is a cornerstone of BED treatment. Among the various types of psychotherapy, cognitive behavioral therapy (CBT) can be particularly effective, as it helps patients recognize and change unhelpful thoughts and behaviors around food. CBT can also teach strategies such as creating regular eating patterns, monitoring eating habits, and developing self-control and problem-solving skills, all of which support long-term recovery ^[4].

Medications are often used to complement therapy. Lisdexamfetamine is the only FDA-approved drug for BED, as it’s shown to reduce impulse control associated with BED ^[5]. However, other pharmacological options include second-generation antidepressants, anti-convulsants, central nervous system stimulants, and certain anti-obesity or diabetes medications such as GLP-1 agonists, which have shown promise in reducing binge frequency and supporting weight management ^[4].

While both psychotherapy and medications can aid progress, a combined approach may produce the best outcomes. Plus, tailoring treatment to address both mental health and physical well-being is optimal for long-term recovery.

Breaking the Cycle

BED is a serious condition that impacts both physical and emotional health, often creating cycles of distress, shame, and secretive eating. Despite these challenges, recovery is possible. 

Evidence-based therapies, such as psychotherapy and medications, can help reduce binge episodes, improve mood, and support healthier eating patterns. However, recognizing the disorder, seeking professional guidance, and addressing both mental and physical health needs are key steps toward lasting change. 

Remember, BED is a treatable condition, not a personal failing. With proper professional support and self-compassion, people can overcome the shame and secrecy that characterizes this disorder and build healthier, more fulfilling relationships with food and themselves, turning food into a source of nourishment rather than distress.