What Is Binge Eating Disorder? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Across America and around the world, millions of people are dealing with an eating disorder.

But if you try picturing who those people might be, chances are you’ll imagine someone who is painfully thin or someone purging over a toilet bowl, not someone suffering from the most common eating disorder of all — binge eating disorder.

That’s because people with this eating disorder don’t fall into either stereotype. People who suffer from anorexia tend to be obviously thin. Those who have bulimia might show telltale signs, such as bloating, swollen cheeks, and chafed fingers from self-induced vomiting. But it’s impossible to tell whether someone has binge eating disorder (BED) just by looking at them. This may be part of the reason why it wasn’t officially recognized as an eating disorder until 2013, when the fifth edition of the American Psychiatric Association Diagnostic and Statistical Manual (DSM-5) was released.

Signs and Symptoms of Binge Eating Disorder

To understand what binge eating disorder is, you first have to understand what it is not. It is not overeating and taking in more calories than your body needs, even if you do that every day. It is not “grazing” — eating small amounts of food more or less continuously throughout the day. It is not overindulging on Thanksgiving, plowing through a giant fast food meal, or even demolishing a pint of ice cream in one sitting.

It’s also important to note that most people who are overweight or obese do not have BED. Genetics, a diet high in processed foods (high in sugar and fat) and large portions, plus a sedentary lifestyle, are the main contributing factors to those conditions, notes the National Health Service (NHS).

To have BED you must experience profound despair about your eating habits. You must regularly go on eating jags in which you consume thousands of calories in one sitting, often far more than the 2,000 calories most adults need for an entire day. And you probably binge in secret, and feel so much guilt and shame that it affects your relationships with friends, family, and coworkers, says Kathleen Ashton, PhD, a psychologist and an associate professor at the Cleveland Clinic Lerner College of Medicine in Ohio. “Instead of feeling in control of your eating, you feel as if your eating is controlling you,” she says.

Specifically, to meet the diagnostic criteria for BED you must:

  • Binge at least once a week for three months, eating in one episode more food than most people would eat within any two-hour time frame
  • Feel as if you can’t stop eating or control what or how much you’re eating

You also must experience at least three of the following:

  • Eating much more rapidly than is normal
  • Eating until uncomfortably full
  • Eating large amounts of food while not feeling physically hungry
  • Eating alone because of feeling embarrassed by how much you are eating
  • Feeling disgusted, depressed, or very guilty after binging

Weight Cycling and Lack of Purging Unique to Binge Eating Disorder

In addition, unlike people with bulimia, binge eaters do not try to compensate for overeating by making themselves vomit, exercising for hours, or using laxatives and enemas. They simply gain weight or they attempt to atone for their binges by severely restricting their eating for hours, even days, a behavior that then triggers another binge. Indeed, weight cycling — repeatedly losing weight and regaining it — is a hallmark of the condition.

Binge eating disorder, just like other eating disorders, is driven by concern over weight. “Most binge eaters are striving to meet the culturally idealized version of body shape and weight,” explains Cortney S. Warren, PhD, a psychologist and an associate adjunct professor of psychology at the University of Nevada in Las Vegas. “Their core motivation is ‘I don’t like the way I look. I’m going to do something about it, so I’m going to lose weight.’ Then they restrict, restrict, restrict until they binge, and then immediately afterward they feel extra guilty and the cycle begins again.”

Causes and Risk Factors of Binge Eating Disorder

The exact cause of BED isn’t known, but experts believe that genetics, biological factors, dieting habits, and psychological issues may determine a person’s risk.

As with all eating disorders, many factors play a role to different degrees in different patients. These factors include:

  • A History of Dieting Binge eating is paradoxical: A person diets hoping to achieve the cultural ideal of thinness and then punishes his or herself for failing to achieve that ideal by eating even more, note the Mayo Clinic.

  • Family History Like most psychiatric disorders, BED tends to occur in families. That means that if your parent or grandparent had the disorder, you’re more likely to have it, too.

  • Mood Disorders Depression and anxiety have been linked to binge eating disorder, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

  • Perfectionism

  • Work Stress

  • Obsessive-Compulsive Tendencies

  • Trauma This might include emotional, physical, or sexual abuse.

  • Food Insecurity This means a fear of not having enough food. Whether due to poverty, per a study published in April 2018 in the Journal of Crohn’s and Colitis,

    others controlling what you eat, or a medical condition that requires a restrictive diet — such as type 1 and 2 diabetes, celiac disease, and Crohn’s disease — food insecurity can contribute to binges, noted a study published in June 2017 in the International Journal of Eating Disorders.

How Is Binge Eating Disorder Diagnosed?

Binge eating disorder is typically diagnosed based on a person’s symptoms and eating habits.

Additionally, doctors may perform a physical exam, recommend a psychological evaluation, or run other medical tests if the disorder is suspected.

An Unseen and Misunderstood Problem

Whether they appear fat, thin, or normal weight, most people with BED never get treated, says Ellen Fitzsimmons-Craft, PhD, a psychologist and an assistant professor of psychiatry at Washington University School of Medicine in St. Louis. One reason, shockingly, is that most doctors and many mental health professionals get little or no training in how to detect or treat any eating disorders.

“If you haven’t been taught about eating disorders, you won’t know what to look for and you won’t spot it,” says Dr. Warren, who also blames undertreatment on a widespread anti-fat attitude. “There is so much weight stigma, which I think oftentimes leads physicians to look at someone who is overweight and automatically think, ‘You’re fat. You eat crappy food and you take no responsibility for your health.’ The conclusion then is, ‘It’s not a real disorder that I can help with.’”

Prognosis of Binge Eating Disorder

A person’s prognosis depends on many factors. The good news is that people with BED have a greater chance of remission compared with those who struggle with other eating disorders, according to the National Eating Disorders Association (NEDA).

Duration of Binge Eating Disorder

How long someone struggles with binge eating disorder varies from person to person, as each individual is different. Some people can recover completely, while for others it remains a challenge throughout their lives.

Treatment and Medication Options for Binge Eating Disorder

BED is highly treatable. The first step: Give up dieting, says Dr. Ashton. “When we address binge eating disorder, weight loss is never our goal. It’s to focus on the eating disorder first with behavioral strategies to end the shame.”

According to studies, these psychological interventions have the best track record:

  • Cognitive-Behavioral Therapy for Eating Disorders (CBT-E) This treatment helps you regain control over your eating by sticking to a schedule (three square meals and one or two snacks daily), and reintroducing formerly “red light” foods, such as ice cream, in moderation to avoid the feelings of deprivation and frustration behind many binges. CBT also involves changing the negative thoughts about yourself and your body that fuel the disorder.

  • Interpersonal Psychotherapy (IPT) This focuses on helping you find better ways to cope with and handle conflicts in relationships, difficult transitions (such as moving, changing jobs, and divorce), and unresolved grief, notes Psychology Today.

    IPT also involves learning to measure your self-worth by more than your weight and body shape, increasing your confidence and self-esteem.

“Both have demonstrated, long-term outcomes,” says Dr. Fitzsimmons-Craft. “But IPT may give you more bang for your buck, so to speak, because it’s also an evidence-based treatment for depression and anxiety, which are both contributing factors to binge eating disorder.”

Medication Options

The stimulant medication Vyvanse (lisdexamfetamine) became the first FDA-approved treatment for binge eating disorder. The approval was based, in part, on a four-week study published in March 2015 in the journal JAMA Psychiatry, in which one-half of participants given 70 milligrams of Vyvanse daily stopped binge eating compared with 21 percent of those taking the placebo.

They also lost weight.

But there are some caveats. Vyvanse alone does not address the negative emotions, worries about body shape, and other psychological factors that are significant contributors to BED. What’s more, in addition to decreased appetite, patients may experience one or more uncomfortable side effects, such as irritability, jitteriness, difficulty sleeping, and dry mouth. It can also be habit-forming.

Alternative and Complementary Therapies

Some people with binge eating disorder discover that alternative and complementary remedies can help ease their stress and improve symptoms.

Common alternative therapies include:

  • Massage
  • Yoga
  • Meditation
  • Acupuncture
  • Exercise

Prevention of Binge Eating Disorder 

While there’s no way to completely prevent binge eating disorder, a person may be able to lower their risk by:

  • Learning about the signs, symptoms, and risks of eating disorders
  • Avoiding crash diets and unhealthy weight loss behaviors
  • Learning to appreciate the body’s functionality and avoiding negative self-talk
  • Seeking help if behaviors become problematic
Getting professional help early on may improve your outcome. If you suspect that a loved one has binge eating disorder, try to encourage them to get treatment.

Complications of Binge Eating Disorder

According to Johns Hopkins Medicine, binge eating disorder is a cycle that taxes every system in the body, setting the stage for other serious health problems over time, such as:

  • Obesity
  • Type 2 diabetes
  • High blood pressure and high blood cholesterol
  • Gallbladder disease
  • Certain cancers
  • Depression and anxiety

Research and Statistics: Who Has Binge Eating Disorder?

BED is by far the most common eating disorder in the United States, affecting 3.5 percent of women, 2 percent of men, and up to 1.6 percent of adolescents — about 3 times the number of people diagnosed with anorexia and bulimia combined.

Black Americans and Binge Eating Disorder

When it comes to BED, people of all races, ethnicities, and demographics are affected. But studies have shown that people of color may be less likely to seek help for their eating disorders, notes Psychology Today.

While one study published in September 2018 in Biological Psychiatry found that the lifetime likelihood of being diagnosed with BED was significantly lower for Black respondents compared with white and Hispanic respondents, other research has suggested that certain symptoms and behaviors may be more severe in Black patients by the time they get treatment.

In a study published in January 2016 in the Journal of Consulting and Clinical Psychology, researchers noted that Black adults had a higher BMI and binge eating frequency than white participants when they started treatment.

Related Conditions and Causes of Binge Eating Disorder

Some health conditions that are related to BED include the following:

  • Depression
  • Obsessive-compulsive disorder (OCD)
  • Anxiety
  • Bipolar disorder
  • Substance abuse disorders

Resources We Love

National Eating Disorders Association (NEDA)

NEDA offers support and educational information about all eating disorders, including binge eating disorder.

Eating Disorder Hope

This online community lets you search for a therapist in your area and connect with others who struggle with eating disorders.

Office on Women’s Health

You’ll find credible information about BED on this government-backed site. The Office on Women’s Health is a division of the U.S. Department of Health and Human Services.

Academy for Eating Disorders

This organization provides a plethora of materials and resources for people struggling with eating disorders.

Additional reporting by Julie Marks.

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