Binge eating disorder is characterized by excessive food intake compared to what another person would normally eat, along with associated factors such as eating to the point of physical discomfort, eating more rapidly than normal, eating when not physically hungry, eating alone, and experiencing distress, guilt, or lack of control over the episode.1
People with binge eating disorder often have other mental health conditions as well. Treatment can involve therapy, medication, and lifestyle changes.
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What Is Binge Eating Disorder?
Binge eating disorder (BED) involves an uncontrolled consumption of food in a short amount of time leading to mental, physical, and emotional issues. This eating disorder often leads to feelings of shame, guilt, and distress after binging. It is common for people to cope with stress and emotional issues by eating food, which for some can develop into binge eating. During the period of time in which one is eating, they may feel at peace, but then feel negatively about themself afterwards.
How Common Is Binge Eating Disorder?
Binge eating disorder is the most common eating disorder, being three times more common than anorexia and bulimia combined.2 Approximately 2.6% of the U.S. population will be diagnosed with BED in their lifetime, and 3.5% of women and 2.0% of men had or will have binge eating disorder during their life.2,3 Unfortunately, less than half of people diagnosed with binge eating disorder will receive treatment.4
Bulimia Vs. Binge Eating
The primary difference between bulimia and binge eating has to do with compensatory behaviors. Both binge eating disorder and bulimia involve recurrent episodes of binge eating. In bulimia however, there are compensatory behaviors in efforts to prevent weight gain that are absent in BED, such as purging, use of laxatives or diuretics, dieting or diet pills, periods of fasting, and excessive exercise.
Weight is not always a factor but obesity is also more common in individuals with binge eating disorder than bulimia. Binge eating disorder is also not to be confused with anorexia binge-purge type where there are occasional binges but the primary disordered behavior is fasting.1
Binge Eating Disorder Symptoms
For the individual struggling with binge eating disorder, their internal experience may be quite different from what is presented to others. For one, there’s a significant emotional component to binge eating that may go unseen. There are also likely underlying, untreated emotional issues such as trauma, anxiety, or depression.
Common symptoms of binge eating disorder include:1,5,6,7
- Regular episodes of excessive food intake in a certain period of time, leading to discomfort, fullness, fatigue, or moodiness as the body is flooded with excess calories, carbohydrates, sugar, and fats
- An obsession with food and planning for the next binge
- Emotional eating, such as feeling empty, anxious, lonely, or depressed before excessive food intake and then feeling shame, guilt, or defeat after
- Denial about the disordered eating behavior
- Hiding food and amount of intake from friends, family, and co-workers; often skipping meals in front of others and then binging at home alone, putting a strain on relationships (i.e., avoiding socializing or going out to lunch with friends)
- Weight is not always affected by binge eating disorder but many will be overweight, obese, or experience weight gain and/or fluctuations
- Lowered self-esteem or self worth that is connected to eating patterns, body image, or weight gain
- Mood changes
- Sleep REM cycle and circadian rhythm may be affected
- Loss of interest in other hobbies and activities
- Body image issues, including altered sense of self as body changes with weight fluctuations and noticing others responding differently to them at different body sizes
- Engaged in a cycle of comfort/gratification (binging) and punishment, self-loathing, deprivation, and remorse
Outward Signs of Binge Eating Disorder
Binge eating disorder, like most types of eating disorders, can present itself physically as well as mentally and emotionally. Because the episodes of binge eating are often hidden, there may be some confusion to friends and family observing the individual suddenly gaining weight.
Signs of a binge eating disorder are:6,7
- Hidden food wrappers and plates
- Sudden weight gain or cycles of weight gain and loss
- A change in mood or mental state
- Fatigue or exhaustion, especially after a binge episode
- Not eating around friends or family but gaining weight
- Withdrawal from friends, family, and social group
- Developing food rituals, such as eating only one type of food
- Obsessing about food
- A change in wardrobe, including covering their body with clothes that would conceal weight fluctuations
- Hobbies that were previously enjoyable are no longer of interest
- Defensiveness if approached by concerned family members or friends about binging behavior
- Psychiatric issues such as depression, anxiety, anger, alcohol misuse
How to Know If You Have Binge Eating Disorder
The best way to know for sure if you have BED is to seek the assessment and diagnosis of a professional. However, if you are concerned about your relationship with food, these questions can be a helpful starting point. Some general signs might include feeling secretive around eating, eating to excess, or eating when feeling emotional overwhelm.
Here are some questions to ask yourself if you suspect you may have binge eating disorder:
- Is my relationship to food causing me distress?
- Do I feel the need to eat in secret?
- Do I feel like I am on autopilot or emotionally numb when I consume food?
- Do I feel disappointed, disgusted with myself, or guilty after eating?
- Do I eat in excess, even when I feel physically uncomfortable?
- Are my portion sizes visibly larger than what I notice compared to others around me?
- Do I often make plans to eat only one portion of something, only to be disappointed that I end up eating two or more portions?
- Has this distressing relationship to food lasted three months or longer?
Why Do People Binge Eat?
When we look at eating disorder causes and risk factors, we can use a biopsychosocial model to assess the individual struggling with binge eating disorder.8 This will include environmental, social, and biological factors that may impact one’s risk of developing binge eating disorder.
Environmental Risk Factors for Binge Eating
Environmental and social factors and risks for binge eating disorder include:
- A chaotic home life, unstable relationships, and growing up in family systems that can not express problems in a healthy way, leading one to stuff their feelings
- An influential person or parent figure in one’s life with any eating disorder, introducing and modeling a dysfunctional relationship with food. The individual is “taught” to diet and “taught” to obsess over food.9
- Issues with attaching to the primary caregiver so food, which was possibly more readily available, takes the place of love and comfort
- Underlying stressors or traumatic incidents that go unaddressed and untreated, causing the individual to attempt to bury with food
- Pressures to lose weight (i.e., media thinness bias, diet culture), leading to feelings of shame around eating and resulting in skipping meals to binge in secret later8
Biological Risk Factors for Binge Eating
Biological factors and risks for binge eating disorder include:
- Genetics
- A predisposition for obsessive compulsive thinking and ruminating thoughts5
- Anxiety disorders or depression, along with difficulty with impulse control and frustration tolerance8
- Communication issues, including difficulty managing and expressing emotions
- Perfectionism and being prone to negative thinking8
- More likely to affect young women beginning in adolescence; however, men can be affected, too4
- Hormonal (i.e., ghrelin, cortisol, and oxytocin) or gastrointestinal (Peptide YY) disruptions10,11
Common Co-Occurring Disorders
Common disorders that co-occur with binge eating disorder include bipolar disorder, depressive disorders, anxiety disorders, and less commonly, substance use disorders.1 These co-occurring disorders are similar to the disorders which occur alongside anorexia and bulimia nervosa.1 The risk factor for co-occurring disorders increases as the severity of BED symptoms increases.1 It is important to note that the risk of co-occurring symptoms is not connected to whether someone is considered obese.1
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Effects of Binge Eating Disorder
Binge eating disorder affects someone’s physical health, emotional well-being, work, and relationships. Long-term health risks in particular include an increased risk for weight gain, development of obesity, and even death.1 Research indicates that most individuals with diagnosed BED are obese, contributing to possible complications such as chronic body pains, diabetes, hypertension, asthma, hormone imbalance, sleep apnea, and certain cancers.12
Binge eating disorder health risks can include:1,12
- Weight gain
- Obesity
- Heart disease
- Chronic pains
- Diabetes
- Hypertension
- Asthma
- Hormone imbalances
- Sleep apnea
- Certain cancers
How Is Binge Eating Disorder Diagnosed?
Binge eating disorder was added as a stand alone disorder in the newest addition of the DSM-5.1 Prior to that it was lumped with anorexia nervosa and bulimia nervosa and could be categorized as “eating disorder, not otherwise specified” (OSFED). There are also similar traits in those with binge eating disorder and substance use disorder, such as addictive and compulsive behaviors.13
It is important to rule out medical conditions such as Hashimoto’s Disease, thyroid issues, Prader Willi Syndrome, or Cushing’s Disease.
Here are other factors that distinguish a binge eating disorder diagnosis:1
- There must be one or more episodes per week for at least three months to be diagnosed
- Rapid eating during the episode
- Becoming uncomfortably full
- Excessive food intake in relation to physical hunger
- Feelings of shame leading one to eat alone or hide evidence of the amount of food consumed
- Feeling disgusted or guilty after the episode
- The diagnosis can range from mild to extreme, depending on the number of episodes per week, from one to fourteen or more
- Distress and lack of control during a binge eating episode
- Lack of inappropriate compensatory behaviors, like purging, laxatives, dieting, starving, or excessive exercise as seen in other eating disorders
Treatments for Binge Eating Disorder
There are several options for those seeking treatment for binge eating disorder, including therapy, medication, and lifestyle changes, along with nutrition counseling. Treatment is not one size fits all and it will be up to the individual in recovery to determine what best suits their needs, but a holistic treatment approach with someone’s primary care provider, therapist, and nutritionist is recommended.
Binge Eating Therapy
Coming to therapy means making a weekly commitment to focusing on yourself. It means meeting with a professional who is trained and equipped to treat people with binge eating disorder. You will receive a combination of psychoeducation on your disorder and reflective, supportive therapy.14
If you’re ready to find a therapist, consider starting your search in a free online therapist directory. You can narrow down your search by criteria like location, cost, and expertise.
Common types of therapies for treating binge eating disorder include:
- CBT: CBT works from the idea that irrational, repressed thoughts trigger emotional responses (like anxiety), which then trigger unwanted behaviors (binge eating). It is typically short-term, approximately 6-12 sessions. The goal behind CBT for eating disorders is to confront irrational thoughts and uncover underlying emotional issues beneath the behavior.15
- DBT: DBT for eating disorders can be extremely effective in helping with impulse control, regulating emotions, tolerating distress, and managing unwanted behaviors. Practicing radical self-love and learning to accept pain rather than stuffing one’s feelings with food. The individual will also learn grounding techniques like the “five senses.” The aim is to forge the gap between the rational and emotional mind for a sense of peace and clarity.15
- MI: Motivational interviewing (MI) was developed for individuals with addictive behaviors. The therapist will confront some of the individual’s resistance to change through gentle probing that suggests their current choices are not in line with their ultimate goals.13
- Long-term psychoanalysis: Psychoanalysis may be open-ended and can help uncover the root of the eating issues. Long-term therapy will be an important part of the recovery process as it’s important to understand how these issues arose and possible solutions to underlying issues, including setting healthy boundaries and self-care. Ideally this is done with a Certified Eating Disorder Specialist (CEDS) who has gone through extensive training with the International Association of Eating Disorders Professionals Foundation.15
- Multi-faceted approach: Many centers for eating disorders can offer a fine-tuned and interdisciplinary approach to those struggling with binge eating disorder. This would include eating disorder group therapy, individual therapy, medication or psychiatric assessment, and a nutritionist on-hand. This may be a good option for the individual looking for a very in-depth, tailored and focused experience of recovery.
Inpatient Rehab for Binge Eating Disorder
Someone with binge eating disorder may find themselves in need of urgent, intensive medical and psychological intervention. Often, another medical reason will bring them to the hospital, such as a heart condition that becomes dangerous when engaging in binge eating. The individual’s food will be monitored by a medical team long enough to stabilize the medical condition. They may also receive intensive psychological attention with daily support groups and therapy.
Medication for Binge Eating Disorder
Medication isn’t always necessary to treat binge eating disorder but research shows there are certain medications that can be used in conjunction with other therapeutic interventions.17 Medication will most often be prescribed by a primary care physician, psychiatrist, or nurse practitioner.
A nutritionist may also be a good option for supplemental vitamins and nutrients to ensure the individual with binge eating disorder is getting proper nutrition throughout the process of renegotiating their relationship with food.
The most commonly prescribed medications for binge eating disorder are:17,18
- Orlistat or Alli (reduce fat absorption)
- Topiramate (appetite suppressant)*
- Liraglutide (appetite suppressant by injection only)*
While appetite suppressants have shown efficacy, cardiovascular adverse events, primary pulmonary hypertension, and valvular regurgitation seem to increase risk. If an individual’s binge episodes are not able to be controlled with medication and therapy alone, bariatric surgery may be prescribed.18
Nutrition Counseling
Nutrition counseling is an important piece of recovery from binge eating disorder. Counseling from a registered dietician who is familiar with eating disorders is the most recommended form of nutrition counseling. You may also seek nutrition counseling from doctors, specialists, or nutritionists. However oftentimes registered dieticians receive more formalized training in the science behind nutrition, especially for those recovering from eating disorders. It is important to ensure that your provider has the training necessary to provide nutrition counseling, otherwise there may be a risk of encouraging restrictive dieting that carries a risk for developing other eating disordered behaviors.
Nutrition counseling can help with planning, organizing, and preparing meals.12 Your registered dietician or nutritionist may also be familiar with other behavioral techniques they can enforce around meal structuring. Additionally, they may be able to help you learn a new relationship with food that combines balancing out nutrition with taste preferences for meals. Remember that a good provider will give you psycho-education combined with support in working through obstacles to BED recovery.
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Eating disorder treatment is hard – which is why you deserve a team. Equip offers evidence-based care delivered virtually by a five-person care team, so you can achieve recovery without pressing pause on your life. We take insurance! Visit Equip
How to Get Help for Binge Eating Disorder
The National Eating Disorders Association is a great place to start for support. Other support groups are Overeaters Anonymous (OA), Food Addicts Anonymous (FAA), and ANAD. If you have trouble finding a local support group, know that all 12-step groups, including Alcoholics Anonymous and Narcotics Anonymous will accept those struggling with eating addiction and needing support.
Since the disorder can cause physical changes and medical complications, a primary care physician is often a first line of defense, even before the individual recognizes their disorder. A PCP may have limited knowledge on emotional supports, but can prescribe appetite suppressants like Topamax, Phentermine, and Bupropion.17,18 In extreme cases, they may recommend bariatric surgery.
Barring any major medical issues, seeing an individual therapist specializing in eating disorders may be more advisable. A suitable course of action would be some combination of free and accessible support, like support groups and literature on body positivity combined with an individual therapist to work through underlying issues. A nutritionist that is informed in compassionate, mindful eating will also be helpful.19
Cost of Eating Disorder Treatment
The cost of a therapist and nutritionist would range from a small co-payment to $100-$200 per session. There is a breadth of resources online and in person for the binge eating disordered individual, like Equip Health. One size doesn’t fit all, and it will be ideal to find the right combination of support for you and your budget. Costs can range from free to the tens of thousands, depending on the level of care you receive.16 Typically, support groups are donation-based or low-cost.
Inpatient rehab, partial hospitalization, or intensive outpatient treatment – which may be prescribed in extreme cases – can cost thousands of dollars even with medical insurance, and are often reserved for those whose addictive behaviors put them in life-threatening emergency situations (such as starvation risk and dangerously low body weight in anorexia).
How to Recover From a Binge Eating Disorder
A person struggling with binge eating disorder can make several lifestyle changes in support of their holistic recovery. First, focus on eating meals until you are feeling satiated and nourished. Recognize that it is OK to feed your body. Enjoy the food you are eating and take pleasure in it, no matter what your weight is. Studies show deprivation is more likely to lead to a binge.
Keep track of your binges so you can identify any emotional triggers and binge foods. You can quickly connect that reaching for that food is more an indicator of an emotional issue than a hunger issue. Educate yourself on the concept of body positivity so you can approach recovery from a compassionate place of self-love and gratification.19
Here are some additional tips for how to deal with binge eating:
- Stick to your treatment plan: It is important to have a treatment plan that provides structure during recovery. Sticking to the plan will help you avoid unnecessary obstacles to treatment.
- Keep a food diary and mood tracker: Monitoring food intake and emotions can help you connect the dots around how emotions affect your relationship with food.
- Practice mindful eating: Individuals with BED often report feeling as if they are stuck on autopilot during eating episodes. Learning mindful eating strategies can help connect you to the present moment and stay sensorily engaged with the process of eating a meal.
- Tell a trusted loved one: Research indicates BED is connected to feelings of abandonment and negative affect.12 Feeling connected to a support system can help minimize feelings of loneliness that might contribute to eating episodes.
- Learn to recognize hunger cues: Under-eating can be connected to binge eating episodes.12 Learning to take time to recognize and respond to hunger cues can help prevent intense hunger that may precede binge eating episodes.12
- Avoid dieting unless supervised by a professional: Research indicates that dieting can reinforce rule systems that contribute to distress around eating.12 Unless dieting is recommended by a medical professional, it is best to avoid dieting during treatment.
- Don’t skip meals, especially breakfast: Research indicates that creating a pattern of eating with no more than 3- or 4-hour gaps between meals can support recovery of BED.12
- Limit access to your trigger foods: Experts recommend identifying what foods tend to lead to binging episodes, and to avoid these foods early on in treatment.12
- Don’t isolate yourself: Isolating tends to promote loneliness, an emotion that can lead to binge eating episodes. Isolating can also lead to instances of boredom or feelings of secrecy, other conditions that can contribute to episodes.
- Move your body in ways you enjoy: Finding a form of movement that is enjoyable can help with underlying mood issues, digestion troubles, and decreased self-confidence often found in individuals with BED.
- Look for positive role models: Role models who have your same core values can give you something to aspire to during recovery. It can be especially beneficial to find role models that are also in recovery from an eating disorder.
- Incorporate other healthy coping mechanisms: It may take awhile to find the types of positive coping mechanisms you enjoy, since eating has been the primary stress-soother prior to recovery. Other healthy coping mechanisms might include new hobbies, urge surfing, or group support.
How to Help Someone With Binge Eating Disorder
Finding help for a loved one who is struggling may be a touchy subject. The individual may be defensive, guarded, or fervently attempting to conceal their issue. Knowing the Stages of Change Model can be helpful for family members who wish to assist their loved one on the path to recovery.14 The stages are precontemplation, contemplation, preparation, action, and maintenance.
Precontemplation indicates that a person is still in denial about their disordered eating behavior. This may be a tough time to approach the person; however, the idea of “planting a seed” can work wonderfully here. Let them know you are there to support them. Inform yourself on signs and symptoms of binge eating disorder so you can answer questions they may have when they’re ready.
Enabling and joining the person in their irrational thoughts about food and eating can be tempting as a sign of support, but it’s important not to legitimize their relationship with food which is causing them distress and suffering.
In contemplation, the individual is ready to admit they have a problem. From there you are likely able to join them in their more rational thinking. Lend a listening ear, help connect to treatment, and provide positive reinforcement and encouragement along the way. Be aware of the possibilities of relapse along the way and remain patient and supportive as setbacks in the process are inevitable.
What’s the Outlook for Someone With Binge Eating Disorder?
Recovery for someone with binge eating disorder may come in fits and starts. Overall, it will be a long process, though there may be immediate short term successes and periods of lapse from binges. Most of the time, outpatient treatment will be effective on its own. Progress can be seen immediately often through the relief of being “seen” and understood. Behavioral habits and changes can take place in as little as three weeks, but to maintain this recovery, individuals may need to remain in weekly therapy for several years.
Additional Resources
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