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, experiencing distress, guilt or lack of control over the episode.1
Patients with binge eating disorder often have other psychiatric conditions. Treatment can involve therapy, medication, and lifestyle changes.
Signs of Binge Eating Disorder: What It Looks Like
Binge eating disorder, like most 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 that someone is struggling with binge eating disorder are:23
- 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
- Individual no longer eats with friends and family but is gaining weight
- Withdrawal from friends, family and social group
- Develops food rituals such as eating only one type of food
- The individual obsesses 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 bingeing behavior
- Psychiatric issues such as depression, anxiety, anger, alcohol abuse21
Symptoms of Binge Eating Disorder
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 the binge eating that may go unseen. There are also likely underlying, untreated emotional issues such as trauma history, anxiety or depression which foster a cycle of binge eating.
Common symptoms of binge eating disorder include:23
- Regular episodes of excessive food intake in a certain period of time, leading to discomfort, fullness, fatigue, or moodiness as body is flooded with excess calories, carbohydrates, sugar and fats
- An obsession with food and planning for the next binge
- An emotional component to eating, such as feeling empty and anxious, lonely, or depressed before excessive food intake and then feeling shame, guilt, or defeat after
- Denial to self and others about disordered eating behavior
- Hiding food and amount of intake from friends, family, and co-workers, often skipping meals in front of others and then bingeing 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 fluctuations4
- Lowered self esteem or self worth that is connected to eating patterns, body image, or weight gain23
- 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
- Lack of compensatory behavior such as purging, excessive exercise, laxatives, dieting/starving self1
- Engaged in a cycle of comfort/gratification (bingeing) and punishment/self-loathing/deprivation (feelings of remorse)
- Psychiatric issues such as obsession compulsion, depression, anxiety, anger, and other addictions such as alcohol abuse21
Causes and Risk Factors of Binge Eating Disorder
When we look at causes and risks, we can use a biopsychosocial model to assess the individual struggling with binge eating disorder.7 This will include environmental, social and biological factors that may impact one’s risk of developing binge eating disorder.
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 food15
- Issues with attaching to the primary caregiver (attachment theory) so food, which was possibly more readily available, takes the place of love and comfort
- Underlying stressors or traumatic incidents (trauma history) that go unaddressed and untreated which the individual attempts 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 later7
Biological factors and risks for binge eating disorder include:
- Genetics: a binge eater is more likely if family members do too
- A predisposition for obsessive compulsive thinking and ruminating thoughts4
- Anxiety or depression, along with difficulty with impulse control and frustration tolerance7
- Communication issues, including difficulty managing and expressing emotions
- Perfectionism and/or prone to negative thinking7
- More likely to affect young women beginning in adolescence, however men can be affected too11
- Hormonal (i.e. ghrelin, cortisol and oxytocin) or gastrointestinal (Peptide YY) disruptions6,12
Diagnosing Binge Eating Disorder
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 and bulimia and could be categorized as an eating disorder, not otherwise specified. There are also similar traits in those with binge eating disorder and substance use disorder, such as addictive and compulsive behaviors.22
It is important to rule out medical conditions such as Hashimoto’s Disease, thyroid issues (Hypothyroidism), Prader Willi Syndrome, or Cushing’s Disease.
Here are some other factors that distinguish binge eating disorder:
- Frequency and Duration: There must be one or more episode per week for at least three months to be diagnosed1
- Rapid eating during the episode1
- Becoming uncomfortably full1
- Excessive food intake in relation to physical hunger1
- 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 more1
- Distress and lack of control during a binge eating episode1
- Lack of inappropriate compensatory behaviors, like purging, laxatives, dieting, starving, or excessive exercise as seen in other eating disorders1
Treatment of Binge Eating Disorder
There are several options for those seeking treatment for binge eating disorder, including therapy, medication, and lifestyle changes. Treatment is not a one size fits all and it will be up to the individual in recovery to determine which best suits their needs.
Therapy
Coming to therapy means making a weekly commitment to gain perspective by focusing on yourself. It means meeting with a professional who is trained and equipped to treat individuals with binge eating disorder. You will receive a combination of psychoeducation on your disorder and reflective, ego-supportive therapy.19
The relationship with your therapist will provide an unbiased, open-minded space for you to explore anything on your mind that may be impacting your recovery. Therapy is not always easy and comfortable, but it will ideally provide the safest space possible for you to work through these challenging and uncomfortable feelings.
Common types of therapies for treating binge eating disorder include:
Cognitive Behavioral Therapy (CBT)
The idea that irrational, repressed thoughts trigger emotional responses (i.e. anxiety) which trigger unwanted behaviors (binge eating). CBT is typically short-term approximately 6-12 sessions. The individual will meet with a CBT certified therapist to complete logs, workbooks and worksheets (often referred to as “homework”). The goal behind CBT for eating disorders is to confront irrational thoughts and uncover underlying emotional issues beneath the behavior.2,9,24
Dialectical Behavior Therapy (DBT)
Dialectical Behavioral Therapy 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 “5 senses.” The aim is to forge the gap between the rational and emotional mind for a sense of peace and clarity.24
Motivational Interviewing (MI)
There are often co-morbidities between individuals with Substance Use Disorder and binge eating disorder.22 Motivational Interviewing 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.
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 is important to understand how these issues arose and possible solutions to underlying issues including setting 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.24
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 support groups, 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
Rarely, a binge eating disordered individual will find themselves in need of urgent and intensive medical and psychological intervention. Often, another medical reason will bring this individual in to the hospital, such as a heart condition that becomes dangerous when engaging in binge eating. In this case the individual’s food will be heavily monitored by a medical team of nurses and doctors for a period of time long enough to stabilize the medical condition. The person may also receive intensive psychological attention with daily support groups and therapy sessions.
Intended Treatment Outcome & Timeline
Recovery for an individual 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 it’s 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 3 weeks, but to maintain this recovery, individuals may need to remain in weekly therapy for several years.
One of the best approaches to treatment may feel counterintuitive. Eat meals so you are feeling satiated and nourished. Recognize that it is okay 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.13
Medication
Medication is not always necessary to treat binge eating disorder but research shows there are certain medications which 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:2,17
- Orlistat or Alli (reduce fat absorption)
- Topirimate (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.2
Lifestyle Changes
A person struggling with binge eating disorder can make several lifestyle changes in support of their holistic recovery.
Some options include:
- Finding an eating disorder support group
- Keep a food journal to identify emotional triggers and addictive foods
- See a nutritionist to get tools to develop a healthy relationship with food
- Learn about and practice mindful intuitive eating
- Read up on body positivity to combat stigma and body image issues while engaging in self-compassion and gratification
- Prioritize healthy meals
- Find joy in cooking
- Identify problematic interpersonal relationships
- Learn to communicate one’s needs through boundary setting
- Take time for yourself to decompress and notice when you are overstressed or overworked
- Learn to relax and engage in your favorite hobbies and interests again3,13
How to Get Help for Binge Eating Disorder
There is a breadth of resources online and in person for the binge eating disordered individual. 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.18 Typically, support groups are donation-based or low-cost.
The National Eating Disorders Association is a great place to start when looking for a support group. 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. You will just have to mentally substitute the words “food addiction” for “alcohol addiction.”
Also of note, traditionally, FAA takes a firmer abstinence-only approach (meaning to abstain from binge and trigger foods all together) and OA can be more of a harm reduction approach.2
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.2,17 In extreme cases, they may recommend bariatric surgery
Barring any major medical issues, an approach at uncovering the underlying emotional issues with an individual therapist specializing in eating disorders may be more advisable. A suitable and reasonable course of action for a binge eating disordered individual 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 for this process.13 The cost of a therapist and nutritionist would range from a small co-payment to $100-$200 per session.
Most people with binge eating disorder don’t meet the medical criteria for Inpatient Rehab, Partial Hospitalization or Intensive Outpatient Treatment, which may be prescribed in extreme cases. These treatments 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 Get Help for a Loved One
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, by Prochaska and DiClemente can be helpful for family members who wish to assist their loved one on the path to recovery.19 The stages described below are not always in order but rather can be cyclical. They are Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance.
As it may sound the Precontemplation Stage would indicate 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 and be open to listening. Inform yourself on signs and symptoms of binge eating disorder so you can answer questions they may have when they are ready to approach the subject.
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. By the next stage, 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. You can 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 a patient support as set backs in the process are inevitable.
Being a support can be very challenging at this time when one can clearly see steps that need to be taken and wishes for their friend or loved one’s recovery. Education, encouragement and connection to the resources provided above is one part of the process while patience and understanding for your loved one’s own self-determination and choice is another.
Binge Eating Disorder Statistics
Consider the following statistics about binge eating disorder:
- BED is the most common eating disorder. BED is 3 times more common than anorexia and bulimia combined.5
- Approximately 2.6% of the U.S. population will be diagnosed with BED in their lifetime.5 Women are most likely to be affected by BED11
- 3.5% of women and 2.0% of men had or will have binge eating disorder during their life20
- Approximately 8 million Americans have an eating disorder, including 1 million men18
- Suicide attempts are more common in individuals with an eating disorder16
- Less than half of individuals diagnosed with BED will receive treatment11
- 36% of US adults are obsese.25 Black women have the highest rates of obesity and binge eating, yet are the least likely to receive treatment.8,14
- The median age of onset for BED is late teens to early 20s11,20
- About half of individuals with BED are obese4
- Up to 50% of individuals with eating disorders abused alcohol or illicit drugs, a rate five times higher than the general population20
- 79% of adults with BED are diagnosed with anxiety disorders, mood disorders, impulse control disorders, or substance use disorders5
- Individuals who began dieting as adolescents are five times more likely to develop an eating disorder later10
- Three out of ten individuals looking for weight loss treatments show signs of BED20
Binge Eating Disorder vs Bulimia
Both BED 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 Tests, Quizzes, and Self-Diagnosis Tools
Your doctor or therapist may give you a questionnaire to help determine a diagnosis, like the Eating Disorders Examination-Questionnaire (EDE-Q), Eating Attitudes Test (EAT) or the Eating Disorder Inventory (EDI). There is no universal screening test and most often these are used for research purposes. Comparing your symptoms to the criteria in the DSM-5 is the most common and universal approach to diagnosis.1
Quizzes and Self Diagnosis
Only a licensed health or mental health professional can diagnose binge eating disorder. It is recommended that you schedule an appointment to speak with a doctor or licensed therapist if you are concerned about your weight or eating patterns.Here are some online tools to help you determine next steps in intervention:
For Further Reading
The following are helpful resources for anyone impacted by binge eating disorder:
Binge Eating Disorder Infographics
