Binge Eating Disorder

What is binge eating disorder?

Binge eating disorder (BED) is a behavioral disorder characterized by chronic, compulsive overeating. While occasional overeating is normal, an eating disorder is a condition that you live with every day. It feels like it controls you and interferes with your mental, emotional and physical well-being. Binge eating means consuming large quantities of food in a short period and feeling like you can’t stop.

What is considered binge eating?

Criteria to diagnose binge eating disorder include:

• Eating a greater amount of food than most people would within a limited period (one to two hours).
• Feeling a sense of compulsion or lack of control associated with eating.
• Binge eating episodes occur at least once a week and have been going on for several months.
• Feelings of distress and/or self-loathing about binge eating.

What is the difference between bulimia nervosa vs. binge eating disorder?

Unlike bulimia nervosa, binge eating disorder doesn’t involve purging calories, such as forced vomiting, abusing laxatives or exercising excessively after eating. A binge eating episode ends with eating. On the other hand, some people with binge eating disorder are chronic dieters. They may attempt to restrict calories before lapsing into binge eating, or they may attempt to diet after a binge to make up for it.

How common is binge eating disorder?

Binge eating disorder is the most common of all eating disorders, accounting for almost half of all diagnoses. In the U.S., it affects almost 3% of the population, including all racial and ethnic groups. It’s more commonly diagnosed in women and people assigned female at birth than in men and people assigned male at birth, by a ratio of about 3:2. It’s also more commonly diagnosed in teenagers than adults, by a ratio of about 4:3.

What are the signs and symptoms of binge eating disorder?

Signs and symptoms of binge eating disorder may include:

• Eating past the point of satisfaction and to the point of discomfort.
• Eating too fast to notice how much you’re eating or how it feels.
• Eating large amounts of food when you’re not hungry or after recently finishing a meal.
• Eating in response to emotional stress (emotional eating).
• Eating alone and in secret and avoiding social eating.
• Organizing your schedule around binge eating sessions.
• Hoarding and stashing food in hidden places to access later.
• Hiding eating from others because you’re embarrassed about how much you’re eating.
• Obsessive thinking about food and specific food cravings.
• Frequent dieting, which may cause weight fluctuations or no weight loss.
• Guilt, remorse, shame and self-esteem issues related to binge eating.

Many people may exhibit signs or symptoms of binge eating occasionally. When they begin to recur regularly (once a week or more), you may have a disorder. Environmental conditions such as stress and relationships can influence your behavior and affect your mental health. These conditions may combine with other causes to push you over the edge from occasional disordered behavior to meeting the criteria for BED.

What causes the urge to binge eat?

Many factors influence eating behavior, including psychology, biology and learned habits. What triggers you to binge eat might be different from what triggers the next person. Eating can release pleasure hormones in your brain (serotonin and dopamine), which might encourage addictive tendencies. Eating can also be a way of escaping or numbing uncomfortable feelings or compensating for unmet needs.

What risk factors are associated with binge eating disorder?

You may be more likely to develop binge eating disorder if you have:

• A family pattern of disordered eating.
• A family pattern of dysfunctional emotional coping.
• A personal history of trauma or abuse.
• A personal history of food insecurity.
• A mood disorder such as depression.
• An anxiety disorder (general or specific).
• Attention deficit/hyperactivity disorder (ADHD).
• Substance use disorder (SUD).
• Body dysmorphic disorder (BDD).
• Executive dysfunction.

What are the possible complications of binge eating disorder?

Any mental health disorder can escalate to cause increasingly destructive thoughts, feelings and behaviors. Binge eating disorder can also bring with it the health complications associated with obesity. While not everyone with BED has obesity, the combination of these two disorders can be especially harmful. The cycle of binge eating and weight gain can compound your mental and physical distress.

Complications of untreated mental illness can include:

• Increasingly antisocial behavior, such as secrecy, avoidance and lying.
• Increasingly erratic behavior, such as stealing and hoarding food.
• Increasing depression, anxiety and body dysmorphia.
• Increasing distress, self-loathing and risk of self-harm.

Complications of obesity can include:

• Type 2 diabetes.
• Cardiovascular disease.
• Gallstones.
• Fatty liver disease.
• Kidney disease.
• Osteoarthritis.

How is binge eating disorder diagnosed?

Healthcare providers diagnose eating disorders by asking detailed questions about your behaviors, thoughts and feelings. You might be reluctant to open up about these details, but honesty is important to getting the right diagnosis and the right treatment. You can start by talking to your primary care practitioner or seek out a mental health care practitioner. Either one can make the diagnosis.

Is there a test for binge eating disorder?

There’s no test, though the questions you’ll answer might take the form of a quiz. Your healthcare provider will analyze your answers according to the diagnostic criteria listed in the DSM-5. They may also ask follow-up questions not listed in the manual. If they think you meet the diagnostic criteria, they’ll diagnose binge eating disorder.

Do I need a diagnosis?

You don’t necessarily need a diagnosis to begin treatment. In fact, you may benefit from treatment even if your symptoms are “subclinical” (meaning, they don’t quite meet the criteria for diagnosis). Going through the interview process with a healthcare provider will help you and them to learn more about what type of support may benefit you. Some people feel relieved or validated by receiving a diagnosis and more empowered to seek help. This can be especially important for parents trying to help their children.

How do you recover from binge eating disorder?

There’s no quick fix, but with a consistent, long-term treatment plan, you can recover. Psychotherapy is usually the foundation of this treatment plan, and it’s proved effective for most people. Depending on the individual, your plan may also include medications or nutrition advice. You may interact with a variety of healthcare specialists, such as a psychologist, a psychiatrist or registered dietitian.

What’s in the treatment plan for binge eating disorder?

Psychotherapy (talk therapy) is the most important part of the treatment plan. You can choose from several different methodologies or approaches. Medications or diet may play supportive roles in your treatment plan. Medications and diet don’t address binge eating disorder directly, but they can help you manage some of the factors that may contribute to your disorder.

Therapy

There are many types of psychotherapy. The most studied and proven methods for treating BED are:

• Cognitive behavioral therapy (CBT): CBT helps you examine your behaviors and the thoughts and feelings behind them. Your therapist then works with you in a structured way to break those patterns and find more constructive ways of responding to those thoughts and feelings.
• Interpersonal therapy (IPT): IPT is a short-term, focused type of individual therapy that addresses the current conflicts and stress factors affecting your life. Rather than dig into childhood issues, your therapist focuses on problem-solving to relieve your most pressing pain points.

Other options include:

• Dialectical behavior therapy.
• Psychodynamic therapy.
• Individual psychotherapy.
• Group therapy.

Medication

Lisdexamfetamine (Vyvanse®), an ADHD medication, has recently become the first U.S. Food and Drug Administration (FDA)-approved drug to treat binge eating disorder. Research has shown it can help with impulse control in both conditions. It shouldn’t be your only treatment, as impulse control is only one factor involved in BED. It can help suppress BED and keep you from relapsing longer, but it doesn’t address the root of the disorder.

You may also need medication to treat another condition related to your eating disorder, such as antidepressants or anxiety medications. Treating your underlying mental health conditions can help take the edge off your eating disorder. In addition, some providers may prescribe appetite suppressants for some people. These medications have shown short-term benefits for people in treatment for BED.

Diet and nutrition

People of all shapes and sizes can have BED, and they can also have various types of malnutrition. They may be deficient in micronutrients (vitamins and minerals) even if they have an excess of macronutrients (sugar and fat). Nutrient deficiencies can motivate binge eating by producing cravings and a vague sense of not getting enough. Nutritional supplements and nutrition education can help.

Some people find that a structured, nutritionally balanced meal plan can simply reduce some of the decision-making stress related to eating. It can satisfy your physical needs while leaving less room to act impulsively or emotionally. Although weight loss isn’t the main goal of treatment, it can be a side effect, and this can help relieve stress for some people. However, diet may be triggering for others with BED.

Will I always have binge eating disorder?

Most mental health conditions are chronic, which means that even after successful treatment, the seeds remain in the soil. They always have the potential to flare up again. But your disorder can go into remission, and that remission can be lasting. This is what recovery means for binge eating disorder. The road to recovery may not be short or straight, but most people do get better with treatment.

What are some tips for living with binge eating disorder?

If you’re trying to get a handle on your binge eating, it can help to become more mindful of the urges that motivate your eating habits. By paying attention to your urges, you can learn to distinguish true hunger from the urge to binge eat. You can also learn to recognize when your hunger is satisfied, and you can become more conscious of what triggers your urge to binge eat. Here are some tips:

• Practice mindful eating. When you’re thinking about eating, or you find yourself preparing to eat, slow down. Take a deep, slow breath. Then just notice, without judgment, what’s happening in your mind and body. You can also stop and do this while you’re eating.
• Learn to recognize hunger. Physical hunger symptoms include stomach pangs or grumbles, light-headedness and hunger headaches. You may feel slightly tired or weak from low blood sugar. One self-test is to ask yourself if you’re hungry enough to eat something healthy, like salad.
• Eat when you’re hungry. This is just as important as learning to stop eating when you’re not hungry. If you really are hungry, now is the time to eat. Don’t wait until you’re starving, or you’ll be more likely to overeat.
• Stop before you’re full. It takes time for your stomach to receive and digest the food you’ve just eaten. Eating too fast can lead to eating too much, simply because you haven’t had time to notice that you’re full. One technique is to stop when you feel almost full — like 80%.
• Keep a journal. Journaling is one of the most tried-and-true methods for becoming more conscious of your thoughts, feelings and behaviors. Take note of what you eat each day and what you’re thinking and feeling. You’ll start to recognize patterns, and maybe triggers.
• Tackle your triggers. If you’ve noticed that certain foods or situations tend to lead to binge eating, look for ways to remove them from your life. Clear your home of your favorite binge foods and plan alternative meals in advance. Avoid social settings that encourage binge eating.

When should I contact a healthcare provider about BED?

If you think you or someone you care for has an eating disorder, it’s always better to contact a healthcare provider sooner than later. People who have eating disorders often don’t recognize that anything is wrong, so others who care for them can play an important role in bringing attention to the matter. A healthcare provider can advise you on what to do next to help yourself or your loved one.

A note from Cleveland Clinic

Binge eating disorder (BED) only recently entered the DSM-5 as a diagnosis in 2013, which may be why public awareness of the disorder is low. But it’s since become clear that it’s the most common of all eating disorders. If you think you have BED, it’s important to know that you’re not alone and that it’s treatable. Talk to a qualified healthcare provider to find out if you have it, and how they can help.