What Is Binge-Eating Disorder?

Binge-Eating Disorder, or BED, is an eating disorder in which an individual frequently consumes excessive amounts of food and feels unable to stop. Binge eating is characterized as eating in a short amount of time (within any two-hour period), an amount of food that is unusually larger than what most people would consume in a similar time period, under similar circumstances.

A hallmark trait of binge eating is the feeling of being out of control and having an inability to stop eating. An important distinction to make is the difference between binge eating and over-eating. Many people, at times, may overeat or eat beyond feeling full. Holidays, family gatherings, or special occasions, can lead to this behavior. However, binge eating is a recurrent experience of eating unusually large amounts of food in a short amount of time, feeling without the ability to stop.

What Are the Symptoms of Binge-Eating Disorder?

A common misconception about binge-eating disorder is that anyone who struggles with the disorder is overweight or obese. In reality, although most people who are diagnosed with binge-eating disorder are overweight or obese, some people remain at a normal weight. The following list represents the Diagnostic and Statistical Manual of Mental Disorders ( Fifth Edition) signs and symptoms of binge-eating disorder:

• Eating unusually large amounts of food in a specific amount of time (within a two-hour period)
• Eating behavior feels out of control
• Eating even when full or not hungry
• Eating rapidly during binge episodes
• Eating until uncomfortably full
• Frequently eating alone or in secret
• The binging occurs, on average, at least once weekly for three months
• Feeling depressed, disgusted, ashamed, guilty or upset about eating habits
• Frequently dieting, possibly without weight loss

In contrast with bulimia, after a binge eating episode, it does not lead to regularly compensating for extra calories consumed by vomiting, using laxatives, or over-exercising. Often times, those who binge eat may try to diet or eat normal meals. However, restrictive dieting may lead to more binge eating.

The severity of binge-eating disorder is determined by the frequency of binge eating episodes that occur during a week.

What Causes Binge Eating Disorder?

There is still much to learn in regards to determining the causes of BED. The causes are likely due to several different risk factors, including:

• Genetics: Research has revealed genetic risk factors that may contribute to the development of BED, and that it may be inherited. Studies have also shown a heightened sensitivity to dopamine (chemical in the brain that is responsible for feelings of pleasure and reward) in people diagnosed with BED.
• Gender: BED is more common in women than in men, with 3.6% of women in the United States having been diagnosed with BED, compared to 2.0% of men. This variation may be due to underlying biological factors.
• Changes in the brain: Studies have shown that people with BED may have differences in brain structure that produce a heightened response to food and reduction in self-control.
• Body size: Weight and body mass may be correlated to the onset and development of BED. Nearly 50% of people diagnosed with BED are clinically obese, and about 25-50% of people seeking weight-loss surgery meet criteria for BED.
• Body image: A negative body image can be a contributing factor in the development of BED. Body dissatisfaction can lead to unhealthy eating habits, which may result in the development of BED.
• Binge eating: People diagnosed with BED often report a history of binge eating, with it being one of the first experienced symptoms. It can present in childhood or teen years.
• Trauma: Stressful life events, such as abuse, death of a loved one, natural disaster, chronic pain, separation from a family member, or a car accident can all be risk factors for developing BED. Bullying experienced in childhood, related to weight, has also shown to be a risk factor.
• Other psychological conditions: Nearly 80% of those diagnosed with BED have another mental health diagnosis. Depression, anxiety, PTSD, and substance use issues are just a few of those diagnoses. Binge eating episodes can be triggered by stress, negative thoughts about body image, access to food, dieting, or boredom.

The causes of BED continue to be researched, and are not yet fully known. Similar to other eating disorders, various genetic, environmental, social, and psychological risks contribute to its development.

How Is Binge Eating Disorder Diagnosed?

As mentioned, it is common across genders to overeat on occasion and this does not necessarily constitute an eating disorder. To diagnose binge-eating disorder, a patient must meet specific criteria for a clinical diagnosis.  A medical professional may recommend a psychological evaluation, including discussion of eating habits and a patient’s relationship with food.

A medical professional may also recommend other tests to check for adverse health consequences of binge-eating disorder. Specific issues may include high cholesterol, high blood pressure, heart problems, diabetes, GERD and sleep-related breathing disorders. The tests may include:

• A physical exam
• Blood and urine tests
• A sleep disorder center consultation

How Is Binge-Eating Disorder Treated?

Treatment for BED often consists of a combination of treatments, or a more integrated approach. Depending on the degree of severity, eating disorders can be effectively treated by individual psychotherapy, group therapy, family therapy, or residential treatment options. Points of focus tend to be aimed at reducing and changing unhealthy thought patterns and distorted thinking, improving unhealthy eating behaviors, and working to increase self-esteem and a positive body image. Treatments for BED include, but are not limited to, the following evidence-based therapies:

Cognitive-Behavioral Therapy (CBT) focuses on identifying the negative thoughts, feelings, and behaviors that contribute to binge eating and creates goals and strategies to help improve them. CBT has proven to be one of the most effective treatments for BED.

Interpersonal Psychotherapy (IPT) views binge eating as a way to cope with underlying problems. The core of treatment is identifying and resolving the underlying issues. This therapy model is often used with more severe cases.

Dialectical Behavioral Therapy (DBT) sees binge eating as a reaction to distress or adverse life experiences. It utilizes mindfulness techniques and teaches emotional regulation skills to help reduce emotional distress and binge eating episodes. It is unclear if it sustains long-term effectiveness.

Weight Loss Therapy seeks to improve binge eating symptoms by helping the patient reach a healthy weight and develop a more positive body image. Although it has not been proven to be as successful as CBT or interpersonal therapy, it may still be helpful for some individuals.

Medications

Antidepressants may be helpful in reducing some of the symptoms of binge-eating disorder. However, more research is needed to determine the short and long-term effectiveness in relation to the treatment of BED.

What Are Complications of Binge-Eating Disorder?

There are several complications that may result from BED. Often times BED has a co-morbidity of anxiety or depression. The complications can include physical, social, and emotional difficulties. Some of these complications are:

• Cardiovascular disease
• Type 2 Diabetes
• Insomnia or sleep apnea
• Hypertension
• Gallbladder disease
• Muscle and/or joint pain
• Gastrointestinal difficulties
• Depression and/or anxiety