Binge Eating

Binge-eating disorder (BED) is a serious and potentially life-threatening eating disorder in which people frequently consume unusually large amounts of food and feel unable to stop eating. BED is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress, or guilt after the binge; and not regularly using unhealthy measures (e.g., purging) to counter the binge eating. BED is a severe and life-threatening eating disorder. People with BED often experience functional impairment, an increased risk of suicide, and a high frequency of co-occurring psychiatric disorders. People with binge eating disorder are usually very upset by their binge eating and may experience stress, trouble sleeping, and depression. Binge eating disorder may lead to weight gain and to related health problems, such as heart disease and diabetes.

BED is the most common eating disorder in the United States. It affects 3.5% of women, 2% of men, and up to 1.6% of adolescents. Among women, BED is most common in early adulthood, while among men it is most common in midlife. People with obesity are at a higher risk for developing BED than people of normal weight. Although most people with obesity do not have BED, most people who have the disorder are obese.People of normal weight can also have BED.

Like other eating disorders, BED can be treated with a combination of psychological support and counseling, family support, and lifestyle changes.

BED is a vicious cycle of recurrent binging without purging, and people with the disorder experience feelings of despair, disgust, and a sense of loss of control. Emotional and physical distress can become so severe that work, school, and social relationships are impaired.

People with BED display:

• Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Secretive food behaviors, including eating secretly (e.g., eating alone or in the car, hiding wrappers) and stealing, hiding, or hoarding food
• Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting; and developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, not allowing foods to touch)
• Extreme restrictions and rigidity with food and periodic dieting and/or fasting
• Periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling uncomfortably full, but does not purge
• Lifestyle schedules or rituals to make time for binge sessions
• Feelings of anger, anxiety, worthlessness, or shame preceding binges
• Feelings of disgust about body size.

Certain thought patterns and personality types are associated with BED, including:

• Rigid and inflexible “all or nothing” thinking
• A strong need to be in control
• Difficulty expressing feelings and needs
• Perfectionistic tendencies
• Working hard to please others

In BED, body weight varies from normal to mild, moderate, or severe obesity. Weight gain may or may not be associated with BED. There is a correlation between BED and weight gain, but not everyone who is overweight binges or has BED.

The cause of BED is unknown. Like other eating disorders, BED probably results from a combination of genetic, psychological, emotional, social, and other factors. BED has been linked to depression and anxiety, and painful childhood experiences such as family problems and critical comments about shape, weight, or eating may also make some people more likely to develop the disorder.

A diagnosis of BED is made according to the following criteria:

• Loss of control over amount of eating
• Marked distress over binge episode
• The binges occurs at least once per week for 3 months

People with BED also:

• Eat more rapidly than normal
• Eat until feeling uncomfortably full
• Eat large amounts of food when not feeling physically hungry
• Eat alone because of being embarrassed by the quantity of food being consumed

In BED, the binging is not associated with the use of purging to control weight gain, such as in bulimia nervosa.

People struggling with BED often express distress, shame, and guilt over their eating behaviors and they report a lower quality of life than those without eating disorders. BED is often associated with symptoms of depression, and, compared with normal weight and obese people, people with BED have higher levels of anxiety and major depression.

The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of BED include:

• High blood pressure
• High cholesterol levels
• Heart disease
• Type II diabetes
• Gallbladder disease
• Fatigue
• Joint pain
• Sleep apnea

BED is a stigmatized and frequently misunderstood disease. Resources, treatment, and support for recovery are available for people suffering from BED.

People receiving treatment for BED can use the following self-care steps to reinforce a treatment plan:

• Stick to treatment. Do not skip therapy sessions. If you have a meal plan, do your best to stick to it.
• Avoid dieting, unless it is supervised. Talk with your doctor about appropriate weight management strategies.
• Eat breakfast. Many people with binge-eating disorder skip breakfast, but, if you eat breakfast, you may be less prone to eating higher calorie meals later in the day.
• Arrange your environment. The availability of certain foods can trigger binges for some people. Keep tempting binge foods out of your home or limit your exposure to those foods, if possible.
• Get the right nutrients. Ask your doctor if you need vitamin and mineral supplements.
• Stay connected. Do not isolate yourself from family members and friends who want to see you get healthy.
• Get active. Ask your health care provider what kind of physical activity is appropriate for you, especially if you have health problems related to being overweight.

The goals for treatment of BED are to reduce eating binges, and, when necessary, to lose weight. Because binge eating is so entwined with shame, poor self-image and other negative emotions, treatment also may address these and other psychological issues.

Treatment usually starts with psychotherapy that helps patients change unhealthy habits and behaviors. Cognitive behavioral therapy helps patients identify and cope with situations that lead them to overeat, and interpersonal therapy helps patients identify and improve relationships that may lead them to binge. While there are no medications specifically designed to treat binge eating disorder, antidepressant medications and the anti-seizure medication topiramate (Topamax) may help reduce binge eating behavior, especially when used in combination with psychotherapy.