Binge eating disorder: recognizing the signs

Most of us overeat sometimes, like when on vacation or during Thanksgiving dinner. But for some people, overeating can feel out of their control. Binge eating disorder involves frequently and compulsively eating large amounts of food at one time. 

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Binge eating disorder (BED) is a type of eating disorder recognized more recently in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria for binge eating disorder include (Iqbal, 2021):

1. Consuming a larger amount of food than other people would be able to in a similar amount of time (typically within 2 hours)

2. Loss of control of eating and feeling guilty after eating

Episodes of binge eating must occur at least once a week for three months for a person to be diagnosed with BED. 

Suppose binge eating is followed by purging behaviors (excessive exercise, self-induced vomiting, or laxative use). In that case, it may be considered bulimia nervosa instead of BED.

On the other end of the spectrum, anorexia nervosa is an eating disorder associated with an extremely low calorie intake and low body weight.

Binge eating disorder leads to issues with both physical and mental health. BED is more commonly diagnosed in women and typically starts around the age of 23 (Iqbal, 2021).

The warning signs of binge eating disorder may be more difficult for other people to recognize because the bingeing often happens in private. 

The symptoms of binge eating disorder include (Iqbal, 2021):

• Eating large amounts of food within a short period of time

• Feeling out of control around food

• Eating when you’re full or not hungry

• Eating until uncomfortably full

• Eating alone or in secret

• Feeling guilt, shame, or disgust about your eating habits

• Frequent dieting attempts

• Hiding wrappers or hoarding food

• Feeling shame or guilt about your weight or body

• Low self-esteem

People with BED often feel extremely unhappy about their eating, body image, and weight. Often they will make efforts to lose weight and have feelings of guilt about eating foods that aren’t on their meal plan. 

The exact cause of binge eating disorder is unknown. It is likely caused by a combination of risk factors, including (Iqbal, 2021): 

• Genetics—A family history of eating disorders or mental illness may increase your risk for eating disorders.

• Body size—BED is more common in people who have obesity. Weight problems seem to both contribute to causing BED and are the result of it.

• Body image—Poor body image and shame about body size may increase risk.

• Emotional distress—Stressful events, like trauma, death, car accidents, or being abandoned, may contribute to BED.

• Other mental health conditions—About 80% of people with BED have another type of mental illness or mood disorder, such as anxiety, post-traumatic stress disorder, substance abuse, and phobias. 

• Dieting and fasting—Rigid dieting and fasting for weight control may increase the risk of developing BED (Lindardon, 2017; Stice, 2008). In one study, 65% of participants with BED reported making dieting attempts before they began binge eating (Grilo, 2000). 

Trouble managing emotions seems to be one of the common triggers for binge eating episodes. Tasting food can trigger neurotransmitters, such as dopamine, to send reward signals and pleasure to the brain (Iqbal, 2021). People with BED may rely on food as their way to cope with their emotions. 

People with binge eating disorders are likely to gain weight because of episodes of excessive food intake. The excess calories put them at higher risk for chronic health conditions such as (Iqbal, 2021):

• Type 2 diabetes

• Hypertension or high blood pressure

• Chronic joint and muscle pain

• Heart disease

• High cholesterol

• Sleep apnea

• Metabolic syndrome

• Hormone imbalances

• Gallbladder disease

• Irregular periods

If your eating habits are causing you mental distress, talking with a mental health professional can help you feel better.

People with binge eating disorder often avoid seeking help. They often feel shame around their eating habits or believe they just need to exert more willpower. Most people with BED seek medical treatment for their weight or obesity rather than their underlying eating behaviors (Brode, 2020). 

Bariatric surgery and other weight loss methods won’t change the desire to binge eat in people who have or are at risk for BED. Identifying and treating eating disorders leads to fewer complications and less weight regain (Meany, 2015).

Treating binge eating disorder focuses on psychotherapy as the first approach. Options include (Iqbal, 2021). 

• Cognitive-behavioral therapy (CBT)—In both individual and support groups, cognitive-behavioral therapy is highly effective at treating binge eating disorder. It teaches new ways to cope with emotions, self-control techniques, and problem-solving skills. 

• Interpersonal psychotherapy—This style of therapy focuses on identifying areas that trigger binge eating episodes and focus on changing negative beliefs and growing coping skills. This type of therapy can be done in individual or group sessions.

• Dialectical behavioral therapy (DBT)—DBT teaches people skills for managing behaviors and emotions. It helps to balance feelings, thinking, and actions. 

Medications aren’t usually used right away for binge eating disorder, unless a person has another condition, like anxiety, depression, or bipolar disorder. In those cases, antidepressants, mood stabilizers, and antianxiety medications may be recommended.

Some people may continue to seek weight reduction during their binge eating disorder treatment. If you continue to try to lose weight, it may help to also receive therapy, which helps to reduce body shame and disconnect feelings of self-worth from food and weight.

Stress management, mindful eating, and intuitive eating techniques could help with recovering from binge eating disorder. Shame and guilt around food and body shape are a common trigger for binge eating episodes. It can be helpful for people to remove their focus from weight while recovering from an eating disorder. Sometimes weight loss will still occur naturally after stopping binge eating episodes (Iqbal, 2021). 

Studies show that following intuitive eating diet patterns may be associated with a lower BMI, healthy weight, and better mental health (Van Dyke, 2013). Intuitive eating is a diet practice that emphasizes eating when hungry and stopping when full. No food groups are restricted in intuitive eating unless necessary for a medical condition. Instead, the focus is placed on eating foods that help you feel good physically and satisfy cravings (Barraclough, 2019).

A 2017 study showed that intuitive eating was associated with less “good” and “bad” labeling of food and better body appreciation (Linardon, 2017).

Eating disorders often can’t be entirely prevented. Many people don’t look for other coping skills or treatment until after developing an eating disorder.

Research suggests that promoting a healthier relationship with food, limiting black and white thinking around food, and promoting body acceptance may help prevent eating disorders (Linardon, 2017).

Binge eating episodes are commonly triggered by excessive negative emotions and limited coping skills. Therapy and support to build coping skills and emotional awareness may be effective for preventing future binging episodes.

The long-term outlook for people with binge eating disorder is better than other types of eating disorders, and people are more likely to remain in remission, so it’s both important and effective to seek help (Iqbal, 2021). 

If you or a loved one is experiencing the symptoms of binge eating disorder, you can contact the National Eating Disorders Association helpline to be connected with support. 

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Current version

May 26, 2021

Written by

Ashley Braun, RD, MPH

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.