Binge eating disorder (BED) is a serious condition characterized by recurrent episodes of consuming large quantities of food in a short period, accompanied by a sense of loss of control. It is distinct from occasional overeating and has significant physical and psychological consequences. Unlike bulimia nervosa, BED does not involve compensatory behaviors like purging or excessive exercise. Affecting approximately 1.2% of American adults, BED is more prevalent than anorexia and bulimia nervosa.
Defining Binge Eating Disorder
Binge eating involves consuming a large amount of food rapidly and uncontrollably, often exceeding the point of fullness. This behavior is typically driven by psychological factors rather than physiological hunger. Common triggers include fear of failure or rejection, unmet expectations, and feelings of inadequacy. Episodes may be planned or spontaneous. A diagnosis of BED is typically made when binge eating episodes occur at least once a week for three months. However, even less frequent binge eating can be problematic. Secrecy often surrounds BED, with many individuals struggling in silence, leading to worsening consequences.
Diagnostic Criteria
According to the DSM-5, key diagnostic features of binge eating disorder include:
Recurrent episodes of binge eating, characterized by consuming an amount of food larger than most people would eat in a similar time frame under similar circumstances.
A sense of lack of control over eating during the episode.
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The presence of three or more of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating.
The binge eating occurs, on average, at least once a week for three months.
The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (e.g., purging) and does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder.
Physical Consequences
The unusual eating habits associated with BED can lead to significant health problems.
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Physical Discomfort
A typical meal contains about 850 kilocalories, but during a binge, individuals can consume close to 3,000 kilocalories in one sitting. This high volume of food often leads to gastrointestinal distress.
Sudden Death
Rapid consumption of large quantities of food can lead to stomach or intestinal perforation. The leakage of liquids into surrounding tissues can be life-threatening. Even individuals without a formal BED diagnosis can experience sudden death during a binge.
Weight Gain
Many individuals with BED are overweight or obese, increasing their risk of cardiovascular disease, high blood pressure, high cholesterol levels, and adult-onset diabetes.
Insomnia
Binge eating and sleep problems are closely related. Many individuals with BED struggle to sleep after a binge, while others binge due to an inability to sleep. Lack of adequate rest can lead to fogginess and emotional distress.
Gout
Binge eating and an inactive lifestyle can contribute to the development of gout, an inflammatory arthritis.
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Further Health Risks
- Heart Disease: Overweight individuals are more likely to have high blood pressure, high cholesterol, and high triglyceride levels, increasing the risk of heart attack.
- Type 2 Diabetes: Weight gain from binge eating increases the risk of developing type 2 diabetes.
- Gallbladder Diseases: BED can increase the risk of developing gallbladder diseases.
- Fertility issues
- Gastric rupture or intestinal blockage
Psychological Consequences
BED has significant psychological effects that can profoundly impact an individual's quality of life.
Isolation
Extreme shame often surrounds BED, leading individuals to engage in the behavior privately. Social isolation occurs as individuals allocate time to binge and recover.
Poor Mental Health
Feelings of shame, self-hatred, anxiety, and depression are common immediately after a binge. Continuing the behavior for months or years intensifies feelings of depression, anger, sadness, and loneliness.
Lack of Treatment
Weight stigma surrounding BED can prevent individuals from seeking help, as they may feel they are not "sick enough" for treatment. Stereotypes often cause individuals to suffer in silence for extended periods before seeking help.
Substance Abuse
Binge eating and substance abuse are closely tied. Some individuals use substances to cope with the psychological distress caused by bingeing, which can worsen the eating disorder.
Emotional Symptoms
- Strong dissatisfaction or self-loathing around one’s body or appearance
- Anxiety and/or depression
- Intense stress
- Low self-esteem
- Extreme shame
Risk Factors
Several factors contribute to the development of BED:
Dieting and Weight Concerns
A personal history of dieting, calorie restriction, and food-related stress can predate binge eating onset and episodes. Individuals with binge eating disorder may diet, especially if they are overweight. Since dieting involves restriction, it can lead to feelings of deprivation, which in turn leads to bingeing.
Psychological Factors
Depression, anxiety, low self-esteem, ADHD, stress, and trauma history are associated with BED.
Childhood Experiences
Adverse childhood experiences, such as trauma, bullying, or teasing, can also result in emotional eating patterns. Painful childhood experiences-such as family problems and critical comments about your shape, weight, or eating habits-are linked to developing binge eating disorder.
Sociocultural and Environmental Pressures
Cultural beauty ideals and weight stigma contribute to body dissatisfaction, leading to emotional eating and binge episodes. Facing negative comments, bullying, body shaming, and media-driven body image concerns can also contribute to low self-esteem and a higher risk.
Socioeconomics and Food Access
Limited access to nutritious food increases BED risk.
Biological Factors
Hormone irregularities and genetic loading can contribute to the onset of BED.
Seeking Help and Treatment
Discussing BED and disordered eating can be challenging. However, understanding the illness and seeking professional help are crucial for recovery.
Evaluate Your Beliefs
There are two reasons to eat: nourishment and enjoyment. Food meets the body’s requirements and provides pleasure. Both need to be present in balance. With binge eating, the potential exists for neither to be present. Often, the type of food ingested is not beneficial to the body and is not enjoyed.
Acknowledge the Issue
Examine your behavior and ask, “Am I eating for reasons other than nourishing my body or enjoying myself?” Then, consider what needs you are trying to meet through food.
Avoid Dieting
Individuals with BED may diet, especially if they’re overweight. Since dieting involves restriction, it leads to feelings of deprivation, which leads to bingeing. Instead, try reconnecting with your body’s signals of hunger and fullness. If you desire to eat, ask yourself, “Am I really hungry?” If not, try to understand why you want to eat when you are not hungry. Could it be loneliness, anger, frustration, or depression?
Seek Professional Help
A therapist or counselor can help you understand the "why" of your eating behavior and find new ways of dealing with the emotions that underlie the behavior. Therapists who use cognitive behavioral therapy techniques are usually the most successful. If medical complications exist, consult a physician.
Treatment Approaches
- Cognitive Behavioral Therapy (CBT): Helps individuals identify and change negative thought patterns and behaviors related to eating.
- Dialectical Behavioral Therapy (DBT): Teaches coping skills to manage emotions and reduce impulsive behaviors.
- Interpersonal Psychotherapy: Focuses on improving relationships and social skills to address emotional triggers.
- Nutrition Education: Provides guidance on healthy eating habits and helps individuals reconnect with hunger and fullness cues.
Recognizing the Signs and Symptoms
Recognizing the signs and symptoms of BED can help individuals seek timely care:
- Feeling a lack of control with food, eating when not hungry, eating in secrecy.
- Skipping meals or not eating much throughout the rest of the day.
- Negative body image and poor self-esteem.
- Constipation, diarrhea, and other GI problems.
- Food hiding or hoarding.
- Increasing social isolation.
- Obesity, although 50% of people with BED can be normal weight.
- Frequent dieting.
- Family history of Binge Eating Disorder.
- Guilt or shame related to eating.
Recovery
Recovery from BED is possible with proper care and treatment. Eating disorders are treatable, and individuals can experience a full recovery and return to a normal life. Self-compassion and patience are essential during the recovery process. It is important to treat yourself with kindness and understanding as you work towards recovery. Remember that the journey to recovery may have ups and downs, and that's okay. During your treatment, your care team will work closely with you to develop a relapse prevention plan and aftercare support to help keep you stable and sustain your recovery.
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