What Is Binge Eating Disorder?

Definition

Binge eating disorder (BED) is when you have repeat episodes of binge eating. A binge means eating a large amount of food in a short time — more than most people would eat in the same setting. It’s different from simply overeating. During a binge, people with BED often feel distressed or like they can’t control the amount (or type) of food they eat. 

Though BED wasn’t officially recognized as a separate eating disorder until 2013, it’s actually the most common eating disorder in the U.S. It affects between 2% to 5% of adults and 1% to 3% of adolescents and children.

BED can affect people at any age, but it usually starts in teens or young adults. It’s somewhat more common in women, but it can affect anyone. While many people may think that eating disorders only affect young, white women, they’re just as common in people of color. 

BED also affects all body sizes — only about half of people with BED are considered to have obesity according to their BMI (body mass index).

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Causes

There’s no single cause of BED. Factors like your genes, behaviors, and life experiences may play a role in whether you’re at risk for developing BED. Each person is different, but here are some common risk factors for BED.  

Physical and genetic risk factors:

• Having a close relative (like a parent) with an eating disorder

• Having a family member with a mental health condition

• Having an anxiety disorder

• Having a history of controlling your weight through diets or other methods

• Having certain genes that may be linked to BED

• Having Type 1 diabetes, which can lead to skipping insulin injections to stay thin (diabulimia)

Psychological risk factors:

• Being a perfectionist, especially toward yourself

• Being unhappy with your body image

• Having a hard time changing your behaviors  

Social risk factors:

• Feeling lonely and isolated 

• Being exposed to weight stigma (discrimination or stereotyping based on weight)

• Being teased or bullied in the past, especially about weight

• Having a traumatic life event or stress

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Symptoms

People with BED have repeated episodes of binge eating. During these episodes: 

• A person eats a large amount of food in a short period of time. The amount of food is more than what most other people would eat in the same setting.

• The binge feels beyond a person’s control. They feel they can’t stop or control what they’re eating.

For BED to be diagnosed, a person must have distressing episodes of binge eating at least once a week, for at least 3 months. To “qualify” as binge eating, the episodes must also have at least three of the following features:

• Eating much faster than normal

• Eating until uncomfortably full

• Eating a lot of food even when not hungry

• Eating alone because of shame  

• Feeling depressed, guilty, or disgusted with the binge eating behavior

Other signs of possible BED include:

• Hiding food containers or wrappers

• Gaining or losing a lot of weight

• Being preoccupied with your weight, food, and body

• Skipping meals or eating at unusual times

• Eating to deal with stress

• Having frequent and intense food cravings

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Getting a diagnosis

If you’re concerned about binge eating disorder, talk to your healthcare provider. They will ask you about your eating habits, feelings, and behaviors related to food as well as any other problems you might have. Sometimes they might do a physical exam or order other tests to make sure. 

Your provider can use all of this information to decide whether or not you have BED. They may also use the DSM-5 (a clinical manual) to confirm your diagnosis. The DSM-5 is a book that lists all of the symptoms of mental health conditions, including eating disorders.

And keep in mind: It might take a few visits to your provider before you know for sure if you have BED. It’s important to be patient. Though it might feel hard to talk about food, try to be as honest as you can. And if you need to, don’t be shy about taking a stand against weight bias. All of these things can help you get the right diagnosis as soon as possible. 

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Treatments

Binge eating disorder is treated with therapy and medications. Treatment often involves a team of providers, like a primary care provider, psychiatrist, and nutritionist. The main goal is to work together to reduce binge eating episodes. 

Therapy is a first-choice treatment for BED. Options include:

• Cognitive behavioral therapy (CBT): CBT can help identify and change your thoughts, feelings, and behaviors. 

• Interpersonal psychotherapy: This can help improve relationships and resolve interpersonal issues. 

• Dialectical behavior therapy: This can help people accept themselves, change their behavior, and regulate difficult or overwhelming emotions. 

If in-person therapy for BED isn’t available in your area, there’s evidence that online therapy may also be an effective alternative. 

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Medications

Medications can also be used along with psychotherapy. Most medications work by decreasing binge eating behavior or treating obesity associated with BED. Scientists continue to study new medications. 

Here are some of the most commonly used medications:

• Lisdexamfetamine (Vyvanse) is the only medication the FDA has approved to treat BED. It works by stimulating your brain to release dopamine and norepinephrine, chemicals that lower the urge to binge.

• Topiramate (Topamax) is a medication commonly used to treat seizures and migraines. It can help lower binge eating and extra weight in people with BED. This medication is used “off-label” for BED.

• SSRIs, like citalopram (Celexa) and sertraline (Zoloft), are examples of medications often used to treat depression that can work for BED. These medications are also used “off-label” for BED.

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Living

Living with — and treating — an eating disorder can be challenging. Be kind to yourself and take it one day at a time. Here are some self-care tips that can help:

• Find a healthcare team that you trust. Your team might include your primary care provider, a therapist, a nutritionist, or other healthcare provider(s). What matters most is finding a team that supports and listens to you. 

• Stick with your treatment plan.

• If you have a setback, don’t give up on the whole plan.

• Don’t diet unless you’re in a supervised weight-management program.

• Avoid your triggers as much as possible.

• Find a friend or family member you can talk to about what’s going on.

• Try keeping a journal of your feelings and behaviors.

• Consider joining a support group.

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