What is Binge Eating Disorder?
Binge eating disorder is an eating disorder characterized by frequent episodes of excess food consumption. The disorder differs from common (and normal) over-eating in that the sufferer often feels that their eating is out of control and that they are powerless to stop the compulsion to eat. They may feel guilty about their eating, and they may want to stop. The symptoms have a significant negative impact on the physical health of the sufferer and their mental state.
Symptoms of Binge Eating Disorder
While not at all a new problem, Binge eating disorder was recently officially recognized as a mental disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental disorders]. The latest edition, the DSM-5, was published in 2013.] Symptoms of diagnosable binge eating disorder include:
- Episodes of binge eating that fit at least three of these descriptions:
- The sufferer eats at a faster pace than normal.
- The sufferer eats until he or she is over-full and physically uncomfortable.
- The sufferer overeats even when he or she doesn’t feel hungry.
- The sufferer is embarrassed by binge eating and often eats alone to hide it.
- The sufferer feels guilty, sad, or disgusted with him or herself after the episode.
- Frequent episodes of binge eating. When the sufferer eats excessively and compulsively happens more than once, and the episodes occur at least once a week over a period of at least three months.
- Episodes cause disruption and distress. Binge eating harms the sufferer’s ability to function normally and happily.
- Symptoms of other eating disorders are absent. Sufferers of binge eating disorders don’t compensate for binges by vomiting, exercising compulsively, or taking laxatives, as is common in other eating disorders.
What Causes Binge Eating Disorder?
Binge eating disorder does not have a definable cause, but several risk factors make it more likely that you could develop the disorder. The most common risk factors for binge eating disorder include:
- A family history of the disorder. People with a parent or a sibling who has experienced binge eating disorder symptoms are much more likely to develop the disorder themselves.
- A history of dieting. Binge eating disorder is common in people who have a long and persistent history of trying to lose weight through dieting. Binges are often triggered when a dieter eats very little and is struck by a strong urge to over-eat in compensation.
- A mood disorder or undiagnosed psychological problem. Binge eating disorder is very often associated with depression, anxiety, or other mood disorders. Stress, low self-esteem, or body-image issues may also play a role in the development of binge eating disorder.
Is Binge Eating Disorder Hereditary?
Eating disorders, in general, tend to occur more often within families with a history of the disorders than in the general population. Recent research has looked at binge eating disorder, in particular, to determine if the disorder can be inherited, and there appears to be strong evidence that the disorder does run in families.
- A study in Norway looked at binge eating disorders in young-adult twins between 18 and 31. The study concluded that the heritability rate of binge eating disorders in these twins was about 41%, compared to an occurrence rate of about 3% in the general population.
- A study conducted between 2002 and 2004 in Boston looked at the prevalence of the disorder in families. The Boston researchers compared their results to those of the Norwegian researchers and concluded that the new data showed an even higher heritability rate of about 57%.
These studies and others strongly suggest that some factors contribute to the development of binge eating disorder that can be passed down through families. The disorder is not merely the result of external environmental factors.
How Is Binge Eating Disorder Detected?
The long-term consequences of binge eating disorder, both physical and psychological, can be devastating, so early detection and treatment of the disorder are vital.
The early risk factors and warning signs of binge eating disorder include:
- Many failed attempts at dieting
- Poor body image
- Avoidance of activities or social situations because of weight or body-image issues
- Being bullied because of weight or body issues
- Hiding evidence of binges, such as food wrappers or packages
- Hoarding food
- Eating alone
- Eating quickly and to the point of discomfort
- Eating outside meal times, possibly even continuously
- Eating to deal with stressful situations
- Weight gain caused by binges
- Embarrassment about eating
- Lying about eating
- Changes in routine to accommodate binges
- Guilt or depression after binges
- Depression or anxiety
- Alcohol or substance abuse
How Is Binge Eating Disorder Diagnosed?
To diagnose binge eating disorder, doctors look for a pattern of symptoms, risk factors, and a family history of eating disorders. The diagnostic process will also likely include exams to look for complications that often arise due to binge eating disorder. The whole diagnostic process usually includes physical examinations, tests, and a review of medical and family history.
Diagnostic steps may include:
- A physical exam. This exam is to rule out specific physical conditions that could be causing the symptoms. One area the exam may focus on is sleep patterns because sleep-related breathing issues may contribute to the disorder’s development.
- Blood and laboratory tests. These tests will look at the patient’s blood chemistry for issues that may be causing the symptoms and complications that may occur as a result of the symptoms. Tests will likely look for high cholesterol, high blood pressure, diabetes, and heart disease.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to look for symptoms of binge eating disorder and signs of depression or other mental issues that may underlie the symptoms. The assessment results will be compared to the diagnostic criteria in the DSM-5 to determine whether an official diagnosis of binge eating disorder is appropriate.
How Is Binge Eating Disorder Treated?
Treatment for binge eating disorder aims to get eating binges under control, but it also addresses the psychological issues associated with it and may trigger the binges. This means treating the sources of poor body image or self-esteem, depression, and anxiety that typically go along with binge eating, in addition to the bingeing behavior itself.
Therapy sessions with a mental health professional, either one-on-one or in a group therapy setting, will give the sufferer the tools and skills necessary to get binge eating and its underlying issues under control.
Psychotherapy treatment for binge eating disorder can take several different approaches:
- Cognitive Behavioral Therapy (CBT). This type of psychotherapy aims to teach the sufferer how to recognize the behavior surrounding the binges and develop strategies for changing those patterns.
- Dialectical Behavior Therapy (DBT). This type of therapy is similar to CBT in that it helps the sufferer to develop coping strategies. Still, DBT tries to understand the underlying emotional issues that may contribute to binge eating episodes.
- Interpersonal Therapy. This type of therapy concentrates on the sufferer’s relationships with the people around them. This therapy may be beneficial when the binges are linked with relationship problems or stresses.
Medications may be used to treat binge eating disorder directly or treat other psychological issues associated with binge eating.
- Vyvanse. Vyvanse is a brand name for the drug lisdexamfetamine dimesylate. This drug is a stimulant first used to treat attention-deficit hyperactivity disorder. Still, the Food and Drug Administration has approved it as a treatment for moderate-to-severe binge eating disorder. This drug may be habit-forming and is sometimes abused. It is known to have occasionally serious side effects, and it can have potentially serious interactions with a long list of other drugs.
- Topamax. Topamax is a brand name for the drug topiramate. Initially, an anticonvulsant was used to treat seizures, and the drug has shown effectiveness at treating binge eating disorder.
- Antidepressants. These medications may be used to treat mood disorders present, and they may also help control bingeing episodes.
Because dieting is often seen as a contributing factor in the development of binge eating disorder, weight-loss programs are typically discouraged during treatment for the disorder. However, some medically supervised behavioral weight-loss programs–rather than diet-based programs–may sometimes be a part of the treatment plan.
How Does Binge Eating Disorder Progress?
If left untreated, binge eating disorder can lead to many serious health problems, not to mention a decreased quality of emotional life. Potential physical complications of long-term binge eating disorder include:
- High blood pressure
- High cholesterol
- Heart disease
- Sleep apnea or insomnia
- Swelling of the joints and extremities
- Joint pain or degenerative arthritis
- Irritable bowel syndrome (IBS)
- Kidney disease
- Gallbladder disease
- Some types of cancer
How Is Binge Eating Disorder Prevented?
There is no sure way to permanently control binge eating without treating the disorder directly. However, it may be possible to control the frequency of binges by pursuing some of these strategies:
- Learn how to recognize the physical signs of hunger, such as a growling stomach, dizziness, or irritability. It may be helpful to develop a scale for ranking how hungry you are and apply it whenever you get the urge to eat.
- Keep your home free of the foods you usually binge on.
- Plan your meals ahead of time, and keep a record of everything you eat. Do not, however, try to restrict your food intake or follow any kind of weight-loss diet.
- Drink lots of water.
- Develop an exercise routine.
- Avoid situations that will make you bored or stressed.
- Eat at mealtimes, and don’t multitask while you eat.
Binge Eating Disorder Caregiver Tips
Caring for someone with a binge eating disorder is made more difficult by the complexity of the emotional and psychological issues that are typically involved. Caregiving is also challenging because of the guilt and shame that the sufferer feels about binge eating. To provide the best possible care and to bolster your own emotional state, keep these tips in mind:
- First, learn as much as you can about binge eating disorder, its causes, and its associated psychological issues. It’s important to understand that the disorder is not just about food.
- Be alert to warning signs of binge eating behavior. Remember that the sufferer feels guilt about bingeing and will likely try to hide the behavior from you.
- Talk openly about the disorder with the sufferer to lessen any feelings of shame or embarrassment.
- Don’t feel guilty if you feel frustrated or angry with the sufferer. Frustration is an inevitable part of the caregiving process.
- Get away from the situation when you need to. Caregivers are at risk of damage to their own emotional health, so take the time to take care of yourself, too.
- Finally, find a support group for caregivers.
Many people with binge-eating disorder (BED) also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with anorexia:
- About a third of people with BED also suffer from depression.
- As many as two-thirds of people with BED have an anxiety disorder such as social anxiety disorder or a specific phobia.
- Obsessive-compulsive disorder (OCD) affects about 40 percent of people with BED.
- Approximately one-quarter of people with BED also have post-traumatic stress disorder (PTSD).
- About one in five people with BED struggle with alcoholism or another substance use disorder.
Binge Eating Disorder Brain Science
In the past, eating disorders were primarily thought to result from environmental factors or a culture that encourages unhealthy attitudes toward food and body image. More recently, however, scientists have been inspired by the link between eating disorders and family history and have begun to look for internal causes in the areas of brain chemistry and neurological function. For example:
- Researchers at the University of Alabama Birmingham conducted a study using transcranial direct current stimulation (tDCT) to treat binge eating disorder. This method uses a low-voltage electric current to stimulate a targeted part of the brain. In this study, scientists targeted a part of the brain generally associated with depression. The hypothesis was that because binge eating disorder is often associated with depression, stimulation of this part of the brain might also help control bingeing. The study seemed to indicated that tDCT decreased cravings for problematic foods, especially in men.
- Scientists are finding connections between eating disorders (including anorexia, bulimia, and binge eating disorder) and the processes in our brains that make us feel pleasure and a sense of reward. In a normally functioning brain, eating induces a sense of satisfaction, which encourages us to eat the amount of food we need. In the brains of people with eating disorders, the normal balance of this pleasure-producing response seems to be askew, leading to either abnormally increased or decreased pleasure from eating. The hope is that regulation of this response might help to control eating disorders.
Binge Eating Disorder Research
Scientists are working on several research projects to expand on the information associated with binge eating disorder. The research will improve knowledge about the factors that increase the risk for binge eating disorder, the causes, and the best treatments. It will aid people living with binge eating disorder and their caregivers.
Title: Eating Disorders Genetics Initiative
Principal Investigator: National Institute of Mental Health
Study Type: Observational
Start Date: June 12, 2020
Locations: Chapel Hill, North Carolina; Brisbane, Queensland, Australia; Christchurch, Canterbury, New Zealand
Eligibility: Ages 15–99, Accepts Healthy Volunteers
The overarching intention of the Eating Disorder Genetics Initiative (EDGI) is to lay the foundation for all future genomic discovery in eating disorders–anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED)–by exploring both genetic and behavioral factors. To do this, information will be collected from 4000 people who have provided DNA samples for the Anorexia Nervosa Genetics Initiative (ANGI), and the same information and DNA will be collected from an additional 16,000 people. The goal is to better understand eating disorders and how they relate to each other so that better treatments can be developed.
Title: Optimizing Mindfulness and Acceptance Based Behavioral Treatment for Bulimia Nervosa and Binge Eating Disorder
Principal Investigator: National Institute of Mental Health
Study Type: Interventional
Start Date: June 5, 2020
Location: Philadelphia, Pennsylvania
Eligibility: Ages 18–70, Does Not Accept Healthy Volunteers
The current study will use a full factorial design to identify the independent and combined effects of four core MABT components when combined with standard behavioral treatment for BN and BED. The primary aim of the study will be to evaluate the independent efficacy of Mindful Awareness, Distress Tolerance, Emotion Modulation, and Values-Based Decision Making on eating pathology (at posttreatment and at 6 and 12-month follow-ups). Secondary aims will be (1) to test target engagement of each MABT component, i.e., to confirm that each treatment component impacts both the variable which it targets and self-regulation and that improvements in these are associated with improvements in outcomes and (2) to test the hypotheses that the efficacy of each component is moderated by related baseline deficits in self-regulation (e.g. individuals with worse distress tolerance at baseline are most likely to benefit from conditions that include the Distress Tolerance component). A final exploratory aim will be to quantify the component interaction effects, which may be partially additive (because components overlap and/or there is diminishing return), fully additive, or synergistic (in that components may partially depend on each other).