Binge Eating Disorder: Symptoms, Causes, and Asking for Help

Binge eating disorder (BED) is a type of feeding and eating disorder that’s now recognized as an official diagnosis. It affects almost 2% of people worldwide and can cause additional health issues linked to diet, such as high cholesterol levels and diabetes.

Feeding and eating disorders are not about food alone, which is why they’re recognized as psychiatric disorders. People typically develop them as a way of dealing with a deeper issue or another psychological condition, such as anxiety or depression.

This article looks at the symptoms, causes, and health risks of BED, as well as how to get help and support to overcome it.

What is binge eating disorder, and what are the symptoms?

People with BED may eat a lot of food in a short amount of time, even if they aren’t hungry. Emotional stress or destress often plays a role and might trigger a period of binge eating.

A person might feel a sense of release or relief during a binge but experience feelings of shame or loss of control afterward (1, 2Trusted Source).

For a healthcare professional to diagnose BED, three or more of the following symptoms must be present:

• eating much more rapidly than normal
• eating until uncomfortably full
• eating large amounts without feeling hungry
• eating alone due to feelings of embarrassment and shame
• feelings of guilt or disgust with oneself

People with BED often experience feelings of extreme unhappiness and distress about their overeating, body shape, and weight (1, 2Trusted Source, 3Trusted Source).

What causes binge eating disorder?

The causes of BED are not well understood but likely due to a variety of risk factors, including:

• Genetics. People with BED may have increased sensitivity to dopamine, a chemical in the brain that’s responsible for feelings of reward and pleasure. There is also strong evidence that the disorder is inherited (1, 4Trusted Source, 5Trusted Source, 6Trusted Source).
• Gender. BED is more common in women than in men. In the United States, 3.6% of women experience BED at some point in their lives, compared with 2.0% of men. This may be due to underlying biological factors (4Trusted Source, 7Trusted Source).
• Changes in the brain. There are indications that people with BED may have changes in brain structure that result in a heightened response to food and less self-control (4Trusted Source).
• Body size. Almost 50% of people with BED have obesity, and 25–50% of patients seeking weight loss surgery meet the criteria for BED. Weight problems may be both a cause and result of the disorder (5Trusted Source, 7Trusted Source, 8Trusted Source, 9Trusted Source).
• Body image. People with BED often have a very negative body image. Body dissatisfaction, dieting, and overeating contribute to the development of the disorder (10Trusted Source, 11Trusted Source, 12).
• Binge eating. Those affected often report a history of binge eating as the first symptom of the disorder. This includes binge eating in childhood and the teenage years (4Trusted Source).
• Emotional trauma. Stressful life events, such as abuse, death, separation from a family member, or a car accident, are risk factors. Childhood bullying due to weight may also contribute (13Trusted Source, 14Trusted Source, 15Trusted Source).
• Other psychological conditions. Almost 80% of people with BED have at least one other psychological disorder, such as phobias, depression, post-traumatic stress disorder (PTSD), bipolar disorder, anxiety, or substance abuse (1, 8Trusted Source).

An episode of binge eating can be triggered by stress, dieting, negative feelings relating to body weight or body shape, the availability of food, or boredom (1).

How is BED diagnosed?

While some people may occasionally overeat, such as at Thanksgiving or a party, it does not mean they have BED, despite having experienced some of the symptoms listed above.

BED typically starts in the late teens to early twenties, although it can occur at any age. People generally need support to help overcome BED and develop a healthy relationship with food. If left untreated, BED can last for many years (16Trusted Source).

To be diagnosed, a person must have had at least one binge eating episode per week for a minimum of three months (1, 2Trusted Source).

The severity ranges from mild, which is characterized by one to three binge eating episodes per week, to extreme, which is characterized by 14 or more episodes per week (1, 2Trusted Source).

Another important characteristic is not taking action to “undo” a binge. This means that, unlike bulimia, a person with BED does not throw up, take laxatives, or over-exercise to try and counteract a binging episode.

Like other eating disorders, it’s more common in women than men. However, it’s more common among men than other types of eating disorders (17Trusted Source).

What are the health risks?

BED is associated with several significant physical, emotional, and social health risks.

Up to 50% of people with BED have obesity. However, the disorder is also an independent risk factor for gaining weight and developing obesity. This is due to the increased calorie intake during binging episodes (8Trusted Source).

On its own, obesity increases the risk of heart disease, stroke, type 2 diabetes, and cancer (18Trusted Source).

However, some studies have found that people with BED have an even greater risk of developing these health problems, compared with people with obesity of the same weight who don’t have BED (16Trusted Source, 18Trusted Source, 19Trusted Source).

Other health risks associated with BED include sleep problems, chronic pain conditions, asthma, and irritable bowel syndrome (IBS) (16Trusted Source, 17Trusted Source, 20Trusted Source).

In women, the condition is associated with a risk of fertility problems, pregnancy complications, and the development of polycystic ovary syndrome (PCOS) (20Trusted Source).

Research has shown that people with BED report challenges with social interactions, compared with people without the condition (21Trusted Source).

Additionally, people with BED have a high rate of hospitalization, outpatient care, and emergency department visits, compared with those who don’t have a feeding or eating disorder (22Trusted Source).

Although these health risks are significant, there are a number of effective treatments for BED.

What are the treatment options?

The treatment plan for BED depends on the causes and severity of the eating disorder, as well as individual goals.

Treatment may target binge eating behaviors, excess weight, body image, mental health issues, or a combination of these.

Therapy options include cognitive behavioral therapy, interpersonal psychotherapy, dialectical behavior therapy, weight loss therapy, and medication. These may be carried out on a one-to-one basis, in a group setting, or in a self-help format.

In some people, just one type of therapy may be required, while others may need to try different combinations until they find the right fit.

A medical or mental health professional can provide advice on selecting an individual treatment plan.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) for BED focuses on analyzing the relationships between negative thoughts, feelings, and behaviors related to eating, body shape, and weight (2Trusted Source, 23Trusted Source).

Once the causes of negative emotions and patterns have been identified, strategies can be developed to help people change them (2Trusted Source).

Specific interventions include setting goals, self-monitoring, achieving regular meal patterns, changing thoughts about self and weight, and encouraging healthy weight-control habits (23Trusted Source).

Therapist-led CBT has been demonstrated to be the most effective treatment for people with BED. One study found that after 20 sessions of CBT, 79% of participants were no longer binge eating, with 59% of them still successful after one year (23Trusted Source).

Alternatively, guided self-help CBT is another option. In this format, participants are usually given a manual to work through on their own, along with the opportunity to attend some additional meetings with a therapist to help guide them and set goals (23Trusted Source).

The self-help form of therapy is often cheaper and more accessible, and there are websites and mobile apps that offer support. Self-help CBT has been shown to be an effective alternative to traditional CBT (24, 25Trusted Source).

Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is based on the idea that binge eating is a coping mechanism for unresolved personal problems such as grief, relationship conflicts, significant life changes, or underlying social problems (23Trusted Source).

The goal is to identify the specific problem linked to the negative eating behavior, acknowledge it, and then make constructive changes over 12–16 weeks (2Trusted Source, 26Trusted Source).

Therapy may either be in a group format or on a one-to-one basis with a trained therapist, and it may sometimes be combined with CBT.

There is strong evidence that this type of therapy has both short- and long-term positive effects on reducing binge eating behavior. It is the only other therapy with long-term outcomes as good as CBT (23Trusted Source).

It may be particularly effective for people with more severe forms of binge eating and those with lower self-esteem (23Trusted Source).

Dialectical behavior therapy

Dialectical behavior therapy (DBT) views binge eating as an emotional reaction to negative experiences that the person has no other way of coping with (23Trusted Source).

It teaches people to regulate their emotional responses so that they can cope with negative situations in daily life without binging (23Trusted Source).

The four key areas of treatment in DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness (23Trusted Source).

A study including 44 women with BED who underwent DBT showed that 89% of them stopped binge eating by the end of therapy, although this dropped to 56% by the 6-month follow-up (27Trusted Source).

However, there is limited information on the long-term effectiveness of DBT and how it compares with CBT and IPT.

While research on this treatment is promising, more studies are needed to determine if it could be applied to all people with BED.

Weight loss therapy

Behavioral weight loss therapy aims to help people lose weight, which may reduce binge eating behavior by improving self-esteem and body image.

The intent is to make gradual healthy lifestyle changes in regards to diet and exercise, as well as monitor food intake and thoughts about food throughout the day. Weight loss of about 1 pound (0.5 kg) per week is expected (23Trusted Source).

While weight loss therapy may help improve body image and reduce weight and the health risks associated with obesity, it has not been shown to be as effective as CBT or IPT at stopping binge eating (23Trusted Source, 25Trusted Source, 28, 29Trusted Source).

As with regular weight loss treatment for obesity, behavioral weight loss therapy has been shown to help people achieve only short-term, moderate weight loss (25Trusted Source).

However, it may still be a good option for people who were not successful with other therapies or are primarily interested in losing weight (23Trusted Source).

Medications

Several medications have been found to treat binge eating and are often cheaper and faster than traditional therapy.

However, no current medications are as effective at treating BED as behavioral therapies.

Available treatments include antidepressants, antiepileptic drugs like topiramate, and drugs traditionally used for hyperactive disorders, such as lisdexamfetamine (2Trusted Source).

Research has found that medications have an advantage over a placebo for the short-term reduction of binge eating. Medications have been shown to be 48.7% effective, while placebos have been shown to be 28.5% effective (30Trusted Source).

They may also reduce appetite, obsessions, compulsions, and symptoms of depression (2Trusted Source).

Although these effects sound promising, most studies have been conducted over short periods, so data on the long-term effects is still needed (30Trusted Source).

In addition, side effects of treatment may including headaches, stomach problems, sleep disturbances, increased blood pressure, and anxiety (17Trusted Source).

Because many people with BED have other mental health conditions, such as anxiety and depression, they may also receive additional medications to treat these.

How to overcome binging

The first step in overcoming binge eating is speaking to a medical professional. This person can help with a diagnosis, determine the severity of the disorder, and recommend the most appropriate treatment.

In general, the most effective treatment is CBT, but a range of treatments exists. Depending on individual circumstances, just one therapy or a combination may work best.

No matter which treatment strategy is used, it is important to also make healthy lifestyle and diet choices when possible.

Here are some additional helpful strategies:

• Keep a food and mood diary. Identifying personal triggers is an important step in learning how to control binge impulses.
• Practice mindfulness. This can help increase awareness of binging triggers while helping increase self-control and maintaining self-acceptance (31Trusted Source, 32Trusted Source, 33Trusted Source).
• Find someone to talk to. It is important to have support, whether it is through a partner, family, a friend, binge eating support groups, or online (34Trusted Source).
• Choose healthy foods. A diet consisting of foods high in protein and healthy fats, regular meals, and whole foods will help satisfy hunger and provide needed nutrients.
• Start exercising. Exercise can help enhance weight loss, improve body image, reduce anxiety symptoms, and boost mood (35Trusted Source, 36).
• Get enough sleep. Lack of sleep is associated with higher calorie intake and irregular eating patterns. It’s recommended to get at least 7–8 hours of good sleep per night (37Trusted Source).

The bottom line

BED is a common feeding and eating disorder that, if not treated, can seriously affect a person’s health.

It’s characterized by repeated, uncontrolled episodes of eating large amounts of food and often accompanied by feelings of shame and guilt.

It can have negative effects on overall health, body weight, self-esteem, and mental health.

Fortunately, very effective treatments are available for BED, including CBT and IPT. There are also many healthy lifestyle strategies that can be incorporated into everyday life.

The first step in overcoming BED is to ask for help from a medical professional.