Disordered eating is a prevalent issue nationwide. Approximately 9% of the US population, present with an eating disorder at some point in their lifetime. Eating disorders can have serious, long-lasting physical and psychological consequences. Therefore, it is imperative we educate ourselves on these disorders to combat widespread misunderstanding of such serious conditions and promote their treatment. As there are multiple eating disorders, each with distinct characteristics, in this blog we will specifically discuss binge eating disorder.
What is Binge Eating Disorder?
Binge eating disorder (BED) is a serious psychiatric condition that is characterized by the recurrent episodes of eating excessively large amounts of food, often quickly and to the point of physical discomfort. To be clear, although BED involves eating past the point of feeling satiated, it is different from simply overeating. It is not uncommon for people without BED to overeat, especially in social and celebratory dining settings, like Thanksgiving dinner. But for those with BED, the recurrent episodes of overeating are far more severe and typically associated with significant physical and psychological consequences. Those with BED often feel like they lack control of their eating patterns and develop intense feelings of shame, guilt, or embarrassment surrounding the act of eating. Binge eating disorder is often confused for another serious eating disorder, bulimia nervosa. The key distinction between the two eating disorders is that those with BED will not typically engage in compensatory behaviors after eating, such as self-induced vomiting, overexercising, or long periods of fasting.
BED affects approximately 3% of the population – about 3x more than anorexia and bulimia combined – making it the most common eating disorder seen in American adults. Of those with eating disorders, 47% are diagnosed with BED, 3% with anorexia nervosa, 12% with bulimia nervosa, and 38% with other eating disorders. BED can affect people of all ages, gender, race, and ethnicity. The average age of onset for the disorder is 21 with the average duration of the disorder lasting 4 to 8 years. Those under the age of 30 are at a greater risk for developing BED than older individuals. Lifetime risk of developing BED is higher in females (1.6%) than in males (0.8%) at a ratio of 2:1, but severity of impairment due to the disorder is clinically equal across genders. The prevalence rates of BED across different racial and ethnic groups are comparable among white (1.4%), Latino (2.1%), Asian (1.2%), and black (1.5%) American adults. Individuals of all BMIs can present with BED, but the disorder is one of the eating disorders most commonly associated with increased weight. Those with BED are 3-6 times more likely to be obese than those without an eating disorder. Additionally, the disorder is highly associated with an earlier onset of being overweight and history of obesity, with 30% of those diagnosed with BED reporting childhood obesity. By BMI categorical distinctions, approximately 55% of those with BED are normal weight or overweight, and 45% are obese.
Ample research has been conducted that demonstrate the negative impact BED can have on individuals’ physical and mental health. In terms of comorbidities, those with BED have a high prevalence of accompanying psychiatric conditions. Nearly 80% of those with BED have at least one other comorbid psychiatric or substance use disorder, while nearly 50% had three or more comorbid psychiatric or substance use disorders. In addition to psychiatric comorbidities, common physical comorbidities found in those with BED include chronic diabetes, hypertension, back and neck pain, chronic headaches of migraines, and other types of chronic pain. Additionally, studies have found long-term consequences of BED as evidence suggests that binge eating may increase an individual’s risk for developing obesity and metabolic syndrome. Metabolic syndrome is a term to describe a cluster of physiological abnormalities that are associated with the development of type 2 diabetes and cardiovascular disease, such as high blood pressure, high blood sugar, abnormal cholesterol levels, and more. Lastly, some studies have found that those with obesity and BED are at increased risk of developing respiratory and gastrointestinal diseases when compared to healthy controls.
Signs and Symptoms
There are a host of behavioral, emotional, and physical symptoms of BED. Some of the most common symptoms of BED include:
- Eating abnormally large amounts of food in a short period of time
- Feeling that your eating behavior is out of your control
- Eating even when you are not hungry
- Eating quickly
- Eating until you are uncomfortably full
- Frequently eating alone or in secret
- Preoccupation with eating, food, body shape, or weight
- Feeling disgusted, ashamed, or guilty about your eating
- Frequently dieting, often without weight loss
In addition to symptoms, recognizing the signs of BED can be especially useful in identifying the disorder in yourself and others. Some of the most common signs of BED include:
- Skipping meals or eating extremely small portions of food at regular meals
- Stealing or hoarding food in strange places
- Developing abnormal food rituals, such as eating only a particular food group or excessive chewing
- Noticeable fluctuations in weight (can be both an increase or decrease in weight)
- Evading questions about weight, eating, or exercise
- Creating lifestyle schedules to accommodate for binge sessions
In reading up to this point you may have asked yourself, “Do I have binge eating disorder?” If this is the case, here are some helpful non-diagnostic, preliminary questions to ask yourself:
- Do I struggle to control when and how much you eat?
- Do I eat large amounts of food even when I’m not hungry?
- Have I ever hid my eating behaviors from others, especially loved ones?
- Have I ever hoarded food or empty food containers?
- Do I experience feelings of guilt or shame after eating?
”These questions are not sufficient to diagnose BED, but if you commonly struggle with the experiences described by these questions, you should consider consulting with a therapist for binge eating disorder. Even in diagnosis by a professional, there is not a specific binge eating disorder test. Instead, your provider may use blood and urine tests to assess your physical condition, which may be suffering as a result of struggling with BED.
Dr. Kirsten ThompsonFounder, CEO & Supervising Psychiatrist
The National Eating Disorders Association has an in depth online questionnaire which may be used to gauge if you have or are at risk for an eating disorder. Still, official diagnosis can only be assessed by a professional. In assessing an individual for BED, a mental health professional may use the DSM-5, which includes five criterions and a severity grading. The DSM-5 diagnostic criteria for BED is:
- Recurrent episodes of binge eating, which is characterized by both of the following:
- Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in the same period of time under similar circumstances
- The sense of lack of control over eating during the episode
- Binge-eating episodes are associated with three (or more) of the following: eating much more rapidly than normal; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating
- Marked distress regarding binge eating is present
- The binge eating occurs on average at least 1 day a week for 3 months
- The binge eating is not associated with the regular use of inappropriate compensatory behavior and does not occur exclusively during the course of anorexia or bulimia
- Severity Scale
- Mild: 1 to 3 episodes per week
- Moderate: 4 to 7 episodes per week
- Severe: 8 to 13 episodes per week
- Extreme: 14 or more episodes per week
How to Treat Binge Eating Disorder
BED is a severe, potentially life-threatening psychiatric condition that decreases a person’s quality of life, and left untreated, could result in serious damage to a person’s mental and physical health. For these reasons, it is imperative that BED is assessed and treated by a mental health professional. According to meta-analyses of different methods of treatment for BED, psychotherapy with specifically a CBT-based approach, is considered the most effective intervention for BED. In addition to CBT-based psychotherapy, pharmacological treatment is proven effective in treating BED. As with treatment of several other psychiatric disorders, sometimes the simultaneous use of pharmacological and psychotherapy methods is seen in a person’s treatment plan.
CBT stands for cognitive behavioral therapy. CBT-based psychotherapy treatment for BED is typically centered on the theory that unhealthy eating, shape, and weight concerns give rise to food restriction habits, which in turn, leads to binge eating. CBT therapy aims to address the abnormal thoughts and behaviors which contribute to a person’s BED, identify their triggers, and develop healthier responses to those triggers. To date, the only drug approved by the FDA to treat BED is lisdexamfetamine, which is a stimulant also used in the treatment of ADHD. Other common medications used in the pharmacological treatment of BED include antidepressants, antiepileptics, anti-obesity, and other stimulant medications. Pharmacological treatment can aid in the treatment of BED directly and indirectly. Directly, these medications may make it so a person is less inclined to engage in binge eating behaviors. Indirectly, these medications may make a person more receptive to psychotherapy, thus enabling more effective treatment.