LISTEN TO THIS ARTICLE:
People with Binge Eating Disorder deal with weekly episodes of uncontrollable overeating. They feel like they can’t stop after they start eating and become emotionally detached or numb during a binge. Binges only end when people are painfully full or when someone else interrupts them. Additionally, binge eating is very stressful for most people. They feel embarrassed and regretful and go to great lengths to hide their eating from others. Although this may sound like Bulimia Nervosa, people with Binge Eating Disorder do not use unhealthy methods to avoid gaining weight afterwards.
The disorder most commonly first appears in people in their late teenage years and early twenties. This is the age when people are moving out of the home, going to college, and encountering the adult challenges. Combining these emotional stresses with a genetic predisposition and a history of body-shaming in childhood sets the stage for Binge Eating Disorder. Fortunately for these people, Binge Eating Disorder has reliably high rates of improvement after treatment. Also, the risk of developing other eating disorders is relatively low.
Signs that someone has Binge Eating Disorder include planning for a binge like buying huge amounts of food just for themselves and then isolating themselves from others. Roommates or partners may suddenly find garbage cans full of empty food containers without any explanation. These people may eat relatively average amounts of food or even diet when around others while doing most of their eating in secret.
Causes and Risk Factors
Despite being less well-known than Anorexia Nervosa or Bulimia Nervosa, Binge Eating Disorder is actually more common than both of those disorders put together. Roughly 3-5% of women and 2% of men will suffer from Binge Eating Disorder at some point in their lives.
Body image as a child and adult
If people grow up in an environment (be it at home, at school, or elsewhere) where adults or peers are critical and negative about their body weight and appearance, they are more likely to develop eating disorders when they grow up. Jobs that have a focus on appearance can continue these trends into adulthood and worsen body image problems.
Adults with Binge Eating Disorder focus heavily on their body weight, and being overweight is crushing for their self-esteem. When people agonize over this, depressive feelings set in and make people even more likely to binge again. People binge at these low points because it relieves those negative feelings, if only for a short period before they return.
Trauma and PTSD
Up to half of people who binge eat (either in Binge Eating Disorder or in Bulimia Nervosa) have at least some symptoms of Post-Traumatic Stress Disorder. Over a third of women and 16% of men with Binge Eating Disorder have been the victims of sexual abuse. When the emotions of past trauma haunt people, they take solace in binges, which help them evade the awful memories.
Like many other qualities of eating disorders, binge eating has a significant genetic foundation – up to 45% of the risk is heritable. This genetic basis also holds an increased risk of suicide, Major Depressive Disorder, and Alcohol Use Disorder. Researchers have also identified multiple independent genes that promote symptoms like impulsive eating and eating in response to negative emotions. Several other disorders can cause people to overeat compulsively as well. These include genetic conditions like Prader-Willi syndrome and a rare sleep disorder called Kleine-Levin syndrome. However, people with these disorders who binge eat would not also be diagnosed with Binge Eating Disorder.
Because many of these people are either overweight or obese, they are at higher risk for related medical problems. High cholesterol, high blood pressure, irregular blood sugar levels, and excess body fat all put these people at higher risk of heart disease, stroke, and diabetes. Additionally, binge eating can contribute to people developing gallstones.
People who have suffered from other eating disorders like Anorexia Nervosa or Bulimia Nervosa are at higher risk of getting Binge Eating Disorder. The most common mental disorders (aside from other feeding and eating disorders) that appear in concert with Binge Eating Disorder are mood disorders like depression and Bipolar Disorder. Anxiety disorders, Obsessive Compulsive Disorder, and substance use disorders appear frequently as well.
Diagnosing Binge Eating Disorder
The main hallmark of Binge Eating Disorder is frequent episodes (at least once a week) where people consume massive amounts of food in a short period of time. During these times people feel out of control, unable to manage what or how much they eating. These people usually eat very quickly, much faster than anyone without the disorder. Binges feel unstoppable, and they only end when people are so painfully full that they can no longer eat. Additionally, binges happen even when people aren’t hungry at all.
Avalanches of negative emotions accompany binges before, during, and after they happen. During binges, people isolate themselves because they feel embarrassed about their eating. Binges ruin people’s self-esteem, too. They feel ashamed and horrified at what they have done, and this feeling stays with them for days after.
Binge Eating Disorder vs. Bulimia Nervosa
While both these disorders include periods of excessive eating, only people with Bulimia Nervosa take steps like vomiting, laxatives, or excessive exercise to avoid gaining weight. People with Binge Eating Disorder do not try to avoid weight gain and are frequently overweight or obese.
Treating Binge Eating Disorder
Cognitive Behavioral Therapy (CBT), interpersonal therapy, and Dialectical Behavioral Therapy can help people with Binge Eating Disorder. In CBT, people can learn techniques to help control the urges that trigger binges. These urges are often unique to different people, but they do fall into a few general categories. These might be emotions associated with certain types of food, worries about body image, or other psychological issues like depression and anxiety. Strategies for building a regular eating schedule and replacing unhealthy attitudes towards food help reduce the frequency and intensity of binges.
Interpersonal therapy explores the parts of individuals’ pasts that may have contributed to them developing Binge Eating Disorder. This focuses on how people view themselves and their relationships with others as a part of managing their disorders.
Although Dialectical Behavioral Therapy (DBT) was originally developed to treat Borderline Personality Disorder, it is quite effective for Binge Eating Disorder as well. This treatment approaches binge eating as something people use to manage their negative emotions. When people binge, it keeps psychological pain at bay for a short time, which makes them even more likely to binge again in the future. To address this, DBT helps teach people new skills for calming uncomfortable feelings without self-destructive binges.
Vyvanse (lisdexamfetamine) is the only medication that has been approved by the FDA to directly treat Binge Eating Disorder. However, this medication has a major downside because it is a stimulant that people can potentially abuse.
Topamax (topiramate) is an anti-seizure medication that has promise for reducing binges and helping with weight loss. Topamax seems especially effective in the long term, helping people lose weight and keeping it off. Other potential medications include antidepressants like Paxil (paroxetine), Zoloft (sertraline), and Prozac (fluoxetine), which reduce binge eating episodes for some people. These also help with depression that frequently accompanies Binge Eating Disorder.
Managing Binge Eating Disorder
Weight loss and binge eating
Although Binge Eating Disorder is closely associated with being overweight or obese, trying to diet while at the same time recovering from the disorder is very difficult and not recommended. For these people, dieting – especially when it is irregular or extreme – can often lead to more episodes of binge eating. It adds a constant source of stress to peoples’ lives and makes it that much easier for a tense event to cause a binge. Instead of dieting, a better approach to weight loss is through behavioral weight loss programs. These kinds of plans promote developing regular, healthy eating habits rather than the risky cycle of on and off dieting. These methods usually use strategies like keeping detailed diaries of food, exercise, and weight loss progress.
Examine triggers for binges
Stressful situations, emotions, and environments serve as triggers for binges. These could be reminders of past trauma, anything that brings people back to a time when they felt vulnerable. However, stress not tied to the past – like pressure in work or school – can set off binges as well. When people binge, they usually have certain foods they return to each time, and just seeing those foods can trigger a binge too. Avoiding high-sugar foods and soft drinks will also help. While triggers, especially those with deep emotional roots, should be explored in therapy, avoiding some of them can be helpful strategy. This might entail not buying specific foods, ordering smaller portions at restaurants, or asking for personal space in stressful situations.
Binge eating is a disorder of secrecy: People almost always binge alone because they feel ashamed and embarrassed. In support groups, people are relieved to find others like them after being alone with their binge eating for so long. The National Eating Disorders Association (NEDA) is a good source for finding support groups. People familiar with twelve-step programs like Alcoholics Anonymous may also like the program Overeaters Anonymous, which follows a similar model.