AUTHORITY NUTRITION

Binge Eating Disorder: Symptoms, Causes and How to Stop

Written by Elise Mandl, BSc, APD on December 16, 2017

Binge Eating Disorder (BED) is a serious illness that can have a significant negative impact on those who have it.

It is the most common type of eating disorder and affects almost 2% of people worldwide, though it remains under-recognized.

This article looks at the symptoms, causes and health risks of BED and what you can do to stop it.

Overweight Woman Portrait

Binge Eating Disorder (BED) is characterized by repeated episodes of uncontrolled binge eating and feelings of extreme shame and distress.

It typically starts in the late teens to early twenties, although it can occur at any age. It is a chronic disease and can last for many years (1).

Like other eating disorders, it is more common in women than men. However, it is the most common type of eating disorder among men (2).

A binge eating episode is characterized by eating larger than normal amounts of food in a relatively short period of time. In BED, this behavior is accompanied by feelings of distress and lack of control (3, 4).

For a doctor to diagnose BED, three or more of the following must also 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 (3, 4, 5).

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

To be diagnosed, people must have had at least one binge eating episode per week for a minimum of three months (3, 4).

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 (3, 4).

Another important characteristic is the absence of inappropriate compensatory behaviors. This means that, unlike bulimia, a person with BED does not throw up, take laxatives or over-exercise to try and “make up” for a binging episode.

Summary BED is characterized by repeated episodes of uncontrolled intake of unusually large amounts of food in a short period of time. These episodes are accompanied by feelings of guilt, shame and psychological distress.

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

  • Genetics: People with BED may have increased sensitivity to dopamine, which is responsible for feelings of reward and pleasure. There is also strong evidence that the disorder is inherited (3, 6, 7, 8).
  • Gender: BED is more common in women than men. In the US, 3.6% of women experience BED at some point in their lives, compared to 2.0% of men. This may be due to underlying biological factors (6, 9).
  • Changes in the brain: There are indications that people with BED may have changes in brain structure that result in heightened responses to food and less self-control (6).
  • Body size: Almost 50% of people with BED are obese, and 25–50% of patients seeking weight loss surgery meet the criteria for BED. Weight problems may be both a cause and consequence of the disorder (7, 9, 10, 11).
  • Body image: People with BED have a very negative body image. Body dissatisfaction, dieting and overeating contribute to the development of the disorder (12, 13, 14).
  • 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 (6).
  • Emotional trauma: Stressful life events, such as abuse, death, separation from a family member or a car accident, have been found to be risk factors. Childhood bullying due to weight may also contribute (15, 16, 17).
  • 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 (3, 10).

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 (3).

Summary The causes of BED are not fully known. As with other eating disorders, a variety of genetic, environmental, social and psychological risks are associated with its development.

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

Up to 50% of people with BED are obese. However, the disorder is also an independent risk factor for gaining weight and becoming obese. This is due to the increased calorie intake during binging episodes (10).

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

However, some studies have found that people with BED have an even greater risk of developing these health problems, compared to obese people of the same weight who don’t have BED (1, 18, 19).

Other health risks associated with BED include sleep problems, chronic pain conditions, asthma and irritable bowel syndrome (IBS) (1, 2, 20).

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

People with BED also experience a reduced ability to function properly in social settings, with severe dysfunction occurring in 13% of people (1).

Additionally, patients with BED have a significantly worse quality of life and high rate of hospitalization, outpatient care and emergency department visits, compared to healthy people (21).

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

Summary BED is linked to an increased risk of weight gain and obesity, as well as associated diseases like diabetes and heart disease. There are also other health risks, including sleep problems, chronic pain, mental health problems and reduced quality of life.

Therapy for BED depends on the causes and severity of the disease, 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 will be able to advise you on the therapy best suited for you.

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 (4, 22).

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

Specific interventions include setting goals, self-monitoring, achieving regular meal patterns, changing thoughts about self and weight and encouraging healthy weight-control habits (22).

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 (22).

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 (22).

The self-help form of therapy is often cheaper and more accessible, and you can also find websites and mobile apps that offer support. Self-help CBT has been shown to be an effective alternative to traditional CBT (23, 24).

Summary CBT focuses on identifying the negative feelings and behaviors that cause binge eating and helps put strategies in place to improve them. It is the most effective treatment for BED and may be done with a therapist or in self-help format.

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 (22).

The goal is to identify the specific problem linked to the negative eating behavior, acknowledge it and then make constructive changes over a period of 12–16 weeks (4, 25).

Therapy may either be in 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 (22).

It may be particularly effective for people with more severe forms of binge eating and those with lower self-esteem (22).

Summary IPT views binge eating as a coping mechanism for underlying personal problems. It addresses binge eating behaviors by acknowledging and treating those underlying problems. It is a successful therapy, particularly for severe disease.

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 (22).

It teaches people to regulate their emotional responses so that they can cope with negative situations in daily life without binging (22).

The four key areas of treatment in DBT are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness (22).

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 six-month follow-up (26).

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

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

Summary DBT sees binge eating as a response to negative experiences in daily life. It uses techniques such as mindfulness and the regulation of emotions to help people cope better and stop binging. It is unclear if it is effective in the long term.

Weight Loss Therapy

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

The intent is to make gradual healthy lifestyle changes in diet and exercise and monitor food intake and thoughts about food throughout the day. Weight loss of about 1 pound (half a kilogram) per week is expected (22).

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 (22, 24, 27, 28).

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 (24).

However, it may still be a good option for people who were not successful with other therapies or who are primarily interested in losing weight (22).

Summary Weight loss therapy aims to improve binge-eating symptoms by reducing weight and thus improving body image and self-esteem. It is not as successful as CBT or interpersonal therapy, but it may be useful for some individuals.

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 (4).

Research has found that medications do 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 (29).

They may also be effective at reducing appetite, obsessions, compulsions and symptoms of depression (4).

Although these effects sound promising, most studies have only been conducted over short periods, so data on the long-term effects are still needed (29).

In addition, side effects of treatment may including headaches, stomach problems, sleep disturbances, increased blood pressure and anxiety (4).

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

Summary Medications may help improve binge eating in the short-term. However, long-term studies are needed. Medications are generally not as effective as behavioral therapies and can have side effects.

The first step in stopping binge eating is to speak to a medical professional. This person can help diagnose you properly, determine the severity of your illness and recommend the most appropriate treatment.

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

No matter which treatment strategy you use, it is important to also make healthy lifestyle and diet choices when you can.

Here are some additional helpful strategies you can implement yourself:

  • Keep a food and mood diary: Identifying your personal triggers is an important step in learning how to control your binge impulses.
  • Practice mindfulness: This can help increase awareness of your binging triggers, all while helping you increase self-control and maintain self-acceptance (30, 31, 32).
  • Find someone to talk to: It is important to have support, whether it is through your partner, family, a friend, binge eating support groups or online (33).
  • Choose healthy foods: A diet consisting of foods high in protein and healthy fats, regular meals and whole foods with lots of fruit and vegetables will help keep you full and provide the nutrients you need.
  • Start exercising: Exercise can help enhance weight loss, improve body image and improve your mood and anxiety symptoms (34, 35).
  • Get enough sleep: Lack of sleep is associated with higher calorie intake and irregular eating patterns. Ensure you are getting at least seven to eight hours of good sleep per night (36).
Summary CBT and IPT are the best treatments for BED. Other strategies include keeping a food and mood diary, practicing mindfulness, finding support, choosing healthy foods, exercising and getting enough sleep.

BED is a common, under-recognized eating disorder that can seriously affect your health.

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

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

Luckily, very effective treatments are available for Binge Eating Disorder, including CBT and IPT. There are also many healthy lifestyle strategies that you can implement in your everyday life.

With proper care and support, you can stop binging and live a happy, healthy life. And you can start today.

An evidence-based nutrition article from our experts at Authority Nutrition.

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