Also called: Binge Eating Disorder
Binge eating disorder (BED) is a condition that causes people to experience recurring episodes of uncontrolled eating. During a binge, the person typically does not stop eating until they feel uncomfortably full. People with BED find the binges to be soothing at the time, but later feel extreme guilt and sadness over their loss of control.
BED may be confused with another common eating disorder called bulimia nervosa. However, BED differs from bulimia nervosa in that it is not associated with purging behaviors (e.g., self-induced vomiting, use of laxatives) or extreme exercise to avoid weight gain.
BED causes many physical and psychological problems for patients. Obesity and depression are both strongly correlated with the disorder, although in both cases it is unclear whether these symptoms are the source of BED or a result of it. Patients with BED also tend to withdraw socially, as embarrassment over their condition causes them to eat at home in private.
Binge eating affects women more often than men. It often begins in a person’s late adolescence or early 20s. The exact cause of binge eating remains unclear. Experts believe it results from a combination of biological, psychological and sociocultural factors. Like other eating disorders, binge eating is closely associated with self-perceptions regarding body weight, appearance and body shape.
In some cases, people who binge eat are so good at hiding their condition that they may show few symptoms, if any. Even close friends and family may be unaware of the binges. Nonetheless, their condition may be diagnosed when they visit a physician regarding a related medical disorder, such as obesity, high blood pressure or depression. If the primary care physician suspects binge eating disorder, the patient will likely be referred to a mental health professional.
Early intervention is a key to success in treating binge eating. Patients who have BED learn to redefine their relationship with food in treatment. Binge eating is typically treated through psychotherapy. Weight loss is often an important part of treatment as well.Patients who have a problem with binge eating can take several steps to help control the behavior. Patients are urged to avoid dieting and to instead eat regular, healthy meals. Cutting back on the amount of food kept in the house can reduce the temptation to overindulge, and finding ways to relax may lessen the anxieties that often trigger a binging cycle.
About binge eating
Binge eating disorder (BED) is characterized by recurring episodes of uncontrolled eating. It should be noted that BED has not officially been classified as a mental health disorder. Debate remains as to whether binge eating is a medical condition or merely a group of symptoms. As a result, the American Psychiatric Association has yet to establish criteria for a definitive diagnosis. Nonetheless, experts believe the condition to be very common. It tends to begin in late adolescence or in a person’s early 20s.
Many people occasionally overindulge when it comes to eating. This does not mean they have an eating disorder. However, people with BED have little control over how much food they consume and tend to eat even when they are not hungry. Episodes where a person eats excessive amounts of food in a given time period are referred to as “binges.”
The definition of a typical binge varies. Some experts define it as a period of overeating that lasts for about two hours. However, others believe that a binge can last an entire day. Many patients are unable to separate binges into the individual episodes. Binging may take place over the course of the day with no planned meal times. Rather than identifying individual episodes, patients may have more success identifying the days in which they binged as opposed to the days in which they did not.
Binging or overeating does not typically stop until the person is uncomfortably full. People with BED find the binges to be soothing at the time, but later feel extreme guilt and sadness about their loss of control.
BED may be confused with another common eating disorder called bulimia nervosa. However, BED differs from bulimia in that it is not associated with purging behaviors (e.g., self-induced vomiting, use of laxatives) or extreme exercise to avoid weight gain.
BED often affects all aspects of a person’s life. Patients may not be able to enjoy casual meals with family or friends and may withdraw socially in order to binge eat in private. However, research shows that a significant amount of binge eating takes place in restaurants. Obesity is common in patients who binge eat, as are psychological symptoms including depression, anxiety and low self-esteem. Researchers are continuing to look at how brain chemicals and the body’s use of calories (metabolism) may affect binge eating. In addition, some evidence suggests a possible hereditary component to binge eating. Studies continue to address these questions.
Risk factors and causes of binge eating
The exact cause of binge eating remains unclear. Experts believe that it results from a combination of biological, psychological and sociocultural factors. Some people with binge eating disorder (BED) may be prone to overeating because the part of their brain called the hypothalamus fails to register that they are full. Research also suggests that the neurotransmitter serotonin may play a role in binge eating.
In addition, several factors are known to be associated with this eating disorder. For example, obesity is commonly associated with BED. However, scientists remain unsure whether obesity causes binge eating or vice-versa.
Depression is also closely associated with BED. People with the condition often suffer from depression. As with obesity, it is unclear whether depression causes BED or vice-versa. Some studies have indicated that people who binge eat may have difficulty dealing with emotions and may eat when feeling angry, sad, bored or worried or during periods of stress.
Research also indicates that binge eating may have a genetic component. People are more likely to binge eat if an immediate family member also engages in the behavior. However, family eating habits can affect those of its members.
Like other eating disorders, BED is closely associated with self-perceptions regarding body weight, appearance and body shape. For example, research shows that adolescents with poor body images are more likely to engage in unhealthy eating behaviors, including binge eating. However, those who binge eat often have a poor body image as a result of it.BED affects both children and adults. It does not appear to affect certain ethnic groups more than others.
Signs and symptoms of binge eating
In some cases, people who binge eat are so good at hiding their condition that they may show few symptoms, if any. Even friends and family may be unaware of their binges. However, certain signs are often associated with binge eating.
Patients who binge eat consume food to the point of discomfort or pain. They eat much more food than they would during a normal meal or snack and also tend to eat more quickly than usual. Patients may also eat alone because they are embarrassed by their eating habits.
People who binge eat usually gain weight and may become obese. Obesity can lead to several health conditions, including high blood pressure, high cholesterol levels, heart disease, type 2 diabetes (uncontrolled blood sugar) and gallbladder disease (inflammation or infection of the gallbladder, which helps digest fats). People who are obese and who have BED tend to gain the weight at a younger age than obese people without the disorder. They may also lose and gain weight cyclically more often than others.
Other physical illnesses associated with long-term binge eating and related obesity include:
- Digestive problems
- Joint pain
- Muscle pain
- Sleep apnea
Binge eating can also take a psychological and social toll on patients. They may experience feelings such as shame, disgust, depression and guilt. Low self-esteem is often associated with BED. Patients may miss work, school or social activities in order to binge eat in private.
Other psychological signs and symptoms often present in those who binge eat include:
- Difficulty sleeping
- Impulsive behavior
- Feeling that one is not in control of one’s actions
- Not noticing feelings, or not talking about them
- Separation from the community
- Substance abuse
- Suicidal thoughts
Diagnosis methods for binge eating
Binge eating disorder (BED) is most likely to be diagnosed when the patient visits a physician regarding a related medical condition, such as obesity, high blood pressure or depression. Physicians generally diagnose BED based on the patient’s symptoms and eating habits.
During an initial consultation, a physician will record the patient’s weight and perform a thorough physical examination.The physician will also compile a comprehensive medical history including family history of physical and psychological disorders (e.g., depression, obsessive-compulsive disorder [OCD]) as well as inquire about the patient’s history of dieting and/or eating patterns.
Some of the questions a physician may ask include:
- How long has the binging been occurring?
- How often do binges occur?
- Is binging followed by purging?
- Has the patient gained a lot of weight recently?
- Is the patient experiencing emotional stress or anxiety?
- Does the patient avoid socializing and instead spend time eating alone at home?
- What other symptoms are present?
In addition, a physician may order diagnostic tests to identify any signs of complications of BED. These tests may include:
- Blood tests. Laboratory analyses – including a complete blood count(CBC) – of blood samples to measure levels of hormones, enzymes, proteins, electrolytes, vitamins and other substances in the blood. Blood tests assess the function of various organ systems including the liver, kidney, thyroid and pituitary glands as well as the ovaries(female reproductive glands).
- Urinalysis. Chemical examination of a patient’s urine sample to screen for urinary tract infections, kidney disease and diseases of other organs that result in the appearance of abnormal metabolites (break-down products) in the urine.
- Electrocardiogram (EKG). This test measures the pattern of electrical impulses generated by the heart. During the procedure, electrodes (devices that detect electrical impulses) are attached to the patient’s chest. The electrical impulses are then recorded on a graph. In patients with eating disorders, an EKG can help detect irregular heartbeats and identify the presence of any damage to the heart.
If BED is suspected, a primary care physician may refer the patient to a mental and/or behavioral health specialist (typically a psychiatrist) for further evaluation and treatment. Psychological questionnaires and self-assessment forms may be used to help determine a patient’s attitude about food and physical appearance. The mental health professional will also probe for signs of related disorders, such as depression or anxiety.
To date, BED has not officially been classified as a mental health disorder. Debate remains as to whether binge eating is a medical condition or merely a group of symptoms. Some experts believe it is a form of bulimia. However, the American Psychiatric Association has proposed criteria for BED that include the following:
- Recurrent episodes of discrete time periods in which the patient engages in binge eating. The binge eating is characterized by consuming an amount of food larger than most people would eat in a similar period of time under similar circumstances.
- Patients must experience an inability to control their eating and feelings of distress related to their eating.
In addition, three or more of the following must be present for diagnosis:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts despite not feeling hungry
- Eating alone due to embarrassment over amount consumed
- Feelings of disgust for oneself, depression or guilt after overeating
In addition, binge eating must occur on average for at least two days a week over a period of six months, and must not involve extreme attempts to rid the body of calories (e.g., purging, extreme exercise). Finally, symptoms of binge eating cannot occur exclusively in relation to another eating disorder, such as anorexia nervosa or bulimia nervosa.
Treatment options for binge eating
Early intervention is a key to success in treating binge eating disorder (BED), as it arrests troublesome eating behaviors before they become lifelong habits, and helps prevent the development of health problems after long-term binge eating.
Patients who have BED must learn to redefine their relationship with food. Unlike substance abusers, patients with BED cannot avoid the substance that causes problems, because food is necessary for survival. Therefore, therapy usually concentrates on building healthier relationships with food.
Binge eating is typically treated through psychotherapy. Patients may work with a psychiatrist, psychologist or other mental health professional to learn new methods of dealing with their eating disorder. Therapy may take place in an individual or group setting, or a combination of the two environments.
Cognitive behavior therapy can help patients to track and change their eating habits. It can also help patients learn to better deal with tough situations and to feel better about themselves and their bodies. Interpersonal therapy can help patients to examine their relationships with family and friends and to make any necessary changes. Dialectical behavior therapy can help patients learn to more evenly regulate their emotions.
Some patients may also benefit from taking medications such as antidepressants or certain anticonvulsants. Finally, self-help books, videos and support groups can also help many patients to control their tendency to binge eat. People who binge eat are urged to consult a physician and try to reduce their weight (if necessary). Nutrition experts, such as dieticians, can help patients to plan meals that are healthy and satisfying while also promoting sound eating patterns. Patients may also be referred to a dentist (physician who specializes in dental health) for the treatment of dental complications related to binge eating, such as tooth and gum decay.
Prevention methods for binge eating
Patients who have a problem with binge eating can take several steps to help control their behavior. Patients are urged to avoid dieting and to instead eat regular, healthy meals. Eating breakfast is especially important, as studies show that people who eat breakfast are less likely to indulge in higher-calorie meals later in the day. Patients can consult a physician or dietician for assistance with healthy meal planning.
Reducing the amount of food in the house, and refraining from purchasing certain types of foods, can, in turn, reduce the temptation to overindulge. Finding ways to relax may lessen the anxieties that often bring on a binging cycle. Patients are also strongly urged to adhere to their treatment plan, attend support groups and avoid isolating themselves from family and friends. Regular exercise and reading or watching self-help materials can lessen anxiety and depression. Patients with depression or anxiety are encouraged to seek treatment for these conditions. Treating these related conditions can also help address the binge eating.Parents who suspect that their child has BED are urged to discuss the topic with their child. Signs of such a problem may include finding food containers hidden in a child’s room, increasingly irregular eating patterns and increased eating in response to stress. By addressing the topic early, the parent can get the child into treatment and help prevent the child’s binge eating from becoming a lifelong habit.
Questions for your doctor about binge eating
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to binge eating:
- How do I know if I have a binge eating problem? Is it possible that I just overeat?
- What are the symptoms of binge eating that I should look for in a loved one?
- What are some of the long-term dangers of binge eating?
- How will you diagnose my binge eating disorder?
- Do you suspect that I may have other conditions related to my binge eating?
- What are my treatment options? What are the side effects?
- How can I prevent binges?
- Do you know of local support groups that may be helpful?
- What are some of the emerging treatments for binge eating?
- What are some of the techniques I can use to lose weight?