Binge Eating Disorder

Topic Overview

What is binge eating disorder?

Binge eating means eating large amounts of food in a short time. A person with binge eating disorder binges regularly for several months. When you binge, you feel like you can't control your eating, and you feel unhappy about it afterward.

Binge eating disorder is not the same thing as bulimia. Unlike bulimia, if you have binge eating disorder, you don't vomit or try other ways to get rid of calories. But you might try to limit how much food you eat between binges. Binge eating disorder is sometimes called compulsive overeating.

Some people who binge have a normal weight. But over time, many people who have binge eating disorder gain weight and have problems from being obese. People with binge eating disorder also often have depression, anxiety, or other emotional problems.

Having an eating disorder is not a sign of weakness or a character flaw. And it is not something you can overcome with just willpower. Many people struggle with eating disorders for a long time. Some people try to keep it a secret or deny that they have a problem. In most cases, you will need treatment to get better. If you have binge eating disorder, treatment can prevent health problems, help you feel better about yourself, and improve the quality of your life.

What causes binge eating disorder?

Experts are not sure what causes binge eating disorder, but it seems to run in families. Experts think that cultural attitudes about body shape and weight also play a role.¹ Anxiety, depression, or stress can cause some people to binge.²

What are the symptoms?

From time to time, most of us feel like we have eaten more than we should. But eating too much every now and then does not mean that you have binge eating disorder. If you have binge eating disorder, you may:

• Eat way too much in a short period of time (less than 2 hours) on a regular basis.
• Eat when you are not hungry, to ease stress or to comfort yourself.
• Eat for emotional reasons, such as being sad, angry, lonely, or bored.
• Feel like you can't stop eating.
• Eat faster than normal when you binge.
• Eat so much that you feel painfully full.
• Feel unhappy, upset, guilty, or depressed after you binge.
• Eat alone because you are embarrassed about how much you eat.

Even if you don't have all the symptoms of binge eating disorder, having even a few symptoms can be a sign of a problem that needs treatment. It is important to get help right away if you or someone you know has any of these symptoms.

How is binge eating disorder diagnosed?

A doctor can find out if you have binge eating disorder by doing a physical exam and asking questions about your eating habits and past health. Your doctor may also ask questions about your mental health and how you feel about food and the shape of your body.

How is it treated?

Treatment for binge eating disorder includes getting counseling and, in some cases, taking medicine such as antidepressants. Your doctor may have you do both. You may need treatment for a long time to fully recover. You also may need treatment for other problems that often occur with binge eating disorder. These can include depression, obesity, or problems with being overweight.

Who gets binge eating disorder?

Binge eating disorder most often starts in the late teens or the young-adult years. It is more common in women than men. About 2 out of 100 females in the United States have it.¹ And experts estimate that 25 out of 100 people who are obese have it.¹

Binge eating disorder can be triggered by dieting, depression, or anxiety. It can even start because of boredom or stress, which is then relieved by binging. Your risk for binge eating increases if:

• You or your parents are overweight.
• You are a perfectionist. This means that you feel like you have to do everything exactly right all the time.
• You have a poor body image, which means that you don't like the way your body looks.
• You live in a culture that values being thin.

Frequently Asked Questions

Symptoms

If you have binge eating disorder, you:²

• Eat an extremely large amount of food within a 2-hour period (a binge) at least 2 times a week on average for at least 6 months.
• Feel unable to control how much you eat during a binge.
• Feel very unhappy about binging.

If you have binge eating disorder, you also have three (or more) of the following symptoms:

• You eat more quickly than normal during a binge.
• You eat until you are painfully full.
• You binge when you are not hungry, to reduce stress or to comfort yourself.
• You eat alone because you are embarrassed about how much food you eat.
• You feel upset, guilty, or depressed after a binge.

Common personality traits found in those with binge eating disorder and other eating disorders include excessive concern about body size and shape, low self-esteem, and depression.³

Binge eating disorder is different from bulimia, because people with binge eating disorder do not regularly vomit or use other ways to get rid of calories. For more information on bulimia, which also is called "binge-purge disorder," see the topic Bulimia Nervosa.

Some people eat very little during the day but eat very large amounts of food in the evening and at night. This is called night eating syndrome.

Many people who have an eating disorder also struggle with depression or anxiety disorders. It can be difficult to treat binge eating disorder if these other conditions are not also treated.

Frequent binge eating can cause you to gain a large amount of weight, even though you might try to restrict your food intake between binges. People with binge eating disorder often try to follow strict diets. But dieting does not stop the binging for the long term and might actually make the problem worse.

You might feel so discouraged at times that you stop trying to control your eating disorder altogether. One binge might merge into the next, with no period of normal eating in between.

Although you might not have all of the symptoms of binge eating disorder, even a few symptoms can be a sign of a problem that needs treatment. If you have any of these symptoms, or someone you know does, talk to a health professional, friend, or family member about your concerns right away.

Exams and Tests

Doctors diagnose binge eating disorder by doing a physical exam and asking questions about your medical history and eating habits. Your doctor also might do a mental health assessment, which is an evaluation of your emotions and how well you think, reason, and remember.

Binge eating disorder often is associated with being overweight. Your doctor might use a tool called the body mass index (BMI) to look at how much you weigh compared with your height.

Treatment Overview

Treatment for binge eating disorder includes counseling and sometimes medicine. Goals in treating binge eating often include:

• Reducing your number of eating binges.
• Developing healthy eating and exercise habits.
• Dealing with shame or guilt about your eating disorder.
• Developing a healthy view of yourself and your body.
• Getting treatment for other conditions that you also might have, such as depression, anxiety, or health problems related to being overweight.

Most people with binge eating disorder need treatment, but many people who have an eating disorder try to keep it secret or deny that they have a problem. Some might join weight management programs to lose weight but do not seek treatment for binging or for mental health problems related to the condition. It often is a family member or friend who convinces the person to seek treatment.

If you think that you or someone you know might have an eating disorder, talk to your doctor. Signs of an eating disorder that needs treatment include binges, concern or embarrassment about eating behaviors, secretive eating habits, preoccupation with weight or body image, or an unhealthy body weight because of eating problems.

Counseling

Several types of counseling can be useful in treating eating disorders.

• Cognitive-behavioral therapy (CBT) . This type of therapy can help you control the urge to binge, especially when combined with nutritional counseling and a weight-reduction program.¹ CBT often deals with learning how to eat a balanced diet, because this is important to recovery. Developing more regular eating habits can help reduce binging.
• Interpersonal therapy . This type of therapy can help you examine any connection between your relationships and your symptoms of binge eating.
• Dialectical behavior therapy . This approach focuses on helping you manage emotions. By coping better with life's challenges and your emotions, the binging behaviors may decrease. This type of therapy helps reduce binging that is related to stress.⁴
• Group counseling. This can be used to enhance individual therapy. Speaking with other people who have this condition often can be helpful.
• Family therapy . Sometimes family members unknowingly interfere with a loved one's recovery. Family therapy can help family members learn about the disorder, get support, and eventually focus on dealing with other family issues. Family therapy often is used as a part of treatment for teenagers who have binge eating disorder. This type of therapy can help reduce binging that is triggered by stress, tension, or relationship problems.³

Medicine

Antidepressants sometimes are used in the treatment of binge eating disorder. Treatment with antidepressants can help reduce episodes of binging. It is useful in treating the depression that often occurs along with binge eating disorder.⁵

Sibutramine (Meridia) is a medicine that reduces appetite. It appears to be effective in helping people with binge eating disorder. Combined with a low-calorie diet, this drug can help people lose weight, and it also might help people stop binging.⁶

Topiramate (Topamax), which is a medicine used to treat seizures, is sometimes used to reduce the urge to binge and to promote weight loss in those who are overweight because of binge eating disorder.⁷

What To Think About

Medicines and counseling may help you quit binging and lose excess weight. But this will take some time and patience. Some people find that they still have trouble losing excess weight, even after they stop binging. Talk to your doctor about what results are realistic to expect from treatment.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health professionals to closely watch for warning signs of suicide in children and adults who are taking antidepressants. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children, who might be less able to control their impulsivity as much as adults and therefore might be at greater risk for suicidal impulses. The FDA does not recommend that people taking antidepressants stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. If concerns arise, contact a health professional.

Unfortunately, many people don't seek treatment for mental health problems. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasonswhy people don't get help and how to overcome them.

Home Treatment

Continuing healthy habits at home can improve binge eating disorder.

• Develop a plan for eating a balanced diet. A registered dietitian can help you with this. For more information, see the topic Healthy Eating.
• Become more physically active. Talk with your doctor about how to increase your activity. For more information, see the topic Fitness.
• Take care of yourself. Pace yourself, and try to spend time with other people who care about you.

It is helpful when family members are supportive of their loved one with binge eating disorder. Learning about the disorder will be useful for the entire family.

In many cases, eating disorders are associated with poor body image and low self-esteem. Parents can help reduce the chances that their children will develop an eating disorder by teaching them to have:

• A healthy view of themselves.
• Healthy attitudes about eating and exercise.

For more information, see the topic Healthy Eating for Children.

Other treatment

Other treatments can be helpful to reduce binge eating.

Self-care programs. These are organized programs that provide self-help materials such as manuals or computer-based activities that can be useful in treating eating disorders. But most people who have an eating disorder also need counseling and possibly medicine.

Stress management techniques. Many people report that their binging episodes are triggered by feelings of anxiety or tension. Although not part of the treatment of binge eating disorder, relieving stress can help during recovery and can improve quality of life. Techniques to reduce stress include:

• Exercising. Regular physical activity is one of the most effective stress-management techniques.
• Writing. Research shows that expressing yourself in writing can be a very effective way to reduce your stress level.
• Expressing your feelings. Talking, laughing, crying, and expressing anger are normal parts of the emotional healing process.
• Doing something you enjoy. A hobby or other healthy leisure activity that is meaningful to you can help you relax. Volunteer work or work that helps others can be a powerful stress-buster.
• Body-centered relaxation. This includes breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, and traditional Chinese relaxation exercises such as tai chi and qi gong.
• Mindfulness activities. These include learning how to relax your body through self-hypnosis, meditation, or imagery exercises or listening to relaxing music or using humor to reduce stress.

For more information on stress reduction, see the topic Stress Management.

Other Places To Get Help

Organizations

Related Information

• Anorexia Nervosa
• Bulimia Nervosa
• Depression
• Healthy Eating for Children
• Obesity
• Weight Management

References

Citations

1. Agras WS (2005). The eating disorders. In DC Dale, DD Federman, eds., Scientific American Medicine, section 13, chap. 9. New York: WebMD.

2. American Psychiatric Association (2000). Binge-eating disorder. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 785-787. Washington, DC: American Psychiatric Association.

3. Steering Committee on Practice Guidelines, American Psychiatric Association (2006). Treating eating disorders: A quick reference guide. Available online: www.psych.org/psych_pract/treatg/quick_ref_guide/EDs_QRG.pdf.

4. Safer DL, et al. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4): 632-634.

5. Yager J, et al. (2006). Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd ed. Arlington, VA: American Psychiatric Association. Also available online: www.psych.org/psych_pract/treatg/pg/EatingDisorders3ePG_04-28-06.pdf.

6. Appolinario JC, et al. (2003). A randomized, double-blind, placebo-controlled study of sibutramine in the treatment of binge-eating disorder. Archives of General Psychiatry, 60(11): 1109-1116.

7. McElroy SL, et al. (2003). Topiramate in the treatment of binge eating disorder associated with obesity: A randomized, placebo-controlled trial. American Journal of Psychiatry, 160(2): 255-261.

Other Works Consulted

• Anderson AE, Yager J (2005). Eating disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 1, pp. 2002-2021. Philadelphia: Lippincott Williams and Wilkins.

• Brownell KD, et al. (2005). Obesity. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 2124-2136. Philadelphia: Lippincott Williams and Wilkins.

• Coughlin JW, Guarda AS (2006). Behavioral disorders affecting food intake: Eating disorders and other psychiatric conditions. In Modern Nutrition In Health and Disease, 10th ed., pp. 1353-1361. Philadelphia: Lippincott Williams and Wilkins.

• Fairburn CG, Harrison PJ (2003). Eating disorders. Lancet, 361(9355): 407-416.

• National Eating Disorders Association (2005). Binge eating disorder. Available online: http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=286&Profile_ID=41140.

• National Eating Disorders Association (2005). What is an eating disorder? Some basic facts. Available online: www.nationaleatingdisorders.org/p.asp?WebPage_ID=320&Profile_ID=41145.

• Striegel-Moore RH, Franko DL (2003). Epidemiology of binge eating disorder. International Journal of Eating Disorders, 34(Suppl): S19-S29.

• Wonderlich SA, et al. (2003). Psychological and dietary treatments of binge eating disorder: Conceptual implications. International Journal of Eating Disorders, 34(Suppl): S58-S73.

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