Binge Eating Disorder Explained: Causes, Symptoms, And Treatments
Binge eating disorder (BED) is one of the most common eating disorders in the U.S. It's three times more prevalent than both anorexia and bulimia combined, reports the National Eating Disorders Association. It's said to affect somewhere between 7.2% to 13% of people at some point during their lives, and the disorder appears to be increasing in prevalence in many parts of the globe (via Journal of Eating Disorders).
Despite its high prevalence, however, the research on BED is still in its infancy (via National Eating Disorders Association). There are many gaps yet to be explored, particularly in comparison to anorexia and bulimia. The recognition of BED as an official mental health diagnosis is fairly new: It was first accepted into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 (via Eating Disorder Hope).
BED is characterized by recurring episodes of binge eating (via Europe PMC). This occurs without compensatory behaviors like purging, which are seen in people with bulimia. The disorder can cause significant emotional and physical distress and is associated with various medical health problems. The exact origin of BED is unknown. However, many researchers and clinicians believe that the illness stems from a combination of genetic, social, physical, and psychological factors. Here's a more in-depth look into the symptoms, etiology, and treatment approaches for BED.
The symptoms of binge eating disorder
BED doesn't consist of just one isolated binge -– it's marked by repeated episodes of excessive food consumption (via Journal of Eating Disorders). People typically experience a sense of "losing control" when eating, and sometimes around food in general. They may consume a large amount of food in a very short space of time. But the duration and frequency of these episodes, as well as the amount of food that's consumed, tends to vary between individuals. Like most mental health disorders, BED sits on a spectrum of severity.
People struggling with BED often report feeling embarrassed, guilty, disgusted, and uncomfortably full after a binge, notes a study published in the Journal of Rational-Emotive & Cognitive-Behavior Therapy. And yet, individuals may feel like they can't stop eating. Many patients also describe losing self-consciousness during a binge eating episode. In this sense, BED can feel like an addiction (via Behavioral Sciences).
To be diagnosed, a person must have had at least one binge eating episode per week for at least three months (via Annals of Internal Medicine). A binge will involve eating more food than the average person in a given period of time. This will cause significant emotional distress and is accompanied by a feeling of out-of-controlness. BED occurs without the presence of compensatory behaviors like purging, fasting, or excessively exercising.
The health complications of binge eating disorder
BED is associated with quite a few different physical and mental health issues (via Biological Psychiatry). Many people with the condition also struggle with obesity, though not everyone who has BED is overweight.
Research shows that BED elevates an individual's risk of diabetes, asthma, hypertension, sleep disorders, gastrointestinal problems, and pain conditions, to name a few (via Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity). And many health issues arise independently of obesity. Among women with BED, some common medical challenges include menstrual disorders, fertility problems, pregnancy complications, and polycystic ovary syndrome.
BED is also a strong risk factor for developing other mental health conditions like anxiety, depression, addiction, and borderline personality disorder (via Current Opinion in Psychiatry). It's estimated that 79% of people with BED have one other psychiatric disorder (via Europe PMC). Meanwhile, approximately 49% of patients have a lifetime history of two or more coexisting disorders, such as a mood disorder or social phobia.
Out of all eating disorders, BED tends to be the most predictive of depressive symptoms, according to a study published in Adolescent Health, Medicine and Therapeutics. Patients often report having a poor quality of life and experiencing various social challenges. If left untreated, BED can have life-threatening consequences, with attempted suicide being a significant risk.
If you or anyone you know is having suicidal thoughts, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Who's affected by binge eating disorder?
BED is estimated to affect around 3.5% of women and 2% of men throughout their lifetime, per the National Eating Disorders Association. It's observed in about 1.6% of adolescent females. It's also one of the most common eating disorders among Hispanic, Asian-American, and African-American women, according to a study from the International Journal of Eating Disorders.
BED usually shows up in people around the age of 23 (via Europe PMC). It often occurs with a mental health condition like anxiety or depression (via Adolescent Health, Medicine and Therapeutics). But the relationship between BED and poor mental health is bidirectional.
Women and girls who are chronic dieters are more likely to experience BED than non-dieters. The disorder is said to have two peaks of onset throughout adolescence: The first one being right after puberty (around 14 years old), when individuals undergo various physical, hormonal, social, and neurobiological changes, and the second in late adolescence (somewhere between the ages of 18 and 20). Ultimately, however, BED can affect anyone at any age.
Traumatic experiences can increase the risk of binge eating disorder
It's common for individuals with eating disorders to report a past history of trauma, including emotional, physical, and sexual, according to research published in Eating Disorders: The Journal of Treatment & Prevention. Childhood abuse and post-traumatic stress disorder (PTSD) in particular are strongly associated with BED (via European Eating Disorders Review). Approximately 20% of women with binge eating disorder meet the criteria for lifetime PTSD, per the National Eating Disorders Association.
The precise way in which PTSD may trigger binge eating is not yet well-understood (via Eating Disorders: The Journal of Treatment & Prevention). But it's been suggested that compulsive eating may serve as a behavioral coping mechanism in that it helps people regulate the painful emotions that stem from unresolved trauma (via Appetite). People who have difficulty verbalizing, processing, and acknowledging their emotions may turn to food instead.
"Escape theory" proposes that binge eating provides short-term relief, helping individuals temporarily escape or numb their pain (via Cogent Psychology). When people try to avoid thinking about their traumatic memories, they may dissociate and turn off their feelings. This reduces self-awareness and removes inhibitions, which can make it more likely for people to overeat or engage in a binge.
The psychological triggers for binge eating disorder
A number of mental health risk factors have been identified for BED (via Journal of Eating Disorders). Some key ones include depression, anxiety, lack of healthy coping strategies, and unhealthy beliefs about eating.
Low self-esteem is also believed to play a significant role in the development and maintenance of BED. It's theorized that people who hold negative core beliefs about themselves are more likely to participate in binge eating episodes and develop disordered eating behaviors over time. For example, an individual with low self-worth who has overly critical self-evaluations might be less motivated to take care of their body and health. People may also use food to lift their mood and feel better about themselves.
Research has shown that dysfunctional metacognitive beliefs about eating, such as "I have no control over my bingeing", can influence individuals' cognitive and emotional state, causing feelings of anger, anxiety, and sadness (via Journal of Rational-Emotive & Cognitive-Behavior Therapy). These challenging emotions can serve as key triggers for binge eating episodes.
If you or someone you know needs help with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.
The rise of binge eating during the pandemic
People with eating disorders saw their symptoms worsen during the COVID-19 pandemic (via Frontiers in Psychology). There was also a notable rise in new cases of eating disorders. Binge eating, in particular, was found to soar during periods of lockdown (via Open Life Sciences).
The pandemic heightened feelings of loneliness, uncertainty, and fear, which were already common risk factors for BED (via Journal of Eating Disorders). Social isolation, confinement, and the sudden inability to use familiar coping mechanisms exacerbated the impact of psychosocial stressors (per Journal of Eating Disorders). Many people experienced a massive disruption to their daily lives and routines, which gave them more time to ruminate and left them feeling even more out of control than normal. Sometimes, when an individual's sense of control is low, eating can be one thing that still feels controllable.
Additionally, the pandemic impacted the availability of food at home for a lot of people, creating food shortage and insecurity. Perceived scarcity of food can play havoc with an individual's thoughts and eating habits, causing restrictive, compulsive, and hoarding behaviors. Many people also had reduced access to healthcare services during this time. This left some individuals feeling like they were a "burden", an "inconvenience", and "forgotten" by the government. The pandemic created a challenging environment for people, and was a particularly vulnerable time for those with post-traumatic stress disorder who are at high risk for binge eating and BED (per European Eating Disorders Review).
The role of genetics in its development
Despite having a multifactorial origin, genetic factors are believed to significantly contribute towards the development of BED (via Therapeutic Advances in Psychopharmacology). These factors are related to the microbiome, the metabolic and endocrine system, the immune system, and the brain.
Twin and family studies estimate that the heritability of BED is somewhere between 41% and 57% (via Neuroendocrinology). It's been suggested that biological abnormalities like brain structure and hormonal processes, which are said to run in families, may underlie binge eating behaviors.
Research has also shown that binge eating and emotional eating are more likely to occur in people who are genetically predisposed to obesity (via Current Obesity Reports). Earlier studies identified a mutation in a particular gene related to the suppression of appetite in people with obesity and BED. Other studies have shown that binge eating tends to be a characteristic of people who share several different genetic abnormalities (via Nutrition Research).
Could brain chemistry be part of the problem?
Some studies suggest that the overlap between depressive symptoms and binge eating could be rooted, at least partly, in brain chemistry (via Journal of Psychiatry & Neuroscience). Binge eaters, in particular, have been found to have abnormally low levels of serotonin caused by increased serotonin uptake in the brain. Serotonin is also known as the brain's "feel-good" neurotransmitter (via Holistic Momma).
For many people, binge eating is an attempt to self-soothe and regulate their emotions (via Journal of Psychiatry & Neuroscience). However, the relief is only temporary. While the fluctuations in neurotransmitters and hormones caused by excessive carbohydrate consumption can produce a sense of satisfaction, it can also play havoc with the body's insulin levels and the brain's neurological balance. This may amplify binge eating behaviors and maintain the binge-eating cycle.
The central dopamine system has also been pinpointed as playing a critical role in the development of binge eating. Some studies have shown that binge eaters are more likely to have diminished dopamine levels (via Journal of Eating Disorders). Dopamine is the neurotransmitter that's involved in human motivation, food craving, decision making, executive function, and impulsivity. For those suffering from low dopamine, disordered eating may serve as a way to achieve emotional homeostasis.
Is binge eating disorder the same as food addiction?
Some researchers believe that a person can become addicted to the chemical reactions in the brain, which are triggered by eating certain foods, such as highly palatable foods and saturated fats (via Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity). Specifically, these foods cause a surge in dopamine, the brain's "motivation" chemical. This creates a reward circuit in the brain which encourages people to want and seek out more of a particular substance or to repeat a certain behavior (via eNeuro). Consuming these foods, over time, can disturb the workings of the dopamine system and cause a deficiency of the neurotransmitter, leading to a cycle of addiction in the long-term.
Food addiction is a fairly new and controversial concept (via Current Drug Abuse Reviews). Although it shares many characteristics with BED, they're considered to be two separate mental health issues. BED is believed to result from a combination of emotional, biological, environmental, and psychosocial factors that go beyond the addictive potential of certain foods. These may include body shape and weight concerns, maladaptive eating patterns, unresolved trauma, and eating-related cognitive distortions. Research shows that 57% of BED patients meet the "diagnosis" for a food addiction, indicating that there are as many differences as there are similarities between the two conditions.
What are some effective treatments for binge eating disorder?
Cognitive behavioral therapy (CBT) is the most researched and widely recognized treatment for BED, according to research (via Annals of Internal Medicine). It can reduce the symptoms of BED by helping patients understand the interplay between their thoughts, emotions, and behaviors. This time-limited intervention addresses the beliefs and habits that may be fueling the disorder and helps the individual to build and establish adaptive coping skills. It also teaches people strategies and tools to help prevent relapse. Some patients find interpersonal psychotherapy to be effective, which can be delivered in both an individual or group format.
Given the biochemical imbalances that may underlie BED, some clinicians prescribe antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs). These have been shown to reduce binge-eating episodes and compulsive thoughts, as well as improving mood and emotional well-being, which in turn can help alleviate other symptoms.
Mindfulness-based interventions have also been shown to produce promising results (via Appetite). This approach combines mindfulness practices and strategies with mindful eating. It can help decrease binge eating behaviors, but its effects on short-term weight loss remain unclear. Mindfulness-based eating awareness training helps reduce and prevent BED symptoms by teaching people to become more aware of their bodily cues (such as hunger and satiety) as well as the various triggers that may lead up to a binge (via Mindfulness).
The controversy of weight loss treatments
Since many people with BED develop obesity, weight loss is a common goal for treating the disorder (via JAMA Psychiatry). Research has shown that behavioral weight loss programs can be effective in treating people with BED who also have excess weight (via Cognitive and Behavioral Practice). These interventions use behavioral techniques that aim to reduce calorie intake and increase physical activity.
According to a study published in American Psychologist, around 74.4% of patients who followed a behavioral weight loss intervention were able to lose weight and abstain from binge eating. The study also highlighted the potential benefits of weight loss medications, particularly among patients who don't immediately respond to behavioral weight loss interventions.
However, other studies suggest that the efficacy of behavioral weight loss in obese patients with BED is unclear (via Journal of Consulting and Clinical Psychology). Weight loss interventions could even do more harm than good, since dietary restraint and restrictive eating are believed to be precipitating factors that cause people to binge eat (via Journal of Eating Disorders). The focus on weight can exacerbate feelings of shame and guilt, which are strongly associated with increased binge eating symptomatology (via Eating Behaviors). On the other hand, learning to eat intuitively rather than following a strict regimen may serve as a protective factor for people experiencing weight-related shame.
Is it possible to recover from binge eating disorder?
BED is a serious illness that can have major physical and mental health consequences, say researchers (via Adolescent Health, Medicine and Therapeutics). It can interfere with your day-to-day life, cause mental and emotional distress, and have serious physical effects on your body. If left untreated, the disorder can last for many years.
Fortunately, it's possible for people to recover from BED (via Europe PMC). In fact, it tends to have a better prognosis than other eating disorders. Like most mental health conditions, early diagnosis and treatment are more likely to produce positive outcomes (via Adolescent Health, Medicine and Therapeutics). Early detection can help prevent the evolution and worsening of symptoms, and receiving professional support can help people overcome the illness and gradually develop a healthy relationship with food.
If you've been experiencing episodes of binge eating and think you might be struggling with BED, reach out to your doctor for an assessment. From here, you can uncover the type of therapy that's most suitable for you.