Binge Eating

Binge eating is the consumption of a large amount of food within a limited time period, such as one or two hours. A pattern of frequent binge eating is classified as binge-eating disorder (BED).

BED is the most commonly diagnosed eating disorder in the United States, affecting about 3.5% of females and 2% of males at some point in their lives. About 1.6% of teenagers have BED. The prevalence of BED is similar in other industrialized countries. A much larger percentage of children and adults have episodes of binge eating or compulsive overeating that do not occur with the frequency required for a diagnosis of BED. In the United States, BED appears to affect people of different racial/ethnic groups similarly. In women, BED most often begins between the ages of 18 and 29, whereas in men it most often starts between ages 45 and 59.

BED is more common in people with obesity, especially severe obesity. As many as one half of people attending weight-loss clinics are considered to have BED. However, most people with obesity do not have BED, and BED also occurs in people of average body weight.

The duration of a binge-eating episode can vary significantly, but it is characterized by an inability to stop eating during each episode and a general feeling of being out of control. A binge typically ends only when all of the desirable binge foods have been consumed or when the individual feels too full to continue. During a binge, people generally eat very fast and alone—usually out of embarrassment—and afterwards suffer strong negative feelings such as guilt, shame, or depression. Although most people overeat on occasion, BED is a pattern of frequent bingeing that differs from continuous snacking and often occurs in the absence of hunger.

For the first time in 2013, the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classified BED as a distinct type of behavioral feeding and eating disorder. However, not all experts agree with this classification. Some experts believe that binge eating should be classified as an obesity-related behavior, even though not all binge eaters are obese, and most people with obesity are not binge eaters. Furthermore, binge eaters are far more likely to report significant mood problems, especially depression, and greater dissatisfaction with their weight and shape than people with obesity. Other experts believe that binge eating is a subtype of bulimia nervosa. Bulimia is characterized by episodes of binge eating followed by self-induced purging by vomiting; abuse of laxatives, diuretics, or enemas; fasting; or compulsive exercise. Although people with BED often attempt to diet between binges, they do not practice purging, nor do they exhibit anorexia nervosa or self-starving behaviors. It has been pointed out that the classification of BED as a distinct mental health disorder coincided with the promotion of Adderall (mixed amphetamine salts) and Vyvanse (lisdexanfetamine mesylate) for treating binge eating. The U.S. Food and Drug Administration (FDA) approved Vyvanse for BED in 2015, thereby extending its patent protection.

Risk factors for binge eating are similar to those for other eating disorders, including:

Like other eating disorders, BED has multiple causes. Some people appear to be genetically predisposed to binge eating. Researchers believe that this may be related to abnormalities in neurotransmitters in the brain that help regulate appetite. Binge-eating episodes may be triggered by strong negative emotions, such as depression or anxiety, or by less well-defined feelings of tension or stress. People who binge eat are far more likely than others to report personal and work problems and hypersensitivity to the opinions of others. As with bulimia, people with BED are more likely than others to be diagnosed with major depression, substance-related disorders, or personality disorders. Binge eating is often triggered by stress. Sometimes the stress is caused by a very restrictive diet, but often it is caused by social and cultural factors, such as family conflicts or dysfunctional relationships. Pressure from cultural and media messages promoting slimness as desirable can lead to binge eating as a coping mechanism. Some patients report that their binges are related to the consumption of certain “trigger foods,” usually carbohydrates.

Whatever the cause, binge eating appears to temporarily alleviate uncomfortable or painful feelings. While binge eating, patients typically describe themselves as “numb” or “spaced-out.” The relief is shortlived, however, leading to repeated episodes. This out-of-control eating is a frightening experience for most people, and they usually report feeling embarrassed and ashamed. In the aftermath of a binge, many people experience overwhelming feelings of guilt, self-disgust, anxiety, or depression. They may vow never to binge again but are unable to stop themselves.

Binge eating often occurs in private. Specific symptoms can include:

Binge eating can be difficult for healthcare providers to diagnose because people often go out of their way to hide how much they eat. Patients may not reveal their eating habits in the course of family and personal medical histories. They may, for example, buy snack food at the grocery store and eat it in the car before they get home, or they may buy food in secret and hide it so that others will not know they are bingeing.

Several different evaluations can be used to examine patients' mental states. In addition to discussing eating habits, the doctor or mental health professional assesses their thoughts and feelings about themselves, their bodies, their relationships, and their risk for self-harm. These assessments are usually administered in an office setting.

The DSM-5 diagnostic criteria for BED are:

The physician will conduct a physical examination and will probably order standard laboratory tests such as a complete blood count (CBC), urinalysis, and blood tests to check the levels of cholesterol, triglycerides, and electrolytes. Additional tests, such as a thyroid function test, may be ordered to rule out other disorders. If the patient is obese, tests may be done to check for obesity-related diseases such as high blood pressure, diabetes, cardiovascular disease, and sleep apnea.

Binge eating is usually treated most effectively by a combination of psychotherapy, group therapy, and possibly drugs. Physicians are more likely to concentrate on weight-control issues, using drugs, diet, and nutrition counseling to reduce the risk of obesity-related diseases. Although nutrition counseling and meal planning may help control weight, they do not address the impulse to binge eat. Psychologists are more likely to treat behavior and thought patterns that cause abnormal eating, because obesity may be easier to treat once bingeing behavior is controlled.

As of 2018, lisdexamfetamine (Vyvanse) was the only FDA-approved medication for BED. Lisdexamfetamine is a stimulant that has the potential to be habitforming and abused. A 2016 study reported that, in addition to cognitive-behavioral therapy (CBT) and lisdexamfetamine, antidepressants—including selective serotonin-reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), and bupropion (Wellbutrin)—can be helpful for BED, depending on the individual. SSRIs are FDA-approved for bulimia, which involves binge-eating behavior. These medications increase serotonin levels in the brain and are thought to affect the sense of fullness. SSRIs may be prescribed for BED regardless of whether there are signs of depression. Rarely, other appetite suppressants or tricyclic antidepressants (TCAs) are prescribed for BED. The anticonvulsant topiramate (Topamax), which is normally used to control seizures, has been found to reduce binge-eating episodes, but this drug can have serious side effects.

People with eating disorders can be at risk for abusing dietary supplements and herbal products for weight loss or appetite suppression. Such products can also have serious side effects and interactions. They should not be used without consulting a physician.

Self-help programs, including books and manuals, videos, and support partners and groups, can be helpful for treating binge eating. They are also cost-effective. BED self-treatment, however, is typically ineffective. Nevertheless, experts recommend self-care steps including:

Nutrition counseling and meal planning can help bring weight under control, but they do not address uncontrolled bingeing impulses. Nutrition counseling needs to be part of a broader treatment program that includes psychotherapy and possibly drug therapy. Although weight-loss programs are helpful for some people with BED, they generally are not recommended until after BED treatment, because reduced-calorie diets can trigger binge eating. Furthermore, weight-loss programs generally do not address binge-eating triggers to the same extent as psychotherapy. Weight loss should be medically supervised.

Several types of psychotherapy can be effective for individuals who truly want to stop binge eating.

No clear prognosis is available for BED, although overall rates of recovery are higher than for bulimia. Because stress often triggers bingeing, relapses are most likely to occur in response to stressful life events. Some individuals find that simply seeking help or even receiving a placebo improves their control over binge eating. Many studies are underway to test different approaches to binge-eating treatment. Individuals interested in participating in a no-cost clinical trial can find a list of studies currently enrolling volunteers at https://www.clinicaltrials.gov .

Binge eating is difficult to prevent, because its causes are unclear, and it can be difficult to detect. Prevention strategies include:

See also Anorexia nervosa ; Body image ; Bulimia nervosa ; Cravings ; Eating disorders ; Intuitive eating ; Nutrition and mental health ; Obesity .