Binge eating disorder (BED) is a serious mental illness, whichinvolves eating a lot of food in a small amount of time until you are uncomfortably full. Episodes of uncontrollable overeating may also be referred to as ‘binges’. Unlike other types of eating disorders like bulimia nervosa, those with BED often do not follow through with ways to get rid of the food they have eaten (e.g. vomiting). BED can affect anyone regardless of age, ethnicity, gender, or background.
This article looks at the symptoms, causes, and health risks associated with BED, as well as getting help if you are experiencing BED.
Causes of binge eating disorder
There are lots of reasons why you may feel compelled to binge eat. Although the cause of BED remains unclear, some research suggests the interaction between your genotype and the environment (phenotype) and the role it plays in the development of BED.1 Environmental factors that play a role in the pathogenesis of BED may include: perfectionism, childhood obesity, family problems, substance abuse, and physical and sexual abuse.2
Signs and symptoms of binge eating disorder
The main symptom of BED is eating a larger amount of food in a short amount of time until you are uncomfortably full. This is also known as a binge-eating episode. However, you may also experience lots of other symptoms such as:
- Eating alone or secretly
- Having feelings of guilt, shame or disgust after a binge-eating episode
- Eating when not hungry
- Eating very fast during a binge-eating episode
Although sometimes you may experience uncomfortable fullness after a large meal, those with BED often partake in frequent binge-eating episodes.
There may be certain warning signs of an eating disorder that you may identify with your friends or family members. These may look like someone:
- Hiding how much food they are eating
- Stashing food for a binge-eating episode
- Weight gain (although this does not happen with everybody experiencing BED)
- Eating a lot of food quickly
Management and treatment for binge eating disorder
The treatment options for BED are stated within the National Institute for Health guidance on binge-eating disorder. The first-line treatment often includes binge-eating-disorder-focused guided self-help programmes. These programmes may include:
- The use of cognitive behavioural self-help materials
- Supportive sessions
- Focus on adherence and following of the programme to ensure efficient treatment of BED
Treatment may look different for everyone. Sometimes, self-help programmes may not be appropriate for your BED treatment. For example, if a self-help programme does not prove to be effective after 4 weeks, cognitive behavioural therapy specifically for those afflicted with eating disorders (CBT-ED) may be required. This type of therapy may be carried out in a group setting, or individually, dependent on your circumstances and needs.
CBT-ED may look like:
- Approximately 16 sessions
- Support and advice for avoiding relapses
- Challenging negative views and associations you may have with your body and body image
- Identifying binge-eating triggers and finding ways to reduce these
- Focussing on self-monitoring of dietary intake
It is not recommended to solely use medication for the treatment of BED. However, medication may be appropriate in combination with psychological treatment for some individuals dependent on their symptoms, and other medical conditions present. Your general practitioner should assess your BED on an individual basis, working with you to provide the best support.
If you think you may have BED, it is important that you seek help from your GP as soon as possible. In your first appointment, you may expect to be asked about your eating habits and how you are feeling. They may also need to carry out some physical measurements (e.g. weight, height). It can be difficult to admit that you need help, so bringing a friend or family member to your appointment may help.
A diagnosis for BED will be given if you meet certain criteria. Within the UK, this criteria is published within the DSM-5 guidance. For example, your GP will look at whether you:
- Are eating a larger than average amount of food within a set amount of time (e.g. 1 hour), that many other individuals in similar conditions
- Feel a lack of control when you are eating during a ‘binge’ episode
- Have associated feelings of guilt, disgust, or shame after a binge-eating episode
- Eat until you are uncomfortably full
- Partake in binge-eating behaviours once a week for more than 3 months
- Have concurrent behaviours similar to other disorders (e.g., bulimia nervosa)
After gaining a thorough understanding of your behaviours, thoughts, and feelings towards eating, your GP will be able to distinguish whether you should receive a diagnosis for BED. Sometimes, a BED diagnosis is not as straightforward for identifying the signs and symptoms of disordered eating. BED may also occur alongside other eating disorders (e.g. binge-eating/purging subtype), or may be another feeding or eating disorder (OFSED).
However, your experience of eating is more than a set of DSM-5 symptoms and criteria. Oftentimes, individuals with a BED diagnosis find it difficult to separate their identity from their diagnosis. It is therefore important to continually understand that you may experience this illness, but it does not define your worth. Self-help and other management techniques should help you understand your diagnosis, and how to cope with it alongside your personal life and identity.
Many different factors may heighten the risk of BED, and these may concur together. Genetics and family history may be deemed as the 2 main risk factors. These may include:2
- History of sexual trauma or abuse
- History of emotional abuse or neglect
- Growing up with family members who exhibited disordered eating behaviours
- Family history of depression or low mood
Other risk factors may include:
- Weight-related bullying
- Poor self-esteem
Adolescence and young adulthood is the most common time for the development of eating disorders (including BED). This may be due to several reasons, including low self-esteem, bullying, social media and peer-related pressures.
A variety of health complications may arise from untreated binge eating disorder. These complications may affect you physically or mentally/behaviourally.
For example, BED may trigger physical complications:3
- Fertility issues - for people who menstruate, amenorrhoea (loss of periods) may occur due to hormonal imbalances from periods of overeating. Long-term infertility issues may also arise due to a disruption in the normal regulation of hormones. The prevalence rate of infertility for those with BED is unknown, however, infertility is associated with a variety of eating disorders4
- Gastrointestinal (GI) issues - Eating large amounts of food within a short time can trigger colonic discomfort.5 Symptoms of diarrhoea, urgency, constipation, and a feeling of anal blockage are commonly reported lower GI issues in those with BED.6 Upper GI issues may also be associated with BED and these may include: heartburn, dysphagia (difficulty with swallowing), and regurgitation6
- Obesity - Those with BED are 3-6 times more likely to be obese than those without an eating disorder.7 However, obesity is not a defining characteristic for the diagnosis of BED, and anyone regardless of body size or shape may be afflicted with a binge eating disorder
- Type 2 diabetes - Many individuals with BED often report a diagnosis of type 2 diabetes. However, there is conflicting evidence that BED causes type 2 diabetes. Many factors may cause type 2 diabetes such as depression and obesity. Therefore, more research is required to determine BED as a direct cause of type 2 diabetes
Poor mental health and behavioural issues may occur alongside BED, such as:
- Social isolation
- Severe anxiety
How can I prevent binge eating disorder?
There is no way of preventing the development of binge eating disorder. However, management techniques (e.g., psychological interventions) may be utilised to prevent further binge eating episodes. Seeing a healthcare professional when you are experiencing
How common is binge eating disorder?
Within the United Kingdom, approximately 1 in 50 people experience a binge eating disorder. In addition, 40% of individuals diagnosed with BED identify as male. Binge eating disorders may affect anyone regardless of ethnicity, age, background or gender.
When should I see a doctor?
Binge eating disorder is mostly associated with binge-eating episodes. Binge-eating episodes may look like eating until you are uncomfortably full, eating a large amount of food within a set period, feeling a lack of control when eating, or having feelings of guilt after eating. If you are experiencing any of these symptoms you must seek professional help. It is also important to see your GP when you have any issues with eating, as these may suggest any number of eating disorder(s). You can use this resource to bring along to your first doctor’s appointment to help you speak about the symptoms you have been experiencing.
Binge eating disorder is a type of eating disorder. There may be many reasons why someone develops BED, including environmental and genetic factors. Common symptoms of BED may include: eating large amounts of food within a small amount of time, hiding food, eating until uncomfortably full, and having feelings of shame after eating. BED may look like other eating disorders, and may be diagnosed alongside other eating disorders. Diagnosis of BED looks at the signs and symptoms of binge episodes alongside current national guidance. Once a diagnosis is sought, strategies will be implemented to reduce the likelihood of binge eating. These management techniques may include supportive sessions, cognitive behavioural therapy designed for those with eating disorders, and self-help resources. Comorbid conditions may occur if BED treatment is not pursued, including depression, anxiety, and GI issues. Therefore, it is important to seek advice and support from your healthcare professional if you are experiencing any signs or symptoms of BED.
- Hudson JI, Lalonde JK, Berry JM, Pindyck LJ, Bulik CM, Crow SJ, et al. Binge-eating disorder as a distinct familial phenotype in obese individuals.
- Fairburn CG, Doll HA, Welch SL, Hay PJ, Davies BA, O’Connor ME. Risk factors for binge eating disorder: a community-based, case-control study. Archives of General Psychiatry [Internet]. 1998 May 1 [cited 2023 Jun 12];55(5):425–32. Available from: https://doi.org/10.1001/archpsyc.55.5.425
- Mehler PS, Birmingham LC, Crow SJ, Jahraus JP. Medical complications of eating disorders. The treatment of eating disorders: A clinical handbook. 2010:66-80.
- Kimmel MC, Ferguson EH, Zerwas S, Bulik CM, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord [Internet]. 2016 Mar [cited 2023 Jun 12];49(3):260–75. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683401/
- Delgado-Aros S, Camilleri M, Castillo EJ, Cremonini F, Stephens D, Ferber I, Baxter K. 338 Burton D, Zinsmeister AR. Effect of gastric volume or emptying on meal-related symptoms after 339 liquid nutrients in obesity: a pharmacologic study. Clin Gastroenterol Hepatol. 2005;3:997-1006.Available from: https://pubmed.ncbi.nlm.nih.gov/16234046/
- Cremonini F, Camilleri M, Clark M, Beebe T, Locke G, Zinsmeister A, et al. Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study. Int J Obes (Lond) [Internet]. 2009 Mar [cited 2023 Jun 12];33(3):342–53. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754813/
- Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, et al. The prevalence and correlates of binge eating disorder in the WHO World Mental Health Surveys. Biol Psychiatry [Internet]. 2013 May 1 [cited 2023 Jun 12];73(9):904–14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628997/