The Facts

Binge eating disorder (BED) is an eating disorder where a person has recurrent episodes of binge eating. During these episodes, the individual eats a large amount of food quickly and feels a lack of control over this eating. BED is different from bulimia in that people with binge eating disorder do not engage in purging behaviour (such as throwing up or overuse of laxatives) to try to get rid of the calories they have consumed. Having binge eating disorder can cause significant impairment in a person’s work life, personal life, and social life.

Until 2013, the diagnosis “eating disorder not otherwise specified” (EDNOS) encompassed all eating disorders that did not meet the criteria for anorexia nervosa or bulimia nervosa. Binge eating disorder was previously grouped together with other eating disorders in the EDNOS category, but is now recognized as its own separate condition.

According to the World Health Organization Mental Health Survey, binge eating disorder affects approximately 8 in every 1000 people globally. Women are more affected by BED than men: females have a 3.5% chance of developing BED in their lifetime, while males have a lifetime chance of 2.0%. Binge eating disorder affects people of all ages, races, ethnicities, and socio-economic statuses. In adults, the median age for onset of BED is about 23 years. It can affect children as young as 10 years old, and there is an increasing recognition that it affects people in middle age as well.  Binge eating disorder is distinct from obesity and overeating. It is important to note that BED affects people who are normal weight as well as overweight.

Causes

While the exact causes of binge eating disorder are not clear, its development seems to be associated with genetic, biological, psychological, and environmental factors. Binge eating disorder may signal that an individual is having difficulties coping with their identity and self-esteem issues. Events such as weight gain, dieting, or binge eating may be associated with development of BED. 

Symptoms and Complications

Some symptoms of binge eating disorder may include:  

• repeatedly eating much larger amounts of foods than others would in a similar period of  time under similar circumstances
• a sense of lack of control over eating during the episode
• eating much more rapidly than normal
• eating until feeling uncomfortably full
• eating large amounts of food when not feeling hungry
• eating alone or in secret because of feelings of embarrassment
• feeling disgusted, depressed, or guilty after an episode
• feeling distressed about binge eating
• frequent dieting, possibly without weight loss

You may not experience all of the symptoms listed above, but to be diagnosed with binge eating disorder, you must meet certain criteria when evaluated by your doctor. The severity of your condition depends on how frequently the binge eating episodes occur.

Binge eating disorder often occurs together with conditions such as mental illnesses. People with BED may experience weight gain over time, which puts them at a higher risk of developing conditions associated with obesity. These include high blood pressure, high cholesterol, heart disease, type 2 diabetes, and gallbladder disease. However, the health consequences of BED are not solely based on the associated weight gain. Binge eating disorder is associated with type 2 diabetes even when comparing people who have the same weight. This means weight gain alone does not explain the association between diabetes and BED.

Making the Diagnosis

To diagnose binge eating disorder, your doctor will need to clinically assess you. Your doctor will ask about your symptoms and take a comprehensive history, as well as assess your medical, mental, and nutritional statuses. There is no test to diagnose BED. Diagnosis is mostly made based on the symptoms you experience and their duration and frequency. However, your doctor may order tests to rule out other conditions that may cause similar symptoms, or to evaluate health consequences of BED.

Treatment and Prevention

Many people with binge eating disorder do not seek treatment. Some are embarrassed or ashamed of their eating; others do not realize BED is a real condition with treatments available.

Treatment goals should be tailored to each individual, and can include:

• lowering the number of binge eating episodes
• reducing excess weight
• enhancing self-acceptance of one’s body or reducing concerns with body image
• treating coexisting psychiatric or medical conditions
• improving daily functioning

Studies have shown that psychotherapy and structured self-help based on cognitive-behavioural interventions are most effective in the treatment of binge eating disorder. Cognitive-behavioural intervention is a form of counselling that focuses on the way you think and behave. You learn to recognize triggers that lead to binge eating and develop strategies to cope with them. Interpersonal psychotherapy is also effective in treating binge eating disorder, especially if the condition is more severe. With the support of health care professionals, family, and friends, it is certainly possible to treat binge eating disorder and return to normal work, personal, and social life.