Though it has only recently been established as a formal psychiatric diagnosis, binge eating disorder (BED) is already the most common eating disorder in the United States. Its medical and psychological costs affect millions of Americans every year.
Like substance use disorders, BED emerges from efforts to soothe psychological distress by consuming substances that trigger chemical changes in the brain. Because its symptoms are easy to disguise, many people with BED do not seek help.
Instead of seeking treatment, many people with binge eating disorder make unsuccessful dieting attempts that cause psychological harm and further reinforce the underlying causes of the disorder.
What Is Binge Eating Disorder?
Not everyone who overeats has episodes of binge eating or eating large amounts of food in a single session. Additionally, not everyone who binge eats has binge eating disorder or regular episodes of binge eating with negative psychological effects.
Many people eat too much on occasion, even to the point of making themselves sick. Under certain circumstances, overeating can be good manners and a way to bond with others. Several holidays, like Thanksgiving and Hanukkah, involve sharing heaping plates of food with loved ones.
Some people have single episodes of binge eating that are linked to transient stress. For example, people may overeat in response to losing a job or after breaking up with a romantic partner. These episodes of binging do not indicate a binge eating disorder unless they are part of a larger pattern.
Why do people binge eat? One of the most common causes of binge eating disorder is emotional overeating. In addition to satiating physical hunger, some individuals overeat because it helps them feel comforted or safe. For many people with BED, binge eating is a way to cope with other psychological conditions, social isolation or trauma.
Symptoms of Binge Eating
Binge eating is not simply a matter of how much a person eats. Factors that are important to consider are how and why a person eats and how it makes them feel.
Many behaviors associated with binge eating are normal on their own and only indicate binging in specific contexts. For example, some people might eat alone out of feelings of shame over binge episodes, while others may simply find it accommodates their schedules.
One of the reasons binge eating disorder has only recently been recognized as a distinct mental health condition is that it lacks symptoms typically associated with eating disorders, like binge-purge cycles and periods of severe food restriction. Signs of binge eating are subtler and harder to detect. People frequently hide binge eating episodes from others by only binging when they are alone or late at night when others are asleep.
Binge eating symptoms usually occur in clusters. When several of the following signs are present, a person may be having episodes of binge eating:
- Continuing to eat after feeling full
- Stashing food in strange or hidden places
- Feeling disgusted or ashamed after eating
- Leaving large numbers of empty containers in the trash
These episodes need to be repeated over an extended period of time for a person to qualify for a diagnosis of binge eating disorder. Binge eating disorder symptoms include behavioral and physical symptoms that only emerge from multiple episodes of binging, such as:
- Recurrent fluctuations in weight
- Frequently changing or resuming diets
- Food-related obsessions and compulsions
- Obsessively following new food or diet fads
- Having unusual eating schedules or mealtimes
- Making significant efforts to avoid eating in front of others
People with chronic binge eating disorder often develop complications that affect their health. These can include chronic medical conditions like diabetes and heart disease and mental health disorders like anxiety disorders and depression.
Causes of Binge Eating
What causes binge eating? Any number of factors can cause people to binge eat episodically or develop binge eating disorder. Sometimes, the causes of binge eating are physical. People who make several attempts to lose weight by dieting can temporarily or permanently change their appetite or metabolism in ways that increase food cravings or make it harder for them to detect when they are full. Genetic and biological factors can also trigger the disorder.
Emotional and psychological factors are a major cause of episodic food binges and binge eating disorder, especially if people grew up in environments where food was the primary source of comfort or positive emotions. People often eat to manage a wide range of negative feelings, including stress, anxiety, disappointment, loneliness and depression.
How Is Binge Eating Diagnosed?
Binge eating disorder has a significant physical component but is defined by its psychological effects. BED was just added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) when the fifth edition of the manual (DSM-5) was published in 2013.
Like many other mental health conditions, binge eating disorder is usually diagnosed through a series of interviews with mental health professionals. Using the DSM as a guide, a clinician typically asks targeted questions to determine if a person’s symptoms meet the diagnostic criteria for the disorder.
Important binge eating facts that help a clinician make a diagnosis include the amount of food a person eats, how often they eat this amount of food and their feelings afterward. For someone to be diagnosed with BED, they must have episodes of binge eating that meet two DSM criteria:
- Eating significantly greater amounts of food than normal in a single episode
- Feeling a lack of control during the episode (feeling unable to stop or slow down)
These episodes must be associated with marked distress and three or more of the following symptoms:
- Eating faster than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food even when not feeling physically hungry
- Eating alone because of feeling embarrassed about the amount being eaten
- Having negative self-directed feelings after eating like disgust, guilt or depression
Finally, DSM criteria for diagnosing binge eating disorder require a person to have at least one episode of binge eating every week for at least three months.
It is common for people to overeat in response to psychological distress, and co-occurring disorders are prevalent among people with BED. Consequentially, a careful process of differential diagnosis is usually required to determine if someone has BED. Many clinicians specifically focus on the frequency of binge episodes and the significance of any behavior people engage in to accommodate these episodes.
Anything that marks binge eating episodes as a pattern helps confirm a diagnosis, especially when repeated binge eating episodes are associated with specific psychological triggers and effects. For example, if a person overeats in response to interpersonal conflict and feels self-loathing afterward, a binge eating disorder diagnosis may be indicated if other criteria are met.
Who Is at Risk for Binge Eating?
Given the close association between eating and emotional comfort, many people are at risk for binge eating at some point in their lives. It is rarer for people to develop a chronic binge eating disorder. Specific risk factors associated with the development of BED include:
- Low self-esteem or recurrent feelings of guilt or shame
- Sudden or prolonged work-related or interpersonal stress
- A history of dieting, restricting calories or altering metabolism
- Co-occurring mental health conditions like depression or anxiety
- A history of childhood trauma or abuse, including shaming or ridicule
- A family history of eating disorders or unusual eating styles or schedules
- A family pattern of using food instead of communication to resolve conflict
The people most at risk for BED are those with low self-esteem whose families used food as an alternative to emotional intimacy. Their risk increases even further when they have a history of repeatedly dieting and causing long-term changes to their metabolism, including inducing specific food cravings through deprivation.
Binge Eating Statistics
Binge eating disorder statistics show that BED is commonly experienced and rarely treated, despite carrying significant risks and comorbidities.
About 3 percent of American adults have binge eating disorder, making it the most prevalent eating disorder in the United States. Rates of BED are twice the rates of anorexia and bulimia combined.
More women than men have binge eating disorder, but it is the most common eating disorder among men.
Binge eating disorder commonly co-occurs with other psychiatric conditions, including bipolar disorder, major depressive disorder, anxiety disorders and substance use disorders.
People with binge eating disorder are more likely to have attempted suicide.
Only about 44 percent of people with BED will ever receive treatment for their disorder.
Binge eating disorder resembles substance use disorders to the extent that researchers have even considered calling it “food addiction.” When people have binge eating and co-occurring substance use disorders, the combined effects can be overwhelming and seem insurmountable.
You or a loved one may have asked, “How do I stop binge eating and using substances at the same time?” The answer is finding the right program that provides treatment for binge eating disorder and addiction. The Recovery Village operates facilities across the United States that provide integrated treatment options for these co-occurring disorders. Contact The Recovery Village today to learn more about which options are right for you.