Binge-Eating Disorder (Compulsive Overeating)
Binge-eating disorder involves the recurrent consumption of a large amount of food in a short amount of time. Binge-eating episodes are associated with eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not physically hungry, and feeling disgusted with oneself or depressed afterward. Binge-eating usually occurs in secrecy or as inconspicuously as possible. Unlike bulimia, there is no purging after the eating episodes; as a result, binge-eaters tend to gain weight and may be overweight or obese. But while binge-eating is associated with obesity, most obese individuals do not engage in recurrent binge-eating.
Almost everyone overeats occasionally, and sometimes, depending on the circumstances (such as celebrations), it may be culturally appropriate to eat a large amount of food. Such situations are occasional, social, and celebratory. By contrast, binge-eating, or compulsive overeating, reflects a pattern of recurrent episodes of gorging that involve a loss of control and cause an individual significant distress; individuals engaging in binge-eating often feel depressed, disgusted, or ashamed about their eating habits. In addition, binge-eating involves consuming what most people think is an unusually large amount of food very quickly, eating to the point of discomfort, eating in secrecy, and eating even when not hungry.
Binge-eating disorder may be the most common eating disorder in the United States, where as many as 4 million adults struggle with it. It is more prevalent among women than men in the U.S. and afflicts individuals from all racial and ethnic groups. The condition is found more often among people seeking weight-loss treatment than in the general population. About 15 percent of the mildly obese, including those who try to lose weight on their own or with commercial products, are thought to have the disorder.
The primary symptom of binge-eating disorder is recurrent episodes in which someone eats, within a 2-hour period, an amount of food that is significantly larger than what most people would eat under similar circumstances. Per the DSM, this episode should be characterized by a feeling that one lacks control over their eating behavior. In addition, the episode should be characterized by 3 or more of the following:
- Eating more quickly than normal
- Eating until the point of uncomfortable fullness
- Eating when not physically hungry
- Eating alone due to embarrassment about the amount of food one is eating
- Feeling guilty, depressed, embarrassed, or disgusted with oneself
In order to meet the criteria for binge-eating disorder, the binge-eating episodes must occur, on average, at least once a week for three months. The diagnosis is can be categorized as mild, moderate, severe, or extreme based on the number of binge-eating episodes per week.
- Mild: 1-3 binge-eating episodes per week
- Moderate: 4-7 binge-eating episodes per week
- Severe: 8-13 binge-eating episodes per week
- Extreme: 14 or more binge-eating episodes per week
The condition typically begins in adolescence or young adulthood, but can begin in childhood or later adulthood.
Binge-eating behaviors may also occur in individuals who have the eating disorder bulimia nervosa. Yet binge-eating disorder is distinct from bulimia nervosa, because people with bulimia often perform some activity to keep from gaining weight after they overeat. They may purge by vomiting or using diuretics; they may fast, not eating for long periods of time; or they exercise strenuously. Individuals with binge-eating disorder do not engage in these behaviors after a binge and thus tend to gain weight as a result of the condition.
People who compulsively overeat sometimes isolate themselves from public gatherings because of their embarrassment and depression over the disorder. They may miss work or school. Their ability to hide their habits may become so good that often even the people closest to them don't know they have the disorder; this can further increase feelings of isolation and may stop them from seeking treatment out of shame.
Depression is frequently associated with binge-eating disorder. It’s also common for binge eaters to become clinically obese, which can increase the risk for developing medical conditions or exacerbate existing conditions such as diabetes, high blood pressure, high cholesterol, gallbladder disease, heart disease, and certain types of cancer.
Binge-eating disorder and clinical depression frequently co-occur; some evidence suggests that as many as half of people who binge eat also have a mood disorder such as depression. The disorders may develop concurrently, perhaps due to a genetic vulnerability. It's also possible for one disorder to precede the other; binges can be an attempt to numb the painful feelings of depression, for example, while binges can themselves worsen self-esteem and lead to chronically low mood.
The causes of binge-eating disorder are largely unknown. The disorder appears to run in families, which may reflect a genetic predisposition to developing eating disorders or a familial preoccupation with food or weight. Similarly, some experts suspect that psychological factors such as low self-esteem, poor body image, a penchant for yo-yo dieting, or stress can trigger or exacerbate episodes of binge eating. On a neurological level, the neurotransmitter dopamine is thought to play a role; some studies have found that people who engage in binge-eating behaviors may have abnormal levels of dopamine in their brains, though further research is needed to solidify this connection.
The most common antecedent to an episode of binge-eating is negative emotion. Other triggers include interpersonal stressors, feeling hungry or restricted by an overly strict diet, negative feelings related to body image, and boredom.
There are several options for people who want help controlling their tendency to binge eat. Cognitive-behavioral therapy (CBT) teaches people how to keep track of their food consumption and change unhealthy eating habits; it also helps people alter the way they react in difficult situations. Interpersonal psychotherapy (IPT) helps people to look at their relationships with friends and family and make changes in problem areas that could be triggering bingeing behavior. Drug therapy, such as stimulant medications or antidepressants, may be helpful for some people.
While CBT, IPT, and medication are effective, researchers continue to search for more helpful therapeutic strategies. Other potential avenues include dialectical behavior therapy (DBT), which helps people regulate their emotions; drug therapy with the anti-seizure medication topiramate; exercise used alone or in combination with cognitive-behavioral therapy; and self-help strategies—self-help books, videos, and groups such as Overeaters Anonymous have helped some people control binge eating.
Weight loss surgeries, such as gastric bypass, may be used to help someone manage their weight. However, if the underlying psychological problem is not properly treated or monitored, such procedures can be dangerous for those who binge eat. It's critical that individuals disclose their binge eating behaviors before surgery—some with BED stay quiet out of fear that disclosing will disqualify them from receiving the procedure—and discuss the pros and cons of surgical interventions with all members of the treatment team, including therapists and dietitians. Post-surgery challenges may lead to relapse of binge-eating behaviors.
Exact treatment needs will vary from individual to individual. It is important for anyone struggling with an eating disorder to enlist a trusted health professional in coordinating and overseeing care.
Many people with eating disorders respond to outpatient therapy, including individual, group, or family therapy, as well as medical management by their primary care provider. Support groups, nutritional counseling, and psychiatric medications taken under careful medical supervision have also proven helpful for many individuals.
The ADHD medication lisdexamfetamine dimesylate (sold under the brand name Vyvanse) is also FDA-approved to treat binge-eating disorder. Vyvanse may help increase dopamine in the brain, overriding the need to increase dopamine with food. Like many stimulant medications, it can also lead to decreased appetite as a side effect. Other medications used to treat binge-eating disorder include weight loss medications or antidepressants, especially if binge-eating behaviors co-occur with depression.
Hospital-based care (including inpatient, partial hospitalization, intensive outpatient, and/or residential care in an eating disorders specialty unit or facility) may be necessary when an eating disorder results in physical problems that may be life-threatening, or when it is associated with severe psychological or behavioral problems, such as suicidality.