Binge-eating disorder

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Binge-eating disorder is a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.

Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, excessive overeating that feels out of control and becomes a regular occurrence crosses the line to binge-eating disorder.

When you have binge-eating disorder, you may be embarrassed about overeating and vow to stop. But you feel such a compulsion that you can’t resist the urges and continue binge eating. If you have binge-eating disorder, treatment can help.

Symptoms

Most people with binge-eating disorder are overweight or obese, but you may be at a normal weight. Behavioral and emotional signs and symptoms of binge-eating disorder include:

Eating unusually large amounts of food in a specific amount of time, such as over a 2-hour period
Feeling that your eating behavior is out of control
Eating even when you’re full or not hungry
Eating rapidly during binge episodes
Eating until you’re uncomfortably full
Frequently eating alone or in secret
Feeling depressed, disgusted, ashamed, guilty or upset about your eating
Frequently dieting, possibly without weight loss

Unlike a person with bulimia, after a binge, you don’t regularly compensate for extra calories eaten by vomiting, using laxatives or exercising excessively. You may even try to diet or eat normal meals. But restricting your diet may simply lead to more binge eating.

The severity of binge-eating disorder is determined by how often episodes of bingeing occur during a week.

When to see a doctor

If you have any symptoms of binge-eating disorder, seek medical help as soon as possible. Binge-eating disorder usually doesn’t get better by itself, and it may get worse if left untreated.

Talk to your primary care doctor or a mental health provider about your binge-eating symptoms and feelings. If you’re reluctant to seek treatment, talk to someone you trust about what you’re going through. A friend, loved one, teacher or faith leader can help you take the first steps to successful treatment of binge-eating disorder.

Helping a loved one who has symptoms

A person with binge-eating disorder may become an expert at hiding behavior, making it hard for others to detect the problem. If you have a loved one you think may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns.

Provide encouragement and support. Offer to help your loved one find a qualified doctor or mental health provider and make an appointment. You might even offer to go along.

Causes

The causes of binge-eating disorder are unknown. But family history, biological factors, long-term dieting and psychological issues increase your risk.

Risk factors

Factors that can increase your risk of developing binge-eating disorder include:

Family history. You’re much more likely to have an eating disorder if your parents or siblings have (or had) an eating disorder. This may indicate that inherited genes increase the risk of developing an eating disorder.
Psychological issues. Most people who have binge-eating disorder feel negatively about themselves and their skills and accomplishments. Triggers for bingeing can include stress, poor body self-image, food and boredom.
Dieting. Many people with binge-eating disorder have a history of dieting — some have dieted to excess dating back to childhood. Dieting or restricting calories during the day may trigger an urge to binge eat, especially if you have low self-esteem and symptoms of depression.
Your age. Although people of any age can have binge-eating disorder, it often begins in the late teens or early 20s.

Complications

You may develop psychological and physical problems related to binge eating.

Complications that may be caused by binge-eating disorder include:

Feeling bad about yourself or your life
Poor quality of life
Problems functioning at work, with your personal life or in social situations
Social isolation
Obesity
Medical conditions related to obesity, such as joint problems, heart disease, type 2 diabetes, gastroesophageal reflux disease (GERD) and some sleep-related breathing disorders

Psychiatric disorders that are often linked with binge-eating disorder include:

Depression
Bipolar disorder
Anxiety
Substance use disorders

Preparing for your appointment

Treatment of binge-eating disorder may require a team approach that includes medical providers, mental health providers and dietitians with experience in eating disorders.

Here’s some information to help you get ready for your appointments, and what to expect from your health care team. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of the situation.

What you can do

Before your appointment make a list of:

Symptoms you’re experiencing, including any that may seem unrelated to the reason for your appointment
Key personal information, including any major stresses or recent life changes
All medications you’re taking, as well as any herbs, vitamins or other supplements, and their dosages
A typical day’s eating, which can help your provider understand your eating habits

Questions to ask your doctor include:

Is this condition temporary or long lasting?
What treatments are available, and which do you recommend?
If medication is a part of treatment, is a generic drug available?
Are there any brochures or other printed material I can take home with me? What websites do you recommend?

Don’t hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your doctor or other health care provider is likely to ask you several questions, such as:

What does your typical daily food intake look like?
Do you eat unusually large amounts of food or until you’re uncomfortably full?
Do you feel your eating is out of control?
Have you tried to lose weight? If so, how?
Do you think about food often?
Do you eat even when you’re full or not hungry?
Do you ever eat in secret?
Do you feel depressed, disgusted, ashamed or guilty about your eating?
Do you ever make yourself vomit to get rid of calories?
Are you concerned about your weight and your appearance?
Do you exercise? How often?

Tests and diagnosis

To diagnose binge-eating disorder, your doctor may recommend a psychological evaluation, including discussion of your eating habits.

Your doctor also may want you to have other tests to check for health consequences of binge-eating disorder, such as high cholesterol, high blood pressure, heart problems, diabetes, GERD, and some sleep-related breathing disorders. These tests may include:

A physical exam
Blood and urine tests
A sleep disorder center consultation

Criteria for diagnosis

For a diagnosis of binge-eating disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:

Recurrent episodes of eating an abnormally large amount of food
Feeling a lack of control during bingeing, such as how much you’re eating and whether you can stop eating
Binge eating that’s associated with at least three of these factors: eating rapidly; eating until you’re uncomfortably full; eating large amounts when you’re not hungry; eating alone out of embarrassment; or feeling disgusted, depressed or guilty after eating
Concern about your binge eating
Binge eating at least once a week for at least three months
Binge eating that’s not associated with purging, such as self-induced vomiting, or other compensating behaviors to lose weight, such as excessive exercise or laxative use

Treatments and drugs

The goals for treatment of binge-eating disorder are to reduce eating binges, and, when necessary, to lose weight. Because binge eating is so entwined with shame, poor self-image and other negative emotions, treatment also may address these and other psychological issues.

By getting help for binge eating, you can learn how to feel more in control of your eating.

Psychotherapy

Whether in individual or group sessions, psychotherapy (also called talk therapy) can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. Examples of psychotherapy include:

Cognitive behavioral therapy (CBT). CBT may help you cope better with issues that can trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and help you regulate eating patterns.
Interpersonal psychotherapy. This type of therapy focuses on your relationships with other people. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and co-workers. This may help reduce binge eating that’s triggered by poor relationships and unhealthy communication skills.
Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.

Medications

Lisdexamfetamine dimesylate (Vyvanse), a drug that’s used to treat attention-deficit hyperactivity disorder, is now approved to treat binge-eating disorder in adults. This drug is the first FDA-approved medication to treat moderate to severe binge-eating disorder. Vyvanse is a stimulant and can be habit-forming and abused. Common side effects include dry mouth and insomnia, but more serious side effects can occur.

Several other types of medication may help reduce symptoms. Examples include:

The anticonvulsant topiramate (Topamax). Normally used to control seizures, topiramate has also been found to reduce binge-eating episodes. However, there are side effects, such as dizziness and kidney stones, so discuss the risks and benefits with your doctor.
Antidepressants. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be helpful. It’s not clear how these can reduce binge eating, but it may relate to how they affect certain brain chemicals associated with mood.

Behavioral weight-loss programs

Many people with binge-eating disorder have a history of failed attempts to lose weight on their own. However, weight-loss programs typically aren’t recommended until the binge-eating disorder is treated because dieting may trigger more binge-eating episodes, making weight loss less successful.

When appropriate, weight-loss programs are generally done under medical supervision to ensure that your nutritional requirements are met. Weight-loss programs that address binge triggers can be especially helpful when you’re also getting cognitive behavioral therapy.

Lifestyle and home remedies

Typically, treating binge-eating disorder on your own isn’t effective. But in addition to professional help, you can take these self-care steps to reinforce your treatment plan:

Stick to your treatment. Don’t skip therapy sessions. If you have a meal plan, do your best to stick to it and don’t let setbacks derail your overall efforts.
Avoid dieting, unless it’s supervised. Trying to diet can trigger more binge episodes, leading to a vicious cycle that’s hard to break. Talk with your doctor about appropriate weight management strategies for you — don’t diet unless it’s recommended for your eating disorder treatment and supervised by your doctor.
Eat breakfast. Many people with binge-eating disorder skip breakfast. But, if you eat breakfast, you may be less prone to eating higher calorie meals later in the day.
Arrange your environment. Availability of certain foods can trigger binges for some people. Keep tempting binge foods out of your home or limit your exposure to those foods as best you can.
Get the right nutrients. Just because you may be eating a lot during binges doesn’t mean you’re eating the kinds of food that supply all of your essential nutrients. Ask your doctor if you need vitamin and mineral supplements.
Stay connected. Don’t isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart.
Get active. Ask your health care provider what kind of physical activity is appropriate for you, especially if you have health problems related to being overweight.

Alternative medicine

Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications. If you use dietary supplements or herbs, discuss the potential risks with your doctor.

Coping and support

Living with an eating disorder is especially difficult because you have to deal with food on a daily basis. Here are some tips to help you cope:

Ease up on yourself. Don’t buy into your own self-criticism.
Identify situations that may trigger destructive eating behavior so you can develop a plan of action to deal with them.
Look for positive role models who can help lift your self-esteem. Remind yourself that the ultrathin models or actresses showcased in women’s magazines often don’t represent healthy, realistic bodies.
Try to find a trusted relative or friend whom you can talk with about what’s going on.
Try to find someone who can be your partner in the battle against binge eating — someone you can call on for support instead of bingeing.
Find healthy ways to nurture yourself by doing something just for fun or to relax, such as yoga, meditation or simply a walk.
Consider journaling about your feelings and behaviors.Journaling can make you more aware of your feelings and actions, and how they’re related.

Get support

If you have binge-eating disorder, you and your family may find support groups helpful for encouragement, hope and advice on coping. Support group members can understand what you’re going through because they’ve been there themselves. Ask your doctor if he or she knows of a group in your area.

Prevention

Although there’s no sure way to prevent binge-eating disorder, if you have symptoms of binge eating, seek professional help. Your primary care doctor or other health care provider can advise you on where to get help.

If you think a friend or loved one has a binge-eating problem, steer them toward healthier behavior and professional treatment before the situation worsens. If you have children:

Foster and reinforce a healthy body image, no matter what their size or shape is.
Talk with your pediatrician. Pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development.