Binge Eating Disorder: Symptoms, Causes, and Treatment

What is binge eating disorder (BED)? 

Binge eating occurs when we uncontrollably consume large amounts of food within a short time frame without realising it. Most of us may indulge in binge snacking or binge eating occasionally when we’re stressed or bored, or while mindlessly watching TV over the weekend. But, when such behaviour occurs frequently, they are considered episodes of binge eating. When episodes of overeating occur at least once a week for 3 consecutive months, it is indicative of Binge eating disorder (BED). It is a mental health condition according to DSM-5 that involves recurring episodes of binge eating. These episodes involve:

1. Eating a larger amount of food than what the individual or most people would usually eat in a short time (about less than 2 hours)
2. Feeling a loss of control over what is eaten and how much
3. Occurs at least once a week for 3 consecutive months

What is considered binge eating?

According to the DSM-5, a binge eating episode is characterised by at least 3 of the following:

1. Eating until uncomfortably full
2. Eating much more rapidly than normal
3. Eating alone due to embarrassment over eating behaviour
4. Feelings of disgust, depression, or guilt
5. Eating large amounts of food despite not feeling physically hungry

How common is binge eating disorder?

Eating disorders are common all over the world due to stress, poor lifestyle and other factors. Studies show binge eating disorder is one of the most common eating disorders in the United States, affecting 1.25% of all women and 0.42% of all men in the adult population, making it more common in women than men. BED is rampant among teenagers aged 13 to 18 years and affects about 1.6% of all teens in the US. The average age for BED to first occur is 25 years. 

Studies on eating disorders in the Indian population are rare however, an increasing trend has been observed. A survey was done in Mysore, Karnataka on 1600 students of 15-25 years. The study also recorded their physical measurements, and family history, and administered a blood test to check haemoglobin levels. The results indicated significant discrepancies in the students’ eating habits and the prevalence of eating disorders with a profound effect on their mental and physical health.

Who is more likely to develop a binge eating disorder?

Anyone can develop a binge eating disorder irrespective of age and ethnic background. However, certain factors contribute to the possibility of developing BED. These include severe obesity, a stressful lifestyle, and individuals with type 1 and type 2 diabetes. The constant focus required to control food and weight can be distressing and may contribute to developing BED. The reverse is also present where individuals with BED have higher chances of developing type 2 diabetes as it becomes difficult to maintain their blood sugar levels.

Individuals who have gone through hurtful experiences while growing up or in their daily lives such as body-shaming, judgement on their appearance, and eating habits, instances of bullying, isolation, loneliness, and struggles at work or in their personal lives are likely to develop BED. Researchers have also identified a genetic component that shows BED runs in families. 

Difference between BED, anorexia nervosa and bulimia nervosa

There are 3 types of eating disorders commonly found: BED, anorexia nervosa and bulimia nervosa. While all three involve an unhealthy relationship with food, significant key differences are present.

Individuals with BED uncontrollably consume large quantities of food rapidly and are unable to stop themselves followed by feelings of uneasiness, guilt, disgust or shame. It must be noted that they do not overcompensate for this behaviour by engaging in exercise or purging.

Individuals with anorexia nervosa have poor body image and feel extremely conscious of their weight, body shape, and how much they eat. Very often, individuals with anorexia nervosa are significantly underweight but still experience strong dissatisfaction with their physical appearance. They experience an intense fear of gaining weight and try to prevent it by eating less or skipping meals, restricting foods with carbs or fats, obsessively counting their calorie intake and intense exercise.

Individuals with bulimia nervosa binge eat and compensate by indulging in purging behaviours to control their weight. Purging behaviours include inducing vomiting, using laxatives, diuretics and other medications intermittent fasting and excess exercise. 

Root Causes of BED 

The root causes of binge eating disorder cannot be narrowed down to specific factors but genes, long-term dieting, and mental health concerns increase the risk of BED. Many factors influence BED including one’s unique metabolism and learned eating habits. The brain associates eating with safety and comfort thereby, releasing happy hormones (serotonin and dopamine) that make the behaviour addictive due to the positive feeling it induces. Eating is also an escape mechanism to numb unpleasant emotions or compensate for unmet emotional needs.

Signs & Symptoms of BED

The two key features of binge eating disorder are:

• Recurrent binge eating episodes, where the individual consumes a large amount of food in a relatively short time
• Feeling out of control when eating, being unable to stop once you start eating even when uncomfortably full

The symptoms of BED can be understood as physical, psychological and behavioural:

Physical Symptoms of BED

• Feeling weak and tired
• Difficulty sleeping
• Feeling bloated, constipated, or developing intolerance to certain foods
• Changes in weight
• Gastrointestinal issues

Cardiovascular issues

Psychological Symptoms of BED

• Feeling unhappy with their body shape and size regardless of the numbers on the weighing scale
• Preoccupation or constantly thinking about eating, food, body shape or weight
• Feeling numb while eating uncontrollably
• Never satisfied despite how much you eat
• Emotionally sensitive to comments about their eating behaviour, exercise or body image
• Feeling stress and tension that is only relieved by eating
• Feeling embarrassed, guilt, shame, disgust, and self-loathing after an episode of binge-eating 
• Feeling extreme distress, sadness, and anxiety, especially after a binge-eating episode
• Distorted body image 
• Low self-esteem, depression, anxiety, irritability
• Desperation to control your weight 

Behavioural Symptoms of BED

• Periods of uncontrolled, impulsive or continuous eating
• Eating until uncomfortably full 
• Feeling unable to stop
• Often hiding food, eating alone or in secret 
• Unexplained disappearance of food, hiding or hoarding food 
• Eating normally around others but gorging when you’re alone
• Evading questions about eating and weight
• Avoiding social situations or becoming more socially withdrawn
• Eating continuously throughout the day without planned meal times
• Spending large amounts of money on food, or shoplifting food
• Self-harming behaviour, use of substances and suicidal thoughts or ideation

Common Conditions Co-occurring with BED

Individuals experiencing binge eating disorder are at an increased risk of experiencing co-occurring psychiatric and medical concerns.

Research indicates that 55-97% of people diagnosed with an eating disorder are also diagnosed with one or more mental illnesses. The most commonly co-occurring mental conditions with BED are mood and anxiety disorders, PTSD and trauma, personality disorders, sexual dysfunction, self-harming behaviour and suicidal ideation.

Individuals with BED frequently complain of medical concerns such as diabetes, PCOS, osteopenia and osteoporosis, hypotension, gastrointestinal problems, joint pains, headache and migraine, and menstrual concerns. 

Long-term effects of BED

In the long term, the side effects of overeating can result in many physical and mental health problems along with negative effects on their lifestyle.

Side effect of BED on Mental Health 

Individuals with long-term BED end up withdrawing from social situations and eventually experiencing social isolation and loneliness coupled with chronic depression and anxiety. The reduced quality of life arises from being unable to enjoy life, immense dissatisfaction and unfulfillment in their personal, professional and social life.

Side effect of BED on Physical Health

Long-term BED or side effects of overeating have adverse consequences on physical health including cardiovascular diseases, type 2 diabetes, high blood pressure and/ or high cholesterol, arthritis and difficulty breathing during sleep (sleep apnea) ultimately resulting in a reduced lifespan. 

Side effect of BED on Lifestyle Activities and Others 

Long-term BED results in substantial weight gain that may lead to developing further harmful behaviours such as substance use (alcohol, drugs, medications), and shoplifting or stealing food. Long-term BED inevitably causes financial constraints with large sums of money being spent on food and medical bills, it may result in debt, gambling, strained relationships or an absent social life.  

What other health problems can you have with binge eating disorder?  

The symptoms of an illness can transform into additional ailments when left unchecked i.e. a common cold is followed by cough and fever. Similarly, binge eating disorder may develop into other eating disorders such as anorexia nervosa, bulimia nervosa, and body dysmorphic disorder (BDD) over time. Individuals with BED also constantly experience high levels of mental and physical stress accompanied by their respective concerns. This increases your risk for cancer and other chronic health problems.

Risk factors of BED 

Genetics

Individuals are more likely to have BED if they have a blood relative who has or had BED i.e. parent or sibling. This is passed on from one generation to the next through the family’s genetic material, putting such individuals at a higher risk of having BED. A family pattern of dysfunctional emotional coping is also a learnt behaviour and a significant risk factor.

Individuals with a history of dieting

Dieting or constraining calorie intake triggers the urge to binge eat. The guilt and shame after a binge episode also trigger the urge to binge eat as the only way to relieve their distress. Hence, it’s a cyclical behaviour that puts the individual at a higher risk of developing BED.    

Mental health concerns

Individuals with poor body image may have low self-esteem and negative thoughts about themselves. They may also have poor stress management and place immense emphasis on their appearance. Certain circumstances such as eating while watching a show, eating out or ordering frequently, and attending parties or social events often also increase the risk of BED. 

Complications of BED with Mental Health and Others

BED can create multiple complications for one’s physical and mental health. Individuals may experience rapid weight gain and obesity-related medical problems such as cardiovascular disease, gallstones, kidney disease, and fatty liver disease due to poor nutrition. 

Individuals may feel uncomfortable being themselves, feel underconfident, unable to enjoy life and their accomplishments and experience depression, anxiety, and dysmorphia. They may withdraw from society and become reclusive, avoidant or antisocial. They may increasingly engage in unpredictable behaviour like being secretive, lying, stealing and hoarding food. Increasing severity of distress and self-loathing may lead to self-harm tendencies or suicide attempts. 

How is binge eating disorder diagnosed?

BED also known as an excessive eating disorder can be diagnosed by consulting a mental health professional (Psychologist, psychiatrist)

Is there a test for binge eating disorder?

To diagnose an individual with BED, the healthcare professional will explore the individual’s history of eating behaviour and any medical and psychological concerns that have come up due to the same. The professional may also conduct a physical exam with the individual’s consent to check their height, weight, and other measurements. Blood and urine tests are recommended to check for risk of high BP, cholesterol, heart problems, electrolyte imbalance, acid reflux, digestive issues, poor nutrition and sleep issues.

Do I need a diagnosis?

It is important to understand that binge snacking or eating may occur occasionally and is completely natural. Your concerns are valid if you display signs of sudden weight gain, excessive eating, feeling conscious of your body or appearance, and irritability. But, avoid self-diagnosis. Kindly consult a psychologist specialising in eating disorders to provide you with a professional diagnosis and supportive course of treatment required, if any.

Which specialist will treat BED?

Individuals can consult a psychologist or psychiatrist for the same due to the nature of the condition. Taking a holistic approach with a team of various professionals equipped to handle eating disorders like doctors, mental health professionals, and dieticians shows better treatment outcomes for BED.

Treatment options for BED

While the impact of BED on our overall health and life may seem disheartening, there are ample treatment options available and yes, it is possible to recover from BED. 

How do you recover from binge eating disorder?

Learning how to stop binge eating or how to overcome a binge eating disorder can be a long and somewhat tedious journey. The goal is to create healthy eating habits. Psychotherapy is essential to the treatment of BED and helps individuals unlearn old habits and relearn sustainable habits supportive of them. It is a long-term plan that requires support to maintain consistency. 

What’s in the treatment plan for binge eating disorder?

Binge eating disorder treatment commonly includes talk therapy, medications, and making lifestyle changes with the help of a dietician.

Therapy

Therapy includes various modalities used by psychologists and forms the core of treatment for BED. The different therapies are as follows: 

Cognitive behavioural therapy (CBT)

It is used to help individuals observe their behaviours and restructure the negative thoughts and feelings behind them i.e. the thought “I’m worthless” makes the individual feel sad and prompts eating behaviour to make them feel better. The therapist aids individuals to break these patterns and substitute them with healthier ways of responding to such thoughts and feelings. 

Interpersonal therapy (IPT)

Focuses on the present concerns such as interpersonal conflicts or stressful situations in daily life that are reducing the individual’s wellbeing. The therapist takes a solution-oriented approach to address the concerns and supportive ways of handling them. 

Dialectical behaviour therapy (DBT)

While it is derived from the principles of CBT, this therapy also promotes the idea of two things co-existing at once such as BED patients understanding that their unhealthy condition needs to change while simultaneously learning self-love and acceptance.  

Psychodynamic therapy

The focus is on the individual’s past. Childhood and puberty can be turbulent for many as they are at a vulnerable or impressionable age. The therapist explores unpleasant experiences in childhood and adolescence around eating, appearance and body weight such as bullying, negative comments, sexual abuse, body shaming, and so on are explored to identify the root cause of the individual’s eating behaviours.

Individual and group therapy

Individuals may attend therapy one-on-one or with a group of individuals sharing the same concerns. Both aim to alleviate the individual’s distress, provide support and teach them supportive ways of addressing their problems. The treatment occurs in a structured and systematic way within a tentative time frame. 

Medication

Medications exist to aid BED treatment and only play the role of a catalyst in the treatment process. Research demonstrates medications are helpful with impulse control and delay relapse but cannot be relied on as the sole treatment for BED as they do not address the root cause of the disorder. The medications prescribed by a doctor or psychiatrist may be anti-depressants, anti-anxiety medicines or appetite suppressants and provide short-term benefits. Hence, medications are helpful in combination with therapy.

Bariatric surgery

Bariatric surgery is a big step for individuals with severe BED or severe obesity and its related problems. Bariatric surgery involves various surgical procedures to reduce the size of the stomach to aid with weight loss. Decrease food craving and consumption.

Diet and Nutrition

Individuals with BED experience malnutrition. Malnutrition can be defined as the imbalance of essential nutrients in the body. These may be a deficiency in micronutrients (vitamins and minerals) or excess macronutrients (carbs and fats). Nutritional deficiencies produce urges or cravings and a lack of satiety or fullness. Nutritional education and supplements help us plan nutritionally balanced meals that alleviate the stress related to eating, meet our physical needs, and promote weight loss. 

Will I always have a binge eating disorder?

BED is a mental health condition that develops over time. It requires a long-term treatment plan and though it is possible to recover from BED, there may be relapses as progress is not linear. These relapses are an expected part of recovery and individuals are encouraged to continue being persistent with their treatment by adopting a healthy diet, and lifestyle along with therapy. A successful recovery may look like a decline in symptoms of BED (remission) and this remission can be long-lasting.

Living With BED: 8 Tips to Help someone to Overcome with BED

Living with BED may be challenging. Here are 8 helpful tips to overcome BED:

1. Learn to identify your triggers - Observe triggers that induce binge episodes or the urge to eat. List such triggers and avoid or remove them from your life. They may be certain places, situations, or food items at home. If unavoidable, create an action plan to deal with them beforehand or ask friends and family for support.
2. Learn to identify hunger - the body displays signs of hunger and thirst such as stomach rumbling, dry throat, light-headedness, headaches, feeling weak, tired or dizzy. This indicates dropping blood glucose levels and the body requires food and water.  
3. Eat when you’re hungry - train yourself to eat only when hungry and not out of boredom or stress. A helpful test is to ask yourself if you’re hungry enough to eat an apple. If yes, you are hungry. Avoid starving as it makes you likely to overeat. If the answer is no, drink water and keep yourself occupied with a hobby or task.
4. Stop when you’re full - the brain and body take time to register that you’ve just eaten and provide the feeling of fullness thus, we must be a little patient instead of eating rapidly. Try to stop when you feel about 80% full to avoid overeating. 
5. Practice mindful eating -  when you’re about to eat, take a deep breath and try to notice the food's colour, smell, taste and texture. Chew slowly and eat at a relaxed pace to feel more satisfied when you eat.
6. Keep a journal - Note down what you eat daily and any thoughts or feelings that come up. Documenting your thoughts and feelings is a reliable way to identify triggers, thoughts and behaviour patterns that have been unsupportive to us. 
7.  Avoid skipping meals - eat at regular meal times in appropriate portion sizes. Delayed meals or skipping them may feel helpful momentarily but results in overeating in the next meal and becomes a vicious cycle.
8. Get enough sleep - sleep is a vital body process for digestion and to regulate our appetite. Lack of sleep may lead to impulsive eating, and poor decision making like opting for junk food instead of something healthy.

Finding treatment for binge eating disorder 

If you suspect you have an eating disorder, it is recommended to contact your regular healthcare provider as soon as possible. Those who experience eating discrepancies may be oblivious to them. In such situations, the insight and support of their loved ones are crucial to help bring the matter to the individual’s attention and seek professional help to prevent the concern from escalating. The healthcare provider may be your GP or psychologist and can guide you or your loved one on the next steps accordingly.

Conclusion

Binge eating disorder is a common disorder with adverse effects when left unchecked. It may be daunting and make one feel isolated. However, there are resources and treatments available to overcome BED. It is treatable and preventable with a healthy diet and lifestyle. 

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