What is Binge Eating Disorder?
Written by Andrea Clares, ANutr & Talia Cecchele, RD
It is estimated that 1 in 50 people will experience binge eating disorder (BED) in their lifetime. It is the most common eating disorder, but the least understood leaving many people stuck in their illness. Binge eating disorder is not about overindulging, having a lack of willpower or being greedy.
It is a serious illness associated with extreme guilt, shame and distress. Many people suffer alone, too fearful to seek support and embarrassed by what others might think.
What is Binge Eating Disorder?
BED is an eating disorder (ED) characterised by food binges in which a person experiences a loss of control over eating followed by intense feelings of distress, shame and guilt. Currently, BED is the second most prevalent ED after EDNOS (eating disorder not otherwise specified) and affects people of all ages, genders and ethnicities (1).
According to the Diagnostic Statistical Manual for eating disorders (DSM-V) a person must meet the following criteria to be diagnosed with BED:
1. Recurrent and persistent episodes of binge eating
2. Behaviours must be occurring at least weekly, for at least three months, and one must meet at least three of the following criteria:
Eating more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone as a result of feeling embarrassed by how much one has eaten
Experiencing feelings of shame, guilt or disgust after overeating
3. Marked distress regarding binge eating
4. Absence of regular compensatory behaviors (such as purging)
Unlike in people with Bulimia, no compensatory behaviours (e.g. vomiting, laxative misuse, over exercise) are present in individuals with BED.
Is Binge Eating the Same as Overeating?
A food binge has two specific features:
The amount of food consumed is significantly larger than what a person would eat normally in a discrete period of time and,
There is a sense of loss of control over eating during the binging episode.
Overeating is a part of normal eating. It happens on occasion, that feeling of being uncomfortably full and eating a little more than planned. If overeating is something you do on occasion but it doesn't distress you, you don't lose control and you can stop eating, then you probably aren't binging. It’s important to not use the term overeating interchangeably with binge eating as they are in fact different things.
Why do Binges Happen?
As with all EDs, one specific root cause for BED has not been identified. However, evidence shows that the development of any ED can result from a complex interaction between various factors, including biological such as the influence of a person’s genetics, psychological such as an existing history of trauma, and social like in the case of people engaging in dieting or appearance focused sports such as dancing and gymnastics.
Although the clear cause of the binge eating itself is complex to identify, we know that there are some common triggers for it:
Restrictive dieting
A well founded body of research has shown that dieting is the number one predictor of binge eating and weight gain (2). Restriction of any kind, either delaying the time when one starts eating, cutting out foods or reducing the number of calories will lead to food deprivation. This in turn, increases the body’s drive to eat which will increase the risk for binge eating.
Emotional eating
Emotional eating is normal. We all eat when we are sad, feel lonely, happy or had a bad day. But if emotional eating becomes one of your main coping mechanisms used to deal with negative emotions or feelings this can increase risk of binge eating.
Isolation
This has been identified as a trigger for binging episodes, especially as many people with BED binge in secret to avoid being judged, and eat to manage feelings of loneliness.
Body dissatisfaction
Although weight and shape concerns are not part of the DSM-V criteria for BED, research suggests that body dissatisfaction is associated with increased levels of binge eating (3).
Weight gain
People with BED are commonly very concerned about either their weight or shape. Unfortunately, engaging in binge eating increases the risk of weight gain as blood sugar levels and hunger and fullness levels become unregulated and many people become insulin resistant. This makes it even harder to manage weight and increases the desire to further restrict, which only increases risk of binging more.
What are the Consequences of Binge Eating?
EDs can become life-threatening if misdiagnosed or left untreated for too long. Physical complications resulting from binge eating can include:
gastrointestinal issues such as acid reflux and abdominal pain as a result of stomach distension
cardiovascular problems such as high blood pressure
hormonal issues which can potentially lead to infertility
insulin resistance
weight cycling
increased risk of type II diabetes
BED also impacts a person's mental health and they may experience mood swings, low self-esteem, anxiety, depression and social isolation.
Is Recovery From BED Possible?
Most people with BED recover after receiving appropriate treatment. Evidence-based guidelines suggest that the most effective treatment for BED is the new enhanced version of cognitive behavioral therapy (CBT-E) (4). This form of therapy focuses on improving disordered eating behaviours by tackling the ingrained food and diet rules and black and white thinking styles.
What Can I Do?
If you are experiencing binge eating episodes, try the following as a starting point to reducing binge triggers:
Eat 3 meals and 2-3 snacks a day with gaps of no more than 3 hours between meals and snacks. This will help to regulate your blood sugar levels and appetite and reduce cravings
Include complex sources of carbohydrates with eat main meal. Carbohydrates are often feared as they are a "trigger" food, but we know that when people include them regularly in their diet cravings actually reduce as the brain isn't deprived of energy!
Keep a food and thought diary to monitor your eating behaviour and identify binge eating triggers. Record the time and place you have eaten, give a brief description of the food/drink consumed and any comments about feelings or thoughts resulting from eating. Note down if you experience a binge and reflect back on the records regularly to notice patterns.
If you are currently experiencing any symptoms of BED, we advise you to contact your GP and seek professional help as soon as possible. We also recommend the book “Overcoming Binge Eating” by Christopher G. Fairburn as this has a self-help guide to get started while you explore treatment options.
Andrea Clares & Talia Cecchele
TCN Team
Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. The American journal of clinical nutrition, 109(5), 1402–1413.
Goldschmidt, A. B., Wall, M., Loth, K. A., Le Grange, D., & Neumark-Sztainer, D. (2012). Which dieters are at risk for the onset of binge eating? A prospective study of adolescents and young adults. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 51(1), 86–92.
Racine, S. E., VanHuysse, J. L., Keel, P. K., Burt, S. A., Neale, M. C., Boker, S., & Klump, K. L. (2017). Eating disorder-specific risk factors moderate the relationship between negative urgency and binge eating: A behavioral genetic investigation. J Abnorm Psychol, 126(5), 481-494.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2008). Enhanced cognitive behavior therapy for eating disorders ("CBT-E"): An overview. In Cognitive behavior therapy and eating disorders. (pp. 23-34).
Talia is a registered dietitian working in private practice and as an eating disorder specialist dietitian in London's leading private mental health hospital. As a freelance dietitian, Talia not only offers 1:1 consultations but can present at your workplace, create recipes or articles or host a cooking demonstration. To enquire please fill out a contact form.