Understanding Binge Eating Disorder

by Michelle Yates | Jun 10, 2024 | Uncategorized

A woman struggling with binge eating disorder eats a pizza

Binge eating is a massively growing public health concern worldwide but is also commonly misunderstood. It’s not just about overeating: binge eating is a complicated, emotional issue. Many feel too ashamed to speak up about and as a result, are suffering in silence. But there is hope, and binge eating disorder recovery is possible.

Let’s discuss the prevalence, diagnostic criteria and some alarming consequences of binge eating. We’ll also discuss some ways to reduce our risk and help manage binge eating.

As a Registered Dietitian with a masters in health psychology, I’m extra passionate about the intersection between nutrition and psychology. With that, my focus is on disordered eating. Binge eating in particular is one of the biggest issues I see with the women I work with.

So let’s dive into learning more about what binge eating disorder really is. We’ll explore the differences between binge eating vs bulimia, emotional eating and other disordered eating patterns.

What Is Binge Eating?

As we dive into this topic, I want to first clarify what I mean when I say “binge eating”.

Binge eating is characterized as:

Eating an amount of food, typically within a 2 hour window, that is definitely larger than most people would eat in a similar period of time under similar circumstances. (So holidays don’t count because that’s what everyone is doing!).
Feeling a loss of control over eating during the episode. (E.g. a feeling that one cannot stop eating or control what or how much one is eating)

If we really look at this definition, it isn’t the most cut-and-dry explanation for what binge eating looks like. What one person defines as “definitely larger than what most people would eat in a similar circumstance” might be different from someone else’s binge eating definition.

It’s also important to understand that there’s a difference between a one-time or very occasional binge and consistent binging.

If there are recurrent episodes of binge eating, then we may be looking at a clinical binge eating disorder diagnosis. The official criteria for a binge eating disorder diagnosis is that the binge eating needs to be happening at least 1 day a week for 3 months.

Bulimia Nervosa vs Binge Eating Disorder

It’s also important to understand that binge eating disorder is not the same as bulimia nervosa. Bulimia involves compensatory behaviors such as purging, laxative use, or exercise. Those with binge eating disorder do not try to “get rid of” the calories they eat.

Signs of Binge Eating Disorder

With binge eating disorder, there is also a great deal of distress over the binge. People struggling with binge eating typically identify with at least 3 of the following:

1) Eating much more rapidly than normal

2) Eating until feeling uncomfortably full

3) Eating large amounts of food when not feeling physically hungry

4) Eating alone because of being embarrassed by how much one is eating

5) Feeling disgusted with oneself, depressed, or very guilty after overeating

Binge Eating Disorder vs Binge Eating

There are also many people who are experiencing sub-clinical binge eating or what I like to call “casual” binge eating. Casual binges may not be meeting criteria for a true binge, but the individual is labeling it as a “binge.” Even if it’s not meeting that criteria, it’s still worth paying attention to as it may be a red flag that something may be off in their relationship with food.

A woman struggling with binge eating disorder eats a burger and fried chicken

What Causes Binge Eating Disorder?

Binge eating disorder is a relatively new eating disorder diagnosis. It was only added to the latest (2013) version of the Diagnostic Statistical Manual for mental disorders (the DSM-V). Since then, we have learned a lot more about binge eating, what causes binge eating and the different risks associated with it.

We don’t really know why binge eating disorder develops at this point. But we do know there are some factors that are involved:

Genetics
Socio-environmental factors (e.g. society’s ‘ideal look’)
Potentially some differences in the brain biochemistry. For example, a systematic review of 32 studies looked at the neuroimaging of those suffering from bulimia nervosa and binge eating disorder. They found reductions in the overall size of the brain, as well as diminished activity in the frontostriatal circuits (a region associated with self regulation).
Possibly some dysregulation in the reward center of the brain and impulse control issues.

How Common is Binge Eating Disorder?

Binge eating disorder has an estimated prevalence of about 1.5% of women and 0.3% of men worldwide. In America, however, rates are even higher. About 3.5% of American women and 2% of American men are struggling with binge eating disorder.This suggests that BED is even more common than anorexia nervosa and bulimia nervosa combined.

It’s important to note that there is a very high likelihood that these stats are skewed and potentially underreporting the true prevalence of BED. Because BED is literally characterized by a sense of shame and guilt around the binge episodes, it’s reasonable to assume that not everyone is opening up about their struggles with binge eating.

Additionally, the research done on Americans to come up with our estimates of 3.5% for women and 2% of men was a study performed on just over 9,000 people, which is a TINY pocket of people compared to our US population of about 332 million.

All that to say, we still don’t fully know just how big of a problem this is.

Who is At Risk for Binge Eating Disorder?

What we are seeing according to 2 meta analyses from 2023 reviewing 39 studies is an estimation that 1.32% of children and adolescents meet criteria for BED and 3.0% for subclinical BED.

Young adults are potentially the most at risk. Some reports of BED show it most commonly beginning in the late teenage years or early 20s, but it has been reported in both young children and older adults as well.

Many individuals struggling with binge eating disorder are also struggling with obesity. However, there are some reports saying that only ½ of the individuals struggling with BED are obese. Therefore, it’s not helpful to assume just because someone is obese that they have binge eating disorder, and vice versa.

Frequently consuming a high amount of calories can certainly contribute to obesity and the associated physical risks along with that, but there are still individuals who are not obese but who do suffer from Binge Eating Disorder.

Regardless of obesity and body size, studies have shown an association between binge eating disorder and chronic pain, other psychiatric disorders, and diabetes (as seen here, here, and here), it is something we need to take seriously in the public health space.

How Does Binge Eating Disorder Impact Your Health?

There are many ways that binge eating disorder can impact your physical and mental health.

For any eating disorder, we can expect an overall higher mortality rate.

Binge eating disorder is also strongly linked to lifetime mental health symptoms, depression, anxiety, mood disorders, substance use disorders, borderline personality disorder, and post-traumatic stress disorder. In addition, about 1 in 5 individuals struggling with BED will attempt suicide.

Binge eating disorder can also affect your relationships. A study done on over 2,000 married women with binge eating disorder also showed that binge eating is comparable to or worse for a marriage than other psychiatric disorders. Needless to say, binge eating has a massive disruption on both the physical health and mental well being of many people worldwide.

So… how can we manage binge eating?

A woman struggling with binge eating disorder eats alone in a car

Types of Binge Eating Disorder Treatments

First off, it’s important to remember that this is a relatively new diagnosis that we are still seeking to understand. It’s incredibly complex and is a biopsychosocial condition, meaning it can have impacts on our physical health, psychological health and even our social interactions or relationships.

Binge eating disorder dietitians and other professionals are still trying to find the best treatment for it. As you can see in this meta analysis, only about 50% of those with binge eating disorder actually had full abstinence from binge eating. In other words, only about 50% of binge eaters are responding to treatment.

The trouble with this meta-analysis is that not all the studies reviewed used the same treatment modalities. What worked for some of the participants might have worked for the others. But they did not undergo all of the same treatments.

In another meta analysis comparing 28 different treatments, researchers found that lisdexamfetamine – a stimulant medication that aims to increase attention and decrease impulsiveness – was superior for decreasing binge episodes compared to antidepressants. CBT was also generally more effective for reducing binge episodes than a standard weight loss program that employs calorie restriction and increased exercise.

Is Binge Eating Disorder Recovery Possible?

Let’s discuss the goals of binge eating disorder treatment. What we’re looking for from a successful treatment is abstinence from binge eating. Recovery looks like having normal, healthy eating patterns.

We also want to improve psychological well-being and regulate body weight, if needed. Ideally, achieving these goals would also reduce the risks typically associated with binge eating and binge eating disorder.

So, how exactly do we reach these goals?

Therapy for Binge Eating Recovery

I’ve brought up cognitive behavioral therapy a few times, so let’s first discuss the therapeutic side of binge eating recovery. CBT is assigned as grade A treatment for binge eating disorder.

In a couple of studies (here and here), we’ve seen some promising remission rates of between nearly 36% and 61% for those who underwent CBT. Interestingly, both studies were randomized, placebo controlled, and double blind studies to test the effectiveness of fluoxetine (commonly known as Prozac) alongside CBT. We don’t see any long term difference between using fluoxetine or using a placebo with CBT. Unfortunately, these studies were very small.

There is some evidence showing that self-guided CBT has some really promising results as well as interpersonal psychotherapy (IPT), and dialectical behavior therapy (DBT). We definitely need more research on therapeutic and pharmacological interventions for binge eating.

Nutrition for Binge Eating Recovery

Now let’s dig into my favorite part: the nutrition side of things. I am a dietitian, after all.

When it comes to nutrition interventions for binge eating disorder, remember that one of the goals of binge eating recovery is to normalize eating patterns and increase psychological well-being.

Typically, when someone is experiencing guilt or shame around their food choices, the way they eat, and how their body looks, this can actually be a trigger to drive them deeper into binge eating as they try to seek some relief from those feelings.

For this reason, I find that it makes more sense to help clients achieve a positive relationship with food with an emphasis on food neutrality. This means that there are no “good” or “bad” foods. I also find that teaching them to be more mindful and intuitive about their eating can help them to slow down when things are otherwise pretty chaotic.

This, alongside reframing their thoughts around food, correcting inaccurate beliefs around nutrition, and addressing body image distress can help them to no longer feel the need to binge as the feelings of guilt and shame are no longer present.

The Impact of Diet Culture on Binge Eating

Additionally, binge eating may oftentimes be the result of restricted eating or dieting. In a study done on over 17,000 adolescents, researchers found an increase in the risk of binge eating as dieting increased.

One likely explanation for this is Neuropeptide Y. NPY is a chemical that belongs to a family of gut-brain peptides, produced in the brain, that trigger our drive to eat carbohydrates. NPY is triggered in response to a caloric deprivation and increases the longer we have fasted. What binge eaters often describe as an issue of “willpower” or “discipline” is often not actually about discipline at all. Rather, their biology – specifically the chemical NPY – is driving them to eat foods high in carbohydrates.

With all of the ridiculous diet advice out there preying on those who are desperate to lose weight, many are adopting dangerous nutrition patterns that often involve deprivation. This can be a major trigger for binge eating. Interestingly, in a study done with Nazi concentration camp survivors, researchers found that binge eating was more likely to develop among those who have experienced deprivation.

With that being said, simply eating enough food is one of the biggest ways that we can prevent binge eating. In addition, taking CBT inspired approaches to how we think about food and health may have some significantly positive impacts on either reducing binge eating or alleviating it all together.