Binge Eating Disorder (BED)

Binge Eating Disorder (BED) became a new diagnostic category of eating disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2013.¹ According to a comprehensive review of the most current studies, BED is the second most common eating disorder diagnosed only surpassed by Other Specified Feeding or Eating Disorders (OSFED).² Approximately 2.7% of women, 1.7% of men and 1.8% of adolescents suffer from BED.^2,3 This disorder is seen in all age groups, races, ethnic backgrounds, and socioeconomic income levels. While BED is most common in adults, studies have found that it is also common in adolescence, with rates of approximately 1.8% for all adolescents.^2,4

BED is characterized by recurrent episodes of binge eating and eating larger amounts of food in a discrete period of time than most people would in the same situation. Other associated behaviors include eating very rapidly, eating past the point of being full, eating when not hungry, and eating alone. This behavior is coupled with intense feelings of “loss of control” over eating, shame and guilt. BED is diagnosed when an individual engages in binge eating, on average, at least 1 day a week for 3 months.⁵

Diagnostic Criteria

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To be diagnosed with Binge Eating Disorder (BED) according to the DSM-5 TR, the following criteria must be met:⁵

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

• Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  • A sense of lack 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).
• The binge eating episodes are associated with three (or more) of the following:
  • Eating much more rapidly than normal.
  • Eating until feeling uncomfortably full.
  • Eating large amounts of food when not feeling physically hungry.
  • Eating alone because of feeling embarrassed by how much one is eating.
  • Feeling disgusted with oneself, depressed, or very guilty afterward.
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for 3 months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Warning Signs and Symptoms of Binge Eating Disorder (BED)

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Please note that even though these are common symptoms not everyone with binge eating disorder displays all of these emotional and behavioral symptoms.

Emotional and Behavioral Signs and Symptoms:⁵

• Engages in episodes of binge eating large amounts of food in a short period of time, often in secret
• Avoids eating in public or with others and often feels embarrassed about the quantity of food consumed
• Steals or hoards food in strange places
• Repeated failure to sustain weight loss through dieting, increased activity, or the use of weight loss medications
• Creates lifestyle schedules or rituals to make time for binge sessions
• Withdraws from friends and previously pleasurable activities and becomes more isolated and secretive
• Shows extreme concern with body weight and shape
• Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
• Manipulation of insulin dosage to accommodate binge episode
• Experiences shame, guilt and despair after binge-eating episodes
• Fluctuations in weight
• Frequently experiences low self-esteem

Physical Signs and Symptoms:⁵

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Difficulties concentrating

Frequent Co-Occurring Conditions

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The following are some conditions that frequently co-occur with binge eating disorder:^6,7,8,9

• Anxiety disorders including generalized anxiety disorder, social anxiety, phobias, panic disorder and post-traumatic stress disorder
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Bipolar Disorder
• Depression and other mood disorders
• Substance use disorders
• Suicidality

Health Consequences

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Research shows that individuals with BED are at a higher risk for developing the following health conditions:^10,11,12,13

• Type 2 Diabetes
• Metabolic syndrome which includes a higher waist circumference, increased triglyceride levels, elevated blood pressure (hypertension), elevated fasting glucose, and reduced HDL cholesterol
• Polycystic ovarian syndrome (PCOS) which can lead to menstrual irregularities
• High LDL cholesterol
• Chronic pain or pain syndromes such as neck/back pain and headaches
• Sleep problem
• Asthma
• Gastrointestinal symptoms and disorders such as acid regurgitation, heartburn, dysphagia, bloating, and diarrhea
• Cardiovascular problems

Treatment Considerations

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Treating binge eating disorder (BED) requires working with a multidisciplinary team of health and mental health professionals who have expertise in treating this type of eating disorder. The treatment team may include a physician, psychiatrist, psychotherapist, and dietician.¹⁴ Given the serious physical and psychological consequences that can result from BED it is essential to seek professional help as soon as possible. Early intervention has also been shown to be an important factor in improving treatment outcomes.⁶

Learn more about treatment here.

Learn more about finding treatment providers in your area here.