Binge eating disorder

Overview

Binge eating disorder (BED) is the most common eating disorder. People with BED regularly eat a very large amount of food in a short period of time and feel unable to stop or control how much they are eating. Binges are often followed by feelings of guilt, shame or disgust. Unlike bulimia nervosa, people with BED do not regularly try to compensate by vomiting, using laxatives or exercising excessively.

BED affects people of all ages, genders and body sizes, though many people with BED live with overweight or obesity. It often develops in the late teens or early twenties and is linked with low mood, anxiety and stress. BED is a real mental health condition, not a lack of willpower. It is very treatable, particularly with psychological therapy, and recovery is possible.

Causes and risk factors

• Genetics: eating disorders and obesity can run in families
• Dieting and food restriction, which can trigger cycles of bingeing
• Emotional difficulties: stress, anxiety, depression, low self-esteem
• Difficulty managing emotions, with food used to cope
• Trauma, bullying, abuse or weight-related teasing
• Body dissatisfaction
• Social and cultural pressures around weight and appearance
• Other mental health conditions, such as ADHD

How it develops (pathophysiology)

Normal eating control

Eating is regulated by a balance between hunger and fullness signals from the body and the brain's reward and self-control systems:

• Hormones such as ghrelin (from the stomach) increase hunger, while leptin, insulin, GLP-1 and peptide YY signal fullness.
• The hypothalamus integrates these signals.
• Reward circuits involving dopamine make tasty food pleasurable.
• The prefrontal cortex helps us plan and stop eating when we have had enough.

What goes wrong

BED results from an interaction of psychological, biological and environmental factors:

1. Restraint and deprivation: strict dieting or skipping meals increases hunger and makes high-calorie foods more rewarding, raising the risk of losing control.
2. Emotional regulation: food can temporarily reduce negative emotions such as stress, sadness or boredom. Bingeing becomes a way of coping, reinforced by short-term relief.
3. Reward sensitivity: some people have heightened responses in reward circuits to food cues, similar to patterns seen in addictive behaviours, leading to strong cravings.
4. Reduced inhibitory control: the prefrontal cortex is less effective at stopping eating once it has started, especially when tired, stressed or after restriction.
5. The cycle: after a binge, guilt and shame often lead to more strict dieting, which increases hunger and the risk of the next binge.

Why the symptoms happen

• Eating large amounts quickly reflects loss of control and strong reward drive.
• Eating when not hungry reflects emotional rather than physical hunger.
• Eating alone or in secret reflects shame.
• Distress after bingeing reflects guilt and self-criticism.
• Weight changes result from regular excess energy intake.

How treatment acts on the mechanism

Cognitive behavioural therapy for eating disorders (CBT-ED) establishes regular eating to reduce restriction and hunger, helps people understand and break the binge cycle, and builds coping strategies for emotions. Guided self-help using CBT principles is often a first step. Lisdexamfetamine, approved in some countries, may reduce binge frequency by acting on dopamine and noradrenaline. Some antidepressants may help. Treatment of co-occurring conditions supports recovery.

Types

BED is graded by the number of binge episodes per week:

• Mild: 1 to 3
• Moderate: 4 to 7
• Severe: 8 to 13
• Extreme: 14 or more

Signs and symptoms

• Regularly eating unusually large amounts of food in a short time
• Feeling unable to stop or control eating
• Eating very quickly
• Eating until uncomfortably full
• Eating large amounts when not hungry
• Eating alone because of embarrassment
• Feeling guilty, ashamed or upset after eating
• Frequent dieting without lasting weight loss
• Low mood or anxiety

How it is diagnosed

• Assessment by a GP or eating disorder specialist
• Questions about eating patterns, emotions and behaviours
• Physical examination and blood tests to check for health effects, such as diabetes or high cholesterol
• Screening for depression, anxiety and other conditions

Goals of treatment

Treatment aims to stop binge eating, establish regular eating patterns, improve emotional wellbeing and address physical health effects.

Medicines

• Lisdexamfetamine in some countries for moderate to severe BED in adults
• Antidepressants (SSRIs) in some cases
• Topiramate occasionally
• Treatment for diabetes or other health conditions

Other treatments

• Guided self-help using CBT-based programmes
• CBT for eating disorders (CBT-ED), individually or in groups
• Interpersonal therapy
• Dialectical behaviour therapy for emotional regulation
• Dietetic support
• Support groups

Living with it and prevention

• Eat regular meals and snacks, avoiding long gaps
• Avoid strict dieting
• Find other ways to cope with stress and emotions
• Seek help early if eating feels out of control
• Focus on health rather than weight

Monitoring and follow-up

Progress is reviewed regularly during treatment, including binge frequency, mood and physical health. Relapse prevention plans help maintain recovery.

Outlook

BED is treatable, and many people recover fully with therapy. Relapse can occur during stressful periods, but skills learned in therapy help.

Recovery is very possible, and many people stop binge eating with structured psychological treatment. Setbacks are common and are part of recovery rather than a sign of failure. Support from family, friends and peer groups makes a real difference to long-term progress.

Special considerations

• Men: affected more often than in other eating disorders and may be underdiagnosed
• People living with obesity: BED should be assessed before weight management treatments
• Adolescents: early intervention is important