Binge Eating Disorder: Symptoms, Causes, and Treatment

Binge eating disorder refers to recurrent episodes of eating large amounts of food. Let's look at its symptoms, possible causes and what experts are doing to tackle it.

Reviewed and approved by la psicóloga Laura Ruiz Mitjana.

Written by Josberth Johan Benitez Colmenares

Last update: 10 March, 2023

Binge eating disorder is when we eat more food than normal in a short period of time. It’s the most common eating disorder, with a global estimate of 3.5% in women and 2% in men throughout life.

This condition was included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In this edition, the diagnostic criteria were specified, particularly the frequency and duration of symptoms. We analyze the main characteristics of this condition, with special emphasis on the way it manifests itself.

Symptoms of binge eating disorder

The DSM-V includes the characteristics under which binge eating disorder manifests itself. In principle, there are five criteria under which the disorder can be diagnosed.

Criterion 1

The main characteristic of binge eating disorders is a large amount of food intake in a period of time of around 2 hours. This intake would significantly exceed the amount of food that a person would eat in the same period of time and under the same context. Similarly, eating is accompanied by a feeling of lack of control. For example:

• The size of the portions being eaten
• The consequences derived from ingestion
• A lack of control over the type and amount of food
• The inability to stop eating

Criterion 2

The above signs are characteristic of the disorder. It’s also accompanied by the following:

• Eating much faster than normal
• Eating huge amounts of food when you aren’t hungry
• Eating until you reach a feeling of fullness in the stomach
• Shame eating from previous binge eating episodes.
• Developing feelings of guilt, shame, or disgust due to overeating.

Criterion 3

The third characteristic that the DSM-V collects in relation to binge eating is a clear anxiety regarding the process. Anguish manifests itself before, during or after; it helps encourage a lack of control by satiating the urge to eat.

Criterion 4

Another feature that accompanies the disorder is the frequency. A person may occasionally have such an experience (as at a party, for example), but this isn’t considered to be binge eating disorder. For this to be the case, it must be done once a day or at least once a week for 3 months in a row.

Criterion 5

In contrast to other eating disorders, binge eating isn’t accompanied by compensatory behaviors. For example, purging, exercising, or fasting. Nor do they occur exclusively within the context of anorexia nervosa or bulimia nervosa.

In addition to these criteria, it’s important to consider the severity based on how frequently binge eating occurs throughout the week. Four types are thus distinguished:

• Mild: between 1 and 3 episodes throughout the week.
• Moderate: Between 4 and 7 episodes throughout the week.
• Severe: between 8 and 13 episodes throughout the week.
• Extreme: more than 14 episodes throughout the week.

As experts warn, this condition is associated with reduced psychological and physical well-being. Therefore, it can be accompanied by anguish, depression, obesity, chronic pain, diabetes, metabolic syndrome and others. Similarly, it can be characterized by the following:

• Discomfort when eating near other people.
• A fear of eating in public.
• Adjusting schedules or lifestyles to combine them with binge eating.
• Reducing social activities with friends and family (isolation episodes).
• Development of eating rituals (for example, prioritizing some groups over others, preventing them from touching, and so on).
• Low self-esteem.

As you can see, binge eating disorder is a very complex phenomenon. The most common symptoms are eating food for an average of 2 hours over a period of 3 months at least once a week. The intake is done quickly and isn’t usually accompanied by an objective feeling of hunger.

Causes of binge eating disorder

The exact causes of binge eating disorder are not known. It occurs under a triad of psychological, environmental, and biological elements. The interaction between these factors is what leads a person to develop this type of disorder. Let’s take a look at some of them:

• Episodes of childhood obesity.
• Episodes of loss of food during infancy.
• Conflicts in the family and problems during upbringing.
• Experiences of physical or sexual abuse.
• Similar problems in parents, siblings, and other family members.
• Behavior problems during childhood.
• Alterations in the gut microbiome.
• A history of psychiatric disorders (such as depression and anxiety).
• A history of eating disorders.
• Family attitudes in relation to body image and food.
• Alterations in the way in which dopamine is produced or metabolized (recent research warns about this possibility).

Episodes of addiction or substance abuse can also predispose a person to develop this disorder. Often one of these factors alone is not enough, but needs to be boosted or complemented by others.

Treatment options for binge eating disorder

Given all the implications of the disorder, treatment options cover different aspects. All of these used together can help control episodes. This requires a group of professionals from different disciplines to help achieve the following:

• Reducing the frequency of binge eating
• Addressing food-related cognitive disorders
• Improving metabolic health and body weight
• Addressing potential illnesses or conditions that have arisen in between
• Improving mood (anguish, anxiety, depression, and others).

To achieve all of these, these approaches are used: psychotherapy, pharmacotherapy and options to lose weight and follow a balanced diet. Psychotherapy is considered the main way to stop episodes of this type. Cognitive behavioral therapy, interpersonal psychotherapy, and dialectical behavior therapy are preferred in these settings.

Pharmacotherapy is considered when there’s a rejection of psychotherapy or when no progress has been made by this approach. Selective serotonin reuptake inhibitors and antiepileptic drugs are the most widely used. At the specialist’s discretion, medications for attention deficit hyperactivity disorder and those prescribed for shift work disorder may also be considered.

A low-calorie diet and exercise complement the above. In general, the prognosis of this disorder is better than others of its type, since the remission and relapse rate is much more favorable. Acting in time is very important in order to prevent health complications that can be permanent and put your life at risk.