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Binge Eating Disorder (BED)

Binge Eating Disorder, recognized as a distinct condition since 1994, is probably the most common eating disorder.
Eating disorders are not addictions and require treatment models that reflect their unique nature.

What is Binge Eating Disorder?

Binge Eating Disorder (BED) is an illness recognized as a distinct condition in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). People with BED have episodes of uncontrolled eating or bingeing.

Individuals with binge eating disorders feel that they lose control of themselves when eating. They eat large quantities of food and do not stop until they are uncomfortably full. Usually, they have more difficulty shedding excess weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

[Diagnostic Criterion]

How Does Someone Know if He or She Has Binge Eating Disorder?

Most of us overeat from time to time, and many people often feel they've eaten more than they should have. Eating a lot of food does not always mean that a person has binge eating disorder. Doctors generally agree that most people with serious binge eating problems often

  • feel their eating is out of control
  • eat what most people would think is an unusually large amount of food
  • eat much more quickly than usual during binge episodes
  • eat until so full they are uncomfortable
  • eat large amounts of food, even when they are not really hungry
  • eat alone because they are embarrassed about the amount of food they eat
  • feel disgusted, depressed, or guilty after overeating.

Binge eating also takes place in another eating disorder called bulimia nervosa. Persons with bulimia nervosa, however, usually purge, fast, or do strenuous exercise after they binge eat. Purging means vomiting or using a lot of diuretics (water pills) or laxatives to keep from gaining weight. Fasting is not eating for at least 24 hours. Strenuous exercise, in this case, means exercising for more than an hour just to keep from gaining weight after binge eating. Purging, fasting, and over-exercising are dangerous ways to try to control your weight.

How Common Is Binge Eating Disorder, and Who Is at Risk?

Binge Eating Disorder is probably the most common eating disorder. Most people with this problem are either overweight or obese,* but normal-weight people also can have the disorder.

About 2 percent of all adults in the United States (as many as 4 million Americans) have BED. About 10 to 15 percent of people who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have BED. The disorder is even more common in people who are severely obese.

Binge Eating Disorder is a little more common in women than in men; three women for every two men have it. The disorder affects blacks as often as whites. No one knows how often it affects people in other ethnic groups.

People who are obese and have binge eating disorder often became overweight at a younger age than those without the disorder. They might also lose and gain back weight (yo-yo diet) more often.

* The 1998 NIH Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults define overweight as a body mass index (BMI) of 25 to 29.9 and obesity as a BMI of 30 or more. BMI is calculated by dividing weight (in kilograms) by height (in meters) squared.

What Causes Binge Eating Disorder?

No one knows for sure what causes BED. As many as half of all people with BED are depressed or have been depressed in the past. Whether depression causes BED or whether BED causes depression is not known.

Many people who have BED say that being angry, sad, bored, or worried can cause them to binge eat. Impulsive behavior (acting quickly without thinking) and certain other emotional problems can be more common in people with binge eating disorder.

It is also unclear if dieting and binge eating are related. Some studies show that about half of all people with BED had binge episodes before they started to diet.

Researchers also are looking into how brain chemicals and metabolism (the way the body uses calories) affect BED. This research is still in the early stages.

What Are the Complications of Binge Eating Disorder?

People with BED can get sick because they may not be getting the right nutrients. They usually eat large amounts of fats and sugars, which don't have a lot of vitamins or minerals.

People with BED are usually very upset by their binge eating and may become very depressed.

People who are obese and also have BED are at risk for

  • diabetes
  • high blood pressure
  • high blood cholesterol levels
  • gallbladder disease
  • heart disease
  • certain types of cancer.

Most people with BED have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school, or social activities to binge eat. Persons who are obese with BED often feel bad about themselves and may avoid social gatherings.

Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members don't know they binge eat.

Should People With Binge Eating Disorder Try To Diet?

People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting here means skipping meals, not eating enough food each day, or avoiding certain kinds of food (such as carbohydrates). These are unhealthy ways to try to change your body shape and weight. Many people with BED are obese and have health problems because of their weight. These people should try to lose weight and keep it off. People with BED who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for BED before they try to lose weight. BED and obesity are two separate but related health issues. Dieting does not cure BED. Establishing a stable pattern of regular eating may be the most effective first step.

How Can People With Binge Eating Disorder Be Helped?

People with BED whether or not they want to lose weight, should get help from a health professional such as a psychiatrist, psychologist, or clinical social worker for their eating behavior. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. There are several different ways to treat BED. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.

Researchers are still trying to find the treatment that is the most helpful in controlling BED. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program that also offers treatment for eating disorders might be the best choice.

If you think you might have BED, it's important to know that you are not alone. Most people who have the disorder have tried but failed to control it on their own. You may want to get professional help. Talk to your health care provider about the type of help that may be best. The good news is that most people do well in treatment and can overcome binge eating.

For More Information

For more information, contact one of the centers listed below.*

National Eating Disorder Association
Information and Referral Program
603 Stewart Street, Suite 803
Seattle, WA 98101
1-800-931-2237
(206) 382-3587
(206) 829-8501 (fax)
Web: www.nationaleatingdisorders.org

Academy for Eating Disorders
6728 Old McLean Village Drive
McLean, VA 22101-3906
(703) 556-9222
(703) 556-8729 (fax)
Web: http://www.aedweb.org/

Weight-control Information Network

1 Win Way
Bethesda, MD 20892-3665
Phone: (202) 828-1025 or 1-877-946-4627
Fax: (202) 828-1028
Email: win@info.niddk.nih.gov

Internet Address: http://www.niddk.nih.gov/health/nutrit/win.htm

The Weight-control Information Network (WIN) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, under the U.S. Public Health Service. Authorized by Congress (Public Law 103-43), WIN assembles and disseminates to health professionals and the public information on weight control, obesity, and nutritional disorders. WIN responds to requests for information; develops, reviews, and distributes publications; and develops communications strategies to encourage individuals to achieve and maintain a healthy weight.

Diagnosis

Binge-eating disorder is listed as a mental disorder according to the American Psychiatric Association’s DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). According to the manual, the criteria for diagnosing binge-eating disorder are:

  • Repeated episodes of binge eating. A “binge” involves eating a larger-than-normal amount of food in a discrete period of time (for example, within a 2-hour period). The circumstances also define binge behavior. Someone who eats a huge amount of food at a holiday dinner or wedding, for example, is not necessarily binging. Feasting is an important part of many celebrations. Someone who is binging feels out of control; they aren’t able to stop eating.
  • The binges are associated with three or more of the following:
    • eating more quickly than normal;
    • eating until feeling uncomfortably full;
    • eating large amounts of food even when not feeling physically hungry;
    • eating alone because of being embarrassed by how much one is eating;
    • feeling disgusted with oneself, depressed or guilty after overeating.
  • The binges occur at least twice a week for 6 months.
  • The binges are NOT associated with regular purging (vomiting, fasting or excessive exercise).

2/2007— Study by Harvard affiliated McLean Hospital, finds BED more common than other eating disorders. Calls binge eating disorder a "major public health burden" because of its direct link to severe obesity and other serious health effects.

Keep in mind that disordered eating exists on a spectrum. We don't jump from healthy eating to full-blown BED overnight. There's a huge middle ground. Just because you don't fit precisely into the diagnostic criteria for binge eating disorder, does not mean that you don't have a problem with an eating disorder. A substantial percentage of individuals requesting treatment for an eating disorder do not meet the full formal diagnostic criteria. Available research suggests that approximately one fifth of the people who seek professional treatment for obesity meet the criteria for Binge Eating Disorder. Eating disorders are NOT addiction and require treatment models that reflect their unique nature.

The bulk of the information on this page (text of main article) is from the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health's, NIH Publications No. 99-3589,  04-3589, and other U.S. Government sources that are in the public domain. The text on this page is NOT copyrighted.

More info at: http://win.niddk.nih.gov/publications/binge.htm

This web site is for informational purposes only and is not meant to serve as medical advice or to replace consultation with a professional dietician, nutritionist, physician, or mental health professional. None of the information presented within this web site is meant to diagnose, prescribe, or to administer to any physical or emotional ailments or conditions.
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