About Binge Eating Disorder (BED)

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without subsequent purging episodes (e.g. vomiting).

BED is a recently described condition, which was required to distinguish binge eating similar to that seen in bulimia nervosa but without characteristic purging.

Individuals who are diagnosed with bulimia nervosa and binge eating disorder exhibit similar patterns of compulsive overeating, neurobiological features of dysfunctional cognitive control and Food addiction, and biological and environmental risk factors. Indeed, some consider BED a milder version of bulimia, and that the conditions are on the same spectrum.

Binge-eating disorder is a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.

Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, excessive overeating that feels out of control and becomes a regular occurrence crosses the line to binge-eating disorder.

When you have binge eating disorder, you may be embarrassed about overeating and vow to stop. But you feel such a compulsion that you can’t resist the urges and continue binge eating. If you have binge-eating disorder, treatment can help.

Binge eating is one of the most prevalent eating disorders among adults, though there tends to be less media coverage and research about the disorder in comparison to anorexia nervosa and bulimia nervosa.

Signs and Symptoms

Binge eating is the core symptom of BED; however, not everyone who binge eats has BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED.

This example may be considered an eating problem (or not), rather than a disorder. Precisely defining binge eating can be problematic, however binge eating episodes in BED are generally described as having the following potential features:

• Eating much faster than normal. perhaps in a short space of time
• Eating until feeling uncomfortably full
• Eating a large amount when not hungry
• Subjective loss of control over how much or what is eaten
• Binges may be planned in advance, involving the purchase of special binge foods,  and the allocation of specific time for binging, sometimes at night
• Eating alone or secretly due to embarrassment over the amount of food consumed
• There may be a dazed mental state during the binge
• Not being able to remember what was eaten after the binge

Feelings of guilt, shame or disgust following a food binge

In contrast to bulimia nervosa, binge eating episodes are not regularly followed by activities intended to prevent weight gain, such as self-induced vomiting, laxative or enema misuse, or strenuous exercise. BED is characterized more by overeating than dietary restriction and over concern about body shape. Obesity is common in persons with BED, as are depressive features,  low self-esteem, stress and boredom.

Diagnosis

To diagnose binge-eating disorder, your medical care provider may recommend a psychological evaluation, including discussion of your eating habits.

Your medical care provider also may want you to have other tests to check for health consequences of binge-eating disorder, such as high cholesterol, high blood pressure, heart problems, diabetes, GERD and some sleep-related breathing disorders. These tests may include:

• A physical exam
• Blood and urine tests
• A sleep disorder center consultation

Causes

As with other eating disorders, binge eating is an “expressive disorder”a disorder that is an expression of deeper psychological problems.  People who suffer from binge eating disorder have been found to have higher weight bias internalization, which includes low self-esteem, unhealthy eating patterns, and general body dissatisfaction. Binge eating disorder commonly develops as a result or side effect of depression, as it is common for people to turn to comfort foods when they are feeling down.

There was resistance to give binge eating disorder the status of a fully fledged eating disorder because many perceived binge eating disorder to be caused by individual choices. Previous research has focused on the relationship between body image and eating disorders, and concludes that disordered eating might be linked to rigid dieting practices.

In the majority of cases of anorexia, extreme and inflexible restriction of dietary intake leads at some point to the development of binge eating, weight regain, bulimia nervosa, or a mixed form of eating disorder not otherwise specified.

Binge eating may begin when individuals recover from an adoption of rigid eating habits. When under a strict diet that mimics the effects of starvation, the body may be preparing for a new type of behavior pattern, one that consumes a large amount of food in a relatively short period of time.

Psychotherapy

Whether in individual or group sessions, psychotherapy (also called talk therapy) can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. Examples of psychotherapy include:

• Cognitive behavioral therapy (CBT). CBT may help you cope better with issues that can trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and help you regulate eating patterns.
• Interpersonal psychotherapy. This type of therapy focuses on your relationships with other people. The goal is to improve your interpersonal skills how you relate to others, including family, friends and co-workers. This may help reduce binge eating that’s triggered by problematic relationships and unhealthy communication skills.
• Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.

Prognosis

Individuals suffering from BED often have a lower overall quality of life and commonly experience social difficulties. Early behavior change is an accurate prediction of remission of symptoms later.

Individuals who have BED commonly have other comorbidities such as major depressive disorder, personality disorder, bipolar disorder, substance abuse, body dysmorphic disorder, kleptomania, irritable bowel syndrome, fibromyalgia, or an anxiety disorder. There may also be panic attacks and a history of attempted suicide.

While people of a healthy weight may overeat occasionally, an ongoing habit of consuming large amounts of food in a short period of time may ultimately lead to weight gain and obesity. Binging episodes usually include foods that are high in fat, sugar, and/or salt, but low in vitamins and minerals, as these types of foods tend to trigger greatest emotional reward.

The main physical health consequences of this type of eating disorder are brought on by the weight gain resulting from the binging episodes.[citation needed] Up to 70% of individuals with BED may also be obese, and therefore obesity-associated morbidities such as high blood pressure and coronary artery disease  type 2 diabetes mellitus gastrointestinal issues (e.g., gallbladder disease), high cholesterol levels, musculoskeletal problems and obstructive sleep apnea may also be present.

Treatment

Evidence-based therapies to consider for the treatment of binge eating disorder include:

• Cognitive behavioural therapy for binge eating disorder
• Interpersonal psychotherapy
• Dialectical behaviour therapy
• Lisdexamfetamine dimesylate (LDX), a central nervous system stimulant medication

Note: If the person with the eating disorder also presents with symptoms of obesity, this will need to be managed simultaneously using the appropriate treatment.

Side-effects

Generally, it takes a combination of things to develop binge eating disorder—including your genes, emotions, and experience.

Social and cultural risk factors. Social pressure to be thin can add to the you feel and fuel your emotional eating. Some parents unwittingly set the stage for binge eating by using food to comfort, dismiss, or reward their children. Children who are exposed to frequent critical comments about their bodies and weight are also vulnerable, as are those who have been sexually abused in childhood.

Psychological risk factors. Depression and binge eating are strongly linked. Many binge eaters are either depressed or have been before; others may have trouble with impulse control and managing and expressing their feelings. Low self-esteem, loneliness, and body dissatisfaction may also contribute to binge eating.

Biological risk factors. Biological abnormalities can contribute to binge eating. For example, the hypothalamus (the part of your brain that controls appetite) may not be sending correct messages about hunger and fullness. Researchers have also found a genetic mutation that appears to cause food addiction. Finally, there is evidence that low levels of the brain chemical serotonin play a role in compulsive eating.

Effects of binge eating disorder

Binge eating leads to a wide variety of physical, emotional, and social problems. You’re more likely to suffer health issues, stress, insomnia, and suicidal thoughts than someone without an eating disorder. You may also experience depression, anxiety, and substance abuse as well as substantial weight gain.

As bleak as this sounds, though, many people are able to recover from binge eating disorder and reverse the unhealthy effects. You can, too. The first step is to re-evaluate your relationship with food.

Binge eating recovery tip 1: Develop a healthier relationship with food

Recovery from any addiction is challenging, but it can be especially difficult to overcome binge eating and food addiction. Unlike other addictions, your “drug” is necessary for survival, so you don’t have the option of avoiding or replacing it.

Instead, you need to develop a healthier relationship with food a relationship that’s based on meeting your nutritional needs, not your emotional ones. To do this, you have to break the binge eating cycle by:

Avoiding temptation. You’re much more likely to overeat if you have junk food, desserts, and unhealthy snacks in the house. Remove the temptation by clearing your fridge and cupboards of your favorite binge foods.

Listening to your body. Learn to distinguish between physical and emotional hunger. If you ate recently and don’t have a rumbling stomach, you’re probably not really hungry. Give the craving time to pass.

Eating regularly. Don’t wait until you’re starving. This only leads to overeating! Stick to scheduled mealtimes, as skipping meals often leads to binge eating later in the day.

Not avoiding fat. Contrary to what you might think, dietary fat can actually help keep you from overeating and gaining weight. Try to incorporate healthy fat at each meal to keep you feeling satisfied and full.

Fighting boredom. Instead of snacking when you’re bored, distract yourself. Take a walk, call a friend, read, or take up a hobby such as painting or gardening.

Focusing on what you’re eating. How often have you binged in an almost trance-like state, not even enjoying what you’re consuming? Instead of eating mindlessly, be a mindful eater. Slow down and savor the textures and flavors. Not only will you eat less, you’ll enjoy it more.

Not only will you eat less, you’ll enjoy it more.

The importance of deciding not to diet

After a binge, it’s only natural to feel the need to diet to compensate for overeating and to get back on track with your health. But dieting usually backfires. The deprivation and hunger that comes with strict dieting triggers food cravings and the urge to overeat.

Instead of dieting, focus on eating in moderation. Find nutritious foods that you enjoy and eat only until you feel content, not uncomfortably stuffed. Avoid banning or restricting certain foods, as this can make you crave them even more. Instead of saying “I can never eat ice cream,” say “I will eat ice cream as an occasional treat.”

Tip 2: Find better ways to feed your feelings

One of the most common reasons for binge eating is an attempt to manage unpleasant emotions such as stress, depression, loneliness, fear, and anxiety. When you have a bad day, it can seem like food is your only friend. Binge eating can temporarily make feelings such as stress, sadness, anxiety, depression, and boredom evaporate into thin air. But the relief is very fleeting.

Identify your triggers with a food and mood diary

One of the best ways to identify the patterns behind your binge eating is to keep track with a food and mood diary. Every time you overeat or feel compelled to reach for your version of comfort food Kryptonite, take a moment to figure out what triggered the urge. If you backtrack, you’ll usually find an upsetting event that kicked off the binge.

Write it all down in your food and mood diary: what you ate (or wanted to eat), what happened to upset you, how you felt before you ate, what you felt as you were eating, and how you felt afterward. Over time, you’ll see a pattern emerge.

Learn to tolerate the feelings that trigger your binge eating

The next time you feel the urge to binge, instead of giving in, take a moment to stop and investigate what’s going on inside.

Identify the emotion you’re feeling. Do your best to name what you’re feeling. Is it anxiety? Shame? Hopelessness? Anger? Loneliness? Fear? Emptiness?

Accept the experience you’re having. Avoidance and resistance only make negative emotions stronger. Instead, try to accept what you’re feeling without judging it or yourself.

Dig deeper. Explore what’s going on. Where do you feel the emotion in your body? What kinds of thoughts are going through your head?

Distance yourself. Realize that you are NOT your feelings. Emotions are passing events, like clouds moving across the sky. They don’t define who you are.

Sitting with your feelings may feel extremely uncomfortable at first. Maybe even impossible. But as you resist the urge to binge, you’ll start to realize that you don’t have to give in.

There are other ways to cope. Even emotions that feel intolerable are only temporary. They’ll quickly pass if you stop fighting them. You’re still in control. You can choose how to respond.

Tip 3: Take back control of cravings

Sometimes it feels like the urge to binge hits without warning. But even when you’re in the grip of a seemingly overpowering and uncontrollable urge, there are things you can do to help yourself stay in control.

Accept the urge and ride it out, instead of trying to fight it. This is known as “urge surfing.” Think of the urge to binge as an ocean wave that will soon crest, break, and dissipate. When you ride out the urge, without trying to battle, judge, or ignore it, you’ll see that it passes more quickly than you’d think.

Distract yourself. Anything that engages your attention will work: taking a walk, calling a friend, watching something funny online, etc. Once you get interested in something else, the urge to binge may go away.

Talk to someone. When you start to notice the urge to binge, turn to a friend or family member you trust. Sharing what you’re going through can help you feel better and discharge the urge to binge.

Delay, delay, delay. Even if you’re unsure if you’ll be able to fight the urge to binge, make an effort to delay it. Try to hold off for 1 minute.  If you succeed. Try to stretch it out to 5 minutes. If you delay long enough, you may be able to avoid the binge.

Tip 4: Support yourself with healthy lifestyle habits

When you’re physically strong, relaxed, and well rested, you’re better able to handle the curveballs that life inevitably throws your way. But when you’re already exhausted and overwhelmed, any little hiccup has the potential to send you off the rails and straight toward the refrigerator. Exercise, sleep, and other healthy lifestyle habits will help you get through difficult times without binge eating.

Make time for regular exercise. Physical activity does wonders for your mood and your energy levels, and it’s also a powerful stress reducer. The natural mood-boosting effects of exercise can help put a stop to emotional eating.

Get enough sleep every night. When you don’t get the sleep you need, your body craves sugary foods that will give you a quick energy boost. Sleep deprivation may even trigger food addiction. Getting plenty of rest will help with appetite control and reduce food cravings, and support your mood.

Connect with others. Don’t underestimate the importance of close relationships and social activities. You’re more likely to succumb to binge eating triggers if you lack a solid support network. Talking helps, even if it’s not with a professional.

Manage stress. One of the most important aspects of controlling binge eating is to find alternate ways to handle stress and other overwhelming feelings without using food. These may include meditating, using sensory relaxation strategies, and practicing simple breathing exercises.

How to help someone with binge eating disorder

Since binge eaters often try to hide their symptoms and eat in secret, it can make it tough for family and friends to spot the warning signs. And you can’t always identify a binge eater by appearance, either. While some are overweight or obese, others manage to maintain a normal weight.

The warning signs that you can spot include finding piles of empty food packages and wrappers, cupboards and refrigerators that have been cleaned out, or hidden stashes of high-calorie or junk food. If you suspect that your loved one has binge eating disorder, bring up your concerns. It may seem daunting to start such a delicate conversation, and the person may deny bingeing or become angry and defensive. But there’s a chance that he or she will welcome the opportunity to share the struggle.

If the person shuts you out at first, don’t give up; it may take some time before your loved one is willing to admit to having a problem. And remember: as difficult as it is to know that someone you love may be have an eating disorder, you can’t force someone to change. The decision to seek recovery has to come from them. You can help by offering your compassion, encouragement, and support throughout the treatment process.

Tips for helping someone with binge eating disorder

Encourage him or her to seek help. The longer an eating disorder remains undiagnosed and untreated, the more difficult it will be to overcome, so urge your loved one to get treatment.

Be supportive. Try to listen without judgment and make sure the person knows you care. If your loved one slips up on the road to recovery, remind them that it doesn’t mean they can’t quit binge eating for good.

Avoid insults, lectures, or guilt trips. Binge eaters feel bad enough about themselves and their behavior already. Lecturing, getting upset, or issuing ultimatums to a binge eater will only increase stress and make the situation worse. Instead, make it clear that you care about the person’s health and happiness and you’ll continue to be there.

Set a good example by eating healthily, exercising, and managing stress without food. Don’t make negative comments about your own body or anyone else’s.

Binge Eating Disorder Causes and Risk Factors

While research has not identified exact binge eating disorder causes, several factors are thought to play a part in BED. The combination of causes and risk factors varies from person to person but possible factors include:

• Genetics
• Dieting/restrictive or irregular eating patterns
• History of significant weight changes
• Depression, anxiety, other mood disorders, including bi-polar disorder
• Experiences of weight stigma, weight-related discrimination, or bullying
• Problems with family or other significant relationships
• Significant trauma/loss experiences
• Emotional/physical abuse or neglect
• Addictions to drugs/alcohol
• Sexual trauma