Binge eating disorder (BED) is the most common eating disorder in the US, affecting 3.5 percent of women and 2 percent of men. Yet it is only in recent history that this prevalent condition was recognized as a diagnosable disorder. Before the most recent DSM (Diagnostic and Statistical Manual of Mental Disorders), the DSM-5, was released in 2013, people with this condition were diagnosed under the subcategory Eating Disorder Not Otherwise Specified. Now that binge eating disorder has been recognized as its own separate disorder, people with this debilitating condition can seek proper medical care, as insurance companies will only cover treatment when it comes with a DSM diagnosis.
What is binge eating disorder?
Binge eating disorder is characterized by episodes during which an individual eats large quantities of food in a short period of time (usually quickly and past the point of discomfort), feeling a complete loss of control and resulting in shame, guilt, or distress. While it is normal for people to periodically eat too much, BED goes beyond the occasional overindulgence. According to the DSM-5, the diagnostic criteria for binge eating disorder are as follows:
“A. 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).
B. 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.”
Characteristics of binge eating disorder
Outside of the diagnostic criteria of this disorder, there are certain characteristics that are prevalent among people with binge eating disorder. Not everyone will display these characteristics, and not everyone with these characteristics has BED. However, you can use these characteristics to reflect on your own behaviors or the behaviors of a loved one.
- Eating secretly and engaging in other secretive eating behaviors, such as only eating alone, eating in the car, hiding wrappers, and stealing and hoarding food.
- Abnormal eating behaviors, such as eating throughout the day without meals, skipping meals entirely or eating abnormally small portions, engaging in intermittent fasting and/or dieting, and developing food rituals (e.g. only eating one kind of food)
- Periods of out-of-control and impulsive eating beyond the point of fullness without purging.
Creating rituals or changing lifestyle or schedule for binge sessions.
- Feelings of anxiety, anger, shame, or worthlessness before a binge. The binge serves to numb pain and relieve tension.
- Highly comorbid with other mental health disorders, including depression and anxiety.
- Dissatisfaction with body image. It’s common for people with BED to have been teased about their weight as a child.
- Avoiding conflict.
- Having perfectionist tendencies.
- Being a “people pleaser.”
- Difficulty expressing feelings.
- Control issues.
- People with BED range from normal body weight to severely obese.
- People with BED often gain weight; however, not everyone who is overweight has BED.
What causes BED?
The research into BED that has been conducted thus far suggests that binge eating disorder has a neurobiological basis, with genetic and environmental risk factors contributing. For example, one study found that the impulse-control region of the brain is less active in people with BED. Additionally, the dopamine levels may be off in the case of BED, generating an increase desire for a specific type of food. Binge eating disorder also tends to run in families, suggesting that there may be genetic influences at play. Certain studies have seen differences in the genes of the brain’s reward center in people with BED. Finally, there are environmental factors at play when it comes to binge eating disorder. One study found that more stressful life events were reported frequently during the year preceding the onset of binge eating disorder for people with BED than the control group without BED. Additionally, another study found that the majority of people (90 of women, 98 percent of men) with BED have experienced trauma (including combat, physical or sexual assault, and natural disasters).
The effects of BED
Binge eating disorder causes great distress to those who have it. It is strongly correlated to depression and anxiety, as well as feelings of shame and guilt. This disorder can have a profound effect on one’s psychological and physical health.
While most people who are obese do not have BED, two-thirds of people with BED are obese. Many of the consequences of BED are the same as the consequences for obesity, including high blood pressure, high cholesterol, diabetes, heart disease, fatigue, joint pain, and sleep apnea. In addition, people with BED are more likely to experience lifetime depression, anxiety, and a lower quality life. Despite the many distressing effects of BED, many people do not seek treatment for this disorder. This is likely because of the social stigma of this disorder. Binge eating disorder is largely misunderstood, and many people don’t realize that it isn’t as simple as just stopping binging behavior. To conquer this distressing disorder, it is crucial to seek psychotherapy. Cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and interpersonal therapy (IT) have all shown to be effective treatments through empirical research.
At Long Island Counseling, we have experience working with people with binge eating disorder to establish healthy eating habits and break the cycle of binging. Contact us today to learn more about what psychotherapy on Long Island can do for you.