Binge Eating Disorder

Binge eating disorder (BED) is a serious mental health condition characterised by episodes of eating large amounts of food and feeling a loss of control during these episodes.

It is the most common eating disorder in the UK

What is Binge eating disorder?

During episodes of binge eating people:

• Eat more rapidly than normal
• Eat when not feeling physically hungry
• May eat until uncomfortably full
• Often eat alone due to embarrassment about the quantity of food
• May feel depressed, guilty or disgusted after a binge

Binge episodes are not followed by compensatory behaviours such as vomiting or over-exercise (unlike in the case of bulimia). However, many people with BED restrict their diet heavily between binges, which can increase the likelihood of future episodes.

The shame and other negative feelings they feel as a result of their binge eating behaviour can likewise add to people’s vulnerability, with binge eating serving both as a source of initial emotional relief and subsequent distress.

Binge eating disorder – often misunderstood

BED is the most common of the eating disorders, is highly distressing for sufferers and can cause severe medical problems, however it is far less researched than anorexia and bulimia and thus remains less understood both in terms of its causes and effective treatment options.

Binge eating disorder was classified as a discrete mental health disorder for the first time in 2013.

This was the result of accumulating evidence from studies comparing BED to anorexia, bulimia and obesity – the research¹ found:

• BED often runs in families
• Binge eating disorder is distinct from obesity
• People with BED are also much more likely to be concerned about their shape and weight than people with obesity
• People with binge eating disorder commonly also have anxiety, depression or other mental health difficulties.
• Compared to the other eating disorders, there is less gender imbalance between men and women
• Binge eating disorder tends to start later in life

People with BED often experience medical difficulties including obesity and metabolic disorders, cardiovascular problems and Type 2 diabetes.

The good news is there is also a higher rate of recovery from BED compared to the other eating disorders.

¹ Wonderlich et al., (2009)

What causes binge eating disorder?

Like other eating disorders and many other mental health conditions, there is not one set cause of binge eating disorder. Instead, BED is caused by the interplay of a variety of biopsychosocial factors that vary from person to person.

Reflecting the fact that BED has only recently been formally recognised as a discrete eating disorder, it remains very under-researched. However, it has been hypothesised to share many causal and maintenance factors with other eating disorders with a binge-eating component (i.e., bulimia nervosa and the binge-purge subtype of anorexia nervosa). Read more about the causes of other eating disorders

These conditions also shares risk factors with many other mental health disorders and as many as 80% of people with a binge eating disorder will have another comorbid mental health condition, such as anxiety, depression, OCD or PTSD.

The causes specific to BED are thus far less well understood.

1. Biological causes of binge eating disorder
   Studies have shown that binge eating disorder is likely to be highly heritable¹ with some genes that may contribute to vulnerability to BED also increasing risk for mood and substance use problems. Research into a specific gene that is responsible for eating disorders is still in its infancy, however increasingly studies are suggesting that between 60-80% of eating disorders can be accounted for, to some degree, by genes².
   
   Brain imaging research has shown that some people with binge eating disorder have differences in their brain structure compared to people without the condition which give them a heightened response to food triggers and less ability to self-control food consumption.
   
   
2. Psychological causes of binge eating disorder
   People with BED often also suffer with anxiety and mood difficulties. Binge eating can develop as a way of regulating overwhelming feelings due to these conditions or stressors in their environment (e.g., demanding jobs, unhappy relationships, traumatic episodes).
   
   Many people with BED report a brief sense of calm or alternatively a relieving absence of emotion during or after binges. For them, binging may provide a powerful but short-lived and ultimately destructive coping mechanism.
   
   Body dissatisfaction is very common in all eating disorders, including BED. People who report high levels of body dissatisfaction focus intensely on their body image, often thinking about it for hours every day and basing their sense of identity and self-worth on their shape and weight to the exclusion of other aspects of who they are.
   
   Body dissatisfaction can lead to excessively restrictive eating patterns, which then leave people susceptible to binges when they break their own excessive dieting rules. This in turn can lead to even stricter dieting, continuing the vicious cycle of binging and restraint.
   
   
3. Environmental causes of binge eating disorder
   There is no evidence of a direct link between particular life experiences and the development of binge eating disorder. In line with a biopsychosocial model, it appears that certain events, teamed with predisposing vulnerabilities can result in the development of BED. Research to date suggests a link between BED and:
   • Trying very restrictive diets
   • A history of abuse and other forms of trauma
   • Depression
   • Smoking and alcohol dependence.

¹ Kirkpatrick et al., (2017)
² Klump et al., (2011)

Binge eating disorder symptoms

There are some common signs of binge eating disorder:

• Eating large quantities of food in one episode
• Eating food very quickly
• Being secretive about eating
• Having certain rituals around binges (for instance particular foods or times)
• Feeling out of control during a binge
• Not being able to remember what you ate during a binge
• Being depressed and/or anxious
• Becoming socially withdrawn
• Organising plans around binges
• Feelings of stress or anxiety that are only relieved during a binge
• Lack of sensation or feelings during a binge
• Eating until uncomfortably full
• Thoughts preoccupied with the next binge
• Feelings of immense disgust, shame and distress following a binge
• Self-harm or thoughts of self-harm
• Low self-worth and self-confidence

It’s common for people who have BED to be overweight and have other physical health complications, such as diabetes, high cholesterol or joint complaints. This can exacerbate feelings of low self-worth and confidence and can result in a vicious cycle of bingeing to help decrease these feelings.

The criteria for binge eating disorder examines how long the person has been experiencing binge episodes and with what frequency.

It is important to note that you do not have to wait for the illness to get severe before you get help. Many people with binge eating disorder do not seek help until they feel completely out of control with the illness, at which point it is much harder to treat.

Binge eating disorder Treatment

People with binge eating disorders often keep their illness secret from others and it is common that the condition comes as a complete surprise to friends and families.

Sufferers may feel like they are living double lives, performing competently in professional, familial and social roles while feeling a great sense of shame and emotional turmoil caused by their binge eating. As a result, it can be very difficult to come forward and seek help.

Getting help early

It can take huge courage to seek help for binge eating disorders due to the shame and guilt associated with the condition. While it is very normal to feel this way, help is available and can be hugely effective.

Specialists in eating disorders have a wealth of experience of working with binge eating disorders and are there to help the individual come to terms with and address their illness.

Read more about getting help for eating disorders

Download our Adult Eating Disorder Assessment Guide

Often people with binge eating disorder suffer in silence. They may feel ashamed of their eating habits or even disgusted with themselves, attributing their difficulties to personal weakness or a lack of self-control. Social stigma regarding overeating and limited awareness of binge eating disorder as a clinical condition can exacerbate their sense of shame and make them reluctant to seek help. But it is vital that they do. BED is a potentially debilitating but highly treatable disorder. By understanding the patterns underlying their binge eating and any related emotional difficulties and developing strategies to address them, people can make a full and sustained recovery.

Dr Charlie Baily

PhD, CPsychol

Clinical Psychologist

London

Dr Charlie Baily is a Clinical Psychologist currently working in the private sector. He has a PhD in Clinical Psychology and is a member of The British Psychological Society and Health and Care Professions Council.