Binge Eating Disorder: Beyond Overeating
Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 2, 2022.
DSM V Recognizes BED As A Separate Type of Eating Disorder
Although Binge Eating Disorder (BED) is the most common type of eating disorder in the U.S., it was only recognized as a separate diagnostic entity when DSM-V - the go-to diagnostic manual of mental disorders - was published in 2013.
Affecting over 2.8 million people in the United States, BED is characterized by the repeated consumption of exceptionally large amounts of food in a very short time period. In addition, people with BED have a sense of lack of control over what and how much they eat. They eat rapidly until they are uncomfortably full even when they don't feel hungry. Shame, guilt and embarrassment over how much they have eaten usually follows a binge period. To be diagnosed as BED, binge eating must take place at least once a week for three months and not be associated with any compensatory activity such as purging. Binge eating followed by purging is more likely to be diagnosed as bulimia nervosa.
BED is NOT just occasional overeating. It is a repetitive disorder that requires expert help. For someone to be diagnosed with BED, the binge episodes must occur at least once a week for three months. However, any instances of binge eating are still a cause for concern.
BED: Symptoms Not Always Obvious
BED is a serious type of eating disorder and associated with depression, anxiety, and a greater risk of suicide. Because sufferers of BED often feel intense shame or guilt at their behavior, they may hide their disorder from others, making diagnosis all the more challenging. Signs of BED may not always be obvious but friends or family may notice:
- The disappearance of large amounts of food over short periods of time
- The appearance of significant numbers of empty wrappers or containers, sometimes in odd, hidden places
- Secretive food eating (ie, alone or in the car)
- Hoarding or hiding of food
- Eating throughout the day with no planned mealtimes, or eating small amounts at regular mealtimes
- Repetitive dieting or the development of food rituals (such as excessive chewing or separating foods into different colors or types)
- Scheduling of the person's lifestyle around binge sessions.
Many people with BED were teased about their size while growing up, and personality traits such as always feeling the need to please others or shunning conflict are common among BED sufferers. People with BED are often perfectionists and may have difficulty expressing their feelings or needs.
Although up to two-thirds of people with BED are obese, not everybody with the disorder is overweight.
Long-Term Effects Of BED Can Be Life-Threatening
Significant feelings of guilt and shame can cause people with BED to develop depression, which increases their risk of suicide. Other life-threatening consequences of BED are typically associated with obesity; such as heart disease and high blood pressure, high cholesterol, type 2 diabetes, joint pain (osteoarthritis), sleep apnea, fatigue, and gallbladder disease. Surveys indicate people with BED have an overall lower quality of life.
BED is frequently misunderstood and sufferers can feel stigmatized. This often stops people with the disorder accessing the right treatment and support necessary for their recovery.
With Right Support, BED Can Be Effectively Treated
The road to recovery from BED can be long and difficult but can be made easier with expert help. The National Eating Disorders Association (NEDA) offers a toll-free confidential helpline (1-800-931-2237) and will help people find an expert best suited to their needs, taking into account any associated disorders and their location.
Trials have shown BED can be effectively treated. Evidence supports the use of cognitive or behavior therapy first-line, or in combination with second-generation antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), or citalopram (Celexa). Lisdexamfetamine (Vyvanse) is also approved for BED but it tends to just mask the symptoms of BED rather than providing the insight and tools needed by people to manage their condition. The antidepressant bupropion (Wellbutrin), although desirable because of its especially low risk for causing weight gain, is usually avoided because it can increase the risk for seizures in patients with electrolyte abnormalities from vomiting. Interpersonal therapy (IPT) and dialectical behavioral therapy (DBT) may also help. What is clear is that no one treatment benefits all people with BED, and several may need to be tried, either alone or in combination, before an effective one is found.
Behavioral weight loss therapy may also be considered. This aims to help people lose weight by teaching them healthy lifestyle changes in regards to diet and exercise, which can help improve a person's self-esteem and body image; however, it has not been shown to be as effective as CBT or DBT.
CBT: Changing The Way You Perceive Your Body
Cognitive Behavioral Therapy (CBT) for BED makes sense. That's because the cause of all eating disorders is psychological - an over-evaluation of body shape, size, and weight. Trials also support the use of CBT as first-line treatment, with the majority showing either more or equal effectiveness to other forms of treatment.
People with BED base most, if not all, of their self-worth on their size and how well they can control it, unlike people without eating disorders who use various domains such as personality, sporting prowess, and intelligence to rate themselves. There are various types of CBT, but one of the most effective forms of CBT used for BED is guided self-help CBT (CBTgsh).
CBTgsh is simple for therapists to teach and easy for people with BED to learn. With the aid of a self-help manual, therapists initially explain the rationale behind CBT and train people with BED to monitor their own eating behavior. Self-control strategies and problem-solving techniques to prevent relapse are also taught. Therapists also help to set reasonable goals and modules address obstacles likely to stand in the way of resolution of BED, such as perfectionism, low self-esteem and relationship difficulties.
Unfortunately, although CBTgsh is effective long-term for reducing binge eating behavior, it does not usually result in clinically meaningful weight loss.
Lisdexamfetamine (Vyvanse): Good Results Seen For BED
Experts believe it helps curb impulsive and compulsive behaviors typically associated with BED, such as reaching for food when depressed or continuing to eat even once you feel full. In trials, lisdexamfetamine was significantly more likely than placebo to reduce the number of binge eating episodes per week, to result in complete cessation of binge eating, or to cause weight-loss. The most common side effects reported were dry mouth, decreased appetite, sleeplessness, and headache, although overall discontinuation rates because of side effects were low. However, it does not teach people how to manage their condition long-term, instead it just masks the symptoms short term.
Antidepressants For Binge Eating Disorder
Other medications, such as antidepressants, may be used "off-label" for the treatment of binge eating disorder.
Antidepressants may be more effective in people with coexisting mood disorders such as depression or anxiety, or who misuse substances. Trials to date seeing how efffective antidepressants are in people with BED have mostly short, small, or excluded people with other psychological disorders.
The rationale behind using antidepressants is that they work on dopamine, serotonin, and norepinephrine pathways; these are all neurotransmitters that have been associated with eating behavior.
Evidence For The Effectiveness Of Antidepressants In BED Is Not Overwhelming
Unfortunately, trials that have been conducted have mostly shown inconsistent results.
Another study reported bupropion (Wellbutrin) to be more effective than sertraline at reducing weight in BED patients with depression. However, no difference in symptoms such as binge-eating frequency, food cravings, or depression levels was reported when bupropion was compared to placebo (a pretend pill) in another trial. Trial participants did lose on average 1.8% of their BMI over the eight week trial period.
Although findings do not generally support using antidepressants as stand-alone treatments for BED, they may be considered when coupled with other interventions such as CBT or lifestyle changes.
Other Therapies For BED May Be Worth A Try
Interpersonal psychotherapy first identifies which features of a person's personality underlie the development of the eating disorder they currently have. Therapy sessions then attempt to change these aspects of a person's behavior and strategies put in place so the person with BED has some tools to manage future relapses. Progress is reviewed after 16 or more weeks. Although there are similarities to CBT, interpersonal therapy does not contain any of the specific behavioral or cognitive procedures that characterize CBT.
Dialectical behavior therapy (DBT) is an off-shoot of CBT that concentrates more on the social aspects of the eating disorder, including over-reactions or odd reactions to emotional situations typically found in romantic, friend or family relationships. Originally developed to treat borderline personality disorder, it has been found to be useful in some instances of BED.
Good support underlies successful treatment for BED. Find a doctor who specializes in eating disorders and who understands successful resolution of the disorder may require a combination of treatments. BED is a very real disorder, but it can be beaten.
Finished: Binge Eating Disorder: Beyond Overeating
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