People often use the term “bingeing” casually to mean watching a whole Netflix series in one weekend. When it comes to food, however, bingeing can be the sign of a serious illness, known as binge eating disorder (BED). So what is BED, and how can you know if you or a loved one are struggling with it?
What is BED?
Binge eating disorder is the most common eating disorder in the US, affecting an estimated 3.5% of women and 2% of men, and up to 1.6% of adolescents. Despite that fact, societal biases mean that BED is often overlooked.
Binge eating disorder was first officially recognized as an eating disorder diagnosis in 2013, when it was added to the The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). A person with binge eating disorder has recurrent eating episodes where they consume an objectively large amount of food (even if they’re not hungry) in a short period of time, often to the point of physical discomfort and with a feeling of being out of control. It’s common to experience intensely painful emotions such as shame and guilt leading up to a binge, and many folks also feel depressed or guilty afterward.
Unlike bulimia, which is defined as recurrent episodes of binge eating followed by purging, BED doesn’t involve any compensatory behaviors after binges to get rid of the calories consumed. But similarly to both anorexia and bulimia, those with BED are likely to struggle with body image concerns and have a history of dieting.
Warning signs of binge eating disorder
What can families be on the lookout for when it comes to identifying BED? Binge eating often occurs in isolation, so it can be hard for others to know if their loved one is struggling. Possible signs of binge eatingdisorder include:
- Weight fluctuations
- Avoiding eating with friends or family
- Hiding or hoarding food
- Food wrappers/containers found hidden or in the garbage
- Food missing from its usual place
- Negative body image
- Frequent dieting
- Having rules about “good” and “bad” foods
- Low self-worth
- Social withdrawal
If you’re concerned about potential binge eating disorder in your child, there are a couple things to consider about BED in young people. First, it’s also important to note that while children might experience eating with a loss of control, it can be difficult for them to describe it or understand what that means. Additionally, while it’s challenging for anyone to determine what is an “objectively” large amount of food, it’s especially difficult when it comes to young people whose nutritional needs fluctuate throughout growth periods. If you have concerns about your child’s relationship with food, it’s important to get an evaluation and support from a professional.
Who gets binge eating disorder?
One common myth about BED is that it only affects people who are in larger bodies. The truth is, as with any eating disorder, you can’t tell someone has BED just by looking at them. Binge eating disorder affects people in a range of body sizes, across races, ethnicities, genders, and socioeconomic statuses.
Although the average age of onset for BED is 21 years old, binge eating disorder can be seen across a person’s lifespan. If you notice any signs that have you worried about a loved one, trust your intuition and seek a professional opinion.
The binge-restrict cycle and causes of BED
Like all eating disorders, binge eating disorder is complex and can be influenced by multiple factors, including genetic vulnerabilities and social components. It may be impossible to pinpoint a particular cause of someone’s BED, just as with other eating disorders. The good news is that It isn’t necessary to identify a cause in order to start treating the symptoms of binge eating disorder and begin moving toward recovery.
Although we may not be able to identify a specific trigger for binge eating disorder, we do know that certain risk factors can increase someone’s vulnerability, in particular the binge-restrict cycle. A common catalyst for binge eating is dietary restriction, or not taking in enough calories. It can be helpful to remember that a strong biological drive for food after a period of food restriction is a survival tool. Insufficient amounts of food for any reason—or adequate food intake with a lack of satisfaction around food—can send the brain signals that food is scarce, causing it to seek out large quantities of food when possible. This pattern of restricting food, becoming uncontrollably hungry, and binge eating, is known as the binge-restrict cycle and is common in eating disorders, especially BED.
What does treatment for binge eating disorder look like?
As with other eating disorders, the most effective approach for treating binge eating disorder in young people is Family-Based Treatment (FBT). Through Equip’s virtual FBT model, patients and their loved ones get wraparound support from a team of specialists, including a therapist, a medical provider, a dietitian, a peer mentor, and a family mentor.
FBT for binge eating disorder starts with educating the whole family about the illness and empowering everyone to work together to fight the eating disorder. Nutritional rehabilitation is always step one, and that means making sure the patient is eating enough and eating regularly, as well as getting enough variety, satisfaction, and pleasure from food. During FBT sessions, the therapist will help the family and patient focus on normalizing eating patterns and ensuring adequate food intake occurs throughout the day, as patients benefit from the support of their family to achieve this goal.
Throughout treatment, patients and families are supported in unlearning common diet beliefs and taking an “all foods fit” approach to help end the binge-restrict cycle. In addition, developing body image resilience, learning a wide range of coping skills, and rebuilding trust and safety around food can support lasting recovery from BED. Treatment of co-occurring conditions, such as post-traumatic stress disorder can be important to incorporate once eating is consistent. To bolster relapse prevention, Equip also provides patients with an evidence-based body empowerment program.
Like all eating disorders, binge eating disorder is not a choice or a character flaw. Instead, it’s a serious, brain-based illness that can be life-threatening. The good news is that BED can be treated, and with Family-Based Treatment, recovery can happen at home.
- Kessler, Ronald C. et al. The Prevalence and Correlates of Binge Eating Disorder in the World Health Organization World Mental Health Surveys, Biological Psychiatry, Volume 73, Issue 9, 2013, Pages 904-914, ISSN 0006-3223, https://doi.org/10.1016/j.biopsych.2012.11.020.
- Swanson, Sonja A et al. “Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement.” Archives of general psychiatry vol. 68,7 (2011): 714-23. doi:10.1001/archgenpsychiatry.2011.22
- Keski-Rahkonen, Anna Epidemiology of binge eating disorder: prevalence, course, comorbidity, and risk factors. Current Opinion in Psychiatry, Volume 34, Number 6, November 2021, pp. 525-531(7). https://doi.org/10.1097/YCO.0000000000000750
- Allen, K.L., et al. The dual-pathway and cognitive-behavioural models of binge eating: prospective evaluation and comparison. Eur Child Adolesc Psychiatry 21, 51–62 (2012). https://doi.org/10.1007/s00787-011-0231-z
- Mitchell, K S et al. “Binge eating disorder: a symptom-level investigation of genetic and environmental influences on liability.” Psychological medicine vol. 40,11 (2010): 1899-906. doi:10.1017/S0033291710000139