What is binge eating disorder (BED)?

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What is BED?

Binge eating disorder (BED) is the most common eating disorder in the US. People with BED engage in repeated episodes of binge eating, or eating a large amount of food quickly while feeling out of control. Unlike bulimia, people with BED don’t throw up or engage in other purging behaviors after binging. Binge eating disorder is not a choice or a lack of willpower. BED, like all eating disorders, has complex neurological and biological underpinnings, which is why we refer to it as a brain disorder. Social and environmental influences—like social media, family dynamics, and diet culture—can play a role, but they’re never the one “cause” (nor is anything else). BED, and all eating disorders, emerge out of a perfect storm of different factors. BED has serious short- and long-term health consequences, but lasting recovery is possible with the right treatment.

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Signs and symptoms of binge eating disorder

Many people brush off the symptoms of binge eating disorder as not having enough “discipline” or “willpower.” This mentality ignores the fact that BED is a serious mental health condition that requires professional treatment. Binge eating disorder can have significant negative effects on physical, mental, and emotional health, as well as greatly reduce quality of life. Learning to recognize the symptoms of BED—whether it’s in yourself or a loved one—is the first step toward getting the help necessary to recover.

Weight changes, both up and down
Lack of energy
Stomach cramps or other gastrointestinal complaints, like constipation or acid reflux
Thinning or loss of hair

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Bradycardia

Though BED is more common among people in large bodies, it affects people of all body sizes

The binge-restrict cycle

While they may seem like polar opposites from one another, binge eating and restrictive eating are two sides of the same coin. These behaviors often go hand-in-hand, with one fueling the other, in a pattern known as the binge-restrict cycle. The binge-restrict cycle is common and even normalized in our society (think about “saving up” calories for a big meal), but when it happens consistently, it can lead to an eating disorder.

What is bingeing?

A binge is when a person eats an objectively large amount of food in a short amount of time. Eating an extra slice of cake or going back for a third serving of pasta isn’t a binge—binges are distinct psychological events with specific characteristics. Someone who’s engaging in a binge may feel like they’re unable to control how much they’re eating, and even have the sense that they’re outside their body while the binge is occurring. During a binge, a person typically continues to eat after they feel full, often to the point of extreme physical discomfort. Episodes of binge eating are almost always followed by intense feelings of shame or guilt and significant emotional distress.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), binge eating episodes are defined by two things²:

Within a 2-hour period, eating an amount of food that is definitely larger than most people would eat under similar circumstances

Feeling a lack of control over eating during the episode

Episodes of binge eating are also associated with other characteristics, including:

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 being embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after overeating

How the cycle works

The binge-restrict cycle refers to periods of restricted eating followed by episodes of binge eating. Restriction is when you ignore your body’s hunger cues and eat very little, or nothing at all. A binge is when you eat an objectively large amount of food in a short span of time, often past the point of fullness and with a sense of not having control. The binge-restrict cycle is a natural consequence of not listening to your body’s needs. When you restrict food—either by not eating, eating very little, or not allowing yourself of the foods you really want—you deprive your body of the nutrients and energy it requires to function. Your body then tries to communicate to you that it needs nourishment. One of the ways it does this is by producing a hormone called ghrelin, known as the “hunger hormone,” which stimulates your appetite. As you continue to restrict, more ghrelin is produced, causing your hunger to grow to a point where it takes the wheel. When you look at it this way, binge eating is a natural evolutionary adaptation: your body thinks you’re starving, and so when it finally gets food, it tries to consume as much as it can. But it’s not just that binges tend to inevitably follow periods of restriction; restriction can also be a common response to a binge. That’s because binges are almost always followed by intense feelings of guilt and shame (which can be compounded by diet culture messages that tell us that restriction is an accomplishment and eating is a failure), and these feelings can lead to more restriction. The restriction can serve to “make up for” the food eaten during the binge, or even as a self-imposed punishment for binge eating. Either way, the cycle continues. Though the binge-restrict cycle most commonly shows up in binge eating disorder and bulimia, it’s also present in some forms of OSFED, and the anorexia binge-purge subtype.

When you look at it this way, binge eating is a natural evolutionary adaptation: your body thinks you’re starving, and so when it finally gets food, it tries to consume as much as it can.

The 4 stages of the binge-restrict cycle

There are four stages of the binge-restrict cycle. They all exist in relation to one another, with each stage fueling the one that follows and making it nearly impossible for you to establish normal, healthy eating habits without help.

Restriction

You restrict your food intake, which can take the form of fasting, skipping meals, avoiding certain foods or entire food groups, or eating much less than your body needs.

Craving

The restriction triggers intense cravings or extreme hunger.

Bingeing

Your hunger becomes too much to ignore, and you eat an excessive amount of food in a short period of time. This is your body’s attempt to make up for the earlier restriction.

Guilt

Once the binge is over, you experience intense feelings of guilt, shame, and other hard emotions. Those emotions then lead you to restrict yet again.

Risks and complications of BEDWhen left untreated, BED can have a serious negative impact on physical health, mental health, and overall quality of life.

Physical health risks of BED

Increased risk for diabetes, high blood pressure, high cholesterol, and some kinds of cancer
Gastrointestinal issues, like bloating, cramping, nausea, vomiting, or constipation
Acid reflux
Lethargy
Gallbladder disease
Arthritis
Insulin resistance
Sleep apnea
Musculoskeletal problems

Mental health risks of BED

Increased risk for psychiatric illnesses, particularly depression, anxiety and substance use disorder
Low self-esteem
Social withdrawal and isolation that interferes with interpersonal relationships
Decreased productivity and motivation at work, school, or home

BED is the most common eating disorder in the US, affecting roughly 3% of Americans during their life.³

Binge eating disorder treatment

Stereotypes, stigma, and the pressures of diet culture can make people affected by binge eating disorder feel like they should be able to overcome their behaviors through “willpower” and “discipline.” They may try, again and again, to “just stop” their binge eating behaviors, then feel shame, guilt, and low self-worth when they binge again. But this isn’t a failure: it’s the natural result of trying to treat a serious mental illness without the right support. Just like any other eating disorder, binge eating disorder needs to be treated with multidisciplinary, evidence-based care that addresses all the aspects of the disease. The goals of binge eating disorder treatment are similar to the goals of treatment for other eating disorders: stopping disordered behaviors (in this case, binge eating), establishing a healthier relationship with food and body, and developing coping techniques to replace disordered behaviors. As with treatment for anorexia and bulimia, the first step toward achieving those goals is to address the nutritional and behavioral aspects of the disorder. In the case of BED, this doesn’t just mean stopping binges (though that’s a big part of it) it also means eating regularly throughout the day. Because binges often occur after a period of restriction, eating three meals and snacks throughout the day is a key part of stopping the binge behavior.

There are many different potential treatment settings and programs for binge eating disorder:

Inpatient hospitalization

Usually a short-term treatment reserved for those experiencing medical instability

Residential treatment

Patients stay at the treatment facility 24 hours a day, with round-the-clock supervision

Partial hospitalization program (PHP)

Patients attend treatment for most of the day, but return home to sleep

Intensive outpatient program (IOP)

Patients attend treatment for several hours a day, several times a week

Virtual treatment

There are many different types of virtual treatment for BED. Depending on the program, patients will have different levels of support and involvement. Research has shown that virtual eating disorder treatment is as effective as in-person care.

Binge eating disorder doesn't just go away

It's not feasible to treat BED on your own. If you’re struggling with binge eating, we recommend getting a professional consultation by your healthcare provider or an eating disorder expert as soon as you can.

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What to expect from BED treatment at Equip

At Equip, we treat patients of all ages and acuity levels who are affected by binge eating disorder. The specifics of treatment are tailored to each patient’s unique needs, challenges, and life circumstances, but all Equip treatment includes certain components, like nutritional support, therapy, and a dedicated multidisciplinary care team. Our care teams supports patients with the following services throughout the recovery process.

Your therapist will help you address the emotional and psychological factors that may be contributing to disordered behaviorals, as well as identify triggers and develop healthy coping strategies. They’ll also help you work through any co-occurring conditions, like anxiety or depression. All Equip therapists are licensed practitioners who have specialized experience and training in eating disorders.

Recovery is possible

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Common questions about binge eating disorder

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As frustrating as it is, there is rarely one identifiable cause of an eating disorder, and binge eating disorder is no different. More often than not, it is a constellation of neurobiological and environmental factors: in other words, someone has a genetic predisposition to developing an eating disorder, and then the eating disorder is “turned on” by environmental factors. You can learn more about the causes of eating disorders on our blog.

As with all eating disorder treatment at Equip, the initial focus of binge eating disorder treatment is normalizing eating habits and stopping eating disorder behaviors. We focus on these behavioral and nutritional aspects first and foremost, because it's difficult for patients to make progress in other areas when they're actively engaging in eating disorder behaviors.

Disordered or erratic eating patterns can lead to malnutrition, regardless of a patient's weight or other medical signs. When the body is malnourished, the brain is, too. A malnourished brain doesn’t think clearly or take in new information well. People who are malnourished are more likely to be depressed, anxious, and have trouble paying attention.

Once patients have been able to normalize their eating habits and stop or significantly reduce their binge eating behaviors, the focus of treatment can shift to other areas. That might mean working on interpersonal relationships, setting goals outside of their eating disorder, learning to handle triggers in their daily life, or understanding potential root causes of the eating disorder.

To accomplish all this, our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).

Though the specifics of a binge will look different from person to person and circumstance to circumstance, there are some defining criteria. A binge is defined as an episode of eating in which a person eats a large quantity of food while feeling a lack of control. This often means eating past the point of fullness until uncomfortable, eating extremely quickly, eating alone, and feeling shame after eating.

Our patients are experiencing an early and sustained response to Equip treatment

Patients requiring weight restoration who reached their target weight

After 16 weeks

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