Binge eating disorder is a serious mental illness and is not just “overindulging”. Dr Louise Wiseman explains the signs to look out for, and how to get help early.
Binge eating disorder can affect anyone of any age, gender of background. More women than men are affected, but this may be because women tend to consult earlier or may be more outwardly worried about weight gain that may occur as a result of their bingeing.
When your relationship with food becomes unhealthy, this can cause real and concerning health implications that may affect other aspects of your life. Treatment is out there and it is important that symptoms are recognised early so help can be sought as soon as possible.
What is binge eating disorder?
Binge Eating Disorder (BED) involves recurrent episodes of binge eating. The bingeing will involve eating a larger quantity of food over a specific period of time (two hours, for example) than you usually would, as well as feeling a lack of control over your eating during the episode. Patients usually feel markedly distressed about their bingeing.
The episodes usually need to occur at least once a week for three months or twice a week for six months before binge eating disorder is diagnosed. The doctor rates the severity according to how many times a week the binge eating happens.
Unlike the other eating disorders, binge eating disorder does not involve purging, fasting or excessive exercise to try and compensate for the eating. The overeating is thus likely to result in obesity and other complications.
Binge eating disorder symptom
A binge eating episode will likely include three or more of the following factors:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food despite not feeling physically hungry
- Eating alone or in secret because of feeling embarrassed by how much one is eating
- Feeling disgust or self-loathing, depressed or very guilty after eating.
Binge eating disorder triggers
Many believe binge eating disorder can stem from the habits that we develop when we are younger. For example, you might use food as a comfort when you’re younger and become unable to self-soothe in other ways as an adult. Sugar boosts serotonin levels for all of us, so it is no surprise that we can use a quick sugar fix as an emotional crux on a bad day.
BED is also described by many as occurring in response to dieting or feeling deprived. Dieting has been shown to increase cravings and impulsive eating, so long term, the idea of making healthy food choices, not intermittent dieting, is recommended.
Binge eating disorder causes
The following factors may cause binge eating disorder:
- Family history of BED or other mental health issues (environment and/or genetic)
- Hormonal or specific genetic causes(e.g. extra sensitivity to dopamine)
- Small overlap with risk factorsfor obesity
- Brain structuremay mean less self-control or heightened response to food
- Disparaging commentsabout weight, body or eating (e.g. from parents or carers)
- Traumaincluding abuse scenarios (PTSD)
- Emotionally unsupportive environment at any stage in life, food becomes a comfort.
Binge eating disorder implications
Up to half of BED sufferers are obese and BED is also likely to lead to obesity.
Therefore BED sufferers may acquire all the inherent risks of being obese, including:
- Type 2 Diabetes
- Heart Disease
- Sleep problems, including sleep apnea
- Chronic pain and arthritic picture from general increased body inflammation
- Asthma may worsen with inflammatory picture
- Fertility problems in women including polycystic ovarian syndrome
- Any other health problems or hospital admissions could be worse due to the general effects of obesity
- Quality of life can be severely compromised in many ways which could lead to a vicious cycle of further bingeing.
Binge eating disorder diagnosis
There are strict criteria that doctors follow before making a diagnosis of binge eating disorder. Bingeing is subjective, meaning that one person’s binge may be a regular meal to another and suitable treatment may differ.
The doctor will want to know how you see the problem and how it affects your life.
They may ask to weigh you, measure your pulse and blood pressure and possibly talk about your food diary.
It might be helpful to book a double appointment if you are worried and take along a trusted relative or friend.
Once a diagnosis has been suggested, the GP will refer you to a specialist clinic. Many universities have their own special clinics and where you are treated may depend upon the provisions in your local area.
Binge eating disorder treatments
You will have a professional assessment from someone experienced in eating disorders.
The NICE Guidelines recommend that all people diagnosed with BED, whether children, adolescents or adults, are offered what we call “guided self-help”.
This involves working through a specific book about binge eating while having ongoing sessions with a therapist or specialist practitioner to check in with how you are progressing. Usually, these sessions last for 20 minutes and sufferers will need between four to nine sessions, but this will be tailored depending upon how you are progressing.
This helps you monitor what you are actually eating, make realistic meal plans and learn triggers and find other ways of coping with feelings.
Cognitive behavioural therapy
Working on stopping deep-rooted negative thought patterns may help to treat eating disorders.
In the UK, group CBT is often offered if the guided self-help is not enough. Four months of weekly 90-minute group sessions is standard. Sometimes one-on-one CBT is given.
A 2010 review looked at 25 trials of BED and found that CBT decreased the number of binge days and episodes, as did self-help. Both treatments increased abstinence from bingeing.
A systematic review of more than 200 women showed that aerobic exercise combined with CBT reduced the number of binges and patients’ BMIs. It also found the exercise-CBT combo was better at reducing depressive symptoms than CBT alone. Yoga was also proven to be helpful.
Future treatment would include a healthy exercise regime alongside other therapies.
The above treatments aim to help you:
- Plan your daily food intake – it is important to be realistic as dieting while having treatment is known to impede the success of treatment
- Work out your binge triggers
- Challenge the way you feel about your body and reduce negativity
- Improve body image and self esteem
- Stop you relapsing by sticking to new healthy habits – careful nutritional advice may focus on healthy foods and eating patterns that trigger feel good chemicals
- Planning snacks not just main meals may also be important
These treatments are not designed to help you lose weight. That might be part of a separate part of treatment addressed by your clinical team.
Private treatment can sometimes include inpatient treatment.
Medication is not the mainstay of treatment of BED. If you suffer other conditions at the same time e.g. anxiety, depression, OCD, as an adult you may be prescribed medication for those specifically. The National Centre for Eating Disorders does not recommend medication finding most recover with good therapy.
Long-term lifestyle changes
An informed new confidence with food choices and awareness of triggers should help long term alongside a healthy but not obsessive exercising lifestyle. Surround yourself with those who support you.
By the very nature of this delicate condition you may have a lack of self-belief or confidence in the fact that you can make a full recovery but many patients do and go on to have a healthy relationship with food and eating. It can be really overwhelming to take the first step and ask for help but sufferers must realise they are not alone and that resolution is possible. You can regain control over your eating and thus your health.