What is Binge-Eating Disorder (BED)?

Binge-eating disorder is a type of eating disorder characterised by recurrent episodes of binge eating during which individuals sense a lack of control and consume larger amounts of food than most people would under similar circumstances.

Binge-eating disorder (BED) made its first appearance as a separate eating disorder diagnosis in the latest Diagnostic and Statistical Manual for Mental Disorders (DSM-V), before being listed as a subtype of the broader EDNOS category¹American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.: DSM 5. Virginia: American Psychiatric Association 2013..

There are formal criteria needed to be met in order to achieve a diagnosis of binge-eating disorder. These are:

1. Recurrent episodes of binge eating, characterized as:
   • Eating, in a discrete period of time (e.g., 2 hour period), an amount of food that is larger than most people would eat in a similar period of time and under similar circumstances.
   • A sense of lack of control over eating during the episode.
2. The binge-eating episodes are associated with at least three of the following:
   • Eating much more rapidly than normal.
   • Eating until feeling uncomfortably full.
   • Eating large amounts of food when not feeling physically hungry.
   • Eating alone due to feelings of embarrassment.
   • Feeling disgusted, depressed, or guilty after the binge eating episode.
   • Marked distress associated with the binge eating.
3. The binge eating occurs, on average, at least once a week for three months.
4. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviours (e.g., laxative misuse, self-induced vomiting) and does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder.

Causes and risk factors for binge-eating disorder

There is no single cause of binge-eating disorder.

Psychological, social, and physical factors may all play a role in the development of binge eating. Established risk factors for binge eating include:

Psychological factors

• Personality traits: A chronic and negative view of the self (i.e., low self-esteem), and the tendency to be extremely competitive and set unrealistically high standards (i.e., perfectionism) from an early age, are risk factors for binge eating²Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behavior Research and Therapy. 2003;41:509-528.. Impulsive tendencies may also influence the development of binge eating³Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin. 2002;128:825-848..
• Dieting: Dieting in a rigid, inflexible, and extreme fashion is one of the most powerful risk factors for binge eating⁴Polivy J, Herman CP. Dieting and binging: A causal analysis. American psychologist. 1985;40(2):193.. Usually, the physiological and psychological deprivation caused by dieting encourages people to overindulge or binge on the very foods that are avoided.
• Body image concerns: How we feel about and evaluate our body is an important factor that places people at risk for binge eating. A negative body image encourages people to seek out extreme weight control methods (e.g., dieting, weight loss pills, excessive exercise etc.), which increases susceptibility to binge eating behaviour⁵Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin. 2002;128:825-848..

Physical & Social factors

• Gender: Women tend to be affected much more by binge eating than men, although recent research has shown that this gender gap is quickly closing⁶Mitchison D, Mond J. Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. J Eat Disord. 2015;3:20-29.. A possible reason for this is that women are much more likely than men to adopt inflexible diet practices and engage in various and extreme weight control behaviours (e.g., laxative use).
• Age: Binge eating typically develops in the adolescent years. During this time, people are more likely to prescribe to the thin idealised body shape and are therefore more likely to go to extreme lengths to achieve this body type, placing them at risk for binge eating⁷Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin. 2002;128:825-848..
• Obesity: Childhood obesity poses a risk for the development of binge eating. Obesity amplifies body image concerns, shame, and low self-esteem, which can put someone at risk for losing control over their eating⁸Fairburn CG, Doll HA, Welch SL, et al. Risk factors for binge eating disorder: a community-based, case-control study. Archives of general psychiatry. 1998;55(5):425-432..
• Genetics: Genetics play a role in the development of binge eating, partly because binge eating runs in the family. Research has yet to pinpoint a specific “binge eating” gene, although it is possible that epigenetic processes are involved, i.e., where certain behaviours like dieting change the expression of specific genes to influence binge eating⁹Klump KL, Perkins PS, Burt SA, et al. Puberty moderates genetic influences on disordered eating. Psychological Medicine. 2007;37(05):627-634..

Consequences & effects of binge-eating disorder

The consequences of binge eating and binge-eating disorder can be dire, and can include:

• Impaired quality of life and reduced life satisfaction
• Breakdown of interpersonal relationships and social isolation
• Mood, anxiety, and substance use disorders
• Obesity and obesity-related diseases (e.g., Type 2 diabetes, hypertension etc.)
• Death
• Low self-esteem

Prevalence of binge-eating disorder and binge eating behaviour

Binge-eating disorder is the most prevalent eating disorder. Here are some data on the prevalence of binge-eating disorder:

• The lifetime prevalence of binge-eating disorder for females ranges from 2.5%-4.5% and for males ranges from 1%-3% ¹⁰Erskine HE, Whiteford HA. Epidemiology of binge eating disorder. Current opinion in psychiatry. 2018., ¹¹Keski-Rahkonen A, Raevuori A, Hoek HW. Epidemiology of eating disorders: an update. Annual Review of Eating Disorders: CRC Press 2018:66-76..
• The global point prevalence of binge-eating disorder for females is 1.4% and for males is 0.5%.
• Binge-eating disorder point prevalence rates are similar in high-income countries (estimate of 0.9%) and low-income countries (estimate of 0.7%)¹²Erskine HE, Whiteford HA. Epidemiology of binge eating disorder. Current opinion in psychiatry. 2018..

The prevalence of binge eating behaviour (i.e., those who binge eat but may not necessarily meet diagnostic criteria for binge-eating disorder) is considerably higher and is growing at a consistent rate in both men and women ¹³Mitchison D, Hay PJ, Slewa-Younan S, et al. Time trends in population prevalence of eating disorder behaviors and their relationship to quality of life. PloS One. 2012;7:1-7..

• Research in Australia, for example, shows that 4.1% of men and 5.7% of women report binge eating at least once per week over the past 3 months¹⁴Mitchison D, Hay PJ, Slewa-Younan S, et al. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health. 2014;14:943..
• These estimates for binge eating have more than doubled since 1998 for both men (2.6%) and women (2.7%)¹⁵Mitchison D, Hay PJ, Slewa-Younan S, et al. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health. 2014;14:943..
• Binge eating is most common in those aged between 15-24 years (8.7%) compared to those aged between 25-44 years (5.3%) and > 44 years (3.5%)¹⁶Mitchison D, Hay PJ, Slewa-Younan S, et al. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health. 2014;14:943..

Psychological Treatments for Binge-Eating Disorder

Binge-eating disorder is one of the “easier” eating disorders to treat, in that recovery rates observed from binge-eating disorder treatments are usually double the recovery rates observed in bulimia nervosa and anorexia nervosa treatments¹⁷Linardon J. Rates of abstinence following psychological or behavioural treatments for binge-eating disorder: Meta-analysis. International Journal of Eating Disorders. 2018:1-13..

Two clear evidence-based binge-eating disorder treatments exist:

1. Cognitive-Behavioural Therapy:  Cognitive-Behavioural Therapy is the most effective treatment for binge eating and binge-eating disorder¹⁸Linardon J, Wade T, De la Piedad Garcia X, et al. The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis Journal of Consulting and Clinical Psychology. 2017;85:1080–1094.. Cognitive-Behavioural Therapy primarily aims at tackling the cognitive (e.g., body image concerns) and behavioural (e.g., dieting behaviours) mechanisms that are thought maintain or drive the binge eating behaviour¹⁹Fairburn CG. Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press 2008.. Cognitive-Behavioural Therapy is typically a fast-acting binge-eating disorder treatment, meaning that many patients experience most of their improvements within the first couple of sessions²⁰Linardon J, Brennan L, de la Piedad Garcia X. Rapid response to eating disorder treatment: A systematic review and meta‐analysis. International Journal of Eating Disorders. 2016;49:905-919.. Research has shown that nearly 60% of patients recover from binge-eating disorder after receiving Cognitive-Behavioural Therapy²¹Linardon J. Rates of abstinence following psychological or behavioral treatments for binge-eating disorder: Meta-analysis. International Journal of Eating Disorders. 2018:1-13..
2. Interpersonal Psychotherapy: Interpersonal Psychotherapy is also an effective binge-eating disorder treatment. Interpersonal Psychotherapy rests on the assumption that binge eating primarily occurs in response to interpersonal conflict and tension. Therefore, Interpersonal Psychotherapy aims to indirectly tackle binge eating by helping patients develop and learn more adaptive interpersonal skills²²Wilfley DE, Welch RR, Stein RI, et al. A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry. 2002;59:713-721.. Interpersonal Pschotherapy usually takes a long time to “work” (sometimes even a year), but patients generally experience large and sustained reductions in binge eating and associated body image concerns²³Fairburn CG, Bailey-Straebler S, Basden S, et al. A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy. 2015;70:64-71.. Research has shown that around 70% of patients recover from binge-eating disorder after receiving Interpersonal Psychotherapy, although the evidence-base for Interpersonal Psychotherapy is much smaller than for CBT²⁴Linardon J. Rates of abstinence following psychological or behavioral treatments for binge-eating disorder: Meta-analysis. International Journal of Eating Disorders. 2018:1-13..

Useful Strategies to Stop Binge Eating

There are a whole host of strategies known to stop binge eating behaviour.
Some of the techniques that have generated the most research support include:

1. Self-monitoring your behaviour: monitoring your eating patterns provides you with important information about the nature of your binge eating, including where, when, and what you binge on. Knowing this information will help you understand the factors that are driving your binge eating behaviour, allowing you to intervene accordingly.
2. Planned meal times: planning to eat at least 3 controlled meals and snacks per day is a fundamental step to reducing your binge eating.
   Eating regularly will prevent any gnawing hunger pangs that are known to trigger binge eating behaviour.
3. Keep busy: coming up with a list of enjoyable activities to implement in between your planned meals/snacks will keep you busy, distract you, and prevent you from acting out on any urges to binge eat. Beating the urge to binge eat at one time is a good predictor of you beating the urge to binge eat at another time later on!
   Activities to consider are: light exercise; yoga; reading; talking on the phone; playing video games, or any other activity that you can think of.

For more self-help strategies for binge eating, click on the link to this article.