Signs and Symptoms of Binge-Eating Disorder

What is binge-eating disorder?

Binge-eating disorder is a type of eating disorder characterised by recurrent (at least once per week) episodes of binge eating during which a person consumes a large quantity of food while experiencing a sense of loss of control.

Binge-eating disorder is a little different to bulimia nervosa, in that there are no attempts to compensate for the large number of calories consumed during a binge episode. This can explain why binge-eating disorder usually co-occurs with overweight/obesity.

Globally, binge-eating disorder affects around 1.5% of the female population and around 0.5% of the male population¹ Erskine, H. E., & Whiteford, H. A. (2018). Epidemiology of binge eating disorder. Current opinion in psychiatry, 31(6), 462-470. .

Treating binge-eating disorder is an important priority, because the disorder has been linked to a broad range of negative physical and psychological health outcomes, including obesity and related diseases (e.g., type 2 diabetes), depression and anxiety, low self-esteem, and reduced quality of life² Olguin, P., Fuentes, M., Gabler, G., Guerdjikova, A. I., Keck, P. E., & McElroy, S. L. (2017). Medical comorbidity of binge eating disorder. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 22(1), 13-26. .

Do I have binge-eating disorder? Core Symptoms

Let’s now delve into the many signs and symptoms of binge-eating disorder

Binge Eating

Binge eating is conceptualised synonymously with uncontrollable eating.
We usually think of two distinct types of binge eating episodes.

1. Objective binge eating: This is where a person consumes an unusually large amount of food in a short period of time (~ 2 hours) while also experiencing a sense of loss of control. An unusually large amount of food has been estimated to be around 1,500-2,000 calories.
2. Subjective binge eating: this is where a person consumes what is perceived as an excess amount of food, but in reality is not objectively large, while simultaneously experiencing a sense of loss of control.

In order to receive a diagnosis of binge-eating disorder, the binge eating episodes must be objective in nature. However, it is important to point out that the degree of psychosocial impairment associated with both objective and subjective binge eating is highly comparable. So, it is important to treat any binge eating behaviour, whether the amount consumed is or is not excessive. The loss of control component, in addition to marked impairment, is what differentiates binge eating from overeating.

Other Features of Binge Eating

There are a whole host of characteristics that underpin binge eating behaviour.

1. Rapid eating: during a binge episode, the person usually eats at a much quicker rate; there is little conscious effort to take in the smells, textures, and taste of the foods.
2. Feeling full: given the sheer volume of food consumed during an objective binge episode, it is common for people to feel uncomfortably full. In extreme cases, the stomach may actually stretch so much to the point of a medical emergency.
3. Eating in the absence of hunger: people aren’t generally hungry when they are binge eating. Rather, they are eating in this manner because they feel like they can’t control their behaviour. If people could eat according to their physiological hunger and satiety cues, then binge eating wouldn’t occur.
4. Eating alone: during binge eating episodes, it’s quite common for people to eat alone due to feelings of embarrassment. For example, people may take food to their room, eat in their car, or wait until other family members are asleep to begin eating.
5. Negative feelings: given the amount of food consumed, in addition to the feelings of perceived loss of control, people who binge eat usually feel a whole host of negative emotions, including disgust, depression, anger, and guilt.

Shape and weight overvaluation

Another important feature of binge-eating disorder is shape and weight overvaluation. Although shape/weight overvaluation is not part of the diagnostic criteria for binge-eating disorder, research has consistently found evidence that an undue influence of shape and weight on self-worth is observed in many people with disorder³ Grilo, C. M. (2013). “Why no cognitive body image feature such as overvaluation of shape/weight in the binge eating disorder diagnosis?” International Journal of Eating Disorders 46: 208-211.. In addition, people who present with shape/weight overvaluation consistently report higher levels of eating disorder symptoms, quality of life impairment, and psychological distress than people with binge-eating disorder who do not present with this feature⁴ Linardon, J. (2016). “Correlates of the over-evaluation of weight and shape in binge eating disorder and mixed eating disorder samples: A meta-analytic review.” Eating Disorders 25: 183-198. .

What does shape/weight overvaluation mean?

Whereas most people evaluate their self-worth by how they perform in a variety of different domains (e.g., sport, academia, work, friendships), people who present with an overvaluation of weight/shape usually judge their self-worth largely, or even exclusively, on their ability to control their weight and shape.

Therefore, these people tend to equate who they are as a person on what they weigh or how they look. For example, someone who puts on 1kg in a week will automatically think that they’re not a worthy human being.

Another issue with this feature is that it promotes many other features of eating disorders, including the various forms of negative body image behaviours (i.e., body checking and avoidance), social comparisons, and unhealthy weight control behaviours⁵ Fairburn, C. G., et al. (2003). “Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment.” Behavior Research and Therapy 41: 509-528 .

It’s not surprising, then, that psychological treatments for binge-eating disorder spend a lot of time trying to eliminate this overvaluation of weight and shape⁶ Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY, Guilford Press .

Warning Signs

Being aware of the more benign signs of binge-eating disorder can be difficult. Let’s take a look at some less obvious physical, psychological, and behavioural signs of binge-eating disorder⁷ Fairburn, C. G. and P. J. Harrison (2003). “Eating disorders.” The Lancet 361: 407-416. .

Physical signs

• Lethargy and insomnia
• Rapid weight gain
• Feeling bloated or constipated

Psychological signs

• Obsessing about food, eating, or cooking
• General dissatisfaction and shame associated with one’s body
• A general negative view of the self
• Heightened sensitivity to comments related to food, weight, eating, or exercise
• Depression, anxiety, or irritability
• Inability to maintain healthy interpersonal relationships

Behavioural signs

• Disappearing around meal times
• Hoarding food
• Increased isolation and withdrawal from pleasurable activities
• Unusual food rituals