Binge-Eating Disorder

Overview

Binge-eating disorder is a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.

Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, excessive overeating that feels out of control and becomes a regular occurrence crosses the line to binge-eating disorder.

When you have binge-eating disorder, you may be embarrassed about overeating and vow to stop. But you feel such a compulsion that you can't resist the urges and continue binge eating. If you have binge-eating disorder, treatment can help.

Symptoms

Most people with binge-eating disorder are overweight or obese, but you may be at a normal weight. Behavioral and emotional signs and symptoms of binge-eating disorder include:

• Eating unusually large amounts of food in a specific amount of time, such as over a two-hour period
• Feeling that your eating behavior is out of control
• Eating even when you're full or not hungry
• Eating rapidly during binge episodes
• Eating until you're uncomfortably full
• Frequently eating alone or in secret
• Feeling depressed, disgusted, ashamed, guilty or upset about your eating
• Frequently dieting, possibly without weight loss

Unlike a person with bulimia, after a binge, you don't regularly compensate for extra calories eaten by vomiting, using laxatives or exercising excessively. You may try to diet or eat normal meals. But restricting your diet may simply lead to more binge eating.

The severity of binge-eating disorder is determined by how often episodes of bingeing occur during a week.

When to see a doctor

If you have any symptoms of binge-eating disorder, seek medical help as soon as possible. Binge-eating problems can vary in their course from short-lived to recurrent or they may persist for years if left untreated.

Talk to your medical care provider or a mental health professional about your binge-eating symptoms and feelings. If you're reluctant to seek treatment, talk to someone you trust about what you're going through. A friend, loved one, teacher or faith leader can help you take the first steps to successful treatment of binge-eating disorder.

Helping a loved one who has symptoms

A person with binge-eating disorder may become an expert at hiding behavior, making it hard for others to detect the problem. If you have a loved one you think may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns.

Provide encouragement and support. Offer to help your loved one find a qualified medical care provider or mental health professional and make an appointment. You might even offer to go along.

Causes

The causes of binge-eating disorder are unknown. But genetics, biological factors, long-term dieting and psychological issues increase your risk.

Risk factors

Binge-eating disorder is more common in women than in men. Although people of any age can have binge-eating disorder, it often begins in the late teens or early 20s.

Factors that can increase your risk of developing binge-eating disorder include:

• Family history. You're much more likely to have an eating disorder if your parents or siblings have (or had) an eating disorder. This may indicate that inherited genes increase the risk of developing an eating disorder.
• Dieting. Many people with binge-eating disorder have a history of dieting. Dieting or restricting calories during the day may trigger an urge to binge eat, especially if you have symptoms of depression.
• Psychological issues. Many people who have binge-eating disorder feel negatively about themselves and their skills and accomplishments. Triggers for bingeing can include stress, poor body self-image and the availability of preferred binge foods.

Complications

You may develop psychological and physical problems related to binge eating.

Complications that may be caused by binge-eating disorder include:

• Poor quality of life
• Problems functioning at work, with your personal life or in social situations
• Social isolation
• Obesity
• Medical conditions related to obesity, such as joint problems, heart disease, type 2 diabetes, gastroesophageal reflux disease (GERD) and some sleep-related breathing disorders

Psychiatric disorders that are often linked with binge-eating disorder include:

• Depression
• Bipolar disorder
• Anxiety
• Substance use disorders

Prevention

Although there's no sure way to prevent binge-eating disorder, if you have symptoms of binge eating, seek professional help. Your medical care provider can advise you on where to get help.

If you think a friend or loved one has a binge-eating problem, steer her or him toward healthier behavior and professional treatment before the situation worsens. If you have a child:

• Foster and reinforce a healthy body image, regardless of body shape or size
• Discuss any concerns with your child's primary care provider, who may be in a good position to identify early indicators of an eating disorder and help prevent its development

Diagnosis

To diagnose binge-eating disorder, your medical care provider may recommend a psychological evaluation, including discussion of your eating habits.

Your medical care provider also may want you to have other tests to check for health consequences of binge-eating disorder, such as high cholesterol, high blood pressure, heart problems, diabetes, GERD and some sleep-related breathing disorders. These tests may include:

• A physical exam
• Blood and urine tests
• A sleep disorder center consultation

Treatment

The goals for treatment of binge-eating disorder are to reduce eating binges and achieve healthy eating habits. Because binge eating can be so entwined with shame, poor self-image and other negative emotions, treatment may also address these and any other mental health issues, such as depression. By getting help for binge eating, you can learn how to feel more in control of your eating.

Psychotherapy

Whether in individual or group sessions, psychotherapy (also called talk therapy) can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. Examples of psychotherapy include:

• Cognitive behavioral therapy (CBT). CBT may help you cope better with issues that can trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and help you regulate eating patterns.
• Interpersonal psychotherapy. This type of therapy focuses on your relationships with other people. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and co-workers. This may help reduce binge eating that's triggered by problematic relationships and unhealthy communication skills.
• Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.

Medications

Lisdexamfetamine dimesylate (Vyvanse), a drug for attention-deficit hyperactivity disorder, is the first FDA-approved medication to treat moderate to severe binge-eating disorder in adults. A stimulant, Vyvanse can be habit-forming and abused. Common side effects include a dry mouth and insomnia, but more-serious side effects can occur.

Several other types of medication may help reduce symptoms. Examples include:

• Topiramate (Topamax), an anticonvulsant. Normally used to control seizures, topiramate has also been found to reduce binge-eating episodes. However, there are side effects, such as dizziness, nervousness, sleepiness and trouble concentrating, so discuss the risks and benefits with your medical care provider.
• Antidepressants. Antidepressants may reduce binge-eating. It's not clear how these can reduce binge eating, but it may relate to how they affect certain brain chemicals associated with mood.

While these medications can be helpful in controlling binge-eating episodes, they may not have much impact on weight reduction.

Behavioral weight-loss programs

Many people with binge-eating disorder have a history of failed attempts to lose weight on their own. However, weight-loss programs typically aren't recommended until the binge-eating disorder is treated, because dieting may trigger more binge-eating episodes, making weight loss less successful.

When appropriate, weight-loss programs are generally done under medical supervision to ensure that your nutritional requirements are met. Weight-loss programs that address binge triggers can be especially helpful when you're also getting cognitive behavioral therapy.

Lifestyle and home remedies

Typically, treating binge-eating disorder on your own isn't effective. But in addition to professional help, you can take these self-care steps to reinforce your treatment plan:

• Stick to your treatment. Don't skip therapy sessions. If you have a meal plan, do your best to stick to it and don't let setbacks derail your overall efforts.
• Avoid dieting, unless it's supervised. Trying to diet can trigger more binge episodes, leading to a vicious cycle that's hard to break. Talk with your medical care provider about appropriate weight management strategies for you — don't diet unless it's recommended for your eating disorder treatment and supervised by your medical care provider.
• Eat breakfast. Many people with binge-eating disorder skip breakfast. But, if you eat breakfast, you may be less prone to eating higher calorie meals later in the day.
• Arrange your environment. Availability of certain foods can trigger binges for some people. Keep tempting binge foods out of your home or limit your exposure to those foods as best you can.
• Get the right nutrients. Just because you may be eating a lot during binges doesn't mean you're eating the kinds of food that supply all the essential nutrients. Ask your medical care provider if you need to adjust your diet to provide essential vitamins and minerals.
• Stay connected. Don't isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart.
• Get active. Ask your medical care provider what kind of physical activity is appropriate for you, especially if you have health problems related to being overweight.

Alternative medicine

Most dietary supplements and herbal products designed to suppress the appetite or aid in weight loss are ineffective and may be misused by people with eating disorders. And natural doesn't always mean safe. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications.

If you use dietary supplements or herbs, discuss the potential risks with your medical care provider.

Coping and support

Living with an eating disorder is especially difficult because you have to deal with food on a daily basis. Here are some tips to help you cope:

• Ease up on yourself. Don't buy into your own self-criticism.
• Identify situations that may trigger destructive eating behavior so you can develop a plan of action to deal with them.
• Look for positive role models who can help lift your self-esteem. Remind yourself that the ultrathin models or actresses showcased in women's magazines often don't represent healthy, realistic bodies.
• Try to find a trusted relative or friend whom you can talk with about what's going on.
• Try to find someone who can be your partner in the battle against binge eating — someone you can call on for support instead of bingeing.
• Find healthy ways to nurture yourself by doing something just for fun or to relax, such as yoga, meditation or simply a walk.
• Consider journaling about your feelings and behaviors. Journaling can make you more aware of your feelings and actions, and how they're related.

Get support

If you have binge-eating disorder, you and your family may find support groups helpful for encouragement, hope and advice on coping. Support group members can understand what you're going through because they've been there themselves. Ask your medical care provider if he or she knows of a group in your area.

Preparing for your appointment

Treatment of binge-eating disorder may require a team approach that includes doctors and other medical care providers, mental health professionals and dietitians with experience in eating disorders.

Here's some information to help you get ready for your appointments. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of the situation.

What you can do

Before your appointment make a list of:

• Symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
• Key personal information, including any major stresses or recent life changes
• All medications you're taking, as well as any herbs, vitamins or other supplements, and their dosages
• A typical day's eating, which can help your medical care provider or mental health professional understand your eating habits

Questions to ask your medical care provider or mental health professional include:

• What treatments are available, and which do you recommend?
• If medication is a part of treatment, is a generic drug available?
• Are there any brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your medical care provider or mental health professional is likely to ask you a number of questions, such as:

• What does your typical daily food intake look like?
• Do you eat unusually large amounts of food or until you're uncomfortably full?
• Do you feel your eating is out of control?
• Have you tried to lose weight? If so, how?
• Do you think about food often?
• Do you eat even when you're full or not hungry?
• Do you ever eat in secret?
• Do you feel depressed, ashamed or guilty about your eating?
• Do you ever make yourself vomit to get rid of calories?
• Are you concerned about your weight?
• Do you exercise? How often?

Your medical care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.