How Binge Eating Became A Recognized Eating Disorder

When you hear the term "eating disorder", you usually imagine a stick-thin female with anorexia, correct? Images of obese people gorging on bags of cookies or containers of ice cream aren't on your radar screen, since over-eating is believed to be a personal choice. But medical experts increasingly agree that Binge Eating Disorder (BED) may not simply be a matter of choice. BED is estimated to be far more prevalent than anorexia, and new research, using MRI brain scans, links BED to specific brain signaling pathways. The American Psychiatric Association gives BED a unique diagnosis code in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The diagnostic criteria for Binge Eating Disorder include:

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by:

  • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
  • A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)

B. The binge-eating episodes are associated with 3 or more 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 because of feeling embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty after overeating

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for 3 months.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior and does not occur exclusively during the course Bulimia Nervosa or Anorexia Nervosa.

How is BED different from bulimia?

People with bulimia binge and then purge, exercise or fast to compensate for the excessive calorie intake. Their weight typically stays within the normal range. But people with BED do not purge or compensate. They just keep gaining weight, frequently becoming obese. The consequences of all those calories become visible. Binge eaters typically feel embarrassed, guilty, out of control and powerless to stop.

BED occurs in both men and women

Binge eating is not unique to women. Men are increasingly diagnosed with BED, and represent roughly half of cases. Contrast that statistic with anorexia cases: about 10% are men. It's easy to miss BED in men. It's more socially acceptable for men to gorge on food (think of all those hot dog eating contests), so the binge eating can go on for a long time before anyone, including the binge eater himself, recognizes it's a problem.

BED research is evolving

Binge eating disorder has been getting some research attention, thanks to more sophisticated brain scanning techniques. For example, research has shown that brain reward signals in obese people are less responsive than in normal weight people. Result: an obese overeater doesn't perceive "reward" signals that shut off eating behavior, so they just keep eating. Other research will examine how binge eaters respond to visual cues of food. Eventually some of this research might lead to effective medical intervention techniques.

Getting professional help for BED

Most binge eaters would rather get help now. But the solution is not another diet. You need to identify and deal with the triggers to the behavior. The good news is that you don't have to struggle alone. Psychotherapy can work well for binge eaters.

  • A psychotherapist can help you recognize the triggers and behaviors that drive binge eating, allowing you to exert more control.
  • Be sure to ask prospective therapists if they have experience working with BED, and their success rate.
  • As you work with the therapist, you should also consult with a qualified registered dietitian nutritionist who has experience in eating disorder treatment. She or he can help you learn about healthy and appropriate food choices.
  • Some people are successful figuring it out on their own and seizing control of their behavior. Calorie monitoring and exercise can certainly help in those efforts. But if you find yourself slipping back over and over again, you may need more help and support.

If you or a loved one has BED, check out the eating disorder support website at National Eating Disorders Association.

Originally published on 21 August 12
Updated on 13 September 2019

Donna P Feldman MS RDN is author of Feed Your Vegetarian Teen and Food Wisdom for Women: nutrition for aging with energy, vitality and health. Donna writes about food and nutrition at Radio Nutrition and is co-host of the Walk Talk Nutrition podcast.
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Disclaimer: The information provided here does not constitute medical advice. If you are seeking medical advice, please visit your healthcare provider or medical professional.

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Eating Disorders/Binge Eating Disorder

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