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July 1, 2024

Binge Eating Disorder: A Comprehensive Guide to Understanding, Diagnosis, and Treatment

Binge Eating Disorder: A Comprehensive Guide to Understanding, Diagnosis, and Treatment

Binge eating disorder (BED) is the most common eating disorder in the United States, with more people experiencing BED than anorexia nervosa and bulimia nervosa combined. Despite its widespread impact, BED is generally less well-known than anorexia and bulimia. 

This lack of recognition can be a significant barrier to getting help. Knowing what to look for when it comes to the signs of binge eating disorder can empower you to identify BED early in yourself, a loved one, or a patient. Early intervention for this serious illness is essential to mitigating harm to physical, emotional, and mental well-being and setting the stage for a long and successful recovery.

Read on for a comprehensive exploration of binge eating disorder, including its signs and symptoms, risk factors, treatment options, and more. We’ll give you the knowledge and resources you need to help you, your loved one, or your patient understand and heal from binge eating. 

What is Binge Eating Disorder (BED)? 

Binge eating disorder (BED) is characterized by recurrent binge eating episodes that are accompanied by a sense of loss of control and feelings of disgust, guilt, and self-loathing. Bingeing episodes involve eating an excessively large amount of food in a short period of time—often leading to physical pain and discomfort. The eating occurs without compensatory behaviors like purging, excessive exercise, or laxative misuse. 

Additional BED symptoms include eating when not hungry and eating alone (for fear of being judged by others for the amount of food eaten). For someone with BED, food serves as a way to temporarily soothe or numb unpleasant emotions such as anxiety, stress, or boredom. Eating disorders like binge eating disorder are complex psychiatric illnesses that stem from a combination of biopsychosocial factors. These factors differ from person to person but can include:

  • Biological:
    • Genetics, including a family history of BED
    • Neurochemical imbalances, including the dysregulation of neurotransmitters like serotonin and dopamine
    • Exposure to dieting or changes in food availability/security
    • Puberty/menopause
  • Psychological/Traits:
    • Co-occurring conditions (e.g., anxiety, depression, bipolar disorder, post-traumatic stress disorder, substance use disorder)
    • Stressors, such as relationship changes, life transitions, or major illness or injury
    • Prolonged exposure to emotional trauma
    • Poor self-worth
    • Negative body image
  • Social/Environmental:
    • Societal weight and appearance pressures
    • Comments or teasing related to weight, size, or other aspects of appearance (e.g., height, early or late development)
    • Excessive use of social media
    • A history of dieting

This intricate web of biological, psychological, and social factors contributing to BED highlights the need for a multifaceted treatment approach that addresses all aspects of the disorder. 

Signs and Symptoms of BED 

Recognizing the signs and symptoms of binge eating disorder is a crucial first step toward healing. Whether it’s yourself, a loved one, or someone you care for as a provider, getting the right support is essential. 

While many symptoms of BED are internal struggles, several outward signs are helpful indicators. Here are some of the behavioral, physical, and emotional signs to be aware of:

Behavioral Symptoms of BED: 

  • Eating objectively large amounts of food in a short amount of time
  • Eating much more rapidly than usual
  • Comments about feeling out of control after eating
  • Eating despite a lack of hunger
  • Isolating during meal times, eating in secret, or hiding or hoarding food
  • Food wrappers/containers found hidden or in the garbage (in an attempt to conceal evidence of a binge)
  • Frequent dieting
  • Strict rules about “good” and “bad” foods
  • Eating to the point of feeling uncomfortable or ill
  • Wearing baggier or less-revealing clothes (out of increased self-consciousness or to conceal real or perceived changes in weight)

Physical Symptoms of BED:

  • Markers of poor nutrition, as a result of restrictive dieting that may follow a binge, such as dry skin, and brittle hair or nails
  • Facial acne (in those susceptible) due to the hormonal changes that occur with disordered eating behaviors
  • Gastrointestinal complications, such as bloating, abdominal pain, nausea, acid reflux, heartburn, cramping, and diarrhea
  • Low energy and sluggishness due to the impact of binge eating on the body
  • Weight fluctuations

Emotional Symptoms of BED:

  • Feeling guilty, disgusted, ashamed, or sad after eating
  • Social isolation or withdrawal
  • Self-loathing surrounding one’s body or appearance
  • Intense stress
  • Increased moodiness or irritability
  • Emerging or worsening anxiety and/or depression symptoms
  • Increasing thoughts about food and weight
  • Heightened sensitivity to comments or concerns about body shape or weight and eating habits

BED vs. Other Eating Disorders 

Binge eating disorder (BED) is distinct from other types of eating disorders. Let’s explore what sets it apart from anorexia, bulimia, Avoidant/Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding or Eating Disorders (OSFED).

  • Anorexia nervosa is characterized by severe food restriction, an intense fear of weight gain, and a distorted body image. Unlike those with binge eating disorder, people with anorexia primarily focus on restricting food intake.
  • Bulimia nervosa is characterized by recurrent binge eating episodes that are followed by compensatory behaviors in an attempt to prevent weight gain. While bulimia and BED share the behavior of binge eating, BED does not include compensatory behaviors like self-induced vomiting, compulsive exercise, and fasting. 
  • Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by a persistent inability or unwillingness to eat due to a lack of interest in food, aversion to certain textures or smells, or fear of choking or other negative consequences of eating. People with BED might experience distress after binges, but their primary concern isn’t related to sensory issues or fear of food.
  • Other Specified Feeding or Eating Disorder (OSFED) is characterized by eating disorder behaviors that cause marked distress, impair social or occupational functioning, and/or have significant medical consequences, but do not match the full diagnostic criteria for the other diagnoses. The key distinction between OSFED and BED lies in the frequency and duration of the binge eating episodes. For example, the binge eating occurs at least once a week in BED, while binge eating may be less frequent or shorter in duration in OSFED.

The Path to a Binge Eating Disorder Diagnosis

Here at The Emily Program, we offer an Eating Disorder Assessment Quiz to help assess whether you, your loved one, or your patient might benefit from additional evaluation from an eating disorder treatment professional. The quiz covers a range of eating disorder behaviors, thoughts, and emotions, including those that come with binge eating disorder. 

Here’s a glimpse of what you can expect when you begin your recovery journey with The Emily Program:

  1. Reach out: If you answered “yes” to two or more of the assessment questions, then it’s time to contact us. Call 855-875-5812 to reach our admissions team. During this phone call, one of our compassionate, knowledgeable Admissions Specialists will gather your basic contact, demographic, and insurance information, ask about your eating experiences, answer any questions you have about treatment, and schedule your official intake appointment. 
  2. Formal Eating Disorder Assessment: The purpose of your intake appointment is to evaluate your symptoms and unique treatment needs. During this 45-60 minute appointment, a dedicated Intake Therapist will ask you questions about your relationship with food and body image, as well as questions related to your personality, family and social situation, co-occurring conditions, and any special life circumstances. At the end of your intake appointment, you’ll receive a recommendation for the most appropriate level of care along our care continuum, ranging from around-the-clock inpatient programming to outpatient treatment. In certain cases, a medical intake will be completed to ensure that the treatment that’s been recommended is medically safe for you.  
  3. Admission: For the third and final step, you will be paired with an Admissions Coordinator who will serve as your primary point of contact, guiding you through the admissions process to ensure your transition into care is as smooth as possible. They will help you coordinate the medical, financial, and logistical aspects of admission, including lodging and travel if necessary, and your treatment start date. 

On the first day of treatment, either in person or virtually, you will attend orientation and meet your dedicated multidisciplinary care team. The process of healing from your eating disorder has officially begun. 

Binge Eating Disorder Treatment Options 

Despite popular belief, the best ways to treat and manage binge eating disorder are not through weight management, diet and exercise programs, or food restriction. All of these misguided efforts are focused on the external manifestations of these brain-based illnesses and they can further exacerbate eating disorder symptoms, having the opposite effect of their desired outcomes. 

Full recovery from binge eating disorder requires comprehensive, multidisciplinary care from a specialty eating disorder treatment center, NOT a weight loss center or general hospital. Receiving care from experts who focus on your overall health, not your weight, is the best way to protect yourself against implicit or explicit weight bias, and to ensure that your unique needs are thoroughly acknowledged and addressed in treatment. You deserve treatment that meets you where you are, not treatment that reinforces your disordered habits or tries to mold you into something at odds with lasting recovery.

Binge eating disorder treatment at The Emily Program is personalized to fit each patient. We use a variety of treatment interventions tailored to an individual’s eating disorder presentation, medical status, specific needs and challenges, co-occurring conditions, identity, personal preferences, and more. When beginning care for BED at The Emily Program, you can expect the following from your treatment:

  • Therapy sessions with a licensed psychotherapist are a central component of BED treatment. The Emily Program therapists provide services for individuals, groups, and families, and are informed by a unique blend of approaches including CBT, CBT-E, DBT, and FBT. Regular therapeutic check-ins will help you identify your binge triggers, learn to cope with urges, discover how to prevent compensatory restrictive behaviors, and celebrate your recovery victories.
  • Nutritional guidance from our registered dietitians will provide you with the optimal nutrition therapy and education. You’ll learn to identify and challenge damaging internalized messages about food and diet, and begin to practice an inclusive and flexible “all foods fit” approach to eating. With the help of our therapeutic assistants, you’ll also receive mealtime support on your path to better understanding your eating habits and healing your relationship with food.
  • Medication management and psychiatric care is a valuable complement to therapy for many people with BED. Psychiatric help is particularly effective in addressing any underlying conditions that may be contributing to the eating disorder. 
  • A supportive environment is critical to healing. People with BED are too often met with invalidation, which dismisses the severity and life-limiting nature of this illness and its underlying factors. Our team is composed of nonjudgmental, compassionate, and informed healthcare professionals, all of whom are here to provide an emotional safety net as you process, learn, and progress through treatment.

Binge Eating Disorder Treatment Centers 

Struggling with binge eating disorder? You don’t have to go through this alone.

The Emily Program’s treatment centers in Durham, Charlotte, and Atlanta offer personalized programs to address the root of your binge eating and guide you toward a peaceful relationship with food and your body.

Explore our treatment locations and reach out today to begin your healing journey.

  • RTP – Durham, NC
  • Douglas – Durham, NC
  • Triangle – Durham, NC
  • Charlotte, NC
  • Atlanta, GA

Living with BED: Recovery and Support

Life with binge eating disorder is far more than occasional overeating. It’s common to overeat on occasion. You probably have some sense of what it feels like to eat a box of cookies in one sitting because you “just can’t leave them alone” or to go for seconds of a favorite dish despite being full. These experiences might even spark feelings of regret and guilt or bring on bloating or heartburn. 

Unlike occasional overeating, which is considered part of a normal and flexible relationship with food, binge eating episodes are experienced as something beyond your control. Those living with binge eating disorder are typically aware that their eating behaviors are not helpful, but still, they feel driven to engage in them repetitively. An individual with BED cannot simply “control” their actions and return to eating normally. 

Holding this internal struggle and managing the many societal misconceptions around binge eating can be an incredibly isolating experience for someone with this eating disorder. The myth that binges are due to a lack of willpower or discipline can lead to feelings of defeat, shame, and anxiety in those struggling, which in turn can activate even more binge eating behaviors and the continuation of the disordered cycle. Our society’s diet culture mentality pushes restriction and the pursuit of thinness, so binge eating is often seen as a “failure” rather than a natural response to deprivation or a learned coping mechanism.

Binge eating disorder is a newer diagnosis, first officially recognized as an eating disorder in 2013 in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Its newer clinical status contributes to a lack of understanding—especially within a backdrop of strong societal bias. Pervasive cultural weight stigma increases the risk for those suffering to feel invalidated, particularly those who live in larger bodies or who have experienced changes in their weight and size as a consequence of their eating disorder. 

So, how can someone truly heal from binge eating disorder? As mentioned, it starts with working with a treatment team that understands your unique needs and can tailor treatment to you. Your care plan should include behavioral intervention, stabilization, and total health promotion. While treatment will vary from person to person, here are some important facilitators of the BED recovery process:

  • Supported exploration of the interplay of variables that contribute to BED
  • Supported exploration and cessation of dieting behaviors, including weight-loss dieting and arbitrary food rules, while developing food freedom 
  • Time to unpack the influence of diet culture and internalized weight stigma
  • A shifted focus from weight loss to true health-promoting behaviors
  • Self-compassion, along with the knowledge of the functions binge eating has served in your life 
  • Supported self-reflection, including identifying people, situations, and emotions that may trigger binge eating behaviors
  • The development of a self-care practice
  • Exploration of coping skills to sit with and manage hard emotions
  • Exploration of experience in the body, including body respect and appreciation
  • Exploration of relationship to movement, along with guided gentle movement and opportunities for repairing the connection with the self/body
  • Identification of social supports (e.g.,., trusted family, friends, and loved ones)
  • A safe and comfortable community environment characterized by group affiliation (i.e., others in the same situation who can discuss lived experiences with binge eating)

Tips for Taking Control of Binge Eating

Practice mindful eating.

Turn your meals into mindful moments by eliminating external distractions. Try turning off the TV, silencing your phone, and stepping away from work while you eat. This focused environment allows you to fully engage with the experience of eating. As you savor each bite, what flavors can you distinguish? What are the textures? What aromas accompany each part of the meal? This mindful approach is a component of intuitive eating, which can increase your awareness of your body’s hunger and fullness cues.

Stick to a recovery meal plan.

Work with an eating disorder dietitian to craft a meal plan tailored to your body’s unique nutritional needs. Restricting or skipping meals often leads to intense hunger, potentially triggering binge episodes. A structured eating schedule, with regular meals and snacks, establishes a predictable eating pattern that fosters a more stable relationship with food. Read about approaches to planning meals. 

Identify your triggers.

Consider keeping a journal to record the emotions, thoughts, and circumstances surrounding your binge eating. This simple practice can help you identify patterns and triggers that contribute to these episodes. Do you find yourself eating when you’re anxious or lonely? Do certain social situations or events increase the likelihood of binge eating? Discuss these insights with an eating disorder specialist – they’ll be your guide in creating a personalized plan to address your triggers and help you develop healthy coping mechanisms.

Practice healthy coping strategies. 

With support, you can learn ways to manage stress, anxiety, or emotional distress without turning to food. Perhaps you’d enjoy relaxation techniques like deep breathing exercises. Maybe meditation is a good fit, allowing you to gently focus on the present moment and quiet intrusive thoughts. Together with your treatment team, you can curate a personalized toolbox of healthy coping mechanisms that will support your journey toward recovery.

BED in College Students 

College students are particularly susceptible to eating disorders, including binge eating disorder. Although people across the lifespan can develop binge eating disorder, its average age of onset is 21 years old, putting typical college students squarely in the risk zone for age.

Studies of college student populations report varied rates of BED, from 0.31% on the lower end up to 12.9%, depending on the specific population. The prevalence of binge eating behaviors on college campuses is as high as 50% in female undergraduates. Students with BED self-report higher levels of anxiety and depressive symptoms, lower self-esteem, and higher rates of diagnosed co-occurring mental health conditions such as post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD). 

College is a time of tremendous transition and change. Big life transitions can bring about intense emotions that trigger or exacerbate disordered eating behaviors in those who are predisposed to developing an eating disorder. Some of the eating disorder risk factors within the college environment include:

  • Newfound independence and increased responsibility
  • An unfamiliar environment
  • A loss of personal space and privacy
  • Living away from parents, friends, and other support people
  • An abundance of food choices and food-centered activities
  • Change in routine and a loss of structure
  • Irregular eating patterns that can disrupt hunger cues
  • Increased workload
  • Academic and financial pressures
  • Athletic pressures for student-athletes
  • Desire to fit in (which is heightened for marginalized populations)
  • Exposure to drugs and alcohol
  • Fear of the “Freshman 15”
  • Increased screen time with online classes

When Should I Get Help For Binge Eating Disorder?

BED can interfere with all areas of life as a college student. In student populations, we know that binge eating is associated with worsened quality of life, impaired relationships, the onset of or worsening of mental health problems, and lower academic performance, all of which can lead to long-term consequences.

The good news is that the sooner you get connected with help, the sooner you can begin the road to recovery, equipped with the right support and tools you need to thrive as a college student. 

If your relationship with food and body is suffering and you recognize some of the warning signs of binge eating disorder within yourself, please trust your intuition. Our Eating Disorder Assessment Quiz will let you know if it’s time to speak with a professional.

What’s Next?

  • Make use of campus resources. Most campuses offer students confidential medical and counseling services, including individual therapy, psychiatric consultation, and medical management. If you’re worried about your eating habits, your student health center may be able to help you determine whether you may benefit from ongoing on-campus care or a referral to a specialty treatment center. Regularly meeting with an on-campus counselor can also help you work through overwhelming emotions and develop accessible coping skills to manage the academic and social stressors of campus life.
  • Explore virtual pro-recovery support groups. Healing happens in community. Virtual support groups offer the option of instant connection without the need to venture off-campus. Openly sharing your anxieties and eating disorder experiences with a safe group of people who “get it” can make a world of difference in inspiring hope and reducing feelings of isolation and shame. Check out The National Alliance for Eating Disorders’ assortment of free virtual support groups led by licensed eating disorder clinicians. Among them are weekly Pro-Recovery Support Groups, an LGBTQ+ Pro-Recovery Support Group, and a Larger Bodied Individuals Support Group.
  • Contact The Emily Program. Take your first step toward healing. Reach out to our admissions team at 1-888-364-5977 or complete our online form. We’re here when you need us—7 days a week. We’ll answer any questions, talk about what you’re experiencing, collect your information, and schedule your official intake.

Binge eating disorder doesn’t have to be forever. Don’t let misconceptions about this serious illness keep you from seeking help for yourself, your loved one, or your patient. Contact The Emily Program at 888-364-5977  to learn more about our specialized, individualized approach to binge eating disorder treatment.

Get help. Find hope.