Binge-Eating Disorder (Compulsive Overeating)

Binge-eating disorder, or compulsive overeating, involves the consumption of a large amount of calories in a short amount of time. Unlike bulimia, there is no purging after the eating episodes; as a result, binge-eaters tend to gain weight. They often struggle with feelings of shame and depression.

Binge-eating is characterized by eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. Binge-eaters also feel a lack of control over eating during the episode.

Binge-eating episodes are associated with eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not physically hungry, and feeling disgusted with oneself or depressed afterward. Binge-eating usually occurs in secrecy or as inconspicuously as possible.

Binge-eating disorder may be the most common eating disorder in the United States, where as many as four million adults struggle with it. It is more prevalent among females than males in the U.S. and afflicts females from all racial and ethnic groups. This condition is found more often among people seeking weight-loss treatment than in the general population. About 15 percent of the mildly obese, including those who try to lose weight on their own or with commercial products, have the disorder. While binge-eating is associated with obesity, most obese individuals do not engage in recurrent binge-eating. 

Symptoms

Almost everyone overeats occasionally, and sometimes, depending on the circumstances (i.e., celebrations), it may be culturally appropriate to eat a large amount of food. Such situations are occasional, social, and celebratory, while binge-eating reflects a pattern of recurrent episodes of gorging that involve a loss of control and cause an individual significant distress. In addition, binge-eating involves consuming what most people think is an unusually large amount of food very quickly, eating to the point of discomfort, and eating even when not hungry. Additionally, individuals engaging in binge-eating often eat alone due to embarrassment about how much they are consuming or feel depressed, disgusted, or ashamed about their eating habits.

In order to meet the criteria for binge-eating disorder, the binge-eating episodes must occur, on average, at least once per week for three months. The diagnosis is also categorized as mild, moderate, severe, or extreme based on the number of binge-eating episodes per week.

Binge-eating also occurs in the eating disorder bulimia nervosa. In the strictest sense, binge-eating is separate from bulimia nervosa, because people with bulimia often perform some activity to keep from gaining weight after they overeat. Either they purge by vomiting or using diuretics; they fast, not eating for long periods of time; or they exercise strenuously.

People who compulsively overeat sometimes isolate themselves from public gatherings because of their embarrassment and depression over the disorder. They may miss work or school. Their ability to hide their habits becomes so good that often even the people closest to them don't know they have the disorder.

The depression associated with the disorder is a constant health difficulty. The obesity that regularly arises from the disorder can also lead to risky medical conditions, such as diabetes, high blood pressure, high cholesterol, gallbladder disease, heart disease, and certain types of cancer.

Causes

Little is known about the development of binge-eating disorder. The condition typically begins in adolescence or young adulthood, but can begin in childhood or later adulthood.

Binge-eating disorder appears to run in families, which may reflect a genetic predisposition to developing the condition or a familial preoccupation with weight.

The most common antecedent to an episode of binge-eating is negative emotion. Other triggers include interpersonal stressors, eating too little while dieting, negative feelings related to body image, and boredom.

Treatment

There are several options for people who want help with controlling their tendency to binge-eat. Cognitive-behavioral therapy teaches people how to keep track of their eating and change unhealthy eating habits; it also helps people alter the way they react in difficult situations. Interpersonal psychotherapy helps people to look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.

While CBT, IPT, and medication are effective, researchers continue to search for helpful therapeutic strategies. Other therapies include dialectical behavior therapy (DBT), which helps people regulate their emotions; drug therapy with the antiseizure medication topiramate; weight-loss (gastric bypass) surgery; exercise used alone or in combination with cognitive-behavioral therapy; and self-help strategies — self-help books, videos, and groups such as Overeaters Anonymous have aided some people in controlling their binge-eating.

Many people with eating disorders respond to outpatient therapy, including individual, group, or family therapy, as well as medical management by their primary care provider. Support groups, nutritional counseling, and psychiatric medications taken under careful medical supervision have also proven helpful for some individuals.

Hospital-based care (including inpatient, partial hospitalization, intensive outpatient, and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life-threatening, or when it is associated with severe psychological or behavioral problems.

Exact treatment needs will vary from individual to individual. It is important for anyone struggling with an eating disorder to enlist a trusted health professional in coordinating and overseeing care.

References

  • American Psychiatric Association, Diagnostic and Statistical Manual, Fifth Edition.
  • National Institutes of Health.

Last reviewed 02/26/2019