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Binge-Eating Disorder

By

Evelyn Attia

, MD, Columbia University Medical Center, New York State Psychiatric Institute;


B. Timothy Walsh

, MD, College of Physicians and Surgeons, Columbia University

Last full review/revision Jun 2020| Content last modified Jun 2020
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Binge-eating disorder is an eating disorder characterized by the repeated consumption of unusually large amounts of food (binge eating) with a feeling of loss of control during and after the binge. Binge eating is not followed by attempts to compensate for the excess food eaten—for example, by ridding the body of the excess food consumed (purging).

  • Binge-eating disorder is more common among people who are overweight or obese.

  • People eat large amounts of food rapidly, do not purge, and are very distressed by their behavior.

  • Doctors base the diagnosis on people’s description of their behavior.

  • Treatment aims to help people control binge eating and includes cognitive-behavioral therapy, selective serotonin reuptake inhibitors (SSRI, a type of antidepressant), and stimulant drugs.

  • Weight-loss programs, some weight-loss drugs, and stimulant drugs may help control weight.

Overall, about 3.5% of women and 2% of men have binge-eating disorder. But the disorder becomes more common with increasing body weight. In some weight-reduction programs, 30% or more of obese people have the disorder.

Most people with binge-eating disorder are overweight or obese, and the disorder contributes to their consumption of excessive calories. In contrast, most people with bulimia nervosa have a normal weight, and people with anorexia nervosa are thin. People with binge-eating disorder are older than those with anorexia nervosa or bulimia nervosa, and nearly half are men.

Did You Know?

  • Nearly half of the people with binge-eating disorder are men.

Symptoms

During an episode of binge eating, people eat a much larger amount of food than most people would eat in a similar time under similar circumstances. Circumstances and culture are important because the amount considered excessive for a normal meal may differ from the amount considered excessive for a holiday meal. During and after a binge, people feel as if they lost control and are distressed. People with binge-eating disorder do not compensate for the binge by purging (by making themselves vomit or misusing laxatives, diuretics, or enemas), exercising excessively, or fasting. Binge eating occurs in episodes, as opposed to constant overeating.

People with binge-eating disorder may also do the following:

  • Eat much more rapidly than normal

  • Eat until they feel uncomfortably full

  • Eat large amounts of food when they do not feel hungry

  • Eat alone because they are embarrassed

  • Feel disgusted, depressed, or guilty after overeating

People with binge-eating disorder are distressed by it, especially if they are trying to lose weight. People are more likely to have depression or anxiety compared with those who do not have the disorder. Also, obese people with binge-eating disorder are more likely to be preoccupied with body shape, weight, or both than obese people who are not binge eaters.

Diagnosis

  • A doctor's evaluation

Doctors diagnose binge-eating disorder when

  • People report binge eating at least once a week for 3 months or more.

  • Binges are accompanied by a feeling of no control over eating.

  • People have typical symptoms and behavior.

Treatment

  • Psychologic therapy

  • Certain antidepressants and stimulant drugs

  • Possibly weight-loss drugs and appetite suppressants

  • Possibly self-help groups and conventional weight-reduction programs

The following treatments may help:

  • Cognitive-behavioral therapy can help control binge eating over the long term but has little effect on body weight.

  • Interpersonal psychotherapy is as effective as cognitive-behavioral therapy but also has little effect on body weight.

  • Stimulant drugs (such as those used to treat attention-deficit/hyperactivity disorder [ADHD]) and selective serotonin reuptake inhibitors (a type of antidepressant), such as fluoxetine, can help people stop binge eating for a short period of time and may result in weight loss.

  • Weight-loss drugs (such as orlistat) or appetite suppressants (such as topiramate) may help with weight loss.

  • Self-help groups that follow the principles of Alcoholics Anonymous (such as Overeaters Anonymous and Food Addicts Anonymous) are widespread, but their effectiveness is uncertain.

  • Conventional behavioral weight-reduction programs can help people lose weight and stop binge eating for a short period of time, but people tend to return to binge eating.

  • Surgery to treat severe obesity may be done, but its effects on binge eating are unclear.

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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