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Equip: What is BED?

Binge eating disorder (BED) is the most common eating disorder in the US. People with BED engage in repeated episodes of binge eating, or eating a large amount of food quickly while feeling out of control. Unlike bulimia, people with BED don’t throw up or engage in other purging behaviors after binging.

Binge eating disorder is not a choice or a lack of willpower. BED, like all eating disorders, has complex neurological and biological underpinnings, which is why we refer to it as a brain disorder. Social and environmental influences—like social media, family dynamics, and diet culture—can play a role, but they’re never the one “cause” (nor is anything else). BED, and all eating disorders, emerge out of a perfect storm of different factors.

BED has serious short- and long-term health consequences, but lasting recovery is possible with the right treatment.

Signs and symptoms of binge eating disorder

Many people brush off the symptoms of binge eating disorder as not having enough “discipline” or “willpower.” This mentality ignores the fact that BED is a serious mental health condition that requires professional treatment.

Binge eating disorder can have significant negative effects on physical, mental, and emotional health, as well as greatly reduce quality of life. Learning to recognize the symptoms of BED—whether it’s in yourself or a loved one—is the first step toward getting the help necessary to recover.

Physical symptoms
  • Weight changes
  • Lack of energy
  • Stomach cramps or other gastrointestinal complaints, like constipation or acid reflux
  • Thinning or loss of hair
  • Consuming large amounts of food in a short period of time
  • Evidence of binge eating, including large amounts of food disappearing of empty food wrappers and containers
  • Frequent dieting, often without weight loss 
  • Eating until feeling uncomfortably full
  • Eating without feeling hungry
  • Stealing or hoarding food in strange places
  • Avoiding eating in public or with others
Psychological and behavioral symptoms
  • Experiencing shame or guilt after eating
  • Feeling fearful or uncomfortable eating in front of others
  • Low self-esteem
  • Social withdrawal
  • Creating routines or rituals to make time to binge sessions
Body image symptoms
  • Being highly critical of body shape of weight
  • Frequently checking weight
  • Wearing loose clothes
  • Pinching areas to check for "fat"

 

The binge-restrict cycle

While they may seem like polar opposites from one another, binge eating and restrictive eating are two sides of the same coin. These behaviors often go hand-in-hand, with one fueling the other, in a pattern known as the binge-restrict cycle. The binge restrict cycle is common and even normalized in our society (think about “saving up” calories for a big meal), but when it happens consistently, it can lead to an eating disorder.

What is bingeing?

A binge is when a person eats an objectively large amount of food in a short amount of time. Eating an extra slice of cake or going back for a third serving of pasta isn’t a binge—binges are distinct psychological events with specific characteristics.

Someone who’s engaging in a binge may feel like they’re unable to control how much they’re eating, and even have the sense that they’re outside their body while the binge is occurring. During a binge, a person typically continues to eat after they feel full, often to the point of extreme physical discomfort. Episodes of binge eating are almost always followed by intense feelings of shame or guilt and significant emotional distress.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), binge eating episodes are defined by two things²:
  1. Within a 2-hour period, eating an amount of food that is definitely larger than most people would eat under similar circumstances
  2. Feeling a lack of control over eating during the episode

Episodes of binge eating are also associated with other characteristics, including:

  • 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 being embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty after overeating

How the cycle works

The binge-restrict cycle refers to periods of restricted eating followed by episodes of binge eating. Restriction is when you ignore your body’s hunger cues and eat very little, or nothing at all. A binge is when you eat an objectively large amount of food in a short span of time, often past the point of fullness and with a sense of not having control. 

The binge-restrict cycle is a natural consequence of not listening to your body’s needs. When you restrict food—either by not eating, eating very little, or not allowing yourself of the foods you really want—you deprive your body of the nutrients and energy it requires to function. Your body then tries to communicate to you that it needs nourishment. One of the ways it does this is by producing a hormone called ghrelin, known as the “hunger hormone,” which stimulates your appetite. As you continue to restrict, more ghrelin is produced, causing your hunger to grow to a point where it takes the wheel. When you look at it this way, binge eating is a natural evolutionary adaptation: your body thinks you’re starving, and so when it finally gets food, it tries to consume as much as it can.

But it’s not just that binges tend to inevitably follow periods of restriction; restriction can also be a common response to a binge. That’s because binges are almost always followed by intense feelings of guilt and shame (which can be compounded by diet culture messages that tell us that restriction is an accomplishment and eating is a failure), and these feelings can lead to more restriction. The restriction can serve to “make up for” the food eaten during the binge, or even as a self-imposed punishment for binge eating. Either way, the cycle continues. 

Though the binge-restrict cycle most commonly shows up in binge eating disorder and bulimia, it’s also present in some forms of OSFED, and the anorexia binge-purge subtype. 

The 4 stages of the binge-restrict cycle

There are four stages of the binge-restrict cycle. They all exist in relation to one another, with each stage fueling the one that follows and making it nearly impossible for you to establish normal, healthy eating habits without help.

Restriction

You restrict your food intake, which can take the form of fasting, skipping meals, avoiding certain foods or entire food groups, or eating much less than your body needs.

Craving

The restriction triggers intense cravings or extreme hunger.

Bingeing

Your hunger becomes too much to ignore, and you eat an excessive amount of food in a short period of time. This is your body’s attempt to make up for the earlier restriction. 

Guilt

Once the binge is over, you experience intense feelings of guilt, shame, and other hard emotions. Those emotions then lead you to restrict yet again. 

Risks and complications of BED

When left untreated, BED can have a serious negative impact on physical health, mental health, and overall quality of life.

Physical health risks of BED
  • Increased risk for diabetes, high blood pressure, high cholesterol, and some kinds of cancer
  • Gastrointestinal issues, like bloating, cramping, nausea, vomiting, or constipation
  • Acid reflux
  • Lethargy
  • Gallbladder disease
  • Arthritis
  • Insulin resistance
  • Sleep apnea
  • Musculoskeletal problems
 Mental health risks of BED
  • Increased risk for psychiatric illnesses, particularly depression, anxiety and substance use disorder
  • Low self-esteem
  • Social withdrawal and isolation that interferes with interpersonal relationships
  • Decreased productivity and motivation at work, school, or home

Common questions about binge eating disorder

What are the causes of binge eating disorder?

As frustrating as it is, there is rarely one identifiable cause of an eating disorder, and binge eating disorder is no different. More often than not, it is a constellation of neurobiological and environmental factors: in other words, someone has a genetic predisposition to developing an eating disorder, and then the eating disorder is “turned on” by environmental factors. Some factors that can contribute to the development of binge eating disorder include depression, an increased sensitivity to dopamine, and childhood bullying. Poor body image and dieting are also risk factors for BED. Learn more about the causes of eating disorders on our blog.

What does binge eating disorder treatment look like?

Treatment for binge eating disorder focuses on identifying factors that increase risk of engaging in eating disorder behaviors and introducing tools and skills to stop behaviors. Once the patient has made progress with normalizing eating behaviors, treatment may shift to other areas, like co-occurring conditions, handling triggers, and relapse prevention.

To accomplish all this, our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).

What is the definition of a binge?

Though the specifics of a binge will look different from person to person and circumstance to circumstance, there are some defining criteria. A binge is defined as an episode of eating in which a person eats a large quantity of food while feeling a lack of control. This often means eating past the point of fullness until uncomfortable, eating extremely quickly, eating alone, and feeling shame after eating.

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