Diseases & Conditions

Binge-eating disorder

Almost everyone overeats on occasion, having seconds or thirds of a holiday meal or devouring an entire bag of chips while watching a scary movie. Sometimes, though, overeating becomes a regular occurrence, shrouded in shame and secrecy. It's called binge-eating disorder, a serious eating disorder in which you frequently consume unusually large amounts of food.

When you have binge-eating disorder, you may be deeply embarrassed about gorging and vow to stop. But you feel such a compulsion that you can't resist the urges and continue binge eating.

Although binge-eating disorder is the most common of all eating disorders, it's still not considered a distinct condition. That may change as researchers learn more about it. Meanwhile, if you have binge-eating disorder symptoms, treatment can help you win back control and overcome secret shame.

When you have binge-eating disorder, sometimes called compulsive overeating, you regularly eat excessive amounts of food (binge). A binge is considered eating a larger amount of food than most people would eat under similar situations. For instance, you may eat 10,000 to 20,000 calories worth of food during a binge, while someone following a normal diet may eat 1,500 to 3,000 calories in a day.

The precise definition of a binge remains up for debate, though. A binge episode is typically considered to last about two hours. But the duration also is under debate, and some experts say binges can last an entire day.

You may have no obvious physical signs or symptoms when you have binge-eating disorder. You may be overweight or obese, or you may be of a normal weight. In fact, most obese people don't have binge-eating disorder.

On the other hand, when you have binge-eating disorder you often have numerous behavioral and emotional signs and symptoms. These may include:

• Eating large amounts of food
• Eating even when you're full
• Eating rapidly during binge episodes
• Feeling that your eating behavior is out of control
• Depression
• Anxiety
• Frequent dieting without weight loss
• Frequently eating alone
• Hoarding food
• Hiding empty food containers
• Feeling depressed, disgusted or upset about your eating

After a binge, you may try to diet or eat normal meals. But restricting your eating may simply lead to more binge eating, creating a vicious cycle.

If you have any binge-eating disorder symptoms, seek medical help as soon as possible. Binge-eating disorder usually doesn't get better by itself, and it may even get worse if left untreated.

When you have binge-eating disorder, your life may revolve around food and eating, making it difficult to enjoy normal activities and to live life to its fullest. You may frequently feel embarrassed and ashamed. And you may miss work or school and avoid social activities. If you're overweight or obese, you may develop serious health problems, such as diabetes.

If you have a primary care doctor, talk to him or her about your binge-eating symptoms and feelings. Or seek help directly from a mental health provider. If you're reluctant to seek treatment, try to work up the courage to confide in someone about what you're going through, whether it's a friend or loved one, a health care professional, a teacher, a faith leader or someone else you trust. They can help you take the first steps to successful binge-eating disorder treatment.

Helping a loved one with binge-eating disorder symptoms
If you have a loved one you think may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her.

Binge-eating disorder is not yet officially classified as a mental disorder, and not all experts think it should be. Mental health experts hope that ongoing research will determine if binge eating is a distinct medical condition, a nonspecific type of eating disorder, or simply a cluster of symptoms.

Binge eating is similar to bulimia nervosa, another eating disorder, and some experts think it may be a form of bulimia. But unlike people with bulimia, who purge after eating, people with binge-eating disorder don't try to rid themselves of the extra calories they consume by self-induced vomiting, overexercising or other unhealthy methods. That's why most people with binge-eating disorder are overweight. In fact, some experts say that binge eating may be a type of obesity disorder.

In any case, when doctors suspect someone has an eating disorder, they typically run a battery of tests and exams. These can help pinpoint a diagnosis and also assess any related complications.

These exams and tests generally include:

• Physical exam. This may include such things as measuring height and weight; assessing body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin; listening to the heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check such things as cholesterol levels, thyroid functioning, electrolytes and blood sugar, which may determine if you have metabolic syndrome.
• Psychological evaluation. A doctor or mental health professional will discuss your thoughts, feelings and eating habits with you. You may be asked about binge-eating symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar issues in the past. You may also be asked to complete psychological self-assessments and questionnaires.
• Other studies. Other studies may be done to check for health consequences of binge-eating disorder, such as heart problems, gallbladder disease or sleep apnea.

Criteria for diagnosis
All these evaluations help doctors determine if you meet the criteria for binge-eating disorder or if you may have another eating disorder, such as bulimia. The criteria to diagnose mental health conditions are set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

The DSM says more research is needed before determining whether binge-eating disorder is truly a unique medical condition. However, it offers some criteria for diagnosing binge-eating disorder.

DSM diagnostic criteria for binge-eating disorder include:

• Recurrent episodes of binge eating, including eating an abnormally large amount of food and feeling a lack of control over eating
• Binge eating that's associated with at least three of these factors: eating rapidly; eating until you're uncomfortably full; eating large amounts when you're not hungry; eating alone out of embarrassment; or feeling disgusted, depressed or guilty after eating
• Distress about your binge eating
• Binge eating occurs at least twice a week for at least six months
• Binge eating isn't associated with inappropriate methods to compensate for overeating, such as self-induced vomiting

Some people may not meet all of these criteria but still have an eating disorder. As researchers learn more about eating disorders, the diagnostic criteria may evolve and change. Don't try to diagnose yourself — get professional help if you have any eating disorder symptoms.

The goals for treatment of binge-eating disorder are to reduce eating binges, improve your emotional well-being and, when necessary, to lose weight. Because binge eating is so entwined with shame, poor self-image, self-disgust and other negative emotions, treatment needs to address these and other psychological issues.

There are four main types of treatment for binge-eating disorder.

Psychotherapy
Psychotherapy, whether in individual or group sessions, can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. But definitive scientific research about the benefits of psychotherapy remains lacking. Some studies do show that a few types of psychotherapy may be helpful, including:

• Cognitive behavioral therapy. Some studies show that cognitive behavioral therapy may help you cope better with issues that may trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and eating patterns. However, cognitive behavioral therapy hasn't been shown helpful in reducing weight. So if you're overweight, you may need additional treatment.
• Interpersonal therapy. Interpersonal therapy focuses on your current relationships with other people. This may help reduce binge eating that's triggered by poor relationships and unhealthy communication skills. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and colleagues. You learn how to evaluate the way you interact with others and develop strategies for dealing with relationship and communication problems.
• Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.

Medications
There's no medication specifically approved by the Food and Drug Administration (FDA) to treat binge-eating disorder. And research results about the effectiveness of medications to treat binge-eating disorder have been mixed. Some studies show that combining therapy with medications may be more effective than either treatment alone. But more studies are needed before drawing firm conclusions. However, some studies show that several types of medications may be helpful, including:

• Antidepressants. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be helpful for binge eating. It's not clear how these can reduce binge eating, but it may be related to how they affect certain brain chemicals associated with mood.

  Be aware that all antidepressants have potentially harmful side effects. In particular, antidepressants have an FDA-mandated black box warning about their possible connection to increased thoughts of suicide. If you take antidepressants, you must be carefully monitored for such thoughts, especially when you first start treatment or have any changes in dosage.

• The anticonvulsant topiramate (Topamax). Normally used to control seizures, topiramate has also been found in some studies to reduce binge-eating episodes. However, it can cause serious side effects, including blurred vision, double vision, clumsiness or unsteadiness, dizziness, drowsiness, and trouble in thinking.
• The anti-obesity medication sibutramine (Meridia). Officially included in the group of antidepressants known as serotonin and norepinephrine reuptake inhibitors (SNRIs), sibutramine has been FDA approved for long-term obesity treatment. Sibutramine may be most helpful if you have binge-eating disorder and are obese. It's been found to suppress hunger and make you feel full, leading to weight loss. However, it can cause dangerous changes in your blood pressure and other side effects.

Behavioral weight-loss programs
More so than psychotherapy, weight-loss programs focus on losing excess body weight. They're typically conducted under medical supervision to ensure that your nutritional requirements are met. Some programs are known as very low calorie diet programs because they include an initial period of strict calorie restriction for fast weight loss.

Weight-loss programs may also address issues that tend to trigger binges, but often to a lesser extent than psychotherapy does. However, weight-loss programs, especially those that are not medically supervised, may not be appropriate for everyone with binge-eating disorder. And such programs typically aren't recommended until the binge-eating disorder is treated. Very low calorie diets can trigger more binge-eating episodes making the condition worse.

Self-help strategies
Some people with binge-eating disorder find self-help books, videos and support groups effective. Some eating disorder programs offer self-help manuals that you can use on your own or with guidance from mental health experts. Self-help strategies may not be effective on their own, though. You still may need professional treatment with psychotherapy or medications.