Picture those moments when stress hits hard, emotions run high, or boredom sets in—suddenly, the cookies disappear faster, or a bowl of ice cream becomes an entire pint. Usually in these instances, we might feel physically full, but it passes quickly, and we move on and let it go. More importantly, it’s not a pattern.
Binge eating is different from occasional overeating. “People with a binge eating problem may continue eating long after feeling full, and they often feel distressed about their eating and about body shape and weight,” said Lisa Ranzenhofer, PhD, a clinical psychologist and researcher at the Columbia University Center for Eating Disorders.
If binge eating becomes a persistent pattern that is distressing or interferes with daily functioning, it may be indicative of binge eating disorder, or BED, an eating disorder that can have physical and psychological health consequences without professional intervention and support, she said.
The National Eating Disorders Association’s annual campaign runs this year from Feb. 26 to March 3. Learn about eating disorders, raise awareness, and share information and resources. Join the conversation using the hashtag #NEDAwareness.
Columbia Psychiatry News spoke with Dr. Ranzenhofer about distinguishing binge eating from binge eating disorder, the prevalence of BED, possible causes and treatments, and strategies for parents who suspect their teen is struggling with binge eating or other disordered eating patterns.
How can you tell if binge eating indicates a more serious disorder?
The line between overeating, binge eating, and binge eating disorder can be a fine one, but there are some important distinctions. Most people overeat occasionally—think Thanksgiving—and binge eating also tends to happen infrequently. Afterward, there may be a sense of guilt or regret, but the behavior doesn’t dominate one’s thoughts or significantly disrupt daily life. Binge eating disorder involves chronic and distressing episodes of binge eating that occur regularly and persist over time, usually at least once a week for three months or more. With BED, episodes of binge eating often include eating quickly, eating until uncomfortably full, and eating when not physically hungry. The bingeing tends to happen alone or in secret, and afterward people may struggle with feelings of shame, guilt, or low mood. Ultimately, the key difference between binge eating and a serious disorder lies in the frequency, intensity, and impact of the binge eating behavior on one’s life and well-being.
How common is binge eating disorder?
The National Institutes of Mental Health estimates 1.6% of adult women and 0.8% of adult men have binge eating disorder, more than double the number of people diagnosed bulimia and anorexia combined. Approximately 2.8% of adults in the United States will experience binge eating disorder at some point in their lives. Despite its prevalence, BED often flies under the radar, overshadowed by more well-known eating disorders.
Does sporadic bingeing typically develop into binge eating disorder?
Occasional binge eating does not always progress to binge eating disorder, but it can be a risk factor for its development. Studies show that children who feel out of control with eating (regardless of how much food) are at higher risk of developing binge eating disorder as teenagers, so addressing this behavior early on can help prevent the development of eating disorders. It is important to note that binge eating in itself is not an eating disorder. It’s a discreet behavior that can go along with any eating disorder. Binge eating also occurs as part of bulimia nervosa, defined as at least once weekly binge eating followed by compensating for calories eaten, often by purging. Many patients with anorexia nervosa also experience binge eating as part of their illness interspersed with purging or long periods of little food intake.
What causes binge eating disorder?
BED is a complex and multifaceted illness, involving a combination of genetic, biological, psychological, environmental, and social factors. While the exact causes may vary from person to person, common contributors may include:
A family history of eating disorders or other mental health conditions
Psychological factors, such as low self-esteem, perfectionism, or a history of trauma
Chronic dieting or restrictive eating behaviors, which can disrupt normal hunger cues and lead to episodes of binge eating as the body attempts to compensate
Negative body image or dissatisfaction with one’s appearance can fuel feelings of shame or guilt around food, exacerbating binge eating behavior
Stressful life events, unresolved emotional issues, or difficulties coping with emotions
What are the best strategies to reduce binge eating behavior?
The best approach to addressing binge eating can depend on the specific eating disorder, as well as factors unique to the individual. For those restricting their eating, especially if this has led to extreme weight loss, addressing the restriction and/or malnourishment is always the first step. Presuming the individual is in an appropriate weight range, targeting the behavior first by setting up a regular, predictable, and sufficient pattern of eating—for example, three meals and two to three snacks at regular times each day—can be helpful for breaking a pattern of binge eating and restriction. Cognitive behavior therapy can be very useful for this step and for continuing to work on other thought patterns and emotions, such as negative thoughts about one’s body. In some cases, some types of medication can be helpful when still struggling after trying a behavioral approach first.
What should parents do if they suspect their teen is bingeing or begin to notice disordered eating patterns?
Eating disorders are not about choice. In many cases, if your teen is binge eating, they are likely already feeling bad about it and criticism can lead to increased secrecy. Talk with your teen if you suspect they are struggling with binge eating. Rather than say you’re concerned with their health or weight, say that you know that this pattern of eating stresses them out. For some families, the doctor’s office can be a good starting point; however, it is possible that some doctors may not fully understand binge eating, exacerbating myths about willpower and feelings of shame. Or, if your teen is of a healthy weight, binge eating may be more likely to go unaddressed even if it is highly distressing. A specialized eating disorder treatment provider can often help you figure out if binge eating is something to be concerned about while creating a safe and supportive atmosphere.
Binge eating is not anybody’s fault, and it is not about willpower. There is usually a “perfect storm” of biological, physiological, environmental, and psychological factors that intersect to lead to binge eating, and there are treatments that can help.
