The most common eating disorder you’ve never heard of

Despite being more common than anorexia nervosa or bulimia nervosa, binge eating disorder (BED) receives much less media attention. So, for World Eating Disorders Action Day, I'm bringing attention to BED.

What is binge eating disorder (BED)?
BED isn't a choice. It isn't a moral failing, and it's not a lack of "personal responsibility" or an "excuse" for a lack of self-discipline. BED is a psychiatric disorder that is associated with significant distress and reduced functioning at work and in relationships. In a nutshell, BED is regular binge-eating, at least once a week, for at least three months. Unlike bulimia nervosa, however, the binges occur without problematic behaviors like self-induced vomiting to compensate for the calories.

Despite the relative lack of media attention, BED is common. It is the only major eating disorder where a significant percentage of those affected are men: about 1 in 30 women and 1 in 50 men will get BED in their lifetime.  We don't know exactly what causes BED but early risk factors include childhood trauma and/or having obesity. For many with BED, emotional distress can trigger binge eating.

What qualifies as a binge?
Binging is different from overeating. Binging is an episode of significant overeating, often past the point of physical discomfort, in which an individual feels out of control and powerless to stop the binge. Binge eating can occur when someone isn't hungry and can be more rapid than normal eating. There is often tremendous shame around the binging, which often leads to people suffering in silence and secrecy. Unfortunately, people who eventually seek treatment for BED have typically suffered for many, many years in silence before seeking help.

How is BED different from obesity?
While BED is more common among those with obesity, the majority of people with obesity don't have BED, and you don't need to have obesity to have BED. Most people seeking bariatric surgery for weight loss meet criteria for BED, and those with BED are more likely to have poorer post-surgical outcomes, long-term. People with both BED and obesity have much higher rates of depression, anxiety, and other mental health issues than those with obesity but not BED. In addition to being a risk factor for other mental health issues, people with BED are more likely to get obesity and associated health problems.

How can I stop binge-eating?
In many cases, self-help is a reasonable first-line treatment.  The self-help book, Overcoming Binge Eating by Dr. Christopher Fairburn, is a good choice and is based on the most recent research on BED. If self-help is unsuccessful or not desirable, certain psychotherapies have been shown to be particularly effective in helping, and even curing, BED. Look for a therapist with expertise in eating disorders trained in cognitive-behavioral therapy (CBT) and/or interpersonal therapy (IPT).

Medication is also a way to treat BED though there is only one drug that is FDA-approved for this use: lisdexamfetamine dimesylate, a stimulant already approved for ADHD.  The drug has been associated with a reduction in number of binge episodes, but has not been shown to reduce weight or cure BED. Antidepressants may also help, but medication alone is unlikely to prevent recurrent binge eating over the long-term.

Three things to start today

If you are prone to binge-eating, here are three simple first-steps you can start today to help reduce binging.

Log your food consumption and mood on a daily basis. With the advent of smartphone apps such as Recovery Record, this has never been easier.

Eat regularly scheduled meals and snacks (e.g., three meals and three snacks per day). Don't skip any meals or snacks but don't eat between regularly scheduled meals and snacks. This won't prevent all emotional eating, but it will reduce, if not eliminate, binges triggered by hunger.

Identify any foods that seem to trigger binging. Remove these foods from your home and diet. Reintroduce them after you've been binge-free for at least several weeks.

Finally, binge eating is more about feelings than food.  Identify and address sources of chronic stress in your life. End hopeless relationships.

Stacey C. Cahn, PhD is associate professor of clinical psychology at the Philadelphia College of Osteopathic Medicine (PCOM). Dr. Cahn specializes in eating disorders, obesity, and cognitive-behavioral therapy.

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