As the most common form of eating disorder in the United States, binge eating disorder affects two percent of the male population and as much as 3.4 percent of women at some point in their lives, according to NEDA. That makes BED more common than anorexia nervosa and bulimia nervosa combines. BED also stands out from other disorders in that it affects men more frequently, although it is still more common in women. As compared to anorexia nervosa, in which less than 10 percent of cases are male, BED cases are 40 percent men.
For a disorder that affects millions, the causes of binge eating disorder are still not completely understood. Like most mental health disorders, BED is likely a result of a combination of parenting and home environment, the presence of co-existing disorders like depression, genetics, and biological factors such as sex. Additionally, since BED was only officially recognized as an eating disorder in 2013, the eating disorder treatment community is still learning more about its causes and commonality.
Defining the Signs and Symptoms of Binge Eating Disorder
Before discussing treatment options and recovery, it is essential to define the signs of binge eating disorder and understand its potential health risks. Unlike the more well-known disorders anorexia and bulimia nervosa, BED doesn’t usually include restrictive or purging behaviors. The main behavioral symptom of binge eating disorder is the repeated pattern of eating large amounts of food, in short periods, beyond the point of being full. Some other behavioral symptoms to look out for include:
- Weight fluctuations, including weight gain and loss
- Hoarding and/or hiding food away
- Hidden food wrappers (or large amounts of them in the trash) indicating a binge eating episode
- Avoiding mealtimes or eating sparingly at them
- Eating past the point of being full
- Expressing a feeling of being fat or dissatisfied with their body
- Engaging in frequent or excessive dieting
- Social isolation
Binge eating disorder, when left untreated, can result in physical consequences that require medical attention that have to be treated in conjunction with the therapy. Because the binge eating episodes that define the disorder are not followed by purging behaviors such as vomiting, laxative abuse or excessive exercise that are associated with bulimia nervosa, people with BED may be in a larger body. Of course, this is not a hard and fast rule; some people with BED don’t gain significant amounts of weight, and BED may co-occur with another eating disorder or medical condition that prevents weight gain. Some of the health risks of untreated binge eating disorder include:
- Heart disease
- Sleep apnea
- Irritable bowel syndrome and other gastrointestinal problems
Studies have shown people with binge eating disorder have a higher risk of developing these kinds of physical issues, largely because the foods often eaten during an episode are “junk foods” with high fat and salt content. If you observe some or all of these behaviors in yourself or a loved one, it is better to explore treatment sooner rather than later, as the complications can be severe if left untreated.
Causes of Binge Eating Disorder
As mentioned earlier, the eating disorder treatment community can’t agree on a single cause for BED; it’s not like the measles or COVID-19 where a virus or bacteria causes it. As is common with most mental health and behavioral health disorders, it is generally thought a combination of factors can lead to BED. These can be broadly separated into three categories:
A person’s relationship with food and eating is influenced strongly by their parents’ attitudes about the same. Children who have a parent with BED or see binge eating disorder in a close relative or friend are much more likely to develop the disorder themselves. Even if the parents don’t have BED themselves, frequent criticism of a child’s weight or eating habits can negatively influence their body image and self-esteem. This may cause them to go on crash diets, setting the stage for secret binges to counteract their self-starvation and provide a dopamine boost that can become compulsive.
In some cases, certain forms of glandular or hormonal diseases can prompt the development of BED. For example, the hypothalamus gland can malfunction, leading to hunger even when full. The hypothalamus, a gland in the brain, controls the feeling of satiation, and when it works incorrectly, a person may lose the ability to feel full. People with dopamine and serotonin disturbances also have a higher risk of developing BED, as the binge eating episodes can trigger the release of these “feel-good” brain chemicals.
Binge eating is much more common in people who suffer from other kinds of mental health illnesses than in those who don’t. General anxiety disorder and similar disorders like OCD can prompt compulsive, repetitive behaviors, such as repeated binge eating episodes. BED sufferers frequently feel a sense of guilt or shame about their episodes, which can prompt further anxiety. Clinical depression also frequently co-occurs with BED, and may prompt people with BED to “eat their feelings” or engage in comfort eating.
Dieting, BED, and Self-Image
Although the symptoms of eating disorders vary, from the caloric intake restrictions of anorexia nervosa to the binge-and-purge cycle of bulimia nervosa, one symptom is almost always present: negative self-image. Body dysmorphia, or a sense of dissatisfaction with one’s body, often begins in childhood and early adolescence. This sense of being fat or otherwise unattractive or flawed is often contradictory to reality; as an example, people with anorexia nervosa who are dangerously underweight will still see themselves as “fat” and take steps to lose more weight.
A negative self-image is usually formed through several different factors. The pressures put on a child by their parents to lose weight, for example, can cause them to start seeing flaws every time they look in the mirror. It should be noted that the parents almost never want to make their child feel bad, instead having a genuine concern for their health. However, unless it’s clear that the child’s natural body shape can be healthy and beautiful, parents run the risk of inadvertently instilling a distorted body image.
It’s not simply parental influence on a person’s self-image, however. Especially as puberty comes into the picture and teenagers experience bodily changes and new socialization patterns, their peers’ opinions take precedence. This isn’t always bullying, i.e. someone calling another person fat, although that certainly does occur. More often, a person with body dysmorphic disorder will compare themselves to classmates that are popular or who they consider to be beautiful. In trying to match that person’s body shape or size, they may resort to dieting.
Another common precursor to most eating disorders is frequent experiments with dieting. Diet culture is thankfully facing more criticism than it has in the past, however, it is still pervasive in milieus from medicine to social media. A person with developing BED or body image is already struggling with the feeling that they are fat or unattractive; when they see the photoshopped images of a model on a magazine cover or a TikTok from a fitness professional, they take on an unrealistic expectation of what their body should look like. This leads to more dieting (and often excessive exercise), which leads to more binge eating episodes, and so on in a vicious cycle.
What Can I Do About Binge Eating Disorder?
Binge eating disorder recovery is difficult, but possible. The most important factor in treatment for BED is early intervention. Because mental health conditions left untreated tend to worsen over time, the disordered eating behaviors and body image struggles may increase unless steps are taken. This also leads to increased risk for the health complications noted above. It may be difficult for the individual with BED to reach out to a therapist or doctor themselves, as the feelings of guilt and shame that come with BED may make them want to hide the problem from others. Because of this, close friends and family may want to reach out to an interventionist or therapist to help. A gentle, non-judgmental discussion in private may also help.
When the individual has accepted that they need to seek help, it’s time to reach out to an eating disorder treatment facility, on a residential or outpatient basis. It is possible to prescribe appetite-suppressing drugs to stop the binge eating episodes, but no reputable center would do so – it just reinforces the negativity of diet culture and does nothing to address the underlying psychological causes of BED. A fully recovered lifestyle is only possible if the root causes and emotions are addressed through compassionate, understanding therapy from people who understand the journey to eating disorder recovery. Aside from stabilizing and medical and physical symptoms that may occur with BED, recovery programs generally focus on rehabilitating self-image and establishing a healthier pattern of eating – “healthy” meaning regular, nutritious meals and the cessation of binge eating episodes.
Techniques like cognitive behavioral therapy (CBT) are often used to address distorted body image. Through a number of sessions, clients engaging in CBT will identify disordered thoughts and feelings surrounding food and self-perception, and objectively explain to the therapist and themselves why they are distorted. This objectivity and mindfulness allow for a “remapping” of the brain over time, replacing negative attitudes with positive ones.
One of these positive attitudes is a better relationship with food and eating. Many people with BED see food as a kind of enemy –vacillating between dieting and binge eating makes people uncomfortable being around food in social situations. Breaking this cycle is possible by accepting themselves and their body – not ignoring a medically appropriate weight and nutritional balance but not putting undue pressure on oneself to meet an unrealistic goal of attractiveness.