Binge eating disorder

Last updated: March 14, 2023

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Binge eating disorder is an eating disorder characterized by recurrent uncontrollable binge eating episodes that occur at least once a week for 3 months. Binge eating episodes are associated with significant distress, without compensatory behaviors to counteract weight gain. Causes are multifactorial and similar to those of anorexia nervosa (e.g., genetic factors, psychiatric disorders, and psychosocial factors such as bullying). It is important to assess for malnutrition severity in affected individuals, regardless of body weight or body mass index (BMI). The diagnosis is confirmed if individuals fulfill all of the DSM-5 diagnostic criteria for binge eating disorder. Individuals should be evaluated for associated complications (e.g., comprehensive assessment of patients who are overweight or obese) and underlying conditions that may affect weight or cause a change in eating behaviors (e.g., thyroid disorder). Treatment is typically provided in an outpatient setting, but the presence of red flags in eating disorders may indicate the need for hospitalization. All individuals should be referred for psychotherapy (preferably cognitive behavioral therapy) and nutritional management, including binge eating prevention strategies. Pharmacotherapy (e.g., with antidepressants or lisdexamfetamine) may be considered to help reduce the frequency of binge eating episodes.

Epidemiological data refers to the US, unless otherwise specified.

The etiology of binge eating disorder is multifactorial and not entirely understood. Contributory factors are similar to those associated with anorexia nervosa; see “Etiology of Anorexia nervosa” for details. [3]

  • Genetic factors (family history is common)
  • Strict dieting and having access to preferred binge foods
  • Psychological issues (e.g., poor body self-image, stress, childhood bullying)

Approximately 25% of affected individuals experience suicidal ideation. [1]

General principles

DSM-5 diagnostic criteria [1][7]

DSM-5 diagnostic criteria for binge eating disorder [1][7]
  • Recurrent binge eating episodes, which are characterized by both of the following:
    • Consumption of an excessive amount of food within a given period of time (usually ≤ 2 hours)
    • Lack of control in relation to what and/or how much food is consumed
  • Episodes of binge eating are associated with ≥ 3 of the following:
    • Eating faster than normal
    • Eating until uncomfortably full
    • Eating large amounts when not hungry
    • Eating alone because of embarrassment over the amount of food eaten
    • Feeling of disgust, depression, and/or guilt after eating
  • Significant distress over binge eating
  • Binge eating occurs at least once a week over a 3-month period (on average).
All criteria must be fulfilled.

All individuals with binge eating disorder experience emotional distress about their binge eating, but not all individuals necessarily experience distress over their weight or appearance. [1][5]

Individuals with binge eating disorder often conceal their eating behaviors (e.g., by eating alone). [1]

Severity (according to the DSM-5) [1]

Based on the number of binge eating episodes per week

  • Mild: 1–3 episodes/week
  • Moderate: 4–7 episodes/week
  • Severe: 8–13 episodes/week
  • Extreme: ≥ 14 episodes/week

The differential diagnoses listed here are not exhaustive.

General principles [5][6][7]

Nutritional management [6]

Psychotherapy [6][7]

First-line therapy for binge eating disorder

Pharmacotherapy [5][6][7]

Research on pharmacotherapy for binge eating disorder has primarily involved adults, therefore, there are no clear recommendations for adolescents. [5][6]

The antidepressant bupropion lowers the seizure threshold and is contraindicated in individuals with a history of anorexia nervosa, bulimia nervosa, or purging behaviors, and those with seizure disorders. [6]

Weight reduction is a possible side effect of the binge eating disorder medications lisdexamfetamine and topiramate, although neither are specifically approved for weight loss. [5][6]

Management of patients with overweight or obesity [7]

Recommend binge eating prevention strategies instead of dietary restrictions (e.g., avoiding specific food groups, limiting calories), as restrictions can inadvertently increase binge eating. [6]

See “Complications of eating disorders.”

We list the most important complications. The selection is not exhaustive.

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association ; 2013
  2. National Institute of Mental Health: Eating Disorders. Updated: November 1, 2017. Accessed: October 9, 2020.
  3. Masheb RM, Grilo CM. Emotional overeating and its associations with eating disorder psychopathology among overweight patients with Binge eating disorder. Int J Eat Disord. 2006; 39 (2): p.141-146. doi: 10.1002/eat.20221 . | Open in Read by QxMD
  4. Davidson KW, Barry MJ, et al. Screening for Eating Disorders in Adolescents and Adults. JAMA. 2022; 327 (11): p.1061-1067. doi: 10.1001/jama.2022.1806 . | Open in Read by QxMD
  5. Hornberger LL et al. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2021; 147 (1). doi: 10.1542/peds.2020-040279 . | Open in Read by QxMD
  6. American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders. undefined. 2022 . doi: 10.1176/appi.books.9780890424865 . | Open in Read by QxMD
  7. Giel KE, Bulik CM, Fernandez-Aranda F, et al. Binge eating disorder. Nat Rev Dis Primers. 2022; 8 (1). doi: 10.1038/s41572-022-00344-y . | Open in Read by QxMD
  8. Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician. 2021; 103 (1): p.22-32.

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