Binge Eating Disorders Treatment

Binge Eating Disorders Treatment

Overcoming Night Time, Compulsive, and Over Eating Disorder

Treatment Experts on the Latest Research, Best Practices and Treatment Options – October 2015

In regard to eating disorders, anorexia and bulimia are generally the first disorders that come to mind. Binge eating disorder, or BED, is even more common than anorexia or bulimia, and it can be incredibly debilitating for those who suffer from it. BED is also known as compulsive overeating.
Binge eating disorder (BED) is a mental health disorder characterized by overeating or eating too fast with a feeling of no control over one’s eating habits. To be classified as BED, episodes must occur at least once a week over three months as a result of emotional reasons or an unexplained drive to eat, regardless of hunger. Individuals often experience guilt, embarrassment, depression and disgust as a response to their own binge eating behaviors.

The conventional definition of binge eating is consuming more food in a short period of time than a person typical – to the point of being uncomfortably full. It’s a common condition. This is not to be confused with the definition of the disorder of binge eating as stated in the DSM-5.

Just about everyone has overeaten on occasion, such as at a party or on other special occasions. For those who are struggling with BED, overeating becomes chronic, feels out of the person’s control, and is accompanied by feelings of guilt, embarrassment, and self-loathing or disgust. Complicating the issue is that the person often hides or eats alone, so other people don’t see or recognize that the individual is binge eating. Because people don’t tend to admit to their binge eating habit, it can be hard to get an accurate understanding of exactly how many people are affected.

binge eating response

Nevertheless, it is possible to treat BED. As with many addictions, people who struggle with compulsive eating can learn to manage their symptoms and cravings through various physical and psychological therapies that enable them to understand, monitor, and control the triggers for binge eating incidents, as well as work through the underlying factors that may contribute to their compulsions to binge eat.

What is Binge Eating?

The diagnostic criteria below can help determine whether or not a person is suffering from compulsive overeating

Signs and Symptoms of Binge Eating Disorder

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – the standard used to identify and diagnose mental health disorders in the United States – updated the status of BED to be its own specific disorder, whereas it was previously considered one of a number of nonspecific eating disorders. Unlike with bulimia, people who suffer from BED do not take actions to counter their episodes of binge eating. As defined by DSM-5, the signs and symptoms of BED include:

Repeated incidents of overeating, which can include:

  • Eating much more food in a short period of time than one typically would
  • Feeling that one has no control over the amount one eats
signs and symptoms of binge eating
Incidents of eating that may involve :

  • Eating faster than is typical
  • Eating to a point of discomfort
  • Overeating even when not hungry
  • Eating alone because of embarrassment about overeating
  • Feeling guilty, depressed, or disgusted with oneself about eating too much
  • Extreme emotional response about overeating
  • Episodes of binge eating that occur at least once a week over three months
  • Binge eating without resorting to countering actions, such as vomiting or exercising

The Causes of BED

The causes of BED are not completely understood; however, factors that contribute to this condition can be emotional, mental, social, or genetic, among others. Some research has shown that BED can be associated with both physical and mental health challenges that lead to dysfunctional behavior and loss of productivity. However, it is still not known entirely whether these occur first, or if the tendency for BED comes first and causes these issues. Occurrence of BED has also been strongly associated with child abuse or other trauma in the individual’s past, and often is related to post-traumatic stress disorder (PTSD).

In many cases, while it may not be possible to determine which issue came first, the conditions often become inextricably linked over time, requiring both to be resolved in order to avoid relapse of either.

Further Reading

Co-Occurring Disorders

Treating Depression

Co-Occurring Issues
In fact, perhaps because of these correlations, BED often co-occurs with other psychological diagnoses, such as depression, anxiety, schizophrenia, or other disorders, requiring that treatment be implemented toward both the eating disorder and the other condition.

Complications of BED

The co-occurrence of other psychological conditions in combination with BED may be an underlying factor for BED, whether or not the eating disorder came before the other condition. No matter the cause, a range of psychological conditions have been shown to be prevalent in people with eating disorders, with the highest levels of psychological comorbidity occurring in women with BED, compared with men.
Psychological challenges that may complicate or otherwise co-occur with BED include:

  • Depression
  • Anxiety
  • Bipolar disorder
  • Schizophrenia
  • OCD
  • Insomnia
  • PTSD

Physical illness or other disorders may also co-occur with BED, either alongside the eating disorder or, more commonly, resulting from the physical issues that may arise from compulsive overeating, such as obesity.

Further Reading

Food Addiction

Behavior Addictions

These types of physical illnesses include:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Gall bladder disease
  • Joint problems
  • Liver or kidney disease

The co-occurring conditions can add to the underlying issues that contribute to BED, creating a cycle that can be hard to break. For example, a person struggling with BED may gain excess weight and become embarrassed or upset about the weight gain, which in turn leads to a worsening of depression symptoms, triggering more bingeing, which then results in further weight gain. Because of this cycle, treating both issues of the dual diagnosis is the most effective way to help the individual achieve a more effective recovery.

Correlation of Obesity and Binge Eating Disorder

Because BED does not involve compensatory behaviors like those that occur with bulimia, such as purging, people who are struggling with this condition may have an issue with excessive weight – up to two-thirds of those with BED are also obese. This increases the possibility of other co-occurring physical conditions that can result from obesity, such as high cholesterol, osteoarthritis, type 2 diabetes, and heart disease, among others.

It cannot be said that anyone who is overweight or obese is dealing with BED. Obesity is considered a medical illness, while BED is a psychiatric disorder, and it is perfectly possible for an obese person to have a healthy mental attitude toward food. It is also possible for a person to be at a healthy weight or mildly overweight and still have issues with compulsive overeating.

In fact, about 30 percent of the participants in weight loss programs have symptoms meeting the BED diagnostic criteria. For this reason, it cannot be assumed that someone who is not obese does not have BED.

obesity binge eating connection

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Treatment for BED

There are multiple avenues for determining whether someone has BED and a number of treatments that can help people gain control of their compulsive eating. They can be pursued whether or not a person is aware of a struggle with BED – as with many addictions, people who exhibit BED behaviors may not be aware they have a problem. However, the following topics can raise awareness in both clinical and personal settings, and offer options to help manage chronic bingeing.

Testing and Assessment

There has been much research into finding methods that accurately diagnose BED. There are no specific medical tests for the condition, but a combination of other assessments can help in diagnosing individuals who may be struggling with this disorder.

testing assessment
The first and most straightforward methods include interview screenings and self-assessments that can help identify the behaviors and attitudes associated with binge eating as a disorder rather than an occasional behavior. Tests such as the eating disorder examination interview (EDE) and related self-assessment questionnaire (EDE-Q) are considered to be helpful in identifying people who may be struggling with BED. However, they have some limitations, such as being long and cumbersome, and they are not always accurate in the information they convey. In particular, they were developed before BED was designated as a specific disorder, rather than a general eating disorder. The binge eating scale (BES), on the other hand, is a more specific self-assessment that has been shown to be accurate in discovering true cases of compulsive overeating.
Another type of testing that can help provide information about people who have BED rather than just an occasional binge eating event is hormonal. There are indications that various hormones connected to appetite, hunger, and stress have correlations in people with BED; these hormones include digestive hormones such as leptin and ghrelin, and stress hormones like cortisol. People with BED are also likely to have a larger stomach capacity in combination with hormone imbalances. Blood or saliva tests to measure hormonal factors can help to determine whether an eating disorder is present.
In addition, there is a correlation between people who have adrenal insufficiency and those who have issues with binge eating. When the adrenal glands don’t work properly, they don’t release enough cortisol – a hormone that helps provide energy during stress. If the body doesn’t have enough cortisol, the brain can’t get energy and signals the body to get more food. This can be part of the reason for binge eating events, as the person is stressed and continues to eat while the body is unable to process the food into sugars for the brain, leading to overeating.

Interestingly, sleep assessments can also help to screen for BED. Night eating patterns have been found to be correlated with testing on the binge eating scale (BES), and in particular a disorder called night eating syndrome is highly correlated with BED. Assessing night eating behaviors can help uncover symptoms of BED that may not otherwise be obvious.

These tests in combination can be extremely helpful in assessing suspected cases of BED while ruling out other eating disorders or non-disordered obesity.


A variety of treatments have been shown to have value in treating BED. Some medical treatments are available, and some medicines are being tested and used for treatment. Still, for the most part, psychological treatments of various kinds have had the most positive effect on the behavioral patterns of those struggling with BED.

Cognitive Behavioral Therapy (CBT) can help treat the psychological aspects of many compulsive behaviors, including compulsive eating. CBT is a method that helps individuals observe, recognize, and develop strategies in response to the situations that may cause them to binge eat.

Psychological treatments of various kinds have had the most positive effect on the behavioral patterns of those struggling with BED

treatment therapies bed

One type of CBT is particularly tuned to people who may have suffered some sort of trauma that contributes to the emotional aspects of their compulsive overeating. Trauma-focused CBT (TFCBT) has specifically been noted for helping people feel a qualitative reduction in their PTSD symptoms, which reduces some of the underlying symptoms that can contribute to chronic binge eating.

Another form of CBT that can help people become aware of the triggers of their undesirable behaviors, and then analyze and apply alternative responses that prevent them from repeating the undesired behaviors. This type of therapy can significantly reduce binge eating by the time treatment is over, but may need other supportive therapies to help maintain recovery in the long-term after treatment ends.

This support may find a form in Motivational Interviewing (MI), which is a post-therapy method that provides occasional interventions after treatment is over to remind individuals of their work in an attempt to help them maintain motivation.

Interpersonal Therapy
In addition, using interpersonal therapy (IPT) can help people build the support structures that can help them maintain their recovery and avoid binge eating. This therapy helps people improve their social connections and their self-esteem, which can in turn reduce the frequency of binge eating by removing some of the emotional triggers that can result in a binge event. IPT has long-term outcomes that are comparable to those of CBT, making it a preferred treatment modality for BED.

Teaching Good Eating Habits

Education about eating awareness – also known as mindful or attuned eating – can benefit people with BED by showing them how to be more aware, not only of when and how much they eat, but what their mental state is before and during eating. This mindful thoughtful process encourages individuals to pay attention when they have cravings or feel hungry, and to first explore the nature of their hunger before they decide to eat. If they do decide that hunger is authentic, they then pay attention while they are eating, again exploring their hunger cues and emotions to help them stop before they overeat.

This method has been shown to be even more likely than CBT to help people with their BED. In fact, a study showed that for up to four months post-treatment, about 95 percent of people treated using this method no longer met the criteria for BED.

attuned eating


exercise and activity bed
In combination with behavioral therapy, exercise and activity provide a supportive benefit in helping people control their BED. Physical activity – particularly aerobic activity – helps to reduce symptoms of depression that can arise and co-occur with BED, as well as enables individuals to reduce the number of their binges.

Yoga also showed promise in providing support for psychological treatments in reducing binges. As an added benefit, both aerobic exercise and yoga helped people reduce their body mass index (BMI) for improvement in co-occurring obesity. In other words, these activities help people to reduce both the frequency of their binges and their weight.

These therapies don’t just provide a physical benefit; they can also boost the individual’s moods and self-esteem, which is helpful in reducing the triggers of bingeing events.

Treating Comorbidity

Because other disorders and medical issues often co-occur with BED, the ability to manage dual diagnosis cases is important in programs designed to address BED. In many cases, treating one of the disorders can significantly help treatment of the other issue.

For example, in the case of a person who has BED and another psychological disorder such as depression, treating one can significantly effect the other. Some BED treatments, such as behavioral therapy or an exercise regimen, can help to reduce depression. On the other hand, both medical and therapeutic treatments for depression can help a person avoid some of the triggers of BED.

Physically, treating BED can often help obesity, along with other disorders and medical illnesses. Although not all people who recover from BED are able to lose weight, many are able to, and others are at least able to stop gaining weight.

Treating Comorbidity BED
This, in turn, can have an effect on the medical issues that accompany BED and obesity, such as diabetes, hypertension, and osteoarthritis. In turn, treating physical issues may help to manage the symptoms of BED. In cases where physical conditions may contribute to the emotional issues that can underlie BED, it may be possible to help these individuals begin to control their cravings and binge eating events.

Statistics, Facts, and Data

binge eating disorders statistics

Frequently Asked Questions

Is being overweight a sign of binge eating?

While obesity and BED do often co-occur, being overweight or obese does not necessarily mean someone has BED. Obesity is sometimes a result of chronic binge eating, but some people can be overweight and not have BED; at the same time, some people can have BED and not be overweight.

People who have BED are more likely to be obese than people who have typical eating patterns. Among people who seek weight control treatment, the number who have BED can be as much as 30 percent. Nevertheless, people who are obese can have a healthy relationship with food, while some people who are not overweight or not significantly overweight can have BED.

Why am I always hungry?

For people with BED, one of the causes of the uncontrollable need to eat can be a chemical imbalance – specifically in the hormones that regulate hunger and the drive to eat. When these chemicals are out of balance, the brain can send messages to the body that the body needs food even though it doesn’t.

This imbalance can be the result of several factors, one of which is adrenal insufficiency, where the adrenal glands don’t make enough of the hormone cortisol; other chemicals that regulate hunger are leptin and ghrelin, both of which have been shown to be unbalanced for some people who are experiencing BED.

Whatever the cause, the end result is that the imbalance of these chemicals causes the brain to send signals to the body that it needs more food. The result is that the individual feels some degree of desire to eat, ranging from cravings to hunger, all the time – even when the person is already full.

What does low cortisol mean?

Cortisol is a hormone that is released from the adrenal glands as part of the stress response. A correlation has been found between people who have low cortisol levels and BED. During the stress response, cortisol helps to deliver energy to the brain to help manage the stress; if the body is not producing enough cortisol, the brain may not get the energy it needs, resulting in it triggering a hunger response that makes the individual eat even when they already have enough food in their body. This is also referred to as adrenal insufficiency.

Because of this, treating adrenal insufficiency may help in decreasing the desire to binge for people with BED. Testing cortisol levels can also help to determine whether someone who is exhibiting symptoms of compulsive eating fully meets the diagnostic criteria for BED.

What happens to my fat cells when losing weight?

When people lose weight, they don’t lose fat cells. Instead, the fat cells they have in their bodies shrink. When a person eats more food than the energy used by the body, the extra energy gets stored in the fat cells, which then expand to hold the excess in the form of chemical bonds in a substances called triglycerides; this is what causes weight gain. When weight is shed, these cells simply lose the excess energy they are carrying and shrink. As with other cells throughout the body, fat cells die and are replaced many times over a person’s lifetime. Between 8-10 percent of fat cells are replaced in the body every year.

Generally, the number of fat cells a person has is settled in adolescence. People who are obese in childhood can end up with more than twice as many fat cells as people who aren’t, and their fat cells may be larger than those of people who are not obese, too. However, even with people who are obese, the number of fat cells in their bodies are constant through adulthood, and the rate of cellular replacement is the same as for those who are not obese, no matter how much weight they lose or gain.

How can I stop binge eating and lose weight?

Because BED is a psychological condition, overcoming binge eating is not just a matter of deciding to stop or exerting willpower. Instead, getting medical and psychological treatment for eating disorders provides the methods most likely to help people get control of their compulsive eating and maintain long-term recovery from BED. When this happens, it is often the case that people are also able to lose weight and become healthier.

Finding a treatment program designed specifically to treat BED as separate from other eating disorders is the most helpful way for people to learn to manage their disorders. In particular, a residential program that provides research-based medical and psychological interventions is most likely to help a person recover from BED and maintain healthy eating habits.

It is important to keep in mind that the main goal of this treatment is to recover from BED. Research shows that approaching treatment as a weight loss plan – referred to as behavioral weight loss – is not as effective as CBT, DBT, or IPT in reducing binge eating. These other therapies treat the whole condition, making it easier to gain control over the relationship with food, which may then lead to weight loss.

Can prediabetes be reversed?

Studies have shown that for people diagnosed with prediabetes, losing approximately 10 percent of their body weight can help them reverse that diagnosis. However, this may not be enough to overcome some of the other risks of prediabetes and obesity. Along with losing weight, exercise and healthy eating habits can help lead to long-term reversal of the health issues that can arise through or co-occur with BED.

For this reason, it is helpful to introduce activity and nutritional education as part of the treatment for BED. Getting exercise and learning to eat healthier meals, in combination with the psychological therapies that can help reduce cravings and binge eating episodes, can help reverse prediabetes and lower the risk of the additional medical complications that may arise, with or without diabetes.

Does alcohol slow metabolism?

Contrary to popular opinion, consumption of alcohol does not slow metabolism. In fact, in moderate consumption, alcohol can increase energy use by the body.

However, this does not mean it can help in weight loss. Alcohol does not get stored in the body as fat, but it does suppress the use of the fat already stored by the body. In particular, while drinking alcohol does not seem to directly affect weight gain in people who are not overweight, it can contribute to further weight gain in those who are already overweight. This potentially accounts for the perception that alcohol consumption slows metabolism and stalls weight loss.

Does eating at night cause weight gain?

Eating at night, on its own, does not cause weight gain. There is a popular myth that the calories consumed at night cause weight gain because they are not burned during sleeping hours. However, this is not the case.

The human body is always burning calories. Calories are required for all bodily functions, including breathing, circulation, brain function (including dreaming), and other automatic physical processes that take place even when we’re not thinking about them.

However, when it comes to BED, bingeing at night can be an issue. A person who has an uncontrollable urge to eat excessive amounts of food at night – especially in order to hide their eating habits from others – may be dealing with compulsive overeating. In fact, there is a strong correlation between people who have issues with night eating syndrome and BED.

Does the heat affect eating habits?

Psychologists are hesitant to say that weather doesn’t affect eating behaviors. Biologically, our body functions seem to support the idea of eating more in colder weather to manage lack of food availability, and less in hot weather due to rich food availability.

Nevertheless, our conscious brains are able to overcome the instinctive drives related to eating based on the season because of modern conveniences. Because of this, we don’t have to relegate our eating habits to some primordial or seasonal drive. However, this also means that if people have compulsive eating behaviors based on psychological factors – as well as hormonal imbalance – they will not necessarily be affected by changes in the weather.

Rather than letting the weather determine our eating habits, we can help our brains by setting our habits through conscious, therapy-based strategies to change eating patterns. Using Cognitive Behavioral Therapy or other constructive counseling methods, it is possible to teach ourselves to eat in a way that is healthy and control eating urges that may not be as good for the body.

Do weight loss “fat” camps work?

Recent studies have shown that weight loss interventions like fat camps can work for severely obese individuals, and they can result in long-term weight loss. However, in the case of binge eating disorder, this may not be as effective without providing therapy that addresses the underlying issues that contribute to compulsive overeating.

As discussed above, psychological counseling like CBT or IPT can help manage the underlying psychological issues that can contribute to the physical manifestation of chronic binge eating. Without these elements, this type intervention may work in the short-term, but it is less likely to provide long-lasting results and tools that can help individuals maintain recovery and control over binge eating episodes.

Comprehensive treatment that includes physical intervention, psychological therapy, and education to manage triggers and cravings with mindful eating habits is the method most likely to result in management of BED and reduction of the risks that come with compulsive eating and resultant physical health issues.