Binge eating disorder: symptoms, causes and treatment

Key points

• Binge eating disorder is a mental health condition in which a person repeatedly eats a large amount of food in a short time while unable to stop [1][2].
• What separates it from ordinary overeating is not the amount of food, but the loss of control, the distress afterwards and the pattern over time [4][8].
• It occurs in people of every body size, and appears to be more common than the other eating disorders [4][6].
• NICE recommends binge-eating-disorder-focused guided self-help first for adults, then group and then individual eating-disorder-focused CBT [1].
• NICE advises against dieting during treatment, because it is likely to trigger binge eating, and says weight loss is not a therapy target [1].

What binge eating disorder is

Binge eating disorder is a mental health condition in which a person regularly eats a large amount of food in a short time and feels unable to stop or control what they are eating [2]. Episodes are usually followed by shame, guilt or low mood [7].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger. Beat’s eating disorder helplines are free and open 3pm to 8pm, Monday to Friday: England 0808 801 0677, Scotland 0808 801 0432, Wales 0808 801 0433, Northern Ireland 0808 801 0434 [5].

No reliable UK figure exists for binge eating disorder alone, though Beat estimates at least 1.25 million people in the UK have an eating disorder [6]. International surveys put lifetime prevalence at around 1.9% [8].

Symptoms

Symptoms vary between people, and nobody has all of them.

During an episode

• Eating a large amount of food in a short time, often faster than usual [2][8].
• A sense of loss of control, of not being able to stop once it has started [4].
• Eating when not hungry, until uncomfortably full, and often alone because of embarrassment [2][8].

Between episodes

• Guilt, shame or low mood afterwards, and marked distress about the eating, which is part of what defines the condition [2][7][8].
• Restricting eating or setting strict food rules, which often leads to further episodes [4].

It is commonly confused with ordinary overeating, which most people do without loss of control or distress [4], and with bulimia nervosa, which involves regular compensatory behaviour [8].

Types

Binge eating disorder has no recognised subtypes. Clinicians describe presentations that differ in severity and in what else is present.

• Binge eating disorder itself. Episodes are frequent and distressing enough to meet diagnostic criteria [8].
• Subthreshold presentations. Distressing episodes that do not meet every criterion, sometimes classed as other specified feeding and eating disorders. NICE says treatment must not be withheld on the basis of a single measure such as body mass index [1].
• With a co-occurring mental health condition. Depression, anxiety, self-harm and obsessive-compulsive disorder are common, and NICE recommends assessing for them [1].
• With a physical health condition. Where diabetes or weight-related problems are present, NICE cross-refers to its obesity guideline [1].

Causes and risk factors

There is no single cause. It develops from a mix of biological, psychological and social influences, and it is usually not possible to say why one person develops it [1][3].

Factors linked to higher risk include:

• A family history of eating disorders, depression or substance misuse [2].
• Dieting and food restriction, which produce hunger and a sense of deprivation that can lead to binge eating [4][8].
• Strong concern about body weight or shape [2].
• Anxiety, perfectionism or low self-esteem [2].
• Difficult experiences, including bullying about body size [2].

Two popular explanations are not supported. It is not greed or weak willpower, and describing it that way increases the secrecy that keeps it going [3]. Nor is it caused by foods being addictive like a drug. The evidence points instead to a cycle of restriction and binge eating [4].

How it is diagnosed

Diagnosis starts with a GP, who asks about eating patterns and physical health [2]. NICE says that where an eating disorder is suspected, the person should be referred immediately to a community-based, age-appropriate eating disorder service [1]. Such services are staffed by psychiatrists, psychologists, mental health nurses and dietitians.

Assessment covers eating behaviour, the sense of control during episodes, the distress it causes, physical health and other mental health problems [1]. NICE says questionnaires such as SCOFF must not be the sole basis for diagnosis, and that single measures such as body mass index or duration of illness must not decide whether treatment is offered [1].

The NHS classifies conditions using ICD-10. The American DSM-5-TR criteria, used in most research, require episodes on average at least weekly for three months, marked distress, and no regular compensatory behaviour [8].

NHS England monitors children and young people’s eating disorder services against an access and waiting time standard; adult waits are set locally [9].

Treatment

NICE recommends psychological treatment, in a stepped order [1].

• Binge-eating-disorder-focused guided self-help, first line for adults: cognitive behavioural self-help materials with brief practitioner support, typically 4 to 9 sessions of around 20 minutes over 16 weeks [1].
• Group eating-disorder-focused cognitive behavioural therapy (CBT-ED), offered if guided self-help is unacceptable, contraindicated or ineffective after 4 weeks, typically 16 weekly 90-minute sessions over 4 months [1].
• Individual CBT-ED, considered if group therapy is unavailable or declined, typically 16 to 20 sessions [1].

Guided self-help does not work for everyone, which is why NICE sets out a stepped order [1].

NICE is direct about weight. Practitioners should explain that psychological treatments for binge eating have a limited effect on body weight, and that weight loss is not a target of the therapy [1]. They should advise people not to try to lose weight, for example by dieting, during treatment, because this is likely to trigger binge eating [1]. Treating the eating disorder and managing weight are separate things [1].

NICE says not to offer medication as the sole treatment for binge eating disorder [1]. Medicines are sometimes prescribed for a co-occurring condition such as depression or anxiety, and decisions rest with a GP or psychiatrist.

Living with binge eating disorder

Eating regularly is the step most closely linked to fewer episodes. Long gaps without food increase hunger and the chance of an episode, so a regular meal pattern is a standard part of CBT-ED [1][8].

NICE advises against dieting alongside treatment [1]. If a clinician raises weight for a physical health reason, it is reasonable to say you have binge eating disorder and ask that any plan takes account of it.

Noticing what comes before an episode helps. The trigger is often a feeling or a long gap between meals rather than the food itself [8].

You do not have to tell an employer or university, though telling one person can make appointments easier. Beat supports anyone affected, including family [5], and NICE tells professionals to find out what family members and carers know about eating disorders and to address any misconceptions [1].

When to speak to a professional

Speak to your GP if any of these apply.

• Episodes with a sense of loss of control have happened regularly for several weeks.
• You feel distressed or ashamed after eating, and it is affecting work, study or relationships.
• You are caught in a cycle of restricting and then binge eating.

You do not need to have been unwell for a long time, or to be a particular size, to ask for help [1].

Contact NHS 111 and choose the mental health option, or your GP urgently, if you are struggling to cope or your mood has dropped sharply. Call 999 or go to A&E if anyone is in immediate danger. Samaritans: 116 123. Shout: text SHOUT to 85258.

Common questions

What is the difference between binge eating disorder and overeating?

The difference is not the quantity of food: most people eat more than they meant to sometimes [4]. Binge eating disorder involves loss of control during the episode, marked distress afterwards, and a pattern that repeats [8].

Can you have binge eating disorder at any body size?

Yes. It occurs across the full range of body sizes [4]. NICE says a single measure such as body mass index must not decide whether treatment is offered [1].

Should I try to lose weight if I binge eat?

NICE advises against trying to lose weight while being treated for binge eating disorder, because dieting is likely to trigger binge eating [1]. Weight loss is not a target of the therapy itself, and physical health concerns can be discussed with a GP separately [1].

How is binge eating disorder different from bulimia nervosa?

Both involve binge eating with loss of control. The difference is what follows: in bulimia nervosa, episodes are regularly followed by behaviour intended to undo the eating [8].

Clinical review pending

References

1. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69). NICE, 2017. https://www.nice.org.uk/guidance/ng69/resources/eating-disorders-recognition-and-treatment-pdf-1837582159813
2. NHS. Binge eating disorder. NHS. https://www.nhs.uk/conditions/binge-eating/
3. NHS. Eating disorders: overview. NHS. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/
4. Beat. Binge eating disorder. Beat Eating Disorders. https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/binge-eating-disorder/
5. Beat. Helplines. Beat Eating Disorders. https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/i-need-support-now/helplines/
6. Beat. How many people have an eating disorder in the UK? Beat Eating Disorders. https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/how-many-people-eating-disorder-uk/
7. Mind. Types of eating disorders. Mind. https://www.mind.org.uk/information-support/types-of-mental-health-problems/eating-problems/types-of-eating-disorders/
8. Mars JA, Iqbal A, Rehman A. Binge Eating Disorder. StatPearls Publishing, last updated 11 August 2024. https://www.ncbi.nlm.nih.gov/books/NBK551700/
9. NHS England. Children and young people’s eating disorders. NHS England. https://www.england.nhs.uk/mental-health/cyp/eating-disorders/