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Binge-eating disorderBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/binge-eating-disorder/DS00608
Binge-eating disorder is a serious eating disorder in which you frequently consume unusually large amounts of food. Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, overeating crosses the line to binge-eating disorder and it becomes a regular occurrence, usually done in secret.
When you have binge-eating disorder, you may be deeply embarrassed about gorging and vow to stop. But you feel such a compulsion that you can't resist the urges and continue binge eating. If you have binge-eating disorder, treatment can help.
You may have no obvious physical signs or symptoms when you have binge-eating disorder. You may be overweight or obese, or you may be at a normal weight. However, you likely have numerous behavioral and emotional signs and symptoms, such as:
- Eating unusually large amounts of food
- Eating even when you're full or not hungry
- Eating rapidly during binge episodes
- Eating until you're uncomfortably full
- Frequently eating alone
- Feeling that your eating behavior is out of control
- Feeling depressed, disgusted, ashamed, guilty or upset about your eating
- Experiencing depression and anxiety
- Feeling isolated and having difficulty talking about your feelings
- Frequently dieting, possibly without weight loss
- Losing and gaining weight repeatedly, also called yo-yo dieting
After a binge, you may try to diet or eat normal meals. But restricting your eating may simply lead to more binge eating, creating a vicious cycle.
When to see a doctor
If you have any symptoms of binge-eating disorder, seek medical help as soon as possible. Binge-eating disorder usually doesn't get better by itself, and it may get worse if left untreated.
Talk to your primary care doctor or a mental health provider about your binge-eating symptoms and feelings. If you're reluctant to seek treatment, talk to someone you trust about what you're going through. A friend, loved one, teacher or faith leader can help you take the first steps to successful treatment of binge-eating disorder.
Helping a loved one who has symptoms
A person with binge-eating disorder can become an expert at hiding behavior, making it hard for others to detect the problem. If you have a loved one you think may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns. You can offer encouragement and support and help your loved one find a qualified doctor or mental health provider and make an appointment. You may even offer to go along.
The causes of binge-eating disorder are unknown. But family history, biological factors, long-term dieting and psychological issues increase your risk.
Factors that can increase your risk of developing binge-eating disorder include:
- Family history and biological factors. You're much more likely to have an eating disorder if your parents or siblings have (or had) an eating disorder. Some people with binge-eating disorder may have inherited genes that make them more susceptible to developing the disorder, or their brain chemicals may have changed.
- Psychological issues. Most people who have binge-eating disorder are overweight, acutely aware of their appearance, and feel bad about it. When you have binge-eating disorder, you may act impulsively and feel you can't control your behavior. You may have a history of depression or substance abuse. And you may have trouble coping with stress, worry, anger, sadness and boredom.
- Dieting. Many people with binge-eating disorder have a history of dieting — some have dieted to excess dating back to childhood. Dieting may trigger an urge to binge eat, especially if you have low self-esteem and symptoms of depression.
- Your age. Although people of any age can have binge-eating disorder, it often begins in the late teens or early 20s.
You may develop psychological and physical problems related to binge eating. Some of these complications arise from being overweight due to frequent bingeing. Other complications may occur because of unhealthy yo-yo eating habits — bingeing followed by harsh dieting. In addition, food consumed during a binge is often high in fat and low in protein and other nutrients, which could lead to health problems.
Complications that may be caused by, or linked with, binge-eating disorder include:
- Suicidal thoughts
- High blood pressure
- Type 2 diabetes
- High cholesterol
- Gallbladder disease and other digestive problems
- Heart disease
- Some types of cancer
- Joint pain
- Muscle pain
- Menstrual problems
Preparing for your appointment
Treatment of binge-eating disorder may require a team approach that includes medical providers, mental health providers and dietitians with experience in eating disorders.
Here's some information to help you get ready for your appointments, and what to expect from your health care team.
What you can do
- Write down the symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications you're taking, as well as any herbs, vitamins or other supplements.
- Ask a family member or friend to come with you, if possible, to help you remember key points and give a fuller picture of the situation and your home life.
Write down questions to ask your doctor, such as:
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- If medication is a part of treatment, is a generic drug available?
- Are there any brochures or other printed material I can take home with me? What websites do you recommend?
Don't hesitate to ask questions at any time if you don't understand something.
What to expect from your doctor
Your doctor or other health care provider is likely to ask you a number of questions, such as:
- Are you concerned about your weight and your appearance?
- Have you tried to lose weight? If so, how?
- Do you think about food often?
- Do you eat even when you're full or not hungry?
- Do you eat unusually large amounts of food or until you're uncomfortably full?
- Do you ever eat in secret?
- Do you feel your eating is out of control?
- Do you feel depressed, disgusted, ashamed or guilty about your eating?
- Do you exercise? How often do you exercise?
Tests and diagnosis
Binge eating is similar to bulimia, another eating disorder. However, people with binge-eating disorder don't purge themselves of the extra calories they consume. That's why many people with binge-eating disorder are often overweight.
To diagnose an eating disorder, your doctor may recommend:
- A physical exam
- Blood and urine tests
- A psychological evaluation, including discussion of your eating habits
Your doctor may want you to have other tests to check for health consequences of binge-eating disorder, such as heart problems or gallbladder disease.
Criteria for diagnosis
Your doctor will determine if you meet the criteria for an eating disorder. To be diagnosed with binge-eating disorder, you must meet these criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association:
- Recurrent episodes of binge eating, including eating an abnormally large amount of food and feeling a lack of control over eating
- Binge eating that's associated with at least three of these factors: eating rapidly; eating until you're uncomfortably full; eating large amounts when you're not hungry; eating alone out of embarrassment; or feeling disgusted, depressed or guilty after eating
- Concern about your binge eating
- Binge eating at least twice a week for at least six months
- Binge eating that's not associated with purging, such as self-induced vomiting
Treatments and drugs
The goals for treatment of binge-eating disorder are to reduce eating binges, to improve your emotional well-being and, when necessary, to lose weight. Because binge eating is so entwined with shame, poor self-image, self-disgust and other negative emotions, treatment needs to address these and other psychological issues. By getting help for binge eating, you can learn how to properly lose weight and keep it off.
There are four main types of treatment for binge-eating disorder.
Psychotherapy, whether in individual or group sessions, can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. Examples of psychotherapy include:
- Cognitive behavioral therapy (CBT). CBT may help you cope better with issues that can trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and eating patterns. If you're overweight, you may need weight-loss counseling in addition to CBT.
- Interpersonal psychotherapy. Interpersonal psychotherapy focuses on your current relationships with other people. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and colleagues. This may help reduce binge eating that's triggered by poor relationships and unhealthy communication skills.
- Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.
There's no medication specifically designed to treat binge-eating disorder. But, several types of medication may help reduce symptoms, especially when combined with psychotherapy. Examples include:
- Antidepressants. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be helpful. It's not clear how these can reduce binge eating, but it may relate to how they affect certain brain chemicals associated with mood.
- The anticonvulsant topiramate (Topamax). Normally used to control seizures, topiramate has also been found to reduce binge-eating episodes. However, potentially it can cause serious side effects, so discuss these risks with your doctor.
Behavioral weight-loss programs
Many people with binge-eating disorder have a long history of failed attempts to lose weight on their own. However, weight-loss programs typically aren't recommended until the binge-eating disorder is treated because very low calorie diets may trigger more binge-eating episodes.
When appropriate, weight-loss programs are generally done under medical supervision to ensure that your nutritional requirements are met. Weight-loss programs that address binge triggers can be especially helpful when you're also getting cognitive behavioral therapy.
Some people with binge-eating disorder find self-help books, videos, Internet programs or support groups effective. Some eating disorder programs offer self-help manuals that you can use on your own or with guidance from mental health experts. However, you still may need professional treatment with psychotherapy or medications.
Lifestyle and home remedies
Typically, treating binge-eating disorder on your own isn't effective. But in addition to professional help, you can take these self-care steps to reinforce your treatment plan:
- Stick to your treatment. Don't skip therapy sessions. If you have a meal plan, do your best to stick to it and don't let setbacks derail your overall efforts.
- Avoid dieting. Trying to diet can trigger more binge episodes, leading to a vicious cycle that's hard to break. Talk with your doctor about appropriate weight management strategies for you — don't diet unless it's recommended for your eating disorder treatment and supervised by your doctor.
- Eat breakfast. Many people with binge-eating disorder skip breakfast. But, if you eat breakfast, you may be less prone to eating higher calorie meals later in the day.
- Don't stock up. Keep less food in your home than you normally do. That may mean more-frequent trips to the grocery store, but it may also take away the temptation and ability to binge eat.
- Get the right nutrients. Just because you may be eating a lot during binges doesn't mean you're eating the kinds of food that supply all of your essential nutrients. Talk to your doctor about vitamin and mineral supplements.
- Stay connected. Don't isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart.
- Get active. Ask your health care provider what kind of physical activity is appropriate for you, especially if you have health problems related to being overweight.
Some complementary and alternative therapies, such as those below, may be helpful in achieving the goals set by your health care team.
- Massage and therapeutic touch may help to reduce anxiety often associated with eating disorders.
- Mind-body therapies, such as meditation, yoga, biofeedback and hypnosis, may provide a sense of mindfulness that could increase awareness of your body's cues for eating and fullness, as well as promote a sense of well-being and relaxation.
- Acupuncture, although not proven, shows promise in studies on anxiety and depression.
Risks of herbs and dietary supplements
Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications. If you use dietary supplements or herbs, discuss the potential risks with your doctor.
Coping and support
Living with an eating disorder is especially difficult because you have to deal with food on a daily basis. Here are some tips to help you cope:
- Ease up on yourself. Don't buy into your own self-criticism.
- Identify situations that may trigger destructive eating behavior so you can develop a plan of action to deal with them.
- Look for positive role models who can help lift your self-esteem, even if they're not easy to find. Remind yourself that the ultrathin models or actresses showcased in women's magazines often don't represent healthy, realistic bodies.
- Try to find a confidant you can talk to about what's going on. Together, you may be able to come up with some treatment options.
- Try to find someone who can be your partner in the battle against binge eating — someone you can call on for support instead of bingeing.
- Find healthy ways to nurture yourself by doing something just for fun or to relax, such as yoga, meditation or simply a walk.
- Consider journaling about your feelings and behaviors. Journaling can make you more aware of your feelings and actions, and how they're intertwined.
If you have binge-eating disorder, you and your family may find support groups helpful for encouragement, hope and advice on coping. Support group members can truly understand what you're going through because they've been there themselves. Ask your doctor if he or she knows of a group in your area.
Although there's no sure way to prevent binge-eating disorder, if you have symptoms of binge eating, seek professional help. Your primary care doctor or other health care provider can advise you on where to get help.
If you know someone with a binge-eating problem, steer them toward healthier behavior and professional treatment before the situation worsens. Here's how you can help:
- Cultivate and reinforce a healthy body image in your children no matter what their size or shape.
- Talk with your pediatrician. Pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development.
- If you notice a relative or friend who seems to have food issues that could lead to or indicate an eating disorder, consider supportively talking to the person about these issues and ask how you can help.
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