A 3-Part Series on Binge Eating Disorder: What is BED? (Part 1) / by Gia & Danielle

By Drs. Danielle Keenan-Miller and Gia Marson

[Part 2: What Causes Bed?]

Binge Eating Disorder (BED) affects 6.5 million Americans-- more than anorexia nervosa and bulimia nervosa combined [1]. However, BED is less commonly discussed, and much less attention has been given to it in clinical research, maybe because it was only recognized as its own distinct eating disorder in 2013. Most people with BED receive treatment for other emotional problems, but less than half have ever receive treatment for binge eating [2]. That means that even though people with BED are seeking treatment, they’re either not bringing their binge eating up to their therapists, or therapists may not know how to address this problem. It is important for both clinicians and people suffering with BED to be able to recognize the symptoms and to know that there are highly effective treatments available for this prevalent eating disorder.

BED is characterized by recurrent periods in which an individual eats an amount of food that is significantly larger than would be eaten by others in similar circumstances. Although many people may feel like they “binged” if they ate an extra slice of dessert or didn’t follow the rules of a diet, true binge eating is more extreme than those behaviors. It might look like the equivalent of eating several meals’ worth of calories. It also needs to be more than others would eat in a similar circumstance-- so eating a large amount after a marathon or on Thanksgiving probably doesn’t count.  Another important part of binge eating is that the person feels a loss of control over eating. These binge eating episodes must be associated with other negative physical or emotional experiences including eating more quickly than normal, eating to the point of physical discomfort, eating large amounts of food when not hungry, eating alone due to embarrassment, and feeling remorse, disgust, or depression following the binge episode. In order to meet criteria for the diagnosis, these episodes must occur at least once a week for three months and cause distress, and not be accompanied by purging like is seen in bulimia nervosa [3]. Unlike other eating disorders, people with binge eating disorder may or may not be preoccupied with their weight and shape, but having a lot of body image concerns in BED is often associated with more distress [4]. It’s important to note that even if someone doesn’t meet all of these criteria, they might still benefit from treatment for binge eating if it’s something that is of concern to them.  

Several factors can get in the way of people realizing that they have an eating disorder or their health or mental health providers recognizing the problem. First, we tend to think of eating disorders as a “female” problem, but the rates of BED in men and women are fairly similar [5]. We also know that BED tends to strike later in life in comparison to other kinds of eating disorders, usually in the mid-to-late twenties. Finally, people often assume that having an eating disorder means that someone looks extremely skinny or is underweight, but BED can occur in individuals with a wide range of weights, shapes and sizes [6]. Finally, a fear of stigma and shame may prevent individuals with BED from bringing these concerns forward to medical and psychological treatment providers [7]. It’s important for people suffering with BED and their health care providers to recognize that this disorder does not result from a lack of willpower-- it is a true mental health condition that can be effectively treated. Recognizing the problem and seeking help is the first step on the road to recovery. 

[1] Hudson, Hiripi, Pope, & Kessler, 2007
[2] Hudson et al., 2007
[3] American Psychiatric Association, 2013
[4] Grilo, 2013
[5] Hudson et al., 2007
[6] Kessler, et al., 2013
[7] Hepworth & Paxton, 2007

Clinicians looking for additional information are referred to Marson & Keenan-Miller’s companion article in The Los Angeles Psychologist (2016).