Binge eating disorder

Binge eating describes a pattern of eating where someone:

• eats a large amount of food – this can be as much as, or much more than, what one person might eat in a day
• without stopping, for anything from half an hour to a few hours
• whilst feeling out of control and distressed.

Binge eating is different to eating a large portion size, occasionally overeating on purpose, or eating when you feel sad. Many of us eat when we aren’t hungry, or eat large amounts of food from time to time.

People who binge eat will often feel ashamed and guilty, and so will often do it in secret. This can make it difficult for them to seek help early on.

Binge eating would be considered binge eating disorder when it:

• happens several times a week, over the course of a few months
• makes you feel distressed and out of control
• negatively affects your quality of life.

Some people will binge once or twice a week, while other people will binge several times a day.

If someone has experienced binge eating behaviours at least once a week for three months, this would be diagnosed as binge eating disorder.

Binge eating disorder involves a cycle of restriction.

In this cycle, you try to gain control over what you are eating by dieting, fasting or restricting what you eat in some other way.

However, restricting what you eat is incredibly difficult, because it makes you hungry. You will probably find it really difficult to continue to restrict, and might lose control and eat a large amount of food to satisfy your hunger. Once this has happened, you will try to restrict again to ‘make up’ for bingeing. This cycle then repeats itself.

Unlike other eating disorders such as anorexia nervosa or bulimia nervosa, people with binge eating disorder will not necessarily ‘compensate’ for their bingeing in other ways. For example, by:

• purging (vomiting)
• fasting (not eating anything or eating very little)
• exercising a lot

It is possible for people with binge eating disorder to have experienced other eating disorders. However, it isn’t possible to be diagnosed with binge eating disorder and another eating disorder at the same time.

Binge eating disorder is actually more common than other, potentially more well known eating disorders, like anorexia nervosa or bulimia nervosa.

Binge eating disorder is estimated to affect between 1 and 2 in every 100 women, and less than 1 in every 100 men.

In the UK, it is estimated that around 1 in 25 people experience symptoms of binge eating disorder. In people who have a body mass index (BMI) of over 30 who are seeking out weight loss interventions, 3 in 10 experience significant bingeing behaviours.

People with binge eating disorder can be any weight or size, and of any background. There is no one way for someone with binge eating disorder to look.

There is no one reason why someone develops an eating disorder. Like other eating disorders, there are many different things that can happen and work together to cause someone to develop binge eating disorder.

Some potential causes include:

• body dysmorphia – where someone becomes preoccupied with their body, or certain parts of it
• experiencing physical or sexual abuse in childhood
• a family history of eating disorders.

Other things that can lead to binge eating disorder include:

Weight stigma

Weight stigma is when people experience discrimination from society because of their weight or size. You do not have to be a certain weight or size to experience weight stigma, but the more someone weighs the more likely they are to experience weight stigma.

Research shows that weight stigma can have negative effects on physical and mental health. People who experience weight stigma are more likely to have unhealthy eating patterns such as binge eating.

Weight stigma can also lead to people not seeking medical care. It is important for medical professionals to work to reduce the impact of weight stigma when treating patients. We have included some useful information for medical professionals who are treating people with binge eating disorder at the end of this resource.

Medications

People who have binge eating disorder often also experience anxiety, depression, or other mental illnesses.

Some medications that are prescribed to people with mental illnesses can cause appetite changes. This can lead to people developing binge eating behaviours.

If you are taking a medication that you think might be affecting your eating behaviours or weight, speak to your doctor. They may be able to prescribe you a different medication.

Hormonal changes

Hormonal changes associated with some physical health conditions, such as polycystic ovary syndrome (PCOS) or diabetes, might also lead to unhelpful eating behaviours.

People living with binge eating disorder often feel guilt or shame that can make it hard to talk about the condition or seek help. Many people keep their binge eating a secret.

When bingeing, some people will feel disconnected from what they are doing, or forget they have done it. This is called dissociation and is something that our brains do to help us cope with stress.

Like other eating disorders, people with binge eating disorder can’t just choose not to binge, and will need support to recover.

“I’ll be going around the supermarket and I’ll be picking up all the bits I’m going to binge on. Then as soon as I’m walking out the shop I’m thinking, why did I just buy all that? I just want to throw it in the bin. I just want to take it back. But I’ve got to eat it.” - Hannah

Mental health conditions

People with binge eating disorder often have other mental health conditions. One study shows that in every 10 people who have binge eating disorder:

• 7 will also have a mood disorder like depression or bipolar disorder
• 7 will also have a substance use disorder
• 6 will also have an anxiety disorder
• 3 will also have post-traumatic stress disorder (PTSD)

In the same study, up to 2 in every 10 people living with binge eating disorder had attempted suicide.

Eating disorders are also more common in people with attention deficit hyperactivity disorder (ADHD).

Why does this happen?

It is always hard to know why one condition happens at the same time as another. For example, people with binge eating disorder might be more likely to have these other conditions, or having binge eating disorder might lead to another condition developing.

We do know that the shame and stigma associated with binge eating and weight gain can negatively affect self-esteem, which might lead to someone developing a mental illness.

It is very important that people with binge eating disorder receive the help they deserve, and that their challenges are taken seriously.

Physical health problems

People who have binge eating disorder are more likely to gain weight. This can sometimes lead to them developing high blood pressure, or conditions like type 2 diabetes, which can be very serious. This is another reason it is important to get help early if you are experiencing binge eating disorder. 

Binge eating disorder is treatable. It is important that people who have binge eating disorder seek help and are provided with the right support.

If you are experiencing binge eating behaviours, and think you might have binge eating disorder, speak to your GP. They might refer you to an eating disorder service, or suggest some things you can do to help yourself.

Below are the recommended treatments that you should receive if you have binge eating disorder.

Guided self-help

As a first step, your GP might recommend that you try a guided self-help programme designed specifically for people with binge eating disorder. You should be given materials that use the principles of cognitive behavioural therapy (CBT), which you can then practice on your own.

You should be supported by your doctor to follow this programme.

Group CBT for eating disorders

If you don’t want to use guided self-help, or have tried guided self-help but it hasn’t worked after 4 weeks, you should be offered group CBT. This will be eating disorder-specific, and a trained psychological therapist will run the sessions.

What happens in group CBT?

In group CBT for eating disorders, you will work to:

• understand your eating behaviours
• identify any problems you’re having
• decide on the goals you have for treatment.

You will also identify:

• what leads to you binge eating
• negative beliefs you might have about your body and how to challenge these
• the kinds of things that might trigger you to binge eat
• how you can avoid relapses.

Some people find group therapy helpful, because it allows them to learn from other people, and to discuss challenging topics in a supportive setting. Some people don’t like group therapy or find it unhelpful, and some people just prefer to receive support on their own. Speak to your doctor or other healthcare professional to decide the best option for you.

How long does it last?

Group CBT for eating disorders will usually happen in 90-minute sessions each week. These sessions will usually last for 16 weeks.

Individual CBT for eating disorders

If group therapy doesn’t work for you, or isn’t available in your area, you might be offered individual CBT.

How does it work?

In individual CBT you will start by discussing the challenges you are facing, and how what you eat and how you feel relate to your binge eating.

In CBT, you will monitor what you eat and when you binge eat. This should be done in a positive way, and is not supposed to be a way for you to shame yourself for bingeing or overeating. You will also address any body image issues you might have.

How long does it last?

Individual CBT for eating disorders will usually last for 16 to 20 one-hour sessions.

Is there a medication for binge eating disorder?

There are no medications recommended for binge eating disorder. However, if you are experiencing other mental or physical health problems that might be contributing to your binge eating disorder, you might be prescribed a medication. For example, if you are experiencing depression, you might be offered antidepressants. This should be offered alongside therapy.

If you have another health condition, medical professionals should work together to understand how to best treat both things, and the impact these treatments might have on each other. For example, if you have diabetes the people treating you will need to think about how you can manage your diabetes in a way that doesn’t negatively affect your binge eating disorder.

Weight loss is not the aim of treatment for binge eating disorder. Treatment for binge eating disorder should, over time, help you to develop a better eating pattern. This should help to stabilise your weight.

Losing weight can be an important goal for some people. However, it is important for you to focus on treating your binge eating disorder first.

Losing weight will not make binge eating disorder go away, as the condition is not caused by being a certain weight.

If you have binge eating disorder, it is important to seek professional help so that you can get the support you need. However, there are also things that you can do to support yourself:

Be kind to yourself when you binge

If you have binged, it can be easy to think that you have undone your hard work. Everyone makes mistakes from time to time. This is not a backward step, and it is important to be kind to yourself.

Avoid restrictive diets

Any kind of restrictive diet will likely lead to you bingeing, as it encourages the cycle we have spoken about before, where you limit what you eat, feel hungry, lose control and binge.

Keep a food diary

In a food diary you will monitor how much you are eating and when. You might have kept a food diary in the past, but in binge eating disorder this diary should not be used as a way to punish yourself, or to restrict what you eat.

Keeping a food diary can help you to understand:

• times that you are more likely to binge
• triggers for bingeing, such as stressful events or difficult emotions.

A food diary can help you to notice the pattern of restricting, loss of control and bingeing that we covered at the beginning of this resource. By noticing this pattern, you can take steps to break this cycle.

When you keep a food diary, be kind to yourself. It can be helpful to get support when starting a food diary, so that this is done in the right way.

Practice a healthy eating pattern

A healthy eating pattern means:

• eating regularly
• not skipping meals
• eating until you are full.

Even if you have binged, you should still eat as normal. For example, if you have binged in the afternoon, you still deserve to eat dinner as usual. Doing this can help you to return quickly to a healthy eating pattern.

Other things that might be helpful include:

• planning your meals and snacks for the day, especially if you are more likely to binge at certain times of the day
• not going shopping when you are hungry.

Use distraction techniques

Some people find that there are certain times of day, or certain activities that can act as a trigger to bingeing. You could think of these as ‘risk times’.

You might find it helpful to use distraction techniques to get through these risk times. For example, going for a walk or meeting a friend might help you to avoid bingeing.

The most important thing to do if someone has told you they have binge eating disorder is to ask them what they would find helpful.

Once you have done that, there are some other things that you might want to try to help the person to feel supported:

Respond with compassion and understanding

If someone tells you that they have binge eating disorder, it is important to respond with compassion and understanding. They will probably be feeling ashamed or guilty, and you might be the first person they have told.

Think about your language

It can be easy to talk about food, dieting or weight in your daily life without realising you are doing it. There are certain topics or ways of talking that can be upsetting to people who have, or have had problems with food, weight or dieting.

Here are some things to try to avoid:

• Casual diet language - “I’m having a cheat day” or “I’m going to skip lunch because we’re going for dinner later”.
• Describing foods as good or bad - “I’m going to be naughty and have a piece of cake” or “I’m eating healthily this week”.
• Talking about weight loss or gain – “I’m slimming down for the summer” or “I put on so much weight over Christmas”.

Avoid commenting on weight loss or gain

If someone has an eating disorder, weight gain or loss can be a complicated topic. Unless you are asked to, it is always best to avoid commenting on someone’s weight, even if you mean to be kind.

As an example, instead of saying “you look great now you’ve lost weight” you could simply say “you look great”.

Or instead of saying “it’s great to see that you’ve lost weight” you could say “it’s great to see that you look so happy”.

The eating disorder charity Beat has an article with 10 helpful things to say to someone with an eating disorder.

Understand trigger foods

The person you know might be more likely to binge on certain foods. These are sometimes called ‘trigger foods’ because they can trigger, or set off, binge eating behaviours.

You could help by:

• not keeping these foods in the house if you live with the person
• not bringing these foods into the office
• not giving these foods as gifts.

However, it isn’t your job to hide or restrict food from someone.

Encourage positive behaviours

You can encourage the person you know to have a healthy relationship with food. This could be by cooking for or with them, or by eating meals together. Make sure that this is done in a way that they are comfortable with.

Be patient

Finally, remember that recovery from an eating disorder is not a quick process. Binge eating disorder is a condition that can get better or worse over time. Someone can have setbacks as they are working to get better. It can take a long time for someone to develop a positive relationship with food, and they might have times when they binge again.

You can encourage them by reminding them that bingeing doesn’t mean they have undone their good work. Every time they relapse they will learn more about their condition and themselves.

Healthcare professionals can be the first person that someone has spoken to about their binge eating. How you approach the person who is seeking help can have a hugely positive effect on their emotional and physical health, and how they manage their binge eating disorder.

Here are some ways that you can offer the best support possible:

Avoid stigmatising behaviour

Binge eating disorder is a mental illness, and like any other mental illness should be approached in a non-stigmatising way.

Remember that people with binge eating disorder can have a lot of negative feelings towards themselves. Reaching out and asking for help can make people feel very vulnerable. Acknowledge the strength it has taken for them to share their experiences.

Do not encourage restrictive dieting

If someone appears to be experiencing an eating disorder of any kind, they should be referred to eating disorder support before being referred onto any weight management programme, regardless of their weight.

Restrictive diets are likely to lead to further bingeing in someone with binge eating disorder, so it is important not to recommend this to someone who is seeking help for these behaviours.

Research has shown that restrictive diets are not sustainable, because any weight loss is not maintained once the diet is stopped. It is more helpful for you to support people with binge eating disorder in maintaining their weight.

Screen for co-existing conditions

It is important to check for any co-existing mental illnesses, such as anxiety, depression, PTSD or self-harm, or neurodevelopmental conditions like ADHD or autism.

You should also screen for co-existing physical health issues like diabetes and hypertension, taking care to do so in a sensitive manner that does not reinforce weight stigma.

Use a trauma-informed approach

People with binge eating disorder may have experienced significant trauma, which may have contributed to them developing the disorder in the first place. They might not have disclosed this to anyone before.

You can help by providing an open and non-judgmental space to discuss experiences of trauma, or by suggesting that the person books a second appointment to discuss their experiences in more detail.

Refer to eating disorder services if necessary

Engage with your local eating disorder unit to find out what their criteria for referral are, and what treatments are available. This will help you to manage your patient’s expectations appropriately.

Look out for dissociative eating and dissociative episodes. These can make binge eating disorder harder to treat and means that the individual is more likely to require support from eating disorder services.

Signpost to self-help resources

Signpost to reliable self-help resources. Consider seeing the patient again after signposting to self-help resources, especially if they have disclosed trauma.

Books

• Overcoming Binge Eating, Christopher Fairburn – This book offers information and self-help guidance to people who struggle with out-of-control eating.
• The compassionate-mind guide to ending overeating: using compassion-focused therapy to overcome bingeing and disordered eating, Ken Goss - This book offers information and guidance on understanding overeating behaviours, and dealing with stress, self-criticism and shame.

About binge eating disorder

• Binge eating disorder, NHS – Information on binge eating disorder from the NHS
• Binge eating disorder, Beat – Information on binge eating disorder from the eating disorder charity Beat

Guidance

• Eating disorders: recognition and treatment, information for the public, NICE – In this guidance from the National Institute for Health and Care Excellence (NICE) you can see the care that people with binge eating disorder should be provided by healthcare professionals.

Local support

Beat also offers support to people affected by eating disorders across the UK. Find eating disorder support services in your area, or contact the Beat Helpline.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Samantha Scholtz and Dr Lucy Tweedlie

Special thanks to the people with lived experience of binge eating disorder who contributed to this resource: Hannah Moore and James Downs