Binge Eating
What Is It?
Binge Eating Disorder, or Binge Eating, is an eating disorder characterized by recurrent episodes of consuming a significantly larger amount of food than most people would eat in the same time frame and under the same conditions. Additionally, these episodes are accompanied by a feeling of loss of control over eating. These episodes tend to be triggered by mood changes, emotional stress, relationship problems, or everyday stressors and serve the purpose of emotional stabilization.
Unlike Bulimia Nervosa, people with Binge Eating do not use compensatory methods (vomiting, laxative/diuretic abuse, enemas, fasting, or excessive physical exercise) and may not necessarily have strict dietary rules. After these episodes, there is a tendency to experience feelings of guilt, ineffectiveness, disgust, and concerns about the effects of the eating on weight and body image. Another characteristic of Binge Eating is rapid consumption of more food than normal without being accompanied by the physical sensation of hunger, alone (away from family or friends) until feeling uncomfortably full. The severity of this disorder ranges from mild (1 to 3 episodes per week) to extreme (14 or more episodes per week).
What Are the Main Signs and Symptoms?
1) Behavioral and Cognitive Domain:
- Inability to stop eating or control what is being eaten;
- Rapid consumption of large quantities of food;
- Eating even when already full;
- Tendency to hide or store food to be eaten later;
- Eating normally in front of others but compulsively when alone;
- Frequent thoughts about food;
- Continuous and unregulated eating throughout the day, without planned meals.
2) Emotional Domain:
- Anxiety or tension that can only be relieved through eating;
- Embarrassment related to the amount of food consumed;
- Feeling of alienation during episodes of binge eating;
- Intense feelings of guilt, disgust, and sadness after binge eating;
- Filling a void with high-calorie foods;
- Low satisfaction in relationships and feelings of rejection, criticism, or abandonment.
3) Physical Consequences:
- Weight gain or obesity;
- High cholesterol;
- High blood pressure;
- Respiratory problems;
- Kidney problems;
- Bone problems;
- Arthritis;
- Skin problems;
- Irregular menstruation.
What Are the Possible Causes and Risk Factors?
Biological Factors
Physiological and genetic factors are highly significant in the development of Binge Eating. Genetic studies indicate heredity rates between 41% and 57% for this disorder. Molecular studies have found that genes related to reward processing (such as obtaining food), mood, and homeostatic control (responsible for maintaining the body's balance) may be primarily involved.
Psychological Factors
Some features of psychological functioning represent risk factors for the development of Binge Eating. These include tendencies toward perfectionism, negative affectivity, behavioral difficulties, and dissatisfaction with body image. Difficulties in controlling the amount of food eaten during childhood predict the development of Binge Eating during adolescence.
Environmental Factors
Exposure to the sociocultural context that idealizes thinness can contribute to the pressure to be thin and the internalization of this ideal body image, making it a predictive factor for the development of Binge Eating in adolescents. Exposure to family conflicts, eating problems, and weight concerns within the family and unhealthy parenting practices also constitute risk factors.
Can It Be Associated with Other Disorders?
Binge Eating, like Anorexia Nervosa and Bulimia Nervosa, tends to occur simultaneously with other psychiatric disorders. The disorders that most commonly co-occur with Binge Eating include Alcohol Use Disorder and Major Depressive Disorder, with suicidal ideation reported in 25% of individuals with this disorder. The co-occurrence with other disorders seems to be more associated with the severity of binge eating and less with the degree of its physical consequences, such as obesity. Binge Eating is associated with a range of functional consequences, including social adjustment problems and increased medical morbidity and mortality.
What Is the Prevalence?
Binge Eating has a high prevalence not only among patients with eating behavior disorders (30%) but also in the general population (4.6%). It is, thus, the eating disorder with the highest prevalence in the general population. The prevalence of this disorder may vary culturally and generally affects people who have undergone restrictive diets for weight loss and experienced relapses. Binge Eating is also the eating disorder most commonly associated with other mental and physical disorders.
How Can Psychotherapy Help?
Individual, couples, family, or group psychological counseling is essential, as Binge Eating is the eating disorder with the best prognosis. In fact, some studies have shown that complete remission is higher than in Bulimia Nervosa and Anorexia Nervosa. Through psychotherapy, it is possible to help the person understand the thoughts that can lead to binge eating, increase awareness and control over how food is used to cope with emotions, and understand the function of compulsive eating.
In psychotherapy, the identification of situations that trigger episodes (triggers) and the acquisition of tools to reduce or stop them can be worked on. Relaxation and emotional self-regulation techniques are frequently used, including Mindfulness, Eye Movement Desensitization and Reprocessing (EMDR), and Focusing, among other techniques. Family, romantic, and peer relationships are an important dimension in the context of this disorder, and skills related to communication and setting boundaries (such as saying 'no' appropriately, making requests, and expressing opinions and needs) can be developed, promoting healthier and mutually rewarding relationships.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association.
Fairburn, C. G., Cooper, Z., Shafran, R., & Wilson, G. T. (2008). Eating Disorders: A Transdiagnostic Protocol. In D. H. Barlow (Ed.), Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (pp. 578-614). The Guilford Press.
Hilbert, A. (2019). Binge-eating disorder. Psychiatric Clinics of North America, 42(1), 33-43.
Morins M., Fonseca S., Mendes A., Ribeiro J., Silva L. & Cruz M. (2006). “Binge Eating” - A Case Report. Revista Comportamento Alimentar, Vol 3, nº9, pp: 9-12.