Binge Eating Disorder

ByEvelyn Attia, MD, Columbia University Medical Center;
B. Timothy Walsh, MD, College of Physicians and Surgeons, Columbia University
Reviewed/Revised Jul 2022
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(See also Introduction to Eating Disorders.)

Binge eating disorder affects about 3.5% of women and 2% of men in the general population during their lifetime. Unlike bulimia nervosa, binge eating disorder occurs most commonly among people with overweight or obesity and contributes to excessive caloric intake; it may be present in 30% of patients in some weight-reduction programs. Compared with people with anorexia nervosa or bulimia nervosa, those with binge eating disorder are older and more likely to be male.

Symptoms and Signs of Binge Eating Disorder

During a binge episode, people eat a much larger amount of food than most people would eat in a similar time under similar circumstances. During and after a binge, people feel as if they have lost control. Binge eating is not followed by purging (by inducing vomiting, misusing laxatives, diuretics, or enemas), excessive exercising, or fasting. Binge eating occurs in episodes; it does not involve constant overeating ("grazing").

People with binge eating disorder are distressed by it. Mild to moderate depression and preoccupation with body shape, weight, or both are more common in people with obesity who have binge eating disorder than in people of similar weight who do not binge eat.

Diagnosis of Binge Eating Disorder

  • Clinical criteria

Clinical criteria for diagnosis of binge eating disorder (1) require that

  • Binge eating occurs, on average, at least once a week for 3 months

  • Patients have a sense of lack of control over eating

In addition, 3 of the following must be present:

  • Eating much more rapidly than normal

  • Eating until feeling uncomfortably full

  • Eating large amounts of food when not feeling physically hungry

  • Eating alone because of embarrassment

  • Feeling disgusted, depressed, or guilty after overeating

Binge eating disorder is differentiated from bulimia nervosa (which also involves binge eating) by the absence of compensatory behaviors (eg, self-induced vomiting, use of laxatives or diuretics, excessive exercise, fasting).

Diagnosis reference

  1. 1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, DSM-5-TRTM, Feeding and eating disorders.

Treatment of Binge Eating Disorder

  • Cognitive behavioral therapy

  • Sometimes interpersonal psychotherapy

Cognitive behavioral therapy is the most studied and best supported treatment for binge eating disorder, but interpersonal psychotherapy appears equally effective. Both result in remission rates of 60%, and improvement is usually well-maintained over the long term. These treatments do not produce significant weight loss in patients with obesity.

Conventional behavioral weight-loss treatment has short-term effectiveness in reducing binge eating, but patients tend to relapse. Antidepressant drugs (eg, SSRIs

Key Points

  • People with binge eating disorder have episodes of consuming large quantities of food, do not compensate by vomiting or purging, and tend to have overweight or obesity.

  • Diagnose binge eating disorder based on clinical criteria (including binge eating, on average, at least once/week for 3 months, with a sense of lack of control over eating).

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