Following a stressful day at work, Liam visited a fast food drive-through on the way home, where he ordered four hamburgers and then proceeded to eat them all himself. When he would go out to restaurants, he would order (and eat) two meals in one sitting. Sometimes, he’d devour junk food before going home, where he’d still enjoy dinner with his family but not admit he’d already eaten. Liam had secret stashes of snacks hidden around the house and would often eat alone in his car to hide his habits. He would eat until he was uncomfortably full, even when he wasn’t hungry. And when he binged, he felt like he was out of control. But when Liam was diagnosed with binge eating disorder, he denied he had a problem at all: "I don't have an eating disorder."
Fortunately, there is new hope on the horizon for people like Liam.
When most people hear the words “eating disorder,” they tend to think about anorexia nervosa or bulimia nervosa because these are the most publicized illnesses of this kind. Binge eating is also a type of eating disorder. In fact, it’s the most common eating disorder in the United States, where as many as 4 million people live with the condition. It's more common than anorexia and bulimia combined. Binge eating disorder involves eating a large amount of food at one time, called a “binge." Nowadays, the word binging is thrown around casually and often refers to "binge-watching" television shows, but when it’s used in reference to alcohol, drugs, or food, it means excessive or compulsive consumption.
Binge eating disorder isn't just a matter of overindulgence on a special occasion or during the holiday season. The condition is characterized by recurrent episodes of compulsive eating, at least once a week on average, over a period of three months or longer. Unlike other eating disorders, binge eaters don’t purge, exercise excessively, or fast. Binge eating disorder is pervasive, but it is often overlooked. It's been identified since the 1950s, but the condition wasn’t officially recognized as a mental health disorder until the latest Diagnostic and Statistical Manual for Mental Disorders was published in 2013.
The main symptom of binge eating disorder is consuming a large amount of food in a short period of time and not being able to stop, even when past the point of fullness. The person eats until they are uncomfortable, even when they’re not physically hungry. Binge eaters may eat faster than normal during a binge or reach for “special” binge foods, like fast food. Liam reported that he would frequently wolf down an entire package of cookies followed by a carton of milk. Those affected by this disorder often misjudge their food intake and also carry distorted attitudes about eating, shape, and weight. Some, not all, may be overweight or obese. They tend to eat alone or in secret too. Liam admitted that he hid his behavior from his friends and family to avoid judgement; he once ate a whole pizza sitting on the floor in the closet. Many people with the condition experience a sense of shame afterwards, and feel embarrassed, disgusted, or distressed by their binging.
Binge eating is driven by emotions, not hunger. People with this condition overeat as a way to cope with stress, depression, grief, anger, or boredom. They often use food as comfort or a reward—a habit that’s often learned in childhood. Binge eating is underpinned by psychological, behavioral, social, and genetic factors; it often runs in families. There is a high comorbidity with binge eating and other mental health issues, including depression, anxiety, mood disorders, and personality disorders, especially borderline personality disorder (BPD).
It can be difficult for those affected by binge eating to admit that they need help. Even in the face of his extreme behavior, Liam was in denial that he had a problem. It’s also difficult for people without the disorder to understand, because overeating is so common in the Western world. Binge eating disorder is often trivialized, however, it isn’t a poor lifestyle choice that can be cured with willpower and a good diet plan. It’s a mental health disorder that affects physical and emotional health. Untreated, it can pose significant health risks, including heart disease and type 2 diabetes. But binge eating disorder can be almost impossible to treat without clinical treatment. This usually involves therapy, in particular cognitive behavioral therapy (CBT), in conjunction with nutritional counseling and medication.
In fact, Liam is part of an ongoing clinical study in which patients with binge eating disorder receive deep brain stimulation to limit the urge to overeat. This method is routinely used to quell tremors in patients with Parkinson's Disease. The procedure involves placing a device in the brain to regulate aberrant signals. The device stimulates neurons when it detects an electrical signal to start a binge. The area of the brain that is activated is the nucleus accumbens, located in the brain's reward center, located deep in the center of the brain. When deep stimulation is used to calm those neurons, people no longer want to binge eat.
The results of this study have been promising so far, with researchers noting improved self-control of food intake and also weight loss in their subjects. The study is ongoing, but offers new hope for many people.
Fortunately, with the right approach, recovery from binge eating disorder is possible.
To find a therapist near you, visit the Psychology Today Therapy Directory.
References
Brownley KA, Berkman ND, Peat CM, Lohr KN, Cullen KE, Bann CM, Bulik CM. Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Ann Intern Med. 2016 Sep 20;165(6):409-20. doi: 10.7326/M15-2455. Epub 2016 Jun 28. PMID: 27367316; PMCID: PMC5637727.
Shivacharan, R.S., Rolle, C.E., Barbosa, D.A.N. et al. Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating. Nat Med 28, 1791–1796 (2022). https://doi.org/10.1038/s41591-022-01941-w
Zanarini MC, Reichman CA, Frankenburg FR, Reich DB, Fitzmaurice G. The course of eating disorders in patients with borderline personality disorder: a 10-year follow-up study. Int J Eat Disord. 2010 Apr;43(3):226-32. doi: 10.1002/eat.20689. PMID: 19343799; PMCID: PMC2839025.
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