Why This Eating Disorder Is the Most Misunderstood, According to Experts

5 min readBinge eating disorder (BED) is the most common eating disorder in the United States, yet it’s still widely misunderstood. When people hear “binge eating,” they may assume it means eating too much or occasionally overindulging. But BED is far more complex—and it isn’t actually even defined by the amount of food someone eats.So what actually separates BED from simply overeating? Here’s what experts want you to know.Meet the experts: Jasmine Sawhne, MD, is a psychiatrist and founder and CEO of Power of Psychiatry. Moriah O’Barr, PsyD, is a psychologist and clinical director of Cultivating Courage Psychological Services. Cynthia Vejar, PhD, is an associate professor of clinical mental health counseling at Lebanon Valley College.What is binge eating disorder?“Binge eating disorder is when someone has repeated episodes of eating a large amount of food in a short period of time and feels like they can’t stop or control how much they’re eating,” says Cynthia Vejar, PhD, an associate professor of clinical mental health counseling at Lebanon Valley College. It’s not about occasionally eating more than you intended or having a particularly big meal; it’s a recurring pattern in which someone feels unable to manage their eating.BED also doesn’t have one clear cause. While binge eating may be linked to stress or difficult emotions for some people, the disorder can develop from a combination of biological, psychological, and environmental factors, that all interact with one another, says Vejar.For example, stress or emotional strain may affect eating behaviors, while biological or environmental factors can shape how someone responds to those feelings. This may also help explain why BED commonly occurs alongside other mental health conditions such as depression, anxiety, and trauma-related disorders, says Moriah O’Barr, PsyD, a psychologist and clinical director of Cultivating Courage Psychological Services.Why BED Is So MisunderstoodFor people with BED, binge episodes can feel difficult or even impossible to control and are often accompanied by intense feelings of distress, shame, or guilt, says O’Barr. And, because diet culture tends to frame overeating as something that can be “fixed” with more willpower, she explains that people with BED may blame themselves for symptoms or fail to recognize that they’re experiencing a legitimate (and treatable!) eating disorder.That misunderstanding also makes it harder to know how common BED really is, but research suggests about 1.25 percent of adult women and 0.42 percent of adult men in the U.S. have it. “BED is more common than many people realize, but it’s also important to emphasize that these numbers probably don’t tell the whole story,” says Jasmine Sawhne, MD, a psychiatrist and founder and CEO of Power of Psychiatry. That may be because feelings of embarrassment or shame can make it hard for people to talk about their eating behaviors, meaning BED may go unrecognized and untreated.Signs and Symptoms of Binge Eating Disorder BED can look different from person to person, but the defining feature is a sense of losing control around food. “Patients in my practice describe it as, ‘I wasn’t even hungry, but once I started eating, I felt like I couldn’t stop,’” says Dr. Sawhne.During a binge, someone may eat faster than usual, continue eating even after feeling uncomfortably full, or eat when they aren’t physically hungry, says Vejar. They may also eat alone or in secret due to embarrassment about how much they’re eating, hide or stockpile food, or find themselves thinking about food and eating far more than usual, she adds.The emotional aftermath can be difficult, too. According to O’Barr, people with BED may experience intense guilt after a binge and resolve to restrict their food intake the next day. They might promise themselves they’ll “be good,” cut out certain foods, skip meals, or try to make up for what they ate. Unlike bulimia nervosa, however, those with BED do not regularly compensate for a binge by vomiting, fasting, using laxatives, or exercising excessively, she explains.How is binge eating disorder diagnosed?There isn’t a blood test or brain scan that can diagnose BED. Instead, diagnosis is based on a comprehensive evaluation with a mental health professional. “We start by asking about a person’s eating patterns, whether they feel a loss of control while eating, how much distress it causes, and how frequently a binge episode happens,” says Vejar. A clinician may also ask about behaviors during and after a binge, as well as a physical and mental health history.Along with these factors, clinicians use specific diagnostic criteria to determine whether someone meets the definition of BED. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the handbook for diagnosing mental disorders, binge eating must occur, on average, at least once a week for three months for an official diagnosis, Dr. Sawhne says.How to Cope With—and Treat—Binge Eating DisorderThe good news is that BED is highly treatable, and recovery doesn’t have to mean dieting or trying harder to control your eating. Treatment is individualized and focuses on breaking the cycle of restriction and bingeing, addressing the thoughts and emotions that contribute to it, and building a more consistent relationship with food.According to Dr. Sawhne, psychotherapy—a form of treatment that involves talking with a mental health professional about thoughts, feelings, and behaviors—is a key part of treatment, particularly cognitive behavioral therapy (CBT). CBT can help people identify patterns that may contribute to binge eating, such as restricting food during the day, following rigid food rules, or using food to cope with difficult emotions, and then work toward changing those patterns, she explains. Therapy can also help people develop healthier ways to manage stress, anxiety, shame, and other emotions that may trigger or follow a binge.In addition to clinical treatment, supportive strategies can make day-to-day life more manageable. After a binge, someone may be tempted to skip the next meal, drastically cut calories, or exercise to “make up for it.” But Dr. Sawhne says those behaviors can actually fuel the cycle. “Instead, try to return to regular, balanced meals and snacks, and avoid labeling foods as ‘good’ or ‘bad’ because rigid food rules can make certain foods feel even more psychologically charged,” she says.It can also help to pay attention to what’s happening before a binge. Are you extremely hungry, stressed, lonely, or exhausted? Have you been restricting food throughout the day? Keeping a simple, nonjudgmental record of these patterns—not calories or weight—can help you identify triggers and better understand your eating habits, Dr. Sawhne says.Still, while these strategies can be helpful, they are not a substitute for professional support. “You don’t have to wait until the problem becomes severe,” says Vejar. “If you regularly feel out of control around food, feel significant guilt or shame after eating, or notice that your eating is affecting your health or everyday life, it may be helpful to talk with a doctor, therapist, or eating disorder specialist.”O’Barr agrees. “No one chooses to have an eating disorder, you cannot simply willpower your way out of an eating disorder, and being more disciplined isn’t the solution,” she says. Ultimately, recovery starts with treating yourself with compassion and building a support team that understands eating disorders and can help you move forward.