Most people have eaten too much at one time or another. Maybe you ate too much turkey and mashed potatoes at Thanksgiving. Or, maybe you ate a quart of ice cream after a bad break-up. This behavior does not mean you have a binge eating disorder. Binge eating is different than overeating in a few ways. When you binge eat, you:

• Diet frequently, sometimes without weight loss
• Eat an unusually large amount of food—more than others would— very quickly and usually in two hours or less—while feeling out of control
• Eat until you are uncomfortably full
• Feel like you have lost control over how much food you are eating
• Often eat alone or in secret because you are embarrassed by how much you are eating
• Feel regret, disgust, or guilt when you finish bingeing

Binge eaters do this regularly, at least one day a week for three continuous months. Between one and four percent of the American population has binge eating disorder. It can affect anyone, regardless of gender, age, background, or weight status. Unlike people with bulimia, binge eaters do not try to get rid of the calories through vomiting, using laxatives or enemas, dieting, or exercising excessively. Binge eating is frequently associated with excess weight but not all binge eaters are overweight. Facing the diagnosis of binge-eating disorder can be worrisome, but we are here to help you and your loved ones overcome this disorder.

Researchers are not sure what causes binge eating. It appears to involve psychological, biological, and environmental factors and may be linked to other mental health conditions. Almost half of all binge eaters have a history of depression and many report feeling strong negative feelings—often before a binge. Many binge eaters tend to be impulsive with food choices.

In addition, eating disorders, including binge eating, seem to run in families. People who binge eat often come from a family that puts an unusual emphasis on food. Families may use food as a reward or a way to soothe or comfort.

Binge eating can also be a side effect of certain psychiatric or other types of medications.

Common symptoms

Symptoms of binge eating can be physical or emotional.

Physical symptoms include:

• Difficulty concentrating
• Eating large amounts of food when you are not hungry
• Having unusual eating habits, such as eating only a little bit or not at all during the day
• Hoarding food, maybe in your closet or under your bed
• Maintaining food rituals, such as chewing too much or only eating certain foods
• Noticeable changes in weight
• Obesity
• Having medical conditions related to obesity, such as joint problems, heart disease, and type 2 diabetes

Emotional symptoms can include:

• Being moody or irritable
• Difficulty functioning at work, in your personal life, or in social situations
• Eating to avoid tension or numb bad feelings
• Feeling worthless, angry, ashamed, and anxious after eating
• Feeling isolated
• Having depression, or a history of depression
• Having a difficult time dealing with anger, boredom, and stress
• Poor quality of life

Binge eating disorder can also be associated with psychological problems such as depression, bipolar disorder, anxiety, and substance abuse.

Complications

Binge eaters are often—but not always—overweight. It makes sense and binge eaters consume a lot of calories. Being overweight or obese can lead to a variety of health issues such as:

• Arthritis
• Sleep apnea
• Cancer
• Depression, anxiety, and other mood problems
• Heart disease
• High blood pressure
• Type 2 diabetes

Diagnosis

It can be difficult to spot binge eating because most people with eating disorders try to hide them. To diagnose binge eating, your doctor will talk to you about your eating habits. You may get questions about your medical history and any family members with eating disorders. We will do a physical exam, request blood and urine tests, and may recommend a sleep disorder center consultation. A psychological evaluation is also part of diagnosing binge eating. Your doctor may also order additional tests to make sure there are no other reasons for your fluctuating weight.

Physicians often divide binge eating into levels, based on how often you binge each week:

• One to three times a week: mild
• Four to seven times a week: moderate
• Eight to thirteen times a week: severe
• Fourteen or more times a week: extreme

Treatment

When we treat binge eating, we want to reduce how often you binge and help you develop healthy eating habits. We often use a multi-pronged approach: psychotherapy, medication, and nutritional management. The goal is to improve your quality of life and help you feel less depressed and anxious.

At Mount Sinai, we offer both individual and group sessions. We use several approaches in treating binge eating:

• Cognitive-behavioral therapy
• Interpersonal psychotherapy, which is traditional talk therapy
• Dialectical behavior therapy, which helps you learn skills to tolerate stress, regulate your emotions, and improve your relationships with others
• Brief Coaching-led interventions based on cognitive behavioral therapy

These therapies help you acquire skills that can reduce your desire to binge. We may also prescribe medication or offer nutritional counseling.

Once you have successfully addressed your binge eating, we may be able to help with behavioral weight loss programs. We do not want to address this too soon, as dieting can trigger more binge eating. When you are ready, we can help you address your weight safely, under medical supervision.