Understanding Binge-Eating Disorder

Editor’s note: This article originally ran December 5, 2018, and was updated October 24, 2023. 

When you hear the words “eating disorder,” you may think of anorexia nervosa (extreme low weight) or bulimia nervosa (binge eating followed by purging).

But the most common eating disorder is binge-eating disorder, which affects an estimated 2.8 million people in the United States. That’s more than three times the number of people diagnosed with anorexia and bulimia combined.

“Historically, binge-eating disorder hasn’t gotten nearly as much attention as anorexia nervosa or bulimia nervosa, and it still doesn’t get the attention it deserves,” says UNC Health clinical psychologist Cynthia Bulik, PhD.

“One reason is that binge-eating disorder wasn’t even recognized as a formal diagnosis until 2013, when for the first time it was included in the DSM-5,” Dr. Bulik says. (DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which the American Psychiatric Association published in 2013.)

Defining Binge-Eating Disorder

Binge-eating disorder is characterized by several behavioral and emotional signs or symptoms. These include eating a larger amount of food than typical during a two-hour period, a feeling that you can’t control what or how much you are eating, and recurrent episodes of binge eating.

In addition, people with binge-eating disorder often say they feel disgusted, depressed, ashamed or guilty after a binge episode. As a result, they may eat alone so others won’t see how much they eat. They may also eat until they feel uncomfortably full, eat large amounts of food even when they don’t feel hungry or eat much faster than normal.

People with binge-eating disorder usually do not try to compensate for overeating by purging (self-induced vomiting) or exercising excessively, as is common in people with bulimia nervosa.

Treatment of Binge-Eating Disorder

Binge-eating disorder is most commonly treated in an outpatient setting, but some people may require hospitalization or a residential treatment program.

Treatment services for binge-eating disorder vary by person but typically include psychotherapy (including individual, family or couples, or group therapy), family member support or education, specialized nutrition counseling and medication therapy.

Analysis by Dr. Bulik and other researchers on treatment options for binge-eating disorder was published in the Annals of Internal Medicine in 2016.

Their review concluded that several courses of treatment helped reduce binge eating and the negative feelings that people often experience because of it, including:

  • Cognitive behavioral therapy
  • Lisdexamfetamine (Vyvanse), the first drug approved by the Food and Drug Administration for treating binge-eating disorder in adults
  • Antidepressants such as fluoxetine (Prozac), bupropion (Wellbutrin), sertraline (Zoloft), escitalopram (Lexapro) and citalopram (Celexa), as well as topiramate (Topamax), an anti-seizure drug

A New Study for Binge-Eating Disorder

Dr. Bulik led a new study, the Binge Eating Genetics INitiative (BEGIN), to better understand genetic factors that may be associated with binge-eating disorder and bulimia nervosa. Researchers intend to use insights from the study to develop better treatments.

The study enrolled nearly 1,000 participants via Recovery Record, an app that helps people manage their eating disorders. Participants contributed information about their thoughts, emotions and behaviors associated with binge eating and received intervention through the app. They also provided heart rate and activity data, as well as saliva and stool samples for testing.

The investigators are studying the data collected and results are expected soon.

Need help for binge-eating disorder for yourself or a loved one? Contact the UNC Center of Excellence for Eating Disorders at 984-974-3834.