Binge eating disorder: symptoms, causes and treatment

The NHS describes binge eating disorder as regularly eating a lot of food over a short period until you are uncomfortably full, and calls it a serious mental health condition in which people eat without feeling in control. Binges are sometimes planned in advance but can be spontaneous, are usually done alone and may include special binge foods. Guilt or shame often follows.

The features the NHS emphasises are the regularity of the episodes and the lack of control while eating.

The NHS says you will probably be offered a guided self-help programme first, usually working through a book or an online guide with sessions with a healthcare professional. NICE guideline NG69 says guided self-help for adults should use cognitive behavioural self-help materials and be supplemented with brief supportive sessions, for example 4 to 9 sessions of 20 minutes over 16 weeks.

If this has not helped after 4 weeks the NHS says you may be offered cognitive behavioural therapy (CBT) or medicine. NICE says group CBT for eating disorders typically involves 16 weekly 90-minute sessions over 4 months, covering psychoeducation, self-monitoring, a daily food intake plan, identifying binge cues, body exposure training and relapse prevention; if group CBT is unavailable or declined, individual CBT of 16 to 20 sessions may be considered.

NICE guideline NG69 also says that medication should not be offered as the sole treatment for binge eating disorder, and that children and young people should be offered the same treatments recommended for adults. The NHS says antidepressants are rarely prescribed for children and young people under 18.

The NHS says the main symptom is eating a lot of food in a short time and not being able to stop when full. People who regularly eat in this way may have binge eating disorder. Other symptoms listed by the NHS include:

• Eating when not hungry.

• Eating very fast during a binge.

• Eating alone or secretly.

• Feeling depressed, guilty, ashamed or disgusted after binge eating.

The NHS describes the most common eating disorders as anorexia nervosa, bulimia and binge eating disorder, plus other specified feeding or eating disorder (OSFED), which it says is the most common, and avoidant/restrictive food intake disorder (ARFID). The key difference between binge eating disorder and bulimia is what happens after a binge.

The NHS says bulimia involves losing control over how much you eat and then ridding your body of the extra food by purging, which may include making yourself sick, taking laxatives or diuretics, or avoiding eating for long periods. In binge eating disorder, the NHS describes the binges but does not describe regular purging.

The NHS says the exact causes are not known. You are more likely to have an eating disorder if you or a family member has a history of eating disorders, depression, or alcohol or drug misuse; if you are too worried about being slim, particularly under pressure from society or work; if you have anxiety, low self-esteem, an obsessive personality or perfectionism; or if you have experienced a stressful event or trauma.

The NHS says to see a GP as soon as you can. They ask about eating habits and how you feel and check your weight and overall health, and should refer you to an eating disorder specialist or team if they think you have binge eating disorder or another eating disorder. It notes it can be hard to admit you need help and that bringing a friend or loved one may help. The eating disorders charity Beat is the NHS-named source of confidential advice.

The NHS says someone may have an eating disorder if they change their behaviour or mood, eat a lot of food very quickly, try to hide how much they eat, store up food supplies or put on weight, although weight gain does not happen to everyone with the disorder. It suggests letting the person know you are worried and encouraging them to see a GP, perhaps offering to go along.

The NHS says you should not try to diet during treatment because dieting can make it more difficult to stop binge eating, and CBT helps plan regular meals and snacks, work out triggers, manage negative feelings about your body and avoid relapse. NICE says to explain to people that psychological treatments aimed at binge eating have a limited effect on body weight and that weight loss is not a therapy target in itself. The NHS says most people recover with the right support and treatment, though it may take time.

NICE says children and young people with binge eating disorder should be offered the same treatments as adults, while the NHS notes antidepressants are rarely prescribed for under 18s.

NHS care runs through a GP and local eating disorder or talking therapy services, with Beat offering support groups. Private therapists offer CBT-based care too. Ask whether the therapist is trained specifically in eating disorder CBT and follows a programme like the one NICE describes, and be cautious of any programme built around calorie restriction.