Know the Psychological and Physical Symptoms of Binge Eating Disorder

Binge eating disorder (BED) is the most common eating disorder in the United States. It typically manifests when people are in their late teens or early 20s, but BED can begin at any age. Left untreated, it can be life-threatening. Before that, BED interferes with patients' mental, physical, and sexual well-being and their relationships.

Approximately 3.5 percent of women and 2 percent of men are affected by BED at some point, which is more than three times more prevalent than anorexia and bulimia combined, according to the National Eating Disorders Association.

Common symptoms of binge eating disorder

BED is characterized by feeling out of control around food and consuming large portions in a short time, leading to discomfort and shame. With binge eating, there is no compensatory action—purging, using a laxative or exercising—as is typical with bulimia, a closely related condition.

The most common symptoms of binge eating disorder include the following:

• Eating without feeling hungry
• Eating to uncomfortably intense fullness
• Eating more food than you intended to
• Eating in isolation out of shame or embarrassment
• Hoarding or hiding food
• Forming habitual or ritualistic behaviors around food and binges
• Eating more over a certain amount of time than others would
• Isolating yourself socially out of shame or embarrassment

To meet the diagnostic criteria for BED, some of these symptoms need to occur at least every week for three or more months.

Other common symptoms include weight fluctuations, body obsessions, food group elimination, fad dieting and gastrointestinal distress, according to Melodie Simmons, D.H.A., L.P.C., a certified eating disorder specialist and the executive director of the Center for Discovery in Mesa, Arizona.

Binge eating disorder screening tests and diagnosis

The standard binge eating disorder screening test is the Eating Disorder Examination (EDE), which is a longer interview format, according to Jenna DiLossi, Psy.D., a licensed clinical psychologist and board-certified behavioral and cognitive psychology specialist in Ardmore, Pennsylvania.

"This is not necessarily time efficient and thus used more in research," said DiLossi, who is a co-founder and clinical director of the Center for Hope & Health. "In clinical settings, the corresponding self-report questionnaire is used more, EDE-Q."

The EDE-Q is a 28-item questionnaire that's been in use for more than 25 years to measure eating disorder behaviors and attitudes in research and clinical practice. This report helps differentiate between disordered eating and actual eating disorders. The four original subscales of this questionnaire are restraint, eating, weight and shape, and concern.

Another test, the EAT-26, is a standard questionnaire for a primary care physician to use before referring patients to a specialist, according to Simmons. It is a self-reporting questionnaire that helps determine the socio-cultural factors behind eating behaviors and determine whether someone should be referred for professional help.

Eating disorder risk is also evaluated with this test. It can help uncover the potential of eating disorders forming in a person who doesn't yet meet the criteria of a disorder. A low score on the test can still indicate a need for someone to see a professional. For instance, some people with binge eating disorder report low scores on the EAT-26 but their disorder may still be serious.

When to seek help and who to see

Diagnostic tools are useful, but they are only a stepping stone. The first action is to seek help if you need it.

"If you suspect you have an eating disorder, please find an eating disorder specialist who can further evaluate," Simmons said.

DiLossi recommended seeking care if you have marked distress or impairment in your life, which may present as psychosocial or medical.

"They should seek an evaluation by an eating disorder specialist with expertise in cognitive-behavior therapy-enhanced for eating disorders (CBT-E)," DiLossi said.

What happens if BED goes undiagnosed?

Binge eating disorder that goes undiagnosed is not likely to resolve on its own.

"Bingeing will likely persist and worsen over time, much like substance use wherein the person needs more of the substance to feel the desired impact," DiLossi said.

This could lead to further medical complications, including type 2 diabetes, hypertension, weight gain and social isolation.

"Eating disorders are fatal and second only to the opioid epidemic," Simmons said.

Myths and misconceptions

Simmons and DiLossi agree that one of the biggest misconceptions about BED is that those who experience it must be overweight.

"It's a myth that there is a certain 'look' to any eating disorder, including BED," DiLossi said. "While it is true that many who struggle with BED have higher weights, those in lower weight bodies can also engage in repeated binge episodes and meet the diagnostic criteria for BED."

BED is also not an issue of lack of willpower, as many people may wrongfully believe.

"Many people binge due to undereating throughout the day and then engage in episodes of binge eating," DiLossi said. "Binge eating then can become classically with various stimuli and used as a source of coping for distress."