Binge eating disorder is the most common eating disorder you’ve never heard of

For many people, eating past the point of fullness on occasion is a familiar experience — a second helping at Thanksgiving, a late-night snack that turns into an accidental meal. In binge eating disorder, however, these episodes go beyond sporadic emotional eating — they are more frequent, more distressing, and often feel impossible to control.

Binge eating disorder, or BED, affects an estimated 2.8% of adults in the United States, making it the most common eating disorder in the country. Yet it remains widely misunderstood — in part because it doesn’t always align with cultural stereotypes of what an eating disorder “looks like.”

Experts say greater awareness is essential, not only to help people recognize the signs in themselves or loved ones, but to shift how we think about eating disorders in general: as complex mental health conditions that don’t discriminate by size, gender, or background.

What is binge eating disorder?

BED was added to the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders classification system in 2013, characterized by two specific behaviors: the first is that an individual will eat a significantly greater amount of food than most people in a two-hour period, and second is that they will experience a feeling of being out of control of their eating.

In addition, says Deborah Beck Busis, LCSW, director of the Beck Institute Weight Management Program, they must meet at least three of these criteria: “They eat much more rapidly than usual. They eat until they feel uncomfortably full. They eat large amounts of food even when they’re not feeling hungry. They are embarrassed by how much they are eating, so they eat alone. Afterwards, they feel disgusted with themselves, depressed, or quite guilty. Also, they need to experience significant distress about their binge eating. They have at least one episode a week for three months. And they don’t regularly compensate for their binge eating by purging, using laxatives, or other compulsive behaviors.”

The severity of someone’s binge eating has its own grading system determined by frequency, says Busis, with 1-3 episodes per week being labeled mild, 4-7 moderate, 8-13 severe, and more than 14, extreme.

While, when we hear about eating disorders, most people think of anorexia or bulimia, BED is actually far more common, affecting over 17 million people globally.

How is binge eating disorder diagnosed?

Though the list of criteria may be very clearly defined, diagnosing BED is not often a simple task. “Individuals may have disordered eating behavior, but not meet full criteria for BED, either because their frequency of binge episodes is too low, or they don’t meet another diagnostic metric,” says Busis. But that doesn’t mean that their suffering is any less real.

Often a co-occurring disorder, people with binge eating disorder may simultaneously be contending with mental health issues like anxiety, depression, or PTSD. “People commonly think of binge eating as a lack of willpower or discipline, which it isn’t,” says Jonathan Levine, LCSW, therapist lead at virtual eating disorder clinic Equip Health. “Part of it is that we’re feeling really bad, we experienced a core trauma, or we’re severely depressed, and we don’t want to feel those feelings. And one way of trying to avoid them is a repetitive behavior like eating.”

Though binge eating disorder follows different patterns than anorexia or bulimia, it’s still often influenced by restriction, which can lead to misunderstandings and misdiagnosis. “After a binge episode there is often some desire to compensate for it,” Levine explains. ‘So, you eat a lot of food and then say, “I’m not going to eat all day tomorrow, or I’m going to run so much I burn it off.” This pattern, often referred to as the “binge-restrict cycle,” can contribute to increased feelings of loss of control over eating for some people. While restriction was previously believed to be a major cause of binge eating, recent research suggests that its impact on binge eating may depend on other factors like the severity of restriction, presence of negative emotions, and low self-esteem.

There’s also a lot of cultural stigma around the notion of binging (we are, after all, a society that holds extreme restriction in high esteem) so reaching out for help can be a challenge. More awareness around binge eating disorder can help address some of that stigma. “Binge eating being discussed without an undertone of disgust is a positive thing,” says Levine, adding that compassion and using the right language when talking about food and diet culture is key.

How is binge eating disorder treated?

While there is no universal approach for treating binge eating disorder, research has found several approaches to be effective. As with most eating disorders, says Levine, it’s often behaviors that clinicians will address first. “It’s really hard to target cognitive beliefs, and core beliefs about yourself and change those things quickly, and much easier to implement behavioral changes,” says Levine. Both Busis and Levine are huge proponents of CBT (cognitive behavioral therapy) as a first line defense for BED. DBT (dialectical behavior therapy) and IPT (interpersonal therapy) have also shown to be effective for BED in randomized controlled trials.

“[CBT] teaches individuals essential skills for changing their thinking, so they can then change their eating behavior,” says Busis. That can mean figuring out triggers and coming up with strategies in advance for how to manage and avert a binging episode, says Busis. Or learning how to evaluate the accuracy and helpfulness of an intrusive thought. It can also help with the dietary restraints BED sufferers put on themselves. “The more you tell yourself not to do something, it’s the elephant in the room, so it’s about normalizing eating so that your body’s getting the food it needs and taking away the power of what we call binge food,” says Levine. If he has a client who says their binge food is potato chips, the homework he’ll often give them is to eat them every day. “If you normalize it, it’s not going to be as powerful,” he adds.

As for GLP-1s, they have also become part of the binge eating disorder conversation because early research suggests they decrease binge frequency. “Semaglutide sends signals to the brain that the stomach is full, so people don’t feel as hungry, and it changes the way the brain reacts to food rewards,” says Busis, who says they are sometimes used in tandem with CBT.

But, says Levine, there is really only one medication, the stimulant lisdexamfetamine (brand name Vyvanse) that is evidence based in supporting BED. “We need better data to understand both the possible risks and benefits of GLP-1 medications on eating behaviors,” says Hiba Jebeille, a dietitian and research fellow at the University of Sydney who currently has a paper on the topic under review. What’s clear is that the path to treating binge eating disorder isn’t about just eating less. “What society says is all we need to do is make someone thin and it’ll be fine and that is a very oversimplification of health,” says Levine.

Getting care starts with acknowledging that you need (and deserve it), and finding a supportive clinician. You can ask your primary care provider for a referral or you can search for one on the National Eating Disorders Association (NEDA) site, which allows you to filter by location, specialty, and insurance coverage.