Does Your Patient Have Binge Eating Disorder?

Have you ever had a patient say to you “I am addicted to sugar” or “I am a food addict” or “I am an emotional eater”?

If so, this comment should be an area to explore in therapy. It could mean nothing, or it could mean your patient is struggling with a full-blown eating disorder.

Food, weight, and shape are all part of the normative conversation in Western society. Diet and food talk is everywhere at cocktail parties, print and social media and even at work. So for most of us, it doesn’t seem unusual for a patient to talk about a particular diet they may be following, whether it is for health or weight loss.

I have had patients who have done years of therapy and have never talked to their therapist about their eating style. Some of them might be too ashamed and some might not even know that they have an eating disorder.

It has been my clinical experience that often, patients don’t know that they have an eating disorder. They assume that they just can’t follow a diet and chalk that up to one more personal failing and poor willpower.

People who identify that they are food addicts may be dealing with binge eating disorder (or another type of eating disorder).
Binge eating can be very distressing and must be addressed in therapy.

Prevalence of Binge Eating Disorder

Binge eating disorder (BED) is one of the most common types of eating disorder, more common than anorexia nervosa and bulimia nervosa combined. According to the Binge Eating Disorder Association, 3.5% of women and 2% of men meet the criteria for binge eating disorder. Thirty to forty percent of weight loss-seeking adults meet the criteria for binge eating disorder.

Binge eating disorder, unlike other eating disorders, occurs among all genders, body sizes, ages, social-economic classes and ethnicities.
Binge eating disorder often co-occurs with other mental health conditions such as bipolar disorder, substance abuse, depression and anxiety disorders.

Criteria for Binge Eating Disorder

1. Reoccurring and persistent episodes of binge eating
2. Binge eating episodes that are associated with three or more of the following:

  • Eating much more rapidly than normal
  • Eating until uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of embarrassment at how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty after overeating

3. Marked distressed regarding binge eating
4. Absence of regular compensatory behaviors such as purging, over-exercising, and laxative abuse

Potential Causes and Risk Factors for Developing Binge Eating Disorder:

While the causes of binge eating disorder are still be studied, some potential risk factors for its development include:

  • Genetics
  • Dieting and other chaotic eating patterns
  • History of significant body weight changes
  • Mood disorders
  • Weight stigma, bias, and/or weight based-bullying
  • Poor interpersonal functioning
  • Trauma
  • Abuse and neglect
  • Addiction

Sufferers of BED may make the following statements:

  • I feel addicted to food (or a certain food).
  • Once I start eating this food, I can’t stop.
  • I am an emotional eater. I eat when I am happy or sad or stressed.
  • I can’t stop eating after dinner.
  • I don’t like to eat in front of others.
  • I have a stash of food that no one knows about.
  • Sometimes I eat two dinners or other meals.
  • I may stop by and get something to eat after work and then go home and have dinner with my family.

Most commercial weight loss programs do not adequately screen participants for eating disorders. Many people who have binge disorder are also considered “overweight,” but many sufferers are considered normal weight. You can’t really tell by looking at someone if they have BED.

Like some other psychological terms, the general public often misuses the term “binge eating.” Clients may say something like “I binged on candy last night.” I’ll ask a follow-up question like, “Tell me what that looks like” or “Tell me more about that.”

The client’s answer may be “Oh, I had a candy bar,” which of course not a clinical binge. On the other hand, the client may say, “I kept going back to the candy bag, and before I knew it, I had eaten two bags of candy.” This behavior is, in fact, a true clinical binge.

Questions you can ask your client to learn more:

Do you feel out of control with food?
Do you often find yourself eating by yourself or feel like you are sneaking food?
Do you feel like you eat large amounts of food?
Tell me about your day yesterday: what time you woke up, what you did, what and how you ate (did you like the food, were you hungry, where and with whom did you eat? )

The bottom line is that like all mental health disorders, binge eating disorder can cause the sufferer to feel significantly distressed and cause impairment in psychosocial functioning. BED can lead to isolation, interfere with relationships, school, or work, cause financial problems, and increase health risk.

To learn more about binge eating disorder:

1. Binge Eating Disorder Association
2. “Overcoming Binge Eating” by Dr. Christopher Fairburn
3. “Crave” by Dr. Cynthia M. Bulik

Alison Pelz a psychotherapist and has been a registered dietitian for more 16 years specializing in the treatment and prevention of body image disturbance, eating disorders and other fitness and weight-related concerns. Currently, she maintains a private practice in Austin, TX. You can download her free guide: “A Therapists Guide: Helpings Client Improve their Body Image” (Even if you struggle with body confidence yourself). Link


Does Your Patient Have Binge Eating Disorder?