Symptoms and Signs of Binge Eating Disorder

Binge Eating Disorder Symptoms

The main symptom of binge eating disorder is binge eating, accompanied by an inability to control the binges, and guilt and/or distress because of these eating episodes. Other signs are not specific to binge eating disorder but are related to the consequences of binge eating. Some of these signs may be gaining weight, being overweight, high cholesterol, or blood sugar levels.

Binge eating disorder is more than just eating too much. Binge eating disorder is a serious condition characterized by uncontrollable eating, significant distress, and often results in weight gain. Although binge eating disorder can be diagnosed in people with normal weight, almost all individuals with binge eating disorder who are seeking treatment are overweight or obese. People suffering with binge eating disorder may feel ashamed and try to hide their symptoms. Eating episodes are usually done secretly to avoid having other people know what is going on. This can, unfortunately, make people reluctant to seek help or treatment so they continue struggling alone.

DSM-5 Diagnostic Criteria for Binge Eating Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires the following criteria for a diagnosis of binge eating disorder:

1. Recurrent episodes of binge eating. Binge eating means eating much more than what other people would eat in a short amount of time (for example, within a two- to three-hour period). During the episode, the person will feel that they have lost control, that they can't stop eating, or can't control what they are eating.

2. The binge-eating episodes are associated with at least three of the following:

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amount of food when not feeling physically hungry
• Eating alone because of feeling embarrassed by how much one is eating
• Feeling disgusted with oneself, depressed, or very guilty afterward

3. People have marked distress regarding binge eating.

4. The binge eating occurs, on average, at least once a week for three months.

The number of binge-eating episodes per week defines the severity of binge eating disorder: mild, one to three; moderate, four to seven; severe, eight to 13; extreme, 14 or more.

If a person used to meet criteria for binge eating disorder but now has one or fewer episodes per week for a sustained period of time (for example, more than a month), they would be considered to be in partial remission. If they no longer have any binge-eating episodes for a sustained period of time, they would be considered in full remission according to the American Psychiatric Association 2013 criteria.

Binge Eating Disorder Causes

The exact causes of binge eating disorder are unknown. Like other eating disorders, binge eating disorder seems to result from a combination of genetic, biological, and psychological factors. Each of these areas can be affected by a person's childhood development, exposure to trauma, how their families dealt with food, physical appearance (and ideals of attractiveness), and what supports a person has.

1. Genetic effects: Because binge eating disorder has been accepted as a formal diagnosis only recently, few studies have investigated genes associated with the disorder. However, some studies suggest that there may run in families, but the genes causing this have not been identified. More studies including larger numbers of families will need to be done for specific genes to be identified.

2. Biological factors: Certain brain chemicals (neurotransmitters) and brain regions may be affected in binge eating disorder.

• Serotonin is a brain chemical that is strongly linked to both mood and anxiety. Depression and increased anxiety are both related to low serotonin levels in parts of the brain. Many antidepressant and antianxiety medications work by increasing serotonin levels in the brain. Although less known, serotonin also participates in appetite regulation. Serotonin may be related to eating disorder behaviors through both of these pathways, and some binge eating disorder treatments work through the serotonin system.
• Dopamine is another neurotransmitter related to appetitive behaviors and the reward pathways in the brain. Appetitive behaviors are the actions taken to seek pleasurable or rewarding experiences -- including sex, food, or drugs -- which activate the reward pathways. The reward pathways are involved with triggering positive feelings in response to positive and pleasurable activities but also in response to the use of many addictive drugs including heroin, cocaine, and alcohol. Eating disorders, particularly binge eating disorder, may be considered a "food addiction" and involve these dopamine pathways.
• Recent studies using brain imaging (functional magnetic resonance imaging or MRI) have implicated both the frontal cortex (involved with our ability to resist certain behaviors) and the striatum (a brain center involved in reward to food and other pleasure) in how the brains of people with binge eating disorder react differently to food and eating.

3. Psychological factors

• How satisfied a person is with their body and image is believed to be an integral part of self-esteem. Individuals assess their bodies by measuring them against culture's ideal body type. How a person's family viewed body image and eating can also have a strong influence on adult ideas of self-image and eating.
• Personality traits such as impulsivity, impulsive decision making, stress reactivity, harm avoidance, perfectionism, and other personality traits are common in patients with eating disorders. As discussed previously, certain personality types seem to be more commonly associated with binge eating disorder.
• Some studies showed a relationship between childhood abuse or trauma and eating disorders. This relationship is complex, since many who experienced early trauma never develop eating disorders.