When you have binge-eating disorder, sometimes called compulsive overeating, you regularly eat excessive amounts of food (binge). A binge is considered eating a larger amount of food than most people would eat under similar situations. For instance, you may eat 10,000 to 20,000 calories worth of food during a binge, while someone following a normal diet may eat 1,500 to 3,000 calories in a day.

The precise definition of a binge remains up for debate, though. A binge episode is typically considered to last about two hours. But the duration also is under debate, and some experts say binges can last an entire day.

You may have no obvious physical signs or symptoms when you have binge-eating disorder. You may be overweight or obese, or you may be of a normal weight. In fact, most obese people don't have binge-eating disorder.

On the other hand, when you have binge-eating disorder you often have numerous behavioral and emotional signs and symptoms. These may include:

• Eating large amounts of food
• Eating even when you're full
• Eating rapidly during binge episodes
• Feeling that your eating behavior is out of control
• Depression
• Anxiety
• Frequent dieting without weight loss
• Frequently eating alone
• Hoarding food
• Hiding empty food containers
• Feeling depressed, disgusted or upset about your eating

After a binge, you may try to diet or eat normal meals. But restricting your eating may simply lead to more binge eating, creating a vicious cycle.

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It's not known specifically what causes binge-eating disorder. As with many mental illnesses, it's thought that a variety of factors are at play in binge-eating disorder and may include:

• Biological. Biological vulnerability may play a role in developing binge-eating disorder. Both genes and brain chemicals may be involved. In addition, researchers are studying appetite regulation of the central nervous system for clues, along with gastrointestinal changes that might shed light on causes.
• Psychological. Psychological and emotional characteristics may also contribute to the condition. You may have low self-worth and trouble controlling impulsive behaviors, managing moods or expressing anger.
• Sociocultural. Modern Western culture often cultivates and reinforces a desire for thinness. Although most people who have binge-eating disorder are overweight, they're acutely aware of their body shape and appearance and berate themselves after eating binges. Some people with binge-eating disorder have a history of being sexually abused.

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It's not known with certainty how many people have binge-eating disorder, in part because it's still not clear exactly what binge-eating disorder is. But some experts say that binge-eating disorder is the most common of all eating disorders. Estimates suggest that up to 4 percent of the U.S. population has binge-eating disorder, with girls and women slightly more likely than boys and men to develop the condition. Both children and adults can develop binge-eating disorder, but it's most common when in your 40s and 50s.

Mental health experts are still trying to understand what factors may increase the risk of developing binge-eating disorder. The risk factors may vary from those of other eating disorders, such as anorexia or bulimia. Risk factors for binge-eating disorder may include:

• Dieting. Dieting is often a risk factor for anorexia and bulimia, but it's not clear what role it plays in binge-eating disorder. People with binge-eating disorder have a mixed history of dieting — some have dieted to excess dating back to childhood, while others haven't dieted. Dieting may trigger an urge to binge eat.
• Psychological issues. Certain behaviors and emotional problems are more common when you have binge-eating disorder. As with bulimia, you may act impulsively and feel a lack of control over your behavior. You may have a history of depression or substance abuse. Binge eaters may have trouble coping with anger, sadness, boredom, worry and stress.
• Sexual abuse. Some people with binge-eating disorder say they were sexually abused as children.
• Media and society. A preoccupation with body shape, weight and appearance is common when you have binge-eating disorder. Messages in the media that equate thinness with success may heighten the self-criticism that's common in binge eating.

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If you have any binge-eating disorder symptoms, seek medical help as soon as possible. Binge-eating disorder usually doesn't get better by itself, and it may even get worse if left untreated.

When you have binge-eating disorder, your life may revolve around food and eating, making it difficult to enjoy normal activities and to live life to its fullest. You may frequently feel embarrassed and ashamed. And you may miss work or school and avoid social activities. If you're overweight or obese, you may develop serious health problems, such as diabetes.

If you have a primary care doctor, talk to him or her about your binge-eating symptoms and feelings. Or seek help directly from a mental health provider. If you're reluctant to seek treatment, try to work up the courage to confide in someone about what you're going through, whether it's a friend or loved one, a health care professional, a teacher, a faith leader or someone else you trust. They can help you take the first steps to successful binge-eating disorder treatment.

Helping a loved one with binge-eating disorder symptoms
If you have a loved one you think may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her.

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Binge-eating disorder is not yet officially classified as a mental disorder, and not all experts think it should be. Mental health experts hope that ongoing research will determine if binge eating is a distinct medical condition, a nonspecific type of eating disorder, or simply a cluster of symptoms.

Binge eating is similar to bulimia nervosa, another eating disorder, and some experts think it may be a form of bulimia. But unlike people with bulimia, who purge after eating, people with binge-eating disorder don't try to rid themselves of the extra calories they consume by self-induced vomiting, overexercising or other unhealthy methods. That's why most people with binge-eating disorder are overweight. In fact, some experts say that binge eating may be a type of obesity disorder.

In any case, when doctors suspect someone has an eating disorder, they typically run a battery of tests and exams. These can help pinpoint a diagnosis and also assess any related complications.

These exams and tests generally include:

• Physical exam. This may include such things as measuring height and weight; assessing body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin; listening to the heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check such things as cholesterol levels, thyroid functioning, electrolytes and blood sugar, which may determine if you have metabolic syndrome.
• Psychological evaluation. A doctor or mental health professional will discuss your thoughts, feelings and eating habits with you. You may be asked about binge-eating symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar issues in the past. You may also be asked to complete psychological self-assessments and questionnaires.
• Other studies. Other studies may be done to check for health consequences of binge-eating disorder, such as heart problems, gallbladder disease or sleep apnea.

Criteria for diagnosis
All these evaluations help doctors determine if you meet the criteria for binge-eating disorder or if you may have another eating disorder, such as bulimia. The criteria to diagnose mental health conditions are set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

The DSM says more research is needed before determining whether binge-eating disorder is truly a unique medical condition. However, it offers some criteria for diagnosing binge-eating disorder.

DSM diagnostic criteria for binge-eating disorder include:

• Recurrent episodes of binge eating, including eating an abnormally large amount of food and feeling a lack of control over eating
• Binge eating that's associated with at least three of these factors: eating rapidly; eating until you're uncomfortably full; eating large amounts when you're not hungry; eating alone out of embarrassment; or feeling disgusted, depressed or guilty after eating
• Distress about your binge eating
• Binge eating occurs at least twice a week for at least six months
• Binge eating isn't associated with inappropriate methods to compensate for overeating, such as self-induced vomiting

Some people may not meet all of these criteria but still have an eating disorder. As researchers learn more about eating disorders, the diagnostic criteria may evolve and change. Don't try to diagnose yourself — get professional help if you have any eating disorder symptoms.

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If you're like others with binge-eating disorder, you don't enjoy eating to excess. You find it upsetting and distressing. And you may even develop psychological and physical problems related to binge eating, making you even more miserable and further reducing your quality of life.

Some of these complications can arise from being overweight as a result of frequent bingeing. Other complications may occur because of unhealthy yo-yo eating habits — binging followed by harsh dieting. In addition, food consumed during a binge is often high in fat and low in protein and other nutrients, which could actually lead to malnourishment even if you're overweight.

Complications that binge-eating disorder may cause or be associated with include:

• Depression
• Anxiety
• Panic attacks
• Substance or alcohol abuse
• Obesity
• High blood pressure
• Type 2 diabetes
• High blood cholesterol
• Gallbladder disease
• Heart disease
• Stroke
• Osteoarthritis
• Joint pain
• Muscle pain
• Gastrointestinal problems
• Headache
• Sleep apnea

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The goals for treatment of binge-eating disorder are to reduce eating binges, improve your emotional well-being and, when necessary, to lose weight. Because binge eating is so entwined with shame, poor self-image, self-disgust and other negative emotions, treatment needs to address these and other psychological issues.

There are four main types of treatment for binge-eating disorder.

Psychotherapy
Psychotherapy, whether in individual or group sessions, can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. But definitive scientific research about the benefits of psychotherapy remains lacking. Some studies do show that a few types of psychotherapy may be helpful, including:

• Cognitive behavioral therapy. Some studies show that cognitive behavioral therapy may help you cope better with issues that may trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and eating patterns. However, cognitive behavioral therapy hasn't been shown helpful in reducing weight. So if you're overweight, you may need additional treatment.
• Interpersonal therapy. Interpersonal therapy focuses on your current relationships with other people. This may help reduce binge eating that's triggered by poor relationships and unhealthy communication skills. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and colleagues. You learn how to evaluate the way you interact with others and develop strategies for dealing with relationship and communication problems.
• Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.

Medications
There's no medication specifically approved by the Food and Drug Administration (FDA) to treat binge-eating disorder. And research results about the effectiveness of medications to treat binge-eating disorder have been mixed. Some studies show that combining therapy with medications may be more effective than either treatment alone. But more studies are needed before drawing firm conclusions. However, some studies show that several types of medications may be helpful, including:

• Antidepressants. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be helpful for binge eating. It's not clear how these can reduce binge eating, but it may be related to how they affect certain brain chemicals associated with mood.

  Be aware that all antidepressants have potentially harmful side effects. In particular, antidepressants have an FDA-mandated black box warning about their possible connection to increased thoughts of suicide. If you take antidepressants, you must be carefully monitored for such thoughts, especially when you first start treatment or have any changes in dosage.

• The anticonvulsant topiramate (Topamax). Normally used to control seizures, topiramate has also been found in some studies to reduce binge-eating episodes. However, it can cause serious side effects, including blurred vision, double vision, clumsiness or unsteadiness, dizziness, drowsiness, and trouble in thinking.
• The anti-obesity medication sibutramine (Meridia). Officially included in the group of antidepressants known as serotonin and norepinephrine reuptake inhibitors (SNRIs), sibutramine has been FDA approved for long-term obesity treatment. Sibutramine may be most helpful if you have binge-eating disorder and are obese. It's been found to suppress hunger and make you feel full, leading to weight loss. However, it can cause dangerous changes in your blood pressure and other side effects.

Behavioral weight-loss programs
More so than psychotherapy, weight-loss programs focus on losing excess body weight. They're typically conducted under medical supervision to ensure that your nutritional requirements are met. Some programs are known as very low calorie diet programs because they include an initial period of strict calorie restriction for fast weight loss.

Weight-loss programs may also address issues that tend to trigger binges, but often to a lesser extent than psychotherapy does. However, weight-loss programs, especially those that are not medically supervised, may not be appropriate for everyone with binge-eating disorder. And such programs typically aren't recommended until the binge-eating disorder is treated. Very low calorie diets can trigger more binge-eating episodes making the condition worse.

Self-help strategies
Some people with binge-eating disorder find self-help books, videos and support groups effective. Some eating disorder programs offer self-help manuals that you can use on your own or with guidance from mental health experts. Self-help strategies may not be effective on their own, though. You still may need professional treatment with psychotherapy or medications.

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While there's no sure way to prevent binge-eating disorder, there may be ways to help. For instance, pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development. During routine well-child checks or medical appointments, pediatricians can ask children questions about their eating habits and satisfaction with their appearance. Parents can also cultivate and reinforce a healthy body image in their children no matter what their size or shape. Be certain not to tease or joke about a child's size, shape or appearance.

In addition, if you notice a family member or friend with low self-esteem, severe dieting, frequent overeating, hoarding of food or dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent binge-eating disorder or another eating disorder from developing, you can talk about healthier behavior or treatment options.

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Binge-eating disorder generally isn't an illness that you can treat on your own. But you can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care steps for binge eating:

• Stick to your treatment. Don't skip therapy sessions. If you have meal plans, do your best to stick to them and don't let setbacks derail your overall efforts.
• Avoid dieting. Trying to diet can trigger more binge episodes, leading to a vicious cycle that's hard to break.
• Eat breakfast. Many people with binge-eating disorder skip breakfast. But studies show that if you eat breakfast, you're less prone to eating higher calorie meals later in the day.
• Don't stock up. Keep less food in your home than you normally do. That may mean more-frequent trips to the grocery store, but it may also take away the temptation and ability to binge eat.
• Get the right nutrients. Just because you may be eating a lot during binges doesn't mean you're eating the kinds of food that supply all of your essential nutrients. Talk to your doctor about vitamin and mineral supplements.
• Stay connected. Don't isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart.
• Get active. Talk to your health care providers about what kind of exercise is appropriate for you, especially if you have health problems related to being overweight.

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When living with an eating disorder you may face an especially difficult struggle to cope, since food is essential to survival. There's no avoiding it — you have to deal with food on a daily basis. Having an eating disorder and being overweight is a double whammy. So how do you cope with a serious condition that may also subject you to ridicule and scorn?

• Ease up on yourself. Don't buy into your own self-criticism.
• Identify situations that are likely to trigger thoughts or behavior that may contribute to eating binges so that you can develop a plan of action to deal with them.
• Look for positive role models who can help lift your self-esteem, even if they're not easy to find. Remind yourself that the ultrathin models or actresses showcased in women's magazines or gossip magazines often don't represent healthy, realistic bodies.
• If you're hiding your eating disorder from loved ones, try to find a trusted confidante you can talk to about what's going on. Together, you may be able to come up with some treatment options.
• Try to find someone who can be your partner in the battle against binge eating — someone you can call on for support instead of bingeing.
• Find healthy ways to nurture yourself by doing something just for fun or to relax, such as yoga, photography, meditation or simply a walk.
• Consider journaling about your feelings and behaviors. Journaling can make you more aware of your feelings and actions, and how they're intertwined.

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