Binge Eating Disorder
Binge eating disorder (BED) involves recurrent episodes of eating unusually large amounts of food with a sense of loss of control, defined per DSM-5-TR and treated per the APA 2023 Practice Guideline for the Treatment of Patients With Eating Disorders.
Symptoms
Recurrent binge eating episodes (eating an unusually large amount of food with a felt loss of control) at least once a week for 3 months, marked by eating rapidly, eating past fullness, and eating alone out of embarrassment, followed by distress -- without the regular compensatory behaviors seen in bulimia.
Causes and risk
A combination of genetic, psychological (including trauma and mood disorders), and social factors; BED is not caused simply by a lack of willpower and is not the same as occasional overeating.
How it is evaluated
Diagnosis follows DSM-5-TR criteria based on frequency, distress, and the absence of regular compensatory behaviors.
Treatment
CBT is first-line per the APA guideline; lisdexamfetamine is the only FDA-approved medication for moderate-to-severe BED in adults (not indicated for weight loss), and combining CBT with medication showed higher remission (70%) than either alone in a randomized controlled trial.
When to seek care
Thoughts of self-harm require immediate crisis support. New chest pain, palpitations, or high blood pressure while on lisdexamfetamine should be evaluated promptly, since stimulants carry cardiovascular effects.