Binge-eating disorder is characterized by recurrent episodes of consuming large amounts of food with a feeling of loss of control. It is not followed by inappropriate compensatory behavior, such as self-induced vomiting or laxative use. Diagnosis is based on clinical criteria. Treatment is with cognitive behavioral therapy or sometimes interpersonal psychotherapy or medications (selective serotonin reuptake inhibitors [SSRIs] or lisdexamfetamine).Binge-eating disorder is characterized by recurrent episodes of consuming large amounts of food with a feeling of loss of control. It is not followed by inappropriate compensatory behavior, such as self-induced vomiting or laxative use. Diagnosis is based on clinical criteria. Treatment is with cognitive behavioral therapy or sometimes interpersonal psychotherapy or medications (selective serotonin reuptake inhibitors [SSRIs] or lisdexamfetamine).
Binge-eating disorder affects approximately 1 to 2% of women and less than 1% of men in the general population during their lifetime. By some estimates, more than 3% of adolescent girls and 1% of adolescent boys are affected (1). Unlike bulimia nervosa, binge-eating disorder occurs most commonly among people with overweight or obesity and contributes to excessive caloric intake; it is present in 17 to 27% of patients in some weight-reduction programs (2, 3). Compared with people with anorexia nervosa or bulimia nervosa, those with binge-eating disorder are older, on average, at diagnosis (4).
Genetic variation and the intestinal microbiome may play a causative role, but this has not been definitively shown (1).
References
1. Giel KE, Bulik CM, Fernandez-Aranda F, et al. Binge eating disorder. Nat Rev Dis Primers. 2022;8(1):16. Published 2022 Mar 17. doi:10.1038/s41572-022-00344-y
2. Graungaard S, Christensen TL, Soendergaard LN, Telléus GK. Prevalence of eating disorder symptomatology among outpatients referred to health promotion from somatic hospital departments. BMC Psychiatry. 2023;23(1):841. Published 2023 Nov 15. doi:10.1186/s12888-023-05331-5
3. Montano CB, Rasgon NL, Herman BK. Diagnosing binge eating disorder in a primary care setting. Postgrad Med. 2016;128(1):115-123. doi:10.1080/00325481.2016.1115330
4. Udo T, Grilo CM. Prevalence and Correlates of DSM-5-Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biol Psychiatry. 2018;84(5):345-354. doi:10.1016/j.biopsych.2018.03.014
Symptoms and Signs of Binge-Eating Disorder
During a binge episode, people eat a much larger amount of food than most people would eat in a similar time under similar circumstances. During and after a binge, people feel as if they have lost control. Binge eating is not followed by purging (by inducing vomiting, misusing laxatives, diuretics, or enemas), excessive exercising, or fasting. Binge eating occurs in episodes; it does not involve constant overeating ("grazing") (1).
People with binge-eating disorder are distressed by it. Mild to moderate depression and preoccupation with body shape, weight, or both are more common in people with obesity who have binge-eating disorder than in people of similar weight who do not binge eat (2, 3).
Binge-eating disorder is strongly associated with overweight and obesity, and patients with binge-eating disorder are at risk for the development of obesity-related medical complications such as hypertension and diabetes (4).
Symptoms and signs references
1. Uniacke B, Walsh BT. Eating Disorders. Ann Intern Med. 2022;175(8):ITC113-ITC128. doi:10.7326/AITC202208160
2. Sommer LM, Halbeisen G, Erim Y, Paslakis G. Two of a Kind? Mapping the Psychopathological Space between Obesity with and without Binge Eating Disorder. Nutrients. 2021;13(11):3813. Published 2021 Oct 26. doi:10.3390/nu13113813
3. Jones-Corneille LR, Wadden TA, Sarwer DB, et al. Axis I psychopathology in bariatric surgery candidates with and without binge eating disorder: results of structured clinical interviews. Obes Surg. 2012;22(3):389-397. doi:10.1007/s11695-010-0322-9
4. Giel KE, Bulik CM, Fernandez-Aranda F, et al. Binge eating disorder. Nat Rev Dis Primers. 2022;8(1):16. Published 2022 Mar 17. doi:10.1038/s41572-022-00344-y
Diagnosis of Binge-Eating Disorder
Psychiatric assessment
Clinical criteria for diagnosis of binge-eating disorder from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR) require the following (1):
Binge eating occur, on average, at least once a week for 3 months
Patients have a sense of lack of control over eating
In addition, ≥ 3 of the following must be present:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of embarrassment
Feeling disgusted, depressed, or guilty after overeating
Binge-eating disorder is differentiated from bulimia nervosa (which also involves binge eating) by the absence of compensatory behaviors (eg, self-induced vomiting, use of laxatives or diuretics, excessive exercise, fasting).
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, DSM-5-TRFeeding and Eating Disorders: Binge-eating disorder. American Psychiatric Association Publishing, Washington, DC, pp 392-396.
Treatment of Binge-Eating Disorder
Cognitive behavioral therapy
Sometimes interpersonal psychotherapy
Consideration of pharmacologic therapy, usually selective serotonin reuptake inhibitors (SSRIs) or lisdexamfetamineConsideration of pharmacologic therapy, usually selective serotonin reuptake inhibitors (SSRIs) or lisdexamfetamine
Cognitive behavioral therapy is the most studied and best-supported treatment for binge-eating disorder, but interpersonal psychotherapy appears equally effective (1). Both result in remission rates of approximately 50%, and improvement is usually well maintained over the long term (2). These treatments do not produce significant weight loss in patients with obesity.
Conventional behavioral weight-loss treatment has short-term effectiveness in reducing binge eating, but patients tend to relapse (3). Antidepressant medications (eg, SSRIs) also have short-term effectiveness in eliminating binge eating, but long-term effectiveness is unknown. Lisdexamfetamine is also prescribed for the treatment of moderate to severe binge-eating disorder. It can reduce the number of binge days and appears to cause slight weight loss, but its long-term effectiveness is unknown. Appetite-suppressing medications (eg, topiramate) or weight-loss medications (eg, orlistat) may be helpful.) also have short-term effectiveness in eliminating binge eating, but long-term effectiveness is unknown. Lisdexamfetamine is also prescribed for the treatment of moderate to severe binge-eating disorder. It can reduce the number of binge days and appears to cause slight weight loss, but its long-term effectiveness is unknown. Appetite-suppressing medications (eg, topiramate) or weight-loss medications (eg, orlistat) may be helpful.
Bariatric surgery can lead to short-term improvement in binge-eating disorder, likely by altering both the hormonal milieu and the gut microbiome (4). Evidence for long-term outcomes is less clear; in 1 study, about one-third of those with preoperative binge eating reported binge eating 10 years after bariatric surgery (5).
Treatment references
1. Grilo CM. Treatment of Eating Disorders: Current Status, Challenges, and Future Directions. Annu Rev Clin Psychol. 2024;20(1):97-123. doi:10.1146/annurev-clinpsy-080822-043256
2. Linardon J. Rates of abstinence following psychological or behavioral treatments for binge-eating disorder: Meta-analysis. Int J Eat Disord. 2018;51(8):785-797. doi:10.1002/eat.22897
3. Giel KE, Bulik CM, Fernandez-Aranda F, et al. Binge eating disorder. Nat Rev Dis Primers. 2022;8(1):16. Published 2022 Mar 17. doi:10.1038/s41572-022-00344-y
4. Morad-Abbasi R, Zare-Shahne F, Naeini F, Saidpour A, Etesam F, Hosseinzadeh-Attar MJ. Effects of bariatric surgeries on Binge eating disorders, Food addiction, and eating behaviors: A comprehensive systematic review of RCTs. Clin Nutr ESPEN. 2025;67:222-232. doi:10.1016/j.clnesp.2025.03.016
5. Reas DL, Lie SØ, Mala T, Lundin Kvalem I. Binge Eating Behaviour Before and 10 Years Following Metabolic and Bariatric Surgery. Eur Eat Disord Rev. 2025;33(3):544-550. doi:10.1002/erv.3161
Key Points
People with binge-eating disorder have episodes of consuming large quantities of food, do not compensate by vomiting or purging, and tend to have overweight or obesity.
Diagnose binge-eating disorder based on clinical criteria (including binge eating, on average, at least once/week for 3 months, with a sense of lack of control over eating).
Treat with cognitive behavioral therapy or interpersonal psychotherapy and sometimes medications (eg, SSRIs, lisdexamfetamine). Treat with cognitive behavioral therapy or interpersonal psychotherapy and sometimes medications (eg, SSRIs, lisdexamfetamine).
Drugs Mentioned In This Article
