Binge Eating Disorder: Understanding Triggers, Diagnostic Criteria, and Evidence-Based Treatments

Dr. Tracey Marks provides a comprehensive overview of Binge Eating Disorder (BED), distinguishing it from bulimia by the absence of purging behaviors. She outlines the specific diagnostic criteria, which include consuming a massive amount of food in a short period while feeling out of control, occurring at least once a week for three months, alongside at least three specific associated symptoms like eating faster than normal, feeling uncomfortably full, eating when not hungry, eating alone due to shame, and experiencing post-binge disgust, depression, or guilt. The severity of BED is also categorized based on the frequency of binge episodes per week.

The podcast delves into the emotional triggers for BED episodes, highlighting sadness, anger, and frustration as primary culprits, with frustration often encompassing feelings like discouragement, guilt, irritation, inadequacy, and resentment. These emotions are frequently linked to interpersonal interactions. A key insight is that individuals with BED often exhibit reduced emotional awareness, struggling to differentiate nuanced negative feelings (e.g., insulted vs. misunderstood), which hinders healthy emotional processing and leads to eating as a maladaptive coping mechanism. The temporary relief from eating, particularly high-sugar and high-fat foods, is quickly overshadowed by guilt and shame, perpetuating the cycle.

Treatment approaches emphasize therapy, often combined with medication. Evidence-based therapies include Cognitive Behavioral Therapy (CBT), which addresses over-restriction and body image; Interpersonal Therapy (IPT), focused on identifying and coping with negative emotions stemming from relationships; and Dialectical Behavior Therapy (DBT), originally for Borderline Personality Disorder, which teaches mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. CBT guided self-help is also presented as an accessible option, with a specific manual by Christopher Fairburn mentioned.

Medication options include Selective Serotonin Reuptake Inhibitors (SSRIs), though potential side effects like weight gain can be counterproductive. Vyvanse, a stimulant typically used for ADHD, is FDA-approved for BED and has shown efficacy in reducing binges, cravings, and promoting some weight loss, though its exact mechanism in BED is not fully understood. The episode underscores the importance of addressing underlying emotional dysregulation and developing healthier coping strategies for effective management of Binge Eating Disorder.

Binge eating disorder is a newly defined disorder and the criteria is as follows: Eating a massive amount of food in a short period of time, like over a couple of hours, and this would be more than what an average person would eat.

While you're doing this you feel out of control like you just can't stop eating.

This eating behavior has to occur at least once a week for period of three months.

Binge eating disorder episodes have been shown to be triggered by sadness, anger and frustration.

Regardless of the trigger and the emotions with BED, you're unable to tolerate dealing with the negative emotions in a healthy way and eating becomes the coping mechanism.

People with BED are less emotionally aware of their feelings.

Your mouth is a very intimate part of your body... This dynamic plays in to why putting something in your mouth becomes what would be considered a primitive coping mechanism to deal with the internal distress.

The main treatment for binge eating disorder is therapy with or without medication.

Vyvanse is a stimulant that we use to treat ADHD. We don't know exactly how it helps with binge eating disorder, but it has been shown to reduce the binges or the cravings and result in some weight loss.