FITNESS & NUTRITION Eating Disorders • Eating disorders • Anorexia nervosa • Bulimia nervosa • Binge-eating disorder

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Almost everyone overeats on occasion, perhaps having seconds or thirds of a holiday meal or scarfing down an entire bag of chips while watching a scary movie. You feel stuffed for a few hours and then resume your normal, healthy eating habits.

For some people, though, overeating like this doesn't just become a way of life, it takes over their life. It's called binge-eating disorder, and although people with this condition feel embarrassed and ashamed about gorging themselves for what could be hours on end and resolve to stop doing it, they also feel a compulsion to continue.

Because binge-eating disorder has only recently started attracting serious attention and there's still uncertainty over its definition, it's unknown how many people are affected. Most estimates say it's the most common of all eating disorders. Estimates suggest that about 0.7 percent 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.

Find out what constitutes binge-eating disorder, what treatments are available and how binge eating differs from other eating disorders.

People with binge-eating disorder 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. A precise definition of a binge remains up for debate. 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.

People who binge may eat when they're not really hungry and continue eating even long after they're uncomfortably full. After a binge, they often try to diet or eat normal meals. But restricting their eating can lead to more bingeing, perpetuating the cycle.

Physically, people with binge-eating disorder may show no signs or symptoms. They may be overweight or obese, but not always. Most obese people don't have binge-eating disorder, though.

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

• Eating until the point of discomfort or pain
• Eating much more food during a binge episode than during a normal meal or snack
• Eating faster during binge episodes
• Feeling that their eating behavior is out of control
• Frequent dieting without weight loss
• Recurrent episodes of binge eating
• Frequently eating alone
• Hoarding food
• Hiding empty food containers
• Feeling depressed, disgusted or upset over the amount eaten
• Depression or anxiety

Binge-eating disorder is not yet officially classified as a mental disorder, and not everyone thinks 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 another eating disorder, bulimia nervosa, 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 inappropriate methods. That's why most people with binge-eating disorder are overweight. In fact, other theories say binge eating may be a type of obesity disorder.

As in other eating disorders, in binge-eating disorder people are often overly focused on — and unhappy with — their weight, body shape and appearance. People with binge-eating disorder often feel miserable about their lives and are at higher risk of serious health complications than are those without the disorder.

Because researchers only recently began studying binge-eating disorder, they're still trying to learn more about potential causes.

As with other mental disorders, there's likely no single cause. Rather, binge-eating disorder probably arises from an interplay of biological, psychological and sociocultural factors, including family, relationships and life experiences.

Here's a closer look:

• Biological. Some people may be biologically vulnerable to developing binge-eating disorder. Both genes and brain chemicals may be involved in the disorder. 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. People with binge-eating disorder may have psychological and emotional characteristics that contribute to the disease. They may have low self-worth, for instance. They may have trouble controlling impulsive behaviors, managing their 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.

Mental health experts are still trying to understand what factors may put someone at risk of developing binge-eating disorder. People with binge-eating disorder may have different risk factors from people with other eating disorders, such as anorexia or bulimia.

Here are some risk factors under study:

• Dieting. Dieting is often a risk factor for anorexia and bulimia. People with binge-eating disorder have a mixed history of dieting — some have dieted to excess dating back to childhood, while others haven't.
• Psychological issues. Certain behaviors and emotional problems are more common in people with binge-eating disorder. Like people with bulimia, they tend to act impulsively and feel a lack of control over their behavior. They may have a history of depression or substance abuse.
• Sexual abuse. Some people with binge-eating disorder report having been sexually abused as children.
• Media and society. People with binge-eating disorder are typically preoccupied with their body shape, weight and appearance. Messages in the media that equate thinness with success may heighten the self-criticism that's common in binge eating.

When everything revolves around what you eat and how you look, it's difficult to enjoy normal activities and live life to its fullest. You may not even be able to enjoy a simple meal with family and friends, knowing it could trigger a full-fledged binge.

You may turn to binge eating as a way to cope with or ignore painful emotions or stress and anxiety. And then once you binge, you're ashamed, embarrassed and critical of yourself. Urges to eat may be too powerful to resist, even if you know you'll feel worse afterward.

Indeed, binge-eating disorder can exact a heavy toll. You may miss work or school, avoid social activities and have frequent health problems. And if you're overweight, you also have that emotional hardship to deal with.

If you're experiencing any of these problems, or if you think you may have an eating disorder, you'd probably benefit from a medical evaluation, which can help you get appropriate treatment. Because of its powerful pull, binge-eating disorder can be difficult to manage or overcome by yourself.

If you think your child may have an eating disorder, talk to him or her. Your child may not be ready to acknowledge having an issue about food, but you may be able to open the door by expressing concern and a desire to listen. You may also want to consider contacting your child's doctor about your concerns. You can get a referral to qualified professionals for treatment.

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 can assess thoughts, feelings and eating habits. Psychological self-assessments and questionnaires also are used to help determine your attitudes about food and your appearance. Because eating disorders are often associated with depression and anxiety, doctors can check for those conditions, too.
• 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
Binge-eating disorder is not yet classified as a specific mental health condition. Mental health conditions are spelled out 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 are:

• 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 uncomfortably full; eating large amounts when not hungry; eating alone out of embarrassment; feeling disgusted, depressed or guilty after eating
• Distress about binge eating
• Binge eating occurring at least twice a week for at least six months
• Binge eating not 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 and need professional help.

People with binge-eating disorder don't enjoy eating to excess. Most are upset and distressed about their behavior and may develop depression and other health problems. Some people may believe that those with binge-eating disorder have fewer health risks than do those with anorexia or bulimia, but that's not necessarily true. People with binge-eating disorder face a host of medical complications.

Some of the complications can arise from being overweight as a result of frequent bingeing. Other complications may occur because of unhealthy yo-yo eating habits — binges followed by periods of calorie restriction. In addition, food consumed during a binge is often high in fat and low in protein and other nutrients, which could lead to malnourishment.

Physical complications of binge-eating disorder include:

• 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

In addition, people with binge-eating disorder are at higher risk of other health issues, including:

• Depression
• Anxiety
• Stress
• Sleeping problems
• Substance abuse

People with binge-eating disorder may find their health problems worsened by lack of exercise. But with a poor body image, they may be reluctant to exercise, especially in public.

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

Research shows four types of treatment in particular may be most effective. They are:

• Psychotherapy. Psychotherapy, whether in individual or group sessions, can help teach people how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. It teaches you how to monitor your eating and your moods, develop problem-solving skills and learn how to respond to stressful situations. Psychotherapy can also help improve relationships and mood.

  Studies show that a few types of psychotherapy in particular may be effective. These are cognitive behavior therapy, interpersonal therapy and dialectical behavior therapy — an intensive type of therapy that focuses on learning how to more evenly regulate emotions. For children with binge-eating disorder, family therapy also may be beneficial.

• Medications. There's no medication specifically approved by the Food and Drug Administration (FDA) to treat binge-eating disorder. However, studies show that several types of medications may be helpful, including the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), certain appetite suppressants and certain anti-seizure medications, such as topiramate (Topamax).

• 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 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. These programs typically aren't recommended until the binge-eating disorder is treated. Very low calorie diets can trigger more binge-eating episodes — only serving to make 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.

Some studies show that people with binge-eating disorder may see an improvement in their symptoms simply from the process of seeking help, even if they aren't given a specific treatment. For example, they may see a reduction in their symptoms if they receive a placebo instead of an actual medication. Those responses are what drive some experts to conclude that binge-eating disorder shouldn't be classified as a separate and specific mental illness.

In young children and adolescents, pediatricians may be in a good position to identify early indicators of an eating disorder and prevent the development of full-blown illness. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance.

Make sure your children attend well-child doctor visits. These visits should include checks of body mass index and weight percentiles. Those checks can provide an early warning about overeating — or undereating.

Family dining habits may also influence the relationships children develop with food. Try to eat some meals together as a family. Teach children about the pitfalls of dieting, and encourage healthy eating. If your child has symptoms of anxiety, depression or other mood disorders, seek medical care.

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 an eating disorder from developing, you can talk about healthier behavior or treatment options.

By its definition, an eating disorder means you aren't taking care of yourself. Even when you're in treatment, it can be hard to adopt or maintain healthy habits. And you may have occasions when you return to your old, unhealthy eating behaviors.

But proper self-care can help you feel better during and after treatment and help maintain your health. Try to follow through on some of these self-care steps, but if you can't, don't let that fuel more self-criticism:

• Avoid dieting.
• Eat breakfast. Most people with binge-eating disorder skip breakfast. But studies show that people who eat breakfast are less prone to eating higher calorie meals later in the day.
• Cut back on how much food you stock at home. That may mean more-frequent trips to the grocery store, but it may also take away the temptations.
• Talk to your doctor about appropriate vitamin and mineral supplements. 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.
• Stick to your treatment. Don't skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.
• 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.
• 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.
• Read self-help books that offer sound, practical advice. Consider discussing the books with your health care providers.
• Find healthy ways to nurture yourself by doing something just for fun or to relax.

People with eating disorders may face an especially difficult struggle, since food is essential to survival. There's no avoiding it — you have to deal with it on a daily basis. Having an eating disorder and being overweight is a double whammy, particularly since many people think of the emaciation of anorexia when they think about eating disorders.

So how do you cope with a serious illness 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 this disorder. Someone you can call on for support instead of bingeing.
• Consider journaling about your feelings and behaviors. Journaling can make you more aware of your feelings and actions, and how they're intertwined.