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# Binge-eating disorder

Repeated episodes of eating large amounts of food with a loss of control, followed by distress, without vomiting or other compensation. Linked to obesity.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Hypothalamus](https://durgical.com/en/anatomy/hypothalamus/)
- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Insula](https://durgical.com/en/anatomy/insula/)
- [Amygdala](https://durgical.com/en/anatomy/amygdaloid-body/)
- [Cingulate gyrus](https://durgical.com/en/anatomy/cingulate-gyrus/)

## Why it happens

- [Cachexia, anorexia nervosa and bulimia](https://durgical.com/en/general-pathology/cachexia-anorexia-nervosa-and-bulimia/)

## What it is

An eating disorder marked by recurrent binges, eating much more food than most people would in a short period while feeling unable to stop, with marked distress and no regular compensatory behaviour such as vomiting, laxatives or excessive exercise.

## Who gets it

The most common eating disorder in adults, more frequent in women but with a smaller gap between sexes than anorexia or bulimia. It is often seen in people seeking weight-loss treatment, and with rising obesity in Colombia and Latin America it is frequently missed in primary care.

## Causes

- Genetic and family factors
- Repeated restrictive dieting and weight-related teasing or stigma
- Using food to regulate negative emotions or stress
- Childhood adversity and trauma

## Risk factors

- Female sex and onset in late adolescence or early adulthood
- Obesity and a history of repeated diets
- Depression, anxiety and ADHD
- Low self-esteem and body dissatisfaction
- Family history of eating disorders or substance use

## Pathophysiology

Binges are thought to arise from a cycle of restriction, negative emotion and loss of control. Altered reward processing (dopamine), reduced inhibitory control from frontal regions and disturbed hypothalamic appetite and satiety signals make highly palatable food especially rewarding. The guilt after a binge feeds the next cycle of restriction and distress.

## Classification

- Mild: 1 to 3 binge episodes per week
- Moderate: 4 to 7 per week
- Severe: 8 to 13 per week
- Extreme: 14 or more per week

## Symptoms and signs

- Eating a large amount of food in a discrete period with a sense of loss of control
- Eating much faster than normal and until uncomfortably full
- Eating large amounts when not physically hungry
- Eating alone because of embarrassment
- Disgust, depression or guilt afterwards
- Weight gain or obesity, though weight can be normal

## Red flags

- Suicidal thoughts or severe depression
- Hidden compensatory behaviours (vomiting, laxatives), which suggest bulimia
- Rapid weight gain with complications (diabetes, sleep apnoea)
- Substance use alongside binges

## Diagnosis

**Clinical**
DSM-5: recurrent binges at least once a week for 3 months, with loss of control, at least 3 associated features (eating rapidly, until uncomfortably full, when not hungry, alone, guilt afterwards), marked distress and no regular compensatory behaviour. Non-judgemental questions about eating are key, because patients rarely volunteer it.

**Tests**
Screening for medical consequences: glucose or HbA1c, lipid profile, [liver](https://durgical.com/en/anatomy/liver/) enzymes, blood pressure and, when indicated, thyroid function.

**Imaging**
Not needed for diagnosis.

## Differential diagnosis

- Bulimia nervosa (binges with regular compensation)
- Night eating syndrome
- Overeating in depression or with some medicines (antipsychotics, corticosteroids)
- Hypothalamic lesions, Prader-Willi syndrome or Kleine-Levin syndrome

## Goal of treatment

Stop or reduce binges, treat associated depression and anxiety, improve the relationship with food and manage weight-related medical complications, without stigma.

## Treatment

**Conservative**
Psychotherapy is first-line: cognitive behavioural therapy (CBT) focused on eating, including guided self-help, and alternatives such as interpersonal therapy or dialectical behaviour therapy.

**Medical**
Medicines when needed: SSRIs reduce binges and treat depression; lisdexamfetamine is approved in some countries for moderate to severe disease in adults; topiramate is an off-label option.

**Lifestyle**
Regular meals, avoidance of strict dieting and, after binges are controlled, structured weight management when indicated.

**Follow-up**
Follow-up of weight, glucose, blood pressure and lipids, and screening for depression and suicide risk.

## Complications

- Obesity
- Type 2 diabetes and metabolic syndrome
- Hypertension and dyslipidaemia
- Obstructive sleep apnoea and gastro-oesophageal reflux
- Depression, anxiety and substance use

## Prognosis

Many patients improve substantially with CBT, with remission in a large proportion, but relapse is common. Weight loss does not always follow the end of binges, and associated mood disorders need ongoing care.

## Prevention

- Avoiding weight stigma and restrictive diets, especially in adolescents
- Asking about loss of control over eating in people with obesity
- Early treatment of depression and anxiety

## Test yourself

Think of the answer, then tap the question to see it.

## What distinguishes binge-eating disorder from bulimia nervosa?

In binge-eating disorder there is no regular compensatory behaviour such as vomiting, laxatives or excessive exercise.

## What is the first-line treatment for binge-eating disorder?

Cognitive behavioural therapy focused on eating.

## Which stimulant is approved in some countries for moderate to severe binge-eating disorder in adults?

Lisdexamfetamine.

## What is the minimum frequency and duration of binges for DSM-5 diagnosis?

At least once a week for 3 months.

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## Related conditions

- [Obesity](https://durgical.com/en/conditions/obesity/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Metabolic syndrome](https://durgical.com/en/conditions/metabolic-syndrome/)
- [Bulimia nervosa](https://durgical.com/en/conditions/bulimia-nervosa/)
- [Anorexia nervosa](https://durgical.com/en/conditions/anorexia-nervosa/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/)
- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Binge Eating Disorder](https://www.niddk.nih.gov/health-information/weight-management/binge-eating-disorder) (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2025).

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Source: https://durgical.com/en/conditions/binge-eating-disorder/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/binge-eating-disorder/