2/25/26 | By: Dana Harron

UNDERSTANDING BINGE EATING DISORDER

When people think of eating disorders, they tend to think of anorexia or bulimia because they have been most prominent in popular media. But actually, eating disorders encompass a wide range of problematic food behaviors.

BINGE EATING DISORDER (BED)

Binge-eating disorder (BED) is primarily characterized by recurrent episodes of bingeing or eating large amounts of food in relatively short periods of time. A person may plan to binge and hit the grocery store specifically for that purpose or may feel suddenly overtaken and go through much of the food in the house. During a binge, people often feel trancelike and out of control. These episodes must meet at least three of the following criteria for a diagnosis:

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 over the amount being eaten

feeling disgusted, depressed, or very guilty after overeating

The person with BED does not try to get rid of the calories in any way—this behavior would be associated with bulimia (but here is a good example of the limitations of our diagnostic system - in real life people may oscillate between bingeing and purging and bingeing without purging).

The bingeing must also cause distress; someone who binges and is fine with it wouldn’t qualify for this diagnosis. The binges must also happen about once a week for at least three months.

Of course, a great many people who don’t meet this threshold are nevertheless suffering profoundly. If you binge but not often enough to be diagnosed with binge-eating disorder, see the criteria for OSFED (other specified feeding and eating disorder) below.

Binge-eating disorder is the most common eating disorder in the United States, affecting 3.5 percent of women and 2 percent of men. For women, it is more common in early adulthood as the pressures of career and family mount. Men are more likely to suffer BED during midlife. BED is extremely undertreated, with more cases than bulimia and anorexia combined but with less than 3 percent of sufferers getting treatment.

AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID)

Avoidant restrictive food intake disorder (ARFID) has been with us a while but was officially recognized in the DSM-V (American Psychiatric Association 2013), largely based upon the previous diagnosis known as selective eating disorder.

It is quite similar to anorexia nervosa in terms of behaviors (reduced caloric intake, food avoidance), but the motivations are quite different. In the case of ARFID, there is no body-image disturbance or worry over body shape and size. Rather, it’s the food itself that is problematic. People with ARFID may be concerned about food allergies, choking, or nausea, or may be strongly put off by the textures and tastes of many foods.

OTHERWISE SPECIFIED FEEDING AND EATING DISORDER (OSFED) AND UNSPECIFIED FEEDING OR EATING DISORDER (UFED)

If someone doesn’t neatly fit into any of the previous categories but does suffer from disordered eating behaviors, s/he could receive a diagnosis of otherwise specified feeding and eating disorder (OSFED) or unspecified feeding or eating disorder (UFED). OSFED typically applies when there is an observable pattern to the eating behavior, whereas UFED is more of a catchall diagnosis for eating problems that don’t fall into any other category.

People who binge or who binge and purge (but not often enough to qualify for a diagnosis of binge-eating disorder or bulimia) or who restrict their food intake but for other reasons are not at a low weight (atypical anorexia) would likely receive a diagnosis of OSFED. Purging disorder, in which a person purges but doesn’t binge, falls into this category, as does night eating syndrome, a condition in which people consume a large portion during the night due to a disrupted biological clock.

The following list includes the more commonly seen conditions that fall under the umbrella term of UFED but nevertheless have identifiable patterns; many of these conditions require more research to be fully understood and may eventually qualify as “other specified” or fully sepa- rate diagnoses.

ORTHOREXIA

Orthorexia is similar to anorexia in many ways, but the focus here is on the perceived healthiness of the food as opposed to its calorie content. The fear is not of gaining weight so much as of food being contaminated in some way or not “ideally healthy”.

People with orthorexia may be overly preoccupied with avoiding pesticides or preservatives, or they may obsess over getting enough of some nutrient. This is not so-called clean eating: food preferences often become so rigid that the sufferer is not able to enjoy everyday social interactions like going out to a restaurant with friends.

Ironically, orthorexia often has negative health effects for the sufferer; a very rigid diet often does not provide enough nutrient variety and balance.

MUSCLE DYSPHORIA (BIGOREXIA)

As the name implies, people with muscle dysphoria are preoccupied with the shape and size of their muscles. They may spend hours at the gym, obsess over exercise routines, and continue to push their bodies even when injured or sick. They might miss important events so they can work out, or panic if they must skip a day at the gym. Disordered pat- terns of eating are often a part of this picture, as diet can be seen as a part of muscle building. Some people may abuse supplements, protein, or anabolic steroids. A sufferer’s sense of self-worth and lovability is overly influenced by how muscular he deems himself to be. This condition tends to affect men more than women, but women are certainly not immune.

ANOREXIA ATHLETICA (COMPULSIVE OVEREXERCISING)

In this condition, exercise becomes a primary obsession. There may be some overlap between this condition and muscle dysphoria, but in anorexia athletica the exercise is geared not toward muscle building but toward athletic performance. People with this condition may train obsessively even when injured or sick. They may be preoccupied with exercise routines and panic if they view their performance negatively. Exercise and training may interfere with social relationships, job performance, or other aspects of a well-balanced life.

COMPULSIVE OVEREATING

Compulsive overeating is often confused with binge eating, but it is different. In binge-eating disorder, people have lots of food in a discrete period of time. In compulsive overeating, people overeat generally but do not restrict their eating to particular time periods. They don’t binge, per se, but they do use food for emotional reasons.

Many people who compulsively overeat are in larger bodies. For some, eating more than the body needs has resulted in the body storing that energy for later use. For others, living in a larger body in our fatphobic society has led them to soothe their inevitable resentment with food. This is much more common than many people realize. Another term for compulsive overeating is emotional eating.

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BEYOND ANOREXIA AND BULIMIA