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Binge eating disorder is an eating disorder characterized by recurrent uncontrollable binge eating episodes that occur at least once a week for 3 months. Binge eating episodes are associated with significant distress, without compensatory behaviors to counteract weight gain. Causes are multifactorial and similar to those of anorexia nervosa (e.g., genetic factors, psychiatric disorders, and psychosocial factors such as bullying). It is important to assess for malnutrition severity in affected individuals, regardless of body weight or body mass index (BMI). The diagnosis is confirmed if individuals fulfill all of the . Individuals should be evaluated for associated complications (e.g., ) and underlying conditions that may affect weight or cause a change in eating behaviors (e.g., thyroid disorder). Treatment is typically provided in an outpatient setting, but the presence of may indicate the need for hospitalization. All individuals should be referred for psychotherapy (preferably cognitive behavioral therapy) and nutritional management, including binge eating prevention strategies. Pharmacotherapy (e.g., with antidepressants or lisdexamfetamine) may be considered to help reduce the frequency of binge eating episodes.
The etiology of binge eating disorder is multifactorial and not entirely understood. Contributory factors are similar to those associated with anorexia nervosa; see “Etiology of Anorexia nervosa” for details. 
- Genetic factors (family history is common)
- Strict dieting and having access to preferred binge foods
- Psychological issues (e.g., poor body self-image, stress, childhood bullying)
- Recurrent that are not associated with : See also “DSM-5 diagnostic criteria for binge eating disorder.”
- Pronounced at a young age is common; BMI may also be normal.
- Can be associated with:
- Course: typically chronic, relapsing disease
Approximately 25% of affected individuals experience suicidal ideation. 
- See “Screening for eating disorders” for indications and screening modalities. 
- Determine if individuals fulfill all of the DSM-5 diagnostic criteria for binge eating disorder to confirm the diagnosis. 
- Evaluate for complications and comorbidities, and rule out possible organic etiologies for change in weight and/or eating behaviors: See “Initial evaluation for a suspected eating disorder.”
DSM-5 diagnostic criteria 
|DSM-5 diagnostic criteria for binge eating disorder |
|All criteria must be fulfilled.|
All individuals with binge eating disorder experience emotional distress about their binge eating, but not all individuals necessarily experience distress over their weight or appearance. 
Individuals with binge eating disorder often conceal their eating behaviors (e.g., by eating alone). 
Severity (according to the DSM-5) 
Based on the number of binge eating episodes per week
- Mild: 1–3 episodes/week
- Moderate: 4–7 episodes/week
- Severe: 8–13 episodes/week
- Extreme: ≥ 14 episodes/week
- Bulimia nervosa 
- Mood disorders (i.e., major depressive disorder, bipolar disorder)
- Impulsive behavior of borderline personality disorder
- Other conditions associated with , e.g.: 
- Substance use disorder (i.e., alcohol and/or cannabis use) 
The differential diagnoses listed here are not exhaustive.
General principles 
- Determine the most appropriate care setting: See “Disposition for eating disorders.”
- Establish treatment goals, e.g., 
- Decrease the number of binge eating episodes
- Improve disordered thoughts and beliefs about weight, body image, and eating behaviors
- Improve knowledge of healthy eating habits, including .
- Comanage nutritional management with a dietitian.
- Refer all individuals for psychotherapy (e.g., ).
- Pharmacotherapy may help reduce the frequency of binge eating episodes (e.g., by reducing the impulse to binge); options include:
- Consider additional management for patients who are overweight or obese as needed.
- Identify and manage associated comorbidities; see “Clinical features.”
- Regularly reassess for remission. 
Nutritional management 
- Evaluate nutritional intake.
- Assess for food insecurity.
- Provide education on healthy eating habits, including .
First-line therapy for binge eating disorder
- (in-person; individual or group format) 
- Preferred agents
- Alternative agent: Topiramate may be considered if the benefits outweigh the risks. 
The antidepressant bupropion lowers the seizure threshold and is contraindicated in individuals with a history of anorexia nervosa, bulimia nervosa, or purging behaviors, and those with seizure disorders. 
Management of patients with overweight or obesity 
- bariatric surgery may be considered if appropriate. or
- Identify and treat underlying conditions contributing to weight gain (e.g., PCOS) and/or complications of obesity.
Recommend instead of dietary restrictions (e.g., avoiding specific food groups, limiting calories), as restrictions can inadvertently increase binge eating.