Trigger Warning: This article discusses topics related to binge eating, including detailed descriptions of binge eating behaviors and potential psychological triggers. Please proceed with caution if you are sensitive to content about eating disorders or mental health struggles. If you or someone you know is struggling with an eating disorder, we encourage seeking professional help from a healthcare provider or contacting a specialized support service.

The best feeling in the world is eating food that satisfies your soul! Food is something that everyone can enjoy without a thought. 

Food is comforting to all age groups, and it also becomes the brain’s rewarding mechanism. 

Food indulgence in moderation increases healthy dopamine (happy hormone), whereas over-indulgence is a leading cause of unhealthy eating habits (dopamine-dependent behaviors).

One of the unhealthiest eating disorders is binge eating. 

In this article, you will read about the types of eating disorders, predominantly focusing on the binge eating disorder. We will also understand neuroscience and its implications for our food habits. 

What is a Binge Eating Disorder?

Over-indulgence of food/drinks and addictive eating episodes daily are considered binge eating disorders (BED). Consuming large amounts of food as you lose control over your eating behaviors is associated with neurobiological changes. 

Binge eating disorders are often accompanied by obesity. More observations and meta-analysis studies are being conducted to understand the causes and factors affecting binge eating and its symptoms. 

The hormones we produce during stress are directly proportional to binge eating and vice versa. 

The concept of food consumption is associated with the brain’s reward system. Ghrelin (the hunger hormone) and leptin (the satiety hormone) are hormones related to your eating habits. The hypothalamus stimulates these during hunger and satiety. 

With binge eating disorder, there is a disbalance in these hormones that leads to a loss in the circadian regulation of the brain. Circadian cycles are the rhythmic cycles of the brain that stimulate neuronal activities in the body by considering various factors like stress, sleep, environment, genes, food, temperature, and sexual activities. (Lewis et al., 2021) 

The worldwide prevalence of BED for the years 2018 – 2020 is estimated to be 0.6–1.8% in adult women and 0.3–0.7% in adult men. (Giel et al., 2022)

Is Binge Eating a Psychological Disorder?

DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) recognizes binge eating as a psychological disorder.

The reason for considering binge eating as a psychological disorder is its relevance to the changes in the central nervous system.

As we discuss the brain’s reward system, let us dive into details to understand its complexities. 

• The smell, taste, and starvation stimulate hunger and the ghrelin hormone, paving the way for dopamine release.
• The dopamine pathway is also associated with palatable foods like sugary treats and fat-dense foods. This is the reason for the junk food addiction. 
• The brain’s reward system is linked to dopamine release. The human brain always expects a reward to find pleasure. 
• A vicious cycle is connected through stress, reward anticipation, food, and pleasure. 
• Humans search for a reward system, especially during stress. Food, substances, and sexual activities stimulate the brain's mesolimbic system to release dopamine.
• This is when a human brain links stressful events to good food or pleasurable activities in anticipation of a dopamine release. 
• Acute stress relates to dopaminergic behaviors, and binge eating is one of them. 

Stress, environment, and psychosocial conditions majorly impact the food habits we develop using the dopaminergic responses. Losing control over eating habits and addictive food behaviors are all considered psychological eating disorders. (Bloomfield et al., 2019) 

Symptoms of Binge Eating

DSM 5 officially identifies binge eating disorder as a distinct eating disorder accompanied by symptoms like

1. Excessive weight gain. (DSM 5 - criteria 1)
2. Eating more quickly than usual. (DSM 5 - criteria 2)
3. Impulsive eating and purchasing of foods. (DSM 5 - criteria 2)
4. Eat large amounts of food even when not hungry. (DSM 5 - criteria 2)
5. Eating alone. (DSM 5 - criteria 2)
6. Embarrassment and eating again in guilt. (DSM 5 - criteria 2)
7. Depressed about weight and feeling helpless after overeating. (DSM 5-criteria 3)
8. Binge eating occurs at least 2 days a week for six months continuously or one day a week continuously for three months (DSM 5 - criteria 4)

(Table 1, DSM-IV and DSM-5 Diagnostic Criteria for Binge-Eating Disorder, 2015)

Do you identify any of these symptoms in yourself or your friends? This is the right time to seek professional advice. 

DSM 5 also specifies that binge eating is not associated with purging behaviors, and it does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

Types of Eating Disorders

Eating disorders are among the most lethal of neuropsychiatric disorders.

• Binge eating disorder: Eating food in larger amounts without any control, accompanied by obesity, shame, and guilt, is a binge eating disorder, which is one of the common types of eating disorders. 

• Anorexia nervosa: A person restricts their caloric intake and stops consuming food in intense fear of gaining weight. Often, these people define their eating patterns concerning body shame and body guilt. However, they are always underweight. Women and girls are commonly seen with anorexia. Purging is also seen in anorexic people in a few cases.

• Bulimia nervosa: Eating in larger amounts and purging is the main concept of bulimia. People with this disorder have no control over their eating and hence tend to excessively consume foods. They are of typical weight and use purging(vomiting), laxatives and diuretics, and excessive exercising in anticipation of maintaining their weight. 

• Pica: Consuming things that are not edible and are not considered as food. Individuals with pica might crave things like ice, dirt, soil, soap, paper, hair, wool, pebbles, detergent etc. They often have an increased risk of poisoning and nutritional deficiencies. Pica is commonly seen in individuals with developmental conditions like autism spectrum disorder (ASD) and mental health conditions like schizophrenia. 

• Rumination disorder: A newly recognized disorder where the person regurgitates the food they previously chewed and swallowed. This regurgitation happens within 30 mins of eating and the person re-chews and then re-swallows. These people often avoid eating in public to avoid embarrassing conditions. 

• Avoidant/restrictive food intake disorder: People with this disorder avoid eating completely as they lose interest in food. This might happen due to a traumatic event or even for any unknown reason. The person shows a complete disinterest in food and eating, leading to deficiencies and hospital admissions for tube feeding. 

Why Am I Binge Eating? 

Some people occasionally binge on food and there are also people who have episodic binge eating habits. These episodes happen quite frequently without any control over the mind ultimately leading to consuming larger amounts of food in one go. What causes binge eating disorder can be multifactorial:

• Binge eating disorder can be a genetical risk factor. (Genetic Risk Factor for Binge Eating Discovered | Chobanian & Avedisian School of Medicine, n.d.)
• It can be a consequent neurological disorder aftermath of a traumatic event in one’s life.
• Acute or chronic stress that changes the dopaminergic responses in the brain.
• Addictive behaviours in anticipation of the brain’s reward system 
• Changes in circadian oscillations can alter the mesolimbic system (receives dopaminergic inputs) in the brain leading to addictive behaviours associated with food and substances. 
• Developmental conditions, mental health conditions and cognitive behavioural issues can lead to binge eating.
• Neurological changes (due to drugs and substance abuse) and the onset of depressive disorders are other major reasons for developing binge eating habits. 

Treatment and Help for Binge Eating

• The first line treatment is psychotherapy.
• Nutritional guidance plays a key role to establish health eating habits and resolve nutritional deficiencies. 
• Cognitive behavioural therapy and counseling play a major role in diagnosing the underlying health condition. 
• FDA-approved medications to control impulsive behaviours. 
• Medications like Lisdexamfetamine dimesylate is the first FDA-approved drug to treat binge eating disorder. 
• Anti-depressants and serotonin reuptake inhibitors are also prescribed. 

(Medications to Treat Binge Eating Disorder, n.d.)

Conclusion

The brain game is quite challenging. The pain of binge eating disorders is somatic and psychological in nature. All eating disorders are considered very draining to the person experiencing them. While binge eating disorder can be mentally stressful to the person, it also develops co-morbid conditions like obesity, cardiovascular diseases, hypertension, metabolic conditions, and cholesterol.

Eating disorders accompanied by vomiting, purging, enema or excessive usage of diuretics and laxatives see a great deal of health concerns like hyperphagia (extreme hunger), oesophageal lesions, delayed gastric emptying, electrolyte imbalance, hospitalizations, tube feedings, dental problems, cardiac arrhythmias, along with difficulty adapting in social environment.

It is always advisable to identify the symptoms and get professional help through counseling and therapy. 

References

• Bloomfield, M. A., McCutcheon, R. A., Kempton, M., Freeman, T. P., & Howes, O. (2019). The effects of psychosocial stress on dopaminergic function and the acute stress response. ELife, 8. https://doi.org/10.7554/ELIFE.46797
• Genetic Risk Factor for Binge Eating Discovered | Chobanian & Avedisian School of Medicine. (n.d.). Retrieved March 20, 2024, from https://www.bumc.bu.edu/camed/2016/10/26/genetic-risk-factor-for-binge-eating-discovered/
• Giel, K. E., Bulik, C. M., Fernandez-Aranda, F., Hay, P., Keski-Rahkonen, A., Schag, K., Schmidt, U., & Zipfel, S. (2022). Binge eating disorder. Nature Reviews. Disease Primers, 8(1), 16. https://doi.org/10.1038/S41572-022-00344-Y
• Lewis, R. G., Florio, E., Punzo, D., & Borrelli, E. (2021). The Brain’s Reward System in Health and Disease. Advances in Experimental Medicine and Biology, 1344, 57. https://doi.org/10.1007/978-3-030-81147-1_4
• Medications to Treat Binge Eating Disorder. (n.d.). Retrieved March 20, 2024, from https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/medications-binge-eating-disorder
• Table 1, DSM-IV and DSM-5 diagnostic criteria for binge-eating disorder. (2015).
• https://www.healthline.com/nutrition/common-eating-disorders