Binge eating disorder

The third night of Eid, and the flat in Mohammadpur is quiet at last: the guests gone, her husband and children asleep, her mother-in-law snoring in the next room. Rumki, 35, who teaches maths at a coaching centre, opens the fridge. Shemai, the last of the beef bhuna, her Khala’s halwa, a pot of Bogura doi. She eats standing, fast, hardly tasting, until it hurts. Then she rearranges the boxes so the gaps do not show, and washes the spoon.

In the daytime she barely eats. At the Eid dawat her Phupu said, loud enough for the table, “Rumki, you’ve become healthy, mashallah. At her biye she was so slim.” Everyone laughed, Rumki too. Her sister-in-law slid a third piece of roast onto her plate and whispered, “Ignore her. She said the same to me in 2015.” It was kind, and it was funny, and that night was the worst yet.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding binge eating disorder

Binge eating disorder is repeated episodes of eating much more food than most people would in a similar time, with a sense of losing control, followed by distress, shame or guilt. Unlike bulimia nervosa, there is no regular vomiting, laxative use or over-exercise to make up for it. Episodes are often fast, solitary and secret. UK guidelines note that dieting is likely to trigger binge eating, which is why a day of near-fasting can set up a night like Rumki’s. It is not greed or a lack of willpower. It is a recognised eating disorder, and it occurs at many body weights. In the WHO World Mental Health Surveys, people’s recollections suggested that other mental disorders could predict its later onset.

How common is binge eating disorder?

In the WHO World Mental Health Surveys of 24,124 adults in 14 mostly upper-middle and high-income countries, the median lifetime prevalence of binge eating disorder was 1.4%, higher than that of bulimia nervosa, and fewer than half of people with it had received treatment. Figures for Bangladesh are not available.

Signs and symptoms of binge eating disorder

• Eating very large amounts quickly, often alone or at night
• Feeling unable to stop once started
• Eating when not hungry, until uncomfortably full
• Hiding food or wrappers, and deep shame afterwards
• Cycles of strict dieting followed by binges

Treatment for binge eating disorder

UK national guidelines (NICE) recommend, first, a guided self-help programme focused on binge eating, using CBT materials with brief supportive sessions. If that is not enough, they recommend group or individual eating-disorder-focused CBT (CBT-ED); individual therapy is typically 16 to 20 sessions. Therapy builds regular meals and snacks so that hunger does not set up a binge, finds the emotional triggers, and works on beliefs about the body. NICE advises against trying to lose weight by dieting during treatment and says medication should not be offered as the only treatment. A 2022 review of meta-analyses found that psychotherapy outperformed active control treatments for binge eating disorder, and that medicines had short-term effects. A psychiatrist will also check mood, anxiety and physical health.

What getting better can look like

Rumki’s days might hold three meals and a plate of muri at four o’clock, the fridge opened at night for a glass of water and closed again, and a reply to Phupu she has practised: “Phupu, have some more shemai.”

Common questions about binge eating disorder

What is the difference between binge eating disorder and overeating?

Everyone overeats sometimes, at a dawat or on Eid. Binge eating disorder means repeated episodes of eating a very large amount with a sense of losing control, causing marked distress, without regular vomiting or other compensation. It is a recognised condition, not a matter of willpower.

Does dieting help binge eating?

UK national guidelines advise against dieting to lose weight during treatment for binge eating disorder, because dieting is likely to trigger binges. They recommend regular meals and snacks instead, alongside CBT focused on binge eating.

When to see a psychiatrist

If you feel out of control around food, are eating in secret, or feel hopeless or ashamed, please talk to a doctor. Help is confidential, and in an emergency call 999.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Kessler et al., Biological Psychiatry, 2013 (PMID 23290497)
• Monteleone et al., Neuroscience and Biobehavioral Reviews, 2022 (PMID 36084848)
• NICE guideline NG69, Eating disorders: recognition and treatment (last reviewed 15 August 2024)