Psychiatry/Behavioral · PANCE / PANRE

Binge Eating Disorder (BED)

Recurrent binge eating without compensatory behaviors; most common eating disorder.

Also known as: BED, binge eating disorder, compulsive overeating

Overview

Recurrent episodes of binge eating without recurrent inappropriate compensatory behaviors, occurring on average >=1/week for >=3 months, with marked distress, and associated features such as eating rapidly, until uncomfortably full, when not hungry, alone due to embarrassment, or with subsequent disgust/depression/guilt.

Epidemiology

Lifetime prevalence ~1-3% (most common eating disorder in US adults). Female-to-male ratio ~1.5:1. Strongly associated with obesity though not all patients are obese.

🔒 Free preview limit reached

Keep reading — start your free trial

You've read your 2 free diagnosis previews. Create your free account to unlock the full Binge Eating Disorder (BED) outline — plus all 514 diagnoses, 3,500+ board-style questions, flashcards, and an AI tutor. Your 7-day free trial includes everything, and there's no credit card required.

Start your 7-day free trial → Sign in

Free to start · No credit card · Cancel anytime

Risk factors

Family history of eating disorders, obesity, mood disorders
Childhood obesity, dieting history
Trauma, adverse childhood experiences
Mood, anxiety, ADHD, substance use comorbidity
Female sex

Pathophysiology

Dysregulated reward processing with altered dopaminergic signaling and impaired prefrontal inhibitory control. Negative affect and dietary restraint serve as binge precipitants.

Clinical presentation

Symptoms

Episodes of eating a large amount of food in <2 hours with loss of control
Associated features (>=3): rapid eating, eating until uncomfortably full, eating when not hungry, eating alone due to embarrassment, feeling disgusted/depressed/guilty afterward
Marked distress regarding binge eating
No regular compensatory behaviors

Signs / physical exam

Often obesity-related findings: HTN, dyslipidemia, type 2 diabetes, OSA
No specific physical signs unique to BED

Differential diagnosis

Bulimia nervosa — Binge + compensatory behaviors
MDD with overeating — Hyperphagia during depressive episodes without loss-of-control quality
Night eating syndrome — Consumption of >=25% of daily intake after dinner or nocturnal awakenings to eat
Hypothalamic/genetic obesity syndromes — Prader-Willi, leptin deficiency — early onset, hyperphagia without loss of control concept

Diagnostic workup

Diagnostic criteria

DSM-5-TR: (A) Recurrent binge eating episodes; (B) Associated with >=3 of: rapid eating, eating until uncomfortably full, eating when not hungry, eating alone from embarrassment, feeling guilty/disgusted; (C) Marked distress; (D) Occurs on average >=1/week for >=3 months; (E) Not associated with recurrent compensatory behaviors and not exclusively during anorexia or bulimia. Severity by frequency: mild 1-3, moderate 4-7, severe 8-13, extreme >=14 episodes/week.

Labs

Metabolic screen: fasting glucose/A1c, lipid panel, LFTs (NAFLD), TSH
ECG if cardiovascular risk
Screen for OSA, depression, anxiety

Imaging

Not routinely indicated for diagnosis

Diagnostic algorithm

Feature	Bulimia	BED	Anorexia
Weight	Normal/above	Often elevated	Significantly low
Binges	Yes	Yes	Sometimes (B/P subtype)
Compensatory behaviors	Yes	No	Yes (B/P subtype) or restriction
FDA-approved drug	Fluoxetine 60 mg	Lisdexamfetamine	None (olanzapine adjunct)

Key eating disorders compared.

Treatment

First-line

Cognitive behavioral therapy for eating disorders (CBT-ED) — strongest evidence
Interpersonal therapy (IPT)
Lisdexamfetamine — FDA-approved for moderate-to-severe BED (30-70 mg/day); reduces binge days
Self-help CBT for milder disease

Second-line / adjunct

SSRIs (fluoxetine, sertraline, citalopram) — modest reduction in binge frequency
Topiramate — reduces binges and supports weight loss; teratogenic, monitor cognitive side effects
Behavioral weight loss programs as adjunct (do not replace BED-focused treatment)
Bariatric surgery — outcomes equivalent to non-BED patients with proper presurgical evaluation

Complications

Obesity and its sequelae: T2DM, HTN, dyslipidemia, CAD, OSA, NAFLD, osteoarthritis
Depression, anxiety, substance use, suicidality
Functional impairment, social withdrawal
Weight cycling

PANCE pearls

Lisdexamfetamine is the only FDA-approved medication for BED — useful especially when comorbid ADHD; monitor BP, HR, sleep, appetite.
Treat the eating disorder before pursuing weight-loss interventions — restrictive dieting can worsen binge frequency.
Roughly half of BED patients have a history of comorbid depression — screen and treat concurrently.
Many primary care obesity patients have undiagnosed BED — ask about loss of control and binge episodes.

References

APA 2023 — American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders, 4th ed. (2023)
NICE NG69 — NICE Guideline 69: Eating disorders
DSM-5-TR — American Psychiatric Association. DSM-5-TR (2022)
McElroy 2015 — McElroy SL et al. Lisdexamfetamine dimesylate for adults with moderate to severe BED. JAMA Psychiatry 2015

Practice Psychiatry/Behavioral questions on FirstPassPA

Turn this outline into retention. 3,500+ board-style questions with an AI tutor that explains every answer — free to start, no card required.

Start studying free → Browse all 514 diagnoses

Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.