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Binge Eating Disorder in Children and Adolescents

By Janet Lydecker, PhD

Does my child have binge-eating disorder (BED)?

BED is an eating disorder that is similar to bulimia nervosa but has binge-eating episodes without consistent purging episodes (e.g., vomiting). Many adults with BED report that their binge eating began during childhood, but many children have a subthreshold form of BED (less than weekly binge-eating episodes), in part due to how a “binge” is defined.

A “binge” has two key characteristics. First, the individual feels a loss of control while eating. Second, the individual eats an amount of food, in a discrete amount of time, that is unusually large for the context. When binges happen regularly (at least once a week) for a sustained period of time (at least three months) and cause distress, then the individual is diagnosed with BED.

What does it mean to “lose control” while eating?

People describe losing control as feeling unable to stop. Someone in the middle of a binge might be eating because of strong emotions, or to zone out, or because they feel bored, rather than because they are physically hungry. They may eat much faster than they normally do or eat foods or combinations of foods they do not normally eat. They may want to stop but feel unable to stop in the moment. They may keep eating until they feel uncomfortably full. Often, they feel strong negative emotions after the binge ends, such as feeling ashamed, embarrassed, depressed, guilty or upset.

What does “unusually large” mean?

Binge size is a tricky aspect of binge eating to evaluate in everyone, and especially in children and adolescents. There are no strict guidelines, and one diagnostic manual now has loss of control as the defining feature of BED, no matter how much food is consumed during the binge. A clinician deciding whether to diagnose a binge will consider the context (at home? out at a restaurant? holiday dinner? how long since the last meal?), the eating behavior of others in that context (is a sibling or friend or parent eating the same amount?), and the individual themselves (is there a higher metabolic or macronutrient need for the food consumed, such as athletes’ experience? is the child in a growth spurt? does the binge differ from what or how much food the individual usually eats during typical meals and snacks?).

What are some signs that my child might be binge eating?

Parents of pre-teens and teens often notice an increase in the amount of food their children eat and may feel like they are always replenishing food cabinets. This is normally because children have growth spurts and appetite has a normal and expected increase during these spurts when
children need more nutrients. This kind of eating, while noticeable, is not a problem. Feeling out of control while eating and feeling upset about eating this way is when “normal” becomes disordered. As with all eating disorders, there are certain behavioral, environmental, and emotional signs that parents can look for in their child, but no one sign is definitive and many “signs” can have reasonable, non-eating-disordered, explanations. When you notice some of the signs below becoming a pattern (for example, happening every weekend or happening after getting into arguments) or interfering with your child’s mood, friendships, and/or schoolwork, it’s worth seeking an evaluation and possibly treatment.

  •  Eating when home alone, sneaking food, hiding food wrappers
  •  Buying and eating food outside the home without telling you
  •  Eating at unusual times such as the middle of the night
  • Getting embarrassed when asked whether they had a meal or snack
  • Starting dieting or skipping meals – some children try to “make up for” the food they eat
    during a binge by having very little food in advance of or following a binge
  • Following strict rules about eating – such as when or what they can eat – or getting into
    arguments with you when they are not allowed to follow these rules
  • Avoiding situations they used to enjoy (like a favorite restaurant or buffet) because they
    are afraid a binge might happen in front of others
  • Worrying about their body image or avoiding people or events they used to enjoy
    because they feel dissatisfied with their weight or shape

Is binge eating the same as obesity?

No. BED can occur at any weight status. Over time, binge eating can be associated with weight gain and can contribute to the development of obesity. Research studies have shown consistently, however, that individuals with BED are more similar to those with bulimia nervosa than to those with larger body sizes who do not have any disordered eating behaviors.

What can I expect from treatment?

Treatment is usually provided by a child eating disorder specialist, although this type of provider can be difficult to find. There is good evidence for how to treat BED in adults, but treatment studies for youth are ongoing because we need more information about how well treatments work for youth with binge eating. Available evidence suggests that cognitive-behavioral therapy, interpersonal therapy and dialectical behavioral therapy could work well for children and adolescents with binge eating and loss of control eating. These therapies generally focus on a combination of establishing a regular eating pattern, improving positive social support and communication, and developing and practicing coping skills. It is important to communicate your child’s needs and your goals with your treatment provider. In our research clinic, we counsel any parent who is hoping for weight loss that our treatment is designed to work on binge eating but is unlikely to produce any change in weight. Indeed, attempting to lose weight, especially without the assistance of a health care provider who understands eating disorders, can make binge eating worse – because many individuals with binge eating also engage in unhealthy dietary restriction, that pattern needs to be disrupted before binge eating can improve.

Further Reading:

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington,
    VA: American Psychiatric Publishing; 2013.
  • Stein DJ, Szatmari P, Gaebel W, Berk M, Vieta E, Maj M, de Vries YA, Roest AM, de Jonge P, Maercker A,
    Brewin CR, Pike KM, Grilo CM, Fineberg NA, Briken P, Cohen-Kettenis PT, Reed GM. Mental, behavioral
    and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and
    controversies. BMC Med. 2020;18(1):21.
  • Tanofsky-Kraff M, Schvey NA, Grilo CM. A developmental framework of binge-eating disorder based on
    pediatric loss of control eating. Am Psychol. 2020;75(2):189-203. Epub 2020/02/14. doi:
    10.1037/amp0000592. PubMed PMID: 32052994; PMCID: PMC7027731.

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