Binge Eating Disorder: Care Staff Guide to Recognition and Support

Binge eating disorder is the most common eating disorder that many people have never heard of. It is often hidden behind shame, and because it does not always involve visible weight change, staff may not suspect it. It can affect people of any age and background, and it is a serious mental health condition that responds well to the right support. This guide, based on NHS information, explains the signs, causes and treatment of binge eating disorder and how care staff can offer help without judgement.

What is binge eating disorder?

The NHS describes binge eating disorder as a serious mental health condition in which people regularly eat large amounts of food in a short time and feel unable to control it. Binges may be planned or spontaneous, are usually carried out alone, and may involve "special" binge foods. Afterwards, people often feel guilty or ashamed. The NHS says it can affect men and women of any age and often starts in a person's 20s or later.

It differs from bulimia, described in our guide to bulimia nervosa, in that people with binge eating disorder do not regularly purge. It also differs from anorexia, described in our guide to anorexia nervosa. NICE guideline NG69 names binge eating disorder, along with bulimia nervosa and other specified feeding or eating disorders, as a diagnosis that most people with an eating disorder meet the criteria for.

Signs and symptoms

According to the NHS, the main sign is eating a lot of food quickly and not stopping when full. Other signs include:

• eating when not hungry
• eating very fast
• eating alone or in secret
• feeling low, guilty, ashamed or disgusted after binges

Warning signs in someone else, the NHS says, include changes in mood or behaviour, hiding how much they eat, stockpiling food and weight gain, although weight gain does not happen to everyone. In care settings, staff may notice food disappearing, hidden wrappers, large amounts of food bought or requested, avoidance of eating with others and withdrawal.

What causes it?

The NHS says the exact causes are unknown, but the risk is higher with:

• a family history of eating disorders, depression, or alcohol or drug misuse
• excessive worry about being slim, especially under pressure from society or work
• anxiety, low self-esteem, obsessive traits or perfectionism
• stressful events or trauma

Past trauma is often part of the picture, and the principles in our guide to trauma-informed care in practice apply: safety, choice, trust and collaboration.

Shame is the real barrier

Many people with binge eating disorder have kept it secret for years. They may have been told, or told themselves, that it is greed or a lack of willpower. Staff can make a big difference by treating it as the health condition it is. Avoid comments about the person's weight or food choices, avoid jokes about eating and do not describe the behaviour as "bad". A calm, respectful response makes it more likely that someone will talk about it.

Getting help

The NHS advises seeing a GP as soon as possible. The GP will ask about eating habits and feelings, check weight and overall health, and refer to an eating disorder specialist or team if needed. Bringing a friend or loved one to the appointment may help. Confidential advice is available from the eating disorders charity Beat: the adult helpline is 0808 801 0677 and the youth helpline is 0808 801 0711. If you are worried about someone, tell them you are concerned, encourage them to see a GP and offer to go with them.

Treatment

The NHS says most people recover with the right support, though it can take time. The main options are:

• Guided self-help. This is usually offered first and often combines a self-help book or online guide with sessions with a therapist. A self-help support group, such as Beat's online groups, may also help. If it is not enough after four weeks, CBT or medicine may be offered.
• Cognitive behavioural therapy (CBT). This is usually delivered in groups, though one-to-one sessions are possible. The NHS says people should be offered about 20 sessions over 20 weeks, with group sessions lasting about 90 minutes. The therapy helps people plan regular meals and snacks, identify binge triggers, manage negative feelings about their body and keep new eating habits to avoid relapse.
• Medicines. The NHS says antidepressants should not be the only treatment. They may be combined with therapy or self-help to manage conditions such as anxiety, depression, social phobia or OCD, and are rarely prescribed for people under 18.

The NHS also advises that people should not diet during treatment, as this can make it harder to stop binge eating. Staff should be aware of this when supporting a person who wants to "get back on track" after a binge. Dieting talk can be unhelpful, and the person's treatment team can advise.

How care staff can help

• Offer regular, relaxed meals and snacks, in line with any agreed plan, because long gaps between meals can make binges more likely.
• Avoid policing food. Locking away food or monitoring portions can increase secrecy and shame unless it is part of an agreed care plan with the person's consent or in their best interests.
• Notice triggers, such as loneliness, boredom, conflict or low mood, and record them to share with the clinical team.
• Support emotional wellbeing, through activity, social connection and access to talking therapies.
• Encourage appointments and help with transport, reminders and keeping a food and mood diary if the therapist has recommended one.
• Check for other health needs, as the NHS notes that people with eating disorders often have other mental health conditions, so watch for low mood, anxiety and self-harm.

Frequently asked questions

Is binge eating just overeating?

No. The NHS describes it as a serious mental health condition in which people regularly eat large amounts in a short time and feel unable to control it, often with guilt and shame afterwards.

Does everyone with binge eating disorder gain weight?

No. The NHS notes that weight gain does not happen to everyone.

Can people recover?

The NHS says most people recover with the right support, although it can take time.

Keep building your knowledge

A non-judgemental response helps people to seek help sooner. Explore the health and social care learning available through Learnsignal CPD to keep your knowledge up to date.

This article is general information for care staff, based on NHS information, and does not replace the advice of a person's own clinicians. If you are worried about someone's health right now, contact their GP, NHS 111 or, in an emergency, call 999.