Binge Eating Disorder: The Most Common Eating Disorder

Binge eating disorder is an illness of repeated episodes of eating an unusually large amount of food while feeling unable to stop, followed by distress, without the vomiting, laxatives or fasting that define bulimia nervosa. In the large population surveys described below it is more common than bulimia nervosa or anorexia nervosa, yet fewer than half of the people who have it ever receive treatment for it. This page sets out how the diagnosis is defined, who it affects, what it is linked with, and what the treatment trials found, with numbers on both sides. The wider family of conditions is covered on the Eating Disorders page.

Table of Contents

  1. How the Diagnosis Is Defined
  2. How Common It Is
  3. Who It Affects
  4. Links With Obesity, Diabetes and Mood
  5. Psychological Treatments
  6. Lisdexamfetamine, the One Approved Drug
  7. Topiramate and Antidepressants
  8. Glucagon-Like Peptide-1 Receptor Agonists
  9. Magnetic Brain Stimulation
  10. The 2023 American Psychiatric Association Guideline
  11. What Is Not Known
  12. Key Research Papers
  13. Connections
  14. Featured Videos

How the Diagnosis Is Defined

Binge eating disorder became a formal diagnosis in 2013, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of the American Psychiatric Association. The World Health Organization added it to its International Classification of Diseases in 2018, with criteria that a 2022 review describes as broadly the same, except that the World Health Organization version is more liberal about how often episodes happen and how large they are.

As the 2022 review in Nature Reviews Disease Primers and the 2018 United States national survey paper describe the manual's criteria:

The manual grades severity by the number of episodes a week: mild (one to three), moderate (four to seven), severe (eight to thirteen) and extreme (fourteen or more). The review notes that a clinician may grade severity higher when other symptoms and loss of day-to-day functioning are taken into account. Studies that tried to measure the size of a binge reported quantities between 3,000 and 4,500 kilocalories.

The older surveys on this page used the earlier fourth edition of the manual. The World Health Organization surveys applied a three-month duration window rather than the six months that edition required, a choice the authors described as likely to raise the estimates. Prevalence figures from different editions and interviews are therefore not exactly comparable.

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How Common It Is

The largest cross-national study is the World Health Organization World Mental Health Surveys, which interviewed 24,124 adults in 14 mostly upper-middle and high-income countries (Kessler and colleagues, 2013). Its findings:

National surveys in the United States give other figures, in part because the criteria changed:

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Who It Affects

Binge eating disorder affects both sexes, more evenly than the other eating disorders do. In the World Health Organization surveys, women had about 2.4 to 3.6 times the odds of men of developing either binge eating disorder or bulimia nervosa, and men made up a larger share of people with binge eating disorder than of people with bulimia nervosa. The authors read this as binge-eating men being less likely than binge-eating women to use vomiting or other compensation. In the 2012–2013 United States survey, the odds of the diagnosis were significantly higher for women after adjusting for age, race and ethnicity, education and income.

Other patterns in the surveys:

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Obesity

In the World Health Organization surveys, 32.8% to 41.7% of people with binge eating disorder or bulimia nervosa were obese, against 15.8% of people with no eating disorder. In the National Comorbidity Survey Replication, lifetime binge eating disorder was associated with current severe obesity (body mass index of 40 or more). The 2022 review cites a mean body mass index of 33.9 kg/m² among people with binge eating disorder in a nationally representative United States study. Many people with binge eating disorder are not obese, and in the surveys a quarter to a third of people with these disorders were of normal weight. See Obesity.

Diabetes and the metabolic syndrome

The World Health Organization surveys looked at which came first. Binge eating disorder or bulimia nervosa that began earlier was followed by higher odds of later diabetes (odds ratios 2.9 to 3.1 for the two disorders), hypertension, chronic pain conditions and other problems; after adjusting for other mental disorders, an association with diabetes (odds ratio 2.4) and hypertension remained. These were based on people's own recall of when conditions began.

A prospective study gives a more mixed picture. Hudson and colleagues (2010) followed 134 people with binge eating disorder and 134 people with no eating disorder, matched for age, sex and starting body mass index, for up to 5 years. After adjusting for body mass index and weight change, the binge eating group was more likely to be newly diagnosed with abnormal blood fats (hazard ratio 2.2) and with two or more parts of the metabolic syndrome (hazard ratio 2.4). The rises in new type 2 diabetes (hazard ratio 1.6) and high blood pressure (hazard ratio 1.5) were not statistically significant. The authors concluded binge eating disorder "may confer a risk" beyond that of obesity alone. The 2022 review adds that up to 20% of people with type 2 diabetes have an eating disorder that often goes undetected, most commonly binge eating disorder, and that binge eating worsens blood sugar control. See Type 2 Diabetes and Metabolic Syndrome.

Depression and other mental disorders

In the World Health Organization surveys, 79.0% of people with lifetime binge eating disorder also met criteria for at least one other mental disorder among the 14 assessed, which included major depression and other mood disorders, anxiety disorders, behavior disorders and substance use disorders. The odds of each of those disorders were raised, with a median odds ratio of 2.8. Based on people's recall of when each began, the links ran in both directions: other disorders that came first were followed by higher odds of later binge eating disorder (median odds ratio 3.4), and binge eating disorder that came first was followed by higher odds of later disorders (median odds ratio 2.3). The surveys cannot show cause. The 2022 review notes that depressive symptoms appear to matter for how well treatment works. See Depression.

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Psychological Treatments

The treatments most often tested are cognitive behavioral therapy delivered by a therapist, guided self-help based on cognitive behavioral therapy (a structured self-help program with shorter, fewer sessions of support), and interpersonal psychotherapy, which focuses on relationships and social difficulties.

What the pooled trials show

The two-year head-to-head trial

Wilson and colleagues (2010) randomized 205 adults with a body mass index between 27 and 45 to 20 sessions of interpersonal psychotherapy, 20 sessions of behavioral weight loss treatment, or 10 sessions of guided self-help based on cognitive behavioral therapy, all over 6 months. Two years later, both interpersonal psychotherapy and guided self-help had produced more remission from binge eating than behavioral weight loss (odds ratios 2.6 and 2.3 against weight loss treatment); the two did not differ much from each other (odds ratio 1.2). People with low self-esteem and more severe eating disorder symptoms did comparatively better with interpersonal psychotherapy. The authors described guided self-help as a first-line option for most patients, with interpersonal psychotherapy or full cognitive behavioral therapy for those with more severe symptoms.

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Lisdexamfetamine, the One Approved Drug

Lisdexamfetamine is a stimulant that the body converts to dextroamphetamine. It is also approved for attention-deficit/hyperactivity disorder. It is the only medicine approved by the United States Food and Drug Administration (FDA) for binge eating disorder.

What the label says

What the trials found

Several authors of the 2015 and 2017 trials were employees of the drug's maker at the time, as the papers disclose.

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Topiramate and Antidepressants

Neither topiramate nor any antidepressant is approved by the Food and Drug Administration for binge eating disorder.

Topiramate

Topiramate is an anti-seizure drug associated with weight loss.

Antidepressants

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Glucagon-Like Peptide-1 Receptor Agonists

Glucagon-like peptide-1 receptor agonists, used for type 2 diabetes and weight management, act on appetite in the gut and the brain. None is approved for binge eating disorder, and the evidence is early. Background on the drug class is on the Glucagon-Like Peptide-1 Receptor Agonists page.

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Magnetic Brain Stimulation

Repetitive transcranial magnetic stimulation (rTMS) uses a magnetic coil held against the scalp to stimulate brain areas involved in self-control, most often the left dorsolateral prefrontal cortex. Its results in binge eating disorder point both ways.

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The 2023 American Psychiatric Association Guideline

The American Psychiatric Association published a practice guideline for the treatment of eating disorders in 2023 (Crone and colleagues). A 2026 review co-written by one of the guideline's authors summarizes its approach. In that review's words, eating disorders are "treated primarily with psychotherapy focusing on eating behaviors," and pharmacotherapy is recommended "when psychotherapy is insufficient or unavailable, or when medication treatment is preferred by the patient."

For binge eating disorder specifically, the review reports that the guideline "suggests that adults with [binge eating disorder] who prefer medication or have not responded to psychotherapy alone be treated with either lisdexamfetamine or an antidepressant medication."

The guideline also contains statements on psychotherapy for binge eating disorder. The full guideline is not openly available, and this page does not paraphrase statements it could not read.

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What Is Not Known

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Key Research Papers

  1. Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry. 2013;73(9):904-14. PubMed PMID: 23290497
  2. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348-58. PubMed PMID: 16815322
  3. Udo T, Grilo CM. Prevalence and Correlates of DSM-5-Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biol Psychiatry. 2018;84(5):345-354. PubMed PMID: 29859631
  4. Giel KE, Bulik CM, Fernandez-Aranda F, Hay P, Keski-Rahkonen A, Schag K, et al. Binge eating disorder. Nat Rev Dis Primers. 2022;8(1):16. PubMed PMID: 35301358
  5. Hudson JI, Lalonde JK, Coit CE, Tsuang MT, McElroy SL, Crow SJ, et al. Longitudinal study of the diagnosis of components of the metabolic syndrome in individuals with binge-eating disorder. Am J Clin Nutr. 2010;91(6):1568-73. PubMed PMID: 20427731
  6. Brownley KA, Berkman ND, Peat CM, Lohr KN, Cullen KE, Bann CM, et al. Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Ann Intern Med. 2016;165(6):409-20. PubMed PMID: 27367316
  7. Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S, et al. Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. J Consult Clin Psychol. 2019;87(1):91-105. PubMed PMID: 30570304
  8. Wilson GT, Wilfley DE, Agras WS, Bryson SW. Psychological treatments of binge eating disorder. Arch Gen Psychiatry. 2010;67(1):94-101. PubMed PMID: 20048227
  9. McElroy SL, Hudson JI, Mitchell JE, Wilfley D, Ferreira-Cornwell MC, Gao J, et al. Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder: a randomized clinical trial. JAMA Psychiatry. 2015;72(3):235-46. PubMed PMID: 25587645
  10. Hudson JI, McElroy SL, Ferreira-Cornwell MC, Radewonuk J, Gasior M. Efficacy of Lisdexamfetamine in Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2017;74(9):903-910. PubMed PMID: 28700805
  11. Grilo CM, Ivezaj V, Yurkow S, Tek C, Wiedemann AA, Gueorguieva R. Lisdexamfetamine maintenance treatment for binge-eating disorder following successful treatments: randomized double-blind placebo-controlled trial. Psychol Med. 2024;54(12):3334-3344. PubMed PMID: 39258475
  12. McElroy SL, Arnold LM, Shapira NA, Keck PE Jr, Rosenthal NR, Karim MR, et al. Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. Am J Psychiatry. 2003;160(2):255-61. PubMed PMID: 12562571
  13. McElroy SL, Hudson JI, Capece JA, Beyers K, Fisher AC, Rosenthal NR. Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biol Psychiatry. 2007;61(9):1039-48. PubMed PMID: 17258690
  14. Allison KC, Chao AM, Bruzas MB, McCuen-Wurst C, Jones E, McAllister C, et al. A pilot randomized controlled trial of liraglutide 3.0 mg for binge eating disorder. Obes Sci Pract. 2023;9(2):127-136. PubMed PMID: 37034559
  15. Emptage I, Kozmér S, Cobham-Wilson A, Sousa B, Sugden K, Wheeler L, et al. The effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on binge eating in patients with obesity: a systematic review and meta-analysis. EClinicalMedicine. 2026;98:104007. PubMed PMID: 42666688
  16. Aoun L, Almardini S, Saliba F, Haddadin F, Mourad O, Jdaidani J, et al. GLP-1 receptor agonists: A novel pharmacotherapy for binge eating (Binge eating disorder and bulimia nervosa)? A systematic review. J Clin Transl Endocrinol. 2024;35:100333. PubMed PMID: 38449772
  17. Maranhão MF, Estella N, Cury MEG, Schmidt U, Campbell IC, Claudino AM. Repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex in binge eating disorder: a double-blind randomized controlled trial. Psychol Med. 2025;55:e149. PubMed PMID: 40376936
  18. Ramanathan B, Vijayan S, Mohan M, Venkatesan V, Selvaraj A, Sivakumar P. Non-invasive brain stimulation as an experimental treatment approach for bulimia nervosa and binge eating disorders: A meta-analysis and systematic review of literature. Indian J Psychiatry. 2026;68(5):411-428. PubMed PMID: 42381852
  19. Crone C, Fochtmann LJ, Attia E, Boland R, Escobar J, Fornari V, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. Am J Psychiatry. 2023;180(2):167-171. PubMed PMID: 36722117
  20. Allam AR, Attia E. Recent developments in treatments for eating disorders. Neurotherapeutics. 2026;23(1):e00773. PubMed PMID: 41145336

Drug label facts are taken from the current United States prescribing information for lisdexamfetamine dimesylate capsules, as posted on the National Library of Medicine's DailyMed service.

PubMed Topic Searches

  1. PubMed: binge eating disorder prevalence
  2. PubMed: binge eating disorder and cognitive behavioral therapy trials
  3. PubMed: binge eating disorder and lisdexamfetamine
  4. PubMed: binge eating disorder and glucagon-like peptide-1 receptor agonists
  5. PubMed: binge eating disorder and transcranial magnetic stimulation
  6. PubMed: binge eating disorder and type 2 diabetes

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Connections

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