By Lisa M. Shank, Ph.D., MPH
March 16, 2023

U.S. Air Force photo by C/Maj. Elizabeth Parkes

Eating disorders are most often associated with conditions like anorexia nervosa, a disorder characterized by low body weight and a fear of gaining weight, or bulimia nervosa, a disorder characterized by binge-eating episodes and compensatory behaviors such as purging. However, the most common eating disorder in adults is binge-eating disorder.¹ It is estimated that 0.6-1.8% of women and 0.3-0.7% of men will meet the full criteria for binge-eating disorder² over the course of their lifetime. Given that binge-eating disorder is associated with adverse physical and psychological outcomes,^1-3 like type 2 diabetes and mood disorders, it is important to recognize and treat the condition.

What is binge-eating disorder?

Binge-eating disorder and bulimia nervosa both involve binge-eating episodes which involves eating an objectively large amount of food while also experiencing a sense of loss-of-control over their consumption.⁴ While many of us occasionally consume a large amount of food (e.g., Thanksgiving), for an episode to meet the size criteria, it must be an amount of food that is significantly larger than what most people would eat in a similar circumstance and in a similar amount of time.⁴ The sense of loss-of-control over eating is not just regret or experiencing “a lack of willpower.” It is an inability to stop an eating episode from occurring or an inability to control what or how much someone is eating. Some individuals say this sensation is like a “ball rolling down a hill” or a “car without brakes.” Although the mechanisms that drive a binge-eating episode are complex and not fully understood, stress and negative emotions are believed to be important factors for many who experience them.^5,6

To meet the criteria for full-threshold binge-eating disorder:

• Individuals must experience objectively large episodes of eating along with a feeling of loss-of-control overeating habits at least once a week, on average, for three months
• A person must feel significant distress about these eating episodes
• These episodes must be associated with at least three of the following five characteristics:
  1. Eating more rapidly than normal
  2. Eating until uncomfortably full
  3. Eating large amounts of food when not physically hungry
  4. Eating alone due to embarrassment over the amount of food being consumed
  5. Feeling disgusted, depressed, or very guilty after the episode
• Individuals cannot have recurrent inappropriate compensatory behavior (e.g., driven exercising, purging), as seen in bulimia nervosa
• The symptoms cause social and/or occupational/academic dysfunction⁴

What do we know about binge-eating disorder in service members and veterans?

While the prevalence of binge-eating disorder may be lower in active duty service members compared to civilian populations,⁷ findings in veterans have been more mixed.⁷ Two studies of U.S. military veterans found that 1.2-5.2% of women and 0.3-2.9% of men reported symptoms consistent with binge-eating disorder.^8,9 Additionally, subthreshold binge-eating disorder appears to be common in veterans, with one study finding that 35% of women veterans reported experiencing binge-eating episodes.¹⁰ Notably, active duty service members and veterans who have experienced traumatic events or have a diagnosis of posttraumatic stress disorder appear to be more likely to also report symptoms of binge-eating disorder.^7,10-12

How is binge-eating disorder treated?

The goal of binge-eating disorder treatment is to reduce the occurrence of binge-eating episodes and the associated feelings of loss of control. The most common treatment approaches for binge-eating disorder are psychological and/or pharmacological interventions. The most studied evidence-based approaches include psychotherapy (primarily cognitive-behavioral therapy), structured self-help interventions, and a combination of psychotherapy and pharmacological interventions.^13,14

Many individuals with eating disorders delay seeking treatment.¹⁵ Although there are effective treatments for binge-eating disorder, a recent review found that when individuals with binge-eating disorder first presented for eating disorder treatment, they experienced binge-eating disorder, on average, for over five and a half years.¹⁶

Awareness is the first step; if you are experiencing symptoms of binge-eating disorder, check out the resource links below, talk to your provider, and explore treatment options.

Resources

To learn more about binge-eating disorder and other eating disorders visit:

• The National Institute of Mental Health: This site provides an overview of eating disorders, signs and symptoms, risk factors, treatments, and therapies

For immediate help, reach out to:

• SAMHSA: This free and confidential helpline is always available (24/7, 365 days a year) to provide resources and treatment referrals at 1-800-662-HELP (4357)
• Suicide and Crisis Lifeline: This line provides 24/7 crisis support for veterans, service members, and their loved ones. To reach the veterans crisis line, dial 988 then press 1 or text 838255

References

1. Udo, T., Grilo, C.M. (2022). Epidemiology of eating disorders among US adults. Curr Opin Psychiatry, 35(6):372-378. doi:10.1097/YCO.0000000000000814
2. Keski-Rahkonen, A. (2021). Epidemiology of binge eating disorder: Prevalence, course, comorbidity, and risk factors. Curr Opin Psychiatry, 34(6):525-531 doi:10.1097/YCO.0000000000000750
3. Appolinario, J.C., Sichieri, R., Lopes, C.S., et al. (2022). Correlates and impact of DSM-5 binge eating disorder, bulimia nervosa and recurrent binge eating: a representative population survey in a middle-income country. Soc Psychiatry Psychiatr Epidemiol, 57(7):1491-1503. doi:10.1007/s00127-022-02223-z
4. American Psychiatric Association. (2013). Diagnostic and statistical manual Of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
5. Naish, K.R., Laliberte, M., MacKillop, J., Balodis, I.M. (2018). Systematic review of the effects of acute stress in binge eating disorder. Eur J Neurosci,50(3):2415-2429. doi:10.1111/ejn.14110
6. Burton, A.L., Abbott, M.J. (2019). Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating. J Eat Disord, 7:18. doi:10.1186/s40337-019-0248-0
7. Touma, D.A., Quinn, M.E., Freeman, V.E., Meyer, E.G. (2022). Eating Disorders in U.S. Active Duty Military Members and Veterans: A Systematic Review. Mil Med. 2022;doi:10.1093/milmed/usac180
8. Masheb R.M., Ramsey C.M., Marsh A.G., et al. (2021). DSM-5 eating disorder prevalence, gender differences, and mental health associations in United States military veterans. Int J Eat Disord, 54(7):1171-1180. doi:10.1002/eat.23501
9. Mitchell, K.S., Masheb, R., Smith, B.N., Kehle-Forbes, S., Hardin, S., Vogt D. (2021). Eating disorder measures in a sample of military veterans: A focus on gender, age, and race/ethnicity. Psychol Assess, 33(12):1226-1238. doi:10.1037/pas0001050
10. Buchholz, L.J., King, P.R., Wray, L.O. (2018). Rates and correlates of disordered eating among women veterans in primary care. Eating Behaviors, 30:28-34. doi:10.1016/j.eatbeh.2018.05.022
11. Gaviria, D., Ammerman, A. (2023). Eating disorders and disordered eating in servicemen and women: A narrative review. J Clin Psychol, 79(2):316-373. doi:10.1002/jclp.23424
12. Slane, J.D., Levine, M.D., Borrero, S., et al. (2016). Eating behaviors: Prevalence, psychiatric comorbidity, and associations with body mass index among male and female Iraq and Afghanistan veterans. Mil Med, 181(11):e1650-e1656. doi:10.7205/MILMED-D-15-00482
13. Hilbert, A., Petroff, D., Herpertz, S., et al. (2019). Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. J Consult Clin Psychol, 87(1):91-105. doi:10.1037/ccp0000358
14. Hilbert, A., Petroff, D., Herpertz, S., et al. (2020). Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder. Int J Eat Disord, 53(9):1353-1376. doi:10.1002/eat.23297
15. Flatt, R.E., Norman, E., Thornton, L.M., et al. (2021). Eating disorder behaviors and treatment seeking in self-identified military personnel and veterans: Results of the National Eating Disorders Association online screening. Eat Behav, 43:101562. doi:10.1016/j.eatbeh.2021.101562
16. Austin, A., Flynn, M., Richard, K, et al. (2021). Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature. Eur Eat Disord Rev, 29(3):329-345. doi:10.1002/erv.2745

Lisa M. Shank, Ph.D., MPH, is a PFS contractor supporting Psychological Health Center of Excellence, Defense Health Agency. Her doctoral degree is in medical psychology. She has been involved in research focused on the psychological and physical health of individuals in the military family for over eight years.