Binge eating disorder may last longer than previously thought

The research team said its results contradict previous studies that documented faster remission times.

“The big takeaway is that binge-eating disorder does improve with time, but for many people it lasts years,” said Kristin Javaras, a first study author and an assistant psychologist in the Division of Women’s Mental Health at McLean, in a statement. “As a clinician, oftentimes the clients I work with report many, many years of binge-eating disorder, which felt very discordant with studies that suggested that it was a transient disorder.”

“It’s very important to understand how long binge-eating disorder lasts and how likely people are to relapse so that we can better provide better care,” she added.

The researchers said binge eating disorder is estimated to impact between 1% and 3% of adults in the United States. They added that the average age of onset is 25 years old and is characterized by periods when people feel they’ve lost control over their eating habits.

The scientists said previous retrospective studies relied on people’s sometimes faulty memories. The previous studies reported binge eating disorder can last an average of 7 years to 16 sixteen years.

Prospective studies tracking subjects with the disorder have also suggested many people with the disorder enter remission within a smaller time frame — from 1 to 2 years.

Researchers also noted most previous prospective studies were limited by small sample sizes (fewer than 50 participants) and weren’t representative because they focused only on adolescent or young-adult females, most of whom had body mass indexes (BMI) less than 30, whereas around two-thirds of people with binge eating disorder have BMIs of 30 or more.

The researchers in the new study followed for five years 137 adults who had the disorder.

The participants ranged in age from 19 to 74 and had an average BMI of 36. Researchers also assessed the subjects for the disorder at the beginning of the study, then re-examined them 2.5 years and 5 years later.

Most participants still experienced binge eating episodes after five years, although many showed improvements.

After 2.5 years, 61% of the subjects still had the disorder and another 23% experienced “clinically significant symptoms, although they were below the threshold for binge eating disorder.”

After five years, 46% of subjects met the full criteria and 33% experienced “clinically significant but sub-threshold symptoms.”

“Notably, 35 percent of the individuals who were in remission at the 2.5-year follow-up had relapsed to either full or sub-threshold binge-eating disorder at the 5-year follow-up,” the study authors wrote.

Criteria for diagnosing binge eating disorder have changed since the study.

Javaras said that under the new guidelines, an even bigger percentage of participants would have been diagnosed with the disorder at 2.5 years and 5 years.

Javaras said the study’s results better represent binge eating disorder’s natural time-course because subjects may or may not have been receiving treatment as opposed to people who are enrolled in a treatment program.

The authors said treatment appeared to lead to faster remission, suggesting people with binge-eating disorders can benefit from intervention. Javaras said there are major inequities regarding who receives treatment.

Although there was variation among participants, the team was unable to find strong clinical or demographic predictors for the disorder’s duration.

“This suggests that no one is much less or more likely to get better than anyone else,” Javaras said.

The researchers said that since the study ended they have been investigating and developing treatment options for binge eating disorder and examining screening methods to better identify individuals who would benefit from treatment.

“We are studying binge eating disorder with neuroimaging to get a better understanding of the neurobiology involved, which could help enhance or develop new treatments,” Javaras said. “We are also examining ways to catch people earlier because many don’t even realize they have binge eating disorder and there is a major need for increased awareness and screening so that intervention can begin earlier.”

Supatra Tovar is a clinical psychologist and registered dietitian who works with people with eating disorders who was not involved in the new study.

She told Medical News Today that binge eating disorder relapse is critical and often misunderstood.

“It’s essential to acknowledge that relapse does not necessarily imply a failure of the treatment but rather underscores the chronic nature of eating disorders and the ongoing necessity for support,” Tovar said.

She added that relapse can be an indication the person wasn’t fully recovered.

“This does not necessarily mean that no progress was made. Rather, it may suggest that some deeper, underlying causes of the disorder were not completely addressed in the initial treatment phase,” Tovar said. “This could include unresolved trauma, ongoing exposure to stressors that reinforce unhealthy coping mechanisms, or persistent negative self-beliefs and body image issues.”

Tovar said recovery from binge eating disorder isn’t just about managing eating behaviors but also about developing coping strategies for stress and emotional turmoil.

“The occurrence of relapse might indicate areas where therapeutic interventions need to be strengthened or modified to better support long-term recovery,” Tovar said. “It’s not simply a matter of ‘curing’ the symptoms but involves a deeper, more sustained engagement with both psychological and lifestyle factors that contribute to the disorder. Recovery is a dynamic process that requires adaptability in treatment approaches, considering the individual’s evolving needs and life circumstances.”

Rachel Goldberg, a licensed marriage and family therapist and a personal trainer who wasn’t involved in the research, told Medical News Today the study’s findings aren’t surprising.

“I would venture to guess that had they prolonged the study, they might have discovered that the duration of recovery extends beyond the estimated 2.5 to 5 years,” she said. “I also believe they may have found that some individuals, previously deemed recovered, may have relapsed because binge eating disorder often comes in waves, depending on other factors happening in that person’s life.”

Goldberg said treating binge eating disorder is “exceptionally challenging, akin to all eating disorders, due to its deep-seated roots, often originating in early childhood.”

“Unlike substance abuse, where abstinence is an option, refraining from food is not sustainable. Food remains an ever-present trigger,” Goldberg said. “Binge eating disorder has specific criteria to be medically diagnosable. However, recognizing it is fairly straightforward. Someone with binge eating disorder experiences frequent episodes of excessive overeating in a short period, accompanied by shame and a feeling of loss of control. This is not the typical type of overeating that one might do on Thanksgiving or after having too much to drink and finding themselves at a fast-food joint.”

Goldberg said the disorder is characterized by consuming large quantities, usually of a variety of unhealthy foods, in a short period of time.

“Often, individuals will describe being in a trance-like state during binges, not even enjoying the food or feeling much at all. During a binge, they often describe a feeling of numbness. However, once it’s over, there is an extreme feeling of shame that overwhelms them,” she explained.

Goldberg added that “recovery is often a lifelong process involving the affected person becoming very self-aware, understanding its roots, identifying triggers, and developing alternative coping mechanisms.”

She noted that treatment often involves addressing the root causes, forming new habits, and potentially incorporating therapies such as dialectical behavioral therapy (DBT) to regulate emotions and improve interpersonal relationships.

She said lifestyle changes such as stress management, adequate sleep, physical activity, and social support are also crucial. Many people can also benefit from professional assistance.

“Additionally, certain drugs, both FDA-approved specifically for binge eating disorder and used off-label, are often prescribed to aid in treatment,” Goldberg said. “Recently, the new GLP-1’s have shown anecdotal promise in helping those with this disorder. However, the mechanism of their effectiveness and their long-term effects are still largely unknown, necessitating further investigation.”