Binge Eating Disorder

What is the medical definition of binge eating disorder?

• The American Psychiatric Association officially recognized binge eating disorder as a diagnosis in 2013.
• Binge eating disorder includes eating binges but has no behavior component to compensate for the eating (for example, purging behavior or excessive exercise).
• Binge eating disorder is thought to be the most common eating disorder, ahead of both anorexia and bulimia.
• Not all people with binge eating disorder are overweight, but most who seek treatment for binge eating disorder are overweight or obese.
• People with binge eating disorder commonly have other psychiatric conditions, such as depression, bipolar disorder, or anxiety.

How do you know if you binge eat?

• There is no specific test or procedure to diagnose binge eating disorder. DSM-5 criteria have been used as a diagnostic tool.
• Binge eating disorder is likely caused by a combination of genetic, biological, and psychological factors.
• Treatment for binge eating disorder may include medications, psychotherapy, or both.
• Although binge eating disorder can last for years, for the majority of people, treatment can reduce the symptoms and complications of binge eating disorder.

Binge eating disorder is characterized by binge eating without subsequent episodes of purging, using laxatives or excessive/driven exercise. Although binge eating disorders have been described since the 1950s, binge eating disorder has only been officially recognized as a formal diagnosis by the American Psychiatric Association since 2013, with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Before the DSM-5 inclusion, binge eating disorder was considered an "unspecified eating disorder."

Binge eating disorder is different from other eating disorders, including anorexia nervosa, bulimia nervosa, orthorexia (obsessively eating "healthy foods"), or restrictive eating disorder (restricting eating of certain foods).

The exact causes of binge eating disorder are unknown. Like other eating disorders, binge eating disorder seems to result from a combination of genetic, biological, and psychological factors. Each of these areas can be affected by a person's childhood development, exposure to trauma, how their families dealt with food, physical appearance (and ideals of attractiveness), and what supports a person has.

1. Genetic effects

Because binge eating disorder has been accepted as a formal diagnosis only recently, few studies have investigated genes associated with the disorder. However, some studies suggest that there may run in families, but the genes causing this have not been identified. More studies including larger numbers of families will need to be done for specific genes to be identified.

2. Biological factors

Certain brain chemicals (neurotransmitters) and brain regions may be affected in binge eating disorder.

• Serotonin is a brain chemical that is strongly linked to both mood and anxiety. Depression and increased anxiety are both related to low serotonin levels in parts of the brain. Many antidepressant and antianxiety medications work by increasing serotonin levels in the brain. Although less known, serotonin also participates in appetite regulation. Serotonin may be related to eating disorder behaviors through both of these pathways, and some binge eating disorder treatments work through the serotonin system.
• Dopamine is another neurotransmitter related to appetitive behaviors and the reward pathways in the brain. Appetitive behaviors are the actions taken to seek pleasurable or rewarding experiences -- including sex, food, or drugs -- which activate the reward pathways. The reward pathways are involved with triggering positive feelings in response to positive and pleasurable activities but also in response to the use of many addictive drugs including heroin, cocaine, and alcohol. Eating disorders, particularly binge eating disorder, may be considered a "food addiction" and involve these dopamine pathways.
• Recent studies using brain imaging (functional magnetic resonance imaging or MRI) have implicated both the frontal cortex (involved with our ability to resist certain behaviors) and the striatum (a brain center involved in reward to food and other pleasure) in how the brains of people with binge eating disorder react differently to food and eating.

3. Psychological factors

• How satisfied a person is with their body and image is believed to be an integral part of self-esteem. Individuals assess their bodies by measuring them against culture's ideal body type. How a person's family viewed body image and eating can also have a strong influence on adult ideas of self-image and eating.
• Personality traits such as impulsivity, impulsive decision making, stress reactivity, harm avoidance, perfectionism, and other personality traits are common in patients with eating disorders. As discussed previously, certain personality types seem to be more commonly associated with binge eating disorder.
• Some studies showed a relationship between childhood abuse or trauma and eating disorders. This relationship is complex, since many who experienced early trauma never develop eating disorders.

The main symptom of binge eating disorder is binge eating, accompanied by an inability to control the binges, and guilt and/or distress because of these eating episodes. Other signs are not specific to binge eating disorder but are related to the consequences of binge eating. Some of these signs may be gaining weight, being overweight, high cholesterol, or blood sugar levels.

Binge eating disorder is more than just eating too much. Binge eating disorder is a serious condition characterized by uncontrollable eating, significant distress, and often results in weight gain. Although binge eating disorder can be diagnosed in people with normal weight, almost all individuals with binge eating disorder who are seeking treatment are overweight or obese. People suffering with binge eating disorder may feel ashamed and try to hide their symptoms. Eating episodes are usually done secretly to avoid having other people know what is going on. This can, unfortunately, make people reluctant to seek help or treatment so they continue struggling alone.

DSM-5 Diagnostic Criteria for Binge Eating Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires the following criteria for a diagnosis of binge eating disorder:

1. Recurrent episodes of binge eating. Binge eating means eating much more than what other people would eat in a short amount of time (for example, within a two- to three-hour period). During the episode, the person will feel that they have lost control, that they can't stop eating, or can't control what they are eating.

2. The binge-eating episodes are associated with at least three of the following:

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amount of food when not feeling physically hungry
• Eating alone because of feeling embarrassed by how much one is eating
• Feeling disgusted with oneself, depressed, or very guilty afterward

3. People have marked distress regarding binge eating.

4. The binge eating occurs, on average, at least once a week for three months.

The number of binge-eating episodes per week defines the severity of binge eating disorder: mild, one to three; moderate, four to seven; severe, eight to 13; extreme, 14 or more.

If a person used to meet criteria for binge eating disorder but now has one or fewer episodes per week for a sustained period of time (for example, more than a month), they would be considered to be in partial remission. If they no longer have any binge-eating episodes for a sustained period of time, they would be considered in full remission according to the American Psychiatric Association 2013 criteria.

Most people overeat from time to time, and many people believe they frequently eat more than they should. We may have seconds or thirds of a holiday meal, or sometimes even eat to the point of feeling uncomfortable! Eating large amounts of food, however, does not mean that a person has binge eating disorder. However, if one finds that he or she is eating excessively once a week or more, often when alone, and feel ashamed or guilty about your eating, these may be warning signs that he or she has binge eating disorder.

Eating disorders are a mental-health condition with a direct impact on physical health. In addition to biological factors (such as brain chemicals like serotonin and dopamine) that can be treated in part by medications, unhealthy patterns of thoughts and behaviors are best addressed by psychotherapy (talk therapy). Binge eating disorder, like other eating disorders, may be identified and treated by various specialists. A person's primary-care doctor (PCP) or psychiatrist are often the first physician specialists to make the diagnosis and provide treatment. Because of the complexity of eating disorders, treatment ideally involves an interdisciplinary team of specialists. Medical management, including monitoring blood tests and prescribing medications, is most often the role of a psychiatrist or primary-care physician (internal medicine or family medicine). A registered dietician has an important role in education about and monitoring of nutrition and eating habits. The behavioral and cognitive aspects of binge eating disorder are best addressed by a psychologist or other psychotherapist with experience in the treatment of eating disorders. In some specialty eating disorders programs, there may also be family therapists or other members of the treatment team.

Both bulimia nervosa ("bulimia") and anorexia nervosa ("anorexia") may include binge-eating episodes, but they also include purging. Purging includes behaviors to undo or make up for eating binges. Common purging behaviors include inducing vomiting and excessive exercise episodes. Some individuals inappropriately use medications such as laxatives, diet pills, and diuretics ("water pills") as a purging method. Binge eating disorder is different from both bulimia and anorexia because there is no purging behavior following binge-eating episodes.

There are many reasons that people eat too much, or binge eat. The most common reason that people describe is feeling sad or "down." Others describe bingeing when there is conflict or stress in their relationships with other people. Eating as a way to deal with (negative) emotions and conflict is also called "emotional eating." People who are dieting, restricting their food, or are unhappy with their weight and/or appearance are also more likely to binge. All of these reasons are more common in people who have dealt with serious depression or anxiety during their lives. After binge eating, people usually report a feeling of relief, or of feeling better. However, this relief usually lasts only a short time, and they often feel more negative or guilty later.

Those who have been bullied, abused, or suffered trauma (verbal, emotional, physical, or sexual) are more likely to binge eat. Binge eating is a way that many people use to cope with uncomfortable feelings and emotions, especially when they have never seen or learned more effective and healthy strategies. Negative emotions and eating seem to get connected, and this cycle of eating for comfort can be hard to break. Unfortunately, they often end up feeling sad and guilty about not being able to control their eating, which increases the stress and fuels the binge eating disorder cycle.

Binge eating disorder is increasingly recognized as a common cause of morbidity (complications from medical disorders) and mortality (risk of death) in young individuals. Binge eating disorder is a serious medical disorder; that can result in death from health complications related to binge eating.

In the United States, the lifetime prevalence rate for BED is 2.9%.  In survey samples from weight loss clinics, about thirty percent of the participants met the criteria for the BED diagnosis. Almost half of the patients with BED are of normal weight and less likely to seek treatment.

Many individuals suffering from binge eating disorder will eventually seek treatment, but many of them seek treatment for associated medical or psychiatric conditions and not for the eating disorder itself.

Binge eating disorders are more common in women than men,  The lifetime prevalence in females and males was 3.5% versus 2%. There are probably similar numbers of American teens with binge eating disorder; like other eating disorders, binge eating disorder usually starts in adolescence. The actual numbers may be higher, since those with binge eating disorder may keep their symptoms and behavior a secret and never go to a health-care professional for diagnosis or treatment. Binge eating disorder does not appear to be related to race, marital status, or employment status.

Many people struggling with binge eating disorder also have other psychiatric conditions. The most common conditions that occur with binge eating disorder are mood disorders, including depression (major depressive disorder or dysthymia [persistent depressive disorder]) and bipolar disorder (type 1 or type 2). Anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and obsessive-compulsive disorder (OCD) are also common.

Substance-use disorders (abuse of alcohol or other drugs) may also be diagnosed but somewhat less often. Certain personality traits or disorders are also common in people with binge eating disorder. The most common personality disorders were avoidant and obsessive-compulsive personality (cluster C personality types). Somewhat less common were cluster B personality traits, particularly borderline personality. Studies investigating what other diagnoses accompany binge eating disorder are not able to determine if one diagnosis causes the other; they are only able to suggest how commonly a person may have both conditions. Suicidal thoughts and suicide attempts are serious consequences of psychiatric diagnoses, including binge eating disorder, particularly when they have not been treated.

People who have experienced serious trauma in childhood or early life are more likely to develop depression and posttraumatic stress disorder (PTSD) and are more likely to have cluster B personality traits or disorders. Many people with binge eating disorder have survived trauma as well, suggesting a link between trauma and this eating disorder, as well. Exactly how they are connected is not known, but the challenges for trauma survivors in developing a healthy self-image, as well as maintaining healthy emotional outlets and relationships, may increase the chances of developing an eating disorder, too.

Non-psychiatric medical conditions may also be found in people with binge eating disorder. However, in contrast to psychiatric diagnoses, medical disorders seem to result from the unhealthy eating patterns in binge eating disorder; the medical conditions do not appear to cause binge eating disorder. When people seek treatment for binge eating disorder, most of them are overweight or obese. Because of this, high cholesterol or lipids (dyslipidemia), heart disease, high blood pressure (hypertension), and diabetes are frequently diagnosed in people with binge eating disorder.

Like most other psychiatric disorders, there is no single test or imaging study that can diagnose binge eating disorder. The diagnosis is made mostly from a clinical interview reviewing the symptoms and behaviors that a person reports. If there is a concern for an eating disorder, the evaluating professional will complete a careful evaluation of eating patterns, body image, and perceptions about weight. Because depression, anxiety, and a trauma history are common in people with eating disorders, a complete assessment of other psychiatric symptoms will also be completed.

Medical doctors, including psychiatrists, may also order lab tests and complete a physical examination. Blood tests are particularly important in anorexia and bulimia that can cause potentially life threatening electrolyte (the salts in your bloodstream, like sodium and potassium) imbalances. For binge eating disorder, particularly with overweight and obese patients, checking blood sugar levels (glucose testing) for diabetes and examining lipids for high cholesterol levels are also important.

For some people, their eating disorder may be uncovered when they are seeking help or treatment for other conditions like depression or anxiety. A thorough interview by a mental-health professional may reveal eating disorder symptoms at the same time they are trying to understand a person's other mental health diagnoses. During a visit with a primary care provider or other physician, eating disorders may be uncovered when reviewing labs, or in discussing conditions like diabetes and high cholesterol that may go along with binge eating disorder. In these cases, the doctor may refer the person to a behavioral health or eating disorder specialist.

Diagnosis of eating disorders can be challenging; because people may feel ashamed, they won't admit the symptoms and behaviors, even to their doctor, therapist, or behavioral-health provider. Since many individuals may keep their eating symptoms secret even from close friends and family, the illness can go undetected for long periods of time, and no one else can encourage them to seek help. Keeping this secret increases the distress and isolation and may even worsen their symptoms.

For more specific diagnostic information, see the above section on DSM-5 diagnostic criteria for binge eating disorder that is used by some members of the American Psychiatric Association.

Eating disorders are serious health conditions that can be both physically and emotionally destructive. It is important for people who struggle with binge eating disorder to recognize that it is a real medical condition and that there are treatments that can help. Early diagnosis and intervention may improve recovery. Eating disorders can become chronic, debilitating, and even life-threatening conditions without appropriate treatment.

When one begins to notice that disordered eating habits are affecting one's life, happiness, and ability to concentrate, it is important to talk to somebody about what's going on. Seek professional help from a primary-care provider, a psychiatrist, or other behavioral-health provider. If someone you know is showing signs of binge eating disorder, let them know you are concerned and want to help. You may offer to help them find medical advice.

Treatment for binge eating disorder may include medications, psychotherapy, or both. As awareness of binge eating disorder has increased, more studies investigating potentially effective treatments have become available. As with anorexia and bulimia, a few treatments are specifically for eating disorders but still have been shown to provide some positive effects.

Certain types of psychotherapy are still believed to be the most effective treatments for binge eating disorder. The types of therapy that have the most evidence are cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT). These therapies have been adapted to specifically address binge eating disorder, with good success rates. Recently, other types of therapy have also been explored as binge eating disorder treatments.

1. Cognitive behavioral therapy (CBT) is a form of treatment that focuses on examining the relationships between thoughts, feelings, and behaviors. The CBT model for binge eating disorder emphasizes the critical role of both cognitive and behavioral factors in maintaining binge-eating behaviors and focuses upon regulating food intake and reducing episodes of binge eating.
2. Interpersonal psychotherapy (IPT) is another type of psychotherapy that focuses on how relationships with others can affect our psychological functioning. Like CBT, IPT is usually designed to last for 12-16 weeks, with weekly therapy sessions. Group IPT is a viable alternative to group CBT for the treatment of overweight patients with binge eating disorder. Both treatments showed initial and long-term efficacy for the core and related symptoms of binge eating disorder.
3. Self-help interventions have a place in the treatment of binge eating disorder. Self-help manuals can be utilized without the aid of a mental-health professional, in a "pure self-help format'' (PSH), where individuals are not provided with direct feedback about their progress or any assistance in applying the concepts described by the program (for example, simply reading the book and following the treatment program). In contrast, "guided self-help'' (GSH) refers to a combination of self-help programs, with brief visits by a therapist designed to help patients implement the treatment program. Behavioral weight loss treatment (BWL) and guided self-help based on cognitive behavior therapy (CBTgsh) have both resulted in short-term reductions in binge eating in obese patients with binge eating disorder. CBT and IPT are significantly more effective than BWL in eliminating binge eating after two years.
4. Other psychotherapy approaches include dialectical behavior therapy (DBT), which is under investigation for treatment of binge eating disorder, though most results have been obtained from uncontrolled trials. Motivational interviewing (MI) interventions, mostly used in treating addictive disorders, have been used to increase retention in eating disorder treatment. However, reviews of MI suggest it is not well supported for binge eating disorder treatment. Mindfulness-based approaches are growing in popularity as interventions for disordered eating and weight loss. The study suggested that mindfulness meditation effectively decreased binge eating and emotional eating in populations engaging in this behavior; evidence for its effect on weight was mixed.
5. Treatment for youth target young people, since binge eating disorder typically begins in adolescence and treatments can capitalize on parental/family involvement. Family based treatment (FBT) may be effective for young people with binge eating disorder (approximately 30% remission rate).

Medications used to treat binge eating disorder generally have been found to help with weight loss or to reduce the compulsive eating binges, but few have clearly helped with both. Until recently, no medications had received a Federal Drug Administration (FDA) approval for treating binge eating disorder. This does not mean that other medications are not helpful, just that no company obtained approval for their medications to treat binge eating disorder. In 2014, one of the stimulant medications also approved for treating attention deficit hyperactivity disorder (ADHD), lisdexamfetamine (Vyvanse), was approved for treating binge eating disorder.

1. Stimulant medications: Stimulants are most often prescribed for attention deficit disorder (ADD) or ADHD. However, stimulants have also been used to suppress appetite and to help with weight loss. These medicines work by increasing dopamine and noradrenaline (norepinephrine) in the brain. As mentioned previously, these brain chemicals are involved with reward pathways and addictive behaviors. Since overeating and bingeing may be related to these brain systems, lisdexamfetamine was studied to determine if it could both decrease binge eating and help with weight loss. Patients with moderate to severe binge eating disorder showed reduced bingeing behavior and modest weight loss during the 12-week trial period. Although other stimulant medications, such as methylphenidate (Ritalin, Concerta) or mixed amphetamines (Adderall, dexamphetamine) have not been FDA approved for binge eating disorder, they work through the same brain systems and may also have benefits for treating binge eating disorder. However, as with any prescription medicine, they should only be used when prescribed by a doctor. These medicines can be addictive and could have serious side effects if used improperly.
2. Serotonin specific reuptake inhibitors (SSRIs): These are probably the most prescribed antidepressant and anti-anxiety medications. They have shown significant benefit for many people with depression, obsessive-compulsive disorder (OCD), and generalized anxiety disorder. They have also been used for other impulsive or compulsive behavior. This class of medications includes fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil). SSRIs have been found to effectively suppress binge eating and may slightly reduce weight. These agents are generally well tolerated. They also have the advantage of potentially treating comorbid depression and anxiety.
3. Anticonvulsant medications: Anticonvulsant medications were developed to treat epilepsy and seizures. Some of them have also been used for headaches, other neurologic conditions, or as mood stabilizers for bipolar disorder. The anti-epileptic agent topiramate (Topamax) is known to have a side effect of significant weight loss in some individuals. For this reason, it has been tried as a treatment to encourage weight loss and in binge eating disorder. Topiramate has been used experimentally now in a number of trials in individuals with binge eating disorder. These trials have shown reductions in binge eating episodes and weight loss, many times involving weight reductions in excess of what is seen with other pharmacological interventions. Unfortunately, the use of topiramate has been limited by other side effects, including sedation and cognitive (thinking) problems. Another anticonvulsant, zonisamide (Zonegran), showed similar effects on binge eating frequency and weight loss in a smaller number of studies. However, like individuals taking topiramate, many people stopped taking the medication because of side effects (sedation, cognitive problems, and psychological problems). Most other anticonvulsant medications are commonly associated with weight gain and may be counterproductive in binge eating disorder. Others, such as lamotrigine (Lamictal), have only very limited data on how effective they may be in treating binge eating disorder.
4. Other medications: Other classes of antidepressants, including tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), have also been studied for binge eating disorder treatment. TCAs are older antidepressants and also can decrease binge eating and improve depression and anxiety. However, they have more risk of side effects and do not result in significant weight loss. Similar to SSRIs, SNRIs may decrease binge eating and modestly reduce weight.

Other weight loss medications have also been considered for binge eating disorder treatment. Sibutramine was another stimulant weight loss drug that reduced binge eating and weight but was taken off the market by the FDA due to safety concerns (cardiac side effects and strokes). Orlistat is a weight loss drug that works by blocking the absorption of fats from the diet. Orlistat may improve weight loss during binge eating disorder treatment but commonly causes gastrointestinal side effects.

People can take these self-care steps to reinforce the treatment plan:

• Stick to the treatment; don't let setbacks derail one's overall efforts.
• Consider finding online support groups or therapy resources. Cognitive behavioral therapy approaches have been found to work in an online format and not just in person.
• Avoid dieting. "Crash" or "fad" diets will not help one keep weight off and may cause health problems and more frustration in the end.
• Eat breakfast. After starting the day with a reasonable breakfast, one may be less prone to eating higher calorie meals later in the day.
• Get the right nutrients. It is important to continue eating a healthy diet. It is better for one's overall health, as well as success in combating an eating disorder, to keep eating healthy foods on a regular basis. If unsure about maintaining a balanced diet or fulfilling nutritional needs, find reliable information on the Internet, from books and libraries, or from health-care professionals. One place to start is http://www.choosemyplate.gov.
• Stay connected. Don't isolate oneself from caring family members and friends.
• Get active. Try to do physical activity that is appropriate, especially if one has health problems related to being overweight.
• Get enough sleep. Inadequate or poor sleep has been linked to weight gain and poorer eating habits. Sleep problems have also been connected to depression and other psychiatric conditions.

The major complications of binge eating disorder are the conditions that often result from being obese. These include: 

• diabetes,
• high blood pressure,
• high cholesterol,
• gallbladder disease,
• heart disease,
• shortness of breath,
• certain types of cancer,
• menstrual problems,
• decreased mobility (inability to move around),
• fatigue or tiredness, and
• sleep problems, including sleep apnea.

Psychiatric conditions associated with binge eating disorder can also have serious consequences, including suicidal thoughts and suicide attempts.

Many individuals go undiagnosed and thus untreated. Without treatment, binge eating disorder is likely to last for many years, and to cause a significant impact on weight, health, psychiatric symptoms, and ability to function at home, work, and school. In some cases, serious effects of binge eating disorder on health could result in death from suicide or medical complications.

Binge eating disorder is widespread in the general adolescent population. The diagnosis and treatment of binge eating disorder in young people is particularly important. Untreated binge eating disorder can persist for years and may have serious lifelong effects from the weight gain and psychiatric symptoms, combined with the persistence of symptoms and complications related both to weight gain and other psychiatric symptoms. Their impact is demonstrated by generally strong associations with other psychiatric disorders, role impairment, and suicidality. The unmet treatment needs in the adolescent population place these disorders as important public-health concerns.

Some studies show that binge eating disorder may persist for 10 years or more, with only a small percentage resolving in the first year of the illness. This is longer than many people with other eating disorders such as anorexia and bulimia that tend to last six years or less.

Overall outcomes with treatment of binge eating disorder are difficult to assess. Reports suggest that between 15%-60% of subjects with binge eating disorder show significant improvement after treatment. However, these rates vary greatly depending on the type of treatment, length of treatment, and severity of illness. Improvement is usually measured by how frequently binge eating still occurs. Fewer people had substantial weight loss after binge eating disorder treatment.

As described above, there are treatments that can help binge eating disorder. As people are more aware of binge eating disorder and larger clinical trials are completed, there will hopefully be a better understanding of what treatments are most effective for this diagnosis.

It is helpful for people to begin treatment as soon as they begin to have symptoms. By treating early symptoms, people may have a better chance of avoiding the full syndrome and have a quicker recovery.

In addition, teaching and encouraging healthy eating habits and realistic attitudes about food and body image also might be helpful in preventing the development or worsening of eating disorders. Varieties of programs have been developed and could be found on campuses, online, or in other settings. Interaction and discussion with a peer group may improve how useful these interventions may be.

It is also important to identify and treat other psychiatric conditions that could complicate or worsen eating disorder symptoms. Recognition and early treatment of depression, anxiety, and other psychiatric disorders also improves the chances of full recovery.

Support Groups for Binge Eating Disorder

Overeaters Anonymous (OA)
http://www.oa.org
OA has been a resource for those with eating issues such as binge eating disorder since 1960. They follow a 12-step program similar to AA or NA.

Binge Eating Disorder Association
http://bedaonline.com
This association provides information about binge eating disorder, including personal stories and information on non-diet based therapy.

National Eating Disorders Association (NEDA)
http://www.nationaleatingdisorders.org
This is a good site for information about all eating disorders, including links for support groups, information, and treatment.

Reliable information about binge eating disorder, other eating disorders, and psychiatric diagnoses can be found at the National Alliance for Mental Illness (NAMI) or the National Institutes of Mental Health (NIMH).

Information about nutrition and healthy eating can be found at the United States Department of Agriculture (USDA) "Choose My Plate" web site.